Pediatrics Exam 2

Factors influencing severity of pain in a child?

Age, gender, cognitive level, temperament, previous experiences, family and culture, situation

Factors influencing pain responses in a child?

Type of pain, extent of pain, age and developmental level, cultural and family norms surrounding expression

Behavioral pain indicators in an infant

Facial expressions, body movements, crying, irritability, refusal to move body part, interrupted sleep

Physiological pain indicators in an infant

Increased heart rate, decreased O2 sats, decreased vagal tone, plantar/palmar sweating

What type of words should a nurse use when discussing pain with a toddler?

Owie and boo-boo

How should a nurse approach a conversation about expected pain with a preschooler?

Sugar coat to discuss thier pain

True or False: A school age child can usually characterize their pain?

True

What is the expected concern about pain and control in a adolescent patient?

Concerns about body image and control may result in denying pain

The FACES pain assessment tool should be used in what types of patients?

Patients who are cooperative but cannot fully verbalize/characterize their pain

The FLACC pain assessment tool should be used in what types of patients?

Babies and non-verbal patients

What score would a patient with severe pain score on the FLACC scale?

7-10

What score would a patient with moderate pain score on the FLACC scale?

4-6

What are the 5 parts of the FLACC scale?

Face, legs, activity, cry, consolability

Nonpharmacological approaches to pain in pediatric patients

Relaxation, distraction, massage, nonnutritive sucking with sucrose, heat and cold

Pharmacological approaches to pain management in pediatric patients

Analgesics, PCA, local, epidural, conscious sedation

True or False: Ibuprofen can be administered to patients under 6 months to manage pain?

False

What tool can be used for cutaneous stimulation for pain management?

Buzzy

What is the best way to prevent infection?

Handwashing

Different methods for infection prevention?

Handwashing, immunizations, proper food handling and prep, judicious antibiotic use

Chain of infection

Infectious agent → Reservoir → Portal of exit → Modes of transmission → Portal of entry → Susceptible host

Nursing Implications: Infectious Agent

Handwashing, wearing gloves, cleaning, disinfection, or sterilizing equipment

Nursing Implications: Reservoir

Follow guidelines for disposing of infectious waste, provide proper wound care, assist children to carry out appropriate hygiene, change out linens

Nursing Implications: Portal of exit

Education, cover mouth and nose, avoid talking, coughin, or sneezing over open wounds or sterile fields, PPE

Nursing Implications: Mode of transmission

Wash hands, PPE, urge patient and family to wash hands frequently

Nursing Implications: Portal of Entry

Proper sterile technique, wound care, disposal of needles and sharps in proper disposal, provide children with own personal care items

Nursing Implications: Susceptible host

Maintain integrity of skin and mucous membranes, protect normal defenses with regular hygiene

What immunity is present in infants at birth?

Cellular immunity

What type of immunity is present in infants when the body encounters a new disease?

Humoral immunity

Is disease protection from immunizations in infants complete or incomplete?

Incomplete

Common labs for infectious diseases?

CBC, ESR, CRP, culture and sensitivity, cultures

Treatments for infectious disorders?

Hydration and fever reduction

Medications for infectious disorders

Antibiotics, antivirals, antipyretics, antipuritics

Infection stimulates the release of what?

Endogenous pyrogens

Pyrogens act on what and trigger the production of what?

Act on hypothalamus and trigger prostaglandin production

A fever with what symptom can be a sign of a more emergent illness?

Stiff neck

Symptoms of a bacterial infection in children?

High fever, green/yellow nasal discharge

Examples of different types of bacterial infections in children

MRSA, pertussis, tetanus, botulism, osteomyelitis, spetic arthritis, scarlet fever, diphtheria

Untreated strep can evolve to what?

Scarlet fever

True or False: Viral infections cannot be treated with medications and must run their course naturally?

True

What is the best prevention of viral illnesses in children?

Vaccines

If someone had chicken pox as a child, what may occur later in life?

Shingles

Examples of different viral infections in children?

Rubella, Measles, Roseola Infantum, Shingles, Chicken Pox, Human Parovirus/Erythema Infectiosum

Zoonotic/Vector borne illnesses

Diseases caused by infectious agents that are transmitted directly or indirectly from animals or vectors

Examples of zoonotic illnesses in children?

West nile virus, dengue fever, zika, lyme disease, rocky mountain fever, malaria, rabies

What zoonotic disease my cause a child to present with a target-like rash on their skin?

Lyme Disease

Parasitic and helminthic infections

Can be spready by direct or indirect contact, requires treatment to eradicate

Parasitic infection examples

Head lice, Pubic Lice, Scabies

Helminthic Infection examples

Ascariasis, Hookwrom, Pinworm

What is the main cause of STIs in adolescents

Lack of education and resources

True or False: Condoms do not prevent all STI's

True

What is the main cause of STIs in an infant or newborn?

If mother is untreated during pregnancy and delivery

What is the difference in anatomy of an infants nose?

Obligate nose breathers, produce less mucus, sinuses are not developed, newborns have small nasal passages and are prone to obstruction

What is the difference in anatomy of a pediatric patients throat?

Tongue larger in relation to oropharynx, children have enlarged tonsillar and adenoid tissue

Inspection findings of a child in respiratory distress

Increased respiratory effort; Anxiety, pallor, cyanosis, clubbing, nose and oral cavity, nasal flaring and tracheal tugging, rate and depth of respirations

What is often the first sign of a serious illness in a pediatric patient?

Changes in breathing

What may a chest radiography reveal in a pediatric patient in respiratory distress?

Hyperinflation and areas of atelectasis or infiltration

What may an ABG show for a child in respiratory distress?

CO2 retention or hypoxemia

Common medical treatments for a pediatric patient in respiratory distress?

Oxygen, high humidity, suctioning, physiotherapy and postural drainage, saline gargles, chest tube, bronchoscopy

What is the maximum flow rate of a nasal cannula in a child?

4L/min

When is high flow oxygen used for a pediatric patient?

When in severe respiratory distress

What is the maximum flow rate of high flow oxygen in a pediatric patient?

2L/kg/min

True or False: Flow and FIO2 can be adjusted separately on high flow oxygen?

True

Risk factors for respiratory disorders in a pediatric patient?

Prematurity, chronic illness, developmental disorders, secondhand smoke, immune deficiency, crowded living conditions, daycare

Risk factors for TB in a pediatric patient

HIV infection, incarceration and institutionalization, positive recent history, immigration or travel, exposure at home

Acute infectious disorders

Common cold, sinusitis, pharyngitis, tonsillitis, laryngitis, RSV, influenza, pneumonia, bronchitis

Chronic respiratory disorders

Allergic rhinitis, asthma, chronic lung disease, cystic fibrosis, apnea

s/s of Pneumothorax

Chest pain, tachypnea, retractions, nasal flaring, grunting

Risk factors of pneumothorax in a pediatric patient

Chest rauma or surgery, intubation and mechanical ventilation, history of chronic lung disease

Treatment of pneumothorax in a pediatric patient

Chest tube, nonrebreather oxygen therapy

s/s of Bronchiolitis (RSV)

Clear runny nose, pharyngitis, low grade fever

When is RSV usually the worst?

4-5 days of illness

Treatment of RSV

SUCTION, fluids, oxygen

What is asthma triggered by

Allergens, illness, activity

s/s of asthma

Airway hyperresponsivenss, airway edema, mucus production, tachypnea, cough, increased work of breathing, wheezing

What is viral croup mostly caused by

Parainfluenza

Viral croup

Inflammation of upper airway, mucus production

The narrowing of the larynx and trachea in viral croup leads to what?

Stridor, hoarseness, barking cough

What type of genetic disorder is cystic fibrosis?

Autosomal recessive

Cystic Fibrosis

Excess thick mucus lining airways causing decreased resistance to infection, air trapping, wheezing

Cystic fibrosis leads to what?

Pancreatic enzymes and hypersecretion of gastric acids

Treatment of cystic fibrosis

Chest physiotherapy, bronchodilators and steroids, inhaled dornase alfa, antibiotics, KADE vitamin supplementation, well balanced diet

If a patient with a recent tonsillectomy is frequently swalling, it may indicate what?

Bleeding

Management of tonsillectomy

Prone or side lying positioning, maintain fluid volume, discourage coughing, encourage fluids

What is the expected urine output in pediatric patients?

0.5mL/kg/hr

Exstrophy of the bladder

Bladder is born outside of the internal organs

What is exstrophy of the bladder caused by?

Error in fetal midline closure

Pre-op interventions for a pediatric patient with exstrophy of the bladder

Keep Supine, keep bladder moist, cover with a sterile dressing, keep stool away

Post-op interventions for a pediatric patient with exstrophy of the bladder

Keep Supine, meticulous hygiene, suprapubic or indwelling catheter

Hypospadias

Urethral opening on the ventral side of the penis

Those with hypospadias are more prone to what?

UTI’s and fistula

Infants should not undergo what until they get their hypospadias repaired?

Circumcision

Why must hypospadias be treated early?

To prevent issues with sexual insecurity or castration anxiety

Epispadias

Opening is on the dorsal side of the penis

Obstructive Uropathy

Any obstruciton of ureter between kidney pelvis and bladder that does not allow the urine to eliminate which cuases damage to the organs above

Vesicoureteral Reflux

Backflow of the urine in the ureter

What may untreated vesicoureteral reflux cause?

Hydronephrosis, pyelonephritis, renal failure

How is vesicoureteral reflux diagnosed?

Voiding-cyst-urethrogram (VCUG)

True or False: UTIs are 4 times more common in girls than boys

True

Prevention methods for UTIs

Wipe front to back, reduce frequency of baths and scented soaps, appropriate sexual hygiene, wear appropriate fitting cotton underwear