Pediatrics Class Review

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

apgar score ranges when is the apgar score conducted

0 to 3 represent severe distress 4 to 6 signify moderate difficulty, 7 to 10 all good 1 minute after birth and 5 minutes after birth

Human interaction floor with gym mirror rattles crib mobile feet and wrist shaker

0-6 months infant

___ out of every 4 children will be affected in hemophilia

1 out of 4

train soft gym stand and build set stuffed animals picture books

1 year old young toddler

anything over ___ mcg is considered lead poisoning treatment for lead poisoning is called ____ therapy

10 mcg = lead poisoning treatment = chelation therapy

at __ months, the child develops object permanence

10 months

toilet the child every

10-15 minutes after meal

1g of wet diaper weight =

1mL or urine take overall weight of diaper and subtract the dry diaper weight to get urine output

patient will be npo ____ hours before the procedure

2

can't keep a child NPO for more than

2 hours

sandbox tea set dolls building boxes finger paints

2 years old old toddler

Meconium should regularly be passed within ___ hours

24

for a nephroblastoma - surgery will occur within __to__ hours - need to educate the patients

24-48 hours

you want to start vitamin D at _ months

3

how often is factor 8 given

3 times a week

cut out dolls dress-up tricycle building sets jump rope

3,4,5 preschool

can have breast milk up to __ hours until surgery can have formula __ hours until surgery

4 hours until surgery 6 hours until surgery

Breast Fed babies START iron supplementation at

4 months

EA and TEF occurs at __to__ week of development

4th to 5th week of development

DIY kits musical instrument science experiment interactive game game with peers

5-10 years school age

how many wet diapers per day indicates adequate hydration

6-8

xylophone and mallet teethers shape box peek-a-boo standing gym

7-12 months

An IQ below ____ is considered an intellectual disability

70

Hemophilia A is clotting factor Hemophilia B is clotting factor

A = 8 B = 9

when you empower you are

ADDING to what they know

Which has a better prognosis ALL or AML

ALL has better chance of recovery - younger the kid the better the chance of survival - if the count is LESS THAN 50k it is favorable

diagnostic factor for AGN is

ASO titer - antisteptolysin O worried about strep infection previous

at the time of the diagnosis what should the nurse do

ASSESS, what they know - childs feelings - all of that stuff & EMPOWER - build on what they know

What does the Apgar scoring system assess? Select all that apply. a. Respiratory effort b. Heart rate c. Core temperature d. Reflex irritability e. Muscle tone f. Color

All answers BUT C

leukemia patient at risk for

Anemia // bleeding - not RBCs or WBCs

Aplastic Anemia is when: Hemolytic Anemia is when

Aplastic - not enough RBC production Hemolytic - destruction of RBCs

Pain at McBurney point =

Appendicitis

So BEFORE the crisis starts - DURING crisis -

BEFORE - hydration DURING - pain meds

with acute Glomerulonephritis you will see

BLOOD IN THE URINE

B R A T diet what is it used for

Banana Rice Apple Sauce Toast what to eat after a stomach bug or bad diarrhea to get stomach back to normal

Any time you send an infant to the cardiac cath lab, you need to establish a ______

Baseline! Take vital signs

Diagnosis of leukemia is injection given at

Bone marrow aspiration - shows infiltration of blast cells posterior iliac crest

etiology of preterm birth

Box 8-3 Etiology of Preterm Birth Maternal Factors Socioeconomic • Malnutrition • Age • Race Chronic medical conditions • Heart disease • Renal disease • Diabetes • Hypertension Behavioral • Substance abuse • Smoking • Poor or absent prenatal care Factors Related to Pregnancy Multiple pregnancy Low body mass index (<19.8 kg/m2) (Fanaroff, 2011) Abruptio placentae or placenta previa Incompetent cervix Maternal hypertension Premature rupture of membranes or chorioamnionitis Polyhydramnios or oligohydramnios Infection Trauma Fetal Factors Chromosomal abnormalities Congenital anomalies Nonimmune hydrops Erythroblastosis Unknown Factors

treatment for Leukemia

CHEMO Bonemarrow transplant

tetralogy of fallot is cyanotic or acyanotic??

CYANOTIC

the 3 C's of EA or TEF are

Coughing, Choking, Cyanosis

Treatment of DKA - 1st: 2nd:

DKA 1st: INSULIN 2nd: rehydration through IV

patient in DKA you want to place them on a _______ ________ because their _____ levels may be increased

DKA - cardiac monitor because of elevated potassium levels

what agent is used as a local anesthetic before giving an injection

EMLA

because of not eating, you may see ____ __ ______ in compromised heart babies

Failure to Thrive

people with Sickle Cell Disease will need to take

Folic acid FOR LIFE

Ribbonlike // Foul smelling stools =

Hirschsprung Disease

child doesnt have meconium until 3-4 days after birth: the nurse suspects

Hirschsprung Disease

Differences between hyperglycemia and hypoglycemia Hyper = Hypo=

Hyperglycemia - peeing, thirsty, Hypoglycemia - Confused, Sweaty, Headache, Dizzy, Shaky

what is a screening tool for CF

IRT

for severe dehydration youre going to place the patent on an

IV

if kid is losing consciousness - to get their sugar up you would do it

IV

Associative play:

In associative play, children play together and are engaged in a similar or even identical activity, but there is no organization, division of labor, leadership assignment, or mutual goal.

Erikson's stages Infancy: Toddler: Preschool" School Age:

Infancy - trust vs mistrust toddler - autonomy vs shame Preschool - initiative vs guilt School age - industry vs inferiority

for infants with formula, the nurse will stress the importance of using:

Iron-fortified formula

you will see ____ respirations with DKA

Kussmaul

LEFT to RIGHT shunt = RIGHT to LEFT shunt =

LEFT to RIGHT shunt = OXYGEN - pink RIGHT to LEFT shunt = NO OXYGEN - Cyanotic

medication on synthroid for hypothyroidism is

LIFELONG

Cleft Lip is repaired within

LIP - 2-3 months PALATE - 6-12 months

Which happens first in gestation? Cleft Lip or Palate

Lip - 6 weeks Palate - 7-12 weeks

children 2-3 have greater metabolizing capacity for certain drugs so often need _______ frequent administration of pain meds

MORE frequent

always ____ pulse site so future nurses can assess easier

Mark them with marker

Hirschsprung Disease is a

Mechanical Obstruction from inadequate motility of the intestine due to absence of ganglion cells in the colon

what test do you do to check for brachial palsy

Morro Reflex

what is the antidote for acetaminophen overdose

Mucomyst (acetylcysteine)

post-op for cleft surgeries - Never place the child in ____ position

Never in PRONE position

Pathological Jaundice vs Physiologic Jaundice - when do they happen

PATHOLOGICAL is immediate - physiologic is 2nd to 4th day

Nephrotic Syndrome

PROTEINUREA - low albumin -high lipid -edema -

First intervention for a sickle cell crisis is ALWAYS

Pain management- treat pain FIRST

examples of emancipated minors

Pregnancy, high school graduation, independent living, military service

Nursing interventions for terminally ill Preschool: school age:

Preschool: Clarify misconceptions of illness/death as punishment Child life specialist Use simple language and repeat often Encourage parents to stay and participate in care School age: Give clear and concrete information Allow as many changes as possible. Encourage contact with peers Encourage parents to be present and involved.

RICE !! to prevent bleeding episodes and after injury

REST ICE COMPRESSION ELEVATION

what kind of goals do we want to set in a chronically ill patient

Realistic goals - lets go for a playdate tomorrow - lets be able to add 10+10 by the end of the week

how should you deliver meds in the pediatric patient

SYRINGE to deliver meds - side of mouth - little by little - watch swallow

Sickle Dex is used for Hgb electrophoresis is

Sickle Dex: screening purposes Electrophoresis is the gold standard for sickle cell diagnosis

if patient in DKA is unconscious two things you wanna do is

Suction to prevent aspiration insert foley to see urine measure

the biggest thing to rememberwith a neuroblastoma is that it CROSSES

THE MIDLINE

All children are infected with rotavirus (diarrhea) at least once by 5: true or false Acute diarrhea is the leading cause of illness in children younger than 5 years of age true or false

TRUE TRUE

Restraints are needed for Cleft surgical repairs true or false

TRUE - elbow restraints

infants operate by building

TRUST

School age always wants to know ___

WHY - "I'm giving this to help you breathe better"

Hemophilia is ____ this means that mostly ____ are effected

X-linked recessive - mostly boys are effected

a big intervention the nurse can do for a child with autism is bring the child

a toy from home

what do you do to assess for EA and TEF

abdominal X ray

what do we want to check on a child with encopresis

abdominal X ray to check for impaction of feces - we wanna know how severe it is - if nothing pathological we assess psych

what do we measure pre-op for patient with EA / TEF always have HOB

abdominal girth HOB always elevated

facial paralysis how long does it last? what cranial nerve?

about 15 minutes - short term cranial nerve 7

The child usually goes to bed asymptomatic to awaken later, complaining of sore throat and pain on swallowing. The child has a fever; appears sicker than clinical findings suggest; and insists on sitting upright and leaning forward (tripod position) with the chin thrust out, mouth open, and tongue protruding. Drooling of saliva is common because of the difficulty or pain on swallowing and excessive secretions.

acute epiglottis

neuroblastoma is located on the

adrenal glands above the kidney

A child is NEVER npo without

an IV // some source of fluid intake

non responsive to contact, voice, or movement - we think

autism

as a child ages and realizes they are different than most kids, they may _____

begin to be more bothered and have a more negative self image

temperature <5 >5

below five - axillary above five - oral temp

After the patient has a stroke, what do they usually get

blood infusion - this prevents the blood from becoming viscous

Who is at risk for iron deficiency

breastfed infant

if you suspect a poisoning of your child the first thing you always do is

call poison control before ANY interventions - always the first thing is to call

in a neuroblastoma you will see ___ in the urine

catecholamines

for cephalhematoma and caput succedaneum interventions subgleal hemorrhage interventions:

cephalhematoma and caput succedaneum no interventions! swelling will subside on its own Subgleal - early detection is vital - head measurements and inspection of back nd neck for edema - CT scan or MRI- monitor loc

Clubbing of the fingers is a LONG TERM sign of

congenital heart issues

long term controller of asthma

corticosteroids

hoarse, barking, brassy cough = home remedy =

croup cold air

never assess heart or lung sounds when a child is

crying - wait for them to calm down then assess

an exclusive sign found only in children indicative of dehydration is

crying without tears

precocious puberty is before what age in boys: girls:

develop before 9 in boys 8 in girls

in CF - pancreas is affected so you expect lungs are effected so you expect- most CF men are

diabetes (REGULAR EYE EXAMS), trouble digesting fat and pancreatic enzyme - fatty and foul smelling stools lung failure - possible transplant - recurrent infections men are sterile

classic manifestations of asthma

dyspnea, wheezing, coughing

child pulling on their ears - the nurse assumes

ear infection

blood brain barrier is immature so the patient who takes many meds is at risk for _____________

encephalopathy

for jaundiced baby- you want them to eat every __ to __ hours - so you need to wake them up what is the main form of treatment

feed every 3-4 hours phototherapy is the main treatment

otitis media with effusion means

fluid in the middle ear

as soon as patient wakes up, you want to promote

fluids

Tofranil, Desmopressin, oxybutynin

given for encopresis

Leuprolide Acetate - Lupron

given for precocious puberty

if an infant is NOT afraid of strangers and is not smiling what are we thinking

growth failure

to prevent a vasoocclusive crisis- you want to encourage

hydration

Risks for infant after cardiac cath lab always assess which pulses

hypothermia, hypotension, allergies, pedal pulses are always checked because they will use femoral artery to scope the heart and you want to ensure blood is making its way down the leg

if mom is rH _____ and baby is rH _____ the first pregnancy will be ____ but everyone after will be _____ what drug do you give after the first delivery OR abortion

if mom is rH NEGATIVE and baby is rH POSITIVE - first baby fine but every baby after is screwed give RhoGAM

never have a traumatic procedure where?

in the child's room or play room - you want them to view their room as a safe place

AGE Ranges: Infant toddler preschool school age adolescent

infant 0-1 toddler 1-3 preschool 3-5 school age 6-12 adolescent 13-18

never feed a baby flat because of the risk for

infection - fluid can go into ear

initial progressive severe signs of RSV:

initial - runny nose, coughing, wheezing, intermittent fever progressive - increased coughing // wheezing, retractions, CYANOSIS severe - >70 breaths / minute - apneic spells, poor breath sounds

what is a common complication with a blood transfusion if this level is high - they will need

iron overload - if iron level is high, they may need chelation therapy

Iron supplement should be taken THROUGH A STRAW because Iron administration should never be administered with

it can be harmful to the teeth never administer iron supplements with MILK

what will happen to the PTT time of a hemophiliac

it will get longer - they bleed for longer

hemophiliacs can see bleeding in the

joints

if strep isn't treated it can lead to strep needs an ____ and children have to be home for the first ____ because its still contagious

kidney failure ANTIBIOTIC for strep - children home 24 hours after first treatment change toothbrush - towels - pillowcase - retainer disinfected etc.

bottle fed babies with facial nerve paralysis may need a

large holed bottle

Values less than _% and greater than _% are considered abnormal on a growth chart

less than 5% and greater than 95%

Toddlers are egocentric - what intervention is good to use before using a stethoscope on them for example

let them play with the stethoscope

babies with phrenic nerve palsy may need to be placed on

mechanical ventilation

first sign of CF

meconium ileus

Wilms tumor or NEPHROBLASTOMA will be on ONE side of the

midline

first sign of cyanosis will be around

mouth and eyes

myringotomy is - tympanovstomy is -

myringotomy - surgical incision tympanovstomy - artificial tube

A 5-year-old child is brought into the clinic with lethargy, abdominal ascites, and peripheral and periorbital edema. The history indicates ongoing diarrhea and decreased urine output.

nephrotic syndrome

number 1 number 2 number 3 risk to cardiac cath

no.1 allergic reaction no.2 bleeding no.3 infection

a patient with phrenic nerve paralysis would have ____ chest movements

paradoxic

for young children, the greatest source of support is their

parents

if child comes in with bedwetting, what will be suggested?

physical examination to rule out physical causes

EA and TEF are likely seen when the mother has

polyhydraminos

posterior fontanel closes around anterior fontanel closes around

posterior - 8 weeks anterior - 18 months

primary enuresis/encopresis secondary enuresis/encopresis

primary = they've never been potty trained before secondary - they are potty trained and now experiencing this

projectile vomiting =

pyloric stenosis

tachycardia can indicate

respiratory issues

acute otitis media follows a is purulent discharge normal

respiratory tract infection yes

in nephrotic syndrome you will see:

retention of fluids - gain weight - puffy face - PROTEIN IN URINE

a temper tantrum in separation anxiety is ______ a temper tantrum in a chronic disease is _______

separation anxiety - tantrum normal chronic disease - tantrum NOT normal

no tears = ______ dehydration

severe

kids are more susceptible to ear infections because the lobes are

shorter & thicker

babies with respiratory distress need to be placed on their

side

Separation Anxiety: Stage 1 is: is stage 1 normal Stage 2 is:

stage 1: protest - cry, bite, kick, hit, cling to parents and avoid strangers - its NORMAL stage 2: despair - inactive, withdrawn, no interest, could regress into things like not being potty trained

patient will be given __ for nephrotic syndrome

steroids - risk of infection w steroids

first line of treatment in nephrotic syndrome what risk

steroids - risk for infection

acute glomerulonephritis can stem from

strep

the most dangerous type of hemorrhage is a ______ what does it cross could lead to

subgaleal hemorrhage crosses suture line increased ICP

Hemoglobin A1C monitors:

sugar levels over 3 months

give preterm infants with immature lungs ___

surfactant

most treatment for Hirschsprung disease is

surgical

Congenital hypothyroidism - you will check the newborn for what labs

t4 levels, TSH levels

what is the earliest sign of dehydration

tachycardia

The first thing you will see in a child with heart failure is

tachycardia !! they also aren't eating - eating is like exercise for little infants and it takes a lot of energy so if heart isn't functioning they will be fatigued and won't eat

never use the word ____ with preschoolers Give them ____ !! in terms of pain - they can show you

take "I'm gonna take" preschoolers need choices what face they're feeling

if a child is saying their belly or chest hurts bad, you want to educate the parents to

take them to the ER immediately

what vital sign is most important for a child with chemo

temp!! infection teach infection -

by toddler age - we are hoping to be able to have our kid be okay with toddlers are egocentric and need to feel independent - toddlers can pick finger foods and do things to feed themselves

temporary separation

Assent means that

the child or adolescent has been informed ALL about the procedure and is willing to permit a HCP to perform it

always allow parents to stay with child until

the surgery begins

children 0-3 have __

their mothers immunity !! makes them more protected from infection

what will happen to the levels of factor 8 and 9 in the bloodstream with hemophiliacs

they will decrease -

when young kids refuse to take medication - why are they doing this ? what should they nurse do

to gain controls - they want a say give them options - this sticker or that sticker - grape or cherry?

Age related concepts of death

toddlers - dont understand death preschoolers - death is reversible school age - death is a punishment for being bad by 9-10 the child understands the real meaning of death

Vitamin C facilitates absorption of iron true or false

true !!!

what CONFIRMS CF

two consecutive positive sweat tests

child with chemo is at risk for

ulcers - no acidic things - soft tooth SOFT DIET look out for extervasion -buildup of the drug outside of the vein

when you UNDRESS you want to do the ____ side first when you DRESS you want to do ___side first

undress = unaffected first dress = affected first

exclusively breastfed infants are at risk for what should you try to do to help

vitamin D deficiency give vitamin fortified cereals

When you enable you are assessing

what they ALREADY KNOW

high pitched or musical, prolonged, slowly progressive or sudden, association with labored breathing.

wheeze

leukemia is cancer of the first sign is

white blood cells - lack of immunity first sign is BONE pain


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