pediatric

Question 1

shaken baby syndrome signs

Answer 1

inc. head circumference (inc. intracranial bleeding, buldging fontanels), fractures, previous injuries, respiratory distress

Question 2

when can child use aspirin, acetaminophen, ibuprofen

Answer 2

aspirin not recommended until 18yrs, associated w/ rye syndrome: acute encephalopathy, fatty degeneration liver failure)

acetaminophen: 2 months
ibuprofen: 6 months

Question 3

how to give children intramuscular (Im) injection, what’s the best location

Answer 3

anterolateral thigh: use vastus lateralis muscle in anterolateral thigh, has a large muscle mass

Question 4

preferred site for medical intramuscular injections in adult

Answer 4

ventrogluteal (on the hip), is thick, has high muscles, fewer nerves, etc… also better for meds w/ large volume
anterolateral thigh can also be used.

deltoid muscle of the arm is also good especially for vaccine (its recommended over ventrogluteal and self-administration.

Answer 5

newborn skin is thinner, less fragile
they lose heat more rapidly, higher risk of sun damage.
newborn have lower melanin (lower production)

Question 6

allergen contact dermatitis
what is it, what are treatments, how long does it last?

Answer 6

skin came in contact w/ an allergen and develops an immune response. could be poison ivy, poison oak, rubber, fragrances.
can last 3-4 weeks without trreatment
s/s: edema, pruiritis

treatments: calamine lotion, cool compresses(relieves inflammation, oatmeal/Aveeno baths, antihistamine
topical steroids only if less than 10% of body area if affected, oral steroids if 10 percent

Question 7

diaper dermaittis

treat w/ zinc oxide, frequent diaper change, leave open air for 5mn after change
if infected w/ candida yeast, treat w/ nystatin

now what about seborrheic dermatitis, treatments, precautions

Answer 7

standard infections for seborrheic dermatitis
recurrent inflammation, overgrowth of yeast. seen most often in infants and adolescents.
treatment: selenium sulfide shampoo for scalp, steroids for other areas

Question 8

impetigo

Answer 8

contact precautions, highly contagious

hand hygiene to prevent bacteria
s/s: honey colored crust
topical mupirocin ointment, oral antibiotics
complications: post strep GNT cellulitis

Question 9

cellulitis
s/s
interventions

Answer 9

bacterial skin infection
s/s: redness, warthm, tenderness, and swelling, sore or rash, pain at site.

interventions: wound care, antibiotics
contact precautions if the client has an open wound

Question 10

scabies

Answer 10

oral antihistamine to stop itching
antibiotics

Question 11

lice treatment

Answer 11

pediculosis shampoo, permethrin
apply to dry hair, let it sit for 10mn then rinse

Question 12

tinea ringworn corposis, jock itch, athletes foot (pedis)

Answer 12

contact precautions
funcal infection
skin infections: clotrimazole
scalp: griSeofulvin

Question 13

atopic dermatitis

Answer 13

what I had/have.
has no cure. goal is hydrate and lubricate the skin, reduce pruritis (itching), manage infections, minimize inflammatory responses. oral histamine for itching, topical steroids to reduce inflammation, humidifieer for dryness

fam hx of allergies, eczema, asthma

Question 14

sebaceous glands inc. production of sebum mixed w/ keratinocyes

Answer 14

acne
treatment: retinoids, oral contraceptive (birth controls), accutane

Question 15

epiglotittis
which breath sounds
wheezing, stridor, normal, or crackles?
what’s the condition
what are nursing interventions

Answer 15

a medical emergency.
sore throat: severe and sudden
difficulty swallowing: painful and can cause drooling
diff breathing, esp when lying down
breath sounds are abnormal or high pitched (STRIDOR)
fever 100.4f or higher
irritability, restlessness, muffled or horse voice.

caused by bacterial/viral/fungal infections (in children, usually by bacteria haemophilus influenza type b), adults: strep pneumoniae or herpes/varicella

Question 16

heart diseases in peds that dec. the pulmonary flow

Answer 16

cyanotic effect,
tetralogy of Fallot, tricuspid atresia

Question 17

heart diseases in peds that inc. the pulmonary flow

Answer 17

non-cyanotic defect

patent ductus arterious (its patent), atrial septal defect, ventricular septal defect

Question 18

tetralogy of Fallot aortic stenosis, pulmonary stenosis

Answer 18

obstructive heart diseases, peds

Question 19

mixed defect

Answer 19

truncuns arteriosus
hypoplastic left heart syndrome: the left heart is tiny

Question 20

Kawasaki disease

Answer 20

inflammation of blood vessels and can damage the heart

Question 21

acute rheumatic fever

Answer 21

needs IV antibiotics so heart doesn’t get damage (heart murmur, EKG changes, tachy, slurred speech

Question 22

narrowest part of airways in children

Answer 22

circoid

Question 23

how to help preschooler w/ pain from tonsilectomy
a. provide help w/ coping skills
or
b. provide them w/ a magical blanket

Answer 23

magical blanket. infants that age cannot work on their coping skills

Question 24

epiglotittis
explain the disease and some of its symptoms and precautions
what causes it and how can it be prevented?

Answer 24

inflammation of epiglottis, may lead to airway obstruction. it is a medical emergency
epiglottis: prevents food from going on wrong side, it closes trachea during swallowing (prevents food from going to lungs, prevents aspiration)
w/ epiglottitis
can lead to airway issues, issues w/ swallowing, pain in throat, drooling (not able to swallow down saliva very well), muffled voice

causes of epiglotittis: droplet precautions ***
most common cause: h-influenzae type b, but also strep pneumonia, etc..
preventable by vaccines (hib vaccine, 3-4 doses receive it at 2, 4, 6, 12-15 months

s/s: mnemonics: add air nurse, they need air b/c they have airway issues
we’ll talk about add air nurse in next slide

Question 25

epiglottis s/s, hint mnemonics

but what don’t you see w/ epiglottitis, hints: starts w/ a c

Answer 25

mnemonics: add air nurse (which they need due to airway issues)
abnormal position (tripod: helps open airway)
dysphagia: diff swallowing –> drooling
difficulty speaking (muffled/soft voice)
apprehension (irritable due to low o2 levels)
increased temperature (high fever)
rapid onset (all of a sudden, bad changes

nasal flaring (not getting enough air in, nasals may flare
using assessory muscles to breathe
retractions on the chest (that and nasal flaring needs immediate attention, skin is tight, not getting air)
stridor (inspiratory, airway is being blocked)
enlarged epiglottis (on x-ray)

a cough is usually not present w/ epiglottitis, stridor can’t cough

Question 26

what should you never do in a epiglottitis pt?

and what to have at the bedside
how would you take the temp for this patient?

Answer 26

never insert anything in their mouth
no tongue blades, no oral temps (don’t put the thermometer in their mouth), may cause spasm, don’t do even if they have a sore throat
spasm can cut their airway
do rectal temp

what to have to maintain airway: intubation (if its severe, that will be needed, suction)

Question 27

epiglottitis nursing interventions

Answer 27

assess o2 stat, resp effort rate and sounds, above 60 is really not good
o2 stat, color? cyanotic? blue is not good
heart rate (usually inc.)
retractions? nasal flaring? really not good, airway is closing, we need to do something

keep child calm, don’t restraint. keep child w/ parent.
most comfortable position: tripod
(not supine).
keep npo
meds, iv fluids, antibiotics, steroids (to reduce swelling)

Question 28

wrapping the baby snugly in a blanket or cloth is called

Answer 28

swaddling the baby: wrapping the baby snugly in a blanket or cloth to provide security and comfort.
so swaddling doesn’t mean you’re moving the newborn, it actually prevents the newborn from moving so its good for a procedure like a heel stick: to draw blood.

Question 29

how to eat if an infant has heart failure

Answer 29

small frequent feedings
max time of feeding 30mn
baby should be fed every 3hrs
high calorie meals: so that baby can save energy

Question 30

normal resp rate, hr, temp for a newborn

Answer 30

40 - 60 breaths per minute

100 - 160 beats /min

temp: 96.8 - 100 (rectally)

Question 31

car seat rules

Answer 31

rear facing: 0 - 2yrs
front/forward facing: 2 - 4yrs (or when they reach upper limit of height & weight)

booster seat: age 4 - 8yrs, 4’9 or less preferabily

Question 32

child in a crib rules

Answer 32

nothing in the crib but the child

environment: cooler is better, too warm is a risk for sudden infant death syndrome

MAKE SURE THEY SLEEP ON THEIR BACK until they can turn on their own.

Question 33

when to do when a child got poison foods accidently

Answer 33

do not induce vomiting (no syrup of icepack)
call 911 if unstable (ex: not breathing)
call poison control (IF STABLE)
at home:assess for symptoms, remove poison from mouth/irrigate eye/rinse skin
hospital: NG w/ activated charcoal, (NG tube to try to get it out of their stomach), NARCAN (if its opiods poisoning)

Question 34

in which position should infant sleep?

Answer 34

infant should sleep on their back (until they can roll, but at least 6 months, 1yr preferably)

don’t put infant in their stomach, inc. risk of sudden infant death syndrome

Question 35

children developmental milestone
when in doubt, give the child more time.
1. child should sit up by 8 months (if not child is delay)
2. Child should walk by 16 months

going up the stairs and run by 3
jump rope by 5

Answer 35

normal heart rate for
newborn - 1yr old: 100 - 160 (remember In apgar scoring)

2 months old: 140
normal hr for adolescent (13-18): 60 - 100

normal resp rate for infants: 40 - 60, 30 when they’re sleeping

infants starts to grow teeth around 4 months: visible lower incisors

infants should double their body weight by 6 months and triple by 12 months. if born at 7 pounds in 2 months = 14 pounds, if not concerning

8.2lbs at birth, at 1yr = triple
double by 6 months and triple by 12 months
8.2 x 3 = 24lbs

Question 36

incisors are the first 4 teeths
central incisors are the 2 middle teeths,
the laterals are next to them
the lower central incisors come in first in infant.

read questions fully
at 14 months, which dvpt milestone would the child have RECENTLY mastered. I didn’t read fully and didn’t see recently and put sitting without support (wrong b/c this is mastered by 7-8 months). while walking alone masters around 14-16 months.
moral of the story: read questions fully

Answer 36

when to babies start following objects with their head?
babies will start follow objects with their head (turn their head to look at things) by 2 months

10 month old is walking while holding onto something is called CRUISING (they start 10-12 months): walking while holding onto something

mastered by
rolling over: 4 months
sitting up: 7 months
princer grasp: 12 - 14 months