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Peds > Exam 4 Blueprint > Flashcards

Exam 4 Blueprint Flashcards

1
Q

What is a macule?

A

circular, flat discoloration < 1 cm

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2
Q

What is a papule?

A

superficial, solid, elevated <0.5 cm

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3
Q

What is a plaque/annular?

A

ring-like with central clearing

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4
Q

What is a vesicle?

A

circular collection of free fluid < 1 cm

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5
Q

Wha is a pustule?

A

vesicle containing pus

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6
Q

Why are children at risk for skin injuries?

A

due to their developmental immaturity, they suffer accidental minor injuries frequently

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7
Q

Approximately one in ____ children experience child abuse or neglect

A

4

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8
Q

What is a non accidental injury to a child

A

done with harm intent ; child abuse

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9
Q

What are the types of injuries?

A

abrasions, lacerations, bites, bruises, burns

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10
Q

Where are common sites of bruises (these are caused by normal play)

A

-forehead
-eyebrows
-elbows
-shins
-knees

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11
Q

Questionable sites for bruises in children include places such as ?

A

-things
-calves
-neck
-back
-tips of shoulders
-etc

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12
Q

Risk factors for child abuse include

A

-poverty
-prematurity
-chronic illness
-intellectual ability
-parent w/abuse history
-unrelated partner
-alcohol/substance abuse
-extreme stressors

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13
Q

Why are premature infants, children with intellectual ability, and children with chronic diseases at higher risk of maltreatment?

A

it is harder to care for them

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14
Q

If a child comes into the ED with injuries in uncommon locations (such as backside) and has multiple in places other than the legs, the nurse should be suspicious of

A

child abuse

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15
Q

Bruises in an infant <9 months should raise suspicion to?

A

child abuse

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16
Q

What should the nurse observe for if she is working in the ED and suspects child abuse?

A

-frequent visits / delay in seeking care
- inconsistent stories
-unusual caregiver-child interaction

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17
Q

Physical cues of abuse include?

A

-suspicious location
-injuries in various stages of healing
-fear of parents
-lack of emotional responses

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18
Q

Infant <6 months sun safety rules

A

-keep out of direct sunlight
-use minimal sunscreen

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19
Q

What extra clothing can a child wear to increase sun safety

A

-hats
-sun shirts

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20
Q

Sun exposure time should be limited between what hours

A

10am - 4 pm

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21
Q

Why should sunscreen be broad spectrum

A

-screens out other UVA and UVB rays

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22
Q

Requirements for choosing a good sunscreen:

A

-fragrance and oxybenzone free
-spf 15 or higher

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23
Q

What can be applied to nose, cheeks, ears, and shoulder areas to provide extra sun protection

A

zinc oxide products

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24
Q

Sunscreen should be applied 30 minutes before activity, and reapplied how often?

A

-q 80-90 min if in water
-at LEAST q 2 hours

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25
Q

What is the primary burn assessment the nurse should perform when a child comes to the ED?

A
  1. assess if airway is patent
    2.determine if airway injury is present
    3.evaluate child’s skin color, respiratory effort, pulse ox, ABG, carboxyhemoglobin levels, and breath sounds
    4.determine pulse strength, perfusion status, and HR
    5.note any edema
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26
Q

IF a client experiences an electrical burn, what do they require?

A

an EKG

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27
Q

S/s of airway injury from burn or inhalation include?

A

-burns to face/lips
-nose hairs singed
-black sputum
-stridor, hoarseness, wheezing

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28
Q

The secondary assessment a nurse should perform upon child admission to the ED with burns is?

A
  1. determine burn depth
  2. estimate burn extend by calculating BSA affected
  3. inspect child for other traumatic injuries (I.E spinal cord injury)
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29
Q

Describe a first degree burn:

A

damage to epidermis

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30
Q

Appearance of first-degree burn:

A

-pink to red in color
-no blisters
-blanches

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31
Q

Describe a second degree Superficial Partial Thickness burn

A

-damage to the entire epidermis
-dermal elements remain intact

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32
Q

Appearance of a second degree Superficial Partial Thickness burn

A

-moist, red, painful
-blisters
-mild to moderate edema
-blanches
-no eschar

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33
Q

Describe a second degree Deep Partial Thickness burn

A

-damage to the entire epidermis and some parts of the dermis
-sweat glands and hair follicles remain intact

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34
Q

Describe the appearance of a second degree Deep Partial Thickness burn

A

-mottled, red to white
-blisters
-moderate edema
-blanches

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35
Q

Describe a third degree burn

A

-damage to the entire epidermis and dermis
-possible damage to subcutaneous tissue
-nerve endings, hair follicles, and sweat glands are destroyed

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36
Q

What is the appearance of a third degree burn?

A

-red to tan, black, brown, or waxy white color
-dry, leathery appearance
-no blanching

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37
Q

Describe a fourth degree burn

A

-damage to all layers of the skin that extends to muscle, fascia, and bone

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38
Q

Describe the appearance of a fourth degree burn

A

-color variable
-dull and dry
-charring
-possible visible ligaments, bone, and tendons

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39
Q

What type of burn is painful, heals in 3-5 days, and has no scarring

A

first

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40
Q

What type of burn is painful, heals in < 21 days. Has variable amts of scarring, is sensitive to temperature changes/air/light touch

A

superficial partial thickness burn (2nd)

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41
Q

What type of burn is painful, is sentive to temp changes/light touch, and scarring is likely

A

deep partial thickness burn (2nd)

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42
Q

What stage of burn has pain that begins as burn heals, scarring is present, and a skin graft is needed

A

full thickness burn (3rd)

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43
Q

what stage of burn has no pain, scarring is present, skin graft is needed, amputation is possible

A

deep-full thickness (4th)

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44
Q

How many minutes before dressing changes or procedures should we administer pain medications to clients with burns

A

45 minutes

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45
Q

What combination of pharmacologic pain management is used when treating burns

A

-opioids: morphine and fentanyl
-sedative: midazolam

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46
Q

Nonpharmacologic pain measures should be used in clients with burns. Examples of these include

A

-music, distraction

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47
Q

Fluid resuscitation for 2nd and 3rd degree burns are based on

A

TBSA (Lund and Browder formula)

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48
Q

What solution is used for fluid replacement for burns in the first 24 hours

A

LR

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49
Q

24-48 hours after a burn, when capillary permeability improves, what is added to IV fluids to help resuscitation

A

colloids such as albumin and FFP

50
Q

Adequacy of fluid replacement when treating burns is determined by

A

evaluating urine output

51
Q

A urine output of ___ should be maintained when treating burns

A

1-2 ml/kg/hr

52
Q

What should be monitored when administering fluid resuscitation to clients with burns

A

DW, fluid and electrolyte imbalances, I and O’s

53
Q

Nursing considerations for wound care

A

-maintain standard precautions/ PPE
-clean with mild soap and water
-assist with debridement and hydrotherapy

54
Q

Should nurses pop blisters while performing wound care?

A

no, leave blisters intact

55
Q

Loose skin from burns should be removed with

A

sterile scissors

56
Q

How to prevent infection when caring for burns?

A

-use aseptic technique
-use Pt-designated equipment such as BP cuffs and thermometers

57
Q

If a tetanus vaccine is > 5 years old or if status is unknown, what should happen if they have a burn

A

administer one to prevent infection

58
Q

Why should flowers/plants be avoided in clients with burns

A

avoids exposures to pseudomonas to prevent infection

59
Q

Complications of burns include:

A

-carbon monoxide injury
-hypovolemic/septic shock
-wound infections
-inhalation injury

60
Q

What is a skin abrasion

A

superficial rub or wearing off of the skin usually due to friction; mainly limited to the epidermis

61
Q

What is a laceration

A

injury that penetrates skin and soft tissue

62
Q

What is atopic dermatitis (eczema)

A

inflammation/rash/itching caused by antigen response to environmental factors, temp changes, sweating

63
Q

common sites of atopic dermatitis/eczema include

A

wrists, antecubital of arm, popliteal space

64
Q

What does atopic dermatitis/eczema cause?

A

elevated IgE levels

65
Q

What medications are used to treat atopic dermatitis/eczema

A

-topical corticosteroids
-immune modulators - tacrolimus

66
Q

Nursing considerations for tacrolimus include

A
  • used in children > 2
  • must avoid direct sunlight
    -can cause itching, flu-like symptoms ,and HA
67
Q

We should educate parents that children with atopic dermatitis should avoid soaps containing

A

perfumes, dyes, or fragrances

68
Q

How to promote moisture in children with atopic dermatitis?

A

-pat skin dry and leave moist while applying moisturizers multiple times daily

69
Q

Should children with atopic dermatitis bath in warm or hot water

A

2 x a day in warm water / avoid hot

70
Q

What type of clothes should children with atopic dermatitis wear?

A

-100% cotton clothing AND bed linens
-avoid synthetics and wool
-keep fingernails short

71
Q

What drugs may be given at bedtime for children with atopic dermatitis

A

antihistamines

72
Q

What is diaper dermatitis

A

inflammatory reaction caused from urine, feces, harsh soaps, wipes

73
Q

T or F: diaper dermatitis can be either non-candida or candida

A

yes

74
Q

Non-candida diaper dermatitis assessment finding s

A

red, shiny, NOT IN CREASES OR FOLDS
-occurs on buttocks, thighs, abdomen and waist

75
Q

Candida diaper dermatitis assessment findings

A

deep red lesions, scaly with satellite lesions (outside of diaper area)
-OCCURS IN CREASES OR FOLDS

76
Q

Children with candida diaper dermatitis may also have

A

thrush of the mouth

77
Q

Does candida dermatitis improve with standard diaper cream

A

no

78
Q

tx for non-candida diaper dermatitis

A

-topical A,D, and E or zinc oxide

79
Q

Tx for candida diaper dermatitis

A

nystatin or miconazole anti fungal cream

80
Q

Diaper dermatitis management include

A

-change diaper s frequently
-avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives

81
Q

Why should nurses obtain the date of LMP for females with acne during their history assessment

A

acne is worse 2-7 days prior to start of menses

82
Q

During the history and physical assessment for acne vulgaris, the nurse should ask

A

-onset of lesions
-medications that exacerbate
-note oily skin/hair
-hx of endocrine disorder

83
Q

We should educate clients with acne to avoid

A

oil - based cosmetics and hair products, headbands, helmets/ hats

84
Q

We should educate our patients with acne to do what to manage their symptoms

A

-clean skin with mild soap and water BID
-shampoo hair regularly
-avoid picking/squeezing
-eat a balanced diet

85
Q

How does tretinion work to treat acne

A

interrupts abnormal keratinization

86
Q

How does benzoyl peroxide, an OTC medication help manage acne

A

-inhibits growth of P. acnes

87
Q

What topical antibacterial medication can be given to reduce acne

A

clindamycin

88
Q

What oral antibiotics can be given to treat acne

A

-tetracycline and erythromycin

89
Q

What teratogenic medication can be given for severe cases of acne

A

isotretinoin

90
Q

How can oral contraceptives be used to help reduce acne

A

decreases endogenous androgen production

91
Q

what is rubeola (measles)

A

a highly contagious viral respiratory illness spread via droplets

92
Q

Assessment findings of measles includes

A

-Fever, Koplik spots, cough, nasal inflammation, malaise, conjunctivitis

93
Q

How does maculopapular rash spread with rubeola

A

starts on face –> neck –> trunk > arms > legs > feet

94
Q

Patients with rubeola need to be placed on what type of precautions

A

airborne

95
Q

Nursing management of Rubeola / measles includes

A

-supportive care
-antipyretics
-bedrest, fluids, humidification

96
Q

If a client is 6 months - 2 years old and is hospitalized or immunocompromised with rubeola, what is the treatment

A

Vitamin A

97
Q

Complications of rubeola / measles includes

A

diarrhea, OM, PNA, encephalitis

98
Q

Rubeola is communicable _______ days before rash appears and until ______ after the rash disappears

A

3-5 ; 4-6 days

99
Q

Physical findings of pertussis include?

A

-acute respiratory disorder
-paroxysmal cough
-whooping cough
-copious nasal / oral secretions

100
Q

Patients with pertussis need to be placed in

A

droplet/standard precautions

101
Q

therapeutic management of pertussis

A

-high humidity environment
-observing airway for obstruction
-push fluids
-abx compliance

102
Q

What is the medication treatment for pertussis?

A

-Macrolides “mycins”
-erythromycins, azithromycins

103
Q

If a client is < 1 month of age, pertussis must be treated with

A

azithromycin

104
Q

Pertussis can be prevented with what vaccine? When is it given?

A

-DTaP
-2,4,6,8, 15-18 months
-booster at 11 years

105
Q

Clinical manifestations of fever include

A

-sweating, weakness, lethargy, flushing, s/s of dehydration if severe

106
Q

A fever in an infant younger than 3 months is

A

100.4 or higher

107
Q

A fever in a child 3 months to 3 years is

A

102.2 or higher

108
Q

An older child will have more traditional s/s of fever such as

A

-rash
-appearing sick
-persistent diarrhea or vomiting
-s/s of DHD

109
Q

How often should temp be assessed if client has a fever

A

-assess q 4-6 hours
-30 - 60 min after administering antipyretic
- any change of condition

110
Q

Should the nurse change the site or device used for temperature measurement for a client experiencing a fever

A

No ; use the same to accurately gage changes in temperature

111
Q

When should antipyretics be administered

A

when child is experiencing discomfort or cannot keep up with metabolic demands of the fever

112
Q

Nursing interventions during fever

A

-assess fluid intake
-encourage oral intake
-IV fluids per order
-keep linens and clothing dry

113
Q

What two medications are given to manage fever

A

-tylenol 10-15 mg/kg/dose q 4-6 h
-ibuprofen 5-10 mg/kg/dose q 6-8 h

-ibuprofen only given if > 6 months

114
Q

Physical findings of Lyme disease include

A

-onset of rash and erythema migrans
-fever
-HA
-joint/muscle pain that progresses to larger joints

115
Q

How long after bite from deer tick does onset of rash and erythema migrans occur

A

usually 7-10 days

116
Q

Lyme disease treatment for clients > 8 years old

A

-14-28 day course of Doxycycline

117
Q

Lyme disease treatment for clients < 8 years old

A

-Amoxicillin to prevent teeth discoloration

118
Q

Nursing education for preventing future tick bites includes

A

-wear protective clothing that fits tightly around wrists, waists, and ankles
-do a full body check after leaving area with ticks
-examine gear, clothes, and pets for ticks
-tumble dry gear on high heat for an hour
-insect repellent is temporary and may be toxic to children

119
Q

Teaching patients how to remove a tick includes

A

-using fine-tipped tweezers
-protect fingers with gloves
-do not twist or jerk the tick
-clean site with some and water or alcohol
-save the tick in case child becomes sick

120
Q
A

Peds (3 decks)

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