Block #2 - Assessment, Psychosocial/Cognitive, Immunological, Infectious, Gastrointestinal Flashcards
What measurements best reflect the nutrition status of children?
Head circumference and Height
Where is BP assessed if an arm is unavailable?
The leg
What is the order of vitals assessment?
RR > Apical HR > BP > Temperature
When do the fontanelles close?
- Posterior: 2-4 months
- Anterior: 12-24 months
Amblyopia and treatment
Lazy-eye
Patch over the good eye
Ear Assessment
Low ears = Down’s syndrome and/or liver problems
Which way should the ear be pulled to assess/give ear drops? (> or < 3 years)
<3: down and back
>3: up and back
Hemoglobin and Hematocrit Values in children
Hgb: <12
Hct: <36
What is the antidote for a Tylenol OD?
Mucomist
What damage can be caused by Tylenol?
Liver Damage
Who should the FACES scale be used to assess pain for?
English speakers, >3 yr
Who should the Oucher scale be used to assess pain for?
Non-English speakers
Which is worse and why? Ileostomy/Colonostomy
Ileostomy because the stool is more water
Shaken Baby Syndrome: red flags
- Retinal bleeding
- Possible loss of consciousness
Munchausen Syndrome by Proxy: Definition
Caregiver fabricates the s/s of illness in the child to gain attention from the medical staff
Munchausen Syndrome by Proxy: Warning Signs
- One or more illnesses that don’t respond to treatment or follow a puzzling course
- S/S don’t make sense or disappear when caregiver is gone
- Physical and lab findings don’t match story
- Repeated admits with failure to find a diagnosis, transfers to other hospitals, leaves AMA
- Parent refuses to accept a non-medical diagnosis
Warning Signs of Possible Autism
- Not babbling by 12 months
- Not maintaining eye contact
- Not pointing or using gestures by 12 months
- No single words by 16 months
- No two word sentences by 24 months
- Loss of language or social skills at any age
Behavior Management for Autism
- Do not bargain
- Consistency in caregivers and routine
- Low pitched voice and remain calm
- Redirect attention
- Ignore inappropriate behavior (when possible)
- Praise self control
- Restraints only when absolutely necessary
Learning Disabilities: Types
Dyslexia: problems with reading, writing, and spelling (MOST COMMON)
Dyscalculia: problems with math and computation
Dyspraxia: problems with dexterity and coordination
Dysgraphia: problems producing the written word
Fetal Alcohol Syndrome: signs
- Long Philtrum
- Flattened midface
- Small eye openings
- Thin upper lip
- Low nasal bridge w/ short upturned nose
Intellectual Disabilities: 3 Criteria
- IQ <70
- Limits in 2 skills of ADLs
- Onset before 18 yrs
Intellectual Disabilities: Levels
- Mild: IQ 50 - 70
- Moderate: IQ 35 - 50
- Severe: IQ 20 - 35
- Profound: IQ <20
Chickenpox (Varicella): Treatment
Acyclovir - doesn’t cure, prevents further outbreaks
Chickenpox (Varicella): Precautions
Airborne
- RN: N95 mask
- Patient: surgical mask outside of room
Chickenpox (Varicella): Communicability
No longer contagious once lesions have crusted over
5th Disease: S/S
- Red rash (face, then chest) [looks like child was slapped]
- Mild fever
- Runny nose
- Contagious before rash appears
Scarlet Fever: Precautions
Droplet and Contact
Scarlet Fever: S/S
1st day- light rash, white strawberry tongue
3rd day- more profound rash, red strawberry tongue
Scarlet Fever: Sequelae
Can cause glomerulonephritis and rheumatic heart disease
Scarlet Fever: Treatment
Penicillin
Koplik’s Spots (Rubeola/Measles)
- Red lesions in mouth with white spot in center
- “Strawberry tongue”
- Airborne precautions
Teratogenic Conditions
Conditions which are harmful to the fetus
Rubella/German Measles, 5th disease, and chickenpox
HIV is not teratogenic
Pinworms
- S/S: rectal itching
- Testing: tape test
- Treatment: Vermox (treat whole family and wash clothes in hot water)
Tetanus “Lockjaw”
May occur through the umbilical cord
S/S: muscle rigidity (masseter and neck), accumulated secretions, atelectasis, pneumonia, respiratory arrest, tachycardia, diaphoresis, possible fever
Tetanus Booster Recommendations
1st dose
1-2 months after initial dose
6 months after initial dose
Vitamin D Requirements
400 mg/day (recently doubled from 200 mg)
Rabies Treatment Doses
- Day of Event
- Day 3
- Day 7
- Day 14
- Day 28
Painful injection (HRIG), use local anesthetic (EMLA)
What causes Mono?
Epstein-Barr Virus
Lupus (SLE): Nursing Care
- Manage pain and inflammation
- Treat S/S
- Prevent complications
- Give antimalarial medications
- Give corticosteroids
- Give immunosuppressive agents
- Give palliative care and psychosocial support
Lupus (SLE): S/S
- Fever
- Malaise
- Chills
- Fatigue
- Weight Loss
- Butterfly Rash
- Arthritis
Lupus (SLE): Diagnostic Criteria - need at 4
- Butterfly rash
- Neuro disorder
- Immunologic disorder
- Discoid rash
- Renal disorder
- Oral ulcers
- Arthritis
- Serositis
- Photosensitivity
Cleft-Lip/Palate
- Can only delegate care to RN
- Cleft Lip cannot say “da da da”
- Interferes with dental development
- Large nipple needed on bottle
Eating Disorders: Types
Anorexia: doesn’t eat
Bulimia: eats, then forces self to vomit (damage to esophagus and teeth)
Pica (Low iron): eats ice, chalk, mud, play doh, etc.
Rumination: chews food, spits out, chews again
Obesity: BMI >95th percentile
Hirschsprung Disease
Large intestine ganglion dysfunction = constipation
Temporary colostomy (3 months) needed
Down’s = increased risk
Appendicitis
Pain in RLQ
Fever
Extreme pain
-goes away = rupture
-peritonitis/sepsis risk
Vomiting
WBC >10,000
Meckel’s Diverticulum
Diverticula form during fetal development
Most common GI malformation
Crohn’s vs. Ulcerative Colitis
Crohn’s - Diarrhea
UC - bloody/mucus diarrhea
Intussusception
Intestine rolls over itself
Flat, jelly-like stools, fever, dehydration, abd distention, lethargy, and grunting, sausage protrusion in abdomen
Treatment: Barium Enema
Celiac Disease: 4 Symptoms
Steatorrhea (fatty stools)
General malnutrition
Abdominal distention
Secondary vitamin deficiency
Celiac Disease: BROW Diet (foods to avoid)
B- Barley
R- Rye
O- Oats
W- Wheat
Rehydration
Offer electrolyte drinks (Pedialyte) of 1.5-2 oz. q15min, even if N/V persists
Encopresis
Potty-trained child regresses
Pyloric Stenosis
Pylorus: Opening of small intestine into duodenum
Projectile Vomiting after feedings
Requires surgery
SODA (to assess daily activity)
S- Sleep
O- Output (BM, UOP, etc.)
D- Diet
A- Activity
Communication: Infants
Different cries (caregiver knows the difference/meanings)
Communication: Early Childhood (1-6 yr)
Egocentric- only talk about pt, be honest, let them touch equipment, pts. take things very literally
Communication: School Age (6-12 yr)
Pts. want to know rationale, ensure modesty
Communication: Adolescent (12-19 yr)
Modesty and privacy are key, regression possible during hospitalization
What meds should be alternated for fever control?
Tylenol and Ibuprofen
Lead Poisoning: S/S
- Headache
- Irritability
- Abdominal Pain
- Vomiting
- Anemia
- Weight loss
- Poor attention span
- Noticeable learning difficulty
- Slowed speech development
- Hyperactivity
Lead Poisoning: Effects
- Reading and learning disabilities
- Speech and language handicaps
- Lowered IQ
- Neurological deficits
- Behavior problems
- Mental retardation
- Kidney Disease
- Heart Disease
- Stroke
- Death
Which children are on strict Input/Output while in the hospital?
ALL CHILDREN ARE ON STRICT INPUT/OUPUT
Starting an IV for pediatrics
- Use EMLA at IV site
- Hand and feet are good sites
- Don’t change site, if possible
- Have everything (and backups) in the room before starting
- Monitor closely for infiltration
Behavioral-Cognitive Pain Management Strategies
- Relaxation
- Distraction
- Imagery
- Thought Stopping
- Biofeedback
- Play
Factors Influencing Children’s Behavior
- Biologic/Genetic factors (1/5 kids)
- Nutrition
- Physical health
- Developmental ability r/t bullying
- Environmental or family interactions
- Temperament
- Caregivers’ responses to behaviors
Suicide Risk: S/S
- Depression
- Other mental illness
- Withdrawal from friends/family
- Mental Health/Personality changes
- Decline in School
- Giving away possessions
- Preoccupation with death/dying
- References to dying
- Access to methods of suicide
Suicide: Risk Factors
- Previous attempts
- Change in school performance, sleep, or appetite
- Loss of interest in previous interests
- Feelings of helplessness or depression
- Thoughts of self harm or suicide
Pervasive Developmental Disorder Scale (Spectrum)
- Autistic Disorder (lack of social and communication skills, repetitive behaviors)
- Asperger’s (mild autism)
- Rett’s Disorder (development normal until 6 months [female children])
Subtypes of ADHD
Hyper-active Impulsive
Inattentive
Combination
Complications of Eating Disorders
- Fluid and Electrolyte Imbalance
- Decreased Blood Volume
- Cardiac Arrythmias
- Esophagitis
- Rupture of the Esophagus or Stomach
- Tooth Loss
- Menstrual Problems
- 18% mortality
Immunity: Mechanical Barrier
The mechanical action of lfuids (tears, urine, vaginal secretions, and semen) that flow out from the body and carry away unwanted intruders
Immunity: Chemical Barriers
(Acidic secretions of the stomach and digestive enzymes) neutralize organisms taken into the body through the mouth
Mumps
Incubation: 14-21 days
S/S: fever, malaise, orchitis (testicular inflammation -> may cause sterility), and meningioencephalitis
Dropplet and Contact Precautions
Rabies
Transmitted by saliva after an animal bite
Managed with dose of HRIG (Human Rabies Immunoglobulin)
This is a painful injection, use EMLA at site
Tick Removal Teaching Guidelines
- Protect fingers with a tissue, paper towel, or latex gloves
- Grasp tick as close to skin as possible and pull upward with steady and even pressure
- Do not twist or jerk the tick
- Once removed, clean the site with soap and water. Then, wash hands
- Save tick for identification in case the child becomes sick
Lyme Disease
- Bull’s Eye Rash
- Dysrhythmias
- Nucchal Rigidity
Treat with PO antibiotics
May become chronic
Rocky Mountain Spotted Fever
- Sudden N/V, lack of appetitie, abdominal pain, malaise, deep muscle pain, severe headache
- Blanchable red rash
- Splenomegaly, Hepatomegaly, and Jaundice
Treat with: Tetracycline or Doxycycline (not in <8 yr old)
Vaccines: IM Injection Routes
Dtap, DT, Tdap Hep A, Hep B HiB Influenza Pneumococal HPV MCV4
Vaccines: SubQ Injection Routes
IPV
MMR
Varicella
MPSV4
Nursing Care for Anaphylaxis
- Perform CPR
- Activate the emergency system
- Ensure airway
- Adminster Epi
- Tourniquet proximal to site
- Keep pt. flat, warm, and feet elevated
- Determine cause of attack
- Adminster corticosteroids and anithistamines
Swallowing: Reflex vs. Choice
Swallowing is a choice after 3-months-old.
Keep in mind for PO meds
Cleft Lip/Palate Surgery Timing
Cleft Lip- 3 months
Cleft Palate- 18 months
Inguinal Hernia
S/S: oainless swelling towards or into the scrotum
Complications: incarcerated/strangulated intestinal tract
5x more likely in males
Umbilical Hernia
S/S: soft midline swelling in the umbilical area
Complications: incarcerated/strangulated intestinal tract
Most resolve by 3-5 yr
Irritable Bowel Syndrome
S/S: abd pain, flatus, bloating, constipation or diarrhea, “nervous stomach”, and/or muscle spasms when exposed to triggers
Additional: HA, N/V, mucus stools, anorexa, and weight loss
What is the most common cause of Diarrhea?
Rotaviruses
Dehydration: Risk Factors
- Diarrhea
- Vomiting
- Decreased PO intake
- Sustained fever
- DKA = polyuria
- Extensive burns
Vomiting: Nursing Care
- Treatment of cause and prevention of complications
- Bowel rest
- Rehydration
- Bland solid foods
- Anti emetics
- Monitor Input/Output
- Oral hygiene
- Zofran
What medication treats Rocky Mountain Spotted Fever?
Tetracycline or Doxycycline
Scarlet Fever
Penicillin
Chickenpox (Varicella)
Acyclovir
