Exam #1 Flashcards
When is the RV vaccine given and how many doses?
2 months, 4 months, 6 months. 3 doses
When is the DTaP vaccine given and how many doses?
2,4,6 months, between 15-18 months, and between 4-6 years old. 5 doses
When is the Hib vaccine given and how many doses?
2,4,6 and between 12-15 months. 4 doses
When is the PCV13 vaccine given and how many doses?
2,4,6 and between 12-15 months. 4 doses
When is IPV vaccine given. and how many doses?
2, 4, and between 6-18 months, between 4-6 years 4 doses
When is the influenza shot given?
Can be given starting at 6 months. Done yearly
When is the MMR vaccine given and how many doses?
Between 12-15 months and 4-6 y/o. 2 doses
When is the varicella vaccine given and how many doses?
Between 12-15 months and 4-6 y/o. 2 doses
When is hep a vaccine given?
Between 12-23 months
What stage of Erikson’s development is birth to 12-18 months?
Trust vs. mistrust
What is the desired outcome of trust vs mistrust?
sense of trust and security
What stage of Erikson’s is 18 months to 3 years?
Autonomy vs shame and doubt
What is the desired outcome of autonomy vs shame and doubt?
Feelings of independence lead to belief in
yourself and your abilities
What stage of Erikson’s is 3 to 5 years?
Initiative vs guilt
What is the desired outcome of initiative vs guilt?
Self-confidence; the ability to take the
initiative and make decisions
What stage of Erikson’s is 5 to 12 years?
Industry vs inferiority
What stage of Erikson’s is 12 to 18 years?
identity vs confusion
What is the desired outcome of industry vs inferiority?
Feelings of pride and accomplishment
What is the desired outcome of identity vs confusion?
a strong sense of identity, strong picture of future
Characteristics of sensorimotor stage?
Motor activity without use of
symbols. All things learned are based
on experiences, or trial and error, Object permanence
What stage of Piaget is birth to 18-24 months?
sensorimotor
What Piaget stage is 7 to 11 years old?
concrete operational
What Piaget stage is 2 to 7 years old?
Preoperational
Characteristics of preoperational stage?
Development of language, memory,
and imagination. Intelligence is both
egocentric and intuitive, Symbolic
though
Characteristics of the concrete operational stage?
More logical and methodical
manipulation of symbols. Less
egocentric, and more aware of the
outside world and events,Operational
though
What Piaget stage is adolesence to adulthood?
formal operational
Characteristics of formal operational stage?
Use of symbols to relate to abstract
concepts. Able to make hypotheses
and grasp abstract concepts and
relationships, Abstract concept
What is a binuclear family?
divorced or separated into two separate families, one headed by each
parent
What is authoritarian parenting style?
focused on dominating and control, care more about
obedience than nurturing or protecting their children
What is permissive parenting style?
think of their children as equals or friends, kids make their own
rules, parents give them little responsibilities or expectations
What is authoritative parenting style?
nurturing, responsive, but still set boundaries and
expectations for their children
What pain scale is used for children 2 months-7 years?
FLACC
What does FLACC stand for?
Facial Expression
position of Legs
Activity
Crying
ability to be Consoled
What is another common pain scale used in children 3 years and older?
FACES. Draws happy faces and sad to depict levels of pain
What are some causes of water depletion/dehydration?
Fever
Vomiting / diarrhea
Diabetes
Burn
Shock
High output kidney failure
Phototherapy
Environmental heat
What are signs/symptoms of water depletion?
Weight loss, increased heart rate, Thirst, No tears, Variable temperature, Depressed fontanel in infant,Dry skin and mucous membranes, Poor skin turgor and skin perfusion, Fatigue, lethargy
Diminished urinary output
Altered level of consciousness
What are labs indicative of water depletion/dehydration?
High urine specific gravity
Increased BUN
Increased hematocrit
Increased Sodium (Na)
Variable serum electrolytes
Increased serum osmolarity
What is management for dehydration?
-oral (if alert and awake): rapid over 4-6 hours (use pedialyte, 1/2 strong gatorade, not clear liquids, no caffeine, no BRAT diet, no juice)
-IV (if unable to ingest enough fluid) to prevent shock
-NPO-spray mouth
-Intraosseous infusion (emergent)
-central venous line
What is active immunity?
-exposure to a disease organism triggers the immune system to produce antibodies to that disease.
-long lasting, sometimes lifetime immunity
What is natural immunity?
Exposure to the disease organism can occur through
infection with the actual disease
What is vaccine-induced immunity?
introduction of a killed or weakened form of the
disease organism through vaccination
what is passive immunity?
-Occurs when a person is given antibodies to a disease
rather than producing them through his or her own immune system. A
newborn acquires passive immunity from its mother through the placenta.
Passive immunity can also be obtained through antibody-containing blood
products such as immune globulin, which may be given when immediate
protection from a specific disease is needed. This is a major advantage to
passive immunity; protection is immediate, whereas active immunity takes
time (usually several weeks) to develop. However, passive immunity only
lasts for a few weeks or months.
What is the etiology of cystic fibrosis?
-inherited autosmal trait
-diagnosed in infancy and early childhood
-life span increasing >30 years now
What is the patho of cystic fibrosis?
-increased viscosity of secretions
-lungs:atelectasis
-clogged pancreatic ducts
-absence of pancreatic enzymes in small intestines (unable to absorb fats and protein)
What are ways to diagnostic cystic fibrosis?
-sweat test
-72 hr fecal fat
-chest x-ray
-prenatal DNA of amniotic fluid (most common)
S & S of cystic fibrosis?
cough, sputum, dyspnea, decreased Sao2, crackles or wheezes in lungs, cyanosis, digital clubbing, bulky, frothy, foul-smelling stools (steatorrhea), meconium ileus
assess: skin turgor & hydration
Nursing care for CF?
-high calorie, high protein foods
-admin pancreatic enzymes with all meals and snacks
-administer fat-soluble vitamins (K,D,E, A)
-avoid pulm treatment after eating to decrease risk of vomiting
Medications for CF?
pancreatic enzymes, antibiotics, fat soluble vitamins, mucolytics, bronchodilators
Child and family education for CF?
-Avoid exposure to respiratory infections
-Chest percussion and postural drainage
-High-calorie and high protein diet
-Activity and exercise will loosen secretions
-Genetic counseling
Diagnostics for asthma?
chest x ray, pulmonary function test
Symptoms of asthma?
WHEEZING, dry cough, prolonged expiration, restlessness, fatigue, tachypnea, cyanosis, marked respiratory distress
Nursing care for asthma?
-Assess resp status, administer humidified oxygen prn, monitor pulse ox
-maintain IV access, avoid cold liquids
-position high fowlers
Medications used in asthma?
Bronchodilators
Anti-inflammatory agents (steroids)
IV fluids
Oxygen
Child and family asthma education?
-avoid triggers
-check peak flow daily
-inhalers with patient at all times
S & S of epiglottis?
-EDEMATOUS, CHERRY RED epiglottis
-Sudden onset of high fever, sore throat, pain w swallowing
-anxious, restless, looks ill, tripod positioning
-dysphonia, dysphagia, drooling of saliva
Diagnosis of epiglottis?
-Throat exam contraindicated
-lateral neck x-ray
-x-ray
-CBC, blood culture
Nursing care for epiglottis?
-NPO, IV fluids
-Assess resp distress symptoms
-Do not leave unattended
-Intubation equipment ready
Meds for epiglottis?
Antibiotics
Antipyretics
Corticosteroids
IV fluids
Education for epiglottis?
Discuss importance of Hib vaccine and reassure parents that recurrence of epiglottitis is uncommon
Risk factors for RSV?
- older siblings
- smoking
- day care
- sharing a cup
- not using soap at the sink
S & S of RSV?
- cough *
- thick secretions *
- fever *
- tachypnea
- retractions
- anorexia
- labored breathing
- wheezing / crackles
- nasal flaring
Diagnosis of RSV?
nasopharyngeal swab and looking at symptoms
Treatment of RSV?
- fluids
- suction
- O2
RSV Meds?
steroids to decrease inflammation
Nursing care RSV?
- resp assessment
- I&O
- weight daily
- contact precautions
- clustering care
What is the HUS triad?
anemia, thrombocytopenia, renal failure
Clinical manifestations of HUS?
Primarily in infants 6 mos to 5 yr old
Acquired hemolytic anemia, thrombocytopenia, renal injury, and CNS symptoms
Associated with e.coli (undercooked ground beef), unpasteurized milk or fruit juice (apple), sprouts, lettuce, salami or drinking-swimming in sewage-contaminated water
CKD diet?
-Low in protein, potassium, sodium, phosphorous
-High in carbohydrates
-Unrestricted amount of fat
-Limit fresh fruit and veggies
-High in calcium
Treatment for HUS?
-Hemodialysis or peritoneal dialysis (for those anuric for 24 hrs, or oliguria w/uremia or HTN & seizures)
-FFP and plasmapheresis, fresh/washed packed cells
Nursing care of cleft palate?
-repaired usually between 6-18 months, before 2 years of age
Position on side or back after surgery
Cool mist tent
Blended diet
Elbow restraints: 4 - 6 weeks
No straws, pacifiers, spoons, or fingers
in or around mouth for 7-10 days.
No oral temps.
Treatment for pyloric stenosis?
Pyloromyotomy – laparotomy - relatively
uncomplicated surgery
Feeding 4 - 6 hours postop, progressing from
glucose or electrolyte fluid to formula within 24
hours of surgery
Discharge home 2nd postop day
What is the hallmark sign of pyloric stenosis?
PROJECTILE VOMITING, olive-shaped mass in epigastrium
Patho of Hirschsprung’s?
Congenital absence of ganglion cells in rectum & colon
Genetically acquired – failure in utero
Colon becomes a “megacolon”
CMs of Hirschsprung’s?
No meconium with 1st 24-48 hours
Distended abdomen & vomiting
Signs of enterocolitis
Chronic constipation
Ribbon-like, foul-smelling stool
Post & pre-op care for Hirschsprung’s?
Preop
Depends on age & condition-enemas
Postop
NPO
NG suction
Abdominal assessment
Ostomy-temporary
Later: pull-through
Ostomy revised: anal stricture & incontinence are
potential complications
CMs of GERD?
-Spitting up or vomiting
-Excessive crying
-Arching of the back
-Cough, wheeze, stridor, gag
-Bloody emesis
-Apnea
-Difficulty swallowing
-Chest pain
-Heartburn
Treatment for GERD?
-Avoid foods that intensify reflux (citrus, caffeine, etc.)
-Weight control
-Small frequent meals
-Thickened feeds
-Elevate HOB for 1 hour after feed
-PPI’s-omeprazole, H2 receptor inhibitors-ranitidine
-Surgical management-nissen fundoplication
5 roles of peds nurse?
- Therapeutic relationship
- Patient educator (disease prevention and health promotion)
- Patient/family advocate
- Case manager (coordinate nd collaborate)
- Researcher
4 leading causes of infant mortality in US?
- Low birth weight
- Prematurity
- Sudden infant death
- Congenital anomalies
Main causes of child mortality ages 1-4?
accidents and congenital abnormalities
Main cause of child mortality in ages 5-14?
-accidents
-cancer
Main cause of child mortality in ages 15-18?
-accidents
-suicide
When do anterior fontanels close?
12-18 months
When do post fontanels close?
2-3 months
Developmental biologic changes within first 6 months?
- Birth weight doubles (on quiz)
- Grows 1’’ per month in length
- Head circumference increases by 1/2’’ per month
- Grasps as reflex, more with eyes, palmar grasp
- between 4-6 months head control established
- Tooth eruption begins
- Turns from abdomen to back at 6 months.
Developmental biologic changes within first 7-12 months?
- Birth weight triples by end of 1st year
- Grows 1/2” per month in length (mostly in trunk)
- Manipulates items: pulls to mouth, pincer grasp
- Head control > straightening of back > then sitting
- Sit alone by 7 months & sit>explore from sitting at 8 mos
What are the two oral-social stages?
Food intake (first 3-4 months) and grasping.
or biting possibly due to teething
What is attachment in infants? When does this occur?
When able to discriminate mother from others, happens at 6 months
When does stranger fear develop?
6-8 months
When does separation anxiety begin, peak, and usually end?
9 months, 18 months, 3 years
Age appropriate toys for first year of life?
- Rattles
- Mobiles
- Teething toys
- Nesting toys
- Playing with balls
- Reading book
What is colic?
- vigorous crying & drawing legs to abdomen
- most common < 3 months, can occur at birth - 6 months
- paroxysmal abdominal pain or cramping
- specific cause is rarely identified
- onset usually late in afternoon
- episodes last from 30 min to greater than 3 hours
- between crying periods usually happy
How to help colic?
- Rule out organic causes
- May try a different formula
- Use of antispasmotics, sedatives , antihistamines or antifluctuents
- Nursing mothers may need to change diet
- Position changes
- Caregiver support!!!!!
What is the dose max for acetaminophen?
Acetaminophen (10 - 15 mg/kg per dose-max. 5 doses/day)
How much does a newborn sleep on average?
16-20 hrs, awake 6 x to feed
Promoting nutrition between 1-6 months?
Support breastfeeding efforts
Vitamin D (200 IU/day)
Infants do not require additional fluids
Teach iron-fortified formula preparation (do not microwave)
Feed formula 6 x daily
Cereal – rice low allergy – 4-6 months – iron fortified*
Promoting nutrition after 6 months?
Formula or breastmilk 4-5 x daily
Fruits & veggies: 6-8 mos
Meat, fish, poultry: 8-10 mos
commercial low protein, include organ meat high iron
Finger foods: 6-7 mos –teething cracker, fruit/veggie
Chopped table or junior foods: 9-12 mos
Introduce when hungry-one at a time
Spoon feed pushing food to back of tongue
What normally causes protein-energy malnutrition?
chronic illnesses such as CF, renal dialysis, GI malabsorption, anorexia
What is Kwashiokor?
-severe protein malnutrition and bilateral extremity swelling
High starch diet
fed only rice beverage diet, parental ignorance, cow’s milk intolerance=muscle wasting, skin depigmentation, blindness due to Vit A deficiency
What are the most common causes of SIDS?
- maternal smoking (12%)
- co-sleeping
- prone sleeping in soft bedding-overheating
- infant was apparently healthy
- not caused by suffocation -no identifiable cause
Risk factors for SIDS?
- Maternal health during pregnancy
- Twins
- Preemie
- SGA
- Persistent apnea
- BPD (bronchopulmonary dysplasia)
- Family history of SIDS
- Environment
Water excess causes?
- Water intoxication
-Child maltreatment
-Contest winner ? - IV overload
- Incorrect feeding
-Too much
-Inappropriate preparation - Swimming lessons
- Too rapid dialysis
- Tap water enemas
Signs of water excess?
- Rales “wet” (difficulty breathing)
- Increased venous pressure
- Slow, bounding pulse
- Weight gain
- Lethargy
- Increased spinal pressure /seizure /coma
Water excess labs?
- Low urine SG
- Decreased HCT and serum electrolytes
Decreased Requirements
- CHF
- SIADH
- Increased ICP
- Oliguric renal failure
CMs of celiac disease?
- Abdominal distention, vomiting
- Anorexia, muscle wasting
- Diarrhea with a foul odor
What does green bilious vomiting suggest?
bowel obstruction
What does Curdled stomach contents, mucus, or fatty foods that are vomited several hours after ingestion suggest?
poor gastric emptying
What does coffee ground emesis suggest?
GI bleed
Treatment of strep?
- Antibiotics
- Acetaminophen or NSAIDs for throat pain and fever
- Encourage use of salt water gargles, oral rehydration via ice chips or frozen juice pops.
- Wash toothbrush thoroughly or replace.
Diet for ESRD?
- low sodium
- low potassium
- acknowledge fluids
- CHICKEN!
What foods should be avoided with ESRD?
- bananas
- orange juice
- carbs
- turnip greens
Signs of respiratory distress?
Struggling for each breath or short of breath.
Tight breathing so that your child can barely speak or cry.
Ribs are pulling in with each breath (called retractions).
Breathing has become noisy (such as wheezing).
Breathing is much faster than normal.
Lips or face turn a blue color.
What is HUS associated with?
e coli
What are examples of things that may contain e coli?
(undercooked ground beef),
unpasteurized milk or fruit juice (apple), sprouts, lettuce,
salami or drinking-swimming in sewage-contaminated
water
What is the prognosis of HUS?
Prompt tx = 95% recovery
Residual renal impairment 10-50%
Complications: chronic renal failure, HTN, CNS disorders
Feeding for child with FTT?
- Consistent “primary” caregiver
- Unstimulating atmosphere
- Maintain calm, even temperament
- Talk to the child giving directions about eating
- Be persistent
- Maintain face-to-face posture
- Introduce foods slowly
- Follow the child’s rhythm
- Develop structure
What are some causes of apnea in infants?
sepsis, seizures, neurologic disorders, upper or lower respiratory infection, GE reflux, hypoglycemia, metabolic problems
What are F & E differences in peds?
- Percentage of body weight
- Loss of water per day
- Immature kidney function
- Water and electrolyte disturbances more likely
- Larger body surface area (BSA)
- Higher basal metabolic rate
- Immature kidney function
- Greater fluid requirements
When do anatomical and physiological aspects for pain transmission develop?
3rd trimester, preterm and full-term neonates may be more sensitive to pain stimuli
Risk factor of tonsilitis?
Smoking
Daycare
School
S & S of tonsilitis?
Fever
Sore throat
Enlarge tonsils
Peritonsilar exudate or white patches on the tonsils
Treatment for tonsilitis?
Antibiotics
Antipyretics
Surgical tonsillectomy
Post-op tonsilectomy care?
- Provide patient with ice collar for inflammation and pain.
- Assess for frequent swallowing or throat clearing as this may be a sign of bleeding.
- Avoid red food/liquids, straw, coughing, or blowing nose forcefully.
What is otitis media?
Upper respiratory infection causes congestion and inflammation, leading to obstruction of the eustachian tube and inflammation of fluid in the middle ear
Risk factors for otitis media?
- Cigarette smoke exposure
- Recent upper respiratory infection
- Daycare
- Bottle fed babies
S & S for otitis media?
- Drainage from affected ear(s)
- Fever
- Pulling at affected ear(s)
- Irritability
- Bulging/red tympanic membrane
Diagnose with clinical exam
Treatment for otitis media?
- Acetaminophen or NSAIDs for pain
- Antibiotics (amoxicillin)
- Myringotomy (tube placement) for recurrent ear infections.
What is otitis externa?
Inflammation of the ear can or external structures.
- Persistent moisture in the external ear leads to bacterial (or fungal) overgrowth and inflammation.
risk factors for otitis externa (swimmers ear)?
- Swimming
- Foreign object insertion (cotton swabs, earbuds)
S & S of otitis externa?
- Ear pain
- Discharge from ear
- Ear itching and/or redness
- Tinnitis
Diagnose with visual and clinical exam
S & S of strep throat?
- Sore throat
- Pain with swallowing
- Fever
- Cervical lymphadenopathy
- Foul breath odor,
- Tonsillar erythema/exudate
- (white patches)
Diagnose with rapid strep culture
Treatment for otitis media?
Otic drops, usually combination of antibiotics and steroids
What can happen if strep throat is left untreated?
can lead to rheumatic fever or glomerulonephritis
family education for otitis media?
- Proper administration of ear drops (lie with affected side up, instill drops warmed to body temperature, remain on side for 3-5 min.
- Prevention: Use 1:1 solution of isopropyl alcohol and white vinegar after swimming or showering
- Frequently sanitize earbuds
- Avoid use of cotton swabs in ear
Treatment with strep throat?
- Antibiotics
- Acetaminophen or NSAIDs for throat pain and fever
- Encourage use of salt water gargles, oral rehydration via ice chips or frozen juice pops.
- Wash toothbrush thoroughly or replace.
What are the most common causes of diarrhea?
- rotavirus
- salmonella
- shigella
S & S of rotavirus?
- Fever
- Starts with vomiting and then watery, grassy green foul smelling diarrhea
S & S of salmonella?
- Person to person or under cooked chicken
- June-August
- Hamsters, turtles, dogs and cats carry it too!!
- Nausea, vomiting, abdominal pain, bloody diarrhea
S & S of shigella?
- Fever, fatigue, anorexia
- Crampy abdominal pain preceding watery or bloody diarrhea
- Do not give antidiarrheal medications
Treatment for diarrhea?
- Fix the fluid and electrolyte imbalance-oral or IVF
- Small frequent oral rehydration (10 ml/kg for each stool) or 40-50 ml/kg every 4 hours
- IVF-Normal Saline or D5W with HCO3
- Avoid carbonated drinks, fruit juice, chicken broth
- Resume regular diet after rehydration
What is GER?
transfer of gastric contents into the esophagus
What is GERD?
tissue damage from GER
- Poor weight gain
- Esophagitis
- Persistent respiratory symptoms or complications
What is fifth’s disease?
-“slapped” red cheeck
-lacy rash on trunk and limbs
-HPV 19
What are causes and S & S of conjunctivitis?
-viral, bacterial, chlamydia
-purulent drainage, crusting eyelids, swollen lids, reddened conjunctiva
-24 hr antibiotic treatment
Nursing care for stomatitis?
-control pain
-swish and swallow (or spit)
-hydration
What is a cardinal symptom and test for enterobiasis (pinworms)?
-intense peri-anal itching
-tape test, microscopic exam
Treatment and medication of pinworms?
- Wash hands
- Treat all in household
- Albendazole – Re-treat in 2 weeks
- Pyrvinium pamoate – stains red
5
What is impetigo?
-highly contagious skin infection
-caused by strep and staphylococcus
-most common skin condition in children ages 2-5
Signs & symptoms and treatment of impetigo?
Pruritus, redness, honey-colored crusting, yellow exudate
* Wash 2-3 times per day with soap & water. Warm
saline soaks,
* Topical / oral antibiotic
* May need to cut fingernails
* Do not remove crusts
Characteristics of scabies?
- Mite sarcoptes scabeos
- Grayish brown threadlike burrow
- 5% permethrin leave on 8-12 hrs
repeat in 7 days, cover entire body
Characteristics of pediculosis capitis (head lice)?
- Incubation of eggs = 10 days
- Find nape of neck – separate sections of
hair with q-tips - Find eggs not louse
- Shampoo – beauty shop
- Nix not Lindane, repeat in
7-12 days, treat environment
8
Stage 1 lyme disease symptoms?
Fever, HA, malaise, fatigue,
anorexia, conjunctivitis,
cough, stiff neck,
lymphadenopathy
Stage 2 lyme disease?
Neuro, cardiac,
Musculoskeletal systems
Stage 3 lyme disease?
Musculoskeletal pain,
arthritis
Treatment for lyme disease?
penicillin
SIgns and symptoms of rocky mountain spotted fever?
fever for 2-3
weeks, malaise, deep muscle pain,
h/a, chills, conjunctival infection, rash-
ext to trunk; petechia later / non itchy
Complications of RMSF?
DIC, GI, pneumonitis,
cardiac and renal, shock
Treatment for RMSF?
antibiotics
Signs and symptoms of diptheria?
thick, bluish
white to grey patch covers
the tonsils.
Fever, anorexia, malaise,
cough, hoarseness, odor,
sore throat
Complications of diptheria?
myocarditis,
ascending paralysis
Treatment of diptheria?
IV antitoxin, Pen G
Signs and symptoms of tetanus?
Stiff neck and jaw, facial
spasms, difficulty
swallowing, MUSCLE
RIGIDITY Lock jaw and muscle
spasm (Sardonic smile)
Opisthotonus
tx of tetanus?
Tetanus
immunoglobulin, Tetanus
toxoid, ICU care, paralysis,
ventilator et,
Revaccinate q 10 years
S & S of pertussis?
Runny nose, cough that
becomes more severe
and spasms, flushing,
cyanosis, vomiting
Tx of pertussis?
Antibiotics,
steroids
Vaccine 6 wks to 6 years
Side effects of DTaP?
redness, pain, Temp to 101,
fussy
Serious: inconsolable crying, temp
>102, anaphylaxis, shock
S and Sx of measles?
High fever, conjunctivitis,
coryza, cough, anorexia,
malaise, Koplik spots, Rash
maculopapular from face to
trunk to extremities.
Complications: pneumonia,
bronchitis, encephalitis
S & Sx of mumps?
Malaise, low grade fever, earache,
headache, pain with chewing,
swelling parotid gland
S & S of chicken pox/varicella?
Mild fever, malaise, irritability, tear-
drop, centripetal, rose petal rash,
HIGHLY PRURITIC, contagious one day
before until 6 days after first crop
crusted over.
Characteristics of scarlett fever?
-Accompanies streptococcal infection
High fever, headache, vomiting,
chills, sore throat, then rash
White strawberry tongue then red
What is the most common STI?
HPV
