PEDS Exam 3

characteristics of diaphragmatic hernia

- lung sounds absent on affected side - heart sounds at right side of chest - bowel sounds in lung fields

nursing interventions for enterocolitis

- measure abdomen girth every 1-2 hours - leave diaper off to decrease pressure

5 p's of tissue ischemia to prevent compartment syndrome

- pain - pulses - pallor - paresthesia - paralysis

what foods can kids with celiac disease HAVE:

- potatoes - rice/buckwheat - soy - quinoa - popcorn/corn chips - fruits and veggies

nursing interventions for esophageal atresia

- prevent aspiration - maintain patent airway - NPO - prevent pneumonia

treatment for clubfoot (4)

- stretching of the foot - application of a long leg cast to hold the foot in place (4-8 weeks) - final cast for 3 weeks - brace for 2-4 years

parent teaching for child with constipation

- structured bowel training - increase fluids - increase fiber

toddlers with constipation should have what diet

- whole wheat - fruit, veggies - increased fluids

Pavlik harness

- worn full time 3-4 months - may continue at night for 4-6 weeks if positive

Assessment for type 2

Blood pressure, lipid levels

Apparent at birth

Cleft lip

Seen on ultrasound at 13-14 weeks

Cleft lip

Affects speech development

Cleft palate

May not be apparent at birth

Cleft palate

Open posterior fontanelle, thick tongue, dull expression, hypotonia/activity, poor sucking

Congenital hypothyroidism

Doesn't limit physical development and is not painful for young children

DDH

Risk for ________ with central diabetes insipidus

Dehydration

Complications of Cleft lip and palate

Dehydration, skin breakdown

prevention of mumps

MMR vaccine

Painless rectal bleeding at age 1-2

Meckel diverticulum

Medication for type 2

Metformin

vesicle size of nonbullous impetigo

2 cm

nonbullous impetigo

2-5 years

When is cleft lip repaired

2-6 months

after traction, the bed shouldn't be elevated more than

20 degrees

severe dehydration treatment

20 mL/kg bolus of NS over 30-60 minutes

The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder?

"When they get my son's thyroid levels normal, he won't be so tired."

Complication to monitor for with esophageal atresia

Aspiration

assess for cardiac distress and defects with omphalocele & gastroschisis

- auscultate heart sounds - listen for murmurs - rate & rhythm - BP in all four extremities - compare peripheral pulses - monitor for cyanosis

prodromal phase of measles

- clear conjunctival drainage - cough - koplik spots - maculopapular rash beginning at the head

nursing interventions for biliary atresia

- cover hands with mittens - monitor liver enzymes - monitor for bleeding - tepid baths - central line care

nursing management for intussusception

- decompress stomach - IV fluids - pain control - monitor for peritonitis, shock

normal urine output for a child

1-2 mL/hr

normal urine output for an infant

1-3 mL/kg/hr

Pedialyte

1-3 teaspoons every 10-15 minutes

with biliary atresia, bilirubin levels are above

1.2

Rule of 10s used for cleft lip/palate surgery

10 weeks old, 10 lbs, hemoglobin of 10

topical mupirocin might be given for impetigo for what duration

10-14 days

normal sodium in infants

134-150

normal sodium in children

135-145

treatment for DDH should be completed before what age

4 years

mild to moderate dehydration treatment

50-100 mL/kg in 2-4 hours

You can give Ondansetron in children older than

6 months

After patient recieves PSARP surgery, they might need a temporary colostomy for

6-8 weeks

Precocious puberty in girls

8 years

What age are children when Meckel diverticulum becomes inflamed

8 years

normal glucose level

80-120

Precocious puberty in boys

9 years

When is cleft palate repaired

9-18 months

Inflamed Meckel diverticulum looks like

Acute appendicitis

If a child with varicella is immunocompromised, what medication do they get?

Acyclovir

Main sign of precocious puberty

Advanced bone age

Risk factors for omphalocele

Alcohol, smoking, SSRIs, obesity

Shiny velvet like patches that appear in type 2 dm due to insulin resistance

Ancathosis nigricans

Respiratory distress shortly after birth

Diaphragmatic hernia

Nursing intervention for an infant born with omphalocele

Dress with saline gauze and impermeable dressing

Cyanosis, coughing, choking

Esophageal atresia

arches neck when feeding cries excessively additional respiratory symptoms

GERD

bloody or bilious vomit indicates

GI bleed or obstruction

Diameter 2-3

Gastroschisis

Life threatening Bowel inflamed and edematous with delayed enteral nutrition

Gastroschisis

Umbilical cord to the left of abnormality Born preterm C-section recommended

Gastroschisis

Fasting blood glucose (DX of diabetes)

Greater than 126

2 hour plasma glucose (DX of diabetes)

Greater than 200

Random plasma glucose (DX of diabetes)

Greater than 200

Diabetes insipidus causes

Hypertonic dehydration

Screening required before discharge at birth

Hypothyroidism

Burns and severe nausea and vomiting cause

Hypotonic dehydration

If burns are over 30% of the body or more, the child is at risk for

Hypovolemia, shock

Cleft lip and cleft palate infants can have increased otitis media due to:

Ineffective Eustachian tubes, improper middle ear drainage

Vomiting and diarrhea causes what type of dehydration

Isotonic

treatment for biliary atresia

Kasai procedure, liver transplant

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?

Low T4 level and high TSH level

Acquired Unrelated to pituitary gland

Nephrogenic diabetes insipidus

Full term Diameter: 2-15 Umbilical cord attached to sac Normal bowels

Omphalocele

First intervention for dehydration

Oral rehydration

corrects anorectal malformations done at 6 months

PSARP

S/s of central diabetes insipidus

Polydipsia, nocturia, enuresis

First presenting symptom of rubella

Rash on the face, spreads to trunk

Diagnosis of esophageal atresia

Resistance when attempting to pass an NG tube

Small pinpoint papule with threadlike track

Scabies

Superficial partial thickness burns should get what medication for infection prevention

Silver iron

Use during pregnancy causes a 2x greater risk of cleft lip and cleft palate

Smoking

Meckel diverticulum causes a disruption in which electrolytes

Sodium, potassium, chloride

S/s of dehydration

Tachycardia, delayed capillary refill, decreased peripheral pulses

Respiratory distress

Tachypnea, grunting, use of accessory muscles, cyanosis

A child with varicella continues to be contagious until when

The lesions have crusted over

Hospitalized after diagnosis

Type 1

Must have insulin

Type 1

encopresis can cause an increase in

UTIs

VACTERL syndrome

V: vertebral abnormality A: imperforate anus C: cardiac abnormality TE: tracheoesophageal R: renal abnormality L: limb deformity

Risk for what type of complications with type 2

Vascular

S/s of type 1 diabetes

Weight loss, labile, polydipsia, polyphagia, polyuria, fatigue, blurred vision

history of constipation, straining, ribbon-like stools

anal stenosis

no meconium stool in 24 hours after birth indicates

anorectal malformation

no pain meds until the diagnosis is confirmed mcburney's point

appendicitis

pain in lower abdomen associated with vomiting

appendicitis, UTI

instructions for malathion for lice treatment

apply on dry hair and leave in overnight

how to apply permethrin 5% for scabies

apply to affected area and rinse off 8-12 hours later

instructions for permethrin use for lice

apply to wet hair and leave on for 10 mins

remove what from a child with constipation's diet

bananas, rice, cheese, white bread

knees out laterally palpable and audible click is heard DDH

barlow test

intially asymptomatic 2-3 weeks after birth: jaundice

biliary atresia

stools are clay-colored urine is dark tea colored

biliary atresia

will probably need a liver transplant later in life

biliary atresia

type of medication for osteogenesis imperfecta

biphosphonates (-dronate)

children with Osteogenesis imperfecta should avoid

contact sports

barrel-shaped chest sunken abdomen

diaphramatic hernia

side effect of antibiotics

diarrhea

history of chronic constipation after 4 years old

encopresis

excessive frothy, bubbling salivation and drooling

esophageal atresia

A 6-week-old infant has been diagnosed with congenital hypothyroidism. Once the level of medication has been determined, in order to maintain the proper dosing of thyroid hormone, the nurse instructs the parents to have the baby's levels tested how often during the first year?

every 1 to 3 months

diagnosis of hirschprung's disease

exam of tissue biopsy (absent ganglion cells)

True or false: put a heating pad on a child with suspected appendicitis to help relieve pain

false

The nurse is performing an assessment of a child with a spider bite and documents the findings in the chart note above. Which finding(s) prompts the nurse to anticipate treatment for cellulitis? Select all that apply. fever chills erythema cool skin around the infected area lymphadenopathy

fever chills erythema

initial treatment of constipation

goLYTELY

A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition?

graves disease

what can relieve itching in a cast

hair dryer on cool

best way to prevent Hepatitis A

handwashing

complication of vancomycin therapy

hearing issues

acute severe jaundice increased liver enzymes, PTT, and PPT

hepatitis B, C, D

absence of peristalsis/motility distended abdomen failure to pass meconium in 24 hours repeated vomiting

hirschsprung's disease

abrupt, severe, colicky episodic abdominal pain nausea, vomiting, diarrhea currant jelly stools

intussusception

prior respiratory adenovirus infection

intussusception

Shortly after delivery, a newborn is diagnosed with hypocalcemia. What manifestation will the nurse assess in this client?

jitteriness

contagious 4 days before and after the rash

measles (rubeola)

stool is brick-colored and looks like red currant jelly

meckel diverticulum

inconsolable cry, excessive irritability

meningitis, intussusception

complications of mumps

meningitis, orchitis

hypokalemia, hyponatremia, hypochloremia can lead to

metabolic alkalosis

pain med for appendicitis

morphine sulfate

knees to chest test detects DDH

ortolani test

blue sclera

osteogenesis imperfecta

increased WBCS, c-reactive protein, ESR

osteomyelitis

preschoolers (3-5) with constipation should have what diet

peanuts, popcorn, raisins

drawing up knees to chest, avoidance of unnecessary movement

peritonitis, intussusception

when can diaphramatic hernia be diagnosed

prenatally at 16-24 weeks

pyloric stenosis manifests with

projectile vomiting

what position should the infant be in after PSARP

prone

often seen with omphalocele

pulmonary hypoplasia

parent instructions for children with lice

put toys in a bag for 3 days

baby is hungry soon after vomiting

pyloric stenosis

peristalsic waves in upper abdomen olive-shaped mass in RUQ

pyloric stenosis

sudden onset at 3-5 weeks of age of projectile vomiting

pyloric stenosis

with intussusception, child will be NPO until

resolved

medication for measles

ribavirin

First symptom is the rash (fine, red/pink rash) disappears after 3 days lymphadenopathy

rubella

diagnosis of rubella

rubella-specific serum IgM

truncal asymmetry improperly fitting clothing no back pain

scoliosis

rupture of appendix can lead to

sepsis, shock

deep respirations, tachypnea thready pulse BP very low dark tones, difficult to arouse, unconscious, apprehensive sunken eyes and fontanel minimal or absent output; absent tears H&H increased

severe dehydration

remove brace for scoliosis only for __________

showering

sex hormones increase with increased

skeletal growth

pull applied directly to bone with surgically placed pins

skeletal traction

pull placed directly on skin that indirectly puts traction on the bone and muscle

skin traction

diagnosis of appendicitis

ultrasound

give what antibiotic typically for osteomyelitis

vancomycin

children with celiac disease need sources of

vitamin D and calcium

what can children with celiac disease NOT have

wheat, barley, rye

treatment for intussusception

initiate hydrostatic air

pyloric stenosis causes what electrolyte imbalance

metabolic alkalosis

RR, HR, BP = normal alert, restless, thirsty flat fontanel output slightly decreased

mild dehydration

tachypnea, tachycardia, low BP prolonged cap. refill sunken eyes/fontanel skin turgor poor (2-3 seconds) output dark and increased specific gravity

moderate dehydration

A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child?

mumps

Fever and systemic symptoms last up to 5 days

mumps

S/S of increased intracranial pressure

mumps

infectious 7 days before and 8 days after parotid swelling

mumps

self limiting virus spread by respiratory secretions that spreads in the body via lymphatic system

mumps

spine curve that is 25 degrees

no treatment

sudden spontaneous relief of pain during appendicitis means the appendix has ruptured PRIO nursing action:

notify provider

give antibiotics for _____ fractures

open

only touch a wet plaster cast with

open palms

injects sodium influx through nerve cell membrane and causes paralysis and death of louse

permethrin

what medication for scabies can be used in children older than 2 months

permethrin 5%

food particles in vomit indicates

slowed mobility

true or false: impetigo is self limiting

true

parent teaching for infant with GERD

- hold infant upright for 30 min after feedings - avoid placing infant in car seat after feeding - thicken feedings as directed - burp infant after every 1-2 oz of formula or 5 minutes breastfeeding

when appendix ruptures, what to assess for (THESE ARE BAD)

- hypoactive bowels - increased HR - increased RR - fever - decreased BP

Severe burns cause

Immunosuppression

Projectile vomiting means

Increased ICP

when can hepatitis B vaccines be given

birth, 2 months, 6 months

for suspected osteomyelitis, what should be done before beginning antibiotics

blood culture

spine curve that is 30-40 degrees is treated with

bracing

blisters on trunk of infants

bullous impetigo

bullous impetigo

infants

Replace fluids slowly with _________ dehydration to avoid water intoxication and cerebral edema

hypertonic

serum sodium level increased (above 150)

hypertonic dehydration

what electrolyte imbalance with meckel diverticulum

hypokalemia

vomiting can lead to

hypokalemia, hyponatremia, hypochloremia

serum sodium decreased (below 130)

hypotonic dehydration

absence of an anal opening

imperforate anus

permethrin might cause

increased itching

stools frothy, greasy, and foul-smelling

celiac disease

medication for bullous impetigo

cephalosporin

pain in right upper abdomen associated with vomiting

cholethiasis, pneumonia

the rectum, vagina, and urethra form a common channel with 1 opening

cloacal anomaly

skeletal traction is used for

spine injury

impetigo is caused by

staphylococcus aureus

spine curve that is 45-50 degrees is treated with

surgery

true or false: Gore Tex Casts can be flushed with warm water and soap

true

true or false: No scratching under the cast with anything

true

true or false: Permethrin kills alive lice but not nits

true

true or false: hearing loss is a manifestation of osteogenesis imperfecta

true