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Pediatrics Test I > Pediatric Basics > Flashcards

Pediatric Basics Flashcards

1
Q

Ten Rights of Medication Administration

A
  • right patient
  • right drug
  • right dose
  • right time
  • right route
  • right documentation
  • right assessment
  • right evaluation
  • right education
  • right to refuse medication
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2
Q

what is the most reliable source for administering medications to child?

A

parents

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3
Q

what is the preferred route for administering medications to children?

A
  • oral
    • most meds are dissolved and suspended in liquid preparations
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4
Q

caution regarding oral medication administration

A
  • many peds meds are given by drops or dropper
    • many droppers are marked in tenths of mLs
    • a good way to avoid error is to demonstrate the technique and mark device for administration
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5
Q

what to be cautious of with a G button?

A

have to watch for granulation/scar tissue is not forming/blocking the stoma

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6
Q

what type of water should be used to flush a gastrostomy tube?

A

tap water

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7
Q

what are the drug dosage usually calculated in?

A

mg/kg

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8
Q

what difference with a safe dose range is okay with pediatrics?

A

+/- 10%

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9
Q

body water content for:

premature infant

newborn infant

one year old

>2 yo

A

90%

70-80%

64%

60%

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10
Q

what are the ratios of % of ECF to % cellular premature infants?

A

65% to 25%

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11
Q

what are the ratios of % of ECF to % cellular for newborns?

A

40-45% vs 30-35%

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12
Q

what are the ratios of % of ECF to % cellular for 1 yo?

A

24% vs 40%

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13
Q

what are the ratios of % of ECF to % cellular for >2 yo?

A

20% vs 40%

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14
Q

what are infants and small children more vulnerable to rapid fluid and electrolyte imbalance?

A
  • greater body surface area
  • inc metabolic rate: so inc RR, inc HR
  • proportionately infants have a smaller body water reserve
  • body surface area is greater so insensible loss is greater
  • b/c of higher metabolic rate, there are more waste products ot excrete
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15
Q

fluid maintenance requirements

A
  • 0-10 kg: 100 mL/kg/24 hr
  • 11-20 kg: 1000 mL + (50 * kg >10 kg)
  • 21-70 kg: 1500 mL + (20 * kg >20 kg)
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16
Q

what are the reasons for the majority of fluid and electrolyte imbalances in children?

A
  • secondary to vomiting and diarrhea
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17
Q

dehydration

A
  • occurs when body fluids are lost in excess of gains
    • most worried about sodium levels
  • common alterations due to:
    • GI tract
    • skin–burns
    • metabolism
    • lungs
18
Q

isotonic dehydration

A
  • proportional losses of fluid and electrolytes
    • Na is b/w 130-150
    • observable losses may bot be isotonic, but other avenues make adjustments
    • net loss is isotonic
    • greatest loss from ECF–>shock is greatest concern
19
Q

hypotonic dehydration

A
  • losses of electrolytes exceed fluid
    • Na < 130
    • ICF is more concentrated than the ECF, so water moves in and cells expand
    • greater loss from ECF–>shock is a problem–>inc HR and dec BP
20
Q

hypertonic dehydration

A
  • losses of fluids excess electrolytes
    • Na > 150
    • most dangerous and requires more specific tx
    • ECF is more concentrated, so water moves there from ICF and cells shrink
      • so shock less apparent, b/c water moving to ECF and wouldn’t see a drop in BP
    • seizures are more likely b/c of the shrinking cells
21
Q

assessment of level of dehydration

A
  • assess systemic perfusion
    • S/S of poor perfusion include:
      • HR inc initially then dec
      • cool extremities
      • cap refill >2 sec
      • weak peripheral pulses
      • mucous membranes pale and dry
      • urine output dec
      • BP normal then postural dec
22
Q

what are significant weight changes for:

infants?

children?

adolescents?

A
  • infants: 50 g in 24 hr
  • child: 200 g in 24 hr
  • adolescent: 500 g in 24 hr
    • concerned about both inc and dec in weight
23
Q

what age can you start using tears as an indication of hydration status?

A

2-3 mos

24
Q

where is the best place to assess skin turgor on an infant?

A

thigh or abdomen

25
Q

when do the fontanels close?

A
  • posterior: 2 mos
  • anterior: 18 mos
26
Q

what are the appropriate urine volume parameters for pediatrics?

A

1 mL/kg/hour

27
Q

what is normal urine specific gravity in children?

A

1.005-1.020

28
Q

what are the normal serum carbon dioxide balance in:

premies?

newborns?

infant/child?

A
  • premie: 14-27
  • newborn: 13-22
  • infant/child: 20-28
29
Q

what can you assess to determine hydration status and fluid/electrolyte balance?

A
  • ask about vomiting, diarrhea
  • type, freq, amt of food given
  • urinating pattern
  • any weight loss or gain
  • fever? evidence of infection?
  • V/S: temp, HR, RR, BP
  • skin assessment
  • anterior fontanel and eyes
  • I&O
  • urine specific gravity
  • labs: urine and serum electrolytes, SG, ABGs, EKG
30
Q

weight loss indicating mild dehydration in infants and children

A
  • infants: 3-5% weight loss
  • children: 3-4% weight loss
31
Q

weight loss indicating moderate dehydration in infants and children

A
  • infants: 6-9% weight loss
  • children: 6-8% weight loss
32
Q

weight loss indicating severe dehydration in infants and children

A
  • infants: > or equal to 10% weight loss
  • children: 10% or greater weight loss
33
Q

how to assess how much weight loss the child experienced due to dehydration?

A
  • pre illness weight minus post illness = difference
  • (difference divided by preillness weight)*100=percent weight loss
34
Q

goals of rehydration

A
  • maintain intravascular volume and systemic perfusion
  • replace volume deficit and ongoing losses
  • continue to provide maintenance fluid requirements
    • IV fluids for children with severe fluid volume deficit is initiated to restore first–>will expand extracellular volume
35
Q

what route will we use to give meds/fluids if the child is extremely dehydrated or if veins are non-accessible?

A

intra-osseous route

36
Q

fluid replacement in hypotonic vs isotonic vs hypertonic dehydration

A
  • fluid replacement is RAPID during isotonic or hypotonic dehydration
    • b/c of the signs of shock and low BP with high HR
  • rapid replacement is CONTRAINDICATED in hypertonic dehydration b/c of the risk of water intoxication
37
Q

oral rehydration solution (ORS)

A
  • used for children who have intact suck and swallow, no change in LOC, and not in shock
  • pedialyte is most often used
  • mild dehydration: give 50 mL/kg of the ORS over 4 hours
  • moderate dehydration: give 100 mL/kg of the ORS over 6 hours
38
Q

can we allow breast feeding to continue if a child is dehydrated?

A
  • as long as suck and swallow is intact and LOC is unchanged
  • breast feeding can continue ad lib
39
Q

what body system are we concerned about if the child is experiencing fluid volume excess or deficit?

A

CNS

40
Q

if question asks: if a newborn weighs 2.6 kg and is admitted to the hospital, and the doctor orders similac with iron at 20 cal/oz, and the infant requires 120 cal/kg to grow, how many oz oc the similac ordered will the infant need to ingest in order to maintain his weight?

A
  • newborn’s weight in kg * required cal/kg
    • 2.6 kg * 120 cal/kg=312 cal/24 hours
  • (1 oz/20 cal)*312 cal=15.6 or 16 oz/day

Pediatrics Test I (5 decks)

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