PEDS Exam 3
characteristics of diaphragmatic hernia
- lung sounds absent on affected side - heart sounds at right side of chest - bowel sounds in lung fields
nursing interventions for enterocolitis
- measure abdomen girth every 1-2 hours - leave diaper off to decrease pressure
5 p's of tissue ischemia to prevent compartment syndrome
- pain - pulses - pallor - paresthesia - paralysis
what foods can kids with celiac disease HAVE:
- potatoes - rice/buckwheat - soy - quinoa - popcorn/corn chips - fruits and veggies
nursing interventions for esophageal atresia
- prevent aspiration - maintain patent airway - NPO - prevent pneumonia
treatment for clubfoot (4)
- stretching of the foot - application of a long leg cast to hold the foot in place (4-8 weeks) - final cast for 3 weeks - brace for 2-4 years
parent teaching for child with constipation
- structured bowel training - increase fluids - increase fiber
toddlers with constipation should have what diet
- whole wheat - fruit, veggies - increased fluids
Pavlik harness
- worn full time 3-4 months - may continue at night for 4-6 weeks if positive
Assessment for type 2
Blood pressure, lipid levels
Apparent at birth
Cleft lip
Seen on ultrasound at 13-14 weeks
Cleft lip
Affects speech development
Cleft palate
May not be apparent at birth
Cleft palate
Open posterior fontanelle, thick tongue, dull expression, hypotonia/activity, poor sucking
Congenital hypothyroidism
Doesn't limit physical development and is not painful for young children
DDH
Risk for ________ with central diabetes insipidus
Dehydration
Complications of Cleft lip and palate
Dehydration, skin breakdown
prevention of mumps
MMR vaccine
Painless rectal bleeding at age 1-2
Meckel diverticulum
Medication for type 2
Metformin
vesicle size of nonbullous impetigo
2 cm
nonbullous impetigo
2-5 years
When is cleft lip repaired
2-6 months
after traction, the bed shouldn't be elevated more than
20 degrees
severe dehydration treatment
20 mL/kg bolus of NS over 30-60 minutes
The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder?
"When they get my son's thyroid levels normal, he won't be so tired."
Complication to monitor for with esophageal atresia
Aspiration
assess for cardiac distress and defects with omphalocele & gastroschisis
- auscultate heart sounds - listen for murmurs - rate & rhythm - BP in all four extremities - compare peripheral pulses - monitor for cyanosis
prodromal phase of measles
- clear conjunctival drainage - cough - koplik spots - maculopapular rash beginning at the head
nursing interventions for biliary atresia
- cover hands with mittens - monitor liver enzymes - monitor for bleeding - tepid baths - central line care
nursing management for intussusception
- decompress stomach - IV fluids - pain control - monitor for peritonitis, shock
normal urine output for a child
1-2 mL/hr
normal urine output for an infant
1-3 mL/kg/hr
Pedialyte
1-3 teaspoons every 10-15 minutes
with biliary atresia, bilirubin levels are above
1.2
Rule of 10s used for cleft lip/palate surgery
10 weeks old, 10 lbs, hemoglobin of 10
topical mupirocin might be given for impetigo for what duration
10-14 days
normal sodium in infants
134-150
normal sodium in children
135-145
treatment for DDH should be completed before what age
4 years
mild to moderate dehydration treatment
50-100 mL/kg in 2-4 hours
You can give Ondansetron in children older than
6 months
After patient recieves PSARP surgery, they might need a temporary colostomy for
6-8 weeks
Precocious puberty in girls
8 years
What age are children when Meckel diverticulum becomes inflamed
8 years
normal glucose level
80-120
Precocious puberty in boys
9 years
When is cleft palate repaired
9-18 months
Inflamed Meckel diverticulum looks like
Acute appendicitis
If a child with varicella is immunocompromised, what medication do they get?
Acyclovir
Main sign of precocious puberty
Advanced bone age
Risk factors for omphalocele
Alcohol, smoking, SSRIs, obesity
Shiny velvet like patches that appear in type 2 dm due to insulin resistance
Ancathosis nigricans
Respiratory distress shortly after birth
Diaphragmatic hernia
Nursing intervention for an infant born with omphalocele
Dress with saline gauze and impermeable dressing
Cyanosis, coughing, choking
Esophageal atresia
arches neck when feeding cries excessively additional respiratory symptoms
GERD
bloody or bilious vomit indicates
GI bleed or obstruction
Diameter 2-3
Gastroschisis
Life threatening Bowel inflamed and edematous with delayed enteral nutrition
Gastroschisis
Umbilical cord to the left of abnormality Born preterm C-section recommended
Gastroschisis
Fasting blood glucose (DX of diabetes)
Greater than 126
2 hour plasma glucose (DX of diabetes)
Greater than 200
Random plasma glucose (DX of diabetes)
Greater than 200
Diabetes insipidus causes
Hypertonic dehydration
Screening required before discharge at birth
Hypothyroidism
Burns and severe nausea and vomiting cause
Hypotonic dehydration
If burns are over 30% of the body or more, the child is at risk for
Hypovolemia, shock
Cleft lip and cleft palate infants can have increased otitis media due to:
Ineffective Eustachian tubes, improper middle ear drainage
Vomiting and diarrhea causes what type of dehydration
Isotonic
treatment for biliary atresia
Kasai procedure, liver transplant
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?
Low T4 level and high TSH level
Acquired Unrelated to pituitary gland
Nephrogenic diabetes insipidus
Full term Diameter: 2-15 Umbilical cord attached to sac Normal bowels
Omphalocele
First intervention for dehydration
Oral rehydration
corrects anorectal malformations done at 6 months
PSARP
S/s of central diabetes insipidus
Polydipsia, nocturia, enuresis
First presenting symptom of rubella
Rash on the face, spreads to trunk
Diagnosis of esophageal atresia
Resistance when attempting to pass an NG tube
Small pinpoint papule with threadlike track
Scabies
Superficial partial thickness burns should get what medication for infection prevention
Silver iron
Use during pregnancy causes a 2x greater risk of cleft lip and cleft palate
Smoking
Meckel diverticulum causes a disruption in which electrolytes
Sodium, potassium, chloride
S/s of dehydration
Tachycardia, delayed capillary refill, decreased peripheral pulses
Respiratory distress
Tachypnea, grunting, use of accessory muscles, cyanosis
A child with varicella continues to be contagious until when
The lesions have crusted over
Hospitalized after diagnosis
Type 1
Must have insulin
Type 1
encopresis can cause an increase in
UTIs
VACTERL syndrome
V: vertebral abnormality A: imperforate anus C: cardiac abnormality TE: tracheoesophageal R: renal abnormality L: limb deformity
Risk for what type of complications with type 2
Vascular
S/s of type 1 diabetes
Weight loss, labile, polydipsia, polyphagia, polyuria, fatigue, blurred vision
history of constipation, straining, ribbon-like stools
anal stenosis
no meconium stool in 24 hours after birth indicates
anorectal malformation
no pain meds until the diagnosis is confirmed mcburney's point
appendicitis
pain in lower abdomen associated with vomiting
appendicitis, UTI
instructions for malathion for lice treatment
apply on dry hair and leave in overnight
how to apply permethrin 5% for scabies
apply to affected area and rinse off 8-12 hours later
instructions for permethrin use for lice
apply to wet hair and leave on for 10 mins
remove what from a child with constipation's diet
bananas, rice, cheese, white bread
knees out laterally palpable and audible click is heard DDH
barlow test
intially asymptomatic 2-3 weeks after birth: jaundice
biliary atresia
stools are clay-colored urine is dark tea colored
biliary atresia
will probably need a liver transplant later in life
biliary atresia
type of medication for osteogenesis imperfecta
biphosphonates (-dronate)
children with Osteogenesis imperfecta should avoid
contact sports
barrel-shaped chest sunken abdomen
diaphramatic hernia
side effect of antibiotics
diarrhea
history of chronic constipation after 4 years old
encopresis
excessive frothy, bubbling salivation and drooling
esophageal atresia
A 6-week-old infant has been diagnosed with congenital hypothyroidism. Once the level of medication has been determined, in order to maintain the proper dosing of thyroid hormone, the nurse instructs the parents to have the baby's levels tested how often during the first year?
every 1 to 3 months
diagnosis of hirschprung's disease
exam of tissue biopsy (absent ganglion cells)
True or false: put a heating pad on a child with suspected appendicitis to help relieve pain
false
The nurse is performing an assessment of a child with a spider bite and documents the findings in the chart note above. Which finding(s) prompts the nurse to anticipate treatment for cellulitis? Select all that apply. fever chills erythema cool skin around the infected area lymphadenopathy
fever chills erythema
initial treatment of constipation
goLYTELY
A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition?
graves disease
what can relieve itching in a cast
hair dryer on cool
best way to prevent Hepatitis A
handwashing
complication of vancomycin therapy
hearing issues
acute severe jaundice increased liver enzymes, PTT, and PPT
hepatitis B, C, D
absence of peristalsis/motility distended abdomen failure to pass meconium in 24 hours repeated vomiting
hirschsprung's disease
abrupt, severe, colicky episodic abdominal pain nausea, vomiting, diarrhea currant jelly stools
intussusception
prior respiratory adenovirus infection
intussusception
Shortly after delivery, a newborn is diagnosed with hypocalcemia. What manifestation will the nurse assess in this client?
jitteriness
contagious 4 days before and after the rash
measles (rubeola)
stool is brick-colored and looks like red currant jelly
meckel diverticulum
inconsolable cry, excessive irritability
meningitis, intussusception
complications of mumps
meningitis, orchitis
hypokalemia, hyponatremia, hypochloremia can lead to
metabolic alkalosis
pain med for appendicitis
morphine sulfate
knees to chest test detects DDH
ortolani test
blue sclera
osteogenesis imperfecta
increased WBCS, c-reactive protein, ESR
osteomyelitis
preschoolers (3-5) with constipation should have what diet
peanuts, popcorn, raisins
drawing up knees to chest, avoidance of unnecessary movement
peritonitis, intussusception
when can diaphramatic hernia be diagnosed
prenatally at 16-24 weeks
pyloric stenosis manifests with
projectile vomiting
what position should the infant be in after PSARP
prone
often seen with omphalocele
pulmonary hypoplasia
parent instructions for children with lice
put toys in a bag for 3 days
baby is hungry soon after vomiting
pyloric stenosis
peristalsic waves in upper abdomen olive-shaped mass in RUQ
pyloric stenosis
sudden onset at 3-5 weeks of age of projectile vomiting
pyloric stenosis
with intussusception, child will be NPO until
resolved
medication for measles
ribavirin
First symptom is the rash (fine, red/pink rash) disappears after 3 days lymphadenopathy
rubella
diagnosis of rubella
rubella-specific serum IgM
truncal asymmetry improperly fitting clothing no back pain
scoliosis
rupture of appendix can lead to
sepsis, shock
deep respirations, tachypnea thready pulse BP very low dark tones, difficult to arouse, unconscious, apprehensive sunken eyes and fontanel minimal or absent output; absent tears H&H increased
severe dehydration
remove brace for scoliosis only for __________
showering
sex hormones increase with increased
skeletal growth
pull applied directly to bone with surgically placed pins
skeletal traction
pull placed directly on skin that indirectly puts traction on the bone and muscle
skin traction
diagnosis of appendicitis
ultrasound
give what antibiotic typically for osteomyelitis
vancomycin
children with celiac disease need sources of
vitamin D and calcium
what can children with celiac disease NOT have
wheat, barley, rye
treatment for intussusception
initiate hydrostatic air
pyloric stenosis causes what electrolyte imbalance
metabolic alkalosis
RR, HR, BP = normal alert, restless, thirsty flat fontanel output slightly decreased
mild dehydration
tachypnea, tachycardia, low BP prolonged cap. refill sunken eyes/fontanel skin turgor poor (2-3 seconds) output dark and increased specific gravity
moderate dehydration
A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child?
mumps
Fever and systemic symptoms last up to 5 days
mumps
S/S of increased intracranial pressure
mumps
infectious 7 days before and 8 days after parotid swelling
mumps
self limiting virus spread by respiratory secretions that spreads in the body via lymphatic system
mumps
spine curve that is 25 degrees
no treatment
sudden spontaneous relief of pain during appendicitis means the appendix has ruptured PRIO nursing action:
notify provider
give antibiotics for _____ fractures
open
only touch a wet plaster cast with
open palms
injects sodium influx through nerve cell membrane and causes paralysis and death of louse
permethrin
what medication for scabies can be used in children older than 2 months
permethrin 5%
food particles in vomit indicates
slowed mobility
true or false: impetigo is self limiting
true
parent teaching for infant with GERD
- hold infant upright for 30 min after feedings - avoid placing infant in car seat after feeding - thicken feedings as directed - burp infant after every 1-2 oz of formula or 5 minutes breastfeeding
when appendix ruptures, what to assess for (THESE ARE BAD)
- hypoactive bowels - increased HR - increased RR - fever - decreased BP
Severe burns cause
Immunosuppression
Projectile vomiting means
Increased ICP
when can hepatitis B vaccines be given
birth, 2 months, 6 months
for suspected osteomyelitis, what should be done before beginning antibiotics
blood culture
spine curve that is 30-40 degrees is treated with
bracing
blisters on trunk of infants
bullous impetigo
bullous impetigo
infants
Replace fluids slowly with _________ dehydration to avoid water intoxication and cerebral edema
hypertonic
serum sodium level increased (above 150)
hypertonic dehydration
what electrolyte imbalance with meckel diverticulum
hypokalemia
vomiting can lead to
hypokalemia, hyponatremia, hypochloremia
serum sodium decreased (below 130)
hypotonic dehydration
absence of an anal opening
imperforate anus
permethrin might cause
increased itching
stools frothy, greasy, and foul-smelling
celiac disease
medication for bullous impetigo
cephalosporin
pain in right upper abdomen associated with vomiting
cholethiasis, pneumonia
the rectum, vagina, and urethra form a common channel with 1 opening
cloacal anomaly
skeletal traction is used for
spine injury
impetigo is caused by
staphylococcus aureus
spine curve that is 45-50 degrees is treated with
surgery
true or false: Gore Tex Casts can be flushed with warm water and soap
true
true or false: No scratching under the cast with anything
true
true or false: Permethrin kills alive lice but not nits
true
true or false: hearing loss is a manifestation of osteogenesis imperfecta
true
