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Families Final > Pediatric Final Review - Butts > Flashcards

Pediatric Final Review - Butts Flashcards

1
Q

Infant Birth Weight at 1 year – What Happens?

A
  • Infants double birth weight by 4-6 months
  • TRIPLE birth weight by 1 year
  • At 1 year, average boy 22 lbs (10 kg), average girl 21 lbs (9.5kg)
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2
Q

Developmentally appropriate care based on the age of the child

INFANT

A
  • Maintain at-home schedule when possible
  • Type of Play – observation
  • Pack special toy, blanket or pacifier security
  • If parent cannot stay at hospital have a consistent nurse
  • Separation anxiety at 6 mos
  • stranger anxiety
  • sense stress and anxiety in loved ones
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3
Q

Developmentally appropriate care based on the age of the child

Toddler

A
  • Favorite toy or blanket – “transitional” tiems
  • Role-playing with puppets,
  • Separation from parents is major stressor; fear
  • May see illness as punishment
  • Begins to understand concept of germs
  • Knows names and location of some body parts
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4
Q

Developmentally appropriate care based on the age of the child

Preschooler

A
  • Tell of hospital stay 4 days before

* Separation anxiety at hospital is rough

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5
Q

Developmentally appropriate care based on the age of the child

Child 7

A
  • Tell of hospital stay when tell parents
  • Separation anxiety is not as bad
  • Talk to a peer that has had procedure; require support
  • Regressive behaviors can be caused by stress
  • All to participate in care, engage in arts/crafts
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6
Q

Developmentally appropriate care based on the age of the child

Adolescent

A
  • Separation anxiety is not bad
  • Talk to a peer who has had procedure
  • Tutors
  • understands complex nature of illness
  • concerned with appearance/body image
  • respect need for privacy and independence
  • partner with family and adolescent in care
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7
Q

Pain Scales

CRIES Neonatal

A

The CRIES scale is used for infants > than or = 38 weeks of gestation. … If the CRIES score is > 4, further pain assessment should be undertaken, and analgesic.

  • C = Crying
  • R = Requires increased oxygen
  • I = Increased vital signs
  • E = Expression
  • S = Sleeplessness
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8
Q

Pain Scales

FLACC

A
  • Child cannot give input, language barrier or child has developmental delay
  • Not good for verbal older children…b/c provide no input

**5 Behaviors: facial expression, leg movement, activity, cry, consolability

**Toddler, Preschooler (#1 used)

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9
Q

Pain Scales

Wong-Baker Faces Pain Rating Scale

A
  • six cartoonlike faces
  • Popular with young children as young as 3 years of age
  • **Toddler, preschooler, adolescent
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10
Q

Pain Scales

Oucher Pain Rating Scale

A
  • Six photographs of children’s faces
  • Rating scale of 0 to 100
  • If child can count to 100 and understands increasing value, the number scale can be used.
  • Photos are culturally diverse
  • Children as young as 3 can point to the photographs
  • **Toddler, preschooler, adolescent
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11
Q

Impetigo Contagioso

A
  • caused by b-hemolytic Strep Group A or S. aureus (including MRSA)
  • Incubation: 7-10 days
  • Highly contagious, spread through contact with lesions
  • Underlying scabies can cause d/t scratching that becomes infected
  • Treat with muprocin (Bactroban)
  • Rare – Acute glomerularnephritis or rheumatic fever may occur sequelae
  • Secondary infection to insect bites…often on face and extremities; piercings
  • If extensive, can cause enlarged lymphnodes
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12
Q

Signs and Symptoms that Dehydration is Improving

A
  • S/S of dehydration: tachycardic…how the body compensates; poor skin turgor; dry lips; delayed cap refil; may or may not have fever; lower LOC; hypovolemia, hypernatremia; oliguria
  • Treat slowly…otherwise can cause cerebral edema with NS
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13
Q

Epiglottitis

Why does child sit in tripod position?

What are the assessments of child with epiglottitis?

A

• Tripod – allows maximum air into lungs

  • Assessment –
  • DON’T PUT ANYTHING IN THEIR MOUTH;
  • sore throat, pain, tripod positioning; retractions;
  • DROOLING!!!
  • INSPIRATORY STRIDOR
  • mild hypoxia; distress
  • KEEP CHILD CALM!!!!
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14
Q

Asthma

Priority Nursing Assessment in child exhibiting S/S of respiratory distress?

A
  • Mild respiratory distress – restlessness, tachycardia, tachypnea, diaphoresis (at risk of dehydration), rising CO2 levels
  • Moderate Respiratory Distress – early decompensation; nasal flaring, retractions, grunting, wheezing anxiety, irritability, mood changes, confusion, HTN
  • SEVERE Respiratory Distress – bradycardia, dyspnea, cyanosis (late sign), stupor, coma
  • PRIORITY ASSESSMENT: pulse ox, sit up, allow parents to stay
  • IF can’t control, emergency treatment is epinephrine 0.01mg/kg SQ up to 0.3ml
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15
Q

Cystic Fibrosis

Definition of Disorder
What labs are used for diagnosis?

A
  • Definition – exocrine gland dysfunction that produces multisystem involvement (usually GI and Respiratory tract); autosomal recessive trait; 3% US Cauc population are symptom-free carriers
  • Similar to COPD in adults; drown in mucus; salty sweat; Increase in NaCl in saliva and sweat
  • First sign is meconium ileus

• Labs – Sweat Chloride test on skin; chest x-ray; Pulmonary function test; stool fat and/or enzyme analysis; barium enema

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16
Q

Early Signs of Worsening Condition in Child with Head Injury

A
  • Headache
  • Vomiting w/out nausea
  • Motor weakness; discoordination; seizures
  • Diplopia and blurred vision
  • Irritability; restlessness and behavioral changes
  • Sleep alterations and somnolence
  • Personality changes
17
Q

Late since of child with increased ICP

A
  • Bradycardia
  • Decreased LOC
  • Decreased motor response to commands
  • Decreased sensory response to painful stimuli
  • Alterations in pupil size and reactivity
  • Papilledema
  • Flexion or extension posturing
  • Cheyne-Stokes respirations
18
Q

What is the process of weaning seizure medications in a child that has been seizure-free for the appropriate amount of time

Priority Nursing Care for a child having a seizure

A
  • Weaning: Seizure-free for 2 years; Normal EEG; Avoid during puberty of when pt is subject to frequent infections; recurrence can happen within first year of cessation; DO NOT ABRUPTLY D/C
  • Priority Nursing Care: ABC; Turn child gently onto side to prevent aspirations; Do not restrain; do not place anything in mouth; May have some slight cyanosis; Call provider
  • If child has statis epilepticus – o2 or medication may be needed to stop; 911
19
Q

GERD

Correct Positioning of the baby after feedings

A
  • Position at least 30 degrees
  • Feed child for 30 minutes, burp, 30 degrees
  • Don’t give 60 mLs at one time
20
Q

Hirschsprung’s Disease

What does the stool look like?

A
  • Congenital absence of ganglion cells in rectum & colon
  • more likely in Downs
  • Confirm with rectal biopsy

**STOOL IS FOUL-SMELLING and RIBBON-Y

21
Q

Pyloric Stenosis

What type of vomiting occurs?

A
  • Projectile vomiting 30 min – 1 hour after feeding
  • olive-like mass palpated when stomach is empty
  • you can see peristalsis waves
  • Can have Dehydration – can’t keep anything down
22
Q

Cleft Lip Palate

Post-Op Care

A
  • Protect Operative Site!!
  • No-No’s so they can’t put hands in mouth
  • NPO first 4 hours, then introduce liquids like water slowly; small amount to prevent vomiting
  • special bottle nipple
  • No spoons
23
Q

TEF (Tracheoesophageal Fistula)

Signs and Symptoms

A
  • Foregut fails to lengthen, separate, and fuse into two parallel tubes at 4 to 5 weeks’ gestation
  • Associated with maternal polyhydramnios
  • EXCESSIVE SALIVA
  • Cyanosis, coughing, choking
  • **Maintain airway…suction
24
Q

Celiac Disease

Dietary Needs

A

• Gluten-free

25
Q

Appendicitis

S/S of Rupture

A
  • If Rupture…no longer has pain in RLQ
  • DO NOT GIVE MORPHINE
  • Rebound pain
  • Symptoms of infection; tachy; fever;
26
Q

Tonsillectomy
S/S of Post-Op Bleeding
Priority Care for a child bleeding after tonsillectomy

A
  • S/S of Bleeding – Observe throat directly
  • Active bleeding – tachycardia; restlessness; low BP, pale, frequent clearing of throat; frequent swallowing in younger kids; vomiting bright red blood
  • Priority Care: side lying – call primary provider; may add stitch
27
Q

Nosebleed

Priority Nursing Care

A
  • Upright forward position
  • Pressure
  • Take pulse & BP – if excessive blood loss then tachycardia and hypotension
28
Q

Tetrology of Fallot
What four defects make up this condition
+++ look at picture and be able to tell!!

A 
DROP
•	Defect, septal
•	Right ventricular hypertrophy
•	Overriding of aorta
•	Pulmonary Stenosis
29
Q

Tetrology of Fallot

Positioning for tet (blue) spell

A
  • Walk-squat indicates a hypercyanotic spell
  • creates peripheral vascular resistance to decrease magnitude of right-left shunt across the ventricular septal defect
  • In babies, do knee to chest or put over shoulder
30
Q

Congestive Heart Failure

S/S in Infant

A
  • Tire easily; irritability
  • Weight loss or lack of weight gain (failure to thrive)
  • Diaphoresis
  • Frequent respiratory infections

**Late signs: tachypnea, tachycardia, pallor or cyanosis; nasal flaring/grunting; cough or crackles; S4 gallop

31
Q

Congestive Heart Failure

Appropriate way to measure output in infant

A

• weigh diapers

32
Q

Digoxin

What does nurse need to assess before administration

A
  • Assess HR for full minute before giving

* Bradycardia in an infant is 80-90 BPM

33
Q

Coarctation of the Aorta
Assessment of Vital Signs
What should nurse be aware of?

A
  • Narrowing or constriction of the aorta; often near ductus arteriosus or left subclavian artery; obstructs systemic blood flow
  • Reduces blood flow thru descending aorta
  • Low BP in legs
  • Bounding pulse in brachial
  • Femoral pulse weak
34
Q

Sickle Cell Crisis

What are the precipitating factors?

A
  • Pain!! d/t clumping of RBC in microcirculation d/t:
  • Dehydration
  • Extreme Temperatures
  • Infection
  • Localized Hypoxemia
  • Emotional and physical stress
35
Q

Hemophilia

Assessment findings that indicate the child may have a cerebral bleed?

A
  • Only recommended activity….swimming!!

* S/S of cerebral bleed? Decrease in LOC

36
Q

Care of a Child with Leukemia

What measures are utilized to reduce infections?

A
  • ANC <1000 – risk of infection
  • Administration of Colony-Stimulating Factor filgrastim (neupogen) can help with replacement of WBCs
  • Wash hands
  • limit exposure to large crowds (movie theatres)
  • Screen visitors of infection or recent vaccines
  • No plants or goldfish
  • Daily bath/shower; oral care;
  • Take temp daily; no rectal
  • Stool softener; prevent rectal tear
  • High calorie/high protein foods; no raw veggies or fruits
  • Avoid vaccines (except flu vaccine)
37
Q

Wilm’s Tumor

How does the nurse perform and abdominal assessment?

A
  • Wilm’s Tumor is an intrarenal tumor; firm lobulated mass; usually discovered at bath or clothing change; palpable; HTN seen
  • DO NOT PALPATE ABDOMEN!!! Can cause cancer cells to spread
38
Q

Child Abuse

What is the nurse’s role with reporting suspected child abuse?

A
  • As a mandated reporter, nurses are required to report any suspicions of child abuse or neglect
  • Notify supervisor
  • Child Protective Services or Law Enforcement
39
Q

Rheumatic Fever

What is the precipitating diagnosis?

A
  • Group A beta-hemolytic sterptococci (untreated strep infection)
  • Clinical manifestations include symptoms of CHF, joints are painful, swollen, and tender, fever, rash, and chorea (jerky movements)
  • treatment: antibiotics to eradicate strep, aspirin, steroids, long term antibiotic prophylaxis

Families Final (3 decks)

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