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HURST > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Cephalocaudal development

A

development from the head downward through the body and towards the feet

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2
Q

Proximodistal development

A

development that moves from the center of the body outward to the extremities

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3
Q

When does anterior fontanel close?

A

12 to 18 mo

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4
Q

When does posterior fontanel close?

A

2-3 mo

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5
Q

Why are new foods introduced to infants one at a time?

A

allergies

they have immature GI tracts

  • one new food per week
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6
Q

Why are peanuts so dangerous when aspirated?

A

they swell and crumble when wet

Choking hazard foods: hot dogs, carrots, apples, grapes, peanut butter, nuts, seeds, popcorn, hard candy, chewing gum, marshmallows

Always cut food into little bites that are not round.

Children should never be left unattended while eating. They should be sitting straight up in high chair.

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7
Q

IM injections and peds

A

contraindicated to use ventrogluteal muscle in children who have not been walking for at least a year bc the muscle is underdeveloped.

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8
Q

When viewing auditory canal in young child, how is earlobe positioned?

A

down and back

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9
Q

Most common reason for failed toilet training?

A

not ready

takes boys longer

don’t make a big deal out of accidents / toilet time should not be a time when they get in trouble. Celebrate successes to build self-esteem

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10
Q

How many cups of milk should a 15 mo old toddler consume?

A

2 to 3 cups

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11
Q

At what age does the best friend stage occur?

A

9-10 yrs old

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12
Q

Leading causes of death from accidental injury in infants up to one yr of age?

A

suffocation, MVC, drowning

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13
Q

Car Seat Safety:

A

place infants less than 20 lb in the middle of the back seat in rear-facing car seat (provides best protection for heavy heads and weak necks)

12-23 mo of age = convertible car seat for age and wt (facing forward)

car seats should be used until child weighs 30 lbs

never place padding under or behind an infant or child in a car seat

booster seats can be used for children ages 4 to 8 yrs old (35-80 lbs)

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14
Q

Between 6 and 12, what is major cause of severe accidental injury?

A

motor vehicle accidents

(bicycles, ATVs, playing in street, etc.)

helmet safety

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15
Q

What happens to growth rate between 6 and 12 yrs of age

A

decreases

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16
Q

How many calories does a school age child require a day?

A

2400

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17
Q

How much earlier do girls experience the onset of adolescents than boys?

A

1 to 2 yrs

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18
Q

How to start assessment. Talk to child or parent first?

A

Observation first.

talk to parents to get trusting relationship

Least invasive first!

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19
Q

Progression of Obtaining VS on Pediatric Client

A

Respirations
HR
BP
temp

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20
Q

Always do what when getting RR or HR from infants and toddlers?

A

assess RR and HR for one full minute because of irregularities due to immature nervous system regulation

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21
Q

If a child is crying loudly and kicking at the nurse as she is counting RR, what should she do?

A

try to calm child, distract, but if nothing is working, then simply count RR and document that the child was crying and flailing as the number was recorded.

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22
Q

Don’t get rectal temps from…

A

infants - may perforate the anus

chemotherapy pts

pts w diarrhea

rectal lesions

immunosuppressed

imperforate anus / anorectal malformation (has no anus)

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23
Q

Oral Temperatures

A

start at age 5 to 6 yrs

tympanic = all ages (most unreliable)
axillary = all ages / when oral is not possible
  • note where temperature was taken and do NOT add or subtract a degree
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24
Q

Communication: Newborn

A

Birth to 1 month

nonverbal communication

express themselves through crying

respond to human voice and presence

touch has positive effect (tell parents to touch infant)

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25
Q

Communication: Infants

A

(1 mo to 12 mo)

mainly nonverbal

begin verbal communication (dada)

communicate through crying and facial expressions

attentive to human voice and presence (minimal comprehension of words)

responds to touch through patting, rocking, stroking

Nursing: speak in gentle voice, cuddle, pat, rub to calm, enourage parents presence

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26
Q

Communication: Toddlers and Preschoolers

A

(1 to 5 years)

evolving verbal skills

3 to 4 yr olds use 3 to 4 word sentences (telegraphic speech)

concrete and literal thinking

lots of questions (why)

short attention span / limited memory

egocentric

magical thinking

animism - how they think of non-living objects (toys)

object permanence (becomes more advanced)

nonverbal (play and drawing)

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27
Q

Communication: School-Age Children

A

(6 to 12 yrs)

able to use logic / understand other’s viewpoints

understand cause and effect / understanding body functions
- may want to listen to their own heart during exam

big vocabulary / receptive and expressive language is more balanced
- misinterpretation is still common

Nonverbal: can interpret other’s nonverbal communication
- expression of thoughts and feelings

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28
Q

Communication: Adolescents

A

(13 to 18 yrs)

abstract thinking without full adult comprehension

interpretation of medical terminology is limited

independent / need privacy / trust and understanding build rapport

Nursing Strategies: straight forward approach; talk in private area; conduct at least part of interview without parent present

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29
Q

Communication: Children with Physical and/or Developmental Disabilities

A

nurse should use gestures, picture boards, writing tablets, system of head nods, eye blinks

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30
Q

What are observable signs of respiratory distress in children?

A

use of accessory muscles

nasal flaring

sternal retractions

grunting with respirations

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31
Q

Illnesses that can cause respiratory distress include:

A

pneumonia

atelectasis

pneumothorax

pleural effusion

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32
Q

A viral infection that can result in slight to severe dyspnea, barking or brassy cough, and an elevated temperature?

A

laryngotracheobronchitis

croup

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33
Q

Viral organisms responsible for croup (Laryngotracheobronchitis):

A

parainfluenza, adenovirus, RSV

sound like a barking seal

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34
Q

Treatment for laryngeotracheobronchitis:

A

mild croup: at home

- steam from hot showers 
- cool temp therapy (standing in front of open freezer) 
      - decreases swelling of blood vessels in trachea

If symptoms worsen or no improvement:
- nebulized epinephrine or corticosteroids

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35
Q

Nebulized Epinephrine

A

rapid onset / improvement in 10 to 15 min

watch for relapse and return of symptoms when epi wears off

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36
Q

Epiglottitis

A
  • A serious obstructive inflammatory process
  • Absence of cough, presence of dysphagia, drooling, and rapid progression to severe respiratory distress

Medical emergency - can partially or fully occlude airway

look worse then they sound / less noise they make, the worse the airway obstruction

Minimize anything that would upset the child.
*** never try to visualize the throat or tongue w a tongue depressor

  • H-flu is what causes it / can be prevented with Hib vaccine
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37
Q

RSV

A

(respiratory syncytial virus)
leading cause of lower respiratory tract illness in children less than 2 yrs
caused by acute viral infection that affects bronchioles

life-threatening in infants

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38
Q

RSV Risk Factors

A

prematurity

congenital disorders (like heart defects)

exposure to smoke

being around sick people / unvaccinated ppl

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39
Q

RSV S/sx

A

Begins w a simple URI

nasal discharge

mild fever

wheezing

nonproductive paroxysmal cough

tachypnea with flaring nares

Dyspnea and retractions

** RSV becomes worse at days 2 to 3 and can progress to life-threatening respiratory distress

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40
Q

RSV Treatment

A

Mild –> treat symptoms (supportive care / antipyretics)

Severe

 - IVF
 - albuterol sulfate (may not be effective)
 - antipyretics
 - suction
 - oxygen (may need intubation and mechanical vent)
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41
Q

Pneumonia

A

marked by inflammation of lungs

can be bacterial, viral, fungal, or aspiration of a foreign substance

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42
Q

Pneumonia S/sx

A

same as generalized respiratory distress

  • fine crackles or rhonchi (w productive or non-productive cough)
  • decreased or absent breath sounds over affected lung fields
  • chest pain
  • back or abdominal pain (referred pain from lungs)
  • fever (very high)
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43
Q

Pneumonia Treatment

A

depends on type of pneumonia

FOCUS ON ABCs

  • oxygen
  • plenty of fluids to keep hydrated
  • antibiotics for bacterial / supportive care for viral

supportive care –> hydration, antipyretics, nebulizers

*** childhood vaccines prevent most common types of bacterial pneumonia

44
Q

Cleft Palate / Cleft Lip

A
  • orofacial defect that increases risk of malnutrition or aspiration

Pre-Op treatment - feed w elongated nipple or medicine dropper down side of mouth to prevent aspiration

 - burp frequently to prevent abdominal distention 
        - which increases vomiting and aspiration
45
Q

If baby has cleft lip and cleft palate, which problem do we correct first?

A

cleft lip

lip assists with feeding and promotes parental bonding

wait to repair palate until there is more bone formation

46
Q

Post Op Care for Cleft Lip / Cleft Palate

A

protect the suture line

position –> supine or side lying
- do not place in prone (they had face surgery so don’t put face down / duh)

don’t put hard or rough foods or utensils in childs mouth post cleft palate repair

47
Q

When is the best time for a cleft palate repair to be done?

A

before speech develops

1-2 yrs

48
Q

GERD and Babies

A

risk of aspiration = pneumonia

Reflux Precautions: upright positioning w feeding and for 30 min after & frequent burping during feedings

thickened formula may be better tolerated

49
Q

Pyloric Stenosis

A

PROJECTILE vomiting during or after a feeding / baby is always hungry

olive shaped mass in epigastric region near umbilicus (its the enlarged pylorus)

diagnose with abdominal ultrasound

50
Q

Pyloric Stenosis Treatment

A 
hydration and electrolyte replacement
I/Os
monitor urine specific gravity (assesses hydration status)
daily weights
surgery
51
Q

Intussusception

A

piece of bowel telescopes in on itself, forming an obstruction

52
Q

Intussusception S/sx

A 
sudden onset
cramping and abdominal pain
drawing up of knees
inconsolability
episodes of pain
currant, jelly-like stools (maroon)
53
Q

Intussusception Treatment

A

air-contrast, barium, or ultrasound-guided saline enema can be done bc the pressure might push out the telescoped area

Monitor stools and watch for blood in stool bc it can signal bowel perforation

may reoccur so keep in hospital for several days

54
Q

Hirschsprung’s Disease

A

congenital anomaly also known as aganglionic mega colon that results in mechanical obstruction

there’s a portion of colon that doesn’t have any nerves, so no peristalsis in that section of colon

usually sigmoid colon

55
Q

Hirschsprung’s Disease S/sx

A

constipation
abdominal distention
Ribbon-like stools that have a foul smell

  • there’s an accumulation of feces in the affected area so everything backs up and colon swells (mega colon)
56
Q

Hirschsprung’s Disease Treatment

A

surgery to remove the diseased portion of the bowel

57
Q

Pin Worms S/sx

A 
intense rectal itching
general irritability
restlessness
poor sleep
bed wetting
distractibility
short attention span
58
Q

Pin worms are spread

A

hand to mouth

sandbox, writing name in dirt and stuff and not washing hands before eating

whole family has to be treated / clean bathrooms / wash bedding bc eggs are everywhere

59
Q

Pin Worm diagnosis

A

tape test

60
Q

Pin Worm Treatment

A

Mebandazole (usually one dose)

good handwashing

keep fingernails short

61
Q

Infectious Mononucleosis

A

infectious dz called mono or kissing disease

62
Q

Infectious Mononucleosis S/sx

A

sore throat
fatigue
swollen lymph nodes
liver and/or spleen enlargement

63
Q

Infectious Mononucleosis Causes

A

Epstein Barr virus that’s spread through direct intimate contact

64
Q

Infectious Mononucleosis Treatment

A

rest, analgesics, increased fluids, good nutrition

spleen will be enlarged; limit participation in contact sports to prevent injury

65
Q

Tonsillectomy and Adenoidectomy

A

for children w recurrent upper respiratory infections or obstructive sleep apnea

Post-Op Position on side / elevate HOB / prone –> anything to prevent aspiration

brown and red fluids not given / don’t want to confuse for blood

frequent swallowing can indicate hemorrhage

client is at risk for hemorrhage for up to 10 days post op

scabs on surgical site will slough off at 7 to 10 days (no chips or rough foods for a WHILE)

common complains – sore throat and slight ear pain and bad breath

low grade temp is normal

66
Q

Bad Breath in children

A

old blood (such as tonsillectomy and adenoidectomy)

foreign body in nose that causes infection

67
Q

otitis media

A

infection of the middle ear characterized by bulging, bright red, tympanic membrane and is usually preceded by upper respiratory infection

pain goes away once tympanic membrane bursts

68
Q

Otitis Media Treatment

A

careful use of antibiotics

avoid chewing (makes pain worse) / soft foods

teach parent that child may not be able to hear them very well

avoid smoke of any kind

may need tympanostomy tubes or PE (pressure equalizing) tubes

  - keep middle ear drained / expected to fall out after year or so
  - if they have tubes, must wear ear plugs in bathtub or when swimming
69
Q

Otitis Media Prevention

A

have baby sit up for feedings

no bottle propping

gentle nose blowing

play “blowing” games (blowing pinwheel or blowing up balloons)

avoid smoke of any kind

70
Q

Cystic Fibrosis

A

genetic - have to get it from both parents

exocrine glands / involves both GI and respiratory

Pancreatic Enzymes must be given to improve digestion with EVERY meal and EVERY snack. Take within 30 min of eating and beads should not be crushed or chewed.

Nutrition is major concern. Usually underwt from digestive problems. Must be on well-balanced high fat and high calorie diet.

High fat- meaning body is using less oxygen bc its easier to digest and provides more calories

71
Q

Cystic Fibrosis S/sx

A

steatorrhea - fatty frothy stools
trouble absorbing fat soluble vitamins - give water-miscible form of fat vit.
meconium ileus- failure to pass meconium / earliest sign
* * * thick and sticky secretions (worry about LUNGS)

72
Q

Steatorrhea

A

fatty, frothy stools due to poor intestinal absorption

cystic fibrosis

73
Q

Cystic Fibrosis Diagnosis

A

Sweat Chloride test

they lose sodium through their skin and taste salty

risk for hyponatremia

DNA newborn screening

74
Q

Down Syndrome

What infections are these clients prone to developing?

A

most common birth defect / Trisomy 21

  • Respiratory infections due to poor immune system
75
Q

What is the most common type of physical defect associated with Down Syndrome?

A

Congenital Heart Defects

76
Q

Celiac Disease

A

genetic disorder causing malabsorption due to intestinal intolerance to gluten

77
Q

Celiac Disease Treatment

A

lifelong disorder

No foods with gluten

No BROW

  • barley
  • rye
  • oats
  • wheat

Can have RCS

  • rice
  • corn
  • soy
78
Q

Sickle Cell Disease

A

hereditary anemia / hemoglobin is sickle-shaped

79
Q

Sickle Cell Disease S/sx

A

pain in areas of involvement
anorexia (loss of appetite)
exercise intolerance
fatigue / malaise

Sickle Cell Crisis
decreased blood flow –> decreased oxygen –> pain

80
Q

Sickle Cell Disease Treatment

A 
Bed rest
*** hydration - improves circulation ***
analgesics
antibodies if infection present
blood transfusions / PRBC exchange transfusion
oxygen

hydroxyurea - chemotherapy med that helps reduce number of painful episodes

81
Q

Duchenne’s Muscular Dystrophy

A

most common and severe muscular dystrophy of childhood
x-linked / specific to males
onset is early childhood (3 to 5 yrs)

82
Q

Duchenne’s Muscular Dystrophy S/sx

A 
lordosis - curvature in lower spine
waddling gait
frequent falls - from muscle weakness
toe walking
gower's sign (classic sign of DMD)
    - climbing or walking up oneself to get into upright position
83
Q

Duchenne’s Muscular Dystrophy Treatment

A

maintain optimum muscle function with physical therapy
prevent contractures
steroids to improve muscle strength and respiratory function
support groups and palliative care as disease progresses

84
Q

Tet Spells

A

hypercyanotic spells seen in children w Tetralogy of Fallot

caused by insufficient blood flow to the lungs

85
Q

Treatment for Hypercyanotic Tet Spells

A

knee-chest position (decreases venous return from lower extremities and increases systemic resistance which diverts blood to pulmonary artery for oxygenation)

oxygen 100%

morphine to calm them down

monitor cardiac output

86
Q

Prevention for Hypercyanotic Tet Spells

A

quiet play

minimize stress (fever, constipation)

respond to crying quickly

87
Q

Urinary Tract Infections in Pediatric Clients

A

very common / potentially serious infections

most common in 2-6 yr olds / greater risk in females

88
Q

Urinary Tract Infections in Clients under 2 years of age

S/sx

A

very nonspecific (may appear to be GI problem)

failure to thrive
feeding problems
V/D

if untreated, can lead to kidney failure

infections often reoccur so educate family on s/sx

89
Q

Urinary Tract Infections in Clients under 2 years of age

Causes

A 
renal anomalies
constipation
bubble baths
poor hygiene
pin worms
sexual activity - sexual abuse too
90
Q

Urinary Tract Infections in Clients OVER 2 years of age

S/sx

A

classic symptoms

frequency
dysuria
fever
flank pain
hematuria
foul smelling urine
91
Q

Urinary Tract Infections in Clients OVER 2 years of age

Diagnosis

A

urine specimen

catheterization for most accurate measurement

92
Q

Urinary Tract Infections in Pediatric Clients

Treatment

A

antibiotic therapy (PO or IV)

teach prevention

 - proper wiping
 - no bubble baths
 - cotton underwear
 - limited carbonated drinks
93
Q

Hydrocephalus

A

disturbance of ventricular circulation of CSF / it builds up and causes increased ICP

94
Q

Hydrocephalus S/sx

A

bulging fontanels w head enlargement
dilated scalp veins
depressed or sunken eyes
irritability and changes in the LOC
high-pitched cry (any baby w increased ICP and meningeal irritation will have this)
setting sun sign (seeing white above your iris)

95
Q

Hydrocephalus Diagnosis

A

head circumference measurement (duh)

do until 3 yr old

96
Q

Hydrocephalus Treatment

A

insertion of a VP shunt (ventriculoperitoneal shunt)

97
Q

Post-Op Care of VP shunt:

A

ventriculoperitoneal shunt

  • measure head circumference
  • assess for bulging fontanels and widening cranial suture lines
  • monitor the temperature
  • supine position
98
Q

Hydrocephalus is frequently associated with a _______________.

A

myelomeningocele

sac filled with CSF, nerves, and maybe spinal cord

99
Q

Myelomeningocele Care

A

make baby lie supine

protect the sac and do not let it rupture

cover sac with sterile moistened dressing so it won’t dry while waiting for surgery

100
Q

Scoliosis: Contributing Factors

A

heavy backbacks, bags, carrying children on hip

101
Q

Scoliosis Treatment

A

3 O’s

Observation
Orthosis (supports and braces)
Operation (spinal fusion with rods)

102
Q

Chicken pox

A

childhood communicable disease

VARICELLA ZOSTER —– leads to shingles

vaccine for it

primary focus is to prevent infection of the lesions

relieve itching by oatmeal baths and baking soda paste

103
Q

Authoritarian Parenting Style

A

highly controlling, expects to be obeyed, inflexible rules

104
Q

Authoritative Parenting Style

A

** the good one

sets reasonable limits on behavior, encourages growing autonomy of child, open communication

105
Q

Permissible Parenting Style

A

few or no restraints, unconditional love, much freedom, little guidance, no limit setting

106
Q

Indifferent Parenting Style

A

no limit setting, lacks affection for child, focused on own life

HURST (15 decks)

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