Peds ATI Focused Review Notes

risk factors for bacterial meningitis

- URI (otitis media, tonisllitis) caused by N.meningitides, S.penumonia, H.influenzae, E.coli - Immunosuppression - Injuries that give direct access to CSF (skull fracture, penetrating head wound) - Overcrowded living cond'ns

diagnosis of Reye's

-liver biopsy -CSF study to rule out meningitis

meds for Reye's patients

-osmotic diuretic (mannitol) to decrease cerebral swelling -vit K to improve synthesis of clotting factors

physical assessment findings with Reye's syndrome

-recent viral illness or use of aspirin or aspirin-containing products -Reye syndrome presents in clinical stages based on the severity of liver and neurologic findings -Lethargy -Irritability -Combativeness -Confusion -Delirium -Profuse vomiting -Seizures -Loss of consciousness

A nurse is providing instruction to the teacher of a child who has attention‑deficit/hyperactivity disorder (adhd). Which of the following classroom strategies should the nurse include in the teaching? (select all that apply.) a.eliminate testing. B.allow for regular breaks. c.combine verbal instruction with visual cues. d.establish consistent classroom rules e.increase stimuli in the environment.

Answer: a. allowing for added time when testing can assist the client who has adhd to be successful. B.CORRECT:allowing for regular breaks will assist the client who has adhd to focus on the required tasks. c.CORRECT:combining verbal instruction with visual cues will assist the client who has adhd with learning information. d.CORRECT: Providing consistent classroom rules will assist the client who has adhd to become successful. e. stimuli in the environment distract the client who has adhd, so it should be decreased.

A nurse in the emergency department is caring for a child whose parent reports that the child has swallowed paint thinner. the child is lethargic, gagging, and cyanotic. Which of the following actions should the nurse take? a.induce vomiting with syrup of ipecac. B.insert a nasogastric tube, and administer activated charcoal. c.Prepare for intubation with a cuffed endotracheal tube. d.administer chelation therapy using deferoxamine mesylate

Answer: a. inducing vomiting with syrup of ipecac is contraindicated as a poison control measure. B. activated charcoal is indicated for acetylsalicylic acid poisoning. c.CORRECT:treatment for poisoning with hydrocarbons includes intubation to protect the airway before proceeding with gastric decontamination. d. chelation therapy is indicated for lead poisoning.

A nurse is providing teaching to a parent about acetaminophen poisoning. Which of the following information should the nurse include in the teaching? a.nausea begins 24 hr after ingestion. B.Pallor can appear as early as 2 hr after ingestion. c.Jaundice will appear in 12 hr if the child is toxic. d.children can have 4 g/day of acetaminophen

Answer: a. nausea is a manifestation that begins 2 to 4 hr after ingestion. B.CORRECT:sweating is a manifestation that starts 2 to 4 hr after ingestion. c.Jaundice will appear in 36 hr to 7 days. d. the maximum dose of acetaminophen in children 2 to 5 years of age is 720 mg/day. in children 6 to 12 years of age, it is 2.6 g/day.

A nurse is teaching a group of parents about characteristics of infants who have failure to thrive. Which of the following characteristics should the nurse include in the teaching? a.intense fear of strangers B.increased risk for childhood obesity c.inability to form close relationships with siblings d.developmental delays

Answer: a. these infants do not exhibit the expected fear of strangers. B. these infants are not at an increased risk for childhood obesity. c. these infants are able to form close relationships with siblings. d.CORRECT:these infants can exhibit developmental delays due to decreased nutritional intake needed for brain development

A nurse is teaching the parent of a child about risk factors for attention‑deficit/hyperactivity disorder (adhd). Which of the following should the nurse include in the teaching? a.formula‑feeding as an infant B.history of head trauma c.history of postterm birth d.child of a single parent

Answer: a.Being formula‑fed as an infant is not a risk factor for the development of adhd. B.CORRECT:history of head trauma is a risk factor for the development of adhd. c. history of a post‑term birth is not a risk factor for the development of adhd. d.Being the child of a single parent does not increase the risk of development of adhd

A nurse in a community center is providing an in‑service to a group of parents on management of airway obstructions in toddlers. Which of the following responses by the parents indicates understanding? (select all that apply.) a."i will push on my child's abdomen." B."i will hyperextend my child's head to open his airway." c."i will listen over my child's mouth for sounds of breathing." d."i will use my finger to check my child's mouth for objects." e."i will place my child in my car and take him to the closest emergency facility."

Answer: a.CORRECT: the nurse should instruct the parents to use abdominal thrusts to open an obstructed airway in a child as part of cPr. B. the nurse should teach the parent to position the child with the chin elevated, rather than hyperextended, to open the airway. c.CORRECT: the nurse should teach the parent to look for chest motion and listen for normal breath sounds over the child's mouth and nose when evaluating for an airway obstruction. d.CORRECT: Finger sweeps to check for an impaired airway are not performed as part of cPr because this action can cause an object to be pushed further down into the child's throat, causing injury. e. The nurse should teach the parents to attempt to clear the child's airway according to aHa guidelines and to call 911. Attempting to independently transport the child to an emergency facility delays treatment.

A nurse is teaching a parent about posttraumatic stress disorder (Ptsd). Which of the following information should the nurse include in the teaching? (select all that apply.) a.children who have Ptsd can benefit from psychotherapy. B.a manifestation of Ptsd is phobias. c.Personality disorders are a complication of Ptsd. d.Ptsd develops following a traumatic event. e.there are six stages of Ptsd

Answer: a.CORRECT:children who have Ptsd should be referred to psychotherapy to assist with resolution of the traumatic event. B.CORRECT:the child who is experiencing Ptsd often has new phobias that can be related to the traumatic event. c.Personality disorders are not a complication of Ptsd. d.CORRECT: Ptsd develops following a traumatic event such as assault, serious injury, or a life‑threatening episode. e.Ptsd has three stages: the initial response, and second and third phase

A nurse in the emergency department is admitting an infant who experienced a life‑threatening event. Which of the following prescriptions by the provider should the nurse anticipate? (select all that apply.) a.electroencephalogram B.electrocardiogram c.Urine cultured.arterial blood gases e.Blood culture

Answer: a.CORRECT:eeg is performed to assess for epilepsy. B.CORRECT:ecg is performed to assess for long Qt syndrome or dysrhythmias. c. a urine specimen is obtained for a culture to assess for a Uti. d. aBgs are not routinely performed for an infant who experienced an apparent life‑threatening event. e.CORRECT:a blood culture is obtained to assess for bacterial or viral infections.

A nurse is caring for a child who is experiencing respiratory distress. Which of the following findings are early manifestations of respiratory distress? (select all that apply.) a.Bradypnea B.Peripheral cyanosis c.tachycardia d.diaphoresis e.restlessness

Answer: a.Bradypnea is an advanced manifestation of respiratory distress. B. cyanosis is an advanced manifestation of hypoxia. c.CORRECT:tachycardia is an early manifestation of respiratory distress. d.CORRECT:diaphoresis is an early manifestation of respiratory distress. e.CORRECT:restlessness is an early manifestation of respiratory distress.

physical assessment findings with meningitis

Newborns ●No illness is present at birth, but it progresses within a few days. ●Manifestations are vague and difficult to diagnose. ◯Poor muscle tone, weak cry, poor suck, refuses feeding, and vomiting or diarrhea ◯Possible fever or hypothermia ●Neck is supple without nuchal rigidity. ●Bulging fontanels are a late sign. 3 months to 2 years ●Seizures with a high-pitched cry ●Fever and irritability ●Bulging fontanels ●Possible nuchal rigidity ●Poor feeding ●Vomiting ●Brudzinski's and Kernig's signs not reliable for diagnosis 2 years through adolescence ●Seizures (often initial sign) ●Nuchal rigidity ●Positive Brudzinski's sign (flexion of extremities occurring with deliberate flexion of the child's neck) ●Positive Kernig's sign (resistance to extension of the child's leg from a flexed position) ●Fever and chills ●Headache ●Vomiting ●Irritability and restlessness that can progress to drowsiness, delirium, stupor, and coma ●Petechiae or purpuric-type rash (with meningococcal infection) ●Involvement of joints (with meningococcal and Hib) ●Chronic draining ear (with pneumococcal infection)

Kernig's sign

a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down

signs of shaken baby syndrome

irritability, changes in eating patterns, tiredness, difficulty breathing, dilated pupil, seizures, vomit

risk factors for viral meningitis

many viral illnesses, such as cytomegalovirus, adenovirus, mumps, herpes simplex virus, and arbovirus

Brudzinski's sign

pain with resistance and involuntary flex of hip/knee when neck is flexed to chest when lying supine

nursing care for Reye's patients

●Maintain hydration while preventing cerebral edema. ◯Administer IV fluids as prescribed. ◯Maintain accurate I&O. ◯Insert indwelling urinary catheter as ordered. ●Position the client. ◯Avoid extreme flexion, extension, or rotation. ◯Maintain the head in a midline neutral position. ◯Keep the head of the bed elevated 30°. ●Monitor coagulation and prevent hemorrhage. ◯Note unexplained or prolonged bleeding. ◯Apply pressure after procedures that cause bleeding. ●Monitor pain status and response to painful stimuli. Administer pain medications when appropriate. ●Assist with intubation and maintain a ventilator if required. ●Implement seizure precautions. ●Keep the family informed of the client's status. ●Provide private time for the family to be with the client if death is imminent. ●Initiate referrals to support resources for family