PEDS test 1 Flashcards

1
Q

Trust vs mistrust

A

birth to 1 year

Infants need consistent, loving care by a motherinf person.

mistrust results when their is deficient or lacking of trust in the infants life, or their basic needs are not met.

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2
Q

Autonomy vs shame and doubt

A

1 to 3 years

autonomy - the child is able to control their new physical abilites as well as mental abilities

shame and doubt happens when they are made to feel small, are forced to be dependent in areas they capable of being in control.

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3
Q

initiative vs guilt

A

3 to 6 years

initative, children are able to have their own mind and control their actions with being aware of threats.

If they are bad to feel their actions are bad, they will start to feel a sense of guilt

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4
Q

industry vs inferiority

A

ages 6 to 12

industry- feel the need to work, want to carry activites that they can finish or complete. start to compete and cooperate with others and learn rules.

if too much is expected of them or they feel they cannot measure up they have feelings of inferiority and inadequacy.

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5
Q

identity vs role confusion

A

ages 12 to 18

start to become very concerned with their appearances and discovering their role in life.

if they have trouble discovering their role they end up in role confusion.

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6
Q

Vaccines with live viruses

A

Varicella

influenza (intranasal) - live attenuated

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7
Q

Vaccines given IM (vastus lateralis until 18 months or older, then can be given deltoid as well)

A

DTap, Tdap, hep A, hep B, Hib, IPV, PCV, influenza, MCV4, HPV

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8
Q

c Vaccines given SQ

A

MMR, MMRV, MPSV4, Varicella

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9
Q

when will you know that varicella (chicken pox) is not contagious?

A

When the vesicles have all crusted.

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10
Q

Pertussis ( whooping cough)

A

Resp symptoms seen first

cough until they vomit, usually.

direct or droplet spread, or contact with contaminated objects

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11
Q

nursing care for pertusiss

A

obtain nasopharyngeal culture for diagnosis

encourage oral fluids, offer small amounts frequently/

during paroxysms ensure adequate O2 (put infant on side to decrease risk of aspiration if vomit)

provide humidified O2, suction PRN

observe signs of airways obstruction (increased restlessness, apprehension, retractions, cyanosis)

encourage compliance with AntiBX for household contacts

encourage booster in adolescents

use standard precautions and a mask.

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12
Q

Rota vaccine

A

Rotavirus

first does should be age 6-12wks, shouldnt be given first does after 12wks, should be done with doses at 32 wks, no dose later than 32 wks.

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13
Q

DTap vaccine

A

Diphtheria and tetanus toxoids and acellular pertussis

min age: 6 wks

final does between 4-6 yrs

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14
Q

Hib vaccine

A

haemophilus influenzae type b

min age: 6 wks

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15
Q

PCV

A

pneumococcal vaccine

min age: 6 wks

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16
Q

PPV

A

pneumococcal polysaccharide vaccine

min age: 2 yrs

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17
Q

MMR

A

measles, mumps, rubella vaccine

min age: 12 months

2nd dose usually between 4-6 yrs

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18
Q

MCV4

A

meningcoccal vaccine

min age: 2 years

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19
Q

Nasopharyngitis (common cold)

A

caused by many different viruses (RSV, influenza, rhinovirus)

more severe in infants and young children

fever is common in younger children

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20
Q

nasopharyngitis care

A

rest, fluid, stay home

motrin and tylenol, decongestant if over 6 months, buld syringe

avoid milke products = increase secretions

wash hands !

elevate HOB - helps breathing

premi with underlying cardiac issue or decompensate with RSV- admit to hosp

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21
Q

Acute epigoltitis (type of croup)

A

EMERGENCY - swollen epiglottis cannot rise and allow airway to open

obstructive inflammation (occlusion of trachea)

happens between 2-8

common cause - Hib - get child vaccinated

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22
Q

Acute epiglotitis care

A

DO NOT INSPECT THROAT or do with GREAT caution, complete obstruction can occur, should only be done if intubation can be performed immediately if necessary.

Airway management:

watch for obstruction of epiglottis

have intubation or trach equipment ready

drugs- antibiotics can be used-usually see decrease swelling after 24 hrs, steriods and IV fluids are also used.

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23
Q

Acute laryngotracheobronchitis (LTB)

A

most commone of croup syndromes

usually caused by viral infection

ages 6 mnt - 8 yrs

inflammation of the mucosa lining the larynx and trachea cuase narrowing of airway

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24
Q

LTB s/s

A

s/s usally at night and go away in cold

inspirator stridor and retractions, barking or seal-like couch, tachypnea, hypoxia if unable to inhale enough air, resp acidosis may occur if unable to exhale CO2, may have fever

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25
Q

LTB care

A

montior resp status - rate, retractions, listen to breath sounds before and after and tx

try to keep child calm

supplement O2, maintain cool mist

hydrate

parents can run shower and allow child to breathe warm, moist air

high humidity with cool mist can provide relief

maybe ne nebulized tx

corticosteriods can be used to decreased inflammation

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26
Q

Cystic fibrosis

A

Autosomal recessive trait - one gene from both parents

most common diease to affect white children

disorder of Resp, GI and exocrine glans

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27
Q

most of kids with cystic fibrosis had what as a newborn

A

meconium ileus

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28
Q

most common pathogens responsible form pulmonary infections with cystic fibrosis..

A

staph and pseudomonas

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29
Q

GI problems with CF:

A

need to replace pancreatic enzymes with all food - sprinkle on food before eating

need a well balanced, high protein, high calorie diet

give fat soluble vitamins in the water miscible form

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30
Q

Assessment with cystic fibrosis

A

lung sounds, couch, clubbing, frequency and nature of stools, abdmoinal distention, failure to thrive

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31
Q

S/s cystic fibrosis

A

frequent upper resp infections

bulky, foul stools that float

non productive cough

Have thick, viscous, tenasious secretions - use chest physical therapy to help break this up

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32
Q

when should chest PT be done on a cystic fibrosis child

A

NOT before they eat or after, wait 30 mins or so after eat to do it.

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33
Q

diagnosis for cystic fibrosis

A

sweat electrolyte test - simple painless test for chloride

stool analysis for enzymes

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34
Q

Digoxin ingestion remember..

A

cardiac issues

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35
Q

Varicella is not given until when..

A

after 1 year

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36
Q

IPV can not be given when..

A

with immunocompromised sibling.

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37
Q

social-affective play

A

infant play - they enjoy interactions with adults - when you smile, coo, or talk to the infant

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38
Q

sense-pleasure play

A

nonsocial stimulation - light, color, tastes, odor, textures and consistencies attract childrens attention, stimulate their senes, and give pleasures.

Also handling raw material ( water, sand, food), body motion (swiming, bouncing, rocking) and other sense ablities (smelling, humming)

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39
Q

Skill play

A

after infants develop ability to grasp and manipulate, they demonstrate their ability by repeating and action over and over again.

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40
Q

unoccupied behavior play

A

not playful but focusing attention momentarily on something that stricts their interest.

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41
Q

Dramatic or pretend play

A

begins 11-13 months

start to have imaginations

act of events of daily living that they see from caregives - using a phone, driving a car, rocking a doll - eventually come more complex as they get older - playing house, police, teacher, nurse.

42
Q

onlooker play

A

child watches other children play but makes no attempt to join them.

ex: watching sibling bounce a ball

43
Q

solitary play

A

children play with different toys then the toys used by others in same room.

enojy the presence of other children but their interest is centered on their own activity.

44
Q

parallel play

A

usually seen in toddlers

play along side other children with similar toys but used in their own way. do not make any attempt to influence each other.

45
Q

associative play

A

children play together and are engaged in similiar or even identical activites, but no organization, division of labor, leadership, or mutual goal.

they borrow and lead play materials, follow each other, sometimes try to say who can and cannot play.

46
Q

cooperative play

A

organzied, children play in a group.

They had a plan and purpose of accomplishing an end- to make something, to attain a competitive goal, to dramatixe situations or adult or group life.

requires organization of activities, division of labor, and role playing.

47
Q

What meds need to be double checked..

A

heparin, insulin, digoxin, opiods, anti-arrythmics, chemo therapy drugs, sedatives (pain)

48
Q

What is it okay to have mom do when giving meds?

A

Can have mom give the med, as long as you are there to watch, mom is more familiar to the child.

49
Q

Giving Oral meds

A

in syringe on the cheek

dont give if crying

blow in face or pinch nose to get them to swallow

usually in liquid form- most kids cant swallow pills - crush pills put in small amount of juice, applesauce or jelly.

Infant needs to be upright

50
Q

Injections

A

TB syringe when less then 1 mL

need gauge 25

length - 5/8 - 1 in

site vastus lateralis

0.5-1 ml in infants up to 2 ml in older children

51
Q

IV medss

A

IV site needs to be checked every hour, they have little viens that clot off easily.

52
Q

Rectal meds

A

use when child is vomiting, unconscious, unable to take oral med

stay on child until med is in or they will expell it right away

53
Q

eye medications

A

Child is supine or sitting with head extended, child is asked to look up,

one hand pulls lower lid downward, hand hold med lays on childs forhead.

solution is put in conjuctiva, never directly on the eyeball.

also can from a cup with the lower kid, put med there.

infants close eyes tightly - place eyedrop in nasal corner where lid meets, when eye opens med will go into conjuctiva

young children - play game - close eyes until you count to 3 then open them and thats when you quickly instill the drops.

54
Q

Ear drops

A

child is prone or supine and the head is turned so affect ear is up.

3 and younger - gently pull pinna downward and back,

3 and older - pinna pulled up and back.

after instilled have lay on unaffected side for a few minutes

cotton ball can be used

55
Q

nasal drops

A

lay child flat with head extended back off bed or pillow, the must remain like this for 1 min after the drops instilled.

use footbal hold for infants

56
Q

injuries in infants (0 -12 months)

A

zero sense of danger

Fall down stairs

dont usually hurt themselves when fall

pick things up and eat them

suffocation is most common cause of death

can burn easily - use tepid bath water

they learn from our behavior

57
Q

injury prevention with infants (0-12mnths)

A

clothing shouldnt have ties or buttons

gates, plug covers, side rails on cribs, corner covers

dont use baby powder- could aspirate it - get pneumonia

dont leave alone in high-chair, or on changing table

toys- plastic, washable, age appropriate, no smalle pieces

58
Q
Injury in toddlers (1-3 yr)
 and preschooler (3-5yr)
A

Toddler are at highest risk for posion - can move quicker, open things easier.

not aware of dangers, but can be taught ‘NO”

They tend to dart into the streets

Can drown even in 2 in of water, no afraid of it.

can open car doors while driving

Odor and taste does not matter, will out anything in mouth.

59
Q

injury prevention in toddler and preschooler

A

Do not put non-food items in food containers

teach them ‘NO’

older they get the more they can be taught, they learn by what the see adults do.

60
Q

Types of poisons

A

Cleaning supplies, corhesive substances - do not want them to vomit- burns when comes up, gases-inhale-effects lungs. food posion. lead, cosmetics.

61
Q

TX when ingestion of poison

A

ABCs first,

safe all urine, emesis, and containers and take to ER, to know what was ingested

If on skin- flush skin with soap and water.

CALL POISON CONTROL

62
Q

injury in School age (6-12yrs)

A

Motor vehicles accidents, sport injuries, drugs, firearms, walking to school - avoid unsafe areas, ATVs-four wheelers.

63
Q

injury prevention in school age children

A

teach and enforce safety measures

wear helmets, seat belts

role model- you have to wear the helmet and seat belt as well

64
Q

Injury of Adolecents (13-18 yrs)

A

Motor vehicle, cars, AVTs, firearm, sport injuries, drugs, alcohol.

they are risk takers

need for approval of peers

want freedom and independence

65
Q

Prevention of injury in adolescents

A

enforce safety rules and be consistent

use saftey equipment

Teach about drug and alcohol abuse

keep firearms under lock and key

put them in safety classes

66
Q

chemical antedotes for posion

A

neutralize

milk of mag, sodium bi carb, baking soda

67
Q

physiological antedotes

A

opposite affect of posion

narcan

68
Q

physical antedote

A

protects tissue

activated charcoal - (absorbs everything but sianide) - removes posion from skin and stomach.

69
Q

sources of Lead posioning

A

older cities- lead based paint used in house, peels off and children eat it.

can also be inhaled

70
Q

neurological lead posion

A

non-reversible

can loose some IQ, mental retardation possible, paralyiss, blindness

can lead to cerebral edema = death

71
Q

renal lead posion

A

reversible

affects proximal tubules

72
Q

hematological lead posion

A

reversible

hgb is decreased - become anemic

73
Q

Treatment for lead posioning

A

want to get it out the system - mobilize the lead from the blood and soft tiuuse by enhancing deposition in the bones and excretion in the urine by chelation therapy

5-6 IM injections a day, rotate site, until the lead is out of system.

Monitor BUN, Cr and I & O during tx

74
Q

Thermal agents - burns

A

fire, hot water, steam, frost bite

75
Q

chemical burns

A

cleaners, solvents, alkalies

76
Q

radiation burns

A

sun, x-ray, radiation for cancer

77
Q

electrical current

A

burns inside - follows up tendons - difficult to treat

78
Q

Superficial (1st degree) burn

A

epidermis

errythema, heals 5-10, hospitalization not needed

scalds, sun burns

79
Q

Partial thickness (2nd degree) burn

A

epidermis and dermis

moist, moddled, redness, blisters (dont pop) - leakage of protein to burn site, will heal in time

painful to air

intense heat, emersion of hot liquids, contact with hot objects

80
Q

full thickness (3rd degree) burn

A

entire skin/structure - life threatening, involve all organs

black, leathery, no blisters, sometimes pearly white-frost

treat with grafts, will not heal on own.

no pain 1st 1 -2 days

81
Q

4th degree burn

A

full thickness that also involves muscles, tendons, ligaments, or bones.

82
Q

If larynx is damaged what will you hear?

A

stridor

83
Q

Fluid replacement with burns

A

lots of fluid shifts, 3rd spacing (losing out of vascular beds)

decrease urine output, CO decrease by 50%

hgb decreased - RBCs are destroyed by heat, hct goes up

hypovolemic - loss of plasma

retain sodium and water

potassium increase - massive cellular distrubtion, caught in extracelluar fluid

84
Q

First thing to check with burn victims

A

ABCs

establish airway - O2 100%

remove clothing

dont cool down too much

treat burn site with sterile dressing

85
Q

Nutrition for burns

A

Feer a burn child whenever they want to eat

give protein - dont want in neg nitrogen
ice cream, peanute butter, yogurt, shakes, eggs, meat

high calories - butter, fats

vitamin A and C - ephitheal cell production

zinc- helps with healing

dont want to give TPN - has sugars which can cause infection

86
Q

Rehab stage - starting to heal

A

there will be an increase in urine output, hct decrease - blood diluyes, sodium decrease with water, potassium decreases

mobility promotion and prevention of contractors is important

87
Q

Medications for burn children

A

dont give injections - give meds IV
the med sits right under skin until they recover then med gets in system all at once.

give morphine sulfate for pain - it can be easily reversed and short acting

Dont give ABX profilactic

88
Q

Pulmonary complications of burns

A

PE, laryngeal edema, stridor, bact pneumonia

89
Q

wound sepsis from burns

A

temp spikes - 24 hours before

drop in bp the next day

decrease in urine output

TX with lots of fluids

90
Q

CNS complications of burns

A

hallucinations, LOC changes, seziures and coma due to F&E changes.

91
Q

when to suspect that someone may be getting a contracture.

A

when they are laying in the same comfortable position a lot.

92
Q

what to remember about the recipient site of a graft..

A

DONT touch with out an order !

93
Q

commone from of abuse that children under 5 die from?

A

shaken baby syndrome - brain gets bounced back and forth - get a closed head injury or eye hemorrhage

94
Q

whats a normal stressful event that leads to abuse?

A

potty training

95
Q

who is usually the abuser?

A

a male figure (maybe boyfriend) that is left in charge of the children

They dont know normal growth and development

96
Q

what to do when you suspect abuse?

A

Always report

call child protective services, even if physcian doesnt agree

and take pictures

97
Q

suggestion to parents if cant get child to stop crying

A

put them in safe place, crib or pack n play, and walk away for a minute, child will eventually cry self to sleep

can always walk over to neighbor or call friend to get a break, if you are stressed, the baby can tell and will also be stressed.

98
Q

charcteristics of abused children

A

seeks material gain- will steal

ask many questions

when you reach out to them, they will shy away

will not give up their parents - they are their support and all they know, will tell same story as parents.

99
Q

How to work with an abused child?

A

Explain everything you are doing

Be consistent with care - same care givers

  • to gain trust
  • notice abuse
  • watch parent/child interaction
  • so they cant manipulate us

Use unbiased, factual charthing

let the child vent about their care

100
Q

who is usually the sexual abuser?

A

someone they know in an authoritive position - coach, priest

usually someone in the family knows about it if it is incest

101
Q

Characteristics of sexually abused children

A

child come homes with material gain

complaints of being sick a lot

grades will drop

torn hymens, vaginas, STDs

may grow up to abuse their kids or kill their abuser