test 1 Flashcards
what to consider when talking to patient
developmental age, not just chronological age.
how to make kids less stressed
prepare ahead of time. use a child specialist to show them around, show them what will be used, etc
versed
a med we can give them before we stick them with anything to have a amnesia effect
benefits of hospitalization
gain new coping skills, more socialization
what ages may be most stressed due to separation anxiety
6 months to 5 years
3 phases of separation
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
late adolescence separation anxiety
starting at age 10 is when they tend to want there peers
how to manage parenteral absence
encourage them to stay overnight
get in routines
address comfort
get a baseline of child’s typical personality to tell if things are off
measures to help a infant
cuddling
measures to help a toddler
establish trust, prepare before
measures to help a preschooler
prepare before, match there personality
measures to help a school age kid
tell them why and how
measures to help a adolescent
talk to them, encourage peer support
why should you tell younger kids right before you have to do something painful
so they dont think about it being scary for hours before
care for family of peds patients
assess there needs
educate, offer support
atrumatic care
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
if a child is on isolation, what are things we can do
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
bright futures
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
what are some issues in pediatrics that we can prevent
obesity
childhood injuries
violence
bullying
mental health problems
how to find out a family’s culture to care for them
Early on can ask a open ended question like tell me about your family to learn about their culture
primary goal social role
intimate, continued, face to face contact
more focused on behavior
ex- family, roommates
secondary groups social roles
these groups have limited, intermittent contact
generally less concern for members behavior
offers little support or pressure to conform
ex- teammates, SNA
if a family/culture is against something, what can you do
you dont do it, but it doesn’t mean you cant explain to them why its needed.
Look for other ways to help them
Growth
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
Development
a gradual change and expansion, low to advanced complexity. More so cognitive, such as learning, but could be physical
genes
basic unit of hereditary on a person chromosome
genomics
study of all of a persons genes
genetic defect issues
could cause issues with growth and development, especially heart defects
what should infants eat for the first 6 months
breast milk, formula
when can you introduce cow milk to a infant
12 months, but it needs to be whole milk
what are the live vaccines
MMR, varicella, rotavirus, intranasal influenza
how long should you ride in a rear facing seat
until as long as possible- until they outgrow it
measures to help with infant feeding difficulties: spitting up
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
failure to thrive
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
colic (paroxysmal abdominal pain)
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
tips for colic
swaddling
hold baby on side, stomach or over shoulder (watch for SIDS)
shushing sounds (Imitates blood flowing near womb)
swinging
sucking
SIDS risk factors
Low birth weight, preemies, maternal substance use, inadequate prenatal care, smoking
apparent life threatening event (ALTE)
Near miss SIDS or abortion
diagnostics to determine possible cause, such as apnea
diaper dermatitis
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
seborrheic dermatitis
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
what children are more at risk for serious complications
those on steroids/immunosuppressive therapy
generalized malignancy
immunologic disorders
infants less than 1
children with hemolytic disease
communicable diseases of childhood
chicken pox (varicella)
diphtheria
erythema infectious (fifth disease)
roseola infantum
measles (rubeola)
mumps
pertussis (whooping cough)
rubella (german measles)
scarlet fever/streptococcal pharyngitis
fifths disease
maculopapular rash on extremities and “slapped cheek” look
gets worse with being warm
feels fine
droplet precautions
dont take care of when pregnant
measles (rubeola)
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
pertussis (whooping cough)
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
chicken pox (varicella)
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
scarlet fever
strawberry tongue, sore throat, rash, fever
caused by strep
Could cause acute glomernephritis
Bacterial. Give penicillin and supportive treatment
Droplet precautions
Mumps
may have fever, swollen painful parotid glands, possible ear pain
treatment is supportive
eat soft, bland foods
droplet precautions
roseola
Usually comes after some viral illness
Rash last about 2 days, doesn’t itch
Supportive treatment
rubella (german measels)
rash appears on face and rapidly spreads downward
No pregnant care givers
Droplet precautions for 7 days
can be prevented by vaccine
scabies
infestation by mite, lesions are from the female depositing her eggs
causes significant itching
treated by permethrin cream
pediculosis capitis
lice- parasite
seen in hair, behind ears, nape of neck
use permthrin rinse twice, a week apart
ADHD
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
anorexia nervosa
eating disorder consisting of severe weight loss
primarily in adolescent girls and young woman
life threatening
bulimia nervosa
eating disorder characterized by binge eating, followed by ways to get rid of the food like laxative, throwing up
management for eating disorders
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
infants erikson stage
trust vs mistrust
toddlers Erickson stage
autonomy vs shame and dount
preschool Eriksons stage
initiative vs guilt
school age Ericksons stage
industry vs inferiority
adolescent erickson stage
identity vs role confusion
2 Ts of toddlers
toileting and tantrums
people pleasers
preschoolers
how do we learn
head to toe - cephalocaudal
trunk to extremities- proximodistal
0-3 month milestone
holding head up and learning to control it
social smile (reflux)
4-6 month milestone
rolling
separation anxiety. can recognize parents and strangers
raking grasp
6-7 month milestone
sits unassisted
7-9 months milestone
pincer grasp
object permanence
crawling
10-12 month milestone
saying 3-5 words
walking
when does anterior fontanelle close
18 months
when does posterior fontanelle close
by 2 months
abstract thinking
thinking logically
occurs in adolescents
why do ages less than 3 months have a lower infection rate
maternal antibodies (if breastfeed)
pertussis is common in this age though
why are peds more prone to resp. illness
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.
peak age for resp. illness
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
what does upper resp tract consist of
oronasopharynx, pharynx, larynx, upper trachea
what does lower respiratory tract consist of
lower trachea, bronchi, bronchioles, alveoli
resp assessment of peds
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
min age for ibuprofen and tylenol
ibuprofen is 6 months
Tylenols can be taken at birth
ibuprofen dose for peds
10 mg/1 kg
output/hr in kids less than 30kg
1 mL/kg/hr
output/hr in kids greater than 30kg
30mL/hr
1 goal for care management of resp illness
ease respiratory effort
how to deffriniate the common cold vs allergies
Allergies will have itchiness, and they don’t cause fever.
Yellow/green discharge more common in cold, but could be sinus infection
nasopharyngitis “common cold”
caused by numerous viruses, such as RSV, rhinovirus, etc.
over 200 strains
s/s- possible fever, cough, anorexia, irritability.
managed at home
acute streptococcal pharyngitis
most common cause is Group A strep
s/s- sore throat, fever, possible rash.
treated by abx
possible risk for rheumatic fever
abx for strep
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
describe the scarlet fever rash
very pronounced on chest, groin, elbows. Sand paper like
tonsilitis
inflammation of tonsils
happens from viruses and group A strep
concerns- easy to choke, difficulty breathing, gagging
tonsil surgery post op care
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
what age can you get influenza vaccine
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
otitis media
ear infection
from cold and common flu usually
treated by abx
prevent by not smoking around kids and blowing there nose when sick
risk factors for otitis media
exposure to second hand smoke
bottle propping for feeds
being male
abx treatment for otitis media
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
when is the best time to suction stuffy kids
right before they eat
infectious mononucleosis “mono”
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
croup syndrome
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
acute epiglottis
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
why is acute epiglottis a medical emergency
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
acute laryngotracheobronchitis (LTB)
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
bronchitis
AKA tracheobronchitis
inflammation of trachea and bronchi
mild, self limiting
caused by viruses
s/s- dry cough
common with smoking/vaping
Respiratory syncytial virus
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
max L/min for nasal canula
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
pneumonia
inflammation of the pulmonary parenchyma
could be a primary disease or a complication.
s/s- cough, crackles, fever, chest pain
supportive and symptomatic care
pertussis (whooping cough)
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)
Tuberculosis (TB)
Caused by mycobacterium tuberculosis
s/s- fever, night sweats, cough
treated with isoniazid. this drug is hepatotoxic so watch liver labs
TB risk factors
most common in urban, low-income areas and among nonwhite racial and ethnic groups .
being immunosuppressed
foreign body aspiration
common in children because they put random things in mouth, especially ages 1-3
aspiration pneumonia
risk for child with feeding difficulties
s/s- deteriorating oxygenation, cough
Acute resp distress syndrome (ARDS)
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)
smoke inhalation injury
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
exposure to enviromental tobacco smoke
can lead to resp illness
Third hand Is also dangerous. Educate parent to change there clothes.
kids shouldnt be around smoke period
nonrebreather
o2 needs to be on 12-15 L/min. the mask is closed, we don’t have outside air circulating with it
asthma
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
cystic fibrosis: what is it
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
symptoms of CF
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)
Diagnosis of CF
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
step by step order of meds for CF
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.
treatment for CF
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
can a lung transplant cure CF
it may help, but wont cure.
it is difficult to get on transplant list
nursing considerations for CF
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
why do we need to keep CF patients away from other CF patients
They could spread a new bacteria to the other one, such as pseudomonas aeruginosa, which could create complications.
why do we need to do chest PT for CF patients
we need to get the mucus moving, otherwise it would sit and become infectious
