Midterm Study Guide Pediatrics

What is the Toddler Stage of Development?

Autonomy vs. Shame & Doubt

• The toddler wants to do everything by themselves

What should you do for a 3-year-old who is scared of shots?

• Use therapeutic play

• Provide comfort (a distraction such as a toy, comfort object)

• Allow them to have choices when possible (what color bandaid they want or what sticker they will get after)

What should you do if a child has a seizure?

• Maintain the airway (make sure the child is breathing)

• Side-lying (turn the child on their side to prevent choking)

• Do not restrain the child

What is the priority if a patient has Bacterial Meningitis?

Start IV antibiotics immediately to prevent Sepsis

What is a priority when assess LOC (level of consciousness)?

ABC’s

• Airway

• Breathing

• Circulation

What are signs of Increased Intracranial Pressure (ICP) after a motor vehicle accident?

• Vomiting and nausea

• High-pitched crying (unconsolable)

• Bulging fontanel

What is abnormal development for a 10-month-old?

Unable to sit up

Can regular and NPH insulin be mixed together to administer?

Yes. First, draw up the clear (regular) insulin, then draw up the cloudy (NPH) insulin

What is Reye’s Syndrome?

A life-threatening condition that causes swelling in the liver and brain

What action can reduce Reye’s syndrome?

Do not give aspirin to children with viral illness

• Do not give Alka-Seltzer

• Peptobismal

What are some nursing interventions for Bacterial Meningitis?

• Droplet precautions- mask, gloves, and gown

• Quiet/dim environment

• Elevate the head of the bed

• Seizure precautions

• Only 1 blanket and 1 sheet

• Only 1 person can be in that room

What are nursing actions for a child experiencing seizures?

• Protect the airway

• Place patient in side-lying position

• Suction PRN

• Document onset/duration

How do you determine the level of consciousness in a Pediatric patient?

Glascow Coma Scale

• Eye control

• motor control

• Verbal response

Should be 15… if not, their level of consciousness has changed

What Gross motor and Fine motor skills should a 10-month-old be able to do?

• Sit up

• Pincer grasp (pick up a single cheerio with 2 fingers)

Up to how many mL of medication can you give to a pediatric patient?

• 1 mL

• 0.5mL per muscle (so divide doses to different parts)

Where do you give kids insulin?

On the back of their arm Subcutaneously

What is a fever in the pediatric patient?

Anything over 101 degrees F

How does Bacterial meningitis spread?

• Coughing

• Saliva

Who is at greatest risk for developing a seizure?

• High temperature (Febrile seizure)

• Head injuries

• A child who has already had a seizure

What percentage of kids have febrile seizures?

Less than 5%

What fine motor skills should a 15-month-old have?

• Standing alone (without holding onto anything)

• Feeding themselves

Is a 4-year-old with epilepsy be an epileptic for their whole life? Are there family members likely to have epilepsy as well?

• They will be epileptic from birth, and on

• Not all family members will have epilepsy; it is not directly inherited

Is it normal for a 4-year-old to have imaginary friends

Yes it is normal to have imaginary friends at this age

What is anticipatory guidance?

It is guidance used for prevention as well as anticipating what will come in the near future to create a good outcome, using prior knowledge

What is the first change in LOC in a pediatric patient?

• Lethargic and not arousable

How do you give Diastat?

Rectally

What is Diastat?

A rescue medicine to prevent prolonged seizures

What are Erikson’s stages of development (0-18 years)

• Trust vs Mistrust

• Autonomy vs. Shame & Doubt

• Initiative vs. Guilt

• Industry vs. Inferiority

• Identity vs. Role confusion

Symptoms for increased intracranial pressure (ICP)

• Lethargy

• Nausea and Vomiting

• Crying without consolability

What if a child has a Purpura Rash and has Meningitis?

This indicates a hemorrhage, contact the provider immediately

What is an early sign of altered intracranial

Change in Level of Consciousness (LOC)

What should you do if a child comes in after a Bike accident?

Maintain an airway

What should you do if a child has Reye’s Syndrome

Strict I&O to monitor for dehydration and check for cerebal edema

What should you do for a child who has Hydrocephalus

• VP shunt

• check for infection (look at the drainage behind the left ear) '

• Monitor intake and output

• Check for abdominal distention

• Check if the fontanel is still bulging

• Check for signs of intracranial pressure (crying, vomiting)

What should you educate parents about their child who has a concussion?

Difficulty concentrating for about 2 months after hospitalization

What are seizure interventions?

• Turn the patient on their side

• check airway- use pulse ox, look at color (mucous membranes), use stethoscope to listen to lungs

• Check vital signs

• Time the seizure

• Where is it located?

How would you help an adolescent who has been hospitalized for a long time?

• Let them decorate their room

• let them see their friends or talk on the phone

• let them wear clothes from home

Where is Croup located?

Upper Respiratory

Interventions for Croup

• Humidifier

• Corticosteroids

• breathing treatments

• Put them in the opposite environment (if cold, then move to warm)

At what time does Croup get the worst?

In the evening

How do you diagnose Cystic Fibrosis (CF)?

Sweat test (Sodium chloride)

What is the diet for Cystic Fibrosis patients?

• Low fat

• High protein

• High Carbs

What medicines do Cystic Fibrosis patients take before they eat?

• Pancreatic enzymes

• Vitamins A, B, C, D, E

If a child is having Dyspnea what should you do?

• Sit them up in High-Fowler’s position

• Give oxygen

What are signs of respiratory distress?

• Retraction

• Cyanosis

• Tachypnea

• Tachycardia

• Nasal flaring

• Grunting

• Head bobbing

• Pallor

What are signs of respiratory failure?

• Severe Retractions or cessation of retractions (muscles give out)

• Cyanosis

• Hypoxemia (Low O2 stat)

• NOT BREATHING

How would figure out whether a patient is in failure to thrive or obese?

Plot their height/weight on the growth chart

What is failure to thrive vs. obese?

• Below the 5th percentile

• Above the 95th percentile

What foods would you give a patient with Cystic Fibrosis

• Nuts

• Meat (chicken)

What are some side effects of Gentamicin?

• Damage to ears (ototoxicity) and kidneys (nephrotoxicity)

What are some nursing intervention for RSV?

• Droplet precautions (mask, gown, gloves)

• Calm and quiet environment

• Cluster care (do everything at once)

What assessment would you perform after giving a bronchodilator?

Respiratory assessment

How does a toddler with RSV spread the infection?

Coughing, sneezing, saliva

A Cystic Fibrosis Patient has labored respirations, fatigue, malnutrition, and failure to thrive?

• Loosen secretions (vest)

• Administer oxygen if necessary