PEDS ATI

The nurse should suspect child maltreatment in the form of physical abuse if the adolescent...

(1) Expresses a reluctance to return home or demonstrates a fear of parents. (2) Description of the injury is vague and inconsistent with the actual wounds. (3) Has a blunted response to painful stimuli or injury. (4) Has withdrawn behavior and poor relationships with peers.

Excessive swallowing can indicate what?

Bleeding

Potential indication of physical neglect due to malnutrition in a child?

Failure to thrive

Indication of anemia in a school age child?

Hematocrit level below 32%, Fatigue, lightheadedness, tachycardia, dyspnea, and pallor due to the decreased oxygen carrying capacity.

cheiloplasty

surgical repair of the lips Apply to layer of antibiotic ointment on the infant suture line daily for three days and then continue to apply petroleum jelly to the area for several weeks to promote healing.

intussusception

telescoping of the intestine into itself.

Which pain scale do you use for three year old and older?

Faces pain scale

What is an indication of a hemolytic reaction to a blood transfusion?

Flank pain caused by the breakdown of red blood cells.

How long should the nurse plan to maintain an adolescent with bacterial meningitis in droplet precautions?

For at least 24 hours following initiation of anti-microbial therapy. This practice will insure that the adolescent is no longer contagious.

What contains a high amount of nonheme iron?

Half a cup of raisins

Developmental milestones of a six-year-old

Identifies right from left hand and uses a utensil to spread butter

What size needle should the nurse used to administer and immunization for a four-year-old child?

22 to 25 gauge needle.

Diaper Dermatitis

A common inflammatory skin disorder caused by contact with an irritant such as urine, feces, soap, or friction, and takes the form of scaling, blisters, or papules with erythema. Providing a protective barrier, such as zinc oxide, against the irritants allows the skin to heal.

A diet rich in what decreases lead absorption?

A diet rich in calcium, vitamin C, and iron.

A seven-year-old child who is receiving chemotherapy. What laboratory values should the nurse report to the provider?

A hemoglobin level below the expected reference range of 10 to 15.5 (anemia) A hematocrit level below the expected reference range of 32% - 44% (anemia) A platelet count below 150,000 (thrombocytopenia) Low WBC count (below 5,000 for a 7-year-old)

oral nystatin for treatment of oral candidiasis - patient education

Shake the medication prior to administration to disperse the medication evenly within the suspension and have the child keep the medication in their mouth for as long as possible before swallowing it.

Central venous access device

Should be flushed with heparin solution daily when not in use; should be covered with a semipermeable transparent dressing to reduce the risk of infection.

Serum Creatinine Expected reference range

0.4 to 1.0 for an adolescent. An elevated serum creatinine level can be an indication that the kidneys are not functioning.

What is the expected reference range for urine specific gravity?

1.005 - 1.030 Anything above the expected reference range indicates concentrated urine/dehydration.

A school age child with moderate persistent asthma will need a pulmonary function test every ________ to _________ months to evaluate the presence of lung disease and how the child is responding to the current treatment regimen.

12 to 24 months

Mx of scoliosis

A unilateral rib hump with hip flexion. This results from the lateral S or C shaped curvature to the thoracic spine resulting in asymmetry of the ribs, shoulders, hips, or pelvis. Also, improperly fitting clothing (one leg shorter then the other)

Peritonitis

Abdominal distention

MMR contraindications

Allergy to neomycin with an anaphylactic reaction and clients who have a severe allergy to eggs or gelatin.

Nonpharmacological pain management technique for infants

Allowing the mother to breast-feed the infant prior to or during a painful procedure.

Indication of osteomyelitis

An erythrocyte sedimentation rate above 10 mm/hr.

intussusception mx

Bloody stools that are currant and jelly-like in appearance, vomiting due to the obstruction that occurs when a segment of the bowel telescopes with another segment of the bowel, lethargy due to episodes of severe pain during which the infant cries inconsolably leading to exhaustion and decreased nutritional intake, mucus filled and red jelly like diarrhea, weight loss due to anorexia and episodes of vomiting and diarrhea.

Nursing interventions for a school age child who is in Buck's traction following a leg fracture 24 hr ago?

Buck's traction is a type of skin traction that can be used to immobilize extremities prior to surgery. The nurse should provide frequent neurovascular checks at least every four hours after the first 24 hours of placement in Buck's traction. The nurse should monitor and report signs of neurovascular impairment in the extremities such as cyanosis, edema, pain, absent pulses, and tingling.

Which pain scale do you use for infants who are less than 40 weeks of age?

Cries pain scale

Developmental milestone of a four-year-old

Cuts an outlined shape using scissors

When performing the respiratory assessment for a client with diabetic ketoacidosis what should the nurse expect to find?

Deep and rapid respirations called kussmaul respirations.

Developmental milestone of a five-year-old

Drawing a stick figure with the seven body parts

Mx of pertussis

Dry, hacking cough; also called whooping cough; transmitted through contact with infected large droplet nuclei that are suspended in the air when the child coughs, sneezes, or talks; initiate droplet precautions.

What is the expected reference range of sodium for an infant?

Expected reference range of sodium in an infant is 134 to 150. In adults it is 135 to 145

Kawasaki disease Mx

Increase temperature (Kawasaki disease presents with a fever that is unresponsive to antipyretics or antibiotics), cervical lymphadenopathy (enlarged cervical nodes on one side of the neck that are nontender and greater than 1.5 cm in size), xerophthalmia (Reddening of the conjunctiva and dryness of the eyes), Strawberry tongue, cracked lips, Edema of the oral mucosa and pharynx, and tachycardia with gallop rhythm. Long-term effects include the development of coronary artery aneurysms and myocardial infarction.

Bacterial meningitis Mx

Increased protein concentration, decreased glucose level, and increased WBC in the spinal fluid, and increased CSF pressure are all findings that can indicate bacterial meningitis.

Mx of streptococcal pharyngitis

Inflamed throat with exudate

Vaso-Occlusive crisis

Seen in patients with sickle cell anemia and is indicated by decreased vision; should be reported to the health care provider immediately.

An infant who has an epidural hematoma is at great risk for what?

Seizure activity

Mx of rubeola / measles

Koplik spots on buccal mucosa

Salmeterol inhaler

LABA - Should be used in conjunction with a inhaled corticosteroid and never used alone.

Potential indication of physical neglect in a child?

Lack of subcutaneous fat. This manifestation can be a result of poor health care, infections that were untreated, and/or a lack of delayed childhood immunizations.

What is an indication of an allergic reaction to a blood transfusion?

Laryngeal edema

hypospadias

Look up

sodium polystyrene sulfonate

Medication used to treat hyperkalemia. A potassium level within the expected reference range of 3.4 to 4.7 indicates effectiveness. An adverse effect is diarrhea.

Which pain scale do you use for pediatric clients who are eight years old and older?

Numeric pain scale and Visual analog pain scale

What aids in absorption of iron?

Orange juice

McBurney's point

Pain and tenderness in RLQ with appendicitis

Meningococcemia mx

Petechiae or purpuric rash Can lead to sepsis Immediately report to HCP

Nursing intervention for a school age child who has heart disease and has developed heart failure?

Provide small, frequent meals for the child and restrict play activities to the child's bed to help conserve energy; weigh child daily; maintain child's bed in a semi-Fowler's position.

Mx of bacterial conjunctivitis

Purulent eye drainage

What medication is used to treat hypopituitarism?

Recombinant growth hormone

Potential indication of sexual abuse in a child?

Recurrent urinary tract infections

diabetes insipidus

Sodium rises above the expected reference range of 136 to 145. Deficiency of antidiuretic hormone Mx = Polyuria and polydipsia. Can lead to dehydration.

Potential indication of physical abuse in a child?

Symmetric burns of the lower extremities

Family Education for child with Juvenile idiopathic arthritis

Teach the family the importance of encouraging the child to perform independent self care. This will minimize the child's pain while maximizing mobility. Encouraging and praising the child's efforts for independence will also increase their self-esteem.

What should you apply to a minor superficial burn?

The nurse should apply an anti-microbial ointment to the burned area to prevent infection

RSV infection control

The nurse should initiate Droplet precautions for an infant who has RSV because the virus is spread by direct contact with respiratory secretions. Therefore, designated equipment, such as a blood pressure cuff and stethoscope, should be placed in the infant's room.

Substernal retractions

This finding indicates the newborn is experiencing increased respiratory effort, which could quickly progress to respiratory failure.

Which ototoxic medication can cause mild to moderate hearing loss?

Tobramycin

Where are the actions the nurse should take to discontinue IV fluids and remove a catheter?

Turn off the IV pump, occlude the IV tubing, remove the tape securing the catheter, apply pressure over the catheter insertion site.

Osteomyelitis

Tx = Antibiotics

Tinea Pedis Management

fungal infection of the foot; athlete's foot Sandals allow air to circulate around the feet, decreasing perspiration and eliminating the medium for bacteria and fungus to grow. The nurse should inform the adolescent that wearing sandals, open toed, well ventilated shoes will promote healing of the fungal infection.

Hypercyanotic spells - tx

knee-chest , 100% O2 via face mask, loose clothes, loose diapers, quiet play, no stress, respond quickly to crying, tx infections promptly

Spastic (pyramidal) Cerebral palsy Mx

(1) Ankle clonus - Rhythmic reflex tremor when the foot is Dorsiflexed (2) Exaggerated stretch reflexes (3) Contractures due to tightening of the muscles

The nurse should instruct parents to apply a waterproof sunscreen with a minimum of what SPF for children?

SPF of 15

Cystic fibrosis

Unable to properly digest fats due to fibrosis of the pancreas and limited secretion of pancreatic enzymes. The nurse should increase the child's fat intake to 35% to 40% of total caloric intake. The nurse should plan to administer pancreatic enzymes within 30 minutes of meals and snacks to replace the enzymes lost with cystic fibrosis. The nurse should encourage fluid intake to prevent dehydration caused by the loss of sodium and chloride through perspiration. *** Children who have cystic fibrosis require a higher percentage of the recommended dietary allowances of all nutrients to meet their energy requirements including a diet that is well balanced and high protein and calories.

Spastic (dyskinetic) Cerebral palsy Mx

Uncontrollable movements of the face

Strabismus

crossed eyes Typically disappears at 3 to 4 months of age if not corrected early can lead to blindness.

Pavlik Harness

used for hip dysplasia in infants; the harness is to be worn continuously until the hip is stable which usually occurs within 6 to 12 weeks; Is designed to maintain the infant's hips in a position of flexion and abduction; to prevent soiling of the harness the parent should apply the infants diaper under the straps.