Peds final ugh Flashcards
A 6-month-old is playing by themselves with a soft stuffed animal. What type of play is this?
Solitary play
Three 2-year-olds are in the same room, playing. One is playing with puzzles, the other is playing with large crayons, and the last one is playing with push-pull toys. What type of play is this?
Parallel play
Two 6-year-olds are playing with legos, but one is making a tower and the other is making a house. What type of play is this?
Associative play
A group of 11-year-olds are playing the same videogame using the TV. What type of play is this?
Cooperative play
Which age group will benefit this best if the nurse demonstrates what they are going to do on the doll first?
Pre-schooler
Which age group requires approaching carefully/approaching parents first before talking/touching?
Toddlers
Which age group will benefit the most when the nurse uses diagrams and illustrations to explain things?
School-age
What are the expected findings of an infant’s weight?
X2 of birth weight by 5 months
X3 of birth weight by 12 months
How rapidly should the infant grow?
+1 in/month until 6 months
+ 50% of birth length by 12 months
What is the expected HC increase rate in infants?
Rapid increase until 6 months
+ 10cm by 12 months
What makes infants susceptible to upper respiratory infections?
Lack of IgA in upper respiratory lining
Funnel-shaped larynx
Narrow nasal passageway
Bronchi & bronchioles shorter & narrower
Few alveolis
Large tongue
When should you expect infants to control their head, roll from back to side, and grasp objects with both hands?
4 months
What motor development is expected at 6 months of age?
Rolls back to front
Holds bottle
What motor development is expected at 9 months of age?
Crude pincer grasp
Sit unsupported
Creeps with hands and knees
What motor development is expected at 12 months of age?
Feeds self with cup and spoon
Standing to sitting
2 block tower
When can solid foods be started?
4-6 months; when extrusion reflex is gone
A patient just delivered a baby and would like to breastfeed. What feeding recommendation can be given?
Breastfeed primarily for first 6 months
After 4 months, start iron supplements
A 38 week pregnant mom wants to bottle feed her baby. What feeding recommendation can be given?
Use iron fortified formula
What are some characteristics of toddler’s eating?
Physiologic anorexia
Food jag
Ritualism
How many words should a toddler know by 2 years of age?
50 to 200
What kind of language/language pattern do toddlers use?
Echolalia
Telegraphic language
How can you prepare toddler’s food to make them eat?
At or near room temperature
Small, bite side, soft food
When can kids sit front-facing in the car?
2 years old
What kind of cognitive development should occur in pre-schoolers?
Magical thinking
Animism
Imaginary friend
Can tell time in relation to daily events
What kind of play can help with social development in pre-schoolers?
Pretend play, dress up, role play. Get to explore different roles, emotions, characters
What are some normal assessment findings in school age?
Frontal sinus develop (at 7 yrs)
Tonsil size decrease but still large
Puberty; girls 9-10, boys 10-11
Permanent teeth
What social development occur at school age?
Peer pressure
Feelings of acceptance
Body image
Clubs and BFFs
What 2 supplements should adolescents take due to rapid growth?
Iron & Calcium
Iron: girls 15mg, boys 11mg
Calcium 1300mg
About how much calories should adolescents eat per day?
2000 calories
What are some important factors to consider when caring for an adolescent in the hospital?
Maintain privacy and independence
Encourage them to participate & socialize with friends
Identify any deficits in knowledge or self-care and provide resources
What is the first sign of hypoxemia in children?
Tachypnea
A 3-year-old presents to the ED with nasal flaring, grunting, retractions, head bobbing, clubbed fingers, restlessness, abnormal lung sounds, and cyanosis. What do you think the patient is experiencing?
Hypoxemia
How do you manage hypoxemia?
O2 therapy
Chest physiology
Suction
Pulse Ox
A 6-year-old presents to the ED with dyspnea, SOB, nonproductive cough. After assessment, you notice inspiratory wheeze, use of accessory muscles to breathe, and low O2 sats. What is the patient likely to experience?
Asthma
How can you manage asthma?
Avoid triggers
Use of maintenance meds
What labs/diagnostics are used to identify asthma?
PFT (lung volume capacity & overall function)
PIFR (Used daily to monitor management & signs of acute exacerbation)
Elevated WBC, eosinophil
Elevated CO2, low O2
CXR, Allergy/RAST test
What medications are used for acute exacerbation of asthma?
Albuterol (short acting beta agonist)
Ipratropium (anticholinergic)
Prednisone (corticosteroid)
What medications can you expect to be prescribed to a patient who is discharged from having an acute asthma attack to maintain asthma?
Formoterol (long acting vasodilator)
Fluticasone (inhaled corticosteroid)
Cromolyn (mast-cell stabilizer)
Montelukast (leukotriene receptor antagonist)
What medications are used to manage cystic fibrosis?
Dornase alfa (decrease viscosity)
Anticholinergics
Bronchodilators
Antiinflammtory
IV/nebulized abx
Fat soluble vit A, D, E, K
Pancreatic enzyme
When should pancreatic enzyme administered?
Within 30 minutes of eating
Why is abx used to manage cystic fibrosis?
All the mucus is sitting in the respiratory tract, which bacteria will grow.
Nasty.
What tests are done to diagnose cystic fibrosis?
Sweat chloride test
KUB
Stool analysis (greasy poop)
CXR
PFT
What values from sweat chloride test indicates cystic fibrosis?
Cl >40 in infants <3 month old, >60 for other
Na >90
A 5-year-old presented to the ED with barking cough, inspiratory stridor, tachypnea, and respiratory distress. Mom states that he’s find during the day but coughs bad at night, and it has been lasting for 4 days now. What condition is this patient in?
CROUP
What medications are given to manage CROUP?
Betamethasone (decrease inflammation)
Racemic epi (nebulizer; only lasts 2 hr)
How is CROUP managed?
Usually outpatient
Cool humidifier, steamy bathroom
Educate on increased s/s of respiratory distress
What are the nursing priorities of heart failure?
Oxygenation/ventilation
Promote rest
Adequate nutrition (150cal/kg/day)
How should kids with heart failure fed?
20 min feeding time
If anything remaining, goes through NG/OG
What 4 medications are used to manage heart failure?
Metoprolol (decrease HR and BP & vasodilate)
Lasix (edema)
Captopril/Enalapril (decrease afterload by vasodilation)
Digoxin (increase cardiac contractility)
A 3-year-old presents to the ED. Upon assessment, you notice full, bounding pulse on UEs but weak/absent pulse on LEs. You also notice higher BP in UE and lower BP in LE. With that, there’s soft systolic murmur at base. What condition is this kid likely to have?
Coarctation of the aorta
What’s tetralogy of fallot?
Hole between ventricles, so both oxygenated and unoxygenated blood is being pumped to the body, resulting in poor perfusion
What are the s/s of tetralogy of fallot?
Fainting
Color change with feeding, activity, crying
Loud, harsh systolic murmur
What’s a TET spell?
Hypoxemia, dyspnea, agitation leading to anoxia and unresponsiveness
Especially in the morning
How can you break TET spell?
Knee to chest
Squatting
What nursing management is required for tetralogy of fallot patient?
Promote oxygenation/ventilation (O2, upright position, suctioning)
Adequate nutrition (small, frequent meals or NG/OG, 150 cal/kg/day)
Avoid crying
What are the symptoms of Kawasaki diesease?
High fever for at least 5 days
Unresponsive to abx
Desquamation of fingers, toes, peri area
Significant bilat. conjunctivitis w/o exudate
Mouth & throat dry, fissured lips, strawberry tongue, pharyngeal/oral MM edema
How is Kawasaki disease treated/managed?
High dose aspirin (prevent aneurysm)
Acetaminophen (fever)
Oral care
IVIG (increase immune)
Strict I&Os, daily weight
BPM under what number is considered life-threatening in peds?
< 60
What’s the range of sinus tachycardia in peds?
Infants (160-220)
Children (130-180)
What causes sinus tachycardia in peds?
Usually fever, dehydration, pain, hypoxia
How is sinus tachycardia treated?
By treating the underlying cause
What’s the range for SVT in peds?
Infants >220bpm
Children >180bpm
How does SVT look like on the EKG strip?
Flat P wave
Narrow QRS
How is compensated SVT treated?
Vagal maneuver
If vagal fails, adenosine
How is uncompensated SVT treated?
Adenosine or synchronized cardioversion
What are the assessment findings when a child is dehydrated?
Dry MM
Sunken fontanel
Tearless
Sunken eyes
Poor skin turgor
Oliguria
Hypotension
Tachycardia
Tachypnea
Sudden weight loss
Can you use tap water for oral hydration replacement therapy?
No. Pedialyte only
When is oral hydration used?
For mild-moderate dehydration
How much Pedialyte should be consumed to treat mild dehydration?
50mL/kg within 4 hours
How much Pedialyte should be consumed to treat moderate dehydration?
100mL/kg within 4 hours
How much Pedialyte should be consumed if a child had 3 diarrhea?
10mL/kg/stool
Therefore 30mL/kg
When is IV rehydration initiated?
For severe dehydration or unable to tolerate PO rehydration
How much IVF should you administer to help with severe dehydration?
20mL NS bolus + maintenances
100mL/kg for 1st 10kg
50mL/kg for 2nd 10kg
20mL/kg for rest of kg
A 2-year-old presented to the ED with projectile vomiting. Upon assessment, you notice olive-shaped mass in RUQ, and pt reports hunger right after vomiting. A few labs were done, and the result showed electrolyte imbalance and metabolic alkalosis. What condition is this pt likely to be in?
Pyloric stenosis
What nursing management should be done when caring for a pyloric stenosis patient?
NG tube to decompress stomach
NPO
Prepare for surgery
IVF for electrolyte and dehydration
Post-op incision care
When can post-op pyloric stenosis patient resume PO feeding?
1-2 days after
What are the expected findings of Hirschsprung’s disease in newborns?
Not passing meconium in 24-48 hours
Vomiting bile
Refusal to eat
Abd distention
What are the expected findings of Hirschsprung’s in infants/child?
Constipation
N/V/D
Foul-smelling, ribbon-like poop
Abd distention
Visible peristalsis
Palpable fecal mass
How is Hirschsprung’s treated?
Surgery; colostomy or ileostomy
A 8-year-old presented to the ED with fever, decreased urine output, hematuria, abdominal pain, anorexia, and edema. Upon assessment, pt has HTN, proteinuria, s/s of fluid overload and CHF. Pt stated that she recently had a strep throat. What is this patient likely to have?
Acute glomerulonephritis
What are the nursing priorities when treating acute glomerulonephritis?
Monitor fluid status/volume
Manage HTN
Abx for strep infection
Monitor VS, renal, neuro changes
Monitor urine output
Robin is having watery diarrhea with cramps, a bit of blood in stool, vomiting, not peeing much, and looks pale and toxic. He recently went to a petting zoo and ate a hamburger with ground beef in it. What condition is Robin likely to experience right now?
Hemolytic uremic syndrome
Robin was admitted to the hospital. He has Hemolytic uremic syndrome, and VS revealed that he has HTN. The nurse is creating a care plan on him. What should the nurse include?
Manage HTN
Maintain fluid electrolyte balance
Contact precaution (E.coli)
Monitor for bleeding, pallor, fatigue
Strict I&Os
Possible PRBC & platelet if Robin actively bleeding and it’s not stopping
Possible IVIG
What’s hypospadias?
Abnormal urethral opening on ventral surface of penis (below glandis penis)
How is hypospadias treated?
Urethral stent/drainage tubing.
Taped with penis upright to prevent stress on the incision site
Double diaper to keep poop away
Analgesics for pain
What indicates GH deficiency?
Short stature
High-pitched voice
Delay in sexual, skeletal maturation, dentition
Large, prominent forehead
Underdeveloped jaw
Decreased muscle mass
How is GH deficiency treated?
Biosynthetic GH; SubQ daily
How often should you check height for GH effectiveness?
Q 3-6 months
When is GH therapy stopped?
When growing < 1in/yr
Bone age > 16 in boys, > 14 in girls
What are the manifestations of congenital hypothyroidism?
Hypothermia
Poor sucking reflex
Constipation
Lethargy/hypotonia
Periorbital puffiness
Cool, dry, scaly skin
Bradycardia
RR distress
Large fontanel, delayed closure
What are the symptoms of DKA?
> 330
Polyuria, dipsia, phagia
Kussmals breathing; rapid, deep, fruity
Warm, dry, flushed skin
Dry MM
Confusion, lethargy, weak
Weak pulse, diminished reflexes
How is DKA managed?
ICU admission
Q1H BS check
IV regular insulin drip & sliding scale
IVF for dehydration
Why is it important to check BS Q1H in DKA pt?
Rapid decline in BS level (>100/hr) will lead to cerebral edema
What are the physical cues of hydrocephalus?
Wide, open, bulging fontanel
Sunset eyes
Large head/recent change in HC
Thin, shiny scalp with prominent, visible scalp veins
Vision/gait change
Projectile vomit
Change in LOC
How is hydrocephalus managed?
VP shunt
How do you know is VP shunt is infected/obstructed?
Increased ICP; fever, headache, stiff neck, bulging fontanel, dilated pupil, increase HC
What’s the cushing’s triad for increased ICP?
HTN
Bradycardia
Irregular RR
How do you manage increased ICP?
Decrease stimulation
Elevated HOB, head midline, body alignment
Avoid suctioning, coughing, blowing nose
Stool softener
How is bacterial meningitis managed?
ICU admit with strict droplet until 24 hr of abx or ordered to be off
Ventilator
Manage hyperthermia (NSAIDs, cooling)
Abx after cultures
What lab findings are expected in bacterial meningitis?
LP: high WBC, low glucose, high protein, cloudy
CBC: high WBC
Kernig & Brudzinski sign
What are the s/s of Reye syndrome?
Liver failure
Encephalopathy
Cerebral edema
Severe, continual vomiting
s/s increased ICP
Hyperreflexia
Red, macular rash may be present
Hyperammonemia
Hypocoagulability
Hypoglycemia
What’s the priority of care in Reye syndrome?
Decrease ICP
Manage liver failure
Hope for the best
What medication is given to help hyperammonemia?
Lactulose
Poop it out
What can be given to help with hypocoagulability?
Fresh frozen plasma
Vitamin K
What’s most important when caring for a spina bifida patient?
Sac care
Keep is moist with NS gauze
Keep baby under warmer since we can’t swaddle them
Prone position
Monitor HC & ICP
Promote child-parent bond
What medications are used to manage cerebral palsy?
Baclofen
Botox
Carbidopa
All 3 for muscle relaxing to promote mobility
What type of fx is common in kids?
Greenstick or buckle (compression injury)
What are some common places for child fx?
Wrist
Midclavicular, humerus, femur -> birth trauma
What are some uncommon place for child fx?
Scapula
Femur in immobile kid
Ribs
Pelvic
Hip
Sternal
Any bilateral fx
What are the 2 complications of fx?
Compartment syndrome
Osteomyelitis
How long is acute otitis media treatment?
10-14 days if PO abx
1 dose IM
What are the s/s of pertussis?
Paroxysmal cough
Face red, body cyanotic
Teary eyes, drooling, copious secretions
What meds are used to treat pertussis?
Macrolides (mycins)
< 1 month - Azithromycin
What meds are used to treat Lyme disease?
Doxycycline for > 8 yrs
Amoxicillin for < 8 yrs
For 14-28 days
What’s most important for burn patients for first 24 hours?
Fluid resuscitation to prevent hypovolemic shock
How is required fluid amount calculated in peds burn patient?
Using the parkland formula; fluid calculated based on total body surface area burned)
What chart is used to determine total body surface area burned in peds?
Lund & Browder chart
How much urine output is considered adequate during fluid resuscitation?
1-2mL/kg/hr
What nutritional factors are needed in burn patients?
Increased calorie, protein
Vit A & C for cell
Zinc for wound healing
What medications are used to treat atopic dermatitis?
Topical corticosteroids
Antihistamine at night
Immune modulator (tacrolimus)
How is SCID treated?
IVIG
Bone marrow transplant
Elevated neutrophils indicate
Acute bacterial infection
Elevated eosinophil indicate
Allergic reaction or chronic bacterial infection
Elevated lymphocyte indicate
Viral infection
What does IgG protect against?
Virus, bacteria, toxins
What does IgA do?
1st line defense for respiratory, GI, GU pathogens
What does IgM indicate?
Active infection
What does IgE indicate?
Allergic state, parasitic infection
What does elevated complement C3 mean?
Means that Immune system is active from an infection/injury
How is hemophilia managed?
Administer Factor VIII
External bleeding - direct pressure
Internal bleeding - ice/cold pack & elevate unless contraindicated
If mild, use desmopressin
What does desmopressin do?
Triggers blood vessels to make factor VIII
What are the assessment findings of iron deficiency anemia?
Fatigue
Pallor
SOB
PICA
Spooning of nails
Dizziness
What are the diagnostic cues of iron deficiency anemia?
Low RBC, Hgb, Hct, MCV, MCH, ferritin
High RDW
What are the s/s of sickle cell vaso-occlusive crisis?
Splenomegaly
Severe pain (abd, thorax, joints, digits)
Dactylitis
Increase WOB, fever, tachypnea, hypoxia
Jaundice
When should you start applying O2 on sickle cell vaso-occlusive crisis pt?
When SpO2 < 92%
How often should you check for s/s infection in pt in neutropenic precaution?
Q8H
How is N/V/Anorexia managed?
Bland, dry foods
Offer carbonated drinks, popsicles, ice throughout the day
Room temp food
Small, frequent
What are the s/s of acute lymphoblastic leukemia (ALL)?
Enlarged liver & lymph nodes
Low grade fever
Petechiae, bruising
s/s of infection
Pallor
What are the lab/diagnostic findings in ALL?
Low RBC, Hct, Hgb, platelet
Low/normal/high WBC
BMA is most definite when diagnosing ALL
