Peds Test #3 13-19
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| 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)
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| 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
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| interventions used for Colic | Education and Support
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| ________ and ______ are parts of normal development in the otherwise thriving infant and do not require medical attention | Colic and Spitting up
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| If projectile vomiting occurs a nurse would suspect | Pyloric stenosis or GERD
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| Weight is less than the 5th percentile with height being WNL. | Failure to Thrive
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| 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)
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| 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.
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| 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.)
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| Therapeutic management of apnea in infancy | theophylline/caffiene, home apnea monitors, family support and CPR training for all caretakers of the infant.
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| The sudden death of an infant under one year old during sleep that remains unexplained after investigation. | Sudden infant death syndrome
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| 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
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| 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
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| 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
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| 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.
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| Cognitive development of the toddler (1-3) | according to Piaget, toddlers are continuing the sensorimotor phase
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| A child will actively search for an object when it is taken out of sight | Object permanence
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| Children play alongside, not with, other children. | Parallel play
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| Toddlers like objects that thet can ____ & _____ | Pull and push
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| 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
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| 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
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| Most children continue to have occasional accidents (urine) until what age? | 4-5
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| What type of toilet training is usually first? | Bowel
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| 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
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| 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
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| 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
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| When should parents start caring for their infant/childs teeth? | As soon as they develop
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| When should a child first see the dentist? | After the first teeth erupt and no later than 2 1/2.
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| 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)
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| in realtion to dental care, which is more important? The frequency at which sugar is consumed or the amount? | Frequency
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| In regards to dental care, which foods are the worst? | Foods that are sticky or hard because they remain in the mouth longer
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| Juice should always be offered in a ________. Why? | Cup; because bottle mouth caries can develop if the juice is offered in a bottle.
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| 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.
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| Leading causes of death in the toddler (1-3) | unintentional injury
congenital anomalies
homicide
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| 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
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| Psychosocial development of the preschooler (4-6) | Initiative vs. guilt
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| Characteristics of the preschooler include: | inquisitive learner, enthusiastic about learning new things, feel a sense of accomplishment with the activities they achieve.
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| 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.
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| Icreased brain function in the preschooler is related to | continued myelinization of neurons in the brain.
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| Preschoolers gain _____ lbs/year and grow ___ to _____ inches/year | 5-7 lbs/year
2.5-3 inches/year
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| 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.
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| Preschoolers make judgement based on _______ | Visual apperance
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| 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
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| The thought that the child himself or other people created everything in the world. | Artificialism
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| The belief that inanimate objects such as dolls and stuffed animals are real | Animism
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| The thought that things need to be fair all the time and if a rule is broken, punishment must occur now | Imminent justice
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| 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.
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| The stage at which Kohlberg identifies the development of the inner voice. | Preconventional stage
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| The preschool years are a time of: | refinement of language skills. The children are learning new words and the meaning of those new words
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| What type of speech does the three year old exhibit? | Telegraphic (short sentences that contain only the essential information)
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| 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.
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| Preschoolers recognize that there is two different genders and normally identify with the correct gender except in: | Transgender children
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| 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.
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| 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.
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| A child that is either partially awake or asleep, screaming and crying, with amnesia of the situation after fully awakening is called | Night Terrors
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| 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)
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| _____% of child abuse deaths happen before the age of _______ | 85% 6 years old.
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| 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
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| Adult height is reached by: | 18 years old
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| growth in which different body parts mature at different periods of time | asynchronous growth
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| Chamges associated with puberty | development of breast tissue
Pubic hair
changes in male genitalia
(in response to the secretion of estrogen and testosterone)
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| Puberty results due to triggers in: | The enviornment
The CNS
The hypothalmus
The pituitary gland
The gonads
The adrenal glands
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| 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
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| "Nothing bad will happen to me" | Fable of immunity
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| 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.
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| 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
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| Nursing Management for Varcella Zoster | Airborne and contact precautions
immunizations
fever control
antihistamines
acyclovir
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| 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
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| How long is Varcella Zoster contagious for? | 1-2 days before rash and until all the lesions are crusted over.
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| Hand Foot Mouth disease is spread via | Fecal-oral and respiratory (Enterovirus)
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| 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
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| 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)
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| What is the incubation period of Fifths Disease? | 4-21 days
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| When is fifths disease most contagious? | before the rash appears
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| What causes fifths diease? | Human Parvovirus b-19
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| What ages is the incidence of fifths disease the greatest? | 5-14
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| 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.
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| "Slapped Face" with circumoral pallor | fifths disease
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| 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
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| 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.
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| Nursing Assessment of mumps | Hx of exposure or lack of immunization
unilateral or bilateral parotid swelling
fever
orchitis in boys
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| 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.
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| What is the incubation period of Rubeola (Measles) | 8-12 days
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| When is Rubeola (Measles) contagious? | 3-5 days before the rash and up to 4 days after the rash appears
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| 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
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| Koplik Spots | Associated with Rubeola (Measles), blue/white spots on the buccal mucosa
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| Nursing managament of Rubeola (Measles) | Treatment is supportive
airborne percautions
NonASA antipyretics
dark room r/t photophobis
lots of fluids
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| The best was to prevent the contraction of Rubella (german measles) is: | Immunization
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| How is Rubella transmitted? | Through inhalation or direct contact with resp secretions
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| What is the incubation time for Rubella (GM) | 14-23 days
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| When is Rubella (GM) contagious? | few days before to 7 days after the rash appears
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| Nursing assessment for Rubella (GM) | May be aymptomatic
red rash on face then generalized fever, lymphadenopathy
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| 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
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| Rubella starts on _________ Rubeola starts on ________ | Face; Chest and Trunk
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| Paroxysmal cough | a cough that is nonstop, the child cannot catch their breath.
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| Pertussis is characterized by: | a barking cough and paroxysmal coughing spells
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| Nursing management of Pertussis | High humidity enviornment
frequent suctioning
fluids
droplet precautions
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| Scarlet fever is caused by? | an infection by group A streptococcus
+ strept throat infection
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| 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
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| 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)
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| What constitutes the most frequent infections in the world? | intestinal parasitic disease
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| The two most common intestinal parasitic diseases in the US are: | giardiases and pinworm
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| S%S of pinworms | nocturnal anal itching
sleeplessness
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| Disgnosis of pinworms | direct visualization or eggs detected on transparent tape over the anus in the morning before a child has a BM
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| Transmission of pinworms | Fecal-oral
eggs remain infective in indoor enviornments for 2-3 weeks
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| Drug of choice for pinworms | Vermox or Antiminth
All family members are treated
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| 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
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| True or False You are legally, morally, and ethically bound to report all suspected cases of child abuse to CPS? | True
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| The infliction of physical injury as a result of punching beating, kicking, biting, burning, shaking, or otherwise harming a child | Physical abuse
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| ____ 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
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| _____% of physical abuse deaths are under age ____ | 85%;6
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| __________ is the leading cause of inury related death in children under 5 | Homicide
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| 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
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| 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
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| 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
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| True or False? Many children who present with severe injuries have previously presented with less severe injuries and abuse was overlooked | True
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| Prompt ___________ and __________ of physical abuse is imperative | recognition;reporting
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| 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
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| 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
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| If _______ and ________ allow, question the child about how a injury occured | age and development
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| 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
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| When there is concern for________________ a thorough ____________ should be done | Physical abuse; Physical exam
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| _______ and ______ should be used when documenting physical exams on suspected child abuse cases | Body diagrams; color photos
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| 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)
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| Findings that are associated with physical abuse include: | Unexplainable
Lacerations
bruises
fractures
bite marks
abdominal marks (these can be hidden)
abdominal injuries
head injuries
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| 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
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| 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
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| 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.
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| Cognitive development of the school aged child | Egocentrism starts to decline
they develop moral reasoning and begin to see right from wrong
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| 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.
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| 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.
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| 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.
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| 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
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| True or False? We can make up for lost sleep by sleeping late? | False, we cannot make up lost sleep
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| 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
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| These lesions typically occur on the face and begin as small vesicles which rapidly enlarge to form yellowish brown crusty masses | Impetigo
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| Common infection of infants and children; can be highly contagious; caused by S. aureus but can be caused by beta-hemolytic-strep A | Impetigo
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| Under an impetigo crust, the lesion is ______&__________ and exudes a __________ colored liquid | red & moist, honey
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| ___________ is common in impetigo and can lead to further spread, which is called __________________ | Pruitis; autoannoculation
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| Treatment for impetigo | Topical antibiotics in the early stages, if extensive systemic tx may be needed.
There are many resistant strains.
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| Circular bald patch with redness or scaling is: | Tinea Capitus (fungal)
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| Treatment for tinea capitis | Oral antifungals
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| 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
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| 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.
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| This is caused by a female mite that burrows into the epidermis to deposit eggs and feces. | Scabies
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| When does inflammation r/t scabies occur? | 30-60 days after exposure
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| Treatment for scabies | Topical treatments such as scabicides or oral treatments
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| What type of percautions are needed for a patient with scabies? | Contact
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| Where does the inflammation associated with scabies start? | Between fingers and toes and in inguinal folds
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| How long does an adult louse live? | 48 hours without host and they have a lifespan of 30 days with a host
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| Where do female louse lay nits? | base of hair shaft
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| Treatments for Pediculosis Capitis (head lice) include: | pediculicides and nit removal
(important to prevent spread and reoccurence by cleaning and treating properly)
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| When should you re-do a treatment r/t head lice? | 7-10 days after inital tx. (nits hatch 7-10 days)
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| This is a tick-borne disease | Lyme Disease
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| Therapeutic management of lyme disease | Doxycycline if over 8, if under 8 amoxicillin
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| Lyme disease has a certain rash associtaed with it; describe. | Red ring like rash at site of the bite.
known as the bullseye.
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| 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
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| Nursing management of Lyme disease | Antibiotics
education about completion of antibiotics
education about prevention
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| 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
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| This disease is caused by the bacteria that is found in cat saliva or cat fleas | Cat scratch disease
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| Nursing management of Cat scratch diease | antibiotics if ordered
standard precautions
education for prevention
care of bites or scratches
flea control
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| 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
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| Treatment for contact dermatitis | removal of irritant
glucocorticoids (decreases inflammation)
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| Adverse drug reaction are most often seen where? | skin, rashes are the most common reaction
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| True or False? A reaction to a drug may be immediate or delayed | True
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| What is the treatment of a drug reaction? | discontinue the drug
give antihistamines
if severe, corticosteroid therapy
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| 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)
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| Treatment for Stevens-Johnson | symptomcatic treatment
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| Prognosis for Steven-Johnsons | 10-15% mortality
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| What causes Stevens-Johnson | Drug reaction
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| The involuntary passing of urine | Enuresis
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| Primary Enuresis | the child never achieves bladder control (further assessment is needed)
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| Secondary Enuresis | children have periods of dryness usually several months then display enuresis again (this can happen with stress)
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| Nocturnal Enuresis | urinating at night
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| ______% of boys and _____% of girls are age 5 still have noturnal enuresis. | 7;3
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| At age 10, ______% of boys and ____% of girls still have nocturnal enuresis | 3;2
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| What is the organic cause of noturnal enuresis? | UTI
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| Treatments for nocturnal enuresis | antidiuretics, antispasmodics, tricyclic antidepressants.
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| True or false? Many cases of noturnal enuresis never resolve | False many spontaneously resolve
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| The repeated voluntary or involuntary passage of feces of normal or near normal consistency into places not appropriate for that purpose | Encopresis
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| Primary encopresis | fecal incontinence after age 4 years (sphincter or neuro problem?)
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| Secondary encopresis | fecal incontinence in a child older than 4 after periods of established continence.
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| Encopresis is more common in: | Males
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| Therapeutic management of encopresis | Determine the cause
dietary intervention
management of constipation
psychotherapeutic interventions
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| The typical onset of ADHD is before age ____ | 7
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| ADHD incluses such behaviors as: | Inattention, impulsivemess, and hyperactivity
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| Therapeutic management of ADHD | Classroom management
family education and counseling
behavioral therapy
environmental manipulation
medication
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| Side effets of ADHD meds | insomnia
anorexia and weight loss
hypertension
long term use may suppress growth
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|
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