Pediatrics Exam 2 Flashcards
Why are infants at higher risk than adults for dehydration?
Higher % of H2O in Extracellular Fluid (ECF)
Immature renal function (Decreased ability to concentrate urine & Decrease GFR)
Higher metabolic rates = Higher H2O consumption
Unable to communicate third
Thirst receptors are underdeveloped
Do infants have a high or low metabolic rate
high
Can infants tell when they are thirsty
no
What is different about infant kidneys
cannot concentrate urine well
what are the sign and symptoms of dehydration in infants (NUMBER 1 thing)
WEIGHT LOSS
what else might tell a nurse that an infant is dehydrated?
few wet diapers
no tears
irritable
fontanelles
tachycardia
hypotension
skin turgor = decreased
how do we manage mild/ moderate dehydration
can be managed at home
replace fluids every 4-6
oral rehydration therapy is effective here
how do we manage severe dehydration
this child will likely need to come to the hospital
IV fluids
isotonic IVF for replacement
what viral pathogen is the most common cause of dehydration in infants in the uS
Rotavirus
what advice would you give to parents on feeding a child with GERD
avoid foods that execrate acid reflux
feeding maneuvers
positioning can be important
Zantac for pharm management
What is Hirschsprung disease
congenital anganglionic megacolon
what is the nursing care following surgery of Hirschsprung disease
⇒ Help parents understand defect
⇒ Foster bonding
⇒ Assist with colostomy care
post procedure
What do you need to explain to the parents of a child who needs surgery for Hirschsprung disease
this is a two step procedure !!!
ostomy to relieve distention and then a pull through procedure later
How should you position a child in pain due to appendicitis
in a position of comfort for them
What measures can be taken to care for a child post surgery for cleft lip
post surgery comforting is important
no pacifier
haberman cradle
gavage feeding
What is the nursing care for a child with trachea-esophageal fistula?
we want to make sure we diagnosis this prior to the first feed since it can be super dangerous if not!!
once you diagnosis a child with trachea-esophageal fistula what nursing considerations are there
- monitor for abdominal distention
- maintain patent airway!!!
-usually this is a surgical emergency - NPO !!!
_gastric tube placed
what is nursing care for a child with omphalocele
maintain NPO
IV therapy
moniter infant temp closely
repairing the sac may be staged dependent on how much is outside the body and the infant size
keep the sac moist
what are the symptoms of pyloric stenosis
projectile vommiting !!!!
Lethargy
Fluid/electrolyte disturbances
Upper abdomen distention with visible peristaltic waves
Palpable olive like mass in the upper quadrant
what is the treatment for intussusception
Radiologist guided pneumoenema
Ultrasound guided hydrostatic (saline) enema
If not successful surgical intervention may be needed
Nonoperative reductions are successful in 80% of cases
Recurrence of condition post treatment occurs in 1 out of 10 patients
what is Radiologist guided pneumoenema
air given for intussusception
Other then projectile vommiting, what is another unique feature of pyloric stenosis
Upper abdomen distention with visible peristaltic waves
What is the risk of TPN (total parenteral nutrition)?
long term can lead to liver failure
overfeeding syndrome
What medications are used for severe inflammatory bowel disease?
Aminosalicylates
Corticosteroids
Immunomodulators
Antibiotics
Biologics
what are aminosalicylates used for
prevents leukocytes from entering the bowel in IBD
corticosteriods are used for IBD because
we need to decrease inflammation
when thinking about IBD which two pharmacological interventions are to modulator the immune system
immunomodulators
biologics
what is the normal age for sexual development to begin in girls
Girls between 10 and 14
what is the normal age for sexual development to begin in boys
Between 12 to 16
What is the nursing care for children who receive daily injections of biosynthetic growth hormone?
Early identification of growth problems
Family support and education === Daily injections & Rotating sites
Child’s body image
Treatment is expensive
what is the relationship between exercise to glucose levels in diabetics (children)
exercise lowers blood sugar
more risk of hypoglycemia in these cases
brings snacks
what are the signs of hypoglycemia
Hunger
Dizziness
Anxiety
Shakiness
Sweating
what are the symptoms of DKA
Hyperglycemia ⇒ Diuresis (frequent urination)
Dehydration ⇒ Shock this will be your priority action
Acidosis ⇒ Lipolysis
Rapid deep respirations ⇒ Electrolyte imbalances
Can lead to coma ⇒ Hyperosmolality
in terms of DKA, priority action is …
Dehydration ⇒ Shock this will be your priority action
so we want to rehydrate these patients
at what age can children start giving their own insulin
Around 10 -12
What is the treatment for ketones in the urine of a child with diabetes who has been ill?
need to know urine ketones and blood ketones to then be able to treat using fast acting insulin
negative urine ketones and blood ketones under 0.6 means
no extra insulin and recheck blood every 3 hours
small amount of urine ketones and blood ketones 0.6 to 1.5 means
increase the correction 5% and recheck blood every 3 hours
moderate amount of urine ketones and blood ketones 1.5 to 3 means
increase the correction 10%
large amount of urine ketones and blood ketones over 3 means
increase the corrction 20%
what is unique about a concussion
transient and reversible head trauma that will not show up on a CT scan
What are the symptoms of post concussive syndrome?
You will see fatigue, poor concentration, dizziness, headache, mood swings after getting the concussion
What are the symptoms of brain trauma?
When having neurological issues they can be seen having a wide based gait
Pupil may not be appearing PERLA
Skin abrasions
what are the characteristics of hydrocephalus in a neonate
High pitched cry
Eyes have sunsetting feature
Bulging fontanelle
Fontanels are tense
Scalp veins are distended
Head is bulging
What is the difference between the adult and the infant Glasgow Coma scale?
age appropriate motor and verbal components
what are symptoms of brain trauma
- neurological issues may present in the gait, pupils not appearing PERLA, skin abrasions
what actions should be taken when a child is experiencing a seizure
stay calm
start the timer
ease the child to the floor
place apillow
what does a CT scan tell you
direct tissue injury
the actual damage
will not show you a concussion
what is a risk factor for reye syndrome
aspirin and varicella
what are the characteristics of epilepsy
seizure disorder syndrome
Stiff muscles. Uncontrollable jerking movements of the arms and legs. Loss of consciousness or awareness. Psychological symptoms such as fear, anxiety or deja vu.
what assessments are necessary when a child is admitted with a head injury
24 hour observation
hourly neuro checks
oxygen
positioning is important
looking out for fever and seizures
how do you assess a child’s LOC
dependent on their baseline and developmental abilities
can includee= recognition, cry, verbal ability, feeding, behavior
mild disability with the mental age of 8-12 you can plan to observe
social and vocational skills, some support and guidance as needed as an adult
moderate disability mental age of 3 to 7 you can plan to see
needs a more sheltered condition (can live and work with the right treatment) but can learn simple health and safety things
severe disability mental age of 1 to 3 you can plan to see
usually walks, some language skills, can conform to daily routine and rituals, supervision
profound disability mental age of an infant you can plan to see
needs complete care, some primitive speech
What are the risks of physical activity for children who have Down syndrome?
children with down syndrome have more heart defects
When should developmental stimulation programs for developmentally delayed children begin?
As early as possible
What are appropriate activities for children with Down syndrome?
Normalization is key
everyone is an individual, so activities should be chosen based on the child’s interests and abilities
Boy and girl scouts might be a good example of social activities that could incorporate children with different abilities. Inclusion in family, school and town activities - most kids enjoy these things and will have individual tolerances for activity, socialization, noise, etc.
Kids with Down syndrome still need exercise so activities that involve walking, bike riding, swimming and the like could be enjoyed.
Craft activities geared toward abilities - such as working with play-doh and all the kinds of modeling clay can strengthen hand muscles and fine motor coordination, and give the satisfaction of having created something. So, the idea is that kids with Down syndrome may have ‘differences’ from the ‘norm’ but still have the same human needs for love, interaction, mastery, physical activity, etc., so choose activities that the individual child likes and can be adapted to their abilities
What are the physical characteristics with implications for nursing care of children with Down syndrome?
Tracheoesophageal Fistulas
Atlanto-axial Subluxation/Instability
a small chin, slanted eyes, poor muscle tone, a flat nasal bridge, and a single crease of the palm. Flat occiput and a flattened facial appearance
What is the parent education for iron administration?
give it with OJ (helps the absorption)
expect green tarry stool
if n and v give wihth meals
may stain teeth
What are the symptoms of vaso-occlusive crisis in sickle cell disease?
Pain in areas of involvement, r/t ischemia of involved areas
Extremities – painful swelling of hands and feet, painful joints
Abdomen – severe pain
Cerebrum – stroke, visual disturbances
Chest – pneumonia, protracted pulmonary disease
Liver – obstructive jaundice
Kidney – hematuria
Genitalia - priapism
What is the purpose of daily penicillin for children with sickle cell disease?
significantly reduces the risk of pneumococcal infection
what are three critical complications of sickle cell disease?
- Splenic Sequestration
- Acute chest syndrome
- cerebrovscular accident (stroke)
what are some preventative measures that can be taken for children that have sickle cell disease
- Oral penicillin prophylaxis
- hydroxyurea
- allogenic hematopoietic stem cell transplantation
- avoid precipitant factors
what vaccines should be given with caution to children with HIV
live virus = MMR, varicella, rotavirus
what is mucositis
oral ulcers
how should we care for a child with mucositis
frequent oral care!!
what is important not to use with oral ulcers
viscious lidocaine
lemon glycerin
hydrogen peroxide
milk of magnesium
what are signs of cancer in children
Unusual mass or swelling
Unexplained paleness and los of energy
Sudden tendentot bruise = Bruising that is abnormal
Persistent and localized pain
Prolonged fever
Frequent headaches
Sudden eye or vision changes
What is advice for parents when children sleepwalk?
this will go away!
reintroduce a nap maybe
don’t wake the child
guide back to bed
safey proof
What is advice for parents when toddlers engage in negative behavior?
Use a firm direct approach
Ignore temper tantrums
Use distraction technique
Restrain adequate
Reduce the opportunity to say no
Good behavior = rewards
what is safety advice for parents when toddlers are “into everything”?
Supervise the child constantly
Safeguarding the environment
What are best practices for reducing communicable disease in children?
- vaccination
-hand washing
