Final Peds Flashcards
What is the psychosocial development of an infant? What is it based on? When does separation anxiety generally begin?
trust vs. mistrust
quality of relationship with careiver
4-8 mos
What are is the immunization schedule for the first 12 months?
birth: hep B
2 mo: Dtap, RV, IPV, Hib, PVC, Hep B
4 mo: Dtap, RV, IPV, Hib, PVC
6+ mo: Dtap, RV, IPV, Hib, PVC, Hep B
12 mo: flu
What are the HR ranges by age:
newborn
infant 1mo-12mo
toddler 1-2yr
preschool 3-5 yr
school 6-12yr
adolescent 13-18yr
n: 110-160
i: 90-160
t: 80-140
p: 70-120
s: 60-110
a: 50-100
What are the RR by age:
newborn
infant
toddler
preschool
school
adolescent
n: 30-60
i: 25-30
t: 25-30
p: 20-25
s: 20-25
a: 16-20
Whar are expected BP ranges for age groups?
newborn
infant
toddler
preschool
school
adolescent
(I’m making these easier to remember, they may vary a point or two)
n: 64/40
i: 85/50
t: 85/40
p: 90/50
s: 95/55
a: 120/80
What reflexes disappear by 4 months? What reflex disappears by 8 mos? What reflex disappear by 1 year? 1 month?
sucking
rooting
palmar
moro
tonic neck
plantar
babinski
stepping
What is Erikson’s stage of development for ages 1-3 years? How do the begin to express their independence? What gives them a sense of comfort as they begin to explore?
autonomy vs. shame/doubt
negativism
routine, ritualism and reliability
What is the immunization schedule for 1-3yrs?
12-15mos: IPV, Hib, PCV, MMR, V
12-23mos: Hep A (2 doses 6 months apart)
15-18mos: Dtap
How much milk should a toddler consume? Juice?
24-28 oz
no more than 4-6 oz
What is Erikson’s psychosocial development stage for preschoolers? How is manifested?
initiative vs. guilt
become energetic learners
guide, set appropriate limits, praise, set up for success
What immunizations are given between 4-6 yrs?
Dtap
MMR
V
IPV
flu
What is the psychosocial stage for school-age children? How is it manifested?
industry vs inferiority
sense of accomplishment
love to achieve
need challenge
complete tasks
respond to reward for mastery of skills
What are the immunizations for 11-12 yrs?
Tdap
HPV
MCV (meningococcal)
What is the stage of psychosocial development for adolescents? How is is manifested?
identity vs. role confusion
try on different roles
identify with peer groups
What are the cognitive stages and manifestions of each?
infant
toddler/preschool
school
adolescent
Infant (sensorimotor)
Object permanence
Toddler/Preschooler (preoperational)
Domestic mimicry
imitation
symbolism
egocentrism/centration
time awareness by daily events, not clocks
School-age (concrete operational)
Conservation of mass
problem-solving
tells time
decenter
Adolescent (formal operational)
Abstract thought
thought beyond current
What are risk factors for HIV that can affect infants/children?
Breast milk for HIV mother
exposure to blood products
sexual assault
risky behaviors
IV substance use
How is HIV diagnosed in
>18 mos
<18 mos
positive ELISA (enzyme linked immunosorbent assay
born to infected mothers
polymerase chain reaction
virus culture
What is nursing care for pediatrics and HIV?
encourage balanced diet, high calories, high protein
administer TPN if needed
good oral care
keep skin clean and dry
assess pain, provide mangt and non-pharm mngt
prevent infection
encourange immunizations
monitor for opportunistic infections
psychosocial support
educate on transmission
identify stressors
What antibiotic is administered to all infants born to HIV positive mothers?
trimethoprin-sulfamethoxazole
What are causes of diaper dermatitis? Findings? Preventative measures?
detergents, soaps, or chemicals
candida
red rash on genetalia, can be smaller patches too
red scaly areas on scrotum and penis, labia
pimples, blisters, bumps, pus-filled sores
promptly remove soiled diapers
clean with a non-irritating cleanser
use superabsorbent disposable diapers
apply skin barrier
What is atopic dermatitis/excema? Risk factors? Findings? Nursing care?
integumentary disorder, pruritis, cannot be cured but can be well controlled
family Hx
previous skin disorder causing an exacerbation
exposure to a causitive agent (med, food, soap, animal)
intense pruritis
dry and rough unaffected skin
hypopigmentation
pallor around nose, mouth, ears
blue skin under eyes
infected nail beds
lymphadenopathy
wound infections
lesions
keratosis pilaris
tepid baths to hydrate
apply emollient within 3 mins of bathing to trap in moisture
cotton clothing, avoid wool and synthetics
avoid excessive heat and perspiration
avoid irritants
wash sensitive areas frequently
identify causative agents
keep nail short
What is rubella? Mode of transmission? How can you have artifical immunity? Who is at risk? S/S? Treatment? Precautions?
German measles
contact with droplets
MMR vaccine
incomplete vaccination
outbreaks, endemic areas
immunodeficiency
maculopapular rash on face then trunk and extremeties
fever
HA
malaise
URI
mild conjunctivitis
lymphadenopathy
comfort measures
antipyretics
NSAIDS
droplet
What is rubeola?Mode of transmission? How can you have artifical immunity? Who is at risk? S/S? Treatment? Precautions?
measles
droplet and airborne
MMR
very contageous
3 Cs: cough, coryza (nasal discharge) and conjunctivitis
rash that spreads from head to toe
Koplik spots: white spots in mouth
malaise, HA
GI symptoms
fever
photophobia
cofort measures
antipyretic
topical ointment
airborne
What is Epstein-Barr? Mode of transmission? S/S? Treatment?
mononucleosis
contact with saliva
glandular fever
CNS complications possible
splenic rupture
hepatosplenomegaly
fever
enlarged adenoids
pharyngitis
sharp abdominal pain
acetaminophen and NSAIDs
rest
can take 3-6 months
avoid contact sports because of the spleen
What is the patho of hemorphillia? When is it commonly identified? Where can bleeding occur? Mngt?
sex-linked recessive, lack a coagulation component of factor 8, affects white males most
circumcision at birth
GI tract
peritoneal cavity
CNS
nosebleeds are common
tissue
Factor 8 in blood or concentrate
desmopressin
What is the patho of iron deficiency anemia? What is inhibited? What can affect iron absorption in young children? Symptoms? Lab findings? Tx? Nursing interventions?
most common anemia though on the decline
stems from inadequate dietary iron
hemoglobin cannot be incorporated into RBCs
Drinkiing too much milk, 32+oz a day
Calcium hates iron
pale conjunctiva
pallor
poop muscle tone
enlarge spleen
enlarged heart/systolic murmur
spoon shaped fingernails
Hgb <11
Hct <33%
underlying cause
ferrous sulfate
high iron
high vitamin C
administer iron on empty stomach
avoid giving with milk or tea
give with an acid like OJ
high fiber to minimize constipation
follow-up bloodwork
Patho of sickle cell anemia? Who does it affect most? What is the patho of a crisis? When can this occur? S/S? Tx?
autosomal recessive, erythrocyte sickles increasing blood viscosity with dehydration or hypoxia
Black
sudden, sever sickling, pooling of sickled cells causes tissue hypoxia
GI illness
dehydration
RI
strenuous exercise
idiopathic
low Hgb
sickled cells on peripheral blood smear
elevated bilirubin and reticulocyte
elevated WBC
pale
swelling
joint pain
enlarge spleen and liver possible
acute chest syndrome (tachypnea, wheezing, cough, fever)
pneumonia
cirrhosis
scarred kidney tissue
retinal occlusions
priapism (painful prolonged erection)
pain mngt
hydration
O2
possible exchange transfusion
What is a Wilm’s tumor? Signs? Nursing considerations? Labs? Diagnosis? Tx?
painless, firm, mass on the kidney
fatigue, malaise, weight loss
fever
hematuria
HTN
metastasis: dyspnea, cough, SOB, chest pain
If suspected, DO NOT PALPATE
BUN, Cr
CBC
urinalysis
ultrasound
CT
inferior venacavogram
bone marrow aspiration to rule out metastasis
surgical removal of tumor an kidney
potential chemo/radiation, it depends
What is the most common childhood cancer? Early manifestations? Late?
leukemia
anorexia
HA
fatigue
low-grade fever
pallor
increased bruising
enlarged liver, lymph nodes or joints
conspipation
unsteady gait
pain
hematuria
ulcerations in the mouth
enlarge kidneys or testicles
increased ICP
What does luekemia cause? Doagnosis?
the production of immature WBCs which infiltrate organs and tissue. When it infiltrates the bone it crowds out the production of RBCs, platelets and mature WBCs causing anemia, neutropenia and thrombocytopenia.
CBC
bone marrow aspiration or biopsy
CSF biopsy via lumbar puncture
What are treatments for leukemia?
vincristine
doxorubicin
corticosteroids
methotrexate
allogenic transplant
radiation
What are risk factors for tonsilitis? Findings? Tx?
exposure to virus or bacteria
immature immune systems such as in children
sore throat
Hx of otitis media, hearin difficulties
mouth odor
moeth breathing
snoring
fever
inflammation
redness and edema
difficulty swallowing
viral: comfort measures, salt water gargles
bacterial: antibiotic
What causes bronchiolitis? Early findings? Moderate findings? Severe? Tx?
RSV
rhinorrhea (load of snot)
fever
pharyngitis
ear or eye infection
coughing, sneezing, wheezing
tachypnea, retractions
refuses to bottle feed
copious secretions
tachypnea >70
listless
apnea
poor air exchange
advantageous breath sounds
cyanosis
maintain O2
fluids
mintain airway
meds: corticosteroids, bronchodilator, antibiotic (if bacterial)
No CPT
suctioning
What are expected findings when croup has turned to epiglottitis? Tx? What are the precautions?
cough
drooling
agitation
chin and tongue out
dysphonia
dysphagia
stridor
retractions
fever
do not culture
protect airway
prepare for intubation
provide humidified O2
corticosteroids
fluids
antibiotic
droplet
Risk factors for asthma? Findings?
family Hx
boy
exposure to smoking
low birth weight
obesity
allergens
chest tightness
dyspnea
audible wheezing
cough
mucus
restlessness
anxiety
using accessory muscles
retractions
inaudible breath sounds when severe
Meds for asthma?
short acting beta blocker: albuterol
long acting beta blocker salmeterol
anticholernergic atropine, ipratroprium
What is the patho of cystic fibrosis? risk factors? findings?
mutated gene that causes thick, tenacious mucus which leads to mechanical obstructions along with autonomic abnormalities
recessive trait
white
meconium ileus at birth
URI
wheezing, ronchi
dry cough
dyspnea
paroxysmal cough
emphysema and atelactasis
cyanoiss
barrel chest
clubbed fingers
bronchitis
steatorrhea
weight loss
thin arms and legs
deficiency of fat soluable vits
anemia
reflux
prolapse rectum d/t bulky stool
high salt in sweat, saliva, tears
reproductive issues
decreased insulin production
Treatment of cystic fibrosis?
respiratory: CPT
GI: pancreatic enzymes with food
high protein, high calories
fat vitamin supplements
manage GERD
monitor blood glucose/insulin
What are meds for cystic fibrosis?
respiratory: albuterol, ipratropium, fluticasone
to decrease viscosity of mucus: dornase alfa
antibiotics PRN
pancrelipase for pancreatic insufficiencies and food digestion
Vitamins ADEK
What are nursing actions for cardiac catheterization?
assess for infection presurgery
check for allergies to idodine and shellfish
NPO 4-6 hrs prior
Baseline VS
mark pedal and posterior tibial pulses
administer pre sedation
Post:
monitor heart
assess RR
assess symmetry in pulses
asses temp and color of extremety
assess insertion site
strait flat position for 4-8 hrs
I&O
encourage clear liquids
encourage voiding
What causes rheumatic fever? When does it occur? Findings? Complication?
Group A beta-hemolytic strep in the throat
2-6 week following infection
Hx URI
fever
tachycardia
cardiomeagly, new murmur, friction rub
SQ nodules over bony prominences
painful joints
rash on trunk
muscle weakness, involuntary movements
labile emotions
irritability, chorea (nervousness, decreased attention span, behavioral changes)
may need valve repair
heart disease
a fib
embolism
What is kawasaki disease? Findings?
acute systemic vasculitis of uknown origin, usually resolves within 8 weeks
high fever
irritable
red eyes
chapped lips
strawberry tongue
swelling of hands and feet
red palm and soles
rash
bilateral joint pain
enlarged lymph nodes
myocarditis
What is nursing care for kawasaki? Complications?
monitor cardiac status
assess for heart failure
I&O
daily weights
IV fluids
non acidic foods
IV gamm globulin
aspirin
comfort care
irritabiity can last 2 months
arthritis can last as well
avoid live immunizations for 11 months
heart failure
What are s/s of heart failure?
tachycardia
tachypnea
failure to thrive
poor feeding
fatigue
SOB
What happens is a patent ductus arteriosis? What happens to th blood flow? Does this cause baby to be blue? Assessment? Tx?
fetal shunt fails to close after a few days of life
blood flows from the aorta through the open PDA and into the pulmonary artery, increasing pulmonary blood flow
no, it’s acyanotic because the blood shunting is oxygenated
systolic murmur, 2nd intercostal
furosomide
prostaglandin inhibitor and indomethacin to fascilitate closure
increased calories
closure
What occurs in tricuspid atresia? Assessment?
tricuspid valve is closed preventing blood from entering the left atrium
cyanosis
dyspnea
tachycardia
older: hypoxemia, clubbing
What occurs with congential hypotyroidism? Cause? S/S? Tx?
reduced or absent function
mom was deficient in iodine
missing thyroid
family hX Hashimotos
sleepy
metabolism is SLOW
poor suck
open mouth, large tongue
obesity
hypotonia
constipation
large abdomen
levothyroxine
What is Hyperthyroidism? Cause?
graves disease
most often pituitary tumor
viral/stress
tachycardia
hunger
weight loss
goiter
wide eyed, exophthalmia
beta blockers
PTU to suppress the T4 formation (propylthiouracil)
What is PKU? Tx? Examples?
metabolic deficiency of liver enzyme phenylalanine hydroxylase which then fails to convert AA into tyrosine
builds up in the blood causing brain damage
restirct consumption of PKU containing foods
meat
eggs
milk
What is the cause of acute gastroenteritis? S/S?
typically viral
N/V
dirrhea
What is the most gommon cause of GERD in infants/chiildren? S/S? prevention?
gastroesophageal reflux
inadequate weight gain
irritability
emesis
gagging
choking
vomiting
avoid laying down after meals
elevate upper body on wedge when sleepings
avoid food triggers: acid, chocolate
eat smaller portions
What is pyloric stenosis? findings? Tx?
hypertrophy or hyperplasia of the pyloric sphincter making emptying from the stomach to the duodenun difficult
vomit after feedings
projectile vomiting
sour smell
hungry after vomiting because they are not nauseated
dehydration
hypoglycemia
alkalosis/electrolyte imbalances
laprascopic correction, pyloromyotomy
What is intussusception? When does itusually happen? Reason? findings? complication? Tx?
part of the intestine inverts on one another
first year of life
idiopathic
vomiting
abd pain
bloody stool like red surrant jelly
distended abd
necrosis of affected area
surgery
reduction first then surgery
What is hirchsprnung disease? Findings? Tx? complication?
ansence of ganglionic innervation of a section of the bowl (ost often sigmoid section)
no parastalic wave in that section, area above it dilates
causes chronic constipation or robbon stool
meconium cannot pass
thin
undernourished
dissection of affected area
2 stages: temp. colostomy then dissection
possible colostomy
