final exam Flashcards
when should dornase alfa be given to a a patient with CF?
prior to chest PT
(it loosens the secretions so they can be expelled)
what play is expected for an infant?
solitary
what play is expected fir a toddler?
parallel
what play is expected for a pre-schooler?
associative
what play is expected for a school-age?
cooperative
what atraumatic care techniques can be utilized for an infant?
- soothing music
- therapeutic hugging
- speak in calm tone
what atraumatic care techniques can be utilized for a toddler?
- approach carefully
- use toys/book to distract
- parallel play
what atraumatic care techniques can be utilized for a pre-schooler?
- puppets
- allow to touch equipment
- allow choices
- count out loud
- give bear a shot
what atraumatic care techniques can be utilized for a school-age?
- encourage questions
- use diagrams
- illustrations
what atraumatic care techniques can be utilized for an adolescent?
- respect privacy
- don’t force talk
- use appropriate medical terms
what activities should be utilized for an infant?
- mobiles
- noise-makers
- soft toys
- large blocks
what activities should be utilized for a toddler?
- push-pull toys
- lg-piece puzzles
- balls
what activities should be utilized for an adolescent?
- reading
- listening to music
- peer time
what activities should be utilized for a pre-schooler?
- arts/crafts
- play pretend
- books
what activities should be utilized for a school age?
- board games
- action figures
- models
- video games
what motor skills are expected by 4m?
- back to side
- head control
- grasps objects w/both hands
what motor skills are expected by 6m?
- back to front
- holds bottle
what motor skills are expected by 9m?
- unsupported sit
- creeps on hands/knees
- crude pincer grasp
what motor skills are expected by 12m?
- sits down from standing
- walks w/one hand or on own
- 2 block tower
- simple marks on paper
- feeds self w/cup/spoon
at what month should birth weight be doubled?
5 m
what does birth weight do by 1 yr old?
triples
how much should the heigh increase for the first 6 m?
1in/m
how much should the birth length increase by 12 m?
50%
how big should head be by 12m?
10cm
what resp differences are expected in infants?
- lack of IgA
- narrow nasal passages
- trachea and chest wall more compliant
- shorter bronchioles/bronchi
- funnel-shape larynx
- larger tongue
- fewer alveoli
what is recommended at 4m to infants who are exclusively breastfed?
iron supplementation
how long should cows milk be avoided?
1st year
what type of formulas should be used for bottle fed infants? how many calories/oz?
- iron fortified formulas (10-12mg/liter)
- 20kcal/oz
what reflex must be extinguished to start solid foods around 4-6m?
extrusion
what should be first solid food?
iron-fortified infant cereal (rice, barley, oatmeal)
what are the infant new food rules?
1st - cereal
2nd veggies
3rd fruit
- new food every 3-5 days
how many words are expected by the end of age 2 (toddler)?
50-300 words
what care seat safety education should be provided for toddler?
- read facing, back seat
- forward facing after age 2
- disabled airbag for front seat
what are 3 expected nutritional differences with toddlers?
- physiologic anorexia
- food jags
- ritualism
what is the TAMI mnemonic for cognitive development in pre-schoolers?
T ime
A nimism
M agical thinking
I maginary friend
what are 3 social development cues expected in the pre-schooler?
- fears
- imaginative play
- dramatic play (dress up)
what type of breathing pattern is expected in the school-ager?
diaphragmatic breathing
what are 3 nutritional requirements specific to the adolescent?
- calcium 1300 mg/day
- iron - 11mg (male); 15 mg (female)
- 2000 calories
what are 2 nursing care techniques for the hospitalized adolescent?
- maintain independence
- encourage socialization w/friends
what is often the first sign of resp distress (hypoxia/hypoxemia)?
tachypnea
what are some signs of resp distress?
- restlessness
- grunting
- cyanosis
- rales, wheezes, rhonchi
- retractions
what 4 nursing interventions can be implemented to manage hypoxemia?
- oxygen therapy
- pulse oximetry
- chest physiotherapy
-suctioning
what lab findings are expected for asthma?
- increase WBC and eosinophils
- increase Co2
- decrease O2
what is the function of the PFT? when should this assessment be avoided?
- measures long volume capacity and overall lung function
- NOT used during acute exacerbation
what type of measurement should be taken daily for a child with asthma?
PIFR (peak inspiratory flow rate)
- used daily to monitor effectiveness of management and for signs of acute symptoms
what does a PIFR measure?
- uses flow meter to measure the amount of air that can be forcefully exhaled in 1 second
what medications are used in the prevention of acute exacerbation of asthma?
- formoterol (long-acting bronchodil)
- fluticasone (inhaled corticosteroid)
- cromolyn (mast-cell stabilizer)
- montelukast (leukotriene antagonist)
what meds are used in the management of acute asthma exacerbation?
- albuterol
- ipratropium (anticholinergic)
- prednisone (IV/PO corticosteroid)
what is the pathophysiology of cystic fibrosis?
- epithelial cells don’t conduct chloride, altering water transport
causing thick, tenacious mucus is resp tract, pancreas and GI tract
what is the primary diagnostic for cystic firbrosis?
sweat chloride test
what qualifies children under 3m for cystic fibrosis?
sweat chloride with chloride >40 mEq/L
sodium >90 mEq/L
what qualifies children over 3m for cystic fibrosis?
chloride >60 mEq/L
Sodium > 90 mEq/L
what trademark stool type is seen with cystic fibrosis?
steatorrhea (bulky, fatty, greasy stools)
what can be utilized to clear secretions and prevent infection?
Chest PT w/postural drainage
what does dornase alfa do for the CF patient?
decreases the viscosity of mucus, improving lung function
what supplements are necessary for CF patients?
fat-solubles (A, D, E and K)
when should pancreatic enzyme be given to CF patient?
within 30 min of eating meal/snack
what are the key assessment cues of croup (laryngotracheobronchitis)?
- barking cough
- inspiratory stridor
- sudden onset @ night, gone in morning
- tachypnea, resp distress
- nasal flaring
- intercostal retractions
what are the 2 key meds for management of croup?
dexamethasone and racemic epinephrine
what are the nursing management priorities for croup?
- cool mist humidifier or steamy bathroom
- educate on s/s of increasing resp distress
what should be added to breast milk for children with HF?
HMF (human milk fortifier) to increase calories
what should be given with formula-fed infants with HF?
polycose/vegetable oil to increase calorie
what is the nutritional requirement for a child with HF?
- 150 cal/kg/day
- small, frequent
- 20 min max feeding
- cut bottle nipple (decrease work)
- semi-upright position
how can rest be promoted in the child with HF?
- cluster care
- provide rest periods
- bathe PRN
- quiet diversional activities
what is the mechanism of action for captopril/enalapril?
reduces afterload by causing vasodilation, decreasing the pulmonary and systemic vascular resistance
what should be monitored before and after the administration of enalapril/captopril?
BP
what med manages edema and rids body of excess fluid and sodium?
lasix
what should be monitored for lasix administration?
- BP
- I and O
- daily weight
- s.e. - hypokalemia, N/V, dizziness, ototoxicity
what medication for HF increases contractility of heart muscle?
digitalis (digoxin)
what HR requires digoxin to be held for an infant?
<90 apical
what requires digoxin to be held for a child?
<70 bpm apical
what HR requires digoxin to be held in an adolescent?
<60 bpm
what dig level is expected?
0.8- 2 ng/mL
what are signs of dig toxicity?
- anorexia
- n/v
- bradycardia
- dysrhythmias
what is dig antidote?
digoxin immune fab
what are the key findings of coarctation of the aorta?
- assess pulses:
- full bounding in BLUE
- weak/absent in BLLE
what heart sound is heard for coarctation of aorta?
soft/moderately loud systolic murmur at base or left axilla
which condition is characterized by TET spells?
tetralogy of fallot
what are the 4 components of tetralogy of fallot?
- pulmonary stenosis
- overriding aorta
- VSD
- R. ventricular hypertrophy
what is seen during a TET spell?
- cyanosis, hypoxemia, dyspnea, agitation
- anoxia, unresponsiveness
- especially in AM
what intervention is used for TET spell?
knee to chest
what assessment findings are seen with tetralogy of fallot?
- loud, harsh systolic murmur
- fainting, difficulty breathing, easy fatigue
- polycythemia (elevated RBCs)
what are assessment findings of Kawasaki disease?
- extreme irritability
- high fever unresponsiveness to abx for 5 or > days
- dry mouth/throat
- strawberry tongue, fissured lips
- desquamtion
what are 3 meds used for tx of Kawasaki disease?
- immunoglobulin (IVIG)
- high dose aspirin
- acetaminophen for fever
briefly describe kawasaki disease?
systemic vasculitis, causing inflammation and edema in b.v., especially coronary arteries
which cardiac arrhythmias may be caused by vagal stimulation from passing an orogastric tube?
sinus bradycardia
when does a bradyarrhythmia become life-threatening?
HR < 60 w/ signs of altered perfusion (respiratory compromise, hypoxia, shock)
what may be some causes for sinus tachycardia?
- fever
- pain
- fear
- fluid loss
-hypoxia
what HR defines SVT?
infants >220 bpm
children >180 bpm
- abrupt onset and termination, flattened P wave and narrow QRS
what may be used for tx of compensated SVT?
vagal maneuvers (ice to face, blowing through straw)
what tx is for uncompensated SVT?
adenosine or synchronized cardioversion
what defines sinus tach?
- infants (160 - 220); <220
- children (130-180); <180
what are assessment findings for dehydration?
- sunken fontanelles
- reduced LOC
- reduced cap refill time
- tachycardia/hypotension
- oliguria
- tachypnea
when is ORS used?
mild to moderate cases of dehydration
when should IVF rehydration be used?
severe dehydration or intolerance of ORS (persistent vomiting)
which condition is characterized by hypertrophy and thickening of the pylorus muscle that leads to gastric outlet obstruction?
hypertrophic pyloric stenosis
what are the cues of hypertrophic pyloric stenosis?
- forceful, projectile, nonbilious vomiting
- olive-shaped moveable mass in RUQ
- abnormal electrolytes and metabolic alkalosis due to GI losses
what are the priorities of care for hypertrophic pyloric stenosis?
- correct F/E imbalances
- NGT decompression
- NPO
- strict I/O
- post-op wound care
- resume PO in 1-2 days
what signs of enterocolitis should the nurse monitor for the patient with Hirschsprungs?
- fever
- abdominal distension
- chronic diarrhea/explosive stool
- rectal bleeding
- straining
- notify provider immediately
what type of surgical intervention is expected with hirshprungs disease?
ileo/colostomy
what PMH is expected with acute poststreptococcal glomerulonephritis?
strep throat or strep skin infection
what lab changes are seen with acute poststreptococcal glomerulonephritis?
- hematuria
- proteinuria
- elevated BUN/Creat
- elevated ESR
+ ASO titer (strep antibodies)
what may be noted of past hx for HUS?
- ingestion of ground beef
- visit to water park/public pool
- petting zoo
one of these prior to developing diarrhea
what are assessment findings for HUS?
- toxic appearance
- edema
- oliguria or anuria
- seizures/ altered LOC/coma
- HTN
what are the priorities of care for HUS?
- maintain fluid balance
- manage HTN/acidosis/electrolyte abnormalities
- PRBCs and platelets
- IVIG
what condition is marked by abnormal urethral opening on the ventral surface of penis?
hypospadias
what are clinical manifestations seen with growth hormone deficiency?
- retarded bone growth
- large/prominent forehead, underdeveloped jaw
- high-pitch voice
- delayed sexual maturation
- delayed dentition/skeletal maturation
- decreased muscle mass
what is the tx for growth hormone deficiency?
- Sub-Q biosynthetic GH replacement
- daily doses
what levels are seen in the newborn blood screening with hypothyroidism?
Low FT4 and high TSH
what are the clinical cues of congenital hypothyroidism?
- poor sucking reflex
- hypothermia
- constipation
- lethargy/hypotonia
- periorbital puffiness
- cool, dry, scaly skin
- bradycardia, resp distress
- lg fontanelles, delayed closure
what med if used to manage congenital hypothyroidism?
- L-thyroxine (synthroid, levothyroid) daily
what are the s/s of DKA?
- BS >330 mg/ dL
- Kussmauls
- warm, dry, flushed
- 3 P’s
what are the management priorities for DKA?
- hourly BG monitoring (prevent BS falling more than 100 mg/ dL/hr)
- PICU admission
- IVFs for dehydration
- IV regular insulin drip
what are the physical cues of hydrocephalus?
gait changes, sun-set eyes, projectile vomiting, change in LOC, enlarged ventricles/obstructed CSF flow (CT/MRI)
what condition is ventriculoperitoneal shunt used for?
hydrocephalus
what are the s/s of VP shunt obstruction/infection?
- increased ICP
- fever >101
- headache/stiff neck/bulging fontanelle
- poor feeding/vomiting
- increased head circumference
- dilated pupils on same side as pressure build up
- high pitch cry
what are the seizure precautions?
- padding
- side rails raised
- O2 and suction @ bedside
- supervision (bathing, ambulation, etc)
- protective helmet during activity
- medical alert bracelet
what are the cues of increased ICP?
- HA, vomiting, blurred vision, dizziness, tachycardia
- lowered LOC
- cheyne-stokes resps
- posturing
- fixed and dilated pupils, sunset eyes
what is included in the cushing triad of increased ICP ?
- irregular breathing
- HTN
- bradycardia
what are the interventions for increased ICP?
- head midline w/bed @ 30 degrees
- keep body in alignment
- low stimuli (calm, limited visitors)
- avoid coughing, blowing nose
- stool softeners
- seizure precautions
- monitor I and O
what findings are seen in the LP for bacterial meningitis?
- increase WBCs
- low glucose
- increase protein
- cloudy color
what is the nursing management of bacterial meningitis?
- ICU admission
- droplet isolation until 24 h of abx or order to discontinue
- IV abx
- ventilator support
- seizure precautions
what are 2 physical signs of bacterial meningitis?
- kernig (knee flex elicits pain)
- brudzinski (passive neck flexion elicits hip and knee flexion)
what are nursing priorities for reyes?
- decrease ICP
- supportive care r/t liver failure
what is the focus of nursing care for cerebral palsy?
- promote mobility
- maintain cardiopulmonary function
- prevent complications
- maximize quality of life
what meds are used in cerebral palsy management?
- Baclofen
- Botox (botolinum toxin A)
- carbidopa
what are 2 complications of fractures?
- compartment syndrome
- osteomyelitis
what is therapeutic management of amblyopia?
patching or atropine drops in STRONGER eye
how does the tympanic membrane appear with acute otitis media?
dull, red, bulging or opaque
purulent drainage
what tx measures are indicated for acute otitis media?
- tylenol, ibuprofen
- benzocaine (auralgan) drops
- warm/cool compromises
- abx therapy PO for 10-14 days or 1 IM dose
what is best practice for ear drop administration for <3yr?
pull pinna down and back
what is best practice for ear drop administration for >3yr?
pull pinna up and back
what respiratory condition is marked by a paroxysmal cough?
pertussis
what type of abx are used for pertussis?
- macrolides (-mycins) for infants >1m
- azithromycin if < 1m
what precautions are indicated for pertussis?
droplet and standard precautions
what are the physical findings of lyme disease?
- onset of rash 7-10 days after bite
- erythema migrans at site of bite
- fever, malaise, HA, joint/muscle pain
what is tx for lyme disease?
- doxycycline >8yr old
- amoxicillin for < 8yr
- tx for 14-28 days
what therapeutic interventions are utilized for SCID (absent T and B cell function)?
- bone marrow transplant
- IVIG
what type of prevention is essential for SCID?
infection prevention
what nursing actions would be beneficial for SCID to prevent infection?
- teach good handwashing
- no exposure to infected persons
- prophylactic abx
- no live vaccines
- promote adequate nutrition (possibly enteral)
what are physical cues of JIA (juvenile idiopathic arthritis)?
- hx of irritability/fussiness
- difficulty getting out of bed
- joint stiffness/pain
- systemic fever >103
- limping gait, joint guarding
- eye inflammation
what are the lab diagnostics for JIA?
- mild to moderate anemia
- elevated WBCs
- +RF
- +ANA
- elevated ESR
- elevated CRP
how is the adequacy of fluid replacement determined for burns?
evaluating urinary output
what actions should be taken to promote nutrition for a burn client?
- increase calories
- increase protein
- enteral/parenteral nutrition
- vitamin a & c
- zinc
how much urine output should be maintained for a burn patient?
1-2 mL/kg/hr
what are the assessment findings for atopic dermatitis (eczema)?
- elevated IgE
- wheezing
- dry, itchy, red skin
what meds are used for eczema?
- topical corticosteroids
- tacrolimus (immune modulators)
what are the interventions for eczema?
- no hot water
- bathe 2x/day in warm water
- avoid soaps w/perfumes, dyes and fragrances
- apply moisturizer while skin is still moist
- 100% cotton
- short fingernails
- antihistamines
what type of skin injury is characterize d by superficial rub/wearing off of skin and is usually due to friction?
abrasion
what are the risk factors for skin injuries?
- poverty
- prematurity (<1yr)
- chronic illness
- intellectual disability
- parent w//abuse hx
- alcohol/substance abuse
- extreme stressors
what are some suspicious signs of skin injury?
- injuries in uncommon locations
- bruises in infants <9m
- multiple injuries other than LEs
- frequent ED visits
- delayed care
- inconsistent stories
- unusual caregiver-child interaction
which lab is affected with hemophilia a?
prolonged PTT ~42 (25-35 sec)
what are the physical cues r/t hemophilia?
- hemarthrosis (swollen, stiff joints)
- multiple bruises
- hematuria
- bleeding gums
- bloody sputum/emesis
- black, tarry stools
- chest/abd pain (internal bleeding)
what is the 1st line tx for bleeding episode of a patient w/hemophilia?
factor VIII admin slow IV push
what nursing action should be taken for a joint bleeding w/hemophilia?
- direct pressure to external bleeding
- ice or cold compress
- elevate extremity
what is used for hemophilia bleeding prophylaxis or for mild cases of bleeding?
DDAVP (desmopressin)
what s/s are seen with iron deficiency anemia?
- spooning on nails
- pica
- irritability
- HA
- unsteady gait, weakness, fatigue, dizziness, SOB, pallor
what are the signs seen with a sickle cell vaso-occlusive crisis?
- extreme fatigue/irritability
- pain (abd, thorax, joints, digits)
- c=dactylitis
- cough, inc WOB, fever, tachypnea, hypoxia
- splenomegaly
- jaundice
what are the 3 priorities to address during a sickle cell vaso occlusive crisis?
- pain
- hydration
- hypoxia
what position is used for BMA?
prone
what is the bone of choice for BMA?
iliac crest
what meds are expected to be ordered for a BMA?
- local/topical anesthetic
- conscious sedation (fentanyl/versed)
what are the pre-procedure actions to take prior to a BMA?
- explain
- comfort
- prevent infection
what are the priorities after a BMA?
- hold pressure
- pressure dressing
- monitor for bleeding and infection
Guess the precaution:
- mask on child outside of room
- no raw fruits/vegs/flowers/live plants
- soft toothbrush
- avoid rectal temp/enema/supp/cath
- VS Q4
- assess for signs of infection Q8H and PRN
- hand hygiene (before and after)
- private room
neutropenic precautions
what does an ANC of < 1000 indicate?
neutropenia
