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
