Pediatrics (Test 2)

Test 2 next friday

How to help ease separation anxiety in a toddler

* Bring blankets and toys from home
* support and visits from family and parents
* maintain rituals and routines that the child has at home

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***Greatest fear is being seperated from parents: reassure that parents will come back***

Why are toddlers more prone to otitis media (ear infection)

They have smaller and shorter Eustachian tubes

* easier for bacteria/fluid to get trapped
* less common after 4 years, common after 6-8 mo of age

What are some long term concerns of otitis media

* hearing loss
* speech delay
* can lead to meningitis if not treated

S/S of otitis media (ear infection)

* cough
* congestion
* pulling at ear
* fever

S/S of epiglotitis

* drooling
* fever
* tripod position
* stridor
* muffled voice
* sudden sore throat

***Life threatening medical emergency, rapid progression***

Nsg management for epiglotitis

* oxygen
* maintain airway
* no tongue blade, ect due to possibility of causing further spasm and closing of airway

What substances do you NOT want to induce vomiting after poising

* corrosive substances (acidic things: cleaners, bleach)
* in these cases, gastric lavage or activated charcoal are used
* always call poison control before inducing vomiting no matter what is ingested

Antidote to acetaminophen

Acetalysteline (mucomyst)

Eirksons stage for preschoolers (3-5 yrs)

Initiative vs guilt

Piaget stage for preschoolers (3-5yrs)

preoperational thinking (box is fort, magic powers)

Weight and height increase in toddler (1-3 yrs)

* weight increases about 4-6 lbs/year
* height increases about 5 in/yr
* spinal cord ossification is complete leading to control over urethral and anal sphincters

3 year play

* playground
* swings
* jumping
* playing store

Vocab of 3 year/vision

1000 words

* vision still immature

What may preschool age kids fear in the hosptial?

That they are being punished

* think erickons initiative vs GUILT stage

4 year small motor skills

* using scissors
* lace shoes
* simple buttons

vocab of 4 year old

1,500 words

* curious about gender, death, dying, may ask questions

Can a 4 year old tell the difference between fantasy and reality?

No

5 year (kindergarten) milestones

* print first name
* name days of week
* hammer to pound nails
* talk constantly
* tricycle
* 2,100 word vocab
* limit TV to 1-2 hours/day

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Nutrition for toddler

* simple, nourishing meals
* 2-3 glasses of milk per day (whole milk, skim after 2 years)
* help brushing teeth
* protein needs are high

Will a preschooler nap?

Depends, some do and some do not

* normal

Primary vs secondary enuresis

Primary = child has never been dry (not wet bed)

Secondary= child who has been dry for 1 yr or more begins wetting bed again

Tx for enuresis

desmopressin acetate

imipramine

Medical care for preschooler

* annual well child check

Amblyopia

Lazy eye

* visual deficit, usually in one eye
* brain shuts off input to defect eye

Strabismus

Cross eye

* not able to direct both eyes towards object
* tx by glasses, sometimes surgery
* can lead to amblyopia

Vesicoureteral reflux

* can cause recurrent UTIs
* valve that should close off ureter when peeing leaks and urine backs up into kidneys/ureters
* can cause renal damage, pyelonephritis

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**Diagnosis with ultrasound or voiding cystourethrography**

Febrile seizure

* usually occurs when temp raises too fast
* simple = under 15 min, short
* complex = over 15 min
* generalized = all over
* focal = one part of body (shaking arm or leg)

Care during a seizure

* admin oxygen
* provide safety
* diazepam given if longer than 5 min

Neuro checks in pediatric patients

* pupillary response
* moving arms/legs equal?
* facial symmetry
* crying = good

Croup S/S

* harsh barking (seal) cough
* fever
* stridor
* (children have smaller air passages so they experience more narrowing with inflammation)

Tx for croup

* increase fluids
* hot steam showers
* exposure to cold air/cool mist humidifiers
* corticosteroids
* inhaled epinephrine (monitor closely because relapse can occur after med has worn off)

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**Usually secondary to flu, RSV, pneumonia**

Diet for peds with diarrhea

* soy based formula
* no fruit juices
* BRAT diet

Tx for c-diff

Vancomycin

metronidazole

What do you asses on a child with a broken bone?

* 5 ps
* check finger movement
* pulses
* cap refill
* checking feeling in hands (neurovascular status)

Compartment syndrome

* complication of broken bone
* causes damage to muscles and nearby nerves by pressure from swelling
* paralysis and necrosis can occur
* S/S: severe pain, numbness, tingling

Fat embolism

* complication of fracture, usually of a long bone
* S/S: SOB, jaundice, fever, confusion, increased HR, change in LOC

Findings of a child with cerebral palsy

* jerky, involuntary movements
* trouble with repetitive movements
* scissoring gate (feet crossing over mid-line)

Meds to treat muscle spasms in CP

* diazepam (can cause hallucinations)
* Baclofen (may cause rapid eye movement)

Cushings triad

* Increases systolic BP


* deceased pulse
* decreased respiration.

ABCs, assess for spinal injuries, check for drainage from ears and nose, monitor for fluid volume overload. Neruo checks frequently.

When can the carseat be flipped to forward face?

2 years

Vaccines that a 4-year-old is required to have before attending preschool

* Tetanus vaccination (DTaP/DT/Td)


* Polio vaccine (IVP) (OVP)
* Measles/Mumps
* Hib for influenza
* Hepatitis B vaccination,
* Pneumococcal vaccine (PCV)
* Varicella vaccine (VAR)
* Hepatitis A vaccination

Interventions to relieve a preschool child's anxiety in the hospital

* providing bandaids for children who get shots since they have a fear of bodily harm
* Letting them know when a procedure will hurt, it is ok to cry but they need to hold still
* assure them that they are not being punished and this is not their fault, it is just something that will either help them heal or prevent them from getting sick.
* let them hold the equipment so that they don't feel afraid of it.

Exam test for strabismus

* Corneal light reflex test can be done by shining a light in the child's eye to look for a reflection in the pupils (at the same point/area as the other eye).
* cover test : cover one eye while having the child focus on an object then uncover the eye to see if the covered eye is moving around or stood still (if the uncovered eye doesn't move its aligned/normal)

Common S/S of UTI in a preschooler

Lethargy

irritability

poor feeding

foul smelling urine

incontinence in a potty trained child

What is the most common UTI causing bacteria in a preschooler

E.Coli because they may wipe improperly

* Common in females because the urethra is close to the anus.

what is a serious complication of untreated strep throat?

Rheumatic fever

* can cause heart damage

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Glomerulonephritis

* causes kidney damage

What are other causes for a febrile seizure (other than a fever)

* virus
* encephalitis
* meningitis
* otitis media (ear infection)

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What vaccines decrease need for a dx lumbar puncture

* HiB influenzae


* pneumonia

What age of child is a “toddler”

1-3 years

When are all 20 teeth generally done erupting?

2 years

Psycologic anorexia

* when a toddlers appetite greatly decreases, may eat significantly less than before
* worries parents, but is compleatly normal

Weight and height gain during preschool years (3-5), normal pulse rate

* weight increases about 5lbs/year
* 2.5-3 inches/year height
* Pulse rate 90-110 BPM
* 90% of brain growth achieved

Nutrition for preschoolers (3-5)

* 1600 cal/day
* protien
* iron
* vtimains A and C
* limit fruit juice to 4-6oz/day

Nursing management for otitis media

* warm or cold compress placed on affected side
* placed upright to decrease pain
* if ear is draining, clean with sterile water or hydrogen peroxide

Risk factors for otitis media

smoking in the house, increased pacifier use, cleft palet

* breastfeeding for first 6 mo decreases risk

Treatment for otitis media

Amoxicillin, augmentin

* sometimes is viral, no need for antibiotics

Epiglottitis

Swelling of the tissue above vocal cords. Narrowing of airways

* most common cause is haemophilus influenzae

S/S of fluid imbalance/dehydration

* lethargy
* slow turgor
* cool to touch
* sunken eyeballs
* dry MM
* less wet diapers
* sunken fontanels
* no tearing during crying
* increase pulse, RR
* low BP

Is cerebral palsy a progressive disorder?

No

How much food will a toddler eat compared to an adult?

1/4-1/3 an adult portion size

What size should the toddlers toy be to avoid choking?

larger than toddlers fist

Treatment for lead poisoning

calcium disodium edetate (CaEDTA)

british antilewistle (BAL)

Treatment for salicylate poisoning (ex aspirin)

No specific tx, gastric emptying usually used

3 year old developmental milestones

* help dress and undress selves
* use toilet and wash hands
* eat independently
* may revert to parallel play if uncomfortable