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)
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
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
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
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
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
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
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)
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
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
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
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
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!!!!
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
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
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
Appendicitis
| S/S of Rupture
* If Rupture…no longer has pain in RLQ
* DO NOT GIVE MORPHINE
* Rebound pain
* Symptoms of infection; tachy; fever;
26
Tonsillectomy
S/S of Post-Op Bleeding
Priority Care for a child bleeding after tonsillectomy
* 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
Nosebleed
| Priority Nursing Care
* Upright forward position
* Pressure
* Take pulse & BP – if excessive blood loss then tachycardia and hypotension
28
Tetrology of Fallot
What four defects make up this condition
+++ look at picture and be able to tell!!
```
DROP
• Defect, septal
• Right ventricular hypertrophy
• Overriding of aorta
• Pulmonary Stenosis
```
29
Tetrology of Fallot
| Positioning for tet (blue) spell
* 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
Congestive Heart Failure
| S/S in Infant
* 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
Congestive Heart Failure
| Appropriate way to measure output in infant
• weigh diapers
32
Digoxin
| What does nurse need to assess before administration
* Assess HR for full minute before giving
| * Bradycardia in an infant is 80-90 BPM
33
Coarctation of the Aorta
Assessment of Vital Signs
What should nurse be aware of?
* 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
Sickle Cell Crisis
| What are the precipitating factors?
* Pain!! d/t clumping of RBC in microcirculation d/t:
* Dehydration
* Extreme Temperatures
* Infection
* Localized Hypoxemia
* Emotional and physical stress
35
Hemophilia
| Assessment findings that indicate the child may have a cerebral bleed?
* Only recommended activity….swimming!!
| * S/S of cerebral bleed? Decrease in LOC
36
Care of a Child with Leukemia
| What measures are utilized to reduce infections?
* 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
Wilm’s Tumor
| How does the nurse perform and abdominal assessment?
* 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
Child Abuse
| What is the nurse’s role with reporting suspected child abuse?
* 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
Rheumatic Fever
| What is the precipitating diagnosis?
* 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
