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COD N2 Unit II

COD N2 Pediatrics

QuestionAnswer
Infant: Nursing Implications Encourage parental presence (all ages), adhere to infants home schedule, Utilize topical anesthetics or pre-procedural sedation, quiet environment
Infant: Stressors Separation anxiety, Stranger anxiety, painful, invasive procedures, immobilization, sleep deprivation, sensory overload
Infant:Responses sleep wake cycle disrupted, feeding routines disrupted, displays excessive irritability
Toddler: Nursing Implications Encourage Parent presence, allow parents to hold child as much as possible, allow choices when possible, explain procedure in simple terms
Toddler: Stressors Separation anxiety, loss of self control, immobilization, painful invasive procedures, bodily damage of mutilation, FEAR OF THE DARK
Toddler: Responses Cries if parent leaves the bedside, is frightened if forces to lay supine, wonders why parents don’t come to their rescue, associates pain with punishment
Preschoolers: Nursing Implications Encourage parental presence, allow choices when possible, utilize topical anesthetics, EXPLAIN ALL PROCEDURES AND PROVIDE A NIGHT LIGHT
Preschoolers: Stressors separation anxiety & fear of abandonment, loss of self-control, bodily injury or mutilation, painful invasive procedures, fear of the dark and MONSTERS
Preschoolers: Responses Displays difficulty separating reality from fantasy, fears monsters & ghosts, fears body parts will break when skin is not intact, demonstrates withdrawal aggression projection and regression
school-age child Nursing Implications Enc. Parent participation, allow choices when poss. explain all procedures and offer reassurance, utilize proper sedation, encourage peer interaction via internet phone call ect.
The only safe and effective way to administer an analgesic 1. Calculate a safe does 2. Administer it 3. monitor the patients response to the medication
What is the Wong-Baker pain rating scale FACES
what is the pain scale for patients that are unresponsive The FLACC Scale
What does FLACC stand for F: Face L: Legs A: activity C:cry C: consolability
How often show you re-assess after pain medication is administered IM or IV 30 min
How often show you re-assess after pain medication is administered PO One hour
Children’s behavior that may indicate pain Restlessness, Agitation
Poker chip tool: Four poker chips are used. One chip represents a little hurt and four chips is the most hurt your child could experience.
Oucher scale A vertical numerical scale from 1 to 10 for children who can count. With a picture of different ethnicities according to the patient. patient must have concept of numbers. 0= no hurt, 10= severe hurt.
Why is scheduling important in pain management Better to medicate around the clock than PRN when pain is already severe
Co-Analgesics include NSAIDS Tricyclic antidepressants: Amitriptyline: Desipramine Anticonvulsants: Neurontin,Lyrica, Klonopin, Tegretol Corticosteroids Local Anesthetics Anxiolytic drugs
What age are PCA pumps used as young as 3 yrs, but not usually until 6 yrs
Children may see pain as a form of punishment
Behaviors indicating pain Restlessness hyper alertness difficult to distract irritability facial grimacing posturing anorexia lethargy sleep disturbances depression aggression
What word can you use besides "poke" when giving a child an injection.. you may feel a_______ a slight Pinch or pressure
Always encourage __________ to stay with the child Family
When assessing a child perform ____ and ____ assessments last painful and invasive
An infant older than ____ months is afraid of strangers after 6 months
Which age group is hardest to assess toddler 1-3 yo, can't sit still, put on a parent's lap and start with feet (toe to head)
what kind of questions would you ask the family to get a medical history of patient open ended questions
To help make the child comfortable with assessment, let them play with ____ equipment
When assessing a child don't offer a ____ if there is not one and enlist ____ help don't offer a choice and enlist parents help
Check for turgor on ____ ABD
Posterior fontanel closes at ____ where the anterior should close ____ between 2 & 3 months, 12 & 18 months
The fontanels on the head should be ____ flat
what makes a Childs heart rate rapid (until late school age) cardiac output is rate dependent not stroke volume dependent
until 12-18 months of age kidneys: do not concentrate urine effectively and do not exert optimal control over electrolyte secretion and absorption
What would you do if an infant in your care had a HR of 130? Nothing it is normal
How do you check an infant’s HR? Apical... emergency brachial, femoral
if a child has vasoconstriction the concern is dehydration
Sign of central cyanosis is a sign of: Late ominous sign, or if they have no Hx of Cardiac it could be a sign of eminent cardiac arrest.
what is Munchausen by proxy When a person inflicts something on a child or exaggerates or fabricates illnesses or symptoms usually primary caretaker. A individual — usually a mother — deliberately makes another person sick or convinces others
what is nuchal rigidity Stiffness in the nape of the neck, often accompanied by pain and spasm on attempts to move the head; the most common sign of meningitis.
Until the age of 4-5 what is the primary breathing muscle? Diaphragm
Effects of hospitalization on an Infant: Nursing Implications Encourage parental presence (all ages), adhere to infants home schedule, Utilize topical anesthetics or pre-procedural sedation, quiet environment
Effects of hospitalization on an Infant: Stressors Separation anxiety, Stranger anxiety, painful, invasive procedures, immobilization, sleep deprivation, sensory overload
Effects of hospitalization Infant: Responses sleep wake cycle disrupted, feeding routines disrupted, displays excessive irritability
Effects of hospitalization Toddler: Nursing Implications Encourage Parent presence, allow parents to hold child as much as possible, allow choices when possible, explain procedure in simple terms
Effects of hospitalization Toddler: Stressors Separation anxiety, loss of self control, immobilization, painful invasive procedures, bodily damage of mutilation, FEAR OF THE DARK
Effects of hospitalization Toddler: Responses Cries if parent leaves the bedside, is frightened if forces to lay supine, wonders why parents don’t come to their rescue, associates pain with punishment
where can you go to see the current updates for immunizations www.cdc.gov/vaccines
when do we hold immunizations? allergies, reactions, Given blood, immunoglobulin, vaccines (past 4 weeks), Steroids, chemo-therapy, HIV, SZ, CA
A mother asks the nurse what caused her infant’s respiratory infection. The nurse explains that the organism that is the most common cause of lower respiratory tract infections in infants and young children Pneumonia
a mother states that her child has had to use an albuterol inhaler at least once a day for the past week and a half, and has been awakened by coughing at night at least 2 times this week. W an appropriate priority nursing diagnosis for this child would be Impaired gas exchange due to bronchial constriction
When teaching the mother about the positive outcomes of caccinations, the nurse explains that widespread vaccinations against Haemophilus influenza type b has lead to the decrease tenfold in the incidence of Epiglottitis
An infant is diagnosed with apnea of prematurity. The best explanation to give parent would be that apnea of prematurity It is pathologic with no definable cause that affects infants younger than 37 weeks gestational age
In the child with cystic fibrosis, the finding that would indicate an inadequate dosing of pancreatic enzymes would be Stools have become frothy, greasy and foul smelling
Name strategies for communicating with an infant: Hold them for feedings Hold, Rock, and talk to them talk and sing during care Tell names of objects use high pitched voice with newborns when infant is upset swaddle and hold securely
how do new borns communicate? Coos, babbles & cries
An Infant believes that his parents will feed him. Trust vs. Mistrust
Sense of Initiative versus Guilt Preschooler: Age 3 to 6
A 10 Year old boy proudly displays his principal's award Industry vs. Inferiority
13 y.o. girl fights with her mother about appropriate dress. Identity vs. Role Confusion
A 2 year old boy expresses interest in dressing himself. Autonomy vs. Shame and Doubt
A 15 year old boy worries about how his classmates treat him. Identity vs. Role Confusion
Sense of Industry vs. Inferiority School Aged : Age 6 to 12
Sense of Identity vs. Role Confusion Adolescent: Age 12 to 20
Sense of Trust vs Mistrust Infant : Birth to age 1 year
A Kindergarten student learns the ABC's. Initiative vs.Guilt
Physical growth: birth-1 month Gains 140-200g(5-7oz) a wk grows 1.5cm (1/2in)in first month head circumfrence increases 1.5cm/month
Physical growth: 2-4 months Gains: 140-200g (5-7oz) / wk Grows 1.5cm (1/2in) /mth Head circumference increases 1.5cm (1/2in)/mth Posterior fontanelle closes Eats 120mL/kg/24hr (2oz/lb/24hr)
Physical growth:4-6 months Gains: 140-200g (5-7oz) / wk Doubles birth weight 5-6 mths Grows 1.5cm (1/2in) /mth Head circumference increases 1.5cm (1/2in)/mth Teeth may begin erupting by 6 mths Eats 100mL/kg/24hr (1 1/2oz/lb/24hr)
Physical growth: 6-8 months Gains: 85-140g (3-5oz) / wk Grows 1cm (3/8in) /mth Growth rate slower than first 6 months
Physical growth: 8-10 months Gains: 85-140g (3-5oz) / wk Grows 1cm (3/8in) /mth
Physical growth: 10-12 months Gains: 85-140g (3-5oz) / wk Grows 1cm (3/8in) /mth Head circumference equals chest circumference Triples birth weight by one year
a 8 month old infant is sitting on the floor, grasping blocks and banging them on the floor. He is engaging in ________ play solitary
By the age of 2 yrs old, the birth weight has __________ and the child is _________ of the adult height quadrupled, half
adverse reaction to vaccinations Anaphylaxis, Hives, lethargy, tachycardia, itching–Can happen minutes to hours after administration
you need ___________ before vaccination and ___________ after. Consent, doccumentation
What is proximodistal development refers to the development of motor skills from the center of the body outwards.
What is cephalocaudal development Head is large and lifts it first. It is also the trend of infants learning to use their upper limbs before their lower limbs
What is Associative Play Child may interact with one another
What is Reyes Syndrome It is a deadly disease,ncan attack any child, teen, or adult without warning. All body organs are affected, with the liver and brain suffering most seriously. Unk cause and no cure,linked to use of Asprin children <16 most at risk
How is breast milk stored in the hospital? plastic bottles, can be stored for 24hrs, NO Glass it destroys antibodies
This is how much the nurse will put in the buretrol enough for 2 hours + 10mL
what is the IV infusion rate if the IV infusion pump rate if running at 25 ml/hr 25mL/hr
What is the VTBI when running at 25 ml/hr 50mL
What type of IV solution given to a patient with an uncomplicated appy NS
The fontanel that remains open til about 2-3 mths posterior
Nurse’s next action when she observes that the anterior posterior diameter is smaller than the lateral diameter of the chest of a 5 year old continue her assessment, this is normal
Examples of Abnormal heart sounds murmurs, muffled S1 and S2
Pain assessment tool appropriate for a 5 year old faces, oucher, poker chips
Dada, mama, what age when the child verbalizes this 9-12 mths
object permanence When analyzing a 9 month old, if you cover an object does the baby know it’s still there?
Concrete operational-Piagets stage of cognitive development the concrete operational stage is a period between 7-11 during which children gain a better understanding of mental operations. Children begin thinking logically about concrete events,have difficulty understanding hypethitical concepts
Easy, Difficult, Slow to warm up: Patterns of temperament in an infant
Newborns & young infants more susceptible to infection immune system is not fully mature
until what age is the aveoli smaller and faster 10 y/
Meds to look for serum levels in Lithium, Digoxin, Vancomycin, gentamycin, dilantin
what is peak, and when is it obtained 1/2 hr after med is given
what is trough before then next medication is given
who was the theorist who introduced the concept of including women in to these dev studies? Gilligan
SIADH is a excessive amount of which hormone ADH antidiuretic hormone
what can cause SIADH Brain tumors, PN, chemo, and pulmonary disorders
What hormone is low in diabetes insipidus ADH
if a patient previously Dx with DM becomes symptom free, are the cured and what is that period called they are not, it will return and it is called the Honeymoon period
what are some characterisitc of GHD in children Cherubis faces, high pitched voices, ripply abd fat
Hypothyroidism can be _______ and _______________? congenital and acquired
what are some ways that children can maintain a healthy blood glucose? Diet, anticpate, consistently count carbs
how can you check for pinworms taps test, visual inspection
difference between shigella and salmonella SAL: watery Diar. SHIG: bloody diar
what are some signs and symptoms of DM 2 in children? polydipsia, polyuria, thickening of the skin w/ velevet irregularities in skinfolds
growth refers to the ______________ ability quantitative
development refers to the ________abiltity qualitative
What is VSD? Ventricular Septal Defect: a hole in the septum between the low to chambers
Kawasaki disease the leading cause of acquired Hrt disease in kids is US under 4 y/o
What are the 3 shunts in the fetal circulation that close 10-15 hours after birth Ductus arteriosus Foramen ovale Ductus venosus
How is VSD diagnosed Echo, EKG, Heart catheterization
Some S/S of VSD with large defects S/S CHF, Failure to thrive, fatigue, review history
Treatment for VSD Artery Banding, Some have closing by age 3
What is a cyanotic heart defect Polycythemia: high Hgb, Chronic hypoxia
In a Cyanotic heart defect what lab will be high Hgb
What position is the child in for Cyanotic heart defect Squatting
What causes CHF in children Secondary to heart defect
what are the assessment findings on a child with CHF Cough, increased pulse, blood back up into the liver, poor growth
what can tachycardia also be a sign of Mild dehydration, also respiratory
What is the treatment for the child with CHF o Diuretics  Check for renal  Electrolytes o Digoxin: pulse rate and increase cardiac contractions o Reduce o2 by clustering tasks o Hi calorie foods o Maintain normal body Temp
S/S of Hypovolemic shock Hypotension, thready pulse, clammy skin (diaphoesis, tachycardia, Tachypnea, Reduced UO
What might be some causes of hypovolemic shock burns, GI bleeding, hemmorage, reduced plasma volume & body fluids, dehydration
What is the treatment for hypovolemic shock Warmed IV Crystalloids,blood trasfusion, ID bleeding sites, control bleeding
what are the S/S of cardiac conditions on an infant Tachecardia, irritability, retractions, weight loss, tires easily
What are S/S of cardiac conditions in a child Exercise intolerance, ABD pain, perpherial edema, mottling or pallor, JVD, Perioral/facial edema
How do you manage pediatric cardiac patients daily weight, educate, small feedings, turn frequently, don't smoke (parents too)
What is Cystitis Bladder infection
What is pyelonephritis Kidney infection
S/S of UTI frequent urge to urinate/ void
test for strep ASLO/ASO Anti-streptolysin O
Created by: jaymee4647