Pediatrics

The nurse observes that a preschooler who was admitted to the unit three days ago has enuresis (bed wetting). His mother is very upset and says, "But he hasn't done that in years!" Which of the following responses, if made by the nurse to the mother, is most appropriate? -"This behavior is unusual for a child of this age. I'll call the doctor." -"It is very common for children who have been admitted to the hospital to experience regression where they fall back on old childhood habits. It is usually temporary." -"I remember when my child used to do that. We had her in pull-ups forever!" -Sometimes that happens. It's okay, I'll clean him up."

"It is very common for children who have been admitted to the hospital to experience regression where they fall back on old childhood habits. It is usually temporary." -This happens during times of stress, frustration, or a following traumatic event.

The nurse reviews telephone messages in the peds clinic. Which message will the nurse return first? -"My 2 day old child's legs extent and return back to their previous position when the crib is bumped" -"The circumcision site of my 3-day-old is covered in yellowish oozing" -"My 4 day old who is formula fed has had 1 stool per day for the past 2 days" -"The umbilical cord stump of my 5 day old us moist at the base and slightly red"

"The umbilical cord stump of my 5 day old us moist at the base and slightly red" -Indicates infection or other problems. Should be dry w/o redness. -Moro reflex is normal when a baby is startled. -Yellow exudate us normal during the healing process of a circumcision. -Formula fed infants may pass 1 stool per day while breast fed infants pass 2-5 stools per day.

The mother of a child diagnosed with strep throat asks the nurse "Why do you have to give my child that antibiotic shot?" Which statement would be the nurse's best response? -"You sound concerned. Are you worried about your child getting a shot?" -"This injection may keep your child from getting rheumatic fever" -"Strep throat always results in children developing heart problems" -"I am giving this med because the throat culture showed a viral infection"

"This injection may keep your child from getting rheumatic fever" -antibiotics will decrease fever & pain & treat the strep. -Untreated strep can lead to rheumatic fever, this can lead to rheumatic endocarditis in future years.

Motor skills & language: infant

-2 months: verbal noise (coos), raises head & chest, head control improves, moves head side to side, smiling. -4 months: babbling (copies noises), play, rolls from prone to supine, head leads body when pulled to sit, holds & reaches for toys. -6 months: can sit up w/ support, stranger anxiety, tripod sitting, babbles. -8-9 months: sits w/o support, crawling, stands w/pulling & holds onto objects, pincer grasp, object permanence. babbles more, more expressive (giggles, screeches) -10-12 month: walking, separation anxiety, simple words (dada).

Newborn urination

-48 hrs after birth: 2-6 wet diapers per day. -3-4 days after birth: 6-8 wet diapers per day. -U/O: Newborn/ infant - 1 y/o: 2 ml/kg/hour. Toddler: 1.5 ml/kg/hour. Older child: 1 ml/kg/hour during adolescence.

Which birth factor places the neonate at risk for sudden infant death syndrome (SIDS)? SATA -Birth order -Postmaturity -Multiple births -Method of delivery -Low Apgar scores

-Birth order -Multiple births -Low Apgar scores -Prevent SIDS: supine, no blankets, no toys, sleep in crib alone.

Esophageal Atresia (EA) & Tracheoesophageal Fistula

-Coughing w/ feeding -Choking w/ feeding -Cyanosis

Which fine motor skill would the nurse assess in an infant? SATA -Crawling -Creeping -Sitting erect -Holding a rattle -Picking up objects -Holding a baby bottle

-Holding a rattle -Picking up objects -Holding a baby bottle Gross motor skills: crawling (9 months), creeping, & sitting erect.

The nurse is assessing a child who is scheduled to receive a live virus vaccine. What are the contraindications associated with receiving a live virus vaccine? SATA -The child has asthma -The child had a previous anaphylactic reaction to the vaccine. -The mother reports the child is having intermittent diarrhea. -The child has a disorder that causes a severely deficient immune system. -The mother reports the child has not had an appetite and has been fussy,

-Previous anaphylactic reaction to the vaccine. -Severely deficient immune system (AIDS, SLE, etc) -pregnant women -Severe sensitivity to gelatin

Scarlet Fever

-Strawberry tongue -Sandpaper rash

Laryngotracheitis (Croup)

-Stridor -Subglottic swelling (causes hoarseness in the voice) -Seal-bark cough -Cold air helps

Which is the minimum number of hours of sleep the nurse would recommend for an 11-year-old client? -8 -9 -10 -11

9 -9-11 hours

Children's pattern of play change as they grow from infancy through school age. Rank the order of appearance of each type of play, starting with infant play. -Associative -Cooperative -Parallel -Solitary

1. Solitary 2. Parellel 3. Associative 4. Cooperative -The infant plays alone, with others initiating the play activity. -Toddlers' play activity is described as parallel; they play beside other children but not with them. -Preschoolers' play is associative in loose groups, with activities involving interaction among players. The school-age child is capable of cooperative play, which includes organized play such as sports, board games, and card games.

Between which ages should an infant's anterior fontanel close? -4-10 months -8-12m -12-18m -18-26m

12-18 months Anterior (larger diamond-shaped) -Posterior: triangle shaped. Closes 8-12 weeks. -Premature closure may restrict brain growth & lead to abnormal head shape -Late closure may indicate an underlying condition, such as congenital hypothyroidism -Bulging: Increased ICP or hydrocephalus. Normal when newborn cries, vomits, or is lying down. -Suken: dehydration

How many days is the neonatal period?

28 days

Which is the priority intervention for the infant with developmental dysplasia of the hip? -Flexion of the hip -Extension of the hip -Adduction of the hip -Abduction of the hip

Abduction of the hip -will enable the head of the femur to fit into the acetabulum, thereby correcting the dysplasia. -found at 6wks after birth -need to be restrained in a Pavlik harness to mold into the acetabulum.

Hemophilia

An X-linked recessive disorder in which blood fails to clot properly, leading to excessive bleeding if injured. -Do NOT take NSAIDs -Do NOT admin IM inj. -Use smallest gauge possible -Avoid contact sports -Wear a medical ID bracelet

Which clinical condition is associated with lead poisoning? -Asthma -Anemia -Metabolic acidosis -Systemic infection

Anemia -Lead can interfere with the binding of iron onto the heme molecule. This can cause anemia even the child is not iron deficient. -Children who live in pre-1978 housing are the population generally at greatest risk for lead poisoning. -Children <6y/o are at greatest risk.

According to Erikson's stages of life, which is the stage of development when a child begins walking, feeding, and using the toilet? -Trust vs mistrust -Initiative vs guilt -Identity vs role confusion -Autonomy vs sense of shame and doubt

Autonomy vs sense of shame and doubt

Hirschsprung disease (Toxic Megacolon)

absent ganglion cells in submucosal/myenteric plexus rectosigmoid -Ribbon like stool -Tx: Air (barium) enema

Chest physiotherapy (CPT) in children with Cystic Fibrosis

CF: Genetic disorder that causes mucus secretions to be thicker & stickier than normal. -Education on CPT: Tx 1hr ac & 2 hrs pc. GI upset can be caused because tx is done close to meals. -Diet: High calories Enzymes WITH meals. Lots of fluids for the thick secretions. -At risk for Vit A, D, E & K deficiencies because they are fat-soluble.

Salicylates (Aspirin)

Do NOT give products that contain Salicylates to children recovering from viral illnesses (flu, chickenpox) -Causes Reye's syndrome -Reye syndrome is a rare life-threatening condition that causes massive brain swelling, which leads to seizures & liver damage. -Hepatic encephalopathy can result from the increased ammonia levels within the blood.

Which statement is true about Piaget's theory of development? -Piaget's theory includes 5 periods that are related to age. -In the late preoperational stage, the children experience animism. -In the preoperational stage, children are able to perform mental operations. -During the sensorimotor stage, infants develop an action pattern for dealing with their environment.

During the sensorimotor stage, infants develop an action pattern for dealing with their environment. -Sensorimotor stage, infants develop a schema or action pattern for dealing with the environment. -EARLY preoperational stage, children experience animism. -Operations stage: children are able to perform mental operations. -Formal operations: egocentric thoughts. This occurs during early childhood.

Liquid iron

Educate parents & child that liquid iron can cause stains on the teeth -Take w/straw -Brush teeth after

Which component of the human personality, according to Freud, allows an individual to judge reality accurately? -Id -Ego -Superego -Oedipus complex

Ego -According to Freud the ego allows an individual to judge reality accurately. -Id is basic instinctual impulses driven to achieve pleasure. -Superego is often referred to as the conscience. -Oedipus complex is a belief that a female child fantasizes about her father as a love interest.

Fifth disease (erythema infectiosum)

Human parvovirus B19 -Mild flulike symptoms -"slapped-cheek" facial rash -The virus spreads in droplets when an infected person coughs, sneezes, or touches a surface.

Which treatment would the nurse anticipate for an infant admitted with bronchiolitis caused by respiratory syncytial virus (RSV)? -Humidified cool air and adequate hydration -Postural drainage and oxygen by good -Bronchodilators and cough suppressants -Corticosteroids and broad-spectrum antibiotics

Humidified cool air and adequate hydration -is essential to facilitating improvement in the child's physical status. -Postural drainage is not effective for this -O2 is only used if the infant has severe dyspnea & hypoxia -Bronchodilators are used when the bronchial tree is in spasm -Cough suppressants are ineffective -Corticosteroids ineffective -antibiotics are ineffective because RSV is viral not bacterial

The weight of a 3m old infant w/ tetraolgy of Fallot has declined from the 25th percentile to the 5th. Which mechanism would the nurse suspect is the reason for this inadequate weight gain? -Cyanosis resulting in cerebral changes -Decreased arterial oxygen levels resulting in polycythemia -Pulmonary HTN resulting in recurrent respiratory infections -Inadequate oxygen perfusion leading to activity intolerance, resulting in diminished energy to nurse

Inadequate oxygen perfusion leading to activity intolerance, resulting in diminished energy to nurse -because of quick fatigue, it's difficult for the infant to consume sufficient calories for adequate weight. -Increased caloric intake is needed to meet the infant's nutritional needs.

Measles

Koplik's spots (clustered white lesions on buccal mucosa)

Which nursing action would be included in the plan of care for a child with acute poststreptococcal glomerulonephritis? -Encouraging fluids -Monitoring for seizures -Measuring abd. girth -Checking for pupillary reactions

Monitoring for seizures -Cerebral edema from HTN or cerebral ischemia may occur, which may result in seizures. -Promote diuresis to reduce edema. -Increasing fluid intake can lead to increased BP and edema. -Measuring abd girth is for children w/ nephrotic syndrome, in which hypoalbuminemia causes fluid shifts to the abd. cavity.

hypertonic pyloric stenosis

Projectile vomiting -thickening of the pyloric sphincter, which creates an obstruction. -causes dehydration

Which step would the nurse undertake during the administration of ear drops in children ages 1-3 years? -Pulling the auricle down and backward -Placing the cotton ball in the innermost part of the canal -Keeping the toddler in the side-lying position for 10-15 min -Holding the dropper 3cm above the child's ear canal to instill the drops

Pulling the auricle down and backward -The cotton ball is placed in the outermost part of the ear canal -Toddler is kept in side-lying position for 2-3 min -The dropper is held 1cm above the ear canal for the instillation of drops -In children >3y/o, pull auricle up and out.

Which stage of Kohlberg's theory would a child exhibit fear of punishment? -Stage 1 -Stage 2 -Stage 3 -Stage 4

Stage 1 child afraid of punishment -Stage 2 child recognizes that there is more than 1 correct viewpoint -Stage 3 seeks approval & maintains expectations of one's group. -Stage 4 expands focus from relationship w/ others to societal concerns

Which is the nurses priority intervention after discovering an infant is apneic? -Call for help -Begin CPR -Stimulate the trunk -Place the infant prone

Stimulate the trunk -then call for help, place the infant in prone & flick the heels. -If there is no response still, the nurse will begin CPR. >2 min of CPR the nurse will activate the emergency system.

Lyme Disease

Tick-borne disease caused by the spirochete Borrelia burgdorferi. -Rash that resembles a "bulls-eye" -Caused by ticks -Tx: antibiotics

Infant growth

Weight: doubles (x2) from birth weight in 6 months. Triples in 12 months from birth weight. -Length: should grow 1/2-1 inch every month. -Teeth: First teeth to show are the lower central incisors (10 months) -Fontanelle closure: anterior 12-18m. Posterior 8-12 weeks.

Circumcision

Yellow exudate on the glans penis after circumcision is a normal sign of healing and is not alarming

Epiglottis

a flap of cartilage that covers the windpipe while swallowing -Drooling/ dysphasgia -Tripod position -Do NOT: visualize the throat w/ a tongue blade, NO oral temp, NO throat cultures. Can cause reflex laryngospasms (cuts off the airway).

Wilms tumor

malignant tumor of the kidney occurring in childhood -Avoid palpation of the abd; can cause rupture.

patent ductus arteriosus (PDA)

passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth -Very noticable murmur -Sounds like a bag of rocks or a machine

intussusception

telescoping of the intestines -Currant-jelly stools (bloody) -Palpable sausage-shaped abd. mass