Module 3 + 4 - Pediatrics
What is Reye's syndrome?
A rare syndrome of rapid liver degeneration and swelling in children treated with aspirin during a viral infection Influenza + varicella Can cause death within hours if untreated Elevated liver function tests and elevated serum ammonia levels can confirm diagnosis
What is a generalized seizure?
A seizure that affects both sides of the brain Lose consciousness Febrile (most common) Tonic/Clonic
What is idiopathic scoliosis?
A structural spinal curvature for which no cause has been identified 9-11 years of age and most common scoliosis To assess spine = Have pt put feet together, tuck chin, and have them bend over (also assess if pelvis and scapula are even) Diagnosed with Xray If curvature is <10 you watch it If curvature is >10 you refer to ortho for treatment Treatment = braces (which only stop curve from getting worse) and surgery (the only cure)
What is a voiding cystourethrogram (VCUG)?
A test that can also be performed to determine if vesicoureteral reflux is present If urine is backtracking up the ureter XRAY with cath filled with fluid Males / any pt getting frequent UTIs
What is traction?
Bryant traction - Both the patient's limbs are suspended in the air vertically at a ninety degree angle from the hips and knees slightly flexed Halo traction - Halo gravity traction is a technique of applying traction to the spine pre-operatively through a metal ring (halo) that is attached to your child's head Pin + skin + neuro care
What may you see in a pt with burns?
Burned hair Hoarse voice Respiratory distress Smoke inhalation
When do you use a wet dressing?
Burns Debridement DO NOT use on scab
What is cellulitis?
Erythema Unilateral warmth Swelling Antibiotics and cool compress Draw on the area to monitor for spread Infection of the skin
What teaching should be included for parents of an infant with cleft lip and palate?
Expectation that once feeding is established, the child should otherwise be healthy
What is decerebrate posturing?
Extensor response: Hands pushed to sides and body hyper-extended
What is bacterial meningitis?
FEVERS <2 months 100.4 SEPTIC WORKUP + LP looking for meningitis Inflammation of the tissues surrounding the brain and spinal cord LP = diagnostic (bacterial / viral) ALL SIGNS TREATED AS BACTERIAL UNTIL PROVEN TO BE VIRAL WHICH CAN TAKE 1-3 DAYS No longer contagious 48-72 hours after antibiotics Private room - DROPLET PRECAUTIONS
What clotting factor is deficient in hemophilia A?
Factor VIII
What is hemophilia?
Factor VIII deficiency (hemophilia A)- The most common Factor IX deficiency (hemophilia B- also called Christmas disease) Factor XI deficiency (hemophilia C) Prevent Bleeding If bleeding occurs factor administration is prescribed - once replaced - clotting factors return to fairly normal levels for a period of time Factor replacement prior to any surgeries or other procedures RICE
What is constipation?
Failure to achieve complete evacuation of the lower colon Associated with difficulty in passing hard, dry stools but can also be associated with passing small marble sized stools
What are complications with diabetes and children?
Failure to grow Delayed sexual maturation Poor wound healing Recurrent infections (especially skin) Retinopathy Neuropathy Vascular complications
What are common causes of head trauma in children?
Falls Motor vehicle accident Sports injury Bicycle accident Abuse (story does not match injury + old healing injuries) How is the child behaving in the first 24 hours? What is the nature of the injury?
What is the behavior that a physically abused toddler may exhibit when approached by a nurse?
Fear of physical contact
Which laboratory test is decreased in iron deficiency anemia?
Ferritin level (stored iron)
When is the pt at risk for hypovolemic shock?
First 48 hours treating the burn
What is plagiocephaly?
Flat head syndrome No tummy time :-( Should be started 1 month 3-6 months We do not fix it always - depends on if it is cosmetic or affecting brain
What is hydrocele?
Fluid in the scrotum Goes away on its own Check in spadias Transillumination
What is paraphimosis?
Foreskin gets stuck down - medical emergency
A nurse is caring for an infant with Hirschsprung's disease. Which manifestation of the disease would the nurse expect to note?
Foul-smelling, ribbon-like stools
How do you measure the head?
From the eyebrows to the crown Measure same spot every time
What is the difference between full thickness and deep partial thickness burns?
Full thickness burns extend into the subcutaneous tissue, while deep partial thickness burns extend through the epidermis and involve only part of the dermis.
What is GERD?
Gastroesophageal reflux disease All baby will have spit up at some point due to immature GI system Vomiting + weight loss + poor feed + chronic cough + wheezing + heartburn + dysphagia + coarse cry May cause - esophagitis + esophageal stricture + Barrett esophagus + anemia (bleed) Increased in first year of life and then most outgrow it Burp the baby more! Thicken formula! Medication! (H2 antagonist + PPI) Nissen fundoplication!
What is the side effect Dilantin is known for?
Gingival hyperplasia Gums overgrow teeth
What is celiac disease?
Gluten triggers an attack by the T cells on the patient's intestinal lining, causing abdominal discomfort and diarrhea Strict gluten-free diet: No wheat + oats + barley + rye
How do you prevent UTI?
Goal is to Prevent infection WIPING FRONT TO BACK GOOD HANDWASHING BEFORE AND AFTER USING THE BATHROOM DRINK WATER DON'T HOLD URINE COTTON UNDERWEAR NO TIGHT PANTS VOID AFTER HAVING SEX
What is the rule of 9s?
Head and neck - 18% Each arm - 9% Each leg - 14% Anterior trunk - 18% Posterior trunk - 18% Perineum - 1% Sent to burn unit >10% and on face + hands + feet + genitals + chemical burn
What are early signs of intercranial pressure?
Headache Vomiting (projectile with no nausea) Visual change Dizziness Decreased HR + R Changes in PERRLA Sunset eyes LOC changes Bulging fontanelles (infants) Increased head circumference
A nurse is reviewing the chart of a child with a brain tumor. Which signs/symptom(s) would the nurse expect to note in the history and physical?
Headache and morning vomiting related to the child's getting out of bed
What is physiologic anemia?
Hemodilution that occurs when the plasma increase exceeds the increase in RBC production 2-6 months
The nurse would contact the primary health care provider with concerns about a prescription for valproic acid for an adolescent who has a history of which disorder?
Hepatitis Liver issues
What is urticaria?
Hives Detailed hx Inspect skin and airway
What is a ureteral stent?
Hollow tube placed endoscopically through a cystoscope keeps ureter patent and allows for drainage of kidney Double diaper to prevent infection Poop in 1 pee in the other
What is the nursing management of a child losing a limb?
How to deal with anxiety of losing a limb Stump care - crutch walking Prosthesis Provide emotional support Support group with KIDS OF OWN AGE
How can you help severe dehydration?
IV rehydration therapy
What are signs of a learning disability?
If a child cannot speak in sentences by 30 months of age Does not have understandable speech 50% of the time by age 3 years Cannot sit still for a short story by 3 to 5 years of age Cannot tie shoes, cut, button, or hop by 5 to 6 years of age
What do you think of when you think about rubella?
If pregnant mom exposed can cause birth defects and developmental delay
The nurse provides home care instructions to a parent of a child with hemophilia. What would the nurse tell the parent to do if the child sustains a muscle or joint injury?
Immobilize and elevate the affected joint. RICE
What is Idiopathic Thrombocytopenia Purpura (ITP)?
Immune response following a viral infection that produce antiplatelet antibodies Development of petechiae, purpura, and excessive bruising Recover spontaneously
The nurse is teaching a group of parents behaviors that are seen with autism. Which behaviors would the nurse include in the teaching session? Select all that apply.
Impairment in peer relationships Display of self-injurious behaviors Lack of imaginative play behaviors
What bacterial skin infection presents as honey-colored crust surrounded by erythema?
Impetigo
What is phimosis?
Inability to retract foreskin
What is sepsis?
Life-threatening organ dysfunction caused by a dysregulated host response to infection 3-5 days of a high fever (under 2 months 100.4 - over 2 months 101.4)
What do you think of when you think about hand + foot + mouth (hepangina)?
Little papules on hands and feet and mouth Contagious until rash disappears Not itchy
What is AST/ALT?
Liver
What is important to know about pinworm?
Lives on toilet seats OTC meds Assess rectum with tape or eyes 2-3 hours after sleep
What is atonic seizure?
Loss of muscle tone and falls to the ground Known as "drop attacks" Risk for injury Wear helmet + gait belt
What do you assess during physical exam?
Lymph nodes - multiple nodes is not good Palpate rash - especially viral
What diseases are contact?
MRSA Rotavirus RSV (contact+) Gown + gloves
What is short bowel syndrome?
Malabsorption and diarrhea resulting from extensive bowel resection Goal = Maximize nutritional status and minimize bacterial overgrowth PROBIOTICS Treatment = TPN + antibiotics
What is Duchenne Muscular Dystrophy?
Males only - X linked recessive trait Generalized weakness Can have cardiac dysfunction Muscle wasting Limb and trunk first Gower sign = has to use their own legs to push up with their hands to stand Lose ability to walk / in a wheel chair (around 7yo)
What is osteosarcoma?
Malignant bone tumor Most common malignant bone cancer in children - mostly adolescents at peak of growth spurts Long bones most affected Usually found due to another issue like LIMPING!!! Debulk the tumor Salvage the limb if you can
What is retinoblastoma?
Malignant tumor of the retina Congenital Dx by age 5 - 5 year survival rate is 90% Goals of treatment: eradicate the tumor, preserve vision, have good cosmetic outcome Red reflex needs to be positive!!!!!!!!!
What are signs and symptoms of genitourinary disorders?
Masses in groin + scrotum + abd Flank or abd pain Lower abd distension Nausea Vomiting Poor growth Fever UTI
What are psychostimulants?
Methylphenidate + dextroamphetamine Short and long acting Adderall and Ritalin •Inattention disorders •Hyperactivity True ADHD is managed by medications Given after they eat Don't give any later than noon Side effects = anorexia + headache + abd pain + difficulty sleeping + motors tics + irritability
What is the first-choice medication for the treatment of ADHD?
Methylphenidate.
What laboratory finding would be expected in a toddler with iron deficiency anemia?
Microcytic red blood cells plus slightly reduced reticulocyte count
What nursing intervention would be provided for an infant with an unrepaired cleft lip?
Modifying feeding techniques
What is rotavirus?
Most common cause of viral diarrhea
What is cleft lip and palate?
Most common congenital craniofacial anomaly often associated with other anomalies Complications = Feeding Altered dentition Delayed speech Bonding with child Otitis media Poor nutrition Aspiration Infection Poor bonding FIGURE OUT BEST WAY TO GIVE FORMULA - DIFFERENT NIPPLE If cleft is too severe - may need NG or Mickey Lip closed 2-3 months Palate closed 9-18 months Encourage parent to hold infant immediately after delivery - acknowledge normal feelings of guilt + anger + sadness
A nurse is performing an assessment of a child with nephrotic syndrome. Which manifestation would the nurse most likely note? Periorbital edema Weight loss of 1.5 kg Temperature of 99.2° F (37.3°C) Blood pressure of 128/86 mm Hg
Periorbital edema
The nurse is reading the medical record of a child admitted to the pediatric unit with a diagnosis of nephrotic syndrome. Which sign/symptom of this disorder would the nurse expect to see documented in the record?
Periorbital edema
What is scaling?
Plaque psoriasis
What are the different types of fractures?
Plastic/Bowing - bending Greenstick/Buckle - bone breaks incompletely Complete fracture and open - complete break of bone or bone protruding from skin (significant risk for infection)
A child is admitted to the hospital, where Wilms' tumor is diagnosed. Which is the primary nursing intervention?
Posting a sign over the bed reading, "Do not palpate abdomen"
What is craniosynostosis?
Premature closure of cranial sutures Can lead to ICP + affects brain growth
What is lead poisoning?
Presence of too much lead in the body >3 Anorexia, nausea, vomiting, abdominal pain and constipation Chelation therapy oral or IV (if high)
What would be the nurse's priority assessment for a three-year-old child with a hemoglobin level of 6.4?
Signs of cardiac decompensation Maintaining tissue oxygenation by increasing the workload
What is hemolytic uremic syndrome?
Typically preceded by diarrheal illness including hemorrhagic colitis Characterized by: •Hemolytic anemia •Thrombocytopenia •Acute renal failure Pallor + bruising Caused by E. Coli Restore fluid + electrolyte balance Supportive treatment
How do you position a child post brain surgery?
Unaffected side with the head of the bed flat or at the level prescribed by neurosurgeon Side lying preferred so child can manage secretions
What is cryptorchidism?
Undescended testes Check if they are really there (cremasteric reflex) Orchiopexy - go in and pull the testicle down Check in spadias FIND EARLY - CAN CAUSE STERILITY
What are the complications of circumcision?
•Alterations in the urinary meatus •Unintentional removal of excessive amounts of foreskin •Damage to the glans penis
What are the types of eating disorders?
•Anorexia nervosa •Bulimia •Pica
What are the warning signs for autism?
•Eye contact abnormalities •Delayed language development •Losing language or social skills at any age
What are the clinical findings of a brain tumor?
•Nausea and vomiting •Headache •Unsteady gait •Blurred or double vision (cover one eye) •Seizures •Motor abnormality •Weakness •Swallowing difficulties •Behavior or personality changes •Irritability, failure to thrive, or developmental delay
What are factors that influence child behavior?
•Nutrition •Environmental and family interactions •The child's individual temperament
What are some important behavior management techniques?
•Set limits and hold child responsible for behavior •Be realistic with what youre saying •Ignore inappropriate behaviors •Praise the child's self-control efforts
What are common signs of neurological disease?
●Nausea + vomiting ●Headaches (early morning, frequent, or persistent) ●Changes in gait ●Visual disturbances ●Changes in level of consciousness (LOC) or confusion ●Increased irritability ●Altered muscle tone
What are risk factors for neuro disorders in children?
●Prematurity ●Maternal drug or alcohol ●Maternal infection during pregnancy ●Maternal ingestion of teratogens ●Fetal malnutrition in utero
How do you treat enuresis?
Least invasive to most invasive Pee alarm Medications = DDAVP Imipramine
What can increase ICP?
Pain High fever Fluids given too fast Sneezing Coughing (cool mist + cough suppressant over 6yr) Stimuli PREVENT THESE WITH ICP PT
What is amylase and lipase?
Pancreas
What is encopresis?
Passage of stool around constipation Liquidy mucus Beyond age of expected toilet training
Hydrostatic reduction is performed in a hospitalized child with a diagnosis of intussusception. Which outcome indicates that the procedure was successful?
Passage of stool without blood
What is testicular torsion?
Testis is abnormally twisted on its spermatic cord Surgical emergency! Can lead to sterility! 12-18 yo
The nurse is assigned to care for a child with a diagnosis of Reye syndrome. Which findings would the nurse expect to see on review of the child's medical record? Select all that apply.
The child has been lethargic. The child had varicella 1 week ago. Laboratory findings include a prolonged bleeding time.
What is central precocious puberty?
The hypothalamus is activated to secrete GNRH too early Given Lupron
What is a neural tube defect?
The neural tube fails to encase the spinal cord during early fetal developing Spina bifida occulta 10-20% of population Meningocele - cyst like sac + no other symptoms + fear is sac will rupture and cause infection Myelomeningocele - not good
What is specific gravity?
The ratio of the density of a substances to the density of urine Quickest way to determine dehydration 1.005-1.025 (higher the number = more dehydrated they are)
What is precocious puberty?
The very early onset and rapid progression of puberty If caused by tumor the treatment is radiation/chemo or surgery
What can happen when you remove the neurological issue in children (surgery)?
They can say they do not remember their family Explain this is normal and temporary and to be patient
What is important to know about lyme disease?
Ticks Bullseye rash Can have severe neurological issues if not treated Treated with Augmentin or doxycycline for 10-14 days Remove ticks with tweezers or a VISA CARD ONLY and do not twist - pull up
Why is cleft palate usually repaired before a child starts to speak and why might some surgeons prefer to wait up to two years to repair a cleft palate?
To prevent speech difficulties and to allow for better growth and development
What is hematopoietic stem cell transplant?
Transfer healthy bone marrow into child with disease Stem cell transplant
What is a blood transfusion?
Transfer of blood from one person to another Hgb <7 Monitor pt for first 15 min If pt receives too many blood transfusion it puts them at risk for hemochromatosis (iron overload) MONITOR FOR ELECTROLYTES (LOW CALCIUM = SEIZURES)
What is important to know about scabies?
Treatment cream is toxic so cannot be used on children under 2 from the neck up Itchy + little mites on skin that cause linear lines
What is Nissen fundoplication?
Treatment of GERD Part of the stomach is wrapped and tacked down around the esophagus like a collar to stop food from coming back up
What is a vesicle?
A fluid-filled elevated lesion
A nurse is performing an assessment of a school-age child admitted with acute poststreptococcal glomerulonephritis. Which question would help determine the cause of this acute condition?
"Did you have a sore throat a few weeks ago?"
A client who underwent cleft palate repair has just returned from surgery with elbow restraints in place. The parents question why their child must have the restraints. The nurse would give which of the following as the best explanation to the parents?
"Elbow restraints are used postoperatively to keep childrens' hands away from the surgical site."
A newborn is diagnosed with developmental dysplasia of the hip and the parents ask the nurse about how the disorder will be treated. Which response would the nurse provide to the parents?
"A special harness called a Pavlik harness will be used for about 3 to 6 months."
The parent of a child with iron-deficiency anemia who is receiving an oral iron supplement calls the nurse and reports that the child is having black stools. Which response by the nurse is most appropriate?
"Black, tarry stools are a normal finding when oral iron supplements are being administered."
A nurse provides home care instructions to the parent of a child with pediculosis capitis (head lice). Which statement by the parent indicates a need for further instruction?
"I need to use an anti lice spray on the child and on anything that they have been in contact with." Antilice spray is never used on the child
A nurse is providing home care instructions to the parent of a child who has undergone cleft lip repair. Which statements by the parent indicate an understanding of these instructions? Select all that apply. "I would put the baby on their stomach to sleep." "I shouldn't brush their teeth for 1 to 2 weeks." "I need to rinse their mouths with water after every feeding." "I need to watch for signs/symptoms of infection like drainage or fever." "I would never use a bulb syringe to clear secretions from their mouth."
"I shouldn't brush their teeth for 1 to 2 weeks." "I need to rinse their mouths with water after every feeding." "I need to watch for signs/symptoms of infection like drainage or fever."
The nurse provides instructions to the child and the parent about sick-day rules and self-care measures for diabetes mellitus. Which statement by the child's parent indicates a need for further teaching?
"If my child is not hungry and isn't going to eat, they shouldn't give insulin." Insulin is always administered, even if the child does not have an appetite.
A nurse provides home care instructions to the parent of a child with impetigo. Which statement by the parent indicates the need for further instruction?
"It's OK for the child to go to school tomorrow."
The nurse is providing home care instructions to the parents of a child with immune thrombocytopenic purpura (ITP) whose platelet count is 90,000 mm3 (90 × 109/L); reference range 150,000-400,000/mm3 [150-400 × 109/L]). Which statements by the parents indicate that they understand the instructions? Select all that apply. "We'll use ibuprofen if there is a fever." "It's all right to let the child ride their bike." "We need to avoid giving aspirin." "We will provide an extra-soft toothbrush." "We need to watch for signs/symptoms of bleeding."
"We need to avoid giving aspirin." "We will provide an extra-soft toothbrush." "We need to watch for signs/symptoms of bleeding."
What are the signs and symptoms ketoacidosis?
1. Fruity acetone breath 2. Kassmaul's respirations (fast/deep/labored) 3. Anorexia + nausea + vomiting 4. Ketones in urine + blood 5. Altered LOC
Newborns stomach capacity is?
10-20 ml
What is a tonic clonic seizure?
A generalized seizure in which the patient loses conciousness and gets stiff / shakes Grand mal Experienced during febrile seizure
What is the chance that a child will have sickle cell disease if both parents have sickle cell trait?
25%
The nurse is teaching about osteogenic sarcoma to a group of parents. Which statements regarding osteogenic sarcoma are true? Select all that apply.
A palpable mass may be felt. Pain is localized at the affected site. Early signs/symptoms are usually attributed to normal growing pains.
What do you think of when you think about Exanthem subitum (roseola)?
3-5 days of high fever that then goes away and is replaced by head to toe rash Will go away on its own
What is bladder capacity?
30 mL in newborn Adult size by 1 year
What is a papule?
A raised area of the skin that has no fluid
The nurse assigned to care for an infant is told that the infant has hypospadias. Where would the nurse expect to note the opening of the urethral meatus?
Below the normal placement on the glans penis
What is hemoglobinopathy? Sickle cell
A genetic defect/mutation that leads to a change in hemoglobin Sickle cell PAIN + DEHYDRATION + COLD TEMP + HIGH ALTITDUE + PREVENT INFECTION + O2 SUPPLEMENT Prophylactic antibiotics Drink extra water especially in hot weather Advocacy for PCA Immunizations = Prevnar (pneumococcal) + influenza
What is a pavlik harness?
A harness used for developmental dysplasia of the hip that keeps the hip at 90 degrees Under 6 months treatment Takes off once a week to bathe Neuro checks
What is ketoacidosis?
A high concentration of ketones in the blood that results in an increase in the acidity of the blood Only occurs as a complication of Type 1 diabetes HIGH BLOOD SUGAR
What is hydroxyurea?
A medication used to prevent sickle cell crisis Anti-Sickle
When do iron stores deplete?
4-6 months again with adolescents with rapid growth Iron fortified cereal
What is normal WBC for children?
5000-15000
How do you check pulse on a child?
<1 brachial >1 carotid
What is the normal ICP level?
<10 mmHg
What is a myoclonic seizure?
A brief jerking or stiffening of the extremities which may be symmetrical or asymmetrical Like when feel like you're falling in bed :0
What is a macule?
A flat lesion that differs in color from surrounding skin
What is Cooley's anemia?
Beta thalassemia major Increase rate of RBC destruction Frontal bone can come out far Need blood transfusions Blood iron levels need to be watched carefully and iron chelation therapy is provided
What is Brudzinski's sign?
After forced flexion of the neck there is a reflex flexion of the hip and knee and abduction of the leg
What do you think of when you think about mumps?
Airway Swelling of parotid gland Swelling in neck + pain Virus + Droplet
What is important to know about rabies?
All mammals are susceptible Transmitted via saliva
What is glomerulonephritis?
ACUTE RENAL DISORDER A kidney disease that develops 10 to 14 days after a skin or throat infection of strep It is not caused by the bacteria itself, but by the body's immune system Main symptoms are blood in your child's urine (tons of it) and swollen ankles or puffy eyes If strep still + treatment = antibiotics and BP (meds + low sodium diet + exercise)
What is decorticate posturing?
Abnormal flexion: Hands pulled to chest and hyper-extended
What is congenital clubfoot?
Abnormal twisting of the foot usually inward and downward BONE
What is biliary atresia?
Absence of some of all of the major biliary ducts, resulting in obstruction of bile flow Results in pathologic jaundice (first 24 hrs of life) Yellow + distended belly Kasai procedure (hepatoportoenterostomy) - connects the bowel lumen to the bile duct remnants found at the port hepatis (MAKES a duct) NOT CURATIVE If not corrected early enough will need liver transplant
How do you treat severe + cystic acne?
Acutane - difficult criteria Stay out of the sun - can cause burns Double birth control + pregnancy test once a month (can cause birth defects) Depression Dermatologist
What condition would the nurse suspect in a five-year-old child with abdominal pain, nausea, anorexia, low-grade fever, and pain in the right lower quadrant of the abdomen?
Acute appendicitis
What is impetigo?
Acute, contagious superficial skin infection Around nose and mouth Honey crusted lesions Bactroban (Gram + and -) Hand wash! Wash linens separately from rest of the family
What to remember about phenobarbital?
Addicting Changes LOC DO NOT STOP ABRUPTLY Used in absence seizures and infant spasms
What actions would the nurse anticipate when admitting a client having sickle cell crisis to the nursing unit?
Administer hydroxyurea (prevent sickling), apply oxygen via nasal cannula, and administer IV hydration Pain management
Parent reports that the child has been unusually thirsty and tired and has had trouble with vision. On physical assessment, the nurse notes that the child is dehydrated and lethargic and that the breath has a fruity odor. Blood specimens are drawn, and the laboratory technician calls the emergency department to report that the child has a serum glucose level of 380 mg/dL (21.1 mmol/L). Diabetic ketoacidosis (DKA) is diagnosed. The nurse notifies the PHCP of the child's serum glucose level. Which initial action would the nurse plan to take in treating diabetes ketoacidosis (DKA)?
Administering normal saline solution IV Rehydration is the initial step in resolving DKA
What clinical manifestation helps distinguish a myelomeningocele from a meningocele?
Affected lower extremities.
What is Kernig's sign?
After flexing the hip and knee at 90 degree angles, pain and resistance are noted
What are tricyclic antidepressants?
Amitriptyline Used in Depression + ADHD + tics + anxiety + enuresis Monitor ECG for arrhythmias Side effects = anticholinergic effects + weight loss
What is an inguinal hernia?
An abnormal bulge or protrusion of intestine through the muscle of abd that can be seen and felt in the groin area + scrotal area Bulging + redness Males + preemies Surgery Check in spadias!
What signs and symptoms would the nurse expect when assessing a four-year-old child with newly diagnosed acute lymphocytic leukemia?
Anorexia and petechia Bruising
What are prophylactic antibiotics?
Antibiotics that are given to prevent infection rather than treat it Either every day or before a procedure Sickle cell - every day for 5-6 years to prevent crisis
How do you assess for sensory perception?
Are they acting their selves? Are they way off the baseline?
The nurse is caring for a child who has been diagnosed with lead poisoning. Which nursing considerations are important to include in the plan of care for this child? Select all that apply.
Asking the parents if the child has a known allergy to peanuts (CHELATION THERAPY CONTRAINDICATED IN PT ALLERGIC TO PEANUTS) Monitoring the child's intravenous (IV) site for complications of IV therapy Monitoring kidney function studies for signs/symptoms of nephrotoxicity if the child is prescribed chelation therapy Ensuring that the parents are aware that all lead hazards must be eliminated from the home environment
What do you do if the neurological issue cannot be removed from the child?
Assist child to learn to use adaptive methods to live with permanent changes in sensory perception (i.e., use of eyeglasses) and maximize the use of intact senses
What medications are used for seizures?
Ativan is used for immediate help Anticonvulsants used to prevent the NEXT seizure Anticonvulsants = -Dilantin -Keppra (not as many side effects) -Valproic acid -Gabapentin (not the best) Need blood work before anticonvulsants for liver func. and kidney func.
What are nonstimulant norepinephrine reuptake inhibitors?
Atomoxetine Administer without regard to food once or twice a day Monitor HT, WT, BP and HR Side effects = dizziness + dry mouth
What is ADHD?
Attention deficit hyperactivity disorder Has to be seen in multiple areas of the childs life In the educational setting and the home setting
What is juvenile idiopathic arthritis?
Autoimmune disorder creating morning stiffness, arthritis and gradual loss of motion Usually seen in toddlers and school age Not just growing pains Fevers NSAIDS + corticosteroids - some disease-modifying antirheumatics (prevent disease progression) Maintain joint function - warm baths + splinting + swimming is beneficial AT RISK FOR IRITIS (INFLAMMATION OF THE EYE) CAN LEAD TO BLINDNESS IF NOT TREATED
A nurse is monitoring a 3-year-old with diarrhea for signs/symptoms of dehydration. The child now weighs 42 lb (19 kg), a decrease from a weight of 44 lb (20 kg) 24 hours ago. In addition to dry mucous membranes and lack of tears, what assessment finding would the nurse find? Decreased heart rate Bilateral 1+ pedal pulses Increased blood pressure Urine output of 80 mL in the last 3 hours
Bilateral 1+ pedal pulses
What is important to obtain in the health history?
Birth + med hx Hx of current illness S+S Changes in usual behavior Trips? Pets? What have you done so far?
What do you think of when you think about varicella?
Lesions all over skin Cannot go to school until every lesion is crusted over Vaccinate Can kill older adults - DIC (bleed out) AIRBORNE
What is an absence seizure?
Blanking out staring and not moving at all Can be misdiagnosed (need to rule out other options) Periods of time they do not remember Can be triggered Treated with anticonvulsants Phenobarbital - addicting + LOC change
What is the pathophysiology of a vaso-occlusive crisis in sickle cell anemia?
Blockage of small blood vessels due to clumping RBCs
What is botulin toxin?
Botox Paralyzes nerve cells on the muscle when the serum is injected into it Given every 6 months in CP
What is vesicoureteral reflux?
Backward movement of urine from lower to upper urinary tract - up the ureters Fevers Dysuria Frequency or urgency Nocturia Hematuria Prevent infection Voiding cystourethrogram (VCUG) - diagnostic test Kidney reflux Take ureter and replace it on the top of the kidney + antibiotics
What lab tests are used for infectious diseases?
CBC ESR - inflammation CRP - inflammation Blood culture - first set of labs taken and taken with fresh stick Stool Urine Wound Throat + nasal
What can happen after a child has brain surgery?
Can forget things/people Normal
What to remember about valproic acid?
Can have biggest affect on the liver
What is metatarsus adductus?
Congenital foot deformity Occurs due to positioning in utero Moves back to neutral position when moved Fixed with serial casting - every 2 weeks MUSCLE
What comorbidity is associated with Down syndrome?
Congenital heart disease.
What is Hirschsprung's disease?
Congenital lack of ganglion cells (nerve cells) in the colon leading to uncoordinated peristalsis and decreased motility Increased in down syndrome Rectal Suction Biopsy is the definitive diagnostic test! Child can fail to pass meconium May have stools sometimes (ribbon like) May need every other day enemas until repair (saline) Requires surgical resection of the aganglionic bowel and reanastomosis Requires a temporary ostomy
What is severe acne?
Lesions similar to moderate acne but more widespread Associated with scarring Acne that is infected is treated with clindamycin
What risk should the nurse monitor in a client with scoliosis of the thoracic and lumbar spine?
Cardiac function impairment.
On which body system would the nurse perform a focused assessment in an adolescent with Duchenne muscular dystrophy to identify life-threatening complications?
Cardio-pulmonary
What is type 1 diabetes?
Caused by a deficiency of insulin secretion due to pancreatic β-cell damage Check sugar at all meals and at bedtime
What is diabetes secondary to?
Certain conditions such as cystic fibrosis, glucocorticoid use (as in Cushing syndrome), and certain genetic syndromes such as Down syndrome, Klinefelter syndrome, and Turner syndrome
What nursing action will best achieve the goal of skin integrity in a child with cerebral palsy and urinary/fecal incontinence?
Changing disposable diapers every two to three hours
The nurse assessing a child with hydrocephalus who has been implanted with a ventriculoperitoneal shunt notes the presence of clear drainage on the surgical dressing. What would the nurse do first?
Check the drainage for the presence of glucose. The nurse must first test the drainage for glucose, because CSF contains glucose and we need to make sure the fluid is CSF.
A nurse is caring for an infant with hypospadias. What does the nurse make a priority when assessing the infant?
Check urine output
Intravenous potassium chloride (KCL) in 0.9% sodium chloride solution has been prescribed for a child who is severely dehydrated. Before administering the solution, the nurse must take which priority action?
Check urine output
Who should the nurse notify in a case of suspected child molestation where the parent does not believe the child?
Child Protective Services for immediate intervention.
What is vagal nerve stimulation?
Child that has recurrent epilepsy and seizures 100-200 seizures a day
What is the ketogenic diet used for in children?
Child that has recurrent epilepsy and seizures 100-200 seizures a day High fat diet that slows electrical impulse which decreases seizure activity
The child has been admitted to the pediatric unit. On admission the nurse notes that the child had a streptococcal upper respiratory infection several weeks ago but did not finish the medication. Which findings are specifically associated with rheumatic fever? Select all that apply.
Chorea - involuntary purposeless movement of the muscles Migratory polyarthritis - larger joints become painful and tender and are difficult to move
What is the Salter-Harris classification?
Classifies a fracture in relation to the epiphyseal (growth plates) I-V
What are the interventions for neurogenic bladder?
Clean intermittent catheterization to promote bladder emptying Medications such as oxybutynin chloride (Ditropan) to improve bladder capacity and prevent spasms
What do you do after cleft lip and palate surgery?
Clean suture line No prone position Prevent crying Hands out of their mouth (may need restraints)
What are α-Agonist antihypertensive agents?
Clonidine + guanfacine Used in ADHD + Tourette syndrome + self-abuse + aggression STRONGLY SEDATING Monitor BP + HR Observe for dry mouth, confusion, depression, urinary retention, constipation, respirations
A lumbar puncture is performed on a child with suspected bacterial meningitis and cerebrospinal fluid (CSF) is obtained for analysis. The nurse determines that the diagnosis is confirmed if which finding is noted?
Cloudy CSF Infection
How do you assess the GI system?
Color - Pale or yellow? Hydration status Abd size - measure at umbilicus Mental status Auscultate + percuss + palpate
What is moderate acne?
Comedones and inflammatory lesions like papules and pustules
What is mild acne?
Comedones like black heads
What is a lumbar puncture?
Common lab test for neuro issues Lot of pressure will come out Cerebrospinal fluid assessment Potential sedation with toddlers and above Infants may need to be held in a ball / put on monitor Looks for infection (meningitis) Can leave tube attached and monitor drainage with external ventricular drainage (EVD)
The nurse is caring for a child with intussusception. Hydrostatic reduction was performed unsuccessfully, and surgery is now planned. Before surgery, the nurse notes that the child has passed a normal brown stool. Which action would the nurse take first?
Contact the doctor Passage of a normal brown stool usually indicates that the intussusception has reduced itself. This is immediately reported to the surgeon, who may very well choose to cancel the surgery.
A nurse is preparing a child admitted from the emergency department with a diagnosis of acute appendicitis for an appendectomy, to be performed in an hour. The child tells the nurse that the acute abdominal pain has suddenly subsided. The priority nursing intervention is which?
Contact the surgeon Perforation
What is the priority nursing intervention for a four-week-old infant with hypertrophic pyloric stenosis?
Correcting fluid and electrolyte imbalances.
What is congenital hypothyroidism?
Cretinism Failure of thyroid gland to migrate during fetal development Can cause severe developmental delays Administration of thyroid hormone - L-thyroxine (Monitor for signs of hypo or hyperfunction - vital signs, thermoregulation, and activity level) Signs = Lethargy + hypoactivity + dull expression + enlarged tongue
What is the gold standard urine test to determine treatment?
Culture Tells you what type of bacteria Can take 24 hrs to 5 days
What is myelomeningocele?
Cyst like sac with spinal cord in the sac Prone Moist dressing to prevent skin drying out and cracking May not be able to put diaper over •Neurogenic Bladder - frequent catheterizations (every 4-6 hours at min) may have dribbling of urine •Bowel incontinence/constipation •Hydrocephalus - ICP + VP shunt •Latex allergies - on precaution •Paralysis - positioning + ROM + skin integrity
A nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be admitted to the pediatric unit. The nurse prepares for the child's arrival and plans to implement which type of precautions?
Droplet
Why are children more susceptible to infection?
Due to immature responses of immune system Breast milk + skin to skin can help boost passive immune system in infants Vaccines targeted at certain ages (like with the 2 month check up)
What is the most common cause of a UTI?
E. coli
The nurse teaches the child how to treat a hypoglycemic reaction. Which step would the nurse tell the child to take first when a hypoglycemic reaction occurs?
Eat hard candy Simple sugar
How do you treat a parasitic infection in children?
Lice Shampoo Combing out all eggs Scabies = topical cream
What is atopic dermatitis?
Eczema Limit milk and eggs Asthma and allergy are concerns Hydrate the skin - right after skin was exposed to water Limited use of steroid creams - can cause hyperpigmentation Risk for infection due to itching
What is a EEG?
Electroencephalogram Recording of electrical activity of the brain Episodic or 24+ hours continuous Do not sedate - can lower brain activity
A 4-month-old infant is admitted to the nursing unit with moderate dehydration. Which of the following symptoms does the nurse recognize as inconsistent with this diagnosis? Select all that apply.
Elevated heart rate Urine specific gravity greater than 1.030 Slow capillary refill
What else can cause seizures?
Epilepsy Infection Head trauma Medications (antivirals) Withdrawal (48-72 hrs) Electrolyte imbalance (sodium + calcium) Hypoxia Eclampsia Fever - 50%
Why would you be given desmopressin for GU issue?
DDAVP Reduces volume of urine Makes you less likely to pee Constrictor Usually for bedwetting :O
The nurse is teaching a parent how to administer an iron supplement to a child. The nurse would explain to the parent to administer the iron supplement with which substance?
Daily multivitamin
What is avascular necrosis?
Death of bone tissue due to lack of blood supply School age 7-10 NSAIDS + activity limits + bracing
What are the benefits of circumcision?
Decrease in: •UTI •Sexually transmitted infections •HIV infection •Penile cancer •Cervical cancer in female partners HYGIENE
What are late of intercranial pressure?
Decreased LOC Depressed motor func Bradycardia Irregular respirations Cheyne stokes Decerebrate / decorticate posture Fixed and dilated pupils
What is hypopituitarism?
Decreased secretion of pituitary hormones Poor growth and short stature Grow normal proportionately - but not tall May do a bone scan of the wrist to assess for closure of growth plates Growth hormone: injection via multidose pen - daily subq
How would you classify burns that are painful, red to white, and edematous?
Deep partial thickness burns
What is an indicative finding of moderate dehydration in a four-month-old?
Depressed anterior fontanel
What is the criteria for a diagnosis of intellectual disability?
Deviations in IQ of two or more standard deviations (IQ of less than 70 to 75) Coexisting deficits in at least two adaptive skills
What is dysgraphia?
Difficulty producing the written word (composition, spelling, and writing)
What is dyslexia?
Difficulty with reading, writing, and spelling
What are some signs of endocrine issues in children?
Drinking a lot Polyuria Bed wetting past a age Losing weight Behavior has changed (not acting themselves)
What is an umbilical hernia?
Incomplete closure of the umbilical ring allowing intestinal content to herniate through the opening Preemies Most will have spontaneous closure by age 5 Can hernia be reduced? (push finger - does it go in?)
How do you treat constipation?
Increase fiber and fluids (water) -Infant 2 months or older no sugar added prune juice -Miralax = Go lightly Bicycle the legs Stimulate the rectum (qtip) Suppository if over 3 days Lactulose Mineral oil Perforation = worst case scenario
What is hyperventilation?
Increased rate and depth of breathing Can make ICP go down naturally QUICK way to help a patient whose ICP is very high 30 breaths per minute
What are UTI symptoms in infants?
Infants may exhibit fever, irritability, vomiting, failure to thrive, or jaundice Children may also experience fever and vomiting, but also may have dysuria, frequency, hesitancy, urgency, and/or pain
What is folliculitis?
Inflammation of a hair follicle Women under arms Hydrocortisone cream for no more than 7 days Warm compress
What is appendicitis?
Inflammation of the appendix Rebound Tenderness / McBurney's Point Diarrhea + fever + nausea + vomit + elevated WBC CT needed to confirm Surgery = laparoscopic or open If abdominal pain suddenly relieved without intervention suspect perforation - Contact MD!!!!!!!!!!! Do not put heat or pressure - can lead to perforation
What is encephalitis?
Inflammation of the brain + meninges FEVER + flu like + altered LOC + seizure activity + lethargy Vectors - have you traveled? any contact with pet? hiking? camping?
What is gastroenteritis?
Inflammation of the stomach and intestines
What is diaper dermatitis?
Inflammatory reaction of the skin in the area covered by a diaper If rash satellites out it is probably candidiasis Barrier cream Lukewarm bath Air them out Dry them completely
What is type 2 diabetes?
Insulin resistance
What is the most common cause of anemia in a one-year-old?
Iron deficiency
What is the most common anemia?
Iron deficiency anemia Older infants + toddlers + female adolescent Iron supplementation in form of ferrous sulfate or ferrous fumarate - 3 mg of elemental iron 2-3 times a day Severe cases blood transfusions needed
What are Deferasirox and Deferoxamine?
Iron removal meds Chelation therapy (used in lead poisoning as well) NEED GOOD FLUID INTAKE Lead levels >3 If lead levels HIGH use IV
The nurse is reading the medical record of a child who has been admitted to the hospital with a diagnosis of hypertrophic pyloric stenosis. Which signs/symptoms associated with this disorder would the nurse expect to see documented in the record? Select all that apply.
Irritability and hunger A movable firm mass in the right upper abdominal quadrant
What is the best response from a nurse when asked why a four-month-old infant is having a cleft lip repair at such an early age?
It has an emotional effect on the parents.
The nurse develops a teaching plan of care for the parents of a child in whom impetigo has been diagnosed. Which instructions would the nurse include in the plan of care? Select all that apply.
Itching and burning of the lesions may occur. Antibiotic ointment may be prescribed for application to the lesions. The child would not share towels and linens with the rest of the family.
How do you prevent vector transmission?
Jeans Long sleeve Bug spray Limit exposure
How do you promote skin integrity and prevent scratching?
Keep fingernails short Press rather than scratch on pruritus Use antipruritic and topical ointments or creams as ordered
The nurse observes a child for neurologic disorders. What is the earliest indicator of improvement or deterioration of neurologic status?
LOC
What is factor replacement?
Lack of factors would cause: Unexplained and excessive bleeding from cuts or injuries / after surgery or dental work Many large or deep bruises, Unusual bleeding after vaccinations Pain, swelling or tightness in your joints Blood in your urine or stool Nosebleeds without a known cause In infants - unexplained irritability
What is hypo/hyperpigmentation?
Lack of pigment or more pigmented than surrounding skin
What is Acute Lymphoblastic Leukemia (ALL)?
Most common form of child cancer 1-4 years of age 70% cure rate - if toddler 90% cure rate Diagnosis = WBC HIGH like 30000 (higher the number the worse the prognosis) then look at bone marrow to see exact type of cancer Immature WBC = cannot fight infection BLEED RISK - thrombocytopenia (unexplained bruising) High % of brain involvement - intrathecal methotrexate must be given to protect the brain (CNS prophylaxis) Induction / Maintenance therapy REDUCE PAIN - EMLA cream prior to venipuncture, port access, LP and bone marrow aspiration Trisomy 21 higher risk
What is cerebral palsy?
Most common motor disorder in childhood - lifelong impairment Incidence is higher in premature and low-birth-weight infants Anoxic injury Motor impairments including abnormal motor patterns including spasticity, muscle weakness, and ataxia NON PROGRESSIVE Not always linked to developmental issues Complications: mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus
What is a wilms tumor?
Most common renal tumor Peak incidence between 2-3 years of age Belly getting bigger and bigger - diaper does not fit Once diagnosed DO NOT PALPATE BELLY Nephrectomy +BP is very common No contact sports!!! Protect the kidney! 24 hour urine collection
What are brain tumors?
Most common solid tumor and the second most common type of cancer in children Prognosis depends on size and location and if resectable Complications = hydrocephalus, ICP, brain stem herniation, and negative effects of radiation
What is baclofen?
Muscle Relaxant - manages spasticity Helps in spasticity in CP Can be on a pump - check incision Refill every 3 months Carry implanted device identification and emergency information cards at all times
How do you determine LOC in a child?
Name Who is here with you?
S+S of meningitis?
Neck pain Eye pain (light hurts) Weak cry Poor feeding Kernigs sign Brudzinskis sign
What is nephrotic syndrome?
Not a disease - a clinical state Alterations in the glomerular membrane allow proteins (albumin) to pass into urine Proteinuria Hyperlipidemia Edema - PERIORBITAL Mild hematuria High BP - edema Toddler can double in weight Dipstick Hypoalbuminemia Treatment = corticosteroids Usually runs its course but sometimes can lead to renal failure Low sodium diet
What foods should parents of a child with celiac disease avoid?
Oatmeal, whole wheat bread
What is slipped capital femoral epiphysis (SCFE)?
Occurs in a pre-adolescent Femoral head slips out of the hip - highly linked to hormones (rapid growth) and obesity Do not attempt to perform passive range of motion - this may cause worsening of the condition Bedrest + bracing
What is important to know about a febrile seizure?
Occurs when temperature rises VERY quickly Not exactly just because they have a high fever
What manifestation of hypertrophic pyloric stenosis would the nurse reviewing the record of an infant with this disorder expect to see documented?
Olive-shaped mass palpated in the right upper abdominal quadrant
What is a focal seizure?
One hemisphere involved Partial Do not lose consciousness Taste - weird flavor
How do you perform CPR on a child?
One person = 30 compressions to 2 breaths Place left heel of hand (or two hands) at the sternum/nipple line Two person = 15 compressions to 2 breaths Place left heel of hand (or two hands) at the sternum/nipple line
How do you perform CPR on an infant?
One person = 30 compressions to 2 breaths Place two fingers one fingerbreadth below nipple line Two person = 15 compressions to 2 breaths Place two thumbs encircling the chest at the nipple line
What is hypospadias?
Opening of the urethra on inferior surface of penis due to failure of the urethral folds to close Do not circumcise Risk for infection
What is epispadias?
Opening of the urethra on superior surface of penis Do not circumcise Risk for infection
What is imperforate anus?
Opening to the anus is missing or blocked May need ostomy is there is no rectum Cut away the membrane at birth Prone or side lying Pre op - NPO + bowel cleanse and monitor hydration Post op - pain management + NPO + hydration + gastric decompression until mobility restored NO RECTAL TEMPS PRE OR POST OP
How can you help mild to moderate dehydration?
Oral rehydration therapy
A nurse provides instructions on the administration of oral iron to the parent of a child with iron-deficiency anemia. The nurse determines that the parent understands the instructions if the parent states that iron will be administered with which item?
Orange juice
What is judicious antibiotic use?
Over prescribing them and causing resistance
What is the major cause of iron deficiency anemia in infants?
Overfeeding of milk
What is enuresis?
Primary enuresis: enuresis in the child who has never achieved voluntary bladder control Secondary enuresis: urinary incontinence in the child who previously demonstrated bladder control over a period of at least 3 to 6 consecutive months (assess what is going on in their lives) Diurnal enuresis: daytime loss of urinary control Nocturnal enuresis: nighttime bedwetting
What is dyspraxia?
Problems with manual dexterity and coordination
What is dyscalculia?
Problems with mathematics and computation
What is staphlococcal scalded skin syndrome?
Produced by staphylococcus cause loss of the superficial skin layers Can be external or internal
The nurse is developing a care plan for an infant who will be returning from surgery for cleft lip repair. In which position would the nurse plan to avoid placing the infant?
Prone
What do you do if a child has a seizure?
Put them on left side Suction Padded bed O2 Intubation ready Bite block Keep them close to nurses station
What is hypertrophic pyloric stenosis?
Pylorus muscle hypertrophies (enlarged) creating gastric outlet obstruction Projectile vomiting (non bilious) that becomes more frequent and forceful Hard nodule around xiphoid process (pea) Will see visible peristalsis that move from left to right Watch for DEHYDRATION AND ELECTROLYTE Pyloromyotomy = go into umbilicus and open it up (gold standard treatment) Will have NGT after surgery Start refeeding 6hr after surgery (clear liquid to full feed - if vomit go back)
What are common symptoms for GU issues?
Recurrent UTI Incontinence (sudden) Fever Foul smelling urine Flank pain Abd pain Frequency Dysuria Hematuria
What interventions would be implemented after the pain is under control in a child with sickle cell anemia in vasoocclusive crisis?
Rehydration and O2 therapy Of course pain management too
What is status epilepticus?
Reoccurring epilepsy Seizure lasting upwards of 30 minutes OR 2 seizures with no break GOLD STANDARD = ATIVAN AT HOME = DIAZEPAM Rectal Dia-Stat (diazepam) Nasal diazepam can also be prescribed
What is fetal alcohol syndrome?
Results from in utero alcohol exposure Typical facial features: •Low nasal bridge with short upturned nose •Flattened midface •Long philtrum with narrow upper lip
What is tinea?
Ringworm Pedis = foot Corporis = any other part Versicolor = hyperpigmentation Capitis = head Cruris = groin Antifungals (topical unless head - head is treated with oral antifungal Griseofulvin for 6 weeks) End in azole Griseofulvin affects the liver and is given with food !
What item would the nurse use to feed an infant born with a unilateral cleft lip and palate?
Rubber tipped syringe.
What diseases are droplet?
Rubella Mumps Diphtheria Gown + gloves + mask + shield
How do they treat appendicitis?
Rupture = wicking with high dose antibiotics and THEN removal Nonrupture = surgery
What are common bacterial infections of children?
Scarlet fever - Group A strep Diphtheria - DEHYDRATION + airway + vaccine Pertussis - whooping cough + premature vulnerable + 21 day incubation + 4-5 weeks of coughing Tetanus - lockjaw + vaccine every 10 years unless exposure and it has been less than 5 years since last shot Botulism - honey Osteomyelitis - bone infection Septic arthritis - when synovial fluid gets infected and child cannot walk
What is the treatment for metatarsus adductus / congenital clubfoot?
Serial casting - every 2 weeks Neurovascular checks + skin AFO = ankle foot orthoses
What is tanner staging?
Sexual maturity rating based on secondary sexual characteristics
What clinical finding would the nurse expect in a child with pediculosis capitis?
Small white spots attached to the bases of hair shafts.
WHAT DOES MILD DEHYDRATION LOOK LIKE?
Soft + flat fontanelles Normal eyes Pink and moist mucosa Elastic turgor Normal HR Normal BP Warm + pink skin + cap refill Urine output = slightly decreased
What is infantile spasms?
Spasm of the infant Almost shuddering Parent may say the infant does a weird move Highly linked to neurological disorder and developmental delay Can go on to develop epilepsy Seen around 6 months Phenobarbital - addicting + LOC change
What does urinalysis tell us?
Specific gravity Glucose Ketones Nitrates Protein Etc. Tells symptoms
How much do you poop with breastfeeding?
Stool almost every feed
How much do you poop with bottle feed?
Stool one or 2 times a day
When doing a urine lab for a child what is the gold standard?
Straight cath
What are neutropenic precautions?
Strict hand washing No visitors who are sick No children No raw food, no live plants No free standing water Private room / room with person without infection No suppositories or enemas Be careful with bleeding risks!
What is dysplasia of the hip?
Subluxation vs dislocation Ortolani = clunk Barlow = click Initial treatment = triple diaper
How do we look for dehydration in infants?
Sunken fontanelle Wet diapers Weight
WHAT DOES SEVERE DEHYDRATION LOOK LIKE?
Sunken fontanelles Deeply sunken eyes Pale and dry mucosa Tenting turgor Bradycardia Normal BP - hypotension Cool + mottled + dusky + delayed cap refill Urine output = <1 ml/kg/hr
WHAT DOES MODERATE DEHYDRATION LOOK LIKE?
Sunken fontanelles Mildly sunken eyes Pale and slightly dry mucosa Decreased turgor Slight increased HR Normal BP Warm + pink skin + delayed cap refill Urine output = <1 ml/kg/hr
How are burns classified?
Superficial = epidermis only Partial thickness = involves epidermis and portions of dermis Deep partial thickness = extends deeper into dermis Full thickness = extends through the epidermis, dermis, and hypodermis
How do you treat a bacterial infection in children?
Symptom management + antibiotics
How do you treat a zoonotic + vector borne infection in children?
Symptom management + antibiotics
What diseases are airborne?
TB Varicella (chicken pox) Ebola Measles (rubeola) Respirator
What assessment finding would the nurse expect for a 2-month-old infant admitted with gastroenteritis and dehydration?
Tachycardia
What are signs of a fever in infants?
Tachypnea Tachycardia Agitation Poor feeding If child is under 2 months tell the parent not to treat with just acetaminophen - may require full septic workup
What can cause a child to have a fever?
Teething Bacterial infection Too much clothing Dehydration
What is intussusception?
Telescoping of 1 bowel segment into a distal segment Infants under 1 year (male) Sausage like mass in abd Severe cramping pain + vomiting + diarrhea + currant jelly stools + lethargy Barium enema to diagnose and treat + open it up If does not stay open - surgery is needed Risks = Polyps + cystic fibrosis + celiac + crohn + diverticulum
The laboratory technician again calls the emergency department, this time to report that the serum potassium level is 3.1 mEq/L (3.1 mmol/L). In response, the PHCP prescribes an IV infusion of potassium chloride. Which parameter would the nurse check before starting the potassium chloride infusion?
Urine output Replacement therapy with potassium is performed with caution. Renal failure can result from severe dehydration, and, if the child is anuric, potassium is retained resulting in an abnormal serum level.
How would you assess pain in an adult client with low functioning Down syndrome?
Using the Wong Baker faces pain rating scale
What is the most common infection of children?
Viral Treating symptoms Cool mist to help cough Tylenol for fever Neutral position Nasal suction Antivirals used in individuals with comorbidities - like asthma More prone to viruses in toddler stage - live on surfaces for 6 hrs Nail biting = higher rate of viruses
What does viral exanthems mean?
Virus with rash associated Like varicella Rubella Rubeola Exanthem subitum (roseola) Hand + foot + mouth (hepangina) Slapped cheeks
How do you inspect a child with neurological disorder?
Vitals Cranial nerves Motor func. Reflexes - hyper exaggerated / should be gone ICP
How do you give iron supplementation?
Vitamin C (can be multivitamin) for absorption Given in-between meals Dark stool - normal Can cause constipation - increase fluid and fiber Do not give with milk Drink iron with straw / use dropper - stains teeth and gums
What is the biggest way children dehydrate?
Vomiting and diarrhea Can give zofran at 2 months old to prevent
What is hydrocephalus?
Water on the brain From 3rd and 4th ventricle VP shunt - opens valve to drain into the peritoneal Infection risk - redness at the site + shunt not working correctly + vital changes (antibiotics + remove drain + replace after 7-14 days) If shunt is not working it can lead to increased ICP As they get older it needs to be adjusted to their anatomy
A child with scoliosis will need to wear a brace to correct the deformity, and the nurse teaches the child about its use. Which instruction would the nurse give the child?
Wear a soft fabric shirt under the brace.
What is the most important clinical sign of an accurate degree of dehydration?
Weight loss
What question would a nurse ask a child admitted for appendectomy to determine their understanding of the hospitalization?
What are you doing at the hospital?
What is important to know about diarrhea?
What causes it? •Viruses (rotavirus) •Bacterial •Parasitic •Antibiotic use •Ingestion of undercooked meats, foreign travel, day care, well water Acute or chronic? Chronic = 2 weeks Leading cause of death because of dehydration Metabolic ASSidosis Drinking a lot of apple juice - can act as a laxative!!!
What is leukapheresis?
Whole blood removed - WBC's are extracted, and then the blood is retransfused into the child Monitor BP
What is important to know about hookworm?
Worm in the foot Can cause severe anemia (especially in children)
When do you use an occlusive dressing?
Wound vac Wart
What term describes the inheritance pattern of hemophilia?
X-linked recessive
What is candida?
Yeast infection Thrush - if in the mouth you will see it in the bum Bacteria overgrowth Clean any nipple in their mouth or put nystatin on moms nipple before feeding Nystatin
How do you give fluids for burns?
You give 2/3 of the needed fluid within the first 8 hours
