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Nurs 158- Pediatrics > Week 2 Content > Flashcards

Week 2 Content Flashcards

1
Q

IM injections for kids 3 years+ location

A

deltoid

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2
Q

Preschooler Growth

  • More _______ posture
  • Each year gains about ___ lbs
  • Each year gains about ___ inches in height
A
  • More slender posture
  • Each year gains about 5 lbs
  • Each year gains about 2.5 inches in height
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3
Q

Preschoolers SOCIAL/Cognitive progession

Learns ______ and shapes
Learns ________ identity

A

Learns colors and shapes
Learns sexual identity

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4
Q

Preschoolers: Physical: LEARN

Learns to ____ jump skip and hop
Rides a ________ -3yr
Can use ________ 4yr

A

Learns to run jump skip and hop
Rides a tricycle -3yr
Can use scissors 4yr

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5
Q

3-6 y.o safety

  • _______ safety
  • Helmets
  • _______ safety
  • ________ safety
  • Appropriate ____ Seat
  • Nutrition
  • _______ Times
A
  • Traffic safety
  • Helmets
  • Water safety
  • Stranger safety
  • Appropriate Car Seat
  • Nutrition
  • Screen Times
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6
Q

Preschooler DEVELOPMENT (theories)

SOCIAL - Erikson’s __________________

COGNITIVE - Piaget’s - _______________

A

SOCIAL - Erikson’s Initiative Vs Guilt

COGNITIVE - Piaget’s - Still pre-operational

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7
Q

Erikson—SOCIAL- Initiative vs Guilt

Example: Small successes with performance for example “when playing games” builds confidence and supports initiative to __________________ - When a child fails due to inappropriate expectations leads to _____ and loss of initiative

A

Example: Small successes with performance for example “when playing games” builds confidence and supports initiative to try new activities- When a child fails due to inappropriate expectations leads to guilt and loss of initiative

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8
Q

Piaget—Cognitive- Preoperational Thought (last 2-7 years)

Varying development during preschool years.
Pretends, ___________ is developing
Separation from Parents during Hospitalization
huge _______ during this stage.

A

Varying development during preschool years.
Pretends, Imagination is developing
Separation from Parents during Hospitalization
huge FEARS during this stage.

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9
Q

Preschooler : CARE ISSUES

Very ___________ : Thinks they cause their own illnesses by being bad

Thinks painful procedures are ___________

Fear of mutilation: BANDAIDES ARE GOOD

A

Very egocentric: Thinks they cause their own illnesses by being bad

Thinks painful procedures are punishment

Fear of mutilation: BANDAIDES ARE GOOD

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10
Q

Preschooler - ______________ is beneficial- for example show IV procedure using a doll .
Also helps for them to handle medical equipment

A

Medical play is beneficial- for example show IV procedure using a doll .
Also helps for them to handle medical equipment

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11
Q

Preschool age - pain tool

_________________

A

Wong Baker Faces

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12
Q

Well Preschooler visits:
Goal - pick up _______ _______: Interventions EARLY

A

Goal - pick up delays early: Interventions EARLY

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13
Q

Instructions for Use of FACES Pain Tool

Explain to the child that each face represents a person who has no pain (hurt), or some, or a lot of pain.

“Face 0 doesn’t hurt at all. Face 2 hurts just a little
bit. Face 4 hurts a little bit more” and so on.

A

Explain to the child that each face represents a person who has no pain (hurt), or some, or a lot of pain.

“Face 0 doesn’t hurt at all. Face 2 hurts just a little
bit. Face 4 hurts a little bit more” and so on.

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14
Q

Preschooler and Pain

  • ___________ can be a useful tool at this age- books, music, IPAD… for painful procedures
  • May ______ pain if they fear a shot
A
  • Distraction can be a useful tool at this age- books, music, IPAD… for painful procedures
  • May deny pain if they fear a shot
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15
Q

Pain - Children as young as ___ years of age are able to report the location and degree of pain

A

3

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16
Q

Remember that Chronic Pain such as Sickle Cell Pain
does not always present with _______________________________________

A

physiologic responses such as ↑RR and HR.

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17
Q

Leukemia - Cancer of the :

A

Blood and Bone Marrow

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18
Q

__________ - Among children (ages 0 to 14 years), the most common types of cancer

A

Leukemia

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19
Q

Leukemia is the Most __________ ___________ _________

A

Common Childhood Cancer

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20
Q

Leukemia: 4 Major Types- all have proliferation of immature WBCs

Type of Leukemia based mainly on whether:
*the leukemia is _______ or ________
*where the leukemia starts in ____________ or _____________

A

Type of Leukemia based mainly on whether:
*the leukemia is acute or chronic
*where the leukemia starts in myeloid cells or lymphoid cells.

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21
Q

Leukemia : 4 Major Types

  • __________________ This is the most common type of leukemia in young children. (most commonly dx 2-5 years of age)
  • ___________________ is the most common acute type of leukemia in adults
  • Chronic lymphocytic leukemia (CLL)
  • Chronic myelogenous leukemia (CML)
A
  • Acute lymphocytic leukemia (ALL). This is the most common type of leukemia in young children. (most commonly dx 2-5 years of age)
  • Acute myeloid leukemia (AML) is the most common acute type of leukemia in adults
  • Chronic lymphocytic leukemia (CLL)
  • Chronic myelogenous leukemia (CML)
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22
Q

Blood Cell Types: effected by Leukemia

Platelets: Also known as Thrombocytes

Platelets play a major role in ____________.
Low platelet count is ________________.

A

Platelets play a major role in blood clotting.
Low platelet count is THROMBOCYTOPENIA

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23
Q

Untreated Leukemia
* White blood cells never reach maturity and have no ability to fight infection
* The ___________ of white blood cells will invade (basically clog up) the liver , kidney and spleen and cause multi _______ _________
* Spleen over reacts removing good red blood cells and platelets

A
  • White blood cells never reach maturity and have no ability to fight infection
  • The proliferation of white blood cells will invade (basically clog up) the liver , kidney and spleen and cause multi organ failure
  • Spleen over reacts removing good red blood cells and platelets
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24
Q

Lifespan of a platelet is ________

A

5-7 days

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25
Q

Blood cell types: effected by Leukemia

  • RBC’s are responsible for _____________ _____________________. (lifespan is about 120 days)
A

oxygenation of bodily tissues

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26
Q

Blood cell types: effected by Leukemia

  • WBC’s responsible for __________ ________:
  • Neutrophils – (lifespan is 6-8 hrs)
  • Monocytes- (lifespan is 8 hrs.)
  • Eosinophils-mount the __________ response- (lifespan is 5-24 hrs
  • WBC’s that make antibodies
  • Lymphocytes – B and T cells (lifespan 1 week to a few months)
  • Monocytes –kill and eats micro organisms and also boost immune system (lifespan 1-5 days)
A
  • WBC’s responsible for fighting infection:
  • Neutrophils – (lifespan is 6-8 hrs)
  • Monocytes- (lifespan is 8 hrs.)
  • Eosinophils-mount the allergic response- (lifespan is 5-24 hrs
  • WBC’s that make antibodies
  • Lymphocytes – B and T cells (lifespan 1 week to a few months)
  • Monocytes –kill and eats micro organisms and also boost immune system (lifespan 1-5 days)
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27
Q

CBC : Patient with ALL

Patients present with signs of bone marrow failure

________- Pallor, weakness, persistent fatigue lethargy
______________ – bruising, petechial and bleeding
__________-fever and infection
Bone and joint pain
↑Liver and lymph nodes
Bone Marrow Aspirate will 80-90% immature Blasts (normal is 5%)

A

Anemia- Pallor, weakness, persistent fatigue lethargy
Thrombocytopenia – bruising, petechial and bleeding
Neutropenia-fever and infection
Bone and joint pain
↑Liver and lymph nodes
Bone Marrow Aspirate will 80-90% immature Blasts (normal is 5%)

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28
Q

______ _________ __________

*Will diagnose the type of Leukemia
*Once type of Leukemia is determined specific treatment can begin.

A

Bone Marrow Aspirate

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29
Q

Chemo and Radiation effects:

  • The Hematopoietic system –bone marrow ___________
  • The Gastrointestinal and the integumentary system

Both are composed of rapidly dividing cells. Therefore they are susceptible to the ________ effects of chemo and radiation.

A
  • The Hematopoietic system –bone marrow suppression
  • The Gastrointestinal and the integumentary system

Both are composed of rapidly dividing cells. Therefore they are susceptible to the cytotoxic effects of chemo and radiation.

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30
Q

The provider tells you to take a rectal temp on Bethany, because he wants the most accurate data possible. Your response is:

a) As you wish.
b) It could get messy; I really rather not.
c) She is too old for rectal temps.
d) It’s contraindicated for a patient in Bethany’s condition.

A

d) It’s contraindicated for a patient in Bethany’s condition.

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31
Q

SEVERE Neutropenia is defined as an absolute neutrophil count (ANC) < ____

A

500

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32
Q

Worse-case scenario from F&N
* _______ shock
* ____________ medicine.

A
  • Septic shock
  • Resuscitation medicine.
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32
Q

__________ Puncture - if meningitis is suspected

A

Lumbar

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33
Q

Thrombocytopenia
* ___________ suppression also results in decreased platelet count.
* Normal platlet count ___________________

A
  • Bone marrow suppression also results in decreased platelet count.
  • Normal platlet count 150,000-450,000 (150k-450k)
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34
Q

Mucositis (GI)
* ______ that have developed in the oral mucosa.
* Occurs in pts who have had _______ or radiation.
* Cell __________ occurs consequent to chemo and
radiation–initiates inflammatory response.
* Mucosa is vulnerable to trauma, ulceration and
infection.

A
  • Sores that have developed in the oral mucosa.
  • Occurs in pts who have had chemo or radiation.
  • Cell destruction occurs consequent to chemo and
    radiation–initiates inflammatory response.
  • Mucosa is vulnerable to trauma, ulceration and
    infection.
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35
Q

diarrhea treatment…
* Avoid ____ foods, and those high in ______ (osmotic).

A
  • Avoid fatty foods, and those high in sugar (osmotic).
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36
Q

SICKLE CELL ANEMIA

AUTOSOMAL _____________ INHERITED DISEASE

A

RECESSIVE

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37
Q

______ AFRICAN AMERICANS CARRY THE SCD TRAIT

A

1 IN 13

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38
Q

SICKLE CELL ANEMIA

HEMOGLOBIN ___ REPLACES NORMAL HEMOGLOBIN

  • HEMOGLOBIN S IS VULNERABLE- LIFESPAN <___ DAYS- CHRONIC ANEMIA
  • ↑__________ OCCURS
    -DEHYDRATION
    -COLD WEATHER (CAUSES VASOCONSTRICTION)
    -STRESS
A

HEMOGLOBIN S REPLACES NORMAL HEMOGLOBIN

  • HEMOGLOBIN S IS VULNERABLE- LIFESPAN <40 DAYS- CHRONIC ANEMIA
  • ↑SICKLING OCCURS
    -DEHYDRATION
    -COLD WEATHER (CAUSES VASOCONSTRICTION)
    -STRESS
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39
Q

VASA OCCLUSIVE CRISIS

SICKLING RBCS ___________ AND _________

  • BONE INFARCTS
  • NECROSIS OF FEMORAL HEAD
  • ISCHEMIC STROKE
  • ACUTE CHEST SYNDROME
  • PULMONARY HYPERTENSION
  • PRIAPISM
A

SICKLING RBCS CLUMP UP AND OBSTRUCT

  • BONE INFARCTS
  • NECROSIS OF FEMORAL HEAD
  • ISCHEMIC STROKE
  • ACUTE CHEST SYNDROME
  • PULMONARY HYPERTENSION
  • PRIAPISM
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39
Q

SCD - PAIN CRISIS

  • _______ 10/10 PAIN
  • ABDOMEN
  • THORACIC
  • MUSCLE
  • BONE
A

SEVERE

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40
Q

____________

  • A MYELOSUPPRESSIVE AGENT; THE ONLY EFFECTIVE DRUG PROVEN TO REDUCE FREQUENCY OF PAINFUL EPISODES. (SCD)
  • IT RAISES THE LEVEL OF NORMAL HEMOGLOBIN F AND THE HEMOGLOBIN LEVEL. IT USUALLY DECREASES THE RATE OF PAINFUL EPISODES BY 50 %.
A

HYDROXYUREA

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41
Q

IRON DEFICIENCY ANEMIA

DUE TO _________________, CHILDREN NEED MORE IRON THAN ADULTS

A

RAPID GROWTH

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42
Q

IRON HELPS RBCS _______ __________

A

CARRY HEMOGLOBIN

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43
Q

IRON DEFICIENCY ANEMIA

SERUM _____________ LEVELS ARE LOW

A

HEMOGLOBIN

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44
Q

IRON DEFICIENCY ANEMIA CAUSES:

INADEQUATE FETAL _______
LIMITED _________ INTAKE
CHRONIC _______ LOSS
POOR ____________ BY THE BODY- (CELIAC’S, CRONE’S, ULCERATIVE COLITIS)

A

INADEQUATE FETAL STORES
LIMITED DIETARY INTAKE
CHRONIC BLOOD LOSS
POOR UTILIZATION BY THE BODY- (CELIAC’S, CRONE’S, ULCERATIVE COLITIS)

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45
Q

MOST COMMON AGES - IRON DEFICIENCY ANEMIA
* AGE 12-36 MONTHS OLD
* ADOLESCENT FEMALES

A
  • AGE 12-36 MONTHS OLD
  • ADOLESCENT FEMALES
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46
Q

CBC with Iron Deficiency Anemia

↓ Low ________
↓ Low mean corpuscular volume (MCV)
↓ Low mean corpuscular hemoglobin concentration (MCHC)
↑ Elevated platelet count (>450,000/μL) in many cases.

A

↓ Low Hemoglobin
↓ Low mean corpuscular volume (MCV)
↓ Low mean corpuscular hemoglobin concentration (MCHC)
↑ Elevated platelet count (>450,000/μL) in many cases.

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47
Q

COW’S MILK AND IRON DEFICIENCY ANEMIA
* AT ABOUT ___ MONTHS MOST INFANTS CAN CHANGE FROM FORMULA TO WHOLE MILK
* COW’S MILK INTERFERES WITH IRON ABSORPTION
* IRON SUPPLEMENTS SHOULD NOT BE GIVEN WITH COW’S MILK
* LIMIT COW’S MILK INTAKE TO 24-32 OZ PER DAY

A

12

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48
Q

Otitis Media

  • Infection of ______________
  • Common illness, highest incidence 6 months to 2 years
  • Accumulation of pus and mucus behind _________, blocking eustachian tubes causing pain, swelling
  • Decreased risk of otitis media with pneumococcal and influenza vaccinations, breast feeding and
    avoiding tobacco smoke
A
  • Infection of the middle ear
  • Common illness, highest incidence 6 months to 2 years
  • Accumulation of pus and mucus behind eardrum, blocking eustachian tubes causing pain, swelling
  • Decreased risk of otitis media with pneumococcal and influenza vaccinations, breast feeding and
    avoiding tobacco smoke
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49
Q

Otitis Media

Risk ________ ______ if chronic/persistent condition untreated

A

hearing loss

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50
Q

Tonsillitis

  • Tonsils ________ from viral or bacterial infections
  • Sore throat can interfere with breathing, nasal and sinus drainage, sleeping, swallowing, speaking and hearing.
  • _________ treatment necessary if related to
    streptococcal infection (strep throat) can lead to rheumatic heart disease and glomerulonephritis
  • Refer all children with sore throats for throat _________ to prevent complications from step infection
A
  • Tonsils inflamed from viral or bacterial infections
  • Sore throat can interfere with breathing, nasal and sinus drainage, sleeping, swallowing, speaking and hearing.
  • Antibiotic treatment necessary if related to
    streptococcal infection (strep throat) can lead to rheumatic heart disease and glomerulonephritis
  • Refer all children with sore throats for throat cultures to prevent complications from step infection
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51
Q

Chronically enlarged tonsils can cause upper airway obstruction that leads to ____________

A

sleep apnea

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52
Q

___________ for multiple recurrent infections as well as sleep apnea

A

Tonsillectomy

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53
Q

Laryngotracheobronchitis (croup)
* A _____ infection that leads to swelling of the throat

A

viral

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54
Q

Epiglottitis - Severe life-threatening __________ _________ of the epiglottis

  • Progresses rapidly, causing acute upper airway ____________
A

Severe life-threatening bacterial infection of the epiglottis

  • Progresses rapidly, causing acute upper airway obstruction
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55
Q

Epiglottitis

Do not examine throat (no tongue blade or any object in throat) because of risk of :

A

obstructing the airway completely

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56
Q

_________ : Prevented by DTaP- Violent “Staccato” Coughing

  • Whooping Cough
  • Highly Contagious
  • Bacterium Bordetella Pertussis
  • Droplet Isolation
  • Still around most likely due to waning immunity in adults
  • Deadly risk for newborn too young for immunization
A

Pertussis

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57
Q

Bronchiolitis

Prolonged ___________ _______ of respiration

A

expiratory phase

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58
Q

___________ ________ is the largest cause of Cardiac Arrest in children

A

Respiratory Arrest

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59
Q

Pneumonias

  • Localized Infection of _______ Immune response causes ____________

Alveoli become filled with fluid/mucous

  • Results in _________ of alveoli
  • The more alveoli effected the worse the symptoms.
  • Causes:
    Bacterial/Viral
    Fungal
    Aspiration
A
  • Localized Infection of alveoli Immune response causes inflammation

Alveoli become filled with fluid/mucous

  • Results in collapse of alveoli
  • The more alveoli effected the worse the symptoms.
  • Causes:
    Bacterial/Viral
    Fungal
    Aspiration
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60
Q

Asthma - ___________ Inflammatory and reactive airway disease that is commonly chronic

Leading cause of disease related school __________

A combination of genetic and environmental factors

Diagnosis based on pattern of symptoms and response to treatment

A

Generalized Inflammatory and reactive airway disease that is commonly chronic

Leading cause of disease related school absenteeism

A combination of genetic and environmental factors

Diagnosis based on pattern of symptoms and response to treatment

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61
Q

ASTHMA: Nursing Assessment

Breath sounds:
Early ___________ wheezing;
Inspiratory wheezing occurs with __________ condition-
_______ of Breath sounds is ominous

A

Early EXPIRATORY wheezing;
Inspiratory wheezing occurs with worsening condition- Loss of Breath sounds is ominous

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62
Q

Cystic Fibrosis (CF) - Autosomal-recessive disease causes dysfunction of the __________ glands

  • Tenacious ________ production obstructs vital structures

Multiple problems from the exocrine dysfunction

  • Lung insufficiency (most critical problem)
  • Pancreatic insufficiency
  • Increased loss of sodium and chloride in sweat
A

Cystic Fibrosis (CF) - Autosomal-recessive disease causes dysfunction of the exocrine glands

  • Tenacious mucus production obstructs vital structures

Multiple problems from the exocrine dysfunction

  • Lung insufficiency (most critical problem)
  • Pancreatic insufficiency
  • Increased loss of sodium and chloride in sweat
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63
Q

Immunizations at 4-6 years

A

DTaP
IPV
Influenza yearly
MMR
Varicella

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64
Q

Wong baker is used

A

to assess preschool age kids for pain

[faces scale]

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65
Q

Fever in immunosuppressed kid -

A

> 38 celcius (axillary)

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66
Q

Differences in kids

  • Diameter of airways ________
  • Distance between structures is ________, allowing organisms to rapidly move down
  • Short more horizontal Eustachian tubes
A
  • Diameter of airways smaller
  • Distance between structures is shorter, allowing organisms to rapidly move down
  • Short more horizontal Eustachian tubes
67
Q

Babies and young children will use their __________ muscles much more than adults in order to pull the diaphragm down for breathing.

  • After about 3 years the rib orientation changes to more of a lateral insertion – breathing becomes more efficient .
  • Because of the importance of the abdominal and other muscles used to breathe, babies can become _________ quickly.
A

Babies and young children will use their abdominal muscles much more than adults in order to pull the diaphragm down for breathing.

  • After about 3 years the rib orientation changes to more of a lateral insertion – breathing becomes more efficient .
  • Because of the importance of the abdominal and other muscles used to breathe, babies can become fatigued quickly.
68
Q

SIGNS OF RESPIRATORY DYSFUNCTION
* Irritability /Agitation
* Nasal Flaring
* Tachypnea
* Increased Belly Breathing
* Use of accessory muscles (retractions)
* Inability to lie down

A
  • Irritability /Agitation
  • Nasal Flaring
  • Tachypnea
  • Increased Belly Breathing
  • Use of accessory muscles (retractions)
  • Inability to lie down
69
Q

Wheezing
heard on ___________ due to bronchial obstruction, with extreme disease will also include inspiration- _______ airway sound

A

heard on expiration due to bronchial obstruction, with extreme disease will also include inspiration- lower airway sound

70
Q

Rales/Crackles - Heard on __________ suggests ______ in alveoli- lower airway sound

A

Rales/Crackles - Heard on inspiration suggests fluid in alveoli- lower airway sound

71
Q

Stridor - heard on inspiration; _______ airway sound

A

upper

72
Q

Grunting (young infants)
an expiratory sound caused by sudden closure of the glottis during expiration in an attempt to maintain FRC and prevent alveolar atelectasis. BAD sign-infant close to ________

A

arrest

73
Q

MOST COMMON CONGENITAL CAUSE OF RESPIRATORY DYSFUNCTION - Congenital _____________ Hernia

A

Diaphragmatic

74
Q

STANDARD INTERVENTIONS [respiratory]

  • Patient _________
  • Oropharyngeal suction
  • Nasopharyngeal suction
  • __________ – Blow By or Nasal Canula
  • Non invasive positive pressure (High Flow Nasal Canula, CPAP BiPapp
  • Invasive Positive Pressure (Intubation)
A
  • Patient position
  • Oropharyngeal suction
  • Nasopharyngeal suction
  • Oxygen – Blow By or Nasal Canula
  • Non invasive positive pressure (High Flow Nasal Canula, CPAP BiPapp
  • Invasive Positive Pressure (Intubation)
75
Q

Decreased risk of otitis media with

pneumococcal and influenza ____________
_______ feeding
avoiding ________________

A

pneumococcal and influenza vaccinations
breast feeding
avoiding tobacco smoke

76
Q

After tonsillectomy, monitor for:

A

postoperative bleeding

77
Q

Croup has classical symptoms of

A

barking cough
inspiratory tridor

77
Q

If you are wheezing only on one side, probable cause is

A

aspiration of foreign body

78
Q

What isolation is Pertussis?

A

droplet

79
Q

Bronchiolitis isolation precautions

A

Droplet and contact

80
Q

Bronchiolotis nursing care -

A

Suction airway secretions

81
Q

Asthma is ___________

A

generalized

82
Q

Pneumonias are __________

A

localized

82
Q

Thrombocytopenia – __________, petechial and _________

A

bruising, petechial and bleeding

83
Q

Normal platlet count :

A

150,000-450,000 (150k-450k)

84
Q

________ is a serotonin antagonist and most often given for N/V

A

Zofran

85
Q

PO ________ is usually more effective and less expensive vs IV

A

Zofran

86
Q

Give antiemetics ____ mins prior to chemo

A

30

87
Q

Hydroxyurea is used to treat

A

sickle cell

88
Q

Iron supplement S/E

A

N/V
Constipation
Diarrhea possible

89
Q

Take iron supplement with _______ for better absorption

A

vitamin C

90
Q

An infant until around 6 months, usually breathe through

A

their nose

91
Q

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was bad. The nurses best interpretation of this comment is that it is:​
​

A sign of stress.​

Common at this age.​

Suggestive of maladaptation.​

Suggestive of excessive discipline at home​

A

B. Common at this age.​

​

Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of thisage show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.​

92
Q

During the preschool period, the emphasis of injury prevention should be placed on:​

​

Constant vigilance and protection.​

Punishment for unsafe behaviors.​

Education for safety and potential hazards.​

Limitation of physical activities

A

C. Education for safety and potential hazards.​

​

Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate

93
Q

A 4-year-old child tells the nurse that she does not want another blood sample drawn because I need all my insides, and I don’t want anyone taking them out. Which is the nurses best interpretation of this?​

​

Child is being overly dramatic.​

Child has a disturbed body image.​

Preschoolers have poorly defined body boundaries.​

Preschoolers normally have a good understanding of their bodies​

A

C. Preschoolers have poorly defined body boundaries.​

​

Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.​

94
Q

Imaginary playmates are beneficial to the preschool child because they:​

​

Take the place of social interactions.​

Take the place of pets and other toys.​

Become friends in times of loneliness.​

Accomplish what the child has already successfully accomplished.​

A

C. Become friends in times of loneliness.​

​

One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interactions but may encourage conversation. Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what has already been accomplished.​

95
Q

Which type of croup is always considered a medical emergency?​

​

Laryngitis​

Spasmodic croup​

Epiglottitis​

Laryngotracheobronchitis (LTB)

A

C. Epiglottitis​

​

Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory infection symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.

96
Q

A school-age child has had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of:​

​

Bronchitis.​

Viral-induced asthma.​

Bronchiolitis.​

Acute spasmodic laryngitis.​

A

Bronchitis.​

​

Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

97
Q

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests:​

​

Asthma​

Bronchiolitis​

Pneumonia​

Foreign body in the trachea.​

A

Asthma​

​

Children with asthma usually have these chronic symptoms. Pneumonia appears with an acute onset and fever and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea will manifest with acute respiratory distress or failure and maybe stridor.​

98
Q

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind?​

​

Diet should be high in carbohydrates and protein​

Diet should be high in easily digested carbohydrates and fats​

Most fruits and vegetables are not well tolerated​

Fats and proteins must be greatly curtailed

A

Diet should be high in carbohydrates and protein​

​

Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

99
Q

The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup?​

​

Wheezing is heard audibly.​

It is bacterial in nature.​

It has a harsh, barky cough.​

The child has a high fever.

A

It has a harsh, barky cough.​

Spasmodic croup is viral in origin, is usually preceded by several days of symptoms of upper respiratory tract infection, and often begins at night. It is marked by a harsh, metallic, barky cough; sore throat; inspiratory stridor; and hoarseness. Wheezing is not a distinguishing manifestation of croup. It can accompany conditions such as asthma or bronchiolitis. A high fever is not usually present.

100
Q

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system?​

​

They have a widened, shorter airway​

There is a defect in their sucking ability​

The gag reflex increases mucus production​

Mucus and edema obstruct small airways

A

Mucus and edema obstruct small airways​

​

The airway in infants and young children is narrower, not wider, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways. Sucking is not necessarily related to problems with the airway. The gag reflex is necessary to prevent aspiration. It does not produce mucus.​

101
Q

A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient?​

​

Antibiotic administration​

Bone marrow transplant​

Chemotherapy​

Liver transplant

A

Chemotherapy​

​

The most common type of childhood cancer is acute lymphocytic leukemia (ALL). First-line treatment forALL is inducing remission with chemotherapy. Antibiotics are not used unless the child has an infection. Bone marrow transplant may be considered later in the child’s course of care. A liver transplant would not be a treatment for ALL.​

102
Q

A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse tell the family to help maintain a safe environment for the child?​

​

Do not let the child have chewing gum​

Flowers, plants, and produce are not allowed​

The child can only have one visitor at a time​

Toys and items from home cannot be brought in​

A

B. Flowers, plants, and produce are not allowed​

​

The neutropenic child should not have fresh flowers, plants, fruits, or vegetables because they can harbor infectious microorganisms. The other instructions are not needed.

103
Q

The parents of a child with cancer ask the nurse why the child is losing weight even though he is eating what he normally does. Which response by the nurse is the most appropriate?​

​

Cancer consumes body tissues, causing weight loss.​

He may be going through a growth spurt right now.​

How do you know he is eating like he normally does?​

When you are sick, you need more nutrition than usual.​

A

When you are sick, you need more nutrition than usual.​

​

The demands of illness lead to increased nutritional needs. A child with cancer needs increased nutrition.Cancer does not consume body tissues. The child may be going through a growth spurt, but this is not always the case and is not the best answer. Asking the parents how they know the child’s eating habits have changed may put them on the defensive.​

104
Q

A nurse works on the pediatric oncology floor. After receiving the handoff report, which child does the nurse assess first?​

​

Child on protective isolation​

4 hours post bone marrow biopsy​

Not eating an hour after chemotherapy​

Temperature of 101.5F (38.5C)​

A

Temperature of 101.5F (38.5C)​

​

This fever indicates a probable infection. The nurse will see this child first and provide report to the physician, if this has not already been done. This child is the sickest and should be seen first; one might be tempted to see the child in protective isolation first to avoid cross-contamination, but by following isolation precautions, this risk is minimized. Not eating after chemotherapy is not cause for concern, and the child 4 hours post bone marrow biopsy should be stable.​

105
Q

An accurate description of anemia is:​

​

Increased blood viscosity.​

Depressed hematopoietic system.​

Presence of abnormal hemoglobin.​

Decreased oxygen-carrying capacity of blood.​

A

Decreased oxygen-carrying capacity of blood.​

​

Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition depends on the deceased oxygen-carrying capacity of the blood

106
Q

Which statement best explains why iron deficiency anemia is common during toddlerhood?​

​

Milk is a poor source of iron.​

Iron cannot be stored during fetal development.​

Fetal iron stores are depleted by age 1 month.​

Dietary iron cannot be started until age 12 months.​

A

Milk is a poor source of iron.​

​

Children between the ages of 12 and 36 months are at risk for anemia because cow’s milk is a major component of their diet, and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.​

107
Q

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should she or he suggest?​

​

Iron (ferrous sulfate) drops after age 1 month.​

Iron-fortified commercial formula can be used by ages 4 to 6 months.​

Iron-fortified infant cereal can be introduced at age 2 months.​

Iron-fortified infant cereal can be introduced at approximately 6 months of age​

A

Iron-fortified infant cereal can be introduced at approximately 6 months of age.​

​

Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated. Introducing iron-fortified infant cereal at 2 months should be done only if the mother is choosing to discontinue breastfeeding.​

108
Q

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is:​

​

Aplastic anemia.​

Thalassemia major.​

Sickle cell anemia.​

Iron deficiency anemia

A

Sickle cell anemia.​

​

Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for coagulation. Iron deficiency anemia affects size and depth of color of hemoglobin and does not involve abnormal hemoglobin.​

109
Q

Although _____ , croup can lead to resp. acidosis, failure, and death

A

rare

110
Q

Epiglottitis- make sure to AVOID

A

scaring/agitating Pt as airway can become completely obstructed

111
Q

Onset of Croup VS Epiglottitis

A

Croup- gradual onset
Epiglottitis- rapid onset

112
Q

Croup VS Epiglottitis cough

A

Croup- barking cough
Epiglottitis- NO cough

113
Q

Pertussis- _______ effects upper and lower airways

A

toxins

114
Q

______________
* Inflammation of the bronchioles characterized by thick clear secretions can lead to upper and lower airway obstruction

A

Bronchiolitis

115
Q

_________- Number 1 cause of hospitalization in infants < 12 months

A

Bronchiolitis

116
Q

70% of bronchiolitis in children cased by :

A

respiratory syncytial virus (RSV)- common cold virus

117
Q

Pathologic Process of Asthma
* Airways become ________

A

inflamed

118
Q

ASTHMA
* Is a _________ (increase CO2) problem

Becomes an oxygenation problem (decrease 02) with severe asthma

A

ventilation

119
Q

_______ should be used with inhaler

A

spacer [allows for medication to disperse & go down into lungs]

120
Q

Cystic Fibrosis (CF) Sx

_____________ (excessive fat, greasy stools)
* Foul-smelling bulky stools

A

Steatorrhea

121
Q

Kids with CF should take _______ enzymes

A

pancreatic

122
Q

the replacement rate (how fast you give ) blood is determined by __________________________

A

how fast the blood is lost.

123
Q

the replacement rate (how fast you give ) blood is determined by how fast the blood is lost.

An acute hemorrhage or blood loss will be replaced ________ (rate ordered by MD or provider)

Chronic Blood loss is slow. The blood needs to be replaced slowly. This is ordered and is usually 2-4 hours. (NO longer than 4 hours due to risk of infection)

Blood replaced too quickly in this situation could put the peds patient at risk for heart failure.

A

quickly

124
Q

Chronic Blood loss is slow. The blood needs to be replaced _________. This is ordered and is usually 2-4 hours. (NO longer than ___ hours due to risk of infection)

Blood replaced too quickly in this situation could put the peds patient at risk for heart failure.

A

slowly

125
Q

Chronic Blood loss is slow. The blood needs to be replaced slowly. This is ordered and is usually 2-4 hours. (NO longer than 4 hours due to risk of infection)

Blood replaced too quickly in this situation could put the peds patient at risk for _______________

A

heart failure

126
Q

Preschooler Growth:​

More slender posture​

Each year gains about ___ lbs​

Each year gains about 2.5 inches in height​

Need a ton of sleep ~ _____​

A

More slender posture​

Each year gains about 5 lbs​

Each year gains about 2.5 inches in height​

Need a ton of sleep ~12hrs​

127
Q

IM injections for kids > 3 years: __________ ; Max: 1mL

A

DELTOID

128
Q

4 – 6 y/o vaccine mnemonic:​

A

“I don’t inject my vaccine”​

I - IPV​

Don’t - Dtap​
Inject - Influenza ​

My - MMR​

Vaccine - Varicella

129
Q

Anticipatory guidance for parent of a preschooler

A

TRAFFIC SAFETY ​

HELMETS ​

WATER SAFETY​

STRANGER SAFETY​

APPROPRIATE CAR SEAT ​

NUTRITION: 1800 calories/day​

SCREEN TIMES

130
Q

Developmental Theories​

Erikson vs Piaget

A

Erikson-SOCIAL - INITIATIVE VS GUILT

Piaget- COGNITIVE​ - PREOPERATIONAL THOUGHT (LAST 2-7 YEARS)

131
Q

Children as young as ___ years of age are able to report the location and degree of pain

A

3

132
Q

Remember! ________ Pain such as Sickle Cell Pain does not always present with physiologic responses such as ↑RR and HR. ​

A

Chronic

133
Q

preschool resp. rate

A

18-30
22-34?

134
Q

Rule of thumb: Respiratory Rate > ______ in infants should be NPO and placed on Maintenance IV fluids ​

Goal is to be NPO if BiPAP or Intubation is indicated - *Big risk of aspiration with these procedures – better to be NPO! ​

A

60-70

135
Q

Interventions for ________________ - Regardless of Cause! ​

Patient position​

Oropharyngeal suction​

Nasopharyngeal suction ​

Oxygen – usually nasal cannula is most tolerated ​

Non-invasive positive pressure: High Flow Nasal Cannula (Infant: Nasal CPAP; older children: BiPAP) ​

Intubation

More specific:
Antibiotics​

Bronchodilators​

Racemic Epinephrine​

Steroids​

Diuretics​

Chest Tube

A

Respiratory Distress

136
Q

Nasopharyngitis (common cold) URI: Upper Resp​
Acquired from close contact with an infected individual​

Primary prevention = __________________

A

HAND WASHING!!​

137
Q

Treatment of Croup​

minimize _______​

_________ oxygen​

_______ – reduce inflammation​

Nebulized racemic epinephrine – vasoconstrictor, reduce capillary blood flow​

Treatment is effective if: decrease in RR & stridor, less evident retractions​

If response is poor – admit to ICU for observation​

Consider BiPAP​

If intubation required, select a tube that is smaller than normal for pt’s age​

*Constantly reassess for respiratory failure!

A

minimize stress​

blow-by oxygen​

steroids – reduce inflammation​

Nebulized racemic epinephrine – vasoconstrictor, reduce capillary blood flow​

Treatment is effective if: decrease in RR & stridor, less evident retractions​

If response is poor – admit to ICU for observation​

Consider BiPAP​

If intubation required, select a tube that is smaller than normal for pt’s age​

*Constantly reassess for respiratory failure!

138
Q

Epiglottitis: Upper Resp​

Severe life-threatening bacterial infection of the epiglottis. Serious and communicable (droplet + standard precautions).​

Progresses rapidly, causing acute upper airway ___________. ​

Signs & Symptoms: tachypnea, respiratory distress, increase _____ & _____, drooling, ______ throat, high ______​

Most common cause historically: Haemophilus influenzae type B (Hib); less common due to Streptococcus pneumoniae (is rarely caused by other organisms)​

Vaccines: Hib and PCV = epiglottitis incidences have decreased​

A

Severe life-threatening bacterial infection of the epiglottis. Serious and communicable (droplet + standard precautions).​

Progresses rapidly, causing acute upper airway obstruction. ​

Signs & Symptoms: tachypnea, respiratory distress, increase RR & HR, drooling, sore throat, high fever ​

Most common cause historically: Haemophilus influenzae type B (Hib); less common due to Streptococcus pneumoniae (is rarely caused by other organisms)​

Vaccines: Hib and PCV = epiglottitis incidences have decreased​

139
Q

Epiglottitis: Upper Resp​

Nursing Interventions: MEDICAL EMERGENCY​

_______ oxygen. No IV, No BP, No Temp (Axillary/Lympanic)​

DO NOT examine throat with tongue blade or any object because of risk of obstructing the airway completely ​

Maintain child in _________ position with parent​

Prepare for possible tracheostomy (is there a kit in the room?) and/or prepare to transfer to OR for intubation​

Administer IV __________ after intubation​

Swelling usually will decrease in 24hrs and after 24hrs on antibx epiglottitis d/t Hib will no longer be communicable

A

Blow by oxygen. No IV, No BP, No Temp (Axillary/Lympanic)​

DO NOT examine throat with tongue blade or any object because of risk of obstructing the airway completely ​

Maintain child in upright position with parent​

Prepare for possible tracheostomy (is there a kit in the room?) and/or prepare to transfer to OR for intubation​

Administer IV antibiotics after intubation​

Swelling usually will decrease in 24hrs and after 24hrs on antibx epiglottitis d/t Hib will no longer be communicable

140
Q

Cause of LTB (Croup) VS Epiglottitis

A

LTB (Croup): viral

Epiglottitis: bacterial

141
Q

With ________ there is drooling

A

epiglottitis

142
Q

majority of bronchiolitis is caused by a virus known as _____

A

RSV

143
Q

Bronchiolitis (RSV): Lower Resp​

cough, runny nose (lots of _______ secretions), sneezing, sore throat, eye/ear infection with _________, usually preceded by a _______ & s/s of URTI​

tachypnea, tachycardia, adventitious breath sounds, __________​

A

cough, runny nose (lots of nasal secretions), sneezing, sore throat, eye/ear infection with drainage, usually preceded by a fever & s/s of URTI​

tachypnea, tachycardia, adventitious breath sounds, retractions​

144
Q

RSV SIGNS AND SYMPTOMS​

A
145
Q

Pathologic Process of Asthma:

Airway becomes _______
Bronchial smooth _________ (narrow)
Air trapping occurs in the _________ – difficult to ventilate (exhaleCO2)​

A

Airway becomes inflamed
Bronchial smooth constrict (narrow)
Air trapping occurs in the alveoli – difficult to ventilate (exhaleCO2)​

146
Q

Asthma is a ventilation problem (increase in _____) – becomes an oxygenation problem with severe asthma

Prolonged expiratory phase due to attempt to exhale CO2​

A

Asthma is a ventilation problem (increase in CO2) – becomes an oxygenation problem with severe asthma

Prolonged expiratory phase due to attempt to exhale CO2​

147
Q

Asthma: Lower Resp​- Include teaching for home: ​

Know _________ – viral infections, exercise, dust mites, smoke, cockroaches, grasses, pollen, pets, mold, etc.​

Reduce exposure to triggers​

Remove _______​

Stop indoor _________

A

Know triggers – viral infections, exercise, dust mites, smoke, cockroaches, grasses, pollen, pets, mold, etc.​

Reduce exposure to triggers​

Remove carpets​

Stop indoor smoking

148
Q

Asthma Education: ​

Use of peak expiratory flow meter: ​
1) Take a breath, 2) Close lips around device, 3) Blow out as hard & fast as possible​

Teach importance of Control Medications​

Use of MDI metered-dose bronchodilator inhaler for _______ – dose NOT prevent asthma​

Use a “_______” for children​

Hold MDI upright, shake inhaler, exhale slowly, press inhaler, breathe in slowly (3-5 seconds), hold breath for 10 seconds, exhale slowly, rinse mouth out with water afterwards to avoid fungal infection​

Use _________ first and then corticosteroid​

A

Use of peak expiratory flow meter: ​
1) Take a breath, 2) Close lips around device, 3) Blow out as hard & fast as possible​

Teach importance of Control Medications​

Use of MDI metered-dose bronchodilator inhaler for rescue – dose NOT prevent asthma​

Use a “spacer” for children​

Hold MDI upright, shake inhaler, exhale slowly, press inhaler, breathe in slowly (3-5 seconds), hold breath for 10 seconds, exhale slowly, rinse mouth out with water afterwards to avoid fungal infection​

Use bronchodilator first and then corticosteroid​

149
Q

Cystic Fibrosis: Lower Resp​

Autosomal-recessive disease causes dysfunction of the ___________ glands​

Tenacious mucus production ___________ vital structures​

A

Cystic Fibrosis: Lower Resp​

Autosomal-recessive disease causes dysfunction of the exocrine glands​

Tenacious mucus production obstructs vital structures​

150
Q

Cystic Fibrosis - Skin that taste _______ – sweat chloride test most reliable diagnostic test

A

salty

151
Q

What is ANC?

A

Absolute Neutrophil Count​

​

152
Q

SEVERE Neutropenia is when ANC < _____

A

500

153
Q

FEVER + NEUTROPENIA= _________ NEUTROPENIA

A

FEBRILE

154
Q

fever and neutropenia ​Worst case scenario ​

Patient gets ______________

_____________________ is needed ​

A

Patient gets septic shock ​

Resuscitation medicine is needed ​

155
Q

Sickle Cell Anemia ​

Inherited ____________ __________ disorder of hemoglobin resulting in sickled hemoglobin, chronic hemolytic anemia and ischemic tissue injury​

While sickle cell disease is more common in African-Americans, it can affect people of any race or ethnicity.​

A

autosomal, recessive

156
Q

*1 in ___ African Americans carry the SCD trait​

*1 in ___ African Americans have SCD​

A

*1 in 13 African Americans carry the SCD trait​

*1 in 365 African Americans have SCD​

157
Q

SCD Pathophysiology​

Partial or complete replacement of normal Hgb with abnormal HgbS causes red blood cells to ______​

*Clinical features: ___________ by sickled RBCs, vascular inflammation, increased RBC destruction.​

*Abnormal adhesion of RBCs results in blocked microcirculation, hypoxia and organ failure​

*HgbS has a less than normal life span (less than 40 days) which leads to chronic sickling​

*Tissue __________ causes widespread pathologic changes in spleen, liver, bones and CNS​

*Dehydration, cold weather (d/t vasoconstriction), stress promotes sickling​

*Crisis often precipitated by infection​

​

A

Partial or complete replacement of normal Hgb with abnormal HgbS causes red blood cells to sickle​

*Clinical features: obstruction by sickled RBCs, vascular inflammation, increased RBC destruction.​

*Abnormal adhesion of RBCs results in blocked microcirculation, hypoxia and organ failure​

*HgbS has a less than normal life span (less than 40 days) which leads to chronic sickling​

*Tissue ischemia causes widespread pathologic changes in spleen, liver, bones and CNS​

*Dehydration, cold weather (d/t vasoconstriction), stress promotes sickling​

*Crisis often precipitated by infection​

158
Q

Breast Fed Baby > 6 months Supplement with ______

A

IRON

159
Q

Formula Fed BABY Starting at Birth _____ _________ Formula

A

iron Fortified

160
Q

________ very important in the treatment of sickle cell disease, promotes hemodilution and circulation of red cells through the blood vessels​

A

Hydration

161
Q

Vaso Occlusion Crisis (SCC) nursing care

A

hydration
analgesics
blood transfusion
Hydroxyurea​

162
Q

Hydroxyurea​ [SCC]

Myelosuppresive agent: only effective drug proven to reduce freq of painful episodes​

_______ the level of normal hemoglobin F and the overall hemoglobin level​

Usually decreases rate of painful episodes by _____

Also used to tx chronic myeloid Leukemia

A

Myelosuppresive agent: only effective drug proven to reduce freq of painful episodes​

Raises the level of normal hemoglobin F and the overall hemoglobin level​

Usually decreases rate of painful episodes by 50%​

Also used to tx chronic myeloid Leukemia

163
Q

Thrombocytopenia occurs when platelet levels are low, leading to impaired blood ________ and increased ________ risk. Causes include decreased platelet production (e.g., bone marrow disorders), increased destruction (e.g., autoimmune conditions), or platelet sequestration in the spleen.

A

Thrombocytopenia occurs when platelet levels are low, leading to impaired blood clotting and increased bleeding risk. Causes include decreased platelet production (e.g., bone marrow disorders), increased destruction (e.g., autoimmune conditions), or platelet sequestration in the spleen.

164
Q

Nursing care [Thrombocytopenia] focuses on preventing bleeding, monitoring for signs of __________ (like bruising or blood in urine/stool), and administering _______ transfusions if needed. Patients should be educated on bleeding _________, such as using soft toothbrushes and avoiding activities that could cause injury.

A

Nursing care [Thrombocytopenia] focuses on preventing bleeding, monitoring for signs of bleeding (like bruising or blood in urine/stool), and administering platelet transfusions if needed. Patients should be educated on bleeding precautions, such as using soft toothbrushes and avoiding activities that could cause injury.

165
Q

Anemia Sx

A
  • PALLOR
  • PALE LIPS AND MUCOUS MEMBRANES
  • FATIGUE
  • INCREASE HEART RATE

Nurs 158- Pediatrics (9 decks)

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