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test 1 Flashcards

1
Q

what to consider when talking to patient

A

developmental age, not just chronological age.

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2
Q

how to make kids less stressed

A

prepare ahead of time. use a child specialist to show them around, show them what will be used, etc

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3
Q

versed

A

a med we can give them before we stick them with anything to have a amnesia effect

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4
Q

benefits of hospitalization

A

gain new coping skills, more socialization

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5
Q

what ages may be most stressed due to separation anxiety

A

6 months to 5 years

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6
Q

3 phases of separation

A

protest phase- clinging to parents, crying

despair phase- stop crying, regress

detachment phase- denial, could cause serious impact on parent attachment if parents dont visit much

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7
Q

late adolescence separation anxiety

A

starting at age 10 is when they tend to want there peers

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8
Q

how to manage parenteral absence

A

encourage them to stay overnight
get in routines
address comfort
get a baseline of child’s typical personality to tell if things are off

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9
Q

measures to help a infant

A

cuddling

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10
Q

measures to help a toddler

A

establish trust, prepare before

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11
Q

measures to help a preschooler

A

prepare before, match there personality

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12
Q

measures to help a school age kid

A

tell them why and how

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13
Q

measures to help a adolescent

A

talk to them, encourage peer support

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14
Q

why should you tell younger kids right before you have to do something painful

A

so they dont think about it being scary for hours before

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15
Q

care for family of peds patients

A

assess there needs
educate, offer support

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16
Q

atrumatic care

A

we try to stress them out as little as we can

do painful procedures in a treatment room so they don’t associate it with there own room

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17
Q

if a child is on isolation, what are things we can do

A

Consider dress up, window shades open so they can see around them, fun signs, have activities in the room

some kids may think this is a punishment, explain to them that its not

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18
Q

bright futures

A

national initiative to improve children’s health. we use this to make sure kids are progressing in the way they should be for there age

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19
Q

what are some issues in pediatrics that we can prevent

A

obesity
childhood injuries
violence
bullying
mental health problems

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20
Q

how to find out a family’s culture to care for them

A

Early on can ask a open ended question like tell me about your family to learn about their culture

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21
Q

primary goal social role

A

intimate, continued, face to face contact
more focused on behavior

ex- family, roommates

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22
Q

secondary groups social roles

A

these groups have limited, intermittent contact
generally less concern for members behavior
offers little support or pressure to conform

ex- teammates, SNA

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23
Q

if a family/culture is against something, what can you do

A

you dont do it, but it doesn’t mean you cant explain to them why its needed.
Look for other ways to help them

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24
Q

Growth

A

an increase in number and size of cells as they divide and synthesize new proteins, results in increased size and weight, more of physical changes

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25
Q

Development

A

a gradual change and expansion, low to advanced complexity. More so cognitive, such as learning, but could be physical

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26
Q

genes

A

basic unit of hereditary on a person chromosome

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27
Q

genomics

A

study of all of a persons genes

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28
Q

genetic defect issues

A

could cause issues with growth and development, especially heart defects

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29
Q

what should infants eat for the first 6 months

A

breast milk, formula

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30
Q

when can you introduce cow milk to a infant

A

12 months, but it needs to be whole milk

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31
Q

what are the live vaccines

A

MMR, varicella, rotavirus, intranasal influenza

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32
Q

how long should you ride in a rear facing seat

A

until as long as possible- until they outgrow it

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33
Q

measures to help with infant feeding difficulties: spitting up

A

frequent burping during and after feeds
position child on left side with head slightly elevated
stick binder under crib mattress to elevate to prevent spitting up when sleeping

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34
Q

failure to thrive

A

when kids fall off the growth charts, they arnt gaining weight as they should

possible NG tube or G tube needed, but issues need to be corrected first

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35
Q

colic (paroxysmal abdominal pain)

A

generally described as abdominal pain or cramping that is manifested by loud crying and drawing the legs up to the abdomen

occurs in 5% to 20% of infants

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36
Q

tips for colic

A

swaddling
hold baby on side, stomach or over shoulder (watch for SIDS)
shushing sounds (Imitates blood flowing near womb)
swinging
sucking

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37
Q

SIDS risk factors

A

Low birth weight, preemies, maternal substance use, inadequate prenatal care, smoking

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38
Q

apparent life threatening event (ALTE)

A

Near miss SIDS or abortion

diagnostics to determine possible cause, such as apnea

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39
Q

diaper dermatitis

A

peaks at 9-12 months (kids are going to the bathroom more)
from contact with irritant
adress wetness, pH and fecal irritants

use cream with 40% zinc to help

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40
Q

seborrheic dermatitis

A

cradle cap
could occur on scalp, ears, around mouth, or in inguinal region

From overactive oil glands. Treatment is focused on hygiene, shampoo baby’s head every day

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41
Q

what children are more at risk for serious complications

A

those on steroids/immunosuppressive therapy
generalized malignancy
immunologic disorders
infants less than 1
children with hemolytic disease

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42
Q

communicable diseases of childhood

A

chicken pox (varicella)
diphtheria
erythema infectious (fifth disease)
roseola infantum
measles (rubeola)
mumps
pertussis (whooping cough)
rubella (german measles)
scarlet fever/streptococcal pharyngitis

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43
Q

fifths disease

A

maculopapular rash on extremities and “slapped cheek” look
gets worse with being warm
feels fine

droplet precautions

dont take care of when pregnant

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44
Q

measles (rubeola)

A

Spread by droplets and airborne. These kids need to be in negative pressure room. Treatment is supportive. Keep them separated until 4th day of rash when they typically aren’t contagious anymore

symptoms include fever, malaise, coryza, cough, conjunctivitis, kopliks spots, rash, generalized lymphadenopathy

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45
Q

pertussis (whooping cough)

A

cough that is followed by a sudden high pitched noise, may be worse at night

Common in little babies. Prevention- TDAP shot. Treated by abx Zithromax and supportive care. Cough may last 4-6 weeks. Droplet precautions

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46
Q

chicken pox (varicella)

A

Always will have vesicles, papules and crust. may have fever and will be itchy

Acyclovir for med, antiviral. Shortens it but doesn’t prevent scaring. Supportive treatment

Airborne precautions- negative pressure room

All of those spots need to be crusted over before going back to school.
There is 2 rounds of this shot

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47
Q

scarlet fever

A

strawberry tongue, sore throat, rash, fever
caused by strep
Could cause acute glomernephritis
Bacterial. Give penicillin and supportive treatment
Droplet precautions

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48
Q

Mumps

A

may have fever, swollen painful parotid glands, possible ear pain

treatment is supportive
eat soft, bland foods

droplet precautions

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49
Q

roseola

A

Usually comes after some viral illness
Rash last about 2 days, doesn’t itch
Supportive treatment

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50
Q

rubella (german measels)

A

rash appears on face and rapidly spreads downward
No pregnant care givers
Droplet precautions for 7 days

can be prevented by vaccine

51
Q

scabies

A

infestation by mite, lesions are from the female depositing her eggs
causes significant itching
treated by permethrin cream

52
Q

pediculosis capitis

A

lice- parasite
seen in hair, behind ears, nape of neck
use permthrin rinse twice, a week apart

53
Q

ADHD

A

typical onset by age 7

Do best in a organized classroom with routine
Math and reading best in morning
Recess is a must
Structured environment at home and school

most common drug is a stimulant- side effects may be anorexia, htn, tachycardia

54
Q

anorexia nervosa

A

eating disorder consisting of severe weight loss
primarily in adolescent girls and young woman
life threatening

55
Q

bulimia nervosa

A

eating disorder characterized by binge eating, followed by ways to get rid of the food like laxative, throwing up

56
Q

management for eating disorders

A

reinstate normal nutrition, individual psychotherapy, resolution of the disturbed pattern of family interactions

watch for refeeding syndrome -If we rush to feed them too fast it could cause fluid and electrolyte issues

dr may do calorie counts, possibly NG tube needed depending on that

57
Q

infants erikson stage

A

trust vs mistrust

58
Q

toddlers Erickson stage

A

autonomy vs shame and dount

59
Q

preschool Eriksons stage

A

initiative vs guilt

60
Q

school age Ericksons stage

A

industry vs inferiority

61
Q

adolescent erickson stage

A

identity vs role confusion

62
Q

2 Ts of toddlers

A

toileting and tantrums

63
Q

people pleasers

A

preschoolers

64
Q

how do we learn

A

head to toe - cephalocaudal

trunk to extremities- proximodistal

65
Q

0-3 month milestone

A

holding head up and learning to control it
social smile (reflux)

66
Q

4-6 month milestone

A

rolling
separation anxiety. can recognize parents and strangers
raking grasp

67
Q

6-7 month milestone

A

sits unassisted

68
Q

7-9 months milestone

A

pincer grasp
object permanence
crawling

69
Q

10-12 month milestone

A

saying 3-5 words
walking

70
Q

when does anterior fontanelle close

A

18 months

71
Q

when does posterior fontanelle close

A

by 2 months

72
Q

abstract thinking

A

thinking logically
occurs in adolescents

73
Q

why do ages less than 3 months have a lower infection rate

A

maternal antibodies (if breastfeed)

pertussis is common in this age though

74
Q

why are peds more prone to resp. illness

A

diameter of airways is smaller
distance between structures is shorter, allowing for organisms to move rapidly
Eustachian tubes are short and open

toddlers and preschoolers have high rate of viral infections, immunity increases with age.

75
Q

peak age for resp. illness

A

6 months to 3 years old. They are more prone and more prone to react severely. They don’t have a great immune system

Why? Put things in there mouth, not enough good quality foods
Born premature puts them far more at risk for resp. illness

76
Q

what does upper resp tract consist of

A

oronasopharynx, pharynx, larynx, upper trachea

77
Q

what does lower respiratory tract consist of

A

lower trachea, bronchi, bronchioles, alveoli

78
Q

resp assessment of peds

A

may use accessory muscles in between the ribs

may say there stomach hurts but its really there chest (lungs are right next to tummy in kids anatomy)

auscultate lungs
assess for cough, cyanosis, resp rate, etc

79
Q

min age for ibuprofen and tylenol

A

ibuprofen is 6 months
Tylenols can be taken at birth

80
Q

ibuprofen dose for peds

A

10 mg/1 kg

81
Q

output/hr in kids less than 30kg

A

1 mL/kg/hr

82
Q

output/hr in kids greater than 30kg

A

30mL/hr

83
Q

1 goal for care management of resp illness

A

ease respiratory effort

84
Q

how to deffriniate the common cold vs allergies

A

Allergies will have itchiness, and they don’t cause fever.
Yellow/green discharge more common in cold, but could be sinus infection

85
Q

nasopharyngitis “common cold”

A

caused by numerous viruses, such as RSV, rhinovirus, etc.
over 200 strains

s/s- possible fever, cough, anorexia, irritability.
managed at home

86
Q

acute streptococcal pharyngitis

A

most common cause is Group A strep

s/s- sore throat, fever, possible rash.

treated by abx

possible risk for rheumatic fever

87
Q

abx for strep

A

The number one treatment is amoxicillin. A penicillin drug
Most easily abx with the fewest side effects. Not likely to cause life threatening reactions.
Most common side effects is rash/diarrhea
If you are allergic to penicillin you are allergic to this

88
Q

describe the scarlet fever rash

A

very pronounced on chest, groin, elbows. Sand paper like

89
Q

tonsilitis

A

inflammation of tonsils
happens from viruses and group A strep

concerns- easy to choke, difficulty breathing, gagging

90
Q

tonsil surgery post op care

A

worry about bleeding- look for scabbing that fell off and throwing up blood. This is emergent. You may also see them swallowing more frequently.
To help prevent scab falling off- over hydrating
Monitor for bleeding for 2 weeks

Don’t eat hot stuff. Eat cold things such as popsicles (not red foods as it could resemble blood)
Avoid dairy due to extra mucous

91
Q

what age can you get influenza vaccine

A

beginning at 6 months. The first time kids get this they need 2 doses a month apart, then will be yearly.

only given IM now

92
Q

otitis media

A

ear infection
from cold and common flu usually
treated by abx

prevent by not smoking around kids and blowing there nose when sick

93
Q

risk factors for otitis media

A

exposure to second hand smoke
bottle propping for feeds
being male

94
Q

abx treatment for otitis media

A

Treatment is amoxicillin.
If this doesn’t work then Augmentin- amoxicillin/clavulanate (massive GI upset).
If this still doesn’t work then ceftriaxone (Rocephin) - this drug is given IM or IV (IV if in hospital). They will need IM shots for 3 days. 2 shots- one in each leg, then this occurs the next 2 days. Ceftriaxone is a cephalosporin- worry about C diff

95
Q

when is the best time to suction stuffy kids

A

right before they eat

96
Q

infectious mononucleosis “mono”

A

from some sort of saliva share. Caused by Epstein Barr

this may take a month for symptoms to show

s/s- Symptoms are typically mild- general malaise, headache, low-grade fever. Some kids may develop splenomegaly- runs risk of spleen rupture.

If have splenomegaly- absolutely no contact sports for 3 months.

treatment is supportive

97
Q

croup syndrome

A

a symptom of another virus that causes swelling. Affects the larynx, trachea, and bronchi

characterized by hoarseness, barking cough, inspiratory stridor.

cold humid air helps

98
Q

acute epiglottis

A

Med emergency
A particular type of croup, Almost always caused by homophiles’ influenza B
can be prevented by the HIB vaccine

s/s- sore throat, pain, tripod positioning, fever, irritability, anxiety, drooling, difficulty swallowing, cherry red epiglottis

treated by abx ceftriaxone, family also gets treated for prevention

99
Q

why is acute epiglottis a medical emergency

A

Epigottis could spasm and close. Nobody can inspect the airway unless a crash cart is near. When we do have one near by, only one look, we cant keep looking

trach or intubation may be needed

100
Q

acute laryngotracheobronchitis (LTB)

A

Most common of the croup syndrome, occurs due to inflammation from result of this virus
generally affects younger kids

most commonly caused by parainfluenza

s/s -inspiratory stridor, suprasternal retractions, barking or “seal like” cough, increasing resp distress, and hypoxia

supportive care, not treated with abx
Can give oral steroids (dexamethasone), oxygen, racemic epinephrine nebulizer- will reduce inflammation (this effect will last 4 hours, so the kid will need monitored for 4 hours) only need the neb treatment if severe

101
Q

bronchitis

A

AKA tracheobronchitis
inflammation of trachea and bronchi
mild, self limiting

caused by viruses

s/s- dry cough

common with smoking/vaping

102
Q

Respiratory syncytial virus

A

common, acute, viral infection
common in winter and spring

s/s- runny nose, low grade fever, cough
when the lower airway is involved, symptoms such as crackles, dyspnea, wheezing, tachypnea

This is dangerous in a baby bc they have so many secretions they cant breathe, may end up developing bronchiolitis. Baby’s typically need admitted

Symptom management. Oxygen, NG tube, elevate HOB, humidified oxygen

103
Q

max L/min for nasal canula

A

Max L/min for nasal canula is 6. this is the preferred method, but is stats aren’t good enough we will need to use another O2 method

104
Q

pneumonia

A

inflammation of the pulmonary parenchyma
could be a primary disease or a complication.

s/s- cough, crackles, fever, chest pain

supportive and symptomatic care

105
Q

pertussis (whooping cough)

A

caused by bordetella pertussis.
highly contagious. Prevented by TDAP vaccine
highest incidence in spring and summer

Persistent cough followed by a whoop. Causes it so severe that you could break ribs, bruise and have blood shot eyes, hernias, pneumothorax. This can last for up to 8 weeks.

treated with abx erythromycin or zithromycin (zpack)

106
Q

Tuberculosis (TB)

A

Caused by mycobacterium tuberculosis

s/s- fever, night sweats, cough

treated with isoniazid. this drug is hepatotoxic so watch liver labs

107
Q

TB risk factors

A

most common in urban, low-income areas and among nonwhite racial and ethnic groups .
being immunosuppressed

108
Q

foreign body aspiration

A

common in children because they put random things in mouth, especially ages 1-3

109
Q

aspiration pneumonia

A

risk for child with feeding difficulties

s/s- deteriorating oxygenation, cough

110
Q

Acute resp distress syndrome (ARDS)

A

Caused by infection or injury
Fluid builds up into alveoli, causing less o2 to go to blood stream causing gas impairment

characterized by resp distress with hypoxia 72 hours after serious injury or surgery

treated by fixing the cause.

most common cause is smoke inhalation injury (from fires)

111
Q

smoke inhalation injury

A

heat- usually stops at epiglottis
chemical usually goes deep into lungs

pulse ox can detect carbon monoxide poisoning

therapeutic management. humidifying oxygen at 100%, CPT, bronchodilators, possible ventilation

112
Q

exposure to enviromental tobacco smoke

A

can lead to resp illness

Third hand Is also dangerous. Educate parent to change there clothes.
kids shouldnt be around smoke period

113
Q

nonrebreather

A

o2 needs to be on 12-15 L/min. the mask is closed, we don’t have outside air circulating with it

114
Q

asthma

A

chronic inflammatory disorder of the airways characterized by recurring symptoms, airway obstruction/edema, and bronchial hyper-responsiveness (spasms)

s/s- dyspnea, wheezing, and coughing

dx by pulmonary function test

meds- MDI, corticosteroids, beta blockers, anticholinergics (bronchodilators), leukotrienes

115
Q

cystic fibrosis: what is it

A

a genetic disorder affecting mainly the lungs and digestive system, caused by gene mutation.

Sodium and chloride don’t move across the cell membranes, resulting In thick mucus

116
Q

symptoms of CF

A

sweating
salty tasting skin
chronic cough
wheezing
SOB
inadequate growth and weight gain
greasy stools
meconium ileum- babys first stool is blocking ileum (often the first sign of CF)

117
Q

Diagnosis of CF

A

sweat chloride test >60.
we give them a med that makes them sweat, we use a sticker that collects sweat, then we measure how much chloride is in sweat

genetic testing

most cases are found by age 2

118
Q

step by step order of meds for CF

A

Step by step order of meds. This is done 2-3x daily
1. Albuterol and Atrovent inhaler- bronchodilators
2. Pulmozyme- mucolytic. Breaks down the DNA of mucus (we need to open them up before we get to mucus)
3. Tobramycin- inhaled abx. Attacks the bacteria
4. Pulmicort- steroid. All of these previous meds irritates the lungs, now we are soothing the inflammtion.

119
Q

treatment for CF

A

lots of meds. abx may be needed for infection

fat soluble vitamins - A,D,E and K- these patients dont absorb fat so we need to supplement that and minerals
minerals- Ca, Fe, NaCl, Zn

pancreatic enzyme supplement due to pancreas being blocked- cant release enzymes

high calorie, high protein diet

airway clearance techniques such as chest physiotherapy or vest

120
Q

can a lung transplant cure CF

A

it may help, but wont cure.
it is difficult to get on transplant list

121
Q

nursing considerations for CF

A

ask if they are experiencing a change in symptoms
asses resp status, appetite, weight, bowel habits (may be constipated)

Pts may have clubbing

do daily weights, continuous pulse ox

G tube is often needed

122
Q

why do we need to keep CF patients away from other CF patients

A

They could spread a new bacteria to the other one, such as pseudomonas aeruginosa, which could create complications.

123
Q

why do we need to do chest PT for CF patients

A

we need to get the mucus moving, otherwise it would sit and become infectious

peds (4 decks)

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