Block #2 - Assessment, Psychosocial/Cognitive, Immunological, Infectious, Gastrointestinal Flashcards
1
Q
What measurements best reflect the nutrition status of children?
A
Head circumference and Height
2
Q
Where is BP assessed if an arm is unavailable?
A
The leg
3
Q
What is the order of vitals assessment?
A
RR > Apical HR > BP > Temperature
4
Q
When do the fontanelles close?
A
- Posterior: 2-4 months
- Anterior: 12-24 months
5
Q
Amblyopia and treatment
A
Lazy-eye
Patch over the good eye
6
Q
Ear Assessment
A
Low ears = Down’s syndrome and/or liver problems
7
Q
Which way should the ear be pulled to assess/give ear drops? (> or < 3 years)
A
<3: down and back
>3: up and back
8
Q
Hemoglobin and Hematocrit Values in children
A
Hgb: <12
Hct: <36
9
Q
What is the antidote for a Tylenol OD?
A
Mucomist
10
Q
What damage can be caused by Tylenol?
A
Liver Damage
11
Q
Who should the FACES scale be used to assess pain for?
A
English speakers, >3 yr
12
Q
Who should the Oucher scale be used to assess pain for?
A
Non-English speakers
13
Q
Which is worse and why? Ileostomy/Colonostomy
A
Ileostomy because the stool is more water
14
Q
Shaken Baby Syndrome: red flags
A
- Retinal bleeding
- Possible loss of consciousness
15
Q
Munchausen Syndrome by Proxy: Definition
A
Caregiver fabricates the s/s of illness in the child to gain attention from the medical staff
16
Q
Munchausen Syndrome by Proxy: Warning Signs
A
- 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
17
Q
Warning Signs of Possible Autism
A
- 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
18
Q
Behavior Management for Autism
A
- 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
19
Q
Learning Disabilities: Types
A
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
20
Q
Fetal Alcohol Syndrome: signs
A
- Long Philtrum
- Flattened midface
- Small eye openings
- Thin upper lip
- Low nasal bridge w/ short upturned nose
21
Q
Intellectual Disabilities: 3 Criteria
A
- IQ <70
- Limits in 2 skills of ADLs
- Onset before 18 yrs
22
Q
Intellectual Disabilities: Levels
A
- Mild: IQ 50 - 70
- Moderate: IQ 35 - 50
- Severe: IQ 20 - 35
- Profound: IQ <20
23
Q
Chickenpox (Varicella): Treatment
A
Acyclovir - doesn’t cure, prevents further outbreaks
24
Q
Chickenpox (Varicella): Precautions
A
Airborne
- RN: N95 mask
- Patient: surgical mask outside of room
25
Chickenpox (Varicella): Communicability
No longer contagious once lesions have crusted over
26
5th Disease: S/S
- Red rash (face, then chest) [looks like child was slapped]
- Mild fever
- Runny nose
- Contagious before rash appears
27
Scarlet Fever: Precautions
Droplet and Contact
28
Scarlet Fever: S/S
1st day- light rash, white strawberry tongue
| 3rd day- more profound rash, red strawberry tongue
29
Scarlet Fever: Sequelae
Can cause glomerulonephritis and rheumatic heart disease
30
Scarlet Fever: Treatment
Penicillin
31
Koplik's Spots (Rubeola/Measles)
- Red lesions in mouth with white spot in center
- "Strawberry tongue"
- Airborne precautions
32
Teratogenic Conditions
Conditions which are harmful to the fetus
Rubella/German Measles, 5th disease, and chickenpox
HIV is not teratogenic
33
Pinworms
- S/S: rectal itching
- Testing: tape test
- Treatment: Vermox (treat whole family and wash clothes in hot water)
34
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
35
Tetanus Booster Recommendations
1st dose
1-2 months after initial dose
6 months after initial dose
36
Vitamin D Requirements
400 mg/day (recently doubled from 200 mg)
37
Rabies Treatment Doses
- Day of Event
- Day 3
- Day 7
- Day 14
- Day 28
Painful injection (HRIG), use local anesthetic (EMLA)
38
What causes Mono?
Epstein-Barr Virus
39
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
40
Lupus (SLE): S/S
- Fever
- Malaise
- Chills
- Fatigue
- Weight Loss
- Butterfly Rash
- Arthritis
41
Lupus (SLE): Diagnostic Criteria - need at 4
- Butterfly rash
- Neuro disorder
- Immunologic disorder
- Discoid rash
- Renal disorder
- Oral ulcers
- Arthritis
- Serositis
- Photosensitivity
42
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
43
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
44
Hirschsprung Disease
Large intestine ganglion dysfunction = constipation
Temporary colostomy (3 months) needed
Down's = increased risk
45
Appendicitis
```
Pain in RLQ
Fever
Extreme pain
-goes away = rupture
-peritonitis/sepsis risk
Vomiting
```
WBC >10,000
46
Meckel's Diverticulum
Diverticula form during fetal development
Most common GI malformation
47
Crohn's vs. Ulcerative Colitis
Crohn's - Diarrhea
| UC - bloody/mucus diarrhea
48
Intussusception
Intestine rolls over itself
Flat, jelly-like stools, fever, dehydration, abd distention, lethargy, and grunting, sausage protrusion in abdomen
Treatment: Barium Enema
49
Celiac Disease: 4 Symptoms
Steatorrhea (fatty stools)
General malnutrition
Abdominal distention
Secondary vitamin deficiency
50
Celiac Disease: BROW Diet (foods to avoid)
B- Barley
R- Rye
O- Oats
W- Wheat
51
Rehydration
Offer electrolyte drinks (Pedialyte) of 1.5-2 oz. q15min, even if N/V persists
52
Encopresis
Potty-trained child regresses
53
Pyloric Stenosis
Pylorus: Opening of small intestine into duodenum
Projectile Vomiting after feedings
Requires surgery
54
SODA (to assess daily activity)
S- Sleep
O- Output (BM, UOP, etc.)
D- Diet
A- Activity
55
Communication: Infants
Different cries (caregiver knows the difference/meanings)
56
Communication: Early Childhood (1-6 yr)
Egocentric- only talk about pt, be honest, let them touch equipment, pts. take things very literally
57
Communication: School Age (6-12 yr)
Pts. want to know rationale, ensure modesty
58
Communication: Adolescent (12-19 yr)
Modesty and privacy are key, regression possible during hospitalization
59
What meds should be alternated for fever control?
Tylenol and Ibuprofen
60
Lead Poisoning: S/S
- Headache
- Irritability
- Abdominal Pain
- Vomiting
- Anemia
- Weight loss
- Poor attention span
- Noticeable learning difficulty
- Slowed speech development
- Hyperactivity
61
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
62
Which children are on strict Input/Output while in the hospital?
ALL CHILDREN ARE ON STRICT INPUT/OUPUT
63
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
64
Behavioral-Cognitive Pain Management Strategies
- Relaxation
- Distraction
- Imagery
- Thought Stopping
- Biofeedback
- Play
65
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
66
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
67
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
68
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])
69
Subtypes of ADHD
Hyper-active Impulsive
Inattentive
Combination
70
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
71
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
72
Immunity: Chemical Barriers
(Acidic secretions of the stomach and digestive enzymes) neutralize organisms taken into the body through the mouth
73
Mumps
Incubation: 14-21 days
S/S: fever, malaise, orchitis (testicular inflammation -> may cause sterility), and meningioencephalitis
Dropplet and Contact Precautions
74
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
75
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
76
Lyme Disease
- Bull's Eye Rash
- Dysrhythmias
- Nucchal Rigidity
Treat with PO antibiotics
May become chronic
77
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)
78
Vaccines: IM Injection Routes
```
Dtap, DT, Tdap
Hep A, Hep B
HiB
Influenza
Pneumococal
HPV
MCV4
```
79
Vaccines: SubQ Injection Routes
IPV
MMR
Varicella
MPSV4
80
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
81
Swallowing: Reflex vs. Choice
Swallowing is a choice after 3-months-old.
Keep in mind for PO meds
82
Cleft Lip/Palate Surgery Timing
Cleft Lip- 3 months
| Cleft Palate- 18 months
83
Inguinal Hernia
S/S: oainless swelling towards or into the scrotum
Complications: incarcerated/strangulated intestinal tract
5x more likely in males
84
Umbilical Hernia
S/S: soft midline swelling in the umbilical area
Complications: incarcerated/strangulated intestinal tract
Most resolve by 3-5 yr
85
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
86
What is the most common cause of Diarrhea?
Rotaviruses
87
Dehydration: Risk Factors
- Diarrhea
- Vomiting
- Decreased PO intake
- Sustained fever
- DKA = polyuria
- Extensive burns
88
Vomiting: Nursing Care
- Treatment of cause and prevention of complications
- Bowel rest
- Rehydration
- Bland solid foods
- Anti emetics
- Monitor Input/Output
- Oral hygiene
- Zofran
89
What medication treats Rocky Mountain Spotted Fever?
Tetracycline or Doxycycline
90
Scarlet Fever
Penicillin
91
Chickenpox (Varicella)
Acyclovir
