Test 1 - Study GUide Flashcards
1
Q
Atraumatic Care and Suggestions for Care
A
- Minimizes or eliminates psychological and physical care experienced by children during care
- Based on “do no harm”
Interventions:
- Reduce/Prevent Painful procedures - therapeutic hugging, numbing techniques, keep parent near child, advocate for minimal blood draws
- Family-centered care: accommodations for parent, offer to stay for procedures
- Maintain home routine
- Encourage child to have security item
- Empower family to educate child
- Allow family to make choices when they can
2
Q
Child Life Specialist
A
Trained in developmental impact of illness, injury and trauma
Provides programs to prepare kids for hospitalization , surgery and anything that may be painful or distressing
- Therapeutic play
-Sibiling support - Nonmedical prep for tests, etc.
3
Q
Stages of Anxiety
A
Protest - child is separated, cries, agitated, anger
Despair - quiet w/o crying, depression, lack of interest, sad
Detachment - coping mechanisms form, may lead to developmental delay
4
Q
When does separation anxiety appear?
A
6 months of age when object permanence is developed
5
Q
Infant Hospitalization: What’s happening? Interventions
A
Experience separation anxiety, stranger anxiety and affected by routine change; need trust
Interventions:
- Parents room-in
- Keep home routine
- Comfort by holding, cuddling, swaddling
6
Q
Separation Anxiety
A
Develops by 6 months
7
Q
Toddler Hospitalization: What’s happening? Interventions
A
-Regression
-Separation anxiety
-Negative behavior - tantrums
-Fearful
Interventions:
- Room-in
- Bring Toys from home
- Keep home routine
- Allow child to participate in care
- Therapeutic play
-Ensure safe environment
- Offer praise
8
Q
Preschooler hospitalization: What’s happening? Interventions
A
- Views illness as punishment, feels shame, guilt and fear
-Preoperational thought - verbal expression may or may not be understood
Interventions:
- Room-in
- Magical Play - “straw on arm for medicine”
- Maintain routine
- Allow playtime with other children when possible
- Explain procedures on their level
9
Q
Functions of Play
A
physical, cognitive, emotional, social and moral
10
Q
Therapeutic Play
A
Deals with fears, concerns, stressors of health
- Stress reliever
- Pain reliever/distractor
- Measurement of illness
- Intervention
11
Q
What is considered a fever in pediatrics?
A
> 38C or 100.4F
12
Q
How do you administer acetaminophen in children?
A
10-15mg/kg/dose every 4-6 hours
Recheck fever in 1 hour
13
Q
Iburprofen in children
A
Only given to kids >6 months
Dosed at 5-10mg/kg/dose every 6-8 hours
Recheck fever in hour
14
Q
Why do we not give aspirin to kids?
A
Reyes syndrome
15
Q
Pediatric Cooling Measures
A
Remove excess clothing
Cooling room temperature
Cool compress to forehead
16
Q
Measuring Vital Signs in Infant/Toddlers
A
1) Respirations
2) Apical Heart Rate
3) Blood Pressure - allow preschool take take on doll
4) Rectal Temp - most invasive last ALWAYS
17
Q
Acute Pain
A
Pain associated with rapid onset of varying intensity
- Tissue damage that resolves with healing of injury
Examples - trauma, invasive procedures, sore throat, appendicitis, surgery
18
Q
Chronic Pain
A
Pain that continues past point of healing for injured tissue
Examples: abdominal pain, nonspecific headache, limb pain, chest pain
19
Q
FACES Pain Rating Scale
A
- Children 3-8
- 6 Illustrations from smiling to crying w/ frowning
- Nurse explains words under photo and asks child to id which face matches their pain
20
Q
FLACC Behavioral Pain Scale
A
- Assess pain when child can not accurately report pain
- 6months to 7yo
- Measures 5 parameters: facial expression, legs, activity, cry and consolability - scored as 0, 1, 2
- Max score is 10
- rFLACC used in nonverbal kids with cognitive impairment
21
Q
Nonpharmacologic Pain Management
A
- Relaxation - holding child, stroking child, speaking in soft manner, controlled breathing
- Distraction - counting, repeating specific words, music, playing games, bubbles, favorite stories, tv
- Heat/Cold packs
- Sucking/Sucrose - neonates
- Massage/Pressure
22
Q
Neonate Visual Acuity
A
20/100 - 20/400
23
Q
Age 2-3 Visual Acuity
A
20/50
24
Q
Visual acuity by age 6-7
A
Should be 20/20
25
Infant Ears
Eustachian tubes are shorter, wider, straighter and lie more horizontal in infants
- Ear infection incidence should decrease over time
26
Conjunctivitis: What is it? S/Sx? Treatment
Inflammation of Conjuctiva
Caused by bacteria, viral or allergic agent
Bacterial "pink eye" most common
S/Sx:
-red swollen eye
-excessive tearing
- clear, watery or yellow drainage
- eyelid crusting
Treatment
- Bacterial - antibiotic
- Allergic - antihistamine
- Viral - symptom management
27
Strabismus: What is it? Treatment? Complications?
Cross-eye/Misalignment of eyes - eyes turn inward or outward
Treatment: eye patching, surgery or corrective lenses
Complications: amblyopia, visual deficits
28
Amblyopia: What is it? Treatment? Type?
- Lazy eye
- Reduced vision in 1 or both eyes
Types: disuse (resulting in blindness)
Treatment: glasses/lenses, eye patches, surgery
29
Nystagmus: What is it? Common Causes?
- Rapid, irregular eye movement
- Bouncing of eye
- Requires eval by opthamalogist AND neurologist
Common Causes: Neurologic problem
30
Retinopathy of Prematurity: What is it? Common cause? Interventions?
- injury to developing capillaries in retina
- 2nd leading cause of blindness
Common Cause: oxygen therapy, maybe genetic
Interventions: shield newborn eyes from light, O2 only when needed
31
Ottis Media: What is it? Types? Cause by? S/Sx? Treatment?
- Middle ear infection
- Most common 6months-2 years
2 Types:
Acute OM
- S/Sx: fever, bulging, red tympanic membrane
- Caused by? streptococcus pneumoniae, h. influenzae
- Treatment? antibiotics, analgesic/antipyretic, pressure equalizing tympanostomy tubes
Ottis Media with Effusion
- fluid in middle ear space w/o s/sx of infection
- S/Sx: dull, retracted TM, fullness
Complications:
- Chronic OM
-Hearing Loss
-Meningitis
- Eardrum perforation
- Cystic mass (cholesteatoma)
32
Otitis Externa:
- Infected ear canal "swimmer's ear"
- Common Cause: pseudomonas aeruginosa, staphylococcus auerus, aspergillus
- Treated with steroid drop w/ antibiotic
33
Nose/Throat: Infants
- obligate nose breathers
- more susceptible to infection
- sinuses not developed
34
Nose/Throat: Newborn
Small nasal passages
More prone to obstruction
35
Children Tonsils/Adenoid Tissue
Enlarged
36
Nasopharyngitis: What is it? S/Sx? Treatment?
- Upper respiratory Infection
- Common Cold
S/Sx:
- 4 to 10 days
Treatment:
- Saline drops
- room humidification
- Antipyretics
- Increase fluid to thin mucus
37
Sinusitis:
- inflammation of paranasal sinuses
- Usually starts viral, but may turn to bacterial (sx>10 days)
- Dx based on history/physical
38
Influenza: What is it? S/Sx? Treatment?
- Viral infection
-lasts 4-5 days
S/sx:
- sudden fever/chills
- dry throat and nasal mucosa
- dry cough
- tendency toward hoarseness
Treatment:
- FLUIDS
- REST
- antipyretic, antitussive, prevention (flu vaccine)
39
Pharyngitis: What is it? S/Sx? Treatment?
- Viral or bacterial (group A beta-hymolytic streptococcus)
- Bacterial dx with throat culture
S/Sx:
- enlarged red tonsils
-sore throat
-headache
-FEVER
- ABDOMINAL PAIN
Treatment:
- Antibitoic for bacterial
- Fluids
- Saltwater Gargles
-Analgesic/antipyretic
- Tonsillectomy
40
Posttonsillectomy Care
1) Promote airway clearance - side-lying or prone position
2) Maintain fluid volume - discourage coughing, encourage fluids (NO citrus, brown or red)
3) Pain Relief - ice collar and analgesics (narcotic or not)
***frequent swallowing usually indicates bleeding***
41
Infectious Mononucleosis: cause, transmission, s/sx, treatment
Cause: epstein-barr virus (EBV)
Transmission: direct contact w/ saliva or blood
S/Sx:
- Fever
-Sore throat
- Posterior cervical lymphadenopathy
- Fatigue
- Enlarged spleen
Treatment:
- Supportive Care - NO CONTACT SPORTS due to enlarged spleen
42
Croup
- Affects larynx, trachea and bronchi
- characterized by hoarse, barking or brassy cough
- Usually manifests as URI - low grade fever for 1-3 days before croup symptoms are evident
43
Croup: Acute Laryngotracheobronchitis
- Viral, most Common, slow progression
- Most common cause is RSV
S/Sx:
- fever
- brassy, barking cough
- dyspnea
-restlessness
-irritable
Treatment:
- humidity
- nebulized
- corticosteroids
-
44
Croup: Acute Bacterial Tracheitis: What is it? S/Sx? Treatment
- Bacterial caused by staphylococcus, group a strep, haemophilus influenza
- Moderately progressive
S/Sx;
- URI
- HIGH fever
- Croupy cough
-STRIDOR
- Purulent Secretions
Treatment: Antibiotic
45
Croup: Acute Epiglottis: What is it? S/Sx? Treatment?
- LIFE THREATENING
- Bacterial
S/Sx:
- Dysphagia
- Drooling
- Dysphonia
- Distress - tripod position, tachypnea,
- HIGH FEVER
Treatment:
- NO SUPINE position
- DO NOT LEAVE ALONE
- NO THROAT CULTURES OR ANYTHING IN MOUTH
- EMERGENCY TRACH equipment MUST BE AVAILABLE
- nonrebreather masks
46
BronchiOLITIS: What is it? S/Sx? Treatment?
- RSV most common cause
- Inflammation of bronchioles
S/Sx:
- URI
- Tachypnea
- Retractions
- Thick nasal secretions
- Anorexia
- LOW grade fever
- Wheezing/crackles w/ auscultation
Treatment:
- Humidified O2
- IV FLUIDS
47
Pneumonia: What is it? Dx? S/Sx? Treatment?
- Viral, bacterial or due to foreign body aspiration/inhalation
- Most are bacterial
Dx: chest x-ray
S/Sx:
- cough
- fever
- abdominal pain
- headache
- adventitious breath sounds
Treatment:
- Chest physiotherapy
- REST, FLUIDS,
- Encourage coughing
- Antibiotic if bacterial
- Isolation
Prevention: Vaccine
48
Bronchitis: What is it? Treatment?
- Trachea inflammation and major bronchi
- URI, usually viral
Treatment:
- FLUIDS
- REST
- expectorant to loosen secretions
***We do not like to suppress cough, just want to break up secretions***
49
Tuberculosis: Caused by? Who has increased risk? S/Sx? Treatment?
- Caused by mycobacterium tuberculosis
Increased Risk: children with HIV
Dx: Skin test and sputum culture
S/Sx:
- malaise
- fever
- cough
- WEIGHT LOSS
- anorexia
Treatment:
- 6 to 9 months (must report to health department)
- Nutrition, chemotherapy, supportive
- Antibitoics
50
Foreign Body Aspiration: What is it? Complications? S/sx? Treatment?
Object usually in right main bronchus
Complications: aspiration pneumonia
S/Sx
- Sudden cough or gagging
- hoarseness
- croupy cough
- wheezing
- dyspnea
- cyanosis
Treatment:
- chest thrust
- back blows and abdominal thrust
- bronchoscopy
51
Signs of Respiratory Failure
Irritability
Lethargy
mottled color or cyanosis
Increase respiratory effort - dyspnea, tachypnea, nasal flaring, intercostal retraction
grunting
52
Allergic Rhinitis: what is it? complications?
Seasonal Allergies
Complications - asthma, sinusitits and odis media
53
Asthma: What is it? S/Sx? Treatment? Goals?
Heightened airway reactivity
S/Sx:
- wheezing
- cough
- tachypnea
Treatment:
- Smoking cessation
- Rescue: SABA: Albuterol Rescue (red inhaler)
- Maintenance: LABA, inhaled corticosteroid,
- Asthma Action Plan
Goal:
- Optimal pulmonary function
- Able to perform daily activities
- Participate in sports
54
What conditions does passive smoke exposure increase risk for?
Asthma
Allergic rhinitis
Ottis Media
Other respiratory conditions
55
Bronchopulmonary Dysplasia: What is it? S/Sx? Treatment?
AKA: Chronic Lung Disease
- Complication of prolonged o2 therapy - especially in
- preterm infants on ventilation
- Immature lungs most important factor
S/Sx:
- tachypnea
- wheezing
- rales
- tachycardia
- barrel chest
- pallor
- activity intolerance
- poor feeding
Treatment:
- Bronchodilators
- Corticosteroids
- Diuretics
-Anti-inflammatory
- Nutrition
56
Cystic Fibrosis: What is it? dx? S/sx? Treatment? Goals? COmplications?
Inherited Autosomal Recessive disorder of exocrine gland dysfunction
Abnormal mucous secretion and obstruction
Most common cause of chronic respiratory disease
Dx: gold standard: sweat chloride test (sodium and chloride); >60mEq is positive and test will be repeated; 72-hour stool collection
S/Sx:
- Salty
- Fatty Stools
- Profuse sweating
- clubbing
- Increased A-P chest diameter - barrel chested
-Thin Extremities/muscle wasting
Affected Systems: respiratory, GI, reproductive,
Complication - pancreatic fibrosis
Treatment:
- Pancreatic enzymes to prevent fatty stools
- Vitamin Supplements ADEK
- Antibiotics id'd by culture
- Mucolytics
- Chest physiotherapy
- O2
- High calorie diet, high in protein, low fat
- Preventative Vaccines
Goals: minimize pulmonary complications, adequate growth
57
Autosomal Recessive Disorders: What are they? How do you become carrier?
Both parents MUST pass on gene to child, if both parents are carriers there is a 25% chance of passing on gene
50% chance child can become carrier, to be carrier they must receive one dominant and one recessive gene
58
Pancreatic Enzyme Therapy
- Take before meals and snacks
- Adjusted based on stools
59
Apparent Life-Threatening Event: What is it? Common Causes?
Episode of apnea accompanied by COLOR CHANGE, LIMP MUSCLE TONE, CHOKING, GAGGING
Common Cause:
- prematurity
- sepsis
- seizures
- gastroesophageal reflux
- lower respiratory infection
- child abuse
60
Congenital Heart Disease
Defect in the heart or great vessels
Persistence of fetal structure after birth
Types:
Increased Pulmonic Flow: patent ductus arteriosus (PDA), Atrial Septal Defect (ASD), Ventricular Septal defect (VSD)
Decreased Flow: tetralogy of fallot, tricuspid atresia
Mange w/ indomethacin to close gap or surgery
S/Sx
- Tire easily
61
Tetrology of Fallout: 4 Defects, treatment, symptoms
Pulmonic stenosis
right ventricular hypertrophy
overriding aorta
ventricular septa defect
Treatment: surgery to improve oxygenation
S/Sx: TET spell when bending down
62
Hypercyanosis (TET) spells
- Acute cyanosis and hypoxia
- O2 requirements exceed blood supply
- Relieved by squatting or drawring up legs
63
Coarctation of the Aorta
- Blood pressure difference of 20mm between upper/lower extremities
S/Sx:
- Brachial/radial pulse full
- Femoral pulse weak/absent
Complication: congestive heart failure
64
Transpositon of the Great Vessel
Survival depends on foramen ovale remaining open
Symptoms appear at birth or soon after
Treatment: surgical correction
S/Sx: progressive cyanosis --> hypoxia --> acidosis
65
Heart Failure: Management, Medication
Medication: Digoxin, Diuretics
Nursing Management:
- Promote O2
- Support heart function
- Nutrition
- Promote Rest
Daily weights - Weight gain of more than .5kg/1lb is indicative of fluid retention
Monitor for digoxin toxicity
66
Digoxin Toxicity
Monitor every 6 hours
Therapeutic level is 0.8-2mg/dL
S/Sx: cardiac arrhythmias
67
Rheumatic Fever: Caused by, Dx, Major/Minor S/Sx
Caused by untreated group b strep
Dx based on Jones Criteria - 2 major or 1 major and 2 minor
Major S/Sx: joint arthritis, carditis, chorea, slurred speech, subcutaneous nodules
Minor: fever, elevated ESR, positive c-reactive protein, prolonged PR on ECG
Treatment:
- Pain - ***aspirin***
- Bedrest to decrease ESR
- Steroid
- Antibiotic - penicillin or erthromycin
- Monitor Heart
68
Dyslipidemia Hyperlipidemia/Hypercholesterolemia
Treatment:
- Decrease weight with diet/exercise NOT bp meds
Children ID'd during health screening
Complication: future coronary heart disease
69
Kawasaki Disease: What is it, S/Sx, treatment
Multisystem vasculitis
S/Sx: MUST have 5 out of 6
fever > 5 days, bilateral conjunctivitis, strawberry tongue, red palms, rash, peeling hands/feet, cervical lymphadenopathy
Treatment:
- IVIG/ IV immunoglobulin
- aspirin therapy
***20% of children develop cardiac sequelae*** - MI
70
Hypertension
Must be between 90th and 95th percentile on at least 3 occasions
Treat with diet/exercise (30-60 minutes day)
