Unit 1 Wk 3- Pain, Fluid & Electrolytes

IV Maintenance fluid calculation for pediatrics

100mL per kg of body weight for the first 10kg. 50mL per kg of body weight for the next 10kg 20 mL per kg of body weight for the remainder of body weight in kg. ADD THEM UP.

What is the FACES pain rating scale?

Pediatric pain assessment for ages 3+ where emoticon-like faces are used.

What is the Oucher pain rating scale?

Pediatric pain rating scale for ages 3+ using actual photos of children however they must know number values.

What is the poker chip tool?

Pediatric pain rating scale used for ages 3+ using 1-4 poker chips to describe the pain.

What is the expected urine output for children and adolescents?

1-2mL/kg/hour

A child is being discharged from the hospital and the nurse has completed discharge teaching regarding prescribed liquid medications. Which comments by the parent demonstrates understanding of discharge instructions for safe medication administration? (Select all that apply.) 1. "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy." 2. "I will be sure to not give too much of the liquid medication at one time." 3. "I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections." 4. "I will only need one medicine dropper for both of the medications being prescribed." 5. "I can probably pinch my child's nose to help in swallowing the medication. I do this when I don't want to taste a liquid medication."

1. "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy." 2. "I will be sure to not give too much of the liquid medication at one time." 3. "I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections." Rationale:Only droppers given by the pharmacy for the specific medication should be used. Different syringes may have different measurements than pediatric oral syringes. Mixing medication syringes is avoided if a dropper is packaged with a certain medication since the drop size may vary from one dropper to another. Giving small amounts of liquid avoids aspiration. Pinching the child's nose increases the risk for aspiration and interferes with the development of a trusting relationship.

The nurse is preparing to administer an antibiotic for a severe respiratory infection to a 5-year-old child. The child asks the nurse why he is getting this medication. What is the best response by the nurse? 1. "The medicine will help you feel better so that you can go home soon." 2. "This medicine will kill the bacteria that are in your body making you sick." 3. "The medicine is what your healthcare provider wants you to have to make you better." 4. "The medicine will get rid of the bugs that are making you feel bad."

1. "The medicine will help you feel better so that you can go home soon." Rationale:The nurse must consider the child's developmental level when answering questions about medicine or medical procedures. The 5-year-old child will likely understand that it is to make them feel well enough to go home. Using words or phrases such as "kill the bacteria," and "get rid of bugs" may be understood literally by the child and frighten them. Telling the child that the healthcare provider wants the medication given doesn't give the child a tangible reason for taking the medication.

The nurse is preparing to administer medication to a 5-month-old client. The nurse is aware that at least 2 different client identifiers must be used. Which identifiers could the nurse use? (Select all that apply.) 1. Client's birthday 2. Client's hospital ID number 3. Client's parent's name 4. Client's room number 5. Client's full name

1. Client's birthday 2. Client's hospital ID number 5. Client's full name Rationale:Client identifiers include such things as client's full names, birth dates, and hospital ID numbers. Client room numbers and parents' names should not be used as client identifiers.

A nurse is assessing an infant who has been vomiting and experiencing diarrhea. Which findings would indicate to the nurse that the infant is experiencing severe dehydration? (Select all that apply.) 1. Cool mottled extremities 2. Sunken fontanels 3. Slightly decreased urine output 4. Bradycardia 5. Pink moist oral mucosa

1. Cool mottled extremities 2. Sunken fontanels 4. Bradycardia Rationale:Severe dehydration would be indicated by sunken fontanels, increased heart rate progressing to bradycardia, cool mottled or dusky extremities, dry oral mucosa, and significantly decreased urine output of less than 1 mL/kg/hr. Pink moist oral mucosa and slightly decreased urine output would suggest mild dehydration.

What are some reasons (6) that pharmacokinetics are different in pediatric patients?

1. Higher percentage of body water than adults. 2. More rapid EFC exchange 3. Decreased body fat 4. Liver immaturity, altering first-pass effect. 5. Decreased amount of plasma proteins available for drug binding. 6. Immature BBB, especially in neonates, allowing permeation by certain mediations.

3 Interventions/management to promote fluid and electrolyte balance from a child who is vomiting.

1. ORF 2. Antiemetics 3. IV fluids

The student nurse is preparing a presentation on ways to prevent medication errors in children. What information should the student include? (Select all that apply.) 1. Verify orders for dosages that are unusually large or small. 2. Use 2 client identifiers prior to administering medications. 3. Double-check medication calculations prior to administration. 4. Document the child's weight in pounds and ounces. 5. Utilize the Joint Commission's "Do Not Use" abbreviation list.

1. Verify orders for dosages that are unusually large or small. 2. Use 2 client identifiers prior to administering medications. 3. Double-check medication calculations prior to administration. 5. Utilize the Joint Commission's "Do Not Use" abbreviation list. Rationale:Children's' weights should always be recorded in kilograms, not in pounds. The nurse should always double-check medication calculations and use at least 2 client identifiers prior to administering medications. If the dose seems small or large, the nurse should verify the order prior to administering. The nurse should also utilize the Joint Commission's Do Not Use abbreviation list.

A neonate is brought to the emergency department by the parent because the child "just doesn't look right." The neonate is suspected of having sepsis. Which statement by the parent would help to confirm this suspicion? 1. "The child has had a fever." 2. "My water broke quite a while before I actually birthed the child." 3. "The child's cry seems to be pretty strong." 4. "The child seems to be breathing slowly."

2. "My water broke quite a while before I actually birthed the child." Rationale:Prolonged or premature rupture of membranes increases a neonate's risk for sepsis. A weak cry or lack of smile or facial expression may be present with sepsis. A significant increase in breathing rate (tachypnea) or increased work of breathing evidenced by nasal flaring, grunting, and a retraction is noted with sepsis. Neonates with sepsis do not have a fever. In fact, they may have below-normal temperature.

A parent believes the 2-year-old child is frightened by seeing an intramuscular (IM) medication injected into the child's thigh and requests that the child's "butt" be used. What will be the nurse's response? 1. "Because your child is 2 years old, this will be OK." 2. "The muscle in your child's butt is not well enough developed to receive this injection until the child has walked for 1 year." 3. "Because your child is still in diapers, the thigh is a better choice." 4. "The medication will be better absorbed from the thigh."

2. "The muscle in your child's butt is not well enough developed to receive this injection until the child has walked for 1 year." Rationale:Muscle development follows use, and 1 year of walking allows for full development of the gluteus and less likelihood of injury to the sciatic nerve. Since most children do little walking at 12 months, it is not likely the child has been walking for a year. The other explanations do not address muscle development or are inaccurate statements.

The nurse is to obtain a stool specimen from a 4-year-old child who has very liquid stool. The child is ambulatory but weak. Which collection method would be most effective for the nurse to use? 1. Use a clean bedpan to collect the specimen. 2. Apply a urine bag to the anal area. 3. Have the child defecate into a container in the toilet. 4. Use a tongue blade to scrape a specimen from a diaper.

2. Apply a urine bag to the anal area. Rationale:With very liquid stool, applying a urine bag to the anal area is most effective in collecting the specimen. Using a tongue blade to scrape a specimen from a diaper would be appropriate if the stool is formed. However, putting a diaper on a 4-year-old would be demeaning. Defecating into a collection container that sits at the back of the toilet would be more appropriate for an older child who is ambulatory. A bedpan would be appropriate if the child was bedridden.

A toddler requires 1.5 mL (.05 oz) of an antibiotic given intramuscularly (IM). How will the nurse administer this medication? 1. Reduce the volume of the dose using less diluent than recommended to prepare the antibiotic for IM injection. 2. Divide the dose. Administer 0.75 mL (0.25 oz) IM in each vastus lateralis. 3. Seek an order for an oral form of the antibiotic. 4. Administer the antibiotic IM in the rectus femoris.

2. Divide the dose. Administer 0.75 mL (0.25 oz) IM in each vastus lateralis. Rationale:The recommended amount of solution a toddler should receive in one IM injection should not exceed 1 mL (0.33 oz). Dividing the dose is necessary even though two injections will cause additional stress. These could be given simultaneously by two nurses. Seeking an oral route could be explored, but may not be feasible. The manufacturer's directions regarding the amount of diluent should be followed to ensure safety.

A group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders? 1. Monocytes 2. Eosinophils 3. Lymphocytes 4. Neutrophils

2. Eosinophils Rationale:Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections.

A child has been admitted to the acute care facility for the management of dehydration. The nurse is preparing to administer intravenous fluid replacement to the child. Which fluids are suitable for use? (Select all that apply.) 1. 5% dextrose in water 2. Normal saline 3. 10% dextrose in water 4. Lactated Ringer 5. 0.45% saline

2. Normal saline 4. Lactated Ringer Rationale:Intravenous fluids can be used to treat dehydration. The fluids used need to be isotonic. Examples of isotonic fluids include normal saline and ringer lactate solution.

The nurse is preparing an 18-month-old for discharge after treatment for dehydration following diarrhea. What instruction would the nurse most likely include in the discharge teaching? 1. "Offer her flavored gelatin if she is hungry." 2. "Make sure she gets lots of clear liquids." 3. "Encourage bananas, applesauce, and crackers." 4. "Give her plenty of fruit juice or soda."

3. "Encourage bananas, applesauce, and crackers." Rationale:After rehydration is achieved, it is important to encourage the child to consume a regular diet in order to maintain energy and growth. The solid foods presented are easily digested and age appropriate. The parents should avoid prolonged use of clear liquids in the child with diarrhea because "starvation stools" might result. Fluids high in glucose such as fruit juice, gelatin, and soda may worsen diarrhea. Gelatin is high in glucose and may worsen diarrhea.

A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? (Select all that apply.) 1. Antidiarrheal agents 2. Antibiotic therapy 3. IV fluid administration 4. Daily weight assessment 5. Monitor of intake and output

3. IV fluid administration 4. Daily weight assessment 5. Monitor of intake and output Rationale:Rotavirus is viral in nature. Antibiotic therapy is not used in the care and treatment of a viral infection. Antidiarrhea medications are not utilized as they are not effective. Intake and output will be observed. Daily weight will aid in the determination of hydration status. IV fluids may be indicated in the rehydration process.

The nurse is examining a 7-year-old child with suspected appendicitis. Which physical findings would indicate the possibility of appendicitis? 1. Tenderness that comes and goes in the lower abdomen 2. Intermittent, left lower quadrant pain with rebound tenderness 3. Persistent, right lower quadrant pain with rebound tenderness 4. Diffuse, intermittent abdominal pain

3. Persistent, right lower quadrant pain with rebound tenderness Rationale:With appendicitis, symptoms typically do not come and go. They are usually persistent and intensify with time. With appendicitis, maximal tenderness occurs in the area of the McBurney point in the right lower quadrant, not the left. There is pain upon palpation with rebound tenderness. Pain is usually in the right lower quadrant, not the left, and is persistent. There is pain on palpation with rebound tenderness. Pain typically occurs in the right lower quadrant and is persistent and intensifies with time.

A child weighs 18 lb. The nurse is making sure the intravenous (IV) infusion is flowing at the correct rate. After determining fluid requirements for this child for a 24-hour period, the nurse should be sure that the IV is infusing at how many milliliters per hour?

34mL/hr Rationale:The child's weight must be converted to kilograms (18 lb divided by 2.2 kg = 8.18 kg). This kilogram weight is multiplied by 100 (8.18 x 100 = 818.18 mL) to determine the 24-hour fluid requirement. The 24-hour fluid requirement is divided by 24 (hours)= 34.09 (34 mL/hr).

The nurse has finished completing a client education program for parents on proper medication administration to children. Which statement by a parent would indicate a need for further education? 1. "If my toddler won't swallow her medication, I will hold her nose until she has to swallow." 2. "I will let my preschooler squirt his medication in his own mouth after I have measured it out." 3. "When I give my toddler medication, I will make sure they are sitting up." 4. "I will put my child's pill in a small amount of applesauce to help her learn now to swallow it."

4. "I will put my child's pill in a small amount of applesauce to help her learn now to swallow it." Rationale:Proper medication administration includes placing a pill in applesauce or ice cream to help a child learn how to swallow it. When giving medications to an infant or small child, always have them in an upright position to avoid aspiration. The toddler or preschooler should not squirt medication into their own mouth. You should never force medication into a child's mouth or pinch their nose. This increases the risk for aspiration and interferes with developing a trusting relationship.

The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? (Select all that apply.) 1. The parents remove their personal protective equipment (PPE) at the door before exiting, then wash their hands. 2. The parents wear a respiratory mask when entering their child's room. 3. The parents state, "We will be sure to finish any antibiotic if our child is sent home with a prescription." 4. "The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." 5. "The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing."

4. "The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." 5. "The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." Rationale:All close contacts who are younger than 7 years of age and who are unimmunized or underimmunized should have pertussis immunization initiated or the series completed according to the recommended dosing schedule. Fluids should be increased in order to help thin secretions and prevent dehydration during the infection. The parents are correct in removing their PPE at the door and washing their hands when leaving the room, and wearing a mask. All antibiotics should be finished in order to treat the infection adequately and prevent immunity to antibiotics.

The nurse is taking a health history of a 2-year-old child presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction? 1. Bloody vomiting 2. Effortless vomiting 3. Projectile vomiting 4. Bilious vomiting

4. Bilious vomiting Rationale:The contents and character of the vomitus may give clues to the cause of vomiting. Bilious vomiting is never considered normal and suggests an obstruction. Projectile vomiting is associated with pyloric stenosis. The gender and the age of the child are not consistent with pyloric stenosis. Effortless vomiting is often seen in gastroesophageal reflux. Bloody emesis can signify esophageal or gastrointestinal bleeding.

A child needs a peripheral IV start as well as a venous blood sample for a laboratory test. The nurse will take what action? 1. Place the IV and start intravenous fluids promptly; then request the laboratory obtain the blood specimen. 2. Make sure the laboratory specimen is drawn prior to placing the IV access device. 3. Delay both the IV start and blood draw until the child is well hydrated orally. 4. Coordinate placing the peripheral IV and the lab blood draw.

4. Coordinate placing the peripheral IV and the lab blood draw. Rationale:Coordinate the IV placement and lab blood draw to minimize the number of venipunctures for the child. Gaining venous access for each purpose separately does not do this and is not necessary. Having a well-hydrated child makes venous access easier, but oral hydration will take some time, thus delaying needed treatment.

The nurse administers an antipyretic rectal suppository. The child has a bowel movement 15 minutes later. What is the appropriate nursing action? 1 Recheck the child's temperature to determine if the suppository is needed. 2. Immediately notify the healthcare provider. 3. Administer another suppository, and then hold the child's buttocks together. 4. Examine the stool for the presence of the suppository.

4. Examine the stool for the presence of the suppository. Rationale:The stool should be examined for the suppository that may have been expelled with the bowel movement. If it is found, the healthcare provider can be notified to determine if the suppository should be repeated. The nurse should not administer another dose without examining the stool or contacting the healthcare provider. Rechecking the child's temperature would provide little useful information since only a very limited time has elapsed since the temperature was last checked.

The nurse is preparing to administer a vaccine to a 6-month-old child. The medication is to be given intramuscularly. The nurse is correct in choosing which administration site? 1. Deltoid muscle 2. Ventrogluteal site 3. Dorsogluteal site 4. Vastus lateralis site

4. Vastus lateralis site Rationale:The preferred injection site for infants less than 7 months old is the vastus lateralis muscle. In infants and children greater than 7 months old the ventrogluteal site should be considered. The dorsogluteal site, often used in adults, is not recommended in children younger than 5 years of age. The deltoid muscle may be used in a child older than 3 years of age

A parent must administer a medication in syrup form to a 2-month-old infant. The nurse suggests: 1. placing the syrup in a small amount of rice cereal. 2. mixing the syrup in a small amount of formula. 3. using a measured medicine spoon. 4. placing the medicine in an empty nipple without an attached bottle.

4. placing the medicine in an empty nipple without an attached bottle. The young infant should naturally and easily suck the medicine through an empty nipple, getting the entire dose. Formula and rice cereal are essential foods for the infant and the desirability of them should not be altered by the taste of the medication. In addition, a 2-month-old is not developmentally ready for spoon feeding of rice cereal or medication from a medicine spoon.

With which ages would we use the visual analog and numeric scale?

5+, using a scale of 0-10

The healthcare provider has ordered ibuprofen 150 mg every 6 hours as needed for a 3-year-old child for a fever greater than 38°C. The label of the ibuprofen bottle reads "ibuprofen oral suspension 100 mg/5 mL." How much ibuprofen liquid will the nurse administer if the child's temperature goes above 38°C? Record your answer using one decimal place.

7.5 Rationale:The dose ordered (150 mg) is divided by the available dosage (10 mg) then multiplied by 5 mL.

What is hypertrophic pylori stenosis?

Circular muscle of pylorus becomes hypertrophied causing a gastric outlet obstruction.

Why is metabolism of medications in children altered?

Due to the differences in hepatic enzyme production and the child's increased metabolic rate.

What is the difference between hyperthermia and a fever?

Hyperthermia happens when thermoregulation fails resulting in an unregulated rise in core temperature & in a normally neurologic child, the body doesn't allow fever to rise to lethal levels If it is "just" a fever.

A child presents with non-bilious emesis, hunger soon after vomiting, symptoms of dehydration, projectile vomiting, hard movable mass RUQ, and at a risk for metabolic alkalosis. What do these symptoms point toward in an infant 3-6 weeks of life.

Hypertrophic Pylori Stenosis

What does QUEST stand for relating to pediatric physiologic and behavior pain assessment?

Q- Question the child U- Use a reliable and valid pain scale E- Evaluate the child's behavior and psychologic changes to establish a baseline and determine the effectiveness of the intervention. S- Secure the parent's involvement T- Take the cause of pain into account when interviewing and take action.

Why do we not want to use aspirin in pediatric patients?

Risk of Reyes Syndrome!

What are some developmental considerations regarding pin in Adolescents?

They are concerned about body image and fear losing control. This can lead them to deny pain medication, maintain a stoic affect, and show lact of interest in activities.

What are some developmental considerations regarding pain in Preschoolers?

They may become quiet or withdrawn, may hide, view the treatment as punishment (due to magical thinking), may not verbally report pain. They can start to tell where it hurts and use pain tools but may not be able to relate to characteristics of pain.

What are some developmental considerations regarding pain in School-Aged children?

They may fear being embarrassed by acting out behaviors in response to pain like thrashing or screaming. They can communicate the characteristics of pain or deny it to be brave/avoid pain related intervention. They have fear about illness and may withdraw.

What are some developmental considerations regarding pain in toddlers?

They react to painless procedures as intensely as painful ones, intense emotional/physical upset, aggression, regression. Behavioral: bite, hit, scream, or kick OR remain quiet, saying "owie", facial grimacing, and clenching of teeth. They also may hide or run away.

What are some developmental considerations regarding pain in infants?

They really have no understanding of pain but can experience pain. It's important to watch for behavioral and physiological factors. Behavioral: facial expressions, body movement, crying, increased irritability, interrupted sleep. Physiological: Changes in HR, RR, O2Stat levels, vagal tone, plantar or palmar sweating.

5 Reasons to Call the Provider (education for parents caring for a child with a fever) ?

i. Any child younger than 3 months with a rectal temp above 38C(100.4F) ii. Any child who is lethargic or listless, regardless of temp iii. Fever lasting more than 3-5 days iv. Fever greater than 40.6C(105F) v. Any child who is immunocompromised by illness, such as cancer or HIV, will need further evaluation and treatment.

6 reasons that children are more susceptible to fluid imbalances/losses?

i. Infants and children have a proportionately greater amount of body water than adults ii. Infants and young children require a larger fluid intake than adults iii. Until age 2, extracellular fluid makes up half of the child's total body water iv. Infants and young children are more prone to insensible losses (fever, higher metabolic rate, higher RR- through breathing, etc. ) v. Increased basal metabolic rate> more insensible losses vi. Infants have renal immaturity and do not concentrate urine as well> higher risk of dehydration or over hydration

Guidelines for Fever Oral: > _______________ Rectal: > ______________ Axillary: > ____________ Tympanic: > ______________ Temporal: > ______________

i. Oral: > 37.8 (100.0F) ii. Rectal: > 38C (100.4F) iii. Axillary: > 37.2C (99F) iv. Tympanic: >38C (100.4F) v. Temporal: >38C(100.4F)i. Oral: > 37.8 (100.0F)

How do we calculate percent weight loss (dehydration) in children?

o Take the infant/child's original weight and subtract the current weight: infant weighed 6pounds 6ox at last well child visit. Today the infant weighs 6 pounds. --> 6.375lbs --> 6lbs · 0.375 divided by original weight (6.375) = · 5.8% dehydrated --> HINT: can calculate in pounds or kilograms- do not need to change lbs to kg in order to calculate.