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Peds Test #3 13-19

A transfer of gastric contents into the esophagus that occurs in everyone. It is the frequency and persistency that makes it abnormal. Gastroesophageal Reflux (GER)
Paroxsymal abdominal pain or cramping that is manifested by loud crying and drawing legs up to the abdomen. Cry occurs greater than 3 hours per day and occurs more than three days a week. This occurs in 5-10% of infants and is a normal part of infancy. Colic
interventions used for Colic Education and Support
________ and ______ are parts of normal development in the otherwise thriving infant and do not require medical attention Colic and Spitting up
If projectile vomiting occurs a nurse would suspect Pyloric stenosis or GERD
Weight is less than the 5th percentile with height being WNL. Failure to Thrive
Failure to Thrive is categorized by cause; What are the causes of FTT? Inadequate calorie intake, inadequate absorption (CF- decreased pancreatic enzymes/Celiac Dz- gluten allergy), increased metabolism (hyperthyroidism), defective utilization (genetic/metabolic; child cannot utilize the nutrients taken in)
How do we determine what treatment to implement with imfants with FTT? We have to figure out what is causing the FTT before we can fix it.
This is a common problem in infancy. Chronic inflammation results from the response to the allergens. A lot of times this is associated with certain food allergies. Atopic dermatitis. (Atopic refers to an inherited tendency toward allergic conditions.)
Therapeutic management of apnea in infancy theophylline/caffiene, home apnea monitors, family support and CPR training for all caretakers of the infant.
The sudden death of an infant under one year old during sleep that remains unexplained after investigation. Sudden infant death syndrome
3rd leading cause of death under the age of 12 months, with most cases occuring between the ages of 2 months and 4 months. Sudden infant death syndrome
Developmental tasks of the toddler (ages 1-3) RESSSA: (Red Elephants Sit Silently Staring Ahead) R- receptive language (aquiring) E- expressive language (aquiring) S- social interation skills (developing) S- sense of self control (toilet training) S- self image (developing) A- autonomy (sense o
Physical changes of the toddler (ages 1-3) Learn to walk steadily (12-15 months) Age 3 protruding abdomen (related to lumbar curve) Can run 20 primarry teeth Well developed pincer grasp can copy a single line half of the adult height birth weight is quadrupuled
Pshycosocial development of the toddler (1-3) They realize their ability to fail which leads to shame and doubt. temper tantrums are common and parents tend to give into this negitive behavior which fails to teach the child proper acceptable behaviors.
Cognitive development of the toddler (1-3) according to Piaget, toddlers are continuing the sensorimotor phase
A child will actively search for an object when it is taken out of sight Object permanence
Children play alongside, not with, other children. Parallel play
Toddlers like objects that thet can ____ & _____ Pull and push
Red flags for developmental delay (by 12-18 months) Does not crawl Drags one side of body for more than 1 month Does not speak atleast 15 words by 18 months no object permanence says no single works does not learn to use gestures (waving etc) Does not point to objects or pictures
Red flags for developmental delay (by 2 years) Cannot walk by 18 months fails to develop heel to toe walking does not imitate actions or words does not know functions of common items does not follow simple instructions cannot push a wheeled toy
Most children continue to have occasional accidents (urine) until what age? 4-5
What type of toilet training is usually first? Bowel
What is one of the most important responsiblities of the nurse when it comes to toilet training a toddler Helping the parents identify the readiness signs
Readiness signs for toilet training include: DRRRDCS (Do Red Rabbits Run Down Circle Stairs) D-Dryness for hours R- Regular BM R- Recognize need- verballize they have to go R- Ready to please parent D- Diaper changed (want soiled one off) C- Curiosity S- Sitting on the toilet
What is the way that a child shows that they cannot deal with the present stress. It happens very common in hospitals and is common in toddlers? Regression
When should parents start caring for their infant/childs teeth? As soon as they develop
When should a child first see the dentist? After the first teeth erupt and no later than 2 1/2.
When brushing a childs teeth the ends of the bristles should be: Wiggly and not moving forcefully back and forth (can damage the gums and enamel)
in realtion to dental care, which is more important? The frequency at which sugar is consumed or the amount? Frequency
In regards to dental care, which foods are the worst? Foods that are sticky or hard because they remain in the mouth longer
Juice should always be offered in a ________. Why? Cup; because bottle mouth caries can develop if the juice is offered in a bottle.
What are the new guidelines related to car seat safety? Car seats in which the toddler faces the rear of the car as long as possible.
Leading causes of death in the toddler (1-3) unintentional injury congenital anomalies homicide
When assessing the toddler and the environment in which the child lives be aware of: The parents description of the child Whether the family is poor, overcrowded, fatigued, and dysfunctional
Psychosocial development of the preschooler (4-6) Initiative vs. guilt
Characteristics of the preschooler include: inquisitive learner, enthusiastic about learning new things, feel a sense of accomplishment with the activities they achieve.
Physical changes of the preschooler include: Between 18 months and 5 years hand dominance shows. By 3, alternate feet when climbing stairs During age 3-6, boys are sicker than girls (r/t close contact play) By 4, a child can hop and draw a person with 3 body parts By 5, can skip.
Icreased brain function in the preschooler is related to continued myelinization of neurons in the brain.
Preschoolers gain _____ lbs/year and grow ___ to _____ inches/year 5-7 lbs/year 2.5-3 inches/year
Cognitive development of the preschooler According to Piaget, the child continues in the preoperational stage (from 2-7) the child is egocentric and has a single point of view.
Preschoolers make judgement based on _______ Visual apperance
Preconceptual thought Can focus on a single aspect of a situation -No cause and effect reasoning -Egocentric -Development of intuitive thought difficulty distinguishing fact from fantasy (magical thinking) -Use of symbols
The thought that the child himself or other people created everything in the world. Artificialism
The belief that inanimate objects such as dolls and stuffed animals are real Animism
The thought that things need to be fair all the time and if a rule is broken, punishment must occur now Imminent justice
During the preschool years a child will tell on themselves, sometimes in an exaggerated way, this is due to: the ability to understand right from wrong and the development of a conscience. The child is developing an inner voice that warns or threatens.
The stage at which Kohlberg identifies the development of the inner voice. Preconventional stage
The preschool years are a time of: refinement of language skills. The children are learning new words and the meaning of those new words
What type of speech does the three year old exhibit? Telegraphic (short sentences that contain only the essential information)
What is the greatest fear of the preschooler in relation to body image? Bodily harm; they exaggerate situations such as a shot is interpreted as he is going to literally get shot. Let the children play with items to become familiar with them and explain things to them. Always tell the truth.
Preschoolers recognize that there is two different genders and normally identify with the correct gender except in: Transgender children
This is a healthy natural part of preschool development. non-sexual masturbation; if sexual, look into abuse. It is important to teach the child that there is a time and a place for such activites.
Curiosity about other persons bodies and sexual functions is normal. A parent should not: tease the child about the curiosity or imply that sexual information is dirty or bad.
A child that is either partially awake or asleep, screaming and crying, with amnesia of the situation after fully awakening is called Night Terrors
Related to sleep and rest, children need: Bedtime rituals. While hospitalized, parents and nurses need to keep the same bedtime routine for the child (within reason)
_____% of child abuse deaths happen before the age of _______ 85% 6 years old.
Physical changes associated with adolescents Weight gain (early adolescence) asynchronous growth Growth spurts enlarged stomach and intestines increased weight and volume of lungs improved hand and eye coordination
Adult height is reached by: 18 years old
growth in which different body parts mature at different periods of time asynchronous growth
Chamges associated with puberty development of breast tissue Pubic hair changes in male genitalia (in response to the secretion of estrogen and testosterone)
Puberty results due to triggers in: The enviornment The CNS The hypothalmus The pituitary gland The gonads The adrenal glands
Developmental tasks of adolescents Developing a sense of identity Seperation from family Careet planning Establishing close peer relationships (nurses and parents should foster these relationships as they are very important to the adolescent) Intamacy (sexual or non, may be close conta
"Nothing bad will happen to me" Fable of immunity
Health perception r/t adolescents important to develop a + self image concerned about physical development, apperance and emotions. Some teens will deny illness in fear of losing contact with peers for a length of time.
Nutrition r/t adolescents Balanced diet essentail for optimal growth poor nutrition = retarded growth & delay in sexual maturation because of dissatification with appearence, eating disorders can develop Approx. 15% are obese
Nursing Management for Varcella Zoster Airborne and contact precautions immunizations fever control antihistamines acyclovir
Nursing assessment for Varcella Zoster Acute onset of fever, malaise, headache, abd pain before and during eruption. Rash for a few hours that progresses into vesicular lesions for 1-5 days. Lesions at all stages may be present at once. Crust may remain for 1-3 weeks
How long is Varcella Zoster contagious for? 1-2 days before rash and until all the lesions are crusted over.
Hand Foot Mouth disease is spread via Fecal-oral and respiratory (Enterovirus)
Nursing assesssment for Hand Foot Mouth disease Diffuse lesions on the buccal surface of the mouth, tongue, papulovesicular lesions on the hands and feet for 7-10 days
Nursing management of Hand Foor Mouth disease Good hand hygiene topical pain meds cold drinks to decrease swelling and pain bland foods nonASA antipyretics no school while febrile (contagious)
What is the incubation period of Fifths Disease? 4-21 days
When is fifths disease most contagious? before the rash appears
What causes fifths diease? Human Parvovirus b-19
What ages is the incidence of fifths disease the greatest? 5-14
Nursing Assessment for Fifths Disease mild symptoms: fever, malaise, body aches, headaches. followed by a rash in 7-10 days. Circumoral pallor, lace like symmetrical rash to trunk and extremities. May be itchy.
"Slapped Face" with circumoral pallor fifths disease
After the rash appears in fifths disease, how long does it take to fade and what can exacerbate the rash? 1-3 weeks, hot water can exacerbate the rash
Nursing management of fifths disease droplet percautions nonASA antipyretics antipruritics rest and fluids no direct sunlight (r/t heat and exacerbation) May return to school after rash fades.
Nursing Assessment of mumps Hx of exposure or lack of immunization unilateral or bilateral parotid swelling fever orchitis in boys
Nursing Management of Mumps Management is Supportive Tylenol for fever Oral fluids Ice packs with support to testicles with orchitis. Infertility can occur r/t increased scrotal temp.
What is the incubation period of Rubeola (Measles) 8-12 days
When is Rubeola (Measles) contagious? 3-5 days before the rash and up to 4 days after the rash appears
Nursing assessment for Rubeola (Measles) Children are quite ill in the 3-5 day prodromal period. Koplik spots and red blotchy rash appears days 4-7
Koplik Spots Associated with Rubeola (Measles), blue/white spots on the buccal mucosa
Nursing managament of Rubeola (Measles) Treatment is supportive airborne percautions NonASA antipyretics dark room r/t photophobis lots of fluids
The best was to prevent the contraction of Rubella (german measles) is: Immunization
How is Rubella transmitted? Through inhalation or direct contact with resp secretions
What is the incubation time for Rubella (GM) 14-23 days
When is Rubella (GM) contagious? few days before to 7 days after the rash appears
Nursing assessment for Rubella (GM) May be aymptomatic red rash on face then generalized fever, lymphadenopathy
Nursing management for Rubella (GM) Maternal infection in 1st trimester can lead to defects. droplet precautions isolation from pregnant women NonASA antipyretics fluids no school from 7 days after rash
Rubella starts on _________ Rubeola starts on ________ Face; Chest and Trunk
Paroxysmal cough a cough that is nonstop, the child cannot catch their breath.
Pertussis is characterized by: a barking cough and paroxysmal coughing spells
Nursing management of Pertussis High humidity enviornment frequent suctioning fluids droplet precautions
Scarlet fever is caused by? an infection by group A streptococcus + strept throat infection
Nursing Assessment for scarlet fever fever >101 chills body aches loss of appetite N&V red swollen pharnyx red rash on face, trunk, and extremities strawberry tongue (differential dx) + throat culture
Nursing Management of scarlet fever Pen V cool mist humidifier education on fluid intake droplet precaustions of hospitalized if very ill, give the Pen IM (one time dose)
What constitutes the most frequent infections in the world? intestinal parasitic disease
The two most common intestinal parasitic diseases in the US are: giardiases and pinworm
S%S of pinworms nocturnal anal itching sleeplessness
Disgnosis of pinworms direct visualization or eggs detected on transparent tape over the anus in the morning before a child has a BM
Transmission of pinworms Fecal-oral eggs remain infective in indoor enviornments for 2-3 weeks
Drug of choice for pinworms Vermox or Antiminth All family members are treated
recent act or failure to act on the part of a parent or care taker that results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act that presents an imminent risk of serious harm to a child Child abuse and neglect
True or False You are legally, morally, and ethically bound to report all suspected cases of child abuse to CPS? True
The infliction of physical injury as a result of punching beating, kicking, biting, burning, shaking, or otherwise harming a child Physical abuse
____ children die in american everyday as a result of child abuse or neglect and nearly _____% of the deaths are children under the age of _____ 3 Die everyday 50% are under one year old
_____% of physical abuse deaths are under age ____ 85%;6
__________ is the leading cause of inury related death in children under 5 Homicide
Parental/Caretaker risk factors for being a child abuser Hx of child abuse/neglect as a child Lack of support Poor impulse control unrealistic expectations adolescent/young parent Metal illness substance abuse Domestic Violence Poverty/unemployment Low education Single parent Parent child role reve
Factors that place a child as risk for abuse Age (infants/preschoolers are at increased risk) Rematurity/developmental delay/disability Congenital anomalies Medical conditions Behavior problems Placement in foster care
True or False? Child abuse is generally a single episode and gets better over time? False Child abuse is generally repetitive and tends to escalate
True or False? Many children who present with severe injuries have previously presented with less severe injuries and abuse was overlooked True
Prompt ___________ and __________ of physical abuse is imperative recognition;reporting
When assessing a suspected child abuse victim obatin: a complete health history how, when, and where Allow the caretaker to lead the interview obtain a timeline, any delays in treatment? who was with the child when the injury occured? who witnessed? Look for indications of physical abuse
Indicators of physical abuse No hx for the injury Inconsistent/conflicting hx hx/injury is inconsistent with developmental level of child delay in seeking care doctor shopping
If _______ and ________ allow, question the child about how a injury occured age and development
True or False? You should interview a child about abuse with people in the room False, Whenever possbile, interview the child alone with direct open ended non leading questions
When there is concern for________________ a thorough ____________ should be done Physical abuse; Physical exam
_______ and ______ should be used when documenting physical exams on suspected child abuse cases Body diagrams; color photos
When documenting findings during a physical exam of a suspected child abuse case you should: describe the: location distribution depth color size shape Use accurate measurements (of all cutaneous findings)
Findings that are associated with physical abuse include: Unexplainable Lacerations bruises fractures bite marks abdominal marks (these can be hidden) abdominal injuries head injuries
What is a red flag when it comes to burns in infants/children? Bilateral burns on hands. Burns on burns on both hands is very uncommon
Physical development of the school age child (elementary te middle school before puberty) Weight gain of about 2-4 kg per year grow 5cm per year (until 10-12 for girls and 12-14 for boys) Fine and gross motor development improve
Psychosocial development of the school aged child industry vs. inferiority they have a thirst for knowledge. During this time if a parent intrudes on a childs effort to master a skill a sense of inferiority will develop and a low self confidence will occur.
Cognitive development of the school aged child Egocentrism starts to decline they develop moral reasoning and begin to see right from wrong
Physical Activiy for school aged children Planned regular activites are important. It aides in health, social skills, and self esteem Can be negative if a child is over-scheduled though.
Oral health needs of the school aged child During this time the eruption of the permamnent teeth is taking place. Dental exams Q6 months Assess oral hygiene habits assess the teeth Educate the children on the importance of oral hygiene.
Mental health of the school aged child They are learning their self-concept increased independence and responsibility for self body image and sexuality starting to develop they need sufficient sleep Parental involvement is important without overbearing.
Sleep hygiene in the school aged child Go to bed and get up at same time each day follow a betime routine Avoid caffiene several hours before bed gradually slow down activity 1-2 hrs before sleep Do not watch TV, play games, text etc in the sleep location Avoid late naps Darken the room
True or False? We can make up for lost sleep by sleeping late? False, we cannot make up lost sleep
Injury risks of the school aged child Play; educate about protective gear Motor vehicles fiearms; educate the child on safety Burns; related to curiosity Assault
These lesions typically occur on the face and begin as small vesicles which rapidly enlarge to form yellowish brown crusty masses Impetigo
Common infection of infants and children; can be highly contagious; caused by S. aureus but can be caused by beta-hemolytic-strep A Impetigo
Under an impetigo crust, the lesion is ______&__________ and exudes a __________ colored liquid red & moist, honey
___________ is common in impetigo and can lead to further spread, which is called __________________ Pruitis; autoannoculation
Treatment for impetigo Topical antibiotics in the early stages, if extensive systemic tx may be needed. There are many resistant strains.
Circular bald patch with redness or scaling is: Tinea Capitus (fungal)
Treatment for tinea capitis Oral antifungals
Round, red ring of vesicles or papules with a clear center scattered over the body. An itching and burning sensation may be present Tinea Corporis- Ring Worm
Treatment for Ring worm (tinea corpus) Topical antifungals (no steriod cream, can ncrease fungal infection) you can use OTC fungal treatments such as athlete foot cream and yeast infection products.
This is caused by a female mite that burrows into the epidermis to deposit eggs and feces. Scabies
When does inflammation r/t scabies occur? 30-60 days after exposure
Treatment for scabies Topical treatments such as scabicides or oral treatments
What type of percautions are needed for a patient with scabies? Contact
Where does the inflammation associated with scabies start? Between fingers and toes and in inguinal folds
How long does an adult louse live? 48 hours without host and they have a lifespan of 30 days with a host
Where do female louse lay nits? base of hair shaft
Treatments for Pediculosis Capitis (head lice) include: pediculicides and nit removal (important to prevent spread and reoccurence by cleaning and treating properly)
When should you re-do a treatment r/t head lice? 7-10 days after inital tx. (nits hatch 7-10 days)
This is a tick-borne disease Lyme Disease
Therapeutic management of lyme disease Doxycycline if over 8, if under 8 amoxicillin
Lyme disease has a certain rash associtaed with it; describe. Red ring like rash at site of the bite. known as the bullseye.
Stages of lyme disease Early: localized; rash within 7-14 days Early disseminated; rash 3-5 weeks with fever, malaise, arthalgia Late; recurrent arthritis of large joints week to months after the bite
Nursing management of Lyme disease Antibiotics education about completion of antibiotics education about prevention
Symptoms of lyme disease At first: Flu like symptoms (headache, malaise, fever, chills, sore throat, muscle aches) Insomnia Psychosocial complications Hearing loss Paralysis of the face Heart issues (snycope, palpatation) dyspnea hot swollen painful joints bulls eye rash
This disease is caused by the bacteria that is found in cat saliva or cat fleas Cat scratch disease
Nursing management of Cat scratch diease antibiotics if ordered standard precautions education for prevention care of bites or scratches flea control
this is a type 4 hypersensitivity reaction (inflammatory response not immune) that causes a red, swollen, rash that includes hive like small vesicles. Contant dermatitis
Treatment for contact dermatitis removal of irritant glucocorticoids (decreases inflammation)
Adverse drug reaction are most often seen where? skin, rashes are the most common reaction
True or False? A reaction to a drug may be immediate or delayed True
What is the treatment of a drug reaction? discontinue the drug give antihistamines if severe, corticosteroid therapy
This occurs with the onset of flu-like symptoms, inflammation of the glans penis (blanitis)conjuctivitis, stomatitis. Patient gets a red papular rash and lesions on all surfaces of the body except the scalp. This causes the skin to literally fall off. Stevens-johnson syndrome (erythema multiforme exudativum)
Treatment for Stevens-Johnson symptomcatic treatment
Prognosis for Steven-Johnsons 10-15% mortality
What causes Stevens-Johnson Drug reaction
The involuntary passing of urine Enuresis
Primary Enuresis the child never achieves bladder control (further assessment is needed)
Secondary Enuresis children have periods of dryness usually several months then display enuresis again (this can happen with stress)
Nocturnal Enuresis urinating at night
______% of boys and _____% of girls are age 5 still have noturnal enuresis. 7;3
At age 10, ______% of boys and ____% of girls still have nocturnal enuresis 3;2
What is the organic cause of noturnal enuresis? UTI
Treatments for nocturnal enuresis antidiuretics, antispasmodics, tricyclic antidepressants.
True or false? Many cases of noturnal enuresis never resolve False many spontaneously resolve
The repeated voluntary or involuntary passage of feces of normal or near normal consistency into places not appropriate for that purpose Encopresis
Primary encopresis fecal incontinence after age 4 years (sphincter or neuro problem?)
Secondary encopresis fecal incontinence in a child older than 4 after periods of established continence.
Encopresis is more common in: Males
Therapeutic management of encopresis Determine the cause dietary intervention management of constipation psychotherapeutic interventions
The typical onset of ADHD is before age ____ 7
ADHD incluses such behaviors as: Inattention, impulsivemess, and hyperactivity
Therapeutic management of ADHD Classroom management family education and counseling behavioral therapy environmental manipulation medication
Side effets of ADHD meds insomnia anorexia and weight loss hypertension long term use may suppress growth
Created by: 1272858662