pediatrics final exam

What is cultural humility?

- Lifelong self-reflection & critique

- Addresses power imbalances, curiosity, informed 'not knowing', openness, self-awareness, egolessness

- Preferred over cultural competence

What is the leading cause of death in children > 1 y.o.?

Accidents

What is SAFE PAD?

Acronym for causes of injury/death in infants: suffocation, asphyxiation, falls, electric burns, poisoning, automobile accidents, drowning.

What are the leading causes of death to adolescents?

MVA, homicide, suicide

- Most common method of suicide is with a firearm

- National suicide prevention lifeline number: 988

What is cephalocaudal?

Head to toe growth

What is proximodistal?

Midline to peripheral growth

What is object permanence & when is it achieved?

Awareness that things exist even when not seen, achieved by 9-10 months

What is conservation & when is it achieved?

Quantity is unrelated to arrangement, achieved by school age

What is abstract thinking & when is it achieved?

Achieved in adolescence

What are the general rules for growth expectations?

- Wt doubles by 6 months & triples by 12 months

- 2-3 kg gain per year in toddler to school age

- Birth length doubles by 4 years old

- Half of adult height by 2 years old

When does the anterior fontanel close?

12-18 months

When does the posterior fontanel close?

2 months

What are some nonverbal behaviors and vocalizations used in communication with infants?

- Nonverbal behaviors and vocalizations

- Crying is a way for infants to communicate

- Rocking, holding, and rubbing between the eyes can help calm a crying infant

How is communication adapted for toddlers?

- Be direct and concrete

- Toddlers are egocentric

- Explaining what, how, and why

- Reassure them that their body will be okay

How is communication adapted for adolescents?

- Provide privacy

- Be honest

- Peers: concerned with what their friends think

What should be done first when performing a head-to-toe assessment?

Perform least invasive activities first

- RR first, BP last

Where is the PMI located on children under 7 years old?

located at the 4th intercostal space, lateral to the midclavicular line

Where is the PMI located on children over 7 years old?

located at the 5th intercostal space at the left midclavicular line

What is childhood obesity and what are some risk factors and interventions?

- Weight > 95th percentile

- Risk factors: high caloric intake, having an obese parent, physical inactivity

- Nutrition & activity habits need to be established by age 3

What is the FLACC pain scale & what age group is it used for?

- Pain rating scale for babies

- Facial expression, leg movement, activity, cry, consolability

What is the FACES pain scale & what age group is it used for?

- Compare the pictures to the actual person's face & point out which one they relate to most

- Used for children over 3 years old

What is the numeric pain scale & what age group is it used for?

- Pain rated on a scale of 0 to 10

- Explain to the child that 0 means 'no pain' & 10 means 'worst pain'

- Used for children over 8 years old

What is atraumatic care?

- Using interventions to minimize distress in children and families

- Decrease separation from family, promote sense of control, minimize pain

What are the preferred IM injection sites for infants?

Vastus lateralis (25 g, 5/8-1in)

What are the preferred IM injection sites for adolescents?

Deltoid (25 g, 1 in)

What is the best form of medication for PO administration in children?

Liquid medications to decrease aspiration risk

When does separation anxiety develop?

4-8 months

What are the nutritional/feeding requirements for infants?

Breastmilk is best, no bottle propping, no milk in bed, no fruit juice

What is vaccine education?

- Can protect against SIDS

- Do not give to immunocompromised kids

- Contraindications: severe febrile illness, postponed 3 months after IVIG or blood transfusion, anaphylaxis from previous vaccine

What is SIDS & how can it be prevented?

- Sudden death of an infant younger than 1y that remains unexplained after a complete autopsy

- Risk factors: maternal smoking, preterm birth, non-white, males, bed sharing, prone sleep

- Prevention: breastfeeding, pacifier use, supine sleep, room sharing < 6 months

What is the main cause of death in toddlers?

Drowning

What is negativism?

- Saying 'no' to gain control

- Seen mainly in toddlers

- Do not punish; avoid by not giving child an option to say no

What is ritualism?

- Following familiar patterns and schedules

- ex: will only eat off of the same plate, using the same silverware

What is lead poisoning (definition, risks, treatment)?

- toddlers put things in their mouth; found in paint (homes built before 1978) and in toys from overseas

- there is now considered to be no safe/normal blood levels

- risks: iron deficiency

- s/s: aggression, hyperactivity, developmental delays

- treatment: chelation therapy (increase fluids & monitor renal function)

- screening should begin at 1-2 y.o.

What are the car seat recommendations?

- Rear-facing and in back seat!

- Always readjust straps once child is in seat to ensure appropriate for clothes that are on

- Car seats do have expiration dates after which they are no longer safe

- After an accident, a car seat needs to be destroyed, not just thrown away

What is magical thinking?

Believing thoughts influence events

What is animism?

Attributing lifelike qualities to inanimate objects

- Example: Child scolds stairs for making child fall down.

- Implication: Join child in the "scolding." Keep frightening objects out of view.

What are signs of possible child abuse & how should the nurse react?

- Children < 1y.o. @ highest risk

- Red Flag: Inconsistent story from caregiver about child's injuries

- Interview, take photos, and assess then DOCUMENT

What are common characteristics of abusers?

Usually a male known to victim, gains trust, plays on fears

Often employed in a position related to childcare

What is Abusive Head Trauma?

- Shaken baby syndrome

- Leads to subdural hematomas & retinal hemorrhages

- Can cause lifelong disability

- Parents take child to ER due to other symptoms, not the fact that they were shaken

How is Varicella transmitted?

airborne route and direct contact

what type of isolation precautions are used for varicella?

airborne

gown, gloves, respirator, goggles

What are the symptoms of Varicella?

Fever, malaise, rash - papule, vesicle, crust

What is the treatment for Varicella?

Skin care, oatmeal baths, remove crusts, pressure not scratch

How is Measles transmitted?

respiratory droplets (airborne precautions)

What are the symptoms of Measles?

Fever, cough, rash on face that spreads downwards, Koplik spots, photophobia

What is the treatment for Measles?

Bedrest, fluids, antipyretics

What actions should be taken in case of poisoning?

- Call poison control first (1-800-222-1222)

- Assess child - check circulation, airway, breathing

- Do not induce vomiting at home!

How should a firearm be stored?

unloaded and locked up, store ammunition separately

When does puberty onset & what is its sequence?

Girls: 10 y.o., boys: 12 y.o.

Tanner Stages:

- Stage 1- pre-puberty

- Stage 2- Onset of puberty-breast buds and pubic hair in girls (8-14 years), testicular growth and pubic hair in boys (9-16 years)

- Stage 3- Breasts begin to form mounds and pubic hair is scant but developing course curly pattern. Period begins. Boys penile and testicular growth with pubic hair change.

- Stage 4- Girls areolae and nipple formation on breast mound, pubic hair triangular. Boys continuing growth and pubic hair triangles.

- Stage 5-Mature

What are some red flags for puberty development?

- no breast development by 13 years old for girls

- no testicular enlargement or scrotal changes by 14 years old for boys

What is gynecomastia?

Male breast enlargement that will go away with time

What is bulb suction?

Suction nose to ease respiratory effort (obligate nose breathers)

What is bacterial pharyngitis?

Inflammation of the pharynx caused by GABHS (strep throat)

What are the symptoms of bacterial pharyngitis?

- Abrupt onset,

healed within 3-5 days

- HA, fever, sore throat, abdominal pain, strawberry tongue, 'sandpaper' rash

- Pharynx & cervical tonsils covered in exudate

How is pharyngitis diagnosed?

Throat swab

How is pharyngitis treated?

Oral penicillin for 10 days, infectious for 24 hours after starting antibiotics

What is nasopharyngitis?

Common cold

- s/s: nasal stuffiness, HA, cough for 14 days, - treatment: FFR

What is the post-op care for tonsillectomy?

- Watch for frequent swallowing

- Hypotension is a late sign of bleeding

- Discourage coughing & blowing nose

- Return to normal activity 1-2 weeks post-op

What are expected abnormals after tonsillectomy?

Low grade fever for 5-10 days & slight ear pain common

What is RSV (bronchiolitis)?

Inflammation causes air trapping in lungs

What are the symptoms of RSV (bronchiolitis)?

Rhinorrhea + low-grade fever, cough, poor feeding, eye/ear drainage, wheezing, retractions, tachypnea (>70/min), apneic spells

What type of isolation precautions are used for RSV?

droplet

gown, gloves, mask, goggles

What is the treatment for RSV (bronchiolitis)?

Nasal suctioning, heated high flow nasal cannula, hydration

how can RSV (bronchiolitis) be prevented?

Palivizumab (synagis) only for high risk babies

Normal RR & HR for infants

RR = 30-50, HR = 100-180

Normal RR & HR for children

RR = 20-30, HR = 80-120

Normal RR & HR for adolescents

RR = 12-20, HR = 60-100

What is CF (pathophysiology, manifestations, diagnostics, treatment)?

- autosomal recessive genetic disease that causes impaired regulation of chloride and sodium channels

- s/s: thick mucous (non-productive cough), barrel chest, steatorrhea, anemia, electrolytes lost to sweat, meconium ileus, respiratory infections

- first sign: meconoium ileus

- diagnostic: quantitative sweat chloride test (done twice for result)

what is dornase alpha?

daily nebulizer to decrease viscosity (causes voice changes)

what is pancrealipase?

take within 30 min of all meals; do not crush or chew, rinse mouth after

Diet for CF:

High protein, high calorie, supplement fat-soluble vitamins and salt

What is asthma?

Chronic respiratory disease

- s/s: wheezing, dyspnea, and non-productive cough at nigh

Preventative drug therapy for asthma:

Inhaled corticosteroids, LABA, theophylline

Rescue medications for asthma:

Systematic corticosteroids, SABA

What is a peak-flow meter & how do you use it?

- maximum air that can be exhaled in 1 second

- can be done at home

- educate on technique- stand up, blow out as hard and fast as possible 3x

Nasal Cannula (percent oxygen, amount, RN considerations, situation used):

- 22-44%

- < 4L

- pt must have patent nares

- used in mild respiratory distress with sats 90-95%

Bag-valve mask (percent oxygen, amount, RN considerations, situation used):

- 100%

- 12-14L

- used in respiratory arrest

Non-rebreather mask (percent oxygen, amount, situation used):

- 95%

- 10-12L

- used for decompensation, retractions, nasal flaring, cyanosis

Simple Mask (percent oxygen, amount, situation used):

- 35-60%

- 6-10L

- Mask must fit snuggly

- Used when sats 85-90%

What is mild dehydration?

< 5% wt loss

- s/s: slight thirst, low urine output, normal VS

What is moderate dehydration?

5-9% wt loss

- s/s: increased HR, RR, low BP, very thirsty, dry mucous membranes, oliguria

What is severe dehydration?

> 10% wt loss

- s/s: rapid RR, cap refill > 4sec, sunken eyes & fontanels

How to manage diarrhea:

- no carbs during diarrhea

- normal diet resumed shortly after resolution

- no antibiotics

- prevent with hand hygiene, avoid contaminated water, get rotavirus vaccine

What is appendicitis (s/s, management)?

- Inflammation of appendix from obstruction, usually by stool

- s/s: periumbilical pain, nausea, RLQ pain, vomiting, rebound tenderness,

- treatment: appendectomy

Signs of appendix rupture:

- pain suddenly goes away, rigid abdomen, paralytic ileus

- treat with IV antibiotics, NG decompression

What is Hirschsprung disease (pathophysiology, s/s, management)?

Congenital aganglionic megacolon -> obstruction

- s/s: failure to pass meconium, constipation, palpable fecal mass, ribbonlike, foul-smelling stools

- treatment: enemas, surgery to remove portion of bowel, low fiber diet

What is a common contraindication for cardiac catheterization?

Diaper rash

What should be assessed during pre-op care for cardiac catheterization?

Pulses, baseline VS, accurate ht & wt

How long should a patient be NPO before a cardiac catheterization?

6-8 hours

What should be assessed post-op for cardiac catheterization?

Distal pulses, extremity temp/color

What is the frequency of VS checks during post-op care for cardiac catheterization?

Q 15 min

What should be avoided during post-op care for cardiac catheterization?

Baths, straining

What should be done if there is bleeding during post-op care for cardiac catheterization?

Apply pressure 1 in above wound

What is a ventricular septal defect?

- opening between ventricles

- left-to-right shunt

- s/s: loud murmur, HF

What is an atrial septal defect?

- opening between atria

- left-to-right shunt

- may be asymptomatic

What is tetralogy of Fallot?

- VSD, pulmonic stenosis, overriding aorta, R ventricle hypertrophy

- right-to-left shunt

- s/s: cyanosis

What is the treatment for tet spells?

Knee-to-chest position, O2 administration

What should a nurse do before administering digoxin?

- Listen to apical pulse for 60 seconds

- Double check dose; >1 mL is rare

What are the signs of digoxin toxicity?

Vomiting, bradycardia, dysrhythmias