Pediatrics- Exam One

What kind of diet is needed for a child with hirschsprungs?

-LOW fiber HIGH cal HIGH protein

What are predisposing factors for otitis media?

-URIs -allergies -down syndrome -cleft palate -day care attendance -exposure to second hand smoke -bottle propping

What is asthma and what causes it?

-a chronic respiratory disease -caused by an allergen or antigen -shown by airway inflammation, mucus production, and bronchodilation

What is Hirschsprung's disease?

-a congenital anatomical defect of lack of nerve cells in the walls of the colon -causes absence of peristalsis

What is wheezing?

-a high pitched sound on expiration -it may occur with an obstruction in the lower trachea or bronchioles

What is cystic fibrosis?

-a multisystemic disorder of the exocrine glands -defective CTR, interferes with NaCL transport across cell membrane, causes increased viscosity of mucous gland secretions causing obstructions

What is acute epiglottis and who does it affect?

-a serious obstructive inflammatory disease that requires immediate attention -common in children 2 to 5 years old -rapid swelling -caused by HIB

How do you diagnose hirschprungs?

-abdominal xray -anorecal manometry -rectal biopsy

How would you diagnose EA and TEF?

-abdominal xray -bronchoscopy -endoscopy

How to diagnose intussusception?

-abdominal xray -ultrasound -contrast enema

Who does foreign body aspiration commonly effect?

-age 9 months to three years

List CF respiratory management measures.

-airway clearance -bronchodilator -exercise -treatment of pulmonary infection -IV antibiotics

What are the triggers for asthma?

-allergic -non-allergic -exercise induced

What is bronchiolitis/RSV?

-an acute viral infection of the lower respiratory tract -inflammation of the bronchioles with mucus..obstruction...trapping of air....hyperinflation/collapse of alveoli atelectasis

What medications are used for GER?

-antacids -proton pump inhibitors

What is the allergic triad?

-atopic dermatitis (eczema) -rhinitis -asthma

How should you take a temperature in a child with hirschprungs?

-axiallary NOT rectally

what are the clinical manifestations of bronchiolitis

-begins with a URI -low grade fever -rhinorrhea -OM -conjunctivitis -cough for 1 to 3 days followed by a wheeze -poor feeding

What are the causes and risk of acute streptococcal pharyngitis?

-caused by Group A-B hemolytic (GABAS) streptococcal -at risk for rheumatic fever (damages your heart)

What are the initial symptoms of foreign body aspiration?

-choking -hard/forceful coughing -stridor/wheezing/hoarseness -unable to talk -cyanosis -collapse

How would you assess hirschsprungs in an child?

-chronic constipation -foul smelling, ribbonlike stool -abdominal distention -palpable fecal mass -malnourishment

What should you inspect and observe in the respiratory system?

-color (pallor? cyanosis? acrocyanosis?) -rate/depth of respirations -nose/oral cavity -cough/other airway noises (atelectasis, stridor) -respiratory effort -anxiety/restlessness -clubbing -hydration status

What is a cleft lip/palate?

-congenital abnormalities that occur as a result of failure of soft tissue or boney fracture to fuse

What are rales?

-crackling sounds heard when the alveoli become filled with fluid -may occur with pneumonia

What are the manifestations/four D's associated with acute epiglottis?

-drooling (excessive secretions) -dysphonia (muffled voice) -distress (look worse than they sound) -dysphagia (difficulty swallowing) -absent cough -cherry red throat, inflamed/swollen epiglottis -sore throat -pain -*tripod position* -stridor -mild hypoxia -tachycardia, tachypnea, fever

List clinical manifestations of otitis media

-ear pain -fever -discharge

What is nursing care for nasopharyngitis?

-ease respiratory effort -promote rest and comfort -prevent spread of infection -reduce temp (if child is miserable) -promote hydration -smaller/frequent feedings for babies -family support and home care

List croup syndromes.

-epiglottis -laryngitis -croup -trachitis -laryngotracheobronchitis (LTB)

What vitamin supplements does an individual with CF need.

-fat soluble -ADEK

List the clinical manifestations of streptococcal pharyngitis

-fever -headache -sore throat -abdominal pain (in little children) -halitosis

What is an inguinal hernia and how does it present itself?

-intestinal segment entering into the scrotum -presents with a painless scrotal budge which increases in size with crying

Explain the effect that increased viscosity of mucous gland secretion has on the body.

-it results in mechanical obstruction -the mucoprotein coagulates to form concretions in gland/ducts -effects mainly the respiratory tract and pancreas

Describe nasopharyngitis.

-known as the "common cold" -caused by a virus (mainly RSV) -managed at home, no specific treatment -signs/symptoms: fever, anorexia, vomiting, diarrhea, abdominal pain, cough, sore throat, nasal blockage/drainage, resp sounds

What drug therapy is used for asthma??

-long term control meds -quick relief meds -metered dose inhaler -corticosteroids -cromolyn sodium

What is therapeutic management for LTB?

-maintaining the airway -maintain hydration, orally and IV -nebulized mist w/ supplemental O2 -Neb treatments (epinephrine, steroids)

Nursing care for otitis media

-make them comfortable -treat fever -increase fluids -adminster antibiotics -prevent infection

What is status asthmaticus?

-medical emergency -continuation of respiratory distress despite vigorous therapeutic measures -concurrent infection in some cases

List interventions for a child with diarrhea:

-monitor hydration -VS -IO -monitor skin integrity/teach skin care -monitor electrolytes -mild/mod: ORS -severe: IV

Nursing interventions for bronchiolitis/RSV

-nasal washing for RSV -contact isolation/droplet isolation -bronchiodilators -humidified O2 by hood/tent -hydration

How would you assess hirschsprungs in an newborn?

-no meconium -refusal of fluids -bile stained emesis -abdominal distention

What is the theraupetic Management for strep pharyngitis?

-oral penicillin for atleast 10 days -for children allergic: oral erythromycin

What might you assess in a child with hypertrophic pyloric stenosis?

-palpable, moveable olive shaped mass -peristolic waves before vomiting -projectile vomiting -non bilious content

What is acute spasmodic laryngitis and who does it effect?

-paroxysmal attacks of laryngeal obstruction which occurs chiefly at night -inflammation can be mild or absent -most often affects children 1-3 year of age

What is otitis media and what causes it?

bacterial: -H influenzae -Streptococcus pneumoniae -moraxella catarrhalis -fluid pulled from the mucosal lining, accumulates, and becomes colonized by infectious agents

What are the side effects of epinephrine and what should you watch for?

side effects: -jitteriness, high HR, high BP -watch child because when epinephrine wears off the symptoms can become even worse

What parts of the respiratory system do croup syndromes effect?

the: -larynx -trachea -bronchi

What is hydrostatic reduction?

when air or fluid is used to exert pressure on area involved to lessen, diminish, or rid intestinal prolapse

What are common foods children aspirate on?

-hotdog, round candy, nut, grapes, latex balloon pieces, coin, button, safety pin

What is hypertrophic pyloric stenosis?

-hypertrophy of the pylorus -constriction and obstruction of the pyloric canal between stomach and duodenum

what is therapeutic intervention for status asthmaticus?

-improving ventilation -pharmacologic agents

What is encopresis?

-incontinence of stool -occurs in ages 4-6 -not due to medical condition

What are symptoms of aspiration pneumonia?

-increasing cough -fever with foul smelling sputum -deteriorating O2 -evidence of infiltrate on chest radiographs

What are the clinical manifestations of LTB?

-inspiratory stridor -suprasternal retrations -barking/seal like cough -increasing respiratory distress/hypoxia -can progress to resp. acidosis, and resp failure

List care management for strep pharyngitis

-instrut patients on adminstering meds -cool or warm compresses -warm saline gargles -liquid/ice chips -education that child is no longer contagious after 24 hrs on antibiotics

What are secondary symptoms of foreign body aspiration?

-persistent infection/aspiration pneumonia

How do you diagnose GER?

-ph of esophageal secretions -endoscopy

What are pre-disposing factors for GER?

-prematurity -neuro impairment -overweight -long tern NG tube -hiatal hernia -certain meds

Nursing care post-tonsillectomy

-promote ariway clearance (place child in side-lying or prone position) -maintain fluid volume (avoid citrus/brown/red) -advise to avoid coughing and sneezing -relieve pain (ice collar, analgesics) -inspect all secretions

Nursing management of epiglottis

-provide 100% O2 in least invasive manner -may need trach -have emergency equipment near by DO NOT: -attempt to visualize throat -leave child unattended -place child in supine position

What are the diagnostic symptoms of asthma?

-recurrent episodes of wheezing -chronic persistent coughing -symptoms occur after exposure to stimulants/triggers

What are Nursing Interventions for EA and TEF?

-relieve respiratory distress -NPO -HOB >30 -thermoreg -hydration -parenteral nutrition -pacifier

List CF gastrointestinal management.

-replacement of pancreatic enzymes -high protein, high calorie diet -relief of obstruction -treat GERD

What is the etiology of acute diarrhea?

-rotavirus -salmonella -shigella -campylobacter -C Diff

What would you assess in a n individual with intussusception?

-sausage shaped abdominal mass in URQ -"currant jelly like" stools containing blood and mucus -hypo/hyperactive bowel sounds -vomiting of gastric contents -colicky abdominal pain causing child to scream, draw knees to abdomen

Explain changes in the diet for a child with GER

-small, frequent feedings -make formula thicker with rice cereal -burp frequently -hold child upright for 15-30 min after feedings

What would you assess in child with encopresis?

-soiled clothing -scratching/rubbing of anus -fecal odor -social withdrawal

What are diagnostic tests done for CF?

-sweat chloride -newborn screening -DNA identification -abnormal measurement of nasal potential diff

What is acute laryngothracheobronchitis (LTB) and who does it effect?

-swelling of the upper airway -effects children younger than five years old -preceded typically by a URI caused by: -RSV -parainfluenza -M. pneumoniae -influenza A and B -pneumococci/staphylococci

signs of hemorrhage post-tonsillectomy

-tachycardia -pallor -frequent clearing of the throat or swallowing -vomiting of bright red blood late sign: hypotension

What is intussusception?

-telescoping of one portion of bowel into another portion -results in obstruction to the passage of intestinal contents

What is GER and what causes it?

-the return of gastric contents back into the esophagus -result of relaxation of lower esophageal sphincter

What diagnostic evaluations are used for pyloric stenosis?

-ultrasound -upper GI series -lab studies

What are problems for a child with diarrhea?

-fluid volume deficit -skin integrity -risk for transmission of infection

What would you assess in an individual with EA and TEF?

-frothy saliva the 3 Cs -coughing -choking -cyanosis also: -regurgitation -admobinal distention -increased resp rate during/after feedings

What is stridor?

-high pitch sounds on inspiration -occurs with an upper airway obstruction -can be heard without a stethescope

What are croup syndromes characterized by?

-hoarseness -"barking" cough -inspiratory stridor -varying signs of respiratory distress

What would you assess in a child with GER?

-*passive* regurgitation/emesis -poor weight gain -irritablity -hematemesis -heartburn -anemia

How would you assess hirschsprungs in an infant?

-FTT -constipation -abdominal distention -episodic vomiting -diarrhea

What are clinical manifestations of GI dysfunction?

-FTT -spitting up/regurgitation -nausea, vomiting, diarrhea, constipation -abdominal pain/distention -jaundice -dysphagia -hypo/hyper/absent bowl sounds -fever

How does CF present itself?

-wheezing respiration/dry cough -obstructive emphysema -cyanosis -clubbing -recurring bronchitis and pneumonia -meconium ileus -intestinal obstruction -undigested food in stool (FROTHINESS, FOULODOR) -wasting of tissues -salty skin -delayed puberty -infertility in boys -dehydration

How does aspiration pneumonia occur?

-when food, secretion, inter materials, volatile compounds, or liquid enter the lungs and cause inflammation and chemical pneumonitis

What is EA/TEF?

-when the esophagus ends before it reaches the stomach or the trachea and the esophagus fail to separate -can occur separately or in a combination

Which of the following clinical manifestations would the nurse observe on an infant diagnosed with RSV? A. Increased respiratory rate B. Decreased heart rate C. Poor feeding D. Increased stooling E. High grade fever F. Fussiness

A. Increased respiratory rate C. Poor feeding E. High grade fever

Select all of the clinical manifestations seen in a young child with croup: A. Inspiratory stridor B. High fever C. Barking Cough D. Increased Resp Rate E. Mild retractions F. Drooling

A. Inspiratory Stridor C.Barking Cough D. Increased RR E. Mild Retractions

Which statement by an 8-year-old child with asthma indicates that the child understands the use of a PEF meter? 1. "My peak flow meter can tell me if an asthma episode might be coming, even though I might still be feeling OK." 2. "When I do my peak flow, it works best when I do three breaths without pausing in between breaths." 3. "I always start with the meter about halfway up. That way I don't waste any breath." 4. "If I use my peak flow meter every day, I will not have an asthma attack."

A. My peak flow meter can tell me if an asthma episode might be coming even though i might still be feeling OK

Pancreatic enzyme supplements are given to a child with Cystic Fibrosis: A. between meals and at bedtime. B. each time the child eats something. C. when the child's appetite begins to diminish. D. when stools become bulky and foul smelling.

B. Each time the child eats something

The nurse is caring for a child with cystic fibrosis. Which of the following treatments would be used to promote mucus clearance through percussion or vibration? a. suctioning b. chest tube c. bronchoscopy d. chest physiotherapy

D. Chest physiotherapy

Which of the following symptoms would a three year old child who has epiglottis most likely exhibit? A. Exhaling through pursed lips. B. Crackles upon auscultation. C. Difficulty swallowing. D. Blood tinged mucus.

Difficulty Swallowing.

Why should you monitor for normal, brown stool in a child with intussusception?

It means the intussusception has reduced itself.

What is a child with cleft lip/palate at risk for developing?

Otitis media

A two-year presents to an urgent care center with respiratory distress, cyanosis and unable to speak. Parents report an initial episode of choking. What is the best initial action for the nurse to take? A. Call 911 and have parents wait for ambulance to transport child to pediatric hospital. B. Administer oxygen by face mask and call the child's primary care provider. C. Start CPR after the child loses conscientiousness. D. Perform back blows/abdominal thrust as described in the Heimlich maneuver.

Perform back blows/abdominal thrust as described in the Heimlick maneuver.

A child with a diagnosis of pertussis (whooping cough) is being admitted to the pediatric unit. As soon as the child arrives to the unit, which action should the nurse perform first? A. Weigh the child B. Take the childs temp C. Place the child on a pulse ox D. Administer prescribed meds

Place the child on a pulse oximeter.

A two year old is seen for acute laryngotracheobronchitis. Which of the following observations would most cause you to believe that airway occlusion is occurring? A. Respiratory rate is gradually increasing B. He states he is tired and wants to sleep C. His cough is becoming harsher D. Nasal discharge is increasing

Respiratory rate is gradually increasing

How do you diagnose strep pharyngitis?

Send a culture to the lab

What causes clubbing?

reduction of oxygen in the blood