VATI Pediatrics

What is fluid resuscitation?

(fluid replacement)-replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes

What are manifestations of severe dehydration in infants?

-Absence of tears -Sunken eyeballs -Parched mucous membranes -Sunken fontanelles -Hyperpnea -Oliguria -Loss of 10% body weight

What should the nurse teach to a client with juvenile idiopathic arthritis (JIA)?

-Apply moist heat to relieve pain and stiffness in affected joints -Wear splints during night to prevent joint deformities and reduce pain from inactivity

What are late findings of increased ICP?

-Bradycardia -Dilated pupils (or decreased pupillary response) -Papilledema

What are two protective factors against SIDS?

-Breastfeeding -Use a pacifier when infant is sleeping

What medications are used to treat asthma?

-Bronchodilators (inhalers) -short acting beta2 agonists -albuterol, terbutaline for rapid relief of acute asthma attacks -Cholinergic antagonists-block parasympathetic nervous system, providing relief of acute bronchospasms-iprtropium -Anti-inflammatory agents-decrease airway inflammation for long-term management (corticosteroids-fluticasone, prednisone; Leukotriene modifiers-montelukast; mast cell stabilizers-cromolyn sodium; monoclonal antibodies-omalizumab)

What happens to skin as death nears?

-Cool to touch -Grayish-blue -Mottling in extremities that moves toward body core b/c decrease in CO and perfusion to extremities

What adverse effects should be monitored in anti-inflammatory asthma meds?

-Decreased immunity function -Monitor for hyperglycemia -Advise to report black, tarry stools -Observe for fluid retention and weight gain -Observe throat and mouth for aphthous (cold sore) lesions

A nurse is creating a plan of care for an infant with an epidural hematoma from a head injury. What interventions should the nurse perform?

-Head slightly elevated in midline position to reduce risk of increased ICP -Perform neuro assessment q15 minutes to monitor changes and ICP -IMPLEMENT SEIZURE PRECAUTIONS (infant is at great risk)

What findings would be expected in a client diagnosed with osteomyelitis?

-Leukocytosis -Elevated erythrocyte sedimentation rate (ESR) (elevates in presence of infection/inflammation) -Boring, constant pulsating pain -Positive wound cultures

A nurse is caring for a neonate diagnosed with a congenital heart defect. Which of the following S/S would the nurse note if the client was experiencing HF? -Mottling -Tachypnea -Feeding difficulties -Hyperglycemia -Bounding pulses

-Mottling: tissue hypoxia and vessels are compensating for HF creating a mottled splotchy appearance -Tachypnea: compensatory mechanism to increase O2 supply -Feeding difficulties: Dyspnea and activity intolerance make it difficult for neonate to consume adequate calories

A nurse is teaching parents of an infant how to administer antibiotic eardrops. Which of the following instructions should the nurse include in the teaching?

-Pull pinna downward and straight back during administration -otic solution should be at room temp. to avoid discomfort -Massage anterior ear after administration to assist med to reach target area

What are the signs of respiratory distress in children?

-Tachypnea (>32 breaths/min) -Tachycardia -Nasal flaring -Retraction of accessory muscles -agitation, irritability, anxiety -pallor -clammy, moist skin

What S/S would indicate increased ICP in a school-aged child?

-Vomiting -HA -Increased clumsiness -(not high-pitched crying. That would be for an infant)

What are some risk factors for asthma?

-Young children are more susceptible to infections -Second-hand smoke

What are the signs of dehydration in infats?

-dry mouth -sleepiness -decreased urine output (measured by >3 hours w/o wet diaper) -sunken eyes -sunken fontanelles -rapid heartbeat

What is the presentation of ulcerative colitis?

-frequent diarrhea (containing blood) -weakness -anemia (from blood loss in fri -abd pain -weight loss

Universal consent covers what things?

-med administration -noninvasive diagnostic tests

A nurse is teaching about injury prevention to the parent of a toddler. What safety measures should be taught?

-throw rug under crib in case toddler falls out -Toy box without a lid or that locks in open position. Not one that locks in closed position so toddler doesn't suffocate if entrapment occurs -Move toddler to youth bed when they can climb out of crib

How often should smoke detector batteries be changed?

1-2 times/yr

At what age should a child be able to speak 10+ words?

18 mo

How far should a rectal thermometer be inserted to avoid injury?

2.5 cm (1 in.)

When does the grasp reflex disappear?

3 m

At what age should a client be able to hold head up?

3 mo

An infant should be able to raise its head when placed on abdomen at what age?

3 months. This tummy time helps infant strengthen upper body and neck muscles to get good head control when sitting upright and crawling

How many words should a child be able to speak at 24 mo?

300 words. Also two- and three-word phrases and pronouns

When does the stepping reflex disappear?

4 weeks of age. (infant makes stepping movements when holding infant upright with feet touching a flat surface)

The nurse should instruct parents to set the water heater to what temperature?

49C (120F) to reduce burn risk for infants

At what age should an infant be able to role from supine to prone?

6 mo

At what age should an infant exhibit a fear of strangers?

6 mo when the child develops ability to recognize parents

At what age should a child understand the word "no"?

9 mo

How long should a residual limb be elevated postop?

<24 hours. Longer can cause hip contractures and lead to difficulties with future ambulation

How do you measure dehydration in infants?

>3 hours without a wet diaper

What is iprtropium?

A cholinergic antagonist used for asthma. It blocks the parasympathetic nervous system, providing relief of acute bronchospasms

What is hydroxyurea?

A medication used to prevent sickle cell crisis.

What is submersion injury?

A near drowning, hypoxic incident in which the child has survived for 24 hours after

Friability

A state where mucosa becomes inflamed and bleeds readily

A nurse is assessing an adolescent who has scoliosis. What finding should the nurse expect?

A unilateral rib hump with hip flexion. This results from a lateral S- or C-shaped curve in the thoracic spine resulting in asymmetry of ribs, shoulders, hips, or pelvis

What learning strategy is most effective with adolescent learners?

Actively involve participants in practice of techniques. Learn best when actively involved in participation and use of psychomotor skills

What should the nurse teach about feeding an infant with GERD?

Add rice cereal to formula or breast milk to thicken feedings, which will decrease # of vomiting episodes

The nurse assesses a 6 mo for vaccination readiness. What finding would require delaying the DTaP?

An acute bilateral ear infection. Vaccination in the presence of a moderate-severe infection, w/ or w/o fever, increases risk of injury and decreases chance of mounting a strong immune response to vaccine -DTaP is not a live vaccine

What is Crycrimine (Pagitane)?

Anticholinergic used in Parkinson's disease

A nurse is caring for a client with MRSA. In what order should PPE be donned? A. Goggles B. Gown C. Gloves D. Mask

B, D, A, C Gown, mask, goggles, gloves

When is an Allen test performed?

BEFORE AN ARTERIAL PUNCTURE to determine if you can use or remove them. You compress ulnar and radial artery and tell patient to clench and unclench hands 10 times. Hand will blanch (turn white). You then release one artery and count how long it takes for color to return. Do the same process again and release the other artery. If it takes more than 6 seconds, the other artery can't be trusted to adequately oxygenate hand if one is removed

A nurse has administered the first DTaP (diphtheria toxoid, tetanus and pertussis) immunization to a two-month-old infant. For what symptom should the parents seek immediate medical attention?

Baby cries inconsolably for more than 3 hours. Crying lasting 3_ hours and/or seizures within 48 hours of vaccination indicates encephalopathy that must be treated immediately

What does an increase of protein concentration in spinal fluid indicate?

Bacterial meningitis

How long is the Pavlik harness used for?

Birth-6 mo for kids with hip dysplasia

Prophylactic antibiotic therapy is NOT recommended for what?

Burns

What are late signs of respiratory distress that indicate impending respiratory failure?

Characterized by inadequate oxygenation, ventilation or both -Cyanosis -Altered LOC -Apnea -Bradycardia

When is an electroencephalogram performed?

Child has seizures or to determine brain death in an unconscious child

A nurse in an ED is caring for a toddler who has partial-thickness burns on right arm. What action should the nurse take?

Cleanse affected area with mild soap and water to remove any loose tissue that could cause infection

A nipple with a wide base is used to feed what clients?

Cleft lip

A 3-year-old hospitalized child is on bedrest. To meet developmental needs, the nurse should provide what?

Coloring book and crayons-child is developing hand-eye coordination

What kind of teaching environment is best for ADHD clients?

Consistent environment that is predictable to assist w/ focus and the ability to complete expected tasks

What is one complication of cystic fibrosis?

Constipation b/c of failure to properly breakdown foods, slowing intestinal motility, and thickened enzymatic secretions due to disease process. Therefore, give stool softeners

What does abd distention indicate in children?

Constipation, flatus, or lactose intolerance

What kind of precautions are needed for RSV?

Contact and droplet. Virus can live for several hours on fomites and on hands for 30 min

A nurse is caring for a child who has had diarrhea for one day. The mother asks what diet to resume when the child's appetite returns. The child does not appear dehydrated. What should the nurse say?

Continue child's regular diet. Child will recover from mild-moderate diarrhea faster with this regular diet. -Lost fluids should be replaced, but not overcompensated. Consider popsicles, jell-o, diluted fruit juice, broth, pedialyte

What med class is contraindicated in children with asthma?

Cough suppressants because asthmatic children need to be able to cough up mucus to keep airway open

What does a mild moderate asthma diagnosis mean?

Daily symptoms occur in conjunction with exacerbations twice a week

What does flaking of the scalp with pink, irritated, exposed skin indicate?

Dandruff or a dry scalp

What is clubfoot?

Deformity in which an infant's foot is turned inward, often so severely that the bottom of the foot faces sideways or even upward. Contractures of soft tissues maintain malalignments. Treated with the Ponseti technique=stretching foot, casting (5-10), tenotomy, following by wearing braces

What is a monospot test?

Detects the presence of heterophil antibodies via agglutination of sheep or horse RBCs •Positive = EBV •Negative = CMV

An infant prescribed digoxin has a HR 88 bpm. What does this indicate and what should be done?

Digoxin toxicity. HR <90 bpm indicates toxicity

A nurse is teaching the parents of a 3-year-old child who has persistent otitis media about prevention. What should be taught?

Don't smoke around the child b/c tobacco smoke can cause inflammation of the respiratory tract

What is a manifestation of pertussis?

Dry, hacking cough that is sometimes more severe at night

How is SOB prioritized in the ED?

Emergent triage category. Implies a condition exists that poses an immediate threat to life or limb

What instructions should the nurse give after administering phenytoin?

Encourage client to brush teeth after each meal. Med can cause gingival hyperplasia. Risk can be reduced with good oral hygiene

What nutritional recommendation should nurse give to parents of school-age child who is immobilized after spinal surgery?

Encourage small, frequent meals high in protein. Immobilization decreases appetite. Small, frequent meals will be more readily tolerated. Adequate protein is needed for energy and tissue healing.

What causes mononucleosis?

Epstein-Barr virus (EBV)

What does a pink, nonpuritic macular rash on trunk and inner surfaces of extremities that appears and disappears rapidly indicate?

Erythema marginatum

Children ages 2 mo to 7 years should use what pain scale?

FLACC. -Face (F) -Legs (L) -Activity (A) -Cry (C) -Consolability (C)

True or false. used car seats should be inspected by health department

False, it is recommended to use a second-hand car seat

What is an indication of early septic shock?

Fever (100.4F+) and chills -tachycardia

When are APGAR scores completed?

First few minutes after birth

What is the initial treatment for intussusception?

Fluid resuscitation and decompression of GI tract with an NG tube. Unless perforation or peritonitis, physician will then try an enema to nonoperatively reduct it

How is the peak expiratory flow meter (PEFM) used?

Forcefully exhale for 1 second as quickly as possible to measure amount of air exhaled

What happens to glucose levels with bacterial meningitis?

Glucose level decreases

The nurse is conducting a physical examination of a 2-month-old with suspected pyloric stenosis. Which finding indicates pyloric stenosis?

Hard, moveable "olive-like mass" in the upper right quadrant

What is the last sense to fail as death nears?

Hearing

What does immobilization increase risk for in children?

Hypercalcemia, leading to renal stones, muscle fatigue, and diminished reflexes

When should factor IX be administered to a client?

If they have hemophilia B

What are mummy restraints used for?

Immobilize very young children to keep them safe during procedures. It is likely to increase fear in toddlers and preschoolers

How should fluid intake change after a lumbar puncture?

Increase fluids to replace cerebrospinal fluid removed during the procedure

Toddler with hypoglycemia will exhibit what?

Irritable, labile mood

What part of the GI tract does ulcerative colitis (UC) affect?

Large intestine and rectum -mucosal lesions

What type of nipple should be used for an infant with GERD?

Larger hole to help infant suck more easily

What are transmural lesions?

Lesions that go all the way through a wall to the inner tissue -trans: across -mural: on or relation to a wall

Toddler with hyperglycemia will exhibit what?

Lethargy

What limitations should be placed on people visiting a client being treated with brachytherapy?

Limited to one 30 minute visit per day

What will happen to the extremities as death nears?

Lose movement of lower extremities w/ progressive loss of movement up the body

A nurse is assessing an infant who has a ventricular septal defect. What finding should the nurse expect?

Loud, harsh murmur. D/t left-right shunting of blood (also causes hypertrophy of infant's heart muscle)

An allergy to neomycin with an anaphylactic reaction is a contraindication to receiving what vaccine?

Measles, mumps, and rubella (MMR) vaccine. Clients who have a severe allergy to eggs or gelatin should not receive this vaccine.

What does bloody stool indicate in children?

Meckel diverticulum

An infant losing 6% to 9% is experiencing what type of dehydration?

Moderate dehydration

Tachypnea is evidence of what type of dehydration?

Moderate dehydration

A nurse is caring for an infant following surgical repair of cleft lip. What should nurse do?

Monitor temporal artery temp. for manifestations of infection. Also watch for redness, warmth, and drainage from incision

A nurse is providing education to the mother of a 10-year-old child about to undergo scoliosis screening. Which statement by mother indicates a need for further teaching?

My child will be asked to stand upright, arms stretched above the head

A sodium level of 129 mEq/L puts client at increased risk for what?

Neurological deficits and seizure activity. So, implement seizure precautions!

Can graham crackers be given to a celiac client?

No, they contain wheat flour

Should you cluster invasive procedures for young children?

No. It creates an unnecessarily lengthy and painful period for the client, which increases fear

A client with hemophilia sustains abd trauma from an MVA. What movement should be provided to client?

None. rest the joints during acute bleeding to prevent stretching the joint or bleeding to recur

A nurse is caring for an infant who is post-op following a surgical procedure to correct intussusception. What is the most appropriate way to re-introduce feedings after procedure?

Oral electrolyte solution. Clear liquids should be offered first post-op and then concentration should be increased as tolerable

What type of burn has blisters?

Partial-thickness burns. Epidermis and upper layers of dermis are light pink with denuded moist areas

Denying discomfort during assessment of injuries is indicative of what?

Physical abuse

What do high fever and productive cough raise suspicion of?

Pneumonia. New onset pneumonia is considered an urgent triage category and should be treated quickly, but prioritized higher if respiratory failure seems imminent

An ED nurse is caring for client who ingested kerosene. The child is lethargic, grunting, and gagging. What should the nurse do?

Prepare for intubation w/ a cuffed endotracheal tube b/c of risk of aspiration from lethargic, grunting, and gagging S/S

A nurse is planning care for an adolescent client who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following interventions is the nurse's priority?

Promote bed rest. In vaso-occlusive criss, client has a cellular O2 demand. Therefore, reduce client's metabolic demands for O2 and limit cardiac O2 consumption by encouraging rest

How should an adolescent be positioned following a lumbar puncture?

Prone position or flat in bed for up to 12 hr after procedure to prevent postprocedural spinal headache

Children who have leukemia will not receive what treatment?

Radiation therapy. They will receive chemotherapy.

Capillary refill greater than 4 seconds is evidence of what type of dehydration?

Severe dehydration

Hyperpnea is evidence of what type of dehydration?

Severe dehydration

Lethargy is evidence of what type of dehydration?

Severe dehydration

What does profuse sweating indicate in a client experiencing an acute asthma attack?

Severe respiratory distress from status asthmaticus. It requires immediate intervention and must be reported to provider. Other signs to report: nasal flaring, distended neck veins, tachypnea

A nurse is providing teaching to the parent of a school-age child who has a new prescription for oral nystatin for the treatment of oral candidiasis. What instruction should the nurse include?

Shake the med prior to administration. It is given as a suspension so it should be shaken to evenly disperse the med

If an infant has a propensity to vomit, in what position should they sleep in?

Side-lying (or upright)

How should client be positioned to obtain a rectal temp.?

Side-lying or prone position

How does digoxin work?

Slows conduction through AV node 1 - Blocks Na/K ATPase leading to increased intracellular Ca++ (increased inotropy, tachyarrhythmias) 2 - Increases vagal tone (anti-arrhythmic, bradyarrhythmias)

What part of the GI tract does Crohn disease (CD) affect?

Small intestine, large intestine, and rectum

What are recognizable signs of pediculosis capitis?

Small white spots that adhere to hair shaft, close to scalp

What is the formal operations phase and who fits inside it?

Stage marked by abstract thinking and deductive reasoning. 11-16 y/o

What is the pre-operation stage and who fits inside it?

Stage marked by animism and symbolism (2-7 y/o)

What is the sensory-motor phase and who fits inside it?

Stage marked by egocentricity, simple cause and effect, and development of object permanence. (birth-2 yrs)

What is symbolic play?

Substituting one object to pretend it's another. Pretending a rug is a magic carpet. Starts at about 18 mo

Universal consent does not cover what?

Surgical or invasive diagnostic procedures

What is papilledema?

Swelling of optic disc. Increase in intracranial pressure which causes elevated optic disk with blurred margins, bigger blind spot (can be seen in hydrocephalus)

What does a severe intermittent asthma diagnosis mean?

Symptoms occur continually, along with frequent exacerbation that limits the child's physical activity and quality of life

What does a mild intermittent asthma diagnosis mean?

Symptoms occur less than twice a week

What does a mild persistent asthma diagnosis mean?

Symptoms occur more than twice a week, but not daily

Tenesmus

The feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping.

What is the concrete operations phase and who fits inside it?

Time when children develop more logical and systematic reasoning, become better listeners, and think more objectively... but still depend on concrete objects for understanding. Middle and late childhood (6-11 years)

The nurse is assisting the parents fo a school-aged child with a plan to prepare for impending death of family member. What potential behavior is expected with this stressor?

Uncooperative behavior. It's how school-aged children display fear of unknown

How long should infants be placed in rear facing position in the back seat?

Until they weight 9.1 kg (20 lbs)

A nurse is assessing a child with full-thickness leg burns. What manifestations should be expected?

Variable colors: cream to brown or black. Injury reaches to dermis and possibly muscles, tendons, and bone. Less painful than partial-thickness b/c of nerve destruction

A nurse is preparing to obtain a blood sample for Hgb from a child with hemophilia. How should it be collected?

Venipuncture. It causes less bleeding than a finger puncture

What is one med consideration when administering albuterol?

Watch for tremors and tachycardia

A nurse is providing teaching to the parent of an infant who has diaper dermatitis. The nurse should instruct the parent to apply what to the area?

Zinc oxide-provides protective barrier against the instigating irritants: urine, feces, soap, or friction. The S/S are scaling, blisters, or papules with erythema

What does inotropic mean?

contractility=force of contraction in-sinew, strength, force tropos-turn, direction, way

What is an Allen test?

determine whether the patency of the radial or ulnar artery is normal

What is leukocytosis?

increase in WBCs

Capillary refill 2-4 seconds is evidence of what type of dehydration?

moderate dehydration

Irritability is evidence of what type of dehydration?

moderate dehydration

What is Meckel diverticulum?

outpouching or bulge in the lower part of the small intestine. The bulge is a leftover of the umbilical cord

What is intussusception?

telescoping (folding bowel section in itself) of 1 bowel segment into a distal segment-can occur anywhere in the large or small intestine (ileocecal junction most common)