Module 1 + 2 - Pediatrics
What is the normal appearance of a toddler?
"Pot bellied appearance" protruding abdomen results from undeveloped muscles Bow legged since the legs must bear the weight of the relatively large trunk
What is mycoplasma pneumonia?
#1 cause of atypical pneumonia Walking pneumonia Penicillin ineffective because mycoplasm lacks cell wall Azithromycin is the treatment
What is a nasal pharyngeal washing?
+ identification of RSV or other viral illness with a swab test
What are imaginary friends?
-Helps enhance creativity and cognition -They become the kids friend in times of loneliness -They accomplish what the child is still attempting -They experience what the child wants to forget or remember -The friend is often blamed for wrongdoing -Helps the child differentiate between pretend and reality
When should kids receive hepatitis A vaccines?
1 year old At least 6 months after first dose
What is normal output for an infant?
1-2 ml/kg/hr
When should head and chest circumference be equal?
1-2 years of age
How much sleep does the school age child need?
10-12 hours a night ROUTINE Night terrors and sleepwalking may occur but should resolve by age 8 to 10 years
What is the maintenance fluid formula?
100 mL per kg of body weight for the first 10 kg 50 mL per kg of body weight for the next 10 kg 20 mL per kg of body weight for the remainder of body weight in kilograms
When should kids receive TDAP vaccines?
11-12 years old
When should kids receive meningococcal vaccines?
11-12 years old 16 years old
When should kids receive MMR vaccines?
12-15 months 4-6 years old
When should kids receive varicella vaccines?
12-15 months 4-6 years old
What are the sleep requirements of the toddler?
18 month old: 13.5 hours of sleep per day 24 month old: 13 hours of sleep per day 3 year old: 12 hours of sleep per day May discontinue daytime napping around 3 years of age
When do you receive a rotavirus vaccine?
2 months 4 months
When should kids receive Hib vaccines?
2 months 4 months 12-15 months
When should kids receive pneumococcal (prevnar) vaccines?
2 months 4 months 6 months 12-15 months
When do you receive a Dtap vaccine?
2 months 4 months 6 months 15 months 4-6 years old
When should kids receive polio vaccines?
2 months 4 months 6-18 months 4-6 years old
How long do you have to wait before receiving a DIFFERENT vaccine (if you don't want to get them all together)?
2 weeks Checking for reactions / issues
How long do we adjust premature ages for?
2 years
When does the posterior fontanelle close?
2-3 months
How long will isolation be necessary for a child with meningococcal meningitis?
24 to 72 hours after antibiotic therapy initiation
How do gross motor skills progress in the infant?
3 months neck 6 months sitting up 9 months knees 12 months feet Front to back roll over = 4 months Back to front roll over = 5 months 2-3 months tummy time (neck control, muscle development, prevents plagiocephaly or flat head)
When is it appropriate to use a faces pain scale?
3-6
How long does it need to be before you receive the same vaccine again?
30 days
What is the normal respiration rate of an infant?
30-60 breaths per minute 95% O2 or higher Listen for a full minute
Infant growth: Head circumference
35cm (13.5in) at birth Increases by about 10cm at 12 months
What are some gross motor skills of the preschooler?
3YO -Climbs -Pedals tricylce -Runs -Walks up and down stairs with different feet 4YO -Kicks ball -Catches ball -Hop on one foot -Move back and forward with agility 5YO -Stand on one foot 10 -Skips -Swings and climbs -Somersaults
What are some fine motor skills of the preschooler?
3YO -Undresses self -Holds pencil -Screws and unscrews lids -Turns book pages 4YO -Uses scissors -Copies capital letters -Draws person with 2-4 body parts -Laces shoes 5YO -Prints some letters -Dresses and undress with no assistance -Uses fork and spoon and knife -Mostly cares for own toileting needs
For the infant, where do we hear the heartbeat?
3rd or 4th intercostal space If found at 5th it may be enlarged
Which vaccines would a nurse administer to an 18-month-old toddler who has received appropriate immunizations on time?
4th DTaP vaccine DTaP vaccine can prevent diphtheria, tetanus, and pertussis
When is it appropriate to use a numeric pain scale?
6 and up
Which age group of hospitalized children has the most difficulty with separation anxiety?
6 to 30 months of age
How many wet diapers a day for an infant?
6-8
Average infant blood pressure?
60/40 at birth Steadily increases to 100/50 in first 12 months
How long does a common cold last?
7-10 days
What is a normal heartrate for an infant?
80-150 bpm
When do children understand that dying is permanent?
9 years old (about)
Average infant temperature?
97.5 Fever <2 months = 100.4 Fever >2 months = 101.5
What is Reye's syndrome?
A rare syndrome of rapid liver degeneration and swelling in children treated with aspirin during a viral infection Influenza + varicella
What is negativism?
A typical behavior of toddlers saying "no", refusing to do what is asked, or doing the opposite.
What is PIAGETS developmental theory for school age children?
CONCRETE OPERATIONAL Understands time more Perform operations concretely Develop logical thinking skills
What is important to remember about corticosteroids?
Can affect BP and HR (increase) Causes butt to feel on fire when giving it IV Can affect eyes Hyperglycemia Rinse mouth out after inhaled route
What is important to remember about antivirals?
Can decrease seizure threshold Work best in first 48 hours
What should you remember about albuterol and kids?
Can increase the heartrate (not good if they have a heart defect) Fine tremors
Why wouldn't you want to give an infant benadryl?
Can mask signs of anaphylaxes
What is Acute Respiratory Distress Syndrome (ARDS)?
Cannot breathe and goes into distress RSV + sepsis + pneumonia + drowning Early sign = restlessness + anxiety + tachypnea Later signs = stridor + grunting Make sure airway is clear and provide O2 PEEP - positive end expiratory pressure (always keeps the alveoli and lungs open) higher the number needed the more sick the lungs are!
What are some other problems people with down syndrome have a predisposition towards?
Cardiac defects - monitor Visual and hearing impairment Intestinal malformations An increased susceptibility to infections - especially URI's Hypothyroidism - check every year 6/12 months and then yearly
What is digoxin?
Cardiac glycoside Take HR for full minute before and if below 90 hold and call DR Give with food? NO What if you miss dose? Wait for the next one if greater than 4 hrs since missed dose If they vomit the pill up you do not give another pill! 0.8-2.0 parameter (over is digtoxicity) Digtoxicity = arrythmias + vomiting
What intervention should the nurse include in the plan of care for a child with acute bacterial meningitis?
Check level of consciousness hourly Reveals intercranial pressure issues
How would the nurse respond to a parent's concern about a finicky eater?
Child's behavior is expected due to slower growth
What should you remember about the flu?
Children with additional issues (asthma) need antivirals in the first 48 hours
How do you assist children with chronic illnesses?
Children with chronic illnesses may need specialized health supervision needs and more frequent visits Critical need for coordination of services from multiple specialties through medical home
What do you do for styes?
Clean the eye Warm compress
What are the long term risks for the premature infant?
Cognitive delays Visual impairment, chronic lung disease Cerebral palsy ADD Learning disability Vulnerable child syndrome
How does vocabulary develop in the toddler?
Concerned with the "why" and "how" of things Vocabulary (2 years old) over 200 words, 2 to 3 word sentences Sense of time is exaggerated Points to 5 body parts and carries out 2 and 3 item commands Vocabulary of about 300 words by age 3 Echolalia - Repeating things
When do we hear rhonchi?
Congestion Can usually be cleared with a cough
What approach would be most effective when discussing smoking prevention with adolescents?
Discussing how smoking affects appearance and breath odor
What is furosemide?
Diuretic Need to replace electrolytes like K+
What are the language problem warning signs in the infant?
Does not make sounds at 4 months of age Does not laugh or squeal by 6 months of age Does not babble by 8 months of age Does not use single words with meaning at 12 months of age (mama, dada)
What are the hearing problem warning signs in the infant?
Does not respond to loud noises Does not make sounds by 4 months Does not turn to locate a sound by 4 months
How long does sinusitis last?
Does not start for 14 days A cold that does not go away
What is a selective screening?
Done when a risk assessment indicates the child has one or more risk factors for a disorder
What is trisomy 21?
Down syndrome
What vaccines are attenuated?
EVERY OTHER ONE LMAO ALL IM
What are signs of intercranial pressure?
Early: Headache + vomiting + dizziness + bulging head + large circumference Late: Decreased LOC + bradycardia + respiratory issues Risk: Infection Treatment: Shunt + lay them on unaffected side
What are some development concerns for the adolscents?
Eating disorders Substance abuse Suicide
What are some emotional and social issues in the school age child?
Eating disorders can begin around this time Bullying becomes a larger issue at this time Self esteem development Friendships more important School age fears (most fear out of any age)
How do you minimize physical distress?
Engage the child in identifying what would make him or her comfortable Use distraction methods (music, conversation, sing, bubbles) Topical anesthetics before injections (about an hour)
What are the HEENT changes in preschooler?
Eustachian tubes slanted by age 2 - less prone to swimmers ear / ear infection because easier to drain 20 deciduous teeth should be present
When do infants receive their first full set of vaccines and what do they recieve?
Every 2 months Rotavirus Dtap HIB Pneumococcal Polio BOOSTER hep b
What is a snellen exam?
Eye exam Read from distance (L+R)
What are signs of vision problems in school age children?
Eye rubbing, squinting - could be visual issues or need for glasses Avoids reading Frequent headache Sports-related eye injuries and eye protection are important in this age group
What does development of gross/fine motor skills in the school age child look like?
Eye-hand coordination and balance improve May become awkward as bodies growing faster than able to compensate
What is PIAGETS developmental theory for adolescents?
FORMAL OPERATIONAL Logical thinking and understanding abstract ideas and theories + better problem solving
What is the FLACC scale?
Face Legs Activity Cry Consolability scale Which measures the pain for a child under 3
How do we promote toddler nutrition?
Finger foods that are SAFE to walk around with 18oz of milk a day ONLY (Too much calcium depletes iron stores) 5 Servings of fruits and vegetables
How do teeth emerge in the infant?
First tooth at 6 months First primary teeth are incisors Lose first tooth at 6 years Teething start at 4 months (drooling, pulling at ears, low grade fever, rash)
Why are ear infections more common in children?
Flat/horizontal eustachian tubes until over 2 Fluid being caught in the ear and sitting there collecting bacteria Swimmers ear Maternal smoking - One of the highest risk factors
What care plan would the nurse implement for an infant with non-organic failure to thrive?
Following a structured routine throughout the day
How do you teach about hygiene to adolescents?
Frequent bathing and deodorant Teach hygienic care for body piercings and tattoos
How do you treat failure to thrive?
GAIN WEIGHT High protein diet Pancreatic enzymes need to be given WITH FOOD!!!
What are some changes we see during puberty?
Girls = Breast buds + menses + pubic hair + pigmentation on genitalia Boys = Pubic hair + scrotum and testes enlarge + facial hair + breast tissue disappears
What are beta blockers?
Given for hypertension and arrhythmias HR and BP right before administration Sotalol Atenolol
What is cephalocaudal growth?
Growth from head to toe
Which intervention helps a toddler be more comfortable during an examination?
Have the parent hold the toddler
When do you start CPR on an infant?
Heart rate <50 bpm
How is heart rate effected in the toddler stage?
Heart rate decreases
What developmental interaction would the nurse provide to promote safety among adolescents?
Helping parents minimize risks to their adolescent safety Teaching parents to serve as role models by guiding expectations and providing education
What is a concern during TPN for children?
High glucose
What happens to hemoglobin with the infant?
High levels at birth Decreases over first 2-3 months Stabilizes by 6-9 months WITH ADEQUATE IRON!!!
Which condition would the nurse associate with a six-week-old infant having non-symmetrical folds on their legs?
Hip dysplasia
What are some consequences of childhood obesity?
Hypertension Hyperlipidemia Insulin resistance (19 = normal insulin level)
When do we do a blood gas?
Hypoxia
What statement from the infant's parents supports the nurse's assessment of hyponatremia?
I give my child purified water in the afternoon
What statement by a parent indicates a need for further education about emergency treatment of poison ingestion by preschool-aged children?
I will immediately start treatment at home by using gastrointestinal decontamination Nurses are ones who use gastrointestinal decontamination ONLY AFTER toxicity of the poison is determined and only if it will benefit the child CALL PCC OR TAKE THE CHILD TO THE HOSPITAL ALWAYS!!!
What statement made by a parent indicates an understanding of all-terrain vehicle safety education for their 11-year-old child?
I will make sure my child does not get on an ATV
What is ERIKSONS developmental theory for adolescents?
IDENTITY VS. ROLE CONFUSION Develop sense of self and personal identity through exploration
What is ERIKSONS developmental theory for school age children?
INDUSTRY VS. INFERIORITY Learning new skills successfully leads to industry Learning new skills UNsuccessfully leads to inferiority
What is ERIKSONS developmental theory for preschoolers?
INITIATIVE VS. GUILT (3 to 6 years) They want to help and do things in the home Praising encourages behavior while shaming them promoted guilt
How does imitation help the toddler?
Imitation displays deeper meaning and understanding (such as imitating household activities)
What action would the nurse take first when admitting an infant with bacterial meningitis?
Implement respiratory isolation precautions EXTREMELY CONTAGIOUS - DROPLET
What causes failure to thrive?
Inability to suck and swallow Malabsorption Diarrhea Vomiting
What is egocentric thinking?
Inability to view situations from perspectives of others (this is my toy all of the toys are mine)
What is failure to thrive?
Inadequate weight gain based on standard growth charts Less than the 3rd to 5th percentile on standard growth chart
What is a risk screening?
Includes objective and subjective data to determine the likelihood that the child will develop a condition
What is growth?
Increase in physical size
What do we call a child for 28 days - 1 year of life?
Infant
How do you distract children?
Infant - Pacifier with sucrose (lowers pain threshold) Children - games, toys, books, music
What is a premature infant?
Infant born at <36 weeks' gestation
What is stranger anxiety?
Infant recognizes self and CLOSE people (like mom) as separate from others Develops around 8 months and lasts until walking Peaks around 2 due to siblings and daycare Peaks again around 4-5 due to school
What is a risk a child has with heart defects + cardiac procedures has?
Infection Prophylactic antibiotics Once defect is healed - stop antibiotics Prevents endocarditis
What is bronchitis?
Inflammation of the bronchi (larger airways) Cough Can happen to children who had croup More common as kids grow older
What is bronchiolitis?
Inflammation of the bronchioles (smaller airways) More common in young children
What is epiglottitis?
Inflammation of the epiglottis from croup MEDICAL EMERGENCY Bacterial infection that can cause airway to close in 6 hours AIRWAY main priority Never have them open their mouth to visualize (can cause airway to completely close) Never place in supine Airway supplies at the bedside Signs include drooling + pallor + difficulty breathing + temperature RAPID
What is pneumonia?
Inflammation of the lungs Crackles/rales Use of antipyretic
What is pharyngitis?
Inflammation of the mucous membranes of the oropharynx Can be viral or bacterial Can lead to group A strep
What is tonsilitis?
Inflammation of the tonsils Can be viral or bacterial
What is foreign body aspiration?
Inhalation of an object into the respiratory tract You hear breath sounds that are unequal Right side is more common
How do we verify placement of the tubes in children?
Initial Xray Injection of air used after
What strategy would the nurse use to teach a preschooler about medical interventions?
Initiating therapeutic play
What intervention would the nurse provide for an infant admitted to the pediatric unit with bronchiolitis caused by respiratory syncytial virus (RSV)?
Instilling saline nose drops Maintaining contact precautions Nasal suctioning to remove mucus TREAT SYMPTOMS
Why can't children receive Cipro (antibiotic)?
Joint and cartilage damage
What nursing interventions can help prevent medication errors in Pediatrics?
Knowing medication information Avoiding verbal telephone orders Checking medication label and client information Using authoritative resources as references
What do an infants tonsils look like?
LARGE Only really removed at a young age if they cause OSA because they are so big OR reoccurring infections like strep
What is a labial adhesion?
Labia is adhered together Use creams like Vaseline or estrogen creams
What is amblyopia?
Lazy eye Eye defects in one eye (near-sighted, far-sighted, or astigmatism) Malalignment of the eye muscles (strabismus)
How do we give oxygen to a child?
Least invasive to most invasive Nasal cannula to begin (start at 1/10th of a liter) Suctioning (bulb syringe) to clear Assess before and after
What recommendation should the nurse provide to a parent of a three-year-old afraid to sleep alone due to monsters?
Leave a small light on and state that monsters are not allowed in the house
What is the primary goal for an unconscious child with a closed head injury?
Limit stimuli that increases intracranial pressure
What fears related to growth and development should the nurse plan for a hospitalized pediatric client?
Limited independence Separation from family Receiving investigational treatment Being in an unfamiliar environment
How does temperament range in the infant?
Low to moderately active, regular, and predictable Highly active, more intense, and less adaptable
Which vaccines are live?
MMR Varicella Influenza (NASAL) Rotavirus (ORAL) ALL SUBQ
What should the nurse include in the plan of care for a child recovering from status asthmaticus?
Maintain high Fowler's position
What nursing intervention is advisable for an unconscious child who swallowed a poisonous substance?
Make arrangements for the child to be taken to a hospital immediately
What would the nurse encourage for a school-age client with a chronic illness to enhance a sense of accomplishment?
Making up missed work
What about masturbation with preschoolers?
Masturbation in preschoolers can be a normal behavior Teach about limits and social behaviors
How does the immune system change in school age child?
Matures to adult level around 10 years old Fewer infections experienced
What is rubeola?
Measles Viral infection Fever + runny nose + cough, + white spots in the mouth for three days + rash that started on the face and has now spread to the entire body
What aspect of safe medication administration in the pediatric population should the nurse consider?
Medications can cause unanticipated side effects Dosing ranges are important Many medications have not been tested in children Some may be ineffective
What is asthma?
Most common chronic illness of childhood Wheezing Chronic inflammatory airway disorder Very controllable Non-compliance is very common 3 characteristics = Airway hyperresponsiveness + Airway edema + Mucus production Know your triggers - allergens + exercise + weather Every child needs an asthma action plan - based on peak flow for that day Peak flow test on a non symptomatic day to know baseline
What is the Ages and Stages Questionnaire?
Most common screening tool for childrens development
What is proximal-distal growth?
Motor skills are developed from the core outward
Number one cause of death in school age child is what?
Motor vehicle accidents MUST BE 4'9" or 80lb to sit in the front seat ALSO safety is important during bicycle and sports (WEAR HELMET)
How do you give a flu shot to a child <9 if they have not had one before?
Must get 2 shots - 4 weeks apart
How do you educate the adolescent on sexual health?
Must have access to contraceptives Teens need to learn about these new feelings and how to manage them in an appropriate way Parents need to support in these conversations
Can you give an infant honey?
NO Can cause botulism because it is not pasteurized
Can you give infants <6 months water?
NO Can cause electrolytes to imbalance
Should you change an infants formula regulary?
NO Unsuitable for childs gut health
Can children receive aspirin?
NO If given with a virus can cause Reyes syndrome Can be given for heart defects + seizures
How does nutrition change in the school age child?
NO sugary drinks Needs vary based on age, gender, and activity Daily fruits and vegetables Can use non fat or skim milk now Moderate to vigorous exercise for 60 minutes per day
What does a cardiac cauterization look like for children?
NPO 4 hours before Sedation Pressure on and above the site (femoral) Check pulses No bath for 3 days post op
What is indomethacin?
NSAID, prostaglandin inhibitor Helps close the foramen ovale and ductus arteriosus
What do we call a child for the first 28 days of life?
Neonate
What are the rules for physical activity in school age children?
No more than 2 hours of screen time (non educational) 1 hour of physical activity daily
How do infants breathe?
Nose Produce very little mucus When sick become mouth breathers which makes it hard for them to eat Rate is faster (30-60 breaths per minute)
What is epistaxis?
Nose bleed Pinch nose and lean forward Major cause is nose picking How long has it been bleeding? Can you stop the bleeding? Is this the first time? Mupirocin (ointment) or petroleum jelly
What is a note to remember when giving a child antibiotics?
Note allergies Take for its full time Strep? Throw toothbrush out 24 hours after starting antibiotics
What has the biggest impact on infant growth?
Nutrition Best indicator of nutrition is height and weight (percentiles)
What are monosomies?
Only one copy of a particular chromosome instead of the usual pair
How do restraints work for children?
Order within an hour Face to face check by practitioner within 1 hour of application Renewed every 24 hours Skin check every hour If in a vest restraint THEY NEED to be on observation Arm board used to prevent bending IV arm is NOT a restraint
When can you give expectorants?
Over age 6 Usually only if they cannot sleep
What do pacifiers do for the infant?
Pacifiers good until 1 year Pacifiers at bedtime can prevent infant from getting to the deep sleep where SIDS occurs
What is the most common side effect of a vaccine?
Pain at the injection site
What should you remember about ear infections?
Pain on the outside? Otitis externa Drops Pain on the inside? Otitis media acute Antibiotics - Penicillin unless allergic
What type of play do toddlers use?
Parallel play toddlers Play side by side each other but not together
What is vulnerable child syndrome?
Parents are overly concerned with their child's chronic disease Preterm birth Congenital anomaly Handicapping condition An accident or illness that the child was not expected to recover from Crying or feeding problems in the first 5 years of life (colic)
How is growth measured on a growth chart?
Percentiles
What recommendation would the nurse make to a parent of a six-month-old regarding safe sleep practices?
Place the infant in a supine position for sleep
How do peer relationships change in adolescents?
Play essential role in identity of the adolescent Can have positive or negative influences
What clinical manifestation during administration of Methylprednisolone requires immediate intervention?
Polyuria (large volumes of dilute urine) IV steroid can cause rapid increase in blood glucose
What is a potential indicator of poor growth in an infant with cystic fibrosis?
Poor appetite
What is a physical indicator of cardiac dysfunction?
Poor feeders (higher calorie formula) Tachypnea Crackles Diaphoresis Cyanosis Murmur Sternal lift
What are risk factors for respiratory issues in children?
Prematurity Chronic illness Daycare Cigarette smoke Crowded living conditions
What is PIAGETS developmental theory for preschoolers?
Preoperational substages: preconceptual (2 to 4 years) and intuitive phases (4 to 7 years) Kids develop egocentric thinking conceptualizes time in present terms only, uses symbols to respect objects, develops more logical intuitive thinking, and gains an imaginative ability
What do we call a child for 3-6 years of life?
Preschooler
What is magical thinking?
Preschoolers believe that thoughts or behaviors are all powerful and that they have control over specific situations
What developmental achievements distinguish preschoolers from school-age children?
Preschoolers have imaginary playmates Preschoolers believe that inanimate objects have lifelike qualities
How does friendship and play change with preschoolers?
Preschoolers learn how to make and keep a friend Change to cooperative play (playing together)
What is Atruamatic care?
Prevent or minimize physical stressors, including pain, discomfort, immobility, sleep deprivation, inability to eat or drink, and changes in elimination Minimize child and parent being separated
What is alprostadil?
Prostaglandin Helps keep foramen ovale and ductus arteriosus open
What are the stages of separation anxiety?
Protest - Screams + cries + anger + inconsolable Despair - Withdrawn + quiet + apathy + depression Detachment - Coping mechanisms + resignation but not contentment
How does nutrition change for adolescents?
Provide education to the teen regarding nutritional value of favorite foods and suggest better alternatives for those with lower nutritional value Emphasize the role of physical activity in maintaining healthy weight; provide healthy physical activity options not related to sports (60 minutes per day is recommended)
What measures would be included in the plan of care for a child with nephrotic syndrome (kidneys not working properly)?
Providing symptomatic care Eliminating high sodium foods Monitoring response to steroids
What will growth of the adolescent look like?
Puberty begins in girls around 9 to 10 years old and in boys around 10 to 11 years old Physical development, hormonal changes, and sexual maturation occur during puberty Girls up to 5in a year in growth spurt Average age for menses is 11.9-12.9 Sexual characteristics and reproductive maturity occur
How do you give ear drops to a child <2 years old?
Pull ear back and down (not just back like in adults)
What type of toys should toddlers use for motor skills?
Push pull toys help enhance walking skills Play dough, blocks, containers, toy telephone, wooden puzzles, cloth books, and simple musical instruments
What is important for parents to understand with children dosages?
READ CAREFULLY 0.05 can be mistaken for 0.5
What is cystic fibrosis?
Recessive genetic disorder Excess thick mucus lining airways causing decreased resistance to infection and air trapping Decreased pancreatic enzymes and hypersecretion of gastric acids (risk for malnutrition) Lack vitamins ADEK Symptoms = salty skin + chronic respiratory issues + lung infection + poor growth + meconium ileus + bulky / greasy stools + risk for diabetes + risk for sterility Sweat test is the diagnosis Pancreatic enzymes given with food
What are the psychological effects of hospitalization on children/family?
Regression - can be normal so DO NOT punish it Anger
What is the priority nursing action when a child with laryngotracheobronchitis develops pneumonia, tachycardia, intercostal and substernal retractions, and increased restlessness?
Report the respiratory status to the practitioner immediately
What is RSV?
Respiratory synctial virus Common among children No treatment (treat symptoms) Can the child eat? Are they oxygenating? (O2?) Can last up to 21 days Contact+ precautions = gown and mask and gloves
What is the JONES criteria?
Rheumatic fever criteria list MAJOR ●Carditis ●Migratory polyarthritis ●Erythema marginatum ●Sydenham chorea Subcutaneous nodules MINOR ●Fever ●Arthralgia ●Prolonged PR interval ●Elevated ESR ●+C-reactive protein or ESR
What communicable infection would a nurse in the pediatric clinic be concerned about after receiving a call from the mother of a 12-month-old in Flint who had a fever, runny nose, cough, and white spots in the mouth for three days with a rash that started on the face and has now spread to the entire body?
Rubeola
What is PIAGETS developmental theory for infants?
SENSORIMOTOR (birth to 2 years) Infant uses senses and motor skills to learn about the world Substage 1 = Reflexes (Sucking brings pleasure and nutrition) BIRTH TO ONE MONTH Substage 2 = Primary Reactions (Purposeful action like thumb sucking for pleasure) 1-4 MONTHS Substage 3 = Secondary Reactions (Action with a wanted result like shaking a rattle just to hear it) 4-8 MONTHS Substage 4 = Coordination (Plan with an end goal in mind like crawling across the floor to get to a desired toy) 8-12 MONTHS
What is PIAGETS developmental theory for toddlers?
SENSORIMOTOR AND PREOPERATIONAL Differentiates between itself and an object + increased object permanence + beginning symbolic thought
What do we call a child for 6-12 years of life?
Schoolage
What is a universal screening?
Screening of an entire population regardless of the child's individual risk HEARING + VISION + BMI + SCOLIOSIS (until 16)
What are specific screenings?
Screenings for - Metabolic - height and weight Hearing Vision Iron-deficiency anemia - 12 and 15 months Lead Hypertension - 9 years Hyperlipidemia - 9 years
What is development?
Sequential process of skill attainment
How does the skin change in adolscents?
Skin changes related to increased sebaceous gland secretions may lead to skin eruptions (acne) Avoid squeezing Best thing is water!
What are the characteristics of someone with down syndrome?
Slanted eyes Lower ears Enlarged tongue - occlusion, dry mouth, respiratory infection, colds
What will growth of the toddler look like?
Slow growers Weight gain = 3-5lb a year Height = 3in per year By age 2 they are 1/2 the size they will be as an adult
This shit is 300 terms long???????????
Somebody better pay me for this
How do you speak to a teen?
Speak respectfully as you would to a colleague Ask open-ended questions to clarify and promote understanding Solicit the teen's input in decision making as often as possible Clearly state expectations and set limits fairly
What are the neurological changes in the preschooler?
Spinal cord myelinated by age 3 Allows for bowel and bladder control to be achieved
What is tanner staging?
Staging of adolescents based on secondary sexual characteristics
What happens to iron stores 4-6 months after birth?
Start to deplete
What might change with a physical assessment in children?
Start with least invasive things first HR + R + inspections Maybe start in the center and work peripherally
What developmental task may influence an adolescent with type 1 diabetes to stop adhering to the therapeutic regimen?
Struggle for identity
How do you promote safe sun exposure?
Sunscreen Under 6 months - NO direct sun exposure
What is ERIKSONS developmental theory for infants?
TRUST VS. MISTRUST (birth to 1 year) Does the infant trust you (mom) or mistrust you (stranger)?
What assessment finding would be expected for a 2-month-old infant with gastroenteritis (infection and inflammation of the digestive system) and dehydration?
Tachycardia
What are some concerns for the school age child?
Television and video games (setting limits on both the content and amount of time) School refusal (school phobia) - can cause real physical symptoms Ask why they don't want to go to school?
What is a decreased pulmonary blood flow defect?
Tetralogy of Fallot - 4 defects!!! Large VSD Pulmonic stenosis Overriding aorta RV hypertrophy Cyanosis Whenever bear down + cry puts them at risk for a blue spell Minimize pain + be prepared + take knees and bend to chest to cut off circulation + protect vital organs (knee chest position) + O2 + pain meds
What is object permanence?
The awareness that things continue to exist even when you cannot see them Object permanence is developed at 12-18 months then is well developed at 18-24 months.
Why is the intramuscular polio vaccine used instead of the oral?
The intramuscular vaccine is safer Risk for developing vaccine associated polio paralysis with the oral
What is peak expiratory flow?
The maximal speed of air being exhaled PEFR and symptoms determine the actions needed for asthma Can start monitoring at 6 Done daily
What is precocious puberty?
The very early onset and rapid progression of puberty If they grow too quickly they will stop growing
How do you know if an infant is not tolerating formula?
They may have bloody stools, diarrhea, or vomiting
What are trisomies?
Three of a particular chromosome instead of the usual two
How do we test for strep?
Throat swab (rapid test) If negative must be sent for a culture Sore throat for over 3 days
What do we call a child for 1-3 years of life?
Toddler
What is physiological anorexia?
Toddler is slow growing and does not want to eat as much
How would the nurse respond to a parent of an 18-month-old child who is concerned about their child's temper tantrums and tendency to throw food from the table?
Toddlers are learning to assert independence, and this behavior is expected at this age
Why is play important for toddlers?
Toddlers prefer to play beside other children Toddlers prefer to stay close to their parent while playing
Repeated strep or tonsilitis may need what?
Tonsillectomy Most common time for bleeding is right after surgery Swallowing excessively Usually released the same day unless they have apnea (24 hours) No coughing No straws Soft foods for 2 weeks Avoid red or orange food Avoid dairy
What are LRS like for infants?
Trachea + bronchi + bronchioles are all smaller and more narrow What Smaller numbers of alveoli: higher risk of hypoxemia
What is the most important equipment for a nurse to have available when admitting a child with laryngotracheobronchitis (croup)?
Tracheotomy set Airway
What is a mixed defect?
Transposition of the great vessels: -All vessels reversed! -Closed systems + no oxygenated blood getting anywhere -If we can keep the foramen ovale and ductus arteriosus they will be ok for the time being (kept open with prostaglandins!) -Treatment is complete arterial switch operation Hypoplastic left heart syndrome: -Left ventricle never grows -Heart transplant -Cyanosis + hypotension
How do you treat a cold?
Treat symptoms only
Why couldn't you get a live vaccine?
Under 1 year of age (UNLESS ORAL) Immunosuppressed
What education should the nurse provide to promote oral hygiene in a preschooler?
Use a round soft bristle toothbrush
How do you promote safety in the toddler?
Use a safe car seat in back seat of the car Car seat must be facing the back (until at least 2 years of age) NEVER leave them alone when eating or bathing Childproof home Turn handles of the pans inward
What are physiologic/behavioral signs of pain?
Used under 3 years of age Crying Changes to vital signs Facial grimace
How does language change in the preschooler?
Uses many words appropriately without a real knowledge of their meaning Vocabulary increases to more than 2100 words at the end of 5 years Kids 3 to 4 years old use sentences of about 3-4 words
What can happen if we put too much saline in the Childs nose?
Vagal response Heart rate can plummet
How do you give IM injections in children?
Vastus lateralis before they walk Deltoid once they can walk
What are the risks of being in an unhealthy romantic relationship?
Violence STIs Unwanted pregnancy
What is croup?
Virus between 1-3 years of age Laryngotracheobronchitis Stridor (important to know what is the child doing while experiencing stridor) Seal or barking like cough Can be helped by steam shower or cold air Dexamethasone
How does language change in the school age child?
Vocabulary expands to 8,000 to 14,000 words Culturally specific words are used
What are the toilet training readiness signals?
Walks well alone Has the ability to communicate the urge to go Has awareness of a wet or soiled diaper and the diaper isn't always wet Can hold urine for 2 hours Is interested in pleasing parents Bowel control is accomplished first then bladder control
How do you determine a child dosage by weight?
Weigh the child If the child's weight is in pounds, convert it to kilograms Check a drug reference for the safe dose range (such as 10 to 20 mg/kg of body weight) Calculate the low safe dose Calculate the high safe dose Determine if the dose ordered is within this range
What do we measure for growth?
Weight Length Head circumference Each is plotted on a growth chart!
What will growth of the school age child look like?
Weight gain = 5-7lb a year Height = 2.5in per year Girls may develop faster Secondary sexual characteristics begin to appear
What will growth of the preschooler look like?
Weight gain = 5lb a year Height = 2.5-3in per year Loses baby fat and gains muscle Stands more upright and slender Girls often grow faster than boys and commonly surpass them in height and weight
What are some physiological responses to bronchiolitis that a nurse would expect to observe?
Wheezing Sternal retractions Nasal flaring Prolonged expiratory phase
Which chart would the nurse use to plot an infant's physical growth during a health maintenance visit?
World Health Organization (WHO) Growth Chart
Is there a vaccine for RSV?
Yes <32 weeks and have to meet STRONG criteria (premature babys only)
Is strabismus normal in the infant?
Yes Up to one year After a year they patch the strong eye to strengthen the weak eye
What if you have a child refusing medication but the parent says "they are getting it"?
You can administer the medication
What does special needs mean?
Any child who needs any extra service or requires more care than a typical child Or a children with a terminal illness
Where do you place BP cuff on a child?
Anywhere you can Make sure it is the correct size!
What is a health supervision visit?
Appropriate at-risk screenings - Depression, abuse, financial, unintentional weight loss, TB, covid H&P Immunizations Developmental and behavioral assessment
When does the anterior fontanelle usually close?
Around 12-18 months Toddler
Why is it important to calculate body mass index for age in school-age clients?
Assessing for obesity or overweight children
When do we hear wheezing?
Asthma
What questions would the nurse ask a new school-aged child and their parents related to growth during a health assessment?
At which age did your child get their first tooth? What was your child's approximate length at one year of age? What was your child's approximate weight at six months/1/2/5 years of age?
What is animism?
Attributes life-like qualities to inanimate objects
Infant growth: Length
Average 50cm (20in) at birth Increase by 50% at 12 months
Infant growth: Weight
Average 7.5lb at birth Doubles 4-6 months Triples by 12 months
What interventions would be included when counseling parents about improving the sleep of preschoolers?
Avoid media use in the evening Provide a lovey or favorite blanket at bedtime Establish a soothing and consistent bedtime routine
What is the foramen ovale?
An opening between the right and left atria in the embryo and fetus Closes when baby takes breath Pressure in the left atrium exceeds pressure in the right
What is the ductus arteriosus?
An opening in the embryo connecting the pulmonary trunk to the aorta Closes when baby takes breath
What are you trying to prevent Kawasaki disease from progressing to?
Aneurysm
When should kids receive influenza vaccines?
Annual vaccination starting at 6 months old 2 doses if under 9 (4 weeks apart)
What specific signs and symptoms would the nurse expect in a 10-year-old child with acute poststreptococcal glomerulonephritis (APSGN)?
Anorexia Periorbital edema Increased creatinine level
What do you observe in child pt with breathing issues?
Anxiety + restlessness Pallor + cyanosis of the mucus membranes Clubbing (chronic hypoxia) Hydration status issues Tachypnea Nasal flaring
What is poststreptococcal glomerulonephritis?
ACUTE RENAL DISORDER a kidney disease that develops 10 to 14 days after a skin or throat infection It is not caused by the bacteria itself, but by the body's immune system Main symptoms are blood in your child's urine and swollen ankles or puffy eyes
When do we hear crackles?
ALSO CALLED RALES Fluid filled alveoli
What is ERIKSONS developmental theory for toddlers?
AUTONOMY VS. SHAME AND DOUBT Focuses on autonomy and wants to become own individual separate from caregiver Egotism
What are heart murmurs?
Abnormal heart sounds - change in blood flow Can be a common finding in children Graded based on intensity and loudness (1-6)
What are night terrors?
Abrupt awakenings with panic and intense emotional arousal (3-4 years of age)
What is apnea?
Absence of breathing longer than 20 seconds Can be an acute life threatening event ALTE Need to find cause Stimulation + caffeine IV (premature) for prevention If you find an infant not breathing - move them around (shake them but not SHAKE them) or flick their foot (most sensitive part)
What is the main causes of death for adolescents?
Accidents Homicide Suicide
What can you give an infant for a fever?
Acetaminophen can be given before 6 months Ibuprofen can be given after 6 months
What is Kawasaki disease?
Acute systemic vasculitis 6 months to 5 years of age Leading cause of acquired heart disease Can lead to death In acute phase - high dose aspirin and a single infusion of intravenous immunoglobulin (IVIG) IVIG best given within the first 7 to 10 days of the illness Cannot get live vaccines for 3 months after + keep them away from sick people + hand washing High fever for 5+ days that will not go down + conjunctivitis without drainage + nails fall off + polymorphic rash + irritable + puffy and peeling hands/feet No test - goes by symptoms (sed rate will be HIGH) Other tests that may be taken are: PLT + AST + ALT + WBC + echo + xray Follow up with cardiology every 6 months
What do we call a child for 12-18 years of life?
Adolescent
What is a pneumothorax?
Air in the pleural space Risks = chest trauma + chronic lung disease Signs / symptoms = Tachypnea Retractions Nasal flaring Grunting
What is allergic rhinitis?
Allergies Atopic dermatitis + asthma (high correlation) Dust mites + pet dander + cockroach + molds Nasal vasodilation + runny nose + congestion + pruritus + sneezing Cetirizine = Zyrtec Benadryl can cause sedation and hide the signs of anaphylaxis
What is an increased pulmonary blood flow defect?
An abnormal connection between 2 sides of the heart It leads to increased blood volume on the right side of the heart and too much blood to the lungs causing right sided CHF Blood shunts from left side to right side Still pink because all oxygenated blood being sent out Concern is heart failure Need diuretics + beta blocker + digoxin Causes murmurs Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) -Fixed soon after birth -Indomethacin (prostaglandin inhibitor) helps close ductus arteriosus
What is status asthmaticus?
An acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and steroids Needs epinephrin as usual treatment
What is separation anxiety?
An infant's distress when a familiar caregiver leaves Between 9 and 14 months
What are the types of conjunctiva?
Bacterial: -Purulent discharge -Mild pain -Antibiotic drop Viral: -Watery discharge -Mild pain -Symptom treatment Allergic: -Watery or stringy discharge -Itching -Allergy medicine
When do growth plates close?
Begin to close in school age completely closed a year or 2 after menses - up to 21 for males
What measure would the nurse adopt while promoting health among adolescents?
Being sensitive to the emotional cues delivered by the adolescent Providing counseling to the adolescent undergoing rehabilitation for substance abuse
When do you receive a hepatitis B vaccine?
Birth 1-2 months 6-18 months
How do you assess a childs health history?
Birth history - born premature? (ESPECIALLY under 5) Review of symptoms Family health history Oxygen as a newborn? Intubated as a newborn? Congenital anomaly (Trisomy 21 - respiratory/thyroid/heart issues predisposition) Immunizations Allergies Menstrual cycle for females (Last period, have they had a period?)
What is an obstructive defect?
Blood can not exit the heart because of a stenosis/obstruction of some type Coarctation of the aorta: -Lower extremities affected most -Weak lower extremity pulses / Lower BP in lower extremity -Higher vitals in upper extremity -Headaches + chronic epistaxis + high BP -Treatment = stent + long term antihypertensives if needed (molding) Pulmonic stenosis: -Fatigue + weak pulses + murmur + cardiomegaly -Treatment = stent + valvotomy (opens narrow valve)
How is blood pressure effected in the toddler stage?
Blood pressure increases Start taking BP in the doctors office at age 3
What are the similarities between a preschooler and a toddler?
Both preschoolers and toddlers have similar dietary requirements Both preschoolers and toddlers are eager to independently perform self-care
How does eating progress in the infant?
Breast milk or formula When tongue extrusion reflex disappears and infant can sit up - ADD SOLIDS 1 new food every 3-4 days TO GIVE TIME TO MONITOR FOR ALLERGY Introduce cup early (6 months) Adding things like peanut butter and eggs early into diet can PREVENT allergy Add in iron fortified cereal
If a child is in the hospital and they can pull themselves up to stand, what bed will they need in the hospital?
Bubble top crib
How does language develop in the infant?
By 1 year old knows up to 3 words
How do adolescents establish group identity during psychosocial development?
By building close peer relationships for acceptance in society
How do you make sure both testicles are descended?
Cremasteric reflex Touching inner thigh of the male and the testicle jumps
What are the vision problem warning signs in the infant?
Crosses eyes most of the time by 6 months Does not follow interesting item Does not try and study objects
When do we hear stridor?
Croup
What is racemic epinephrine used for?
Croup Need to be on a cardiac monitor for at least 6 hours to monitor heart rate Can only last for 10-15 minutes Can have rebound issues
What behavior would the nurse expect from an 18-month-old toddler who has never been separated from their parent before admission to the pediatric unit?
Crying relentlessly and consoled by no one but a parent
What is regression?
Defense mechanism in which an individual faced with anxiety retreats to a younger stage of development Example: 10 year old wetting the bed or sucking their thumb NORMAL AND USUALLY SHORT LIVED
What causes the heart rate to rise?
Dehydration Infection Fever
What is acute rheumatic fever?
Delayed sequela of group A streptococcal pharyngeal infection Heart issue Prophylactic antibiotics before procedures forever Aspirin treatment
What is the number one cause for sepsis in infants?
Dental caries Bottle rot - sleeping with a bottle of milk or juice
What are some risk factors for adolescent suicide?
Depression or other mental health illness Poor school performance Difficulties with sexual identity Socially isolated (loner, victim of bullying) Substance abuse
How does nutrition change in preschoolers?
Diet high in nutrient-rich foods Limited amounts of poor, high-calorie foods (fruit juices) 5 servings of fruits and vegetables
How should discipline be used in the school age child?
Discipline should be consistent, applied fairly and focus on the development of the child Positive acknowledgment of positive behaviors are more likely to encourage those positive behaviors and promote development