Test 1 - Study GUide Flashcards by Megan Henning

Atraumatic Care and Suggestions for Care

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

How well did you know this?

Not at all

Perfectly

Child Life Specialist

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.

How well did you know this?

Not at all

Perfectly

Stages of Anxiety

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

How well did you know this?

Not at all

Perfectly

When does separation anxiety appear?

6 months of age when object permanence is developed

How well did you know this?

Not at all

Perfectly

Infant Hospitalization: What’s happening? Interventions

Experience separation anxiety, stranger anxiety and affected by routine change; need trust

Interventions:

Parents room-in
Keep home routine
Comfort by holding, cuddling, swaddling

How well did you know this?

Not at all

Perfectly

Separation Anxiety

Develops by 6 months

How well did you know this?

Not at all

Perfectly

Toddler Hospitalization: What’s happening? Interventions

-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

How well did you know this?

Not at all

Perfectly

Preschooler hospitalization: What’s happening? Interventions

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

How well did you know this?

Not at all

Perfectly

Functions of Play

physical, cognitive, emotional, social and moral

How well did you know this?

Not at all

Perfectly

Therapeutic Play

Deals with fears, concerns, stressors of health

Stress reliever
Pain reliever/distractor
Measurement of illness
Intervention

How well did you know this?

Not at all

Perfectly

What is considered a fever in pediatrics?

> 38C or 100.4F

How well did you know this?

Not at all

Perfectly

How do you administer acetaminophen in children?

10-15mg/kg/dose every 4-6 hours
Recheck fever in 1 hour

How well did you know this?

Not at all

Perfectly

Iburprofen in children

Only given to kids >6 months
Dosed at 5-10mg/kg/dose every 6-8 hours
Recheck fever in hour

How well did you know this?

Not at all

Perfectly

Why do we not give aspirin to kids?

Reyes syndrome

How well did you know this?

Not at all

Perfectly

Pediatric Cooling Measures

Remove excess clothing
Cooling room temperature
Cool compress to forehead

How well did you know this?

Not at all

Perfectly

Measuring Vital Signs in Infant/Toddlers

1) Respirations
2) Apical Heart Rate
3) Blood Pressure - allow preschool take take on doll
4) Rectal Temp - most invasive last ALWAYS

How well did you know this?

Not at all

Perfectly

Acute Pain

Pain associated with rapid onset of varying intensity

Tissue damage that resolves with healing of injury

Examples - trauma, invasive procedures, sore throat, appendicitis, surgery

How well did you know this?

Not at all

Perfectly

Chronic Pain

Pain that continues past point of healing for injured tissue

Examples: abdominal pain, nonspecific headache, limb pain, chest pain

How well did you know this?

Not at all

Perfectly

FACES Pain Rating Scale

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

How well did you know this?

Not at all

Perfectly

FLACC Behavioral Pain Scale

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

How well did you know this?

Not at all

Perfectly

Nonpharmacologic Pain Management

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

How well did you know this?

Not at all

Perfectly

Neonate Visual Acuity

20/100 - 20/400

How well did you know this?

Not at all

Perfectly

Age 2-3 Visual Acuity

20/50

How well did you know this?

Not at all

Perfectly

Visual acuity by age 6-7

Should be 20/20

How well did you know this?

Not at all

Perfectly

Infant Ears

Eustachian tubes are shorter, wider, straighter and lie more horizontal in infants

Ear infection incidence should decrease over time

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Nystagmus: What is it? Common Causes?

Rapid, irregular eye movement
Bouncing of eye
Requires eval by opthamalogist AND neurologist

Common Causes: Neurologic problem

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

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)

Otitis Externa:

Infected ear canal “swimmer’s ear”
Common Cause: pseudomonas aeruginosa, staphylococcus auerus, aspergillus
Treated with steroid drop w/ antibiotic

Nose/Throat: Infants

obligate nose breathers
more susceptible to infection
sinuses not developed

Nose/Throat: Newborn

Small nasal passages
More prone to obstruction

Children Tonsils/Adenoid Tissue

Enlarged

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

Sinusitis:

inflammation of paranasal sinuses
Usually starts viral, but may turn to bacterial (sx>10 days)
Dx based on history/physical

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)

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

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

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

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

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

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

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

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

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

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

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

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

Signs of Respiratory Failure

Irritability
Lethargy
mottled color or cyanosis
Increase respiratory effort - dyspnea, tachypnea, nasal flaring, intercostal retraction
grunting

Allergic Rhinitis: what is it? complications?

Seasonal Allergies

Complications - asthma, sinusitits and odis media

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

What conditions does passive smoke exposure increase risk for?

Asthma
Allergic rhinitis
Ottis Media
Other respiratory conditions

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

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

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

Pancreatic Enzyme Therapy

Take before meals and snacks
Adjusted based on stools

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

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

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

Hypercyanosis (TET) spells

Acute cyanosis and hypoxia
O2 requirements exceed blood supply
Relieved by squatting or drawring up legs

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

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

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

Digoxin Toxicity

Monitor every 6 hours
Therapeutic level is 0.8-2mg/dL

S/Sx: cardiac arrhythmias

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

Dyslipidemia Hyperlipidemia/Hypercholesterolemia

Treatment:
- Decrease weight with diet/exercise NOT bp meds

Children ID’d during health screening

Complication: future coronary heart disease

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

Hypertension

Must be between 90th and 95th percentile on at least 3 occasions

Treat with diet/exercise (30-60 minutes day)

Brainscape's Knowledge GenomeTM

Test 1 - Study GUide Flashcards

Brainscape's Knowledge Genome^TM