peds exam 1
The nurse meets to discuss the denial of the child's diagnosis. During the conversation, the mother finally breaks down crying and tells the nurse, "I just can't believe what I have been thinking. My child is going to die, and it is all my husband's fault! I should never have married him. No one in my family has ever had this disease. My husband is adopted and his parents do not know anything about his biological background. His biological parents must have had this nasty disease and now he has passed it on to my baby. I am such a terrible wife and mother for having these thoughts, but I just can't bear to watch my precious baby suffer." What response reflects that the nurse values the principle of beneficence?
"I know this has to be a very scary and difficult time for you. What can I do to help you?"
Which statement by the parents indicates a correct understanding of a proper nutritional protocol of a client with CF? (Select all that apply. One, some, or all options may be correct.)
-Her diet should include more calories than an unaffected child. -Client should take vitamin A, D, E, and K supplementation along with her diet. -Her diet should consist of high fat, high protein, and unrestricted fats.
acute spasmodic laryngitis
-self-limiting illness that can result from allergens -characterized by paroxysmal attacks of laryngeal obstruction that occur mainly at night
What actions should the nurse educator take to address this? (Select all that apply. One, some, or all options may be correct.)
1. Aerosolized medications should be adminstered before CPT. 2. Instruct the parents to perform chest physiotherapy (CPT) either 2 hours before meals or 2 hours after meals. 3. Encourage "blowing" activities, such as bubbles or pinwheels.
infant normal rr rate
30-60
newborn normal rr rate
30-60 bpm
flutter valve
A one-way valve that allows air to leave the chest cavity but not return; formed by taping three sides of an occlusive dressing to the chest wall, leaving the fourth side open as a valve.
Peds Assessment Triangle
Apperance 1. Awake? 2. Aware? 3. Upright? Work of Breathing 1. Retractions? 2. Noises? Circulation 1. Skin = flushed?
The CNS refers the parents to the local chapter of the Cystic Fibrosis Foundation (CFF). Which rationale best supports this referral?
Community resources often provide support groups for parents of children with CF.
Which instruction should the nurse educator give the client's parents concerning the use of pancreatic enzymes as an oral prescription? (Select all that apply. One, some, or all options may be correct.)
Ensure that enzymes are administered within 30 minutes of consuming meals and snacks
pharyngitis assessment
Fever **Sore throat **Redness or swelling of pharynx and tonsils White/yellow exudate (pus) Enlarged cervical lymph nodes Fine rash over torso Headache Abdominal pain
nasopharyngitis assessment
Fever Sneezing, runny or stuffy nose Aches/discomfort Poor PO intake Post-nasal drip may cause sore/red throat, cough, vomiting, or diarrhea
Anticholinergics
Ipratropium bromide (atrovent) MDI or nebulizer Reduce bronchospasm SE: drying secretions, tachycardia
What information will the nurse include when teaching about the sweat test?
It is a simple and reliable test that measures the chloride in sweat.
The parents have been at the client's bedside since she was admitted to the hospital. The father asks to speak to the nurse outside in the hall. He tells the nurse that the mother is telling everyone that the client is going to be fine and that there has just been a mistake and everything will be all right. What action should the nurse take first?
Make arrangements to meet privately at the first opportunity.
Leukotrienes
Montelukast, zileuton Oral (capsule, chew tab, powder) Reduce chronic inflammation that leads to hyperreactivity
The nurses recognize that energy needs are increased as a result of malabsorption of nutrients and that extra effort is needed for respirations and frequent pulmonary infections. The nurse teaches the client's parents about pancreatic replacement enzymes. Which of the following statements by the parents would indicate a correct understanding of the teaching?
Pancreatic enzymes are needed to digest fats and proteins.
pancreatic issues with CF
Pancreatic obstruction from mucus eventually causes pancreatic fibrosis Decreased enzymes released to break down fats, proteins and nutrients Malnutrition, with potential effects on growth Fatty, frothy, foul smelling stools
Which action indicates to the nurse educator that the parents need more instruction about the respiratory care of the child with CF complications?
Placing the client in a prone position when she is having a dyspneic episode.
what are the causes of rr infections
Shorter straighter airway structures Narrower diameter of airway structures Immune system not fully developed Exploring the world with hands and mouth
The nurse is a preceptor for a student nurse from the local community college. The student nurse asks the preceptor, "I keep hearing about standards of care. What are standards of care?" Which is the best explanation for the nurse to provide to the student?
Standards of care are published statements that describe the level of care that the client can expect from nurses.
Which statement should the nurse record as the expected outcome for this nursing problem?
The client will be able to remove mucus from the airway by coughing.
While discussing pancreatic enzymes, the CNS explains that the dosage of the pancreatic enzyme is adjusted according to stool formation, which indicates how well client is digesting her food. Which adjustment would the nurse anticipate will be required, if client has constipation?
The pancreatic enzymes would be increased with each meal and snack.
Broselow tape
a measuring tape for infants that provides important information regarding airway equipment and medication doses based on your patient's length.
status asthmaticus
a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure.
management for strep throat
amoxicillin for 10 days
most common pharyngitis bacterial
strep throat
Diagnosis of CF
sweat test of 105 mmol/L (normal is 60) also will have elevated LFTs
nursing consideration for strep throat
teach parents to look out for penicillin allergy - raises wheel like rash and itchy
flexhaler
turns dry powder into inhalant budesonide age dependent - >6
MDI - metered dose inhaler
turns med into gas ALWAYS USE WITH SPACER
nasopharyngitis management
viral illness - no antibiotics reduce transmission
If the client attends a daycare center, what should be shared with the daycare workers? (Select all that apply. One, some, or all options may be correct.)
-Proper handwashing between care of the other children -Isolate the child from any children with upper respiratory infections -Correct techniques for performing chest physiotherapy.
The nurse shares with the student nurse that the Society of Pediatric Nurses' Standards of Care includes primary, secondary, and tertiary nursing care prevention. The student nurse asks, "What type of care is given in secondary nursing care prevention?" Which statement by the nurse is correct?
"It is care such as the sweat test and DNA testing that the child received." - intervention
Acetaminophen
10-15mg/kg every 4-6 hours
toddler normal rr rate
20-40
hypotension
< 70+2(age) 70 + 2(6) = 82
cystic fibrosis
A genetic disorder that occurs in people with two copies of a certain recessive allele; characterized by an excessive secretion of mucus and consequent vulnerability to infection; fatal if untreated.
where do you check pulse in children under 2? -
apical for 1 full minute
bronchiolitis
inflammation of the bronchioles
what is the max mL per injection site for infants
o.5mL
where do you check temperature in children older than 5?
oral or axillary
where do you check BP on infants
posterior tibial
child life specialists
professionals who are focused on the coping needs of pediatric patients and their families
intestinal issues with CF
prolapsed rectum
where do you check pulse on kids older than 2?
radial
pulmonary issues with CF
recurrent resp infections esp pseudomonas productive cough/dyspnea CP/wheeze chronic sinusitis infertility 95%
The mother shares with the nurse that she is thinking about separating from her husband for a little while. She states that because her child has been diagnosed with CF, she thinks she may want out of the marriage. Shortly after this conversation, the nurse walks down the hall and the father asks to speak to her in private. He tells the nurse, "I saw you speaking with my wife earlier. I think she is going to leave me, and I am so scared." Based on her previous conversation with the mother, what is the best statement by the nurse?
will sit with your child so you and your wife can talk. We have a quiet room you can use that is private and close by.
school age child normal rr rate
18-25
what is the max mL per injection site for children
1mL
croup syndrome
barking cough stridor swelling in upper airway (larynx and trachea)
where do you check BP for toddlers and kids
brachial
larynx
croup syndromes
asthma
- the most common chronic disease of childhood A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing.
Acute laryngotracheobronchitis
- viral - Caused by RSV, influenza A&B, M. pneumoniae - Sx: Low-grade fever, restlessness, hoarseness, barky cough, inspiratory stridor, retractions
3 main strategies with atraumatic care
1. prevent or minimize the child's separation from the family 2. promote a sense of control 3. prevent or minimize bodily injury and pain
adolescent normal rr rate
12-20
Acute Epiglottitis
Bacterial Croup syndrome Medical emergency! Age 2-5 y/o S/S: Drooling, absence of cough, agitation, retractions Tx: NOTHING in mouth!!! Not even throat culture! Intubation, racemic epi, antibiotics
atraumatic care
Care that minimizes psychologic and physical distress experienced by children and their families in the health care system
Which assessment supports the diagnosis of CF?
Weight loss and delayed growth despite a hearty appetite.
Huff cough
breathe out and cough through small valve in airway
obligatory breathers
breathing through the nose strictly
lower
bronchitis bronchiolitis pneumonia
what food do you avoid with strep throat
citris
what med is given for tonsilitis
dexamethasone for airway edema
alveolar expansion
incentive spirometry
preschooler normal rr rate
20-30
where do you check temperature in children under 5?
axillary
Which documentation further supports the diagnosis of CF? (Select all that apply. One, some, or all options may be correct.)
bulky loose stools hx of frequent rr infectons
upper
nasopharyngitis pharyngitis tonsilitis otitis media
ibuprofen
should not be given to children >6 5-10mg/kg every 6 hours for pain or fever
