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Peds > Test 1 - Study GUide > Flashcards

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
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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.
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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

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4
Q

When does separation anxiety appear?

A

6 months of age when object permanence is developed

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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
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6
Q

Separation Anxiety

A

Develops by 6 months

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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

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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

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9
Q

Functions of Play

A

physical, cognitive, emotional, social and moral

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10
Q

Therapeutic Play

A

Deals with fears, concerns, stressors of health

  • Stress reliever
  • Pain reliever/distractor
  • Measurement of illness
  • Intervention
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11
Q

What is considered a fever in pediatrics?

A

> 38C or 100.4F

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12
Q

How do you administer acetaminophen in children?

A

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

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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

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14
Q

Why do we not give aspirin to kids?

A

Reyes syndrome

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15
Q

Pediatric Cooling Measures

A

Remove excess clothing
Cooling room temperature
Cool compress to forehead

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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

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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

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18
Q

Chronic Pain

A

Pain that continues past point of healing for injured tissue

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

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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
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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
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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
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22
Q

Neonate Visual Acuity

A

20/100 - 20/400

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23
Q

Age 2-3 Visual Acuity

A

20/50

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24
Q

Visual acuity by age 6-7

A

Should be 20/20

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25
Q

Infant Ears

A

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

  • Ear infection incidence should decrease over time
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26
Q

Conjunctivitis: What is it? S/Sx? Treatment

A

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

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27
Q

Strabismus: What is it? Treatment? Complications?

A

Cross-eye/Misalignment of eyes - eyes turn inward or outward

Treatment: eye patching, surgery or corrective lenses

Complications: amblyopia, visual deficits

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28
Q

Amblyopia: What is it? Treatment? Type?

A
  • Lazy eye
  • Reduced vision in 1 or both eyes

Types: disuse (resulting in blindness)

Treatment: glasses/lenses, eye patches, surgery

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29
Q

Nystagmus: What is it? Common Causes?

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

Common Causes: Neurologic problem

30
Q

Retinopathy of Prematurity: What is it? Common cause? Interventions?

A
  • 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
Q

Ottis Media: What is it? Types? Cause by? S/Sx? Treatment?

A
  • 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
Q

Otitis Externa:

A
  • Infected ear canal “swimmer’s ear”
  • Common Cause: pseudomonas aeruginosa, staphylococcus auerus, aspergillus
  • Treated with steroid drop w/ antibiotic
33
Q

Nose/Throat: Infants

A
  • obligate nose breathers
  • more susceptible to infection
  • sinuses not developed
34
Q

Nose/Throat: Newborn

A

Small nasal passages
More prone to obstruction

35
Q

Children Tonsils/Adenoid Tissue

A

Enlarged

36
Q

Nasopharyngitis: What is it? S/Sx? Treatment?

A
  • Upper respiratory Infection
  • Common Cold

S/Sx:
- 4 to 10 days

Treatment:
- Saline drops
- room humidification
- Antipyretics
- Increase fluid to thin mucus

37
Q

Sinusitis:

A
  • inflammation of paranasal sinuses
  • Usually starts viral, but may turn to bacterial (sx>10 days)
  • Dx based on history/physical
38
Q

Influenza: What is it? S/Sx? Treatment?

A
  • 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
Q

Pharyngitis: What is it? S/Sx? Treatment?

A
  • 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
Q

Posttonsillectomy Care

A

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
Q

Infectious Mononucleosis: cause, transmission, s/sx, treatment

A

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
Q

Croup

A
  • 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
Q

Croup: Acute Laryngotracheobronchitis

A
  • Viral, most Common, slow progression
  • Most common cause is RSV

S/Sx:
- fever
- brassy, barking cough
- dyspnea
-restlessness
-irritable

Treatment:
- humidity
- nebulized
- corticosteroids

-

44
Q

Croup: Acute Bacterial Tracheitis: What is it? S/Sx? Treatment

A
  • Bacterial caused by staphylococcus, group a strep, haemophilus influenza
  • Moderately progressive

S/Sx;
- URI
- HIGH fever
- Croupy cough
-STRIDOR
- Purulent Secretions

Treatment: Antibiotic

45
Q

Croup: Acute Epiglottis: What is it? S/Sx? Treatment?

A
  • 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
Q

BronchiOLITIS: What is it? S/Sx? Treatment?

A
  • 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
Q

Pneumonia: What is it? Dx? S/Sx? Treatment?

A
  • 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
Q

Bronchitis: What is it? Treatment?

A
  • 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
Q

Tuberculosis: Caused by? Who has increased risk? S/Sx? Treatment?

A
  • 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
Q

Foreign Body Aspiration: What is it? Complications? S/sx? Treatment?

A

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
Q

Signs of Respiratory Failure

A

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

52
Q

Allergic Rhinitis: what is it? complications?

A

Seasonal Allergies

Complications - asthma, sinusitits and odis media

53
Q

Asthma: What is it? S/Sx? Treatment? Goals?

A

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
Q

What conditions does passive smoke exposure increase risk for?

A

Asthma
Allergic rhinitis
Ottis Media
Other respiratory conditions

55
Q

Bronchopulmonary Dysplasia: What is it? S/Sx? Treatment?

A

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
Q

Cystic Fibrosis: What is it? dx? S/sx? Treatment? Goals? COmplications?

A

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
Q

Autosomal Recessive Disorders: What are they? How do you become carrier?

A

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
Q

Pancreatic Enzyme Therapy

A
  • Take before meals and snacks
  • Adjusted based on stools
59
Q

Apparent Life-Threatening Event: What is it? Common Causes?

A

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
Q

Congenital Heart Disease

A

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
Q

Tetrology of Fallout: 4 Defects, treatment, symptoms

A

Pulmonic stenosis
right ventricular hypertrophy
overriding aorta
ventricular septa defect

Treatment: surgery to improve oxygenation

S/Sx: TET spell when bending down

62
Q

Hypercyanosis (TET) spells

A
  • Acute cyanosis and hypoxia
  • O2 requirements exceed blood supply
  • Relieved by squatting or drawring up legs
63
Q

Coarctation of the Aorta

A
  • Blood pressure difference of 20mm between upper/lower extremities

S/Sx:
- Brachial/radial pulse full
- Femoral pulse weak/absent

Complication: congestive heart failure

64
Q

Transpositon of the Great Vessel

A

Survival depends on foramen ovale remaining open
Symptoms appear at birth or soon after

Treatment: surgical correction

S/Sx: progressive cyanosis –> hypoxia –> acidosis

65
Q

Heart Failure: Management, Medication

A

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
Q

Digoxin Toxicity

A

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

S/Sx: cardiac arrhythmias

67
Q

Rheumatic Fever: Caused by, Dx, Major/Minor S/Sx

A

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
Q

Dyslipidemia Hyperlipidemia/Hypercholesterolemia

A

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

Children ID’d during health screening

Complication: future coronary heart disease

69
Q

Kawasaki Disease: What is it, S/Sx, treatment

A

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
Q

Hypertension

A

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

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

Peds (3 decks)

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