PEDS test 1 Flashcards
Trust vs mistrust
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.
Autonomy vs shame and doubt
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.
initiative vs guilt
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
industry vs inferiority
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.
identity vs role confusion
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.
Vaccines with live viruses
Varicella
influenza (intranasal) - live attenuated
Vaccines given IM (vastus lateralis until 18 months or older, then can be given deltoid as well)
DTap, Tdap, hep A, hep B, Hib, IPV, PCV, influenza, MCV4, HPV
c Vaccines given SQ
MMR, MMRV, MPSV4, Varicella
when will you know that varicella (chicken pox) is not contagious?
When the vesicles have all crusted.
Pertussis ( whooping cough)
Resp symptoms seen first
cough until they vomit, usually.
direct or droplet spread, or contact with contaminated objects
nursing care for pertusiss
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.
Rota vaccine
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.
DTap vaccine
Diphtheria and tetanus toxoids and acellular pertussis
min age: 6 wks
final does between 4-6 yrs
Hib vaccine
haemophilus influenzae type b
min age: 6 wks
PCV
pneumococcal vaccine
min age: 6 wks
PPV
pneumococcal polysaccharide vaccine
min age: 2 yrs
MMR
measles, mumps, rubella vaccine
min age: 12 months
2nd dose usually between 4-6 yrs
MCV4
meningcoccal vaccine
min age: 2 years
Nasopharyngitis (common cold)
caused by many different viruses (RSV, influenza, rhinovirus)
more severe in infants and young children
fever is common in younger children
nasopharyngitis care
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
Acute epigoltitis (type of croup)
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
Acute epiglotitis care
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.
Acute laryngotracheobronchitis (LTB)
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
LTB s/s
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
LTB care
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
Cystic fibrosis
Autosomal recessive trait - one gene from both parents
most common diease to affect white children
disorder of Resp, GI and exocrine glans
most of kids with cystic fibrosis had what as a newborn
meconium ileus
most common pathogens responsible form pulmonary infections with cystic fibrosis..
staph and pseudomonas
GI problems with CF:
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
Assessment with cystic fibrosis
lung sounds, couch, clubbing, frequency and nature of stools, abdmoinal distention, failure to thrive
S/s cystic fibrosis
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
when should chest PT be done on a cystic fibrosis child
NOT before they eat or after, wait 30 mins or so after eat to do it.
diagnosis for cystic fibrosis
sweat electrolyte test - simple painless test for chloride
stool analysis for enzymes
Digoxin ingestion remember..
cardiac issues
Varicella is not given until when..
after 1 year
IPV can not be given when..
with immunocompromised sibling.
social-affective play
infant play - they enjoy interactions with adults - when you smile, coo, or talk to the infant
sense-pleasure play
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)
Skill play
after infants develop ability to grasp and manipulate, they demonstrate their ability by repeating and action over and over again.
unoccupied behavior play
not playful but focusing attention momentarily on something that stricts their interest.
Dramatic or pretend play
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.
onlooker play
child watches other children play but makes no attempt to join them.
ex: watching sibling bounce a ball
solitary play
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.
parallel play
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.
associative play
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.
cooperative play
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.
What meds need to be double checked..
heparin, insulin, digoxin, opiods, anti-arrythmics, chemo therapy drugs, sedatives (pain)
What is it okay to have mom do when giving meds?
Can have mom give the med, as long as you are there to watch, mom is more familiar to the child.
Giving Oral meds
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
Injections
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
IV medss
IV site needs to be checked every hour, they have little viens that clot off easily.
Rectal meds
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
eye medications
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.
Ear drops
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
nasal drops
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
injuries in infants (0 -12 months)
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
injury prevention with infants (0-12mnths)
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
Injury in toddlers (1-3 yr) and preschooler (3-5yr)
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.
injury prevention in toddler and preschooler
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.
Types of poisons
Cleaning supplies, corhesive substances - do not want them to vomit- burns when comes up, gases-inhale-effects lungs. food posion. lead, cosmetics.
TX when ingestion of poison
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
injury in School age (6-12yrs)
Motor vehicles accidents, sport injuries, drugs, firearms, walking to school - avoid unsafe areas, ATVs-four wheelers.
injury prevention in school age children
teach and enforce safety measures
wear helmets, seat belts
role model- you have to wear the helmet and seat belt as well
Injury of Adolecents (13-18 yrs)
Motor vehicle, cars, AVTs, firearm, sport injuries, drugs, alcohol.
they are risk takers
need for approval of peers
want freedom and independence
Prevention of injury in adolescents
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
chemical antedotes for posion
neutralize
milk of mag, sodium bi carb, baking soda
physiological antedotes
opposite affect of posion
narcan
physical antedote
protects tissue
activated charcoal - (absorbs everything but sianide) - removes posion from skin and stomach.
sources of Lead posioning
older cities- lead based paint used in house, peels off and children eat it.
can also be inhaled
neurological lead posion
non-reversible
can loose some IQ, mental retardation possible, paralyiss, blindness
can lead to cerebral edema = death
renal lead posion
reversible
affects proximal tubules
hematological lead posion
reversible
hgb is decreased - become anemic
Treatment for lead posioning
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
Thermal agents - burns
fire, hot water, steam, frost bite
chemical burns
cleaners, solvents, alkalies
radiation burns
sun, x-ray, radiation for cancer
electrical current
burns inside - follows up tendons - difficult to treat
Superficial (1st degree) burn
epidermis
errythema, heals 5-10, hospitalization not needed
scalds, sun burns
Partial thickness (2nd degree) burn
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
full thickness (3rd degree) burn
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
4th degree burn
full thickness that also involves muscles, tendons, ligaments, or bones.
If larynx is damaged what will you hear?
stridor
Fluid replacement with burns
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
First thing to check with burn victims
ABCs
establish airway - O2 100%
remove clothing
dont cool down too much
treat burn site with sterile dressing
Nutrition for burns
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
Rehab stage - starting to heal
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
Medications for burn children
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
Pulmonary complications of burns
PE, laryngeal edema, stridor, bact pneumonia
wound sepsis from burns
temp spikes - 24 hours before
drop in bp the next day
decrease in urine output
TX with lots of fluids
CNS complications of burns
hallucinations, LOC changes, seziures and coma due to F&E changes.
when to suspect that someone may be getting a contracture.
when they are laying in the same comfortable position a lot.
what to remember about the recipient site of a graft..
DONT touch with out an order !
commone from of abuse that children under 5 die from?
shaken baby syndrome - brain gets bounced back and forth - get a closed head injury or eye hemorrhage
whats a normal stressful event that leads to abuse?
potty training
who is usually the abuser?
a male figure (maybe boyfriend) that is left in charge of the children
They dont know normal growth and development
what to do when you suspect abuse?
Always report
call child protective services, even if physcian doesnt agree
and take pictures
suggestion to parents if cant get child to stop crying
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.
charcteristics of abused children
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.
How to work with an abused child?
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
who is usually the sexual abuser?
someone they know in an authoritive position - coach, priest
usually someone in the family knows about it if it is incest
Characteristics of sexually abused children
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
