Exam 2 Peds Flashcards
What is the Erikson stage of psychosocial development for school age (6-12) children?
master their new developmental step: learning a sense of industry or accomplishment (Erikson, 1993). If gaining a sense of initiative can be defined as learning how to do things, then gaining a sense of industry is learning how to do things well.
What are 4 key cognitive developments in school-age children?
Decentering: the ability to project one’s self into other people’s situations, see the world from another’s viewpoint
Accommodation: the ability to adapt thought processes to fit what is perceived, such as understanding that there can be more than one reason for other people’s actions.
Conservation: the ability to appreciate that a change in shape does not necessarily mean a change in size.
Class inclusion: the ability to understand that objects can belong to more than one classification.
What is the growth pattern of school age children? When do children begin to develop secondary sex characteristics?
School-aged children mature slowly but steadily. Their average annual weight gain is 3 to 5 lb; annual increase in height is 1 to 2 in.
■At about age 10, children begin to develop secondary sex characteristics. Preparation helps them accept these changes positively.
According to Erikson, what is the psychosocial devlepment of early adolescents and late adolescents?
to form a sense of identity versus role confusion
to form a sense of intimacy versus isolation.
What is the cognitive development of adolescents? What is involved?
formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, although it may not be complete until about age 25 years
ability to think in abstract terms and use the scientific method (i.e., deductive reasoning)
Problem-solving in any situation depends on the ability to think abstractly and logically.
How can HIV transmission be prevented from infected mother to baby?
administration of combination antiretroviral therapy during pregnancy and labor
planned cesarean delivery prior to the onset of labor and rupture of membranes for all pregnant patients with an HIV viral load of greater than 1,000 copies per mL
antiretroviral prophylaxis to the infant exposed to HIV for 4 to 6 weeks
avoidance of breast feeding
What is atopic dermatitis? What exasperates it?
highly pruritic, chronic inflammatory skin disease that is often the first manifestation of allergic disease
affects 15% to 20% of children
Food allergy is a major trigger of atopic dermatitis in infants
Sweating, heat, tight clothing, and contact irritants such as soap tend to increase the pruritus associated with eczema
What is the common name for rubella? Is it a virus? Incubation period? Infectious? Mode of transmission? S/S?
German measles
yes
Incubation period: Generally, 14 days
7 days before to approximately a maximum of 14 days after the rash appears
droplets
maculopapular rash presents initially on the face and then appears on the trunk and extremities, low-grade fever, headache, malaise, anorexia, mild conjunctivitis, upper respiratory symptoms, and lymphadenopathy
THINK LYMPH
What is the common name for rubeola? Virus? Incubation period? Infectious period? Mode of transmission? S/S? Complications?
measles
yes
8 to 12 days from time of exposure to onset of any symptoms with a range from 7 to 21 days
4 days before the rash to 4 days after the rash appears
droplets or AIRBORNE
acute fever
cough
coryza (clear nasal discharge)
conjunctivitis (the “three Cs”)
maculopapular, erythematous rash
Koplik spots: small white spots seen in the oral mucosa
otitis media, pneumonia, croup, diarrhea, pneumonia, secondary bacterial infection
What is chicken pox? Incubation period? Infectious period? Mode of transmission? 4 stages of legions?
Causative agent: Varicella zoster virus (VZV)
10 to 21 days, with the most common incidence at 14 to 16 days following exposure
1 day before and after all the vesicles have crusted
contact of saliva or open vesicles
macule, papule, vesicle, and crust
What is the causative agent of impetigo? Incubation period? Infections period? Mode of transmission? S/S? Treatment?
Bacteria: streptococcus, group A or Staphylococcus aureus
7 to 10 days for impetigo
outbreak of lesions until lesions are healed
contact
common in children from ages 2 to 5
honey-colored crusts with local erythema most commonly on the face and extremities.
mupirocin (Bactroban) ointment for 7 to 10 days
or retapamulin (Altabax) for children over 9 months twice a day (bid) for 5 days
oral antibiotic that covers both staphylococcus and streptococcus is reserved for extensive impetigo
Whatis enterobiasis? Where to they thrive? where are the eggs laid? Treatment? Patient education
Pinworms
After ingestion of the egg, the mature worms develop over a period of 2 months in the cecum.
The mature female pinworm then migrates out of the anus to deposit eggs on the skin in the anal and perianal region
Treatment is with a single dose of mebendazole (Vermox), pyrantel pamoate (Nemex), or albendazole (Albenza)
don’t bite nails
wash hand
clean bedding, etc.
What is sickle cel lanemia? What occurs in a crisis? What can exasperate a crisis? Complications? Treatment
autosomal recessive
carried on the beta chain of hemoglobin
amino acid valine takes the place of the normally appearing glutamic acid
erythrocytes become elongated and crescent-shaped (sickled) when they are submitted to low oxygen tension (less than 60% to 70%), a low blood pH (acidosis), or increased blood viscosity like with dehydration or hypoxia
sudden, severe onset of sickling
pooling of many new sickled cells in blood vessels
tissue hypoxia beyond the blockage (a vaso-occlusive crisis)
dehydration
respiratory infection that results in lowered oxygen exchange
extremely strenuous exercise
sometimes, no obvious cause of a crisis can be found
acute pain
aseptic necrosis of the head of the femur or humerus causing sharp joint pain cerebrovascular accident from a blocked artery,
coma, seizures, or even death
hematuria or flank pain
pain releif
hydration
electrolyte balance
treat any infection
Why are adolescents at risk for iron deficiency anemia?
poor diet
rapid growth
menses
strenuous activity
obesity
What do RBCs require for production? What is the most common reason for its deficiency?
iron
lack of iron in the diet
What are risk factors for iron deficiency anemia?
prematurity
excessive intake of milk
malabsorption disorders
poor dietary intake
blood loss
What are medical manifestations of anemia?
tachycardia
pallor
spoon shaped fingernails
fatique, irritability
muscle weakness
systolic heart murmur
pica
What are lab tests associated with anemia?
CBC (RBC count, Hgb, Hct)
RBC indices (mean volume, mean Hgb, mean Hct)
# reticulocytes
transferrin
Nursing care concerning iron? Dietary sources?
iron-fortified formula
Diet high in iron and vitamin C
with supplements, don’t take with milk or antacids. Try to take on an empty stomach
Can cause teeth staining
can cause constipation
dried beans and lentils
peanut butter
green leafy vegetables
iron fortified breads and flour
poultry
red meat
What are the complications of sickle cell anemia?
sickling increases blood viscosity
obstructs blood flow causing tissue hypoxia
tissue hypoxia causes tissue ischemia which cause pain
increased destruction of RBCs
What are risk factors for sickle cell disease?
autosomal recessive
african American, mediterranean, indian, middle eastern
people with the trait only do not manifest the disease and can pass it to their offspring
What are manifestations of sickle cell? Crisis? What are they at increased risk for?
pain
SOB, fatigue
pallor, dehydration
jaundice
cold extremities
dizziness
HA
severe pain
swollen joints and extremities
abdominal pain
hematuria
obstructive jaundice
Respiratory infections
retinal detachment and blindness
murmurs
Renal failure and enuresis
hepatomegaly and cirrhosis
seizures
avascular necrosis
visual disturbances
anemia
excessive pooling of blood
reduce circulating of blood = hypovolemia = hypovolemic shock
stroke
pneumonia
priapism (painful erection)
renal scarring
Nursing considerations for sickle cell
rest to preserve oxygen
administer O2
hydration
I&O
blood products and exchange transfusions
treat and prevent infections
vaccines
pharmacologic and nonpharmacologic pain measures
What is the patho of hemophilia? Expected findings? Tests?
bleeding time extended because d/t lack of factor required for blood clotting
often recognized ininfancy with circumcision
X-linked recessive disorder
excessive bleeding
joint pain and stiffness
easy bruising
activity intolerance
bleeding gums, epistaxsis, hematuria, tarry stools
PTT
factor-specific assays
HA, slurred speech, LOC affected
What is the vaccination schedule for children?
Dtap: 4-6 yrs
Tdap: 11-12 yrs (with booster every 10 years)
IPC: 4-6 years (last does of 4)
MMR: 4-6 yrs (last dose of 2)
Varicella: 4-6 (last does of 2)
mennigicoccal (2 doses) 10, 16-18 yrs
HPV (2-3 doses): 11-12 yrs up to 45 yrs
What vaccines should not be administered to immunocompromised?
MMR
varicella
What malignancies are associated with leukemia? How is it classified? What is the peak onset in children?
bone marrow
lymphatic system
type of WBCs that have become neoplastic
acute lymphoid leukemia
acute myelogenous/nonlymphoid leukemia
2-5 yrs
What does leukemia do to the WBCs? What does that do in the bone marrow? spleen, liver, lymph nodes and brain?
increases the production of immanture WBCs
they, in turn, infiltrated organs and tissue
the immature WBCs crowd out the cells that produce RBCs, platelets and mature WBCs causing anemia, thrombocytopenia and neutropenia
tissue fibrosis, intracranial pressure
What are medical manifestations of leukemia?
fever
pallor
bruising petechia
listlessness
enlarged liver, lymph nodes, joints
abdominal, leg, joint pain
constipation
HA
vomiting anexoria
unsteady gait
pain
hematuria
ulcerations in the mouth
elarged kidneys, testicles
increase intracranial pressure
nursing considerations for lumbar puncture?
empty bladder
sterile procedure
topical anisteptic
side-lying position
distraction
possible sedation
pressure and adhesive applied
monitor site
monitor for LOC, intracranial pressure, decreased respirations
flat position for 30 min after
dring water
What are adverse effects of chemotherapy? nursing considerations?
mucosal ulcerations: soft tooth brush, lip balm, mouthwashes
skin breakdown: assess, sitx baths, reposition
neuropathy: prevent constipation, foot drop, jaw pain
pain: anagesiscs and interventions
anorexia: daily wight, fluids, small frequent meals, bland, antiemetics
hemorrhage cystitis: fluids, void
alopecia: prepare
What are vital signs for school age children?
Vital signs
Temperature: 36.7-36.8 C (98.1-98.2F)
Heart rate: 60-110 (dependent on activity)
Respiratory rate: 20-25/min
BP: 94-106/55-62 (dependent upon age and gender)
Why might innocent heart murmurs be assessed on children?
d/t the increasing heart size with rapid growth spurts
When does scoliosis screening start?
8 years
What immunizations need to be up to date by age 6? What is added in preteen years?
Dtap
polio IVP
MMR
Varicella
Tdap every 10 yrs
meningococcal
HPV (2 doses 6-12 months apart)
Erikson’s stage for school age?
industry vs inferiority
What are aspects of Piaget’s concrete operational stage for school age children?
Ability to reason-thinking based on mental operations: logical, mathematical, spatial
Decentering- able to see the perspective of others
Accommodation- able to adapt thought processes to fit what is perceived such as understanding that there can be more than one reason for someone’s actions
Conservation- able to understand that a change in shape doesn’t necessarily mean a change in size
Class Inclusion- ability to classify or group complex information
Limited- by concrete thinking, rather than abstract
What is the early stage and late stage moral development of school age children?
early: rule oriented, right/wrong, reward, conform to avoid disapproval
late: understands golden rule, fair/equal, thinks of others
Hoe long shoulda child be in a booster seat?
until 4’9”
What are VS for adolescents?
Temperature: 36.6-36.8 C (98.1-98.2F)
Heart rate: 50-100 (dependent on activity)
Respiratory rate: 16-20/min
BP: <120/<80 (dependent upon age and gender
Whatis moral development of adolescents?
Motivated by greater good
Solve moral dilemmas using internalized moral principles.
Constructs a personal and functional value system independent of authority figures and peers
Questions society and religion
What is the most common spread from mother to child?
placental spread
How is HIV categorized by symptoms? How is a diagnosis made in babies? What are priority interventions?
Categorized based on symptoms
Category N- asymptomatic
Category A- Mildly symptomatic
Category B- Moderately symptomatic
Category C- Severely symptomatic (AIDS)
Lab Testing/Dx
Infants born to infected mothers: positive polymerase chain reaction and viral culture
≥ 18 months: positive HIV enzyme-linked immunosorbent assay (ELISA) and Western blot immunoassay
Priority Interventions
Encourage good nutrition- NO breastfeeding
Encourage good oral care
Assess for pain and provide pharmacologic and non-pharmacologic pain relief
Infection prevention utilizing standard precautions
What are nursing considerations when treating HIV?
Failure to Thrive
Monitor height/weight
Promote optimal nutrition
Promote developmental progression
Pneumocystis carinii pneumonia
Monitor respiratory status
Medication administration (ABX/Antipyretics/analgesics)
Encourage oral fluids
Infection prevention
What is the pharmacological treatment for HIV?
Antiretrovirals (Zidovudine)
Inhibits reproduction of virus
Lifelong therapy
Close monitoring of CBC and liver function tests
Antibiotics- Trimethoprim-sulfamethoxazole
All infants born to HIV-infected mothers until dx is excluded
IV gamma globulin
Prevention of serious infections
What are 3 allergic responses?
hypersensitivity, immediate
humoral response, antibodies
cell-mediated, T-cells
What are 3 types of contact dermatitis? Medical treatment?
Diaper dermatitis: Detergents, soaps, candida albicans
Prompt diaper removal
Increase air exposure, utilize skin barrier (zinc)
Seborrheic dermatitis (cradle cap)
Unknown etiology
Gently scrub scalp to remove scales
Poisonous plant exposure
Clean area promptly
Antihistamines (educate on sedative effects!)
Antibiotics (for secondary skin infection)
Antifungals
What is priority educations foe atopic dermatitis, Eczema
Skin hydration with moisturizers after bathing
Cotton clothing
Heat avoidance
Irritant avoidance
Hygiene
What is treatment for minor and major burn treatment?
Minor:
Remove clothing to area, cleanse area (tepid water (no ice!), mild soap (avoid friction), provide analgesia
Immunization status (tetanus necessity for >5 years since last dose)
Major
Maintain airway, monitor VS, maintain cardiac output
Fluid replacement (necessity in first 24 hours)
Isotonic crystalloids (lactated ringers) in early stages
Colloid solutions (albumin or plasma) in next 24-48hr
Monitor for septic shock
Provide analgesia
IV opioids (monitor for respiratory depression)
Nonpharmacologic methods
Nutritional support
Increased calories (due to increased metabolic demands)
What are standard precautions? Contact? Airborne? Droplet?
Standard precautions: implemented on all clients to avoid body fluids (hand-hygiene; gloves when in contact with body secretions, excretions, blood/body fluids, non-intact skin, mucous membranes; masks/eye protection/face shield if splashing or spraying of body fluids is possibility)
Transmission-based precautions:
Contact precautions: protects visitors and caregivers from direct & environmental contact (private room or co-room with same infection, gown and gloves)
Airborne precautions (Tb, measles, varicella): protects against very small droplet particles (private room, negative pressure room, masks/respiratory protection device, N95 mask (Tb), full face protection if splashing/spraying is possibility, client wars mask when outside room)
Droplet precautions (Rubella, pertussis, mumps): protects against larger droplets (private room or co-room with same infection, mask for caregiver, client wears mask while outside room)
What is Epstein Barr? How does it manifest? What is found upon assessment? Lab testing? What are the precations? Treatment? Education?
Mono
extreme fatigue
fever
body aches
Extreme fatigue
Fever
Body aches
Enlarged tonsils
Splenomegaly
Common in early school-age children and adolescents
Lab testing/Diagnosis
Blood analysis showing lymphocytosis
Positive Monospot test
Standard
supportive
Avoid contact sports for 4 weeks following onset (splenic rupture)
Prevention of spread (saliva)
Transmission time
Discuss length of symptoms
What is pediculosis capitus? Assessment? Treatment? Education?
Lice
Assessment
Pruritis to scalp
Small, red bumps to scalp
White specks at hair shaft
Treatment
Permethrin 1% shampoo
Remove nits with nit comb
Priority Education
May require follow-up treatment
Wash bedding/clothing in hot water
What is the biproduct after the breakdown of RBC?
bilirubin
Whatis treatment and nursing considerations fro sickle cell?
Medications/Treatment
Pain relief
Hydration
Oxygenation
Blood transfusion
Stem cell transplant
Nursing considerations/education
Promote rest
Monitor I&O-promote high oral intake
Infection prevention/treatment (high altitude considerations)
Vaccine necessity
Activity allowance (no contact sports)
Pain management (pharmacologic and non-pharmacologic)
Monitor lab values (decreased Hgb, increased WBC is sign of crisis)
What are two other sickle cell crisis after vaso-occlusive?
Sequestration
excessive pooling (in spleen, sometimes in liver) resulting in reduced circulating blood hypovolemia, hypovolemic shock
Aplastic crisis
Extreme anemia from decreased RBC production
Hyperhemolytic crisis
RBC destruction anemia, jaundice and reticulocytosis
What is acute chest syndrome (a complication of sickle cell).
Acute Chest syndrome
More common in late childhood/adolescence
Inflammation to lung tissue from hypoxia
Fever/tachypnea/wheezing
Pneumonia
What does radiation do to cells? Client education? What are possible log-term effect from radiation treatment?
Radiation changes cell DNA and prevents replication (external, implantable, surgically targeted)
Client education:
Leave markings on skin for targeted treatment areas (wash with lukewarm water, pat dry)
Avoid creams/lotions/powders unless prescribed
Sun protection (hats, long-sleeved clothing)
Notify provider for blisters, weeping, red/tender skin
Monitor for radioactive sickness (fatigue, anorexia, N&V)
antiemetics prior to procedure
Monitor skin integrity (erythema, tenderness)
Long-term effects based on radiation site:
Bone (asymmetry of growth, easily fractured, scoliosis/kyphosis)
Hormones (evaluation of growth and endocrine function)
Nervous system (assess for lethargy, sleepiness, seizure activity)
Organs (chronic lung disease, heart disease, malabsorption, etc)
What is Wilm’s tumor? How does it present? What are assessment findings? Treatment? Nursing considerations?
a nephroblastoma
Painless, firm, nontender abdominal swelling or mass
Assessment
Fatigue
Weight loss
Hematuria
HTN
Medications/Treatment
Surgical removal of tumor (nephrectomy) or tumor debulking
Chemotherapy following removal
Nursing Considerations & Education
Procedural considerations: educate families, assess allergies to dye/shellfish, provide emotional support
Pre and post-op considerations
Do NOT palpate abdomen and use caution when handling client to avoid trauma to tumor
Monitor for infection
Emotional support
