WKU Peds Final Study Guide

name 3 signs of respiratory distress in an infant/ young child

- nasal flaring

- grunting

- retractions

- tripod position

- rapid resp. rate or shallow breathing

- slow resp. rate an ominous sign

- indicates resp. failure

what is the leading cause of death in children

injuries

how do you prevent injuries from occurring in children

- car seats

- seatbelts

- bicycle helmets

- childproof containers

- fenced pools

a toddler ingests half a bottle of liquid Tylenol (acetaminophen). what med would you expect to be ordered

mucomist

what organ does acetaminophen affect

liver

what age child would be most likely to think their illness is caused by a bad thought or a deed and what are some interventions the nurse could use

- preschoolers: egocentric and magical thinking

- tell the child they are not the cause of the disease, they rarely are upfront about their thinking due to guilt and shame

- encourage them to discuss their thinking and explain their illness and it's cause to them.

list the 4 stage of parental response to illness in order

- denial

- anger

- depression

- exhaustion

comparing VS of a child to an adult, should the pulse be faster or slower

- HR and RR higher

- BP lower

how long should infants be on breastmilk/ formula milk

for the first year

when can infants be introduced to solid foods

after 6 mths: not before due to allergies, head control, tongue thrust, digestibility, teeth erupting

what are examples of choking hazards

- hot dogs

- nuts

- grapes

- raisins

- gum

- fruit and veg chunks

- popcorn

- peanut butter

how do you weigh diapers and measure output

subtract dry wt from wet wt (1gram of wt = 1 ml of output)

what is the preferred site for IM injection in children and what is the max volume for older infants and small children

vastus lateralis (1 mL)

what is a good pain scale to use for children

wong baker faces scale

what is the preferred opioid for children

morphine

why is aspirin not ok for children

reyes syndrome

what are the s/s of dehydration in children

- sunken fontanel

- decr. output

- dry mucous membranes

- decreased tears

- weak rapid pulse

- lethargy

how do you care for a child post cardiac cath

- keep leg straight 4 to 6 hrs

- watch for hemorrhage

- check VS and pulses in affected extremity as well as color and temp/ extremity

what drug is commonly given for HF in peds

digoxin

what are some interventions for digoxin

- always check dose w/ another nurse

- count apical pulse before giving

- don't give if <100 in infants

- s/s of toxicity: n/v anorexia, bradycardia, dysrhythmias

what is a tet spell

hypercyanotic episode often seen in tetralogy of fallot

what are the 4 defects found in tetralogy of fallot

- VSD

- pulmonic stenosis

- overriding aorta

- right ventricular hypertrophy

what are some interventions for tet spells

- place infant in knee chest position

- calm and comfort

- 100% O2

- morphine to slow respirations

name the 2 congenital heart conditions that can occur if the structures necessary for fetal circulation don't close after birth

patent ductus arteriosis and patent foramen ovale

what causes rheumatic heart disease

group a beta hemolytic streptococcal

what is the name of the criteria for rheumatic heart disease

jones criteria

what are the s/s of rheumatic heart disease

- fever

- chorea

- polyarthritis

- rash

- abd pain n/v

- sore throat

how should you examine the ear of a child <2 yo

pull the pinna down and back

what are some risk factors for ear infections in infants

- second hand smoke

- daycare

- pacifier use

- bottle feeding (especially lying flat)

how should you stop a nose bleed

- lean forward

- pinch soft lower portion of nose

- child breathes through nose

- hold 10 to 15 min w/out looking

name 3 interventions for a child post tonsillectomy

- encourage clear cool liquids day 1: no red

- adv to soft

- cool mist humidifier

- pain meds

- ice collar

- phenergan

- observe for s/s of hemorrhage

- swallowing freq when asleep

- bright red vom (old brown ok)

what are the s/s of epiglottitis

- drooling

- difficulty swallowing/ talking

- sitting up tripod position

what are some interventions for epiglottitis

- NEVER examine throat: can cause spasm and throat closure

- always have intubation equip on hand

what age group is SIDS most common in

2-4 mths

how do you prevent SIDS

- back to sleep

- no pillows

- soft bedding

- stuffed animals

- blankets

- no smoking

what is the diagnostic test for CF

sweat chloride test

how do you get CF

inherited autosomal recessive

what is the average life span of someone w/ CF

33 yo

why do children w/ CF need digestive enzymes and vit supplements

they are needed because thick mucus blocks digestive enzymes from the pancreas and vits are given because digestion in the gut is blocked by mucus

what is shaken baby syndrome

a serious brain injury resulting from forcefully shaking an infant or toddler

what are the s/s of shaken baby syndrome

- intercranial hemorrhage and retinal bleeding

- sz

- apnea

- coma

- vomiting w/ lethargy

- retinal hemorrhage

what is the most common trigger for shaken baby syndrome

crying

what are some s/s of downs

- simian crease

- short neck and stature

- epicanthal folds

- small ears

- wide flat nasal bridge

- heart defects

- cataracts

- hypothyroid

what gene is affected in downs

21

what are some developmental areas affected by autism

- rate and appearance of social, physical and language skills

- abnormal response to body sensations

- delayed speech and language

- abnormal ways of relating to people, objects, and events

what are some interventions for helping children w/ autism

- limit staff changes

- keep routines

- sign language

- family member present

what are some common anaphylactic triggers

- nuts

- milk

- eggs

- wheat

- shellfish

what are the s/s of an anaphylactic reaction

- sneezing

- swelling mouth

- tongue

- edema

- flushing

- itching, rash

- respiratory probs

- impending doom

what should you teach family members about regarding a child w/ severe allergies

- carry epipen

- medic alert bracelet

what are some interventions for decreasing GERD in infants

- HOB up

- thicken feeds

- small frequent feeds

- burp frequently

- meds

- possible sx

what are some signs that reflux is a problem for an infant

- watch for FTT

- fussiness

- aspiration

- coughing

- choking

what are the s/s of appendicitis

- progressive pain

- McBurney's point

- n/v

- rebound tenderness

- pain localizes w/ movement

- increased WBCs

what is pyloric stenosis

narrowing of pyloric valve at end of stomach

what are the s/s of pyloric stenosis

- projectile vomiting

- olive sized mass RUQ

- visible peristaltic waves

- dehydration

- hunger

- FTT

what is intussusception

telescoping of bowels

what does intussusception do to the stools

make them look like currant jelly

how do you tx intussusception

- barium air or saline enema

- sx

what are some indicators of physical abuse

- unexplained bruises or welts in odd places, in various stages of healing, and shaped like articles used for abuse such as irons, cigarettes, belts, hangers, etc.

- unexplained burns in odd places or immersion patterns such as gloves, socks

- unexplained fractures in various stages of healing

what type of thyroid problem is graves disease

hyperthyroidism

what causes DI

ADH deficiency

what are some s/s of DI

low urine specific gravity and hypernatremia

what is the problem w/ DM type 1

pancreas unable to produce and secrete insulin (autoimmune process)

how do you tx DM type 1

- insulin pump

- snack before exercise

what is the problem w/ DM type 2

- production of excess insulin but the cells are resistant to it

- r/t obesity

- peak incidence at puberty but seen in children as young as 3 yrs

what are the s/s of DM type 2

may see skin darkening around neck, groin, axilla (acanthosis nigricans)

what is the tx for DM type 2

wt loss and meds

what are the s/s of both types of DM

3 Ps

what is hgb A1C

measure of average blood sugar over the past 3 mths

what is the blood glucose of an A1C of 8

180

what is precocious puberty

early onset of puberty traditionally before 8 in girls, before 9 in boys

how do you tx precocious puberty

GnRH agonist/ blocker

how would you know if a child has a growth hormone deficiency

ht below 5th percentile

how do you tx growth hormone deficiency

growth hormone SQ injections: must be given before growth plates close and best to give at night

how is PKU detected

every newborn is screened

how do you tx PKU

- limit phenylalanine/ protein

- no aspartame

what should you teach parents about taking care of their childs ear tubes

- use ear plugs when in dirty water

- watch for purulent drainage (can still get infections)

- fall out in 6 to 12 mths

how should you check the vision in a 3 yo and what are you trying to prevent

tumbling e or HOTV chart (snellen chart) to prevent amblyopia

how do you tx amblyopia

eye patch on non affected eye

what teaching do you need to do for conjunctivitis

- wipe eye from inner to outer canthus, away from other eye

- clean each eye w/ separately

- don't touch eye drops tip to eye

- contagious until 24 hrs of abx eye drops

- instruct in good handwashing and not to share towels/ cloths

what causes impetigo

staph or strep

what does impetigo look like

lesion w/ honey colored fluid that dries crusty

how contagious is impetigo

very

how is impetigo tx

- abx ointment or systemic abx if extensive

- keep it covered

- good handwashing

candidiasis likes what kind of environment

dark and moist

what is oral thrush

- white, milk curd like plaques on tongue, gums and buccal mucosa that are difficult to wipe off (unlike milk)

- may bleed, hurt to eat, and/ or make mom's breasts sore

where does a diaper rash occur

in the groin area/ skin folds

what does a diaper rash look like

tiny red, raised bumps in clusters

how do you tx candidiasis

nystatin oral (works by staying in mouth, give after feedings) or nystatin or lotrimin cream for bottom

what is scabies

female mites that burrow under the skin

what are the s/s of scabies

- intense pruritis, espec at night

- lesions are linear

- papules, vesicles and nodules often seen on fingers (in webbing), wrists, axillae, groin, buttocks

how is scabies tx

permethrin cream (Elimite) cream: must stay on 8-14 hrs, apply at bedtime, wash off in AM

what is eczema

- intensely pruritic

- dry red plaques on the skin: worsens with heat, or scratchy fabrics, mild detergent

how do you tx eczema

apply lotion after bath while skin still moist

what is seborrhea nonpuritic

oily, yellow scales that block sweat and sebaceous glands: seen on scalp (cradle cap), eyelids

how do you tx seborrhea nonpuritic

- use otc shampoo

- soft bristled brush

- don't use lotions or creams as they aggravate condition

how are burns tx in children

- hydrotherapy

- debridement

- antimicrobial creams (ex. Silvadene)

- initially focus on ABCs, then observe for "burn shock" (hypovolumia) and infection tx

how do you prevent burns

- reduce water temp: set the thermostat on your hot water heater to 120 F (48.8 C) or lower

- avoid hot spills: don't drink or carry hot beverages or soup while holding a child; turn the handles of your pots and pans inward on the stove; avoid using a tablecloth

- establish a 'no zone' area in front of your stove

- unplug curling irons and clothes irons when not in use

- choose a cool mist humidifier instead of a steam vaporizer

- childproof outlets to prevent electrical burns

- fire retardant clothes, lock up matches and lighters, use heaters and candles w/ caution

- sunburn: use SPF 30 or above

when does puberty start for girls

8-13 yo

when does puberty start for boys

9-15

what is epispadias

urethral opening located on dorsal (top) surface of penis (tx: sx correction)