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

causes 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 (strep throat, rheumatic fever, scarlet fever) left untreated or partially treated

how should you examine the ear of a child <3 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)

- no vaccines

- craniofacial abnormalities

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

• Prevent dehydration, may require re-hospitalization

• Post-operative Hemorrhage most serious life-threatening complication

• Watch for frequent swallowing, may indicate early bleeding, medical emergency

• Inspect vomit - new bleeding (bright red), old blood normal (coffee grounds)

• Teach Parent – Assess for hemorrhage first 24 hrs & 812 days after surgery, call provider if signs of bleeding

what are the s/s of epiglottitis

- drooling

- dysphagia

- dysphonia (not talking well)

- distress

- abrupt onset, may awake with difficulty swallowing and high fever

- chin thrust out in “sniffing position”

- 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

- helios or O2

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

mid 40’s

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 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 with feeds → stay sitting up for 30 minutes after

- thicken feeds

- small frequent feeds

- burp frequently

- meds

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

- watch for FTT

- fussiness

- aspiration

- coughing

- choking

• gagging

• lose weight

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 → blocks food from entering small intestine

what are the s/s of pyloric stenosis

- projectile vomiting

- olive sized mass at suprasternal notch

- visible peristaltic waves

- dehydration

- hunger

- FTT

what is intussusception

telescoping of bowels

what does intussusception do to the stools? other s/s?

• make them look like currant jelly (mix of blood and mucus)

• sausage-link lump in upper abdomen

• vomit bile

how do you tx intussusception

- barium air or saline enema → pulls bowel out

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 is the problem w/ DM type 1

• Destruction of beta cells in the pancreas, no insulin produces

• Autoimmune process, pancreatic islet of Langerhans cells destroyed

how do you tx DM type 1

Must have exogenous insulin to survive

what are s/s of DM1

polyuria (or enuresis in a toilet-trained child), polydipsia, polyphagia, wt. loss, high glucose levels, n/v fatigue, abd. pain, increased infections

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

• polyuria (or enuresis in a toilet-trained child), polydipsia, polyphagia, wt. loss, high glucose levels, n/v fatigue,

• abd pain, increased infections, burning sensation of lower extremities, poor wound healing, changes in vision

• acanthosis nigricans skin hyperpigmentation around neck, groin, axilla, AC, back of hand - caused by hyperinsulinemia, normal in darker skinned individuals

what is the tx for DM type 2

• Diet management and Wt. loss

• Oral agents to help decrease insulin resistance, allow body to better use the insulin it makes as the disease progresses & the body can no longer make insulin, the patient will need insulin injections

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

because 7% = 150 → each 1% is = 30

what is precocious puberty

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

how do you tx precocious puberty

• GnRH agonists - work by initially stimulating the pituitary gland, then desensitizes the pituitary causing LH and FSH (sex hormone) production to decrease.

• GnRH antagonists directly block GnRH receptors work in 2-4 wks., don’t miss meds or characteristics will return

• Meds given IM or SQ weekly, monthly, or several months, or continuous release implant lasting 1-2 years

• Stop meds when you want puberty to start (takes about 16 mos.), no evidence of problems with reproduction

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

• low GH levels, growth measurements (child growing <2in (3-4 cm) yr

• <3rd percentile

how do you tx growth hormone deficiency

• synthetic GH replacement, SQ injection of somatropin daily at bedtime or time-release Q 1-4 weeks

• Growth takes 3-6 mos. to start & continues until growth plates close

• average increase 1.5 in. - 2.5 in. , max. growth achieved if started early

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, oral abx, or systemic abx if extensive

- keep it covered

- avoid using same cloth/towel or drinking out of same cup

- good handwashing, trim nails

- not contagious after 24 hrs on tx

- soak crusts with warm soapy washcloth

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 satellite clusters

how do you tx candidiasis

• Nystatin oral (swabbed or swished) or cream

• Or other antifungal cream or suppository (ex. clotrimazole to affected areas

• Diflucan

• Gentian Violet

• Change diaper freq., boil bottle nipples/pacifiers, treat mom’s breasts

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

• Treat food/irritant triggers

• Prevent scratching which can lead to infection

• Wear soft cotton clothing, avoid wool, itchy fabrics

• Use mild, fragrance-free soaps/detergents

• Minimize environmental triggers like dust, pollen, pet dander

• Bathe frequently (in dry climate), Bathe infrequently (humid climates)**

• Use moisturizer frequently and immediately after baths

• Topical steroids short term, topical immunomodulators

• Keep environment cool & humidified, sweating worsens

• Stress/Anxiety may worsen

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 mild soap or otc dandruff or anti-seborrheic shampoo (salicylic acid, coal tar, etc.)

• Use soft bristled brush to loosen scales

• Avoid vigorous scrubbing

• Lotions and creams sparingly

• Steroids, antifungals

how are burns tx in children

1. administer high flow O2

2. initiate fluid resuscitation

3. recognize and tx associated injuries - stop burning process, don’t peel off adhered clothing, brush of chemical powder, flush chemical burns >30 minutes, remove eye lenses

Home care of sunburn cool bath/compress, fluids, moisturizers, local anesthetic spray/cream, acetaminophen or ibuprofen for pain

how do you prevent burns

• No direct sunlight for infants < 6 mos.

• Over 6 mos. Avoid direct sun between 10am & 4 pm

• Protective hats, clothes, sunscreen 30 SPF or higher every hour

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)

what is hypospadias

urethral opening located along the ventral surface (bottom) of penis (tx: sx correction, chordee downward curvature of penis, often associated w/ hypospadias)

what is the minimum urine output for infants through young school age children <30 kg

2 mL/ kg/ hr

what is the minimum urine output for older school age children through adolescent age children >30 kg

0.5-1 mL/ kg/ hr

what usually causes UTIs

presence of urinary tract abnormality that causes urinary stasis, obstruction, reflux, or dysfunctional voiding

what is the most common cause of acute kidney injury in children

severe dehydration