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Peds Test #1

peds test 1

QuestionAnswer
Well Child Checks-EPSDT Early, Periodic/Prevention, Screening, Diagnosis, Treatment
BP should be taken on >3yr, or younger if heart condition, newborn-6months 70/50, 1yr 75/55, 3-5yr 95/60, 10yr 100/65, 12yr 105/65, 14yr 110/70
Weight 3.5-50kg
Pulse newborn 100-160, 6months 110-160, 1yr 90-150, 3yr 80-125, 5yr 70-115, 10-14yr 60-100
Respirations newborn 30-60, 6months 24-38, 1-3yr 22-30, 5yr 20-24, 10-12yr 16-22, 14yr 14-20
If think heart murmur in infant assess 4 extremity BP
Anterior Fontanel Closure closes around 18 months
Posterior Fontanel Closure closes btw 2-3 months
Ears for <3yr pull pinna down/back, >3yr pull pinna up/back
Compensentory Mechanisims nasal flaring, grunting, retractions
Denver Developmental Screening Test/DDST birth-6yrs, not IQ test, screening-not diagnostic, not predictor of future abilities, compares performance on a variety of tasks to other children of same age, fours areas of functioning: personal/social, fine motor/adaptive, language, gross motor
NIPS/Neonatal Infant Pain Scale assessment tool using behavior cues, six item 0-2pt scale w/ total score0-7, used for term neonates up to 2mo, use in combo w/ nursing judgment
FLACC/Face, Legs, Activity, Cry, Consolability each of 5 categories scored from 0-2, total score 0-10
Wong-Baker Faces pain scale using 6 faces from smile to crying, corresponds w/ 0-10 pain scale
DTaP/Diptheria, Tetanus, Pertussis IM, 2,4,6mo + 15-18mo + 4-6yr, contraindications: gelatin allergy, serious side effect w/ prior dose
Hep B IM, birth + 2, 6mo, contraindications: pregnancy
MMR SC, LIVE, 12-15mo + 4-6yr, contraindications: allergy to eggs, mycins, pregnancy, immunosuppressed, immunoglobulin w/in 3mo, together w/ VAR or separated by 28days
VAR SC, LIVE, 12-18mo + >12yr two 4wks apart, contraindications: pregnancy, immunosuppression, allergy to mycins, recent blood transfusion, together w/ MMR or separated by 28days
Immunizations-SE/Adverse effects location rxn @ site: pain, redness, swelling, low grade fever, mild irritability/fussiness, less common SE: noncontagious rash, mild joint pain, adv effects: anaphylaxis, anaphylactic shock, encephalopathy/encephalitis, brachial neuritis, paralysis, death
Dehydration fluid loss>fluid intake, numerous causes, can be from prolonged vomiting/diarrhea, common in children, mild<5% loss, moderate 6-9% loss, severe>10% loss
Dehydration-Nursing Interventions prevention, correct underlying cause, oral rehydration, IVF rehydration, monitor IVF infusion/ fluid choice/amount, freq monitoring/reassessment, teaching s/sx dehydration/ORT, pharmacologic tx, monitor for complications-fluid overload/hypovolemic shock
#1 Indicator of Dehydration Serum CO2(same as arterial HCO3 22-28)
Dehydration-#1 improvement indicator weight gain
Maintenance Fluid Requirements <10kg:4ml/kg/hr, 11-20kg:40ml+(2ml/kg>10kg)/hr, >20kg:60ml+(1ml/kg>20kg)hr
Replacement fluid considerations Goals: preserve CV, renal, neuro function, Bolus: one time infusion, Rehydration plans: make take >24hrs, monitor serum CO2 level, NO potassium added until adequate void(no pee-no K)
Vision Screening should start by 5, most schools mandate
Hearing Screening in NBN, assessed in all well-child visits
Otitis Media inflammation & fluid in middle ear interfering w/ sound transmission, mostly bacterial, ^in winter months, may lead to deafness
Otitis Media-Children at Risk chronic middle ear infections, meningitis, deafness in family, maternal rubella, prematurity, birth trauma w/ hypoxia, high fevers
Otitis Media-Presentation accompanying URI, fever often >102, sharp constant ear pain, irritable, tugging at ears, bulging eardrum, decreased light reflex, drainage w/ rupture
Otitis Media-Nursing Interventions teach parents to feed upright/no bottle propping, keep upright 30 min post feed, admin antibiotics-amoxicillin, symptomatic care-antipyretics for fever-mild pain mgmt., may require tubes if chronic
Otitis Media-Chronic tube placement; allow to drain(polyeltholine pressure equalizing tubes), pre/post surg care, edu parents r/t care; earplugs for swimming, no diving/submerging, careful w/ water during shower
Otitis Media-Chronic-Complications risk for hearing loss, chart in book
Effusion fluid remains in ears after infection has cleared up-several episodes->hearing loss, maybe tubes
Tonsillitis inflammation/enlargement of a tonsil(palantine); adenoids-pharyngeal tonsils, viral or bacterial organism, possible peritonsilar abscess-need antibiotics to decrease infection before surg
Tonsillitis-Presentation sore throat, painful swallowing, ‘beefy’ red swollen tissue, mouth breathing, snoring/sleep apnea, halitosis, purulent exudate on tonsil, fever
Tonsillitis-Nursing Interventions symptomatic care-antipyretics for fever-analgesics for pain, antibiotics if indicated
Tonsillectomy-PreOp assess temp, stress ‘fixing’ throat in age appropriate terms, evaluate labs-WBC/Clotting time, check for loose teeth
Tonsillectomy-PostOp monitor VS q2-4hr, obs freq swling/throat clring, fresh/red bleeding, posit head to side-awake, avoid suct/straw, avoid acidic liq/crunchy/spicy food, maint IV til PO adeq, cool non-irrit liq-NO dark/red-adv diet, pain meds, maint flu based on intake
Tonsilectomy-Main reasons for readmit Dehydration & Hemorrhage->7-10days
Respiratory Problems-Acute generally reversible, vary in severity; RSV, epiglottitis, pneumonia, foreign body aspiration, croup, smoke inhalation, blunt chest trauma
Respiratory Problems-Chronic generally irreversible, characterized by exacerbations & remissions, obstructive sleep apnea, asthma, cystic fibrosis, bronchopulmonary dysplasia, tuberculosis
Epiglottitis inflamed, acute medical emergency, drooling, breathing faster, guarding, do NOT look at throat, emergency trach at bedside, corticosteroid-IV, calm child, conformation-soft tissue film, Tylenol/Motrin for fever, improving-want to drink
RSV infects epithelial cells, mucus-clogs, snorting, suck out w/ bulb syringe but fills back up, if respire 60+ STOP feeding, if 28 wk gestation or less-RSV candidate, Synagis IM inj 1x/month throughout flu season-Very expensive
Asthma chronic inflam disorder of the airways mkd by recurrent atcks of dysp & wheezing due to spasmodic constrict bronchi, highly correlated w/ suscept to environ allergens: smoke, animal dander, dry air, exercise, stress, most common chronic dx of childhood
Asthma-Presentation chest tightness, cough(harsh/nonproductive->secretions w/ ^mucus), wheezing on expiration/prolonged expiration, use of accessory muscles, thick mucus, decreased breath sounds as condition worsens, decreased O2 & ^CO2, decreased LOC if acute exacerbation
Asthma-Hallmark S/Sx bronchoconstriction, inflammation/edema, mucus production
Asthma-What to assess can child talk in complete sentences?, grunting, tripod, circum-oral cyanosis, initially-tachypnea, anxiety, wheezing on expiration->wheezing on inspiration
Asthma-Nursing Interventions-Hosp humid O2(decr anx,WOB,rate),IVF hydrat, monit resp stat(rate/eff,WOB,acc musc, grunt,flar,retract),admin meds(Epi,ster, broncho),monitor(O2 sats,x-ray,PEFR-max flow rate out 1sec,PBV,PFT),CPAP/intub(if unable to sustain)long exp times on vent,edu(MDI use,
Asthma-Nursing Interventions-Home Care coord care w/ parent/sch nurse(indiv health plan, edu about dis proc prn, support grps, log peak flow meter readings), admin quick relief meds prn & monitor resp, MDIs, assess for signs of exercise induced bronchospasm, avoid triggers
Muffled deterioration in respire/ heart rate
Cystic Fibrosis hered dis w/ widespread exocrine gland dysfunction; multisystem involvement w/ accum of excessively thick and tenacious mucus and secretions-respir problems everyday of life, eventually clogs glands(respiratory airways, GI enzyme secretion, repr ducts)
Cystic Fibrosis-Presentation recur respir(drug resis)infect, dry nonprod cough; patches atelect-mucus plugs(x-rays), thick purulent sputum/mucus(clear/ grey-tinged;NOT yellow/green),wheez-air trap, cyanosis/club,steatorrhea;gallbla prob, malnutr;avitaminosis,grwth delays;infert prob
Cystic Fibrosis-Nursing Interventions-Hosp report results sweat test, CPT and postural drainage, inhal Tx; O2 w/ caution, TCDB exer, humid environ, proph antibiotics, diet-panc enz w/meals/snacks; vit supp, high cal-high protein-low dairy,^fluids, home schooling,disc plan:family support services
Cystic Fibrosis-Nursing Interventions-Home Care coord care w/ parents/school nurse & create schedules for: meds, Ts(CPT, resp tx), diet, exercise, Consider: change in body image, freq hospitalizations, discipline iss, financial concerns, gene implic(sib), Identify prim HCP(pedi) basic healthcare, imm
Cystic Fibrosis-Complications Cardiomegaly, Cardio-Respiratory Failure, GI Obstructions
Pediatric Heart Conditions-Nursing Considerations sm freq feeds, upright position, squatting/tripod, monitor daily wts, pulse, BP, admin meds, provide rest, do not allow crying, emotional support, foster app play, immunize/protect from infection, strict I&O
Pediatric Heart Conditions-PreOp prepare for surg, monitor baseline CV status, assist collection of pre-op labs, edu/support parents
Pediatric Heart Conditions-PostOp monitor CV status constantly for 1st 24h, hemorrhage, chest tube output, bleeding from other sites, fluid balance(50-75% maintenance 1st 24h), promote resp fxn(IS), monitor for infection-incision site; peri-operative antibiotics, instr parents-home care
Cardiac Cath-PreProcedure NPO several hours except meds, oral sedative, VS,H&H, cap refill, pulses distal to expected cath insertion site, prepare child/parent
Cardiac Cath-PostProcedure monitor for complic; arrhythmias, bleeding, hematoma, thrombus, infection, VS, perf of lower extrem, monitor pressure dressing q15 minx4 then q30minx1; will be in place 6hrs, BR x6hrs w/ leg straight, avoid elevating HOB-no flexion of hip, monitor I&O-con
Acyanotic L to R shunt of blood, oxygenated blood mixed w/ unoxygenated blood, extra blood vol overloads pulmonary sx, pulmonary HTN: obstructive defects block blood flow from heart, VSD
Ventricular Septal Defect/VSD heart malformation that allows blood to flow btw 2 ventricles, ^blood flow to lungs->CHF & pulm HTN, 50% close spontaneously
Ventricular Septal Defect/VSD-Presentation loud harsh systolic murmur, dyspnea & freq respir infections, exercise intolerance/fatigue, freq squatting/syncope, X-ray reveals R ventricular hypertrophy, ECG shows R vent dysfunction, growth retardation
Ventricular Septal Defect/VSD-Nursing Interventions Lanoxin; cardiotonic to treat CHF-check BP/P
Cyanotic R to L shunt of blood, dilute oxygenated blood heads to body, chronic hypoxemia and cyanosis, Tetralogy of Fallot
Tetralogy of Fallot congenital heart condition consisting of four defects(VSD, PS, ventricular hypertrophy, over-riding aorta), surgical correction
Tetralogy of Fallot-Presentation hypoxia is primary prob since blood flow to lungs is restricted, cyanosis apparent after several months of age & becomes progressively worse, clubbing, abnormal heart sounds, murmur, ^rate/depth of respirations, hypoxic episodes/TET, freq squatting/syncop
Tetralogy of Fallot-Nursing Interventions multiple surgeries, antibiotics-prevention of endocarditis, diuretics-promote diuresis & prevent fluid overload, digitalis-cardiotonic, give prostaglandin E to keep PDA open in preparation for surgery, child too young for corrective surgery may have palli
TET Spells hypoxic episode where baby turns blue w/ crying or feeding, calm child(decrease anxiety/decreased WOB), positioning(knee-chest), O2 as needed, Medications: Morphine and/or Propanolol
Created by: neffielewis