NR328 Exam 1 (Pediatrics)

Yes. She is considered emancipated because she is pregnant. Although, when she has the baby, she is no longer considered emancipated so she can no longer give consent for herself BUT she can give consent for her baby.

Can a 15 year old girl who is pregnant give any kind of consent medical wise?

yes as long as it is a low grade fever (100.4-102) and a mild illness ** sometimes children will have a slight fever due to teething.. which is not a reason to withhold a vaccine

Can children get vaccines with a fever?

not before 6 months of age.. once 6 months, water can be given here and there ** kidneys cannot handle water and it can cause hyponatremia

Can infants have water?

vaccines and when to administer

Hep B Rotavirus (RV) = severe diarrhea Diphtheria (severe respiratory depression), tetanus (issues with muscles), and pertussis (whopping cough) = (DTaP) Haemophilus influenza type B (Hib) = protects against bacteria causing meningitis and epiglottis Pneumococcal conjugate (PCV13) = protects against 13 different bacterias Inactivated polio vaccine (IPV) = paralysis Measles mumps, and rubella (MMR) Varicella = chicken pox Hep a

- holds head up (no bobble head) - shows interest in food - 4-6 months of age ** start with iron fortified cereal ** start with one food at a time for about 3 days (we are checking for allergies... rash, diarrhea, or vomiting)

How do we know if an infant is ready to start solid foods?

20ml/kg

How do you calculate how much to give a pediatric patient when considering IV fluid bolus?

measure right above the eyebrows

How is head circumference measured?

10 minutes

How long after putting nystatin in an infants mouth for a candidiasis infection can they feed again?

the flu vaccine would be contraindicated.. be cautious with the MMR vaccine as well --> go to allergist

If a child is allergic to eggs, what vaccine is contraindicated for a nurse to give?

MMR is contraindicated --> go see allergist

If a child is allergic to neomycin, what vaccine is contraindicated for a nurse to give?

acyclovir

If a child who has HIV gets chicken pox, what can we give them to help lessen their viral load?

RAPID RESPONSE!!! Child has epiglottitis. Child will most likely need to be intubated and possibly trach'ed if airway is too swollen to intubate.

If a nurse walks into a patient's room and sees them in the tripod position and drooling, what should she do?

protein deficiency kwashiorkor = severe protein deficiency s/s = pot belly, thin brittle hair, moon face, ascites

Indications of what? - decreased muscle mass - growth/puberty delay - iron deficiency anemia - delayed wound healing - edema

responses to death

Infants/toddlers: - doesn't understand - mirrors parental emotions - regression Preschoolers: - death is temporary School age: - starts to understand death is permanent - fears death - curious about death Adolescents: - adult like conception of death - difficulty accepting death - guilt - relies on peers for support

more than 3 months

In pediatrics, how long does pain need to be had before it is considered chronic?

manifestations of approaching death

- cool skin - loss of consciousness - no bowel or bladder control - swallowing difficulties - decreased appetite and thrist - bradycardia and hypotension - cheyne stokes - death raddle - hearing is the last to go

chicken pox aka varicella

- lesions that start as macules (flat) --> papules (raised) --> vesicles (fluid filled) - lesions can stay on body for 10 days - contagious until lesions crust over Transmitted by: - respiratory secretions - contact with open lesions Isolation precautions: - airborne - contact when lesions are open Nursing care: - mittens to stop from scratching - keep hydrated (popsicles, water, pedialyte) - calamine lotion, oatmeal bath, and benadryl can help itching Complications: - secondary infection (cellulitis) due to scratching - encephalitis - pneumonia Vaccine given at 1 and 4 years of age

proper way to administer ear drops

- pull pinna down and back for children under 3 - pull pinna up and back for children over 3 - drops at room temperature - child in supine or side lying position - massage

car seat health promotion

- rear facing car seat until 2 - 45 degree angle - shoulder harness in the slots or below level of shoulders - buckle to carseat should be at the level of the infants armpits

nursing interventions for a child in respiratory distress

1. positioning = sniffing (in case of rescue breaths) 2. suction = nasal pharyngeal aka deep suctioning (can't clear secretions on their own) (measure from ear to nare to know how far to suction, insert through nose, suction and turn on way out) 3. oxygen (if child isn't getting better) 4. NG (if they cannot feed due to too many secretions) 5. NPO

She cannot receive MMR vaccine. It is a live vaccine and if administered while pregnant, it can cause a miscarriage or birth defects. She can receive the TDaP vaccine because it is not live. ** remember, DTaP is given for children under 11.. TDaP (think teen) is given for children 11 and older

A 16 year old girl who is pregnant goes to an outpatient clinic wanting the MMR and the TDaP vaccine. Can she receive them?

A. Diphtheria, tetanus, and pertussis (DTaP)

A nurse at a clinic is preparing to administer immunizations to a 5 year old child. Which of the following immunizations should the nurse plan to give? A. Diphtheria, tetanus, and pertussis (DTaP) B. Pneumoccocal (PCV) C. Haemophilus influenza type b (Hib) D. Hepatitis B ( Hep B)

A, B, and C

A nurse is assessing a client who has pertussis. Which of the following findings should the nurse expect? (Select all the apply) A)Runny Nose B)Mild fever C)Cough with a whooping sound D)Swollen salivary glands E)Red Rash

B, C, E

A nurse is assessing an infant who has scabies. Which of the following findings should the nurse suspect? (Select all that apply) A)Presence of nits on the hair shaft B)Pencil-like marks on hands C)Blisters on the soles of the feet D)Small red bumps on the scalp E)Pimples on the trunk

A and B (helps with itchiness) ** burrow solution helps with itchiness and inflammation in those who have poison ivy

A nurse is planning the care of a child who has tinea capitis. Which of the following actions would the nurse include in the plan of care? (Select all that apply) A)Treat infected house pets. B) Use selenium sulfide shampoo. C) Cleanse area with Burrow solution. D) Administer antiviral medication. E) Use moist, warm compresses.

C. Haemophilus influenza type B ( Hib) and Inactivated Polio Virus (IPV)

A nurse is preparing to administer recommended immunizations to a 2-month-old infant. Which of the following immunizations should the nurse plan to administer? A. Human Papillomavirus ( HPV) and Hepatitis A B. Measels, mumps, rubella ( MMR) and Tetnus diptheria and acellular pertussis (TDaP) C. Haemophilus influenza type B ( Hib) and Inactivated Polio Virus (IPV) D. Varicella ( VAR) and Live attenuated influenza influenza vaccine (LAIV)

infancy

Age 0-1 Trust vs mistrust: - feed - change diapers - hold/cuddle Health promotion: - first MD appointment made within 72 hours of discharge - 9-11 hours of sleep needed - teething starts at 4-6 months; 6-8 teeth by age 1 (extra saliva; low grade fever may occur) Nutrition: - breastfeeding provides COMPLETE diet during first 6 months - no whole milk before 1 year of age - vitamin D (prevents rickets) and iron supplement is needed - solid foods start around 4-6 months Pain: - high, tense, loud cry - rigid body with thrashing extremities - tightly closed eyes, square shaped open mouth, eyebrows drawn together and lowered - increased BP and HR, decreased spo2

toddler

Age 1-3 Autonomy vs shame - want to do everything themselves HR: 90-160 RR: 30-60 BP: 65-78/41-52 - rituals/schedules are very important.. if thrown off, tantrum may happen - egocentric - play time is important - regressive behavior during stressful situations - potty training starts at age 2 - coordination increases - picky eaters - be cautious of aspiration and choking --> soft foods are best - minimum of spf 15 when outside - 1 word sentence by 1 year, 2 word sentence by 2 years - grows 3 inches per year - head and chest circumference should be equal by 1 or 2 years of age - at 30 months, they will be 4x birth weight Pain: - harsh, tense, loud cry or screaming - "ouch" "no" "it hurts" - flinching and thrashing of extremities - points to pain - clingy

adolescent

Age 12-18 Identity vs role confusion - trying to figure out who they are - friends are very important HR: 50-100 RR: 16-19 BP: 108/138-63-94 - boyfriends and girlfriends start - doesn't think about consequences - high metabolism and rapid growth - needs to eat healthy Health promotion: - sleep! sleep deprivation is common - safe sex practices - safe driving - no drugs - testicular and breast self exams

preschooler

Age 3-5 Initiative vs guilt - accomplishment and satisfaction in their activities.. never make them feel like what they did or their decision is not good enough HR: 80-140 RR: 25-30 BP: 83-114/38-67 - magical thinking - very autonomous - increased socialization - "why" stage - typically when one can realize a child may have autism - 3.5-6.5lbs gained each year from 3-6 - very important to gain their trust - thinks of sickness as a form of punishment Health promotion: - 12 hours of sleep needed - inconsistent naps - 1 hour physical activity per day, less than 2 hours screen time - street safety and injury prevention --> wear helmet, look both ways Screenings: - by 5, should have been tested for lead poisoning - by 3, they should have been seen by the dentist - obesity

school aged

Age 5/6-12 Industry vs shame - figuring out what they're good at - compares themselves to other peers HR: 60-110 RR: 19-21 BP: 91-125/54-84 - friends are mostly the same gender - bulling starts - less egocentric --> starts to see others' perspectives - baby teeth fall out and permanent teeth erupt by 6 - understands concept of time - puberty between 9-12 Health promotion: - 9 hours of sleep needed but they typically want to stay up - activity is important - avoid fast food - teach how to make healthy choices - at age 10-12 start screening for scoliosis

TDaP ** these illness can be fatal if a young child contracts one

Anybody taking care of an infant should have a ________ vaccine

age 12

At what age can a girl give consent for reproductive health only? (birth control and morning after pill)

around ages 9/10

At what age does a nurse begin to use the numerical scale in pediatrics?

- immunocompromised (cancer and HIV patients, and those who take steroids daily) - patients who have received treatment blood products within 3 months

Besides pregnant woman, who cannot get live vaccines?

pertussis (whooping cough) ** bacterial

Manifestations: - low grade fever - prolonged coughing - crowing or whooping sound upon inspiration that can last 4-6 weeks - cyanosis - emesis - copious secretions Transmission: - respiratory secretions Isolation precautions: - droplet Nursing care: - NG tube for feeding - oxygen Complications: - pneumonia - atelectasis - dehydration Vaccine given at 2,4,6, 12 months, and again at 4-6 years

mumps

Manifestations: - swollen carotid glands (parotitis) - fever - painful chewing - swollen testes - abdominal pain in girls due to swollen ovaries Transmitted by: - saliva (sharing drinks, utensils, swapping spit) Isolation precautions: - droplet - contact Nursing care: - elevate the scrotum - no citrus foods or juices - no sharing - once onset of swelling has occurred, they must stay home for 5 days Complications: - deafness - encephalitis Vaccine given at 1 and 4 years

tinea capitus --> think cap aka head tinea corporis aka ring worm --> think core ** fungal infections

Tinea capitus: - effects the scalp - treated with oral antifungal agents (griseofulvin, terbinafine, or fluconazole) - can cause balding Tinea corporis: - effects the trunk - treated with topical antifungal medication (clotrimazole) ** both can be transmitted by mats, the gym, animals, and brushes

warning signs of child abuse and risk factors for abuse

Warning signs: - inconsistent stories - story doesn't match injury - bruising in weird places - burns - delayed care - hospital hoppers - kids will act "weird"; won't want to be with abuser - kids will act "coached" Risk factors: - hyperactive child - having autisum - lots of tantrums - multiple children - being of a low socioeconomic class - parents who have history of abuse - drugs and alcohol abuse - mental health issues

- waking up from nights/nap time dry - showing interest in using the toilet

What are signs that a toddler is ready to potty train?

- stridor (upper airway issue) - barking cough aka croup - grunting - nasal flaring - head bobbing (using neck muscles to pull air in)

What are some abnormal findings that indicate respiratory distress in children?

- fever - infection - dehydration

What can cause an elevated heart rate in pediatric patients?

M - measles T - TB V = varicella

What communicable diseases utilize airborne precautions?

soft and flat Bulging = ICP Sunken = dehydration

What is a normal finding for the posterior and anterior fontanels?

this is warning the parents about what is to come in their growing child

What is anticipatory guidance?

100.4-102

What is considered a low grade fever in peds?

weight

What is the best indicator of fluid status?

isolation

What is the most important thing to do when taking care of a kid with a communicable disease?

belly and nose breathers

What kind of breathers are kids?

a child with cystic fibrosis

What kind of child will have clubbing of the fingers?

frequent swallowing because it could mean the patient is hemorrhaging

What should a nurse look out for in a child who just had a tonsillectomy?

- TDap - HPV if desired - meningococcal

What vaccines should be administered to children ages 11 and 12?

at 6 months.. they first get half the dose to prime the body, then come back a month later and get the rest of it

When can a child first get the flu vaccine?

babbling/cooing = 3 months one word sentences = 1 year

When do babies start babbling/cooing? When do they start saying one word sentences?

2 months. If they are dehydrated, no tears will be produced.

When do babies start to make tears?

Around 4 months.. head lag should be gone around this time. At 6 months, babies can roll every direction.

When do babies start to roll over?

2-3 months

When do babies start to smile?

double = 6 months triple = 1 year ** averages about 1.5lb weight gain per month

When do infants double their birth weight? When do they triple it?

innate (natural) reflexes

When do they disappear? Tonic neck "fencing" --> 3-4 months Palmar grasp --> 4 months Babinski --> 12 months Rooting --> 4-6 months Plantar grasp --> 8 months Moro --> 3-4 months

at 12 months ** it is ok to wait until 12 months because infants have immunity from mom until about 10 months

When is the MMR and varicella vaccines first given?

They will start creeping (holding on to furniture and walking) at 10 months and by 11 months they should be walking with one hand held.

When should babies start walking by?

they want to receive the vaccination around 12-24 months because hep a is spread by the fecal/oral route and at this age, children are often in daycare and touching others while not washing their hands

When should children receive a hep a vaccination?

administered in the vastus lateralis muscle --> only 1ml at most can be administered into one leg, use other leg if more than 1ml - redness at injection site - tenderness - low grade fever

Where should a vaccine be administered in a pediatric patient? What are common side effects of receiving them?

due to a secondary infection or dehydration

Why are pediatric patients most commonly hospitalized after contracting a communicable disease?

their skin is thinner than adults therefor heat will aggravate the skin and cause a rash that may itch

Why do children develop heat rashes?

it compares children from the same age in order to know the average weight, height, and head circumference... it is important because it tells us if the patient is FOLLOWING THE TREND of the growth chart ** we start to worry when children fall off the growth curve --> failure to thrive

Why is a growth chart so important during pediatric years?

to allow for brain growth anterior = 12-18 months posterior = 2-3 months

Why is an infants skull not fused together right away? When do the anterior and posterior fontanels fuse?

to check for ICP or microcephaly

Why is it important to measure head circumference?

Taking them to a separate room is important so that they do not associate their hospital room as an unsafe place. EMLA cream = numbing cream that takes effect is 30-60 minutes; apply to skin and saran wrap over it Buzzy bee = device that vibrates and the wings are a cold pack (vibration and cold = nonpharmacological distractor when giving immunizations) Shot blocker = device that has small bristles so when held against the skin pain receptors get confused when an immunization is given

Why is it important to take a hospitalized pediatric patient into a different room when doing something that could cause them pain?

- they are nose breathers - small airways - respiratory organs are immature ** children go into respiratory distress a lot easier and quicker than adults

Why is it so hard for children to breathe when they get an upper respiratory infection?

active = acquired from having the illness or by getting vaccinated against it passive = acquired via the placenta or through breastmilk

active immunity vs passive immunity

diaper rash

bright red rash in the diaper area Causes: - clothing dye - laundry detergent - body soap - bubble bath - tight clothes - wool or rough clothing - irritation from a soiled diaper Nursing care: - don't use wipes, dab with warm water - air it out - no baby powder, use cream (desitin)

measles/rubeola

confluent (running together), dark red to purple rash that begins on the face and spreads downward Manifestations: - koplik (white) spots on buccal mucosa - eye irritation --> red conjunctiva - photophobia Transmitted by: - respiratory secretions Isolation precautions: - airborne - contact Complications: - blindness - otitis media - pneumonia - laryngotracheitis - encephalitis Vaccine given at 1 and 4 years of age

scabies

contagious mite infection that is contracted by close body contact with infected individuals - mite burrows into skin and lays eggs - mites like skin folds Manifestations: - itchy rash that worsens at night Treatment: permethrin cream - apply all over body and can wash off after 8-12 hours, then do it again in 7 days Nursing care: - wash bed sheets in hot water - if item cannot be washed, bag it and seal it.. must stay in there for 2 weeks

poison ivy

delayed reaction rash (within 72 hours) after contact with poisonous oil from the sap of a leaf Manifestations: - itchy rash - can last up to 7 days- 2 weeks Nursing care: - wash hands, take off clothes or anything that has been exposed to the oil - calamine lotion, oatmeal bath, benadryl - sometimes hydrocortisone is prescribed - cold compress - mittens - wash clothes in hot water

fine = using hands and fingers to control small objects gross = using large muscles to make large movements

fine motor skills vs gross motor skills

impetigo

highly contagious superficial infection of the skin most often on the face and extremities Causes: - staph infection Manifestations: - macular --> papular --> vesicular rash that oozes and then forms a moist honey colored crust Nursing care: - topical antibiotic --> mupirocin cream - 24 hours after starting antibiotic, they are no longer contagious - wash everything in hot water

bronchiolitis and respiratory syncytial virus (RSV) ** RSV causes bronchiolitis ** RSV can live on tissue for 2 hours and 30 minutes on skin

inflammation of the bronchioles with increased mucus production; very dangerous for children under 2 Manifestations: - cough - grunting - wheezing - lethargy - tachypnea Treatment: - suction - oxygen - albuterol (nebulizer treatment) - may need NG tube - NPO Complications: - respiratory arrest due to bronchioles being so inflamed - more likely to develop asthma

epiglottitis

inflammation of the epiglottis caused by hameophilu influenzae (H-flu); common for 2-5 year olds Isolation precautions: - droplet Manifestations: - tripoding - anxiety - drooling Treatment: - antibiotics - steroids Teaching: - do not stick anything in mouth Vaccine = Hib

otitis externa

inflammation of the outer ear aka swimmers ear; caused by bacteria or fungus Manifestations: - pain - inflammation - foul smelling discharge - fullness feeling in the ear - scaling skin Treatment: - antibiotic and steroid ofloxacin drops Teaching: - dry ears after swimming - wear ear plugs - take a shower

tonsillitis (streptococcal)

inflammation of the tonsils most commonly caused by strep Manifestations: - throat hurts - dysphagia - stridor (if tonsils are super swollen) - snoring - foul smelling breath - fever Tonsilectomy teaching: - tonsils can be removed after 3 (if before, there is a chance the tissue can grow back) - no foods with red dye (stains the throat and makes it look like something is wrong) - avoid dairy (dairy coats the back of the throat which can cause the child to want to clear their throat which is contraindicated after this surgery) - no straws (sucking irritates sutures)

Croup (laryngotracheobronchitis)

laryngeal inflammation that causes upper airway narrowing; can range from mild to severe Manifestations: - rhinorrhea/rhinitis - fever - malaise - anorexia - barking cough - hoarseness - irritable - inspiratory stridor - retractions Teaching: - COOL MIST (head in freezer, stand outside in cold, cool mist humidifier/steam from shower) - cool fluids - can stay home if child only has barking cough, if showing signs of respiratory distress (accessory muscle use, cyanosis, hard time breathing), bring into hospital Hospital treatment for inflammation: - steroids - racemic epi

rotavirus

leading cause of severe diarrhea in peds Transmission: - fecal/oral route Isolation: - contact Nursing care: - IV fluid bolus - pedialyte Complications: - diaper rash - dehydration

rotavirus vaccine ** it is given so early because the infant does not receive immunity from mom

live oral vaccine that is given starting at 2 months

otitis media ** breastfed babies are less likely to get ear infections

middle ear infection common in infants and children due to their eustachian tubes being straighter and easier to obstruct; may be trigger by a URI Manifestations: - tugging at ear - irritable - fever - decreased appetite (sucking irritates the ear) - dizzy Treatment: - antibiotics - surgically inserted tubes may need to be put in place if child has frequent ear infections to help drain fluid (after a couple months, they fall out of their own) Vaccine: PCV13 helps to prevent ear infections

respiratory rates for peds

newborn-1 = 30-60 1-2 = 25-30 2-6 = 21-25 6-12 = 19-21 12+ = 16-19

pediculosis aka lice

parasite that needs a host to live; found close to the scalp; very contagious Transmission: - sharing combs, hats, scrunchies Manifestations: - intense pruritus, especially at night in the lower scalp area Nursing care: - assess for egg shell cases (nits) - wash everything that has came into contact with the head in hot water Treatment = permethrin shampoo - after treatment, remove nits with fine tooth comb - wait 2-3 days and then check again Complications: - secondary infection related to scratching

pectus excavatum = concave chest --> lungs don't fully develop because there isn't enough room pectus carinatum = chest wall that protrudes out

pectus excavatum vs pectus carinatum

dysfunctional grieving

prolonged grieving --> not processing death, just shutting down - seen in those who have low support systems - seen in those who experience a sudden death of a loved one

child life specialist

trained professional who plans therapeutic activities for hospitalized children

dictatorial/authoritarian

type of parenting in which parents control the child's behaviors and attitudes through unquestioned rules and expectations Examples: - child is never allowed to play video games on school nights

permissive

type of parenting in which parents exert little or no control over the child's behaviors and consult the child when making decisions Examples: - child assists with deciding whether they will watch television

democratic/authoritative

type of parenting in which the parent directs the child's behavior by setting rules and explaining the reason for the rules Example: - child can play video games for 1 hour on school nights after completing homework

passive/uninvolved

type of parenting in which the parent is indifferent and emotionally removed Example: - child may play video games whenever he/she wants

sudden infant death syndrome (SIDS)

unexplained and sudden death of an infant - peak age for this to occur is 3 months and peak times are spring and winter - back to sleep campaign - no co sleeping - nothing in crib - baby on back - pacifiers are good because sucking allows the baby to continue to breathe

FACES scale / wong baker

used for children 3 and older

FLACC scale

used for children under age 3; score based on what WE are seeing

mononucleosis ** very contagious... can live in body for months

very contagious disease that is most common in adolescents Cause: - epstein barr virus (EBV) Manifestations: - sore throat - body aches - fatigue - fever - anorexia - epigastric and LUQ pain Diagnosis: - mono spot Complications: - spleen enlargement - spleen rupture - higher risk for getting MS or lymphatic cancer Teaching: - rest - fluids - light exercise, no contact sports - no sharing drinks - no kissing

candidiasis aka thrush

yeast like fungus that grows in moist, warm areas; can also be caused by oral antibiotic therapy or hyperglycemia At risk: - infants who are breastfeeding Manifestations: - cottage cheese like coating in mouth with a bright red surface underneath Nursing care: - mom needs to make sure breasts are clean Treatment = nystatin - coat mouth with it