Peds Flashcards
No small toys for children under what age?
Under 4 yo
No metal toys if _________ is in use
oxygen
3 things to consider for childhood development toy
Is it safe?
Is it age appropriate?
Is it feasible?
0-6 months
Children are __________ so best toy is…
Sensory-motor
Musical mobile
6-9 months
Children are working on ____________ so best toy is…
Object permeance
Cover-uncover toy
9-12 months
Children are working on ____________ so best toy is…
Vocalization
Speaking/talking toys
Toddlers 1-3 yo
Children are working on ____________ so best toy is…
Gross-motor skills
Push-pull toys
Preschoolers
Children are working on ____________ and __________ so best toys are…
Fine-motor skills = toys that use finger dexterity
Balance = tricycle, tumbling, skating, dance class
Cooperative play
Pretend play
School-aged
Children are working on 3 C’s so best toys are…
Creative: Paper and crayons; legos
Collective: beanie babies, Pokemon, barbies
Competitive: games
Piaget: 0-2 yo
Teaching
Sensory-motor
Present-oriented
Teach verbally
Piaget: 3-6 yo
Teaching
Pre-operations
Fantasy-oriented
Teach future tense and play
Piaget: 7-11 yo
Teaching
Concrete operational
Rule-oriented
Teach days ahead: what you’re going to do and skills
What age can a child manage their own care?
12
Intussusception patho
Ileum telescopes into cecum
Obstruction = pain
Compression of blood vessels
Blood flow decreases
Bowel ischemia
Rectal bleeding
Intussusception S+S
Intermittent pain/cramping
Child draws up their legs toward abdomen in severe pain while crying
V + diarrhea
Currant-jelly like stools
Lethargy
Sausage-shaped mass in upper mid-abdomen
Intussusception tx
IV fluids
Abx
Decompression via NG tube
Monitor for perforation and shock
May need air or barium enema
Hypertrophic pyloric stenosis patho
Hypertrophied pyloric muscle causes narrowing of pyloric canal -> thickness creates a narrow stomach outlet
Hypertrophic pyloric stenosis S+S
Projectile vomiting
Non-bilious emesis
Olive-shape mass palpable in RUQ
Infants will be hungry constantly despite regular feedings
Weight loss
Dehydration
Hypertrophic pyloric stenosis tx
Obtain daily weights
Pyloromyotomy
Monitor electrolyte: at risk for hypokalemia
Administer IV fluids
Epiglottitis patho
Inflammation of epiglottis leading to upper airway obstruction
MED EMERGENCY
Vaxx can prevent (Hib)
Epiglottitis S+S
Sudden-onset fever
Sore throat
Toxic appearance: agitated, restless, anxious
Tripod position
4 D’s: drooling, dysphonia, dysphagia, distress
Epiglottitis tx
Never leave pt
May need emergency intubation
Calm environment
Don’t place in supine position
NPO
Epiglottitis meds
Abx
Antipyretics
Corticosteroids
IV fluids
Avoid supine
Potential endotracheal intubation or tracheostomy
Croup patho
Inflammation of larynx, trachea, and bronchi occur as result of viral infx
Croup S+S
Stridor
Subglottic swelling
Seal-bark cough
Croup tx
Seek help if…
Supportive care
Seek help if: confused, cyanosis, increased RR, retractions, nasal flaring, drooling/can’t swallow
Croup vs epiglottitis
Croup: sudden onset, fluctuating fever, cough, viral cause, no emergency usually
Epiglottitis: rapid (w/in hrs), high fever, dysphagia, emergency
Febrile seizures tx
Rectal diazepam
Development dysplasia of hips patho
Abnormal development of hip joint
Baby’s bones still not ossified -> ability to dislocate and relocate easily
Notable S+S of DDH in infants
Asymmetrical or extra gluteal or inguinal folds
Barlow test
Ortolani test
What does it indicate?
Barlow: up and in
Ortolani: down and out
+ for clunks felt or heard (DDH)
Tx of DDH
Pavlik harness for > 6 months
4 months-2 yrs: closed reduction
> 2 yrs: open surgical reduction
Pavlik harness instructions
Must wear at all times
Don’t adjust straps or remove harness until instructed by HCP
Change diaper while baby is harness
Check for redness, irritation, or breakdown 2-3 times per day
Place baby on back to sleep
Place long knee socks and undershirt to prevent rubbing of harness
Tetralogy of Fallot
Ventricular septal defect
Pulmonary stenosis
Overriding aorta
Right ventricular hypertrophy
VarieD PictureS Of A RancH
TOF: Oxygenated and deoxygenated blood mix
Ventricular septal defect
TOF: pulmonary valve narrows or thickens, preventing normal blood flow from the right ventricle to the pulmonary artery
Pulmonary stenosis
TOF: aorta is positioned directly over a ventricular septal defect, instead of over the left ventricle
Overriding aorta
TOF: abnormal enlargement of the cardiac muscle surrounding the right ventricle
Right ventricular hypertrophy
TOF risk for what? What is the tx?
HF
Surgery
S+S of TOF
Hypoxemia -> fatigue, dyspnea, cyanosis
Central cyanosis worse w/ exertion
Hypercyanotic episodes
“Tet” spells
Systolic ejection murmur
Nursing interventions for Tet spells
Knee-chest position/squatting
Administer oxygen
Soothe newborn
IV fluid bolus
Administer morphine
Refeeding syndrome patho
Potentially fatal complication of nutritional rehab in chronically malnourished pts
Lack of oral intake -> decreased insulin production
Refeeding syndrome S+S
Electrolyte imbalances: hypokalemia, hypophosphatemia, hypomagnesemia
Hyperglycemia
Can lead to CHF w/o electrolyte replacement
Nursing interventions of refeeding syndrome
Assess nutritional status
Daily weights
Periodic serum albumin levels
Monitor and replace electrolytes
Continuous EKG monitoring
Collaborate w/ dietitian
Tracheoesophageal Fistula and Esophageal Atresia patho
Congenital malformation
Esophagus fails to develop as continuous structure -> develops as upper and lower esophagus
Upper esophagus ends up in a blind pouch (atresia)
Lower esophagus connects to primary bronchus or trachea via fistula
Places child at risk for aspiration -> pneumonia
S+S of Tracheoesophageal Fistula and Esophageal Atresia
Coughing, choking, vomiting w/ feeding
Drooling
Frothy salvia
Abdominal distention
Apnea, cyanosis, coarse breath sounds
Poor weight gain
Nursing interventions of Tracheoesophageal Fistula and Esophageal Atresia (what to expect)
Feed newborn in semi-upright position
Report increase in drooling or regurgitation during feeds
Anticipate that newborn may initially have difficulty w/ oral feeds
Observe initial oral feeding w/ sterile water
Monitor for signs of tracheomalacia (barking cough)
S+S of acute lymphoblastic leukemia
Manifestations related to pancytopenia:
Decreased RBCs (anemia)
Decreased platelets (thrombocytopenia)
Decreased mature functioning WBCs (neutropenia): infx
Constitutional S+S:
Weight loss
Bone pain
Lymphadenopathy
Neutropenic precautions: avoid
Raw fruits/vegetables and uncooked foods
Fresh flowers
Rectal thermometers, enemas, or suppositories
Live vaxx
Large crowds
Those who are ill
Difference b/w Acute Lymphoblastic Leukemia
and Acute Myeloid Leukemia
ALL: affects production of lymphocytes
AML: affects production of myeloblasts, RBCs, PLTs
Mononucleosis patho
Acute, self-limiting dz caused by Epstein-Barr virus
Spread via direct contact w/ oral secretions, blood, or transplantation
Typically seen in adolescents
S+S of mononucleosis
Fever
Significant fatigue
Sore throat
Tonsillar hypertrophy and exudate
Cervical lymphadenopathy
Hepatosplenomegaly
Rash
Teaching of mononucleosis
Avoid contact sports for 3-4 wks
Increase fluid intake
Antipyretics and analgesics
Salt gargles or anesthetic lozenges
No abx (viral infx)
Schedule rest periods
Fatigue may persist for wks
Avoid sharing drinks and eating utensils to limit spread of illness to others
Report abdominal pain in LUQ or left shoulder pain immediately (splenic rupture)
Pertussis AKA
Whooping cough
Nursing interventions of pertussis
Standard and droplet precautions
Abx
Humidified air
Increase fluid intake
S+S of airway obstruction: suction as needed
Complications: apnea, rib fractures, pneumonia
Pt teaching of pertussis
Avoid triggers that stimulate coughing (exercise, smoke, cold temps)
Abx post-exposure ppx for all household contacts
Vaxx
Mild cough may persist for 6-10 wks
Pts are contagious until they completed 5 full days of abx
Cerebral palsy def
Non-progressive, permanent motor and postural disorder
Caused by brain injury occurring: perinatally/ postnatally
S+S of cerebral palsy
Abnormal muscle tone, posture, and coordination
Spasticity
Disturbances in gait
Impairments in speech and swallowing
Difficulty w/ learning and reasoning
Seizures
Tx of spasticity
ROM exercises regularly
Muscle relaxants (baclofen pump)
Assistive positioning devices
Febrile seizure patho
Convulsions that occur in children w/ oral temp > 100.4 degrees F
Occur in absence of CNS infx or hx of seizures
Benign in nature
Family hx of febrile seizures is a risk factor
S+S of febrile seizures
Fever
Seizures
Nursing interventions of febrile seizures
Antipyretics (acetaminophen)
No tepid sponging
Parental reassurance, education, and emotional support
No long-term behavioral problems
No effect on academic performance
Initiate seizure precautions
Substance use effects during pregnancy (alcohol)
Fetal alcohol syndrome
Growth deficiency, neuro symptoms (microcephaly), indistinct philtrum, thin upper lip, epicanthal folds, flat midface, and short palpebral fissures
Failure to thrive risk factors
Poverty
Social/emotional isolation
Cognitive disability or mental health disorder
Lack of nutritional education
Substance use effects during pregnancy (cigarette smoking)
Perinatal loss, SIDS, low birth weight, prematurity
Substance use effects during pregnancy (Valproate)
Neural tube defects (spina bifida)
Risk factors for SIDS (maternal and infant)
Maternal:
Substance use
Maternal age < 20
Inconsistent prenatal care
Infant:
Prematurity or low birth weight
Sleep environment
Bed sharing
Smoke exposure
Infant CPR
Single: perform 2 mins of CPR before defib (30:2)
2 rescuers: 15:2
Assess brachial pulse for no longer than 10 secs
Chest compressions should be ⅓ of chest’s anterior-posterior diameter depth
Perform compressions using 2 fingers or 2 thumbs
Kawasaki dz (S+S and tx)
S+S: erythematous polymorphous rash, strawberry tongue, bilateral conjunctivitis w/o drainage
Notify HCP if fever develops
Tx: aspirin, IVIG, echocardiography
PKU tx
Low phenylalanine diet is required
Dietary tyrosine
Specially prepared infant formula is given
Meat and dairy products shouldn’t be introduced into diet (high phenylalanine foods)
Aplastic anemia vs. iron deficiency anemia
Aplastic anemia: bone marrow fails to produce new blood cells (pancytopenia)
Interventions: bone marrow biopsy, blood type and crossmatch, monitor for S+S of infx and bleeding
Iron-deficiency anemia: caused by blood loss, malabsorption syndromes, or poor diet of iron
Leukopenia and thrombocytopenia not expected
Interventions: diet recall and monitor stool frequency
Acute poststreptococcal glomerulonephritis S+S
Gross hematuria
Edema
HTN
Acute poststreptococcal glomerulonephritis labs
UA: protein, blood, RBC casts
Increased creatinine, BUN
Strep throat culture
Tx of acute glomerulonephritis
Supportive care
Antihypertensive agents, diuretics, temporary dialysis, abx
Sodium-restricted diet
Report HA to HCP
Seizure precautions
Hydrocephalus def and S+S
Buildup of CSF in brain
S+S: macrocephaly, prominent scalp veins, full anterior fontanelle, behavioral changes, developmental delay, S+S of increased ICP
VP shunt interventions
Seizure precautions
Shave hair on head
Mark location where head circumference was measured
Assess for abdominal tenderness
Report temp >100.4
Test surgical site drainage for presence of glucose (leaking CSF contains glucose)
Teaching of VP shunt
Certain sports should be avoided when the child is older
Shunt requires revision surgeries
Early childhood development programs
Monitor for S+S of increased ICP
S+S of RSV/bronchiolitis
Initial stage: rhinorrhea, cough, pharyngitis, sneezing, fever, adventitious lung sounds
Days 3-5: hypoxia, retractions, apneic periods
Nursing interventions for RSV/bronchiolitis (what precaution?)
Contact and droplet precautions
IV fluids, oxygen, acetaminophen
Suction as needed
Saline drops and bulb syringe to suction nares
Cystic fibrosis patho
Autosomal recessive
Results in thickened, viscous secretions that obstruct:
Small airways
Exocrine ducts
Intestinal tract
Reproductive tract
Dx: positive sweat chloride test
Report that child’s skin tastes “salty”
S+S of cystic fibrosis
Lung:
Frequent infx
Persistent cough w/ mucus
Barrel chest
GI: meconium ileus; steatorrhea
Failure to grow
Endocrine: DM
Reproductive: infertility (male)
Cystic fibrosis interventions
To prevent lung dz:
Chest physiotherapy before meals
Aerosolized bronchodilator
Mucolytics (dornase alfa)
Daily exercise and oral fluids
Pancreatic enzyme supplements (w/ meals and snacks)
High protein, high calorie diet w/ unrestricted fat
Vitamin supplements, esp A, D, E, and K
Annual flu and periodic pneumococcal vaxx
Monitor for DM S+S
Causes of enuresis
Primary:
Maturational delay
Genetic factors
Small bladder
Secondary:
UTI
Constipation
Emotional stress
S+S of enuresis
Episodes of involuntary daytime/nighttime urination
Psychosocial implications:
Feelings of embarrassment and guilt -> low self-esteem
Social isolation
Dx: voiding diary, UA
Nursing interventions of enuresis
Primary:
Avoid punishment
Positive reinforcement for dry nights/days
Timed voiding during day
Limit fluids before bed
Awaken child at specified time each time
Enuresis alarm
Meds:
Desmopressin (synthetic antidiuretic hormone)
Secondary: treat underlying cause
Abx for UTI
Laxatives for constipation
Recognize trigger for emotional stress
Hemolytic uremic syndrome patho
Life-threatening complication of E. coli diarrhea
After diarrheal illness, results in triad of:
Hemolytic anemia
Thrombocytopenia
AKI
S+S of hemolytic uremic syndrome
Hemolytic anemia: fatigue, irritability, pallor
Thrombocytopenia: bleeding etc
AKI: oliguria, edema
Nursing interventions of hemolytic uremic syndrome (what precautions, tx)
Contact precautions
Provide fluids
Administer blood products for anemia and thrombocytopenia
Inform caregivers that most pts improve w/in 2-3 wks
Monitor for worsening AKI:
Strict I+O
Antihypertensive meds
Anuria: prepare for dialysis
Conjunctivitis S+S (bacterial vs. viral vs. allergic)
Bacterial: purulent drainage
Viral: serous drainage
Allergic: intense itching in both eyes
Conjunctivitis AKA
pink eye
Which types of conjunctivitis are contagious?
Viral and bacterial
Nursing interventions of conjunctivitis
Treat underlying cause:
Bacterial -> abx
Viral -> cold compress, saline eye drops
Allergic -> allergen avoidance and antihistamines
Remove accumulated secretions: wipe from inner canthus downward and outward, away from other eye
Separate linens, towels, washcloths
Refrain from rubbing eye
Good hand washing
Length of infx for conjunctivitis (bacterial vs. viral)
Bacterial: up until 24 hrs after initiation of abx
Viral -> until S+S resolve
Acute otitis media
Middle ear infx causes inflammation -> obstruction of eustachian tube
Blocked drainage from eustachian tube causes bacterial growth -> bulging and erythema of tympanic membrane
Risk factors of acute otitis media
Recent upper respiratory infx
Exposure to secondhand smoke
Bottle feeding and use of pacifiers
Attendance at group activities
S+S of otitis media
Fever
Ear pain and pressure
Refusal to eat or nurse/drink due to increased pain while chewing
Irritability
Pulling on affected ear
Hearing loss
Purulent drainage
Nursing interventions of otitis media
Abx (amoxicillin)
Analgesic-antipyretic meds
Analgesic ear drops (benzocaine) if no perforation
Apply warm moist cloth over affected ear
Congenital heart defects
TRouBLe
Needs surgery
Delayed growth
Short life
Apnea monitor
R->L shunting
Cyansosis
R->L shunting
B-> blue
All congenital heart defects that start w/ T =
Trouble defects
All congenital heart defect kids have
Murmur
Echocardiogram
Exacerbation of cystic fibrosis
Greasy, bulky stools (steatorrhea)
Blood-tinged sputum (hemoptysis)
Paroxysmal cough
Hypoxia
Drowning first action
Rescue breaths
Ibuprofen vs acetaminophen SE
Ibuprofen: kidney dz (renal)
Acetaminophen: liver dz (hepatitis)
Labs of acute postinfectious glomerulonephritis
Proteinuria, hypoalbuminemia, hyperlipidemia, edema
Watch for BP
Ear drops for children vs. adults
Children < 3 yo: pinna down and back
> 3 yo: pinna up and back
Iron supplement teaching
Iron supplements given on empty stomach between meals for best absorption
Including vitamin C increases absorption
Milk products and antacids decrease absorption
May cause constipation and black/dark tarry stools
Can stain teeth
