E1 critical peds
Which statement suggests that a parent understands how to correctly administer digoxin?
"I give the medicine at 8 in the morning and evening every day." For maximum effectiveness, the medication should be given at the same time every day.
Which statement will the nurse include when teaching a patient about cephalosporin therapy?
"Inform your health care provider if you develop mouth ulcers."
How should the nurse respond when asked by the mother of a child with beta-thalassemia why the child is receiving deferoxamine?
"To eliminate excessive iron being stored in the organs." Multiple transfusions result in hemosiderosis. Deferoxamine is given to chelate iron and prevent organ damage.
Three distinct syndromes of pulmonary complications may occur in children with inhalation injury:
(1) early carbon monoxide (CO) poisoning, airway obstruction, and PE; (2) ARDS occurring at 24 to 48 hours or later in some cases. (3) late complications of pneumonia and pulmonary emboli
Cushing triad
(systemic hypertension, bradycardia, and respiratory depression) i -Is a late sign of impending brainstem herniation
Trauma assesssment (Order & components)
- ABCs, level of consciousness - Spinal cord injury immobilization? - EMS/BLS/ALS - Control bleeding? - Systematic "head-to-toe" assessment
Manifestations of Cardiogenic Shock in Children
-Hepatomegaly or cardiomegaly -Increased central venous pressure -Periorbital edema -Crackles -Diaphoresis -Oliguria -Reduced capillary refill -Differences in proximal and distal pulses
Respiratory failure: Nursing care management
-Maximize ventilation and oxygen delivery -Correct hypoxemia and hypercapnia -Treat underlying cause -Apply therapy to control oxygen demands -Anticipate complications
A patient is receiving gentamicin therapy: 100 mg intravenously at 0800, 1600, and 2400. At 0730, the nurse is informed that peak and trough levels need to be drawn. When is the best time to obtain the peak level?
0900 Blood should be drawn 45 to 60 minutes after drug has been administered for peak levels and minutes before next drug dosing for trough levels.
A nurse is caring for a preschool child who is receiving prednisone. What is most important for the nurse to consider when administering adrenocorticosteroid therapy?
Suppresses inflammation, decreases antibody production
clinical manifestations of pulmonary congestion in children with congestive heart failure include:
Tachypnea, exercise intolerance, and cyanosis, along with orthopnea, wheezing, and cough
What low level of urine output might indicate kidney failure?
<1 ml/kg/hr = possible renal failure
A child had an aortic stenosis defect surgically repaired 6 months ago. Which antibiotic prophylaxis is indicated for an upcoming tonsillectomy?
Amoxicillin is taken orally 1 hour before the procedure.
Which statements are true regarding the pharmacokinetic changes observed in infants?
An infant's gastric pH is less An infant's gastric emptying is slow An infant's first-pass metabolism is slow
Overview: Atropine sulfate
Anticholinergics (atropine and ipratropium [Atrovent]) help relieve acute bronchospasm. However, these drugs have adverse side effects that include drying of respiratory secretions, blurred vision, and cardiac and CNS stimulation. ◦Cardiac and BP monitoring is essential. ◦Adverse effects ◦Dysrhythmias, tachycardia, myocardial ischemia ◦Restlessness, anxiety, mydriasis ◦Thirst, urinary retention
Which drug increases the risk of Reye syndrome in children?
Aspirin
clinical manifestations in children with spastic cerebral palsy
The Babinski sign, primitive reflexes, ankle clonus, exaggerated stretch reflexes, and contractures
Common causes of skin lesions include
The Child's age, hereditary factors, systemic disease, and contact with injurious agents
Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence?
Blood and urine cultures, antibiotic dose
Revised Trauma Score (RTS)
Components: Glasgow Coma Scale (GCS), Systolic blood pressure (SBP), Respiratory rate (RR) To lose points (max 4 per catagory): GCS <13, SBP <89, RR <9 or >29. 50% points per catagory (2): GCS 8-6, SBP 50-75, RR 6-9. An RTS of less than 11 is used to indicate the need for transport to a designated trauma center.
HF manifestations (General)
Difficulty feeding, poor weight gain Mild tachyapnea, tachycardia Cardiomegaly Galloping rhythm Poor perfusion, edema Liver and spleen enlargement Mottling, cyanosis, pallor
A client has +3 pitting edema in the legs and potassium of 2.3 mEq/L. The nurse should anticipate which order from the health care provider?
Diuretic
The nurse is teaching a parent of a 2-year-old toddler how to administer ear drops. In what direction does the nurse teach the parent to gently pull the pinna?
Down and back
Manifestations of Hypovolemic Shock in Children
Dry mucous membranes Depressed fontanel Cold, clammy skin Oliguria Poor skin turgor Delayed capillary refill
Manifestations of Septic Shock in Children: Early VS Late
Early -Vasodilation -Extremities that are warm to the touch -Tachypnea -Tachycardia Late -Rapid, thready pulse -Cyanosis -Cold, clammy skin -Purpuric skin lesions -Narrow pulse pressure -Oliguria or anuria
poststreptococcal glomerulonephritis cm
Edema, decreased urine volume, and hypertension are common clinical manifestations of acute poststreptococcal glomerulonephritis
Impending cardiac arrest in a child drug anticipated?
Epinephrine is the drug of choice for the management of cardiac arrest, dysrhythmias, and hemodynamic instability
Which of the following statements regarding hypertonic (hypernatremic) dehydration is correct?
Fluids shift from ICF to ECF Seizure monitoring should be implemented Serum sodium level is above normal limits. -In hypertonic dehydration, the sodium concentration is greater than 150 mEq/L
Nursing Care of CHI (Closed head injuries)
Frequent assessments Bedrest with head of bed slightly elevated and head in midline position Seizure precautions Sedation and pain management Limit stimulation Documentation Family support Plan for healing process and rehab
A 10 year old patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient?
His respiratory rate. The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. When death occurs from opioid overdose, it is almost always due to respiratory depression. When opioids are given, care must be taken to titrate the dose so that the patient's pain is controlled without affecting respiratory function.
Questions for victim of a fall?
How far did the child fall? How did the child land (on what part of the body)? On what type of surface did the child land? Was the child's fall broken by any objects?
Questions for For a victim of a Penetrating Injury?
How long and how wide was the blade of the knife? How far away was the gun when it was fired? What type of gun was used, and what was the caliber of the gun?
A nurse is planning care for a toddler who has ingested aspirin. What assessment warrants close monitoring because an increase can result in further complications?
Hyperpyrexia (increased temperature) is a manifestation of acute aspirin poisoning; this leads to increased oxygen consumption and heat loss
What is the greatest threat from isotonic dehydration?
Hypovolemic shock
Which lab value change may indicate osteomyelitis?
Increased ESR (erthrocyte sedentation rate). (due to inflammatory result of the bone infection)
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Influenza (live) vaccine is administered through the intranasal route. The rotavirus vaccine is administered orally. The varicella virus vaccine is given as a subcutaneous injection. The human papillomavirus vaccine is given as intramuscular injection
The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration?
Infusing the drug over at least 1 hour
A nurse is caring for a 3-month-old infant with severe diarrhea following antibiotic therapy. After the effects of dehydration are stabilized, the healthcare provider prescribes Lactobacillus granules. What explanation does the nurse give to the infant's parents about the reason for giving lactobacilli?
Lactobacilli are part of the flora in the healthy gastrointestinal tract. The purpose of administering lactobacilli granules is to help recolonize the normal gastrointestinal flora that were destroyed with antibiotic therapy.
The nurse is teaching parents about the side effects of immunization vaccines. What expected side effect associated with the Haemophilus influenzae (Hib) vaccine will the nurse include in the teaching?
Low grade fever
Overview: Mannitol
Mannitol (or sometimes urea) administered intravenously is the drug most frequently used for rapid reduction of ICP. The infusion is generally given slowly but may be pushed rapidly in cases of herniation or impending herniation Monitor neurologic status, lab results of electrolytes and serum osmolality, I&O
When an infant or child is intubated, medications are usually administered for achieving a successful, atraumatic intubation and decreasing the child's anxiety. Which of the following medications may be used for intubation?
Midazolam, fentanyl, and rocuronium.
Chest tube considerations after cardiac surgery
Monitor chest tube drainage q hour for COLOR uImmediate postop may be bright red, but changing to serous Monitor chest tube drainage for quantity Notify surgeon if chest tube drainage >3 ml/kg/hr ×3 consecutive hours OR 5-10 ml/kg in any 1 hour (possible hemorrhage) Be alert for cardiac tamponade (rapid onset; life threatening)
A patient is taking piperacillin-tazobactam. Which nursing interventions are most appropriate for this drug?
Monitor for symptoms of superinfection, including stomatitis and vaginitis. Send specimen to lab for C&S before antibiotic therapy is started. Instruct patient to take entire prescribed drug.
Overview: Magnesium sulfate
Muscle relaxant that decreases inflammation and improves pulmonary function and peak flow rate among patients with moderate to severe asthma when treated in the ED or ICU ◦Monitor for magnesium toxicity. ◦Adverse effects ◦Hypotension, bradycardia, flushing, sweating ◦Diarrhea, respiratory depression, flaccid paralysis ◦Deep tendon reflex impairment, circulatory collapse
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Nalidixic acid can cause cartilage erosion in pediatric clients. Sulfonamides can cause kernicterus. Chloramphenicol can cause Gray syndrome in neonates and infants. Fluoroquinolones can cause tendon rupture in pediatric clients
Pediatric head injury minor vs major ss
The nurse recognizes the injury as minor if the child exhibits clinical manifestations such as vomiting, listlessness, and somnolence. The nurse recognizes the injury as severe if the child shows clinical manifestations such as papilledema, retinal hemorrhages, and elevated temperature
Postpericardiotomy syndrome
The postpericardiotomy syndrome of fever, leukocytosis, pericardial friction rub, or pericardial and pleural effusion can occur anytime the pericardium is opened, either in the immediate postoperative period or after surgery, typically around day 7 to 21. The cause is unknown, although etiologic theories include viral infection, autoimmune response to myocardial tissue, and a reaction to blood in the pericardium. The syndrome is self-limiting and is treated with rest, salicylates, NSAIDs, and sometimes steroids. Pericardiocentesis or pleurocentesis may be needed to treat large effusions
When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care?
Therapeutic management includes administration of gamma globulin and salicylates. The fever of Kawasaki disease is unresponsive to antibiotics. It is responsive to anti-inflammatory doses of aspirin and antipyretics
When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?
Tinnitus and dizziness
For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?
To improve oxygenation
reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?
To improve oxygenation
A preterm infant with respiratory distress syndrome is receiving inhaled nitric oxide (NO). What is the reason for administering the inhaled nitric oxide?
To reduce pulmonary vasoconstriction and pulmonary hypertension NO is used for infants with conditions such as meconium aspiration syndrome, pneumonia, sepsis, and congenital diaphragmatic hernia.
Mannitol class & primary purpose
Osmotic diuretics, such as mannitol, increase the osmotic pressure of glomerular filtrate and thus decrease absorption of sodium; they are used to treat cerebral edema and increased intraocular pressure
Which antiepileptic drug is used as the first-line treatment for absence seizures?
Valproic acid
The health care provider has prescribed surfactant, beractant (Survanta), to be administered to an infant with respiratory distress syndrome (RDS). The nurse understands that the beractant will be administered by which route?
Via the ET tube Surfactant is administered via the ET tube directly into the infant's trachea
Questions for a Victim of a Motor Vehicle Collision?
Was the child wearing a seatbelt or in a child's car seat? What was the type of seatbelt (lap, lap-and-shoulder, or car seat)? What was the speed of the motor vehicle? With what did the motor vehicle collide? At what location on the motor vehicle was the point of impact? Where was the victim seated in the motor vehicle? How much damage was done to the motor vehicle?
Signs and symptoms that are common in croup conditions include which of the following?
Wheezing Hoarseness Harsh cough Dyspnea
Which drug may cause sudden infant death syndrome?
Phenothiazines
A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated?
Povidone-iodine (Betadine) Iodine compounds are contraindicated in patients with allergies to seafood. The other options are incorrect.
Stages of separation anxiety
Protest: Child is agitated, resists caregivers, cries, and is inconsolable Despair: Child feels hopeless and becomes quiet, withdrawn, and apathetic Detachment: Child becomes interested in environment; may ignore parents' return Regression
A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which?
Serum potassium
Which type of immune preparation, made from donated blood, contains antibodies that provide passive immunity?
Specific immune globin
A 8 month old patient about to receive a morning dose of digoxin has an apical pulse of 68 beats/min. What will the nurse do next?
Withhold the dose, and notify the prescriber. Prior to digoxin administration the apical pulse must be check over 1 minute. For an infant if less than 90 bpm hold and for an older child if it is less than 70 hold. Notify provider.
cardiac tamponade
acute compression of the heart caused by fluid accumulation in the pericardial cavity
Concussion
an alteration in mental status with or without loss of consciousness, which occurs immediately after a head injury.
Epidural (extradural) hematoma
hemorrhage into the space between the dura and the skull. As the hematoma enlarges, the dura is stripped from the skull; this accumulation of blood results in a mass effect on the brain, forcing the underlying brain contents downward and inward as it expands.
What may be a late sign of shock?
hypotension
Digoxin effect
increases cardiac output by slowing conduction through the atrioventricular node and makes the contraction stronger Diuretics, , lasix common, decreases preload volume Works to improve cardiac function (improve contractility) Digoxin = works well in pediatrics Rapid onset, short half-life Digoxin toxicity symptoms—vomiting, neuro signs, visual disturbances
Common clinical manifestations of HIV infection in children include
oral candidiasis, developmental delay, chronic diarrhea, and lymphadenopathy
Treatment of children with smoke inhalation injury is largely symptomatic. The most widely accepted treatment is
placing the child on humidified 100% oxygen as quickly as possible -monitored for signs of respiratory distress and impending failure and intubation may be required. -A laryngoscopy or bronchoscopy evaluation may be done to assess for airway damage.
A 10-year-old child is prescribed tetracycline. Which possible drug-related reactions are associated with this drug?
staining of teeth
Head injury common symptoms in a child with no neurologic deficit:
• irritability, •headache, •vomiting. In Infants less than 1 year of age: •irritability, •pallor with anemia •cephalhematoma. •hypotonia, •seizures, • vomiting, •bulging anterior fontanel •lethargy.
Overview: Epinephrine
◦Drug of choice to treat anaphylactic shock and acute, severe asthmatic attack ◦Give 0.3 to 0.5 mg IM to adults for severe asthma and anaphylactic shock. Side effects ◦Excitability, fear, anxiety, restlessness ◦Monitor closely for tachycardia, dysrhythmias, hypertension, angina.
Overview: Morphine Sulfate
◦Relieves chest pain, treats acute cardiogenic pulmonary edema, dilates venous vessels, and reduces the workload on the heart. ◦Administered 1 to 4 mg IV over 1 to 5 min until chest pain is relieved. Adverse effects ◦Respiratory depression, hypotension ◦Antidote—naloxone reverses action of morphine. ◦Dose 0.4 to 2 mg q2 min as needed
Overview: Albuterol
◦Reverses bronchoconstriction in anaphylactic shock, asthma, COPD, inflammatory narrowing of airways ◦Given via nebulizer or MDI ◦Monitor breath sounds, subjective feelings of respiratory distress. ◦Adverse effects ◦Tachycardia, tremor, nervousness, dysrhythmias, hypertension Ipratropium, when used in combination with albuterol, can be effective during acute severe asthma in improving lung function in children coming to the ED. Children who continue to display respiratory distress despite vigorous therapeutic measures, especially the use of sympathomimetics (e.g., albuterol, epinephrine), are in status asthmaticus
