Paediatrics Flashcards
<1 year old vital sign normal ranges
HR 110-160
RR 30-40
SBP 70-90
1-2 year old vital sign normal ranges
HR 100-150
RR 25-35
SBP 80-95
2-5 year old vital sign normal ranges
HR 95-140
RR 25-30
SBP 80-100
5-12 year old vital sign normal ranges
HR 80-120
RR 20-25
SBP 90-110
5 types of child abuse
Physical, emotional, sexual, neglect, family violence
Indicators of child abuse
Developmental delay, withdrawn, signs of depression/anxiety, attention seeking behaviours, models adult behaviour
Abnormal bruising (intentional) sites
Back, buttocks, back of thighs and calf muscle
Name 5 medication interventions utilised for broncospasm in the paediatric population
Corticosteroids, beta agonists, aminophyline, lidocaine, epinephrine
What is the FLACC scale?
Face, Legs, Activity, Cry, Consolability - observation tool for assessing pain
What ages is the FLACC scale used?
2 months to 7 years
How does the scoring of the FLACC scale work?
Each section has a score out of 3, 0 being the lowest level of pain.
For total scores
0 = relaxed
1-3 = mild discomfort
4-6 = moderate pain
7-10 = severe discomfort or pain or both
What is the Wong-Baker FACES Pain Scale?
Used for self-reporting of pain between the ages of 3-10. Faces showing expressions of sadness/pain along a number scale 0, 2, 4, 6, 8, 10. Children pick the face that they feel corresponds to their pain
What are three non-pharmacological treatment options for a child in pain?
Positive reinforcement, massage therapy, distraction techniques
Three main factors that predispose a newborn to excessive heat loss
Inability to shiver, large surface area, less subcutaneous fat
Which statement is false?
A) Newborns are at greater risk of hypothermia in hot environments.
B) Newborns are unable to adapt as easily to temperature changes in the environment.
C) Newborns require more layers of clothing to keep warm.
D) Newborns should be dried quickly after a bath.
A) Newborns are at greater risk of hypothermia in hot environments.
Can newborns produce heat through increased metabolism and oxygen consumption?
Yes
Congenital cardiac defects
Cardiomyopathy, coarction of aorta, atrial septal defect, ventricular septal defect, patent ductus arteriosus, tetralogy of fallots, transposition of great arteries
Which statement regarding rheumatic fever is false?
A) All sore throats in Māori and Pacific children, and young people (4-19 years) in some parts of the North Island need to be checked.
B) Rheumatic fever can cause the heart, joints, brain and skin to become inflamed and swollen.
C) Rheumatic fever can develop into rheumatic heart disease, and cause serious heart problems.
D) Rheumatic fever starts with a throat infection (strep throat), caused by the Group A Streptococcus bacteria.
E) Strep throat is unresponsive to antibiotics, and most strep throat infections lead to rheumatic fever.
E) Strep throat is unresponsive to antibiotics, and most strep throat infections lead to rheumatic fever.
What is atopy?
A) A predisposition to developing allergic reactions.
B) An allergic reaction that affects the respiratory tract.
C) An allergic reaction of the skin.
A) A predisposition to developing allergic reactions.
Immediate nursing interventions for a 3yr old child admitted with asthma and marked respiratory distress
Assess respiratory distress, administer oxygen, position patient for maximum ventilation and airway patency, administer prescribed meds, suction airway if needed, comfort, reassurance
Which statement regarding epiglottitis is false?
A) It involves swelling and inflammation of the epiglottis.
B) It is often caused by a bacterial infection.
C) It is more common in adults than in children.
D) It is more likely to develop in individuals with a weakened immune system.
C) It is more common in adults than in children.
Which of these reduce the risk of developing epiglottitis?
A) Up-to-date influenzae type b immunisation
B) Dairy free diet
C) Using an asthma preventer inhaler
A) Up-to-date influenzae type b immunisation
Which of the following statements regarding cystic fibrosis is true?
A) For a child to have CF, both parents must carry the abnormal gene.
B) For a child to have CF, only one parent must carry the abnormal gene.
C) For a child to have CF, the mother must carry the abnormal gene.
A) For a child to have CF, both parents must carry the abnormal gene.
What is genetic counselling?
It provides advice to parents who are concerned about the risks of genetic disorders in a future child.
How does genetic counselling relate to cystic fibrosis?
A genetic counsellor can help show the parents how the CF gene is passed down
Symptoms of cystic fibrosis
Coughing up thick mucus, weight loss or difficulty to gain weight, wheezing and SOB, constipation, stomach pain
Higher risk of development with cystic fibrosis
Pancreatitis, diabetes, liver disease, gall stones, low bone density, sinus infections, bronchitis, pneumonia
Two main productions of cystic fibrosis
Thick, sticky mucus and abnormally salty sweat
Pathophysiology of cystic fibrosis
Salt and chloride ions travel toward to skin surface to produce sweat, little is reabsorbed
What environmental factors can quickly cause an ionic balance for people with CF?
Exercise and hot weather
Symptoms of the ionic balance associated with CF
Fatigue, fever, muscle cramps, weakness, stomach pain, dehydration, vomiting, heat stroke
Main organs affected by thick, sticky mucus in CF
Lungs, pancreas, liver, intestines, kidneys
Is there a cure for cystic fibrosis?
No
Treatment and medication for cystic fibrosis
Massage techniques, antibiotics, anti-inflammatory, vitamin supplements, devices to help block the mucus and unblock airways, medication to facilitate digestion of fats and proteins
Treatment in severe cases of cystic fibrosis
Lung, pancreas, liver transplants
Three endocrine conditions in children
Cushing’s syndrome, hypothyroidism, acute adrenocortical insufficiency
True or false?
Type 2 diabetes generally develops after the age of 40 and is not associated with complete loss of insulin production.
True
Which of these statements about the kidney and urine is not true?
A) Only people who have glucose in their urine consistently can be diagnosed as having diabetes.
B) People can lose so much water in the urine in diabetes that they become clinically dehydrated.
C) Some diabetics never have any glucose in their urine.
D) When there is significant glucose in the urine, the rate of urine production is increased.
A) Only people who have glucose in their urine consistently can be diagnosed as having diabetes.
What is the Glasgow Coma Scale?
Clinical scale used to measure a person’s level of consciousness after a brain injury
How does the GCS scoring system work?
Scores range from 3-15. Eye opening 1-4, verbal response 1-5, motor response 1-6. A client with no response would have a score of 3, a fully alert and responsive client would have a score of 15.
What are the implications of decreasing GCS score?
A decreasing score is more predictive of poorer outcome than an initially low GCS, client may need early intubation
What are the indications for use of GCS?
To guide early management of patients with a head injury or other kind of acute brain injury
Another way to assess level of consciousness
AVPU
What is AVPU?
A - patient is awake
V - patient responds to verbal stimulation
P - patient responds to painful stimulation
U - patient is completely unresponsive
Type of spina bifida
Occulta, meningocele, myelomeningocele, closed neural tube defect
Myelomeningocele
Spinal core nerves and cerebrospinal fluid protrude out of an abnormal gap in the vertebrae and form a sac
Meningocele
Some of the membrane and cerebrospinal fluid that surrounds the spinal cord protrude out but the spinal cord itself does not
Occulta
Outer part of vertebrae has not completed closed, but the spinal cord does not protrude
What is hydrocephalus?
A build up of fluid in the deep cavities of the brain, putting pressure on the brain leading to brain damage
How to know if your VP shunt is not working?
The symptoms of hydrocephalus will continue. Patient will become bradycardic, lose consciousness and nauseous
Which of these statements are not true of absence seizures?
A) Patient stops what they are doing and have a blank stare.
B) Patients are always aware that they have had a seizure.
C) They can occur several times a day.
D) They cause a short loss of consciousness.
B) Patients are always aware that they have had a seizure.
Signs and symptoms of meningitis in infants
Fever, cold hands and feet, refusing food, vomiting, drowsy, dislike being handled, unusual crying/moaning, rapid breathing or grunting, tense bulging fontanelle, pale blotchy skin
Signs and symptoms of meningitis in older children
Fever, headache, vomiting, muscle pain and fever with cold hands and feet, hallucinations, aggressive behaviour, drowsiness, stupor and coma
Gastroenteritis
The rapid onset of diarrhoea with or without nausea, vomiting, fever or abdominal pain
Rotavirus
A highly contagious virus which causes diarrhoea
What is the peak age at which rotavirus infection occurs?
Infants 6 months to 2 years are most vulnerable
How is rotavirus transmitted?
Fecal-oral route, usually through direct contact between people
What are the symptoms of rotavirus?
Severe watery diarrhoea, vomiting, fever, and/or abdominal pain
How is rotavirus treated?
There is no specific medicine to treat rotavirus infection, but your doctor may recommend medicine to treat the symptoms
Can antibiotics treat rotavirus?
No, because antibiotics fight bacteria not viruses
What is Escherichia coli?
A bacteria commonly found in the lower intestine of warm-blooded organisms
What is the peak age at which Escherichia coli infection occurs?
Children under the age of 5 years or adults over the age of 65
How is E. coli transmitted?
Through consumption of contaminated foods, such as raw or undercooked ground meat products, raw milk, contaminated raw vegetables and sprouts
What are the symptoms of E. coli?
Stomach cramps, diarrhoea, occasional fever
How is E. coli treated?
There is no specific treatment for E. coli, it will pass on its own within five to ten days. Antibiotics should not be used for this infection
Appendicitis
Inflammation of the appendix
Biliary atresia
Inflammation and damage of the bile ducts, restricting the flow of bile out liver
Coeliac disease
Inflammation and damage to cells of small intestine, due to gluten intolerance
What does coeliac disease interfere with?
Absorption of nutrients and minerals
Pyloric stenosis
Thickening of the muscular valve between the stomach and small intestine blocking food from entering small intestine
Which of these can affect any part of the intestinal tract, from mouth to anus?
A) Coeliac’s disease
B) Crohn’s disease
C) Irritable bowel syndrome
D) Pyloric Stenosis
B) Crohn’s disease
An infant with bile stained vomit requires urgent attention. Which of the below would you suspect in a patient with bile stained vomit?
A) Large intestine obstruction
B) Pyloric stenosis
C) Small intestine obstruction
C) Small intestine obstruction
What is fundoplication?
A) A procedure that involves surgical removal of the appendix.
B) A surgical procedure that is used to reduce the size of the stomach.
C) A surgical procedure that is used to treat gastro-oesophageal reflux.
C) A surgical procedure that is used to treat gastro-oesophageal reflux.
Which statement regarding appendicitis is false?
A) Appendicitis is rare in infants.
B) One potential cause of appendicitis is blockage of the appendix with faeces, leading to bacterial infection.
C) Rupture of the appendix causes bacterial contamination of the peritoneal cavity, which can lead to a number of complications.
D) Symptoms start slowly and progress, and the appendix can rupture one week after the initial complaint of pain.
E) Urgent surgery to remove the appendix (appendectomy) is required, to prevent complications caused by the appendix rupturing.
D) Symptoms start slowly and progress, and the appendix can rupture one week after the initial complaint of pain.
What is compartment syndrome?
A) Fluid within the body tissues builds to dangerous levels.
B) Pressure within a joint capsule builds to dangerous levels.
C) Pressure within an enclosed muscle space builds to dangerous levels.
C) Pressure within an enclosed muscle space builds to dangerous levels.
Contagious skin conditions in children which require discussion for isolation in Public Health settings
Impetigo, Cellulitis, Scabies, Pediculosis (Lice)
What is wet wrapping for eczema?
Applying moisturiser and medication to a flare-up, then wrapping the area with warm, damp fabric or gauze and a second layer of dry cloth, such as cotton pyjamas
Three ways wet wrapping works for eczema
Cooling, moisturising and steroid reabsorption
What is another name for the tympanic membrane?
A) Concha
B) Ear drum
C) Ear lobe
D) Oval window
B) Ear drum
What is rhinitis?
A) Inflammation and irritation of the mucous membrane in the nose.
B) Rhinitis is another name for the common cold.
C) Fungal infection that causes inflammation in the nasal passages.
A) Inflammation and irritation of the mucous membrane in the nose.
Which of the following is not true regarding pharyngitis?
A) It is commonly caused by viral infections such as the common cold or influenza.
B) It is typically treated with antibiotics.
C) It involves inflammation of the pharynx.
D) It can cause difficulty swallowing, and a sore, dry and itchy throat.
B) It is typically treated with antibiotics.
Why is it important to measure the blood pressure of any child with a known or possible renal disorder?
Because high blood pressure increases the chance that the kidney disease will worsen and can lead to heart and vascular disease.
What is hemophilia?
The blood loses the ability to clot
Hemophilia can be life threatening if even a small injury occurs due to
Severe bleeding as the blood is unable to clot
Epistaxis
Severe nose bleeding
Key point of in nursing management of someone with HIV
Confidentiality, education on prevention of transmission, management of diseases related to HIV
Leukemia
Cancer that develops in bone marrow and blood. Cancerous cells spread to lymph nodes, spleen, liver, brain, spinal cord and other organs of body
Lymphoma
Cancer develops in B and T lymphocytes that have undergone malignant changes. Tumours cause swelling of lymph nodes and quickly spread to rest of body
Sarcoma
Develops in connective tissue such as bones, muscles, tendons, cartilage, blood vessels, fat, nerves
Most common cancers in younger children
Neuroblastoma, retinoblastoma
Most common cancers in adolescents
Lymphoma, sarcoma
Nursing interventions to manage nausea and vomiting in children undergoing chemotherapy
Anti-emetics prior to chemotherapy, regular administration of these post chemo
Therapeutic management of ADHD
Behavioural therapy, parenting skills, teamwork with MDT
Neonate
Birth to 28 days
Infants
A child up to 12 months of age
Child
1 to 2 years of age
Factors to remember when working with a child or young person
They are part of a wider family, consider social, emotional and psychological components of care, protect, promote and advocate for their needs
