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NRSG 206: OB > [Exam 3] Chapter 35 – Key Pediatric Nursing Interventions > Flashcards

[Exam 3] Chapter 35 – Key Pediatric Nursing Interventions Flashcards

1
Q

Medication Administration - Difference In Pharmacodynamics and Pharmacokinetics: What is Pharmacodynamics?

A

Behavior of the medication at the cellular level

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2
Q

Medication Administration - Difference In Pharmacodynamics and Pharmacokinetics: What can affect the drugs pharmcokinetics (movement of drugs throughout the body via absorption, distrubtion, metabolism, adn excretion)

A

Child’s age, weight, body surface, and body composition

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3
Q

Medication Administration - Difference In Pharmacodynamics and Pharmacokinetics: In infants and young adults , absorption of orally administered med affected by?

A

slower gastric emptying, increased intestinal motility, a larger small intestine surface area, higher gastric pH, and decreased lipase and amylase secretion.

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4
Q

Difference In Pharmacodynamics and Pharmacokinetics: IM injections in infants and young children affected by what?

A

amount of muscle mass, muscle tone and perfusion, and vasomotor instability

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5
Q

Medication Administration - Difference In Pharmacodynamics and Pharmacokinetics: How does topical absorption affect infants/children?

A

Increased due to greater BSA. Also increased because of permebility of infants skin

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6
Q

Medication Administration - Difference In Pharmacodynamics and Pharmacokinetics: Distrubtion in children affected by what?

A

Higher percentage body water

More rapid ECF exchange

Decreased body fat

Liver immaturity

Decreased amounts of plasma proteins

Immature blood-brin barrier

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7
Q

Difference In Pharmacodynamics and Pharmacokinetics: Immaturity of kidneys until 1-2 years affects what?

A

Renal blood flow, glomerular filtration, and active tubular secretions. Means longer half-life and increases potential for toxicity of drugs

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8
Q

Med Admin - Developmental Issues/Concerns: What explanations should be given to child before administering medications?

A

Why drug is needed, what they will experience, what is expected of child, and how parents can support their child

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9
Q

Med Admin - Developmetnal Issues/Concerns: What must we assure child about when meds need to be administered with needle?

A

Let them know that this is not a consequence of their behavior

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10
Q

GROWTH AND DEVELOPMENT ISSUES RELATED TO PEDIATRIC MEDICATION ADMINISTRATION: Infants issue?

A

Development of trust, which is fostered by consistent care. Development of stranger anxiety later in infancy

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11
Q

GROWTH AND DEVELOPMENT ISSUES RELATED TO PEDIATRIC MEDICATION ADMINISTRATION: Toddler issue?

A

DEvelopment of autonomy with displays of negativisml rituals and routines maintian control

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12
Q

GROWTH AND DEVELOPMENT ISSUES RELATED TO PEDIATRIC MEDICATION ADMINISTRATION: Preschooler issue?

A

Development of initiative, which is fostered when they sense they are helping

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13
Q

GROWTH AND DEVELOPMENT ISSUES RELATED TO PEDIATRIC MEDICATION ADMINISTRATION: School-aged child issue?

A

Development of industry, benefiting from being part of their care; generally very cooperative

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14
Q

GROWTH AND DEVELOPMENT ISSUES RELATED TO PEDIATRIC MEDICATION ADMINISTRATION: Adolescent issue?

A

Development of identity, benefiting from much more control over their care

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15
Q

Determination of Correct Dose: At what weight is adult dose prescribed?

A

Once they reach 40-50 kg

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16
Q

Determination of Correct Dose by BSA: This dosage takes what into account?

A

Child’s metabolic rate and growth, and need a nomogram

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17
Q

Determination of Correct Dose by BSA: What is a nomogram?

A

Divided into three columns: Height (left column) surface area (middle column) and weight (right column)

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18
Q

Determination of Correct Dose by BSA: How to determine BSA?

A

Measure height

Determine weight

Using nomogram, draw a line to connect the two

Determine point where line intersects surface area column

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19
Q

Oral Admin: Why are children younger than 5/6 at risk for aspiration?

A

Because they have difficulty swallowing tablets/capsules. Must be crushed or mixed with pleasant-tasting liquid or food like applesauce

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20
Q

Oral Admin: What should you never crush or open?

A

Enteric-coated or time-release tablet or capsule

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21
Q

Oral Admin: What to know about liquid medications?

A

Shake the bottle to ensure even drug distribution

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22
Q

Oral Admin: When using a dropper, direct the liquid where?

A

Toward the posterior side of the mouth , while giving the drug slowly and allowing child to swallow before more medication placed.

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23
Q

Oral Admin: What angle should children always be palcced in?

A

45 degrees to avoid aspiration

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24
Q

Oral Admin: How can medication be given is they have a gastric tube placed?

A

The meds can be given via the devices present . Allows for meds to be placed directly into stomach

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25
Q

Rectal Administration: How are these meds typically supplied?

A

In the form of suppositories

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26
Q

Rectal Administration: Why is this route not preferable?

A

Because drugs absorption may be erratic and unpredictable and the method is invasive

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27
Q

Rectal Administration: When would this route be used?

A

When the child is vomiting or receiving NPO.

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28
Q

Rectal Administration: What should you do to suppository and how is child positioned?

A

Make sure its lubricated. Place child is side-lying position. Used a gloved finger and insert above anal sphincter.

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29
Q

Rectal Administration: How do you prevent expulsion?

A

Hold the buttocks together for several minutes or until teh child loses urge to defecate.

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30
Q

Ophthalmic Admin: Usually provided in what form?

A

Drops or ointment

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31
Q

Ophthalmic Admin: How is this administered?

A

Retrct the lower eyelid and place the medication in the conjunctival sac.

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32
Q

Ophthalmic Admin: How do you apply ointment?

A

Apply the meidcation in a thin ribbon from the inner canthus outward without touching the eye or eyelashes

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33
Q

Ophthalmic Admin: What to do if child’s eyes are closed?

A

Apply 1-2 drops on inner canthus and then instruct child to open their eyes and drops will enter their eye

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34
Q

Otic Administration: Medications are in what form?

A

Ear drops.

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35
Q

Otic Administration: Often receives this medication why?

A

For an earache.

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36
Q

Otic Administration: How to explain cooperation in younger and older child?

A

Younger: Explain in terms that they’ll understand

Older: Explain purpose of medication

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37
Q

Otic Administration: How to administer pediatric ear drops?

A

Pulling the pinna down and back if younger than 3

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38
Q

Otic Administration: How to administer ear drops to child who is 4 years and older

A

nurse should pull the pinna up and back

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39
Q

Otic Administration: What can happen if cold ear drops used?

A

Can cause pain and possibly veertigo or vomit when they rech the eardrum

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40
Q

Otic Administration: What should child do after medication administered?

A

Should remain in the same posiiton for several minutes to ensure that the medication stays in the ear camel. `

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41
Q

Nasal Administration: Nasnally administered meds are typiclaly what

A

drops and sprays

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42
Q

Nasal Administration: How should child be positioned for nose drops?

A

Position child supine with head hyperextended to ensure that drops will flow back into nares.

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43
Q

Nasal Administration: What to do after it is adminsitered?

A

Maintain childs head in hyperextension for at least 1 minute to ensure drops have contact with nasal membranes

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44
Q

Nasal Administration: How should child be positioned for nasal sprays?

A

Position child upright with head tilted slightly back and place the tip of the spray bottle just inside the nasal opening and tilted toward the back. Hold one nostil closed and instruct to take deep breath.

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45
Q

Intramuscular Admin: What determined IM injection sites?

A

Muscle development and amount of fluid to be injected

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46
Q

Intramuscular Admin: What determines needle size?

A

by the size of the muscle adn the viscosity of the medication.

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47
Q

Intramuscular Admin: Preferred injection site for infants less than 7 months ?

A

Vastus lateralis muscle

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48
Q

Intramuscular Admin: Site for those infants and children greater than 7 months?

A

Ventrogluteal site

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49
Q

Intramuscular Admin: Dorsogluteal site is not recommended for those younger than ?

A

5 years old

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50
Q

Intramuscular Admin: Deltoid muscle is used for those older than ?

A

3 years old

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51
Q

Intramuscular Admin: Solution amount and location for infant?

A

Vastus Lateralis , 0.5 mL

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52
Q

Intramuscular Admin: Needle should be inserted at what angle?

A

90-degree angle.

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53
Q

Subcutaneous and Intradermal Admin: This distibuted medication into where?

A

Faty layers of teh body.

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54
Q

Subcutaneous and Intradermal Admin: This is primarily used for what?

A

insulin, heparin, and certain immunization like MMR

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55
Q

Subcutaneous and Intradermal Admin: Preferred sites include?

A

Anterior thihg, lateral upper arms, and abdomen

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56
Q

Subcutaneous and Intradermal Admin: What size needle is used?

A

3/8 - 5/8 inch, with 23-25 gaguge nedle

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57
Q

Subcutaneous and Intradermal Admin: What should you do to skin for admin?

A

Pinch the skin to isolate tissue from the muscle or pull it taut.

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58
Q

Subcutaneous and Intradermal Admin: Needle inserted at what angle?

A

45-90 degree angle. , release skin if pinched, and inject the medication.

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59
Q

Subcutaneous and Intradermal Admin: Intradermal admin deposits medication where?

A

Just under the epidermis .

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60
Q

Subcutaneous and Intradermal Admin: Usual site for ID admin?

A

Forearm

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61
Q

Subcutaneous and Intradermal Admin: ID Admin usually used for what?

A

TB Screening and Allergy Testing

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62
Q

Subcutaneous and Intradermal Admin: What size is used for ID Admin?

A

1 mL syringe with 5/8 inch, 25-27 gauge.

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63
Q

Subcutaneous and Intradermal Admin: How is ID Admin? Specificially the needle.

A

Insert the needle, with bevel up, at 5-15 degree angle

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64
Q

IV Admin: Primary method for IV med admin is what?

A

Syringe pump.

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65
Q

IV Admin: If pump is unavailable, med may be administered via what?

A

Volume control device.

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66
Q

IV Admin: Direct IV Push is reserved for what?

A

Emergency situations and when therapeutic blood levels must be reached quickly.

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67
Q

Providing Atraumatic Care: How can you decrease discomfort and painf ro child who is to receive an injection?

A

Apply a topical anesthetic such as local anesthetic cream or vapocoolant spray to site before injection

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68
Q

Providing Atraumatic Care: Research supports children experience less paina dn decreased fear if they are in what position?

A

Siting versus lying down

69
Q

Educating Child/Parents: Ways to prevent med errors includes?

A

Confirm childs wt accurate

Always weight in kg

Double check med calculations

Utilize medication ordering and dispensing systems

70
Q

Intravenous Therapy - Sites: IV Therapy may be administerd via what

A

Peripheral vein or central vein

71
Q

Intravenous Therapy - Sites: Peripheral IV therapy sites include

A

hands, feet and forearms

72
Q

Intravenous Therapy - Sites: When selecting an IV site in an extremity, always chose what site

A

the most distal site. Prevents injury to veins superiro to site

73
Q

Intravenous Therapy - Sites: Central IV Therapy is usually administered where?

A

LArge veins, such as subclavian, femoral, or jugular vein or vena cava.

74
Q

Intravenous Therapy - Sites: Where does a device lie for CEntral IV Therapy?

A

Lies in the superior vena cava at entrace of right atrium.

75
Q

Intravenous Therapy - Equipment, Peripheral Access Devices: Devices used here include?

A

Over-the-needle catheters or winged-infusion sets, such as butterflies or scalp vein needles.

76
Q

Intravenous Therapy - Equipment, Peripheral Access Devices: How are the devices inserted here?

A

Vein and then connected to IV solution via tubing to provide a continuous infusion of fluid

77
Q

Intravenous Therapy - Equipment, Peripheral Access Devices: Needle size here?

A

21-25 gauge, dpending on childs size

78
Q

Intravenous Therapy - Equipment, Peripheral Access Devices: Rule of thumb for needle size?

A

Use the smallest-gauge catheter with the shortest length possible to prevent traumatizing childs fragile veins.

79
Q

Intravenous Therapy - Equipment, Peripheral Access Devices: Typically, this is used for how long?

A

Short-term therapy, averaging 3-5 days.

80
Q

Intravenous Therapy - Equipment, Peripheral Access Devices: When are midline catheters recommended?

A

If therapy is to exceed longer than 6 days. Remain outside central vein and can stay up to 2 months.

81
Q

Intravenous Therapy - Equipment, Peripheral Access Devices: Where are midline catheters positioned?

A

Deep in the cephalic or basilic veins

82
Q

Intravenous Therapy - Equipment, Central Access Devices: How long are they used for?

A

Moderate-to- long-term therapy

83
Q

Intravenous Therapy - Equipment, Central Access Devices: When are these devices recommended?

A

When child lacks suitable peripehral access, requires IV fluid or medication for a prolonged period of time, or to receive specific treatments.

84
Q

Intravenous Therapy - Equipment, Central Access Devices: Why is this advantageous?

A

Provides vascular access without need for multiple IV starts, thus decreasing discomfort and fear.

85
Q

Intravenous Therapy - Equipment, Central Access Devices: Associated with complications, such as?

A

Infection at the site, sepsis due to direct access to central circulation and thrombosis.

86
Q

Intravenous Therapy - Equipment, Central Access Devices: What is done after placement?

A

Chest X-Ray to verify proper placement

87
Q

Intravenous Therapy - Equipment, Infusion Control Devices: Why would these be used?

A

To ensure accurate fluid administration

88
Q

Intravenous Therapy - Equipment, Infusion Control Devices: How often is the IV solution bag filled?

A

Every 2 hours, as it avoids accidental fluid overload.

89
Q

Intravenous Therapy - Inserting Peripheral IV Access Devices: What is done prior to insertion?

A

Review childs diagnossi adn medical hx for information that may affect site selection.

90
Q

Intravenous Therapy - Inserting Peripheral IV Access Devices: What extremity is often used?

A

Nondominant extremity

91
Q

Intravenous Therapy - Inserting Peripheral IV Access Devices: How to properly insert IV therapy device?

A

Use hand veins to reduce risk for phlebitis.

Ensure adequte pain releif.

Allow antiseptic used to prepare site.

Use a barrier such as gauze or washcloth.

92
Q

Intravenous Therapy - IV Fluid Administration: Amount of fluid to be adminsitered in a day determined by

A

childs weight

93
Q

Intravenous Therapy - IV Fluid Administration: How many mL per kg for first 10 kg?

A

100 mL

94
Q

Intravenous Therapy - IV Fluid Administration: How many mL per kg for next 10 kg?

A

50 mL

95
Q

Intravenous Therapy - IV Fluid Administration: How many mL per kg for remainder of body weight in kilograms

A

20 mL

96
Q

Intravenous Therapy - Maintaining IV Fluid Therapy: Expected urine output for children adn adolescents?

A

1-2 mL/kg/hour

97
Q

Intravenous Therapy - Maintaining IV Fluid Therapy: What to do when recording output for infant who is not potty trained?

A

Weigh the diaper to determine the output . 1g = 1 mL

98
Q

Intravenous Therapy - Maintaining IV Fluid Therapy: Why may flushing the IV line be necessary?

A

To maintain patency, such as before/after med administered or after obtaining blood speciments.

99
Q

Intravenous Therapy - Maintaining IV Fluid Therapy: What to know about saline adn flushing?

A

Found to be more compatible with the numerous solutions adn medications adminsitered IV, and is less expensive and less irritating to the vein

100
Q

Intravenous Therapy - Maintaining IV Fluid Therapy: If done via a central venous access device, what should you do cleaning wise?

A

Provide site care using sterile technique and flush device according to agency policy. Note the exit site for signs of infection.

101
Q

Intravenous Therapy - Preventing Complications: How often should site be inspected?

A

Every 1-2 hours for inflammation or infiltration.

102
Q

Intravenous Therapy - Preventing Complications: signs of infiltration include?

A

Cool, blanched or puffy skin

103
Q

Intravenous Therapy - Preventing Complications: How often is the IV site changed in adults?

A

Every 72-96 hours when integrity of system has been co mprimised

104
Q

Intravenous Therapy - Preventing Complications: How often should IV site be changed in children?

A

Only when clinically indicated.

105
Q

Intravenous Therapy - Preventing Complications: CDC recommends changing adminsitration sets that are continuously used how often?

A

No more frequently than 72-96 hours but at leasy every 7 days

106
Q

Intravenous Therapy - Preventing Complications: What may be used to prevent infection in children older than 2 months of age?

A

Chlorhexidine-impregnated sponge

107
Q

Intravenous Therapy - Discontinuing IV Device: Atraumatic care can be practiced how?

A

Use water to loosen tape

If transparent, gently lift off dressing by pulling opposite corners

Avoid using scissors

Turn off infulsion solution and pump

108
Q

Intravenous Therapy - Discontinuing IV Device: What to do if IV site was in the arm or near AC speace?

A

Apply pressure until the bleeding stops.

109
Q

Providing Nutritional Support: What is enteral nutrition?

A

Delivery of nutrition into GI tract via a tube

110
Q

Providing Nutritional Support: What is parenteral nutrition?

A

IV delivery of nutritional substances

111
Q

Enternal Nutrition: The tube may be inserted how here?

A

Inserted via nose or mouth or through an opening in abdominal area, with tube ending in stomach or small intestine

112
Q

Enternal Nutrition: What are gavage feedings?

A

Nasogastric or orogastric tube feedings, a tube from the nose to the stomach or from the mouth to the stomach, respectively

113
Q

Enternal Nutrition: This is indicated for who?

A

Children who have a functioning GI tract but cannot ingest enough nutrients orally

114
Q

Enternal Nutrition: What conditions may warrant this?

A

Failure to thrive

Abnormalities of the throat

REspiratory distress

GERD

115
Q

Enternal Nutrition - Inserting Nasogastric or Orogastric Feeding Tube: For infants who are nose breathers, how will it be inserted?

A

Via the mouth

116
Q

Enternal Nutrition - Inserting Nasogastric or Orogastric Feeding Tube / Determining Length: How is length typically determined?

A

Measureing from the nose to ear to mid-xiphoid to umbilicus. (NEMU)

117
Q

Enternal Nutrition - Inserting Nasogastric or Orogastric Feeding Tube / Checking Tube Placement: What is the best way to check tube placement?

A

Radiologic confirmation of tube placement is considered most accurate method, but risk with repeated radiation exposure.

118
Q

Enternal Nutrition - Inserting Nasogastric or Orogastric Feeding Tube / Checking Tube Placement: What are some alternative methods to check for placement?

A

Bilirubin, trypsin, CO2 monitoring.

119
Q

Enternal Nutrition - Inserting Nasogastric or Orogastric Feeding Tube / Checking Tube Placement: How to make sure gavage feeding tube remain in place?

A

Secure it to the child’s cheeck.

120
Q

Enternal Nutrition - Inserting Nasogastric or Orogastric Feeding Tube / Checking Tube Placement: Gastric secretions will have a pH of what?

A

Less than 5

121
Q

Enternal Nutrition - Inserting Nasogastric or Orogastric Feeding Tube / Checking Tube Placement: Small intestine secretions will have pH of what?

A

Greater than 6

122
Q

Enternal Nutrition - Inserting Nasogastric or Orogastric Feeding Tube / Checking Tube Placement: How to gastric secretions often appear?

A

Grassy green or clear and colorless and can have off-white mucous shreds

123
Q

Enternal Nutrition - Inserting Nasogastric or Orogastric Feeding Tube / Checking Tube Placement: Intestinal secretionsd have what color?

A

Bile strianed, light golden to yellowish to brownish green

124
Q

Enternal Nutrition - Administering Enteral Feedings: How often can these be given?

A

Continuously or intermittently

125
Q

Enternal Nutrition - Administering Enteral Feedings: What are bolus feedings?

A

Intermittent feedings. Specified amount of feeding solution given at specific intervals, usually over a short period of time of 15-30 mins.

126
Q

Enternal Nutrition - Administering Enteral Feedings: How are bolus feedings given?

A

Via a syringe, feeding bag, or infusion pump, bolus feedings

127
Q

Enternal Nutrition - Administering Enteral Feedings: Rate for continuous feedings?

A

Given at a slower rate over a longer period of time.

128
Q

Enternal Nutrition - Administering Enteral Feedings: What should you do daily with these feedings?

A

For gastrostomy and jejunostomy tubes, ensure calibration present. Measure length of tube daily. Assess the abdeomen for distentsion and bowel sounds.

129
Q

Enternal Nutrition - Administering Enteral Feedings: How do you check for gastric residual?

A

By aspirating the gastric contents with a syringe, measuring it, and then replacing the contents. Check every 4-6 hours and before every feedings.

130
Q

Enternal Nutrition - Administering Enteral Feedings: How do you begin the feeding?

A

Place child in a supine position with the head and shoulders elevated approximately 30 degrees so that feeding will remain in the stomach area.

131
Q

Enternal Nutrition - Administering Enteral Feedings: How do you prevent occlusion?

A

Flushing the tube with a small amount of water.

132
Q

Enternal Nutrition - Administering Enteral Feedings: Temperature for the feedings?

A

At room temperature

133
Q

Enternal Nutrition - Administering Enteral Feedings: Intermittent feedings lasts how long?

A

15-30 minutes,

134
Q

Enternal Nutrition - Administering Enteral Feedings: What must you do once the feeding is complete?

A

Flush the tube with water. AS water leaves teh syringe or tubing, clamp the tube to prevent air from entering stoamch

135
Q

Enternal Nutrition - Administering Enteral Feedings: What to do if child vomits?

A

Stop the feeding immediately and turn the child onto their side or sit them up

136
Q

Enternal Nutrition - Administering Enteral Feedings: How is feeding performed if child has gastrostomy button?

A

Open the cap and conect adaptor. Feeding solution container connected to the extension tubing or adaptor.

137
Q

Enternal Nutrition - Administering Enteral Feedings: What must you make sure you do for an infant?

A

Burp the infant, while also positioning the child on their right side with head slightly elevated 30 degrees for about 1 hour after feeding

138
Q

Enternal Nutrition - Administering Enteral Feedings: How does venting help child?

A

Helps relieve gas. Removes excess air and can be helpful if the child is bloated or the abdomen is distended.

139
Q

Enternal Nutrition - Providing Skin/Insertion Site Care: How to prevent irritation from occuring?

A

Keep the skin clean and dry.

140
Q

Enternal Nutrition - Providing Skin/Insertion Site Care: How often must the skin be cleaned?

A

At least once a day.

141
Q

Enternal Nutrition - Providing Skin/Insertion Site Care: Routine skin care includes?

A

Gentle cleansing with sterile water or saline for newly placed tubes. or soap and water for established tubes.

142
Q

Enternal Nutrition - Providing Skin/Insertion Site Care: Why should you not rotate jejunal or gastrojejunal tube?

A

Because it can cause kinking

143
Q

Enternal Nutrition - Providing Skin/Insertion Site Care: What would signs of infection look like?

A

Erythema, induration, foul drainage , or pain

144
Q

Enternal Nutrition - Providing Skin/Insertion Site Care: What does normal drainage look like?

A

Small amount of clear or tan drainage , which can be covered with a dressing

145
Q

Enternal Nutrition - Providing Skin/Insertion Site Care: How often should you check volume of the balloon?

A

With a balloon-tipped device once or twice a week, and reinflate balloon to the initial volume if needed. Tube should be able to move slightly.

146
Q

Enternal Nutrition - Providing Skin/Insertion Site Care: Why should you rotate sites where the tube is secured to the abdomen?

A

TO prevent tension on the stoma or skin breakdown

147
Q

Enternal Nutrition - Providing Skin/Insertion Site Care: Measure and record the lengthof the tube how?

A

FRom the exit site of the abdominal wall to the end of the wall

148
Q

Enternal Nutrition - Promoting Growth and DEvelopment: How do you help infants avoid losing desire to eat by mouth?

A

Using a pacifier helps avoid this, allows infant to associate niple in their mouth with feeding

149
Q

Enternal Nutrition - Promoting Growth and DEvelopment: What does sucking motion help with?

A

Exercise the jaw and promote flow of feedings

150
Q

Enternal Nutrition - Promoting Growth and DEvelopment: What promotes an active feeding time?

A

Talking with children, playing music, or reading a story

151
Q

Enternal Nutrition - Promoting Growth and DEvelopment: How do you allow child to participate in feedings?

A

By gathering suplies and administering the actual feeding so that child may experience independence

152
Q

Enternal Nutrition - Educating Family: What topics have to be covered for home enteral nutrition?

A

Type/Size of Tube

Rationale for Therapy

Duration of Therapy

Feeding Solution/Equipment

PRocedure for Flushing Tube

Frequency of weighing child

153
Q

Parenteral Nutrition: What is total parenteral nutrition (TPN)?

A

Parenteral nutrition given via a central venous access device

154
Q

Parenteral Nutrition - Administering TPN: How is concentration and components of TPN solution determined?

A

With thorough assessment of child’s status, including the results of lab testing.

155
Q

Parenteral Nutrition - Administering TPN: What is done at the start of TPN?

A

CEntral venous access is inserted and secured, if one is not already in place.

156
Q

Parenteral Nutrition - Administering TPN: Solution should be hung for how long

A

No longer than 24 hours.

157
Q

Parenteral Nutrition - Administering TPN: How quickly is this infused?

A

Initiated at a slow rate and then gradually increases.

158
Q

Parenteral Nutrition - Administering TPN: What happens if its given too rapidly?

A

Since they are highly concentrated glucose solutions can cause hyperglycemia

159
Q

Parenteral Nutrition - Administering TPN: What is done to make sure essential fatty acids met?

A

Fat emulsions are administered periodically to meet the child’s needs

160
Q

Parenteral Nutrition - Administering TPN: How often should blood glucose be monitoring?

A

Every 4-6 hours to evaluate for hyperglycemia.

161
Q

Parenteral Nutrition - Administering TPN: What happens if blood glucose is elevated?

A

SQ administration of insulin may be needed. And then assess blood glucose levels every 8-12 hours.

162
Q

Parenteral Nutrition - Administering TPN: What to do if TPN infusion is interrupted or stops?

A

BE prepared to begin an infusion of 5-10% dextrose solution at same infusion rate as the TPN. Prevents rebound hypoglycemia

163
Q

Parenteral Nutrition - Administering TPN: What cycle can this be administered on?

A

Continuously over a 24-hour period or after initiation may be given on a cycle basis, over a 12-hour period during night..

164
Q

Parenteral Nutrition - Preventing Complications: Key measures to reduce complications inlcude?

A

Monitor VSs, Adhere to stritch aseptic technique

Ensure the system remains a closed system at all times

Use occlusive dressings. Biopatch dressings may be used.

Assess intake/output

Monitor blood glucose levels

165
Q

Parenteral Nutrition - Promoting Growth/Development: Why should you run TPN over the night?

A

TO allow the child to participate in developmentally appropriate activites during the day

166
Q

A 3-year-old child is to receive a medication that is supplied as an enteric-coated tablet. What is the best nursing action?

Crush the tablet and mix it with apple sauce.
Dissolve the medication in the child’s milk.
Place a pill in the posterior part of the pharynx and tell the child to swallow.
Check with the prescriber to see if an alternative form can be used.
A

Check with the presciber to see if an alternative form can be used

167
Q

The nurse is caring for an infant who weighs 8.2 kg and is NPO and receiving IV fluid therapy. What rate does the nurse calculate as meeting the child’s daily fluid requirements?

82 mL per hour
41 mL per hour
34 mL per hour
22 mL per hour
A

41 mL per hour

168
Q

When administering ear drops to a 2-year-old, which action would be most appropriate?

Tell the child that the drops are to treat his infection.
Pull the pinna of the child’s ear down and back.
Have the child turn his head to the opposite side after giving the drops.
Massage the child’s forehead to facilitate absorption of the medication.
A

Pull the pinna of the child’s ear down and back

169
Q

An infant is to receive intermittent gavage feedings via a nasogastric tube every 6 hours. The feeding tube was inserted with a previous feeding and remains in place. The nurse is preparing to administer the next scheduled feeding. Place the events in the proper sequence.

Check the placement of the feeding tube.
Position the infant on his right side with the head of the bed slightly elevated.
Allow the feeding to come to room temperature.
Flush the tube with water.
Clamp the tube to prevent air from entering the stomach.
Pour the solution into the barrel of the syringe.
A

C, A, F, D, E, B

NRSG 206: OB (42 decks)

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