Exam 1 Peds - Summary Set Flashcards

1
Q

Detergent-like lipoproteins detectable by 24-25 weeks

A

surfactant

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2
Q

____ reduces surface tension within the alveoli

A

surfactant

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3
Q

which substance increases during labor and immediately after birth?

A

surfactant

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4
Q

what can be given to preterm babies to increase surfactant production and lung maturity? (med, route, timing)

A

betamethasone IM injection x2

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5
Q

what condition can delay surfactant production?

A

diabetes

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6
Q

what are the 4 types of triggers that make a newborn breathe?

A

(1) chemical
(2) mechanical
(3) thermal
(4) sensory

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7
Q

expelling fluid or chest compression during birth are examples of ____ triggers for newborn respiration

A

mechanical

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8
Q

changes in environmental temperature is a ____ trigger for newborn respiration

A

thermal

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9
Q

what are 5 sensory triggers for newborn respiration?

A

(1) touch
(2) light
(3) sounds
(4) smells
(5) discomfort

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10
Q

increased PaO2 when the newborn breathes in air leads to ____

A

closing of the shunts (ductus venosus, ductus arteriosus, and foramen ovale)

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11
Q

what are the 4 predisposing factors to heat loss?

A

(1) thin skin with blood vessels close to surface
(2) little SQ fat
(3) 3x more SA to body mass than adults
(4) rate of heat loss is 4x greater than that of adults

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12
Q

____ is the protective factor against heat loss in newborns

A

flexed position

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13
Q

the 4 methods of heat loss are…

A

(1) evaporation
(2) conduction
(3) radiation
(4) convection / air

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14
Q

name the 3 nursing implications for evaporation heat loss

A

(1) keep infant dry
(2) remove wet diapers
(3) minimized exposure during baths

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15
Q

name the 2 nursing implications for conduction heat loss

A

(1) put baby on prewarmed sheet
(2) cover scales / x-rays with warm blanket

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16
Q

name the 2 nursing implications for radiation heat loss

A

(1) keep baby cot away from cold outside walls
(2) cover the baby if stable

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17
Q

name the 4 nursing implications for convection heat loss

A

(1) avoid air current
(2) manage babies inside incubator
(3) organize work to minimize opening portholes
(4) provide warm, humidified O2

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18
Q

name at least 3 s/s of a cold infant

A

(1) restlessness
(2) crying
(3) increased flexion and activity
(4) vasoconstriction - acrocyanosis
(5) metabolism rises

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19
Q

___ is a normal finding in infants, caused by vasoconstriction, and can be an early sign of a cold infant

A

acrocyanosis

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20
Q

____ is the primary source of heat production

A

non-shivering thermogenesis

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21
Q

where is brown fat located in infants?

A

(1) neck
(2) shoulders
(3) back

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22
Q

brown fat appears at ____ weeks

A

26-30 weeks

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23
Q

brown fat increases until ___

A

2-5 weeks after birth

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24
Q

newborns can increase heat by ____ using the NST method

A

100%

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25
Q

what is the basic rule of thumb for covering / dressing an infant?

A

one extra layer than what the parent is wearing

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26
Q

what is NOT a reliable indicator of infection in the newborn period?

A

fever

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27
Q

___ is more common indicator of infection in the newborn period

A

hypothermia

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28
Q

name at least 3 s/s of infection in newborns

A

changes in…
(1) activity
(2) tone
(3) color
(4) feeding
(5) temperature

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29
Q

____ immunity is given from birthing person to newborn

A

passive

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30
Q

how is passive immunity given to infant?

A

IgG crosses the placenta in the 3rd trimester

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31
Q

passive immunity generally lasts ____

A

weeks to month, but can be up to a year

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32
Q

___ protects against gram negative bacteria and increases rapidly a few days after birth

A

IgM

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33
Q

___ protects the GI and respiratory systems after birth

A

IgA

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34
Q

___-fed babies may have slight GI issues

A

formula

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35
Q

gastric emptying is quicker for newborns who ____

A

breastfeed

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36
Q

____ can cause regurgitation in newborns

A

relaxed cardiac sphincter

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37
Q

all digestive enzymes are deficient until ____ in newborns

A

6 months

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38
Q

____ is deficient until 4-6 months in infants (digestive enzyme)

A

pancreatic amylase

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39
Q

which digestive enzymes are present in breastmilk?

A

amylase and lipase

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40
Q

___ and ___ are major component of the infant’s milk diet

A

protein and lactose

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41
Q

what are the 3 main jobs of the liver for the newborn?

A

(1) glucose maintenance
(2) conjugation of bilirubin
(3) iron storage, drug metabolism, coagulation factors

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42
Q

non-breastfed infants should be given milk fortified with ____

A

iron

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43
Q

physiologic jaundice is also called ___

A

transient hyperbilirubinemia

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44
Q

when do we get worried about bilirubin levels in newborns?

A

(1) when the levels are in the double-digits (10 or higher)
(2) levels are trending upwards

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45
Q

___ occurs in 50% of term and 80% of preterm newborns

A

physiologic jaundice

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46
Q

early-onset breastfeeding jaundice is primarily due to ____

A

insufficient fluid intake

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47
Q

what is the intervention for early-onset breastfeeding jaundice?

A

Help parent with breastfeeding and increasing infant intake

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48
Q

which type of jaundice can last 3 weeks to 3 months?

A

late-onset breastfeeding jaundice

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49
Q

what is the treatment for late-onset breastfeeding jaundice?

A

(1) close monitoring of total serum bilirubin (TSB)
(2) at least 8-12 feedings/day
(3) phototherapy (if TSB too high)
(4) if TSB dangerously high, formula feeding for 1-3 days

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50
Q

name the 6 things that make up human breast milk

A

(1) carbohydrates
(2) proteins
(3) fat
(4) vitamins and minerals
(5) enzymes
(6) immune boost

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51
Q

____ usually appears within 24 hours of birth and is NOT normal

A

pathologic jaundice

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52
Q

the typical onset of physiologic jaundice is

A

2-4 days after birth

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53
Q

the typical onset of early-onset breastfeeding jaundice is

A

first few weeks after birth

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54
Q

the typical onset of late-onset breastfeeding jaundice is

A

3-5 days after birth

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55
Q

name at least 3 causes of pathologic jaundice

A

(1) sepsis
(2) blood incompatibilities
(3) metabolic disorders
(4) increased hemolysis or RBCs

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56
Q

___ is double-digit bilirubin that does not resolve

A

hyperbilirubinemia

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57
Q

how do you diagnose hyperbilirubinemia?

A

(1) physical exam
(2) TSB

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58
Q

how do you treat hyperbilirubinemia?

A

(1) home lights / bili blankets
(2) phototherapy (if significant bili levels)
(3) NICU - exchanged transfusion

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59
Q

why is vitamin K injection (IM) given 1 hr after birth?

A

hemorrhage prevention b/c newborns lack the intestinal flora necessary to produce vitamin K,

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60
Q

why is meconium formed in utero?

A

b/c intestines are not absorbing nutrients yet

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61
Q

meconium is usually first passed within ___ hours of birth

A

12

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62
Q

which type of stool is described as mushy, yellow, gold, “sweet”

A

breastfed stool

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63
Q

what is the normal amount of stool for an infant?

A

3 or more per day until 6 weeks of age

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64
Q

most babies void within ___ (timing) of birth

A

24 hours

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65
Q

within 24 hours / before discharge, what 3 things should happen for the newborn?

A

(1) complete physical exam
(2) nutritional status and ability to feed
(3) complete screenings

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66
Q

what nursing interventions should be completed in the “golden hour” / period of reactivity? (5)

A

(1) initial assessment, APGARs
(2) eye-to-eye and skin-to-skin
(3) initiate first feedings
(4) vitamin K injection
(5) erythromycin ointment

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67
Q

the purpose of ___ is to evaluate the need for intervention post-birth

A

APGAR

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68
Q

an APGAR score of ___ requires intervention

A

<7

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69
Q

the nursing interventions that should occur in the first 1-4 hours after birth include:

A

(1) VS q30m
(2) ID infant and initiate security
(3) height, weight, length, head circ
(4) gestational size / age
(5) monitor skin color
(6) assess suck and swallow
(7) assess reflexes and movement
(8) assess for anomalies
(9) skin to skin as much as possible!

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70
Q

why do we care about gestational age and infant size?

A

SGA and LGA can be risk factors for other complications

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71
Q

which exam looks at external and neurologic characteristics?

A

Ballard Exam

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72
Q

infant should receive ___ vaccines by 15 months

A

22

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73
Q

what is the typical timing of well-checks for an infant?

A

(1) 2 weeks
(2) 2, 4, and 6 months
(3) 12 months
(4) 15 or 18 months

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74
Q

when we look at a growth chart, we are looking for what for infants?

A

proportionate growth between height and weight

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75
Q

being fearful / shy of strangers typically occurs at

A

9 months

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76
Q

becoming more mobile and pulling up to stand typically occur at ___

A

12 months

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77
Q

what are the 5 Rs to promoting brain growth?

A

(1) Read together
(2) Rhyme (play, talk, sing)
(3) Routines
(4) Reward
(5) Relationships

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78
Q

when can you start to introduce solid foods to an infant?

A

6-9 months

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79
Q

from 0-6 months, what are the nutritional guidelines?

A

(1) breast or formula exclusively
(2) no free water
(3) vitamin D
(4) caregiver arms

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80
Q

name at least 3 characteristics of safe sleep

A

(1) back is best
(2) firm surface
(3) swaddle
(4) no blankets, toys, etc.
(5) co-room until 6 months
(6) no co-bedding

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81
Q

the 4 main safety risks for infants are:

A

(1) falls
(2) CO and smoke detectors
(3) ingestions
(4) car seats

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82
Q

car seats should be rear facing if infant is…

A

<2 years or under 20 lbs

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83
Q

periods when toddlers don’t feel hungry is called ___

A

physiologic anorexia

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84
Q

sphincter control develops at ___

A

18 months

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85
Q

for potty training, which typically occurs first - bowel or bladder?

A

bowel (then bladder)

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86
Q

when is a toddler ready for potty training?

A

(1) dry >2 hours
(2) intolerant of soiled diapers
(3) awareness

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87
Q

___ language is higher than expressive language in toddlers

A

receptive

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88
Q

“how” “why” ; animism; and magical thinking are characteristic of

A

pre-schoolers

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89
Q

days or spells where kids don’t eat well are ___

A

food jags

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90
Q

full set of primary baby teeth emerge by what age?

A

age 4

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91
Q

give the 5th dose of Dtap at age ___

A

4-6 years

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92
Q

Oral polio should be given at ___

A

4-6 years

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93
Q

normal newborn pulse is

A

120-160 bpm

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94
Q

normal newborn respirations are

A

30-60 per minute

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95
Q

normal newborn temps are

A

97.5-99

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96
Q

___ are changes within a few days to a week after birth

A

molding

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97
Q

an area of localized edema usually over the vertex from pressure on mother’s cervix during labor

A

caput succendaneum

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98
Q

an accumulation of blood under the scalp caused by pressure during birth

A

cephalohematoma

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99
Q

A small amount of vaginal bleeding from the sudden withdrawal of the maternal hormones

A

pseudomenstruation

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100
Q

___ will be enlarged and darker in newborn females

A

labia majora

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101
Q

___ may be dark brown in newborn males

A

scrotum

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102
Q

a collection of fluid around one or both testes, usually resolves if present

A

hydrocele

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103
Q

undescended testis; can occur on one or both sides; likely will descend by 6 months of age

A

cryptorchidism

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104
Q

abnormally located urethral meatus on the underside of the penis or on the perineum

A

hypospadias

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105
Q

urethral meatus on the upper side of the penis

A

epispadias

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106
Q

subsequent daily care for a newborn in the hospital includes (8):

A

(1) VS q6-q8h
(2) assess umbilical cord
(3) hearing screen
(4) metabolic screen
(5) congenital heart screen
(6) I&O
(7) swaddle
(8) initiate immunizations

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107
Q

don’t go more than ___ without feeding an infant

A

3-4 hours

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108
Q

name at least 3 ways to awaken an infant

A

(1) dress or undress
(2) change diaper
(3) talk
(4) increase skin contact
(5) hand-express milk
(6) stimulate rooting reflex

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109
Q

name the 5 S’s of quieting an infant

A

(1) Swaddling
(2) Side/Stomach position
(3) Shushing
(4) Swinging
(5) Sucking

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110
Q

name 2 things about cord care

A

(1) keep clean and dry
(2) keep diapers from irritating the cord

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111
Q

when is the cord clamp removed?

A

~24 hours after birth

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112
Q

when does the cord fall off?

A

10-14 days

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113
Q

T/F: Cord will become brownish black

A

T

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114
Q

What should you check daily on the umbilical cord?

A

(1) odor
(2) oozing
(3) reddened areas

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115
Q

what should you NOT do with uncircumcised infants?

A

do NOT attempt to retract the foreskin b/c it is adherent to the glans for 3-6 years

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116
Q

name at least 3 s/s of respiratory distress in a newborn

A

(1) grunting
(2) tachypnea
(3) retractions
(4) cyanosis
(5) asymmetrical chest expansion

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117
Q

3 ways to prevent respiratory problems in newborns include

A

(1) use of bulb syringe
(2) proper positioning
(3) safe sleep

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118
Q

name at least 3 signs of illness in newborns / infants

A

(1) lethargy
(2) hypothermia
(3) inconsolable
(4) discharge / bleeding from cord or opening
(5) green, watery stool
(6) fewer than 6-8 wet diapers per day
(7) fever

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119
Q

4 common problems in newborns include

A

(1) thermoregulation
(2) hyperbilirubinemia
(3) hypoglycemia
(4) overstimulation

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120
Q

name at least 4 risk factors for hypoglycemia

A

(1) preterm and post-term
(2) SGA, LGA
(3) IUGR
(4) maternal gestational diabetes
(5) cold stress

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121
Q

name at least 4 s/s of hypoglycemia

A

(1) jitteriness
(2) poor muscle tone
(3) poor feeding
(4) tachycardia / tachypnea
(5) apnea
(6) irritability
(7) lethargy

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122
Q

when do we start to worry about an infant with hypoglycemia?

A

When blood glucose is <40 mg/dL

123
Q

in NAS, babies are not addicted, they are ___

124
Q

name at least 4 s/s of NAS

A

(1) high-pitched cry
(2) fussiness
(3) jittery, hyper-reactive
(4) poor feeding
(5) blotchy, mottled
(6) uncoordinated suck / swallow
(7) diarrhea

125
Q

the two NAS assessments are

A

FNASS and ESC

126
Q

the medication treatments for NAS are

A

(1) methadone or morphine
(2) benzodiazepines
(3) phenobarbital

127
Q

name at least 3 non-pharm treatments for NAS

A

(1) co-rooming
(2) skin-to-skin
(3) swaddle
(4) low lights
(5) early feeds
(6) soothing
(7) limiting visitors

128
Q

name at least 4 risk factors for sepsis in newborns

A

(1) poor HH
(2) birthing person with PROM
(3) birthing person positive for GBS
(4) SGA
(5) prematurity
(6) meconium aspiration

129
Q

the 3 key s/s of sepsis in newborns are

A

(1) increased HR
(2) respiratory distress
(3) abdominal distention

130
Q

the key nursing interventions are sepsis in newborns are

A

(1) HH
(2) education
(3) monitoring
(4) labs
(5) abx
(6) prepare for increased support

131
Q

preterm babies are at increased risk for what 4 common issues?

A

(1) hyperbilirubinemia
(2) thermoregulation issues
(3) hypoglycemia
(4) sepsis

132
Q

preterm babies are at increased risk for more serious issues, such as:

A

(1) Respiratory distress syndrome
(2) pulmonary HTN
(3) retinopathy
(4) necrotizing enterocolitis
(5) intraventricular hemorrhage
(6) bronchopulmonary dysplasia (BPD)

133
Q

the 3 leading causes of death in infants are

A

(1) congenital malformations
(2) disorders r/t SGA & LBW
(3) SIDS

134
Q

the 3 leading causes of death in 1-4 year olds are

A

(1) accidents
(2) congenital malformations
(3) assault

135
Q

the 3 leading causes of death in 5-9 year olds are

A

(1) accidents
(2) cancer
(3) congenital malformations

136
Q

the 3 leading causes of death in 10-14 year olds are

A

(1) accidents
(2) cancer
(3) suicide

137
Q

the 3 leading causes of death in adolescents are

A

(1) accidents
(2) homicide
(3) suicide

138
Q

what is the role of the pediatric nurse? (4)

A

(1) first point of contact
(2) more contact with pt than any other
(3) holistic perspective
(4) influence health through genuine partnership

139
Q

one of the most important things about being a pediatric nurse is facilitating _____ communication

A

developmentally-appropriate

140
Q

we want to strive for ____ care as a pediatric nurse

A

atraumatic

141
Q

what are 3 principles that support atraumatic care?

A

(1) prevent / minimize separations from family
(2) promote a sense of control
(3) prevent / minimize bodily harm or pain

142
Q

name the 4 principles of family-centered care

A

(1) dignity and respect
(2) information sharing
(3) support participation
(4) collaborate

143
Q

who is at risk for impaired health literacy?

A

(1) adults >65 yo
(2) marginalized groups
(3) non-native speakers of English
(4) people with income < poverty level

144
Q

name at least 3 interventions to improve health literacy

A

(1) establish trust
(2) sit or stand at patient’s level
(3) listen
(4) use plain language
(5) slow down
(6) be specific
(7) use teach-back

145
Q

3 key influencers on a child’s response to illness are

A

(1) age
(2) developmental age
(3) parents’ reaction / coping

146
Q

child response to illness can be caused by

A

(1) separation anxiety
(2) fear of pain or bodily harm
(3) fear of the unknown
(4) uncertain expectations / rules
(5) loss of control

147
Q

the child response to illness may result in…

A

(1) anxiety / fear
(2) anger
(3) guilt
(4) regression

148
Q

___ is the main stressor for infants and toddlers from 6-30 months

A

separation anxiety

149
Q

the infant / toddler typically passes through 3 stages of separation anxiety:

A

(1) protest
(2) despair
(3) detachment

150
Q

crying, agitation, and inconsolability are signs of ___ of separation anxiety

151
Q

withdrawn, quiet, or hopeless are signs of ____

152
Q

forming attachment to other caregivers, ignoring or “punishing” parents are signs of

A

detachment

153
Q

pre-schoolers in the hospital typically fear ____

A

mutilation

154
Q

do not do noxious things to a child in ___ (location)

155
Q

4 key nursing interventions for pre-schoolers are

A

(1) establish routines
(2) prepare and explain
(3) provide realistic choices
(4) play

156
Q

____ and ___ are the main concerns of school-aged children

A

rules, loss of control

157
Q

name at least 3 things nurses can do to support school-aged children

A

(1) provider clear explanations and education
(2) respect privacy
(3) leave space for questions
(4) teach self-regulation strategies
(5) normalize activities (school, play, etc.)

158
Q

adolescents are most focused on ___ and ___

A

self, identity

159
Q

name at least 3 nursing interventions for adolescents

A

(1) respect privacy
(2) confidentiality limits
(3) seek their perspective
(4) engage patient in decision-making
(5) encourage socialization

160
Q

____ is figuring out how to affirm an experience and adjust it to see the benefits

A

positive reframing

161
Q

___ is a child’s work

162
Q

name at least 3 things siblings may experience while the patient is in the hospital

A

(1) confusion
(2) fear / anxiety
(3) guilt
(4) resentment / jealousy
(5) insecurity
(6) loss of routines

163
Q

___ should only be used a last resort on children

A

restraints

164
Q

most often, falls happen when ____

A

parents are in the room

165
Q

____ is the provider’s responsibility; nurse can witness and advocate

A

informed consent

166
Q

___ is used for routine procedures like med administration

A

general consent

167
Q

___ is customary to obtain agreement with the child if they are over 5 yo

168
Q

most ___ require a provider’s order

A

restraints

169
Q

secure restraint ties to ___, not the mattress or rails

A

bed frames

170
Q

what should you watch for with NG/NJ and G tubes?

A

(1) respiratory distress
(2) cyanosis
(3) abdominal distention
(4) vomiting
(5) measure changes

171
Q

what is one of the biggest dangers of NG tubes?

A

becoming dislodged and ending up in wrong space

172
Q

which types of O2 administration are common for children?

A

(1) cannula
(2) face mask

173
Q

what is the IDEAL model for discharge stand for?

A

(1) Include
(2) Discuss
(3) Educate
(4) Assess
(5) Listen

174
Q

what is the main difference in pediatric medication administration?

A

typically dosed by weight

175
Q

why are peds medications dosed by weight?

A

(1) very small margin of safety
(2) absorbed and metabolized differently based on age

176
Q

name at least 3 s/s of infant dehydration

A

(1) fewer wet diapers than usual
(2) no tears left when crying
(3) lethargy
(4) very poor skin turgor
(5) increased RR
(6) sunken fontanel
(7) sunken eyes
(8) abnormal skin color and temp

177
Q

signs of mild dehydration include:

A

(1) normal skin, mucosa, and eyes
(2) consolable
(3) normal pulse and cap refill
(4) flat fontanelle

178
Q

signs of moderate dehydration include:

A

(1) tenting skin
(2) dry mucosa
(3) deep set eyes
(4) irritable
(5) soft fontanelle

179
Q

signs of severe dehydration include

A

(1) clammy skin
(2) parched mucosa
(3) sunken eyes
(4) lethargic
(5) sunken fontanelle
(6) increased, weakened pulse
(7) cap refill >3 seconds

180
Q

what is the Holliday-Segar 4-2-1 Rule used for?

A

to estimate maintenance hourly fluid requirements

181
Q

the most important thing about fluid administration for infants is…

A

to make sure the fluid order if reasonable based on their size

182
Q

if a pt is <10 kg, what is the hourly rate for fluid administration?

A

4 mL/kg/hr

183
Q

if a pt is <10 kg, what is the daily fluid administration?

A

100 mL/kg/day

184
Q

if a pt is 10-20 kg, what is the hourly fluid administration?

A

40 mL + 2 mL/kg for every kg >10 kg

185
Q

if a pt is 10-20 kg, what is the daily fluid administration?

A

1000 mL + 50 mL/kg/day for every kg >10 kg

186
Q

if a pt is >20 kg, what is the hourly fluid administration?

A

60 mL + 1 mL/kg for every kg >20 kg

187
Q

if a pt is >20 kg, what is the daily fluid administration?

A

1500 mL + 20 mL/kg/day for every kg >20 kg

188
Q

when completing a pediatric health history, 3 key things to asses in the past medical history are:

A

(1) prenatal history
(2) birth history
(3) developmental history

189
Q

when assess pediatric current status, focus on what 4 things?

A

(1) nutrition
(2) elimination
(3) sleep
(4) school / daycare

190
Q

what should you assess for in a peds family assessment?

A

(1) caregiving arrangement
(2) family coping / strengths / challenges

191
Q

when gathering RR and HR data on a pediatric patient, how long should you assess?

A

a full minute

192
Q

wait until a child is ___ yo before taking BP (unless in the hospital)

193
Q

3 ways to take a peds temperature are

A

(1) axillary
(2) tympanic
(3) temporal
(4) rectal (bonus)

194
Q

measure patient length until about what age?

195
Q

measure patient head circumference until about what age?

196
Q

the ___ of the fontanelle closes around 3 months

197
Q

the ___ of the fontanelle closes between 1 year and 18 months

198
Q

bulging fontanelle can indicate ___

199
Q

sunken fontanelle can indicate ____

A

dehydration

200
Q

children can have tonsillar and adenoid tissue issues because…

A

children have large tonsils for the size of their bodies

201
Q

the 5 locations of the cardiac exam should include

A

Apical
Pulmonic
Erb’s
Tricuspid
Mitral

202
Q

normal bowel sounds in a peds patient are

A

5-30 per minute

203
Q

Tanner staging is used to assess ___

204
Q

3 things to do when assessing peds genitals include:

A

(1) have parents present
(2) obtain permission
(3) use correct anatomical terms

205
Q

____ is tibial torsion and metatarsus adduction

206
Q

bowleg is typically seen at what age?

207
Q

knock-knee / genu valgus can be seen at

208
Q

the 3 types of breath sounds are

A

(1) bronchial / upper
(2) bronchovesicular / central
(3) vesicular / peripheral

209
Q

breath sounds are loudest in the ____ and softest in the ____

A

bronchial; vesicular

210
Q

high-pitched crowing; indicates obstruction

211
Q

high or low-pitched rumbling sound from fluid or mucus, clear with coughing

212
Q

sharp, high-pitched or bubbly sounds on inspiration; indicates small airway collapse or presence of fluid

213
Q

dry-gating or rubbing sound from inflammation

A

pleural rub

214
Q

crackling over SQ tissues from air leak

215
Q

attempts to splint airway open

216
Q

what are the 5 main airway differences in peds?

A

(1) tongue is disproportionately larger
(2) epiglottis is larger and floppier
(3) pharynx is smaller and floppier
(4) trachea is narrower and less rigid
(5) most narrow at cricoid

217
Q

the airway continues to grow in ____, but NOT diameter until age 5

218
Q

there are more hospitalizations for respiratory in kids because

A

the airways are longer but not wider / bigger

219
Q

pediatric lungs don’t resemble adult lungs until

220
Q

why are infants obligatory nose breathers?

A

because they need to suck and swallow their food

221
Q

eustachian tubes are relatively horizontal in ____

A

infants and young children

222
Q

T/F: Brief periods of apnea are common in infants

223
Q

early signs of respiratory distress include (8)

A

(1) retractions
(2) nasal flaring
(3) rapid breathing
(4) shallow breathing
(5) diaphoresis
(6) asynchronous movement
(7) grunting or noisy breathing
(8) increased HR

224
Q

late signs of respiratory distress include (5)

A

(1) bradycardia
(2) apnea / slow respirations
(3) cyanosis
(4) decreased responsiveness
(5) loss of consciousness / coma

225
Q

____ arrest typically occurs before cardiac arrest in children

A

respiratory

226
Q

what are s/s of a child with a foreign body in the airways?

A

(1) dysphagia
(2) odynophagia
(3) coughing, stridor, or hoarseness
(4) dysphonia

227
Q

poor swallow

228
Q

painful swallow

A

odynophagia

229
Q

trouble talking

230
Q

all ___ foreign bodies are medical emergencies

A

pharyngeal

231
Q

infection or fluid creating blockage in the middle ear is ___

A

otitis media

232
Q

occurs suddenly and is associated with other signs of illness (infection)

A

acute otitis media (AOM)

233
Q

fluid behind the tympanic membrane without signs of infection; often follows an episode of AOM and resolves in 1-3 months

A

otitis media with effusion (OME)

234
Q

symptom relief for otitis media includes

A

(1) pain relief
(2) antihistamines

235
Q

earache, pulling on ears, irritability, bulging tympanic membrane, and yellowish drainage are all s/s of

A

acute otitis media (AOM)

236
Q

how do you treat AOM?

A

(1) pain medication
(2) antibiotics if not clear in 48-72 hours
(3) tube placement if persistent

237
Q

tinnitus, hearing loss, mild balance disturbances, retracted tympanic membrane, and fluid or air bubbles are s/s of

A

OM with effusion

238
Q

what is the criteria for tube placement for AOM?

A

(1) occurs within 1 month
(2) >3x / 6 months of >4x/year

239
Q

how do you treat OM with effusion?

A

(1) tube placement if persistent
(2) typically falls out within 6-12 months

240
Q

we use ___ and ___ to treat bacterial tonsillitis

A

antibiotics; supportive care

241
Q

we use ___ and ___ to treat viral tonsillitis

A

salt water gurgle; supportive care

242
Q

we use ___ to treat persistent tonsillits

A

surgical removal

243
Q

the most common surgery in children is

A

tonsillectomy / adenoidectomy

244
Q

name the 3 post-op interventions after a tonsillectomy

A

(1) don’t dislodge anything
(2) keep well-hydrated
(3) pain management

245
Q

the two types of pharyngitis are

A

nasal common cold and streptococcal

246
Q

how do you treat nasal common cold?

A

(1) fluids
(2) rest
(3) antipyretics
(4) cool mist humidifier
(5) cough suppressants

247
Q

how do you treat streptococcal?

A

(1) penicillin (family)
(2) antipyretics
(3) pain medication

248
Q

the 3 main types of croup are

A

viral, spasmodic, and bacterial

249
Q

the key s/s of group are

A

(1) barky cough
(2) stridor
(3) hoarse voice

250
Q

how do you treat spasmodic croup?

A

at home -
(1) calm approach
(2) fluids
(3) cool mist or night air

251
Q

how do you treat viral croup?

A

(1) at home - steroids, fluid, rest, antipyretics
(2) racemic epi
(3) O2
(4) IV fluids

252
Q

which type of croup is a medical emergency?

253
Q

what are the 4 D’s of bacterial croup / epiglottitis?

A

(1) drooling
(2) dysphagia
(3) dysphonia
(4) distressed inspirations

254
Q

the cardinal s/s of epiglottitis are

A

Airway inflammation
Increased Pulse
Restlessness
Retractions
Anxiety
Inspiratory stridor
Drooling

255
Q

what should you NOT do with epiglottitis?

A

(1) leave child unattended
(2) examine throat / attempt culture
(3) attempt to give anything PO

256
Q

5 things you should do during epiglottitis are

A

(1) upright positioning
(2) secure airway
(3) humidified O2
(4) IV fluids, abx, antipyretics
(5) manage anxiety

257
Q

inflammation of the main bronchi

A

bronchitis

258
Q

name at least 3 s/s of bronchitis

A

(1) dry, rattly cough
(2) wheezing
(3) general malaise

259
Q

the treatment for bronchitis is ___ and ___

A

symptom management; cough suppressants

260
Q

____ is the most common cause of hospitalization in infants

A

bronchiolitis

261
Q

name at least 3 s/s of bronchiolitis

A

(1) tachycardia
(2) tachypnea
(3) wheezing, crackles, rhonchi
(4) retractions and nasal flaring
(5) decreased intake
(6) cyanosis

262
Q

too much __ can lead to more secretions

A

suctioning

263
Q

do not treat ___ with antibiotics

A

bronchiolitis (it is viral)

264
Q

accumulation of fluid, cells, or pus is ____

264
Q

___ pneumonia is most common in ages <3 years

265
Q

___ pneumonia is most common in ages >5 years

266
Q

sudden high fever and elevated WBC is characteristic of ___ pneumonia

267
Q

the 3 stages of pertussis are:

A

(1) catarrhal (1-2 weeks)
(2) paroxysmal (2-6 weeks)
(3) convalescent (1-2 weeks)

268
Q

the 3 s/s of catarrhal stage of pertussis are

A

(1) mild cough
(2) runny nose
(3) low-grade fever

269
Q

persistent cough, vomiting, drooling, tongue protrusion, and cyanosis are s/s of ____ stage of pertussis

A

paroxysmal

270
Q

you are HIGHLY contagious at what stage of pertussis?

A

paroxysmal

271
Q

episodic cough, whooping, and vomiting describes which stage of pertussis?

A

convalescent

272
Q

describe the treatment for pertussis

A

(1) supportive care
(2) antibiotics - erythromycin
(3) droplet precautions
(4) hospitalization for younger children for IV fluids, O2, airway support

273
Q

how do you prevent pertussis?

A

Dtap (<7 yo)
Tdap (>7 yo)
5 doses at 2, 4, 6, and 15-18 months; 4-6 years

274
Q

___ requires radiographic evidence and positive mantoux

A

tuberculosis

275
Q

___ is a progressive autosomal recessive disorder

A

cystic fibrosis

276
Q

___ is characterized by an abnormal accumulation of thick mucus in lungs and other organs

A

cystic fibrosis

277
Q

the other organs involved in cystic fibrosis include

A

(1) sinuses
(2) skin
(3) liver
(4) pancreas
(5) intestines
(6) reproductive organs

278
Q

___% of CF is diagnosed by age 2

279
Q

___ is the earliest indication of CF

A

meconium ileus

280
Q

name a few key s/s of CF

A

(1) recurrent respiratory infections
(2) barrel chest
(3) large, frothy, greasy, foul-smelling stools
(4) not metabolizing food well
(5) anemia
(6) sterility
(7) increased NaCl in tears, sweat, and saliva

281
Q

the gold standard for diagnosing CF is

A

the sweat chloride test

282
Q

diagnostic criteria for CF is

A
  • Cl level >40 for infants <3 months
  • Cl level >60 for all other ages
  • Na >90
283
Q

long-term treatment of CF is ___

A

lung transplant

284
Q

mean survival after a lung transplant for CF is

285
Q

___ and ___ are two forms of chest physiotherapy

A

vibrating vest; postural drainage

286
Q

3 long-term effects of CF are

A

(1) colon cancer
(2) fertility issues
(3) mental health issues

287
Q

____ is a reversible obstructive airway disease

288
Q

___ is the leading chronic disease in children in the US

289
Q

which sex is more affected by asthma in children?

290
Q

45% of children with asthma experience ___ episode/year

A

at least 1 acute

291
Q

name at least 4 asthma triggers

A

(1) environmental (dust, pollen, pet)
(2) exercise
(3) food allergies
(4) stress
(5) smoke, chemicals, smog
(6) acute illness
(7) respiratory infections

292
Q

nursing care for asthma includes:

A

(1) routine respiratory assessments
(2) administer meds
(3) recognize early signs of an asthma episode / attack
(4) education for pt and family
(5) asthma action plan

293
Q

which activity in the asthma action plan typically has the lowest compliance?

A

measuring peak flow

294
Q

asthma action plan should include:

A

(1) measuring peak flow
(2) medications
(3) triggers

295
Q

what are the long-term controller meds for asthma?

A

(1) inhaled corticosteroids
(2) leukotriene modifiers
(3) combination inhalers
(4) theophylline

296
Q

Flovent and Pulmicort are examples of

A

inhaled corticosteroids

297
Q

the most common long-term controller for asthma is

A

inhaled corticosteroids

298
Q

Singulair and Zyflo are examples of ____

A

leukotriene modifiers

299
Q

Advair, Dulera, and Symbicort are examples of

A

Combination inhalers

300
Q

which asthma med is a daily pill?

A

theophylline

301
Q

name the 3 types of rescue meds for asthma

A

(1) SABAs (albuterol)
(2) anticholinergics (ipratropium, atrovent)
(3) corticosteroids (prednisone, methylprednisolone)

302
Q

____ should only be for short-term use

A

corticosteroids

303
Q

name at least 4 symptoms of asthma that indicate emergency management

A

(1) worsening wheeze or cough
(2) dyspnea / SOB
(3) no improvement after bronchodilator
(4) trouble walking or talking
(5) listlessness, weak cry in infant
(6) grey or blue lips
(7) Status Asthamticus