NR602 / NR-602 Midterm Exam Study Guide (Latest): Primary Care of the Childbearing & Childrearing Family Practicum - Chamberlain | Qwivy

NR-602 Primary Care of the Childbearing &

Childrearing Family Practicum

Midterm Exam Study Guide

2

1. Asthma – all levels of severity

What are s/s of asthma?

• Wheezing

Continuous/persistent cough

Long expir. phase

Diminished breath sounds

Signs of resp. distress

Tachypnea

 Qwivy | Qwivy.com | www.qwivy.com

Retractions Nasal

flaring

Accessory muscles

Apprehension

Drowsiness Tachycardia

Cyanosis of lips

How is asthma dx'd?

• O2 sat

PFT:

-Spirometry

-FEV1: normal >75%, mild 60-75%, mod 50-59%, severe <49%.

-FVC: normal 80-120%, mild 70-79%, mod 50-69%, severe <50%.

What are mild asthma s/s?

• Wheezing @ end of expiration or no wheezing

No/min intercostal retraction along post. axil. line

Slight prolongation of exp. phase

Normal aeration in all lung fieldsCan talk

in sentences

What are moderate asthma s/s?

• Wheezing throughout expiration

Intercostal retractions

Prolonged expiratory phase

Decreased breath sounds at base

What are severe asthma s/s?

• Use of accessory muscles plus lower rib/suprasternal retractions

Nasal flaring

Inspir/expir. wheezing or no wheezing heard w/poor air exchange

Blepharitis

What is blepharitis?

Inflammation/infection of the lid margins (chronic

problem)What are the two types of blepharitis?

• Seborrheic (non-ulcerative)

• Ulcerative

What can cause seborrheic blepharitis?

Irritants (smoke, makeup,

chemicals)What are s/s of seborrheic

blepharitis?

• Chronic inflammation of eyelid

• Erythema

• Greasy scaling of anterior eyelid

• Loss of eyelashes

• Seborrheic dermatitis of eyebrows/scalp

What usually causes ulcerative blepharitis?

• Infection w/staph or strep

What are s/s of ulcerative blepharitis?

• Itching

 Qwivy | Qwivy.com | www.qwivy.com

3

• Tearing

• Recurrent styes

• Chalazia

• Photophobia

• Small ulceration at eyelid margin

• Broken/absent eyelashes

• Most frequent complaint: ongoing eye irritation, conjunctiva redness

What is the treatment for blepharitis?

• Clean w/baby shampoo 2-4 times/day

• Warm compresses

• Lid massage (right after warm massage)

How are infected eyelids with blepharitis treated?

• Antistaph abx: bacitracin, erythromycin 0.05% x1 wk and quinolone ointments

How is blepharitis infection resistant to topical abx treated?

• Tetracycline 250mg PO x4

• Doxy 100mg PO x2

Café au lait spot

What are cafe au lait spots?

• Smooth, regular borders of darkened patch

If a child has >5 cafe au lait spots that are >1.5cm, what should be suspected?

• Possible Von Recklinghausen's dz (90-100%)

LEOPARD syndrome:

-Lentigines

-Electrographic abnormalities

-Ocular hypertelorism

-Pulmonary stenosis

-Abnormalities of genitalia

-Retardation of growth

-Deafness

 Qwivy | Qwivy.com | www.qwivy.com

In kids <5yo with 5 or more cafe au lait spots of at least 0.5cm, what should be suspected?

• Neurofibromatosis

What is a rare but diagnostic sign of neurofibromatosis?

• Smaller 1-4cm diameter cafe au lait spots in axillae (axillary freckling or Crow's sign)

Celiac Disease

• Malabsorption syndromes can be caused by many different genetic, congenital, and acquired conditions

and usually lead to an initial decrease in weight followed by a deceleration in height velocity.

• Celiac disease is an immune-mediated systemic disorder triggered by dietary exposure to wheat gluten

and related proteins in barley and rye.

• It is characterized by the presence of a variable combination of gluten-dependent clinical manifestations,

celiac disease–specific antibodies, HLA-DQ2.5 or HLA-DQ8 haplotypes, and enteropathy.

• Celiac disease has a worldwide distribution with overall prevalence of 1%

Risk factors

o Demographic changes

o Increased gluten exposure

o infants born by cesarean section;

o The most typical presentation occurs between 6 months and 2 years old.

Parent reported gastroenteritis occurring at the time gluten was introduced into the child's diet does not

appear to beassociated with celiac disease.

Clinical Findings

• Chronic or intermittent diarrhea, persistent or unexplained GI symptoms (e.g., nausea and vomiting),

sudden or unexpected weight loss, and prolonged fatigue.

• Delayed puberty can coexist with malabsorption, Impaired growth, FTT, unexplained iron deficiency

anemia, abdominal distention, bloating or cramping pain

4

• May have no symptoms at all despite evidence of small bowel changes;

• maintain a high suspicion for celiac disease in children with metabolic bone disease (such as rickets or

osteomalacia), low-trauma fractures, or those with dental enamel defects.

• An estimated 85% to 90% of individuals with celiac disease are undiagnosed

 Qwivy | Qwivy.com | www.qwivy.com

• Pallor, fatigue, hair and dermatologic abnormalities, digital clubbing, dizziness, cheilosis, glossitis,

peripheral neuropathy (symptoms of vitamin deficiency seen with malabsorption), Skinfold thickness and

lean body mass

Diagnostic Studies

• See chronic diarrhea tests

Specific Testsfor Celiac Disease

• Serologic testing should be done if there is clinical suspicion of celiac disease, the child has an associated

disorder, or there is a first-degree relative with celiac disease.

• Gluten should be eaten in more than one meal every day for 6 weeks prior to testing.

• Recommended serologic tests include IgA tissue transglutaminase antibody (tTGA) and IgA endomysial

antibody (EMA) because of their high sensitivity and specificity

• EMA is more expensive and less accurate in children younger than 2 years old

• Home blood testing is not recommended

• If serologic testing is positive, refer for endoscopy with biopsy for a definitive diagnosis, although

colonoscopy may not be necessary if the tTGA level is greater than 100 units/mL

• Careful follow-up of growth parameters, tTGA testing after 6 months of gluten-free diet (GFD), and then

yearly

• Bone density testing (bone problems may be first symptom of celiac disease).

Management

Celiac Disease

• A strict GFD for life is currently the only effective treatment for celiac disease.

• The standard for being gluten-free is a limit of 20 ppm of gluten

• Adding pure oats to a GFD can improve palatability and increase fiber and vitamin B intake without

causing a systemic or autoantibody response

Complications and Prognosis

 Qwivy | Qwivy.com | www.qwivy.com

• Growth failure is the primary complication of celiac disease.

• risk for fractures and osteoporosis (due to reduced bone mineral density), lymphoma, autoimmune

diseases (e.g., type 1 diabetes, thyroid disorders), primary biliary cirrhosis, and primary sclerosing

cholangitis.

• Sensory peripheral neuropathy may be related to gluten

• Celiac crisis consisting of abdominal distention, explosive watery diarrhea, dehydration with

hypoproteinemia, electrolyte imbalance, hypotensive shock, and lethargy, although rare, can be the first

indication of celiac disease.

Chalazions

What is a chalazion? Benign, chronic lipogranulomatous inflammation of the eyelid

What causes a chalazion? Blockage of the meibomian gland

What puts a person at risk for a chalazion?

• Hordeolum or any condition which may impede flow through the meibomian gland.

Mite species that reside in lash follicles.

What are physical exam findings for a chalazion?

• Painless

Does NOT involve lashes Lid

edema or palpable mass

Red or grey mass on inner aspect of lid margin

What is prevention for chalazion? Good eye hygiene

What is treatment for chalazion? Warm, moist compresses 3x a dayIf

secondarily infected: sulfacetamide or erythromycin

What is the follow-up for chalazion?

• In 2-4 weeks

If still present after 6wks, follow up w/ophthalmologist

Clostridium difficile

 Qwivy | Qwivy.com | www.qwivy.com

No comments found.
Login to post a comment
This item has not received any review yet.
Login to review this item
No Questions / Answers added yet.
Authors Qwivy.com
Pages 55
Language English
Tags NR602 / NR-602 Midterm Exam Study Guide (Latest): Primary Care of the Childbearing & Childrearing Family Practicum - Chamberlain | Qwivy
Comments 0
Sales 0
Recently viewed items

We use cookies to understand how you use our website and to improve your experience. This includes personalizing content and advertising. To learn more, please click Here. By continuing to use our website, you accept our use of cookies, Privacy policy and terms & conditions.

Processing