Exam 4 Pedi-Maternity
Medications for hemophilia
- Factor VIII replacement (IV only, 5mg/kg) - DDAVP Desmopression
signs of celiac disease
- bloating, distended stomach - fatigue - steatorrhea - FTT - malnutrition - N/V - dyspepsia
signs of varicella
- fever - weakness - macular rash - severe itchiness (lesions will pus, dry, and crust)
treatment of constipation
- laxatives - fiber, fluids - prune juice - super bad = disimpact manually - avoid dairy - warm pack on abdomen
signs of otitis media
- pain in ear - pulling/tugging on ear (#1 SIGN) - runny nose - mandible pain - hearing loss (chronic) - TM swelling
motor skills at 3 years
- rides a tricycle - jumps off bottom step - stands on one foot for a few seconds
treatment of measles, mumps, & rubella
- supportive care - analgesics - vaccines!!
PaCO2 normal range
35-45 mmHg
max juice per day for toddlers
6oz
Which pain scale is used to measure the intensity of pain in preschoolers? A.FACES scale B.Visual analog scale C.Numerical rating scale D.Verbal descriptor scale
A.FACES scale
vaccine given at 15 months
DTaP #4
Foods that can cause choking
Grapes, hot dogs, hard candy, nuts, popcorn, small pieces of tough meat or raw vegetables
what is a toddlers favorite word?
MINE
treatment for lyme disease
antibiotics
where is an Epipen given?
rectus femoris
treatment for bee stings?
1. Epipen if allergy 2. topical or oral antihistamines 3. Cool compress
When is Hep A vaccine administered?
12 months, 18 months
how many choices should you give toddlers?
2 choices
How many deciduous teeth are there?
20
preschool age
3-6 years of age
weight at 30 months
4x birth weight
how early can celiac disease by diagnosed?
6-18mos
Which first line medication would the nurse anticipate administering to a client to treat anaphylactic reactions? A.Epinephrine B.Norepinephrine C.Dexamethasone D.Diphenhydramine
A. Epinephrine
A client with iron-deficiency anemia is prescribed iron supplementation daily. To help the client increase iron absorption, the nurse would suggest the client eat foods/drink high in which substance? A.Vitamin C B.Fat content C.Water content D.Vitamin B complex
A.Vitamin C
hemophilia
An X-linked recessive disorder, only males, in which blood fails to clot properly, leading to excessive bleeding if injured.
toddler psychosocial development
Autonomy vs shame and doubt
A toddler with a history of enlarged lymph nides, prolonged fever, erythema of the extremities, and a rash is admitted to the pediatric unit with a diagnosis of Kawasaki disease. Which criteria would the nurse recognize as essential to confirm this diagnosis? •A. An increased antistreptolysin O (ASO) titer •B. A combination of signs •C. A low-grade temperature •D. An increased sedimentation rate
B. A combination of signs
Which assessment findings would indicate a possible asthma exacerbation? Select all that apply. •A. Fever •B. Stridor •C. Wheezing •D. Tachycardia •E. Hypotension
C. Wheezing D. Tachycardia
asthma
Chronic childhood inflammatory disorder of the airways that results in intermittent and reversible airflow obstruction of the bronchioles
At which age is a toddler physiologically and psychologically prepared for toilet training? •A. 13 months •B. 16 months •C. 19 months •D. 22 months
D. 22 months
Which clotting factor would a nurse explain is deficient to the parents of a newly diagnosed child with hemophilia A? A.Factor II B.Factor XII C.Factor IX D.Factor VIII
D.Factor VIII
pain scale for preschoolers
FACES
pain scale for toddlers
FLACC
treatment of celiac disease
Gluten-free diet
vaccine given at 18 months
Hep A #2
allergic rhinitis
IgE inflammatory response causing congestion, nasal engorgement, sneezing, watery discharge, HA
what is a maintenance asthma medication?
LABA (Salmetrol)
what food causes anemia?
Milk
Can you give acetaminophen or ibuprofen after vaccination?
NO, decreases immunoglobulin
causes of enuresis
Reflux, sexual assault, stress in environment (marital problems, new sibling)
most common cause of diarrhea in children < 5 years?
Rotavirus
hypospadias
abnormal congenital opening of the male urethra on the undersurface of the penis
treatment of otitis media
abx, tylenol
Toddlers must have _________ in order to potty train?
anal & urinary sphincter control
cerebral palsy (CP)
condition characterized by lack of muscle control and partial paralysis, caused by a brain defect or lesion present at birth or shortly after
How is Kawasaki disease diagnosed?
diagnosis of exclusion, must have symptoms
Causes of metabolic acidosis
diarrhea
signs of rotavirus
diarrhea, anorexia
Laryngotracheobronchitis (Croup)
inflammation of the larynx, trachea, and bronchi, caused by a viral infection
egocentric thinking
seeing the world from only their own point of view; unable to see things from someone else's viewpoint
causes of metabolic alkalosis
severe vomiting
types of cerebral palsy
spastic, dyskinetic, ataxic, mixed
How is pinworm diagnosed?
tape test
learned skills during preschool
- parallel play shifts to associative play - competitive play begins, understands teamwork & friendships - less separation anxiety - pretend play very healthy - winning is important - less egocentric, focus on caring for others - puzzles, puppets, coloring, books, dress up/pretend activities
how can we help in toddlers development language?
- reading to - conversations w/ them - music
Signs of sickle cell crisis
- severe pain (from hypoxia) - swollen joints - hematuria - jaundice (breakdown of RBCs) - vision changes - fever
treatment for epistaxis
- sit up and lean FORWARD, apply pressure for 10 min •Breathe through mouth •Seek medical attention if bleeding last longer than 30 mins
treatment of hemophilia
- supportive care - most common bleeding into joint spaces causing inflammation - analgesics - RICE - monitor for bleeding - bleeding precautions - give factor VIII to fix the cascade - can give an epipen of factor VIII at home, in hospital given IV
treatment for iron deficiency anemia
- usually, 4-6 weeks of iron supplementation - daily need 11-15mg of iron - need to take iron w/ vitamin C (orange juice) - immediate replenishment = transfusion - straw or syringe to back of mouth r/t staining teeth - lots of fluids r/t constipation
bowel clean out treatment
- w/ miralax (17g polyethyl glycol) - drink then movement - we don't keep them NPO - if they don't drink then we will place an NGT - confirm cleanout by bowel sounds, clear poop - will have sig abdominal bloating during cleanout
G&D skills at 15 months
- walks without help - creeps up stairs - uses a cup well - stacks 2 blocks
treatment for sickle cell crisis
- will give oxygen via nasal cannula - pain medication (IV, continuous PCA (morphine for 1st crisis, then something stronger for chronic)) » Priority action - antipyretics - IV fluids - folic acid - take multivitamins - adequate hydration - prefer warmth over cold - don't like to walk around, rather rest
education for UTI prevention
- wipe front to back - cotton underwear - wash hands - pee after intercourse (adolescents) - change diapers frequently
RR of toddlers
20-30 breaths per min
HCO3 levels in blood
22-26 mEq/L
CO2 normal range
23-30 mEq/L
Max milk per day for toddlers
24oz
A parent of a child asks the nurse how to tell the difference between measles (rubeola) and rubella (German measles). Which finding would the nurse tell the parent differentiates measles from rubella? •A. High fever and Koplik spots •B. Rash on the trunk and pruritus •C. Nausea, vomiting, and abdominal cramps •D. Characteristics of a cold, followed by a rash
A. High fever and Koplik spots
Which parental statement would prompt the nurse to provide additional education to the parent of a preschool age client with a severe food allergy? A.I will send the self-injectable epinephrine device with my child to pre-school B.I have reviewed the symptoms of an anaphylactic reaction with the pre-school C.I have created an emergency action plan in case an anaphylactic reaction occurs D.I am going to create a food allergy plan wit the director to avoid the risk of an accidental exposure
A. I will send the self-injectable epinephrine device with my child to pre-school
Which recommendation would the nurse provide the parent of a 3-year-old who is concerned that their child is afraid to sleep alone because of monsters under the bed? A. Tell the child that monsters do not exist B. Allow the child to sleep with the parent temporarily C. Look under the bed and say "I don't see any monsters" D. Leave a small night light on at night and state "monsters aren't allowed in the house"
D. Leave a small night light on at night and state "monsters aren't allowed in the house"
Which strategy would the nurse use to manage negative behavior of a toddler? •A. Allowing for more openness •B. Using invasive methods •C. Using a flexible routine •D. Offering the toddler choices
D. Offering the toddler choices
Which strategies would the nurse apply when vaccinating a child to decrease pain and anxiety? SELECT ALL. A.Apply a topical anesthetic (EMLA) B.Injecting the most painful vaccine last C.Holding the child upright during the vaccination D.Administering intramuscular injections rapidly without prior aspiration E.Administering acetaminophen or ibuprofen after to vaccination
A.Apply a topical anesthetic (EMLA) B.Injecting the most painful vaccine last C.Holding the child upright during the vaccination D.Administering intramuscular injections rapidly without prior aspiration
When planning long-term care for a 3.5 year old with cerebral palsy which is important for the nurse to consider? A.CP is not progressively degenerative B.The effects of CP are unpredictable C.The child probably has some degree of cognitive impairment D.The child should have genetic counseling before planning a family
A.CP is not progressively degenerative
Which laboratory teat result would the nurse expect to be decreased in a preschooler with iron-deficiency anemia? A.Ferritin level B.Platelet count C.White blood cell count D.Total iron-binding capacity
A.Ferritin level
Which suggestion would the nurse provide to the parent whose child has been constipated for 3 days? Select all. A.Give laxatives to the child B.Reduce the child's fluid intake C.Include dairy products in the child's diet daily D.Increase the child's physical activity E.Include food with a high fiber content in the child's diet
A.Give laxatives to the child D.Increase the child's physical activity E.Include food with a high fiber content in the child's diet
Which parental statement indicates effective learning regarding management of nocturnal enuresis in a 6-year-old child? Select all. A.I should avoid giving my child fluids after dinner B.I should encourage my child to drink lots of water during the day C.I should make my child wear diapers during day hours while at pre-school D.I should give mt child diet soda instead of regular soda in the evening E.I should wake my child at the same time every night to use the bathroom
A.I should avoid giving my child fluids after dinner B.I should encourage my child to drink lots of water during the day E.I should wake my child at the same time every night to use the bathroom
Which laboratory finding would the nurse anticipate identifying in the repost of a client exposed to pollen who reports a runny, stuffy nose and itchy, watery eyes with the nasal examination revealing swollen and pink nasal mucosa? A.Immunoglobulin E level of 150 IU/mL B.Eosinophil count of 2% C.Percentage of neutrophils of 80% D.Total white blood cell count of 3 billion cells/L
A.Immunoglobulin E level of 150 IU/mL
Which manifestation would the nurse include when the parents of a child has just been diagnosed with hemophilia A ask what symptoms of bleeding should they look for in the future? SELECT ALL. A.Nosebleeds B.Blood in the urine C.Painful and swollen joints D.Easy bruising E.Frequent fevers F.Fast clotting of injuries G.Dark-colored tarry stools
A.Nosebleeds B.Blood in the urine C.Painful and swollen joints D.Easy bruising G.Dark-colored tarry stools
Which developmental achievements distinguish preschoolers from school age children. SELECT ALL. A.Preschoolers have imaginary playmates B.Preschoolers can relate events to their causes C.Preschoolers are curious to know about their surroundings D.Preschoolers understand that one object can exist in two shapes E.Preschooler believe that inanimate objects have lifelike qualities
A.Preschoolers have imaginary playmates C.Preschoolers are curious to know about their surroundings E.Preschooler believe that inanimate objects have lifelike qualities
difference between allergy and intolerance
Allergy must be immune mediated Intolerance do NOT involve immune response
Celiac disease
Immune-mediated abnormal response to gluten (the protein in wheat) and related proteins in rye, barley, and possibly oats
growth & development in preschoolers
Lymphatic - tonsils increase in size - IgG and IgA increase Cardiac - murmur is okay - HR 85 bpm Respiratory - risk for upper airway infections Urinary - bladder palpable - frequent urination Muscles - strong muscles - may have knock-knees Teeth - have all 20 teeth by 3y.o. - jaw grows
How is nephrotic syndrome diagnosed?
MRI or renal biopsy
treatment of varicella
Supportive treatment, Benadryl (PO or IV), water/cold therapy, NO CREAMS
magical thinking
a child's belief that what she thinks can affect what really happens
antidote for tylenol
acetylcysteine
Kawasaki disease
acute multi-system inflammatory disease of blood vessels (vasculitits); acquired heart disease
precautions for varicella
airborne and contact
precautions for measles
airborne, contact
what is a rescue asthma medication?
albuterol (SABA)
nephrotic syndrome (nephrosis)
altered glomerular permeability due to an autoimmune process that results in fusion of the glomeruli membrane surfaces, which leads to abnormal loss of protein in urine.
rheumatic fever
an autoimmune disease reaction to a group A B-hemolytic streptococcal infection, where inflammation leads to inflammatory lesions being found in the heart, blood vessels, brain & joints
signs of acetaminophen toxicity
anorexia, nausea, vomiting
most frequent place for drownings between 1-4 years-old
artificial pools
most common chronic illness in children?
asthma
how long should a child be rearing-facing?
at least until 2 years
ataxic CP signs
awkward, have bigger gross motor movements, but fine motor movements aren't coordinated, wider gait
best indicator of dehydration status in toddlers?
body weight
signs of lyme disease
bull's-eye pattern rash, flu-like symptoms, fever, headache, fatigue, malaise
best place for BP on toddler
calf, upper arm
Items that can be choked on?
coins, batteries, legos, magnets, marbles
foods containing iron
dried beans, lentils, peanut butter, green leafy veggies, iron-fortified cereals, breads and flour, poultry, red meat
diagnostic test for celiac disease
endoscopy & intestinal biopsy
what do RBCs look like in sickle-cell disease?
erythrocytes are elongated and crescent shaped
what gender is UTI most common?
females
what disease causes rheumatic fever?
group A B-hemolytic streptococcal infection
signs of food allergies
hives, itchiness, rash, swelling, dyspnea, inflammation, wheezing, pallor, anaphylaxis, throat tightness, nausea, vomiting, diarrhea, syncope, dizziness
spastic CP signs
hypertone, upper motor neurons cannot control, cant abduct hips, place feet down flat, TIGHT
signs of asthma
inflammation, bronchoconstriction, inspiratory & expiratory wheezes, cough, increased mucus production leads to respiratory acidosis
asthma triad of symptoms
inflammation, bronchocontriction, & increased mucus production
preschool psychosocial development
initiative vs guilt
Encopresis
involuntary defecation not attributable to physical defects or illness
enuresis
involuntary discharge of urine
most common anemia in the US
iron deficiency anemia
preschooler posture
more graceful, sturdy, erect
Signs of respiratory distress
nasal flaring, chest retractions, tachypnea
restraint used for preschoolers needing an MRI?
papoose
Initiative vs. Guilt
preschoolers start to learn they are able to act independently, they are able to try things on their own and explore their own abilities
RICE
rest, ice, compression, elevation
treatment for contact dermatitis
topical steroids (hydrocortisone cream)
dyskinetic CP signs
total abnormal involuntary movement, flaccid, slow involuntary movements
constipation
two or less bowel movements a week
vesicoureteral reflux
• Retrograde flow of urine from the bladder into the ureters, occurring when voiding caused by defective at birth or from repeated UTIs
metabolic alkalosis
• The lungs attempt to conserve CO2 and H2O by slowing respirations. - Excessive CO2 retained is converted into HCO3 and pH is elevated.
treatment of hydrospadias
• surgical repair - Should not be circumcised- the surgeon may want to use the foreskin to repair (Meatotomy).
A child with nephrotic syndrome has been receiving prednisone for one week. Which information in the child's record indicates to the nurse that the medication has been effective? Select all that apply. •A. Weight loss •B. Lower blood pH •C. Decreased lethargy •D. Increased urine output •E. Decreased blood pressure
•A. Weight loss •C. Decreased lethargy •D. Increased urine output
treatment for enuresis
•Bowel management •Timed voiding •Hydration management •Improved fiber intake •Behavior management •Biofeedback (electrical signals) •Drug therapy
How is CP diagnosed?
•Complete neuro assessment, metabolic/genetic testing, MRI, EEG, skull x-ray (cerebral asymmetry)
Which change in laboratory values and/or intake and output would the nurse expect after corticosteroid therapy for a 3-year-old with nephrotic syndrome? •A. Oliguria •B. Increase in hematuria •C. Decrease in glycosuria •D. Decrease in proteinuria
•D. Decrease in proteinuria
Which plan of care would the nurse provide for a newborn with hypospadias? •A. Preparing the infant for insertion of a cystostomy tube •B. Explaining to the parents the generic basis for the defect •C. Keeping the infants penis wrapped with petrolatum gauze •D. Giving the parents reasons why circumcision should not be performed
•D. Giving the parents reasons why circumcision should not be performed
treatment for rheumatic fever
•Get ECHO •Check elevated antistreptolysin-O titer (Must have had a recent step infection) •Treat strep infection w/ Abx (penicillin) •Decrease extent of damage to heart •Pain - NSAIDs, ibuprofen • Involuntary movements = diazepam, phenobarbital (reduces involuntary movements) •Possible steroids for reduction of inflammation
treatment for CP
•Medications- Baclofen, Diazepam, Botulinum toxin A, anti-epileptics •Inter-professional care- PT, OT, speech, surgical interventions (release the contractures) •Complications: aspiration, risk for injury •Common diagnosis between 2-4 yrs.
signs of iron deficiency anemia
•Pale mucous membrane •Enlarged heart, spleen •Poor muscle tone, decreased activity, poor growth
signs of nephrotic syndrome
•Proteinuria •Edema (#1 sign = facial edema) •Hypoalbuminemia •Hyperlipidemia
considerations for tubes
- do not submerge head - follow up w/ ENT as advised
Signs of dehydration in toddlers
- drained look (little blob) - malaise - pale - lethargy - decreased appetite - sunken fontanelles (if less than 18mos)
treatment for encopresis
- fluids, fiber, laxatives - routine of miralax (need to drink within 30min for it to actually be effective)
considerations for ferrous sulfate
- give 1 hour before or 2 hours after milk or antacid to prevent absorption - GI upset common - Give w/ Vit C - if IV monitor closely - Always IVPB, slow infusion - dark green to tarry black stools are common - brush teeth after dose or use a straw (decrease staining)
signs of respiratory failure
- grunting (leading to danger zone) - cyanosis (hypoxia) - bradycardia - bradypnea - decreased LOC- confused, irritable - apnea (last longer than 2 sec) - stupor, hypotonia
how can we facilitate initiative in preschoolers?
- guide them to attempt new activities on their own - let them make decisions - involve them in your daily life - positive reinforcement
Parovirus B19
- hand-foot-mouth disease OR - fifths disease
how can we help toddlers achieve autonomy?
- have them help make decisions - offer choices, simple decisions to build confidence
encopresis assessment
- identify hx of bowel habits & nutrition - Assess for sphincter control - Assess for behavioral factors
signs of CP
- impaired muscle control, coordination, posture - fixed hand movements - may not have ability to speak - Visual/speech/hearing impairments, seizures, cognitive impairments
motor skills at 5 years
- jump rope - throw and catch a ball with ease - can walk backwards - ties shoes
considerations for pain in preschoolers
- may have aggressive reaction - use terms they know - Be descriptive of what you are doing - try to include them - give the child body autonomy, avoid holding down - MUST UNDERSTAND FACES IN ORDER TO USE
how do we prevent choking?
- monitor while playing or eating - magnets high on the fridge - cut up and crush food
preschooler cognitive development
- moves away from egocentric thoughts to more social awareness - Magical thinking - preschoolers start to realize a sense of time
signs of mumps
- one sided chipmunk cheek (cervical lymph node is infected) - swelling of 1 testicle
signs of constipation
- pain - distention - hypoactive bowels at first, then no bowel sounds in descending colon - firm, tender abdomen - decreased appetite - N/V
how can we prevent lead exposure?
- paint over or remove lead containing paint - monitor kids in places where lead is around - fix holes - dusting, vacuuming - shoes off before going Inside - clean toys w/ soap & water
Nutrition considerations for toddlers
- blending veggies - dino nuggies (lots of veggies now) - dilute juices w/ water - make water routine, majority of intake - limit amount of milk to <24oz - cut things smaller (smaller than a finger) - keep an eye on them at all times when eating
G&D skills at 4 years
- can skip & hop - catch ball reliably - uses fork well
signs of rheumatic fever
- carditis - subcutaneous nodules - polyarthritis - chorea (involuntary movements) - macular rash - murmur - fever
what medications should we avoid giving preschoolers with rhinitis?
- cough suppressants - Sudafed - Mucinex
treatment for UTI
- Abx - increase fluids - Tylenol or Motrin for pain - Cranberry juice (no AZO)
metabolic acidosis
- Decreased pH, and low HCO3 by breathing rapidly to 'blow off' CO2 to prevent it from combining with H2O and reforming HCO3.
risk factors for sickle cell crisis
- Dehydration - Respiratory illness or GI bug - Extreme strenuous exercise - cold temperatures
Treatment of vesicoureteral reflux
- Double voiding •Prophylactic antibiotics •Surgery to correct the implantation sit of the ureters •Antispasmodics after surgery •Ditroban (oxybutynin)
Signs of Hand-Foot and Mouth disease?
- Fever - HA - malaise - slapped cheek appearance (very red cheeks) - rash beginning at mouth spreads to trunk, hands, feet - cold-symptoms - joint pain
albuterol side effects
- HA, dry mouth, muscle aches, tachycardia, hunger - oxygen levels go down when given (shift of oxygen causes peripheral oxygen to look like its lower, just wait for rebound to come back up, normally within 1hr)
Treatment of Kawasaki Disease
- IVIG - aspirin (80-100mg/kg/day in 4 divided doses)
Treatment of Nephrotic Syndrome
- Measure protein levels via Dip stick - Check CRP & ESR - Admin steroids (decrease protein in urine which leads to decrease in edema) = giving until we see a urine without any protein - Strict I&Os - Abx (secondary source) - Check CBC (WBCs) - Assess for moon face w/ LT steroid use - raise HOB (b/c they love to sleep face down, butt up) - possible Lasix if cannot tolerate steroid
signs of hep A
- N/V/D - fever - malaise - jaundice - dark urine - pale stools - anorexia - extreme fatigue - joint pain - abdominal pain - elevated AST & ALT
signs of pinworm?
- Perianal itching - enuresis - sleeplessness - irritability due to the itching
warning signs of abuse
- Physical evidence of abuse or neglect - Fractures/bruises in various stages of healing - Incompatibility between the history and injury - delay in seeking care
Treatment of asthma
- SABA (albuterol - RESCUE) - LABA (Salmetrol - MAINTENANCE) - Steroid (dexamethasone works for 72hrs) - Oxygen w/ humidification always (92 awake, 88 asleep), likely Hi-flow (can give a higher percentage of oxygen) - suctioning & saline - IV fluids (hydration)
signs of anaphylactic shock
- Tightness - SOB - tingling - clammy - sweaty - anxiety (impending doom) - shaky - itchiness - hives
Education for iron deficiency anemia
- avoid excess milk, calcium products - eat foods high in iron - dark black stools are okay - need lots of fluids to prevent constipation - use straw or syringe for liquid supplement, Brush teeth after taking
treatment for allergic rhinitis
- avoid the allergen - antihistamine, leukotriene inhibitors (chronic), corticosteroids - immunotherapy (bad allergy, worst allergy)
treatment for pinworm
- azoles (2 doses) - treat whole family - proper hand hygiene - proper food prep - clean bedding - deep clean toys
signs of laryngotracheobronchitis (croup)
- barking cough - inspiratory stridor - marked retractions
treatment for laryngotracheobronchitis (croup)
- dexamethasone (steroid) - opens up and reduce inflammation - racemic epi = opens airway (#1 drug) - cool air mist
when does EMLA have to be administered before intervention?
1 hour before
how much water can a toddler drown in?
1 inch
What age is lead poisoning at its highest risk?
1-2 years
prevention of drowning
1. Always supervised around water. 2. Secure fencing, gating, locks around pools 3. Use lifejacket when boating, swimming 4. No horse-play in tub 5. Learn CPR
considerations for bites & bee stings
1. Assess ABC's (AIRWAY) 2. pull out stinger, cool compress to area, topical/oral antihistamines 3. Call HCP if worsening ALWAYS CARRY EPIPEN!
most common food allergies
1. Peanuts 2. Eggs 3. Cow's milk 4. Soy 5. Wheat (gluten) 6. Fish 7. Shellfish 8. Nuts
considerations for poisoning in toddlers
1. TREAT THE CHILD 1st, NOT THE POISON 2. Maintain ABC's 3. Keep warm 4. Contact poison control
Rules of Time Out
1min for every age
pH of blood
7.35-7.45
preschooler HR
85 bpm
HR of toddlers
90-110 bpm
Which goal would the nurse identify for a toddler with dehydration caused by diarrhea? •A. Improvement of fluid balance •B. Continuation of an antidiarrheal diet •C. Administration of antimicrobial treatments •D. Retention of weight appropriate for height
A. Improvement of fluid balance
After completing education on accidental poisoning in the home for the parent of a toddler, which parent statements would concern the nurse? Select all that apply. •A. My cosmetics are in my purse •B. I only keep children's chewable vitamins on the counter •C. I keep my cigarettes and lighter on the shelf in the garage •D. The cleaning solutions are in a locked cabinet above the washing machine •E. I make sure all of my medications are stored in a bottle with a childproof cap
A. My cosmetics are in my purse B. I only keep children's chewable vitamins on the counter
A child in respiratory distress is admitted to the hospital and diagnosed with acute spasmodic laryngitis (croup). At the time of discharge, which recommendation would the nurse make to the parent for handling another attack at home? •A. Place them near a cool-mist humidifier •B. Bring them to the emergency department •C. Give them an over-the-counter cough syrup •D. Offer then warm tea sweetened with honey
A. Place them near a cool-mist humidifier
A toddler seems afraid to select a toy or activity in the clinical playroom. Which age-appropriate play materials would the nurse offer? Select all that apply. A. Plastic tea set B. Mold and clay C. Play telephone D. Pencil and paper E. Simple electronic games
A. Plastic tea set B. Mold and clay C. Play telephone
Which safety instruction would the nurse teach a child/parent with diminished sensation in the legs because of cerebral palsy? A. Test the temperature of the water before a bath B. Overtighten brace straps securely before ambulating C. Set the clock twice during the night to change position D. Look down at the legs when crutch-walking to check how they are positioned
A. Test the temperature of the water before a bath
Which recommendation would the nurse make to the parent who calls to report their child has a fever of 39.2 C, sore throat, irritability and refuses to lie down, preferring to sit up and lean forward? •A. The child needs immediate medication attention; call 911 •B. The parents should provide cool mist and continue to give fluids to the child •C. The child should receive ibuprofen in an appropriate dose to decrease the fever •D. The parents should call back in several hours with an update on the child's condition
A. The child needs immediate medication attention; call 911
In which way do toddlers learn self protection? A. Through trial-and-error strategies B. By imitating playmates and siblings C. By obeying orders from their parents D. By playing with age appropriate
A. Through trial-and-error strategies
Which adverse effects will the nurse instruct the client to anticipate when prescribed albuterol to relieve severe asthma? Select all that apply. •A. Tremors •B. Lethargy •C. Palpitations •D. Bronchoconstriction •E. Decreased pulse rate
A. Tremors C. Palpitations
Which statement explains the importance of play in toddlers? Select all A. Toddlers have imaginations and fantasies B. Toddlers prefer to play beside other children C. Toddlers like to pretend and play different roles D. Toddlers prefer to stay close to their parent while playing E. Toddlers should watch television to expand their vocabulary
B. Toddlers prefer to play beside other children D. Toddlers prefer to stay close to their parent while playing
Which symptom would the nurse expect in a 4 year old child with mild iron deficiency anemia and fatigue? A.Cold, clammy skin B.Increased pulse rate C.Increased blood pressure D.Cyanosis of the nail beds
B.Increased pulse rate
Which complication will the nurse monitor for when caring for a client with an infection caused by group A beta-hemolytic streptococci? A.Hepatitis A B.Rheumatic fever C.Spinal meningitis D.Rheumatoid arthritis
B.Rheumatic fever
Which language milestone would the nurse expect in preschoolers? Select all. A.Starting to understand riddles and jokes B.Wanting to know the reason, asking "why" C.Having a vocabulary of 2100 words D.Knowing that words may have arbitrary meanings E.Unable to distinguish between phonetically similar words
B.Wanting to know the reason, asking "why" C.Having a vocabulary of 2100 words E.Unable to distinguish between phonetically similar words
Which therapy would the nurse manager recommend for young children with viral infection-related diarrhea? •A. A bananas, rice, applesauce, and tea/toast (BRAT) diet until after the diarrhea has stopped •B. An antiviral agent until the prescription is restored •C. Oral rehydration therapy (ORT) until fluid balance is restored
C. Oral rehydration therapy (ORT) until fluid balance is restored
A child with Kawasaki disease is in pain caused by the desquamating rash. Which would the nurse identify as the best short term goal for this child? •A. The rash will diminish after lotion is applied •B. Analgesics will be administered as prescribed •C. Pain will be maintained at a level of 3 on a 0-10 scale •D. Diversional activities will help distract the child from the discomfort
C. Pain will be maintained at a level of 3 on a 0-10 scale
Which immunizations would a child who has received all primary immunization before starting preschool? A. IPV, Hep B, Td B. DTaP, Hep B, Td C. MMR, DTaP, Hib D. TDaP, IPV, Hib
C. MMR, DTaP, Hib
Which type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation? •A. Metabolic alkalosis caused by excessive production of acid metabolites •B. Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide •C. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid •D. Metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formation
C. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid
The nurse teaches the parents of a child with celiac disease about the food that should be eliminated from the diet. Which foods do the parents name that indicate to the nurse that the teaching has been understood? Select all. A.Milk B.Cheese C.Oatmeal D.Rice cakes E.Corn on the cob F.White wheat bread
C.Oatmeal F.White wheat bread
Which findings would the nurse conclude is related to a child's diagnosis of rheumatic heart disease? A.Negative c-reactive protein B.Increased reticulocyte count C.Positive antistreptolysin titer D.Low erythrocyte sedimentation rate
C.Positive antistreptolysin titer
labs increased with kawasaki disease
CRP, ESR, troponin, platelets, WBCs
Which education would the nurse provide the family of a preschool age child about normal growth patterns? A.The rate of physical growth accelerates during this stage of development B.Muscle and bone development are mature during this stage of development C.You can expect your child to keep the potbelly appearance during this stage of development D.Your child's legs will grow in length versus the trunk of the body during this stage of development
D.Your child's legs will grow in length versus the trunk of the body during this stage of development
what bacteria most commonly causes UTI?
E. coli
Autonomy vs. Shame and Doubt
Erikson's stage in which a toddler learns to exercise will and to do things independently - failure to do so causes embarrassment & questioning of abilities
How do you handle tantrums?
Find out the cause of the tantrum - what is happening during this time-period? - Do we need a nap? - Are we having trouble assert autonomy?
signs of allergic rhinitis
Sinus pressure, watery discharge, sneezing, blackened eyes, look of fatigue (bags), HA, congestion, nasal engorgement
signs of UTI
Urgency, frequency, burning, odor, color, hematuria
How is a UTI diagnosed?
Urine dip, urinalysis (UA), UC&S
How is enuresis diagnosed?
VCUG
How is vesicoureteral reflux diagnosed?
VCUG, MRI, CT, cystoscopy, cystography
Hemophilia A is a deficiency of Factor # __________.
VIII (8)
preferred IM injection site for toddlers?
Vastus lateralis
vaccines given at 4-6 years
Very DIM Very - Varicella D - DTaP I - IPV M - MMR COVID, FLU = annually
When does guilt occur for preschoolers?
When they believe they have misbehaved or when they are unable to accomplish a task
When is the MMR vaccine given?
12-15 months, 4-6 years
When is the varicella vaccine given?
12-15 months, 4-6 years
Vaccines from 12-15 months
1VERY MAD HIP 1VERY - varicella M - MMR A - Hep A #1 D - DTaP (@15 months) ~ #4 H - Hib I - inactivated polio P - pneumococcal
risk factors for otitis media
- bottle propping - upper respiratory infections - second-hand smoke
signs of abuse in toddlers
- bruising - burns - do not seek out mom & dad - do not reach to be picked up - fractures & injuries not matching verbal descriptions
Affects of lead on the body
- erythrocytes - bones & teeth - organs & tissues (including brain and nervous system) - hearing - speech - learning disabilities
G&D skills at 2 years
- goes up and down stairs by placing both feet on each step - builds 6-7 block tower
G&D skills at 2.5 years
- jumps in place w/ both feet across floor and off chair or step - can stand on one foot briefly - can tiptoe a few steps - better hand & finger coordination. - Begins to draw & copy shapes, draws circles
How can we help potty training?
- leading by example, showing them - show interest - positive reinforcement
Signs of Kawasaki disease
- rash - strawberry tongue - cracked lips - bloodshot eyes - red palms/soles - swollen hands & feet - swollen cervical lymph nodes
signs of measles
- red spotted maculopapular rash - Koplik spots (white spots on top of mouth) - runny nose - fever - malaise - anorexia
G&D skills at 18 months
- stands from any position - clumsy, falls often - jumps in place w/ 2 feet, - pulls & pushes toys - throws ball overhand - messy with utensils - turns pages of a book - holds crayon - stacks 3-4 block
burn considerations for toddlers
- takes a lower temperature to burn - shorter exposure to heat to burn - more severe burns (thinner skin) - very young children have higher mortality rates - scarring is severe - increased risk of infection - may delay growth
Which parental statements would the nurse recognize as requiring additional education about drowning prevention? •A. My baby likes to take a bath in the kitchen sink •B. My baby loves to watch the birds play in the birdbath •C. Our pool is surrounded by a fence and has a locked gate •D. Any time my baby is in the pool, I make sure I am in there as well
B. My baby loves to watch the birds play in the birdbath
Which etiology is the primary cause of otitis media in young children? •A. Sinusitis •B. Recurrent tonsillitis •C. An inflamed mastoid process •D. An obstructed eustachian tube
D. An obstructed eustachian tube
How is Hepatitis A transmitted?
Fecal-oral route - usually through contaminated food.
where do most drownings occur?
bathtub
When do all deciduous teeth come in?
by 2.5-3years
precautions for mumps & rubella
droplet, contact
signs of contact dermatitis
erythema then pruritic papules and vesicles
risks of acetaminophen toxicity
extreme permanent liver destruction
How is pinworm transmitted?
fecal-oral
treatment of hand-foot-mouth disease
hydration, supportive care, hand hygiene
autonomy
independence
who is most at risk for child abuse?
infants (less than 1 year)
What age is Kawasaki disease most common?
infants and children < 5-years-old
otitis media
inflammation of the middle ear which can lead to permanent hearing impairment
assessment considerations for toddlers
least invasive to most invasive
severe burns causes what metabolic imbalance in toddlers?
metabolic acidosis
what type of play do toddlers engage in?
parallel play
toddler posture
protruding abdomen; lumbar lordosis
How is hand-foot-mouth disease transmitted?
respiratory secretions (saliva, sputum or nasal mucosa), blister fluid, or stool of infected person or blood
when do toddlers transition from crib to toddler bed?
usually by 2y.o.
what causes lordosis in toddlers?
weak abdominal muscles
when are toddlers okay to be front-facing in the car?
when they reach the height, weight, age limits & are developmentally meeting their milestones
contact dermatitis
• Hypersensitivity response from skin coming into contact with an allergen.
Which information would a nurse provide regarding varicella? •A. Communicable until all vesicles are dry •B. Still communicable even when dry scabs remain •C. No longer communicable after the fever has subsided •D. Not communicable while vesicles are surrounded by red areolas
•A. Communicable until all vesicles are dry •D. Not communicable while vesicles are surrounded by red areolas
Which information would the nurse provide the parent of a 2 year old child about how to handle temper tantrums? •A. The child will require counseling by a behavioral child psychologist •B. Tantrums can be reduced with the provision of a less stressful environment •C. Tantrums should be ignored because they are an expected occurrence in toddlers •D. Tantrum will subside quickly if the parents holds the child during the tantrum
•B. Tantrums can be reduced with the provision of a less stressful environment
how is pinworm spread?
•Toddler itches, its now on their fingers, and spreads to toys, bedding, etc
