Pediatric HESI Flashcards
1
Q
What are the primary goals for a child admitted with Eczema (Atopic Dermatitis)?
A
relieve itching and inflammation
lubricate the skin
control secondary infections r/t scratching
2
Q
Where does Eczema (Atopic Dermatitis) commonly occur in adolescents?
A
antecubital
popliteal
3
Q
A child with a skin disorder needs to be monitored for S&S of ______.
A
infection
4
Q
What is Impetigo?
A
a contagious bacterial (strep or staph) infection of the skin
5
Q
Impetigo lesions progress to a crusting stage, where we can expect to see ______.
A
a honey-colored crust
6
Q
What is the nursing priority intervention for Impetigo?
A
isolate the child and use contact precautions (very contagious)
7
Q
When is scabies contagious and how is it transmitted?
A
contagious period - the entire course of infestation
transmission - close contact with an infected person (all those in a household need to be treated simultaneously)
8
Q
What should be taken into consideration when administering Lindane - an alternative med used to treat scabies?
A
do not give to children under 2 years old - neurotoxicity and seizures
rationale - children under 2 have more permeable skin, a higher systemic absorption may occur and put the child at risk for CNS toxicity and seizures
9
Q
How should Permethrin (Elimite) - a med used to treat scabies - be applied?
A
to cool dry skin at least 30 minutes after bathing
to the entire skin, not just the scabies part
10
Q
What patient teaching should be given to the parents of a child with scabies?
A
wash all clothing/bedding once per day for at least a week
11
Q
What is the nursing priority for a child with a burn injury?
A
#1 - stop the burning process #2 - ABCs #3 - remove burned clothing #4 - keep the child warm
12
Q
How are burns documented in a pediatric client?
A
TBSA% using age-related charts
13
Q
What is the MOST accurate way to determine if fluid resuscitation for a burn patient has been adequate?
A
neurological assessment
rationale - the burn itself should not affect the brain, so the child should be AAOX3
14
Q
A nurse suspects scabies when she sees the child’s skin has _____.
A
fine grayish red lines
15
Q
Where do impetigo lesions commonly form?
A
the mouth and nose
16
Q
Do adults or children present with more severe scarring after a burn injury?
A
a child
17
Q
Burns involving more than __% of TBSA require fluid resuscitation.
A
10%
18
Q
A (higher/lower) proportion of body fluid to mass in a child increases the risk fo cardiovascular problems.
A
higher fluid
19
Q
Which pain medication should be avoided in children with sickle cell anemia because it increases the risk of seizures?
A
Meperidine (Demerol)
20
Q
What patient teaching should be given regarding the administration of liquid iron supplements?
A
it stains teeth - use a straw and brush teeth after
21
Q
What INCREASES iron absorption and should be given concurrently with iron supplements?
A
vitamin C
22
Q
What DECREASES iron absorption and should NOT be given with iron supplements?
A
mild or antacids
23
Q
How is aplastic anemia diagnosed?
A
bone marrow aspiration
24
Q
What are some expected assessment findings for a child with aplastic anemia?
A
pancytopenia petechiae purpura pallor bleeding weakness tachycardia
25
What is the primary treatment for hemophilia?
replacement of the missing clotting factor
26
What are some expected assessment findings for hemophilia (a bleeding disorder caused by lack of a clotting factor)?
abnormal bleeding
nosebleeds
pain/tenderness/swelling r/t joint bleeding
easy bruising
27
What will tests that measure platelets show in a child with hemophilia?
they will have NORMAL platelet levels but decreased clotting factors
28
Von Willebrand's Disease is characterized by _____.
bleeding from mucous membranes
29
What does a child with a bleeding disorder need to have with them at all times?
a Medic-Alert bracelet
30
Which groups have the highest incidence of B-Thalassemia?
Those of Mediterranean descent - Italians, Greeks, Syrians
31
What is the priority intervention for a child newly admitted with a bleeding disorder?
put them on bleeding precautions and assess for bleeding
32
What is B-Thalassemia?
an autosomal recessive disorder that reduces the production of hemoglobin
33
What are some expected assessment findings for a child with B-Thalassemia?
frontal bossing (prominent brow ridge/forehead)
maxillary prominence
wide-set eyes
flattened nose
green/yellow skin tone
hepato/splenomegaly
severe anemia
microcytic RBCs
34
What drug will be given to prevent organ damage from iron toxicity (chelation therapy)?
Deferoxamine (Desferal)
| Exjade
35
What, if not given throughout the therapy for a sickle cell exacerbation, will cause pain that can not be controlled?
Hydration - do not deprive fluids
36
What lab result will a patient with iron deficiency anemia display?
microcytic RBCs
rationale - iron aids in the production of hemoglobin for RBCs
37
What is Von Willebrand's Disease?
a hereditary bleeding disorder that causes platelets to adhere to damaged endothelium (organ lining)
38
What is the pathology of leukemia?
developing WBCs depress the bone marrow, causing anemia, infection, and bleeding
39
What will the WBC labs show for a child with leukemia?
they can be low, normal or elevated depending on the stage of the disease
40
What are some common S&S of leukemia?
```
fever
fatigue
pallor
anorexia
hemorrhage
bone and joint pain
pathologic fractures
```
41
A positive bone marrow biopsy for a patient with leukemia will show:
leukemic blast (immature phase) cells
42
What is the number one nursing consideration for a child receiving chemotherapy?
monitor for infection.
43
Hallmark sign of Hodgkin's Disease:
Reed-Sternberg cells
44
What are some assessment findings for Hodgkin's Disease?
painless enlarged fixed lymph nodes
45
What is a Nephroblastoma (Wilms' Tumor)?
the most common intraabdominal and kidney tumor of childhood
46
What is the hallmark sign of a nephroblastoma (Wilms' Tumor)?
a firm non-tender mass within the abdomen
47
What should you NOT do before surgical removal of a nephroblastoma (Wilms' Tumor)?
DO NOT PALPATE the abdomen - the tumor is often encapsulated, and if the capsule breaks we risk metastasis
48
What causes the S&S of neuroblastomas?
compression of the surrounding tissue
49
What is the most common bone cancer in children?
osteosarcoma
50
What are some common assessment findings for an osteosarcoma tumor?
bone pain relieved by a flexed position
51
What is the number one nursing assessment for a brain tumor?
signs of increased ICP
52
Thrombocytopenia is defined as a platelet count less than
20,000
53
What is an EARLY sign of increased ICP?
vomiting
54
What should NOT be administered to a child with a fever? Why?
Asprin b/c of the risk for Reye's syndrome
55
Afre an antipyretic is administered, what should be your next nursing step?
recheck the temp 30-60 minutes after
56
Why are infants and children more susceptible to fluid volume deficit?
their body water is in the extracellular space
57
What % of weight loss will a child with SEVERE dehydration have?
10% or more
58
What will the vitals show for a child with SEVERE dehydration?
HR increased
RR increased
BP decreased
59
What will the capillary bed refill be like in a child with SEVERE dehydration?
very delayed (>4sec) with tenting
60
What is the most accurate measure of dehydration?
weight
61
What is Phenylketonuria (PKU)?
an autosomal recessive disorder that leads to CNS damage from too much phenylalanine
62
How many states require the routine screening of newborns for PKU?
all 50
63
Which foods are high in phenylalanine and should be avoided by a child with PKU?
high protein meats
dairy
aspartame
64
What is Type I Diabetes? Type II?
Type I - the destruction of pancreatic beta cells (that produce insulin)
Type II - the body fails to produce and use insulin properly
65
What is the "normal" blood glucose level?
70-110
66
What are some assessment findings for a child with Diabetes Mellitus?
Polyuria
Polyphagia
Polydipsia
HYPERglycemia
fruity breath
Weight LOSS
blurred vision
change is LOC
H/A
fatigue
lethargy
67
What is a priority nursing action for a child newly diagnosed with Diabetes Mellitus?
plan a consult with a diabetic specialist
68
How many grams of carbohydrates should be consumed for every 30-45 minutes of exercise in a diabetic child?
15 grams
69
When would DILUTED insulin be administered?
in infants who need a smaller dose
70
What is the goal for Hemoglobin A1c levels in a child with Diabetes Mellitus?
< 7%
71
Which is a more accurate measure for blood glucose; a lancet finger prick or a urine test?
a lancet finger prick (BG monitoring)
72
Which voided urine specimen is most accurate when taking a urine cache?
the second one (toss the first one)
73
Urine glucose testing is unreliable, so why/when would we take a urine sample for a diabetic child?
when the child is sick or HYPERglycemic, their urine should be tested for ketones
74
What are some S&S of HYPOglycemia?
"cold and clammy, need some candy"
tingling around the mouth
```
H/A
nausea
sweating
tremors
hunger
confusion / anxiety
slurred speech
```
75
Once a HYPOglycemic child becomes unconscious outside of the hospital, what is the first nursing action?
squeeze cake frosting/glucose paste onto their gums and retest the glucose level in 15 minutes
if it's still low, and the child remains unconscious, prepare to administer glucagon as prescribed
76
What are some food items to treat HYPOglycemia?
```
1/2 cup orange juice
1 box raisins
1 candy bar
1 tsp honey
2-3 glucose tabs
3-4 LifeSavers candies
3-4 hard candies
4 sugar cubes (1 tbsp sugar)
8 oz milk
```
77
HYPERglycemia is defined t what blood glucose level?
200 or more
78
if a diabetic child is sick, should you withhold insulin?
never withhold insulin
79
What is DKA? How does it occur? What are the defining labs?
diabetic ketoacidosis
hyperglycemia turns into a metabolic acidosis
blood glucose > 300
ketones present in the urine
80
What are the S&S of DKA?
```
Kussmaul breathing
acetone (fruity) breath
lethargy
decreasing LOC
HYPOtension r/t dehydration
```
HYPERglycemia symptoms
81
What lab should be monitored during a DKA crisis?
potassium - insulin administration affects potassium levels
82
If a diabetic child is sick AT HOME and presents with ketones in the urine, what should the nurse recommend the parents do?
encourage the child to drink fluids to clear the ketones - it is NOT necessary to bring the child into the clinic immediately at this time
83
A child is being prescribed potassium chloride, what is the PRIORITY nursing assessment before administering this prescription?
chick urine output
rationale - potassium chloride should never be administered in the presence of oliguria or anuria b/c of the risk for HYPERkalemia. If the urine output is less than 1-2mL/kg/hr, potassium chloride should not be administered.
84
What level of phenylalanine defines PKU?
over 20 mg/dL
85
What is the expected INITIAL prescription for a child presenting with DKA?
normal saline - hydration is the first step for HYPERglyemia
rationale - a potassium IV will likely be required, but it is not the INITIAL tx for DKA
86
After administering an antipyretic, why should COLD water not be sponged onto a child with a fever? What should the nurse do instead?
it may cause shivering - increasing metabolic processes and therefore the fever (tepid water is OK)
instead, all excess blankets and clothing should be removed from the child
87
What is an acceptable urine specific gravity to note when a child has been dehydrated and is improving?
1.002 - 1.025
88
What is the major concern for a vomiting child?
dehydration
89
What is the priority nursing intervention for a child who is vomiting?
prevent aspiration
90
What is a major cause of dehydration, especially for children under the age of 5?
acute diarrhea
91
What are the major concerns for a child having diarrhea?
dehydration
loss of electrolytes
metabolic acidosis
92
What might the nurse have to give to a postoperative cleft lip repair child?
a soft elbow/jacket restraints
93
What must be kept at the bedside for a cleft lip repair?
suction
94
What are the "3 c's" of esophageal atresia?
coughing during feeding
choking during feeding
cyanosis
95
What patient teaching should be given to the parents of a child with esophageal atresia repair postoperatively?
ID the need for suctioning - respiratory distress and constricted esophagus
96
What are some complications of GERD?
esophagitis
esophageal sticture
aspiraton of gastric contents
aspiration pneumonia
97
How should a GERD infant be placed when sleeping?
supine - to prevent SIDS unless otherwise prescribed by the HCP
98
What are some hallmark signs of hypertrophic pyloric stenosis?
HPS is the enlargement of the muscles surrounding the pyloric sphincter that may lead to complete obstruction
mild regurgitation turning into projectile vomiting after feeding
peristaltic waves that are visible from left to right during feeding
there is an olive-shaped mass just to the right of the umbilicus
99
What is a pyloromyotomy? When is it done?
an incision through the mm of the pylorus - used for hypertrophic pyloric stenosis
100
What is the priority intervention for a child with lactose intolerance?
eliminate diary or administer an enzyme tablet replacement
101
A child with lactose intolerance will need to take 2 supplements because of the risk of _____ and _____ deficiency.
calcium
| vitamin D
102
What is Celiac Disease?
intolerance to gluten (wheat, barley, rye, and oats)
103
What are the S&S of a celiac crisis?
watery diarrhea
| vomiting
104
What are some dietary interventions for a child with celiac disease?
substitute corn and rice for gluten
105
Where will the most pain be felt for a child with appendicitis?
McBurney's point
106
What is the hallmark indication of a perforated appendix?
sudden relief of pain followed by an increase in pain and guarding of the abdomen
107
What position should a patient be placed in following an appendectomy?
right side-lying or semi Fowler's
108
What therapies should be avoided following an appendectomy?
heat to the abdomen
laxatives
enemas
109
What is the most serious complication of Hirschsprung's Disease (MegaColon)?
enterocolitis
110
What is the first sign of Hirschsprung's Disease in infancy?
failure to pass meconium
| failure to suck
111
What dietary interventions should be carried out for a child with Hirschsprung's Disease?
low-fiber
high-calorie
high-protein
112
What poop will you see for Intussusception (telescoping)?
currant jelly stools (bright red blood and mucus)
113
What is the sign that Intussusception has resolved?
passage of normal brown stool
114
What is an Omphalocele? What is the priority nursing intervention for it?
the intestines herniated through the abdomen - SAC IS INTACT
priority - KEEP THAT SAC INTACT; the sac is covered with sterile gauze to prevent drying out and the patient is kept NPO
115
What is Gastroschisis? What is the priority nursing intervention for it?
the intestines herniated through the abdomen - THE SAC IS NOT INTACT
priority - the exposed bowel is covered in saline-soaked pads but NOT wrapped with plastic b/c if the bowel expands, the wrapping may cause pressure and necrosis
116
What is an incarcerated hernia?
part of the bowel becomes tightly caught in the hernial sac and compromises blood supply - MEDICAL EMERGENCY - may lead to gangrene
117
What is the priority dietary tx for constipation and encopresis (fecal incontinence with constipation)?
high fiber diet and fluids
| decrease milk and sugar intake
118
What are some high fiber foods?
```
bread and grains
raw veggies
fruits
beans
popcorn/nuts
```
119
What are the S&S of IBS in children?
alternating constipation and diarrhea with the presence of undigested food and mucus in the stool
120
What are some preoperative interventions for a child with an imperforate anus?
determine the presence of an anal opening
| look for stool in urine and vagina (indicates a fistula)
121
What is the preferred patient positioning following surgery for a child with an imperforate anus?
side-lying prone with hips elevated
or
supine with legs hips flexed to 90
122
How are all of the Hepatitis viruses acquired?
HAV & HEV - contaminated food
HBV & HDV - body fluids
HCV - parenterally
123
What is Hepatitis? What are some assessment findings during the different phases?
inflammation of the liver
Prodromal & Anicteric phase:
NO jaundice
Fever
Rash
```
Icteric phase:
Jaundice
Dark urine
Pale stools
Pruritus
```
124
Which Hepatitis viruses do we have vaccines for?
A & B
125
How do we prevent the spread of Hepatitis?
handwashing and standard precautions
126
What therapy is administered for a child with lead poisoning?
chelation therapy:
Calcium Disodium Edenate
Chemet
BAL - not for allergy to peanuts, not with iron
127
What defines a toxic dose of Acetaminophen (Tylenol) in children?
150 mg/kg
128
What is the antidote to Acetaminophen (Tylenol) overdose?
Mucomyst
- dilute in juice b/c of odor
- do not give with activated charcoal lavage (in the event of an unconscious pt)
129
What level defines a toxic dose of Aspirin?
300-500 mg/kg
130
What is the treatment for Aspirin overdose?
activated charcoal
131
What should a parent give to their child if they've ingested bleach/paint/detergent after they've called the poison control center?
milk or water to dilute the corrosive
DO NOT induce vomiting
132
What poop will you expect to see for Hirschprung's Disease?
ribbon-like stools
133
What should you do to feed a GERD child?
thicken the feedings with rice cereal
134
Vomiting leads to ______
| Diarrhea leads to ______
vomiting - metabolic ALKalosis (loss of stomach acid)
| diarrhea - metabolic ACIDosis (loss of bicarb)
135
What is strabismus? When is it considered a normal finding?
cross-eyed
| normal until 4 months of age
136
What interventions are expected for a child with strabismus?
patch the good eye
137
What is conjunctivitis?
pink eye
138
What should be suspected if chlamydial conjunctivitis is present?
sexual abuse if the child is not sexually active
139
How should ear drops be administered in a child younger than 3?
pull the pinna DOWN and BACK
for older than 3 - pull it UP and BACK
140
What is a myringotomy? What patient teaching should be given?
tubes for ear infections
| tell the parents that if the tubes fall out - it's ok, just let the HCP know
141
What should NOT be done for a child after a tonsillectomy?
suction - unless they are aspirating
142
What is a sign of bleeding following a tonsillectomy?
frequent swallowing
143
What is a NEVER for epiglottitis (croup)?
do not visualize the throat
do not take an oral temperature
do not obtain a throat culture
all risks for spasm and complete airway occlusion
144
What patient teaching should be given to the parents of a child with laryngotracheobronchitis?
don't give cough syrups/cold medicines - they may dry and thicken secretions
145
What must be implemented for a child with an unknown upper respiratory infection?
isolation precautions
146
What intervention should be encouraged for a child with bronchitis?
increased fluid intake
147
Does a child with RSV need to be isolated?
yes - but they can be put in a room with another RSV patient
148
What is cystic fibrosis?
thick, tenacious secretions that block small passageways around the organs
149
How does cystic fibrosis affect the respiratory system?
emphysema
150
How does cystic fibrosis affect the GI system?
intestinal obstruction
| malnutrition
151
What test is used to diagnose cystic fibrosis?
quantitative sweat chloride test
chloride levels of 40-60 mEq/L
152
How does cystic fibrosis affect the integumentary system?
super salty and chloride sweat
153
SIDS most frequently affects infants ______
2-3 months old
154
What vaccine may cause a negative TB test?
measles
155
What position should a child with pneumonia in the RIGHT lower lobe be placed to increase comfort?
place him RIGHT side-lying
| this is splinting
156
What is a manifestation of respiratory distress in regards to positioning?
tripod positioning
| tachycardia
157
What indicates a positive Tuberculin skin test?
induration of 10mm or more
158
According to the book, should you wear a mask when in contact with an RSV child?
apparently not - only standard precautions are needed
159
What is the most common cause of inadequate cardiac output in infants and children?
a congenital heart defect that produces excess pressure/volume on the heart muscle
160
What medication would you expect to be prescribed for a child with early heart failure?
Digoxin (Lanoxin)
161
When would you NOT give Digoxin?
HR < 90-110
162
What is the expected dose of Digoxin for infants?
1mL
163
What is the therapeutic range for Digoxin?
0.8-2 ng/dL
164
What electrolyte imbalance makes Digoxin toxicity worse? What medication might cause the electrolyte imbalance?
HYPOkalemia
| caused by Lasix (Furosemide)
165
What labs need to be checked before administering potassium?
creatinine and BUN
166
What are the S&S of INCREASED pulmonary blood flow cardiac defects?
```
decreased peripheral pulses
HYPOtension
lethargy
pale cool extremities
feeding and exercise problems
oliguria
```
(everything shunts to the core)
tachycardia
167
What is the most common cardiac defect in Down syndrome? What will the infant present with?
Atrioventricular canal defect (increased pulmonary blood flow)
present with cyanosis that increases with crying
168
What will an infant with a patent ductus arteriosus present with?
widened pulse pressure and bounding pulses
169
Which heart defect will present with higher blood pressure in the upper extremities than in the lower extremities?
coarctation of the aorta
170
What is a hallmark sign of pulmonary stenosis?
murmur and cyanosis
171
What is included in the Tetralogy of Fallot?
VSD
Pulmonary stenosis
Overriding Aorta
Right Ventricular Hypertrophy
172
What indicates that a child is experiencing a "tet" spell or "blue" spell?
they will squat to improve their oxygenation
173
What is the hallmark sign of chronic hypoxia?
clubbing
174
What is the priority treatment for hypoplastic left heart syndrome?
keep the ductus arteriosus open - once it closes, the blood won't be able to get through the aortic atresia
175
What are the priority nursing actions to take if a tet spell occurs in an infant?
1 - knees to chest
| 2 - 100% oxygen
176
What is the priority, postoperative intervention for a cardiac catheterization?
keep the leg straight for 4-6 hours
177
What is the priority nursing intervention if you see bleeding postoperatively after cardiac catheterization?
apply continuous direct pressure at the catheter entry site and report it immediately
178
When does Rheumatic fever typically present?
2-6 weeks after an untreated/partially treated Strep infection (pt will report a "recent sore throat"
179
Left-sided heart failure backs up into the ______.
lungs (LEFT LUNGS)
- crackles/wheezes
- cough
- grunting
180
Right-sided heart failure backs up into the _______.
body (RIGHT BODY)
- ascites
- JVD
- edema
- weight gain
181
What type of rash will children with Rheumatic fever present with?
erythema marginatum - red skin lesions that start on the trunk and move peripherally
182
What will a child with acute Kawasaki's Disease present with?
fever
conjunctival hyperemia
red throat
183
What is the most serious complication of Kawasaki's Disease?
cardiac involvement - aneurysms
184
What can we expect to be prescribed for a child with Kawasaki's Disease?
IVIG
185
What are the EARLY signs of heart failure?
TACHYcardia
TACHYpnea
sudden weight gain
186
What 3 diagnostic tests can confirm Rheumatic Fever?
Anti-Streptolysin O titer
Streptozyme assay
Anti-DNase B assay
187
What may cause glomerulonephritis?
a strep infection
188
What are the classic manifestations of nephrotic syndrome?
```
massive proteinuria
massive lipiduria
hypoalbuminemia (weight GAIN)
edema
anorexia
pallor
```
189
What finding would lead a nurse to suspect cryptorchidism?
testes are not palpable
190
What is NOT done initially for a child with hypospadias or epispadias?
circumcision - the foreskin may be used for the surgical reconstruction of the defect
191
Which side of the penis is an epispadias? hypospadias?
epispadias - top side - DORSAL surface (the dorsal fin is on the TOP of a dolphin)
hypospadias - underside - VENTRAL surface
192
What should NOT be applied to a bladder exstrophy?
petroleum jelly - although we want to keep the bladder moist and clean, petroleum jelly will adhere to the bladder tissue and damage it
193
What will a nurse most likely expect to find in the urine of a child with epispadias?
bacteriuria - the position of the urethral opening facilitates bacterial entry
194
What is the primary goal with Cerebral Palsey?
early recognition to maximize the child's abilities
195
What is the earliest indication of improvement or deterioration of a neurological condition?
level of consciousness
196
Which type of head injury is more severe; open or closed?
closed - b/c the chance for increased ICP is far greater
197
What are the EARLY signs of increased ICP?
bulging fontanel
increased head circumference
Macewen's sign - widely separated bones of the head
Setting Sun sign
198
What are the LATE signs of increased ICP?
bradycardia
pupil alteration
decorticate or decerebrate posturing
Cheyne-Stokes respirations
high shrill cry
199
Why do we need to test drainage from the nose or ears?
if the fluid contains glucose, it indicates CSF leakage
contact the HCP immediately
200
What do we expect to see in a child with hydrocephalus?
increased head circumference
bulging anterior fontanel
Macewen's sign - widely separated bones of the head
Setting Sun sign
201
How is bacterial meningitis diagnosed?
lumbar puncture
- cloudy CSF
- elevated WBC
- elevated protein
- decreased glucose
202
What drug reverses the effect of benzodiazepines?
Flumazenil - don't give to a client with status asthmaticus that was treated with benzos b/c it can reverse the issue
203
What position should a child with a neural tube defect be placed in?
prone with head turned to the side
204
What is the priority for a child with autism?
ensuring a safe environment
205
What is a (+) Kernig's sign? Brudzinski's?
Kernig's - inability to extend the leg when the hip is flexed
Brudzinski's - neck flexion causes adduction and flexion in the lower extremities
both are indicative of meningitis
206
What is contraindicated in a child with a basilar skull fracture?
suction - the position of the fracture makes it possible for the suction to touch the brain and cause trauma/infection
207
What is the priority nursing care for Reye's Syndrome?
providing a quiet and dim atmosphere
208
What does a (+) Ortolani's maneuver and (+) Barlow's test indicate?
hip dysplasia
209
What is congenital clubfoot?
forefoot adduction
midfoot supination
hindfoot varus
ankle equinus
210
What syndrome might be caused by mechanical changes in the position of a child's abdominal contents during surgery that presents with vomiting and abdominal distention?
superior mesenteric artery syndrome
211
What is the treatment for juvenile idiopathic arthritis?
none- treatment is supportive to preserve joint function, minimize inflammation and deformity
212
What systems does Marfan's Syndrome effect?
the connective tissue of the skeletal, cardiovascular, optic and integumentary systems
213
What is contraindicated for a cast?
using lotion or powder around the edges
214
Hip dysplasia will present with:
limited ROM on the affected side
a SHORTENED leg on the affected side
asymmetrical ABDuction of the hips
asymmetrical gluteal folds
215
How often will a child with congenital clubfoot need to be recast?
once per week
216
What is the priority treatment for a child with HIV?
preventing opportunistic infection
217
What is the most common opportunistic infection that occurs in children infected with HIV?
pneumocystis jiroveci pneumonia
218
Beore administering an antiretroviral medication you muist ________.
ensure it is safe for pediatric administration
219
What is the goal of antiretroviral medications?
to suppress viral replication and to slow the deline in CD4 cells
220
What is recommended to parents of a child with HIV?
to get them immunized BUT
- only with inactivated viruses
- NOT measles
- NOT rotavirus
- NOT varicella-zoster (unless they've had chickenpox)
221
The detection of HIV antigens in infants is confirmed by _____.
The detection of HIV antiBODIES in infants is confirmed by _____.
antigens - a p24 antigen assay
antibodies - Western Blot
222
What are the 3 C's of Rubeola (Measles)?
coryza
cough
conjunctivitis
223
What disease presents with Koplik's spots (small red spots with a bluish-white center and red base on the buccal mucosa)?
Rubeola (Measles)
224
What is Roseola (Exanthema Subitum)? How does it present?
Human herpesvirus type 6
sudden high fever followed by a rose-pink rash
225
How is Rubella (German Measles) transmitted? How does it present?
airborne
pink-red maculopapular rash that begins on the face and spreads to the entire body within 1-3 days
226
How is Mumps transmitted? How does it present?
airborne
jaw or ear pain aggravated by chewing - then parotid gland swelling
227
When can a child with chickenpox leave the house?
when the vesicles have dried
228
Do infants receive maternal immunity to Pertussis (Whooping Cough)?
nope
229
How is Diphtheria transmitted? What needs to be prescribed?
direct contact
expect a diphtheria antitoxin to be prescribed (but be sure to R/O sensitivity to horse serum)
230
Hallmark sign of Scarlet Fever?
red strawberry tongue
231
What is a hallmark sign of Erythema Infectiosum (Fifth Disease)?
face erythema (slapped cheek appearance)
"five fingers - fifth disease"
232
What organs does Mononucleosis affect?
lymphadenopathy
hepatomegaly
splenomegaly
233
What teaching should the nurse give to the parents of a child with Mono?
the S&S of splenic rupture - LUQ pain and L shoulder pain
234
An asymptomatic MRSA event is called ______, when it becomes symptomatic, it is called ______.
colonization
| infection
235
How long do flu symptoms usually last?
7 days - if longer, suspect complications
236
Do you need a prescription for a vaccine?
yas
237
What do you need before you give a vaccine?
parental consent
238
What should you do if you suspect that a parent will not bring in their child for a followup immunization?
give the recommended vaccines simultaneously - they are all compatible
239
What dose of vaccination can we expect to be prescribed for a preterm infant?
the full dose - at the appropriate age
240
During which stage of the disease is Pertussis contagious?
the catarrhal stage
241
What should you suggest to a parent who called the clinic 12 hours after a DTaP vaccination and reports redness and swelling around the site of the injection?
a cold pack - it's normal for the injection site to become inflamed for the first 24 hours, a low-grade fever is also OK
242
What is a contraindication for an IPV (polio vaccine) and MMR vaccine?
allergy to neomycin and eggs
243
Where should the MMR vaccine be administered?
SQ in the upper arm
244
What are the general contraindications for receiving live virus vaccines?
- previous allergic reaction
- immunocompromised
- the common cold is NOT a contraindication
245
Is the metabolism of medications accelerated or decelerated in a child?
it is delayed - the kidneys and liver are still immature
246
Pediatric medication doses are always rounded to the ______ and measured using a _______.
100th
| tuberculin syringe
247
Common sites for SQ injections include:
central 1/3 of LATERAL upper arm
abdomen
central 1/3 of the ANTERIOR thigh
248
What mm is used for an IM injection in children? What is not used?
recommended: vastus lateralis
NOT recommended: gluteal mm (too close to the sciatic nerve)
249
What must be considered when administering an IV push medication for a child on I&O's?
the flush volume must be included
250
How much medication, in mL, can an infant take in an IM injection?
1mL (toddler can take the full 2mL)
251
What does BSA mean? SA?
BSA - body surface area
| SA - surface area
252
What should the nurse do when a dosage recommendation for a medication is only specified for adults?
we use a formula using the BSA of the child
253
What are some pain scales we can use for children who are unable to verbally express their pain?
CRIES
FACES
FLACC
Oucher Pain Scale
254
Which communicable disease poses a particular threat to unborn children?
German Measles (Rubella)
255
What is a contraindication for the DTaP vaccine?
history of seizures
256
What is the children's dose of Tylenol - Acetaminophen?
10-15 mg/kg every 4-6 hours
257
What is a contraindication for the Hepatitis B vaccine?
allergy to Baker's yeast
258
What is the Mantoux test?
an intradermal test for TB
259
What invalidates the Mantoux (PPD) test?
subcutaneous injection (rather than the expected intradermal injection)
260
Has Pertussis (Whooping Cough) been eradicated from the United States?
no, there are still fatalities in non immunized infants in the US.
261
What are NORMAL findings after an immunization?
fever
| soreness/redness at the injection site (give Tylenol, bicycle the legs and place a warm washcloth over the site)
262
Recommended daily dose of Vitamin D:
400 IU
263
What vitamins do kids not get enough of?
A, B6, B12, C
264
Where is the best place to check the capillary refill on an infant?
the sternum
265
What fluid bolus amount can a child receive?
20mL/kg
266
What is the normal urine output for infants and children?
1-2mL/kg/hr
267
What should urine specific gravity NOT exceed?
1.025
268
What is the primary nursing action for an abused child?
establish trust and attend to any physical injury
269
What is the syrup of ipecac?
it is used to induce vomiting in the event of a poisoning (no longer recommended)
270
Acetaminophen overdose antidote:
N-acetylcysteine (Mucomyst)
271
What are common household products that are poisonous to a child if ingested?
perfume
aftershave
mouthwash
aloe vera
272
What body system is most severely impacted by lead poisoning?
neuro
273
What are Chelating agents (Dimercaprol, Calcium Disodium) given for? Who shouldn't have them?
lead poisoning
do NOT give if allergic to peanuts
do NOT give iron
274
What two things need to be monitored when giving Chelating Agents (Dimercaprol, Calcium Disodium)?
CBC and renal function
275
What increases lead absorption in the body?
- empty stomach
| - hot water
276
What foods contain vitamin A?
orange foods help the eyes!
sweet potatoes
carrots
peaches
apricots
spinach
liver
277
What disease occurs with vitamin C deficiency?
scurvy
278
What three indicators are the best for determining nutritional status?
weight
skinfold thickness
arm circumference
279
What labs can be expected in a dehydrated child?
alkalosis
HYPOnatremia
HYPOkalemia
Elevated hematocrit/BUN
280
How can burns best be assessed in children?
the Lund-Browder chart
281
What is the priority intervention for a child who has swallowed poison?
ASSESS - airway, cardiac and neuro
282
What are early vs late signs of hypoxia?
early - restless, anxious, TACHYpnea, TACHYcardia
late - extreme anxiousness, BRADYcardia
283
Will a child with asthma present with inspiratory or expiratory wheezing?
expiratory wheezing
284
What nutritional support should be provided for a child with cystic fibrosis?
pancreatic enzymes
285
What is the most common postoperative complication after a tonsillectomy? How will the child present?
bleeding
frequent swallowing
vomiting blood
286
What are the increased pulmonary blood flow defects? Which way does blood shunt in these defects?
ASD
VSD
PDA
Coarctation of the aorta
left to right shunt
287
What are the decreased pulmonary blood flow defects? Which way does blood shunt in these defects?
"The Three T's"
Tetralogy of Fallot
Truncus Arteriosus
Transposition of the Great Vessels
right to left shunt
288
What is common in children with cyanotic defects?
polycythemia - the body needs to produce more RBCs to make up for the chronic hypoxia
289
Some infants may require tube feeding to conserve energy - what is a developmental consideration for these children?
they need to be able to satisfy sucking needs
290
What are the 2 main objectives of treating CHF?
reduce the heart's workload
| to improve cardiac output
291
What 2 cardiac defects are associated with rheumatic fever?
aortic valve stenosis
| mitral valve stenosis
292
What is the priority for an infant with cerebral palsy?
prevent aspiration
293
What is spina bifida?
a neural tube defect
294
What position should a spina bifida patient be in pre and post operatively?
prone
295
What are the signs of increased ICP vs shock?
ICP - BRADYcarida and HYPERtension
Shock - TACHYcardia and HYPOtension
(ICP and shock are opposites)
296
What is the best way to detect early changes in ICP?
know the child's baseline
297
What is the most common cause of increased seizure activity?
medication non-compliance
298
What blood labs can we expect to see with bacterial meningitis?
HYPOglycemia
elevated proteins
bacteria will eat the sugar and poop the protein
299
What should be monitored closely with bacterial meningitis?
fluid status - there may be SIADH going on causing cerebral edema
300
What is a common manifestation of a brain tumor in children?
headache upon awakening
| vomiting without nausea
301
What kind of drug is Mannitol?
diuretic
302
What is Grower's sign?
indicator of mm dystrophy
| the child has to "walk/grow" the hands up the legs to stand
303
What is the first sign of renal failure?
decreased urine output
304
What does acute glomerulonephritis follow?
a strep infection
305
Which has worse edema; acute glomerulonephritis or nephrotic syndrome?
nephrotic syndrome
306
Which has elevated blood pressure; acute glomerulonephritis or nephrotic syndrome?
acute glomerulonephritis
307
Which has dark frothy yellow urine; acute glomerulonephritis or nephrotic syndrome? Which has dark tea-colored urine?
nephrotic syndrome - frothy yellow
| acute glomerulonephritis - tea-colored
308
Which has MASSIVE proteinuria; acute glomerulonephritis or nephrotic syndrome?
nephrotic syndrome
309
Which has a positive ASO titer; acute glomerulonephritis or nephrotic syndrome?
acute glomerulonephritis - (+) ASO
| nephrotic syndrome - (-) ASO
310
What might be the cause of a recurrent UTI in children?
Vesicoureteral Reflex (reflux)
311
What is a Wilms Tumor?
an encapsulated renal tumor that began in embryo
312
With each pregnancy, what are the chances that a child will get sickle cell (an autosomal recessive disease)?
1/4 chance (although all can get it) AND both parents must be carriers
313
Hemophilia is an X-linked recessive trait. If a mother is a carrier, how likely is it that her child will have hemophilia?
a MALE child will have a 50% chance of EXPRESSING
a FEMALE child will have a 50% chance of being a CARRIER
314
What is an important part of treatment for a child in sickle cell crisis?
hydration
315
What do these terms mean; HgbAS, HgbSS, HgbS?
HgbAS - sickle cell trait (heterozygous)
HgbSS - sicle cell disease (homozygous)
HgbS - disease, AND trait
316
What is given PO to a child with sickle cell anemia to stimulate RBC production?
folic acid
317
What do you need to have ready when administering L-asparaginase (a chemotherapeutic agent used to treat acute lymphocytic leukemia)?
epinephrine and oxygen - to treat anaphylaxis
318
What drugs are often used in combination with antineoplastic drugs?
prednisone - to reduce lymphocyte mitosis
| allopurinol - to prevent renal damage r/t uric acid buildup
319
What dietary additive should NOT be given to PKU patients?
NutraSweet (aspartame) - it contains phenylalanine
320
What are the expected labs that diagnosis HYPOthyroidism?
low T4
| high TSH
321
How does a brace affect a child with scoliosis?
it slows the progression but does not correct the spine's curvature
322
What should NOT be used to turn a child with a spica cast?
an abductor bar
323
How many hours/day should a child wear a skeletal brace?
23 hours/day
324
What care is indicated for a child with juvenile rheumatoid arthritis?
splinting of affected joints
| prescribed exercise to maintain mobility
