Pediatrics Flashcards
1
Q
Cephalocaudal development
A
development from the head downward through the body and towards the feet
2
Q
Proximodistal development
A
development that moves from the center of the body outward to the extremities
3
Q
When does anterior fontanel close?
A
12 to 18 mo
4
Q
When does posterior fontanel close?
A
2-3 mo
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
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.
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.
8
Q
When viewing auditory canal in young child, how is earlobe positioned?
A
down and back
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
10
Q
How many cups of milk should a 15 mo old toddler consume?
A
2 to 3 cups
11
Q
At what age does the best friend stage occur?
A
9-10 yrs old
12
Q
Leading causes of death from accidental injury in infants up to one yr of age?
A
suffocation, MVC, drowning
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)
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
15
Q
What happens to growth rate between 6 and 12 yrs of age
A
decreases
16
Q
How many calories does a school age child require a day?
A
2400
17
Q
How much earlier do girls experience the onset of adolescents than boys?
A
1 to 2 yrs
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!
19
Q
Progression of Obtaining VS on Pediatric Client
A
Respirations
HR
BP
temp
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
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.
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)
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
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)
25
Communication: Infants
(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
26
Communication: Toddlers and Preschoolers
(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)
27
Communication: School-Age Children
(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
28
Communication: Adolescents
(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
29
Communication: Children with Physical and/or Developmental Disabilities
nurse should use gestures, picture boards, writing tablets, system of head nods, eye blinks
30
What are observable signs of respiratory distress in children?
use of accessory muscles
nasal flaring
sternal retractions
grunting with respirations
31
Illnesses that can cause respiratory distress include:
pneumonia
atelectasis
pneumothorax
pleural effusion
32
A viral infection that can result in slight to severe dyspnea, barking or brassy cough, and an elevated temperature?
laryngotracheobronchitis
croup
33
Viral organisms responsible for croup (Laryngotracheobronchitis):
parainfluenza, adenovirus, RSV
sound like a barking seal
34
Treatment for laryngeotracheobronchitis:
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
35
Nebulized Epinephrine
rapid onset / improvement in 10 to 15 min
watch for relapse and return of symptoms when epi wears off
36
Epiglottitis
* 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
37
RSV
(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
38
RSV Risk Factors
prematurity
congenital disorders (like heart defects)
exposure to smoke
being around sick people / unvaccinated ppl
39
RSV S/sx
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
40
RSV Treatment
Mild --> treat symptoms (supportive care / antipyretics)
Severe
- IVF
- albuterol sulfate (may not be effective)
- antipyretics
- suction
- oxygen (may need intubation and mechanical vent)
41
Pneumonia
marked by inflammation of lungs
can be bacterial, viral, fungal, or aspiration of a foreign substance
42
Pneumonia S/sx
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)
43
Pneumonia Treatment
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
Cleft Palate / Cleft Lip
- 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
If baby has cleft lip and cleft palate, which problem do we correct first?
cleft lip
lip assists with feeding and promotes parental bonding
wait to repair palate until there is more bone formation
46
Post Op Care for Cleft Lip / Cleft Palate
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
When is the best time for a cleft palate repair to be done?
before speech develops
1-2 yrs
48
GERD and Babies
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
Pyloric Stenosis
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
Pyloric Stenosis Treatment
```
hydration and electrolyte replacement
I/Os
monitor urine specific gravity (assesses hydration status)
daily weights
surgery
```
51
Intussusception
piece of bowel telescopes in on itself, forming an obstruction
52
Intussusception S/sx
```
sudden onset
cramping and abdominal pain
drawing up of knees
inconsolability
episodes of pain
currant, jelly-like stools (maroon)
```
53
Intussusception Treatment
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
Hirschsprung's Disease
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
Hirschsprung's Disease S/sx
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
Hirschsprung's Disease Treatment
surgery to remove the diseased portion of the bowel
57
Pin Worms S/sx
```
intense rectal itching
general irritability
restlessness
poor sleep
bed wetting
distractibility
short attention span
```
58
Pin worms are spread
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
Pin Worm diagnosis
tape test
60
Pin Worm Treatment
Mebandazole (usually one dose)
good handwashing
keep fingernails short
61
Infectious Mononucleosis
infectious dz called mono or kissing disease
62
Infectious Mononucleosis S/sx
sore throat
fatigue
swollen lymph nodes
liver and/or spleen enlargement
63
Infectious Mononucleosis Causes
Epstein Barr virus that's spread through direct intimate contact
64
Infectious Mononucleosis Treatment
rest, analgesics, increased fluids, good nutrition
spleen will be enlarged; limit participation in contact sports to prevent injury
65
Tonsillectomy and Adenoidectomy
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
Bad Breath in children
old blood (such as tonsillectomy and adenoidectomy)
foreign body in nose that causes infection
67
otitis media
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
Otitis Media Treatment
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
Otitis Media Prevention
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
Cystic Fibrosis
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
Cystic Fibrosis S/sx
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
Steatorrhea
fatty, frothy stools due to poor intestinal absorption
cystic fibrosis
73
Cystic Fibrosis Diagnosis
Sweat Chloride test
they lose sodium through their skin and taste salty
risk for hyponatremia
DNA newborn screening
74
Down Syndrome
What infections are these clients prone to developing?
most common birth defect / Trisomy 21
* Respiratory infections due to poor immune system
75
What is the most common type of physical defect associated with Down Syndrome?
Congenital Heart Defects
76
Celiac Disease
genetic disorder causing malabsorption due to intestinal intolerance to gluten
77
Celiac Disease Treatment
lifelong disorder
No foods with gluten
No BROW
- barley
- rye
- oats
- wheat
Can have RCS
- rice
- corn
- soy
78
Sickle Cell Disease
hereditary anemia / hemoglobin is sickle-shaped
79
Sickle Cell Disease S/sx
pain in areas of involvement
anorexia (loss of appetite)
exercise intolerance
fatigue / malaise
Sickle Cell Crisis
decreased blood flow --> decreased oxygen --> pain
80
Sickle Cell Disease Treatment
```
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
Duchenne's Muscular Dystrophy
most common and severe muscular dystrophy of childhood
x-linked / specific to males
onset is early childhood (3 to 5 yrs)
82
Duchenne's Muscular Dystrophy S/sx
```
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
Duchenne's Muscular Dystrophy Treatment
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
Tet Spells
hypercyanotic spells seen in children w Tetralogy of Fallot
| caused by insufficient blood flow to the lungs
85
Treatment for Hypercyanotic Tet Spells
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
Prevention for Hypercyanotic Tet Spells
quiet play
minimize stress (fever, constipation)
respond to crying quickly
87
Urinary Tract Infections in Pediatric Clients
very common / potentially serious infections
most common in 2-6 yr olds / greater risk in females
88
Urinary Tract Infections in Clients under 2 years of age
S/sx
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
Urinary Tract Infections in Clients under 2 years of age
Causes
```
renal anomalies
constipation
bubble baths
poor hygiene
pin worms
sexual activity - sexual abuse too
```
90
Urinary Tract Infections in Clients OVER 2 years of age
S/sx
classic symptoms
```
frequency
dysuria
fever
flank pain
hematuria
foul smelling urine
```
91
Urinary Tract Infections in Clients OVER 2 years of age
Diagnosis
urine specimen
catheterization for most accurate measurement
92
Urinary Tract Infections in Pediatric Clients
Treatment
antibiotic therapy (PO or IV)
teach prevention
- proper wiping
- no bubble baths
- cotton underwear
- limited carbonated drinks
93
Hydrocephalus
disturbance of ventricular circulation of CSF / it builds up and causes increased ICP
94
Hydrocephalus S/sx
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
Hydrocephalus Diagnosis
head circumference measurement (duh)
do until 3 yr old
96
Hydrocephalus Treatment
insertion of a VP shunt (ventriculoperitoneal shunt)
97
Post-Op Care of VP shunt:
ventriculoperitoneal shunt
- measure head circumference
- assess for bulging fontanels and widening cranial suture lines
- monitor the temperature
- supine position
98
Hydrocephalus is frequently associated with a _______________.
myelomeningocele
sac filled with CSF, nerves, and maybe spinal cord
99
Myelomeningocele Care
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
Scoliosis: Contributing Factors
heavy backbacks, bags, carrying children on hip
101
Scoliosis Treatment
3 O's
Observation
Orthosis (supports and braces)
Operation (spinal fusion with rods)
102
Chicken pox
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
Authoritarian Parenting Style
highly controlling, expects to be obeyed, inflexible rules
104
Authoritative Parenting Style
** the good one
sets reasonable limits on behavior, encourages growing autonomy of child, open communication
105
Permissible Parenting Style
few or no restraints, unconditional love, much freedom, little guidance, no limit setting
106
Indifferent Parenting Style
no limit setting, lacks affection for child, focused on own life
