PEDS RETAKE QUIZ 4
What do you want to feed Infants with GER?
Thickened formula w/ 1 tsp to 1 tbsp rice cereal per 1 oz formula
What is Pyloric stenosis and when does it occur?
Thickening of the pyloric sphincter, which creates an obstruction; occurs first few weeks of life
what meds can you take together in Acute Renal Failure
furosemide and mannitol to provoke a flow of urine in child who has oliguria and no lower tract obstruction
What is hypotonic dehydration and what is the lab result for it?
greater loss of electrolytes than water ; Low sodium
What is hypertonic dehydration and what is the lab result for it?
greater loss of water than electrolytes ; High sodium
stepping/dancing reflex
hold up w feet on flat surface baby makes stepping movements up to 4 weeks
when are MMR and V vaccines given
12-15 months, 4-6 years
at what age does child build a tower of two block
15 mo
rooting reflex
when baby cheek is stroked and baby turns head that way 3-6 mo
nursing actions when applying EMLA (lidocaine and prilocaine topical ointment)
-apply 60 min before injection. -place occlusive dressing over cream -before procedure remove dressing and clean skin -check for redness or blanched skin -demonstrate to child its not sensitive -instruct parents to apply med at home before procedure
nursing actions for CV d/o when taking Furosemide
-encourage to eat food high in K+ -monitor I&O & daily wt -monitor AE: hypoK+, n/v/dizziness
nursing actions for Renal d/o when taking Furosemide
-encourage to eat food high in K+ -monitor blood electrolyte levels (hypokalemia)
gentamicin nursing teaching
-finish all abx !
What is the MOA of digoxin? nursing action ?
-improves myocardial contractility - hold if infant or up to school age HR <90 -monitor therapeutic level -monitor for toxicity (bradyc, abd pain, vision changes)
how do you assess internal ear cannal
-infants and toddler - pull pinna down and back to see tympanic membrane -children over 3 pull pinna up and back -light reflex should be visible
What are s/sx of Gastroesophageal reflux (GER) in Children? 5
-noncardiac chest pain -abd pain -heartburn -difficulty swallowing -chronic cough (respiratory or GI)
what are 2 anti-epileptic meds and moa
-phenytoin -diazepam -v severe seizures
what are you going to see in a patient when taking too much calcium supplement
-renal stones -high calcium high HR -low calcium low HR
what is contraindicated when taking Mannitol for Reye syndrome
-salicylates (aspirin)
what is the correct alignment of the ears
-should align w top of the ears and horizontally from outer canthus of eye
describe fontanels
-should be flat -posterior closes at 8 weeks -anterior closes at 12 -18 mo
What s/sx of Hirschsprung's disease in Newborns? (4)
- Failure to pass meconium w/i 24-48 hrs after birth - Episodes of vomiting bile - Refusal to eat - Abd distention
What s/sx of Hirschsprung's disease in Infants? (4)
- Failure to thrive*(weight, height, color) - Constipation* - Vomiting* - Episodes of diarrhea, vomiting
What are three types of Dehydration?
- Isotonic - Hypotonic - Hypertonic
how do assess for dehydration in child
-skin turgor on the abd and thigh and forearm
How is Salmonella transmitted? (2)
-undercooked meats and poultry -person to person
What are some Interventions of Hirschsprung's disease?
- Stop vomiting *(priority) - Give IVF (Admin electrolytes/fluids) - Give TPN (Total Parenteral Nutrition)
What are some client teaching for Salmonella and state 4 things to avoid?
- Teach the client about the importance of hand washing after each bowel movement -
What are s/sx of Pyloric stenosis? 6
- Vomiting - nonbilious vomitus can be blood tinged - Constant hunger - Olive-shaped mass in the right upper quadrant of the abdomen -Failure to gain weight -Dehydration manifestations
What are s/sx of NEC? 8
- abd distention - gastric residuals - bloody stools - periods of apnea begin or worsen - hypotension - lethargy - poor feeding - decreased urinary output
what 2 d/o can Furosemide be used for and MOA?
-Cardiovascular d/o : moa : K wasting diuretic getting rid of fluid and sodium -Renal d/o : moa : rids of fluid from body
For a pt with Isotonic dehydration, how will you treat it? (3)
-D5W -LR -0.9% Normal Saline
What are s/sx of Gastroesophageal reflux (GER) in Infants? 5
-Forceful vomiting* -excessive crying* (vomit could go to lungs) -respiratory problems -Failure to thrive (FTT) -Apnea
For a pt with hypertonic dehydration, what urine gravity are they going to have? Color? (3)
-High -Dark -Little output
What kind of fluid will you give to a pt with hypotonic dehydration?
-Hyper >0.9
What s/sx of Hirschsprung's disease in a Child? (5)
- Abd distention - Visible peristalsis - Palpable fecal mass - Constipation - Foul-smelling, ribbonlike stool
What are 4 intervention for Salmonella and state process*?
- Assess/Monitor I&O - Avoid antibiotics - Avoid antimotility -Oral rehydration therapy* >Start replacement with an oral replacement solution (ORS) of 75 to 90 mEq of sodium/L at 40 to 50 mL/kg over 4 hrs >Repeat if needed >Maintenance therapy w/ ORS of 40-60 mEq of sodium/L and limit 150 mL/kg/day >Replace each diarrheal stool w/ 10 mL/kg of ORS for ongoing diarrhea.
What are 3 reasons to place an NG tube?
- Decompression - Lavage - Gavage
What is mild weight loss in Infants?
3%-5%
what med do you give for Status Epilepticus and moa
DIAZEPAM -muscle relaxant to v muscle spasms
What does it mean when you have aganglionic cells?
Causes a decrease in movement > causes obstruction > vomiting bile
If a newborn has NEC, are you going to feed this infant?
No; Give TPN or IV (to rest GI tract)
What is one intervention for Rotavirus and state process* (4)?
Oral rehydration therapy*: -Start replacement with an oral replacement solution (ORS) of 75 to 90 mEq of sodium/L at 40 to 50 mL/kg over 4 hrs -Repeat if needed -Maintenance therapy w/ ORS of 40-60 mEq of sodium/L and limit 150 mL/kg/day -Replace each diarrheal stool w/ 10 mL/kg of ORS for ongoing diarrhea.
What does the xray show for NEC?
Sausage looking intestines'
What is the antidote for warfarin?
Vitamin K (phytonadione)
If infant has NEC, what surgery may they need?
Temporary Colostomy
What is the antidote for heparin?
protamine sulfate IV
what do you monitor for when taking opioids analgesics?
respiratory depression.
moro reflex
startle reflex when hear loud noise or sudden movement and fingers form C shape (up to4 mo
plantar graps reflex
touch sole and toes curl downward (up to 8 mo
babinski reflex
upward stroke on foot and baby toes fan out up to 1 yr
what is the MOA when taking Mannitol for Reye syndrom and head injury
v cerebral swelling & ICP
at what age does baby hold bottle in fine motor skills
6 mo
at what age does baby roll from back to front in gross motor skills
6 mo
A nurse is reviewing the medical record of a 2-month-old infant who has rotavirus. The nurse notes a hemoglobin level of 12 g/dL and a hematocrit of 51%. Which of the following statements by the nurse indicates an understanding of the laboratory values? A."The infant might be dehydrated." B."The infant might be anemic." C."The infant might have received too much fluid." D."The infant might have leukemia."
A."The infant might be dehydrated." An increased hematocrit level indicates dehydration. Hematocrit levels rise when blood volume is decreased during dehydration.
what are teaching for injury prevention in child
ASPIRATION teaching: avoid small objects , loose buttons, and balloons BODILY HARM teaching : remove sharp objects, firearms kept locked away, BURNS teaching : pot handles should be turned toward back of stone and electrical outlets covered, wear sunscreen outside, water heaters less than 120F DROWNING teaching: dont leave unattended, toddlers closely monitored near pools FALLS teaching: crib mattresses lowest position w rails up, safety gates used across top and bottom of stairs
A nurse is caring for a toddler who has gastroenteritis caused by Salmonella. Which of the following is the priority action for the nurse? A.Weigh the child B.Initiate contact precautions C.Establish a skin care routine D.Obtain a recent food history
B.Initiate contact precautions Salmonella is a type of bacteria that is transmitted via contaminated feces, making contact precautions essential for preventing transmission. This client is at greatest risk for transmission of Salmonella to others; therefore, contact precautions are the nurse's priority.
If you place an NG tube in a baby with NEC, what is it for?
Decompression
What does necrotizing enterocolitis (NEC) interfere with?
Digestion; Ischemia results in death of mucosal celles leading to necrotic patches (interfering w/ digestion)
What is the antidote for digoxin?
DigiFag (digoxin immune fag)
where do u assess for heart rate in infant
apex
tonic neck reflex
arm/leg extension toward facing side up to 3-4 mo
What is Gastroesophageal reflux (GER)?
occurs when gastric contents reflux back up into the esophagus, making esophageal mucosa vulnerable to injury from gastric acid.
how do you monitor all medication therapeutic levels
peak and trough
If child has GI problem, +failure to thrive, +failure to eat, given TPN. Do they need surgery? What does it do? Is it permanent?
Yes; Surgical removal of the aganglionic (cells) section of the bowel; No > Temporary colostomy
at what age does baby move object from hand to hand in fine motor skills
7 mo
at what age does baby start to sit unsupported in gross motor skills
8 mo
at what age does baby use pincer grasp in fine motor skills
8 mo
what age do we use FACES pain scale
> 3 y
what age do we use numeric pain scale
> 5 y
What is severe weight loss in Infants?
>10%
What kind of fluid will you give to a pt with hypertonic dehydration?
-Hypo <0.9
What is necrotizing enterocolitis (NEC)?
-Inflammatory disease of the gastrointestinal mucosa caused by ischemia or hypoxia (no oxygen in area); colon
What are 10 s/sx of Salmonella?
-Mild to severe n/v -abd cramping -bloody diarrhea -fever -diarrhea (up to 2-3 weeks) -headaches -confusion -drowsiness -seizures -Can lead to meningitis or septicemia
If a child has hypertonic or hypotonic dehydration, what symptomology are you going to see?
-Neuro -Skin tinting
What are some client teaching for Rotavirus and state 4 things to avoid? (T=5)
-Parents should inform the child's school or day care of the infection/infestation. The child should stay home during the incubation period (48hrs) -Avoid fruit juices, carbonated sodas, gelatin, and chicken/beef broth (too much sodium/not enough carbs)
what are the 3 adverse effects when taking Chemo meds?
-alopecia -bone marrow depression and suppression -vomiting
nursing actions for iron supplement
-use ztrack method -use a straw w liquid med to prevent staining of teeth -take vitamin c to ^ absorption
at what age does child creep up stairs
15 mo
at what age does child build a tower of 3 or 4 block
18 mo
at what age does child manage a spoon w/o rotation
18 mo
at what age does child push and pull toys
18 mo
what age do we use FLACC pain scale
2 mo - 7 y
at what age does child build a tower of 6 or 7 block
2 y
at what age does child walk up and down stairs
2 y
at what age does child draw circle
2.5 y
at what age does child stand on one foot
2.5 y
when are DTAP vaccines given
2mo, 4mo, 6mo, 15-18mo, 4-6yrs
at what age does baby roll from back to side in gross motor skills
4 mo
at what age does baby roll from front to back in gross motor skills
5 mo
What is moderate weight loss in Infants?
6%-9%
What is Isotonic dehydration?
Equal amount of loss of water & electrolytes
nursing actions for too much calcium
FLUSHHH
Rotavirus is considered as a bacterial infection. TorF
False Its a viral infection
Salmonella is considered as a viral infection. TorF
False Its a bacterial infection
What are 6 s/sx of Rotavirus?
Fever Watery stools Diarrhea for 5-7 days Vomiting for 2 days Affects all aged children Most common cause for diarrhea for children <5yrs old
If child has GI problem, +failure to thrive, +failure to eat, given TPN. What is the priority for this patient, fluid or food?
Fluid d/t vasculature + circulation fluid
If child has GI problem, +failure to thrive, +failure to eat. What can be done for their nutrition?
Give TPN (Total Parenteral Nutrition)
What position should you have an Infant with GER that is vomiting ? 2
Sitting up & back straight (may sleep like this as well)
palmar grasp reflex
placing fingers and baby grasps on it ends at 4 mo