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Pediatric Nursing > Midterm > Flashcards

Midterm Flashcards

1
Q

active transport

A

process which molecules move against the concentration gradient - energy is needed for this process

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2
Q

medical history r/t nutrition

A
  • birth
    • weight, length, head circumference, gestational age up to 2-3 yo (unless more pertinent)
  • tollder - adolesence
    • weight, height
  • all ages
    • previous dx states, comorbidities, hospitalizations, treatments, surgeries
  • developmental history, growth history
  • any issues r/t nutrition
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3
Q

bacterial infectious agents

A
  • TB and haemophilus
  • pertussis
  • strep
  • staph
  • meningococcal
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4
Q

pediatric respiratory rate

A
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5
Q

CF overview pathophysiology

A
  • CFTR (transmembrane conductance regulator) gene causes abnormal chloride-ion transport, reducing flow of water across cell membranes
  • thick, dehydration mucous affects respiratory, GI, genitourinary systems
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6
Q

CRIES

A
  • pain measurement scale
  • crying
  • requires oxygen
  • increased vital signs
  • expression
  • sleeplessness
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7
Q

venous access for parenteral nutrition

A
  • CVL
  • PPN - peripheral parenteral nutrition
    • consider reason
    • consider fluid osmolality - lower than through CVL
    • consider ability to optimize PN peripherally - enough nutrients
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8
Q

common side effects of opioids

A
  • sedation/sleepiness
  • mental confusion
  • N/V
  • pruritis (usually on face)
  • urinary retention
  • constipation
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9
Q

sepsis: “seeding” systemic circulation

A
  • infection seeds sytemic circulation
    • decreased tissue perfusion
    • can’t get proper oxygen into and CO2 and toxins out of tissues
  • leads to septic picture (decreased perfusion)
  • severe sepsis, septic shock, death
    • if you can interject with appropriate antibiotics, fluids in time you can mitigate and stop in its tracks
  • potential is there once you’ve hit the inflammatory and decreased perfusion state
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10
Q

incision of artificial airway

A
  • inferior border of cricoid cartilage
  • de-cannulating
    • pull trach out
    • cover 5-7 days with gauze
    • NO ibuprofen - inhibits stoma healing
    • natural healing
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11
Q

nursing management of sepsis

A
  • early recognition - get help
  • IV access
    • two working peripheral IVs is best practice
  • aggressive fluid resuscitation
  • early accurate antibiotic therapy; other meds
  • ongoing VS assessment
  • monitor urinary output
  • labs
    • blood culture, urine culture prior to antibiotics
  • communicate with team and family
  • accurately document
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12
Q

sepsis and decreased blood return to heart

A
  • periphery not as tight as normal
  • breakdown in ability of body to maintain peripheral contractility
  • more pooling in extremities and periphery
  • decreases blood flow back to heart
  • decrease in CO
    • decrease blood flow to organs
    • vicious cycle
  • increase SV to compensate for low blood flow causes tachycardia
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13
Q

response to disturbance in acid-base equilibirum

A
  1. acid-base buffer systems
    1. bicarbonate-carbonic acid buffers, intracellular protein buffers, phosphate buffers
    2. immediate regulation
  2. lungs alter rate of ventilate for CO2 removal
    1. minutes, hours
  3. kindeys alter excretion of H+ or bicarbonate
    1. hours, days
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14
Q

pnuemonia physical exam findings

A
  • decreased/absent breath sounds
  • accessory muscles
  • adventitious breath sounds
    • wheeze, crackles, partial breath sounds on one side vs other
  • +/- abdominal pain
    • children can’t discern exactly where pain is
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15
Q

parenteral nutrition

A
  • when patients cannot meet nutritional needs PO or enteral
  • sole of adjuntive therapy
    • inadequate GI fxn
    • inadequate oral/enteral take
    • oncologic malignancies
    • extensive burns
    • pre/post op nutrition support
    • severe malnutrition
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16
Q

functional residual capacity (FRC)

A
  • volume in lung after passive expiration
  • decreased in respiratory distress
  • can cause precipitous desaturation
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17
Q

meckel’s diverticulum defined

A
  • outpouching or bulge in lower small intestine
  • congenital and leftover from unbilical cord
  • most common congenital defect of GI tract
  • may contain cells from stomach and pancreas
    • cells from stomach secrete acid, causing ulcers and bleeding
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18
Q

all that wheezes is not asthma

A
  • other diagnoses
    • foreign body aspiration
    • lower airway disease
    • GE reflux
    • GERD
    • OSA
  • response to bronchodilators, CXR may help with diagnosis
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19
Q
A
  • “steeple sign” of croup seen on CXR
  • narrowing at the top of the trachea
  • usually treated symptomatically, not with X-ray
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20
Q

types of bleeds occurring in GI

A
  • trauma
    • 85% blunt
  • meckels diverticulitis
  • food related?
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21
Q

UTI treatment

A
  • less than 3 mo - IV gent and amp, despite deafness risk with gent
  • older children - oral trimethoprim-sulfamethoxazole
  • renal/bladder ultrasound to rule out anomalies
  • voiding cystourethrogram
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22
Q

hypotonic IVF

A
  • osmolarity is less than 300
  • more water, less solute
  • fluid moves from intravascular space into ECF into ICF
    • cerebral edema (cell lysis)
  • .45% NaCl (150 mOsm)
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23
Q

pertussis immunity

A
  • should gain immunity in a pure world, but not everyone has the vaccination and we don’t have heard immunity
  • speculation that the DNA has changed - may not have lifelong immunity
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24
Q

diet history

A
  • usual mode of intake (PO, enteral, parenteral)
  • age-appropriateness of diet
  • food allergies/intolerances
  • vitamin/mineral supplements
  • herbal/natural supplements
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25
Q

omphalocele

A

some fetal organs develop outside abdomen in a transparent sac at base of umbilical cord

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26
Q

6 med admin rights

A
  1. medication
  2. dose
  3. patient
  4. route
  5. time
  6. documentation
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27
Q

measuring head circumference

A

developmental milestone (along w. weight and length) - until 2 yo (WHO says 3 yo)

measure lying down or sitting up with a partner to hold/measure

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28
Q

common reasons for tracheostomy

A
  • long term ventilation
  • bypass obstruction, narrowing or floppiness of airway
    • neuromuscular disease
  • sustain airway in face of CNS issues
    • hypoventilation
    • brain injury
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29
Q

MOSD

A

multi organ system dysfunction

  • respiratory failure
  • tachycardia increases
  • kidneys begin to shut down
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30
Q

pneumococcal disease and sickle cell

A
  • need spleen to get rid of pneumococcal bacteria
  • maintence med for sickle cell patients is penicillin VK (potassium) to prevent infection
  • in addition to immunizations
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31
Q

nursing interventions with chickenpox

A
  • tylenol or ibuprofen
  • oral antihistamines for itching
  • trim fingernails
  • soft cotton mittens
  • isolation precautions
  • vaccine: VZIG
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32
Q

A & B: aeration & breathing

A

differences between adults and children

  • size of airway
  • amount of alveoli
  • trachea - size of child’s pinky (easily obstructed)
    • complicated by developmental behavior of putting things in their mouths
  • chest wall
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33
Q

heat moisture exchanger

A
  • provides humidification for trach
  • keeps secretions thin
  • filter
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34
Q

severe persistent asthma

A
  • several daytime symptoms, nighttime symptoms > 1x/week
  • activity extremely limited
  • requires baseline medications
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35
Q

increased WOB

A
  • use of accessory muscles
  • retractions
  • nasal flaring
  • tripod in older children
  • belly breathing - using abdomen to move diaphragm?
  • faster RR
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36
Q

self-report pain scales

A
  • faces
  • Oucher
  • poker chip
  • numeric rating
  • body outline
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37
Q

thrombocytopenia

A

low platelet count - bleeding and clotting simultaneously

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38
Q

progression of sepsis

A
  1. SIRS
  2. Sepsis (SIRS + infection)
  3. Severe sepsis (sepsis + end organ damage)
  4. Septic shock (severe sepsis + hypotension)
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39
Q

behavioral responses of pain

A
  • short attention span, irritability
  • facial grimacing, biting, pursing lips
  • posturing, guarding, decreased movement
  • drawing up knees, flexing limbs, rubbing affected area
  • quiet, withdrawn
  • sleep disturbances
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40
Q

allergy/hypersensitivity

A
  • small amount can cause immediate severe rxn
  • IgE mediated or non IgE mediated
    • IgE - after specific food
    • Non IgE - cell mediated by GI tract
  • immune system rxn affecting +1 organ
  • may have subsequent late phase rxn
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41
Q

complications of meningitis in pediatrics

A
  • hemorrhaging
  • bacteria gets to kidneys
    • can’t put out urine
    • dialysis, blood products, antibiotics
  • after 24 hours not as infectious, but caregivers also on antibiotics
  • DIC - disseminated internal coagulopathy
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42
Q

GI/GU assessment for peritonitis NOT r/t PID

A
  • sudden ache that develops into severe pain
  • N/V
  • lack of appetite
  • chills
  • high temp
  • rapid HR
  • not passing urine or passing less than normal
  • abdominal swelling
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43
Q

location of upper airway vs. lower airway illnesses

A

upper airway: naso/oropharynx to glottis (above vocal cords)

lower airway: below glottis (vocal cords) including bronchus and branches, lungs, alveoli

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44
Q

osmolality

A
  • concentration of solutes inside the body
  • human body osmolality ~ 300 mOsm/kg
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45
Q

asthma definition

A

chronic lung disease thati nflames and narrows airways…complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hypperresponsivness and inflammation

most common chronic disease in children

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46
Q

A.S.T.H.M.A. patient education

A
  • A: airways - asthma basics
  • S: symptoms
  • T: technique & triggers
  • H: help - where to go
  • M: medications - how and when
  • A: action plan
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47
Q

latent/dormant TB

A
  • positive PPD
  • no physical exam findings
  • CXR normal
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48
Q

pain measurement tools

A
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49
Q

musculoskeletal effects of unrelieved pain

A

fatigue and immobility

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50
Q

respiratory effects of unrelieved pain

A
  • shallow breaths and suppressed cough
  • increased sputum retention
  • atelectasis and hypoxemia and shunting
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51
Q

H. influenzae vaccine

A
  • since 1992
  • CDC recommendations
    • under 5 (first at 2 mo)
    • increased risk of infection
      • sickle cell
      • immunocompromised
      • asplenic (w.o spleen or dysfunctional spleen)
        • cannot fight encapsulated organisms
      • HIV
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52
Q

complications of pertussis

A
  • half of infants less than 1 yo are hospitalized
    • younger the infant more likely treatment will be needed
  • infants
    • pneumonia
    • seizures
    • apnea
    • encephalopathy
    • death
  • teens and adults
    • syncope or rib fracture
    • weight loss
    • loss of bladder control
    • passing out
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53
Q

acute management of asthma

A
  • beta 2 agonists: albuterol, terbutaline
    • relaxes smooth muscle
  • oxygen
  • systemic steroids - reduce inflammation
    • oral, IV
  • anticholinergics: ipatropium bromide
    • anti-inflammatory inhaler
    • only works for the first 24-36 hours, if it works
  • IV fluids (worry about aspiration with oral)
  • methylxanthines: theophylline (sprinkles), aminophylline (IV)
    • ​dilate airways, relax airway muscles
    • used frequently in past - not as much, but more aminophylline now than recently
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54
Q

clinical pathway of Meckels

A
  • painless GI bleeding (in stool) in children
  • diverticulitis (intestinal wall swelling) in young/older adults
  • most common Sx in children
  • bleeding
  • caused by ulcers in small intestine
  • most common Sx in older children/adults
  • bowel obstruction
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55
Q

minimal sedation

A

patients respond normally to verbal commands. cognitive function and coordination may be impaired but respiratory and CV function unaffected

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56
Q

nursing care of H. flu

A
  • immunization status
  • droplet precaution
  • symptom management
  • fluid
  • antibiotics/ antipyretics
  • +/- dexamethasone
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57
Q

clinical pathway of intussusception

A
  • sudden, loud crying caused by abdominal pain
    • colicky and intermittent
    • comes back often
    • will get stronger, last longer each time
  • Classic Triad
    • vomiting, bloodys tools, colicky
  • other Sx
    • bloody, mucous-like bowel movement (currant jelly stool)
    • fever
    • shock (pale, lethargy, sweating)
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58
Q

specialty growth charts

A
  • premature infants
  • down syndrome
  • cerebral palsy
  • williams syndrome
  • turner syndrome
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59
Q

nutrition history

A
  • type/amount of nutrients
  • active/resolved issues that impact nutrition
  • parents knowledge of nutritional needs
  • characterize parent/family nutrition habits
  • educate importance of good nutrition
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60
Q

clinical pathway of non-invasive pneumococcal diseases

A
  • less serious
  • occur outside major organs or blood
  • otitis media
  • sinusitis
  • non-bacteremic pneumonia
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61
Q

urinary tract infection overview

A
  • 2nd most common infection among children, second to upper respiratory infection
  • most significant to neonates b/c of renal issues
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62
Q

bacterial pneumonia

A
  • complex, usually single cell
  • thrives in many environments (hot, cold)
  • many cause little to no harm
  • sputum testing can identify organism or virus
  • macrolides for tx
  • symptoms up to 1 mo
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63
Q

inestinal silo

A

bag that surrounds intestines and keeps them hydrated - allows for gravity to slowly pull intestines back into the child as they grow

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64
Q

hypercapnea

A

increased CO2 in blood

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65
Q

high HR, low RR, BP caused by…

A

cardiac

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66
Q

types of streptococcus

A
  • treat Group A within group beta (strep in throat)
  • GBS is Group B within group beta
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67
Q

nursing management of hyponatremia

A

pool instruction when developmentally appropriate

urine specific gravity (1.000-1.0005

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68
Q

human milk

A
  • easily digested
  • immune properties
  • balanced nutrients and bio-active factors
  • ~20 cal/oz
    • 0.27-0.3 gm protein/oz
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69
Q

quick guide to pediatric BP

A

child older than 1 year:

90 + (2x age in years) / 70

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70
Q

bike injuries

A

head and abdomen (handlebar)

organs more exposed in children than adults because rib cage hasn’t fully enclosed around them

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71
Q

sedation plan

A
  • length of procedure, positioning/draping
  • immobility vs analgesia vs anxiolysis
  • providers available, location of procedure
  • informed consent
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72
Q

S/Sx of UTIs in infants

A
  • 40% asymptomatic
  • FTT
    irritability
  • vomiting, diarrhea
  • incontinence
  • change in urine color
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73
Q

differences between adult and pediatric GI systems

A
  • compact torsos with smaller AP diameters
    • smaller area over which force of injury can be dissipated
  • larger viscera, especially liver, spleen, and bladder
    • extend below costal margin
  • less overlying fat and weaker abdominal musculature to cushion intra-abdominal structures
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74
Q

electrolytes

A
  • ECF/ICF varies with age
    • neonates/infants have larger ECF
    • 45% ECF newborn, 25% infant, 10% child
  • infants: high daily fluid requirement w/ little fluid reserve
    • vulenerable to fluid loss
    • hats, socks, etc.
  • I/Os very important
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75
Q

parasitic infectious agents

A
  • tic/lyme disease
  • children not as hospitalized as much from this
    • unless there are complications
  • classic bulls-eye rash in only 15%
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76
Q

why is a hypotonic solution a common maintenance fluid?

A

replaces water that is normally lost throughout the day - overtime, there is a normal fluid exchange

a bolus would be too much fluid in too little time

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77
Q

sniffing position

A
  • optimal airway opening
  • trachea, pharynx, oral cavity optimally aligned
  • important in babies and young children
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78
Q

metabolic rate

A

amount of energy expended based on:

  • age
  • weight
  • height
  • sex
  • temperature
  • others
    • seizures, shivering, drugs (epi)
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79
Q

sedation medications

A
  • benzos
    • midazolam
    • diazepam
    • lorazepam
  • miscellaneous
    • ketamine
    • propofol
    • dexmedetomidine
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80
Q

on-going screening assessment of sepsis

A
  • fever or hypothermia
    • warming/cooling blankets
  • poor perfusion
    • slow cap refill, low pulse pressure, low urine output
  • hypotension
    • >2 fluid boluses given
    • started/increased vasopressors
  • altered mental status (not enough blood to brain)
    • change? decrease?
    • behavior different from baseline
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81
Q

therapeutic ladder for pain management

A
  1. nonopioid +/- adjuvant
  2. mild opioid +/- adjuvant +/- nonopioid
  3. moderate opioid +/- adjuvant +/- nonopioid
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82
Q

uremia

A

acute kidney failure r/t blood flow obstruction

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83
Q

serum protein r/t nutrition

A
  • decreased during stress, sepsis, acute illness
  • subject to fluid shifts and synthesis of acute phase proteins
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84
Q

fungal infectious agents

A
  • thrush (yeast)
  • candida
  • ringworm (also yeast)
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85
Q

pyloric stenosis defined

A
  • narrowing of pyloric sphincter from hypertrophy or hyperplasia of muscle
  • occurs in first 6 mo of life
  • some genetic component
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86
Q

nursing care of RSV bronchiolitis

A
  • monitor cardiovascular and respiratory status
  • maintain airway patency
    • oral suctioning
  • +/- oxygen therapy
    • delivery method might make them mad and exacerbate
  • chest physiotherapy
    • can be very calming
  • monitor response to meds
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87
Q

“child resistant”

A

80% of children can’t open the bottle within 5 minutes

LOCK medications away - don’t have to worry about which developmental stage your child is at - habit

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88
Q

passe muir valve

A
  • redirects flow of air upward through vocal cords, mouth, nose
  • one-way valve
  • enables trach patient to communicate orally
    • helps with speech therapy
  • need to deflate cuff - airflow won’t pass otherwise
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89
Q

source of E.coli 0157

A
  • GI tract of cattle
  • undercooked meat
  • internalized into vegetables
  • public pools
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90
Q

hepatic effects of malnutrition

A
  • enlarged w. fatty infiltrates
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91
Q

causes of hyponatremia

A
  • IV solutions w/ D5W
  • tap water enemas
    • draws salt out
  • diluting formula
  • swallowing pool/bath water
    • one tsp can throw off electrolytes
  • excessive sweating with incorrect fluid replacement
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92
Q

CF GI pathophysiology

A
  • mucous blocks pancreatic ducts
  • decreased enzyme production
  • poor fat digestion
  • malabsorption
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93
Q

symptoms of croup

A
  • children 3 mo - 4 yo
  • sudden onset, often nighttime
  • barking cough (hallmark), hoarseness
  • rhinorrhea
  • respiratory distress
    • loud breathing, inspiratorys tridor, tachypnea
    • +/- retractions
  • in the upper airway
    • oro/nasopharynx to level of glottic of VC
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94
Q

symptoms of hypernatremia

A
  • neuro effects of too much sodium
    • seizures, altered mental state
  • low urine output, increased urine concentration
    • 1.020-1.030
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95
Q

adult fluid volume distribution

A
  • 2/3 of body water is ICF
  • 1/3 of body water is ECF
    • 1/3 intravascular
    • 2/3 interstitial
  • ~50% of weight is water
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96
Q

laryngotracheobronchitis (croup) definition

A

acute upper airway disease with obstruction resulting from inflammationa and edmea of larynx, trachea, subglottic area

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97
Q

fentanyl

A
  • synthetic opioid
    • 100X more potent than morphine
  • peaks immediately
  • duraiton 30-60 min
  • half life 2.4 hrs
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98
Q

neuro effects of malnutrition

A
  • variable
  • usually in less than 2 yo
  • time of rapid brain growth and development
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99
Q

nursing assessment for pertussis: circulation

A
  • listen to HR for one minute
  • auscultate heart
  • peripheral pulses
  • cap refill on all extremities
  • feel for fontanels
    • flat, not sunken or bulging
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100
Q

bolus

A

large amount of fluid over short amount of time (10-20 minutes)

timing depends on size of child and access (how/where the line is)

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101
Q

treatment of RSV bronchiolitis

A
  • supportive
    • hydration
    • urine output
    • oxygenation/ventilation
    • manage secretion
    • antipyretics
    • enteric tube feedings
  • treatments to consider
    • bronchodilators (some respond, some don’t)
    • +/- steorids (evidence that it doesn’t really help)
  • has about 7-10 day course
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102
Q

most common viruses causing croup

A

parainfluenza types I, II, III

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103
Q

treatment of HUS

A
  • diet, fluid restrictions, high calorie, high carb, low protein, low sodium, low potassium
  • hemodialysis
  • RBC, platelet transfusion
  • daily weights, lab values, neurologic assessment
  • NO antibiotics
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104
Q

patient-controlled analgesia

A
  • > 5-7 yo
  • parent vs. nurse-controlled analgesia when patient is too young
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105
Q

specific pulmonary symptoms that indicate a child should be checked out

A
  • acute status change
    • particularly if fluid intake has changed or decreased
  • high temperature w/ respiratory distress
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106
Q

risk factors for infectious diseases

A
  • poor immune system
  • school/day care
  • poor hygiene
  • can’t articulate that they’re not feeling well
    • not until 9 or 10
    • sometimes just fussy - hard to manage
    • already exposed everyone in that duration
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107
Q

cleft lip/palate feeding

A
  • parental support and assistive feeding devices
  • smaller volumes with increased time to feed
  • feed with head elevated
  • frequent burping
  • breastfeeding
  • NG tube placement
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108
Q

management of pneumonia

A
  • frequent respiratory assessment
    • CXR - not every day necessarily
  • monitor VS
  • respiratory/pulmonary therapies
    • oxygen
    • antibiotics if necessary
    • respiratory tx
    • chest physiotherapy
    • hydration (insensible loss from respiration)
    • positioning
  • pain management
  • nutrition
    • NG tube but often post-pyloric and continous to avoid dumping syndrome
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109
Q

PO/enteral nutritional intake

A
  • PO best, then enteral
    • preserve intestinal function
    • prevents translocation of gut flora into blood stream
      • use trophic feeds
    • allows normal processes and hormonal responses to nutrient intake
    • assist in immune function
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110
Q

pneumonia presentation

A
  • fever
  • cough +/- mucous production
    • GI symptoms from ingesting
  • respiratory distress
  • +/- mild/moderate cyanosis
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111
Q

acute asthma pathophysiology

A
  • small airways obstructed
    • air trapping and atelectasis
    • ventilation/perfusion (VQ) mismatch
      • blood passes by atelectasis to open areas of lungs
      • creates non-uniform perfusion
  • hypoxemia ensues
  • leads to airway remodeling
    • pulmonary capillary bed becoems fibrotic with smooth muscle build-up
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112
Q

causes for hypernatremia

A
  • breast feeding
    • how much/how long to feed
    • count diapers
  • incorrect formula preparation
    • incorrect concentration
  • prolonged diarrhea/vomiting
  • tube feedings
  • certain IV preparations
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113
Q

pain assessment

A
  • use age and illness-specific assessment tools
  • evaluate pain in context and within the child’s trajectory of illness
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114
Q

physical assessment r/t nutrition

A
  • general appearance
  • extremities
  • physical development
    • tanner staging and puberty
  • activity and alertness
  • mechanical/medical devices/ treatments
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115
Q

hemolytic uremic syndrome

A
  • hemolytic anemia, uremia, thrombocytopenia
  • caused by E.coli 0157 from cows, goats, horses
  • toxins cause more than 110,000 illnesses, 80 deaths per year
  • most common cause of acute renal failure (ARF)
  • children less than 4, peaks between 1-2 yo
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116
Q

NIPS

A
  • neonatal infant pain scale
  • expression
  • cry
  • breathing
  • arm and leg movement
  • arousal state
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117
Q

soy-based milk

A
  • milk sensitivity/hypersensitivity
  • galactosemia; lactose intolerance
  • vegetarian/vegan diet
  • ~20 cal/oz
  • ex: similac soy isomil, enfamil prosobee, good start soy
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118
Q

head circumference changes in healthy infants

A
  • 1 cm/month up to 12 mo
  • 25% adult brain size at birth
  • 75% by 1 yo
  • 100% by 7.5-8 yo
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119
Q

school-age (10-12) response to pain

A
  • better understanding of relationship between an event and pain
  • more complex awareness of physical and psychologic pain
  • may pretend comfort to project bravery
  • may regress with stress/anxiety
  • can describe intensity and location w/ miore characteristics
  • can describe psychologic pain
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120
Q

S/Sx of testicular torsion

A
  • extreme pain
  • ipsilateral loss of cremasteric reflex
    • stroke inside of thigh and scrotum should lift one side at a time
  • testicle twists spontaneously on spermatic cord, venous occlusion, arterial ischemia
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121
Q

burns and sepsis

A
  • high risk
  • surface area
    • more than 30% of 2nd and 3rd degree burns = extremely high risk
  • # 1 protective organ has been damaged
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122
Q

asthma presentation

A
  • cough +/wheeze
  • increase WOB
  • c/o chest tightness
  • decreased air entry
  • difficulty breathing
  • breathless at rest
  • speaking in words at a time vs sentences at a time
  • +/- retractions, nasal flaring, S/Sx of URI
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123
Q

progression of infant feeding

A
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124
Q

nursing interventions with staph

A
  • respiratory assessment
  • circulation
  • handwashing
  • hydration and nutritional assessment, blood cultures
  • GI - tubes, catheters, wound cultures
  • isolation - standard and high level precautions
  • chest x-ray
  • no immunization
  • topical, oral, IV antibiotics
    • depending on type and location
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125
Q

INRS

A

indiviualized numeric rating scale (for parents on their child’s pain)

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126
Q

when to use opioids

A
  • severe pain or injury
  • oral, IM, IV
    • determine equianalgesic dose
    • based on drug, child’s weight
    • avoid IM route if possible
  • BMI may affect response b/c of storage capacity
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127
Q

toddler (1-3 yo) response to pain

A
  • does not understand what causes pain or why he/she is in pain
  • localized withdrawal, body resistance, aggression, disturbed sleep
  • cries, screams
  • cannot describe intensity or type ofpain
  • uses common words like ouchie and boo-boo
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128
Q

physiology of respiratory failure

A
  • decreased arterial oxygen concentration and increased carbon dioxide retention
  • acute or chronic repsiratory or neuromuscular process
    • acute = exacerbation of chronic issue
    • neuromusclar = weak thoracic cage
      • viral/bacterial illness puts them at higher risk
  • acute or chronic respiratory issue
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129
Q

post op care of hypospadias/epispadias

A
  • anterior hypospadias have no stents and need no special treatment
  • more severe hypospadias use drippy stent 7-14 days
    • bath, diapering issues
    • prophylactic antibiotics, bactrim
    • bladder spasms tx with oxybutynin
    • no swimming, contact sports 14 days
    • no straddle toys 14 days
    • blood visible ins tent for 14 days
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130
Q

clinical pathway of measles (rubeola)

A
  • incubation period: 3-12 days (begin contagious process)
  • prodromal period: fever, high 40.6
  • three C’s: conjunctivitis, cough, coryza (acute rhinitis)
  • Koplik spots
  • maculopapular rash (still contagious)
    • lasts 5-6 days then fades
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131
Q

post-operative nursing considerations for cleft lip/palate

A
  • arm immobilizers
  • pain management
  • avoid crying
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132
Q

physiological dependence

A

physiologic need for an agent to rpevent withdrawal symptoms

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133
Q

pneumonia overview

A
  • lower airway, respiratory tract infection
  • inflammation of bronchioles and alveolar spaces
  • 80% of cases in children
  • community aquired is 40:1000
  • 20% of pediatric hospitalizations
  • lack of sensitivity and specificity in diagnostic testing
    • children before 12 yo won’t cough for a sample
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134
Q

CF GU pathophysiology

A
  • males often sterile b/c of blocked vas deferens
  • females have reproductive difficulties due to mucous secretion that block sperm travel in fallopian tubes
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135
Q

cardiovascular effects of malnutrition

A
  • decreased CO w/ cardiac muscle showing non-specific changes
  • pericardial effusion in recovery
    • enlargement of heart size r/t increasing muscle mass
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136
Q

treatment for pyloric stenosis

A
  • pyloromyotomy surgery (Ramstedt’s procedure)
    • divides pylorus to open gastric outlet
    • single incision or laparoscopically
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137
Q

growth measurements

A
  • weight
  • height/length
  • head circumference
  • mid-upper arm circumference
    • indicates muscle
    • last area to become edematous in sick child
    • can monitor long-term nutrition
  • skin folds
    • indicate fat stores
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138
Q

hypoxia

A

tissues are starved of oxygen

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139
Q

amino acid-based formula

A
  • extreme protein hypersensitivity
  • intolerance to cow’s milk protein
  • useful in malabsorption, enteropathies
  • ex: neocate, neocate jr, nutramigen AA, elecare
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140
Q

anesthesia

A

state of controlled unconsciousness accompanied by a loss of protective reflexes, including ability to maintain airway independently and respond purposefully to painful stimuli

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141
Q

cleft lip/palate clinical pathway

A
  • cleft lip may be unilateral or bilateral
    • may or may not include cleft palate defect
  • cleft palate not apparent until palpated
    • continuous opening between nasal cavity and mouth
    • can involve hard and/or soft palate
  • hearing oss, otitis media, dental deformity, speech and feeding problems
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142
Q

hemolytic anemia

A

anemia caused by destruction/rupture of red blood cells

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143
Q

asthma risk factors

A
  • gender (more males than females)
  • famil hx, genetic predisposition
  • allergens/atopy
    • people w/ allergies have more asthma incidences
  • airway hyperreactivity
  • pollution
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144
Q

normal chest radiograph

A
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145
Q

before sedation procedure

A
  • consider
    • topical agents
    • diversion
    • procedural medications
    • NPO status - age-dependent
  • avoid delays
  • safe environment
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146
Q

atelectasis

A

partial collapse/some parts of the lung stuck together

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147
Q

Reye’s syndrome

A
  • baby aspirin with varicella
  • causes encephalopathy and continual seizures
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148
Q

symptoms of respiratory distress

A
  • increased WOB
  • +/- cyanosis
  • change in mentation, LOC
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149
Q

treatment of croup

A
  • humidification to decrease upper airway drying
    • cool air and +/- oxygen
  • antipyretics for temperature if present
  • dexamethasone (steroid) to decrease inflmmation/edema
    • 24-48 hours (sometimes more/less)
  • +/- isotonic IV fluids, encourage PO fluids
    • don’t make them irritable with an IV
  • solid food intake may decrease
    • need to at least stay hydrated
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150
Q

clinical pathway of pyloric stenosis

A
  • forceful vomiting
  • dehydration
  • weight loss
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151
Q

abdominal trauma definition

A
  • uncommon in childhood trauma
  • signs can be difficult to interpret
    • if child is scared, traumatized
  • high index of suspicion is needed to identify injuries
    • based on child’s history
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152
Q

cow’s milk-based formula

A
  • from nonfat cow’s milk, vegetable oils and CHO
  • assimilated to breast milk
  • ~20 cal/oz
    • 0.42-0.54 gm protein/oz
  • ex: similac, advance
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153
Q

cognitive effects of unrelieved pain

A

reduction in cognitive function

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154
Q

after sedation procedure

A
  • assess CV and RR function
  • assess arousability
  • assure adequate hydration
  • protect from injury
    • falls from bed/while ambulating
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155
Q

moderate sedation

A

depression of consciousness during which patients respond purposefully to verbal commands

no interventions required to maintain patent airway and spontaneous ventilation is adequate

CV function usually maintained

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156
Q

clinical indicators of malnutrition

A
  • skin
  • nails
  • head and hair
  • mouth
  • eyes
  • abdomen
  • musculoskeletal
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157
Q

immune effects of unrelieved pain

A

depression of immune response

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158
Q

early recognition of sepsis

A
  • complete history: ROS
  • physical exam
    • skin abnormalities
    • rash
    • petechiae
  • VS abnormalities
    • fever > 38C or
    • age-related tachycardia and tachypnea
    • abnormal WBC
      • > 12,000/uL or
      • 10% bands
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159
Q

moderate persistent asthma

A
  • daily Sx with nighttime Sx 3-4x / month
  • requires baseline medication
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160
Q

assessment of patient with hypernatremic dehydration

A
  • tachypnea
  • increased HR
  • lower BP
  • neurologic (not alert, not consolable)
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161
Q

hypoventilation of alveoli results in

A
  • hypoxia
  • hypoxemia
  • hypercapnea
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162
Q

intermitten asthma

A

brief episodes with Sx

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163
Q

celiac disease clinical pathway

A
  • GI distress after cereal
  • large, fatty, foul odor stool
  • cachexia
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164
Q

common maintenance IVFs in young infants

A
  • D5W 0.2% NaCl
    • with or without KCL
  • D10W 0.2% NaCl
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165
Q

overview of acid-base balance

A
  • homeostasis/balance between acid/bases
  • indicated by pH
    • influenced by H+ ion concentration in blood
  • distubances in equilibirum cause pH changes
  • may indicate respiratory or metabolic alterations
    • try to regulate disturbance
  • bases = carbonic acids and bicarbs
  • acids = hydrogen ions (primary driver)
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166
Q

TB latent infection

A
  • common in children
    • 5-10% > 3 yo with untreated latent TB progress to disease
  • infants and adolescents most likely to be symptomatic
    • adolescents cough a lot
    • infants just really sick
  • lung most common site of infection
  • diagnosis made by early AM gastric washing
    • child won’t expectorate into cup
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167
Q

diffusion

A

movement of solutes from areas of high concentration to areas of low concentration

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168
Q

bacterial tracheitis

A
  • secondary infection of upper airway after viral episode of laryngotracheitis
  • airway edema and obstruction r/t copious purulent secretions
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169
Q

medication error reduction strategies

A
  • never use memory
  • include weight, age
  • calculated dose and mg/kg dose
  • no abbreviations
  • use of zeros
  • bar coding
  • allergy documentation
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170
Q

GI effects of unrelieved pain

A

decreased gastric and bowel motility

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171
Q

what causes sepsis?

A
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172
Q

safety issues in pediatrics

A
  • environment
  • toxins, poisons
  • firearms
  • ATVs, bikes
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173
Q

Glasgow Coma Scale: eye response

A
  1. no eye opening
  2. eye opening to pain
  3. eye opening to verbal command
  4. eyes open spontaneously
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174
Q

CF skin pathophysiology

A
  • electrolyte imbalanced due to chloride ion loss in saliva, perspiration, mucous
  • salty taste to skin
    • sodium chloride through pores
175
Q

focused/emphasized GI/GU exam for abdominal trauma

A
  • abdominal distension
  • abdominal tenderness
  • generalized guarding
  • pelvic instability or tenderness
  • blood at urethral meatus
  • inspection of back/perineum
176
Q

common routes to lose fluid from body

A
  • urine
  • stool
  • skin
  • respiratory tract
177
Q

viral infection and sepsis

A

can tip over a compromised patient into infection and put them at risk

178
Q

VACTER syndrome

A

syndrome of anamolies commonly associated with each other

  • Vertebral
  • Anal
  • Cardiac
  • TE fistula
  • Esophageal
  • Radial
179
Q

complications of chickenpox

A
  • secondary infections
    • cellulitis, abscesses, sepsis, meningitis, encephalitis, pneumonia, Reye’s syndrome (baby aspirin), Group A strep, necrotizing entercolitis
  • fatal in children who are
    • immunocompromised, undergoing chemo, steroid treatment, transplant therapy
180
Q

drugs that work on pain modulation

A
  • TCAs
  • SSRIs
  • SNRIs
181
Q

nursing assessment for pertussis: airway and breathing

A
  • RR
  • color changes during breathing and whooping
  • auscultate
    • coarse breath sounds
    • ronchi
    • diminished breath sounds
  • coughing is usually productive
    • difficult to clear
    • will often use suction
182
Q

prevention of tics and lyme disease

A
  • avoid tic habitat
  • dress defensively
  • check for tics
  • shower right away
  • hot dryer
  • protect pets
183
Q

TB skin test

A
  • 5mm or greater + contact with infectious case
    • abomdinal CXR
    • clinical evidence of disease
    • immunosuppressive conditions and/or therapy
  • 10 mm or greater + risk of disseminated disease
    • risk/presence of compromising conditions
    • DM, CRF, malnutrition
    • known frequent exposure
  • 15 mm or greater
    • children > 4 yo
    • no risk factors
184
Q

diagnosis of croup

A
  • history and PE
  • pulse ox to determine CO2 levels
    • oxygenation
  • radiograph of neck
185
Q

goals of CF care

A
  • maintain body system functioning despite frequent illnesses
  • adherence to med regimen
  • nutrition regulation
186
Q

adolescent (13-18) response to pain

A
  • capacity for sophisticated understanding of causes of pain
  • recognized pain is qualitative and quantitative
  • can relate to pain experienced by others
  • wants to behave socially acceptable, controlled response
  • may distract self
  • may not complain if given cues that it should be tolerated
  • more sophisticated descriptions of pain
    • may think nurses in tune with thoughts of pain
    • won’t verbalize it
187
Q

Glasgow Coma Scale: verbal response

A
  1. no vocal response
  2. inconsolable, agitated
  3. inconsistently consolable, moaning
  4. cries but is consolable, inappropriate interactions
    1. crying is NORMAL but needs to be consolable
  5. smiles, oreinted to sounds, follows objects, interacts
188
Q

IVF lingo

A
  • 0.9% NaCl = normal saline or saline
  • 0.45% NaCl = half normal or half normal saline
  • 0.2% NaCl = quarter normal or quarter normal saline
  • D5W = D5
  • potassium chloride = KCL or K
  • CHOPism = hourly maintenance fluid = stock fluid
189
Q

normal ranges for acid-base balance

190
Q

symptoms of hyponatremia

A
  • level of consciousness
  • seizures
191
Q

nutrition and pediatrics

A
  • growth is dynamic
  • indicator of health, well-being, thriving
  • provision of nutriets necessary for growth and life
  • nutrition status affects chld’s response to injury and illness
  • recognize when parents are not making nutritionally sound decisions for their children
  • pediatric health of a society is indicative of the sustainability and prosperity of that society
192
Q

alkalosis

A
  • decreased H+ concentration
  • increased pH
193
Q

maintenance medication therapy of asthma

A
  • corticosteroids
    • inhaled anti-inflammatory beclomethasone, fluticasone (common), budesonide
  • +- allergy meds
  • hyposensitization therapy
  • emergency beta 2 agonist inhaler (patient/family education)
  • recognition of symptoms
  • knowledge/understanding of meds
194
Q

during sedation procedure

A
  • monitor for respiratory depression
    • visual confirmation and O2
  • monitor patient tolerance
  • document vitals every 15 min
195
Q

CF GI care

A
  • acid suppression due to GERD
  • enemas to prevent constipation
196
Q

standards of care related to pain

A
  • pain hx on admission
  • pain assessed/document q4h w/ reliable measurement tools
  • assessment-intervention-reassessment cycle when appropriate
  • pain managed with psycho, bio, developmental interventions
  • partner with families
  • analgestics safely/effectively around the clock
  • performance metrics
    • most frequent pain score over past 3 days
    • unsatisfactory pain relief for > 1 hr - patient or system issue?
197
Q

endocrine effects of malnutrition

A
  • pancreatic atrophy w/ reduced insulin
  • increased cortisol
    • destroys circadian rhythm
  • initial increase in T4
    • w/ unresolved malnutrition T4 and T3 decrease
198
Q

hypospadias and epispadias

A
  • congential defect of penis
  • urine stream deflected r/t abnormal location of urethral meatus
    • dorsal surface epispadias
  • also associated with penile curvature s/t chordee
199
Q

mechanism to restore fluid balance

A

kidneys

    • less able to conserve or excrete water and solutes effectively
  • greater risk fo acid/base imbalance
  • specific gravity = 1.005-1.015
    • lower b/c can’t concentrate urine as much r/t immature kidneys
200
Q

clinical pathway of invasive pneumococcal diseases (IPD)

A
  • bacteremia (sepsis)
  • meningitis
  • bacteremic pneumonia
201
Q

history of epiglottitis

A

beginning to see it again because

  • life threatening
  • many providers have never seen it

used to be challenges in getting immunized and didn’t cover all types

but now, we’re seeing more cases again

202
Q

septic shock definition

A

sepsis + CV dysfunction

203
Q

active TB

A
  • poor weight gain/weight loss
  • +/- fever, night sweats
  • fatigue
  • cough (+/- hemoptysis)
  • chest pain
  • palpable lymph nodes
  • CXR changes
    • most often in UR lobe of lung
  • positive PPD
204
Q

lactated ringer fluid bolus

A
  • lactate - precursor to bicarb - used as a buffer during bleed (acidosis)
  • 10-20 ml/kg per bolus
  • used mostly in operating room, L&D
205
Q

infection definition

A

suspected or documented infection caused by pathogen OR clinical syndrome associated with high probability of infection

206
Q

vital signs of SIRS

A
  • elevated RR
  • elevated temp
  • elevated HR
  • DO NOT depend on BP as a initial symptom
    • children can hold onto their BP for a while
    • but when it falls, it plummets
207
Q

hyponatremic or hypotonic dehydration

A

serum soidum

208
Q

gram-negative bacteria associated with sepsis

A
  • pseudomonas aeruginosa
  • e. coli
  • acinetobacter
  • neisseria meninigitidis
    • see this most often in really sick kids
    • VLBW, premies, etc.
209
Q

albumin r/t nutrition

A
  • commonly used as lab value
  • long half life ~ 14 days
210
Q

haeomphilus influenzae

A
  • H influenzae; H flu
  • categories:
    • encapsulated
      • respiratory: epiglottitis, pneumonia
      • invasive: meningitis, cellulitis, septicemia
    • unencapsulated
      • respiratory: bronchitis, sinusitis
      • invasive: otitis media, conjunctivitis
  • transmission - respiratory droplets
211
Q

cleft lip/palate definition

A

incomplete fusion of lip and/or palate

212
Q

treatment for testicular torsion

A
  • orchiopexy (suturing)
  • orchiectomy (removal)
213
Q

opioid related respiratory depression risk factors

A
  • infants less than 6 mo old
  • children with:
    • compromised airway (lung disease)
    • neurological impairment, muscle weakness
    • kidney/liver disease
    • morbid obesity
    • specific diseases (Downs)
    • hx of respiratory depression/sensitivity to opioids
    • large dose
    • fast administration
    • concurrent use of CNS depression meds
    • opioid naive
214
Q

4,2,1 rule

A

for hourly fluid maintenance

  • 4 ml/kg/hr for first 10 kg
    • 2 ml/kg/hr for second 10 kg
    • 1 ml/kg/hr for third 10 kg
215
Q

hernia

A

protrusion of organ or tissue thru abnormal opening

216
Q

4th vital sign in kids

A

weight

pre and post weights with rehydration therapy

217
Q

nursing interventions for hernia and communciating hydrocele

A
  • wounds dry and clean
  • stitch vs mesh
  • dermabond maybe (5-10 days)
  • no ointments to wound region
  • frequent diaper changes
  • sponge baths 2-5 days
  • no lifting, bike riding 2 weeks
218
Q
A
  • little dark space
  • thickening and mucous and exudate sitting down in lungs
  • why they are on frequent chest physiotherapy
    • to move the stuff as much/frequently as possible
219
Q

gram-positive bacteria associated with sepsis

A
  • staph auerus
  • staph epidermidis
  • strep pyogenes
  • strep pneumoniae
220
Q

risk factors for abdominal injuries

A
  • high impact/deceleration injuries
  • direct blows
  • evidence of injury above/below abdomen
    • unlikely to have been spared
  • seat-belt injuries (duodenum, pancreas)
  • handlebar (duodenum, spleen, pancreas)
  • straddle injuries (perineum, vagina, urethra)
  • penetrating injury
  • injuries suggestive of child abuse
221
Q

chronic asthma pathophysiology

A
  • chronic inflammatory disease causing 3 hallmarks:
    • obstruction of airflow via mucous
    • airway edema
    • airway muscle contraction/constriction
  • immediate inflammatory response by mast cells that release histamines which cause
    • bronchospasm
    • mucosal edema
    • mucous secretion
  • chronicity leaves airway hyperresponsive, leading to acute exacerbations
  • airway remodeilng (permanent) w/ or w/o mucous
222
Q

S/Sx when enteral nutrition is not tolerated

A
  • intractable emesis/diarrhea
  • severe abdominal distension
  • persistent diarrhea
  • chronic, persistent constipation
  • surgical abdomen
223
Q

hypoventilation definition

A

O2 requirements exceed O2 intake (obstruction, injury, poor ability to oxygenate)

224
Q

acidosis

A
  • increased H+ concentration
  • decreased pH
225
Q

definition of staphylococcus

A
  • group of bacteria that causes multitude of diseases
  • bacteria are round and bnched
  • illness directly by infection or indirectly by products
    • toxins (80 types) such as MRSA
  • in normal flora of skin, throat, rectum
  • can infect blood, pulmonary, bones, joints, skin, soft tissues, heart, GI system
  • thousands of deaths/year
  • 80% resistant to penicillins
226
Q

nursing management of epiglottitis

A
  • calm patient - do not separate from caregiver
  • airway maintenance
  • drug therapy
  • hydration
  • emotional/psychosocial support of patient and family
227
Q

causes of hyperkalemia

A
  • burns
  • trauma
  • blood transfusion
  • renal failure
  • IV with K+
  • sickle cell crisis
228
Q

appendicitis defined

A
  • inflammation of appendix
  • common cause of emergency surgery
  • most often occurs when blocked by feces, foregin object, tumor
  • lab tests, including pregnancy for females to rule out other causes
229
Q

normal saline fluid bolus

A
  • 10-20 ml/kg per bolus
  • depending on circumstances, can ahve up to 60 ml/kg
230
Q

modes of nutritional intake when PO doens’t work but gut does

A
  • NG tube
  • orogastric tube
  • nasoduodenal tube
  • NJ tube
231
Q

hypertonic IVF

A
  • osmolarity is more than 300
  • less water, more solute
  • fluid moves out of ICF into ECF into intravascular space
    • brain cells shrink + brain bleed
    • brain collapses on itself because of shrinkage
    • increased BP and bounding pulses
  • TPN (total parenteral nutrition) or 3% saline (ICUs)
    • around 1000 mOsm
232
Q

height gain in health infants

A
  • 2.5 cm/month first 6 mo
  • 1.3-1.5 cm during 7-12 mo
  • 7-7.5 cm/year > 12 mo until adolescent spurt
233
Q

physiologic S/Sx of acute pain

A
  • catecholamine and adrenocorticoid hormone secretion
  • tachycardia
  • tachypnea
  • hypertension
  • pupil dilation
  • pallor
  • increased perspiration
234
Q

definition of pertussis

A

highly contagious respiratory disease caused by bacterium bordetella pertussis

235
Q

illnesses associated with upper vs. lower airway illnesses

A
  • upper
    • common cold (viral)
    • croup
    • sinusitis
  • lower
    • bronciolitis
    • pneumonia
    • asthma
236
Q

how to approach GI system

A
  • bleeding
  • inflammation
  • obstruction
  • motility
  • congenital
  • malabsorptive
  • infections
237
Q

infant

A
  • no understanding of pain - responds to parental anxiety
  • generalized body movements, chin quivering, facial grimacing, poor feeding
  • cries
238
Q

contraindications to enteral nutrition

A
  • gut ischemia
  • prolonged, profound hypotension
  • critical illness with >2 vasoactive meds and/or escalaing vasoactive med
  • malabsorption
  • surgical abdomen
  • intra-abodminal HTN
239
Q

nursing interventions for meningococcemia

A
  • respiratory assessment + oxygen
  • neuro
  • antibiotics and fluids
  • lumbar puncture
    • glucose and protein: low glucose, high protein is symptom
  • isolation for 24 hours
  • identify close contacts and give prophylactic antibiotics
  • vaccine: menactra/MCV4 (serotypes A,C,D,Y)
240
Q

school-age (7-9 yo) response to pain

A
  • understands simple relationships between pain and disease
  • understands need for painful treatments
  • may associate pain with feeling bad/angry
  • may recognize psychologic pain r/t grief
  • passive resistance, clenches fists, holds body still, suffers emotional withdrawal, engages in plea bargaining
  • can specify location and intensity
  • describe physical characteristics in relation to body parts
241
Q

gate control of pain

A
  • pain perception can be inhibited/changed when competing non-pain impulse is sent along same pathway
  • stimulation of larger A-beta fibers causes substantia gelatinosa in dorsal horn of spinal cord to “close the gate” and decrease pain transmission to brain
  • rubbing something that hurts
242
Q

clinical pathway of chickenpox

A
  • incubation period 14-21
  • enters through respiratory tract and conjunctiva
    • replicates at site of entry in nasopharynx and in regional lymph nodes
  • acute onset of mild fever, malaise, anorexia
  • macular rash for few hours that progresses to pruritic vesicular lesions for 1-5 days. up to 500 lesions of all stages
    • crusts may remain 1-3 weeks
  • ulcerative lesions in mucous membranes
  • transmission: both airbone and direct lesion contact
  • contagious state continues until all lesions are crusted over
243
Q

agents seen in conjunction with RSV bronchiolitis

A
  • parainfluenza I, II, III
  • adenovirus
  • rhinovirus
  • novovirus
  • human metapneumovirus
  • mycoplasma pneumonia
244
Q

asthma triggers

A
  • weather
  • exposure to known/unknown allegens
    • dust mites
    • mold
  • pet dander
  • URI
  • airway/respiratory irritants
    • tobacco smoke
    • aerosol sprays
  • exercise
    • pre-medicate
245
Q

what to do during opioid-induced respiratory depression

A
  • stimulate patient
  • give oxygen
  • stop opioid
  • anesthesia STAT or code blue if needed
  • notify the primary service and pain treatment service
  • give naloxone as needed
246
Q

AM gastric wash/lavage

A
  • tests for TB
  • put NG tube at night before they sleep
  • aspirate before/as they wake up in the morning
  • 3 days in a row
247
Q

evaluation of UTI

A
  • urinalysis and urine culture
  • catheter (most reliable) vs bag/clean catch
  • any number of colonies in culture is significant
  • with bagged collection >100,000 single organisms significant
  • for boys, 1,000 ucf is positive
248
Q

isonatremic or isotonic dehydration

A
  • loss of equal amounts of sodium and water
  • 80% of dehydration incidents
249
Q

hydrocele definition

A
  • accumulation of fluid around testicle
  • communicating: no bowel, just peritoneal fluid
  • noncommunicating: no connection to peritoneum
    • rare in children
    • more common in adolescents from fluid from lining of tunica vaginalis
      • fluids will go away, become absorbed
250
Q

definition of pneumococcal disease

A
  • leading cause of serious illness around the world
  • caused by bacterium Streptococcus pneumoniae
    • can attack different body parts
  • illnesses include:
    • pneumonia
    • meningitis
    • middle ear and sinus infection
  • issue with sickle cell disease
251
Q

NEMU method

A

placing temporary enteral tube

tip of Nose, inferior attachment of Ear lobe, Mid-way between xiphoid and Umbilicus

252
Q

musculoskeletal effects of malnutrition

A
  • stunting
  • osteopenia
253
Q

topical sedation therapies

A
  • pain ease spray
  • emila cream
  • LMX -4 cream
  • local cirulatory changes
    • blanching, vasoconstriction
  • lidocaine toxicity
    • prolonged administration or large surface area
254
Q

prevention of UTIs

A
  • hygiene
  • baths, no bubbles, no lotions
  • increase fluids
  • no holding urine
  • voiding after sex
  • long term low dose antibiotics?
255
Q

stacking breaths

A
  • can’t fully exhale in asthma exacerbation
  • breaths on top of breaths
  • lungs expand beyond normal
256
Q

long-term enteral feeding devices

A
  • gastric tube
  • gastric-jejunal tube
  • jejunal tube
257
Q

respiratory syncytial virus (RSV) bronchiolitis

A
  • disease of lower airway caused by RSV invading cell mucosa in smal airways
    • inflammation of bronchioles
      • leads to epithelial necrosis
    • constriction and obstruction of small distal airways
    • air trapping, atelectasis
    • can progress to RSV pneumonia
258
Q

NPO status before sedation

A
  • 0-5 mo:
    • 4 hours solids
    • 3 hours breast milk
    • 2 hours clears
  • 5-36 mo:
    • 6 hours solids
    • 3 hours breast milk
    • 2 hours clears
  • 3+ years:
    • 8 hours solids
    • 2 hours clears
259
Q

thrush

A
  • also from immunosuppression
  • commonly in mouth
  • contamination from mom (full thrush possible)
  • lot of kids with cancer have oral thrush
    • can’t eat, drink, swallow
    • painful
    • goes down entire esophagus
260
Q

clinical pathway of appendicitis

A
  • varied S/Sx in children - hard to diagnose
  • first Sx usually pain around belly button
    • moves to RLQ ~ 12-24 hrs after illness starts
  • if appendix ruptures
    • less pain for a while, followed by:
      • chills and shaking
      • hard stools or diarrhea
      • fever, N/V
261
Q

deep sedation

A

depression of consciousness during which patients cannot be easily aroused but respond purposefully after repeated or painful stimuli.

ability to independently maintain respiratory function may be impaired. require assistance to maintain patent airway and spontaneous ventilation may be inadequate

CV function usually maintained

262
Q

definition of respiratory failure

A
  • inability to maintain effective exchange of oxygen and carbon dioxide
  • hypoventilation of alveoli
263
Q

systematic assessment of child

A
  • A: aeration
  • B: breathing and brain
  • C: circulation
  • D: disabilities and drugs
  • E: expose the patient and electrolytes
  • F: fluids
264
Q

epiglottitis

A
  • inflammation and edema of epiglottis that can occlude trachea
  • presents with acute illness
    • H influenzae - type B
    • strep pneumoniae
    • staph aureus
  • LIFE THREATENING - DO NOT EVALUATE AIRWAY
265
Q

potassium chloride - KCL

A
  • 10 or 20 meq concentrations in IV bags
    • not to be confused with KCL boluses AKA riders
  • kidneys regulate potassium levels and have poor ability to conserve potassium
  • when patient is NPO, KCL should be added to fluids
  • IVF bag with KCL should never be given to patient who has not demonstrated adequate urine output (kidneys)
266
Q

causes of cleft lip/palate

A

mutlifactorial - strong genetic influence

267
Q

extensively hydrolyzed formula

A
  • significant malabsorption
    • short gut, CF, biliary atresia, protracted diarrhea
  • poor taste - introduce prior to bitter taste development
  • ex: nutramigen, pregestimil, good start genlte plus, similac expert care alimentum
268
Q

causes of hypokalemia

A
  • diarrhea
  • wound drainage
  • eating disorders
  • renal disease
269
Q

sepsis and lactic acidosis

A
  • end product of organs functioning and muscle contractility is lactate
  • if you can’t clear it b/c of decreased blood flow and CO
    • buildup of lactate in blood
    • acidic environment
270
Q

anthropometrics

A
  • avoid measurement errors
  • examiner error
    • proper training
    • standardized techniques
  • instrument error
    • precise, calibrated instruments
  • measurement difficulty resutling in inacuracy
    • repeated measurements on same subject
271
Q

clept lip/palate repair

A
  • usually prior to 18 mo
  • closure allows better seal around nipple
  • multidisciplinary management
    • plastic surgery
    • dentistry
    • hearing
    • speech/feeding therapy
272
Q

reasons why young pediatric patients are prone to fluid loss

A
  1. increased body surface area
  2. increased metabolic rate (growing)
  3. immature kidney function
273
Q

infant 6-12 mo response to pain

A
  • has pain memory; responsive to parental anxiety
  • reflex withdrawal to stimulus, facial grimacing, disturbed sleep, irritability, restlessness
  • cries
274
Q

peritonitis defined

A

inflammation of peritoneum

275
Q

pathophysiology of pediatric sepsis

A
  1. insult/injury
  2. inflammatory mediators –> SIRS response
  3. tissue injury –> infection –> decreased tissue perfusion –> sepsis
  4. severe sepsis –> septic shock –> death
276
Q

CF nutrition care

A
  • pancreatic enzymes to aide digestion
  • balanced diet w/ increased caloric intake
277
Q

less common viruses causing croup

A
  • respiratory syncytial virus (RSV)
  • influenza A or B
  • adenovirus
  • rubeola (measles)
278
Q

fluid volume overload caused by:

A
  • infection
    • increased capillary blood flow, inflammation
  • burns
    • increased capillary permeability
  • cardiac failure
    • venous congestion, R side heart failure
  • nephrotic syndrome
    • increased albumin excess
  • tumors
    • blocked lymphatic drainage
  • surgery
    • lymphedema
279
Q

preschooler (3-6 yo) response to pain

A
  • pain is a hurt
  • does not relate to illness, maybe to injury
  • believes pain is punishment
  • can’t understand why painful procedure will help
  • active physical resistance, directed aggression, strikes out physically and verbally, low frustration level
  • language skills to express pain on sensory level
    • can identify location and intensity
    • may deny pain
    • may believe his/her pain is obvious to others
280
Q

definition of lyme disease

A
  • most common tic born illness in N. America and Europe
  • bacterium Borrelia burgdorferi
  • deer tics can harbor bacteria and spread when feeding
281
Q

definition of chickenpox (varicella)

A
  • varicella zoster virus
  • DNA virus and member of herpesvirus group
  • capacity to eprisst in body after primary infection
    • in sensory nerve ganglia
  • primary infection = chickenpox
  • secondary infection/reactivation = herpes zoster (shingles)
  • short survival time in environment
  • can progress to pneumonia or encephalitis
282
Q

etiology of pneumonia

A
  • bacterial
  • viral
  • chemical
    • lung tissue irritation
    • aspiration
    • inhaled meds/toxins/poison
283
Q

symptoms of UTIs in older children

A
  • burning/pain with urination
  • frequent/urgent urination
  • fever
  • lower abdominal pain
  • wetting episodes
  • blood in urine
284
Q

CF respiratory pathophysiology

A
  • affected by 4 wks of age
  • lungs filled with mucus so cilia can’t move
  • air trapped in lower airways causes areas of pulmonary collapse
  • secondary bacterial infections leads to life threatening respiratory failure
  • most common cause of mortality
  • when respiratory system is affected, so are all the other systems
    • can’t do same amount of ventilation/oxygenation
285
Q

treatment of hypospadias and epispadias

A
  • surgery at 6-18 mo before toilet training and knowledge of abnormality
    • do not circumcise - use foreskin to cover opening
  • creation of normal urethral meatus and glans penis
  • straight penis
  • normal urethra
  • skin covering
286
Q

general GU assessment

A
  • urine characteristics
  • pain, discomfort
  • edema, generalized?
  • apperance of genitalia
287
Q

causes of peritonitis

A
  • collection of blood, body fluids, pus in abdomen (intra-abdominal abscess)
  • peritoneum is a sterile environment that reacts to pathologic stimuli with uniform inflammatory response
    • may be infectious or sterile peritonitis (chemical or mechanical)
  • intra-abdominal sepsis is inflammation of peritoneum r/t pathogenic microorganisms and products
  • typical causes: pelvic inflammatory disease r/t STIs
288
Q

hypoxemia

A

decreased oxygen in blood

289
Q

tolerance

A

diminished effectiveness of drug upon repeat administration

290
Q

cloaca

A

one opening where feces and urine exit

291
Q

endotheliopathy of SIRS

A
  • capillary leak
  • leukocyte infiltration
  • erythema, edema
    • shininess

when you see these things, SIRS should always be in the back of your mind

292
Q

behavioral interventions before sedation procedure

A
  • assorted visuals
    • toys, books, etc.
  • breathing techniques
  • comfort measures
    • parent, modify environment
    • familiar objects
    • comfort holding
  • diversional talk
293
Q

pediatric medications

A

weight based dosing

greatest error in calcuation, greatest potential for harm

294
Q

viral infectious agents

A
  • measles
  • parvovirus
  • chickenpox
295
Q

symptoms of RSV bronchiolitis

A
  • rhinorrhea with nasal congestion
  • cough - horase, progresses to wet
    • often productive - coughing and swallowing can cause emesis
  • WOB
    • tachypnea, retractions, +/- wheeze, crackles, nasal flaring, grunting, head bobbing, oral breathing
  • +/- temperature (may be hypothermic)
  • decrased activity
  • usually decreased appetite
  • apnea in young infants (
296
Q

symptoms of hyperkalemia

A
  • palpitations
  • weakness
  • arrhythmias
297
Q

mild persistent asthma

A
  • episodes > 2x/week but less than daily
  • night episodes 1-2x / month
  • requires baseline medication
298
Q

other protein lab values r/t nutrition

A
  • transferrin
  • prealbumin
  • retinol-binding protein
299
Q

spread of TB

A
  • airborne
  • cough, sneeze, talking
  • breathing in bacteria
300
Q

sedation goals

A
  • maintain safety
  • minimize physical discomfort
  • AAA - analgesia, anxiolysis, amnesia
  • control behavior/movement
  • return patient to baseline
301
Q

S/Sx of Hirschsprungs

A
  • no meconium for 48 hours
  • FTT
  • constipation Sx are age related
302
Q

behavioral presentation of epiglottitis

A
  • won’t swallow
    • hurts
    • can’t breathe
  • will drool
  • tripod position
303
Q

insensible loss

A

normal physiological loss of fluid (respiratory, skin)

304
Q

increased HR, RR, BP caused by…

A

pain and fear

305
Q

what is sepsis?

A
  • spectrum of systemic, inflammatory responses to infection
  • life-threatening
  • body’s response to infection
    • up regulation of cytokines, inflammatory response
    • release of pro-inflammatory and anti-inflammatory mediators into systemic circulation
    • activate procoagulation pathways
    • alter CV function and tissue perfusion
306
Q

nursing management of respiratory distress

A
  • patient position to maximize airway for adequate air flow
  • assess RR and WOB, change in use of accessory muscles
  • monitor VS, LOC
  • monitor oxygen sat
    • check equipment
  • administer oxygen
  • ensure emergency equipment is available
  • monitor patient for changes
307
Q

common UTI bacteria

A
  • e.coli
  • enterococcus
  • pseudomonas
308
Q

diaper rash

A
  • yeast infection
  • more incidents in hospitals
    • antibiotics, immunosuppressed
    • not sleeping as well, nutrition not as good
309
Q

addiction

A

psychological syndrome characterized by compulsive drug-seeking behavior

310
Q

nursing interventions for lyme disease

A
  • prevention!
  • oral antibiotics - standard treatment for early-stage disease
    • doxy for over 8 yo
    • amoxicillin for adults, younger children, pregnant/breast-feeding women
    • 14-21 days recommended
  • intravenous - later stage if involves CNS
    • 14-28 days
    • may take time to recover from symptoms
    • usually presents with stroke-like symptoms of paralysis
311
Q

cardiovascular effects of unrelieved pain

A
  • increased peripheral vascular resistance
  • increased myocardial oxygen consumption
312
Q

drugs that work on pain transduction

A
  • local anesthetics
  • capsaicin
  • anticonvulsants
  • NSAIDs
  • aspirin
  • acetaminophen
  • nitrate
313
Q

causative organism of TB

A

mycobacterium tuberculosis

314
Q

osmosis

A

the movement of water from areas that have too much water to areas that have less water

315
Q

Koplik spots

A

white salt granules inside oral mucosa

316
Q

reasons for tracheostomy

A
  • airway issues (stenosis, malacia, web)
    • obstruction
    • abnormal anatomy
  • craniofacial anomalies (Pierre Roban - no chin, can’t intubate)
  • vocal cord paralysis
  • respiratory problems
    • premature lungs
    • prolonged respiratory support
  • neurologic
    • unable to protect natural airway
    • neuromuscular disorders/weakness
  • injury
317
Q

procedural sedation

A
  • primary benefits:
    • minimize anxiety/discomfort while reducing undesirable autonomic response to pain
    • help patient thru painless procedure that requires immobility for extended time period
  • excessive sedation/analgesia may result in RR or CV depression, hypoxia and/or cardiac arrest
  • inadquate sedation/analgesia may result in inaccurate/incomplete test or patient injury
318
Q

nursing interventions for pertussis

A
  • ABC: support for apnea, hypoxia, remain with child during coughing, when hypoxic, give oxygen if needed
  • D: hand hygiene, antibiotics - 5 days
    • droplet prectuations until 5 days after antibiotic therapy or until 3 weeks after onset of paroxysmal coughing
  • F: fluids, IV hydration
  • isolation
  • vaccine to unimmunized contacts under 7 yo
    • acellular pertussis
    • Tdap, DTP, DTaP, ADACEL
319
Q

common organisms of bacterial tracheitis

A
  • staph aureus
  • group A strep
  • moraxella catarrhalis
  • haemophilus influenza
320
Q

intussusception defined

A
  • invagination of part of intestine into itself
  • most common abdominal emergency in early childhood (
  • majority of cases are idiopathic
  • common location: ileocecal valve
321
Q

N. meningitidis bacterium

A
  • encapsulated or unencapsulated
    • nearly all invasive are encapsulated or surrounded by polysaccharide capsule
  • 12 sero groups b/c of capsule
    • six cause majority of infections: A, B, C, W135, X, Y
  • incidence highest in children less than 5 and adolescents
  • generally passes through inhalation but can also be nasopharyngeal or through ear canal
322
Q

celiac disease presentation

A
  • ~ 6 mo when they start eating solid food
  • diarrhea, distended abdomen, nutritional issues
323
Q

management of asthma

A
  • identify and minimize exposure to triggers
    • skin testing for allergens
  • education/monitoring for exacerbation symptoms
  • maintain regular activity/exercise
  • compliance w. control meds
  • early management when sx occur
  • asthma action plan
    • tailored to pt and family
324
Q

types of infectious agents

A
  • bacteria
  • viruses
  • fungal infections
  • parasitic infections
325
Q

respiratory physiology at 24 weeks

A
  • pulmonary surfactant produced by Type II pneumocytes
  • betamethasone at 24-25 weeks gestation can accelerate fetal surfactant production
326
Q

clinical pathway

A
  • catarrhal
    • 7-10 days
    • incubation and infectious process starts
  • paroxysmal
    • infectous period lasts 7 weeks or longer
    • whooping cough stage
  • convalescent stage
    • 6 weeks
327
Q

children usually acquire TB from…

A
  • infected adult
  • at-risk populations
    • low income
    • emigration from under-resourced country
    • residence in place of close co-habitation of large numbers
328
Q

pain pathophysiology

A
  • transduction
  • transmission
  • perception
  • modulation
329
Q

Glasgow Coma scale overview

A
  • pediatrics always want a scale that can be used anywhere - different language, w/o equipment, replicable, understandable
  • 15 = perfect
    • awake, alert, speaking, moving
  • 3 categories:
    • eye, verbal, motor
  • goes down by 1 or 2 points in middle of the night (especially children)
    • document time
330
Q

oxygen consumption of infant

A
  • ~ 6ml/kg/min
  • twice that of an adult
  • related to baseline RR
  • don’t have as much tidal volume - need to breathe faster
331
Q

D5 fluid bolus

A
  • 1-2 ml/kg
  • up to 3-4 ml/kg
  • dextrose is metabolized quickly, leaving “free water”
    • expands both ICF and ECF
    • other fluids expand only ECF
332
Q

intolerance/sensitivity

A
  • adverse food rxn
  • gradual onset after large ingestion
  • +/- frequency of food ingestion
  • no immune system involvement
  • generally limited to GI
  • causes include:
    • lack of enzymes
    • irritable bowel
    • toxic contaminates
333
Q

dehydration caused by:

A
  • vomiting
  • diarrhea
  • hemorrhage
  • burns
  • NG suctioning
  • drainage loss
334
Q

nursing management of child with hypokalemia

A
  • cardiac
  • replace K+
335
Q

assessing pain

A
  • verbal/self report
    • child’s capacity to demonstrate concepts of degree, rank order, estimation, classification
  • parent proxy
  • behavioral indicators
  • individualized NRS (cognitively impaired)
  • physiologic indicators
336
Q

characteristics of pediatric airway

A
  • smaller diameter
  • anterior position
  • floppy epiglottis
  • angled vocal cords
  • narrowest portion is cricoid cartilage
    • funnel shape to the larynx
    • problem with increased secretions
  • small cricothyroid membrane
  • large tongue
  • large occiput
    • causes head to tip forward and airway to close when supine
    • but something under shoulders to open airway
  • large tonsils/adenoids
337
Q

Glasgow Coma Scale: motor response

A
  1. no motor response
  2. extension to pain
  3. flexion to pain
  4. withdrawal from pain
  5. localizing pain
  6. obeys commands
338
Q

severe sepsis definition

A

sepsis + CV OR respiratory dysfunction OR > 2 other organ dysfunctions

339
Q

fontanelles in systematic assessment

A

full, sunken, or flat - we want them flat

full indicates increased intracranial pressure from: infection, trauma, hydrocephalus (increased spinal fluid)

340
Q

classic presentation of measles

A
  • consolidated maculopapular rash behind ears and then spreads to face
  • eyes swollen shut from drainage
  • irritable, febrile
341
Q

focused GI/GU assessment for pyloric stenosis

A
  • typical presentation of initially nonbloody, always nonbilious vomiting at 4-8 weeks of age
  • vomiting intensity increases towards projectile vomiting
  • prolonged diagnosis can lead to
    • dehydration, malnutrition
    • poor weight gain
    • metabolic alterations
    • lethargy
  • parents report trying different formulas b/c of intolerance
342
Q

definition of meningococcal infections

A
  • common outcome is meningitis
  • when caused by Neisseria meningitidis
    • meningococcal meningitis
  • spread via inhalation
  • incubation: 2-10 days
343
Q

D: drugs and disabilities

A

falls, adverse drug reactions, infections, etc.

344
Q

CF diagnostic testing

A
  • state newborn screening
  • genetic testing
  • sweat chloride testing
    • definitive if > 60 mmol/L
    • suspect if 40-60 mmol/L
345
Q

definition of measles (rubeola)

A
  • highly contagious
  • virus in paramyxovirus family
  • normally passed thru direct contact and thru air
  • virus infects mucous membranes then spreads throughout body
  • human disease - does not occur in animals
346
Q

diagnosis of esophageal atresia/TEF

A
  • can be diagnosed before birth
    • mom will develop a lot of amniotic fluid because the baby can’t swallow it
  • otherwise, the 3 C’s
    • coughing
    • choking
    • cyanosis
347
Q

calculating pediatric bladder capacity

A

age in years + 2 (oz)

348
Q

pre-operative nursing considerations for cleft lip/palate

A
  • reduce risk of aspiration
  • assess for respiratory distress
  • ensure adequate nutrition and growth
  • provide feeding training for parents
349
Q

morphine

A
  • prototype opioid
  • mimics endogenous endomorphins
  • peaks 20 min
  • duration 2-4 hours
  • half life 2 hours
350
Q

clinical pathway of lyme disease

A
  • symptoms vary
  • skin, joints, nervous system most often affected
  • early signs
    • rash - not necessarily bulls-eye
      • erythema migrans
    • flu-like symptoms
  • later signs
    • joint pain
    • neurological problems
351
Q

asthma under 2 yo

A
  • generally don’t label a child under 2 yo with asthma
    • call it “reactive airways”
  • b/c some belief that symptomatology is r/t viral illnesses
    • if they make it to the hospital or ICU with these symptoms, then it is labeled asthma
352
Q

testicular torsion

A
  • usually from trauma
  • one of few surgical emergencies in adolescent boys
  • issues with fertility and cosmetic appearance
  • need surgery within 6-8 hours
353
Q

prepare for sedation procedure

A
  • sedation plan
    • what is required
    • length
    • painful?
  • consider development and hx of child
  • work with parents
  • prepare - include expected sensations
354
Q

RSV bronchiolitis education

A
  • highly contagious, incubation period 2-8 days
    • handwashing
    • avoid sick contacts
  • re-infection is common
  • acute illness course is 3-7 days
  • cough and +/- wheeze may persist
  • full recovery can take 3 weeks
355
Q

TB medications

A
  • isoniazid
  • rifampin
  • pyrazinamide
  • ethanmbutol
  • daily, minimum 6 mo
356
Q

patient assessment/physical exam for sepsis

A
  • neurologic
    • altered mental status (irritable vs lethargy) - what is their norm?
    • extreme anxiety
  • respiratory
    • tachypnea
    • increased work of breathing (WOB)
  • CV
    • tachycardia
    • perfusion (start out and work in - different peripherally than centrally?)
    • development of / enhanced murmur
    • warm vs cold hypotension
  • renal funtion/output
  • skin
357
Q

drugs that work on pain perception

A
  • opioids
  • alpha2-agonists
  • TCAs
  • SSRIs
  • SNRIs
358
Q

common CF medications

A
  • inhaled bronchodilators
  • inhaled steroids
  • corticosteroids
  • antibiotics (PO, IV, inhaled)
  • pancreatic enzymes
  • multivitamins (ADEK)
  • lactulose
  • ursodeoxycholate (ursodiol)
359
Q

facilitated diffusion

A

movement of solutes from areas of high concentration to areas of low concentration, but the molecules need a carrier to help with diffusion

360
Q

CF respiratory care

A
  • exercise
    • hard if depressed
    • results in muscle atrophy
  • aggressive chest physiotherapy
  • intermitten spirometry
  • immunizations
    • dysfunctioning immune system from antibiotics
    • will they get sicker with a live virus?
361
Q

GI/GU focused assessment for peritonitis r/t PID

A
  • uterine tenderness or
  • adnexal tenderness or
  • cervical motion tenderness
362
Q

osmolarity

A
  • concentration of solutes outside body
  • ex: IVF solute measurements
363
Q

sepsis definition

A

SIRS in the presence of OR as a result of suspected or documented infection

364
Q

warm shock

A

extremities really warm but hypotensive

365
Q

developmental effects of unrelieved pain

A
  • change in responses to pain
  • altered temperatures
  • possible altered development of pain system in infants
366
Q

gastroschisis defined

A

intestines and possibly other organs located outside of abdomen

367
Q

patients at risk for pediatric sepsis

A
  • premature/VLBW
  • neonates
  • compromised immune status
    • HIV
    • oncologic processes/malignancy
    • transplant
    • cytotoxic, immunosuppressant agents
    • chromosomal disease
      • metabolism is often very different and not completely understood
      • don’t know how system will react to an insult
  • higher index of suspicion in these patients
368
Q

FLACC

A
  • face
  • legs
  • activity
  • cry
  • consolability
369
Q

effects of unrelieved pain on quality of life

A
  • sleeplessness, anxiety, fear, hopelessness
  • increased thoughts of suicide
370
Q

symptoms of hypokalemia

A
  • neurological
  • weakness
  • arrhythmias
371
Q

renal output and sepsis

A
  • making good urine?
  • .5-1 ml/kl/hour in older children and adolescents
  • 1-2 ml/kl/hour in infants and young children
  • blow flow to kidneys good enough to keep making urine?
372
Q

diagnosing pertussis

A
  • gold standard: nasopharyngeal culture
    • can diagnose during prodromal
    • takes 5 days to come back
    • do we treat during prodromal?
  • do not underestimate diagnostic skills
    • coughing, cyanotic, and post cough emesis - probably won’t wait for the culture
373
Q

ventilation of alveolar

A
  • primarily dependent on RR
  • slow breathing = less ventilation AND oxygenation
374
Q

pain in infants vs adults

A
  • infants experience greater pain intensity w. same stimulus
  • pain modifies brain
    • volumetric losses in cortex, corpus callosum, hippocampus, basal ganglia
    • lower cognitive scores
    • increased behavior disorders
  • nerve sheaths are still myelinating - dissemination of the stimuli
375
Q

iron status r/t nutrition

A
  • Hgb/Hct
    • decrease in late Fe deficiency
    • can decrease for other reasons
  • ferritin
    • most sensitive - correlates to w/ total body stores
  • erythrocyte protoporphyrin, serum fe/total binding capacity transferring - dependent on Fe stores
376
Q

treatment of Hirschsprung’s

A
  • bowel management
  • surgical removal
  • temporary colostomy
377
Q

declining respiratory system in a child leads to…

A

EVERYTHING compensates, whereas in adults, it begins with just the heart or just one system

378
Q

identification of Hirschsprung’s disease

A

hypagque barium enema - without innervation, contrast media won’t move

379
Q

viral pneumonia

A
  • no antibiotics
  • protein coat
  • smaller than bacteria
  • viral organism needs host to survive
  • invades cells
    • redirects to produce more virus, increasing viral load
  • improves in 1-3 weeks
380
Q

increased HR caused by…

A
  • pain
  • fear
  • infection
  • dehydration
381
Q

causes of UTI

A
  • urinary stasis
  • vesicoureteral reflex
  • abuse
382
Q

celiac disease defined

A

intolerance to wheat and rye that causes changes in intestinal mucosa which leads to malabsorption

familial, inborn error of metabolism

383
Q

fluids that can be bolused

A
  • 0.9% saline (NaCl) aka NS (normal saline) aka NSS (normal saline solution)
  • lactated ringers (LR) - lactate
  • D5W - dextrose 5%

osmolarity is around 300 (same as body)

384
Q

nursing management of hypernatremia

A
  • ABCs and daily weights
  • assess skin
  • IV replacement (if diarrhea/vomitiing), strict I/O
  • labs for electrolytes, BUN, creatinine
  • fluids, specific gravity
  • support mom with breastfeeding
385
Q

UTI defined

A

clean catch yields > 100,000 units

386
Q

normal water movement in and out of cell…

A

brings nutrients (glucose) and takes away wastes

387
Q

what to do when something is going to hurt?

A

advocate - make it hurt as little as possible

apologize to the child afterwards

388
Q

fungus associated with sepsis

389
Q

assessing for dehydration

A
  • fontanelles and neuro
  • vital signs and cap refill
  • mucous membranes and thirst
  • extremities
  • urine output, diarrhea, specific gravity
390
Q

imperforate anus defined

A
  • several variations of incomplete anal opening
    • pouch that does not connect with colon
    • openings to other structures
      • urethra, bladder, base of penis/scrotum/vagina
    • narrowing of anus or no anus
  • VACTER syndrome sometimes
391
Q

urine output

A
  • infant: 2 ml/kg/hr
  • child: 1-2 ml/kg/hr
  • adolescent: .5-1 ml/kg/hr

minimum output - signifies hydration is adequate

small reduction in urine volume could indicate significant compromise in renal perfusion or function

392
Q

causes of intussusception

A
  • recent upper respiratory illness
  • recent diarrheal illness
  • CF
  • chronic indwelling GI tubes
393
Q

first places that present as edematous r/t fluid overload

A

face and genitalia

394
Q

protein hydrolysate formula

A
  • partially hydrolyzed
    • allergies (IgE mediated)
    • severe GERD
    • prevention of atopic dermatitis
  • ex: carnation good start, good start gentle, peptamen Jr
395
Q

esophageal atresia / tracheoesophageal fistula (TEF) defined

A
  • congenitally interrupted esophagus
  • one or more fistulas may be present between malformed esophagus and trachea
  • surgical emergency
  • failure of esophagus to develop as continuous tube
396
Q

nursing assessment of HUS

A
  • severe gastroenteritis with bloody diarrhea
  • upper respiratory infection or UTI before HUS
  • HTN, pallor, bruising, oliguria
397
Q

safety measures before sedation

A
  • IV access
  • monitoring
    • oxygen, EKG/BP
    • ventilation
  • equipment
    • suction, oxygen
    • airway, bag-valve mask
  • antagonists
    • flumazenil (for benzos)
    • nalaxone
398
Q

ideal pain instrument

A
  • developmentally appropriate
  • easy to use and quickly understood by patients
  • easily scored and recorded
  • available in various languages
  • reasonable validity and reliability
399
Q

weight gain in healthy infants

A
  • 20-30 g/day first 6 mo; double birthweight by 5-6 mo
  • 10-20 g/day 6-12 mo: triple birthweight by 12 mo
  • 8-10 g/day > 1 yr
400
Q

management of pediatric sepsis

A
  • airway - oxygen therapy
  • fluid - may progress to inotropic support
  • antibiotics (within 1 hr if suspicion)
    • usually vanco + cyclosporin
    • monitor urine output b/c vanco is nephrotoxic
    • ceftriaxone in ED
  • blood
    • trauma? bleeding? low hgb (iron carrying capactity)?
    • part of fluid therapy
  • supportive measures - imaging studies
  • nutrition
    • feed as quickly as possible
    • use working GI system if they have one
401
Q

lactose-free milk

A
  • lactase diminished condition
  • intolerance of cow’s milk/soy based formulas
  • ~20 cal/oz
  • ex: similac sensitive; enfamil gentlease
402
Q

sepsis and tissue hypoxia

A

bad oxygen exchange in tissues

403
Q

FLACC scoring

404
Q

pain history

A
  • how does child typically express pain
  • previous experience with pain
  • copes with pain
  • works best to relieve pain
  • parent and child preferences
405
Q

symptoms of upper vs lower airway illnesses

A
  • upper
    • congestion
    • rhinorrhea
    • cough
    • poor appetite
    • +/- febrile
  • lower
    • SOB
    • increased WOB, tachypnea
    • +/- wheezing and retractions
    • febrile
406
Q

isotonic IVF

A
  • osmolarity ~ 300 mOsm
  • no fluid shift between ICF/ECF b/c of equal concentrations of solutes and water
  • 0.9% NaCl or lactated ringers
407
Q

what is SIRS?

A
  • Systemic Inflammatory Response Syndrome
  • inflammatory feedback to illness/injury
  • local rxn at site of injury OR systemic response to infection
  • up-regulation of innate and adaptive immunity of natural physiology
  • clinical manifestations
    • tissue edema
    • hypoperfusion
    • cell proliferation
408
Q

TB precautions

A
  • airborne droplet
  • direct contact w/ infected fluids
    • inhaled organism (bacilli) goes directly to alveoli
      • breaks open in lung and multiplies
      • surrouned and isoalted by macrophages
    • 3 mo for cellular response
      • positive TB skin test
        • 3% false positive
        • partially positive - check w/ CXR
409
Q

TB nursing care

A
  • PPD test
  • if active:
    • airbone TB isolation - N95 mask
    • monitor respiratory status
    • monitor hydration
    • med admin
    • report to public health department
  • isolate family
  • hand hygiene
  • negative pressure room isolation
  • long term follow up with infectious disease and pulmonary
  • follow nutritional status
410
Q

clinical pathway of meningococcemia

A
  • spread via respiratory secretions
  • abrupt onset of fever, chills, malaise, vomiting
  • neurologic signs:
    • decreased mental status, seizures, coma
    • bulging fontaneles, severe headache, stiff neck
    • photophobia, nuchal rigidity
  • maculopaular rash - then petechial and maybe to purpura and sepsis
  • septic shock is a complication
411
Q

pancreatitis and sepsis

A
  • produces insulin and glucagon normally
  • can’t regulate glucose homeostasis
  • can’t fight infection, digest food, hormone regulation
412
Q

classic presentation of pertussis

A
  • uncontrollable, violent coughing that makes it hard to breathe
  • after coughing fits, someone with pertussis needs to take deep breathings (“whooping”)
  • commonly affects infants and young children
    • can be fatal, especially less than 1 yo
    • less than 6 mo have an absent cough (not enough intercostal muscles)
      • apnea is a symptom
      • not as worried once they walk and develop intercostal muscles
  • 100 day cough
    • 3-3.5 months to resolve once symptoms develop
413
Q

Hirschsprung’s disease defined

A
  • congenital aganglionic megacolon
  • absence of nerves in part of intestine
  • usually identified in first two months of life
    • less severe cases later in childhood
414
Q

pertussis and antibiotics

A
  • antibiotics within first 1-2 days of catarrhal (may not know they have it) can help eliminate symptoms
  • once they start paroxysmal coughing, antibiotics won’t help child
    • but can help people they interact with
415
Q

symptoms of impending respiratory failure

A
  • increased severity of WOB
    • accessory muscles
  • dyspnea
  • change in LOC
  • stupor
  • obtunded - LOC
416
Q

nursing interventions with measles

A
  • antipyretics; no antibiotics unless secondary infection
  • IV for hydration; assess nutrition
  • negative air pressure
  • isolation precautions for 3 days
    • until fever is gone for 3 days, rash completely gone, cleared by infectious disease doctor and pediatrician
    • depends on child and if they have immunocompromised children in their classroom
  • cool mist vaporizer; cool liquid frequently
  • suction gently
  • vaccine: MMR 12 mo and 4-6 yo
  • required to call public health department
417
Q

kids are different

A
  • cognition and communication
  • safety issues
  • physiological
418
Q

nursing assessment of hernia

A
  • observation
  • lump, bulge
  • crying, straining
  • lights used for mass vs. fluid
419
Q

family-centered care

A
  • mutually beneficial partnership between patients, families, healthcare team
  • formal method of delivering best care
  • ensure health and well being of patients of all ages
  • families are valued members of Health Care Team
  • supports key principles
    • dignity and respect
    • information sharing
    • participation and collaboration
    • care coordination and access to care
420
Q

common maintenance IVFs in pediatrics

A
  • D5W 0.45% NaCl
    • with or without KCL
  • less common
    • D5W 0.9% NaCl with or without KCL
  • all IVF rates, except TPN, based on weight (4,2,1 rule) unless weight is greater than 50 kg
421
Q

infant/toddler fluid volume distribution

A
  • 1/2 body water is ECF
  • 1st three months, 70-80% of weight is water
  • ECF ratios match adults by 2-3 yo
  • before age 3, 60% body weight is water
422
Q

drugs that work on pain transmission

A
  • peripherally
    • local anesthetics
    • opioids
  • dorsal root ganglion
    • local anesthetics
    • alpha2-agonists
423
Q

hypernatremia/hyperotnic dehydration

A
  • greater loss of water than sodium
  • serum sodium is elevated
  • side effect of high sodium r/t dehydration = seizures
424
Q

sensible loss

A

normal physiological loss due to urine and stool

425
Q

hypernatremic or hypotonic dehydration

A
  • serum sodium > 150 = greater loss of water than sodium
  • hormonal - peeing a lot
426
Q

vicious circle of shock

A

probably starts with vasodilation and increased permeability, but who knows?

427
Q

respiratory effects of malnutrition

A
  • derease diaphragmatic fxn
  • response to hypoxia is blunted
    • not blunted for hypercapnia
428
Q

B: Brain

A

differences between adults and children

  • head circumference
  • fontanelles
  • spinal cord
  • measurements, scoring
  • reflexes
429
Q

nursing assessment for pertussis: gastrointestinal

A
  • nutrition
  • wet diapers? how often?
  • how much eating, how frequently?
  • emesis after feeds, or some feeds?
  • NG tube if they can’t eat well
    • may vomit after coughing
    • can complicate breathing process
    • maintains hydration and prevents hypernatremia or hyperkalemia (seizures and cardiac arrhythmia)
430
Q

immune effects of malnutrition

A
  • altered cell mediated immunity
  • IgG repsonse is normal
  • IgA may increase
431
Q

cold shock

A

extremities really cold but hypotensive

432
Q

UTIs in less than 1 yo

A

increased risk for renal scarring

433
Q

faces of pain

434
Q

nursing management of fluid volume overload

A
  • ABCs and daily weights
  • skin breakdown (turn every 2 hours)
  • labs
  • fluid restriction?
  • specific gravity?

Pediatric Nursing (2 decks)

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