Peds Exam 2
The FLACC scale is a numeric scale with what ratings?
0 to 2 for Face, legs, activity, cry, and consolability. Used for children
What is the average span of a virus?
10-14 days
What is the sleep average for a preschooler?
12 hours per night
At what age does sphincter control occur?
18-24 months
How many words can a toddler speak by the age of 2?
300
At what age can a child get a flu vaccine?
6 months old
An initial bolus of crystalloid fluid replacement for a child in shock is 20 ml/kg. The nurse is preparing to administer how many milliliters of fluid for a child weighing 30 kg?
600 mL
At what age should the numeric pain ratings scale be used for pain?
8 years or older
Who is the typical abuser?
A male the victim knows but may be anyone, all socioeconomic backgrounds
What affect does lead poisoning have on the body?
Affects renal, hematologic, and neurologic systems; developing brain and nervous systems are especially vulnerable
At what age can a toddler throw a ball?
Age 18 months
What type of play does a preschooler do?
Associative play, imitation, imaginary playmates, mutual play with parents
What is the psychosocial development of a toddler?
Autonomy vs. Shame & Doubt, negativism
What is stage 1 of Lyme disease?
Bull's eye - fever, HA, malaise
Paiget's developmental theory states toddlers experience what type of communication?
Egocentric "I want"
What two factors exacerbate asthma?
Environment and noncompliance
What is the nursing care of a maltreated child?
Identify abusive situations as early as possible
What is personal-social behavior of a preschooler?
Independent in dressing, eating, toileting by age 4-5, desire to please
What is the transmission for pinworms and how is it diagnosed?
Inhalation or ingestion of eggs from contaminated hands. Diagnosis - tape test
What is droplet precaution?
Large-particle droplets (sneeze, cough, speech, cry)
The mother of a toddler asks the nurse what she should do with her toddler when he has a temper tantrum. Which suggestion would be most appropriate?
Leave the toddler alone during the tantrum as long as he is safe.
An adolescent presents with a large round ring with a swollen border on the left arm. The adolescent often plays ball games in a field behind the school. What condition does the nurse suspect?
Lyme disease
Asthma is most common in what gender?
Males (2:1 ratio increase)
What is treatment goal for stomatitis?
NSAIDs and topical anesthetics to relieve pain. Prevent spread of illness through oral transmission and handwashing
If too much morphine is administered, what medication will reverse it?
Narcan
What is treatment and precautions for Scarlet Fever?
Penicillin and supportive care, droplet until 24 hours of ABX
What is the treatment and precautions for Flu?
Prevention, antiviral treatment if detected early, supportive care. Droplet Precautions
What is the development of body image?
Refer to body parts by name, avoid negative labels about physical appearance, and recognize sexual differences by age 2
How often can you repeat your quick relief medication for Red Zone asthma?
Repeat every 20 minutes for a total of 3 doses while you go to doctor or ED.
What do you need to watch for when administering morphine?
Respiratory depression
Providing morphine to a patient that has had a respiratory illness such as RSV can lead to what?
Respiratory failure. Will need to bag baby (breathe for them, oxygen won't do anything)
What needs to be monitored when administering opioids?
Respiratory rate, BP, pulse ox
By age 4 years, what is the gross motor behavior?
Skips and hops on one foot, catches ball
By age 5 years, what is the gross motor behavior?
Skips on alternate feet, jumps rope, learns to skate and swim
How do toddlers react to a new infant in the home?
Toddlers don't resent an infant, but do resent the changes in routine a sibling brings
By age 36 months, what is the gross motor behavior?
Walking, running, climbing, jumping
A child underwent a tonsillectomy 4 hours ago. Which assessment finding should make the nurse suspect postoperative hemorrhage?
frequent swallowing
A parent asks the nurse if the lesions around her child's mouth could be impetigo. What manifestations would verify the parent's suspicion?
honey-colored crusts, vesicles, and reddish maculae on the skin
When teaching the mother of a toddler diagnosed with lead poisoning, what should the nurse include as the most serious complication if the condition goes untreated?
neurologic deficits
A toddler is brought to the emergency department after ingesting an undetermined amount of drain cleaner. The nurse should expect to assist with which intervention first?
securing the airway
What is the nursing management of intestinal parasites?
Assist with identification, treatment, and prevention, fecal smears are diagnostic, treat family members, and provide education and support to prevent reinfection
How is a viral illness treated?
Supportive care, antivirals may be needed dependent on the virus being managed and severity. Manage fever, stay hydrated, rest
What are the three transmission-based precautions?
Airborne, droplet, contact
What is the Cries Neonatal pain scale?
Crying, requiring increased oxygen, increased vital signs, expression, sleeplessness
The nurse advises a mother with a 2-year-old child to avoid encouraging excessive milk consumption by the toddler because excess milk consumption can lead to which problem?
iron deficiency
A client in the emergency department is diagnosed with a communicable disease. When complications of the disease are discovered, the client is admitted to the hospital and placed in respiratory isolation. Which infection warrants airborne isolation?
measles
The triage nurse in the emergency department must prioritize the care of children waiting to be seen. Which child is in the greatest need of emergency medical treatment?
a 6-year-old with a fever of 104° F (40° C), a muffled voice, no spontaneous cough, and drooling
Asthma patients should take 2 puffs of quick relief medication 10-60 minutes before what?
Exercise
What is contact precaution?
Exercise judgement with gloves, gowns, and masks
Families will go through stages of grieving with children that need what?
Extensive care
What is the drug of choice for PCA and the dosage?
Morphine, 1mg/ml typical for PCA
What is an example of an opioid and it's side effects?
Morphine. Respiratory depression, constipation, hypotension, sedation, confusion, risk of addiction
What is the age group for the preschool period?
3-5 years of age
How often should asthma patients see their doctor for preventative care?
3-6 months
What pain scale is recommended for use with unconscious and ventilated infants, children, and adolescents?
Comfort Scale
Allergic (immunoglobulin (Ig)E-mediated) asthma is characterized by the presence of IgE antibodies against one of more what?
Common environmental allergens, such as house dust mite, animal danders, and molds
What is the effective management of temper tantrums?
Consistency, developmentally appropriate expectations, stay calm during episodes, ensure safety
What is the treatment plan for nonvaccine communicable diseases - conjunctivitis?
Contact precautions, keep eye clean and dry, administer ophthalmic meds, comfort and supportive care, educate caregivers, prevent spread of infection, nursing management
What disease can lead to myocarditis, fever, malaise, rash, sore throat, and blisters?
Coxsackie virus (Hand, foot, & mouth)
What is the adjuvant analgesic drug of choice for pain spasms?
Diazepam (Valium) - a benzodiazepine
What are the psychosocial developmental tasks of a toddler?
Differentiation of self from others, toleration of separation, ability to withstand delayed gratification, control bodily functions, and improved communications
What are the complications associated with children with communication and cognitive impairment and pain?
Difficult to measure pain, high risk for inadequate treatment of pain, and utilize parent and caregivers to tell if pt in pain
Toddlers experience development of _____
Gender identity (exploration of genitalia is common), playing house, gender roles understood
What are the three asthma zones for best peak flow?
Green Zone (80-100%), Yellow Zone (50-80%), and Red Zone (50% or less)
What is the diagnosis and implications of Lyme Disease?
History and serologic testing. Prevention, tick removal and insect repellent, supportive care, and completion of ABX
What disease has a persistent fever for 3-7 days in child who is otherwise well appearing, slapped cheek appearance, and mild URI symptoms, cough?
Human parvovirus (Erythema Infectiosum - Fifth Disease)
What are examples of NSAIDs and what are the side effects?
Ibuprofen, Naproxen, Ketoralac IV. Nausea, constipation, gastric bleeding, renal issues
What is Erikson's Psychosocial development for a preschooler?
Initiative vs. Guilt, development of superego (conscience), and magical thinking
What is the medication Zofran used for?
Nausea and vomiting
What is the most common form of maltreatment in children?
Neglect
What are the characteristics of the green zone?
No coughing, wheezing, difficulty breathing. Can do usual activities
Toddlers participate in what type of play?
Parallel play
What is stage 3 of Lyme disease?
Systemic involvement 2-12 mo
What disease is characterized by low-grade fever, headache, malaise, sore throat, and RASH?
Rubella virus (German Measles)
How should bacterial illnesses be treated?
Treat with antibiotic. Teach about side effects - diarrhea, vaginal yeast infection, GI upset, and oral thrush. Note antibiotic rifampin can decrease the effectiveness of birth control. **Need to complete full course of antibiotics
Skills for independence may result in what social behavior?
Tyrannical, strong-willed, volatile behaviors
What communicable disease causes a slight fever and malaise in the prodromal stage, pruritic rash that begins as a macule and then erupts, and rash is typically centripetal (extremities, face)?
Varicella-zoster virus (Chicken Pox)
What is the biologic development of a toddler?
Weight gain 4-6lb/year, birth weight quadrupled by 2.5 years, height increase 3 in/year, growth steplike
Problem solving for toddlers is based on what?
What they hear or see, not on recall of past events
A nurse discussing injury prevention with a group of workers at a daycare center is focusing on toddlers. When discussing this age-group, the nurse should stress that
accidents are the leading cause of death among toddlers.
An emergency department nurse is caring for a child diagnosed with moderately severe croup. The nebulizer treatment of choice for a child with moderate to severe croup is:
epinephrine.
A nurse is caring for a client who has just been immunized. When teaching the client's caregivers about potential adverse effects, the nurse should instruct the caregivers to immediately report
generalized urticaria.
When assessing a family suspected of abusing its 4-year-old child, which behavior is the most important criterion that would suggest abuse?
incompatibility between the history (mechanism) and the injury
Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse detects dry mucous membranes and lethargy. What other finding suggests a fluid volume deficit?
sunken fontanel
By what age can a child understand all parts of speech; identify opposites
Age 6
What is the age range for toddlers?
Ages 12 months to 36 months. Intense period of exploration.
At what age should a child say four to five-word sentences?
Ages 4-5
When teaching a caregiver of a 17-month-old about toilet training, which instruction would initially be most appropriate?
Be sure the toddler is ready before starting to toilet train.
What disease manifests as a catarrhal stage of URI symptoms 1-2 weeks, paroxysmal stage of short, rapid cough bought followed by high-pitched crying, whoop or gasp 4-6 weeks cyanosis may occur during episode?
Bordetella pertussis (Whooping Cough) **bacterial
What communicable disease causes URI symptoms, bull's neck, white or gray mucous membranes, fever, cough?
Diptheria
How is varicella transmitted?
Direct contact and respiratory secretions
What is the mode of transmission for giardiasis?
Direct contact with contaminated water or food
What are the precautions for human parvovirus?
Droplet or direct contact. Treatment - supportive care
What is the most frequent infection worldwide?
Intestinal parasites. Young children at highest risk. Most common types in US are giardiasis and pinworms
What is the most common poisoning in early childhood?
Lead ingestion, mercury toxicity is less frequently
What are the characteristics of the red zone?
Medical Alert! Short of breath, difficulty talking, coughing, wheezing not helped with medication or cannot do activities or not responding to quick relief medication.
Respiratory depression, constipation, pruritus, nausea, vomiting, sedation, tolerance, and physical dependence are all side effects of what drug class?
Opioids
What medications are given for moderate to severe pain?
Opioids (Morphine, Codeine, hydromorphone, fentanyl)
The nurse is monitoring a 3-year-old child receiving conscious sedation while undergoing a painful procedure. The child's respiratory rate is 14 breaths/min and heart rate is 64 beats/min. The child is exhibiting which of the following?
Oversedation
What disease leads to parotitis (pain, tender, swelling), prodrom malaise, fever, headache and has complications of sterility, orchitis, sensorineural deafness, and myocarditis?
Paramyxovirus (Mumps)
What are the parental characteristics of physical abuse?
Parental low self-esteem, inadequate maternal functioning, single parents with limited support, and unrelated partners
What risk factors put children at risk for abuse?
Parental unavailability, lack of emotional closeness and flexibility, social isolation, emotional deprivation, and communication difficulties
What is the biologic development of a preschooler?
Physical growth rate slows and stabilizes, physical proportions change - slender but sturdy, graceful, agile, posture erect, males and females similar in size and proportion
What are the consequences of unrelieved pain in neonates?
Physiologic changes - increased ICP, HR, RR, BP, decreased SaO2. Behavioral changes - muscle rigidity, facial expression, crying, withdrawal, and sleeplessness
What are harmful effects of unrelieved pain in pediatric patients?
Physiologic stress responses, chronic pain syndromes. Pain delays healing - terrible hospital experience
What steps are taken to reduce the sibling rivalry response?
Prepare toddler when he becomes aware of pregnancy, provide realistic idea of newborn (not a friend or playmate!), include toddler in caregiving, ensure quality time with toddler
What is the treatment and precautions for Pneumococcal disease?
Prevention, antibiotics, supportive care. Droplet precautions
What is the treatment plan for whooping cough?
Prevention, supportive during hospitalization with suction, humidity, careful oral feeding, and hydration. Antibiotics early-may be less effective if given late in course of illness. Precautions - droplet
What is the symptoms and blood sample for lead poisoning?
Rarely symptomatic, venous blood sample of 3.5mcg/dl
What is stage 2 of Lyme disease?
Rash on hands and feet 3-10 weeks after inoculation - fever, fatigue, lymphadenopathy, cough
What disease is characterized by a prodromal state of fever, malaise, coryza, cough, conjunctivitis, Koplick spots on mucosa, and rash appears on day 3-4 of illness?
Rubeola (Measles) **Viral
What is airborne precautions?
Small particle or evaporated droplets or dust. Negative pressure isolation room
What are the child characteristics of physical abuse?
Social isolation, poor support systems, stressful situations, unrelated caregivers
What should be a priority for a 6-year-old child admitted with third-degree burns?
Start an IV line.
What communicable disease is either apthous ulcers or herpetic gingivostomatitis?
Stomatitis
What disease causes pneumonia, otitis media, sinusitis, localized infections?
Streptococcal pneumococci (Pneumococcal disease)
What is the treatment and precaution for Rubella?
Supportive care, droplet precaution
What are the precautions and treatment for varicella?
Supportive treatment. Airborne precautions (child is contagious a day before rash appears and until vesicles are crusted) and secondary skin infection and complications
What is Reyes Syndrome?
Swelling in liver and brain - NEVER give kids aspirin
When do temper tantrums increase?
When child is ill, hungry, frustrated, or tired
Which urine output indicates that a 5-month-old weighing 15 lb (6.8 kg) and being treated for dehydration has a normal urine output?
1 to 2 mL/kg per hour
When caring for a toddler with epiglottitis, the nurse should first:
place a tracheotomy tray at the bedside.
A nurse is helping a pregnant caregiver devise a plan to help her 2-year-old child adjust to the birth of her second child. Which statement by the client indicates more instruction is needed?
"I'll tell my child that the new baby can be a playmate when the baby arrives."
If an asthma patient has been in the yellow zone for 24 hours, what should they do?
Call their doctor
What are the characteristics of the yellow zone?
Caution! Coughing, wheezing, tight chest, shortness of breath, or nighttime awakenings with symptoms
How soon can a patient return to school/work after treatment with antibiotics?
24 hours after treatment (also free of fever without Tylenol or ibuprofen for 24 hours)
What is an example of an antipiuretic/pain reliever and the side effects?
Acetaminophen. Watch liver and renal function and neutropenia. Has an analgesic ceiling, only give 5 doses/24 hours
What is the treatment for measles?
Antibiotics for secondary bacterial infections such as ear infection and pneumonia, bed rest, and support and Vit A supplementation is beneficial to prevent mortality. Precautions - airborne if in hospital until day 5 of rash
What is the treatment for diptheria?
Antibiotics, bed rest, support. (Droplet precautions)
What are standard infection precautions?
Barrier protection from blood/body fluids, respiratory hygiene/cough etiquette, safe injection practices, hand hygiene
This disease is characterized by a prodromal stage of abrupt, high fever, halitosis, enanthema: tonsils large, edematous, and covered with exudate, strawberry tongue, exanthema: sandpaper like pink rash?
Group A Beta-hemolytic streptococci (Scarlet Fever)
Lyme disease has three stages and is transmitted how?
Infected deer tick bite
What disease leads to abrupt fever, URI like symptoms which progress, malaise, and anorexia?
Influenza virus (varies from year to year)
What medications are given for mild to moderate pain?
Nonopioids (acetaminophen, NSAIDs)
A 6-month-old infant is brought to the clinic. The mother reports the infant has been lethargic and not eating well. The infant's anterior fontanel is sunken. Which additional information is a priority for the nurse to assess?
Number of wet diapers the in the last 24 hours
What virus is characterized by high fever and then fever gone and rash develops, discrete rose pink macular of macular papules on trunk?
Roseola (Herpes virus Type 6)
A 2 1/2-year-old child and his 2-month-old sibling are brought to the clinic by their father, who explains that the older child says "no" whenever asked to do something. The nurse should explain that the negativism demonstrated by toddlers is frequently an expression of which characteristic?
pursuit of autonomy