Exam 1 Blueprint Flashcards
Piaget 4 stages?
sensorimotor
pre-operational
concrete operational
formal operational
(birth to 18-24 months old): motor activity w/o use of symbols. All things learned are based on experiences, or trial/error. Object permanence.
sensorimotor
(2-7 yo): development of language, memory, and imagination. Intelligence is both egocentric and intuitive. Symbolic thought.
preoperational
(7-11 yo): more logical and methodical manipulation of symbols. Less egocentric, and more aware of the outside world and events. Operational thought.
concrete operational
(adolescence – adulthood): use of symbols to relate to abstract concepts. Able to make hypotheses and grasp abstract concepts and relationships. Abstract concepts.
formal operational
results when exposure to a disease organism triggers the immune system to produce antibodies to that disease. It provides long lasting, sometimes lifetime immunity.
active immunity
exposure to the disease organism can occur through infection with the actual disease.
natural immunity
intro of a killed or weak form of the disease organism through vaccination. Either way, it an immune person encounters that disease in the future, their immune system will recognize it and immediately produce antibodies needed to fight it.
vax-induced immunity
occurs when a person is given antibodies to a disease rather than producing them through his or her own immune system. A NB acquires passive immunity from its mom through the placenta. 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; protection is immediate, whereas active immunity takes time (usually several weeks) to develop. However, only last for a few weeks or months.
passive immunity
types of immunity?
active
passive
natural
vax-induced
herd or community
resp distress s/s?
Wheezing and dry cough
Prolonged expiration
Restlessness
Fatigue
Tachypnea
Cyanosis
Vomiting: associated S/S may help to identify etiology?
Fever & diarrhea = infection
Constipation = obstruction
Localized abdominal pain and vomit = appendicitis, pancreatitis, or peptic ulcer disease
Change in LOC or HA = CNS (head trauma, brain tumor, concussion) or metabolic disorder
Projectile vomit = pyloric stenosis
tissue damage from GER (poor weight gain, esophagitis, persistent respiratory symptoms or complications)
GERD
what are the communicable diseases?
HepB
HepA
diphtheria
tetanus
pertussis
polio
measles
mumps
rubella
varicella
scarlet fever
roseola
rotavirus
HPV
Diphtheria s/s, complications, treat?
S/S: thick, bluish white to grey patch covers the tonsils, fever, anorexia, malaise, cough, hoarse, odor, sore throat
Complications: myocarditis, ascending paralysis
Treat: IV antitoxin, Pen G
tetanus s/s, complications, treat?
S/S: stiff neck and jaw, facial spasms, difficulty swallow, muscle rigidity
Complications: laryngospasm, resp distress
Treat: tetanus immunoglobulin, tetanus toxoid, ICU care, paralysis, vent et.
pertussis (whooping cough) s/s, complications, treat?
S/S: runny nose, cough that becomes more severe and spasms, flushing, cyanosis, vomit
Complications: is shared
Treat: ABX, steroids
poliomyelitis s/s, complications, treat?
S/S: fever, HA, stiff neck, progressive weak, resp difficulties, paralysis
Complications: permanent motor paralysis, resp arrest
Treat: support
mumps s/s, complications, treat?
S/S: malaise, low grade fever, earache, HA, pain with chewing, swelling parotid gland
Complications: orchiditis, deafness
Treat: support
rubella s/s, complications, treat?
S/S: pink rash on face to trunk, legs, low grade fever, HA, sore throat, red/inflamed eyes
Complications: arthritis, encephalitis, CRS, no pregnant women
Treat: support
varicella (chicken pox) s/s, complications, treat?
S/S: mild fever, malaise, irritability, teardrop, centripetal, rose petal rash, HIGHLY PRURITIC, contagious one day before until 6 days after 1st crop crusted over.
Complications: pneumonia, arthritis, meningitis, Reyes syndrome
Treat: support, Benadryl, IV acyclovir
scarlet fever treat and s/s?
GABHS (+ ASO tilter)
Accompanies strep
S/S: high fever, HA, vomit, chills, sore throat, then rash, white strawberry tongue then red, rash, peel
Treat: PCN
rotavirus s/s?
Most common cause of severe diarrhea
2-day incubation period
S/S: characterized by vomit and watery diarrhea for 3-8 day, and fever and abdominal pain occur frequently
HPV s/s?
most common STI
S/S: virus infects the skin and mucous membranes. There are more than 40 HPV types shows as genital warts and cancers.
what are the infectious diseases?
5th’s disease
pink eye
stomatitis
pinworms
impetigo
scabies
head lice
folliculitis
dermatophytosis
dermatitis
lyme disease
rocky mountain spotted fever
5th’s disease?
“Slapped cheek”
Lacy rash on trunk and limbs
Human parvovirus 19
Some fetal defects
conjunctivitis (pink eye)?
Causes: bacterial, viral, chlamydia, highly contagious
S/S: purulent drainage, crusting eyelids, swollen lids, red conjunctiva
24 H ABX
stomatitis?
Types: canker sore and cold sore or fever blister (HSV)
Immunocompromised, coxsackie virus
Nursing care: pain control, swish/swallow (or spit), hydrate
pinworms (5-14 yo)?
Tape test (micro exam)
Treat: wash hands, treat all house
Meds: albendazole (re-treat in 2 wks) and pyrvinium pamoate (stains red)
impetigo?
strep & staph (2-5 yo)
S/S: pruritus, red, honey-colored crusting, yellow excaudate
Treat: wash 2-3 times/day w/ soap and H2O. warm saline soaks, topical/oral ABX, may need to cut nails, and don’t remove crusts
scabies?
Grayish brown threadlike burrow
Secondary infections, 5% permethrin leave on 8-12 H repeat in 7 days, cover entire body
Pediculosis Capitis (lice):
Incubation of eggs = 10 days, find nape of neck- separate sections of hair with Q-tip, find eggs not louse
Shampoo, Nix not lindane, repeat in 7-12 days, treat environment
Folliculitis: pimple, furuncle (boil), carbuncle (many boils)?
Cause: staph, MRSA
Treat: topical/oral ABX and don’t squeeze lesions
what are the types of dermatophytosis?
Tinea Capitis: ring worm of the scalp
Tinea Corporis: ring worm of body
Tinea Crusis: jock itch
Tinea Pedis: athletes’ foot
what are the types of dermatitis?
contact, diaper, atopic, and seborrheic
rocky mountain spotted fever – infected ticks?
S/S: multisystem disease, fever for 2-3 weeks, malaise, deep muscle pain, HA, chills, conjunctival infections, rash – ext. to trunk, petechia later/non-itchy
Complications: DIC, GI, pneumonitis, cardiac and renal shock
Treat: ABX
focused on dominating and control, care more about obedience than nurturing or protecting their kid
authoritarian
think of their kids as = or friends, kids make own rules, parents give them little responsibilities or expectations
permissive
nurturing, responsive, but still set boundaries and expectations of their kids
authoritative
types of parenting styles?
authoritarian
permissive
authoritative
lose electrolytes and H2O equally, primary form in kids, lose circulating blood volume, Na+ normal, biggest concern = shock
isotonic
lose more electrolytes than H2O, Na+ <135
hypotonic
H2O loss in excess of electrolytes, most dangerous type, Na+ > 150, seizures more likely
hypertonic
what are the dehydration types?
isotonic
hypotonic
hypertonic
Dehydration degree?
For each 1% weight loss = 10 mL/kg of fluids lost
Take per-ill weight and current weight
Earliest sign = tachycardia
dehydration degree rating?
Mild = <50 mL/kg (cap <2 secs)
Moderate = 50-90 mL/kg (cap 2-3 secs)
Severe = >100 mL/kg (cap >3 secs)
what is the dehydration management?
Oral (when alert and awake) rapid replacement over 4-6 H
IV (unable to ingest enough fluid) rapid expansion of the ECF to prevent shock (20 mL/kg), 0.9% solution (NO DEXTROSE – H2O follows sugar), and expansion, replace deficits, maintenance
H2O depletion labs?
High urine specific gravity
Increased BUN, hematocrit, Na+, serum osmolarity
Variable serum electrolytes
H2O excess labs?
Low urine SG
Decreased HCT and serum electrolytes
Pyloric stenosis hallmark sign?
Projectile vomiting, moveable olive-shaped mass in epigastrium
Oral rehydration for diarrhea?
Oral rehydration therapy (1st)
Use Pedialyte (1/2 str Gatorade)
Not clear liquids/ no caffeine
Not BRAT diet
No juice (high osmolarity)
NPO (spray mouth)
IVT (add K+ to IV with adequate UOP)
Intraosseous infusion (emergent)
Central venous lines (apply pressure)
measles s/s and complications?
- High fever
- Conjunctivitis
- Coryza
- Cough
- Anorexia
- Malaise
- Kolpik spots
- Rash maculopapular from face to trunk to extremities
Complications = pneumonia, bronchitis, encephalitis
respiratory precautions
what is candidiasis?
yeast infection of the mouth, patches cannot be removed, caused by fungus. Clean bottle and nipples carefully after every feeding if breastfeeding instruct the mother to clean their nipples between feedings to prevent. Passed from person – person, may take as long as 2 months to clear up with constant treatment, usually benign. Treatment is with a fungicide PO and nystatin that you can swab around their mouth after their feedings.
what is dried milk?
can be removed with a tongue blade
Neonatal infant pain scale (NIPS)?
0-2 yo
maximal score of 7 points, considering pain > 4
Facial expression (relaxed = 0 pts, contracted = 1 pt, (–) = 2 pts)
Cry (absent = 0 pts, mumbling = 1 pt, vigorous = 2 pts)
Breathing (relaxed = 0 pts, different than basal = 1 pt, (–) = 2)
Arms (relaxed = 0 pts, flexed/stretched = 1 pt, (–) = 2 pts)
Legs (relaxed = 0 pts, flexed/stretched = 1 pt, (–) = 2 pts)
Alertness (sleeping/calm = 0 pts, uncomfortable = 1 pt, (–) = 2 pts)
FLACC?
(2 months – 7 years): behaviors are scored 0-2 for each of 5 behaviors for a total of 0 (no pain) to 10 (worst pain)
Face: no expression or smile = 0, occasional grimace or frown, withdrawn, disinterested = 1, frequent to constant quivering chin, clenched jaw = 2
Legs: normal position/relaxed = 0, uneasy, restless, tense = 1, kicking or legs drawn up = 2
Activity: lying quietly, normal position, moves easy = 0, squirming, shifting back and forth, tense = 1, arched, rigid or jerking = 2
Cry: no cry (awake or asleep) = 0, moans or whimpers, occasional complaint = 1, crying steadily, screams or sobs, frequent complaints = 2
Consolability: content, relaxed = 0, reassured by occasional touch, hug or being talked to, distractible = 1, difficult to console or comfort = 2
FACES?
(3 years and older): rating scales uses drawings of happy and sad faces to depict levels of pain
what are the types of fams?
traditional nuclear
nuclear
blended
extended
single parent
binuclear
communal
married couple with biological/adopted kids
traditional nuclear
couple with dependent kids
nuclear
couple with @ least 1 kid of both parents, plus step-kids
blended
included grandparents, aunts/uncles, cousins, etc.
extended
1 parent with kids
single parent
divorced or separated into 2 separate families, 1 headed by each parent
binuclear
“it takes a village”
communal
chronic inflammatory disorder in which airways narrow and are hyper-reactive to stimuli that do not affect non-asthmatic individuals
asthma
asthma diagnosis?
chest x ray, symptoms, pulmonary function test
asthma s/s?
wheezing and dry cough, prolonged expiration, restlessness, fatigue, tachypnea, cyanosis, marked resp. distress, chronic use of accessory muscles for respiration leads to barrel chest shape.
asthma nursing care?
assess resp. status, administer humidified O2 PRN, monitor pulse ox, maintain IV access, avoid cold liquids to avoid bronchospasms, position high fowlers and cluster nursing care, and sudden cessation of wheezing and decreased breath sounds indicates worsening.
asthma meds?
bronchodilators, anti-inflammatory agents (steroids), IV fluids, O2. Albuterol inhaler and steroids
ESRD/CKI s/s?
tired, pallor (pale/gray skin), hypertension, HA, nausea, muscle cramps, anorexia, itching, neuro involvement
ESRD/CKI complications?
anemia- HTN- infections
ESRD/CKI diet?
most effective means besides dialysis for reducing quantity of waste requiring renal excretion, low in protein, K+, Na+, phosphorous, high in carbohydrates, unrestricted amount of fat, limit fresh fruit and veggies (hyperkalemic), and high in Ca+.
ESRD/CKI treat?
Supplements rich in folic acid and iron, H2O soluble vitamin supplement and D, phosphorus can be controlled by giving phosphorus binding agents (ex: Ca+ carbonate = most common and aluminum hydroxide). Dialysis and transplant only treatment for ESRD.
HepA vax?
Vaccine: IM, 0.5mL
Dose #1 @ 12-23 months
Dose #2 @ 6-18 months later
Given to susceptible folk: military, native AM, Alaskan natives, IV drug, homosexual, etc.
HepB vax?
Vaccine: IM, 0.5mL
Birth – series of 3 doses
If mom is HBSAg+ / 12 H - 2 months, 1 month after, 6 months after that
S/E: pain, red at site, joint pain - serious: anaphylaxis
Contraindication: baker’s yeast
DTaP vax?
Vaccine: IM/0.5 mL
2, 4, 6, 15-18 months and 4-6 years (5 doses)
S/E: redness, pain, temp to 101, fussy - Serious: inconsolable cry, temp >102, anaphylaxis, shock
Contraindication: previous reaction, immunoglobulin within last 90 days
Cocooning: vaccinate all who surround infant
IPV (Inactivated polio vaccine)?
Allergy: neomycin, streptomycin
SubQ, 0.5 mL
2, 4, 6-18 months and 4-6 years (4 doses)
S/E: swelling, tender, irritability
MMR/MMRV: (measles, mumps, rubella) vax?
SubQ, 0.5 mL
12-15 months, 4-6 years (2 doses)
S/E: fever, red or pain at site, rash, joint pain serious: anaphylaxis, chronic arthritis, encephalopathy
Haemophilus Influenza Type B (Hib) vax?
Prevention for bacterial meningitis, epiglottitis, bacterial pneumonia, septic, arthritis, sepsis
IM, 0.5 mL
2, 4, 6, 12-15 months
S/E: pain, red, swelling at site
varicella (chicken pox) vax?
SubQ, 0.5mL
2 doses (12-15 months and 4-6 years)
Live virus
PCV-7 Pneumococcal conjugate vaccine (Prevnar)?
7 doses
IM, 0.5mL
2, 4, 6, 12-15 months
Early as 2 months for sickle cell disease, nephrotic syndrome, renal failure, organ transplants, HIV, cochlear implants, etc.
Pneumo 23 (PPV – 23 types) recommended for older > 23 month
flu vax?
Annually 6 months – 18 years
Trivalent inactivated any > 6 months – covers both A and B types
Contraindication: egg allergy
Live vaccine 2 doses nasally, 1 month apart
meningococcal disease (MCV4) vax?
Increased risk gets 2 doses of MCV4 - menactra or memveo IM 0.5mL, 2 months apart
Regular risk @ 11-12 year old visit (single dose)
Menomune 2-10 years old (SubQ)
Rotavirus vax?
Rotateq: oral vaccine in 3 doses, at 2, 4, and 6 months of age (none after 32 weeks)
Rotarix: oral vaccine at 6 weeks then 4 weeks later
HPV vax?
3 IM shots
11-12 years, 2 months and 6 months later
vax @ birth and 1 month?
HepB
vax @ 2 months?
HepB, RV, DTaP, Hib, PCV13, IPV
vax @ 4 months?
RV, DTaP, Hib, PCV13, IPV
vax @ 6 months?
Hep B, RV, DTaP, Hib, PCV13, IPV, Flu
vax @ 12 months?
HepB, Hib, PCV13, IPV, Flu, MMR, Varicella, HepA
vax @ 15 months?
HepB, DTaP, Hib, PVC13, IPV, Flu, MMR, Varicella, HepA
vax @ 18 months?
HepB, DTaP, IPV, Flu, HepA
vax @ 19-23 months?
flu, HepA
vax @ 2-3 yrs?
flu
vax @ 4-6 years?
DTaP, IPV, Flu, MMR, Varicella
Covid vaccination recommended for ages…
6 months & older
infant dehydration s/s?
- Weight loss
- Increased HR
- Thirst, no tears
- Variable temp
- Depressed fontanel in infant
- Dry skin and mucous membranes
- Poor skin turgor and skin perfusion
- Fatigue, lethargy
- Diminished urinary output
- Altered LOC
what is lyme disease and treat?
Most common tick-borne disorder in the US
Caused by the spirochete that enter the skin through the tick bite
Bullseye appearance
treat: penicillin
what is s/s of lyme disease stage 1?
fever, HA, malaise, fatigue, anorexia, conjunctivitis, cough, stiff neck, lymphadenopathy
what is s/s of lyme disease stage 2?
neuro, cardiac, MS systems
what is s/s of lyme disease stage 3?
MS pain, arthritis
what is RSV?
Respiratory syncytial virus (RSV)
Symptoms: wheezing, tachypnea, increased resp. distress
RSV can stay on objects for an extended period of time
what is the hemolytic uremic syndrome triad?
anemia, thrombocytopenia, renal failure
what are the HUS s/s?
primarily in infants 6 months – 5 years old, acquired hemolytic anemia, thrombocytopenia, renal injury/failure, CNS symptoms, associated with E.Coli (undercooked beef), unpasteurized milk or fruit juice (apple), sprouts, lettuce, salami, or drinking/swimming in sewage contaminated water, and begins with gastro or URI
what is the HUS treatment?
hemodialysis or peritoneal dialysis (for those anuric for 24 H or oliguria w/ uremia or HTN and seizures), FFP and plasmapheresis, fresh/washed packed cells, removed plasma from blood and replace with FFP, emergency support for family and child.
inflammation and swelling of epiglottis, primarily affecting kids between ages 2 and 8.
epiglottitis
epiglottitis s/s?
sudden onset, kid awakens with onset of high fever, sore throat, pain with swallow, anxious, restless, looks ill, insists on sitting upright leaning on arms with chin thrust out and mouth open (tripod position). Dysphonia (muffled voice), dysphagia, drooling of saliva = classic signs. Edematous, cherry red epiglottis is most reliable diagnostic sign.
epiglottitis treat?
NPO, IV fluid for hydration, assess for resp distress continuously, never leave kid unattended, keep intubation equipment available. Meds= ABX (H. Flu), anti-pyretic (fever), corticosteroids (swelling), IV fluids
types of cleft palates?
incomplete cleft palate, unilateral complete lip and palate, and bilateral complete lip and palate
involves a notched upper lip border, nasal distortion, and may include unilateral or bilateral involvement
cleft lip
a visible or palpable gap in uvula, soft palate, hard palate, and/or incisive foramen with exposed nasal cavities and associated nasal distortion.
cleft palate
cleft palate repair?
Cleft palate: 6- 18 months; before 2 years old
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 temp
what is important to know about car seats?
Approved car seats
Toddlers: rear facing back seat until 9.1 kg (20 lbs)
Then approved forward facing car seat in the back seat
Remain in car seat until 4 years of age and/or 40 lbs
Multisystem disorder of exocrine glands
cystic fibrosis
CF s/s?
cough, sputum, dyspnea, decreased SaO2, crackles or wheezes, cyanosis, digital clubbing, bulky/frothy foul-smelling stools (steatorrhea).
CF treat?
provide high-calorie, high protein foods, admin pancreatic enzymes with all meals and snacks, admin fat-soluble vitamins (A,E,D,K), and avoid pulmonary treatments after meals to decrease vomiting possibility. Meds: ABX (treat pulmonary infection), pancreatic enzymes (for fat absorption), Fat-soluble vitamins (A,E,D,K), Mucolytics (to decrease viscosity of sputum), and bronchodilators (to improve lung function)
CF diagnosis?
sweat test, 72 H fecal fat, chest x-ray, and prenatal DNA of amniotic fluid
what is important to know about toilet training?
After kid is walking (18-24 months)
Stand and walks well, pulls pants up and down, recognizes need to eliminate, be able to wait until the bathroom, have the desire to please parents
If child protest, stop and try again in several weeks
Do not begin during time of change or stress
“Mega colon”
Hirschsprung’s Disease
Hirschsprung’s Disease s/s?
no meconium with 1st 24-48 H, distended abdomen and vomit, signs of enterocolitis, chronic constipation, and ribbon-like, foul-smelling stool
Hirschsprung’s Disease treat?
post-op = NPO, NG suction, abdominal assessment, ostomy (temporary), later: pull-through, ostomy revised: anal structure and incontinence are potential complications.
celiac s/s?
abdominal distention, vomit, anorexia, muscle wasting, diarrhea with a foul odor
what are the most common causes of diarrhea?
rotavirus
salmonella
shigella
what is rotavirus?
Most common in kids 3-24 months
Fecal oral
Fever
Starts with vomit and then watery, grassy green foul-smelling diarrhea
Now have oral prevention given with immunizations at 2, 4, and 6 months
what is salmonella?
Bacterial
Person to person or undercooked chicken
June-august
Hamsters, turtles, dogs and cats carry too
N/V, abdominal pain, bloody diarrhea
Fever
May get septic
what is shigella?
Fever, fatigue, anorexia
Crampy abdominal pain preceding watery or bloody diarrhea
Do not give anti-diarrhea meds (can make the symptoms worse)
vomit treatment?
Requires no specific treatment unless complications occur (dehydration, electrolyte imbalances, aspiration)
what are activities for 2 year olds?
Solitary play evolves into parallel play: toddlers observe others and engage in activities nearby
Appropriate activities: coloring, building blocks, shape sorters
Parents can foster motor skills by allowing kid to be active; toddler should not be confined to playpens
Toys that have small parts should be kept out of reach
Age-appropriate toys should be provided
what are H2O excess symptoms?
Symptoms: rales “wet” (difficulty breathing), increased venous pressure, slow, bounding pulse, weight gain, lethargy, increased spinal pressure/seizure/coma
Transfer of gastric contents into the esophagus
GER
GER s/s?
sitting up or vomit, excessive cry, arching back, cough, wheeze, stridor, gag, bloody emesis, apnea, difficulty swallowing, chest pain, heartburn
GER treat?
depends on severity, avoid foods that intensify reflex (citrus, caffeine, lactose, etc.) breastfeeding moms need to avoid these too, weight control, small frequent meals, thickened feeds, elevate HOB for 1 H after feed, PPI’s (omeprazole, H2 receptor inhibitors, ranitidine), and surgical management (Nissen fundoplication)
what is important to know about infant teething?
Erupt between 6-10 months
Age in months -6 = # of teeth (up to 2 years old)
S/S: irritability, difficulty sleeping, refuses to eat, drooling, chewing or biting
Do not belittle beliefs and concerns or discourage home remedies unless harmful
Firm and cold chewing objects, OTC analgesics, no ASA
tylenol
what is the tylenol dosage?
10-15 mg/kg per dose – max 5 doses/day
What are the fluid needs of a child and the calculation?
Body weight (kg): amt of fluid per day
1-10 = 100 mL/kg
11-20 = 1000 mL plus 50 mL/kg for each kg > 10 kg
> 20 = 1500 mL plus 20 mL/kg for each kg >20 kg
fluid output in child
1-2cc/kg/H
Fontanels close?
anterior: 12-18 mos
posterior: 2-3 mos
