pediatric Flashcards
shaken baby syndrome signs
inc. head circumference (inc. intracranial bleeding, buldging fontanels), fractures, previous injuries, respiratory distress
when can child use aspirin, acetaminophen, ibuprofen
aspirin not recommended until 18yrs, associated w/ rye syndrome: acute encephalopathy, fatty degeneration liver failure)
acetaminophen: 2 months
ibuprofen: 6 months
how to give children intramuscular (Im) injection, what’s the best location
anterolateral thigh: use vastus lateralis muscle in anterolateral thigh, has a large muscle mass
preferred site for medical intramuscular injections in adult
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.
newborn skin is thinner, less fragile
they lose heat more rapidly, higher risk of sun damage.
newborn have lower melanin (lower production)
allergen contact dermatitis
what is it, what are treatments, how long does it last?
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
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
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
impetigo
contact precautions, highly contagious
hand hygiene to prevent bacteria
s/s: honey colored crust
topical mupirocin ointment, oral antibiotics
complications: post strep GNT cellulitis
cellulitis
s/s
interventions
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
scabies
oral antihistamine to stop itching
antibiotics
lice treatment
pediculosis shampoo, permethrin
apply to dry hair, let it sit for 10mn then rinse
tinea ringworn corposis, jock itch, athletes foot (pedis)
contact precautions
funcal infection
skin infections: clotrimazole
scalp: griSeofulvin
atopic dermatitis
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
sebaceous glands inc. production of sebum mixed w/ keratinocyes
acne
treatment: retinoids, oral contraceptive (birth controls), accutane
epiglotittis
which breath sounds
wheezing, stridor, normal, or crackles?
what’s the condition
what are nursing interventions
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
heart diseases in peds that dec. the pulmonary flow
cyanotic effect,
tetralogy of Fallot, tricuspid atresia
heart diseases in peds that inc. the pulmonary flow
non-cyanotic defect
patent ductus arterious (its patent), atrial septal defect, ventricular septal defect
tetralogy of Fallot aortic stenosis, pulmonary stenosis
obstructive heart diseases, peds
mixed defect
truncuns arteriosus
hypoplastic left heart syndrome: the left heart is tiny
Kawasaki disease
inflammation of blood vessels and can damage the heart
acute rheumatic fever
needs IV antibiotics so heart doesn’t get damage (heart murmur, EKG changes, tachy, slurred speech
narrowest part of airways in children
circoid
how to help preschooler w/ pain from tonsilectomy
a. provide help w/ coping skills
or
b. provide them w/ a magical blanket
magical blanket. infants that age cannot work on their coping skills
epiglotittis
explain the disease and some of its symptoms and precautions
what causes it and how can it be prevented?
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
epiglottis s/s, hint mnemonics
but what don’t you see w/ epiglottitis, hints: starts w/ a c
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
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?
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)
epiglottitis nursing interventions
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)
wrapping the baby snugly in a blanket or cloth is called
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.
how to eat if an infant has heart failure
small frequent feedings
max time of feeding 30mn
baby should be fed every 3hrs
high calorie meals: so that baby can save energy
normal resp rate, hr, temp for a newborn
40 - 60 breaths per minute
100 - 160 beats /min
temp: 96.8 - 100 (rectally)
car seat rules
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
child in a crib rules
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.
when to do when a child got poison foods accidently
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)
in which position should infant sleep?
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
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
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
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
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
