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Pediatric Nursing > Exam 2 (Chapters 10-13, 19-21, 23) > Flashcards

Exam 2 (Chapters 10-13, 19-21, 23) Flashcards

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1
Q

Significant Stressors for Hospitalized Children

A

Separation from parents

Loss of self-control, autonomy, and privacy

Painful and/or invasive procedures

Fear of bodily injury and disfigurement

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2
Q

Infant Hospitalization Stressors

A

Separation anxiety (biggest one)

Stranger anxiety

Painful, invasive procedures

Immobilization

Sleep deprivation, sensory overload

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3
Q

Infant Responses to Hospitalization

A

Sleep-wake cycle is disrupted

Feeding routines disrupted

Displays excessive irritability

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4
Q

Toddler Hospitalization Stressors

A

Separation anxiety

Loss of self-control

Immobilization

Painful, invasive procedures

Bodily injury or mutilation

Fear of the dark

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5
Q

Toddler Responses to Hospitalization

A

Cries if the parent leaves the bedside

Frightened if forced to lay supine

Wonders why parents do not come to the rescue

Associates pain with punishment

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6
Q

Preschooler Hospitalization Stressors

A

Separation anxiety and fear of abandonment

Loss of self-control

Bodily injury or mutilation

Painful, invasive procedures

Fear of the dark and monsters

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7
Q

Preschooler Responses to Hospitalization

A

Displays difficulty separating reality from fantasy

Fears ghosts and monsters

Fears body parts will leak out when skin is not intact

Fears that tubes are permanent

Demonstrates withdrawal, projection, aggression, and regression

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8
Q

School-Age Child Hospitalization Stressors

A

Loss of control

Loss of privacy and control over bodily functions

Bodily injury

Separation from family and friends

Painful, invasive procedures

Fear of death

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9
Q

School-Age Child Responses to Hospitalization

A

Displays increased sensitivity to the environment

Demonstrates detailed recall of events to self and other patients

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10
Q

Adolescent Hospitalization Stressors

A

Loss of control

Fear of altered body image, disfigurement, disability, and death

Separation from peer group

Loss of privacy and identity

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11
Q

Adolescent Responses to Hospitalization

A

Displays denial, regression, withdrawal, intellectualization, projection, and displacement

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12
Q

Assisting Infant Through Procedure

A

Before: explain procedure, allow parents option of being there, let parents have contact

During: nursing staff should immobilize infant, perform procedure quickly, ask parents to have contact after procedure

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13
Q

Assisting Toddler Through Procedure

A

Before: give explanations of procedure and say toddler did nothing wrong

During: perform in treatment room, give short explanations and directions, immobilize toddler, allow child to cry

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14
Q

Assisting Preschooler Through Procedure

A

Before: give simple explanations, allow child to touch equipment

During: perform in treatment room, give short explanations, allow child to cry, encourage drawing afterwards

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15
Q

Assisting School-Age Child Through Procedure

A

Before: give clear explanations, teach stress reduction techniques

During: be ready to immobilize child, explanations throughout, facilitate stress control techniques, give praise

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16
Q

Assisting Adolescent Through Procedure

A

Before: give explanations, teach stress reduction, explore fear of certain procedures

During: assist in self-control, explain expected outcome

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17
Q

Conditions Dependent on Medications or Special Diet

A

Diabetes mellitus, asthma, seizures, PKU, organ transplantation, CF, celiac disease

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18
Q

Conditions Dependent on Medical Technology

A

Renal failure, bronchiopulmonary dysplasia

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19
Q

Conditions that Require Increased Use of Healthcare Services

A

Cancer, sickle cell disease, CF

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20
Q

Conditions that Cause Functional Limitations

A

Down syndrome, brain injury, autism, myelodysplasia, cerebral palsy

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21
Q

Brain Death Criteria

A

Child must be unresponsive in an irreversible coma from a known cause and have absence of brainstem reflexes

Apnea testing must reveal hypercarbia

Must be confirmed that child does not have hypothermia, conditions, or medications that could contribute to brain death findings

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22
Q

Infants and Death

A

Sensorimotor: senses emotions of caregivers and altered routines, senses separation

Resists cuddling and eats less, may have feeding problems, cries excessively, sleeps more than usual

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23
Q

Toddlers and Death

A

Preoperational: no understanding of death, aware someone is missing, unable to distinguish death from temporary separation

Regresses to younger stage of development, clingy, whiny, irritable, problems with eating and sleeping, fearfulness

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24
Q

Preschoolers and Death

A

Preoperational: believes death is temporary, experiences magical thinking, confuses death with being away, has beginning experience with death of animals

Regression to earlier developmental stage, bowel/bladder control issues, tantrums, withdrawal from activities, fear of sleep, asks a lot of questions, abdominal pain

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25
Q

School-Aged Children and Death

A

Concrete Operations: understands what death is, knows it’s permanent, may have guilt or assume blame for death

Crying, moody, decreased concentration on schoolwork, psychosomatic complaints, may fear another loved one will die

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26
Q

Adolescents and Death

A

Formal Operations: understands death, sense of invincibility conflicts with fear of death, able to recognize effect of death on others

May have severe depression, may seek comfort from friends, eating/sleeping problems, may act-out, may assume responsibility

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27
Q

Infectious Conjunctivitis

A

Viral or bacterial

Viral: chlamydia, gonorrhea, herpes (can cause blindness)

Bacterial: staphylococcus, haemophilus, streptococcus, moraxella

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28
Q

Periorbital Cellulitis

A

Bacterial infection of the eyelid and surrounding tissue caused by streptococcus or staphylococcus

S/S: Swollen, tender, red/purple eyelids, restricted and painful movement of the eye, fever

Tx: IV antibiotics

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29
Q

Hyperopia

A

Farsightedness

All children have some degree until 9-10 years of age

Blurring only occurs with excessive hyperopia

Amblyopia can occur if treatment is not obtained

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30
Q

Myopia

A

Nearsightedness

Most commonly develops at about 8 years of age

Children may complain of headaches and squint to improve distance vision

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31
Q

Astigmatism

A

Child often holds pages very close to the face in order to obtain the best visual image

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32
Q

Strabismus

A

S/S include squinting and frowning when reading, closing one eye to see, having trouble picking up objects, dizziness, headache

Corneal light reflex and cover-uncover tests to confirm

Most common in children with cerebral palsy, hydrocephalus, Down syndrome, and seizure disorder

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33
Q

Amblyopia

A

Lazy eye

Caused by untreated strabismus, congenital cataracts, or uncorrected refractive errors

Tx: compensatory lenses, occlusion therapy, vision therapy, atropine drops

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34
Q

Retinopathy of Prematurity

A

Occurs when immature blood vessels of the retina constrict and become necrotic

May occur in infants of low birth weight or of short gestation

Associated with oxygen therapy

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35
Q

Otitis Media

A

Bulging tympanic membrane, air/fluid bubbles behind tympanic membrane, immobile/poorly mobile tympanic membrane, red tympanic membrane, reduced visibility

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36
Q

Otitis Media with Effusion

A

Tympanic membrane is retracted or neutral, immobile/partly mobile tympanic membrane

Difficulty hearing or responding as expected to sounds

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37
Q

Nasopharyngitis

A

URI causes inflammation and infection of the nose and throat and is a common illness in infancy and childhood

Red nasal mucosa with clear nasal discharge and an infected throat with enlarged tonsils

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38
Q

Sinusitis

A

Inflammation of one or more of the paranasal sinuses

History of URIs is common, persistent cough from postnasal drip

Malodorous breath, fever, mouth breathing, hyponasal speech, cervical lymphadenopathy

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39
Q

Pharyngitis

A

Infection that primarily affects the pharynx, including the tonsils

Major complaint is a sore throat

Minimal throat redness, exudate, mild lymphadenopathy, and low-grade fever are also common

40
Q

Tonsillitis

A

Infection or inflammation of the palatine tonsils

Frequent throat infections with breathing and swallowing difficulties, persistent redness of the anterior pillars, and enlargement of the cervical lymph nodes

41
Q

Adenoiditis

A

Nasal stuffiness, discharge, postnasal drip

42
Q

Initial Signs of Respiratory Failure

A

Restlessness, tachypnea, tachycardia, diaphoresis

43
Q

Early Decompensation of Respiratory Failure

A

Nasal flaring, retractions, grunting, wheezing, anxiety, irritability, mood changes, headache, hypertension, confusion

44
Q

Severe Hypoxia and Imminent Respiratory Arrest

A

Dyspnea, bradycardia, cyanosis, stupor, coma

45
Q

Apnea

A

Cessation of respiration lasting longer than 20 seconds, or any pause in respiration associated with cyanosis, marked pallor, hypotonia, or bradycardia

46
Q

Acute Spasmodic Laryngitis

A

Croup syndrome

Least serious

Abrupt nighttime onset, resolves over 24-48 hours

Afebrile, mild respiratory distress, no signs of respiratory infection

47
Q

Laryngotracheobronchitis

A

Caused by RSV virus

Gradual onset as a URI, progressing to respiratory distress and potential airway obstruction over 24-48 hours

Increased RR, stridor, normal expiration, no retractions, no apnea

48
Q

Bacterial Tracheitis

A

Caused by staphylococcus, moraxella, haemophilus

Progressive over 2-5 days, may present like LTB initially, but worsens

High fever, URI, stridor, purulent secretions, toxic appearance, dysphagia

49
Q

Epiglottitis

A

Caused by haemophilus, streptococcus, staphylococcus

Progresses rapidly, may progress to complete airway obstruction

Increased respiratory rate, stridor, normal expiration, positive retractions

50
Q

Bronchitis

A

Classic symptom is a dry, hacking cough that increases in severity at night

Rarely occurs as an isolated problem

51
Q

Bronchiolitis

A

Air trapping condition common in premature infants, immunosuppressed children, children who attend daycare

Caused by RSV

Increased RR, normal inspiration, longer expiration, positive retractions, positive apnea

52
Q

Pneumonia

A

Inflammation or infection of the bronchioles and alveolar spaces of the lungs

53
Q

Bronchopulmonary Dysplasia

A

Also called chronic lung disease of prematurity

Defined as the need for supplemental oxygen for at least 28 days after premature birth

54
Q

Short Term Treatment for Asthma

A

Short acting rescue inhaler/bronchodilator

55
Q

Long Term Treatment for Asthma

A

Corticosteroid or long acting bronchodilator

56
Q

Upper Respiratory Symptoms of Cystic Fibrosis

A

Clogged sinuses

Nasal polyps, chronic sinusitis, frontal headache, purulent nasal discharge, postnasal discharge

57
Q

Lower Respiratory Symptoms of Cystic Fibrosis

A

Reduced ciliary clearance, obstructed airways, air trapping and hyperinflation, bacterial colonization, chronic fibrotic lung changes

Moist cough, wheezing, coarse crackles, frequent infections, SOB, barrel chest

58
Q

Pancreatic Symptoms of Cystic Fibrosis

A

Poorly digested food, vitamin deficiencies, poor weight gain or failure to thrive, delayed onset of puberty, CF-related diabetes mellitus

59
Q

Gastrointestinal Symptoms of Cystic Fibrosis

A

Meconium ileus at birth, abdominal distention, steatorrhea, constipation or intestinal obstruction, rectal prolapse, liver cirrhosis

60
Q

Characteristic Features of Heart Disease

A

Exercise intolerance

Fatigue (during feeding the infant)

61
Q

Post-Op Care for Heart Surgeries

A

Take heart rate for one whole minute apically

Respiratory status

Intake and output

Pain control

Watch for bleeding

Blood pressure/pulses

62
Q

Medications Used for Heart Disease

A

Lanoxin

ACE Inhibitors

Beta Blockers

Diuretics

Antiarrhythmics

Antibiotics

Aspirin

63
Q

Bacterial Endocarditis Presents with…

A

Fever, pallor, petechiae, anorexia, fatigue, rheumatic fever

64
Q

Risk Factors for Development of Congenital Heart Disease

A

Maternal rubella

Maternal alcoholism

Maternal age over 40 years

Maternal Type I Diabetes

Sibling/parent with a heart defect, chromosomal aberration, other congenital anomalies

65
Q

Hemodynamics

A

High to low pressure, will take the path of least resistance

66
Q

Pressure in the Heart

A

Pressure on the right side is lower than the left

Resistance in pulmonary circulation is less than systemic circulation

67
Q

Left to Right Shunt

A

No cyanosis

Oxygenated blood is sent back to the lungs

Fully oxygenated blood still going out to systemic circulation

68
Q

Right to Left Shunt

A

Causes cyanosis

Deoxygenated blood is being pushed to the left

Deoxygenated blood goes out into systemic circulation

69
Q

Increased Pulmonary Blood Flow

A

Shift: Left to Right

No cyanosis

S/S of CHF

ASD, VSD, PDA

70
Q

Decreased Pulmonary Blood Flow

A

Shift: Right to Left

Cyanosis

No CHF symptoms

Tetralogy of Fallot, Tricuspid Atresia

71
Q

Tetralogy of Fallot

A

Four abnormalities that result in insufficiently oxygenated blood being pumped to the body

  1. Narrowing of the pulmonary valve
  2. Thickening of the right ventricle
  3. Displacement of aorta over ventricular septal defect
  4. Ventricular septal defect
72
Q

Obstruction to Blood Flow Out of the Heart

A

Shift: Left to Right

No cyanosis

CHF symptoms

COA, AS, PS

73
Q

Mixed Blood Flow

A

Shift: Right to Left and Left to Right

Cyanosis: Yes and No

CHF symptoms

Transposition of the great vessels, truncus, hypoplastic left heart

74
Q

Congestive Heart Failure

A

Inability of the heart to pump adequate amount of blood to systemic circulation at normal filling pressures to meet metabolic demands of the body

Septal defects, cardiomyopathy, sepsis, anemia

75
Q

Kawasaki Disease

A

Acute systemic vasculitis

Etiology unknown

Extensive inflammation of arterioles, venules, and capillaries

76
Q

Acute Kawasaki Disease

A

Abrupt onset of high fever, unresponsive to antibiotics and antipyretics

Child is very irritable

77
Q

Subacute Kawasaki Disease

A

Begins with resolution of fever and lasts until all clinical signs have disappeared

Greatest risk for coronary artery aneurysms

78
Q

Convalescent Kawasaki Disease

A

6-8 weeks after onset

79
Q

Therapeutic Management of Kawasaki Disease

A

High-dose IV gamma globulin

Aspirin

80
Q

Sickle Cell Anemia (HbSS)

A

Most common type of sickle cell disease

RBCs are crescent-shaped

Homozygous condition

Child is subject to sickle cell crises

Average lifespan is 45 years of age

81
Q

Sickle C Disease (HbSC)

A

Child inherits one HbS gene and one HbC gene

RBCs are C shaped

Anemia is generally milder than sickle cell disease

Painful crises occur about 50% as often as in HbSS disease

Average lifespan is 64 years of age

82
Q

Sickle Beta + Thalassemia Disease (Hb + SB) and Sickle Beta 0 Thalassemia Disease (Hb0 SB)

A

Combination of sickle cell trait and thalassemia trait

In sickle cell beta +, there is a reduced amount of beta+, there is a reduced amount of hemoglobin A, and the lifespan is near normal

In sickle cell beta 0, there is no hemoglobin A and the lifespan is mid-50s

83
Q

Vaso-Occlusive Crisis

A

Most common type of crisis; caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction

Precipitated by dehydration, temperature extremes, infection, localized hypoxemia, physical/emotional stress

84
Q

Clinical Manifestations of Vaso-Occlusive Crisis

A

Extremely painful

Fever, tissue engorgement, painful swelling of joints in hands and feet, priapism, severe abdominal pain

85
Q

Severity of Vaso-Occlusive Crisis

A

Thrombosis and infarction of local tissue may occur if the crisis is not reversed

Cerebral occlusion can result in stroke, manifested by paralysis and/or other CNS complications

86
Q

Splenic Sequestration

A

Pooling of blood in the spleen

87
Q

Clinical Manifestations of Splenic Sequestration

A

Profound anemia, hypovolemia, and shock

88
Q

Severity of Splenic Sequestration

A

Life-threatening crisis

Death can occur within hours

89
Q

Aplastic Crisis

A

Triggered by infection with parvovirus B19 or depletion of folic acid

90
Q

Clinical Manifestations of Aplastic Crisis

A

Diminished production and increased destruction of red blood cells

Signs include profound anemia, pallor

91
Q

Severity of Aplastic Crisis

A

Life-threatening

92
Q

Thalassemias

A

Group of inherited blood disorders of hemoglobin synthesis characterized by anemia that can be mild or severe

Pallor, jaundice, growth retardation, irritability, hepatomegaly, and splenomegaly are common

93
Q

Hereditary Spherocytosis

A

Hemolytic disorder occurring in 1 in 5000 people of Northern European descent

Clinical manifestations appear in the neonatal/early infancy stages; mild jaundice is usually evident

Aplastic crises is the most serious complication

94
Q

Disseminated Intravascular Coagulation

A

Life-threatening, acquired pathologic process in which the clotting system is abnormally activated, resulting in widespread clot formation in small vessels in the body

Most common cause is sepsis

Gingival bleeding, mucosal bleeding, hemoptysis, petechiae, purpura, bruising, oozing of blood after injection, hematuria, frank bleeding from incisions, tachycardia, and hypotension

95
Q

Immune Thrombocytopenic Purpura

A

Bleeding disorder characterized by increased destruction of platelets in the spleen

Multiple ecchymoses and petechiae and mucosal bleeding in the mouth or nose

Pediatric Nursing (7 decks)

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