COD N2 Pediatrics
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| Infant: Nursing Implications | Encourage parental presence (all ages), adhere to infants home schedule, Utilize topical anesthetics or pre-procedural sedation, quiet environment
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| Infant: Stressors | Separation anxiety, Stranger anxiety, painful, invasive procedures, immobilization, sleep deprivation, sensory overload
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| Infant:Responses | sleep wake cycle disrupted, feeding routines disrupted, displays excessive irritability
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| Toddler: Nursing Implications | Encourage Parent presence, allow parents to hold child as much as possible, allow choices when possible, explain procedure in simple terms
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| Toddler: Stressors | Separation anxiety, loss of self control, immobilization, painful invasive procedures, bodily damage of mutilation, FEAR OF THE DARK
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| 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
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| Preschoolers: Nursing Implications | Encourage parental presence, allow choices when possible, utilize topical anesthetics, EXPLAIN ALL PROCEDURES AND PROVIDE A NIGHT LIGHT
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| Preschoolers: Stressors | separation anxiety & fear of abandonment, loss of self-control, bodily injury or mutilation, painful invasive procedures, fear of the dark and MONSTERS
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| 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
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| 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.
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| 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
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| What is the Wong-Baker pain rating scale | FACES
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| what is the pain scale for patients that are unresponsive | The FLACC Scale
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| What does FLACC stand for | F: Face L: Legs A: activity C:cry C: consolability
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| How often show you re-assess after pain medication is administered IM or IV | 30 min
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| How often show you re-assess after pain medication is administered PO | One hour
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| Children’s behavior that may indicate pain | Restlessness, Agitation
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| 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.
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| 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.
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| Why is scheduling important in pain management | Better to medicate around the clock than PRN when pain is already severe
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| Co-Analgesics include | NSAIDS Tricyclic antidepressants: Amitriptyline: Desipramine Anticonvulsants: Neurontin,Lyrica, Klonopin, Tegretol Corticosteroids Local Anesthetics Anxiolytic drugs
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| What age are PCA pumps used | as young as 3 yrs, but not usually until 6 yrs
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| Children may see pain as a form of | punishment
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| Behaviors indicating pain | Restlessness hyper alertness difficult to distract irritability facial grimacing posturing anorexia lethargy sleep disturbances depression aggression
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| What word can you use besides "poke" when giving a child an injection.. you may feel a_______ | a slight Pinch or pressure
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| Always encourage __________ to stay with the child | Family
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| When assessing a child perform ____ and ____ assessments last | painful and invasive
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| An infant older than ____ months is afraid of strangers | after 6 months
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| 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)
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| what kind of questions would you ask the family to get a medical history of patient | open ended questions
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| To help make the child comfortable with assessment, let them play with ____ | equipment
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| 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
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| Check for turgor on ____ | ABD
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| Posterior fontanel closes at ____ where the anterior should close ____ | between 2 & 3 months, 12 & 18 months
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| The fontanels on the head should be ____ | flat
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| what makes a Childs heart rate rapid (until late school age) | cardiac output is rate dependent not stroke volume dependent
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| until 12-18 months of age kidneys: | do not concentrate urine effectively and do not exert optimal control over electrolyte secretion and absorption
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| What would you do if an infant in your care had a HR of 130? | Nothing it is normal
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| How do you check an infant’s HR? | Apical... emergency brachial, femoral
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| if a child has vasoconstriction the concern is | dehydration
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| 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.
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| 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
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| 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.
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| Until the age of 4-5 what is the primary breathing muscle? | Diaphragm
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| 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
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| Effects of hospitalization on an Infant: Stressors | Separation anxiety, Stranger anxiety, painful, invasive procedures, immobilization, sleep deprivation, sensory overload
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| Effects of hospitalization Infant: Responses | sleep wake cycle disrupted, feeding routines disrupted, displays excessive irritability
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| 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
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| Effects of hospitalization Toddler: Stressors | Separation anxiety, loss of self control, immobilization, painful invasive procedures, bodily damage of mutilation, FEAR OF THE DARK
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| 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
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| where can you go to see the current updates for immunizations | www.cdc.gov/vaccines
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| when do we hold immunizations? | allergies, reactions, Given blood, immunoglobulin, vaccines (past 4 weeks), Steroids, chemo-therapy, HIV, SZ, CA
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| how do new borns communicate? | Coos, babbles & cries
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| An Infant believes that his parents will feed him. | Trust vs. Mistrust
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| Sense of Initiative versus Guilt | Preschooler: Age 3 to 6
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| A 10 Year old boy proudly displays his principal's award | Industry vs. Inferiority
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| 13 y.o. girl fights with her mother about appropriate dress. | Identity vs. Role Confusion
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| A 2 year old boy expresses interest in dressing himself. | Autonomy vs. Shame and Doubt
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| A 15 year old boy worries about how his classmates treat him. | Identity vs. Role Confusion
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| Sense of Industry vs. Inferiority | School Aged : Age 6 to 12
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| Sense of Identity vs. Role Confusion | Adolescent: Age 12 to 20
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| Sense of Trust vs Mistrust | Infant : Birth to age 1 year
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| A Kindergarten student learns the ABC's. | Initiative vs.Guilt
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| 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
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| 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)
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| 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)
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| Physical growth: 6-8 months | Gains: 85-140g (3-5oz) / wk
Grows 1cm (3/8in) /mth
Growth rate slower than first 6 months
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| Physical growth: 8-10 months | Gains: 85-140g (3-5oz) / wk
Grows 1cm (3/8in) /mth
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| 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
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| a 8 month old infant is sitting on the floor, grasping blocks and banging them on the floor. He is engaging in ________ play | solitary
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| By the age of 2 yrs old, the birth weight has __________ and the child is _________ of the adult height | quadrupled, half
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| adverse reaction to vaccinations | Anaphylaxis, Hives, lethargy, tachycardia, itching–Can happen minutes to hours after administration
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| you need ___________ before vaccination and ___________ after. | Consent, doccumentation
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| What is proximodistal development | refers to the development of motor skills from the center of the body outwards.
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| 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
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| What is Associative Play | Child may interact with one another
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| 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
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| How is breast milk stored in the hospital? | plastic bottles, can be stored for 24hrs, NO Glass it destroys antibodies
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| This is how much the nurse will put in the buretrol | enough for 2 hours + 10mL
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| what is the IV infusion rate if the IV infusion pump rate if running at 25 ml/hr | 25mL/hr
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| What is the VTBI when running at 25 ml/hr | 50mL
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| What type of IV solution given to a patient with an uncomplicated appy | NS
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| The fontanel that remains open til about 2-3 mths | posterior
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| 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
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| Examples of Abnormal heart sounds | murmurs, muffled S1 and S2
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| Pain assessment tool appropriate for a 5 year old | faces, oucher, poker chips
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| Dada, mama, what age when the child verbalizes this | 9-12 mths
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| object permanence | When analyzing a 9 month old, if you cover an object does the baby know it’s still there?
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| 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
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| Easy, Difficult, Slow to warm up: | Patterns of temperament in an infant
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| Newborns & young infants more susceptible to infection | immune system is not fully mature
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| until what age is the aveoli smaller and faster | 10 y/
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| Meds to look for serum levels in | Lithium, Digoxin, Vancomycin, gentamycin, dilantin
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| what is peak, and when is it obtained | 1/2 hr after med is given
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| what is trough | before then next medication is given
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| who was the theorist who introduced the concept of including women in to these dev studies? | Gilligan
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| SIADH is a excessive amount of which hormone | ADH antidiuretic hormone
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| what can cause SIADH | Brain tumors, PN, chemo, and pulmonary disorders
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| What hormone is low in diabetes insipidus | ADH
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| 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
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| what are some characterisitc of GHD in children | Cherubis faces, high pitched voices, ripply abd fat
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| Hypothyroidism can be _______ and _______________? | congenital and acquired
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| what are some ways that children can maintain a healthy blood glucose? | Diet, anticpate, consistently count carbs
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| how can you check for pinworms | taps test, visual inspection
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| difference between shigella and salmonella | SAL: watery Diar. SHIG: bloody diar
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| what are some signs and symptoms of DM 2 in children? | polydipsia, polyuria, thickening of the skin w/ velevet irregularities in skinfolds
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| growth refers to the ______________ ability | quantitative
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| development refers to the ________abiltity | qualitative
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| What is VSD? | Ventricular Septal Defect: a hole in the septum between the low to chambers
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| Kawasaki disease | the leading cause of acquired Hrt disease in kids is US under 4 y/o
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| What are the 3 shunts in the fetal circulation that close 10-15 hours after birth | Ductus arteriosus
Foramen ovale
Ductus venosus
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| How is VSD diagnosed | Echo, EKG, Heart catheterization
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| Some S/S of VSD with large defects | S/S CHF, Failure to thrive, fatigue, review history
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| Treatment for VSD | Artery Banding, Some have closing by age 3
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| What is a cyanotic heart defect | Polycythemia: high Hgb, Chronic hypoxia
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| In a Cyanotic heart defect what lab will be high | Hgb
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| What position is the child in for Cyanotic heart defect | Squatting
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| What causes CHF in children | Secondary to heart defect
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| what are the assessment findings on a child with CHF | Cough, increased pulse, blood back up into the liver, poor growth
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| what can tachycardia also be a sign of | Mild dehydration, also respiratory
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| 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
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| S/S of Hypovolemic shock | Hypotension, thready pulse, clammy skin (diaphoesis, tachycardia, Tachypnea, Reduced UO
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| What might be some causes of hypovolemic shock | burns, GI bleeding, hemmorage, reduced plasma volume & body fluids, dehydration
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| What is the treatment for hypovolemic shock | Warmed IV Crystalloids,blood trasfusion, ID bleeding sites, control bleeding
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| what are the S/S of cardiac conditions on an infant | Tachecardia, irritability, retractions, weight loss, tires easily
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| What are S/S of cardiac conditions in a child | Exercise intolerance, ABD pain, perpherial edema, mottling or pallor, JVD, Perioral/facial edema
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| How do you manage pediatric cardiac patients | daily weight, educate, small feedings, turn frequently, don't smoke (parents too)
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| What is Cystitis | Bladder infection
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| What is pyelonephritis | Kidney infection
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| S/S of UTI | frequent urge to urinate/ void
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| test for strep | ASLO/ASO Anti-streptolysin O
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