PEDS

Question 1

What is “silent chest”?

Answer 1

In the case of severe obstruction (from narrowing airway as a result of bronchial constriction, airway swelling, and mucus) –> wheezing/breath sounds are not heard due to lack of airflow = silent chest.
Silent chest: ominous sign and is an EMERGENCY.
Wheezing would be seen as a sign of improvement as air would be moving in the lungs.

Question 2

Facts about PAD:

Answer 2

• Patients will have decreased sensation from nerve ischemia
• Never apply direct heat to the extremity
• PAD patients usually don’t have swelling but decreased blood supply, so the extremity should NOT be elevated above heart level.

Question 3

What is the first-line drug of choice for the treatment of SVT?

Answer 3

ADENOSINE:

• Should be administered rapidly as a 6-mg bolus over 1-2 seconds followed by a 20mL saline flush.
• Injection site should be as close to the heart as possible.

Question 4

What is Kawasaki disease?

Answer 4

Childhood condition that causes inflammation of arterial walls . The etiology is unknown and there are no diagnostic tests to confirm, it is not contagious.

Has three phases:

1. Acute: sudden onset of high fever that doesn’t respond to antibiotics or antipyretics. Child will have swollen red feet and hands, lips become swollen and cracked, and tongue can also become red (strawberry tongue).
2. Subacute: skin begins to peel from the hands and feet.
3. Convalescent: symptoms disappear slowly; child’s temperament returns to normal

Question 5

Treatment of Kawasaki disease?

Answer 5

IV gamma globulin and aspirin.

-Child should be monitored for decreased urinary output, additional heart sounds, tachycardia, and difficulty breathing)

Question 6

Infant CPR pulse assessment:

Answer 6

The brachial artery is used to detect a pulse in an unresponsive client age <1 year.

Question 7

A child presents to the ED, mom claiming her 3yo coughs at night and at times till he vomits. Possible etiology?

Answer 7

Pediatric asthma: Ask about exposure to triggers such as pet dander

Question 8

What is esophageal atresia and tracheoesophageal fistula?

Answer 8

• The upper esophagus ends in a blind pouch and the lower esophagus connects to the primary bronchus or the trachea through a small fistula.
• Can USUALLY be corrected through surgery
• Clinical manifestations include: frothy saliva, choking, coughing, and drooling. Clients may develop apnea and cyanosis when feeding

Question 9

What is the greatest risk for someone with EA/TEF?

Answer 9

Aspiration:
Keep client NPO, position the client supine, elevating the head at least 30 degrees, keep suction equipment near bedside.

Question 10

What is a ventriculoperitoneal shunt?

Answer 10

• Used to treat hydrocephalus and is usually placed at 3-4 months.
• Blockage and infection are complications of shunt placement
• Blockage results in signs of increased ICP.

Question 11

What is meningocele?

Answer 11

A saclike protrusion through the bony defect that contains meninges and CSF; corrected with surgery

Question 12

Expected child abuse and how to handle the “interview”

Answer 12

• Interview should be done without the child present
• Avoid words such as “abuse” and “violence”
• Open-ended questions are less threatening

Can get info on:

• Caregivers perspective on the child’s behavior
• Methods of discipline used with the child
• Routine caregivers for the child
• Caregiver stress, coping, and support systems
• People who care for the kid when parent is gone

Question 13

Bronchiolitis:

Answer 13

Lower respiratory tract infection most commonly caused by respiratory syncytial virus.

• Causes inflammation and obstruction of the lower respiratory tract.
• Infants with this can experience mild cold symptoms or respiratory distress.
• The infant can have difficulty feeding and become dehydrated.
• Irritability may be a sign of hypoxia and causes the infant to be high priority.

Question 14

Rectal temps of what are considered “red flags” in neonates?

Answer 14

> 100.4 and <96.8

Question 15

Nephrotic syndrome:

Answer 15

• An autoimmune disease, affects children age 2-7 and is characterized by increased permeability of the glomerulus to proteins (albumin, immunoglobuline, natural anticoags)
• Clients experience generalized edema, weight gain, loss of appetite, and decreased urine output
• The loss of immunoglobulins causes increased susceptibility to infection –> caregivers should minimize the risk of infection during relapse (limit visitors)
• Parent needs to test child’s urine for protein daily, weight the child weekly, and keep diary of results

Question 16

How do you treat nephrotic syndrome?

Answer 16

• Corticosteroids and other immunosuppressants (cyclosporine)
• Loss of appetite management
• Infection prevention

Question 17

The nurse’s priority for a client with OI is careful handling to minimize additional fractures. Care of the infant includes:

Answer 17

1. Checking blood pressure manually to avoid cuff over-tightening, which may occur with automatic blood pressure cuffs
2. Lifting the infant by slipping a hand under the broadest areas of the body (back, buttocks) so the pressure is distributed
3. Repositioning the infant frequently using supportive devices and gel padding to avoid molding of the soft bones of the skull.

Question 18

For children less than 7 months, where is the site for immunizations?

Answer 18

Vastus lateralis

Question 19

Hemolytic uremic syndrome:

Answer 19

Life threatening complication of E.Coli diarrhea and results in red cell hemolysis, low platelets, and acute kidney injury.
-Hemolysis results in anemia, and low platelets manifest as petechiae or purpura *** watch for this on assessment

Question 20

PED AEDs should be used for how long?

Answer 20

birth to 8yo

Question 21

Birth weight:

Answer 21

• Should double by age 6

- Triple by age 12

Question 22

Anterior fontanelle:

Answer 22

Should be flat, but slight pulsations noted in the anterior font. are normal as is temporary bulging when the infant coughs, cries, or is lying down.
-Should fuse by age 18 months

Question 23

Posterior fontanelle:

Answer 23

-Should fuse by 2 months

Question 24

When developing the plan of care for a newborn who is LGA, the nurse should include:

Answer 24

• Document gestational age assessment, weight, length, and head circumference
• Assess the newborn for birth-related injuries
• Discuss the need for possible feeding supplementation if the newborn is hypoglycemic
• Assist the mother to feed the newborn soon after birth and every 2-3 hours to prevent hypoglycemia
• Obtain BG before feeding and notify HCP if BG reading is <40-45

Question 25

Apgar score:

Answer 25

Assessment tool used to describe how well a newborn is transitioning to extrauterine life.

• Done at 1 and 5 minutes of life
• Repeated every 5 minutes for up to 20 minutes if score iis <7.
• Scores <7 indicate difficult transition