NCLEX Peds

Infant to 1 Year Old Physical Development Milestones

-Posterior Fontanels → Close at 8 weeks

-Anterior Fontanels → close at 18 months

-Clean teeth with a cool, wet cloth

Infant to 1 Year Old Weight and Length Manifestations

-Newborns loose 10% of their birth weight by 3 to 4 days old. (comes back at 2 weeks)

-Birth weight doubles by 6 months

-Birth weight triples by 12 months

-Birth length increases by 50% by 12 months

Motor Skill Development for Infant

-1 month → Head lag

-2 months → Lifts head when prone

-4 month → Rolls back to side

-5 month → Rolls front to back

-6 month → Rolls back to frony

-8 months → Sits unsupported

-12 mohths → Walks with hand held

Piaget Development (Infant to 1 year old)

-Sensorimotor Phase (birth to 2 years)

-Object permanence (learns objects exist behind things) → 9 to 10 months

-Babbles → 3 months

-Three to five words by 12 months

Erickson’s Development (Infant to 1 year old)

-Trust vs Mistrust

-Solitary play

Infant Nutrition

-Breastfeeding for the first 6 months

-Solid food introduced after (iron fortified first)

-Do not provide fruit juice or honey during the first year

-Avoid small food objects like grapes, coins, and candy.

Infant safety

-Set hot water thermostat below 120 F

-Do not heat breast milk or formula

-Secure fencing around pools

-Close bathroom doors

-Have infant sleep supine with no pillows or covers

Car Seat Safety

-Rear-facing at a 45-degree angle (until 2 years old)

-Shoulder harness slots at or below the level of the infant’s shoulders

-If the car seat is in front, then deactivate the airbag

1 to 3 year old Physical Development

-Anterior fontanel closes at 18 months of age

-15 months walks without help

-2 years old runs

Piaget Development (1 to 3 years old)

-End of Sensorimotor → start of Pre-operational phase

-Symbols represent objects

-1 Year old → 1 sentence

-2 Year old → Two word sentences

-3 Year old → Simple sentences

Erickson Development (1 to 3 year old)

-Autonomy vs Shame & Doubt (Toddler)

-Independence!!!!

-Temper Tantrum

-Parallel Play

-Toilet Training

Piaget Development (3 to 6 year old)

-End of Pre-operational → start of Concrete Operational

-Magical Thinking!!!

-Animism → Inanimate objects are alive

Erickson Development

-Initiative vs Guilt → (Pre-schooler)

-Play dress up

-Play war

Booster Seat Education

-Booster seat should be for a kid up to 4 ft 9 or 8 to 12 years old

-The lap belt should lie across the upper thighs (not the abdomen)

-Shoulder belts lay across the chest (not neck)

Piaget Development (6 to 12 year old)

-Concrete Operational firm

-Solves problems

Erickson Development Stage (6 to 12 Year old )

-Industry vs Inferiority (School Age)

-Peer pressure begins

-Bullying occurs

-Organized sports

Piaget Development (12-20 years old)

-Formal Operational

-Able to think about two or more variables at a time when making a descion

Erickson’s Developmental (12-20 year old)

-Identity vs Role Confusion (Adolescent)

-Intimate relationships

-Questions existing moral values to society and individuals

Emotional Neglect Signs

-Failure to thrive

-Lack of hygiene

-School absences

Physical Abuse Signs

-Bruises in unusual areas (abdomen, back, or buttocks)

-Burns

-Aggressive nature of the child

Infant expected vital signs

-HR → 110 to 160 min

-RR → 30 to 60 min

-BP → 65/40 mm Hg

Toddler/Preschool expected vitals

-HR → 80 to 110 min

-RR → 20 to 30 min

-BP → 90/70 mm Hg

Adolescent expected vital signs

Normal adult vitals

Pain Assessment Tools

-FLACC (2 months to 7 years old) → Non-verbal

-Faces (3 years or older) → Kid points to the face

Best non-pharmocological nursing interventions

-Distraction → Play a game with the kid

-Relaxation → Swaddle, reposition

-Imagery

-Behavioral → Give stickers

-Sensory → Massage, skin to skin, pacifier

Ibuprofen note

Do not administer to children if they are under 6 months old

Otic Medication Adminstration

*Place child in prone or supine position

-3 & younger → Ear down and back

-3 & older → Ear up and bacl

Rectal Medication Adminstration

-Insert medication quickly

-Hold buttocks together for 5 to 10 minutes

Children’s Idea/Response to Death

-Infants to Toddlers (0 to 3 years old) → No concept

-Pre-schoolers (3 to 6 year olds) → Magical thinking makes them think they caused the death

-School Age Children (6 to 12 year olds) → Fear of death

-Adolescents → Adult actualization

Heart Defects that Increase Pulmonary Blood Flow (all Left to Right)

-Patent Ductus Arteriosus → Shunts from the aorta to the pulmonary artery → machine hum

-Ventricular Septal Defect → Shunts from right ventricle to the pulmonary artery → Loud murmur

-Arterial Septal Defect → Shunts from both atriums to right side of heart → Asymptomatic

Tetralogy of Fallot is composed of what → Decreased blood floor to the lnungs

1) Pulmonary Stenosis

2) Ventricular Septal Defect

3) Overriding Aorta

4) Hypertrophy of right ventricle

Tet spell and what to do

-Tet spell → Cyanosis & hypoxia

-Treatment → Knee-chest position, administer oxygen, notify provider

HF Pediatric Nursing Interventions

-Minimize crying

-Frequent rest

-Small-frequent meals

-Allow the child to sleep with pillows, allowing them to be in semi-fowler’s

-Monitor oxygen every 2 to 4 hours

-Digoxin → Hold if it is less than 90 in infants & less than 70 for children

Down Sydrome Nursing

-Manifestations → enlarged anterior fontanel, flat forehead, upward eye slant

-Early referrals to other health care teams

-When feeding make sure to push food all the way back in mouth

Club Foot Nursing

Serial Casting is necessary

Developmental Dysplasia of the Hip (DDH) Manifestations

-Asymmetry,

-Positive Ortolani

-Barlow test

Developmental Dysplasia of the Hip (DDH) Nursing Interventions

-Palvik Harness → Check straps every week, keep on all the time except for bathing, asses neuro

-Hip Spica Cast → Position the cast on pillows, apply a waterproof barrier, assess neuro

Spina Bifida Occulta vs Spina Bifida Cystica

Spina Bifida Occulta → Sac not visible

Spina Bifida Cystica → Sac visible

Spina Bifida Pre op care

-Protect the sac → prone infant

-Place sterile 0.9% NS dressing on it (change every 2 hr)

-No diapering or rectal tempatures

Spina Bifida Post Op care

-Maintain prone position

-Inform parents about the risk of Latex allergy

Cerebral Palsy Manifestations

-Abnormal crawl

-Involuntary muscle movements

-Alterations in muscle tone

Cerebral Palsy Nursing Interventions

-Keep HOB

-Ensure suction is available

-OT, PT, SLP, Special Ed

-Meds → Baclofen, Diazepam, Antiepiletics

Pyloric Stenosis

-Projectile Vomiting (Hallmark sign)

-Clear liquid diet for 4 to 6 hrs after surgery → then back to breast feeding

Hirschsprung’s Disease

-Failure to pass meconium stool (24-48 hrs) → Infant

-Ribbion-like stool or palpable fecal mass → Child

-Provide high calorie, high protein, low fiber diet

Intussusception

-Empty lower right quadrant (dance sign)

-Post op → Sign of normal stool passed or passage of contrast

Cleft Lip Nursing Care

-Encourage breastfeeding

-AVOID PRONE → Have infant sitting upright

-Apply elbow restraints (Take off and reassess neuro every 2 hr)

-Clean suture line using cotton tip with any solution

-Apply layer of antibiotic to suture site

Hyperbilirubinemia

-Jaundice is expected, and bilirubin levels exceed 5 mg/dL

-Asses color in natural daylight and weigh daily

-Phototherapy → Ensure face and genitals are covered, monitor tempature.

Appendicitis Manifestations

-Peak incidence is 10 yrs old

-Pain in hip when walking

-Rigid abdomen (perforation causes high temp (103), tachy everything, WBC elevated)

Unruptured and Acute Appendicitis Care vs Ruptured

Unruptured and Acute Appendicitis → NPO, IV fluids, IV antibiotics, NO HEAT, splint with pillow or stuffed animal on abdomen

Ruptured Appendix Nursing Care

-IV fluids, antibiotics STAT

-NG Suction

-Emergency surgery

Nephrotic Syndrome Clinical Manifestations

-Edema

-Dark frothy urine

-Proteinuria

-High specific gravity

-Increased platelets

Nephrotic Syndrome Treatment

-Meds → Steroids, diuretics, antibiotics

-Monitor I & O’s

-Elevate edema parts

-Low-sodium diet

Acute Glomerulonephritis Manifestations

-Recent Streptococcal disease

-Tea-colored urine

-Decreased urine output

-Decreased GFR

Acute Glomerulonephritis Treatment

-Meds → Diuretics, antibiotics

-Fluid and sodium restriction

-Elevate edema parts

UTI Education for kids

-Wipe front to back

-Double void to make sure the bladder is empty

-Wear cotton underwear

-Retract foreskin if uncircumcised

-Void after intercourse

-Complete full course of antibiotics

Acute Epiglottis

-Caused by H. Influenza

-Manifestations → Rapid onset stridor & drooling MEDICAL EMERGENCY

-Treatment → Rapid intubation, trachestomy, droplet precautions, steroids, antibiotics

Acute Laryngitis

-Manifestation → Child goes to bed well, then wakes up in the middle at night and has respiratory distress, symptoms disappear during the day

-Treatment -. Steroids, cool mist

Tonsillectomy

-Pre-op → Informed consent, baseline vitals, report any loose teeth

*Post-op

-Discourage coughing or gargling

-Frequent swallowing → Hemorrhage

-Elevate HOB

-No brown, red, or purple popsicles because it can look like bleeding

-Avoid spicy foods.

-Provide ice collar

RSV (Bronchiolitis)

-Manifestations → Rhinorrhea, copious secretions, positive for RSV antigen

-Meds → Ribavirin

-No bronchodilators or physiotherapy

-Limit visitors

-Suction those secretions before feeding

Surfactant deficiency that results in hypoxia (common in premature infants)

-Manifestations → Tachypnea, pericostal retractions, nasal flaring

-Treatment → Mechanical ventilation, oxygen, IV fluids

-Place the child in the prone position

-Place under a radiant warmer & encourage skin to skin

Bacterial Vs Viral Meningitis CSF Diagnostic Test

Bacterial → CSF cloudy, elevated WBC, Gram-positive

Vital → CSF Clear, Gram-negative

*Manifestations Infants → High-pitched cry, bulging fontanels

*Manifestations Children → Seizures, photophobia, hyperactivity

Meningitis Nursing Care

-Droplet precautions

-IV fluids

-Oxygen

-Antibiotics (bacterial)

-Quiet, low-stimulus environment

-Head slightly elevated or side-lying

-NPO until neurological status is improved

-Implement seizure precautions

Metabolic encephalopathy characterized by hepatic dysfunction decreased LOC, and fever

Reye Syndrome

Reye Syndrome

-Manifestations → Cerebral Edema, personality changes, elevated liver enzymes

-Nursing Care → Oxygen, Mannitol, Vitamin K

-HOB at 30 degrees in neutral position

-Seizure & bleeding precautions

-NO ASPIRIN TO CHILDREN

Substance exposed infant nursing care

-Withdrawals start 24 to 48 hours after birth

-Perspiration (Hallmark sign)

-Provide a quiet low-light environment

-Feed on demand

-Make sure hands are available when swaddling

-Contact child protective services

Most common form of childhood cancer that has a manifestation of a low-grade, unresolving fever

Acute Lymphatic Leukemia

Malignancy of the lymph nodes (they get swollen)

Hodgkin Disease

Firm painless abdominal cancer mass across the midline, that usually causes urinary alterations, found in infants

Neuroblastoma

The most common bone cancer in children that has localized pain, that can cause a gait change

Osteosarcoma

Cancer that causes weight loss and enlarged liver

(DO NOT PALPATE THE ABDOMEN)

Wilms Tumor

Cancer Nursing Intervention

-Stay hydrated

-Provide favorite foods

-Initiate bleeding and neutropenic precautions

-Premeditate opioids & antiemetics

-Ensure sun protection

Otitis Media Nursing Care

-Manifestation → Ear pain, rubbing, tugging at ear, bulging tympanic membrane

-Meds → Antibiotics

-Nursing Care → Apply heat over hear and lie on effected ear, position upright

Tape Test for Pinworms

-Wrap tape with sticky side out and press it across the back of the butt or perineal area

-Do this 3 consecutive mornings

-Place in plastic jar or bag for inspection

Pinworms nursing care

-Trim fingernails

-Dress the child in one-piece pajamas

-Shower instead of bathing

-Meds → Anthelminthics → Pyrantal Pamoate, Pyrviniam Pamoate

Head lice nursing care

-Manifestations → Intense itching of the scalp, small red bumps on the scalp

-Meds → Permethrin (for 7 days)

-Do not share objects that touch the head

-Use nit comb on hair

-Seal non-washable stuff in a bag for 2 weeks

Itchy pruritic rash that has fluid-filled papules and has a dew drop rose pedal

Varcella-Zooster (Chicken Pox)

Varcella-Zooster (Chicken Pox) Nursing Care

-Not contagious once lesions crust over

-Meds → Acyclovir

-NO ASPIRIN → Can cause Reye’s Syndrome

1) Slapped Red cheeks

2) Maculopapular rash after slapped red cheek appearance

-Complication → Aplastic Crisis (Severe anemia)

Fifth’s Disease (Parvovirus B19)

Fifth’s Disease (Parvovirus B19) Nursing Care

-Antipyretics

-Analgesics

-Once rash disappears = Not contagious and can return to school

Epstein-Barr Virus

-Manifestations → Swollen lymph nodes, unusual fatigue, rash

-Complications → Splenic rupture & resp. failure

-Nursing Care → Rest, & IV fluids

Earache aggravated by chewing and parotitis

Mumps (paramyxovirus)

Mumps (paramyxovirus) Nursing Care

-Fluids, analgesics, and soft food diet

-MMR vaccine prevents this

Whooping Cough

-Paroxysmal “whoop” at night which can cause cyanosis

-Treatment → Antibiotics & Oxygen (mechanical ventilation may be needed)

-High temp for 3 to 7 days that suddenly becomes normal

-After becoming normal rosy-pink maculopapular rash forms at the trunks

-Bulging fontanels

Rosela

Rubella (German Measles) vs Rubeola (Regular Measles)

Rubella (German Measles) → Rash starts on face and spreads down, lymph nodes swollen, no fever

Rubeola (Regular Measles) → Rash starts on face and spreads down, Koplik Spots (mouth spots), high-grade fever

*Provide comfort measures & recommend the MMR vaccine

-Abrupt high fever

-Tonsils swollen and covered in red and white spots

-White strawberry tongue

Scarlet Fever

Scarlet fever nursing care

-Penicillin

-Analgesics

-Antipyretics

Celiac Disease Teaching

-High calorie, High protein

-Restrict lactose during acute episodes

-BROWS (bad) → Barley, Rye, Oats, Wheat, Spelt

-Good foods → Rice, corn, millet

Cystic Fibrosis Manifestations

-Chronic, dry cough

-Cyanosis & clubbing

-Failure to thrive

-Lab Tests → Deficiency in fat soluble vitamins (A, D, E, K)

Cystic Fibrosis Nursing Care

-Oxygen

-High Calorie Diet, High Snack Diet→ Pancreatic enzymes administered within 30 mins of eating

-Chest Physiotherapy → Not before or after meals

-Monitor weight loss and muscle wasting

Sickle Cell Anemia Manifestations

-Chronic Anemia → Hemoglobin below 10

-Hands and feet cold to the touch

-Pain

-Vaso-occlusive crisis → Unbearable pain, swelling of joints, priapism.

Sickle Cell Anemia Nursing Care

-”HOP”

-Hydrate

-Oxygen

-Pain management (opiods)

-Apply warm compress to painful joints

-Rest frequently

-No contact sports or long periods of sun exposure

Group of bleeding disorders that results in a deficiency of a clotting factor

Hemophilia

Hemophilia Manifestations

-Prolonged bleeding

-Epistaxis (nose bleed)

-Hemarthrosis (bleeding that causes joint swelling)

-Low aPTT but normal PT

Hemophilia Nursing Care

-Hemophilia A → IV infusion of Factor VIII STAT

-Hemophilia B → IV infusion of Factor IX STAT

-NO ASPIRIN OR NSAIDS

-Bleeding precautions → soft bristle toothbrush, electric razor

-Encourage non-contact sports

-RICE method during injuries

CPR Children

-15:2 Chest compressions/breath

-Compression rate s 100/min

-Infant chest depth → 1.5 inches

-Children → 2 inches

Chocking Children

-Forearm holding position with head down, and give 5 back blows

-Turn the child around and do 5 chest thrusts

-Perform a finger sweep if object is visible (never do a blind finger sweep)

-If doesn’t work, prepare to do CPR

Juvenile Idiopathic Arthritis Nursing Care

-Heat joints

-Splint at night

-Avoid resting during day because that can cause stiffness.