Exam 1 Peds - Summary Set Flashcards
Detergent-like lipoproteins detectable by 24-25 weeks
surfactant
____ reduces surface tension within the alveoli
surfactant
which substance increases during labor and immediately after birth?
surfactant
what can be given to preterm babies to increase surfactant production and lung maturity? (med, route, timing)
betamethasone IM injection x2
what condition can delay surfactant production?
diabetes
what are the 4 types of triggers that make a newborn breathe?
(1) chemical
(2) mechanical
(3) thermal
(4) sensory
expelling fluid or chest compression during birth are examples of ____ triggers for newborn respiration
mechanical
changes in environmental temperature is a ____ trigger for newborn respiration
thermal
what are 5 sensory triggers for newborn respiration?
(1) touch
(2) light
(3) sounds
(4) smells
(5) discomfort
increased PaO2 when the newborn breathes in air leads to ____
closing of the shunts (ductus venosus, ductus arteriosus, and foramen ovale)
what are the 4 predisposing factors to heat loss?
(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
____ is the protective factor against heat loss in newborns
flexed position
the 4 methods of heat loss are…
(1) evaporation
(2) conduction
(3) radiation
(4) convection / air
name the 3 nursing implications for evaporation heat loss
(1) keep infant dry
(2) remove wet diapers
(3) minimized exposure during baths
name the 2 nursing implications for conduction heat loss
(1) put baby on prewarmed sheet
(2) cover scales / x-rays with warm blanket
name the 2 nursing implications for radiation heat loss
(1) keep baby cot away from cold outside walls
(2) cover the baby if stable
name the 4 nursing implications for convection heat loss
(1) avoid air current
(2) manage babies inside incubator
(3) organize work to minimize opening portholes
(4) provide warm, humidified O2
name at least 3 s/s of a cold infant
(1) restlessness
(2) crying
(3) increased flexion and activity
(4) vasoconstriction - acrocyanosis
(5) metabolism rises
___ is a normal finding in infants, caused by vasoconstriction, and can be an early sign of a cold infant
acrocyanosis
____ is the primary source of heat production
non-shivering thermogenesis
where is brown fat located in infants?
(1) neck
(2) shoulders
(3) back
brown fat appears at ____ weeks
26-30 weeks gestation
brown fat increases until ___
2-5 weeks after birth
newborns can increase heat by ____ using the NST method
100%
what is the basic rule of thumb for covering / dressing an infant?
one extra layer than what the parent is wearing
what is NOT a reliable indicator of infection in the newborn period?
fever
___ is more common indicator of infection in the newborn period
hypothermia
name at least 3 s/s of infection in newborns
changes in…
(1) activity
(2) tone
(3) color
(4) feeding
(5) temperature
____ immunity is given from birthing person to newborn
passive
how is passive immunity given to infant?
IgG crosses the placenta in the 3rd trimester
passive immunity generally lasts ____
weeks to month, but can be up to a year
___ protects against gram negative bacteria and increases rapidly a few days after birth
IgM
___ protects the GI and respiratory systems after birth
IgA
___-fed babies may have slight GI issues
formula
gastric emptying is quicker for newborns who ____
breastfeed
relaxed cardiac sphincter can cause ___
regurgitation in newborns
all digestive enzymes are deficient until ____ in newborns
6 months
____ is deficient until 4-6 months in infants (digestive enzyme)
pancreatic amylase
which digestive enzymes are present in breastmilk?
amylase and lipase
___ and ___ are major component of the infant’s milk diet
protein and lactose
what are the 3 main jobs of the liver for the newborn?
(1) glucose maintenance
(2) conjugation of bilirubin
(3) iron storage, drug metabolism, coagulation factors
non-breastfed infants should be given milk fortified with ____
iron
physiologic jaundice is also called ___
transient hyperbilirubinemia
when do we get worried about bilirubin levels in newborns?
(1) when the levels are in the double-digits (10 or higher)
(2) levels are trending upwards
___ occurs in 50% of term and 80% of preterm newborns
physiologic jaundice
early-onset breastfeeding jaundice is primarily due to ____
insufficient fluid intake
what is the intervention for early-onset breastfeeding jaundice?
Help parent with breastfeeding and increasing infant intake
which type of jaundice can last 3 weeks to 3 months?
late-onset breastfeeding jaundice
what is the treatment for late-onset breastfeeding jaundice?
(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
name the 6 things that make up human breast milk
(1) carbohydrates
(2) proteins
(3) fat
(4) vitamins and minerals
(5) enzymes
(6) immune boost
____ usually appears within 24 hours of birth and is NOT normal
pathologic jaundice
the typical onset of physiologic jaundice is
2-4 days after birth
the typical onset of early-onset breastfeeding jaundice is
first few weeks after birth
the typical onset of late-onset breastfeeding jaundice is
3-5 days after birth
name at least 3 causes of pathologic jaundice
(1) sepsis
(2) blood incompatibilities
(3) metabolic disorders
(4) increased hemolysis or RBCs
___ is double-digit bilirubin that does not resolve
hyperbilirubinemia
how do you diagnose hyperbilirubinemia?
(1) physical exam
(2) TSB
how do you treat hyperbilirubinemia?
(1) home lights / bili blankets
(2) phototherapy (if significant bili levels)
(3) NICU - exchanged transfusion
why is vitamin K injection (IM) given 1 hr after birth?
hemorrhage prevention b/c newborns lack the intestinal flora necessary to produce vitamin K,
why is meconium formed in utero?
b/c intestines are not absorbing nutrients yet
meconium is usually first passed within ___ hours of birth
12
which type of stool is described as mushy, yellow, gold, “sweet”
breastfed stool
what is the normal amount of stool for an infant?
3 or more per day until 6 weeks of age
most babies void within ___ (timing) of birth
24 hours
within 24 hours / before discharge, what 3 things should happen for the newborn?
(1) complete physical exam
(2) nutritional status and ability to feed
(3) complete screenings
what nursing interventions should be completed in the “golden hour” / period of reactivity? (5)
(1) initial assessment, APGARs
(2) eye-to-eye and skin-to-skin
(3) initiate first feedings
(4) vitamin K injection
(5) erythromycin ointment
the purpose of ___ is to evaluate the need for intervention post-birth
APGAR
an APGAR score of ___ requires intervention
<7
the nursing interventions that should occur in the first 1-4 hours after birth include (9):
(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!
why do we care about gestational age and infant size?
SGA and LGA can be risk factors for other complications
which exam looks at external and neurologic characteristics?
Ballard Exam
infant should receive ___ vaccines by 15 months
22
what is the typical timing of well-checks for an infant?
(1) 2 weeks
(2) 2, 4, and 6 months
(3) 12 months
(4) 15 or 18 months
when we look at a growth chart, we are looking for what for infants?
proportionate growth between height and weight
being fearful / shy of strangers typically occurs at
9 months
becoming more mobile and pulling up to stand typically occur at ___
12 months
what are the 5 Rs to promoting brain growth?
(1) Read together
(2) Rhyme (play, talk, sing)
(3) Routines
(4) Reward
(5) Relationships
when can you start to introduce solid foods to an infant?
6-9 months
from 0-6 months, what are the nutritional guidelines?
(1) breast or formula exclusively
(2) no free water
(3) vitamin D
(4) caregiver arms
name at least 3 characteristics of safe sleep
(1) back is best
(2) firm surface
(3) swaddle
(4) no blankets, toys, etc.
(5) co-room until 6 months
(6) no co-bedding
the 4 main safety risks for infants are:
(1) falls
(2) CO and smoke detectors
(3) ingestions
(4) car seats
car seats should be rear facing if infant is…
<2 years or under 20 lbs
periods when toddlers don’t feel hungry is called ___
physiologic anorexia
sphincter control develops at ___
18 months
for potty training, which typically occurs first - bowel or bladder?
bowel (then bladder)
when is a toddler ready for potty training?
(1) dry >2 hours
(2) intolerant of soiled diapers
(3) awareness
___ language is higher than expressive language in toddlers
receptive
“how” “why” ; animism; and magical thinking are characteristic of
pre-schoolers
days or spells where kids don’t eat well are ___
food jags
full set of primary baby teeth emerge by what age?
age 4
give the 5th dose of Dtap at age ___
4-6 years
Oral polio should be given at ___
4-6 years
normal newborn pulse is
120-160 bpm
normal newborn respirations are
30-60 per minute
normal newborn temps are
97.5-99
___ are changes within a few days to a week after birth
molding
an area of localized edema usually over the vertex from pressure on mother’s cervix during labor
caput succendaneum
an accumulation of blood under the scalp caused by pressure during birth
cephalohematoma
A small amount of vaginal bleeding from the sudden withdrawal of the maternal hormones
pseudomenstruation
___ will be enlarged and darker in newborn females
labia majora
___ may be dark brown in newborn males
scrotum
a collection of fluid around one or both testes, usually resolves if present
hydrocele
undescended testis; can occur on one or both sides; likely will descend by 6 months of age
cryptorchidism
abnormally located urethral meatus on the underside of the penis or on the perineum
hypospadias
urethral meatus on the upper side of the penis
epispadias
subsequent daily care for a newborn in the hospital includes (8):
(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
don’t go more than ___ without feeding an infant
3-4 hours
name at least 3 ways to awaken an infant
(1) dress or undress
(2) change diaper
(3) talk
(4) increase skin contact
(5) hand-express milk
(6) stimulate rooting reflex
name the 5 S’s of quieting an infant
(1) Swaddling
(2) Side/Stomach position
(3) Shushing
(4) Swinging
(5) Sucking
name 2 things about cord care
(1) keep clean and dry
(2) keep diapers from irritating the cord
when is the cord clamp removed?
~24 hours after birth
when does the cord fall off?
10-14 days
T/F: Cord will become brownish black
T
What should you check daily on the umbilical cord?
(1) odor
(2) oozing
(3) reddened areas
what should you NOT do with uncircumcised infants?
do NOT attempt to retract the foreskin b/c it is adherent to the glans for 3-6 years
name at least 3 s/s of respiratory distress in a newborn
(1) grunting
(2) tachypnea
(3) retractions
(4) cyanosis
(5) asymmetrical chest expansion
3 ways to prevent respiratory problems in newborns include
(1) use of bulb syringe
(2) proper positioning
(3) safe sleep
name at least 3 signs of illness in newborns / infants
(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
4 common problems in newborns include
(1) thermoregulation
(2) hyperbilirubinemia
(3) hypoglycemia
(4) overstimulation
name at least 4 risk factors for hypoglycemia
(1) preterm and post-term
(2) SGA, LGA
(3) IUGR
(4) maternal gestational diabetes
(5) cold stress
name at least 4 s/s of hypoglycemia
(1) jitteriness
(2) poor muscle tone
(3) poor feeding
(4) tachycardia / tachypnea
(5) apnea
(6) irritability
(7) lethargy
when do we start to worry about an infant with hypoglycemia?
When blood glucose is <40 mg/dL
in NAS, babies are not addicted, they are ___
dependent
name at least 4 s/s of NAS
(1) high-pitched cry
(2) fussiness
(3) jittery, hyper-reactive
(4) poor feeding
(5) blotchy, mottled
(6) uncoordinated suck / swallow
(7) diarrhea
the two NAS assessments are
FNASS and ESC
the medication treatments for NAS are
(1) methadone or morphine
(2) benzodiazepines
(3) phenobarbital
name at least 3 non-pharm treatments for NAS
(1) co-rooming
(2) skin-to-skin
(3) swaddle
(4) low lights
(5) early feeds
(6) soothing
(7) limiting visitors
name at least 4 risk factors for sepsis in newborns
(1) poor HH
(2) birthing person with PROM
(3) birthing person positive for GBS
(4) SGA
(5) prematurity
(6) meconium aspiration
the 3 key s/s of sepsis in newborns are
(1) increased HR
(2) respiratory distress
(3) abdominal distention
the key nursing interventions for sepsis in newborns are
(1) HH
(2) education
(3) monitoring
(4) labs
(5) abx
(6) prepare for increased support
preterm babies are at increased risk for what 4 common issues?
(1) hyperbilirubinemia
(2) thermoregulation issues
(3) hypoglycemia
(4) sepsis
preterm babies are at increased risk for more serious issues, such as:
(1) Respiratory distress syndrome
(2) pulmonary HTN
(3) retinopathy
(4) necrotizing enterocolitis
(5) intraventricular hemorrhage
(6) bronchopulmonary dysplasia (BPD)
the 3 leading causes of death in infants are
(1) congenital malformations
(2) disorders r/t SGA & LBW
(3) SIDS
the 3 leading causes of death in 1-4 year olds are
(1) accidents
(2) congenital malformations
(3) assault
the 3 leading causes of death in 5-9 year olds are
(1) accidents
(2) cancer
(3) congenital malformations
the 3 leading causes of death in 10-14 year olds are
(1) accidents
(2) cancer
(3) suicide
the 3 leading causes of death in adolescents are
(1) accidents
(2) homicide
(3) suicide
what is the role of the pediatric nurse? (4)
(1) first point of contact
(2) more contact with pt than any other
(3) holistic perspective
(4) influence health through genuine partnership
one of the most important things about being a pediatric nurse is facilitating _____ communication
developmentally-appropriate
we want to strive for ____ care as a pediatric nurse
atraumatic
what are 3 principles that support atraumatic care?
(1) minimize family separation
(2) promote a sense of control
(3) minimize bodily harm
*name the 4 principles of family-centered care
(1) dignity and respect
(2) information sharing
(3) support participation
(4) collaborate
who is at risk for impaired health literacy?
(1) adults >65 yo
(2) marginalized groups
(3) non-native speakers of English
(4) people with income < poverty level
name at least 3 interventions to improve health literacy
(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
3 key influencers on a child’s response to illness are
(1) age
(2) developmental age
(3) parents’ reaction / coping
a child’s response to illness can be informed by
(1) separation anxiety
(2) fear of pain or bodily harm
(3) fear of the unknown
(4) uncertain expectations / rules
(5) loss of control
the child response to illness may result in…
(1) anxiety / fear
(2) anger
(3) guilt
(4) regression
___ is the main stressor for infants and toddlers from 6-30 months
separation anxiety
the infant / toddler typically passes through 3 stages of separation anxiety:
(1) protest
(2) despair
(3) detachment
crying, agitation, and inconsolability are signs of ___ of separation anxiety
protest
withdrawn, quiet, or hopeless are signs of ____
despair
forming attachment to other caregivers, ignoring or “punishing” parents are signs of
detachment
pre-schoolers in the hospital typically fear ____
mutilation
do not do noxious things to a child in ___ (location)
their bed
4 key nursing interventions for pre-schoolers are
(1) establish routines
(2) prepare and explain
(3) provide realistic choices
(4) play
____ and ___ are the main concerns of school-aged children
rules, loss of control
name at least 3 things nurses can do to support school-aged children
(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.)
adolescents are most focused on ___ and ___
self, identity
name at least 3 nursing interventions for adolescents
(1) respect privacy
(2) confidentiality limits
(3) seek their perspective
(4) engage patient in decision-making
(5) encourage socialization
____ is figuring out how to affirm an experience and adjust it to see the benefits
positive reframing
___ is a child’s work
play
name at least 3 things siblings may experience while the patient is in the hospital
(1) confusion
(2) fear / anxiety
(3) guilt
(4) resentment / jealousy
(5) insecurity
(6) loss of routines
___ should only be used a last resort on children
restraints
most often, falls happen when ____
parents are in the room
____ is the provider’s responsibility; nurse can witness and advocate
informed consent
___ is used for routine procedures like med administration
general consent
___ is customary to obtain agreement with the child if they are over 5 yo
assent
most ___ require a provider’s order
restraints
secure restraint ties to ___, not the mattress or rails
bed frames
what symptoms should you assess for with NG/NJ and G tubes? (5)
(1) respiratory distress
(2) cyanosis
(3) abdominal distention
(4) vomiting
(5) measure changes
what is one of the biggest dangers of NG tubes?
becoming dislodged and ending up in wrong space
which types of O2 administration are common for children?
(1) cannula
(2) face mask
what is the IDEAL model for discharge stand for?
(1) Include
(2) Discuss
(3) Educate
(4) Assess
(5) Listen
what is the main difference in pediatric medication administration?
typically dosed by weight
why are peds medications dosed by weight?
(1) very small margin of safety
(2) absorbed and metabolized differently based on age
name at least 3 s/s of infant dehydration
(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
signs of mild dehydration include:
(1) normal skin, mucosa, and eyes
(2) consolable
(3) normal pulse and cap refill
(4) flat fontanelle
signs of moderate dehydration include:
(1) tenting skin
(2) dry mucosa
(3) deep set eyes
(4) irritable
(5) soft fontanelle
signs of severe dehydration include
(1) clammy skin
(2) parched mucosa
(3) sunken eyes
(4) lethargic
(5) sunken fontanelle
(6) increased, weakened pulse
(7) cap refill >3 seconds
what is the Holliday-Segar 4-2-1 Rule used for?
to estimate maintenance hourly fluid requirements
the most important thing about fluid administration for infants is…
to make sure the fluid order is reasonable based on their size
when completing a pediatric health history, 3 key things to asses in the past medical history are:
(1) prenatal history
(2) birth history
(3) developmental history
when assess pediatric current status, focus on what 4 things?
(1) nutrition
(2) elimination
(3) sleep
(4) school / daycare
what should you assess for in a peds family assessment?
(1) caregiving arrangement
(2) family coping / strengths / challenges
when gathering RR and HR data on a pediatric patient, how long should you assess?
a full minute
wait until a child is ___ yo before taking BP (unless in the hospital)
3
3 ways to take a peds temperature are
(1) axillary
(2) tympanic
(3) temporal
(4) rectal (bonus)
measure patient length until about what age?
2-3 years
measure patient head circumference until about what age?
2 years
the ___ of the fontanelle closes around 3 months
posterior
the ___ of the fontanelle closes between 1 year and 18 months
anterior
bulging fontanelle can indicate ___
ICP
sunken fontanelle can indicate ____
dehydration
children can have tonsillar and adenoid tissue issues because…
children have large tonsils for the size of their bodies
the 5 locations of the cardiac exam should include
Apical
Pulmonic
Erb’s
Tricuspid
Mitral
normal bowel sounds in a peds patient are
5-30 per minute
Tanner staging is used to assess ___
genitals
3 things to do when assessing peds genitals include:
(1) have parents present
(2) obtain permission
(3) use correct anatomical terms
____ is tibial torsion and metatarsus adduction
in-toeing
bowleg is typically seen at what age?
12 months
knock-knee / genu valgus can be seen at
3-4 years
the 3 types of breath sounds are
(1) bronchial / upper
(2) bronchovesicular / central
(3) vesicular / peripheral
breath sounds are loudest in the ____ and softest in the ____
bronchial; vesicular
high-pitched crowing; indicates obstruction
stridor
high or low-pitched rumbling sound from fluid or mucus, clear with coughing
wheezing
sharp, high-pitched or bubbly sounds on inspiration; indicates small airway collapse or presence of fluid
crackles
dry-gating or rubbing sound from inflammation
pleural rub
crackling over SQ tissues from air leak
crepitus
attempts to splint airway open
grunting
what are the 5 main airway differences in peds?
(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
the airway continues to grow in ____, but NOT diameter until age 5
length
there are more hospitalizations for respiratory in kids because
the airways are longer but not wider / bigger
pediatric lungs don’t resemble adult lungs until
age 8
why are infants obligatory nose breathers?
because they need to suck and swallow their food
eustachian tubes are relatively horizontal in ____
infants and young children
T/F: Brief periods of apnea are common in infants
T
early signs of respiratory distress include (8)
(1) retractions
(2) nasal flaring
(3) rapid breathing
(4) shallow breathing
(5) diaphoresis
(6) asynchronous movement
(7) grunting or noisy breathing
(8) increased HR
late signs of respiratory distress include (5)
(1) bradycardia
(2) apnea / slow respirations
(3) cyanosis
(4) decreased responsiveness
(5) loss of consciousness / coma
____ arrest typically occurs before cardiac arrest in children
respiratory
what are s/s of a child with a foreign body in the airways?
(1) dysphagia
(2) odynophagia
(3) coughing, stridor, or hoarseness
(4) dysphonia
poor swallow
dysphagia
painful swallow
odynophagia
trouble talking
dysphonia
all foreign bodies in the __ are medical emergencies
pharynx
infection or fluid creating blockage in the middle ear is ___
otitis media
occurs suddenly and is associated with other signs of illness (infection)
acute otitis media (AOM)
fluid behind the tympanic membrane without signs of infection; often follows an episode of AOM and resolves in 1-3 months
otitis media with effusion (OME)
symptom relief for otitis media includes
(1) pain relief
(2) antihistamines
earache, pulling on ears, irritability, bulging tympanic membrane, and yellowish drainage are all s/s of
acute otitis media (AOM)
how do you treat AOM?
(1) pain medication
(2) antibiotics if not clear in 48-72 hours
(3) tube placement if persistent
tinnitus, hearing loss, mild balance disturbances, retracted tympanic membrane, and fluid or air bubbles are s/s of
OM with effusion
what is the criteria for tube placement for AOM?
(1) occurs within 1 month
(2) >3x / 6 months of >4x/year
how do you treat OM with effusion?
(1) tube placement if persistent
(2) typically falls out within 6-12 months
we use ___ and ___ to treat bacterial tonsillitis
antibiotics; supportive care
we use ___ and ___ to treat viral tonsillitis
salt water gurgle; supportive care
we use ___ to treat persistent tonsillitis
surgical removal
the most common surgery in children is
tonsillectomy / adenoidectomy
name the 3 post-op interventions after a tonsillectomy
(1) don’t dislodge anything
(2) keep well-hydrated
(3) pain management
the two types of pharyngitis are
nasal common cold and streptococcal
how do you treat nasal common cold?
(1) fluids
(2) rest
(3) antipyretics
(4) cool mist humidifier
(5) cough suppressants
how do you treat streptococcal?
(1) penicillin (family)
(2) antipyretics
(3) pain medication
the 3 main types of croup are
viral, spasmodic, and bacterial
the key s/s of croup are
(1) barky cough
(2) stridor
(3) hoarse voice
how do you treat spasmodic croup?
at home -
(1) calm approach
(2) fluids
(3) cool mist or night air
how do you treat viral croup?
(1) at home - steroids, fluid, rest, antipyretics
(2) racemic epi
(3) O2
(4) IV fluids
which type of croup is a medical emergency?
bacterial
what are the 4 D’s of bacterial croup / epiglottitis?
(1) drooling
(2) dysphagia
(3) dysphonia
(4) distressed inspirations
the cardinal s/s of epiglottitis are
Airway inflammation
Increased Pulse
Restlessness
Retractions
Anxiety
Inspiratory stridor
Drooling
what should you NOT do with epiglottitis?
(1) leave child unattended
(2) examine throat / attempt culture
(3) attempt to give anything PO
5 things you should do during epiglottitis are
(1) upright positioning
(2) secure airway
(3) humidified O2
(4) IV fluids, abx, antipyretics
(5) manage anxiety
inflammation of the main bronchi
bronchitis
name the 3 s/s of bronchitis
(1) dry, rattly cough
(2) wheezing
(3) general malaise
the treatment for bronchitis is ___ and ___
symptom management; cough suppressants
____ is the most common cause of hospitalization in infants
bronchiolitis
name at least 3 s/s of bronchiolitis
(1) tachycardia
(2) tachypnea
(3) wheezing, crackles, rhonchi
(4) retractions and nasal flaring
(5) decreased intake
(6) cyanosis
too much __ can lead to more secretions
suctioning
do not treat ___ with antibiotics
bronchiolitis (it is viral)
accumulation of fluid, cells, or pus is ____
pneumonia
___ pneumonia is most common in ages <3 years
viral
___ pneumonia is most common in ages >5 years
bacterial
sudden high fever and elevated WBC is characteristic of ___ pneumonia
bacterial
the 3 stages of pertussis are:
(1) catarrhal (1-2 weeks)
(2) paroxysmal (2-6 weeks)
(3) convalescent (1-2 weeks)
the 3 s/s of catarrhal stage of pertussis are
(1) mild cough
(2) runny nose
(3) low-grade fever
persistent cough, vomiting, drooling, tongue protrusion, and cyanosis are s/s of ____ stage of pertussis
paroxysmal
you are HIGHLY contagious at what stage of pertussis?
paroxysmal
episodic cough, whooping, and vomiting describes which stage of pertussis?
convalescent
describe the treatment for pertussis
(1) supportive care
(2) antibiotics - erythromycin
(3) droplet precautions
(4) hospitalization for younger children for IV fluids, O2, airway support
how do you prevent pertussis?
Dtap (<7 yo)
Tdap (>7 yo)
5 doses at 2, 4, 6, and 15-18 months; 4-6 years
___ requires radiographic evidence and positive mantoux
tuberculosis
___ is a progressive autosomal recessive disorder
cystic fibrosis
___ is characterized by an abnormal accumulation of thick mucus in lungs and other organs
cystic fibrosis
the other organs involved in cystic fibrosis include
(1) sinuses
(2) skin
(3) liver
(4) pancreas
(5) intestines
(6) reproductive organs
___% of CF is diagnosed by age 2
75%
___ is the earliest indication of CF
meconium ileus
name a few key s/s of CF
(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
the gold standard for diagnosing CF is
the sweat chloride test
diagnostic criteria for CF is
- Cl level >40 for infants <3 months
- Cl level >60 for all other ages
- Na >90
long-term treatment of CF is ___
lung transplant
mean survival after a lung transplant for CF is
9.5 years
___ and ___ are two forms of chest physiotherapy
vibrating vest; postural drainage
3 long-term effects of CF are
(1) colon cancer
(2) fertility issues
(3) mental health issues
____ is a reversible obstructive airway disease
asthma
___ is the leading chronic disease in children in the US
asthma
which sex is more affected by asthma in children?
males
45% of children with asthma experience ___ episode/year
at least 1 acute
name at least 4 asthma triggers
(1) environmental (dust, pollen, pet)
(2) exercise
(3) food allergies
(4) stress
(5) smoke, chemicals, smog
(6) acute illness
(7) respiratory infections
nursing care for asthma includes:
(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
which activity in the asthma action plan typically has the lowest compliance?
measuring peak flow
asthma action plan should include:
(1) measuring peak flow
(2) medications
(3) triggers
what are the long-term controller meds for asthma?
(1) inhaled corticosteroids
(2) leukotriene modifiers
(3) combination inhalers
(4) theophylline
Flovent and Pulmicort are examples of
inhaled corticosteroids
the most common long-term controller for asthma is
inhaled corticosteroids
Singulair and Zyflo are examples of ____
leukotriene modifiers
Advair, Dulera, and Symbicort are examples of
Combination inhalers
which asthma med is a daily pill?
theophylline
name the 3 types of rescue meds for asthma
(1) SABAs (albuterol)
(2) anticholinergics (ipratropium, atrovent)
(3) corticosteroids (prednisone, methylprednisolone)
____ should only be for short-term use
corticosteroids
name at least 4 symptoms of asthma that indicate emergency management
(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
the 3 main components of the immune system are ___, ____, and ___
antibodies, WBC, and lymphoid tissues
IgA is found in the ___ and ___
GI tract and mucus membranes
80% of circulating immunoglobulins are ___
IgG
which type of immunoglobulin can we give exogenously?
IgG
____ gives us an early immune response after the age of 9 months
IgM
___ possibly influences B cells (immunoglobulin)
IgD
which immunoglobulin is responsible for the allergic response?
IgE
in the primary immune response, antibodies react to antigens within ___ days
3
T/F: You get better at fighting off infection as you get older
T
____ is when the body makes antibodies in response to antigens through exposure or immunizations
active immunity
name the 4 common signs of immunodeficiency in children
(1) recurrent or persistent infections
(2) opportunistic infections
(3) severe bacterial infections
(4) poor response to treatment
less common signs of immunodeficiency in children include (5)
(1) failure to thrive
(2) skin lesions
(3) chronic diarrhea
(4) enlarged spleen / underdev lymph nodes & tonsils
(5) decreased blood count
what percent of cases of HIV are contracted perinatally in the US?
91%
what is the treatment for HIV?
lifelong antivirals aimed to reduce viral load
____ is an autoimmune disease that is more common in females and onset is typically around puberty
systemic lupus erythematosus (SLE)
the most common symptoms of SLE are ___ and ___
rash and arthritis
long-term effects of lupus include (4)
(1) delayed puberty
(2) increased pain
(3) altered image
(4) decreased bone density
we treat SLE with ___, ___, and ____
steroids, anti-inflammatories, and immunosuppressants
two key nursing considerations for someone with SLE are ___ and ___
comfort and emotional support
____ is an autoimmune disease that affects the synovial joints and erodes bone and cartilage
juvenile idiopathic arthritis (JIA)
___ is 3x more common in girls
JIA
what is the diagnostic criteria for JIA?
(1) <16 yo
(2) swelling in at least 1 joint for >6 weeks and
(3) 2 or more of - decreased ROM, pain, warmth
the 2 main medications to treat JIA are
NSAIDs, Methotrexate
3 long-term results of chronic stress response include:
(1) HTN
(2) coronary artery and heart disease
(3) poor immune function
the PSNS will shut down ___
cortisol
___ is excess fluid in the ventricle in the brain
hydrocephalus
what are the 3 types of hydrocephalus?
(1) congenital
(2) acquired
(3) infectious
we manage acquired and infectious hydrocephalus with
medications
if hydrocephalus is congenital or long-term, we use ___ or ___ for treatment
external ventricular drain (EVD) or shunts
the #1 concern when caring for a patient with hydrocephalus is
infection control
name at least 4 s/s of increased ICP in infants
(1) high-pitched cry
(2) bulging fontanelles
(3) increased head circumference
(4) distended scalp veins
(5) bradycardia
(6) respiratory changes
name at least 4 s/s of increased ICP in children
(1) irritability
(2) headache
(3) vomiting
(4) diplopia
(5) seizures
(6) bradycardia
(7) respiratory changes
the 3 ways to diagnose meningitis are
(1) Brudizinski’s sign
(2) Kernig’s sign
(3) Lumbar Puncture (LP)
What is Brudizinski’s sign?
if you lift their head, the knees come up to relieve the pressure
What is Kernig’s sign?
lay the patient flat; if you extend their knees up, it is painful
in viral meningitis, the LP results will be:
(1) clear
(2) normal glucose and protein
(3) gram negative stain
in bacterial meningitis, the LP results will be:
(1) cloudy
(2) elevated glucose and protein
(3) gram positive stain
name the nursing considerations for meningitis
(1) monitor for signs of increased ICP
(2) spinal headache
(3) seizure precautions
(4) comfort measures
(5) calm, cool, dark room
for viral meningitis, we give ___ and ___
fluids and supportive care
for bacterial meningitis, we give ___, ___, and ___
antibiotics, steroids, nitrous oxide
name a few indications that we should be concerned about a head injury
(1) loss of consciousness or confusion
(2) bleeding does not stop
(3) vomiting
(4) seizures
(5) slurred speech or blurred vision
(6) inconsistent report
the most common cause of concussion in children is
sports
the treatment for concussion is
(1) rest
(2) low light
(3) “brain rest” - no screens
(4) gradual return to school
(5) no activity until symptom-free
the three types of headache are
(1) tension
(2) migraine
(3) cluster
which headache is typically one-sided?
migraine
which headache typically had the same pattern, is repetitive, and associated with females and hormone changes?
cluster headaches
sometimes we give O2 for ____ headaches
cluster
headaches and head injury should cause concern if we see s/s of ___
increased ICP
a few headache s/s that lead to reason for concern include
(1) unusually severe
(2) vomiting
(3) weakness / balance issues
(4) fever / stiff neck
seizures that impact one area of the brain are ___
focal
seizures that impact the entire brain are ___
generalized
what is the diagnostic criteria for epilepsy?
(1) 2 unprovoked seizures at least 24 hours apart
(2) followed by 1 seizures within 10 years
name at least 3 risk factors for seizure disorder
(1) fever
(2) tumors
(3) infections
(4) toxins, drugs
(5) head injury
what are the 6 types of seizures?
(1) clonic (grand mal)
(2) absence (petit mal)
(3) myoclonic
(4) atonic
(5) partial
(6) infantile spasms
the 3 phases of clonic seizures are
(1) tonic
(2) clonic
(3) post ictal
LOC, eye roll, back arch, lasting 10-30 seconds
tonic portion of clonic / grand mal
violent jerking, lasting 30-50 seconds
clonic portion of clonic / grand mal
sleepy and confused for 30-60 minutes
post ictal portion of clonic / grand mal
staring seizure; onset between 4-12 years, generally gone by adolescence
absence
___ seizures are localized to one muscle group
myoclonic
which seizure type is the drop attack?
atonic
___ seizures are localized and may just be tingling or eye aversion
partial
frequent seizures that can interrupt growth and are part of West Syndrome
infantile spasms
name at least 3 nursing considerations for seizure disorders
(1) padded side rails
(2) fall precautions
(3) helmets
(4) O2 available
(5) side-lying position
___ can open the skull and lay a grid to activate different parts of the brain
neuromapping
___ stimulation is a treatment option for seizures
vagal nerve
rescue meds for seizures are
(1) rectal valium
(2) sublingual ativan
always start seizure meds _____
low and titrate up slowly
neural tube defect where the spinal cord fails to close properly
spina bifida
the ___ the lesion, the greater the impairment in spina bifida
higher
name at least 3 nursing considerations for patients with spina bifida
(1) elimination issues
(2) risk for infection
(3) immobility
(4) risk for impaired skin integrity
(5) nutrition
when the spinal cord is protruding through the pouch in the back
meningocele
____ is NOT a progressive neurologic disorder and can look very different for each individual
cerebral palsy
cerebral palsy may include
(1) seizures
(2) vision, hearing, or speech impairments
(3) cognitive impairment
(4) motor impairment
(5) spasticity or weakness
what are the 3 types of cerebral palsy?
spastic, dyskinetic, and ataxic
high tone cerebral palsy is ___
spastic
jerking or twisting movements in cerebral palsy is which type?
dyskinetic
wide gait and lack of coordination can be seen in which type of cerebral palsy?
ataxic
baclofen pump, botox, and tendon lightening can be used to treat
spastic cerebral palsy
the most common fracture site in children is
distal forearm
fractures in infant warrant ___
investigation
bone healing in neonatal period takes ___
2-3 weeks
bone healing in early childhood takes ___
4 weeks
bone healing in later childhood takes ____
6-8 weeks
bone healing in adolescence takes ___
8-12 weeks
what are the components of the neurovascular assessment? (6)
(1) skin color
(2) cap refill time
(3) temperature
(4) sensation
(5) movement of digits
(6) pulse distal to the site
what are the 6 Ps for assessing fractures?
Pain
Pallor
Pulseless
Poikilothermia
Paresthesia
Paralysis
if all 5 Ps are present after immobilization we worry about ____
compartment syndrome
___ is a medical emergency characterized by bleeding / swelling into the tissue
compartment syndrome
poikilothermia
coolness
name s/s of compartment syndrome
pain
pallor
poikilothermia
paresthesia
pulselessness
paralysis
what do we do in the case of compartment syndrome?
(1) take off cast
(2) fasciotomy to relieve pressure
___ is a post-viral syndrome where the muscles become inflamed and achy
acute viral myositis
acute viral myositis can cause ___ damage
renal
administer fluids in acute viral myositis to ____
flush out the myoglobin
___ is rare in children and typically occurs after an injury, overuse, or a burn
rhabdomyolysis
dark or tea-colored urine may be an indication of ___
rhabdomyolysis
___ may require dialysis or CRRT
rhabdomyolysis
___ is an infectious process in the bone that can be caused from exogenous or hematogenous sources
osteomyelitis
the most common causative organism of osteomyelitis is ___
staph aureus
we diagnose osteomyelitis with ___
a bone scan
treatment for osteomyelitis is
(1) prompt, vigorous IV antibiotics for up to 3-4 weeks
(2) monitor renal, hepatic, and hematologic responses
the #1 pain management option for osteomyelitis is
NSAIDs
it is important to monitor renal function in osteomyelitis because
the pt is typically taking long-term antibiotics and NSAIDs
___ may be corrected with exercises / stretching or casting / splinting
club feet
the goal of club feet is
correction before the child starts to walk
___ is a genetic disorder that results in frequent fractures and limb deformities
osteogenesis imperfecta
___ can affect other cartilage, such as eyes, ears, and heart
osteogenesis imperfecta
___ is dwarfism
achondroplasia
people with achondroplasia are at increased risk for (4)
(1) obesity
(2) hydrocephalus
(3) skeletal issues
(4) bowed legs
unpleasant sensory and emotional experience associated with actual or potential tissue damage
pain
___ is the part of the brain that puts meaning to pain
cerebral cortex
name the 8 myths of pain
(1) infants don’t feel pain
(2) children have no memory of pain
(3) quicker recovery
(4) sleep means no pain
(5) parents over-report
(6) builds tolerance and character
(7) children will report pain
(8) higher risk of addiction
short-term consequences of pain include
(1) delayed healing
(2) increased morbidity and mortality
(3) anxiety, stress, fear
long-term consequences of pain include
(1) emotional trauma
(2) pain hypersensitivity
(3) avoidance of healthcare
(4) neurologic changes
(5) needle phobia
the 3 goals of pain management are
(1) relieve or reduce pain
(2) improve function
(3) minimize side effects
___ are the best source of comfort when managing pain
parents
name at least 3 influences on pain
(1) past experience
(2) age
(3) stress
(4) cultural beliefs
(5) coping tools
(6) parents coping
the gold standard for pain assessment is
self-reported
kids as young as ___ can self-report pain
4 yo
if the patient is sedated we look at what to assess pain?
(1) HR 20% change
(2) BP 20% change
(3) facial pallor / redness
(4) tears
treat the patient, not the ___
number
the 4 components of a comprehensive pain assessment are
(1) use of a validated pain scale
(2) direct observation by the nurse
(3) parent report / context
(4) reason for pain
a weak opioid is
tramadol
a strong opioid is
morphine and hydromorphone (dilaudid)
___ is not a first-line pain drug
dilaudid
___ is good for procedural pain
fentanyl
non-medicine interventions should be ____, not instead of medication
in addition to
what are the 4 simple steps to needle pain?
(1) numb the skin
(2) sucrose or breastfeeding
(3) comfort positioning
(4) distraction
before needle procedures, give ____ 30 minutes prior and ____ 2 minutes prior
lidocaine; sucrose
___ peaks after 72 hours, responds to pain medication, and resolves as tissue heals
acute pain
___ lasts or recurs over months, opioids are contraindicated, and persists past healing time
chronic pain
the 3 common characteristics of persistent pain in children are
(1) headaches
(2) abdominal pain
(3) MSK pain
___ is a disorder of the CNS including faulty ascending signals and weak modulation
persistent pain
T/F: In persistent pain, you need to ignore the pain and do normal activities to reboot your pain system
T
which immunoglobulin is passed through breast milk?
IgA
lymphoid tissue does not fully develop until age ___
6 years
in the primary immune response, antibodies react to antigens within ____
3 days
in the secondary immune response, antibodies react to antigens within ___
24 hours
0-3 for APGAR score is
critical
4-6 for APGAR score is
below normal
_____ APGAR scores is normal
7 and above
newborn glucose should be
> or = 40 mg/dL
hyperbilirubinemia risk factors
maternal diabetes
breastfeeding
hematomas
Rh incompatibility
hypoglycemia risk factors
LGA
SGA
maternal diabetes
preterm / post-term
hypothermia
birth trauma
IUGR
hyperbilirubinemia s/s
yellow sclera and skin
poor feeding
hypothermia
hypoglycemia
lethargy
