NUR425 PEDS EXAM 2

normal urine output for older children and adolescents

1 mL/kg/hr

The nurse is caring for a child, with no previous medical history, who weighs 10 kg and is moderately dehydrated. The prescription by the provider is to give an IV bolus over 20 minutes. What would the nurse set the IV pump in at mL/hr to deliver the bolus in the prescribed amount of time?

600 mL/hour

A nurse is providing teaching to a client who has renal failure and an elevated phosphorus level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client? A. constipation B. metallic taste C. headache D. muscle spasms

A

infants will have the following presenting signs in UTI a. vomiting/poor feeding b. tea-colored urine c. proteinuria d. increased number of stool diapers

A

what are the most important signs of heart failure that a nurse would look for in an infant with coarctation of aorta

edema tachycardia tachypnea hypotension feeding difficulty prolonged cap refill ineffective peripheral circulation (cool extremities) weight gain can happen

post op care for cleft palate/cleft lip repair

elbow immobilizers (keep from putting hands in mouth) pain control (crying causes stress on suture lines) feeding when tolerated sitting upright in carseat

what is the earliest sign of dehydration in a child

elevated HR

what are some signs and symptoms of dehydration in a child

elevated HR change in LOC-- irritable, lethargic decrease in skin turgor/elasticity sunken fontanel decrease number of wet diapers/increased # of stool diapers mottling, prolonged cap refill low BP

GCS of 12

emergent neuro consultation

when to give mucosal protectants

empty stomach, QID, two hours before other drugs

what is the most serious complication of Hirschsprung disease

enterocolitis

chronic-recurrent seizures

epilepsy congenital defects

what is decerebrate posturing

extensor body hyperextended problems with midbrain or pons WORSE

clinical manifestations Hirschsprung disease in a newborn

failure to pass meconium within 24-48 hours of life feeding refusal bilious vomiting abdominal distention

T/F: a positive RAPID test is a stable patient

false a positive RAPID is an unstable patient a negative RAPID is a stable patient

acute-nonrecurrent seizures

febrile electrolyte imbalance intracranial infection drugs/toxins/lead

what is the glass test for meningitis

fever with spots or rashes that do not fade under pressure is a medical emergency

Brudzinski's sign

flexion of knees and hips when neck is flexed

what is decorticate posturing

flexor arms move in towards core problems with cervical spinal tract or cerebral hemisphere

what is ICP

force exerted by the three contents (CSF, blood, tissue) on the brain

therapeutic use of Cimetidine

gastric and duodenal ulcers heartburn dyspepsia GERD aspiration pneumonitis

therapeutic use of omeprazole

gastric and duodenal ulcers heartburn dyspepsia GERD aspiration pneumonitis

what causes isotonic dehydration

gastroenteritis with vomiting and diarrhea

what is the RAPID assessment

R = Rapid heart rate A = Altered color or capillary refill P = Peeing nonexistent I = Inability to engage in the environment D = Decreased blood pressure

what drugs can cause irregular facial spasms

Reglan (metoclopramide) because of extrapyramidal symptoms (affects dopamine)

epidural hematoma

above dura arterial blood

findings of bacterial meningitis in children and adolescents

abrupt onset fever headache seizures irritability nuchal rigidity positive Kernig sign positive Brudzinski signs petechiae/purpura

what is Hirschsprung disease

absence of ganglion cells in affected areas of intestine some nerve cells in large intestine are missing leading to stool getting blocked decreases ability of sphincter to relax, increased intestinal tone lack of peristalsis

therapeutic use of mucosal protectants

acute duodenal ulcers

what drugs are likely to interact with the drugs we are studying? a. MAOI B. SSRI C. Theophylline D. warfarin E. digoxin F. tetracycline G. fluoroquinolones H. TCAs

all of them

education for antihistamines/anticholinergics

anticholinergic effects (cant see, cant pee, cant spit, cant sh**) caution with lactation, pregnancy, glaucoma

what is MAP

average BP during one cardiac cycle

what is an adverse reaction of cimetidine a. miscarriage b. impotence c. insomnia d. heartburn

b. impotence

which one includes to check urine at home in the discharge instructions a. AGN b. NS c. UTI

b. nephrotic syndrome

CSF analysis in bacterial versus viral

bacterial - protein content: elevated - glucose content: decreased - bacteria culture: positive - color: turbid or cloudy viral - protein content: normal - glucose content: normal - bacteria culture: negative - color: clear or slightly cloudy

what are the three types of meningitis

bacterial viral (aseptic) tuberculosis

when does cleft palate repair happen

before 12 months of age (speech development)

subdural hematoma

below dura venous blood

what should pulse pressure be in peds

between 10 and 50 mmHg

when does cleft lip repair happen

between 2-3 months of age

mechanism of action of cimetidine

blocks histamine receptors (which produce stomach acid)

mechanism of action of serotonin antagonists

blocks serotonin receptors in the brain (chemoreceptor trigger zone) and vagal nerves

mechanism of antihistamines/anticholinergics

blocks the release of histamine in inner ear and brain

CoA assessment cues

bounding pulses high BP in UE nosebleeds from HTN cool skin, decreased BP in LE headaches

what are some signs of digoxin toxicity

bradycardia nausea, vomiting, anorexia vision changes blurred/yellow vision (halo effect) hold drug if infants heart rate less than 90

education for mucosal protectants

can cause constipation, increase fluids and fiber

right sided heart failure

causes increased pressure in right atrium and systemic venous circulation HTN leading to hepatosplenomegaly and sometimes edema

what is CPP

cerebral perfusion pressure pressure needed to ensure that adequate O2 and nutrients are delivered to the brain difference between MAP and ICP

what are some warning signs of a head injury

change in LOC, seizures slurred speech visual changes pupil changes projectile vomiting bleeding/clear fluid from nose or ears loss of sensation to any extremity

what to look for/ symptoms of increased ICP

changes in LOC eyes posturing (decorticate, decerebrate, flaccid) decreased motor function headache seizures changes in vitals vomiting changes in speech

what is serum sodium concentration regulated by

changes in WATER intake, movement, and excretion NOT by changes in sodium balance

what do you do if someone has blurry vision and headache

check vitals, specifically BP (hypertension)

what are some ways you would diagnose HF

clinical symptoms CXR shows enlarged heart and pulmonary blood flow ventricular hypertrophy arrhythmias ECHO

what is CoA

coarctation of the aorta obstruction to blood flow due to stenotic lesion (narrowing of portion of aorta)

clinical manifestations Hirschsprung disease in an infant

constipation, abdominal distention, possibility of enterocolitis

what are some postop interventions for care of the pediatric client

continuous cardiopulmonary assessment monitor O2 sat maintain body temp promotion of fluid and electrolyte balance continuous vital signs monitoring check for bleeding, signs of infection, LOC, skin, pain

first line therapy for nephrotic syndrome

corticosteroids

care management of nephrotic syndrome

daily weight, measure abdominal girth home care is preferred children can attend school, but avoid contact with ill friends restrict some salt and fluids

management of acute glomerulonephritis

daily weights, vital signs, strict measurement of intake and output dietary restrictions, monitor electrolytes do not treat with antibiotics (post-infection disease)

mechanism of action of synthetic prostaglandins

decreases stomach acid production, increases bicarb, protective mucous in stomach

what are some meds to give for VSD

digoxin (heart failure) and Lasix (decrease BP)

what are the following signs and symptoms in an infant with hydrocephalus

dilated scalp veins high pitched cry separated skull sutures

prototype of antihistamines/anticholinergics

dimenhydrinate (Dramamine)

which drug would the nurse instruct to suck on candy while taking?

dimenhydrinate (anticholinergic can cause dry mouth)

gold standard for ICP monitoring

drain CSF as needed HOB at 15-30 degree elevation midline head position to promote drainage low stimulation environment avoid suctioning and Valsalva infection risk

assessment cues of meningeal irritation

headache photophobia nuchal rigidity (stiff neck) opisthotonic position (neck to heel arching) positive Kernig's sign (resistance to extension of leg while hip is flexed) positive Brudzinski's sign (flexion of hips and knees in response to neck flexion)

what does widened pulse pressure mean

high systolic same diastolic bigger gap between systolic and diastolic

what are some VSD assessment cues

holosystolic murmur right atrium enlarges (hypertrophy) heart failure

what are the two compensatory mechanisms of the heart

hypertrophy of right ventricle-- leads to poor feeding, dyspnea, growth failure sympathetic nervous system release of catecholamines-- leads to tachycardia, sweating, increased BP

treatment for bacterial meningitis

immediate droplet isolation precautions lumbar puncture-- definitive test antimicrobial therapy maintain IV or oral hydration reduce increased ICP implement seizure precautions neuro checks anti epileptic meds

causes of hydrocephalus

impaired absorption of CSF in ventricular system malfunction of arachnoid villi obstruction of flow of CSF

what does digoxin due for cardiac function

improves contractility increase cardiac output dysrhythmia decreases serum potassium

why and when does a TET spell occur

in response to a stressor, like feeding or crying

what happens in VSD

increased blood flow to and through the pulmonary system blood being pushed to the right side of the heart and into the lungs congestion in lungs

left sided heart failure

increased pressure in left atrium and pulmonary veins lungs congested with blood increased pulmonary artery pressures and pulmonary edema

what happens in CoA

increased pressure proximal to defect (arms) decreased pressure distal to defect (legs) increased pressure load on ventricle decreased cardiac output no color change; all oxygenated blood

what are the four hemodynamic characteristics

increased pulmonary blood flow (VSD, PDA) decreased blood flow (TOF) obstruction to blood flow out of heart (CoA) mixed blood flow

what happens in PDA

increased pulmonary blood flow to the lungs

The new classification of heart defects is more descriptive regarding the flow of blood through the heart. Match the classification with the type of congenital heart disease found in that classification. Increased pulmonary blood flow: _____________ Decreased pulmonary blood flow: _____________ Obstruction of blood flow out of the heart: _____________

increased pulmonary blood flow: VSD decreased pulmonary blood flow: TOF (pulmonary stenosis = narrowing) obstruction of flow out of heart: Coarctation of aorta

what is Cushing's Triad

increased systolic BP decreased HR (bradycardia) irregular respirations (Cheyne-Stokes)

PDA assessment cues

increased work on left ventricle (extra blood) machine-like murmur increased pulmonary congestion bounding pulses

mechanism of action of dopamine antagonists

increases tone of esophageal sphincter increases peristalsis decreases dopamine receptors in the brain thus decreasing nausea and vomiting

mechanism of action for PPIs

inhibits an enzyme system in the stomach; suppresses gastric acid production

GCS of 8

intubate and ventilate

polycythemia can result in what

iron deficient anemia clotting thickened blood higher chance of stroke

what is the most common type of dehydration

isotonic

where will you hear the murmur for VSD

left sternal border

precautions with Prilosec

liver dysfunction pregnancy

what will PDA murmur sound like

machine-like

prototype for dopamine antagonists/prokinetics

metoclopramide (Reglan)

education for synthetic prostaglandins

miscarriage, dysmenorrhea

nursing interventions for pediatric seizure

monitor time, movements, and LOC during seizure do not restrain place side lying do not put anything in mouth evaluate postictal feedings give meds

what is intussusception

most common cause of intestinal obstruction in children proximal segment of bowel telescopes into more distal segment

what are some concerns with cleft lip and cleft palate

most unable to feed using conventional methods pre surgery may need Pigeon bottle, cleft palate nurser tend to swallow excessive air with feedings-- pause frequently and burp

what structures are included in the upper GI system

mouth, esophagus, stomach, first part of small intestine (duodenum)

therapeutic use of dopamine antagonists

nausea and vomiting due to chemo, opioids, radiation increases motility in those with GERD or diabetic gastroparesis

therapeutic use of serotonin antagonists

nausea and vomiting related to chemo, radiation therapy, post op

pleural effusion and ascites is related to what

nephrotic syndrome

education for Cimetidine

no antacids within one hour no smoking, alcohol, ASA or NSAIDS (GI irritation) can cause impotence

characteristics of viral/aseptic meningitis

no bacterial growth in CSF cultures abrupt or gradual onset of symptoms not contagious

what are some clinical manifestations of pyloric stenosis

non bilious projectile vomiting after feeding (whatever went down in feeding comes right back out) infant hungry olive-shaped mass dehydration, abdominal distention

what is the best IV fluid to give for hypovolemia related to dehydration

normal saline-- isotonic flui d

prototype for PPIs

omeprazole (Prilosec) other 'zoles'

ADH only affects the

osmolarity

medications for ICP management

osmotic diuretics like Mannitol IV thermoregulation--hyperthermia with cereal dysfunction do NOT give corticosteroids give Barbiturates as last resort

which four interventions are needed with a TET spell

oxygen morphine IV fluids knee to chest

what happens in TOF

oxygenated blood mixes with deoxygenated blood causing cyanosis

Kernig sign

pain during extension of leg while hip is flexed

what is PDA

patent ductus arteriosus left to right shunt (failure) of ductus arteriosus to close opening between the great arteries (aorta and pulmonary)

treatment of intussusception

pneumoenemea (air enema) to straighten out telescoped bowel may need US-guided saline enema may require surgery

treatment of synthetic prostaglandins

prevention of ulcer when one uses NSAIDS for a long time

medication for PDA

prostaglandin inhibitor-- Indomethiacin

management of pyloric stenosis

pyloromyotomy correct dehydration correct metabolic alkalosis

what do ACE inhibitors do for cardiac function

reduce after load promote vasodilation "prils"

clinical manifestations Hirschsprung disease in childhood

ribbonlike, foul smelling stool undernourished, anemia appearance

education for dopamine antagonists

sedation extrapyramidal reactions diarrhea prevents absorption of many drugs including acetaminophen, valium, digoxin, lithium

severe depletion of ECF results in

shock

HF interventions about feeding techniques

small, frequent feedings

aldosterone maintains balance of

sodium and water

treatment of hyper cyanotic TET spells

squatting or knee-chest position (forces more blood to pulmonary artery -> more blood to lungs -> more blood to body) oxygen morphine IV fluids

etiology of acute glomerulonephritis

streptococcal infection group A beta-hemolytic streptococci 10-21 days between infection and start of symptoms

prototype of mucosal protectants

sucralfate (Carafate)

clinical manifestations of intussusception

sudden acute abdominal pain child screaming with knees drawn to chest red currant jelly-like stools palpable sausage-shaped mass in RUQ appears comfortable during intervals

hydrocephalus signs

sunset eyes bulging fontanel dilated scalp veins Macewen's sign (cracked pot sound) thin shiny skin high-pitched cry

assessment cues of TOF

systolic murmur mild to severe cyanosis hyper cyanotic spells (TET spells) polycythemia (making too many RBC to try and compensate for lack of oxygen) anemia (iron stores being used up for RBCs)

symptoms of left sided heart failure

tachypnea dyspnea retractions nasal flaring wheezing

what is hypertrophic pyloric stenosis

thickening and elongation of pyloric sphincter muscle usually occurs in first few weeks of life

what causes hypotonic dehydration

too much water intake burns, renal disease, SIADH replacement of fluid with only tap water

what is a risk associated with a child taking Digoxin

toxicity due to hypokalemia

what will labs and urine look like in acute glomerulonephritis

urine: cloudy, smoky brown (like tea) from increased RBCs and hemoglobin BUN and Creatinine elevated at least 50% positive ASO titer (recent strep infection)

education for serotonin antagonists

use with caution with drugs that affect serotonin transmission (SSRIs, TCAs, fentanyl, lithium) dizzy, constipation, diarrhea

etiology of nephrotic syndrome

usually caused by minimal-change nephrotic syndrome (MCNS) can be caused by secondary disorder or congenital

what is VSD

ventricular septal defect left to right shunt (hole) in septum between the two ventricles increased pulmonary blood flow

therapeutic use of antihistamines/anticholinergics

vertigo (motion sickness) and nausea, vomiting

signs and symptoms of UTI in kids

vomiting, fever, poor feeding pain with urination abdominal or back pain strong smelling urine dipstick shows leukocyte esterase and nitrites

symptoms of right sided heart failure

weight gain peripheral edema periorbital edema neck vein distention ascites hepatomegaly

Which drugs affect bone density? a. lansoprazole b. famotidine c. cal carb

a. lansoprazole (PPI can cause bone loss) also affects pregnant women, vitamin D, Cdiff monitor

why does albumin help with nephrotic syndrome? a. restores lost serum protein b. dilutes urine c. decreases inflammation d. acts as antihypertensive

a. restores lost serum protein

patient is stable, mild dehydration, and can drink

50 mL/kg over 4 to 6 hours

what are three potential reasons for heart failure in the peds patient

1. secondary to structural defects in the heart 2. impaired contractility or relaxation ov ventricles (dysrhythmias, electrolyte imbalance) 3. excessive demands on normal heart muscle (sepsis or anemia)

normal ICP for peds

10-15

px hypotensive, sunken fontanelles. How fast to give bolus?

200 mL over 5-10 minutes

normal CPP for children

40-60

A nurse is caring for a child who just experienced a generalized seizure. Which of the following is the priority action for the nurse to take? A. Position the child in a side lying position B. Try to determine the seizure trigger C. Reorient the child to the environment D. Note the time of the post ictal period

A ABC's priority to avoid aspiration

When is posturing in an unconscious client likely to occur? A. When they are in pain B. With stimulation C. When there is no brain function D. at random times

A, B, D

You are the nurse caring for an infant who has been diagnosed with coarctation of the aorta. The child is scheduled for a repair of this defect tomorrow. When doing your assessment what deviations from normal would you expect to find? (Select all that apply) A. Poor peripheral pulses in the lower extremities B. Equal blood pressure measurements in upper and lower extremities C. Bounding pulses in upper extremities D. A normal exam

A, C

What conditions can affect the neurological response in the pediatric client? (Select all that apply) A. Infections B. eating cheerios C. traumatic brain injury D. exposure to lead

A, C, D

Which of the following interventions would the nurse expect to perform for the pediatric client with increased ICP? (Select all that apply) A. Stabilize airway, breathing, and circulation B. Suction secretions often C. Give mannitol for cerebral edema D. Place HOB elevated at 15 to 30 degrees

A, C, D B- suction if needed to clear airway but not recommended because can increase ICP

A nurse is explaining the role of gradient pressure related to congenital heart disease to a new CVICU nurse. What statement(s) would indicate an understanding of the concept by the new nurse? (Select all that apply) A. Blood flow through the heart takes the path of least resistance B. The higher the pressure gradient, the slower the flow of blood C. Blood flows from an area of high pressure to an area of low pressure in CHD D. The greater the resistance the slower the flow of blood

A, C, D blood flows from high to low pressure blood takes the path of least resistance higher pressure gradient, the faster the rate of flow higher the resistance, the slower the rate of flow

Maternal risk factors for an increased incidence in congenital heart disease in the infant include the following: (Select all that apply) A. Exposure to environmental toxins B. Taking folic acid C. Family history of congenital heart disease D. Alcohol consumption during pregnancy E. Infections during pregnancy

A, C, D, E

Digoxin is a drug that is used frequently to treat heart failure in the pediatric client. What are some signs and symptoms of digoxin toxicity? (Select all that apply) A. nausea and vomiting B. tachycardia C. bradycardia D. vision changes E. arrhythmias

A, C, D, E px will have bradycardia, not tachycardia

You are the nurse caring for an infant in the CVICU who has just been diagnosed with Tetralogy of Fallot. After speaking to the healthcare provider, the parents are still unclear as to what the defect is. You would explain that Tetralogy of Fallot is made up of which of the following defects? (Select all that apply) A. VSD B. ASD C. Overriding aorta D. pulmonary stenosis E. Left ventricular hypertrophy F. right ventricular hypertrophy

A, C, D, F

A nurse is caring for an adolescent who has a closed head injury. Which of the following findings are indications of increased intracranial pressure (ICP)? (Select all that apply) A. Report of a headache B. Increased motor response C. Alteration in pupillary response D. Increased sensory response E. Increased sleeping

A, C, E B- decreased motor response is an indicator of increased ICP D- decreased sensory response is an indicator of increased ICP

You are caring for a child with heart failure in the CVICU. What are some nursing interventions that you can implement to decrease the cardiac demand of your pediatric client? (Select all that apply) A. Cluster care to promote rest B. Keep room hot C. Provide a lot of stimulation D. Provide large meals 3x/day E. Treat fevers with antipyretics

A, E avoid cold or heat stress decrease stimulation small meals or gavage feedings

The nurse in the CVICU has been educating a new nurse about the signs and symptoms of heart failure in a child. Which statement by the new nurse would indicate a need for further education? A. "Children with heart failure often have edema and should be weighed daily." B. "Children with heart failure should eat larger meals more often." C. "Heart failure in children can present with inappropriate sweating and fatigue with eating." D. "It is often difficult for children with heart failure to breathe well when lying flat in bed."

B these patients will have anorexia and feeding intolerance rest of answers are true

renin produced in the kidneys is released when:

BP is low sympathetic nerve cells are activated macula dense cells in distal tubule sense lack of sodium

You are the nurse caring for a child in the NICU who has a history of prematurity and has just been diagnosed with a patent ductus arteriosus. What medication would be an appropriate treatment to promote the closure of this type of congenital heart defect? A. Prostaglandin E B. Morphine C. Indomethiacin D. Digoxin

C Indomethiacin inhibits prostaglandin and can be used to treat and promote closure of patent ductus arteriosus

What is the most important assessment in the pediatric client? A. urine output B. diet C. LOC D. pain

C LOC most important

A child who is arousable by a gentle shaking of the shoulder would be? A. Confused B. Lethargic C. Obtunded D. Comatose E. Stuporous

C confused = forgetful lethargic = drowsy obtunded = arousable by stimulation comatose = cannot arouse stuporous = arousable with vigorous stimulation

Which statement regarding the systolic and diastolic blood pressure of an infant less than a year of age reflects a normal finding? A. The blood pressure in the upper extremities should be higher than in the lower extremities B. The blood pressure in the lower extremities should be higher than the blood pressure in the upper extremities C. The blood pressure in the upper and lower extremities should be approximately the same. D. The blood pressure on the right side should be higher than the blood pressure on the left side of the body

C before one year, should be same after one year of age, systolic in leg is higher by 10-40 mmHg

if a kid comes in with dizzy spells, headaches, nosebleeds. what are you concerned about?

Coarctation of aorta

Place the correct assessment finding and intervention into the correct category: Cushing's Triad & Hydrocephalus A. mannitol IV stat B. Cheyne-Stokes respirations C. high pitched cry D. bradycardia E. increased head circumference F. bulging fontanel G. elevated systolic BP H. VP shunt placement or revision

Cushing's Triad: - A (mannitol IV stat) - B (Cheyne-Stokes respirations) - D (bradycardia) - G (elevated systolic BP) Hydrocephalus: - C (high pitched cry) - E (increased head circumference) - F (bulging fontanel) - H (VP shunt placement or revision)

discharge teaching related to baby's oxygenation with TOF. what statement made by the parents would require additional education A. monitor for wet diapers (not peeing causes fluid retention) B. crying and feeding causes TET spells C. educate on vaccinations D. wrong answer

D

What nursing actions are appropriate for a child with increased intracranial pressure (ICP)? A. Increase the head of the bed at least 45 degrees B. Avoid giving a stool softener C. Suction every 2 hours D. Maintain a quiet environment

D A- HOB should be elevated 15-30 degrees B- stool softener should be given if needed. Straining for BM increases ICP C- suctioning is too much stimulation and can increase ICP

A nurse is assessing a 4 month old infant who has meningitis. Which of the following manifestations should the nurse expect? A. Depressed anterior fontanel B. Constipation C. Presence of rooting reflex D. High pitched cry

D A- bulging fontanel is expected B- vomiting expected, not constipated C- rooting reflex normal till 12 months

causes of altered mental status- MITTEN

M- Metabolic (hypo/hyperglycemia, DKA) I- Infections (meningitis, brain abscess) T- Toxins (FAS, ingestion of drugs) T- Trauma (traumatic head injury) E- Endocrine issues (thyroid) N- Neurological/neoplasms (tumor, seizures)

postmenopausal women should not be on what

Prilosec (PPIs)

what are the four defects in TOF

VSD (blood mixing from shunting) pulmonary stenosis (narrowed pulmonary valve) overriding aorta (aorta overlaps to R ventricle) right ventricular hypertrophy (increased workload of R vent from VSD)

what groups of drugs is given before chemo, radiation, or after surgery

Zofran (serotonin antagonists)

normal urine output for infants and young children

1.5-2 mL/kg/hr

Patient is stable, moderate dehydration, cannot drink, hypertonic dehydration

10 mL/kg over 5 to 20 mins

patient is stable, mild dehydration, but cannot drink and having hypertonic dehydration

10 mL/kg over 5 to 20 mins

Patient is stable, moderate dehydration, can drink

100 mL/kg over 4 to 6 hours

what is the normal bicarb level for newborn and infant

16-24

What is the total daily maintenance fluids for a child weighing 57 pounds?

1618 mL

The nurse is caring for a 1-year-old child who weighs 10 kg. The nurse would expect a minimum urine output of _______ mL over 12 hours. (Respond with a whole number only).

180 mL

formula for calculation of maintenance fluids

1st 10 kg # of kg x 100 mL next 10 kg # of kg x 50 mL leftover kg # of kg x 20 mL

prognosis of nephrotic syndrome

2/3 of children have relapse of MCNS in conjunction with viral or bacterial infection can cause complications such as infection, thromboembolism

Patient is unstable with no cardiac issues

20 mL/kg over 5 to 10 mins

Patient is stable, moderate dehydration, cannot drink, hypotonic or isotonic dehydration

20 mL/kg over 5 to 20 mins

patient is stable, mild dehydration, but cannot drink and having hypotonic or isotonic dehydration

20 mL/kg over 5 to 20 mins

what is the normal bicarb level for child and adult

21-28

The nurse is caring for a 7 pound newborn. The nurse would expect a minimum of _____ mL of urine over 8 hours. (Round kg to nearest 10th. Answer in mL is whole number only.)

38 mL

The nurse is caring for a 12-year-old who weighs 88 pounds The nurse would expect minimum of _______ mL of urine over 12 hours.

480 mL

Patient is unstable with cardiac issues

5 to 10 mL/kg over 10-20 mins

med administration for antacids

QID, drink 8 oz water after

education for antacids

constipation (aluminum and calcium) diarrhea (magnesium) antacids decrease absorption of many drugs (do not give within 1-2 hours of other drugs)

mechanism of action of mucosal protectants

creates a gel that coats ulcers and is a barrier between stomach acid

pathophysiology of nephrotic syndrome

glomerular membrane becomes permeable to large proteins, especially albumin albumin and proteins leak through reduces serum albumin and causes fluid to accumulate in interstitial space and abdominal cavity (edema and ascites) stimulates RAAS system

hallmark sign of nephrotic syndrome

greater than 2+ protein in urine

hypertonic dehydration

hypernatremic more water is lost than sodium fluid shifts from ICF to ECF to equalize neurologic dysfunction due to brain cells shrinking (fluid moves out of cells and they shrink)

what are differences between hypotonic and hypertonic dehydration?

hypotonic: - low sodium - water moves from ECF to ICF - electrolyte loss more than water loss hypertonic: - high sodium - water moves rom ICF to ECF - water loss more than electrolyte loss

pathophysiology of acute glomerulonephritis

inflammation of glomeruli & they become permeable to RBCs glomeruli become edematous increased interstitial fluid volume, causing edema and hypertension

signs of moderate dehydration in child

lethargic, sleepy, irritable dry mucus membranes dark and diminished urine increased HR BP normal cap refill over 2 seconds thirsty slightly sunken eyes decreased tears sunken fontanelle

signs of severe dehydration in child

lethargy, unresponsive or anxious non elastic skin turgor decreased or absent urine increased HR, decreased BP cool extremities cap refill 3-4 seconds increased thirst sunken eyes decreased or absent tears sunken fontanelle

education of Prilosec

long term use can cause bone loss rebound acid hypersecretion when stopping med C-diff

what is the telltale sign of dehydration in a child

low BP

list 7 assessment findings with dehydration

low BP decreased turgor sunken fontanelle (infants) decrease tears dry mouth prolonged cap refill tachypnea tachycardia

prototype for Prostaglandin E Analog

misoprostol (Cytotec)

characteristics of isotonic/isonatremic dehydration

most common equal amounts of sodium and water are lost sodium levels are still normal fluid lost from ECF decrease in blood volume

when are PPIs given

once a day, before first meal

therapeutic use of antacids

peptic ulcer disease GERD

symptoms of acute glomerulonephritis

periorbital edema (both eyes) facial edema in morning may spread throughout day to extremities, genitalia, abdomen mild to severe increase in BP

what to reassess after each fluid bolus

recheck HR and BP often recheck resp rate listen to lungs recheck cap refill and skin turgor skin color wet diaper? needing to void? tears? with crying? mouth moist? membranes dry?

hypotonic dehydration

sodium is diluted & low too much water intake more intake of water than what can be excreted fluid shifts from ECF to ICF to equalize osmolarity causes severe shock

signs and symptoms of nephrotic syndrome

weight gain facial edema (subsides during the day) abdominal ascites pleural effusion BP normal or slightly decreased urine output decreased and frothy anorexia, diarrhea, fatigue, lethargy

A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor for and report which of the following adverse reactions? A. constipation B. flatulence C. palpitations D. headache

A. Aluminum hydroxide can cause constipation

You are the nurse caring for a child who has been diagnosed with nephrotic syndrome. Which of the following findings should you expect to find (SATA) A. urine dipstick 2+ protein B. hyperlipidemia C. polyuria D. anorexia E. hypertension

A, B, D

Common presentations of acute glomerulonephritis include the following findings: (SATA) A. RBCs in urine B. foamy urine C. low BP D. periorbital edema E. history of recent strep infection F. hyperlipidemia

A, D, E B, C, F are symptoms of nephrotic syndrome

A nurse is teaching a client who has a new prescription for cimetidine to treat peptic ulcer disease. Which of the following statements by the client indicates an understanding of the teaching? (SATA) A. "I can take this medication with or without food" B. "I will take this medication in the morning" C. "I should expect my stools to turn black" D. "I will take this medication with an antacid" E. "I will take this medication when I need it for pain" F. "I will eat five small meals each day"

A, F B- the client should take in evening to reduce nocturnal acid production C- The client should report black stools (GI bleed) D- The client should take an antacid 30 min to 1 hr before the cimetidine E- taken on a regular basis to relieve pain, promote healing

An infant, with no medical history, is in the emergency room, for moderate dehydration (8%) and weighs 5.6 kg. The parents inform the nurse that the last wet diaper was 6 hours ago and that the child had been vomiting for the past 24 hours but has had no emesis for the past 3 hours. Caregiver states that the infant is refusing to drink anything. The nurse notes that the infant's heart rate is 154 beats per minute, respiratory rate is 56 breaths per minute, blood pressure is 92/65, capillary refill is 3 seconds, skin is cool and dry, skin turgor is decreased, fontanel is slightly sunken, mucous membranes are dry, and the infant is quiet and does seem to engage in the environment with parents. What would the nurse expect for the initial intervention for this child? A. Administer 112 mL NS IV over 5 to 20 mins B. Administer 112 mL NS with 20meq of K+ IV over 5 to 10 mins C. give 280 mL of oral replacement fluids over 4-6 hours D. start IV fluids D5 NS at 23 mL/hour

A. Administer 112 mL NS IV over 5 to 20 minutes patient is moderately dehydrated, refuses to drink anything, and having isotonic dehydration

An 11-month-old infant has been admitted to the emergency room with a 4 day history of diarrhea and severe dehydration (10%). The child weighs 8.8 kg. The parents inform the nurse that the last wet diaper was more than 24 hours ago and that the child has refused all foods but had about 2 ounces of tap water 5 hours ago. The nurse notes on the child's assessment that the heart rate is 182 beats per minute, respiratory rate is 56 breaths per minute, blood pressure is 62/40, capillary refill is greater than 4 seconds, skin is cool and clammy, skin turgor is poor, fontanel is sunken, and the child is difficult to arouse or keep awake. What would the nurse expect for the initial intervention for this child? A. administer 176 mL NS over 5-10 mins B. Administer 176 mL NS over 30 mins C. Start IV fluids of D5 NS at 36 mL/hr D. Administer 880 mL oral fluids over 4-6 hours

A. Administer 176 mL NS over 5-10 mins Patient has severe dehydration, unstable, but no cardiac issues

A 21-month-old child who weighs 11.7 kg has been admitted to the emergency room with moderate dehydration. Caregiver states she has vomited twice today, the last time being about 6 hours ago. The last wet diaper was about 4 hours ago and the child last had something to drink about 4 hours ago. The nurse notes on the child's assessment that the heart rate is 142 beats per minute, respiratory rate is 38 breaths per minute, Blood pressure is 102/76, capillary refill is less than 3 seconds, skin is cool and dry, skin turgor is decreased. The child is irritable, crying, making some tears and is easily consoled. What would the nurse expect for the initial intervention for this child? A. give 1170 mL of oral replacement fluids over 4-6 hours B. Administer 234 mL NS over 5-20 mins C. Start IV fluids D5 NS at 45 mL/hr D. give 585 mL over the next 4-6 hours

A. Give 1170 mL of oral replacement fluids over 4-6 hours child has moderate dehydration, but awake and able to drink

A 13-year-old child has been admitted to the emergency room after collapsing during football practice with moderate dehydration (8%). The child weighs 30 kg. The coach informs the nurse that they had been practicing all afternoon and that the only water available was inside the school which had been locked up for the past 4 hours. The nurse notes on the child's assessment that the heart rate is 132 beats per minute, respiratory rate is 26 breaths per minute, blood pressure is 112/78, capillary refill is 3 seconds, skin is dry, and mucous membranes are dry. The child is able to follow commands but is lethargic and slow to respond. What would the nurse expect for the initial intervention for this child? A. Start IV fluids D5 NS at 71 mL/hr B. Administer 600 mL NS IV over 5 to 20 minutes C. Give 1500 mL oral replacement fluids over 4-6 hours D. Administer 600 mL NS IV over 5 to 10 minutes.

B. Administer 600 mL NS IV over 5 to 20 minutes px has moderate dehydration, cannot drink, isotonic dehydration

A nurse is teaching a client who has a duodenal ulcer about his new prescription for cimetidine. The nurse should include which of the following instructions in the teaching? A. "Take the medication with an antacid to minimize stomach upset" B. "Your doctor might need to reduce your theophylline dose while taking this medication" C. "Take the medication on an empty stomach for better absorption" D. "You should plan to take this medication for at least 6 months"

B (can increase medication levels)

You are the nurse caring for a school-age child who has acute glomerulonephritis. Which of the following findings should you report to the provider? A. BUN 8 mg/dl B. serum creatinine 1.3 mg/dl C. BP 100/74 mmHg D. urine output 550 mL in 24 hours

B (should not be higher than 0.7)

common presentations of nephrotic syndrome include the following findings: (SATA) A. hypertension B. 2+ protein in urine C. decreased serum lipids D. decreased serum protein E. increased risk for PE or DVT

B, D, E

18 kg child with vomiting diarrhea. cannot drink. how much IV bolus and how fast? A. 180 mL over 5 mins B. 180 mL over 20 mins C. 360 mL over 20 mins

C px stable, so 20 mins

A nurse is teaching a client who has a new prescription for esomeprazole to manage his GERD. Which of the following statements by the client indicates an understanding of the teaching? A. "I won't pass gas as often now that I am taking this medication" B. "I will take this medication each morning with my breakfast" C. "I have an increased risk of getting pneumonia while taking this medication" D. "I will need to take a daily stool softener while taking this medication"

C

The nurse has given her patient the prescribed IVF bolus. What is the priority nursing action now? A. Obtain the prescribed blood work B. Document the current vital signs C. Assess the patient and recheck vital signs D. Ask the patient if they feel better

C

A nurse is providing teaching to a client who has GERD and a new prescription for omeprazole. Which of the following instructions should the nurse provide? A. take NSAIDS if headaches occur B. Decrease intake of vitamin D C. Expect muscle cramps for several weeks D. Report diarrhea to provider

D (omeprazole is associated with C. diff)

what usually causes UTIs

E Coli viruses and fungi uncommon causes

where is fluid lost first when children are ill

ECF

what causes hypertonic dehydration

High protein NG feeds fluids with large amounts of solute seizures due to CNS changes insensible water loss

how quickly to give IVF to unstable patient with positive RAPID

IV bolus over 5 to 10 mins of 0.9% NS

how quickly to give IVF to stable patient with negative RAPID

IV bolus over 5 to 20 mins of 0.9% NS

pneumonic for nephrotic syndrome

NAPHROTIC N- Na decrease (hyponatremia) A- albumin decrease (hypoalbuminemia) P- proteinuria (>3.5 g/day) H- hyperlipidemia R- renal vein thrombosis O- orbital edema T- thromboembolism I- infection C- coagulability

interventions for child with diarrhea

ORAL rehydration-- 5-10 mL every 1-5 mins no high carb drinks, no caffeine, no fruit juice, no chicken soup, no BRAT diet

signs of mild dehydration in child

alert moist mucus membranes normal urine cap refill under 2 seconds no thirst normal eyes flat fontanelle

mechanism of action of antacids

alkaline substance that neutralizes gastric acid

examples of antacids

aluminum hydroxide (Amphojel) magnesium hydroxide (MOM) calcium carbonate (Tums) Magaldrate (mag and aluminum)

what determines if your px will take oral or IV fluids

child's LOC and ability to keep fluids down RAPID assessment positive or negative

what is the prototype for histamine H2 antagonists

cimetidine (Tagamet)

care management of UTI

collection of sterile or clean specimen for diagnosis midstream clean catch of urine avoid collection of specimen in urine collection bags in diapers