Exam 3 MCN
What is our weight gain goal for infants with heart failure?
1 ounce of weight gain per day
How long does it take a newborn to develop their own vitamin K?
1 week, once intestinal flora develops
How many voids are expected on the first day of life?
1 wet diaper and 1 meconium poop
By what age do you most undescended testicle correct themselves?
1 year
Which grades of a VUR are most likely to spontaneously resolve in younger children?
1-3
What are the four management goals for nephrotic syndrome?
1. Decrease urinary excretion of proteins 2. Decrease fluid retention 3. Prevent infection 4. Treat hypertension if it is present
What is the worst time of day to have a child in the sun?
10 AM-4 PM
What is the treatment for acute rheumatic fever?
10 day course of penicillin antibiotics, corticosteroids, rest, pain management, observe for cardiac complications
When does heartbeat begin in a fetus and what causes heartbeat?
2 to 3 weeks gestation, it occurs due to electrical activity in the developing heart cells
How long will it take a patient to heal after hypospadia's repair? And what must remain in place until it heals?
2 to 3 weeks, a catheter or stent will remain in place and caregiver must know how to irrigate, empty, and securing it/taping it to the leg
How often is chest physiotherapy done any child with CF, and what do we do prior to this treatment?
2 to 4 times a day when well, and more often when sick. We gave a bronchodilator prior to allow me a get to escape more easily
How long does treatment last for Isotrentinoin?
20 weeks, it is an oral pill taken twice a day
If a pediatric patient has a family history indicative of hyperlipidemia, when is a risk assessment screening performed?
24 months old
How many readings must be obtained before a diagnosis of hypertension can be made?
3
When is hepatic function fully functional?
3 months
How will respirations appear in a newborn?
30 to 60 breaths per minute, shallow, irregular, periodic breathing
What is the total stomach capacity of a newborn, and what capacity is available for the first 24 hours?
30 to 90 mL total, only 10 to 20 mL for the first 24 hours
Where is the Apex of the heart and children less than seven years old?
4th intercostal space
What is the most common age for acquiring acute rheumatic fever?
5-15
What is considered a yellow reading on a peak flow meter, and wet intervention should be made?
50 to 80% of expected peak flow, the child's medications should be adjusted based on their asthma action plan
Where is the Apex of the heart and children greater than seven years old? And what causes this shift?
5th intercostal space, as the lungs grow the heart is displaced downward
How many voids are expected on the 3rd to 4th day of life?
6 wet diapers and 3 stools a day
What is the exercise recommendation for children with hyperlipidemia?
60 minutes a day
What percentage of newborns body mass is water? And what does this put them at risk for?
75%, fluid loss occurs quickly
When is heart development complete in a fetus?
8 to 10 weeks, but it is passively working and the fetus is still relying on the mother's circulation for support
What is the normal blood volume of a newborn, and what practice can help increase blood volume?
80 to 85 mL per kilogram, delayed cord clamping increases volume as well as iron stores and hemoglobin and hematocrit
How long does a fetal red blood cell live?
80-100 days
What is the optimal newborn body temperature?
97.7-99.5
At what heart rate do we withhold digoxin in adolescents?
<60
At what heart rate do we withhold digoxin in young children?
<70
At what heart rate do we withhold digoxin in infants?
<90
What is the LDL reading indicative of hyperlipidemia?
>/=130
What is the total cholesterol reading indicative of hyperlipidemia?
>/=200
How is a nasal pharyngeal swab performed?
A dry swab is inserted into the nasopharynx and should be performed for 15 seconds
What type of murmur is normal in the neonatal period And why does it occur?
A functional murmur is normal, it occurs because some cardiac structures may take longer to close
What can develop the diaper dermatitis is not resolved in 3 to 4 days, and what would be the treatment for this complication?
A fungal infection can result, that will appear as satellite lesions that are less red than diaper dermatitis. It will be treated with a nystatin
What are the clinical signs of glomerulonephritis?
A healthy child with abrupt onset, typically school aged and has been exposed to strep. They will present with symptoms of fluid overload including shortness of breath, dyspnea, basilar rails, edema, acute hypertension, decreased urinary output, headache, encephalopathy, and possible seizures
What is the difference between a perennial and seasonal allergy?
A perennial allergy is present year-round and in indoor environments, whereas seasonal occur during specific seasons of the year
What is the criteria to diagnose apnea in infants?
A period of no breathing for more than 20 seconds
A nurse is caring for a child who has cellulitis on the hand. Which of the following actions should the nurse take? A. Administer oral antibiotics B. Cleanse area using burrow solution C. Prepare for Cyrotherapy D. Apply a topical antifungal medication
A. Administer oral antibiotics
A nurse is caring for an adolescent who has acne and a prescription for iso Trenton the one from the dermatologist. Which of the following laboratory findings should the nurse plan to monitor? A. Cholesterol and triglycerides B. BUN and creatinine C. Blood potassium D. Blood sodium
A. Cholesterol and triglycerides
A nurse is reviewing the diagnostic findings for a preschool age child who is suspected of having cystic fibrosis. Which of the following findings should the nurse identify as an indication of cystic fibrosis? A. Elevated sweat chloride content B. Increased blood levels of fat soluble vitamins C. 72 hour stool analysis sample indicating hard packed stools D. Chest x-ray negative for atelectasis
A. Elevated sweat chloride content (Children who have cystic fibrosis are expected to have decreased blood levels of fat soluble vitamins, steatorrhea, and atelectasis and obstructive emphysema on chest x-ray)
A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following findings should the nurse expect? Select all that apply A. Erythema marginatum B. Continuous joint pain of the digits C. Tender, subcutaneous nodules D. Decreased ESR E. Elevated C reactive protein
A. Erythema marginatum E. Elevated C reactive protein
A nurse is discussing risk factors for asthma with a group of newly licensed nurses. Which of the following conditions should the nurse include in the teaching? Select all that apply A. Family history of asthma B. Family history of allergies C. Exposure to smoke D. Low birth weight E. Being underweight
A. Family history of asthma B. Family history of allergies C. Exposure to smoke D. Low birth weight (Being overweight is a risk factor for asthma)
A nurse is assessing an infant who has eczema. Which of the following findings should the nurse expect? Select all that apply A. Generalized distribution of lesions B. Papules C. Ecchymosis in flexural areas D. Crusting lesions E. Keratosis Pilaris
A. Generalized distribution of lesions B. Papules D. Crusting lesions
A nurse is assessing a child who has epiglottitis. Which of the following findings should the nurse expect? Select all that apply A. Hoarseness and difficulty speaking B. Difficulty swallowing C. Low-grade fever D. Drooling E. Dry barking cough F. Stridor
A. Hoarseness and difficulty speaking B. Difficulty swallowing D. Drooling F. Stridor (The child will have a high-grade fever and no cough)
A nurse is assessing the reflexes of a newborn. In checking for the stepping reflex, the nurse should perform which of the following? A. Hold the newborn vertically under arms and allow 1 foot to touch table B. Stimulate the pads of the newborns hands with stroking or massage C. Stimulate the soles of the newborns feet on the outer lateral surface of each foot D. Hold the newborn in a semi sitting position, then allow the newborns head and trunk to fall backwards
A. Hold the newborn vertically under arms and allow 1 foot to touch table
The nurse is preparing to administer and vitamin K injection to a newborn. Which of the following responses should the nurse give to the newborns parent regarding why this medications given? A. It assists with blood clotting B. It promotes maturation of the bowel C. It is a preventative vaccine D. It provides immunity
A. It assists with blood clotting
Which of these is an expected finding of a preterm newborn? Select all that apply A. Lanugo B. Long nails C. Weak grasp reflex D. Translucent skin E. Plump face
A. Lanugo C. Weak grasp reflex D. Translucent skin
A nurse is caring for a newborn who is preterm and has respiratory distress syndrome. Which of the following should the nurse monitor to evaluate the newborns condition following the administration of synthetic surfactant? A. Oxygen saturation B. Body temperature C. Serum bilirubin D. Heart rate
A. Oxygen saturation (Surfactant stabilizes the alveoli and helps increase oxygen saturation)
A nurse is teaching an adolescent to self administer a corticosteroid medication using a meter dose inhaler. Which of the following instructions should the nurse include? Select all that apply A. Shake the device prior to use B. Rinse and expectorate after administration C. Inhale slowly with medication administration D. Exhale quickly after medication administration E. Wait 30 seconds between puffs
A. Shake the device prior to use B. Rinse and expectorate after administration C. Inhale slowly with medication administration
A nurse is teaching a new license nurse how to bathe the newborn and observes a bluish brown marking across the newborns lower back. The nurse should include which of the following information in the teaching? A. This is more commonly seen in newborns who have dark skin B. This is a finding indicating hyperbilirubinemia C. This is a forceps mark from an operative delivery D. This is related to prolonged birth or trauma during delivery
A. This is more commonly seen in newborns who have dark skin
A nurse is planning care for a child who has tinea capitis. Which of the following actions should the nurse include in the plan of care? Select all that apply A. Treat infected house pets B. Use selenium sulfide shampoo C. Cleanse area with a burrow solution D. Administer antiviral medication E. Use moist, warm compresses
A. Treat infected house pets B. Use selenium sulfide shampoo
A nurse is assessing in infant who has coarctation of the aorta. Which of the following findings should the nurse expect? Select all that apply A. Weak femoral pulses B. Cool skin of lower extremities C. Severe cyanosis D. Clubbing of the fingers E. Low blood pressure
A. Weak femoral pulses B. Cool skin of lower extremities E. Low blood pressure
A nurse is performing in admission assessment for a child who has cystic fibrosis. Which of the following findings should the nurse expect? Select all that apply A. Wheezing B. Clubbing of fingers and toes C. Barrel shaped chest D. Thin watery mucus E. Rapid growth spurts
A. Wheezing B. Clubbing of fingers and toes C. Barrel shaped chest (Thick mucus and delayed growth are expected findings)
A nurse is teaching a child who has asthma how to use a peak flow meter. Which of the following information should the nurse include in the teaching? Select all that apply A. Zero the meter before each use B. Record the average of the attempts C. Perform three attempts D. Deliver a long, slow breath into the meter E. Sit in a chair with feet on the floor
A. Zero the meter before each use C. Perform three attempts (The child should record the highest reading, the child should breathe hard and fast, and they should stand upright when using)
Which congenital heart conditions result in a increased pulmonary bloodflow?
ASD, VSD, PDA
What are the two types of acquired immunity?
Active and passive
What are the three types of ear infections?
Acute otitis media, otitis media effusion, otitis externa
What type of glomerulonephritis is specific to children, and what infection is it associated with?
Acute post streptococcal glomerulonephritis, it occurs after infection with group a streptococcus from either impetigo or pharyngitis and will occur 10 to 21 days after the infection
What heart diseases are considered acquired?
Acute rheumatic fever, hypertension, hyperlipidemia, Kawasaki disease
What is brown fat?
Adipose tissue around shoulder blades, neck and upper body that keeps infants warm since they cannot shiver
What are some ways to prevent UTIs in children?
Aggressive control of avoiding and constipation, voiding schedule, liberal fluid intake and laxatives, wipe front to back, cotton underwear, fully emptying the bladder when voiding, evaluate scratching, no bubble baths
The acronym air raid can be used to remember the presentation of epiglottitis, what does this acronym stand for?
Airway inflammation/obstruction Increased pulse Restlessness Retractions Anxiety increased Inspiratory stridor Drooling
Is alkaline or acidic urine more likely to grow bacteria and cause a UTI?
Alkaline
Where is blood pressure obtained in a child cardiac patient?
All four extremities
What is allergic rhinitis? And is it acute or chronic?
Allergic rhinitis is a chronic respiratory disorder that is manifested by an allergy to a perennial or a seasonal allergens/trigger
What are the common symptoms of allergic rhinitis?
Allergic salute, sneezing, itching red and watery eyes
What does serum IgE indicate when elevated?
Allergies and atopic disease
What may result from the rapid growth spurt seen in adolescence?
An innocent murmur may form, this murmur is due to leaking valves or a temporary reversal of blood flow
What is the pathophysiology of acne vulgaris?
Androgynous hormones increase the sebaceous gland activity causing increased sebum secretion that clogs the hair follicle and causes a keratin plug. keratin plugs are great areas for acne infections to proliferate. Neutrophils go to the site of the infection and cause inflammation leading to the contents of the clogged follicle to spill into nearby tissue leading to large cysts and scarring at the skin
What is the treatment for otitis externa?
Antibiotic or antifungal eardrops, drying the canal well to decrease recurrence
What is the pathophysiology of glomerulonephritis?
Antibodies filtered from plasma through the kidneys form deposits in the membrane of the glomeruli, these deposits cause occlusion and a decrease in GFR. Decrease in GFR increases the sodium and water retention leading to edema, untreated it can lead to acute renal failure
How much blood loss is worrisome in a newborn?
Any blood loss
What congenital heart defect is diagnosed with a blood pressure reading on all four extremities?
Aortic coarctation
What two things must the nurse check before administering digoxin?
Apical heart rate for one minute and recent lab values, especially potassium level
What are the complications of foreign body aspiration?
Aspiration pneumonia and respiratory distress
If an apnea/bradycardia monitor goes off, what is the nurses first action?
Assess the patient
What condition does pulmonary function testing help diagnose?
Asthma
What is asthma, and what is a risk of uncontrolled asthma?
Asthma is a chronic, reversible inflammatory airway disorder that can cause permanent lung damage if not treated or controlled. The airway is hyper reactive to triggers, causing obstruction through bronchoconstriction
When is the hyperlipidemia universal screening performed?
At ages 9 to 11, and again at ages 18-20
When should both testicles be able to be felt?
At birth
When does screening for hypertension begin in pediatric patients?
At three years old
What other disorders are common for a child to have who also has allergic rhinitis?
Atopic dermatitis and asthma
How do you avoid heat loss by conduction in a newborn?
Avoid cold surfaces Don't touch them with cold hands or objects
What education should be provided following the diagnosis of Kawasaki disease?
Avoid live vaccines for 11 months after the high-dose IVIG regular cardiac follow up with an echo and diagnosis, three weeks, and eight weeks after treatment
A nurse is caring for a child in the postoperative time following a tonsillectomy. Which of the action should the nurse take? A. Encourage the child to blow her nose gently B. Administer analgesics on a schedule C. Offer orange juice D. Position the child supine
B. Administer analgesics on a schedule
A nurse is providing discharge teaching for a child who has cystic fibrosis. Which of the following instructions should the nurse include? A. Provide a low calorie, low protein diet B. Administer pancreatic enzymes with meals and snacks C. Implement a fluid restriction during times of infection D. Restrict physical activity
B. Administer pancreatic enzymes with meals and snacks (They should eat a high calorie high-protein diet, increase fluids to thin mucus, and engage in daily aerobic activity to help lungs expand and stimulate mucus expectoration)
A nurse is teaching a parent of a child who has a urinary track infection. Which of the following should the nurse include in the teaching? Select all that apply A. Wear are nylon underpants B. Avoid bubble baths C. Empty bladder completely with each void D. Watch for manifestations of infection E. White perineal area back to front
B. Avoid bubble baths C. Empty bladder completely with each void D. Watch for manifestations of infection
A nurse is caring for a two-year-old child who has a heart defect and is scheduled for a cardiac catherization. Which of the following actions should the nurse take? A. Place on NPO status for 12 hours prior to the procedure B. Check for iodine or shellfish allergies prior to the procedure C. Elevate the affected extremity following the procedure D. Limit fluid intake following the procedure
B. Check for iodine or shellfish allergies prior to the procedure
A nurse is assessing an infant who has heart failure. Which of the following findings should the nurse expect? Select all that apply A. Bradycardia B. Cool extremities C. Peripheral edema D. Increased urinary output E. Nasal flaring
B. Cool extremities C. Peripheral edema E. Nasal flaring
A nurse is caring for a child who has enuresis. Which of the following is a complication of this? A. UTI B. Emotional problems C. Urosepsis D. Progressive kidney disease
B. Emotional problems
A nurse is assessing an infant who has a suspected urinary track infection. Which of the following are expected findings? Select all that apply A. Increase in hunger B. Irritability C. Decrease urination D. Vomiting E. Fever
B. Irritability D. Vomiting E. Fever (Infants will present with an increase in thirst and an increase in urination)
A nurse is caring for a child who is receiving a broncodilator medication by nebulized aerosol therapy. Which of the following actions should the nurse take? Select all that apply A. Instruct the child that the treatment will last 30 minutes B. Obtain vital signs prior to the procedure C. Tell the child to take slow deep breaths D. Determine if the child should use a mask E. Attach the device to an air source
B. Obtain vital signs prior to the procedure C. Tell the child to take slow deep breaths D. Determine if the child should use a mask E. Attach the device to an air source
A nurse is planning care for a child who has asthma. Which of the following interventions should the nurse include in the plan of care? Select all that apply A. Perform chest percussion B. Placed the child in an upright position C. Monitor oxygen saturation D. Administer bronchodilators E. Administer dornase alpha daily
B. Placed the child in an upright position C. Monitor oxygen saturation D. Administer bronchodilators (A and E are interventions for a child with cystic fibrosis)
A nurse is assessing the reflexes of a newborn. In checking for the grasp reflex, the nurse should perform which of the following? A. Hold the newborn vertically under arms and allow 1 foot to touch table B. Stimulate the pads of the newborns hands with stroking or massage C. Stimulate the soles of the newborns feet on the outer lateral surface of each foot D. Hold the newborn in a semi sitting position, then allow the newborns head and trunk to fall backwards
B. Stimulate the pads of the newborns hands with stroking or massage
A nurse is assessing a child who has a urinary tract infection. Which of the following are manifestations of this? Select all that apply A. Night sweats B. Swelling of the face C. Pallor D. Pale colored urine E. Fatigue
B. Swelling of the face C. Pallor E. Fatigue
A nurse is teaching a newly licensed nurse about neonatal abstinence syndrome. Which of the following statements by the newly licensed nurse indicate understanding of the teaching? A. The newborn will have decreased muscle tone B. The newborn will have a continuous high-pitched cry C. The newborn will sleep for 2 to 3 hours after feeding D. The newborn will have mild tremors when disturbed
B. The newborn will have a continuous high-pitched cry
A nurse is assessing a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status? Select all that apply A. Oxygen saturation 95% B. Wheezing C. Retraction of sternal muscles D. Warm extremities E. Nasal flaring
B. Wheezing C. Retraction of sternal muscles E. Nasal flaring
What is the last newborn reflex to disappear?
Babinski, this will disappear by 12 months of age
What are the risk factors for vulvovaginitis?
Bacteria, yeast, bubble baths, poor hygiene, sexual abuse, fungus, diabetes
What are the two types of pharyngitis, and what are the differences between the two?
Bacterial and viral, viral occurs with cold symptoms and does not require treatment and bacterial occurs without cold symptoms and is treated with penicillin for 10 days
What are the options of short acting bronchodilators, how are they given, and what are the common side effects?
Because bronchodilation by relaxing airway smooth muscle, they are given with a meter dosed inhaler with a spacer or by nebulizer, common side effects are jitters, insomnia, thrush, muscle cramps, arrhythmia
What are the names of common inhaled corticosteroids?
Beclomethasone, budesonide
When does acne vulgaris begin, when does it peak, and what are the most common sites?
Begin: 7-10 Peak: 15-18 Sites: face, chest, and back
What complications are possible with a cardiac cath?
Bleeding, infection, arrhythmia
What is the hepatic system responsible for?
Blood coagulation Conjugation of bilirubin Storage of fat soluble vitamins (A,D,E,K) carbohydrate metabolism Iron storage Detoxification
Heart rate decreases from an average of 120 in infants to an average of 60 in teens, what causes this decrease?
Blood volume increases and the heart becomes stronger, so it no longer needs to beat rapidly in order to maintain cardiac output
Cystic fibrosis and is a autosomal recessive disorder, what does this mean?
Both boys and girls can get it
Why is constipation a risk factor for the development of a UTI?
Bowel sits on bladder or urethra and doesn't allow for emptying of the bladder, 2 to 3-year-olds can now hold stool
What is the pathophysiology of bronchiolitis?
Bronchiolitis is a lower respiratory infection where the lower trachea and bronchial swell and developed mucus, causing a wheezing sound.
When a trigger is introduced to the airway of a child with asthma, mucus secretion increases, airway tone is affected, and smooth muscle responsiveness increases. What does this result in? And what symptoms will we see occur?
Bronchoconstriction will occur due to airway edema and mucus plugging, Leukotriens will cause prolonged airway construction. The symptoms that will result are shortness of breath and wheezing
At what age will newborns produce their own antibodies and reach adult levels?
By nine months to one year of age
A nurse is caring for a child who has bronchiolitis. Which of the following actions should the nurse take? Select all that apply A. Administer oral prednisone B. Initiate chest percussion and postural drainage C. Administer humidified oxygen D. Suction the nasopharynx as needed E. Administer oral penicillin
C. Administer humidified oxygen D. Suction the nasopharynx as needed
A nurse is completing an assessment. Which of the following data indicates the newborn is adapting to extrauterine life? Select all that apply A. Expiratory grunting B. Inspiratory nasal flaring C. Apnea for 10 second periods D. Obligatory nose breathing E. Crackles and wheezing
C. Apnea for 10 second periods D. Obligatory nose breathing
A nurse is caring for a child after a cardiac catherization. What is the nursing priority? A. Allow early ambulation to encourage activity participation B. Check pulses above the catheter insertion site for strength and quality C. Assess extremity distal to the insertion site for temperature and color D. Change the dressing to evaluate the site for infection
C. Assess extremity distal to the insertion side for strength and quality
A nurse is caring for a child who is receiving oxygen therapy and is on a continuous oxygen saturation monitor that is reading 89%. Which of the following actions should the nurse take first? A. Increase the oxygen flow rate B. Encourage the child to take deep breaths C. Ensure proper placement of the sensor probe D. Please the child in the Fowler's position
C. Ensure proper placement of the sensor probe
A nurse is preparing to administer prophylactic eye ointment to a newborn to prevent opthamala neonatorum. Which of the following medications should the nurse anticipate administering? A. Ofloxacin B. Nystatin C. Erythromycin D. Ceftriaxone
C. Erythromycin
A newborn was not dried completely after birth. This place is the infant at risk for which of the following types of heat loss? A. Conduction B. Convection C. Evaporation D. Radiation
C. Evaporation
A nurse is caring for a child who is in the post operative period following a tonsillectomy. Which of the following is a clinical findings of postoperative bleeding? A. Hemoglobin 11.6 and hematocrit 37% B. Inflamed and reddened throat C. Frequent swallowing and clearing of the throat D. Blood tinged mucus
C. Frequent swallowing and clearing of the throat
A nurse is providing teaching to the caregiver of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include? A. Do not offer your baby fluids after giving the medication B. Digoxin increases your babies heart rate C. Give the correct dose of medication at regularly scheduled times D. If your baby vomits a dose, you should repeat the dose to ensure that the correct amount is received
C. Give the correct dose of medication at regularly scheduled times
A nurse is taking a newborn to a parent following a circumcision. Which of the following actions should the nurse take for security purposes? A. Ask the parent to state their full name B. Look at the name of the newborn's bassinet C. Match the parents identification band with the newborns band D. Compare name on bassinet and room number
C. Match the parents identification band with the newborns band
A nurse is assessing the reflexes of a newborn. In checking for the babinski reflex, the nurse should perform which of the following? A. Hold the newborn vertically under arms and allow 1 foot to touch table B. Stimulate the pads of the newborns hands with stroking or massage C. Stimulate the soles of the newborns feet on the outer lateral surface of each foot D. Hold the newborn in a semi sitting position, then allow the newborns head and trunk to fall backwards
C. Stimulate the soles of the newborns feet on the outer lateral surface of each foot
A nurse is caring for an infant who has a high bilirubin level and is receiving phototherapy. Which of the following is the priority finding in the newborn? A. Conjunctivitis B. Bronze skin discoloration C. Sunken fontanelles D. Maculopapular skin rash
C. Sunken fontanelles (Sunken fontanelles is the priority because infants receiving phototherapy are at risk for dehydration from loose stools due to increased bilirubin excretion)
A nurse in the emergency department is assessing a newly admitted infant. Which of the following findings is an early indication of hypoxemia? A. Nonproductive cough B. Hypoventilation C. Tachypnea D. Nasal stuffiness
C. tachypnea
What must parents know with children who go home on a apnea/bradycardia monitor?
CPR
What are signs of respiratory distress in a newborn?
Central cyanosis, pallor, nasal flaring, retractions, grunting, gasping, and labored breathing
How does croup present?
Children will develop hoarseness and a barky cough suddenly at night
How is acne vulgaris managed?
Cleaning the face twice daily with non-comedogenic soap, avoid oil based hair and make up products, avoid highly fragrant products, be sure to clean hair and scalp adequately, healthy diet, decrease stress, adequate rest, and acne medications for moderate to severe cases
Which congenital heart condition is considered an obstructive disorder?
Coarctation of the aorta
What is cryptorchidism?
Condition in which one or both testicles remain in the body cavity.
What occurs due to azotemia in glomerulonephritis?
Confusion and decreased urinary output
What is some treatment options for allergic rhinitis?
Control of allergens, antihistamines, leukotriene receptor antagonist (montelukast, zarfirlukast)
How do we decrease urinary excretion of proteins in nephrotic syndrome?
Corticosteroids and IV albumin
What is the pathophysiology of croup, and what is the other name for this infection?
Croup is a viral infection that causes inflammation, edema, and mucous that obstruct the airway in young children three months to three years. The other name for croup is laryngo-tracheobronchitis
What should be avoided in infants and children with tetralogy of fallot?
Crying, this causes further blood flow restriction to the lungs
What are some ways to maintain skin integrity and prevent infection in children with eczema?
Cut fingernail short and keep them clean, 100% cotton bedsheets and pajamas, behavior modification to prevent scratching such as distraction or tapping on skin
A nurse is teaching adolescent adolescent about the appropriate use of his asthma medications. Which of the following medications should the nurse instruct the client to use as needed before exercise? A. Fluticasone/salmeterol B. Montelukast C. Prednisone D. Albuterol
D. Albuterol
A nurse is caring for a newborn immediately following birth. Which of the following nursing interventions is the highest priority? A. Initiating breast-feeding B. Performing the initial bath C. Giving a vitamin K injection D. Covering the newborns head with a cap
D. Covering the newborns head with a cap
A nurse is planning care of a child who has a urinary track infection. Which of the following interventions should the nurse include? A. Administer an anti-diuretic B. Restrict fluids C. Evaluate the child's self-esteem D. Encourage frequent voiding
D. Encourage frequent voiding
A nurse is completing a newborn assessment in observes small small pearly white nodules on the roof of the newborns mouth. This finding is a characteristic of which of the following conditions? A. Mongolian spots B. Milia spots C. Erythema toxicum D. Epstein's pearls
D. Epstein's pearls
A nurse is assessing the reflexes of a newborn. In checking for the Moro reflex, the nurse should perform which of the following? A. Hold the newborn vertically under arms and allow 1 foot to touch table B. Stimulate the pads of the newborns hands with stroking or massage C. Stimulate the soles of the newborns feet on the outer lateral surface of each foot D. Hold the newborn in a semi sitting position, then allow the newborns head and trunk to fall backwards
D. Hold the newborn in a semi sitting position, then allow the newborns head and trunk to fall backwards
While assessing a four-month-old infant, the nurse notes that the baby experiences a hyper cyanotic spell. What is the priority nursing action? A. Provide supplemental oxygen by face mask B. Administer a dose of IV morphine sulfate C. Begin cardio pulmonary resuscitation D. Place the infant in a knee to chest position
D. Place the infant in a knee to chest position
A nurse is caring for a child who is receiving oxygen. Which of the following findings indicates oxygen toxicity? A. Increase blood pressure B. Hyperventilation C. Decreased PaCO2 D. Unconsciousness
D. Unconsciousness
A nurse is caring for a client who is at 42 weeks gestation and in labor. The client asked the nurse what to expect because the baby is post term. Which of the following statements should the nurse make? A. Your baby will have excess body fat B. Your baby will have a flat areola without breast buds C. Your babies heels would easily move to his ears D. Your babies skin will have a leathery appearance
D. Your babies skin will have a leathery appearance (Excess body fat is seen in a newborn who is macrosomic, flat areolas without breast buds and heels that are movable fully to the ears are seen in preterm newborns)
How do we treat epiglottitis?
Decrease anxiety, do not examine the throat, position for comfort, cool mist humidification, oxygen, no oral fluids, trach tray available, IV fluids, IV antibiotics
What are the therapeutic goals for acne vulgaris?
Decrease sebum production, bacteria, and inflammation
What are signs of cold stress in a newborn?
Decreased HR and hypoglycemia
What is the cause of labial fusions/adhesions?
Deficient estrogen or contact with irritants
What are some treatment options for enuresis?
Desmopressin orally or nasally, wet underwear alarm, bladder conditioning
What are the three types of cardiac catherization?
Diagnostic, interventional, electrophysiology
How would a nurse support cardiac function for a child with heart failure?
Digoxin, furosemide, daily weights at the same time using the same scale
What is the definition of an acquired heart disease?
Disorders that occur after birth, many of her as a complication of congenital heart disease or an infectious disease
What is the function of the foramen ovale?
Divert blood from the right to the left atrium in the fetus
What are some ways that allergens can be controlled for a child with allergic rhinitis?
Don't let pets sleep in the same room as the child, wash sheets in hot water every week, cover pillows in plastic coverings
How do you avoid heat loss by evaporation in a newborn?
Dry them off, avoid wet clothes, diapers, and hair Avoid high respiratory rates as this can cause insensible loss from the lungs
What 3 fetal structures are present in the heart to allow blood to bypass the lungs?
Ductus arteriosus, foreman ovale, ductus venosus
What causes the 3 fetal cardiac structures to close?
During the first breath of life all the blood flow will begin to go to the lungs and pressure changes in the heart as well as increased oxygenation allows for proper closure, if oxygenation is not good sometimes structures will remain open and result in mixed defects
Pharyngitis is characterized by the abrupt onset of:
Dysphagia, with or without a fever, headache, abdominal pain
What lab values may be present in Kawasaki disease, but do not diagnose the condition?
Elevated ESR, leukocytosis, thrombocytosis
How do you avoid heat loss by convection in a newborn?
Eliminate fans and drafts Close hall doors Don't place them near AC
What does the treatment resistant form of nephrotic syndrome lead to?
End stage renal disease
When a trigger is introduced to the airway of a child with asthma, what occurs?
Eosinophils and neutrophils go to the airway and cause injury, other cells will then contribute to the inflammation.
Older children with mild coarctation of the aorta may present with these symptoms:
Epistaxes, headache, leg pain with activity
What is the goal in the nursing management of a UTI?
Eradicate the infection and prevent future infections
How are labial adhesions treated?
Estrogen cream twice a day for one month and petroleum jelly to maintain moisture for the next few months, explain to the child why they are receiving the medication so it is not seen as abuse
What are the two types of DNA testing for cystic fibrosis, and what are the differences?
Ethnic based screening screens for specific disease is common in patients ethnicity, expanded carrier screening screens for many diseases, often those more serious unrelated to ethnicity
What structural difference in children puts them at risk for acute otitis media? In what education can be provided to parents regarding prevention?
Eustachian tube's in children are much straighter than adults, which hinders drainage. Educate parents to not put their child to bed with a bottle, as this will increase the amount of fluid entering the eustachian tube's.
How often must the patient visit the cystic fibrosis clinic?
Every 2 to 3 months
What puts a child at risk for acquiring fungal infections?
Exposure to another person with a fungal infection, pets, tight clothing, non-breathable clothing or socks
When assessing a patient with pharyngitis, what should we inspect for?
Exudate, petechiae on the palate, strawberry tongue, lymphadenitis, and a scarlatinaform rash (group A strep)
What are the risk factors for the development of allergic rhinitis?
Family history of a topic disease, tobacco smoke, known allergy to pet dander, pollens, mold, and late introduction of certain foods (introducing certain foods early in a child's life will protect them from developing an allergy to them)
What is included in the Kawasaki disease diagnostic criteria?
Fever of at least a five day duration in the presence of at least four of the following five conditions: bilateral conjunctival injection, changes of the lips and oral mucosa, changes of peripheral extremities, polymorphous rash, cervical lymphadenopathy
What are common signs and symptoms of a UTI in older children?
Fever, dysuria, enuresis, hematuria
What are the minor criteria in the jones scale?
Fever, elevated ESR, arthralgia, prolonged PR interval
What symptoms are associated with acute otitis media?
Fever, otalgia, fussiness, poor feeding, night awakening, tugging at ears, fluid draining from the ear
What behavioral pattern is present in the first half hour to two hours of life?
First period of reactivity The newborn will be alert, heart rate and respiratory rates are increased, this is a good time for bonding and initiating breast-feeding
When a child has a UTI, they may claim they have abdominal pain. What manifestation is most likely occurring that the child cannot differentiate well?
Flank pain
What are the names of common long-acting bronchodilators?
Formoterol, salmeterol
What is the function of apocrine glands?
Found in hair follicles, mostly armpits and groin and cause body odor, mature during puberty
What measures do we take to maximize chest expansion in children with heart failure?
Fowlers or semi Fowler's position, use of an infant seat
When is the perinatal period?
From the 28th week of gestation until the seventh day after birth ( 7 months pregnant to 7 days)
How do we decrease fluid retention in nephrotic syndrome?
Furosemide, fluid restriction, daily weights, strict IO
What two body systems are most affected by cystic fibrosis?
G.I. tract and respiratory
What are cystic fibrosis patients at risk for due to thick bile?
Gallstones
If a child with heart failure does not finish their feeding orally, what are we to do with the remainder of the feeding?
Gavage the remainder, meaning we will administer it through a tube
What are the blood pressure norms based on?
Gender, age and height
What findings would indicate stage 2 or moderate acne?
Greater blackheads/milia, papules/pustules, slight inflammation, acne breakout may progress from face to other areas
What is considered a green reading on a peak flow meter, and what intervention should be made to the child's medications?
Greater than 80% of expected peak flow, no intervention required. The child is doing well on current medication regimen
How will transitional stool present?
Greenish brown/yellow, seedy
What common respiratory infection occurs most often during the school year?
Group a strep
How is hypospadias repaired?
Gum transplant or foreskin transplant
What are the risk factors for acute otitis media?
Having the first episode of AOM before three months old, allergies, cranial facial anomalies, exposure to passive smoking, not having been breastfed, crowded living and daycare attendance
What are the possible complications of otitis media effusion?
Hearing loss, expressive speech delays
What is the function of the eccrine glands?
Helpful in temperature regulation through water evaporation and are found all over the body, not fully functional until middle childhood; do not work well in infants and younger children
How do we increase calories in infants with heart failure?
High calorie formula or breast milk fortifier, we may also use 24 to 30 cal per ounce of an oil or carb
Due to children with cystic fibrosis having poor growth, what diet interventions should be made?
High calorie, high protein diet They may require additional G tube feeds at night, and TPN feeds in severe cases
What is the classic sign of impetigo?
Honey colored drainage
What are common symptoms of a peri tonsillar abscess?
Hot potato voice, deviated uvula, fever, sore throat
What is the typical lab presentation of nephrotic syndrome?
Hyperlipidemia Hyperalbuminuria Hypoalbuminemia Normal GFR
What is primary hypertension?
Hypertension associated with BMI and waist circumference
What is secondary hypertension?
Hypertension associated with a renal or cardiac disease
What can result from poor carbohydrate metabolism of the newborn liver?
Hypoglycemia, liver releases glycogen stores when feeding but it is intermittent or poor
If a pediatric patient with heart failure requires infective endocarditis, what intervention must be made?
IV antibiotics for 4 to 6 weeks
What is the four hour rule for administering digoxin?
If a dose is messed greater than four hours or a child vomits, wait until the next dose. And two doses are missed notify the doctor.
When should a parent called a healthcare provider in a child with croup?
If the child breathe faster, has retractions, or any other difficulty breathing If nostrils begin to flare or lips/nails have a bluish tint Cough or stridor doesn't improve with exposure to moist air Restlessness increases for the child is confused, begins to drool, and cannot swallow
Why is enuresis a concern long-term?
If untreated it can last into adulthood
What lab value is commonly elevated in a patient with eczema?
IgE
What is the most abundant type of passive immunity in newborns?
IgG, it crosses the placenta and is available at birth
If a child with glomelularnephritis has a rising C3, what does this indicate?
Improving disease, usually normalizes by eight weeks
What is true of newborn vision?
Incomplete at birth, they can focus at 8 to 10 inches and they see mostly shadows so toys for newborns will tend to be black and white, they love faces, and they can begin to see color better at 4 to 6 months old
What is a classic sign of coarctation of the aorta?
Increased blood pressure and bounding pulses in upper extremities compared to lower extremities, it is important to check femoral pulses in infants
What does overheating in a newborn cause?
Increased oxygen use
What is the function of digoxin?
Increases the contractility of the heart and slows the rate
Why do infants have a high heart rate?
Infants have less compliance of the heart muscle, the only way to increase cardiac output in infants is to increase the rate
What is cellulitis and how is it treated?
Inflammation of skin and subcutaneous tissue secondary to break in skin allowing bacteria to travel deeply, localized infections may be able to use topical antibiotics where serious infections require IV antibiotics. Warm soaks can also help ease symptoms
What is diaper dermatitis?
Inflammatory reaction of the skin in the diaper area due to wetness, pH changes, and fecal irritants combining to cause a flat, red, shiny rash on the surfaces of the skin. It is not an allergic reaction.
What are the common respiratory infections that occur in the winter?
Influenza and bronchiolitis
What are the common and inhaled medications given to children with cystic fibrosis?
Inhaled broncodilator's, corticosteroids, antibiotics, and mucolytics
If a murmur improves or subsides with a change in position, what type of murmur is this?
Innocent murmur
What acne medication is indicated for use in severe acne and how does it work?
Isotrentinoin, it reduces sebaceous gland size and sebum production
A child with cystic fibrosis is prescribed pancrelipase in a high dose, what is the action of this medication and how often shut the child take it?
It breaks down fats, proteins, and carbohydrates. It should be taken before every meal and snack. The dose is regulated based on store appearance and how often the stool. If they increase fat in their meal, stool more than 1 to 2 times a day, or see steatorrhea they should increase their dose
What precaution is indicated for immune modulator medication?
It cannot be used in children less than two years old
Dornase alpha is a inhaled mucolytic given to children with cystic fibrosis, how does this help relieve their pulmonary symptoms?
It helps to reduce the thickness of sputum, and eases the work of expelling mucus
What is Kawasaki disease, and what is the most dangerous complication of this disease?
It is a cute systemic vasculitis occurring mostly and young children, peaking at ages 1 to 2 years old, in the most dangerous complication is coronary artery aneurysm's
What is the definition of a mixed defect, and which congenital heart Disorders are present in this category?
It is a defect in which mixing of blood is essential to the survival of the newborn Transposition of the great vessels and hypoplastic left heart syndrome are mixed defects
What is a VCUG test?
It is a diagnostic test looking for the presence of VUR, die is placed through a catheter and x-rays are taken while a child voids onto the table. This test puts a child at risk for a UTI and allergic reactions to the dye
What is testicular torsion and at what age does it occur the most often?
It is a medical emergency where the spermatic cord is twisting on itself, it most commonly occurs between the ages of 12 to 18
What is the critical congenital heart disease screening?
It is a routine screening done on all babies where two oxygen saturation probes are placed, one on the foot and one on the hand. We are looking for significant differences between the two readings
Do newborns have active immunity?
It is absent until exposure to foreign organisms
What is the role of oxybutynin after hypospadias's repair?
It is an anti-spasmodic to avoid bladder spasms after the surgery
What is the pathophysiology of otitis externa?
It is an infection of the ear canal due to bacterial growth from moisture
What is epididymitis and how is it treated?
It is an infection of the testicle that can occur acutely or gradually, it presents with significant pain but not as sudden as testicular torsion. It is treated with antibiotics, ice, and rest.
How is acute rheumatic fever diagnosed?
It is based on Jones criteria, they must have either two major criteria or one major and two minor criteria
What is the cause of infantile acne, when does it appear and how long may it last?
It is caused by maternal hormones, it may appear between 2 to 4 weeks and last up to 4 to 6 months until all hormones are out of their system
What is true of newborn skin?
It is fragile with a high risk for brakes It may look dry and peel after birth
At what intervals digoxin administered?
It is given twice a day at 12 hour intervals, one hour before food or two hours after
A newborn first urination may appear bloody, is this normal? What is the cause?
It is normal, it contains pink uric acid crystals
What is true of a newborn stomach for the first 48 hours of life?
It is rigid and non-elastic
What is the function of IgM?
It is the first to respond to infection
What is epiglottitis, in which vaccines can prevent this?
It is the inflammation of the epiglottis that can include the airway and result in death if not treated, the HIB and Prevnar vaccines can prevent this
How is croup treated?
It is treated symptomatically with humidified air or cold air, and occasional oxygen or corticosteroids
What is furosemide for and how should it be administered?
It is used to manage edema in heart failure, and it should be given with food or milk
What is true of newborn hearing?
It is well developed at birth and they can turn to sound
How long is the iron storage in the liver of a newborn available to the newborn after birth?
It lasts 4 to 6 months, then supplemented via diet. Fetal stores are dependent on the mothers iron intake
If a patient with tonsillitis develops a perry tonsillar abscess that contains a pocket of pus, what treatment as indicated?
It must be drained
What is the function of vernix?
It provides moisturization and protection of the skin, we should delay bathing the patient immediately
Why is double diapering indicated after hypospadias repair?
It separates the urine in the store to avoid contaminating the penis
How does bronchiolitis present?
It starts with a cold, then a cough develops, then a low-grade fever. The child will typically be to tachypnic and hypoxic. Older children will just have cold symptoms because they have bigger airways
How does postural drainage help children with cystic fibrosis?
It's a technique for loosening mucus in the airway so that it may be coughed out, tapping is performed in certain areas with patient in different positions
What are the symptoms of otitis externa?
Itching of the canal, drainage, pain (especially when you pull the tragus)
What can result from the short life cycle and high turn over rate of fetal red blood cells?
Jaundice
What results from poor bilirubin conjugation in newborns?
Jaundice, it can be mild or severe, severe can lead to encephalopathy
What are the major criteria in the Jones scale?
Joint pain, carditis, nodules, erythema marginatum, Sydenham's chorea
What parent teaching should be done for a child with croup?
Keep the child quiet and discourage crying, allow the child to sit up in your arms, encourage rest and fluids intake, if stridor occurs take the child into a steamy bathroom for 10 minutes, administer corticosteroids as directed
How do you avoid heat loss by radiation in a newborn?
Keep them away from windows and outside walls Keep beanie on
What is the state of kidney function in a child with nephrotic syndrome?
Kidney function remains normal as evidenced by a normal GFR
What structural differences are seen in the genitourinary system of children?
Larger kidneys that are not well protected, shorter urethra, smaller bladder
What are the risk factors for developing bronchiolitis?
Less than 12 months old, crowded living, siblings in school, not being breast-fed, season of RSV
At what age are children at most risk for respiratory infections?
Less than 3 to 6 months
What is considered a red reading on a peak flow meter, and what intervention should be made?
Less than 50% of expected peak flow, administer the medications on asthma action plan and go to the nearest ER
What dietary changes are required for nephrotic syndrome?
Limiting sodium, reducing fluid intake, high protein, low-fat
How is a nasal pharyngeal wash performed?
Liquid is inserted through a tube placed into the nasopharynx, and we draw back the liquid to test for RSV, influenza, and pertussis
What three things must we know about a murmur?
Location, quality, intensity (grade 1-6)
What medications are used for the prevention of asthma symptoms?
Long acting bronchodilators in combination with inhaled steroids, or inhaled steroids can be given alone; Leukotriene receptor antagonists
What are the nursing interventions for glomelularnephritis?
Low sodium and potassium diet, fluid restriction, strict intake and output, daily weights, vital signs every four hours paying special attention to blood pressure, bedrest to allow kidneys to rest, and medications including antihypertensives, antibiotics, furosemide
Which gender is most affected by acne vulgaris?
Males
What demographic of patients does Kawasaki disease most commonly occur in?
Males and children of Asian descent
What is the major source for IgA in newborns?
Maternal breast milk
Although most congenital heart disease has no cause, what are some risk factors associated with its occurrence?
Maternal substance use, maternal exposure to infections, family history of CHD
How do newborns obtain passive immunity?
Maternal transfer of antibodies
What is the goal of pulmonary management for a child with CF?
Maximize lung function and minimize pulmonary complications
The most dangerous complication of Kawasaki disease is coronary artery aneurysms, when may these occur and when is the peak prevalence?
May occur as early as 7 to 10 days after onset of fever, peak prevalence 2 to 4 weeks after onset
How is glomerulonephritis diagnosed?
May or may not have a positive strep, rising ASO titer indicating a recent strep infection, low serum complement C3
What symptoms cause us to suspect a child may have cystic fibrosis?
Meconium ileus, steatorrhea, chronic cough, activity intolerance, significant constipation, poor weight gain despite eating well, recurrent infections
Asthma is treated with a step wise approach to medication management, what does this mean?
Medications will be increased when asthma is worsening, and decreased when asthma is improving. As we want the child to be on the least amount of meds possible
What findings would indicate stage 1 or mild acne?
Minor pimples, blackheads and milia, whiteheads, no inflammation
What are differences in the skin of dark skinned children?
More pronounced skin reactions, larger papular reactions with more noticeable change in skin pigmentation, more likely to develop keloids
How old must a patient be to have pulmonary function testing and how is it performed?
Must be at least five years old, their nose is plugged and they have to breathe as hard and as fast as they can
How is bronchiolitis diagnosed?
NP wash
What is the treatment for bronchiolitis?
Nasopharyngeal suctioning, bronchiodilator's, oxygen, IV fluids
What are the signs of digoxin toxicity in children?
Nausea, vomiting, decreased appetite, bradycardia, drowsiness, lethargy
What genitourinary disorder is suspected in a child who presents with edema?
Nephrotic syndrome
What are the acquired renal diseases?
Nephrotic syndrome and glomerulonephritis
What restrictions must be educate the patient and caregiver after hypospadia's repair?
No jumping or increase pressure that can disrupt sutures, tub baths can only happen after the dressing has been removed
How can vulvovaginitis be prevented?
No tight clothes, tight clothes restrict airflow and cause heat for fungus and bacteria to grow
What education should be provided about the action of acne medications?
None of them work right away
What is the normal heart rate of a newborn, and at what heart rate would we initiate interventions?
Normal heart rate is 110 to 160 BPM, less than 100 BPM would require a respiratory intervention, less than 60 BPM would require chest compressions
A nurse assesses a patient post tonsillectomy and notes blood tinged mucus, what should the nurse do?
Nothing, this is a expected finding. If there was Frank blood this would indicate bleeding from the surgical site and the healthcare provider would need to be notified. Hemorrhage can occur up to 10 days after surgery
When testing for pharyngitis, if the first swab is negative what action must we take?
Obtain a second swab to send to the lab
What is the pathophysiology of nephrotic syndrome?
Often after a viral infection but the exact reason is unknown, there is increased glomerular permeability. This permeability allows proteins to leak into the urine at a very high-level. This causes blood and body fluids to shift into cells they shouldn't and compensation by the liver.
When performing skin scraping, what is a positive findings for fungal infection?
Once the potassium prep is added a branching appearance will be seen
What is the medication regiment for the treatment of Kawasaki disease?
One dose of IVIG over 12 hours High dose aspirin while febrile, and then a decreased dose after Comfort care with acetaminophen, quiet environment, and IV fluids
What are the oral treatments for acne vulgaris?
Oral antibiotics used in conjunction with topical ointment, and combination oral contraceptives can reduce androgen production
What may be used in combination with a short acting broncodilator for severe exacerbations?
Oral corticosteroids
What is the treatment for tinea capitis?
Oral griseofulvin with or without selenium sulfide shampoo
How is cryptorchidism repaired?
Orchiopexy, this will pull the testicle down and tack it down so it stays where it supposed to be. We want to fix it early to avoid oligospermia
What medications are indicated after hypospadias repair?
Oxybutynin, antibiotics prophylactically, pain relief
What prevention of RSV is available for certain populations during RSV season?
Palivizumab
What is the reason for gastrointestinal manifestations any a child with cystic fibrosis?
Pancreatic enzyme activity is abnormal due to the thickening of the enzyme carrying fluid
What is a common type of cellulitis in children?
Periorbital
What do we suspect when a child is itching/scratching their perineum?
Pin worms in the rectum
What education should be given on keeping skin hydrated in a child with eczema?
Placed a child in a tepid bath twice a day, use mild soap, after they get out pat them dry to allow moisture to stay on the skin. Put on medicated ointment first after the bath and then coat the skin with moisturizer liberally after the bath and throughout the day
What results from the abnormal sickening of the pancreatic enzyme fluid in children with cystic fibrosis?
Poor absorption of fat soluble vitamins A, D, E, K, malabsorption of fats proteins and carbohydrates, thick bile
What symptoms result in a child with cystic fibrosis due to the malabsorption of fats proteins and carbohydrates?
Poor growth, steatorrhea, retention of fecal matter in distal colon, fecal impaction prolapse or bowel obstruction
What electrolyte should especially be monitored when giving furosemide?
Potassium
What type of newborn is at risk for physiological anemia and why?
Premature Extra iron from mom is transferred to the fetus in the last trimester, babies born before this would have not received it
Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? 1. Previous streptococcal throat infection. 2. History of open heart surgery at 5 years of age. 3. Playing too much soccer and not getting enough rest. 4. Exposure to a sibling with pneumonia.
Previous streptococcal throat infection.
What is the difference between primary enuresis and secondary enuresis?
Primary is when they have had no toilet training, secondary is when they had bladder control and then regressed
In order to prevent infective endocarditis, what must pediatric patients with heart failure due prior to dental or minor procedures?
Prophylactic antibiotics
What is the treatment for a VUR with a grade of 4 to 5?
Prophylactic antibiotics at night, Surgical replantation of the ureters in another part of the bladder, it is very successful
What follow up care is required after acute rheumatic fever?
Prophylactic antibiotics for at least five years or until the patient is 21 years old, it will be given either orally daily or as a monthly injection. The patient will also need to be followed by a cardiologist to monitor for complications such as aortic stenosis or leaking mitral valve
What bacteria proliferates in the keratin plug causing acne vulgaris?
Propionibacterium acnes
Why does edema occur in nephrotic syndrome?
Proteins leaks in the form of albumin, lack of albumin allows blood and body fluids to shift into cells that they shouldn't
What is the function of skin in newborns?
Provides protective barrier to pathogen's Low fat and high water content compared to adults Limits loss of water Assists with thermal regulation Protects from physical trauma
What type of regional anesthesia is used for a circumcision?
Pudendal block
What pulmonary function is present in a child with moderate persistent asthma?
Pulmonary function 60 to 80% of normal
What pulmonary function is present and a child with mild intermittent asthma?
Pulmonary function greater than 80% of their normal
What pulmonary function is present and a child with mild persistent asthma?
Pulmonary function greater than 80% of their normal
What pulmonary function is present and a child with severe persistent asthma?
Pulmonary function less than 60% of normal
What 4 defects are present in Tetralogy of Fallot?
Pulmonary stenosis, VSD, right ventricular hypertrophy, overriding aorta
What testing is performed for allergic rhinitis?
RAST ( blood ), skin testing, and nasal smear (eosinophilis)
In regards to dietary management for hyperlipidemia, what education should be provided?
Read nutrition labels, and choose fat free options
What is the primary cause of acute rheumatic fever?
Recent history of a strep infection
What is the relationship between reflexes and neurological function?
Reflexes are important indicators of neurological function, newborns should lose reflexes that are not protective as they age. If they persist, reappear, or are absent this could indicate a neurological problem
What intervention should be done due to children with cystic fibrosis poorly absorbing fat soluble vitamins?
Replace them with a water soluble product
What are the complications of group a streptococcus pharyngitis?
Rheumatic fever, post streptococcal glomelularnephritis, tonsillitis
What is tinea cruris?
Ringworm in the groin that causes red, scaling, macerated skin. Often called jock itch
What is tinea pedis?
Ringworm of the feet, often called athletes foot, occurs between the toes and on the soles of the feet and it's very itchy
What is tinea capitis?
Ringworm of the scalp, eyebrows, and eyelashes that causes hair loss and peeling
What is tinea corporis?
Ringworm on the arms, legs, body, or face
What is tinea versicolor?
Ringworm on the trunk and extremities that causes a change in pigmentation, upper chest and back are the most common location
What are common signs and symptoms of a UTI in infants?
Same as older children, plus more subtle signs: irritability, poor feeding, foul smelling urine, vomiting
How are fungal infections diagnosed?
Scraping of the skin or use of wood lamp for tinea capitis
What is the treatment for tinea versicolor?
Selenium sulfide shampoo or topical anti fungal
What are risk factors for acquiring MRSA?
Sharing towels, close quarters, openings in skin, outdoor camps, dormitories
What type of medication is indicated for acute treatment of bronco construction and a child with asthma?
Short acting bronchodilators such as albuterol and levalbuterol
What is periodic breathing?
Short periods of newborn respiration pauses less than 10 seconds without changes in heart rate or oxygenation
What position to be lay the patient post tonsillectomy?
Side lying immediately
What findings would indicate stage 3 or severe acne?
Significant inflammation , severe papules/pustules, cystic nodules, high risk for scarring and post inflammatory hyper pigmentation
At what age can a child was a surgeon to see if their undescended testicle will come down on its own?
Six months
What treatment is indicated for a child with eczema?
Skin hydration, avoiding fragrances, topical corticosteroids or immune modulator's, oral anti-histamines, IM injections, maintain skin integrity and prevent infection
What are the skin variations in children?
Skin is thinner, less subcutaneous fat, blood vessels are closer to surface, higher water content, epidermis is loosely bound to dermis, less pigmented
What components comprise a newborns natural immunity?
Skin, mucous membranes, gastric acids, enzymes
What is the typical presentation of nephrotic syndrome?
Slowly worsening edema, marked generalized edema, infection, decreased urine, dark frothy urine, normal blood pressure, nausea and vomiting, children less than three years old
What is scalded skin syndrome and how is it treated?
Staph aureus causes sloughing and younger children, treatment is similar to burns with fluid replacement and IV antibiotics
What are the most frequent causes of bacterial skin infections?
Staphylococcus aureus, group A B hemolytic streptococcus
In order to get a accurate testing for bacteria in children, what method must be used to obtain a urine?
Straight catherization
What anatomical variation in children puts them at risk for ear infections?
Straight eustachian tubes
What is the common name for bacterial pharyngitis and what is the causative bacteria?
Strep throat, group a streptococcus
What may cause eczema flare ups?
Stress, extremes of temperature, skin irritants. Flareups may also cause a patient to not be able to sleep
What is the definition of a congenital heart disease?
Structural anomalies present at birth, half are diagnosed within the first week of life, 28% occur along with a syndrome or chromosome defect
What are the symptoms for foreign body aspiration?
Sudden coughing and audible stridor
What are the adverse effects of isotrentinoin?
Suicidal ideation, aggression, mood changes, increased cholesterol and/or triglycerides, teratogenic affects
What is a possible side effect of topical corticosteroids?
Sun sensitivity
What is the only change in sun protection for children greater than six months old?
Sunscreen can now be used liberally
How can diaper dermatitis be prevented?
Super absorbent diapers, decreased wetness to maintain normal pH, frequent diaper changes, barrier skin creams, drying skin by air
When must treatment for a testicular torsion take place?
Surgery must be performed within 6 to 8 hours to restore blood supply and salvage the testicle and fertility
What is the gold standard testing for cystic fibrosis and how is it performed?
Sweat chloride testing, a mild electrical current push his medicine into the skin to cause sweating, the sweat is collected onto filter paper and the salt content is measured. A result of high chloride is indicative of a likely CF diagnosis
What are the signs of heart failure in children?
Sweating, central cyanosis, tachypnea, tachycardia, poor or prolonged feeding, swelling of the eyes hands and feet, poor growth, fluid retention
What are the symptoms of glomerulonephritis?
Swelling periorbital or peripheral, hypertension, gross hematuria, proteinuria, azotemia
What is a complication of TOF and what nursing actions should be taken?
TET spell (hyper-cyanotic spell) The nurse should remain calm, place the infant or child knee to chest position, provide supplemental O2, administer morphine sulfate, supply IV fluids, and give IV propranolol if severe
How will urine appear in glomerulonephritis?
Tea colored without bacteria
What is a child with cryptorchidism at risk for?
Testicular cancer
Which congenital heart condition result in decreased pulmonary bloodflow?
Tetralogy of fallot
What is the cause of Kawasaki disease and how is it diagnosed?
The cause is unknown, and it is diagnosed through clinical symptoms using the Kawasaki disease diagnostic criteria
What is the benefit of Peak flow meter testing?
The child can learn to perform the test to help determine the status of their asthma, they can provide early identification of subtle symptoms, and early treatment can help decrease risk of permanent lung changes also known as remodeling
What does the term atopy refer to?
The genetic tendency to develop allergic diseases, this includes eczema, asthma, allergic rhinitis
What complications are patients with eczema risk for?
The itching and breaks and skin can lead to cellulitis or super infections
Why does hyperlipidemia occur with nephrotic syndrome?
The liver tries to compensate for the protein loss by making more proteins in the form of lipids
If the woman test negative for the CF gene, what is the next step in screening?
The partner does not need to be tested, since this is a autosomal recessive disorder, both partners must be positive for the child to develop cystic fibrosis
To avoid trauma post tonsillectomy, what instructions must the nurse tell the patient?
The patient should avoid coughing, blowing the nose, clearing the throat, using straws, incentive spirometry
A child with bronchiolitis is able to relieve their wheezing by coughing, what does this mean about the infection?
The secretions are in the lower trachea
A child's tympanic membrane appears white and the doctor states it is tympanosclerosis, what does this mean?
The tympanic membrane has ruptured in the past, and is now healed
Although male children can develop a UTI, why are they less likely to in comparison to females?
Their urethra is longer
A child with bronchiolitis is not able to relieve their wheezing with coughing, what does this mean about their infection?
There is a obstruction of the bronchioles
What are the actions of inhaled corticosteroids and how are they given?
They are anti-inflammatory to reduce the frequency and severity of asthma exacerbation's, they are given with a meter dosed inhaler with a spacer or by nebulizer
How is formula stool in comparison to breastmilk stool?
They are both yellow, but breastmilk is a lighter yellow and more seedy
What is true of newborn touch?
They are sensitive to pain and respond to tactile stimuli
What education should be provided for topical acne medications such as benzoyl peroxide and trentinoin?
They can bleach clothes and fabrics they come in to contact with, avoid contact with eyes and mucous membranes
What is true of newborn smell?
They can distinguish mothers breast milk
What is true of newborn taste?
They can distinguish sweet and sour at 72 hours old
What is different about the urinary concentration of children?
They cannot concentrate urine well and lose a lot of water in their urine due to slower blood flow to the kidneys. This puts them at risk for dehydration. Once they reach two years old their urine in concentration will look more like adults
What is concerning about the child having a more pliable chest wall?
They cannot support their lungs adequately, and movement is dependent on the diaphragm. If the lungs become hyper inflated, intercostal muscles cannot lift the chest wall
Leukotriene receptor antagonist such as montelukast and zarfiirlukast are often used in the treatment of allergic rhinitis, what actions do these medications perform and what route are they provided in?
They decrease inflammation by interfering with Leukotriens, and they are most often given as a chewable tablet
Why do newborns lack IgA and IgM at birth?
They do not cross the placenta
Why are infants at risk for fluid overload?
They have a decreased GFR
What is different about the child trachea compared to an adult?
They have a higher bifurcation, and they are at more risk for aspiration into the right lung
What is true of the G.I. system of a fetus while in utero?
They have an absence of intestinal bacteria in their gut is sterile, they will receive their mucosal barrier within 24 hours of birth
Why do babies tend to spit up a lot?
They have an immature GE sphincter and decreased stomach motility
How are pulse oximeter's placed on pediatric patients?
They must be taped and are usually placed on a big toe with a sock or clothing covering it
While on isotrentinoin treatment, what must the patient do due to the teratogenic affects of the drug?
They must join the iPledge program, and follow these three requirements: 1. Must use two forms of birth control 2. Have monthly pregnancy test 3. Cannot donate blood while using this drug or for one month after discontinuing use
What education should be provided to adolescence on the use of tanning booths?
They should be avoided because the UV rays are 10 to 15 times higher than the midday sun
What sun protection is indicated for children under six months old?
They should be kept out of direct sunlight as much as possible due to having limited pigmentation, they need to wear a hat with a brim, long sleeves, sunglasses, and be kept in the shade. A minimal amount of sunscreen greater than or equal to 15 SPF to small areas on hands and feet (they will absorb chemicals more readily)
What consideration must be made due to the newborns limited detoxification ability of their liver?
They take longer to excrete medications
Children with cystic fibrosis had a mutation of their exocrine glands and the CFTR protein, what does this result in?
They will have an abnormal transport of chloride and water, resulting in high levels of chloride excreted in the sweat causing skin to taste salty. Sweat glands, G.I. tract, pancreas, respiratory tract, and other exocrine tissues become obstructed by thick mucus
What puts newborns at risk for heat loss?
Thin skin Large body surface area Lack of fat Lack of shivering Limited muscle activity Limited stores of energy sources (brown fat)
What route is indicated for trentinoin, what action does it take in the treatment of acne, and what additional information should be provided to the patient?
This is a topical treatment for acne, it unblocks clogged follicle. It is usually used in combination with a topical antibiotic. It's onset is two weeks, and its peak affect is seen at six weeks
What route is indicated for benzoyl Peroxide, and what action does it take in treating acne will vulgaris?
This is a topical treatment for moderate to severe acne, it inhibits the growth of P. Acnes
What is atopic dermatitis?
This is often referred to as eczema, it is a chronic skin condition. Exposure to an allergen causes extreme itching, inflamed red skin. Lichenification of the skin may also occur overtime time. Symptoms usually develop before the age of two.
Why should antibiotics for a UTI be given at night?
This is when the urine is static and the medication will have more time to work
How is pharyngitis diagnosed?
Throat culture
What is the goal of treatment for asthma?
To control and prevent inflammation
What is the goal for hypertensive pediatric patients?
To reduce their blood pressure to less than 90th percentile for their age and gender
If a patient wanting to conceive or pregnancy test positive for being a cystic fibrosis carrier, what is the next step in screening?
To test the partner, if the partner also test positive additional screening is performed depending on if the woman is pregnant or wanting to be pregnant. If the woman is pregnant, chorionic villus sampling or amniocentesis is performed to see if the fetus has cystic fibrosis. If the woman is not pregnant but wishes to be, in vitro fertilization to avoid the CF gene as well as adoption must be discussed.
What is the general treatment for fungal infections?
Topical antifungal medications for four weeks, once we start treatment they are no longer considered contagious and can go back to normal activities
What is the reason for pulmonary manifestations in a child with cystic fibrosis?
Tracheobronchial glands produce excess thick mucus that's hard to cough up and plugs the small airways causing bronchiolitis. Bacterial infections are common causing more inflammation, mucus plugging, chronic infection, tissue damage, and eventually respiratory failure
What is the goal in treatment of bacterial skin infections?
Treat active infection and prevent secondary infections
When a child with asthma is sick, how often should they perform peak flow meter testing?
Twice a day
What are the possible complications of acute otitis media?
Tympanic membrane perforation, acute mastoiditis, intracranial infections
What is a child with labia adhesions at risk for?
UTI
What are two common reasons for secondary enuresis?
UTI and type 1 diabetes
For insurance purposes, when must a circumcision be performed?
Up to four weeks of age in the hospital or pediatric office
What is hypospadias?
Urethral opening located behind the glands of the penis or on the ventral surface of the penile shaft
What is the number one risk factor for a child developing a UTI?
Urinary stasis. The child may not want to stop playing to use the restroom, or they require self catherization
What intervention can be made to allow an infant with heart failure to feed easier?
Use a special nipple with a larger opening so that it is less effort for them to suck
What education should be provided on the use of oral histamine's in children with eczema?
Use them at night to help them sleep and reduce itching because it may cause drowsiness
How is VUR graded?
Vesicoureteral reflux (VUR) is graded according to the severity ⇒ how far urine refluxes back up into the urinary tract (1-5)
What is essential for the nurse to do during post cath care?
Vital signs, neurovascular status of the affected extremity, and dressing checks. This will be done every 15 minutes for the first hour and then every 30 minutes for the next hour until stable
To assist with blood coagulation, what intervention is done in newborns?
Vitamin K is given within 1 hour of birth because the neonate has no liver stores of vitamin K
What is the nursing care indicated for an infantile acne?
Wash daily with clean water, keep dry, and reassure parents that this will resolve on its own and no further treatment is required
Where do we check a pulse in infants?
We can use the radial, brachial, dorsalis pedis, posterior tibial, and femoral Always compare the pulses of the upper extremities to the lower extremities
If a child with cystic fibrosis has healthy lungs, how do we modify their exercise?
We do not, they can exercise just like everyone else
Small frequent feedings are indicated to address nutrition in children with heart failure, when should these feedings be implemented and for how long?
We limit feeding to 20 minutes every three hours
What are common allergens that may cause eczema?
Wheat, eggs, peanuts, environmental, detergents, fragrance, pets, extreme temperature variations
What is the most important question when assessing how much surfactant a fetus may have?
When is the moms due date? Surfactant starts to be produced 22 to 24 weeks gestation, if the baby is coming before 34 weeks betamethasone needs to be given to mom
When can the bag the bag method be used when testing urine in children?
When testing for proteins
When is it recommended for women to be tested for cystic fibrosis risk?
When they are presenting for pre-conception or prenatal care, or natal if they were not seen prenatal
What should be avoided when caring for a child with diaper dermatitis?
Wipes containing alcohol, they can be very painful. Clean with sterile water instead.
When does pulmonary gas exchange begin?
With the first breath of life
Are statins safe to give to children?
Yes
Can pediatric patients receive antihypertensive medications?
Yes, if diet, activity and weight loss do not work
What is common in a previous medical history for a child presenting with acute otitis media?
Young age, recent URI, daycare attendance, and a previous AOM or OME
What is vesicoureteral reflux (VUR)?
abnormal retrograde (backward) flow of urine from bladder into upper urinary tract that can cause pyleonephritis and kidney scarring when urine is not sterile (UTI)
When is the neonatal period?
birth to 28 days
What is surfactant?
chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing
What is cold stress?
exposure to temperatures cooler than normal body temperature so that the newborn must use energy to maintain heat
What is enuresis?
intentional or involuntary passage of urine in a child who is beyond age when bladder control should be normally controlled
What is the function of sebaceous glands?
produce oily sebum to lubricate and waterproof your hair and skin; contributes to the severity of acne
What is thermoregulation?
regulation of body temperature
What is the function of the ductus venosus?
shunts blood away from the fetal liver
What is neonatology?
study of newborns and the treatment of their disorders
What is meconium?
the dark green substance forming the first feces of a newborn infant that occurs in the first 24 hours
What is the function of the ductus arteriosus?
the ductus arteriosus shunts blood directly from the pulmonary artery into the aorta in the fetus