NUR 810 Actual Exam Newest

NUR 810 Actual Exam Newest Questions and Correct Answers Rated A+

What type of coverage do you need for aspiration pneumonia in the medically complex child? -ANSWER-coverage for anaerobes and gram - bacteria

What type of abx do you treat aspiration pneumonia with? - ANSWER-IV - Ampicillin-sulbactam (Unasyn) PO - Augmentin

What is tracheitis? -ANSWER-Rare bacterial infection involving the trachea that you have to worry about in medically complex children

Presentation of tracheitis -ANSWER-Increased thickened or purulent secretions Fever Increased WBCs S/S of systemic infection

Diagnostics/TX for tracheitis -ANSWER-CBC Culture of secretions (prone to colonization with morexella and staph)

CXR: No consolidation

IV ABX for 10-14 days

What is automonic storming? -ANSWER-paroxysmal autonomic instability with dystonia and sympathetic hyperactivity that is uncontrolled and comes and goes

Presentation of autonomic storming -ANSWER-Fevers Irritability Tachypnea Dystonic posturing Diaphoresis HTN Tachycardia Vomiting Retching

WOP with autonomic storming -ANSWER-CBC, ESR, CrP, cultures Procalcitonin

Management of autonomic storming -ANSWER--Identify the trigger (pain is common) -Daily controller med like gabapentin for pain -Clonidine or propranolol for S/S of overactive sympathetic system -Baclofen for muscle rigidity -PRN tx with benzos and or narcotics

What are the most common organisms that lead to shunt infections? -ANSWER-Staph epidermis (coag negative staph = most common)

Staph aureus

Can be from gram - organisms such as E. coli or klebsiella (common with VP shunts where the bacteria was in the gut and progressed its way up)

Presentation of a shunt malfunction -ANSWER-HA Change in vision N/V Behavior change Sleepiness Irritability Abnormal gait Seizures ***All of S/S of increased ICP***

What are the S/S of a shunt infection? -ANSWER-Fever S/S of malfunction Irritability

When is the most common time to get a shunt infection? - ANSWER-In the first few mos after placement or after a revision

When is the most common time to experience shunt malfunction?-ANSWER-More common later on

When should you evaluate a shunt? -ANSWER-When the H&P suggests malfunction or infection

Diagnostics with shunt malfunction -ANSWER--Pumping of reservoir (risk for obstruction and not commonly performed) -Shunt series (Series of x-rays that follow the course of the shunt from the skull to the distal end looking for dislodgment) -CT or MRI to look at ventricle size (most common)

Diagnostics for shunt infection -ANSWER--Testing of fluid from the shunt -Watch for pleocytosis on CSF fluid -CSF sent for cell count, glucose, protein, gram stain -Blood cultures

What would indicate a probable shunt infection in regard to your WBCs in CSF? -ANSWER--If you have pleocytosis of > 50 on your cell count and you have isolation of bacteria with at least 1 S/S of shunt infection, this is enough for dx -If there is > 100 on your cell count, then there is a 96% specificity for infection

How do you treat a shunt infection? -ANSWER-Empiric coverage with Vanco and cefepime OR Vanco and meropenem

Management of shunt infection -ANSWER-ABX Repeat CSF culture until negative Consider shunt removal and temporary external ventricular device until they have negative cultures

How many different patterns of pneumonia are there and what are they? -ANSWER-5 but she highlights 4 Lobar