Pediatric Nursing Review

Flashcards on pediatric nursing topics, including medication dosages, skin conditions, respiratory illnesses, dietary considerations, medications, immunizations, and various diseases and disorders.

Signs/Symptoms of Dehydration

Dry mucous membranes, decreased urine output, no tears, sunken fontanel (less than 18 months), sunken eyes, increased HR and RR, low BP, decreased skin turgor.

Education for Contact Diaper Dermatitis

Clean with soap and water, use skin barrier cream like zinc oxide, consider cornstarch. Baby wipes can irritate the skin.

Pediculosis Capitis

Head lice; comb out nits with a fine-tooth comb after shampoo, then repeat combing in 7-10 days, use 1% permethrin cream/shampoo, wash everything with hot water, vacuum, and bag items for 2+ weeks.

Scabies

5% permethrin cream ALL OVER BODY, wash everything with hot water, vacuum, bag other items for 5 days. They CAN go to school.

Chicken Pox Precautions

Standard (wash hands)

Impetigo Lesions

Papules that turn into vesicles that crust over with honey-colored crust. You HAVE to remove the crust. Not contagious when they are crusted over.

Chicken Pox Lesions

High contagious, contagious until lesions have crusted over (not contagious once crusted), DO NOT remove the crust.

Impetigo Medications

Burrow’s solution to remove the crust, then apply topical abx (or oral).

Chicken Pox Medications

Fever management, skin care and hand hygiene, calamine lotion, has a vaccine, acyclovir (antiviral med).

Activity information for pt. w/ CF

Encourage normal activity and do not suppress coughs.

Activity Recommendations for Juvenile Idiopathic Arthritis (JIA)

Swimming/pool activity, low impact sports, ROM exercises, OT/PT/PCP/eye doctor appts, muscle strengthening activities.

JIA Diagnostic test

Slit lamp eye exam → uveitis

Activity Recommendations w/ HIV

HIV pts can still be physical and be around people! Limited activity.

Activity Recommendations for Mono

Limited activity. No strenuous activities due to enlarged spleen. Encourage rest. No contact sports for 6-8 week due to enlarged spleen, Drink hydrating liquids, Stay hydrated, Saltwater gargles.

Mono Contraindications

NO ABX FOR MONO

LTB Considerations

Try not to let these kids cry (it worsens airway obstruction.)

Dietary Considerations: CF GI

High calorie, high protein, high sodium diet = promotes proper growth.

CF GI (Pancreatic Enzymes)

Pancreatic enzyme within 30 minutes of every meal/snack = promotes normal digestion.

What to monitor: stools

Stools: large, loose, fatty, sticky, foul smelling = not good (means that they aren’t getting enough pancreatic enzymes)

CF Resp Dietary Considerations

No chest physiotherapy around meals!

Pertussis Considerations

Small frequent meals and small drinks because they cough so much they could vomit. So this is to reduce the chance of vomiting Proper positioning when eating, they need to sit up.

Vaccine for pertussis

Vaccine for pertussis is DTap.

When caring for someone with pertussis…

Assessing respiratory, IV abx, Put them on a pulse ox, Wear PPE and mask, Droplet precautions, Maybe suction and chest physiotherapy.

Post op tonsillectomy dietary considerations

No oj, no citric juices or foods. Applejuice is okay! No red/brown colored foods (can get confused with blood)

Post op tonsillectomy dietary considerations

Soft bland diet! (avoid milk and NO ice cream!) Encourage them to have rest (no strenuous activity)

Antibiotics Education

Always finish the full course of meds. Abx are only for bacterial infections! Not viral.

Antipyretics function

Decreases fever. Promotes comfort. Decreases fluid requirement.

Racemic epi

Inhaled through a nebulizer – this is not an epi pen!!! (onset is 30 minutes, lasts 2 hours, keep the pt calm.)

Anaphylaxis Medications

Epi (can be given at home), Antihistamine (Benadryl – can be given at home). At this point you should go to hospital. Steroids (prednisione – given at hospital). H2 blockers (maybe, given at hospital. Will stop the histamine release)

CF Medications

Mucolytic (dornase alfa), Inhaled steroid, Bronchodilator (albuterol), Abx (tobramycin), Pancreatic enzymes, Short acting beta 2 agonists -→ albuterol!, Fat soluble vitamins (ADEK) DON’T GIVE COUGH SUPPRESSANTS!!! LET THEM COUGH IT OUT.

CF causes

BOTH PARENTS MUST HAVE THE TRAIT FOR CF FOR SOMEONE TO CONTRACT IT!!!

Asthma Medications

Albuterol (bronchodilator – WILL HELP BRONCHOCONSTRICTION). Corticosteroids (WILL HELP DECREASE THE INFLAMMATION)

Asthma Action Plan

THE SCHOOL NURSE GETS IT AND THE PARENTS DO TOO. IF THEY ARE OLD ENOUGH AND PHYSICALLY CAPABLE OF USING FLOW METER THEN THEY NEED TO DO IT 3 TIMES A DAY ALL AT THE SAME TIME WITH A BREATH OR TWO IN BETWEEN.

Vaccine Contraindications

IMMUNOCOMPROMISED AND PREGNANT PEOPLE DO NOT GET LIVE VACCINE. FLU VACCINE AT 6 MONTHS OF AGE.

Respiratory Tools

Use a pulse ox and supplemental O2, and incentive spirometer.

Respiratory S/S and Trx:

Grunting, nasal flaring, intercostal retractions, using accessory muscles. Treat this by doing intubation.

Other Respiratory education

Call 911 if kid is lethargic and not breathing well and has blue color.

LTB and epiglottitis and acute spasmodic croup.

Keep them from crying!!

Asthma Tools – peak flow meter:

Deep breath, quick forceful blow and repeat that 3 times a day, breathe in-between and reset inhaler, should be at the same time each day.

Asthma Equipment

Spacer is important because if not they are just shooting it to the back of throat.

Asthma Education – asthma action plan (green yellow red)

Green – great with no s/s and maintenance trx. Yellow – not the best, has s/s, needs trx. Red – very bad, has s/s, needs trx, call 911.

RSV Tools/Equipment

Suction (copious amounts of sputum), O2, pulse ox. If pulse ox isn’t going up you need to suction the nostrils out and clear them as the mucous could be blocking the oxygen!

RSV Education

Highly contagious!! Contact precautions, IV fluids, predisposes to asthma

Chest tube Education

If tube pulls OUT of the drainage system box, clamp the tube. If tube pulls OUT of the chest area, cover with a saline dressing gauze.

Trach Care Tools

When doing trach care on infants, put a rolled towel under the shoulders/neck of the baby (this hyperextends the neck and gives you better access)

Lumbar Puncture Education

Put and hold baby in round or c shape position. Watch the baby’s resp status during procedure. Baby gets a pacifier dipped in a ‘sweetie’ to sedate them (theres not other local anesthetic administered)

s/s of post op bleeding

Bright red emesis, lots of swallowing, lots of throat clearing, decreased BP, increased HR (hypovolemia), pale and restless.

Nursing interventions post op –

pain relief post op – do NOT lay flat, position prone or side lying to promote drainage and prevent aspiration, maintain fluid volume with ices, etc (nothing red!)

Other post op tonsillectomy education –

No sucking on straws, be cautious what you put in mouth during healing process, no strenuous activity for 2 weeks, no swimming/going under water/holding breath, etc.

LTB Meds

The med you give for this is racemic epi (nebulizer). Since the airway is so obstructed you want to prepare for intubation or trach. intubation.

Pregnancy

Bad to have during pregnancy: rubella, fifth disease

Pregnancy w/ HIV

Mom does not transfer HIV to baby during birth, but mom CANNOT breastfeed baby if she has HIV.

Lyme disease

Not all symptoms appear! Not every kid gets every symptom! You have to be in rural areas for this

Fever in 3mo or less

A fever contributes to dehydration! Trx for fever is IV fluids BOLUS!!!

Meningitis S/S: Newborn

Vague, poor tone, weak cry, poor suck, decreased PO, v/d, fever or hypothermia, bulging fontanelles (late sign), supple neck (no nuchal rigidity). Poor feeding

Meningitis S/S: 2 yrs - adolescent

Seizures (often initial sign), nuchal rigidity they will have, positive brudzinski’s and kernig’s signs, fever and chills, headache, vomiting, petechiae or purpuric rash, chronic draining ear, irritability and restlessness progress to drowsiness/delirium/stupor/and coma.

2 definitive diagnostic tests for meningitis

Lumbar puncture and CSF analysis.

Immunization:

B For 3, Dtap, Hib, IPV, PCV, RV, TIV, MMR, Varicella, Hep A, MCV 4, HPV.

Primary immunodeficiencies

comes from ‘ within ‘ the body (hereditary or congenital/present at birth)

Secondary immunodeficiencies

comes from ‘outside’ the body because of a weakened immune system (ex// chronic illness, malignancy, use of immunosuppression meds, malnutrition, prematurity, HIV infection.) treat these with IVIG

Diagnostic testing for HIV

PCR = used for infants less than 18 months. ELISA and Western Blot = older than 18 months old.

Juvenile idiopathic arthritis s/s:

Limping in morning/after rest period. Change in gate. Mobility limitations. Fever. Rash. Joints swollen! other body parts are small and skinny

Type 1

Immediate hypersensitivity

Always ask:

what symptoms do you have during an anaphylactic reaction?

Type 1 hypersensitivity reaction – anaphylaxis

symptoms appear quickly (Seconds-minutes-hours)

ringworm

Woods lamp diagnoses ringworm!

Slit lamp

Slit lamp diagnoses JIA (autoimmune) by checking the eyes!

s/s of Rubella

rash that appears on FACE FIRST, then spreads DOWN. Rash is FINE RED OF PINK. Also have a low grade fever, sore throat, headache, malaise, and cough.

s/s of Cystic fibrosis

thickened secretions (cant cough it out), wheezing, dry, unproductive cough, dyspnea, paroxysmal cough, mucus plug, cyanosis, barrel shaped chest, clubbed fingers, multiple episodes of bronchitis.

Cystic fibrosis Trx

Dornase alfa (mucolytic that decreases viscosity of mucus which INCREASES lung function), inhaled steroids (bubesonide), nebulized abx (tobramycin), chest physiotherapy and flutter valves (airway clearance).

Epiglottis

Thumb sign in x-ray, medical emergency!

RSV Bronchiolitis

Suction because of copious amounts of secretions.