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Peds Test 2
Wong
| Question | Answer |
|---|---|
| When assessing children, is nonverbal or verbal response more reliable? | Nonverbal |
| T/F Avoid sudden or rapid advances, broad smiles, extended eye contact while communicating with children | True |
| T/F Ask private questions last with adolescents | True |
| How to prepare child for procedure? | Tell what will happen in their scope of understanding; parents presence (unless adolescent give choice); non-threatening; do as much as possible without touching first |
| T/F Ask private questions first with adolescents | FALSE, ask them first |
| Formula: auscultate BP systolic 1-7 | Age years + 90 |
| Formula: auscultate BP systolic 8-18 | (2 x age)+83 |
| At what age is recumbent height stopped being used | 2 years |
| Head circumference is measured until age? | 3 |
| How long should respirations be taken for in children? why? | 1 full minute due to irregularities |
| What should the size of the BP cuff be in children over 3 ? | width - 40% of upper arm; length - cover 80-100% |
| Are childrens tonsils bigger or smaller than adults? | Bigger |
| Age in months - 6 = ? | number of teeth |
| Which lung sounds are easier to hear in children? | inspiratory |
| PMI location(Age)? | 4th ICS until 7 then 5th |
| What 3 heart sounds are normal? | sinus arrhythmia, physiologic split s2, venous hum; murmuers - checked by physician |
| What should be used to avoid hypertensive classifications in 10th and 90th percentile patients | HEIGHT and AGE |
| Sites for measuring BP | brachial, radial, popliteal, dorsalis pedis, posterior tibial |
| Infant/toddler vital sign measurement | 1-respirations (before disturbing) 2-apical HR 3-BP (>3) 4-temperature last |
| What eliminates errors and hearing problems in BP readings | using oscillometry (dinamaps) |
| How to rule out heart defects while taking BP | compare BP in upper and lower |
| Two distal horizontal creases fused together to make a single horizontal crease means? | probably down syndrome |
| enlarged, tender, warm lymph nodes | infection or inflammation, but childs lmyphs are bigger than adults |
| What is a normal pulse grade in children | +3 |
| Early sepsis time frame | 24-48 hrs from birth |
| Late sepsis time frame | after 2 weeks of age |
| Most common microorganism involved with EARLY sepsis | E coli |
| Neonatal infection with no TX may lead to... | resp distress, vomiting, jaundice, irritability, seizures |
| How to prevent neonatal infections? | screening mothers prenatally for infection with subsequent antibiotic |
| Usual IV antibiotics given for neonatal infection | ampicillin and gentamicin |
| Earliest non specific signs of neonatal sepsis | lethargy, poor feeding, poor weight gain, and irritability |
| What is the third leading cause of death between 1 month and 1 year | SIDS |
| What does an autopsy show related to SIDS | pulmo edema and intrathoracic hemorrhages |
| What is the peak age of occurrence of SIDS | 2 to 4 months |
| What races is SIDS most common in? | NA AA H |
| What causes a lower incidence of SIDS | breastfed infants |
| Should infants be placed in beds with soft moldable matresses or hard ones to avoid sids? | AVOID SOFT, hard ones |
| The etiology of SIDS may be | brainstem abnormality in the cardiorespiratory center |
| Pathologic apnea occurs what age | older than 37 weeks of gestation |
| Apparent Life Threatening Event (ALTE) related to apnea of infancy | apnea > 20 sec; cyanosis or pallor; hypotonia; choking or gagging; or a frightening situation to observer |
| 2 diagnostic tests for Apnea of Infancy | Pneumocardiogram and Polysomnography (sleep study) |
| What does a pneumocardiogram measure | HR, RR, nasal airflow, O2 sat |
| What does a polysomnography or sleep study measure | HR, RR, nasal airflow, O2 sat, AND brain waves, eye and body movement, esophageal activity, and CO2 |
| Home apnea monitors need to be kept away from what? | possible electrical interferences (tv, cell phones, electric blankets, air conditioners) |
| What is the nurse must teach caregivers of a infant with apnea | CPR, vigorous stimulation when needed |
| What communication approach allows children to 1.agree and express 2. disagree 3. remain silent | Third-person technique |
| Careful listening and reflecting back to patients the feelings and content of their statements | facilitative responding |
| When using an interpreter, what are some guidelines to follow | avoid medical jargon; question about sex, marriage, or pregnancy indirectly (child's father rather than mothers husband); assess interpreter for patients nonverbal cues afterward; use same interpreter for other visits if possible |
| When does stranger anxiety exist in infants | over 6 months |
| What age group requires focus on them and may need "warm up" time | early childhood |
| What age level likes to help and generally behave well and communicate effectively | School Age |
| Avoid judging and criticizing what age group | adolescent |
| Drawing: sex of figure drawn first | childs perception of own sex role |
| Drawing: exclusion of a member | feeling of not belonging or desire to elimintate |
| Drawing: accentuated parts | express concern for areas of special importance |
| Drawing: absence of or rudimentary arms and hands | suggest timidity, passivity, intellectual immaturity, insecurity; hidden hands = guilt feelings |
| Drawing: placement of drawing on page and type of stroke | restricted to small area = insecurity |
| When are complete family assessments done? | comprehensive checkups; developmental delays; child abuse; behavior emotional problems; stressful events and major life changes; new home care patients |
| what should be included in a 3 days nutritional diary | one weekend day |
| Provides info about the number of times in a day, week, or month a child consumes items from the different food groups | food frequency questionnaire or record |
| The measurement of height, weight, head circumference, proportions, skinfold thickness, and arm circumference | anthropometry |
| Children with immunodeficiency, who are they? | receiving steroid therapy; immunosuppressive therapies; generalized malignancies; immunologic disorders |
| 3 ways varicella zoster virus can be spread | direct contact, airbourne droplet, fomites |
| 4 symptoms of chicken pox | fever, lymph, irritability, anorexia |
| Tx for chicken pox | acyclovir, benadryl, oatmeal baths, calamine, short nails, strict isolation |
| What are the common secondary infections or complications of chicken pox | impetigo, cellulitis, sepsis, encephalitis |
| bordetella pertussis | pertussis (whooping cough) |
| S/S of Pertussis | short/rapid coughs followed by whoop sound; bloody purulent nasal d/c; fever; malaise; anorexia; sore throat with gray membrane; bulls neck (lymphs) |
| How is Pertussis spread | direct contact |
| Tx for Pertussis | antitoxin, PCN or EES; strict isolation |
| Complications of Pertussis | Pneumonia, myocarditis (inflammation of muscular tissue of heart) |
| Infections of epiglottis or larynx | croup syndromes |
| what 3 factors contribute to respiratory infection | age (child), size (airway tubes), resistance (immuno) |
| Is tonsillitis viral or bacterial | can be either |
| How do we find out whether tonsillitis is viral or bacterial | throat culture |
| Tx for bacterial tonsillitis | PCN unless allergic --> azithromycin |
| Tonsillectomy | palantine tonsils |
| adenoidectomy | adenoids |
| Signs of hemmorrhage r/t post-tonsillectomy | tach (>120 bpm); pallor; throat clearing; vomiting of bright red blood; restlessness; (dec. BP is late sign of shock) |
| Post-tonsillectomy nursing care | hemmorhage, HOB, VS, Ice Collar, non-red fluids to soft bland diet, antiobiotics and analgesics (at least first 24 h) |
| 3 Tonsillectomy home care focuses (more on PPT) | avoid vigorous tooth brushing; avoid irritating or highly seasoned foods; discourage coughing or throat clearing |
| S/S of infant with otitis media | crying, rubbing/holding/pulling affected ear, rolling head side to side, loss of appetite |
| Chronic otitis media may cause | hearing loss |
| what is usually the cause of otitis media | dysfunctioning eustachian tube |
| Children 6m-2y receive antibiotic Tx when | severe pain and fever are present; if not then observation for 72 h, no antibiotics if improvement occurs during this time |
| Dosage of antibiotics for OM | 80-90mg/kg x 10-14 days AMOXICILLIN if no antiobiotics have been used in past month |
| Myringotomy | incision in ear drum to alleviate pain |
| Tripod position, drooling, inspiratory stridor | acute epiglottitis |
| Tx for Acute Epiglottitis | aggressive Antibiotics, IV fluids, steriods, intubation equipment |
| Rare in children older than 2 | Bronchiolitis |
| Initial s/s RSV | wheezing, ear/eye drainage, rhinorrhea, pharyngitis |
| Sever s/s RSV | >70 breaths/m; listlessness; apneic spells; poor air exchange and breath sounds |
| Chest xray with RSV shows | hyperinflation with consolidation, similar to pneumonia |
| How is RSV diagnosed | ELISA/IFA detection of nasal washings or secretions |
| What two things are used for prevention of RSV | immune globulin(iv antibodies); palivizumab (monoclonal antibody IM q month) |
| RSV-IGIV considered for infants and children | under 24 mo, chronic lung disease, heart defects, premies |
| what age experiences more need for water and F&E balance | under 2 yrs |
| Fever and insensible fluid loss | 7 mg/kg/day for ea. degree > 99 |
| how much insensible fluid loss is from the skin | 2/3 |
| 4 factors affecting childs fluid loss | BSA is greater; increased metabolic rate; immature kidneys; more fluid requirements |
| Water and lyte loss | isotonic |
| lyte loss > water loss | hypotonic |
| water loss > lyte loss | hypertonic |
| Severe dehydration: EYES | absent tears, sunken eyes |
| Severe dehydration: ANTERIOR FONTANEL | Sunken |
| Severe dehydration: SKIN | very delayed cap refill, 4 second tenting and cool acrocyanotic skin |
| Severe dehydration: URINE SPECIFIC GRAVITY | oliguria or anuria |
| Severe dehydration: weight loss | 15%-infants; 10%-children |
| Diaper weight | 1g = 1 ml |
| Dehydration VS | tachycardia, tachypnea, hypotension |
| daily volume of maintenance hydration | less than or equal 150 ml/kg/day |
| With vomiting, give: | hi carb liquids to prevent glycogen and protein depletion |
| With diarrhea, give: | no hi carbs, no antidiarrheals |
| what age is highest incidence of poisoning | 2 y |
| What is the emergency tx process for parents of a child who has ingested something | poison control; assess child; terminate exposure (remove pills/flushing/fresh air/water or milk); to ER if unknown toxin, sedated/unresponsive, or seizures |
| Should parent induce vomiting of a poisoned child | no |
| what systems does lead poisoning effect | renal, hematologic, neurologic |
| what level of lead in blood warrants Tx | 10 mcg/dl |
| Blood lead level of 45-69mcg/dl | chelation tx and removal from environment |
| Chelation Therapy | calcium disodium edetate (EDTA) and succimer (DMSA) and >70 blood level --> add british antilewisite |
| Chelation Therapy and fluids | must have a lot of fluids because kidneys excrete the chelates |
| Chelation and IM injection | EMLA cream 2.5 hrs pre injection; rotate sites |
| What is important in childs diet to avoid lead poisoning | regular meals (lead is absorbed on empty stomach); sufficient iron and calcium, not fat |
| Constitutional delay | slow growth period but will catch up |
| Tall stature for girls | may be treated with estrogen before menarche |
| Short stature for boys | Tx with testosterone or HGH |
| Primary amenorrhea | no 2ndary and menarche by 14-15 OR 2ndary present but no menarche by 16-16.5 |
| Secondary amenorrhea | absence of menses for 6 mo in first 2 yrs or absence of 3 cycles after 2 yrs of menstruation |
| Most common cause of secondary amenorrhea | PREGNANCY |
| Primary dysmenorrhea | no disease; overproduction of prostaglandins or vasopressin |
| bleeding, purulent discharge, dysuria | chlamydia |
| Dx of chlamydia | culture |
| Tx of chlamydia | doxycycline or azithromycin |
| Tx of gonorrhea | ceftriaxone and doxycycline |
| Gardisil ages | 9-25 |
| What is secondary dysmenorrhea caused by | disease, will need exam |
| No IUDs for? | PID |
| Reactions to hospitalization affected by 4 things | developmental age; previous experience; support systems; seriousness of illness |
| Separation Anxiety: PROTEST PHASE | cry and scream, cling to parent |
| Separation Anxiety:DESPAIR PHASE | crying stops, evidence of depression |
| Separation Anxiety:DETACHMENT PHASE | denial; resignation and not contentment; may affect attachment to parent after separation |
| What age is separation anxiety most apparent | 6-30 mo |
| Refusal to eat, crying quietly, and not sleeping, what age of sep. anxiety | preschool (more subtle than toddler) |
| Affected by separation of school and peers more than separation from parents, what age | school age, adolescent |
| May view illness or hospitalization as punishment for misdeeds, what age | preschooler |
| Age: boredom in hospital causes frustration because they need to be productive and busy | school age |
| Age: need privacy and information | adolescent |
| Age: Localize pain and point to it | toddler |
| Age: fear of mutilation | preschooler |
| Age: localize pain and use face pain scale | preschooler |
| Age: stalling behavior | school age |
| Age: can describe pain like an adult | school age |
| Highly stressed at hospital (4) | male, low intelligence, difficult temperament, 6 mo - 5 yr |
| T/F: a greater percentage of the children hospitalized today have more serious and complex problems than those in the past | TRUE |
| What may cause parents to abandon their sick child in hospital | fear or anxiety |
| One of the most common reactions of parents is _______ and ________ intensified attention toward the sick child | specialized and intensified |
| Functions of play to minimize stress are | provide diversion, increase security, decrease separation anxiety, allow expression of feelings |
| Playrooms offer what | distancing |
| Therapeutic play | large muscle usage, dramatic play, drawing, puppets, books |
| What type of pain indicators can infants show | facial expression, hormonal, etc |
| Do children tolerate pain better than adults | no, tolerance increases with age |
| What age can children point to pain on body or mark on a picture of body | 4 yrs |
| How do repeated painful procedures affect children | more procedures may be more painful |
| Do behavioral manifestations reflect pain intensity | NO |
| Are narcotics more dangerous for children | no, same as adult |
| Measures Face, legs activity, crying, and consolability by 1, 2, or 3 | FLACC scale |
| EMLA cream | apply 1 hr before and lasts 1-2 hrs after cleaned off |
| benefits of ambulatory/outpatient | minimize separation anxiety; reduces infection; cost savings |
| What should parent always be told when using telephone triage | child should be seen if any doubt |
| 3 phases of separation anxiety | protest, despair, detachment |
| Emancipated Minor | under 18 but able to give consent when pregnant, married, high school grad., living alone, military |
| Fasting: clear liquids | 2 hrs |
| Fasting: breast milk | 4 hrs |
| Fasting: infant formula | 6 hrs |
| Fasting: non human milk | 6 hrs |
| Fasting: light meal | 6 hrs |
| Conscious sedation for children | versed IV or fentanyl lollipop |
| Individual/Family factors that positively influence compliance | high self-esteem; effective family communication; high degree of autonomy (p1368) |
| Care-setting factors that positively influence compliance | satisfaction with care; positive interactions with practitioners; minimum waiting time for appts. |
| Treatment factors that positively influence compliance | simple; inexpensive; beneficial; tolerable |
| Nasal washings | supine position, 1-3 ml of sterile normal saline is instilled with syringe, then aspirated (usually for RSV) |
| Do attempt what when acute epiglottitis is suspected | throat culture--> may cause occluding airway |
| IM needle size for vastus lateralis, ventrogluteal, deltoid | 22-25 gauge, 0.625-1 inch |
| IM site with fastest absorption | shoulder |
| IM site with most pain | vastus lateralis |
| IM site with less pain | vantrogluteal |
| Where is the ventrogluteal IM site | between iliac crest and spine, 1-2 cm above crease formed in groin |
| Preferred IM site for infant | Vastus Lateralis |
| Max volume to be administered in a single site is | 1 ml |
| Which site is insufficient for infants or smaller children | dorsogluteal |
| Position for IM injection | VL- supine or side lying; VG-side with upper leg flexed |
| Aspiration with IM | yes, if blood is aspirated, change needle and reinsert into new location |
| give which first, eye drops or eye ointment | drops wait 3 mins |
| what helps with digestion when doing gavage feeding | pacifier |
| What position is contraindicated in infants due to pooling of blood in the head | Trendelenberg |
| Enema for 2-4 yr old | 240-360 ml; 5.0 cm or 2 inch |
| Enema for Infant | 120-240 ml; 2.5 cm or 1 inch |
| Enema for 11 yr | 480-720 ml; 10 cm (4 inches) |
| what fluid is used in enema for children | isotonic solution, others cause F/E shift |
| Enema for 4-10 yro | 360-480 ml; 7.5 cm (3 inches) |
| position of comfort for pelvic inflammatory disease | semi fowlers |
Created by:
wb06
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