Peds - Exam Three

Question 1

What would a preschooler’s perception of death be?

Answer 1

• Temporary
• May blame self for sibling’s death
• Parents should use accurate terms and simple explanations
• Reassure child and listen
• Begin to wonder about death at 3-4 years old
• Reassure that most people don’t die until they have lived a long healthy life

Question 2

What is part of a healthy maintenance of sickle cell disease?

Answer 2

• Keep patients in good health between episodes
• Immunizations are important
• Avoid unpressurized plane or exercising at high altitudes
• Oral intake of iron has no value
• Sickle cell crises (painful and can be fatal) - severe abdominal pain, muscle spasms, leg pain, or painful swollen joints, fever, vomiting, hematuria, convulsions, stiff neck, coma, or paralysis can result

Question 3

What is a good understanding of tick bites?

Answer 3

• Wear protective clothing in wooded areas
• Inspect for ticks after play when camping
• Light-colored clothing makes ticks more noticeable
• Can cause Lyme disease (lesions at site of bite, macule with raised border and clear center; may “burn”)
• Remove tick with tweezers
• Treat with amoxicillin or doxycycline

Question 4

Should all immunizations be given separately?

Answer 4

Follow CDC recommended time for vaccines
May need to administer in different locations and monitor for reactions
Location should be documented for each vaccine

Question 5

How long is a child with varicella contagious?

Answer 5

Contagious for 6 days after first appearance of rash

Vaccine given at 12-18 months and preschool age

Question 6

What type of precautions are implemented for varicella?

Answer 6

Airborne isolation precautions - vaccines should be given to try and prevent

Question 7

What classification of medication would make a child more susceptible to opportunistic infections?

Answer 7

Steroids or immunosuppresive drugs - depress the immune system

Question 8

What would be a possible cause for glomerulonephritis?

Answer 8

Acute glomerulonephritis (AGN) - “bright’s disease”; allergic reaction to a group A Beta-hemolytic streptococcal infection. May appear after pt has had Scarlet Fever or skin infections. Antibodies produced to fight the invading organisms also react against the glomerular tissue

Question 9

What is an appropriate intervention for edematous child with nephrotic syndrome with immobility?

Answer 9

Treatment is to minimize edema, prevent infection, reduce loss of protein in the urine, and prevent toxicity from medications.
Diet,- well balanced diet without salt. Normal protein is recommended. Fluid restriction isn’t needed unless when massive edema is present. (page 677)
Positioning-turn frequently to prevent respiratory tract infections, pillow bend knees when child is lying on side prevents pressure on the edematous skin surfaces, elevate head from time to time to reduce edema of eyelids (page 677)
Monitor I/O- measure diapers before and after voids (page 677)
Weight and protection from infection-2-3 times a week to monitor change in edema. Abdominal girth should be measured every day. No vaccinations should be administered during this time (while disease active and immunosuppressive therapy is occurring) (page 677)

Question 10

What food would you avoid to prevent hyperkalemia?

Answer 10

Foods high in potassium, such as beans, dark leafy greens, potatoes, squash, yogurt, fish, avocados, mushrooms, and bananas.

Question 11

What is Cytoxan used for?

Answer 11

Immunosuppressive therapy is used for some steroid-resistant children for controlling edema in nephrotic edema (Nephrotic Syndrome)

Question 12

What should be assessed in a child receiving prednisone?

Answer 12

Edema
Decreased signs of inflammation
Enhanced bronchodilation
Give with food to reduce gastric irritation
Prolonged therapy/high doses may cause immunosuppression
May need to monitor WBC counts to watch for infection

Question 13

What are some initial signs of nephrosis?

Answer 13

Edema
Occurs slowly and child doesn’t appear to be sick
First noticed around eyes and ankles and later becomes generalized
Shifts during sleep depending on the position
Weight gain d/t fluid
Abdomen may be distended
Pale
Irritable
Poor appetite
Normal BP

Question 14

What can be implemented to reduce UTIs for little girls?

Answer 14

Educate about cleansing perineum with each diaper change, wipe front to back, avoid bubble baths, urinate immediately after a bath, use white-cotton underwear, wear loos-fitting pants, and offer adequate fluid intake

Question 15

How does Kawasaki disease affect the body?

Answer 15

Leading cause of acquired cardiovascular disease in the US. Usually affects kids under 5 yrs old. Studies show the no known microbe is associated with KD, but might be response to mild asympyomatic viral infection. Causes inflammation of the vessels in the CV system which can lead to an aneurysm.

S/S: onset of abrupt fever (above 104) that doesn’t respond to meds and lasts for more than 5 days, conjunctivitis without discharge, fissured lips, “strawberry tongue”, inflamed mouth and pharyngeal membranes, and enlarged and nontender lymph nodes are seen. Erythematous skin rash, swollen hands and desquamation (peeling) of the palms and soles. Very irritable and may develop signs of cardiac problems. Abnormal ECGs can be detected by 10th day. Labs results show elevated C-reactive protein, ESR, and WBC count

Question 16

What are major developmental tasks that a preschooler will accomplish?

Answer 16

Control over muscles
Participate in vigorous play
Swing and jump higher
- 3 years= Riding a tricycle, jumps off bottom of step, stands on one foot for a few seconds. Speaks in sentences of 3-4 words. 12 hrs of sleep.
- 4 years= Skips and hops on one foot, and throws ball overhead. Speaks in sentences of 4-5 words. Intuitive thoughts start until 7 yrs old. 12 hrs of sleep.
- 5 years= Jumps rope, walks backward with heal to toe, throws, and catches a ball with ease. 2100 words. Start comparing themselves w/ peers. Eruption of primary teeth if finalized. 12 hrs of sleep.

Question 17

What is intuition to a preschooler?

Answer 17

Preoperational phase (2-7 yrs old per Piaget) divided into two stages: Preconceptual stage (2-4 yrs old) and intuitive thought stage (4-7 yrs old). Preconceptual stage is the increasing development of language and symbolic functioning(pretending a box is a fort). (page 421)

Question 18

What is an example of centering?

Answer 18

Centering is a distinctive characteristic of intuitive thinking by having the tendency to concentrate on a single outstanding characteristic of an object while excluding its other feature An example: tall glass vs. round glass equals the same amount. Kids think it is a different amount (page 421)

Question 19

Why are bedtime routines important?

Answer 19

Parents should be guided to engage child in quiet activities before bed, to maintain specific rituals that signal bedtime readiness (storytelling) and to verbally state, “after this story, it will be bedtime.” Sleeping with parents should be discouraged b/c it rewards the attention-getting behavior and defeats the objectives of the bedtime rituals

Question 20

Are imaginary friends common for a preschooler?

Answer 20

YES! Especially if they are an only child. Parallel play (playing independently within a group) and associative play (playing loosely associated groups) are both typical during this time

Question 21

What is the play like with a 5 year old?

Answer 21

They like associative play (playing with each other/ sharing. (class notes) Wants to play “by the rules” but can’t accept losing, can copy sample shapes and print first name, establishes preference for hand use. Might imagine a trip to the moon which demonstrates the child’s imaginary abilities

Question 22

Is aggression normal in a preschooler?

Answer 22

Yes. They are trying to get independence about age 3 yrs old (class notes) They like to show off newly refined motor skills as well.

Question 23

Is it normal for a 4 year old to touch his penis?

Answer 23

Yes. They are curious. Very common in both genders b/c they experience pleasurable sensations which leads to repetition of the behaviors. Considered harmless if the child is outgoing, sociable, and not preoccupied with the activity

Question 24

What are some examples of food for self-feed?

Answer 24

Mac n cheese
Mashed potatoes (can hide food inside)
Use whole milk, butter, and veggies to help with growth

Question 25

Explain your understanding of timeouts.

Answer 25

They say to use time out for children instead of spanking. 1 min per year of age. 4 yrs old = 4 mins of time out (class notes). Can use reward system for behaviors. Redirect when dealing with aggression (class notes)

Question 26

What is normal language development in a 2 year old?

Answer 26

of the words in the child’s sentence should equal child’s age (2yrs old =2 words in sentence). By 2.5 yrs, most kids evidence possessiveness (my doll).

• 4 years= Can use past tense.
• 5 years= Can use future tense.

Question 27

What are some appropriate snacks for a 2 year old?

Answer 27

Finger foods at moderate temps. (page 413).Mac and cheese(class notes), fruit, bread, cereal, rice or pasta, veggies, milk, meat/beans (page 413)

1 cup of fruit a day, limit juice 4-6 oz and snacks high in sugar

Avoid foods that could impose choking hazards

Question 28

What behaviors will the child exhibit when ready to be potty trained?

Answer 28

Interest in the bathroom, telling you that they are soiled. Bowel comes first, then bladder trained. Must be willing to sit on the potty for several mins at a time (page 412)

Question 29

Is giving praise included when planning anticipatory guidance?

Answer 29

I’d say yes
Make everything fun and exciting
Throw a part when they do something good

Question 30

What is parallel play?

Answer 30

Toddlers engage in parallel play, playing next to, but not with, their peers. They gradually develop cooperative play, which involves imagination and sharing skills (page 418)

Question 31

What growth and development can you expect to find in a 2 year old?

Answer 31

Birth weight has quadrupled by age 2.5 yrs old. 300 words 2/3 words sentences at a time-girls mature faster than boys. 3 yrs old-first and last name, one color, 1000 words.Play-parallel play until closer to 3 then corporative play.Blocks, bubbles, reading (class notes)

Autonomy-doing everything on their own. (their way of control) dress, food, give choices
If we don’t let them dress themselves, they have shame and doubt(don’t think they are good enough which effects rest of life) (class notes)