Additional Quiz Questions Flashcards
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Define consent
An informed decision to accept treatment or to participate in research
How old must a child be to give assent to participate in a research study?
7 years old
Assent is a chid’s agreement to participate and is an adjunct to parental/legal guardian consent, not a replacement.
What dictates a nurse’s “scope of practice” which is essentially what a nurse can and cannot do as a nurse in the state which he/she is license to practice?
The State Nurse PRactice Act in each state defines the scope of practice, which is what the nurse can and cannot do as a licensed RN in that state.
What are the exceptions to nurse-patient confidentiality as outlined by HIPAA?
If the patient is a danger to himself, to others, or is being abused.
What are some basic principles of assuring patient confidentiality?
Protect patient information in public settings (elevators, hallways, etc).
Protect passwords, codes, laptops that allow access to electronic medical records.
Only access patient records for information is needed for patient care.
True or False: Assessments can be delegated to nursing assistive personnel (NAP)/unlicensed assistive personnel (UAP). Examples of NAP/UAP roles are nursing students and nursing assistants.
Assessments can never be delegated to a NAP/UAP.
List a major principle of delegation of care to a NAP/UAP.
Delegation involves the transfer of responsibility for the task but not for the ultimate outcome.
What is Shared Governance?
An administrative model that provides an active role for all nurses in decision-making and policy information.
What is research?
A scientific process to produce new knowledge driven by a research question.
A simple way to think about a research question is that it is a question without an answer in the literature.
What is the nurse’s role in research?
To identify clinical questions for study and to collect data.
What is evidence-based practice?
To identify clinical questions for study and to collect data.
What is evidence-based practice?
It is a rigorous process whereby research findings are applied to practice through the development of standards and policies that guide care.
A simple way to think about an evidence-based practice question is that it is a question with an answer found in the research literature.
What is quality improvement?
A process for continually evaluating care to assure that it is effective and aligned to best practice and existing standards of practice. It involves ongoing data collection about patient care and modifying patient care processes.
What are principles of fall prevention?
- Perform a falls risk assessment on all patients using a falls-prevention tool (e.g. Humpty Dumpty Falls Scale, GRAF-PIF).
- Provide and communicate a fall prevention plan for at-risk children.
What is the ethical principle of beneficence?
Actions taken to promote good.
What is the ethical principle of non-maleficence?
Do no harm
What is the ethical principle of justice?
Treating all people equally
What is an example of how the nurse serves as an advocate?
Defending, speaking for, and safeguarding the chid and family to the interdisciplinary team
What is an example of how the Individuals with Disabilities Education Act (IDEA) would be applied in the school setting?
The child with Down Syndrome is educated in a regular classroom with peers that are the same age and healthy. Their additional needs for special education would be guided by an Individualized Education Plan (IEP).
Describe three (3) primary ways in which growth and development progress:
Cephalocaudally - from head to toe
Proximodistally - from the trunk to the tips of the extremities
From general to specific (e.g. crawling, then walking, then running)
What is the pattern of growth by developmental category?
- Infancy (0-12 mos.) - rapid growth; head grows fastest
- Toddler and Preschooler (1-5 yrs.) - slow growth; trunk grows fastest
- School Age (6-12 yrs.) - slow growth; limbs grow fastest
- Adolescent (13-18 yrs.) - rapid growth for trunk and gonads
What is the key principle for Erikson’s psychosocial stage of infancy?
Trust
What is the key principle for Erikson’s psychosocial stage for the toddler?
Autonomy
What is the key principle for Erikson’s psychosocial stage of the preschooler?
Initiative
What is the key principle for Erikson’s psychosocial stage of the school age child?
Industry / Achievement
What is the key principle for Erikson’s psychosocial stage of the adolescent?
Identity
What are some principles of family-centered care?
- 24-access to the hospitalized child
- Sleep accommodations for parent at bedside
- Promote parental presence during procedures and CPR
- Include parents in interdisciplinary rounds
What is the purpose of the body mass index (BMI) for age?
To access for oerweight and underweight beginning as early as 2 years of age through adulthood.
What are the BMI ranges for obesity?
Overweight = 85% - 95%
BMI 25 - 29.9
What are the BMI ranges for underweight?
Underweight = < 5%
BMI <18.5
What is the average length for a newborn in inches?
Newborn = 20 inches (average)
What is the average linear growth rate in the 1st year in inches?
10 inches
What is the average linear growth rate in the 2nd year?
5 inches
What is the average linear growth rate yearly from 2 years until puberty?
2.5 inches
What is the relationship of birth length to length at 4 years?
Birth length doubles at 4 years of age. The average birth length is 20 inches. And the average length at 4 years is 40 inches.
What is the appropriate pain scale for a child from birth to 3 years?
FLACC
What is the appropriate pain scale for a child from 4-8 years?
Faces Scale/Wong
What is the appropriate pain scale for a child > 8 years?
Numeric scale, visual analogue scale
What is chronological age?
Years or months since birth.
What is mental age?
Level of cognitive function
What is bone age?
hands and wrists x-rayed to determine degree of ossification
What is adjusted/corrected age?
Chronologic age minus # of weeks born prematurely
At what age does the posterior fontanel close?
2 months
At what age does the child turn to a rattling noise and tract objects with the eyes 180 degrees?
3 months
At what age does the instinctual smile emerge?
2 months
At what age does the social smile emerge?
3 months
At what age does the infant laugh?
4 months
At what age does stranger anxiety emerge?
4-6 months
At what age does the child play peak-a-boo?
7-9 months
How many words does the child say at 1 year?
5 words
How many words does the child say at 18 months?
50 words
How many words does the child say at 2 years?
400 words
When do infants roll from front to back?
4 months
When do infants roll from back to front?
6 months
When does na infant sit with support?
5-6 months
When does an infant sit without supprt?
8 months
When does pincer grasp emerge?
9 months
When does an infant clap and wave bye-bye?
10-12 months
What is the range for walking?
12-15 months
What are principles of a safe infant sleep environment?
Back to sleep
Tight fitted crib mattress
Nothing inside crib
Sharing bedroom with parent
Use of pacifier up to 6 months
When does anterior fontanel close?
15-18 months
What are the milestones of toilet training?
18-24 months - readiness
2-3 years - daytime dryness
3-5 years - nighttime dryness
When do teeth emerge?
6 months = 1st deciduous tooth
6-7 years = 1st adult tooth
6-12 years = 4 teeth are lost and replaced each year
When does a child climb stairs?
21 months
When does a child run and jump?
24 months
When does the child begin to share, take turns, and follow rules?
Between 3-5 years
At what age does a child ride a tricycle?
3 years
At what age does a child begin to dress self?
3 years
At what age does a child dress self well?
5 years
At what age does a child build tower > 6 blocks?
3 years
At what age does a child throw a ball overhand?
4 years
What are the appropriate tests for visual acuity in children?
4-5 years = LEA Symbols or HOTV chart
> 6 year = Sloan letter chart
At what age does vision mature?
7 years
List signs of puberty in the female in order of appearance and their average age of onset.
breast development (10 years)
pubic hair (11 years)
height spurt (12 years)
menarche (13 years)
List signs of puberty in the male in order of appearance and their average age of onset.
testicular enlargement (11 years)
pubic hair (12 years)
height spurt (12-14 years)
What are the elements of correct suctioning of a pediatric tracheostomy?
- Suction machine set to 80-100 mmHg
- Instill catheter to premeasured length (not until resistance)
- Do not apply suction on insertion
- Apply intermittent suction and gently rotate catheter whil catheter is being removed
State the rationale for why normal saline is contraindicated for routine use during tracheotomy suctioning.
It is associated with decreased arterial oxygen saturation and leads to nosocomial pneumonia due to removing normal flora in the lung.
How is tonsillitis managed postoperatively?
- Side-lying positioning
- Ice collar
- Analgesics
- Clear cool fluids
- Monitor for signs of hemorrhage
List signs of hemorrhage after a tonsillectomy that warrant nurse surveillance and intervention as well as parent education.
Frequently swallowing; pallor; restlessness; vomiting bright red blood
*Vomiting coffee ground, dark red, or dark brown blood is common and not concerning.
Describe the technique for instilling ear drops in the child up to 3 years of age and the child over 3 years of age.
< 3 years = pull ear down and back
> 3 years = pull ear up and back
Why is otitis media common in infants?
They have shorter, wider, less angled eustachian tubes.
List prevention strategies for otitis media.
- Feed infants upright
- Give pneumococcal vaccine
- Avoid passive smoke
- Discontinue pacifier > 6 months
What are the manifestations of otitis media?
- Bulging, red tympanic membranes
- Pain
- Fever
- Upper respiratory infection
- Rubbing the ear
List the prevention strategy for epiglottitis.
Routine childhood immunizaitons including the Hib vaccine to protect against Haemophilus Influenzae
What are the symptoms of epiglottitis?
- Keep the child calm on parent’s lap
- Prepare tracheotomy and intubation equipment
- Deer inspecting the throat as it can lead to airway closure
- Administer antibiotics as ordered
List the symptoms of laryngotracheobronchitis/croup
- “seal like” barky cough
- Inspiratory stridor
- Respiratory distress
*Is a virally-induced inflammation of the large airway (larynx)
List the treatment for laryngotracheobronchitis/croup
mild cases = oral steroids
moderate - severe cases = inhaled racemic epinephrine
List the side effects of inhaled racemic epinephrine.
Agitation, anxiety, restlessness, headache, dizziness, sleeplessness, tremors
What is the most common cause of bronchiolitis?
Respiratory syncytial virus (RSV)
What is the mode of transmission for RSV?
Spread via contact with secretions; also spreads up to 3 feet via coughing.
*Prevented in high risk infants by monthly doses of RSV-IVIF or Respigam
What is the nursing management of bronchiolitis?
Management is focused on support of systems.
1. Elevate head of bed.
2. Nasal aspiration as needed.
3. Oxygen if pulse-ox < 90%
4. Small, frequent feedings
5. Chest physiotherapy
*The use of albuterol and racemic epinephrine is not evidence based.
What are components of the pathophysiology of asthma?
- Bronchoconstriction
- Chronic inflammation
- Increased mucous production
*Above leads to airway obstruction and air trapping.
What are the clinical manifestations of asthma?
- Cough (often 1st sign)
- Chest tightness
- SOB
- Wheezing
- Respiratory distress
What is the management of asthma?
- Individual Asthma Management Plan
- Monitor peak flow meter
- Avoid triggers
- Medicaitons: long-term controller (e.g., Montelukast (Singulair); bronchodilator (albuterol)) during an acute attack.
What is the rationale for a metered dose inhaler (MDI) with an attached spacer and how are they used and cared for?
An MDI is used with a spacer attached so that the MDI medication is puffed into the spacer and then inhaled. This increases delivery of medication to the lung.
*The spacer should be cleaned and dried regularly to avoid contamination.
What are side effects of asthma medications and how are they managed?
Bronchodilators: increased HR, sleeplessness, tremors, nervousness, headache, vomiting
Controller medications: thrush, sore throat, dry mouth, hoarseness
*To prevent thrush, rinse mouth or brush teeth after taking medicaiton
What are the risk factors for bronchopulmonary dysplasia (BPD)?
Gestational age >30 weeks
Neonatal mechanical ventilation
High inhaled oxygen concentrations
What are the greatest threats for foreign body aspiration?
Dried beans
Peanuts
What is a neonatal symptoms of cystic fibrosis?
Failure to pass meconium in the first 72 hours of life.
What are symptoms of cystic fibrosis?
- Steatorrhea (stool fat)
- Frequent respiratory infections
- Failure to thrive
- Wet, chronic cough
- Wheezing respiration
- Barrel chest
How are secretions cleared in cystic fibrosis?
Mechanical clearance of secretions (ThAIRapy best, cough and deep breathing, chest physiotherapy, flutter mucous clearance device)
Medication clearance of secretions using aerosolized Pulmonzyme (recombinant human deoxyribonuclease)
What are the principles of nutrition management for the patient with cystic fibrosis?
- Administer pancreatic enzymes with meals and snacks (suspend in teaspoon of applesauce)
- High-calorie, high-protein diet
- Give vitamins A, D, E, K (fat soluble)
What are basic principles of infection management and control for the child with cystic fibrosis?
Treat infection promptly and aggressively because bacteria leads to progressive lung disease; Do not promote socialization among children with CF due to the risk of cepacian (special type of bacteria)
What is MOST likely a complication of hypernatremia?
Seizure activity and other neurological disorders; cerebral edema, decrease level of consciousness, hyperreflexia, and hyper-irritability.
Common with hypertonic dehydration. Seen in infants with diarrhea getting large quantities of fluids high in sodium. Children with NG tube feedings high in protein are also at risk due to the excessive solute load on the kidneys.
Clinical manifestations of pain
Tight facial muscles, irregular breathing, and rigid posture
Clinical manifestations of opioid withdrawal
- Sympathetic nervous system: nasal stuffiness, tachypnea, diaphoresis, chills, fever, and mottled skin
- Neuro system: tremors, seizures, irritability, insomnia
- GI system: vomiting, diarrhea, poor feeding, nausea
*These symptoms occur 24 hours after abrupt opioid discontinuation.
What are basic principles of infection management and control for the child with cystic fibrosis?
Treat infection promptly and aggressively because bacteria leads to progressive lung disease; Do not promote socialization among children with CF due to the risk of cepacian.
What are the signs and symptoms of mild and severe carbon monoxide poisoning?
Mild: headache, vertigo, nausea, fatigue
Severe: confusion, seizures, loss of consciousness
How is carbon monoxide poisoning managed?
Move to fresh air/outside
Provide 100% oxygen
How is carbon monoxide poisoning prevented?
Carbon monoxide detectors
Vent gas appliances
Service gas appliance
Never run vehicle in closed garage
What is the normal range for the pH on an arterial blood gas?
pH 7.35 - 7.45
What is the normal range for HCO3 on an arterial blood gas?
HCO3 (called Bicarb): 22-26
What is the normal range for CO2 on an arterial blood gas?
CO2: 35 - 45
Define pH range for acidosis
pH <7.35 = acidosis
Define the pH range for alkalosis
pH 7.45 = alkalosis
Analyze the following acid-base imbalance:
pH = 7.32
CO2 = 47
HCO3 = 25
Respiratory acidosis
The pH is low indicating acidosis.
The CO2 is high indicating a respiratory source.
The HCO3 is normal indicating it is not a metabolic source.
*This is typical in respiratory distress or arrest.
Analyze the following acid-base imbalance:
pH = 7.30
CO2 = 39
HCO3 = 18
Metabolic acidosis
The pH is low indicating acidosis.
The HCO3 is low indicating a metabolic source.
The CO2 is normal indicating it is not a respiratory source.
*This is typical in diarrhea.
What are complications of vomiting?
Dehydration
Metabolic acidosis
Aspiration
List four functions of the gastrointestinal system.
Absorption
Elimination
Protection
Fluid and electrolyte balance
Name four nursing considerations for post-operative abdominal surgery.
Pain management
Prevention of infection
Abdominal decompression
Fluid and electrolyte monitoring
What are important assessments for the patient with vomiting?
- Projectile vs. non-projectile
- Assess for blood or bile (indicates intestinal obstruction) and other characteristics.
- Assess abdomen - bowel sounds, circumference, note pain type and location.
- Assess for metabolic alkalosis.
- Evaluate feeding methods.
What is the most common cause of diarrhea and gastroenteritis?
Rotavirus
Diagnosed with a stool culture.
*Prevented with vaccine.
What are symptoms associated with C. difficile infeciton?
Fever, abdominal pain, bloody diarrhea
What are the nursing management principles of mild diarrhea?
Continue regular diet
Avoid fluids with high osmotic load (e.g. fruit juice, soda)
What are the nursing management principles of moderate to severe diarrhea?
Infants: oral rehydration solution (Pedialyte); continue breast feeding or formula
Children >1 year: Encourage fluids; increase starchy foods (rice, toast, crackers, pretzels).
IV fluids may be needed.
What is pyloric stenosis?
An obstruction caused by thickening of the abdominal muscle around the circular pylorus muscle
What are the manifestations of pyloric stenosis?
- Presents around 4 weeks of age in boys.
- Projectile vomiting that may be heme positive, but will NEVER contain bile.
- Dehydration
- Metabolic alkalosis
- Olive-like mass to the right of the umbilicus
What is gastroesophageal reflux?
The passage of gastric contents from the stomach to the esophagus through incompetent or poorly formed esophageal sphincter
How is gastroesophageal reflux managed?
- Give thickened, small, more frequent feedings.
- Hold upright for 30 minutes after each feeding.
- Administer H-2 Receptor
- Antagonists 30 minutes prior to feedings (Ranitidine; Cimetidine; Famotidine).
- Proton Pump Inhibitors may also be used.
What are nursing management principles for cleft lip and palate?
Feed slowly in upright position. Burp frequently. Use specially designed nipple for cleft palate.
Anticipate surgery at:
Lip: 1-4 months
Palate: 6-12 months (when weaned to an open cup)
What are post-operative interventions for the child with cleft lip?
- Assess respiratory status.
- Keep infant’s hands out of mouth by either using elbow restraints for having parents at bedside holding infant.
- Do not place in prone position to avoid pressure on face.
- Clean suture line with warm water (using a Q-tip) and apply antibiotic ointment.
What are post-operative interventions for the child with cleft palate?
- Assess respiratory status.
- Keep infant’s hands out of mouth by using elbow restraints.
- Nothing is allowed to be plaed into the mouth (nipples, straws, toys, fingers).
- Feeding must be via an open cup (no valve, straws, nipples).
- Speech therapy is consulted.
What is esophageal atresia?
EA is a condition that occurs when the proximal end of the esophagus ends ina blind pouch. Food cannot enter the stomach.
What is a tracheoesophageal fistula?
TEF occurs when there is a connection between the esophagus and trachea.
What are the signs and symptoms of esophageal atresia and/or tracheoesophageal fistula?
History of maternal polyhydraminos; excessive oral secretions in the newborn; abdominal distention; during feeding - coaching, choking, cyanosis
What are manifestations of intussusception?
- Sudden abdominal pain
- Inconsolable crying
- Drawing up knees to chest
- Bilious vomiting
- Current-jelly stools (latest, most classic sign)
What is the management for intussusception?
Typically diagnoses with a barium enema and reduced with an air pressure enema.
In some cases, is managed by surgical reduction with or without resection and ostomy placement.
What is encopresis?
It is fecal soling in child older than 4 years who is previously continent of stool. It occurs typically due to voluntary withholding of stool (often due to starting school and not wanting to use a public restroom).
What are the symptoms of encopressis?
Liquid stool smearing of underwear; abdominal distention and palpable abdominal stool mass.
What is the management of encopresis?
Clear impacted stool with stool softeners, lubricants, suppositories, enemas.
Ongoing prevention with high fiber diet, stool softeners, increased fluid intake, and psychologic support.
What are signs and symptoms of appendicitis?
Diffuse abdominal pain that localizes in right lower quadrant; rebound tenderness; decreased bowel sounds; abdominal distention; guarding; fever; high WBCs
What is typical management of appendicitis?
Most cases of appendicitis are managed with antibiotics and not surgery.
What are the clinical manifestations of inflammatory bowel disease?
- Bloody diarrhea
- Abdominal pain and cramps
- Weight loss
- Growth retardation
What are nutritional considerations in managing Inflammatory Bowel Disease?
High protein, high calorie diet; vitamin supplementation with multivitamin, folic acid, and iron
What are the clinical manifestations of celiac disease?
- Steatorrhea
- Abdominal distension
- Failure to thrive
- Malnutrition
- Muscle wasting
What is the nutritional management of celiac disease?
Follow a gluten-free diet which involves eliminating wheat, barley, rye, and oats.
Give corn and rice products, soy and potato flour, probana formula, and all fresh fruits.
What is Hirschsprung disease?
A congenital anomaly in which a portion of the distal bowel lacks ganglionic cells leading to decreased intestinal motility.
What are the clinical manifestations of Hirschsprung disease?
Symptoms include abdominal distension, constipation, ribbon-like stools
How is Hirschsprung disease managed?
Enemas to relieve mechanical obstruction; surgery to remove affected portion of the bowel; may place temporary ostomy that is later reversed.
Name one intervention which has been proven to be protective against necrotizing entercolitis (NEC).
Exclusive breast feeding or breast milk feeding
What are the manifestations of biliary atresia?
- Jaundice
- Pruritis
- Pale stool
- Hepatomegaly
- Ascites
- Splenomegaly
- Failure to thrive
What is biliary atresia?
A congenital anomaly involving the obstruction or absence of extrahepatic biliary structures.
How is biliary atresia managed?
- Fat soluble vitamins (A, D, E, K)
- Kasai surgial procedure (temporary solution)
- Liver transplanation
Describe the appropriate dosing range for acetaminophen including non-therapeutic dosing and toxic dosing.
- < 10 mg/kg/dose = non-therapeutic
- 10-15 mg/kg/dose = therapeutic
- > 15 mg/kg/dose = toxic
What is the focus of management of the child with an acetaminophen overdose?
Monitor GI status (particularly liver) 24-35 hours after an overdose.
Give antidote, acetylcysteine (Mucomyst).
List the best way to check the placement of an NG tube.
Use a syringe to aspirate gastric contents. Check its pH. With a pH < 5, that indicates gastric placement of the NG tube.
List the live vaccines as well as patients for whom they are typically contraindicated.
Measles, mumps, rubella (MMR); varicella, nasal influenza, rotavirus.
Typically contraindicated in immunocompromised people (toddler receiving chemotherapy).
Children with HIV do receive MMR and varicella vaccines.
What are contraindications to vaccines?
History of life-threatening reaction to a previous dose.
Moderate to severe acute, febrile illness
*Reschedule when well.
Pregnancy for some vaccines.
What are mild side effects for vaccines and how are they managed?
Mild fever and soreness at the injection site.
Comfort measures and antipyretics.
What are classic side effects of live vaccines and when do they typically occur?
Occur 2-4 weeks after the vaccine.
Mimic the disease they are designed to protect against.
Varicella: mild itchy rash
Rotavirus: mild diarrhea or vomiting, irritability, fever, malaise
What are symptoms of an adverse reaction?
- Difficulty breathing
- Hoarseness or wheezing
- Hives
- Pallor
- Lethargy
- Tachycardia
- Dizziness
Regarding vaccines, what signs and symptoms warrant that a parent or caregiver call the healthcare provider?
Symptoms of an adverse reaction:
* High fever
* Behavioral changes
* Any concerns
List principles of vaccine administration and preparation.
- Do not routinely pre-medicate with acetaminophen.
- Use vastus lateralis muscle (anterior thigh) up to 18 months.
- Use deltoid muscle (arm) from 18 months to adult.
- Multiple vaccine administration is safe and recommended by CDC.
How is pertussis managed?
- Maintain patent airway (Suction and ventilation equipment)
- Droplet precautions
- Administer antibiotics (Erythromycin, azithromycin, etc)
- Prophylaxis for contacts
- Vaccine boosters
What is the management of infants younger than 12 months during a measles outbreak?
Infants as young as 6 months will receive an MMR vaccine to protect against the measles during a measles outbreak, but that dose is considered an extra dose and does not count toward two required doses:
Dose 1 = 12-15 months
Dose 2 = 4-6 years
What are signs and symptoms of pertussis?
- (Whooping cough)
- Paroxysmal or spasmodic cough lasting weeks to months; respiratory distress with anoxia and cyanosis
- Vaccinations at 2, 4, and 6 months (tdap vaccine)
- “100 day cough”
What is conjunctivitis?
Inflammation of the conjunctiva caused by bacteria, virus, allergy, or other irritants
What are the signs and symptoms of conjunctivitis?
(pink eye)
Highly contagious, results in itching, burning, scratchiness beneath eyelid, redness, tearing, purulent drainage
What is the management for conjunctivitis?
- Antibiotic opthalamic ointment or drops (for bacterial forms)
- Exlude from school for 24 hours after initiation of antibiotics
- Warm compresses
- Good hand washing
How is varicella transmitted?
Airborn and contact with secretions
When is varicella communicable?
Communicable 1-2 days before rash erupts until it completely scabs over 6-8 days later.
What is the typical management of varicella?
- Keep nails short
- Lukewarm oatmeal baths
- Antipyretics
- Anti-histamines
- Hydration
What is the varicella preventative management for children in high-risk groups (e.g. toddler receiving chemotherapy)?
Give varicella zoster immune globulin (VariZIG) as soon as possible (w/in 10 days of exposure).
What are signs and symptoms of mononucleosis?
- Positive Monospot test
- CBC - atypical monocytes
- Splenomegaly
- Hepatomegaly
- Lymph node enlargement
- Sore throat
- Lethargy
What is the management of the child with mononucleosis?
- Comfort measures
- Rest
- Fluid intake
*Activity restrictions for 3 weeks following acute symptoms resolution to assure spleen has returned to baseline due to the risk of splenic rupture.
Compare and contrast TB infection from TB disease.
TB transmission = droplet
TB Infection = infection with the bacteria that causes the disease. (+TST skin test ONLY)
TB Disease = infection and replication in the lung (+TST skin test AND + x-ray and/or Interferon Gold blood test)
What are signs and symptoms of fifth disease?
Intense red facial rash (slapped cheeks face)
Extremity rash starting one day after facial rash
What is Lyme disease?
A bacterial infection caused by a deer tick bite that results in a bulls-eye rash within 3 to 30 days.
3 phases: early localized; early disseminated; and late disease.
Outcomes are good if treated in early localized phase when bulls-eye rash is present.
What is the prevention and management of Lyme disease?
Prevention: wear long pants and long-sleeved shirts in wooded areas. Inspect skin to find tics that are crawling or hiding prior to biting.
Give antibiotic (e.g. doxycycline, amoxicillin, cefuroxime) as ordered.
What are the principles of anticipatory guidance for the HIV+ women during pregnancy and after birth of her baby to void HIV transmission to the baby?
Antiretrovirals (during pregnancy); Avoid breast feeding; Avoid giving the baby pre-chewed food
Avoid live vaccines of rotavirus and nasal influenza.
MMR and varicella vaccines are recommended even though they are live.
What is amblyopia and how is it managed?
Lazy eye
Patch the healthy eye. Refer to treatment prior to vision maturity at 7 years.
What are signs and symptoms of Down Syndrome?
- Intellectual disability
- Dysmorphic facial features
- Broad, flat forehead
- Low-set years
- Short tongue
- Palmar simian crease
- Protruding tongue
What are interventions for the child with Down Syndrome?
- Consider impact of hypotonia/developmental delay.
- Communicate with the child based on mental age.
- Use small, straight-handled spoon to push food at the back and side of mouth due to protruding tongue and small oral cavity.
What are the three approaches to seizure management?
- Antiepileptic Drug Therapy (70% of patients well-managed with this approach).
- Ketogenic Diet
- Surgical Intervention
a. Brain Surgery (Resection)
b. Vagal Nerve Stimulator (VNS)
What is the ketogenic diet?
A medically-induced high-fat, low-carbohydrate diet used to induce ketosis which generally stops or reduces seizures. It is a second line of treatment for the child with a seizure disorder after anti-epileptic therapy.
Foods: eegs, meat, fish, cheese, low carbohydrate vegetables
What are principles of postoperative management of the VP shunt?
- Lay supine in flat position for 24 hours
- Strict I&O monitoring
- Measurement of head circumfrence
- Incision care
- Monitor signs of infection
- Monitor signs of increased intracranial pressure
What blood lead levels require treatment?
> 45 ug/dL - requires chelation therapy (must be inpatient only if symptomatic)
> 70 ug/dL - requires immediate inpatient chelation therapy
What is a normal hemoglobin value?
11.5 - 14.5 g/dL
What are the clinical manifestations of acute anemia?
- Muscle weakness
- Fatigue
- Pallor
- Headache
- Lightheadedness
- Increased heart rate
What are the clinical manifestations of chronic anemia?
- Growth retardation
- Delayed sexual maturation
- Increased heart rate
- Heart murmur
What instructions should be included when providing information on iron supplementation for iron deficiency anemia?
- Give medicine with a dropper
- Brush teeth after its administration
- Give in between meals with citrus juice
- Adequate levels will turn the stools a tarry green or black
What is the pathophysiology of sickle cell disease?
The RBCs sickle and get trapped in the vasculature.
A chronic hemolytic anemia exists as the red blood cell lives only 20 days.
What interventions are used for managing vaso-occlusive crisis in sickle cell disease?
- Hydration
- Oxygenation
- Pain management
What is the reason children with sickle cell disease are at risk for bacteremia/sepsis?
Splenic failure
The spleen gets infarcted with sickled cells. Normally, the spleen protects against encapsulated bacterial organisms.
What is the management of a child with sickle cell disease and fever?
- History and physical exam
- Blood culture and CBC w/ differential.
- Antibiotics as ordered
- Monitor for signs of sepsis
What is the normal platelet count?
150,000 - 400,000
What are the manifestations of idiopathic/immune thrombocytopenia purpura (ITP)?
- Decreased platelets < 20,000
- Petechiae
- Bruising and bleeding
What is the management of ITP?
What is an Absolute Neutrophil Count (ANC)?
It is the degree of the immune system function integrity. It reflects the degree to which the body is able to fight infection.
What is neutropenia?
A reduction in the circulating neutrophils defined as an absolute neutrophil count (ANC) < 1,000.
A normal ANC in kids is 2,500
What are principles of PRBC administration?
- Take vitals prior to start.
- Check right patient.
- Check right blood type and same type and cross match between donor and patient.
- Have IV normal saline hooked to piggyback tubing.
- Administer slowly.
- Stay with patient.
List the three types of PRBC administration reactions and their symptoms.
- Hemolytic: Flank pain, severe headache, dyspnea, shock and renal failure, fever/chills
- Allergic: hives and itching
- Febrile: Fevers and chills
What are the nursing actions in response to symptoms of a PRBC transfusion reaction?
- Stop infusion
- Maintain patent IV infusion with normal saline
- Take vital signs
- Contact provider
Whgat are the manifestations of leukemia?
- Anemia
- Bleeding disorders
- Lymphadenopathy
- Immunosuppression
What are manifestations of Hodgkin’s Lymphoma?
Painless enlargement of lymph nodes, weight loss, fever, night sweats
What are manifestations of Non-Hodgkin’s Lymphoma?
Swelling in abdomen or neck, congestion and URI-like symptoms, weightloss, fever, night sweats
What are manifestations of Wilms Tumor?
Nontender abdominal mass, abdominal pain, hypertension, hematuria, anemia, constipation
What are interventions for Wilms Tumor?
Do not palpate the abdomen, loose clothing around abdomen, nephrectomy 24-48 hours after diagnosis, chemotherapy
Describe understanding of death by developmental category.
- Toddler - no concept of time; fears separation from parents
- Preschooler - views death as temporary; fears separation from parents
- School age - understands permanence and causality; needs concrete information
- Adolescent - full understanding; involve fully
List some general management approaches to the infant with a cyanotic heart defect.
- Decrease oxygen demands
- Provide oxygen as needed
- Use premie nipple to decrease the energy expenditure with sucking/feeding
- Provide high calorie formula
- Cluster care to decrease energy expenditure and promote periods of rest
How is a TET spell managed?
- Do not interfere with a squatting toddler.
- Put infant ina. knee to chest position.
- Administer 100% oxygen.
What are the signs and symptoms of a Ventricular Septal Defect (VSD)?
Signs of congestive hear failure with right ventricular hypertrophy:
* tachycardia
* diaphoresis
* tachypnea
* failure to thrive
* exercise intolerance
* respiratory infections
What are the treatment approaches to manage Ventricular Septal Defect (VSD)?
- Digoxin
- Strict I&O
- Diuretics
- High calorie foods
- Surgical correction
What are signs of Digoxin toxicity?
- Badycardia
- Dysrhythmias
- Vomiting
- Lethargy
What are management approaches to the child with rheumatic fever?
Prevent by treating strep infections completely
During the acute phase - promote bed rest, administer anti-inflammatory medication, and administer penicillin prophylaxis as ordered.
What are signs of rheumatic fever?
Fever, fatigue, joint pain with swelling, redness and warmth, chorea, erythema marginatum
What are manifestations of Kawasaki Disease?
- High, persistent fever
- swelling of the conjunctiva without drainage
- inflammation of the mouth, lips, tongue
- rash
- swollen red hands and feet
- cervical lymphadenopathy
What are the components of management in Kawasaki Disease?
- IVIG (intravenous immunoglobulins which are antibodies) w/in 10 days onset
- Salicylate therapy
- Cardiaic monitoring
- Treat symptoms
List 3 risk factors in the development of developmental dysplasia of the hip (DDH).
- Breech delivery
- Fetal position inutero
- Genetic predisposition
What is the typical assessment in developmental dysplasia of the hips?
Ortolani click, shortened limb on the affected side, asymmetric skin folds in gluteus, trendelenburg’s sign in child who is talking.
What is the typical treatment in developmental dysplasia of the hips?
Pavlik harness is used in children under 6 months with 95% efficacy.
Identify 4 complications of scoliosis
- Impaired growth and development
- Impaired mobility
- Pain
- Respiratory compromise
Describe approaches to treatment for the child with a mild curvature in structural scoliosis.
- Bracing
- Traction
- Electrical stimulation
Describe approaches to treatment for the child with a severe curvature in structural scoliosis.
Severe curvature is defined as > 40 degrees. Treatment is spinal surgery using rods to realign the spine.
Following surgery, patients are flat in bed for a short time and then begin physical therapy. Lifting is prohibited.
What is the most common causative agent in osteomyelitis?
Staphylococcus
What is osteomyelitis?
An infection of the bone most commonly found in the long bones.
Compare and contrast structural and non-structural scoliosis.
Non-structural scoliosis is a C-shaped curve that disappears when the child bends at the waist.
Structural scoliosis is a S-shaped curve and does not disappear when the child bends at the waist.
What are the clinical assessments in the child with osteomyelitis?
- Fever
- Pain
- Swelling
- Warmth
- Redness
What is Juvenile Idiopathic Arthitis (JIA)?
An autoimmune disorder of the connective tissue causing inflammation and destruction of the joints.
What is the clinical management of the child with osteomytelitis?
4 to 6 week course of antibiotics
May require surgical removal of infected or necrotic bone.
What is the focus of management for the child with Juvenile Idiopathic Arthritis (JIA)?
- Promote exercise and range of motion
- Promote comfort with heat and anti-inflammatory medications
- Allow extra time for activities of daily living
- Prevent vision loss with routine slit eye examinations
What are the manifestations of hypothyroidism?
Impaired growth & development, constipation, sleepiness, hypotonia, hypothermia, slow pulse, easy weight gain.
Only with congenital form: intellectual disability, enlarged tongue
How is hypothyroidism managed?
Thyroid hormone replacement & vitamin D
What is Cushing Syndrome?
Hyperfunction of the adrenal gland where high cortisol levels cause decreased secreiton of ACTH.
What are the manifestations of hyperthyroidism?
Excessive motion, short attention span, insomnia, weight loss despite voracious appetite, accelerated linear growth and bone age, hyperactivity of GI tract, tachycardia, bounding puulse, cardiomegaly
What are potential causes of Cushing Syndrome?
Pituitary tumor and prolonged steroid therapy
What are manifestations of Cushing Syndrome?
Centripetal fat distribution (trunk, neck, back, face), hyperglycemia, susceptibility to infection and poor wound healing, hypertension, osteoporosis and susceptibility to fractures, facial hair, decreased linear growth
What foods need to be eliminated from the diet in a child with PKU?
- High protein foods
- milk
- meat
- eggs
- beans
- nuts
- aspartame
What is the management approach to the child with precocious puberty?
Teach parents to treat child according to developmental age regardless of pubertal signs and symptoms.
50% of cases resolve on own.
Remainder are managed with medication (GnRH).
Describe the ways to manage Cushing Syndrome.
Gradual discontinuation of steroids allows the adrenals to produce cortisol. This is important due to the risk of acute adrenal insufficiency, which is life threatening, with the abrupt discontinuation of a long-term steroid.
Surgical removal of tumor
In order to be considered precocious puberty, sexual development must occur at what age?
- < 9 years in boys
- < 7 years in Cauasian girls
- < 6 years in African American girls
What are manifestations of Phenylketonuria (PKU)?
- Brain damage
- Seizures
- Musty odor to urine
What are the manifestations of galactosemia?
- Liver failure
- Renal tubule problems
- Cataracts
How is galactosemia managed?
Lactose free diet
What are the manifestations of Type 1 diabetes?
- polyuria (increased urine)
- polydypsia (increased thirst)
- polyphasia (increased hunger)
- thin and malnourished
- warm, dry, flushed skin
- weakness
- fatigue
- headache
- acetone breath odor
What glucose levels are considered hyperglycemia?
> 130 mg/dL fasting
180 mg/dL 2 hrs. after eating
What are the caues of hyperglycemia?
- increased intake of sugar
- decreased use of insulin
- decreased exercise without decreasing food intake
- increased stressors
- infections
- cortisone use
What are manifestations of hypoglycemia?
blood glucose < 70 mg/dL
- sweaty
- shaky
- tachycardia
- confusion
- irritability
- poor coordination
- cold, clammy skin
What are the onset and peak of various insulin types?
Lispro/Humalog:
* onset: 5-15 minutes
* Peak: 30-90 minutes
Regular:
* Onset: 30 minutes
* Peaks: 2-4 hours
NPH:
* Onset: 2-4 hours
* Peaks: 8 hours
Lantus - basal needs, no peaks
What are the signs and symptoms of Type 2 diabetes?
- overweight
- hypertension
- hyperlipidemia
- sleep apnea
- acanthosis nigricans (thickening and hyperpigmentation of the skin on the back of the neck or axilla)
In addition to diet and exercise, what medication can be used to manage type 2 diabetes?
Metformin (Glucophage) given orally
What is the impact of exercise and illness on glucose in the child with type 1 diabetes?
exercise: decreases glucose and decreases need for insulin
Illess: increases glucose and increases need for insulin
What is antidiuretic hormone (ADH)?
A hormone which tells the kidneys not to urinate. When levels are normal it, along with adequate hydration, helps to maintain adequate fluid and electrolyte balance.
ADH is also called vasopressin.
A condition where urine is extremely dilute and the blood is extremely concentrated is known as ______.
Diapbetes Insipidus (DI)
The child with DI has increased serum osmolality, hypernatremia and hypovolemia.
Is diabetes insipidus a condition of too much or too little ADH?
too little
DI is caused by a posterior pituitary hyposecretion of ADH.
What is syndrome of inappropriate antidiuretic hormone (SIADH)?
A syndrome of hyponatremia and hypoosmolality that results from the excessive production of ADH. The body holds onto fluid which dilutes the blood thereby causing the serum sodium levels to be low.
*Low serum sodium levels are associated with cerebral edema and seizures.
What are ways to manage SIADH?
- Fluid restriction
- Sodium replacement if symptomatic
- Diuretics
- Careful assessment and management of neurologic status due to the risk of cerebral edema and seizures
What are ways to manage DI?
- Fluid replacement
- DDAVP
- Vasopressin (ADH)
When a child is received gentamycin, what body system is at most risk for complications?
Hearing. Gentamycin is ototoxic.
(Remember Dr. Benson’s son in the ER show.)
What is a primary nursing role in the management of the child affected by abuse?
- Protect the child.
- Reassure the child.
- Report the abuse to authorities.
- Nurses are mandated reporters.
What are thge risk factors for child abuse by developmental category?
- Infants and young children are at increased risk for physical abuse.
- School age and adolescents are at increased risk for sexual abuse.
What is the most common type of abuse?
neglect
List specific types of burns that are associated with child abuse.
- Burns on the buttocks
- Burns on both lower legs
- Cigarette burns
What are the characteristics of an adult abuser?
- stress
- Lack of resources
- Low tolerance for frusteration
- Abused as a child
What are common characteristics of perpetrators of Munchausen’s Syndrome by Proxy?
Typically, the child’s mother:
* Feels jealous of child
* Felt unwanted as a child
* Enjoys healthcare professional’s attention
List the prinviples of prevention of opioid withdrawal.
Use opioid weaning medication withdrawal protocols and assessment scales for infants and children who are being weaned from opioids received for 5 or more days.
Treat withdrawal symptoms with medication (e.g. methadone)
What is the management of the infant with neonatal abstinence syndrome?
Neonatal abstinence syndrome is caused by exposure to opioids in utero. Symptoms begin 1-3 days after birth.
Treat withdrawal symptoms with:
* medication (e.g. methadone)
* minimize stimuli
* small frequent feeds of high calorie formula
What are principles of management of the child with autism?
- Early recognition of warning signs
- Highly structured behavioral modification
- Introduce slowly to new situations
- Decrease stimuli
What are the two types of ADHD and their symptoms?
Hyperactive Impulse Type:
* fidgets, squirms, talks excessively, interrupts, difficulty taking turns
Inattentive Type:
* Inattentive to details, difficult to follow directions, difficult to organize tasks, easily distracted, forgetful
What is the management of ADHD?
Psychostimulant medication
Behavioral/environmental interventions
List the management approaches in the care of the child with anorexia.
- Weigh 1-2 times/week with back to the scale
- Monitor signs of malnutrition (e.g. bradycardia, ammenorrhea)
- Maage anxiety and depression symptoms (antianxiety and antidepressant medications)
- Family psychoterapy
- Monitor during meals and 1 hour following meals
List management approaches in the care of the child with bulimia.
- Manage symptoms of anxiety and depression (antianxiety and antidepressant medications)
- Monitor signs of slef-induced vomiting (e.g. dental decay, irritated knuckles)
- Initiate food contracts
- Initiate group psychotherapy
What is the most common cause of enuresis in a child who is toilet trained?
Enuresis is a term for “bed wetting” in a toilet trained child. It is most commonly related to a urinary tract infection.
List the risk factors for a UTI.
- Vesicoureteral reflux
- Bubble baths
- Poor hygiene
- Incomplete bladder emptying
What is hypospadias?
It is a congenital anomaly of the penis in which the urethral meatus opens on the ventral surface.
What is the management for hypospadias?
Avoiding circumcision during infancy with anticipation of surgical repair with circumcision an duse of foreskin in surgical repair 1-4 years.
In a toddler hwo has undescended testes, what is the anticipatory guidance for the family regarding the approach to management of this condition?
Anticipate testing to assure normal kidney function since the kidneys and the testes arise from the same germ tissue.
Surgery is performed between the age of 2 and 5 years to avoid testes remaining in the abdominal cavity after 5 years of age, which can lead to sterility.
What are manifestations of nephrotic syndrome and how is it managed?
- Proteinuria
- hypoalbuminemia
- hypovolemia
- dark foamy frothy urine
- decreased urine output
- microscopic hematuria
- edema
- hypokalemia
- fatigue/lethargy
Managed by high calorie/protein diet w/ no added salt, strict I&Os, daily weight, corticosteroids.
What are the symptoms of acute glomerulonephritis?
- Cola-colored urine
- Decreased volume of urine
- Increased blood pressure
- Anemia
- Edema
- Irritability
- Lethargy
How is acute glomerulonephritis prevented?
The condition is entirely preventable. Taking a full course of antibiotics with a strep infeciton will prevent this condition.
What is the mangement for acute glomerulonephritis?
- Coritcosteroids
- Antibiotic therapy
- Anti-hyertensives
What are the normal serum sodium (Na) value range in children?
135 - 145
What are serum sodium values and symptoms for the child with isotonic dehydration?
Normal sodium levels of 135-145 with typical dehydration signs and symptoms
*This is the most common (705) and safest type of dehydration.
What are the serum sodium values for the child with hypotonic dehydration?
< 135
Seizures and cerebral edema
What are the causes of isotonic dehydration?
- glomerulonephritisVomiting
- Diarrhea
- NPO status
- Burns
What are causes of hypotonic dehydration?
- Water intoxication
- Watering down infant formula
What are the CDC guidelines for management of mild to moderate dehydration?
- Oral rehydration therapy
- Use a rehydration solution (e.g. Pedialyte)
- Give 2-4 mls every 2-3 minutes or 5-10 mls every 5 minutes
Nutritional support = age appropriate diet
What are the serum sodium values and for the child with hypertonic dehydration?
> 145
> Late symptom onset of dehydration
What are causes of hypertonic dehydration?
- Excessive sweating
- Ketoacidosis
- Malnutrition
- Diabetes insipidus
What is the classic assessment of Impetigo?
Small vesicles or pustules that rupture and become honey-colored crusts with a moist erythematous base
What is the management of Impetigo?
Topical antibiotic with or without a systemic antibiotic
How is tinea corporis (ring worm) prevented?
Wear flip-flips in public showers. Avoid sharing towels, linens, and other grooming items. Avoid storing sweaty exercise clothes in moist, hot, dark places (like a closed gym bag).
What is the treatment for head lice?
Application of permethrin 1% cream rinse (Nix) of promethrin with piperonyl butoxide (RID). Apply at time of diagnosis and repeat 7-10 days later. Manually comb out nit cases with fine tooth comb. Machine wash all linens and clothing and thoroughly vacuum. Seal all non-washable items in a plastic bag for 14 days.
What are the classic assessments in the child with scabies?
Intense itching, worsening at night, skin burrows and papules, vesicles and crusts
How is scabies managed?
Apply a scabicide below the neck leaving on for 8 hours and then rinsing off.
Repeat one week later.
Wash clothing and linens in hot water.
What are signs and symptoms of Steven’s Johnson Syndrome?
Flu-like symptoms, painful red/ purple rash/ blisters with skin sloughing
How is Steven’s Johnson’s Syndrome managed?
Discontinue all medication as this is normally caused by a medication. Normal moist, normal saline would healing dressings. Magic mouthwash. Lubricants for eyes to prevent blindness.
