Pediatrics Class Review
apgar score ranges when is the apgar score conducted
0 to 3 represent severe distress 4 to 6 signify moderate difficulty, 7 to 10 all good 1 minute after birth and 5 minutes after birth
Human interaction floor with gym mirror rattles crib mobile feet and wrist shaker
0-6 months infant
___ out of every 4 children will be affected in hemophilia
1 out of 4
train soft gym stand and build set stuffed animals picture books
1 year old young toddler
anything over ___ mcg is considered lead poisoning treatment for lead poisoning is called ____ therapy
10 mcg = lead poisoning treatment = chelation therapy
at __ months, the child develops object permanence
10 months
toilet the child every
10-15 minutes after meal
1g of wet diaper weight =
1mL or urine take overall weight of diaper and subtract the dry diaper weight to get urine output
patient will be npo ____ hours before the procedure
2
can't keep a child NPO for more than
2 hours
sandbox tea set dolls building boxes finger paints
2 years old old toddler
Meconium should regularly be passed within ___ hours
24
for a nephroblastoma - surgery will occur within __to__ hours - need to educate the patients
24-48 hours
you want to start vitamin D at _ months
3
how often is factor 8 given
3 times a week
cut out dolls dress-up tricycle building sets jump rope
3,4,5 preschool
can have breast milk up to __ hours until surgery can have formula __ hours until surgery
4 hours until surgery 6 hours until surgery
Breast Fed babies START iron supplementation at
4 months
EA and TEF occurs at __to__ week of development
4th to 5th week of development
DIY kits musical instrument science experiment interactive game game with peers
5-10 years school age
how many wet diapers per day indicates adequate hydration
6-8
xylophone and mallet teethers shape box peek-a-boo standing gym
7-12 months
An IQ below ____ is considered an intellectual disability
70
Hemophilia A is clotting factor Hemophilia B is clotting factor
A = 8 B = 9
when you empower you are
ADDING to what they know
Which has a better prognosis ALL or AML
ALL has better chance of recovery - younger the kid the better the chance of survival - if the count is LESS THAN 50k it is favorable
diagnostic factor for AGN is
ASO titer - antisteptolysin O worried about strep infection previous
at the time of the diagnosis what should the nurse do
ASSESS, what they know - childs feelings - all of that stuff & EMPOWER - build on what they know
What does the Apgar scoring system assess? Select all that apply. a. Respiratory effort b. Heart rate c. Core temperature d. Reflex irritability e. Muscle tone f. Color
All answers BUT C
leukemia patient at risk for
Anemia // bleeding - not RBCs or WBCs
Aplastic Anemia is when: Hemolytic Anemia is when
Aplastic - not enough RBC production Hemolytic - destruction of RBCs
Pain at McBurney point =
Appendicitis
So BEFORE the crisis starts - DURING crisis -
BEFORE - hydration DURING - pain meds
with acute Glomerulonephritis you will see
BLOOD IN THE URINE
B R A T diet what is it used for
Banana Rice Apple Sauce Toast what to eat after a stomach bug or bad diarrhea to get stomach back to normal
Any time you send an infant to the cardiac cath lab, you need to establish a ______
Baseline! Take vital signs
Diagnosis of leukemia is injection given at
Bone marrow aspiration - shows infiltration of blast cells posterior iliac crest
etiology of preterm birth
Box 8-3 Etiology of Preterm Birth Maternal Factors Socioeconomic • Malnutrition • Age • Race Chronic medical conditions • Heart disease • Renal disease • Diabetes • Hypertension Behavioral • Substance abuse • Smoking • Poor or absent prenatal care Factors Related to Pregnancy Multiple pregnancy Low body mass index (<19.8 kg/m2) (Fanaroff, 2011) Abruptio placentae or placenta previa Incompetent cervix Maternal hypertension Premature rupture of membranes or chorioamnionitis Polyhydramnios or oligohydramnios Infection Trauma Fetal Factors Chromosomal abnormalities Congenital anomalies Nonimmune hydrops Erythroblastosis Unknown Factors
treatment for Leukemia
CHEMO Bonemarrow transplant
tetralogy of fallot is cyanotic or acyanotic??
CYANOTIC
the 3 C's of EA or TEF are
Coughing, Choking, Cyanosis
Treatment of DKA - 1st: 2nd:
DKA 1st: INSULIN 2nd: rehydration through IV
patient in DKA you want to place them on a _______ ________ because their _____ levels may be increased
DKA - cardiac monitor because of elevated potassium levels
what agent is used as a local anesthetic before giving an injection
EMLA
because of not eating, you may see ____ __ ______ in compromised heart babies
Failure to Thrive
people with Sickle Cell Disease will need to take
Folic acid FOR LIFE
Ribbonlike // Foul smelling stools =
Hirschsprung Disease
child doesnt have meconium until 3-4 days after birth: the nurse suspects
Hirschsprung Disease
Differences between hyperglycemia and hypoglycemia Hyper = Hypo=
Hyperglycemia - peeing, thirsty, Hypoglycemia - Confused, Sweaty, Headache, Dizzy, Shaky
what is a screening tool for CF
IRT
for severe dehydration youre going to place the patent on an
IV
if kid is losing consciousness - to get their sugar up you would do it
IV
Associative play:
In associative play, children play together and are engaged in a similar or even identical activity, but there is no organization, division of labor, leadership assignment, or mutual goal.
Erikson's stages Infancy: Toddler: Preschool" School Age:
Infancy - trust vs mistrust toddler - autonomy vs shame Preschool - initiative vs guilt School age - industry vs inferiority
for infants with formula, the nurse will stress the importance of using:
Iron-fortified formula
you will see ____ respirations with DKA
Kussmaul
LEFT to RIGHT shunt = RIGHT to LEFT shunt =
LEFT to RIGHT shunt = OXYGEN - pink RIGHT to LEFT shunt = NO OXYGEN - Cyanotic
medication on synthroid for hypothyroidism is
LIFELONG
Cleft Lip is repaired within
LIP - 2-3 months PALATE - 6-12 months
Which happens first in gestation? Cleft Lip or Palate
Lip - 6 weeks Palate - 7-12 weeks
children 2-3 have greater metabolizing capacity for certain drugs so often need _______ frequent administration of pain meds
MORE frequent
always ____ pulse site so future nurses can assess easier
Mark them with marker
Hirschsprung Disease is a
Mechanical Obstruction from inadequate motility of the intestine due to absence of ganglion cells in the colon
what test do you do to check for brachial palsy
Morro Reflex
what is the antidote for acetaminophen overdose
Mucomyst (acetylcysteine)
post-op for cleft surgeries - Never place the child in ____ position
Never in PRONE position
Pathological Jaundice vs Physiologic Jaundice - when do they happen
PATHOLOGICAL is immediate - physiologic is 2nd to 4th day
Nephrotic Syndrome
PROTEINUREA - low albumin -high lipid -edema -
First intervention for a sickle cell crisis is ALWAYS
Pain management- treat pain FIRST
examples of emancipated minors
Pregnancy, high school graduation, independent living, military service
Nursing interventions for terminally ill Preschool: school age:
Preschool: Clarify misconceptions of illness/death as punishment Child life specialist Use simple language and repeat often Encourage parents to stay and participate in care School age: Give clear and concrete information Allow as many changes as possible. Encourage contact with peers Encourage parents to be present and involved.
RICE !! to prevent bleeding episodes and after injury
REST ICE COMPRESSION ELEVATION
what kind of goals do we want to set in a chronically ill patient
Realistic goals - lets go for a playdate tomorrow - lets be able to add 10+10 by the end of the week
how should you deliver meds in the pediatric patient
SYRINGE to deliver meds - side of mouth - little by little - watch swallow
Sickle Dex is used for Hgb electrophoresis is
Sickle Dex: screening purposes Electrophoresis is the gold standard for sickle cell diagnosis
if patient in DKA is unconscious two things you wanna do is
Suction to prevent aspiration insert foley to see urine measure
the biggest thing to rememberwith a neuroblastoma is that it CROSSES
THE MIDLINE
All children are infected with rotavirus (diarrhea) at least once by 5: true or false Acute diarrhea is the leading cause of illness in children younger than 5 years of age true or false
TRUE TRUE
Restraints are needed for Cleft surgical repairs true or false
TRUE - elbow restraints
infants operate by building
TRUST
School age always wants to know ___
WHY - "I'm giving this to help you breathe better"
Hemophilia is ____ this means that mostly ____ are effected
X-linked recessive - mostly boys are effected
a big intervention the nurse can do for a child with autism is bring the child
a toy from home
what do you do to assess for EA and TEF
abdominal X ray
what do we want to check on a child with encopresis
abdominal X ray to check for impaction of feces - we wanna know how severe it is - if nothing pathological we assess psych
what do we measure pre-op for patient with EA / TEF always have HOB
abdominal girth HOB always elevated
facial paralysis how long does it last? what cranial nerve?
about 15 minutes - short term cranial nerve 7
The child usually goes to bed asymptomatic to awaken later, complaining of sore throat and pain on swallowing. The child has a fever; appears sicker than clinical findings suggest; and insists on sitting upright and leaning forward (tripod position) with the chin thrust out, mouth open, and tongue protruding. Drooling of saliva is common because of the difficulty or pain on swallowing and excessive secretions.
acute epiglottis
neuroblastoma is located on the
adrenal glands above the kidney
A child is NEVER npo without
an IV // some source of fluid intake
non responsive to contact, voice, or movement - we think
autism
as a child ages and realizes they are different than most kids, they may _____
begin to be more bothered and have a more negative self image
temperature <5 >5
below five - axillary above five - oral temp
After the patient has a stroke, what do they usually get
blood infusion - this prevents the blood from becoming viscous
Who is at risk for iron deficiency
breastfed infant
if you suspect a poisoning of your child the first thing you always do is
call poison control before ANY interventions - always the first thing is to call
in a neuroblastoma you will see ___ in the urine
catecholamines
for cephalhematoma and caput succedaneum interventions subgleal hemorrhage interventions:
cephalhematoma and caput succedaneum no interventions! swelling will subside on its own Subgleal - early detection is vital - head measurements and inspection of back nd neck for edema - CT scan or MRI- monitor loc
Clubbing of the fingers is a LONG TERM sign of
congenital heart issues
long term controller of asthma
corticosteroids
hoarse, barking, brassy cough = home remedy =
croup cold air
never assess heart or lung sounds when a child is
crying - wait for them to calm down then assess
an exclusive sign found only in children indicative of dehydration is
crying without tears
precocious puberty is before what age in boys: girls:
develop before 9 in boys 8 in girls
in CF - pancreas is affected so you expect lungs are effected so you expect- most CF men are
diabetes (REGULAR EYE EXAMS), trouble digesting fat and pancreatic enzyme - fatty and foul smelling stools lung failure - possible transplant - recurrent infections men are sterile
classic manifestations of asthma
dyspnea, wheezing, coughing
child pulling on their ears - the nurse assumes
ear infection
blood brain barrier is immature so the patient who takes many meds is at risk for _____________
encephalopathy
for jaundiced baby- you want them to eat every __ to __ hours - so you need to wake them up what is the main form of treatment
feed every 3-4 hours phototherapy is the main treatment
otitis media with effusion means
fluid in the middle ear
as soon as patient wakes up, you want to promote
fluids
Tofranil, Desmopressin, oxybutynin
given for encopresis
Leuprolide Acetate - Lupron
given for precocious puberty
if an infant is NOT afraid of strangers and is not smiling what are we thinking
growth failure
to prevent a vasoocclusive crisis- you want to encourage
hydration
Risks for infant after cardiac cath lab always assess which pulses
hypothermia, hypotension, allergies, pedal pulses are always checked because they will use femoral artery to scope the heart and you want to ensure blood is making its way down the leg
if mom is rH _____ and baby is rH _____ the first pregnancy will be ____ but everyone after will be _____ what drug do you give after the first delivery OR abortion
if mom is rH NEGATIVE and baby is rH POSITIVE - first baby fine but every baby after is screwed give RhoGAM
never have a traumatic procedure where?
in the child's room or play room - you want them to view their room as a safe place
AGE Ranges: Infant toddler preschool school age adolescent
infant 0-1 toddler 1-3 preschool 3-5 school age 6-12 adolescent 13-18
never feed a baby flat because of the risk for
infection - fluid can go into ear
initial progressive severe signs of RSV:
initial - runny nose, coughing, wheezing, intermittent fever progressive - increased coughing // wheezing, retractions, CYANOSIS severe - >70 breaths / minute - apneic spells, poor breath sounds
what is a common complication with a blood transfusion if this level is high - they will need
iron overload - if iron level is high, they may need chelation therapy
Iron supplement should be taken THROUGH A STRAW because Iron administration should never be administered with
it can be harmful to the teeth never administer iron supplements with MILK
what will happen to the PTT time of a hemophiliac
it will get longer - they bleed for longer
hemophiliacs can see bleeding in the
joints
if strep isn't treated it can lead to strep needs an ____ and children have to be home for the first ____ because its still contagious
kidney failure ANTIBIOTIC for strep - children home 24 hours after first treatment change toothbrush - towels - pillowcase - retainer disinfected etc.
bottle fed babies with facial nerve paralysis may need a
large holed bottle
Values less than _% and greater than _% are considered abnormal on a growth chart
less than 5% and greater than 95%
Toddlers are egocentric - what intervention is good to use before using a stethoscope on them for example
let them play with the stethoscope
babies with phrenic nerve palsy may need to be placed on
mechanical ventilation
first sign of CF
meconium ileus
Wilms tumor or NEPHROBLASTOMA will be on ONE side of the
midline
first sign of cyanosis will be around
mouth and eyes
myringotomy is - tympanovstomy is -
myringotomy - surgical incision tympanovstomy - artificial tube
A 5-year-old child is brought into the clinic with lethargy, abdominal ascites, and peripheral and periorbital edema. The history indicates ongoing diarrhea and decreased urine output.
nephrotic syndrome
number 1 number 2 number 3 risk to cardiac cath
no.1 allergic reaction no.2 bleeding no.3 infection
a patient with phrenic nerve paralysis would have ____ chest movements
paradoxic
for young children, the greatest source of support is their
parents
if child comes in with bedwetting, what will be suggested?
physical examination to rule out physical causes
EA and TEF are likely seen when the mother has
polyhydraminos
posterior fontanel closes around anterior fontanel closes around
posterior - 8 weeks anterior - 18 months
primary enuresis/encopresis secondary enuresis/encopresis
primary = they've never been potty trained before secondary - they are potty trained and now experiencing this
projectile vomiting =
pyloric stenosis
tachycardia can indicate
respiratory issues
acute otitis media follows a is purulent discharge normal
respiratory tract infection yes
in nephrotic syndrome you will see:
retention of fluids - gain weight - puffy face - PROTEIN IN URINE
a temper tantrum in separation anxiety is ______ a temper tantrum in a chronic disease is _______
separation anxiety - tantrum normal chronic disease - tantrum NOT normal
no tears = ______ dehydration
severe
kids are more susceptible to ear infections because the lobes are
shorter & thicker
babies with respiratory distress need to be placed on their
side
Separation Anxiety: Stage 1 is: is stage 1 normal Stage 2 is:
stage 1: protest - cry, bite, kick, hit, cling to parents and avoid strangers - its NORMAL stage 2: despair - inactive, withdrawn, no interest, could regress into things like not being potty trained
patient will be given __ for nephrotic syndrome
steroids - risk of infection w steroids
first line of treatment in nephrotic syndrome what risk
steroids - risk for infection
acute glomerulonephritis can stem from
strep
the most dangerous type of hemorrhage is a ______ what does it cross could lead to
subgaleal hemorrhage crosses suture line increased ICP
Hemoglobin A1C monitors:
sugar levels over 3 months
give preterm infants with immature lungs ___
surfactant
most treatment for Hirschsprung disease is
surgical
Congenital hypothyroidism - you will check the newborn for what labs
t4 levels, TSH levels
what is the earliest sign of dehydration
tachycardia
The first thing you will see in a child with heart failure is
tachycardia !! they also aren't eating - eating is like exercise for little infants and it takes a lot of energy so if heart isn't functioning they will be fatigued and won't eat
never use the word ____ with preschoolers Give them ____ !! in terms of pain - they can show you
take "I'm gonna take" preschoolers need choices what face they're feeling
if a child is saying their belly or chest hurts bad, you want to educate the parents to
take them to the ER immediately
what vital sign is most important for a child with chemo
temp!! infection teach infection -
by toddler age - we are hoping to be able to have our kid be okay with toddlers are egocentric and need to feel independent - toddlers can pick finger foods and do things to feed themselves
temporary separation
Assent means that
the child or adolescent has been informed ALL about the procedure and is willing to permit a HCP to perform it
always allow parents to stay with child until
the surgery begins
children 0-3 have __
their mothers immunity !! makes them more protected from infection
what will happen to the levels of factor 8 and 9 in the bloodstream with hemophiliacs
they will decrease -
when young kids refuse to take medication - why are they doing this ? what should they nurse do
to gain controls - they want a say give them options - this sticker or that sticker - grape or cherry?
Age related concepts of death
toddlers - dont understand death preschoolers - death is reversible school age - death is a punishment for being bad by 9-10 the child understands the real meaning of death
Vitamin C facilitates absorption of iron true or false
true !!!
what CONFIRMS CF
two consecutive positive sweat tests
child with chemo is at risk for
ulcers - no acidic things - soft tooth SOFT DIET look out for extervasion -buildup of the drug outside of the vein
when you UNDRESS you want to do the ____ side first when you DRESS you want to do ___side first
undress = unaffected first dress = affected first
exclusively breastfed infants are at risk for what should you try to do to help
vitamin D deficiency give vitamin fortified cereals
When you enable you are assessing
what they ALREADY KNOW
high pitched or musical, prolonged, slowly progressive or sudden, association with labored breathing.
wheeze
leukemia is cancer of the first sign is
white blood cells - lack of immunity first sign is BONE pain