Basic peds, pain, immune

Question 1

What is peds nursing?

Answer 1

Health care of children from infancy through adolescence.

Children are about 24% of the population

Question 2

Basic ethical issues include what?

Answer 2

Autonomy, beneficence, nonmaleficence, justice, veracity, fidelity.

Question 3

What’s included in the “bill of rights for children”?

Answer 3

Call by name, compassionate care, know providers names, basic needs met, unrestrained if able, parents present, interpreter available, object noisily, educated honestly, respect as a person, respect confidentiality

Question 4

What kinds of consent are involved for minors?

Exceptions for parent consent?

Answer 4

Consent is parent-oriented. Initial (blanket) consent form, informed consent, special circumstances
Exceptions include a mature minor/emancipated minor, and confidential care to minors. Parental refusal of treatment.

Question 5

Assent vs dissent?

Answer 5

Both involve the child’s agreement to the plan.
Assent is agreeing to the treatment plan. Child’s participation in the decision-making process. Age greater than or equal to 7 years.
Dissent is disagreeing with the treatment plan. Are 12-17 years, binding in some states

Question 6

What is involved in atraumatic care?

Answer 6

Preventing or minimizing physical stressors, child and family separation. Promoting a sense of control

Question 7

What is the nurse’s role in caring for the hospitalized child?

Answer 7

Minimize physical stress during procedures. Provide play activities. Use effective communication. Provide child and family education. Prepare for discharge.

Question 8

How do you prepare for a peds exam?

Answer 8

Focus on the CC or any system that prompts the nurse’s critical thinking. Process reflects developmental stage, age, temperament, and health status of the child. Gather needed equipment and toys.

Question 9

Explain peds pulses?

Answer 9

Pulse rate decreases with age. Apical pulse is 1 minute on most children. Fever, anxiety, and activity can increase the pulse.

Question 10

Explain respiratory rates?

Answer 10

Decrease with age. Count for 1 min, esp in infants (diaphragmatic breathers up until about age 1). May have irregular pattern.
Fever, anxiety, activity increase rate

Question 11

Reading BP?

Answer 11

Increases with age. 40% of upper arm length, 8–100% of the arm circumference

Question 12

What parts of growth should be measured when it comes to peds?

Answer 12

Height/length. Weight. BMI > or equal to 3 years of age. Head circumference for less than <3 years of age. Growth charts.

Question 13

Interpreting 1-10 pain scales?

Answer 13

0=no pain
1-3=mild pain
4-6=moderate pain
7-10=severe pain

Question 14

How to manage pain in children?

Answer 14

Individualize interventions. Use both pharmacologic and non-pharmacologic methods. Involve the parents in their child’s pain control.

Question 15

Examples of behavioral-cognitive strategies of non-pharma pain control?

Answer 15

Relaxation, distraction, imagery, biofeedback, positive self-talk

Question 16

Examples of nonpharma interventions?

Answer 16

Non-nutritive sucking for infants, heat and cold applications, massage, pressure

Question 17

Explain nonopiod analgesics for children?

Answer 17

Includes acetaminophen and NSAIDs. Routes can be oral, rectal, IV. Mild to moderate pain. First-line agent. Also used for fever management. NO aspirin in children. NSAIDs only after the age of 6 months

Question 18

Opioid analgesics for children?

Answer 18

Agonists: morphine (used most often in children), codeine, fentanyl, meperidine, hydromorphone, oxycodone, hydrocodone. Moderate to severe pain. Route oral, rectal, IM, IV, transdermal (fentanyl).
Side effects: CNS depression, N/v, decreased peristalsis, pruritus

Question 19

Adjuvant meds for children?

Answer 19

Benzodiazepines to reduce anxiety. Anticonvulsants and tricyclic antidepressants: neuropathic pain

Question 20

Topical anesthetics for children?

Answer 20

EMLA, TAC, LET, and LMX4. Used for procedures. Minimal risk of adverse effects.

Question 21

What are variations in meds A/P that could affect an immunization?

Answer 21

Immature responses of the immune system. Decreased inflammatory response. Limited exposure. Decreasing passive immunity. Incomplete immunization protection.

Question 22

Nursing assessment of a child with a communicable disease?

Answer 22

Health history. Assess lesions or wounds, accurately describer rashes, observe child’s behavior, assess hydration status, vitals, look for inflammatory markers. Lab and diagnostic testing.

Question 23

Nursing management of the child with a communicable disease?

Answer 23

Manage fever: antipyretics, non-pharma interventions, parent educations.
Mange skin rashes.
Promoter hydration: oral fluids, proper Iv fluid management, strict I/O, fluid status

Question 24

Common drugs for communicable diseases?

Answer 24

Antibiotics, antivirals, antifungals, antiparasitics

Question 25

Caused by the bordatella pertussis bacteria. Children under 4 years old. Management?

Answer 25

7-10 days of URI symptoms. Paroxysmal coughing spells up to 4 weeks. Convalescence occurs over several months.
Provide respiratory support. Encourage fluids. Reassure family. Antibiotic education.

Question 26

Caused by the varicella zoster virus. Routes of transmission include direct contact with lesions, reparatory secretions, and transplacentally. Assessment and management?

Answer 26

Chicken pox.
Assess distinct rash patterns and symptoms. More immunization status. Complications.
Isolation, supportive care and skin care, antiviral therapy and/or IVIG for high-risk.

Question 27

Caused the measles virus and transmitted by small droplet. Assessment and management?

Answer 27

Rubeola.
Assess distance rash, note Koplik spots. Assess immunization status, complications.
Isolation, supportive care, skin care. Possible vit A supplementation. Cool mist humidifier and gentle eye care.

Question 28

Caused by the paramyxovirus. Saliva and droplet transmission. Assessment and management?

Answer 28

Parotitis (mumps).
Assess symptoms: fever, earache, malaise. Note gland swelling and pain. Complications.
Isolation: contacta and droplet. Supportive care. Soft diet. Pain management. Fluid management and hydration.

Question 29

Ability to recognize the “self” from the “not-self.” Ability to destroy and remove antigen from the body.

Answer 29

Immunity.

Antigens are foreign organisms. Pathogens are antigens that cause disease.

Question 30

Produced to remove antigens. Specific to an organism.

Answer 30

Antibodies, immunoglobulins.

Question 31

Type of immunity in which immunoglobulins are transferred from one person to another.

Answer 31

Passive immunity.

Lasts only weeks or months. IVIG, maternal breast milk. No Immunologic memory.

Question 32

Type of immunity in which own immune system generates immune response.

Answer 32

Active immunity.

Lasts for years or lifetime. Natural pathogens or vaccines. Immunologic memory.

Question 33

Vaccine with a modified living organism that replicates in the body but don’t cause disease.
Vaccine that uses whole organisms or pieces, weaker antigen, requires multiple doses.

Answer 33

Live attenuated vaccines.

Inactivated vaccines.

Question 34

Types of inactivated vaccines?

Answer 34

Whole, that contains whole killed organism (virus or bacteria).
Fractional, contains pieces of the viruses or bacteria. Includes protein-based (toxoid), polysaccharide (pure, not <2 years), polysaccharide-conjugate (linked with protein)
Recombinant (genetically engineered)

Question 35

DTaP/Tdap vaccine?

Answer 35

Diphtheria, pertussis, tetanus. IM. DTaP for children under 7. Tdap for older children and adolescents.

Question 36

Haemophilus influenze type B vaccine?

Answer 36

Hib. IM. Causes life-threatening illnesses in children under age 5. Meningitis, epiglottis, septic arthritis.

Question 37

Polio vaccine?

Answer 37

SC or IM. Inactivated polio vaccine (IPV) currently recommended in the US. Killed virus, poses no risk of infection.

Question 38

Hepatitis B vaccine?

Answer 38

IM. Recombinant vaccine. Series usually started at birth before discharge from hospital.

Question 39

Pneumococcal vaccine?

Answer 39

IM. Streptococcus penumoniae cause of serious infections under age 2. Conjugate vaccine (PCV13-13 strains) started in infancy. Polysaccharide vaccine (23 strains) given to high risk children greater than age 2.

Question 40

Rotavirus vaccine?

Answer 40

PO. Most common cause of severe gastroenteritis. Liv vaccine, given by oral route to infants.

Question 41

MMR vaccine?

Answer 41

Measles, mumps, rubella. Live attenuated virus combination. 2 doses given to children greater than 12 months of age.

Question 42

Varicella vaccine?

Answer 42

Chicken pox. SC. Live attenuated virus. 2 doses given to children greater than 12 months of age.

Question 43

Hepatitis A vaccine?

Answer 43

IM. Inactivated whole virus vaccine. One of the most frequently reported diseases in the US. 2 doses given to children greater than 12 months of age.

Question 44

Meningococcal vaccine?

Answer 44

MCV4. IM. Neisseria meningitis causes meningitis and sepsis. 10-12% of infected persons die, 20% of survivors suffer long-term consequences.

Question 45

Human papilloma virus vaccine?

Answer 45

HPV. IM. Infection is more common in adolescents and young adults who are sexually active. HPV causes genital warts that can lead to cervical cancer.

Question 46

Influenza vaccine?

Answer 46

IM, IN, ID. Universally recommended greater than or equal to 6 months of age. Quadrivalent.
Less than 9 years initially need 2 vaccines, 1 month apart.
0.25mL: 6-35 months.0.5mL: greater than or equal to 36 months

Question 47

Who updates vaccine schedules yearly?

Who should any clinical significant adverse reactions be reported to?

Answer 47

Advisory Committee on Immunization Practices (ACIP)

Vaccine Adverse Event Reporting System (VAERS)

Question 48

What should be kept in mind when dealing with vaccines?

Answer 48

Proper storage, screening, administration, documentation

Question 49

Precautions for vaccines?

Answer 49

Increase the risk of adverse reaction (benefits weighed against risk). Reduce the ability of the vaccine to produce immunity. Seizures, prolonged crying, high fever (pertussis), moderate-severe illness, recent receipt of IG.

Question 50

Contraindications for vaccines?

Answer 50

Conditions that advise withholding vaccine. Severe immunodeficiency, antiviral therapy (viral vaccines), pregnancy (live vaccines).
Permanent contraindications include anaphylaxis (causative vacine), encephalopathy (pertussis), intussusception (rotavirus)

Question 51

What are some post-vaccine interventions?

Answer 51

Tylenol every 4 hours for pain or fever. No ibuprofen to infants under 6 months. No ASA to any child under 16 years of age. Warm baths or cool compresses. Encourage ambulation or use of affected extremity.

Question 52

What should be documented when giving a vaccine?

Answer 52

Child’s name, date, vaccination name, manufacturer, lot number, expiration date, site, route, vaccine information sheet date, facility, name of the administering HCP

Question 53

What should a copy of be given to each parent with each vaccine?

Answer 53

Vaccine information sheet (VIS). Review indications, common side effects, adverse reactions, and reporting process. Use the most current VIS and record date on the vaccine record.

Question 54

What are some barriers to vaccination?

Answer 54

Parental concerns as far as safety. Misconceptions. More than 1 health care provider. Multiple children in the family. Cost. Concern about multiple vaccines.