N366 exam 1 ALL

how do you determine compatibility?

- LOOK IT UP (Davis drug guide, Micromedex...) 1. always determine if dose is safe 2. look under IV administration ---> intermittent infusion (IVPB, syringe pump, or direct IV push over mins) ---> know diluent (NS, D5W, SW) ---> rate of administration ---> Y site compatible or incompatible?

Insulin is a special SQ injection, where can it be given?

- Lateral/posterior aspects of upper arm - Fatty tissue of lower abdomen - Lateral aspect of thigh - Scapular area of upper back - Flank (upper ventrodorsal gluteal areas)

how do you self report a pain rating scale for children over 4 years? - what pain scale gets used? - when do you switch over to numeric?

- children > 4 years of age understand instructions and can point to verbalize so they use wong-baker FACES scale - numeric scale can be used for as young as (must know how to count)

what are some issues in health care for children?

- children living in poverty - obesity - firearm deaths & injuries - no health insurance

what are nursing interventions for hyponatremia?

- nursing process - take complete hx: ---> diet ---> medications ---> ask fam about pt behavior ---> weight ---> I and Os ---> Vital Signs ---> monitor na levels ---> replace ====> diet ====> restrict fluids (NEEDS NA REPLACEMENT) ---> IV therapy (9% NaCl or LR) - discharge teaching

low creatinine indicates?

- older clients w/ dec muscle mass - muscular dystrophy - paralysis

ADULT OXYGENATION PPT

...

INJECTION SITES PPT

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LABORATORY DATA PPT

...

NASOGASTRIC & OROGASTRIC FEEDING PPT

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growth & development ppt

...

safe administration of injections

1. check medication has NOT expired (check sterile diluent date if reconstructing) 2. select proper sized syringe & needle 3. keep medication, syringe, & needle(s) sterile 4. site selection (single most consistent factor associated w complications & injury) 5. prepare skin w an antimicrobial/alcohol wipe 6. dispose of syringe & needle in sharps container (DO NOT RECAP NEEDLES)

describe the cardiopulmonary circulation

1. contraction of R ventricle pumps blood to lungs via pulmonary arteries (2) 3. blood flows through capillary beds, loads O2, unloads CO2 4. oxygenated blood returns from lungs via pulmonary veins to to L atrium of heart

A nurse is assessing a child who may have bacterial epiglottis. Which of the following manifestations is likely to be present? (Select all that apply) A. Drooling and stridor B. Difficulty swallowing C. Low grade fever and dry barking cough D. Hoarseness and difficulty speaking

A. Drooling and stridor B. Difficulty swallowing D. Hoarseness and difficulty speaking

what are the nursing responsibilities for hyperkalemia?

FOR CRITICALLY ILL PT: - Restrict potassium - Correct cause of imbalance • Infusion of insulin and glucose or sodium bicarbonate • IV infusion of calcium gluconate • Kayexalate - Dialysis - Cardiac monitor - Monitor potassium levels

deltoid injections

Gauge 22-25 Length 1-1.5" for adults 0.5-1" for children Max Volume 2 ml for adult 0.5-1 ml for children

what is hematocrit (HCT) - what are normal levels - what do low & high levels indicate?

HCT measures the percentage of RBCs found in whole blood - expressed as total percentage of blood volume composed or RBC - normal levels: 42-52% - low HCT levels indicate: -----> overhydration -----> anemia -----> bleeding -----> bone marrow suppression - high HCT levels include: -----> dehydration -----> polycythemia vera

what does I&O indicate? - is it the most accurate measure of fluid status?

I & O provides a means of assessing fluid balance -- it is NOT the most accurate measure of fluid status -- DAILY WEIGHT is the most accurate measure of fluid status

what does a typical order for an IV infusion look like

IV LR @ 125/hr ----> keep running until provider decides to discontinue IV D5NS 1 liter @ 150 x 1 -----> one time order... seen in ER Bolus IV NS 500 cc now -----> pt's after surgery who faint due to low BP from standing ------> vitals are then taken IV NS TKO (to keep open) ------> IV running due to multiple meds Quick lock or saline lock (or heparin lock) IV -------> take off bag/tubing and have IV hanging -------> not connected to fluids --------> check IV site, flush and then hook to fluids

what is hyperkalemia?

K > 5.0 mEq/L - causes ---> Acute and chronic renal failure ---> Excessive release from cells secondary to traumatic injury, severe infection, or burn ---> Excessive infusion of IV solutions that contain K+ or excessive oral intake ---> Acidosis ---> Medications ---> Fast growing cancers s/s: - Abdominal cramps - Diarrhea - Hypotension - Irregular heart rate - Muscle weakness, especially in the legs - Nausea - Paresthesia (numbness, tingling) - Convulsions - Cardiac arrest

what is hypokalemia?

K+ < 3.5 mEq/L - causes: ---> excretion or loss of K+ exceeds intake ---> surgery ---> alcoholism --->medications ---> hyperaldosteronism ---> liver disease ---> cancer Redistribution of K+ - Healing phase: burns and or trauma - Alkalosis - Increased levels of sodium intake - Increased levels of insulin s/s: - Muscle cramps - Anorexia - Abdominal distension - Constipation - Weakness & fatigue - Nausea & vomiting - Weak, irregular pulses - Abnormal EKG

The infant should be crawling by: a. 3 months of age b. 10 months of age c. 5 months of age d. 12 months of age

b. 10 months of age The infant should be crawling by 8-10 months of age

A clinic nurse assesses the communication pattern of a 4-month-old infant. The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant: a. Uses simple words such as "mama" b. Uses monosyllabic babbling c. Links syllables together d. Coos when comforted

b. uses monosyllabic babbling - Using monosyllabic babbling occurs between 3-6 months of age - Use of mama occurs between 9 and 12 months of age - Linking syllables together occurs between 6 and 9 months - Cooing begins at birth and continues until 2 months of age

what are methods for feeding?

bolus: by gravity in a syringe - slip tip syringe intermittent/continuous - feeding pump

what are the purposes of NG intubation? (4)

decompression: removal of gastric secretions compression: internal application of pressure to prevent GI bleed rest: after a major gastric surgery lavage: irrigation of stomach

what's involved in the physiological development of toddlers?

decr appetite

what do extracellular electrolytes do? give examples what do intracellular electrolytes do? give examples

extracellular electrolytes - exerts their effects OUTSIDE the cell - electrolytes involved: ----> Na ----> Cl ----> Ca ----> HCO3- intracellular electrolytes - works INSIDE the cells - electrolytes involved: ----> K ----> PO4- ----> Mg

pain definition:

fam knows the child best -- whatever the child says their pain is -- it's the 5th vital sign

pediatric nursing is....

family-centered care approach

nursing diagnosis for needing an IV?

fluid volume deficit, secondary to: - vomit - increased temp - blood loss - drainage sites or tubes - diarrhea - diuretics OR fluid volume excess, secondary to: - excess sodium intake - medications - renal or cardiac failure - inaccurate IV infusion rate

high BUN indicates?

- CHF - excessive protein levels - GI bleed - hypovolemia - kidney disease - kidney failure - UTI - shock - elderly

what is atraumatic care?

- DO NO HARM - prevent/minimize child's separation from family - promote a sense of control - prevent/minimize bodily injury & pain

what are the theories of human development? (4)

- Freud: Psychosexual theory - Erikson: Psychosocial theory - Piaget: Cognitive development theory - Kohlberg: Moral development theory

what are the 3 components of freud's psychosexual theory?

- Id= unconscious mind - Ego= conscious mind - Superego= conscience

what are the stages of human development? (5)

- Infant: birth-1 year - Toddler: 1-3 years - Preschooler: 3-6 years - School-age child: 6-12 years - Adolescent: 12-19 years or older

what are the suction settings on an NG suction canister?

- LIS (low intermittent suction) - LCS (low continuous suction) - Clear plastic (penne shaped) connector - clamp tubing when disconnecting - clamp NG

example of compatibility b/t IV meds

*Give Vancomycin while Piperacillin/tazobactam in running* - Is Piperacillin/tazobactam compatible w/ Vancomycin? ---> Caution: not compatible, you have to flush then administer vanco - Is Vancomycin compatible w/ IV solution D5 1/2NS + 20meqKCL? ---> Not tested for D5 1/2NS, check with pharmacy but IS compatible with KCl - What is rate of administration of Vancomycin? - What is rate of infusion on pump? - What if you cannot find information about compatibility?

EXAMPLE

*Need to give Piperacillin/tazobactam (medication)* 1. IV is infusing D5 1/2NS + 20meq KCL (primary fluid) 2. Administer as Intermittent Infusion: IVPB ---> Diluent: NaCl, Sterile Water (SW), or D5W ---> Dilute in 100 ml ---> Rate of administration: Over 30 minutes ---> Rate of infusion on pump: (100 mL x 60 min)/(30 min) = 200 mL/hr ---> Y site compatible: √ to KCL

what are normal values for magnesium?

- 1.3-2.1 mEq/L - 1% in blood - 49% found intracellularly - 50% in bone - most is bound to ATP molecule - more than 300 biochemical reaction

what are normal values for phosphorous? what is phosphorous? hyperphosphatemia? hypocalcemia?

- 2.4-4.1 mg/dL - essential mineral - absorption facilitated by vit D - maintains pH of body fluids - maintains cellular osmotic pressure - important component of DNA & RNA - inverse proportionate relationship to calcium - levels controlled by intake & renal func - kidney failure = hyperphosphatemia & hypocalcemia - hypocalcemia = bone demineralization

How much of the needle should be inserted in an IM injection?

- 3/4 of the needle

what are normal values for creatinine levels?

- 5-1.1 mg/dL - waste product produced in muscles from breakdown of creatinine

what are normal glucose levels? what is glucose screened for?

- 60-100 mg/dL (fasting) - formed by digesting carbohydrates & stored in liver as glycogen screening: - diabetes mellitus - gestational diabetes - hypoglycemia

what are normal values for calcium?

- 9.0-10.5 mg/dL - 99% found in bone

what angle should IM injections be given?

- 90 degree angle - below dermis & subcutaneous to promote rapid drug absorption

what is hypocalcemia?

- < 9.0 mg/dL - common in older adults

what is hypercalcemia?

- > 11 mg/dL - common in metastatic malignancy (lung, breast, ovary, prostate) - hyperparathyroidism - thiazide diuretic therapy

status asthmaticus - what is it? - nursing care?

- A MEDICAL EMERGENCY - a continuous asthma attack nursing care: - close observations, working w RT, education, symptom, mgmt - lab values (eosinophils) - family support - medications: MDI -- albuterol, inhaled coricosteroids (pulmicort, flovent) --- breathing techniques, yoga, acupuncture, diet, herbal remedies

why are older adults more susceptible to adverse drug events?

- Absorption - Distribution - Metabolism - Excretion - Pharmacodynamics - Adherence - Unintentional - Intentional

what are the values for chloride levels and what does chloride do?

- Adult: 98 - 106 mEq/L - Critical Values: < 80 or >115 mEq/L - Major extracellular anion Follows sodium losses and accompanies sodium excesses in an attempt to maintain electrical neutrality - Affects water balance - Serves as a buffer to assist in acid-base balance

what are gerontologic considerations for administering medications?

- Age: >85 - Renal: some level of insufficiency - Weight: low - Chronic illness: >6 - Medications per day: >12 dosages - PMHx: previous adverse drug reaction

what are the objectives of IV therapy

- List five characteristics of IV solution/bag that one must review before administration. - Describe the important aspects of assessing an IV site. - Discuss signs and symptoms of complications of IV therapy such as infiltration, phlebitis, IV infections, and hypervolemia. - Participate in IV bag/solution group activity. - Participate in application and critical thinking exercises.

why do older adults take so many drugs?

- Multiple prescribers - Multiple pharmacies - Herbal supplements - OTC products - Lack of communication between healthcare providers - Customer demand - Inadequate disease treatment - Nonadherence

what electrolytes/compounds are included in the basic metabolic panel?

- Na - Chloride - Potassium - CO2 - Calcium - Magnesium - Phosphorus - Bun/Creatine - Albumin/Total Protein - ALT/ALP/AST/Billirubin

what are some non-pharmacological pain management techniques?

- Non-nutritive sucking - Kangaroo care - Swaddling - Guided imagery - Parent involvement - Heat - Distraction ---> Music ---> + self-talk ---> Play >>>>>>>>> Blowing bubbles >>>>>>> Computer games - sucrose (only for invasive procedures of infants) - pet therapy - art therapy - deep breathing (2x a day for 4 breath cycles)

vastus lateralis site

- One handbreadth above the knee - One handbreadth below the great trochanter - Site is located in the middle 3rd aspect of thigh, anterior-lateral portion

ventrogluteal site location

- Point thumb toward groin - Point index finger toward anterior superior iliac spine - Extend middle finger back along the bony ridge of iliac crest toward the buttock (fan out your fingers to form a "V") - The center of the formed triangle (the "V" area) is the injection site

what are the sites for IM injections? (3)

- Ventrogluteal - vastus lateralis - deltoid

what are nursing responsibilities for hypernatremia?

- Vital Signs - Monitor sodium levels - Correcting the underlying disorder - Giving oral fluid replacement - IV hypotonic saline .45% NaCl or D5W - GO SLOW! - Discharge teaching

what is IV compatibility?

- ability for meds to co-exist in same IV line - determine compatibility for your IV meds ---> IV solution that med will dwell in (primary fluid, dilution fluid) ---> other meds using IV line ---> Y site vs additive

what are normal values for carbon dioxide?

- adult: 23-30 mEq/L - venous blood specimens are not highly accurate for measuring true CO2 content - uses as rough guide to evaluate acid-base balance

when choosing a site what should be considered?

- age of pt - size of pt - med type - volume of med - muscle mass - frequency/# of injections to be given - ability of pt to assume position safely

how do you test hepatic func (liver profile) & evaluate liver for injury, infections, inflammation?

- alanine aminotransferase (ALT) - alkaline phosphatase (ALP) - aspartate aminotransferase (AST) - total bilirubin & direct bilirubin - total bilirubin & direct bilirubin - albumin & total protein

what are complimentary management techniques?

- alternative meds - integrative nursing interventions ---> herbal remedies ---> aroma therapy ---> acupuncture ---> reiki ---> massage --->---> gentle --->---> slow --->---> responsive --->---> intentional --->---> boundaries

what are some important points of IM injections? (3)

- always use filter needle if drawing meds from glass ampule --> change to appropriate size admin needle - hold the skin taut - inject 1 ml per second - do not massage at site

what are long-term respiratory dysfxn - asthma ---> what is it? ---> what are the 4 categories? - what influences the persistence & severity of the disease? - what are some key words to recognize?

- asthma ---> most common chronic disease of childhood ---> a chronic inflamm disorder of the airways in which many cells & cellular elements plays a role: in particular mast cells, eosinophils, T lymphs, macrophages, neutrophils, & epithelial cells - allergies influence the persistence & severity of the disease - reactive/heightened airway for child less than 2 who have similar asthma sx - four categories (do not need to memorize) ---> intermittent, mild, moderate & severe - key words: triggers, attacks, exacerbations, exercise- induced

describe asthma - potential risk factors & triggers? - s/sx? - dx? - tx? - nursing diagnosis

- asthma is a persistent but variable inflamm if the airways that results in edema of the airways, bronchoconstriction, & airway hyperactivity - allergic response to certain triggers risk factors & triggers: ---> see pic s & sx: ---> wheezing ---> diminished lung sounds ---> paroxysmal coughing (frequent & violent) ---> chest tightness ---> dyspnea ---> tachycardia ---> tachypnea dx: ---> H&P (history & physical) ---> PFTs (pulmonary fxnal test) ---> peak flow meter ---> eosinophil count & IgE levels & allergic propensity ---> allergy skin testing tx: ---> bronchodilators ---> anti-inflamm meds nursing care: ---> O2 admin & monitoring ---> IV fluid admin ---> pt education on med adherence nursing diagnosis: ---> anxiety r/t to difficulty breathing, perceived or actual loss of control, and fear of suffocation

how to check placement of NG tube?

- auscultate small amount of air given through the tube using a syringe ---> listen to "air pop" w/stethoscope placed on stomach - x-ray confirmation (depending on facility protocol) - aspirate stomach contents ---> measure volume & pH ---> return contents

what are nutrition sources?

- breast/donor milk - formula - water - special ordered formula (mixed by nutrition services)

how are electrolytes measured?

- calcium and phosphates are measured in mg/dl - sodium, potassium, magnesium, chloride are measured in mEq/L

what are some developmental milestones for school-age?

- can read - jump rope - roller skate

what are the steps to pt verification/education & set up for the procedure?

- check 3 identifiers of pt (name, DOB, MRN) - educate pt on procedure & purpose of NG tube - raise pt bed to a good working height then place pt in high fowler's position, place side rail next to you down - open packages, tear tape, place bedside table w supplies within reach. apply non-sterile gloves

what is the nurses responsibilities to collecting urine, stool, sputum, and blood?

- collect, temporarily store, and perform tests --> urine -----> clean-catch, midstream, straight cath, foley, or timed test (24 hr-collection) --> creatine clearance ----- determines the glomerular filtration rate & tubular excretion ability of the kidney --> blood ---------> FSBS --> HgbA1C ---------> used to monitor diabetes tx ---------> non-diabetic adult: 4-5.9% ---------> good diabetic control: < 7%

what is COPD? - it is the ____ leading cause of death - s/sx? - diagnostics? ( history, cxr, lab tests, spirometry) - tx? - nursing diagnosis?

- copd is preventable disease w/persistent airflow limitation that is usually progressive - source of illness: smoking, recurrent respiratory infections, alpha-1 antitrypsin deficiency (have to take a med their entire life to prevent illness) or exposure to other noxious particles & gases - COPD is THIRD leading cause of death in the U.S. - often times, the illness is not diagnosed until it is moderately advanced s/sx: ---> cough ---> sputum production ---> progressive dyspnea first w/exertion then later w/rest, ------> use of accessory muscles --------- become cachexia bc of it and sit in a tripod way ---> barrel chest (bc air trapped in lungs) ---> fatigue ---> polycythemia ---> CO2 retention! diagnostics: ---> history: smoking, chemical exposure, GERD, infection ---> CXR shows hyperinflation, poss. enlarged heart ---> lab tests-- + for strep pneumoniae/haemophilus influenzae ---> blood gases (drawn from arteries), CBC, alpha 1 antitrypsin screening ---> spirometry / pulmonary fxn test (PFT) ---> increase in residual volume -- air trapping tx: ---> reduce risk ---> smoking cessation ---> bronchodilatoes & corticosteroids ---> pneumococcal vaccine (age 62 or up) ---> antibiotics/antitussives ---> mucolytic agents ---> alpha antitrypsin augmentation agents (prolastin) ---> O2 -- start w/low rates bc of CO2 narcosis nursing diagnosis: ---> ineffective airway clearance r/t expiratory airflow obstruction, ineffective cough & tenacious secretions

what are the factors that contribute to respiratory changes

- decr pulmonary elasticity as a result of collagen & elastin changes - accessory muscle atrophy of pharynx & larynx - decr respiratory muscle strength - decr chest wall compliance, due to stiffness of chest wall & costal cartilage calcification - incr anteroposterior diameter of chest - alveolar duct & sac enlargement & less total alveolar surface for gas exchange - fewer alveoli in lungs & thickening of the alveolar membranes - dec diffusion - decr is ciliary hair movement - incr trapping of air - decr blood flow in pulmonary circulation - incr in residual volume & fxnal residual capacity - decr in vital capacity & expiratory flow rates - decr in arterial O2 sat

describe pneumonia - etiology? - types of pneumonia? - manifestations? - dx? - tx? - nursing implications? - nursing diagnosis?

- description: inflamm of lung parenchyma (alveolar spaces), creating a build up of fluid & excrement in the alveoli --> decreases gas exchange - etiology: bacteria, virus, fungus, gastric contents (bad GERD), chemical (RSV is 2nd leading cause of pneumonia in adults) - types: community-acquired, hospital-acquired, ventilator-associated, aspiration, opportunistic - manifestations: cough (dry or productive), colorful sputum, pleuritic CP (chest pain??), SOB, incr heart rate, adventitious lung sounds (rhonchi, crackles), nausea/vomiting (N/V) - dx: CXR, CBC, sputum culture & gram stain, blood cultures (obtain cultures prior to antibiotic admin) - tx: oxygen therapy as indicated, antibiotics, rest, fluids (TO THIN SPUTUM!!!), antipyretics, nutrition - nursing impl: encourage adequate pulmonary toilet (encourage to cough & get respir tx) & educate on prevention -- good hand washing, vaccinations, avoid exposure & aspiration precautions (when someone swallows, everything they swallow goes down to their lungs). pneumonia can be life threatening & is often associated w/significant morbidity & mortality - nursing diagnosis: ineffective airway clearance r/t inflammation & increased secretions AEB crackles heard upon auscultation, decr o2 saturation, & purulent sputum

high creatinine indicates?

- diets high in meat - heavy metal chemotherapy - cephalosporins - dehydration - elderly/renal disease

what is lactic acid measured for?

- document & quantify degree of tissue hypoxemia r/t shock or localized vascular occlusion - measurement of treatment success

what are the parts of a salem sump (5)?

- double lumen - openings - radiographic markings - blue pigtail - anti-reflux valve (blue-blue) (blue pigtail) - always make sure system is closed!

cystic fibrosis? - description? - cause? - diagnosis? - major organs affected: - sx: - chronic respiratory problems? - nursing care? - goals?

- dysfunc of exocrine glands that produces thick tenacious mucous - hereditary: autosomal recessive trait cause: - thick mucous obstructs respiratory passages, causing trapped air & over inflation of lungs - thick mucous obstructs secretory ducts of pancreas, liver, & reproductive organs diagnosis: - elevation of sweat electrolytes - sodium & chloride are affected w/ abnormal chloride movement - family history - stool analysis major organs affected: - pancreas - liver - intestine - sex organs sx: - nutritional deficiencies (absence of pancreatic enzymes) - chronic respiratory problems (wheezing, clubbing of fingers & toes, thick tenacious secretions) - fatty & foul smelling stools (steatorrhea) - taste salty when kissed nursing care: - treat respiratory infection w/ antibiotics - pulmonary hygiene: CPT - pancreatic enzymes given w/ all meals & snack before - fat soluble vit A, D, E, & K - high caloric diet - comprehensive assessment of all affected systems w/ special focus on pulmonary & GI systems - pts require hospitalization only for pulmonary infections, uncontrolled diabetes or coexisting morbidities -> meet emotional needs of child & family! - typically managed @ home - anticipatory guidance & education crucial goals: - prevent/minimize pulmonary complications - prevent chronic pseudomonas infection - ensure adequate nutrition for growth - encourage appropriate physical activity - promote a reasonable quality of life for that child & family

nursing interventions for all children w/respiratory problems

- ease respiratory effort - promote rest - promote comfort - prevent spread of infection - reduce temp - promote hydration - provide nutrition - provide fam support & home care instructions

what is healthy people 2020 goal?

- eliminate health disparities - inc quality & length of life - leading health indicators (overweight & obesity, injuries & violence, substance abuse)

who can given consent for a child?

- emancipated minor can give informed consent - minor parents of child - child can sign own consent depending on situation

what are the indications for gastrostomy tubes (G-tube)?

- eternal nutrition/tube feeding (nutrition delivered in GI tract through surgically placed tube in stomach - child has functioning GI tract but cannot take any or enough oral nourishment OR it is unsafe to do so - feeding via G-tube is often used for children when passage of a tube through mouth, pharynx, esophagus or cardiac sphincter of stomach is contraindicated - to avoid the constant irritation of a NG tube in children who require tube feeding over an extended period of time - neurologic impairment - prematurity w/ poor suck/swallow - GI anomalies - craniofacial anomalies - cystic fibrosis - genetic disorders - metabolic disorders - malignancy - inflammatory bowel disease - burns/trauma

what is extravasation of phenergan?

- extravasation: leakage of medication in the extravascular tissue - phenergan: promethazine, an allergy medication that is potentially toxic to tissue if not careful preventable by ensuring IV is not leaking

what is family-centered care?

- family is constant in child's life - enable to create opportunities - empower to acquire a sense of control

what are some complications?

- feeding intolerance (nausea, diarrhea) - tube placement, breakage, occlusion, or migration - excessive granulation tissues - site infection

what are the differences in adolescent growth spurts in males and females? ---> females & males peak height velocity @ what ages ? ---> weight increases follows same growth curve as what?

- females peak height velocity @ ~ 11 or 6-12 months before menses - males peak height velocity @ ~ age 13 - weight increases follows same growth curve as height

Z-tract (not specific for exams)

- for bigger muscles - displace skin 1-1.5" - leave needle in skin for 10 seconds - release both skin and needle to create a seal!

what is a GJ tube? what are indications?

- gastric jejunum placement bypasses stomach indications: - recurrent aspiration - pneumonia - severe gastroesophageal reflux - gastric outlet obstruction - poor gastric emptying

what is the blood collection process?

- gather supplies: vacutainer vs butterfly (20g), 5-10 ml syringe, alchol wipes, 2x2 cotton gauze, tourniquet, gloves - check arm band & explain procedure - assess pt's veins-- avoid an arm if it has an AV fistula or if pt has had a mastectomy - apply tourniquet 4-6 in. above elbow - have pt pump fist & feel for veins - release tourniquet

nursing process in peds

- growth & development - adapt ADPIE to child (cannot separate child from family)

growth & development of infant at 1 year of age: - height increases by what? - weight increases by what? - head circumference equals what

- height incr by ~ 1 foot during 1st yr of life - weight- doubles at 6 months, triples at 1 yr - head circumference equals chest circumference by 1 yr

what are some improvement w/ health status of children?

- inc immunization rates - dec adolescent birth rates - improved health outcomes

what is hypomagnesium?

- incr cardiac irritability - aggravate cardiac arrhythmias

how to verify placement of NG tube?

- inject air bolus & hear swoosh sound w stethoscope - aspiration - pH-- below 5.5 - chest Xray (CXR) ____________________________________________________________________________________________________________ IF PT IS TURNING BLUE, TRYING TO CATCH THEIR BREATH, COUGHING OR GAGGING --> YOU'RE IN TRACHEA INSTEAD OF ESOPHAGUS!!!! REMOVE NG TUBE & REPLACE

what are some childhood health problems?

- injuries (most common cause of death & disability) - suicide (injury mortality & unintentional injuries( - motor vehicle accidents - falls - mechanical suffocation - violence - mental health issues (every 1 out of 5, and 1 out of 10 have serious emotional problems that affects daily func) - infant mortality ( birth weight determining factor & # of deaths during 1st year of life per 1000 live births) - childhood mortality (unintentional injury leading cause) - childhood morbidity (acute illness, respiratory illness = 50% of illnesses, 11% caused by infection & parasites, 15% by injury) - groups of children w/ inc morbidity (low birth weight, homeless, living in poverty, day care centers, chronic illness & foreign born adopted)

what are the steps of inserting an NG tube?

- instruct pt on what to expect - have assistant hold glass of water - lubricate the tube w/Vaseline before insertion - gently support the head w/non dominant hand while it is slightly hyperextended - insert the NG tube aiming toward the near ear - when meeting resistance, tip chin towards chest and sip some water (this helps to swallow tube) - advance tube 5-10 cm w/each swallow - secure tube w tape and dog ear

what injections should ALWAYS be aspirated?

- intramuscular (IM)

how do you care of site?

- keep clean & dry --> use soap & water --> avoid dressings --> avoid ointments unless prescribed --> prevent pulling on tube (granulation tissue may develop around site) - child can bathe, swim, or lay on abdomen one week after placement

low BUN indicates?

- liver failure - low protein diet - malnutrition - overhydration

what is low WBCs called? what is high WBCS called?

- low WBCs: leukopenia - high WBCs: leukocytosis

how to assess with NG in place?

- monitor amount, color, and consistency of contents in canister - Document in I and O and in appropriate area of assessment in chart - turn the suction off temporarily to hear bowel sounds

what are some anticipatory guidances?

- nightmares and night terrors - diversion of aggressive behaviors - set limits - readiness for pre-k and kinder - dental visits start at age 3 yrs

after verifying order in the pt's chart, what equipment should be gathered?

- non-sterile gloves - clear tape & or ready made securing device.. safety pin & rubber band - chux pad - irrigation kit (contains 60 cc syringe & container to pour water into), anti-reflux device & plastic connector (penne)

what are normal levels of WBCs? what are the types of WBCs expressed in %?

- normal: 4,500-10,000 per microliter - types of WBCs expressed in % (differential) -----> basophils: .5-1% -----> eosinophils: 1-4% -----> lymphocytes (T and B cells): 20-40% -----> monocytes: 2-8% -----> neutrophils: 40-60% Never Let Monkeys Eat Bananas

what are some pediatric words of wisdom?

- pain is whatever the child says it is - use their words to talk ab pain "u have a boo boo?" - growth & development - there are many tools and/or scales to help assess pain in a child - remember that the fam knows the child best so LISTEN - use least invasive intervention first - it's ok yo give pain meds - child life specialists!!! - distraction is powerful - be an advocate for the child - analgesic vs anesthetic

what is the blood collection procedure when obtaining a sample?

- perform hand hygiene - open al packages then don gloves - apply tourniquet, have pt pump fist if necessary - cleanse site w/alcohol - hold skin taut w/non-dominant hand & insert needle @ 30 degrees (unless garden hoses present) w/bevel up. once in vein, lower needle to prevent going through vessel - when blood is noted, remove tourniquet - remove required amount - remove needle & place 2x2 over the site, have pt. hold pressure if able. place needle in sharps - transfer to tubes & gently rotate - label tubes - reassess puncture site, then remove gloves

what are some physiological developments of pre-schoolers? what are some gross and fine motor developments?

- physical growth slows - body systems mature - increased eye-hand coordination - improved muscle coordination - develop fine motor skills

what should your ROS (review of systems) focus on?

- physically assess pt ---> cardiac ---> vascular ---> pulmonary ---> integumentary ---> renal

KEY POINTS - piaget has ___ stages of cognitive development - there are ____ levels of moral development in kohlberg's theory - each developmental stage of childhood has specific physiological development, unique developmental milestones, need for anticipatory guidance

- piaget: 4 stages - kohlberg: 3 levels

why might an IV burn?

- potassium getting infused in the IV site

vastus lateralis injection

- preferred in infants/toddlers - ONLY sit for under 7 months - safe and rapid Gauge 20-23 for adults 22-25 for children Length 1-1.5" for teens/adults 1-1.25" for children 1" for infant under 1 yr 5/8" for neonates Max Volume 2-3 ml for adult 2 ml for children 1 ml for small children 0.5 ml for infants

what are some anticipatory guidances for growth & development?

- preventative measures - provide info to parents based on child's developmental stage - priority: PREVENT INJURY! - stranger and separation anxiety

what is the role of peds nurse?

- primary concern = welfare of child & family (growth & development) - meaningful relationships w/ boundaries - communicate openly (critical thinking, evidence-based practice) - advocate - compassion & show empathy - provide education & anticipatory guidance (prevention) - play - safety

what are interfering factors for lactic acid levels?

- prolonged use of tourniquet - vigorous exercise - medications (aspirin, cyanide, ethanol)

what are disparities in pediatric health?

- race - ethnicity, socioeconomic status - geographic factors

what do you look for in a respiratory assessment

- rate - depth - ease - labored breathing - rhythm - adventitious noises (rhonchi, wheezes, crackles, rales) - equality of breath sounds - use of accessory muscles

what does the obstruction of pulmonary blood flow cause?

- reflex broncho-constriction in affected region - impaired gas exchange - loss of alveolar surfactant in area of injury - V/Q mismatch-- ventilation w/o perfusion - RVF (right ventricular failure), pulmonary HTN, tricuspid regurgitation - compression ofRCA (right coronary artery) - elevated BNP (test to see if ppl have CHF) & troponin (level tested for MI) ----> when both are elevated, there's high suspicion for PE - necrosis of lung parenchyma

what is hypermagnesium?

- retards neuromuscular conduction - respiratory depression

what are the nurses responsibilities for labs? (5)

- review the order-- is it STAT or routine? fasting? - educate the pt on how specimen will be collected & why we are collecting it - obtain consent if necessary-- HIV - notify provider of any abnormal labs - document ur notif or attempted to notif in chart

ventrogluteal injection

- safest (avoids blood vessels and nerves) - great for volumes above 2 mL - preferred for 18+ months Gauge 20-23 for adults ( 18-19 for oils ) 22-25 for children Length 1/2 -1" for children 1-1.5" for adults Max Volume 2-5 ml for adults (poor absorption after >3 ml) 2 ml for larger children 1 ml for smol children 0.5 ml for infants

what are some IVPB technical key points?

- secondary infusion is ALWAYS higher than the primary infusion - operates basically by gravity - pump is not THAT smart - follow instructions on pump - don't forget your roller clamo

elevations in lactic acid indicate?

- shock - sepsis - tissue ischemia - carbon monoxide poisoning - severe liver disease - genetic errors of metabolism - diabetes mellitus

Deltoid injection site

- site for 3 yrs and older - for non irritating injections - 2-3 fingerbreadths below acromion process

SQ injections

- slower than IM Gauge 25-30 Length 5/8" Max volume 0.5-1.5 ml for adults 0.5 ml for children

what injections should NEVER be aspirated?

- subcutaneous (SQ) - intradermal (ID)

what are creatinine test used for?

- test used to diagnose impaired kidney func & to determine renal damage

developmental milestones for preschoolers?

- throws a ball overhand - climb well - buttons clothes

what is blood urea nitrogen (BUN)?

- urea nitrogen is what forms when protein breaks down - effected by certain drugs - normal: 7-20 mg/dL

what are other lab tests?

- urinalysis (UA) for pH, glucose, protein, ketones, blood, nitrates or bacteria - finger sticks (AccuChek) - stool specimens - blood culture - sputum culture - throat culture - wound culture

how do you administer medication with feeding tubes?

- use correct port - do not add medication to formula in feeding bag - give each medication separately, using a syringe - always flush w/ water before, during, & after administration - use liquid form of medication whenever possible; dilute medication if needed - crush immediate release tablets & mix w/ water - do not crush extended release, enteric coated or capsules - always follow facility protocol & consult pharmacy as needed

Intradermal (ID) injections

- used for tuberculin and allergy tests (skin tests) - skin should be taut - wheal should form - needle point should be visible under skin - inject PPD solution slowly (you should feel firm resistance) - DO NOT massage site Gauge 25-27 Length 1/2-5/8" Max volume 0.01-0.1 ml

what are normal values for lactic acid?

- venous blood: 5-20 mg/dL

what is virchow's triad? - what is thrombosis? - what is thrombosis triggered by?

- virchow's triad= contributions of thrombosis --> stasis of blood flow, vessel wall injury, & hypercoaguability of blood - thrombosis is formation of blood clot within a blood vessel ---> triggered by venostasis (slowing of blood flow in a vein), hypercoaguability, & vessel wall inflamm

what are some physiological developments of school-aged children?

- weight/height incr - HR slows - RR slows - lose baby teeth - ugly ducks

what should be assessed critically before giving an IV?

- what are their vital signs - labs - I and Os - weight - can they get fluids and supplements somewhere else? - is it appropriate? ---> risk for infection ---> self care (and discharge)

what should be included in the planning phase of IV therapy? (3)

- when to initiate IV therapy - return pt to homeostasis (restore fluid balance) - assess pt response to IV therapy

what are the development milestones for infants from: ---> 4-6 mo ---> 6-8 mo ---> 8-10 mo ---> 10-12 mo

---> can roll over 4-6 mo ---> sits alone 6-8 mo ---> crawls 8-10 mo ---> stand alone 10-12 mo

what are some developmental milestones for toddlers? -- can undress self at what age? -- walks alone at what age?

---> can undress self at 1-2 yrs ---> walks alone 12-14 mo

describe atelectasis - what is it caused by? - what are its risk factors? - clinical manifestations? - diagnosis (dx)? - treatment (tx)?

-description: normal exchange of O2 & CO2 is altered by a collapse in the alveoli... it's not a disease but a condition or sign that results from disease or abnormalities in the body - caused by: infection, blockage of airways (mucus, tumor or foreign body), compression, scarring from radiation, pneumothorax or immature lungs - risk factors: advanced age, immaturity, smoking, immobility, CHF, trauma, obesity, & lung disease - manifestations: dyspnea, diminished lung sounds, fine rales, decreased O2 sat, low-grade - dx: chest x-ray (CXR) - tx: IS, TCDB, adequate pain relief & pulmonary hygiene... using incentive spirometer

procedure for inserting feeding tube?

1. gather supplies ---> lubrication, correct feeding tube size, syringe, stethoscope, & tape 2. prepare feeding ---> breastmilk, donor milk, formula, special formula made by nutrition services 3. pre-measure nose to earlobe, earlobe to midway b/t xiphoid & umbilicus, w/measuring tape for right length of tube 4. re-measure w/feeding tube-- note cm marking, if no cm markings, mark placement 5. swaddle infant 6. select nare or corner of mouth for insertion 7. lubricate tube & insert tube to placement marking ---> water soluble lubricant or sterile water 8. check placement w/syringe-- once confirmed, secure w/tape 9. administer feeding ---> offer non-nutritive sucking w/pacifier ---> tube will be removed after feeding or left in depending on type of tube/follow facility protocol

what are types of gastrostomy feeding button?

1. mic-key button 2. flexible silicon device - used for children who require long-term enteral feedings - allows extension tubing to be put on & taken off, easy to care for, cosmetically pleasing, extension tubing has medication port & is washable w/ soap & water - must have an established gastrostomy site

what are 3 types of incompatibility?

1. physical (precipitation, hazy) 2. chemical (decomposition of drug) 3. therapeutic (undesirable pharmacologic activity)

what are types of G-tube?

1. placement under general anesthesia 2. PEG (Percutaneous endoscopic gastrostomy) - pt sedated & local anesthesia for placement w/ an endoscope

how to administer meds with an NG?

1. turn off suction 2. clamp tubing 3. verify placement by applying 60cc syringe to NG, insert 30 cc of air or aspirate gastric contents 4. re-clamp tubing 5. prepare med, flush before and after each med w/ 15 to 30cc of water. after all medications --> flush w/ 30-60cc of water 6. keep suction discontinued (clamped) for 1 hr. reconnect to suction

what amounts can be given through IV?

1000 ml 500 ml 250 ml

what angle is a SQ injection given?

45 degree angle, have to pinch the fatty tissue

what angle should ID injections be?

5-15 degrees

med administration w/ NG/OG procedure

> check placement b4 admin meds > give each med separately, using a syringe > flush tubing w/a small amount of water to ensure med has reached the stomach ---> clamp tubing when complete > if feeding is infusing ---> pause feeding -- clamp tubing ---> attach med using syringe then unclamp tubing & admin meds ---> flush meds w/small amount of water then restart feeding --->---> do not mix meds w/enteral feeding (possible incompatibility issues) > use liquid form of med; dilute med if needed > crush immediate release tablets & mix w/ a small amount of water > DO NOT crush extended release, enteric coated or capsules > follow facility protocol & consult pharm as needed

You are caring for Mrs. G., a 56-year-old client who underwent a open appendectomy 2 days ago. During your morning assessment, you note that she has a low-grade fever of 100.6° F, diminished breath sounds, and fine crackles to the bases on auscultation. This description is consistent with: a.) Atelectasis b.) Pneumonia c.) Lung abscess d.) Upper respiratory infection

A) atelectasis

when a nurse is collecting a sputum sample, they should (select all that apply) a. check for an order b. instruct pt to spit in the cup c. label specimen at the bedside d. obtain sample before antibiotics are started

A, C, D

what is being assessed and what body sites should be focused on?

Assess for fluid excess and fluid deficit - head and neck ---> face, mucous membranes, and neck - trunk ---> chest - are lungs clear? ----> are there rales? (rattling of lungs) ---> abdomen/sacrum - extremities ---> arms/legs

Which of the following best describes the stools of a child with cystic fibrosis? A. Dark colored tarry stools B. Fatty and foul smelling stools C. Blood streaked stools with mucous strands D. Hard and dry stools with difficult evacuation

B. Fatty and foul smelling stools

Which of the following is an appropriate nursing intervention for a child with cystic fibrosis? (Select all that apply) A. Limit fluids B. Place the child on a low-calorie low-protein diet C. Administer pancreatic enzymes with food and snacks D. Administer fat soluble vitamins of A, D, E, K

C. Administer pancreatic enzymes with food and drinks D. Administer fat soluble vitamins of A, D, E, K

A pediatric respiratory disorder that is considered a medical emergency is A. Pharyngitis B. Bronchitis C. Bacterial epiglottis D. Acute spasmodic laryngitis

C. Bacterial epiglottis

Diagnosis of Respiratory Syncytial Virus (RSV) is accomplished through A. A collection of a sputum specimen B. A throat culture C. Nasal aspiration D. Obtaining blood for a CBC

C. Nasal aspiration

It was determined that your client, Mrs. G., has atelectasis. Which of the following nursing interventions is most effective in resolving atelectasis? a.) Changing Mrs. G.'s position every 4 hours b.) Ambulating Mrs. G. down the hall c.) Placing Mrs. G.on 2 L of oxygen via nasal cannula d.) Ensuring that Mrs.G. uses her incentive spirometer correctly 10 times/hour while awake

D) ensure she uses her IS 10 times/hr

Which of the following are assessment findings seen in a child with cystic fibrosis? A. Thin watery mucous drainage B. Wheezing upon auscultation of breath sounds C. Rapid growth spurts D. Clubbing of fingers and toes

D. Clubbing of fingers and toes

A 75 year old patient has been newly diagnosed with copd. All of the following should be included in his teaching plan except: A. Avoiding environmental irritants B. Smoking cessation C. Obtaining a Pneumovax D. Not exercising

D. Not exercising

what is a DRG?

Diagnosis Related Group; is a method of classifying patients into categories based on the primary diagnosis. Linked to a fixed payment amount based on the average treatment cost of patients - the group of patients have similar clinical characteristics & similar treatment costs.

match each developmental theories with its inventor Freud's Preoperational Stage Erikson's Preconventional stage Kohlberg's Phallic Piaget's Initiative versus guilt

Freud's ----> Phallic ***F.... phhh*** Erikson's---> Initiative vs guilt Kohlberg's----> preconventional stage ***Koh.... CONventional*** Piaget's-------> preoperational stage ***p... pre***

Mr. Gee is a 70-year old man who came to the hospital complaining of nausea, vomiting, anorexia, abdominal distention, and constipation. BP is 90/68 HR 115 and irregular. His H&H came back at: HGB 21 and HCT 54%. - What does this preliminary lab tell us? - What physical assessment findings would support this?

He is dehydrated (raises H and H) Check his cap refill, mucous membranes, and tenting

what is MCV (mean corpuscular volume)?

MCV is useful in classifying anemias and it provides info about size of RBCs ---> RBCs are either normocytic, microcytic, or macrocytic - adults should be at 80=95 fL (femtoliter)

acute epiglottis - description? - cause? - diagnosis? - sx? - nursing care?

MEDICAL EMERGENCY!!!! - serious obstructive inflamm process - quickly progresses to severe respiratory distress ---> absence of cough ---> drooling (common side effect) ---> agitation -- anxiety incr as respiratory distress incr caused by H. influenza B nursing care mgmt: ---> maintain airway, admin IV antibiotics, corticosteroids ---> positioning, comfort, possible intubation, reduce anxiety ---> fam support ---> Human influenza B vaccine

what should be monitored, taught, and done during planning?

Monitor - labs - fluid balance - electrolytes - weight - VS - I and Os Teach - diet - fluid - prevention ---> deficit ---> excess Action -is the IV appropriate

what are respiratory dysfunctions caused by noninfectious agents?

NO SPECIFIC TEST QUESTIONS - aspiration: inhaling foreign objects or substances ---> coins ---> marbles ---> formula ---> food - pulmonary edema - acute respiratory distress syndrome (ARDS) - smoke inhalation injury - tobacco smoke exposure

what is hyponatremia?

Na < 135 mEq/L - causes ---> medications ---> inadequate Na intake ---> water gain (dilution) ---> na loss s/s: - ab cramps - headaches - nausea - seizures - twitching, tremor, weakness - altered LOC ---> lethargy ---> confusion

what is hypernatremia?

Na+ > 145 mEq/L - Causes ---> Water deficit Excessive sodium intake s/s: - Polyuria - Anorexia - Vomiting - Weakness - Agitation & restlessness - Confusion - Dry & flushed skin - Intense thirst - Lethargy - Tachycardia - Low-grade fever (From dehydration)

what is PT? - what are the seconds needed? - coumadin therapy needs to be ? - what is INR?

PT is prothrombin time - coumadin therapy needs to be prolonged - INR (international normalized ratio) -- it stands for a way of standardizing the results of prothrombin time tests, no matter the testing method

what is PTT?

PTT= partial thromboplastin time - normal: 60-70 secs - heparin therapy: prolonged

what are complications of IV therapy and solutions?

Phlebitis ---> DC IV and apply warm compress Infiltration ---> DC IV and apply warm compress (encourage absorption) extravasation of med ---> DC infusion ---> attempt to aspirate drug (depending on drug) ---> apply ice (to stop meds from furthering in tissues) ---> research medication (antidote for injury?) ---> notify health care provider =====> central venous device?

what are some bad signs in assessment sites?

Phlebitis (vein inflammation) left pic - Erythema ---> streak formation - Pain - Edema Infiltrations (leakage into tissue) right pic - Skin blanches - cool to touch - edema - pain - bruised

what orders exist for IV bags?

Types of fluid - isotonic ---> LR (lactated ringer's) ---> 0.9% NS (normal saline) - hypertonic ---> D5W 0.45% NS (dextrose 5% in water) ---> D10W - hypotonic ---> 0.45% NS (half normal) ---> D5W

what are some pharmacological managements to treat pediatric pain?

WHO-- 2 step strategy ---> dosing at regular intervals --->---> timing is crucial ---> using appropriate route non-opioids (mild-moderate pain) - tylenol ---> 10-15 mg/kg/dose Q 4-6 hrs ---> do not exceed 5 doses in 24 hrs in children --->---> no more than 4000 mg in adults/day -ibuprofen ---> 5-10 mg/kg/dose Q 6-8 hrs ---> 30 mg/kg/day or 3200 mg/day is maximum - opioids (moderate- severe pain) ---> addiction ---> tolerance ---> weaning/withdrawal ---> monitor side effects morphine ---> coanalgesic/adjuvant - epidural analgesia - PCA

what should you assess before giving an IV?

Why does the pt need an IV Homeostasis - for med administration - alteration to fluids (blood vol) - alteration in electrolytes - secondary to: ---> preexisting disease ---> trauma ---> surgery ---> nutritional losses

acute vs chronic asthma sx?

acute asthma sx: - prolonged expiratory phase - wheezing, chest tightness, cough - tachypnea, accessory muscle use, retractions, nasal flaring - agitation or altered mental state - hyperinflation, incr AP diameter chronic asthma sx: - chronic cough, esp at night - prolonged cough w/colds & triggers - allergic sx and/or rhinitis - w/ or w/o incr AP diameter - wheeze though it may only be evident during acute episodes or w activity - atopic dermatitis - recurrent pneumonia &/or sinusitis - SOB on exercise - seasonal pattern - response to beta agonist therapy - if elevated eosinophils for lab values, is detection for asthma

when do teeth eruption start?

age 6-8 months

what are the two types of local anesthetics used?

needle free lidocaine - 1% buffering lidocaine EMLA - 2.5% lidocaine / 2.5% prilocaine - occlusive dressing 45-60 mins

influenza - cause? - diagnosis? - sx? - nursing care?

cause: - orthomyxoviruses (types A, B, C) diagnosis: - nasopharyngeal swab (RTPCR) sx (4-5 days): - dry throat, hoarseness, lack of energy, sudden onset of fever & chills complications of sx: - viral pneumonia - bacterial infections: otitis media, sinusitis, pneumonia nursing care: - prevention (PPE)/isolation - Flu vaccine (make sure not allergic to eggs) - symptom management - family support

croup syndromes? - cause? - diagnosis? - sx? - nursing care?

cause: - w/vaccines preventing H influenza B, the most common causes are viruses like parainfluenza, human metapneumovirus, influenza A & B, adenovirus & measles diagnosis: - inflamm of larynx, trachea, & bronchi sx (dependent of anatomic area involved): - epiglottis, laryngitis, laryngothracheobronchitis (LTB), & tracheitis (severe effects on the voice & breathing) - hoarseness, brass, barky cough, inspiratory stridor, respiratory distress nursing care: - airway protection *common in kids less than 3 *barky sound

proper procedure for labeling?

check your orders, then proceed NEVER - label tube/specimen container prior to obtaining specimen - leave the room/bedside before labeling the tube/specimen container - collect specimen from a pt w/o an ID band - double label a specimen/container

UPPER RESPIRATORY TRACT INFECTIONS acute viral nasopharyngitis - description? - cause? - diagnosis? - sx? - nursing care?

common cold cause: viruses --> rhinoviruses, RSV, adenoviruses, enteroviruses, influenza viruses, parainfluenza diagnosis: --> nasopharyngeal swab (RTPCR) swab far back in nare, not comfy sx: ----> fever, poor feeding, vomiting, diarrhea, abdominal pain, nasal blockage/discharge, cough, respiratory sounds, sore throat, headache, neck pain nursing care: - PREVENTION & protection (isolation/PPE) - comfort, symptom management, hydration, managing secretions - fam support

what are the different infusion methods?

continuous infusion ---> maintenance infusions/fluids ---> TPN ---> medications ---> larger volumes, given over longer pds of time intermittent infusion (aka secondary infusion) ---> smaller volumes, typical 50-100 ml ---> can be hung alone or added to continuous infusion ---> IVPB --->---> meds --->---> fluid boluses ---> syringe pump / mini infuser infusion methods ---> IV push --->---> NOT DOING THIS SEM --->---> very small vol administered by syringe --->---> meds given rapidly

what are the types of NG tubes? (4)

salem sump - double lumen levin - single lumen donhoff - feeding tube w/stylus sengstaken-blakemore - compression w/balloons (to stop areas of bleeding)

describe pulmonary embolis. - when do a majority of fatalities occur after onset? - whaat does it often present as? - clinical manif? what are these dependent of? - dx? - tx? - nursing care? - nursing diagnosis?

describe: ----> blockage of one or more pulmonary arteries by fat or thrombus, amniotic fluid or tumor tissue ----> lungs are ideal place for a PE bc of its extensive vascular network. the lower lobes are most often affected ----> a majority of fatalities occur within FIRST 1-2 HRS AFTER ONSET ----> often presents as code arrest clinical manif are dependent on the size of the emboli ---> small emboli= pleuritic chest pain, cough, fever, wheezing, crackles, dyspnea, hemoptysis, & hypoxia ---> massive emboli = change in mental status, a sense of pending doom, hypotension, pallor, sudden cardiac arrest dx: CT Scan, ventilation perfusion scan, D-dimers appear within one hr after thrombus formation... EKG may show tachycardia & R ventricular involvement tx: fibriolytics (TPA) --> clot buster, anticoagulants (heparin, lovenox, coumadin, embolectomy), Inferior Vena Cava (IVC) filter --> to catch clots risk factors: - birth control - surgery (orthopedic esp.!) - polycythemia - cancer/pregnancy (rare) - immobility nursing care: ---> identify @ risk pt ---> thrombus prevention w/early ambulation & SCDs ---> supportive therapy - O2, IV fluids, med admin, monitor lab values for safe admin of anticoagulants (PTT- heparin, PT- coumadin, INR-coumadin) nursing diagnosis: decr c/o rt right ventricular failure AEB hypotension (86/50), O2 sat 88%, & confusion

LOWER RESPIRATORY TRACT INFECTIONS bronchitis - description? - cause? - sx? - nursing care (symptomatic tx):?

description: - aka "tracheobronchitis" - inflamm of large airways frequently associated w/URI cause: - viruses - M. pneumoniae in kids older than 6 y.o. sx: - dry hacking non-productive cough (worsens @ night!) nursing care: (symptomatic tx): - 5-10 recovery - humidity - analgesics - antipyretics

pneumonia? - description? - classification by etiology - cause? - symptoms? - nursing care?

description: - inflamm of lobes of lungs (common in early childhood) classification by etiology: - viral-- associated w/URI - bacterial-- onset is abrupt - aspiration cause: - agent inhaled directly into lungs or comes from bloodstream & varies according to child's age sx: - fever, malaise, non-productive to productive cough, & chest pain nursing care: - supplemental O2, antibiotics, fluids, rest ---> prevention: bev did not mention

respiratory syncytial virus (RSV) - description? - cause? - transmission? - sx? - nursing care?

description: - most frequent cause of hospitalization in children younger than 1 yr, rare occurrence after 2 yrs old - by the age of 3 yrs, most children have has RSV once - respiratory infection of the bronchioles (contagious) - common cold ... but for infants - RSV season: early Nov --> beginning of april cause: - adenoviruses, parainfluenza viruses, human metapneumovirus, & rarely M. pneumoniae transmission: - exposure from contaminated secretions sx: - sneezing, wheezing, tachypnea, apnea, poor air exchange, coughing, pharyngitis, rhinorrhea (runny nose), cyanosis (check mucus membranes), large secretions (common sx) nursing care: - suctioning, isolation (PPE), O2 therapy, family support prevention: (NOT TESTABLE) - monoclonal antibody, palivizumab (synagis): IM injection that is given monthly for high risk pts - Prevent spread of infection through HAND WASHING Synagis vaccine given to prevent severe RSV disease: ---> infants < 29 weeks gestation ---> infants < 32 weeks gestation w CLD ---> multiple siblings in the household ---> going to daycare ---> smoking in the home

what are the principles of growth and development? (6)

development is: - orderly and sequential - directional - unique - interrelated - becomes increasingly differentiated - new skills predominate

what does an order that says "DC IC" mean?

discontinue intravenous tube

describe tuberculosis - etiology - affects what in body? - affects which group of people? - dx? - precaution? - s & sx? - tx? - nursing diagnosis?

etiology: caused by mycobacterium tb & is infectious affects what in body: the lungs but can travel through lymphatic system & settle in cerebral cortex, spine, bone, liver, kidneys, lymph nodes, and adrenal glands ppl most @ risk: homeless, inner-city neighborhoods, those living/working in institutions (prisons, LTC, psychiatric facilities), immunosuppressed (HIV, malignancy or corticosteroid use), foreign-born (may carry TB in lungs >> latent TB that can become active), poor & IV drug users dx: chest x ray & TB test precaution: airborne droplets are spread from person to person... other airborne illnesses are measles, varicella, and severe acute respiratory syndrome (SARS)... STUDENTS CAN NOT ENTER THESE ROOMS... don't want to anyways s & sx: - a bad cough that lasts longer than 3 weeks - chest pain - coughing up blood or tenacious sputum - fatigue/weakness - weight loss/no appetite - chills & fever - night sweats - lungs may sound normal or have crackles or other adventitious sounds tx: LASTS 6-9 MONTHS!!! most common meds used to treat TB: isoniazid, rifampin (rifadin, rimactane), ethambutol (myambutol), pyrazinamide nursing diagnosis: ineffective health management & noncompliance r/t lack of disease knowledge, lack of motivation, long term nature of tx, and lack of resources

when should tubing be changed?

every 96 hrs/4 days - if unlabeled replace ---> always label after spiking

where can sensible fluid loss be accounted? how does it occur?

sensible loss can be accounted through urination, defecation, & wounds - it occurs through skin & lungs

GAVAGE FEEDING - what is gavage? - what are indications for gavage? - what are feeding tubes? where are the placements (2)? - what are the tube sizes?

gavage: feeding by gravity indications: infants unable to feed orally bc --> unable to coordinate suck, swallow, & breathing --> too weak to suck --> lack of gag reflex feeding tubes: used to instill feeding for infants as well as other children - placement of tubes ---> nose ---> mouth tube sizes: ---> 3.5 french ---> 5 french ---> 6.5 french ---> 8 french

distinguish b/t gross & fine motor

gross motor: able to use large muscle groups to maintain balance & for locomotion fine motor: able to coordinate hand-to-eye movement in an orderly manner

define growth AND development

growth: a physiologic increase in size through cell multiplication or differentiation development: physiological, psychosocial, and cognitive changes occurring over one's life span. Leads to new activities and behavior patterns.

what is hemoglobin? - what are normal levels? - what level is needed for transfusion? - what does low & high levels indicate?

hemoglobin is a protein in RBC carries O2 - test is used to evaluate O2 carrying capacity of blood - normal: 14-18 gm/dL - transfusion ≈ ≤ 7.0-8.0 - low levels of anemia indicate: -----> anemia/bleeding/surgery -----> overhydration -----> bone marrow suppression - high levels of anemia indicate: -----> dehydration -----> polycythemia vera -----> pulmonary fibrosis

discuss purposes of lab data?

homeostasis - diagnosing ---> reveals occult problems ---> determines the stage of disease ---> estimates the activity of the disease process ---> measures the effect of therapy --------> vancomycin, heparin, coumadin multiple lab tests are usually ordered - assists in diagnosing problems - rules out certain disease states - venous blood lab tests may be ordered and analyzed individually or as a panel (group) - cost-effective - every lab establishes its own normal values for each test

what are the three solutions in IV bags?

hypertonic - higher osmolality than blood serum - causes cells to shrink hypotonic - lower osmolality than blood serum - hydrates cells, causes expansion isotonic - same osmolality as blood - cells unchanged - expands ECF (extracellular fluid)

what is the health care goal for children?

improve quality of healthcare for children (0-17) & their families

what are the gross motor and fine motor skills abilities for: - infants - toddlers - preschoolers - school age

infants: - gross: hand control, rolling over, sitting, crawling - fine: hold mottle and banging objects toddlers: - gross: walking, jumping - fine: throw ball overhand, build towers, grasp small objects preschool: - gross: riding tricycle, skipping, jumping rope - fineL drawing & dressing school age: - gross: organized sport - fine: cursive writing

SQ injection sites

infants: anterior thigh older children & adults: dorsum of upper arm, abdomen, anterior thigh

intracellular is ______ of body water extracellular is ______ of body water

intracellular fluid is 2/3 of body water extracellular fluid is 1/3 of body water

what do you do when checking meds?

look up meds for: - type of meds & indication of use - safe dose - infusion time - rate of infusion - compatibility (is secondary compatible w/primary?) can find this info micromdex, davis drugs, etc

tier 4 interventions

missing under prescription analgesics: NSAIDs & non-narcotic analgesisc

acute laryngotracheobronchitis (LTB) - croup syndrome affecting who? - description? - cause? - diagnosis? - sx? - nursing care?

most common croup syndrome affecting --> primarily affects 6mo-3yrs cause: - viruses, rarely bacterial sx: - preceded by URI which descends to other structures - "barky" cough retractions, nasal flaring nursing care mgmt: - maintain airway, manage secretions, cool mist, vigilant observation & rest - family support complications of LTB is bacterial tracheitis: -lower respiratory tract infections - bronchitis, RSV & bronchiolitis, pneumonia & TB

what does potassium do? what is the normal concentrations?

normal K concentration: 3.5 - 5.0 mEq/L - main ICF electrolyte Serum concentration levels depend on: - Aldosterone - Sodium reabsorption - As sodium is reabsorbed, K+ is lost. »Sodium-Potassium Pump Review - Protein and carbohydrate metabolism - Cellular building - Transmission of electrical impulses ---> Nerve ---> Heart ---> Skeletal ---> Intestinal ---> Lung tissue

what does sodium do? what is the normal concentration?

normal NA serum concentration: 135-145 mEq/L the chief ECF electrolyte - maintains water balance ---> generation/transmission of nerve impulses ---> Chloride usually accompanies sodium

health promotion themes

nutrition: - obesity & diabetes type 2 ---> 30% overweight ---> 17% obese oral health: - prevent dental caries

how deep should ID injections be?

only about 1/8"

what are the 5 stages of Freud

oral (0-1 yr) --- biting / sucking/ chewing anal (1-3 yrs) --- interest centers on anal regions since sphincter muscle develops --- they say "my sphincta hurts :(" phalic (3-6 yrs) --- interest in genitals (saran used to breastfeed her dolls) --- kids recognize differences b/t sexes latency (6-12 yrs) --- interested in gaining knowledge and play genital (12 yrs+) --- maturation of repro system & production of sex hormones Only Armies Possess Lethal Grenades

how is pain assessed in kids?

pain assessed through behavioral pain tools: - FLACC ----> trained observer for infants & kids < 4 years ----> the higher the #, the more uncomfy the kid is ----> behavioral based only - Observational - non-verbal & cognitive impairment - infants feel pain

CHILD W/ RESPIRATORY DYSFUNCTION PPT

pediatric respiratory

what is included in infant pain evaluation?

physiological & behavioral - VS (NIPS, CRIES, NPASS, PIPP) - oxygenation - color + ---> muscle tone ---> facial expression ---> body movements ---> cry ---> changes in state - consider: ---> infants maturity, behavioral state, energy resources available to respond, risk factors for pain

what is platelets ordered as? - normal levels? - what are high and low levels called?

platelets are ordered as part of a CBC - normal levels: 150,000 to 450,000 platelets per microliter of blood - high levels: thrombocytosis - low levels: thrombocytopenia

what are the 3 stages of kohlberg?

preconventional (1-3 yrs): understands good/bad (3-6 yrs): understands concept of right behavior conventional (6-12 yrs): obeying; concerned w/loyalty & conforming post conventional (12-18 yrs): formal operations & develop ethics

what is the COMFORT recipe for success? PUCPP

prep: - offer developmentally appropriate info & reassurance - promote positive coping skills & mastery utilizing the tx room: - maintains bed as a safe haven for kids coaching: - giving caregiver an active role in child's tx positioning: - utilizing positions of comfort providing a supportive environment: developing a calm & quiet atmosphere - utilize child life specialists

what is RBC ? what are normal values? and abnormal values

produced in bone marrow in response to blood oxygen levels normal: 4.7 to 6.1 million per microliter

what's important to remember when administering NG/OG feeding? what are additional routes due to intolerance to NG/OG feedings?

remember to check placement before every feeding ---> confirm cm marking on tube ---> auscultate/aspirate for content/return contents gavage by gravity/bolus feedings intermittent by syringe or kangaroo pump additional routes: ---> jejunum ---> duodenum

what are the nursing responsibilities for hypokalemia?

replace K - diet - supplement - IVs - correct cause of imbalance - cardiac monitor - monitor K levels - monitor magnesium levels

what is chief illness of children?

respiratory

what are the 4 stages of piaget's?

sensorimotor (0-2 yrs) -- 6 sub stages -- governed by sensations in which simple learning takes place -- sense of "cause/effect" -- learn object permanence preoperational (2-7yrs) -- egocentrism (unable to put oneself in another's place) -- concrete/tangible thinking bc they cannot think ab what is not observable concrete operations (7-11yrs) -- logical/coherent thoughts -- able to problem solve formal operations (11-15 yrs) -- adaptable/flexible thinking -- able to think in abstract terms & can draw conclusions Super Puffy Cheetos From 7/11

how to measure NG tube for placement?

tip of nose --> ear lobe --> xiphoid process (halfway b/t belly button) --> tape

what are the 5 stages of erikson's

trust vs mistrust (0-1 yrs) -- basic needs and trust autonomy vs shame/doubt (1-3 yrs) -- incr control autonomy vs shame and doubt (1-3 yrs) -- incr ability to control own body, selves, and environment initiative vs guilt (3-6 yrs) -- interested on exploration of world -- develop conscience industry vs inferiority (6-12 yrs) -- interest centers on tasks -- learn to take rules -- cooperative identity vs role confusion (12-18 yrs) -- rapid/ marked physical changes -- preoccupied w/self & appearance TRUST the AUTO IN INDUSTRY, INDENTIFY roles

what structures are affected in respiratory infections:

upper respiratory tract (UPOL) - pharynx - oronasopharynx - larynx lower respiratory tract (LTAABB) - trachea - alveoli - alveolar duct - bronchi - bronchioles croup syndromes (CEL) - epiglottis - larynx

define ventilation, perfusion, diffusion

ventilation: - moving gasses in & out of lungs - requires muscular & elastic properties of lungs & thorax to be coordinates perfusion: - cardio system must have ability to pump oxygenated blood to the tissues & then return it to lungs diffusion: - movement of respiratory gases from one area to another by concentration gradients

VTBI

volume to be infused