PEDS EXAM 1 Flashcards
Growth and Development: What are Erikson’s theories?
1.Trust vs. Mistrust
2. Autonomy vs. Shame and Doubt
3. Initiative vs. Guilt
4. Industry vs. Inferiority
5. Identity vs. Role Confusion
TAIII
Example of Trust vs. Mistrust and when does it occur?
Ex: Babies trusting you when you care for them while theyre crying, feed them, dont ignore them when they are seeking for attention/help.
-Occurs during first year of life
Example of Autonomy vs Shame and Doubt. When does it occur?
Ex: Babies/toddlers wanting to do things on their own. Saying “no” to you and wanting to be independent/do things on their own.
-Occurs 1-3 yrs old
Example of Initiative vs Guilt. When does it occur?
Ex: Wanting to explore, new activities and ideas
-Occurs 3-6 yrs old
Example of Industry vs Inferiority. When does it occur?
Ex: New social activities, pride in accomplishments
-Occurs 6-12 yrs old
Example of Identity vs Role Confusion. When does it occur?
Ex: Self identity, developing own beliefs/morals
-Occurs during teen yrs
What are Freud’s theories?
1.Oral stage infancy
2.Anal-toddlerhood
3.Phallic preschool/early school-age
4.Latency school-age
5.Genital adolescence
Example of oral stage infancy?
Infants developing sucking, eating pleasure
Example of Anal-toddlerhood?
Babies developing pleasure from control of bodily secretions
Example of phallic preschool/early school-age?
Working out gender relationships “making friends”
Example of latency school-age?
Sexual energy at rest Think of when kids start to develop hormones/discover sexuality
Example of genital adolescence?
Mature sexuality, end of physical growth, building adult relationships
What are Piaget’s theories?
1.Sensorimotor
2.Pre-operational
3.Concrete operational
4.Formal operational
Example of sensorimotor? When does it occur?
Gaining sensory contact/object permanence
-Occurs during birth to 2yrs old
Example of Pre-operational? When does it occur?
Use words to describe things but doesnt have well developed thought process
-Occurs during 2-7yrs old
Example of Concrete Operational? When does it occur?
Understands cause and effect
-Occurs during 7-11yrs old
Example of Formal Operational? When does it occur?
Can think abstractly, consider diff outcomes
-Occurs during adolescence to adulthood
Major milestones in each age group? Toddlers (0-3 months)
-Holds rattles
-Can turn head to find noise
-Coos/cries/babbles
-Can hold neck up with support by arms
-Posterior fontanel closes
-Smiles in response to stimuli
THINK OF CHLOE
Major milestones in each age group? Toddlers (4-6 months)
-Can turn from stomach to back. BIG MILESTONE!
-Birth weight doubles
Major milestones in each age group? Toddlers (6-8 months)
-Can sit alone/start crawling. BIG MILESTONE!
Major milestones in each age group? Toddlers (8-10 months)
-Can stand, crawl
-Understands object permanence
-Understands “mama, dada”
-Uses pincer grasp
-Stranger anxiety occurs
Major milestones in each age group? Toddlers (10-12 months)
-Can stand alone
-Understands object permanence
-Birth weight tripled
Major milestones in each age group? Toddlers (1-3 yrs old)
-Runs, walks, jumps, kick balls. BIG MILESTONE!
-Anterior fontanel closes at 18months
Major milestones in each age group? PRE-SCHOOL (3-6 yrs old)
-Wants to do things on their own
-Role plays adults
-Can throw ball overhead. BIG MILESTONE*
Major milestones in each age group? School-age (6-12 yrs old)
-can concentrate for longer periods
-jump rope/rides bikes, can do art crafts, like rewards (stickers, prizes out of box)
Major milestones in each age group? Adolescence (12-20 yrs old)
-Growth spurts
-want independence
-understand consequences
-thinks abstractly
-understand moral values
-growing social skills (going out on their own, driving)
Pain Assessment and Treatment: What are the pain scales used for peds?
-NIPS SCALE (Neonatal/infant pain scale)
-FLACC SCALE (Faces, Legs, Activity, Consolability, Crying
-FACES (Smile scale from sad to happy)
What are the common myths of pain for infants/children
-They cant feel pain
-They wont remember the pain
-They are less sensitive to pain
-They will tell you when they are in pain
-If they can be distracted, then they are not in pain
-They cant tolerate the side effects of pain medication
-Narcotics can lead to addiction
Procedure pain adjuncts (meds used for procedures)
-EMLA cream
-LMK cream
-Refrigerent sprays
Non-pharmacologic methods for pain-relief
-Relaxation methods
-Distraction
-Guided Imagery
-Massage
-Play and art
-Skin to skin
-Oral sucrose (for infants)
Pharmacologic uses for pain-relief
-NSAIDS
-Acetaminophen
-Ibuprofen
-Naproxen
-Trilisate
-Indomethacin
-Diclofenac
Opiods:
-Morphine
-Fentanyl
-Hydromorphone
-Methadone
-Oxycodone
Peds med orders should include what?
The dose in mg/kg
Gastro: Diarrhea/Vomiting CM?
-Diarrhea/watery stool
-Fever
-Vomiting
-Dehydration
-Tachycardia
-Hypotension
-Tachypnea
-Pain
-Aches/cramps
Diarrhea/V: Treatment?
-IV Fluids
-starchy foods (toast)
-rest
Diarrhea/vomiting: NC?
-Monitor electrolytes
-Get stool culture
-Get urine sample
-Admin antiemetic
-Promote hygiene
-Promote skin integrity
-Strict I&Os
Constipation: CM?
-Distended abdomen
-discomfort/pain
-cramping
Constipation: Treatment
-Docusate, Miralax (laxatives)
-Increase fluids, fiber, fruits and veggies
-Encourage activity
Constipation: NC?
-Educate about diet and opportunity to go to bathroom
-Assess diet changes
-Assess environmental changes
-Assess stool
Hirschsprung disease: CM?
what is it?
Is the inflammation and blockage of intestine due to damaged nerves
-Abdomen distention
-vomiting
-feeding intolerance
-constipation
-Failure to pass meconium during first 48hrs of life
-explosive diarrhea
-ribbon-like very smelly stool
THINK OF “SPRUNG” OR SPRING LIKE A RIBBON IS LOOPED AROUND LIKE A SPRING
Hirschsprung Treatment?
-Removal of affected colon area
-Temporary colostomy
Hirschsprung: NC?
-Assess abdominal girth daily
-Pain control
-frequent feedings of protein
-decrease sodium to improve nutrition
-encourage low fiber, high protein and high calorie diet
GERD CM
-low weight
-spitting up
-excessive crying
-stridor,gagging,choking
-stomach pain/heartburn
GERD management
-thickened feedings
-smaller frequent feedings
-elevate HOB
-PPI (-prazole) meds
-Histamine 2 recpetors(pepcid)
-Fundoplication surgical procedure for severe complications
Pyloric Stenosis CM?
-projectile vomiting
-dehydration
-vomiting
-failure to thrive
-olive shaped mass to right of umbilicus
-increased pH and bicarb
-decreased electrolytes (due to vomiting)
Pyloric Stenosis Treatment and managment?
-surgical relief/removal
Pre-op:
-NG decompression
-NPO
-Rehydration
-Record descriptions of vomiting
-Strict I & O
-Small feedings after surgery
-Increased feedings 48hrs after surgery
Appendicitis CM?
-Periumbilical pain
-N/V
-RLQ pain
-fever
-tachycardia (because of vomiting
-Increased WBC because of fever
Appendicitis treatment and managment?
-IV antibiotics
-IV Fluids for hydration
-pain management
-wound care
-surgical removal
-ultrasound, UA, CBC
Intussusception CM
-Vomiting
-pain (comes and goes)
-between cramping, child has no pain
-rectal bleeding
-sausage shaped mass
-jelly like stool
-weight loss because of decreased appetite
Intussusception treatment and management
TREATMENT FOR BEFORE AND AFTER SURGERY?
-IV fluids
-monitor for septicshock
-NG decompression
-watch stools
After surgery:
-Pain control
-strict I&O’s
-stool monitoring
What makes children (girls or boys) different? What the diff between infants and children?
Female ureters are shorter than male putting them at greater risk for infection
-babies are more dependent on others for perineal care and hygiene
UTI: CM?
-pain/burning with urination
-fever (infection)
-cloudy urine
-frequent urge of urination
-toilet trained but bed wetting
UTI: Treatment?
Antibiotics:
-Amoxicillin
-Ceftriaxone
-Gentamycin
-Trimethoprim-sulfa
-Phenazopyridine
UTI: NC?
-examine child
-ask for symptoms
-ask for family hx of UTI
-ask for diet changes
Urinary reflux: CM?
-recurrent uti
Urinary reflux: Treatment?
-surg repair
Urinary reflux: Management?
-minimize risk of infection
-prepare for surg repair
-monitor UOP
What puts infants/children at greater risk for dehydration?
-greater body surface area
-majority of body surface being water
Signs and symptoms for dehydration?
-weight loss
-LOC changes
-decreased skin turgor
-prolonged cap refill
-tachycardia
-sunken eyes
-sunken fontanels
-circulatory failure (pale,cyanosis,grey)
Dehydration management/treatment
-IV Fluids (normal saline)
-measure I&O
-Fluid restriction
What are Isotonic fluids. What is it given for?
0.9% Normal Saline
Lactated Ringers
Ringers solution
5% Dextrose
-given at admission until we establish fluid labs
What are hypertonic fluids. What is it given for?
“more than 0.9%”
3% Nacl
5% Nacl
Dextrose 10% in water
-to decrease swelling/hyponatremia/edema
What are hypotonic fluids. What is it given for?
“less than 0.9%”
0.45 Nacl
0.33% Nacl
0.2% Nacl
2.5% Dextrose water
-to increase swelling/hypernatremia
Types of dehydration, which one is most common?, which one is most dangerous and their findings
- Isotonic (most common) water and electrolyte loss is balanced
- Hypertonic (most dangerous) more water loss than sodium/electrolyte loss
- Hypotonic more electrolyte loss than water loss
Ringworm: which precautions are needed? What symptoms/signs are seen?
Precautions: Isolation (contagious)
Symptoms: ring-like/circles that can be on skin and head
Ringworm tx:
Nurs conisderations?
TX: -Oral griseofulvin for several months
-Topical miconazole
NC: Dont share helmets/hats, hairbrushes
Varicella: which precautions are needed? What signs/symptoms are seen?
Precautions: contact
Cardinal symptoms: centripetal rose petal rash
CM: fever, rash, irritability, highly pruritic, teardop, malaise (feeling of being unwell/tired)
Varicella tx:
Nurs Considerations? (during what time is it contagious)
TX:Benadryl (to help relieve itch), IV Acyclovir
NC: contagious 1 day before symptoms pop up until 6 days after they crust over
Think of virus=vir “acyclovir”
Varicella vaccine education
Its a live vaccine
-cant give to preg women, little babies or immunocompromised people
Complications of varicella
THINK R.M
-reyes syndrome
-meningitis
reyes-swelling of brain
Meningitis-inflammation of brain
they share smtg
Impetigo/cellulitis: caused by?
Which precautions are needed?
Cause: strep or staph infection (2-5y/o)
-Contact precautions
Impetigo/cellulitis: signs and symptoms?
Cardinal symptom: sores that can pop and turn into honey colored crust MAINLY ON NOSE AND MOUTH
CM: Pruritus, redness, yellow exudate/honey colored crust
Impetigo/cellulitis tx?
-Wash 2-3 times a day with soap and water
-warm saline soaks
-topical/oral antiobiotic
-cut fingernails DONT PICK AT IT
Head lice: Isolation precautions?
Tx:
Precautions: can return to school before resolved
Tx:Permethrin, beauty shops may treat, incubation of eggs
Head lice: Nurs Considerations?
-found along nape of neck
-separate sections with q-tip
-everyone must be treated
-all linen/clothes may be washed in hot water
-change pillow cases daily
-find eggs not louse
-remove with fine tooth comb
Scabies NC/TX?
If not resolved in days it may be an allergy
Tx: Permethrin 5%, leave on for 8-12 hrs repeat for 7 days
Eczema: tx? symptoms/signs? causes?
signs/symptoms: scaly patches common in skin folds/creases
tx: clean, apply topical meds, avoid tight clothing
Causes: detergent and fragrances may cause itching, food allergies and genetic tendences
Diaper dermatitis: CM? Tx?
CM: Redness/demarcation lines, inflammation
Tx: soap and water, NO WIPES, keep dry and aired, apply topical meds and keep on DO NOT WASH OFF WITH CHANGING, avoid eating acidic foods if eating solids
Diaper dermatitis: NC?
-teach about fragrance free diapers, creams, proper hygiene and diaper changes, will go away and prn pain meds
Oral candidiasis/thrush: CM? Tx?
CM: white patches on tongue that cannot be removed
Tx: fungicide, -zole meds
Oral candidiasis/thrush: NC?
wash all bottles and nipples after every feed, breastfed babies-mom must wash nipples after feeds
Burns: what are infants/kids at risk for when experiencing burns? Tx:
-infection, dehydration, resp probs
Tx:
-IV hydration
-IV antibiotics
Immunization meaning
Active or passive immunity obtained by artificial immunobiologic
Immunity meaning
inherited or acquired state in which individual is resistant to disease
Natural immunity meaning
State of immunity/resistance to disease in which you were born with
Acquired immunity meaning
Think of the meaning of acquired. It means getting/obtaining something. Therefore remember this as immunity you get after exposure to/getting the disease
Active immunity meaning
State in which immune bodies are actively formed against specific antigens
Passive immunity meaning
Think passing by means being there temporarily.
-Means temporary immunity obtained by antitoxins from another human ex: mother to fetus
Antibody meaning
a protein formed from exposure to antigen
Antigen meaning
viruses, toxins, bacteria, foreign substances/proteins
Immunoglobulin meaning
Sterile solution containing antibodies from blood
Herd immunity meaning
Condition in which majority of population is vaccinated and are able to protect those who are not vaccinated (spread of disease decreases)
Combination vaccine meaning
combo of vaccines given into one form
Monovalent vaccine meaning
Vaccine given for one single antigen or organism
Conjugate vaccine meaning
A carrier protein with immuno potential combined with an antigen to enhance type and magnitude of immune response
Hib vaccine: viral or bacterial?
Complication?
-Bacterial
Complication: meningitis, sepsis
Think bacteria=sepsis
Rubella vaccine: what does rubella look like? what are the symptoms?
looks like pink rash on face which spreads to trunk, fever, h/a, sore throat, red inflammed eyes
Rubella complications & isolation precautions?
Complications: arthritis, encaphalitis, CRS, dont give to preg women
Isolation precautions: contact, droplet
A.C.E Think All,Children,Eat
Measles: CM?
-Highly contagious, resp/airborne, mobillvirus
CM: high fever, conjunctivitis, coryza, cough, anorexia, malaise, koplik spots, rash from face to trunk extremities
Measles complications?
pneumonia, bronchitis, encephalitis, blindness
think resp and brain/head(eyes) probs
Mumps: isolation precautions?
CM? Complications?
-Contact precautions
CM:
-Fever, malaise, earache, h/a, pain while chewing, swollen parotid gland
Complications: orchitis, deafness
Pneumococcal vaccine: PPV (who is it recommended for? What diseases is it given for?
-Recommended for children older than 23 months
-sickle cell disease, nephrotic syndrome, renal disease/failure, HIV, organ transplant, cochlear implants
What are live virus vaccines?
varicella
MMR
Intranasal (flu)
Rotavirus
V.I.R.M
Bacterial vaccines?
Hib-DBT
Meningcoccal-Pneumococcal
Viral vaccines?
Influenza
Varicella
HPV
MMP
Hep B
Polio
Rotavirus
H.I.H.M.R.P.V “HI.I.HAVE.MOST.RESP.PULMONARY.VIRUSES”
Newborn vitals (rr,bp,temp,hr,02) and how to take these vital signs for this group
RR: 30-55 (1min)
02: 100%
HR: 100-170bpm (take on brachial artery or count apical pulse for 1 min)
BP: take on calf
TEMP: 37.5-37.7 (take in axillary or rectal-most accurate)
Infant-2y/o vitals (rr,bp,temp,hr,02) and how to take these vital signs for this group
RR: 25-40
HR: 80-130; average is 120 (take on brachial artery)
TEMP: 37.3 (axillary)
2-6 y/o vitals (rr,bp,temp,hr,02) and how to take these vitals for this group
RR: 16-30; 22 is highest by age 6
HR:70-120; average 110; take at radial for ages older than 2y/o)
BP: upper arm
TEMP: 37.2-36.8 (axillary, tympanic, oral if they can hold it, rectal most accurate but only for emergencies)
