WVU NSG320 Final Exam

Expected Output

1mL/Kilo/Hr

Interventions (Medication Administration)

-Calculate Safe Dose Using Current Weight

-Advocate for Patient

-Double Check High Risk Meds w/ Another RN

-Do Meds Checks in Quiet, Nonstimulating Area

-Gather All Supplies

-Two Patient Identifiers

Interventions (Oral Medication Administration)

-Use Med Syringe/Cup

-Measure in mL, not tsp or TSP

-Do Not Mix w/ Formula

-Do Not Refer to As Candy or "Yummy"

-Hold or Sit Upright

-Administer Small Amounts Inside of Mouth

-Use Tricks to Get Child to Swallow

-May Consider Adding Flavor, Mixing w/ Applesauce, Using Popsicles, Using a Chaser

-Give Choices, Not Chances

-Use Play/Distraction

-Check Tube Placement, Consider Flush

Neonatal and Infant Pain Scale (NIPS

-Facial Expression

-Cry

-Breathing Pattern

-Arms

-Legs

-State of Arousal

Faces, Legs, Activity, Cry, Consolability (FLACC)

Used in Infants and Children <7

-Facial Expression

-Position of Legs

-Activity

-Crying

-Consolability

FACES

Used >3

-Rates Pain 0-5 Using Diagrams of Faces

OUCHER

Used 3-13

-Rates Pain 0-5 Using Photographs

Visual Analog Scale (VAS)

Used >7

-Rate Pain 0-10

Additional Assessment Data (Pain)

-Facial Expression

-Dilated Pupils

-Guarded Movement

-Moaning/Crying

-⬇️Attention Span

-Non Cooperative

-Changes in VS

Temperature (Pediatric Vital Signs)

Normal➡️<37.7C (99.9F)

-Toddler w/ Fever➡️Nonemergent

-Infant (<4 Months) w/ Fever➡️Emergency

Pulse (Pediatric Vital Signs)

Normal➡️100ish

-Higher in Infants➡️Slows as You Grow

-Children <12 w/ Pulse <60 and Symptomatic➡️CPR

Respirations (Pediatric Vital Signs)

Normal➡️20-30ish (Infants/Toddlers), 20ish (Children)

-Higher in Infants➡️Slows as You Grow

BP (Pediatric Vital Signs)

Normal➡️60-80/40-50 (Infants), 100ish/50-70 (Children)

-Lower in Infants➡️Higher as You Age

General (Pediatric Health Assessment)

-Muscle Tone

-Body Odor

-Eye Contact

-Follows Commands

-Speech/Language

-Motor Skills

-Interaction w/ Family

-Skin, Hair, Nails

-Lymph Nodes➡️Small, Palpable, Contender, Mobile

Head (Pediatric Health Assessment)

Usually Assessed Last

-Shape➡️Head Circumference

-Fontanels

-Face

-Neck➡️Check ROM

Fontanels (Pediatric Health Assessment)

-Flat, Pulsate

-Sunken➡️Dehydration

-Posterior➡️Closes 2-3 Months

-Anterior➡️Closes 12-18 Months

Eyes (Pediatric Health Assessment)

-Visual Acuity➡️Formally Assessed After 3

-Corneal Light Reflex➡️Symmetrical by 4-6 Months

-PEERLA

-Red Reflex➡️Should be +

-Permanent Color by 1

Ears (Pediatric Health Assessment)

-Hearing

-Alignment➡️Tops of Ears and Eyes

-Nontender

-<3➡️Pinna Down and Back

->3➡️Pinna Up and Back

-Assess for Redness,⬇️Mobility, Pus

-Assess TM for "Dancing"

Mouth/Throat (Pediatric Health Assessment)

-Visible Tonsils Common

-~6 Months-2 Years➡️Age (In Months)-6=# of Teeth

Thorax/Lungs (Pediatric Health Assessment)

-Infants Chest Shape➡️Circular

-<7➡️Abdominal Muscle Movement During Respirations

-Infants Respiratory Rate is Often Irregular

-Often Hard to Determine Upper vs Lower Respiratory Sounds

-Assess for Retractions,⬆️RR/Effort

Heart/Pulses (Pediatric Health Assessment)

-Sinus Arrhythmia Associated w/ Respirations Common

-Innocent Murmurs Common

-Listen Upright and Reclines

-Observe for Clubbing➡️Abnormal >6 Months

-Listen to All 4 Valvular Areas

-Assess Brachial and Femoral Pulses

PMI (Pediatric Health Assessment)

-Infants to 4➡️4th ICS Left Midclavicular Line

-4 to 6➡️4th ICS Left Midclavicular Line

->7➡️5th ICS Left Midclavicular Line

Genitalia (Pediatric Health Assessment)

Males:

-Locate Testes

-Examine Scrotum, Meatus

-Assess for Adhesions

Females:

-Assess for D/C, Adhesions

-Importance of Proper Wiping

Musculoskeletal (Pediatric Health Assessment)

-Examine Spine

-Note Muscle Tone

-Legs, Hips, Creases Should be Even

-Examine Joints➡️Swelling, Redness, Pain

-Note Gate➡️Toddler Bowlegged, Preschooler Knock Knee

-Feet Should Face Forward, Shoes w/ Even Wear

Neuro (Pediatric Health Assessment)

-Infant Reflexes

-DTR

-Language

-Cognition

-Fine/Gross Motor Development

Sx (Physical Neglect)

-Failure to Thrive

-Lack of Hygiene

-Frequent Injuries

-Dull Affect

-Self Stimulating

Sx (Physical Abuse)

-Bruises

-Welts

-Fx in Different Stages of Healing

-Aggression

-Lack of Emotion

Sx (Emotional Neglect/Abuse)

-Failure to Thrive

-Enuresis

-Sleep Disturbances

-Self Stimulating

-Delayed Development

Sx (Sexual Abuse)

-Lacerations Around Mouth, Genital Area, Anus

-STI/UTI

-Regressive Behaviors

-Personality Changes

Sx (Abuse in Infants)

-Bruising

-Fx

Shaken Baby Syndrome/Shaken Impact Syndrome:

-Vomiting

-Poor Feeding

-Bulging Fontanel

-Retinal Hemorrhages

-Seizures

-Apnea

-Bradycardia

Authoritarian Parenting

-Strict Rules

-Little Decision Making

Authoritative Parenting

-Consistent Rules, Room for Adapting

-Consequences of Actions Reinforced

Permissive Parenting

-Children Control Environment

Discipline

⬆️Desirable Behaviors, ⬇️Undesirable Behaviors:

-Positive Reinforcement➡️Time In

-Extinction➡️Time Out, Ignoring

Punishment

Negative or Unpleasant Experience:

-Verbal➡️Scolding, Disapproving Statements

-Nonverbal➡️Spanking

Recommendations (Discipline)

-Clear, Consistent Expectations

-Avoid Spanking

-Role Model Desired Behavior

-Give Attention, Praise Desired Behavior

-Provide Consequence of Behavior (+/-) Immediately

Permanent Contraindications (Immunizations)

-Anaphylaxis

-Encephalopathy

Temporary Contraindications (Immunizations)

-Immunocompromised

-Pregnant➡️No Live Vax

-Intussusception➡️No Rotovirus

-Recent Blood Products➡️Passive Immunity for 3-6mo

-Moderate-Severe Illness

Infancy (Immunizations)

-Hep B➡️3 Dose, Birth

-Diptheria, Tetanus, Pertussis (DTaP)➡️2mo

-HIB➡️2mo

-Polio (IPV)➡️Inactivated, 2mo

-Pneuomcoccal➡️2mo

-Rotovirus➡️Live, Oral, <32weeks

Toddlerhood (Immunizations)

-Varicella➡️Live, >12mo, Booster at 4

-MMR➡️Live, >12mo, Booster at 4

-Hep A➡️2 Dose, >12mo,

-Varicella/MMR➡️Given Together or 28 Days Apart

Age 11 (Immunizations)

-HPV➡️3 Doses, Boys/Girls, Early as 9

-Meningococcal➡️11, Booster at 16

Weight (Infant)

-Birth Weight Doubles by 6mo

-Birth Weight Triples by 1 Year

Gross Motor Skills (Infants)

Cephalocaudal Development➡️Head to Tail:

-Head Control➡️2-4mo

-Roll Over➡️5mo

-Sit Up➡️6-8mo

-Crawl➡️8-9mo

-Pull to Stand➡️10mo

-Walk➡️12mo

Fine Motor Skills (Infants)

Proximodistal:

-Hold Hands in Front of Face➡️3mo

-"Bats" w/ Hands➡️4mo

-Gross Grasping➡️5mo

-Transfers Objects➡️7mo

-"Rakes" Objects➡️8mo

-Bangs Objects➡️9mo

-Neat Pincher Grasp➡️10-11mo

-Attempt to Build Tower of 2 Blocks➡️12mo

Motor Development Red Flags (Infants)

-Extremities Stiff/Floppy

-Major Head Lag at 3mo

-Use Only 1 Side of Body

-Does Not Crawl or Stand w/ Support by 12mo

-Primitive Reflexes Persist

Communication Development (Infants)

-Coos/Makes Vocalization/Differentiates Cries➡️1-3mo

-First Real Smile➡️2mo

-Vowel Sounds/Laughs/"Raspberries"/Vocalizes Response/Responds to Own Name➡️4-5mo

-Squealing/Yelling➡️6mo

-Babbling Progresses to Words➡️7-10mo

-Attaches Meaning to Words➡️9-12mo

-2-3 Words➡️12mo

Communication Development Red Flags (Infants)

-Does Not Make Sound by 4mo

-Does Not Laugh/Squeal by 6mo

-Does Not Babble by 8mo

-Does Not Use Any Words w/ Meaning by 12mo

Breastfeeding (Infants)

-Birth Until Parent/Child Comfort➡️Goal 12mo

-Feed Upon Demand

-No Water Supplementation Needed

-Vit D Supplementation Recommended

Formula (Infants)

-Birth to 12mo

-Standard Formula➡️Based on Cow's Milk, 20kcal/oz➡️24-32oz/Day

-No Water Supplementation Needed

Solids (Infants)

-Delay Until 6mo

-Introduced New Foods 4-7 Days Apart➡️Identify Allergies

-Baby Cereal➡️Fruit/Veggies➡️Meats (10mo)

-Juice➡️Only in Cup➡️Max 4oz/Day

Nutrition (Infants)

-Feed When Cues of Being Hungry➡️Before Crying

-Eat as Family

-Model Good Eating Behaviors

-Do Not Allow Child to Eat "Whatever"

-Do Not Coerce into Cleaning Plate

-Serving Size➡️1 TSP/Year (Age)

Prevention (SIDS)

-Back to Sleep

-No Tobacco

-Prevent Overheating

-Firm, Tight Fitting Mattress➡️No Pillows, Quilts

-Ensure Head is Kept Uncovered

-Discuss Safe Cosleeping➡️Same Room, Not Same Bed

-Encourage Breastfeeding

-Offer Pacifier

-Keep Immunizations UTD

Diaper Dermatitis

Inflammatory Reaction of Skin in Area Covered by Diaper

-Flat Red Rash in Skin Creases

-Bright Red Satellite Lesions➡️Yeast

Interventions (Diaper Dermatitis)

-Super Absorbent Diapers, Non Fragrance Wipes

-Change Frequently

-Allow Air Time

-Skin Barrier w/ Zinc Oxide

-Nystatin (Clotimazole)➡️Yeast

Seborrheic Dermatitis

"Cradle Cap," Chronic Inflammatory Dermatitis on Skin/Scalp:

-Thick/Flaky, Greasy Yellow Scales on Scalp, Forehead, Ears, Neck, Diaper Area

Interventions (Seborrheic Dermatitis)

-Apply Mineral Oil➡️Massage➡️Wait 15min➡️Shampoo w/ Soft Brush

-Use Dandruff Shampoo 3x/Week

Play (Toddlers)

-Important➡️Their Work/How They Learn

-Parallel Play➡️Alongside Other Children

-Short Attention Span

-Egocentric➡️Do Not Expect Sharing

-Learning to Sort Shapes/Colors

-May Start to Play Make Believe

Play (Preschoolers)

-Associative Play➡️Cooperative Play w/o Rigid Rules

-Appropriate Toys

Toilet Teaching (Toddlers)

-Assess for Readiness➡️Pulls Pants Down, Brings Diaper to Adult, Dry While Napping, Favorite Spot

-Approach in Calm, Non-Punitive Manner

-Praise Appropriate Behavior

Psychosocial Development (School Age)

Industry vs Inferiority (Erikson):

-Industry Achieved Through Advancements in Learning

-Motivated by Tasks that Increase Self Worth

-Rule Following Behavior

-Increased Interactions Outside of Home➡️Develop Best Friends

Psychosocial Development (Adolescents)

Identity vs Role Confusion (Erikson):

-Focus on Bodily Changes

-Compare Self to Others

-Frequent Mood Changes

-Strives to Master Skills Within Peer Group➡️Separate From Family

-Begin to Be Attracted to Others

-Impulsive

-Tests Limits/Rules

-Develop Own Sense of Values/Beliefs

Puberty (Adolescents)

-Rapid Growth

-Sexual Characteristics/Reproductive Maturity

-Girls➡️9-10➡️Thelarche (Breasts), Adernarche (Pubic Hair), Menarche (Menses)

-Boys➡️10-11➡️Penis/Scrotum Enlarge

Education (Fever)

-Fever➡️Protective Mechanism to Fight Infection

-Common in Toddler Years

-⬆️PO Intake

-Teach S/Sx of Dehydration

-Antipyretics Not Always Necessary

-No ASA➡️Reye Syndrome

-Febrile Seizures Common

-Seek Tx in Young Infant, Fever Lasting >3-5 Days, "Toxic Looking/Acting," Temp >105-106F, Underlying Condition

Impetigo

Very Common Skin Condition if Toddlers/Preschoolers:

-Etiology➡️Staph

Assessment (Impetigo)

-Reddish Macule

-Vesicular➡️Ruptures➡️Exudate Dries to Honey Colored Crust

-Pruitis

Interventions/Education (Impetigo)

-Burrows Solution Compresses

-Topical ABX Cream➡️Bactroban

-Handwashing

Scarlet Fever

Strep Throat That Produces Toxin That Causes a Sandpaper Rash:

-Peak Age 4-8, Unlikely in Children <2

-Risk of No Tx➡️Glomerulonephritis, Rheumatic Fever

-Etiology➡️Group A Strep, Droplet, Contagious During/24hr After ABX

Assessment (Scarlet Fever)

-Fever

-HA

-N/V

-Sore Throat➡️Pharyngitis

-Lymphadenopathy

-Strawberry Tongue

-Sandpaper Rash➡️Fine, Maculopapular Rough Rash in Groin, Axilla, Neck Folds➡️Skin of Fingers/Toes May Peel After Rash Fades

Interventions (Scarlet Fever)

-Administration of Penicillin or Amoxicillin as Ordered

-Fluids to Keep Child Hydrated➡️Soups, Popsicles, Milkshakes

-Cool Mist Humidifier

-Acetaminophen or Ibuprofen➡️Pain, Fever

-Replace Toothbrush

-Throat Lozenges

Education (Scarlet Fever)

-Wash Hands

-Do Not Share Drinks/Utensils

-Isolate Until 24hr After ABX

-Complete ABX

-Change Toothbrush

-Wash Linens

Rubeola (Measles)

Contagious Illness That is Infrequently Seen in the US:

-Etiology➡️Airborne Transmission

-Incubation➡️8-12 Days

-Communicability➡️1-2 Days Before Prodromal Sx, 3-5 Days Before Rash, 4 Days After Rash

Assessment (Measles)

-Prodromal

-Rash

-Systemic

Prodromal Sx (Measles)

-Coryza

-Cough

-Conjunctivitis

-Fever

-Malaise

-Koplik Spots➡️Small Red Spots in Mouth w/ Bluish White Center

Rash (Measles)

-Brownish, Red Macular Rash

-Starts at Hairline➡️Spreads Down

Systemic Sx (Measles)

-Fever

-Cough

-Red, Watery Eyes

-Coryza

Interventions/Education (Measles)

-Supportive Measures

-Manage Fever w/ Acetaminophen, Ibuprofen

-Keep Child Isolated for 5 Days After Rash

-Dim Lights if Photophobia Occurs, Use Warm Compresses to Remove Crust from Eye

-Give Soft, Bland Foods

-Keep Child Well Hydrated

-Cool Mist Humidifier

-Vit A Supplementation➡️Decreased Mortality, Complications

-Avoid Exposure to Pregnant Women

-Isolation

-Supportive Care

Complications (Measles)

-Ear Infections

-Diarrhea

-Encephalitis

-Pneumonia

-Seizures

-Deafness

-Mental Retardation

-Death

Hand Foot and Mouth Disease

Infectious Disease Causing Lesions to Mouth, Hands and Feet:

-Etiology➡️Enterovirus, Direct Contact

Assessment (HFMD)

-Fever

-Vesicles on Tongue that Erode into Ulcers, Football Shaped Vesicles on Hands/Feet

-⬇️PO Intake

Interventions/Education (HFMD)

-Supportive

-Isolate to Home

-PO Fluids

-S/Sx of Dehydration

-Pain Control

Expectorant (Respiratory DO)

⬇️Viscosity of Thickened Secretions by⬆️Resp. Tract Fluid

Decongestant (Respiratory DO)

Tx of Runny/Stuffy Nose Associated w/ Cold, Sinusitis, Allergic Rhinitis >6

Cough Suppressant (Respiratory DO)

Suppress Cough Reflex

Antihistamines (Respiratory DO)

Tx of Allergic Conditions:

-May Cause Dry Mouth, Drowsiness

Short Acting B2-Adrenergic Agonist (Respiratory DO)

Relax Smooth Muscles, Bronchodilators➡️Albuterol:

-May Be Taken Before Exercise as Needed

-Acts Within Minutes to Relieve Sx

-Can Be Used for Acute Relief of Bronchospasm

-May Cause Nervousness, Tachycardia, Jitteriness

-Not to Be Used >2x/Week

Long Acting B-2 Adrenergic Agonist (Respiratory DO)

Used for Chronic Asthma Management➡️Formoterol, Salmeterol:

-Used Only for Long Term Control, Exercised Induced Asthma

-Not for Relief of Bronchospasm, Acute Wheezing Episode

-Racemic Epinephrine Produces Bronchodilation➡️Croup

Leukotriene Receptor Antagonists (Respiratory DO)

⬇️Inflammatory Response:

-Montelukast (Singulair)

Mast Cell Stabilizers (Respiratory DO)

Prevents Release of Histamines From Mast Cells:

-Cromolyn, Nedocromil

Corticosteroids (Respiratory DO)

Suppress Inflammation and Normal Immune Response:

-Inhaled

-Oral

Inhaled Corticosteroids (Respiratory DO)

Used for Asthma Maintenance:

-Beclomethasone, Budesonide, Fluticasone, Mometasone

-Not for Tx of Acute Wheezing

-Rinse Mouth After Inhalation to⬇️Incidence of Fungal Infection, Dry Mouth, Hoarseness

-Minimal Systemic Absorption

Oral Corticosteroids (Respiratory DO)

Used for Asthma Exacerbations, Wheezing w/ Chronic Lung Disease, Severe Croup:

-Prendisolone, Prendisone

-May Cause Hyperglycemia

-Very Effective

-Long Term Use➡️Peptic Ulceration, Altered Growth➡️Assess Growth in Long Term Use

Caffeine (Respiratory DO)

Stimulate Respirations for Apnea

Pulmozyme (Dornase Alfa) (Respiratory DO)

Used in CF:

-⬇️Viscosity of Sputum

RSV Meds (Respiratory DO)

-Abrysva➡️Mom Vax Between 32-36 Weeks

-Nirsevimab/Beyfortus➡️Baby <8mo Start of RSV Season

-Synagis (Palivizumab)➡️Helps to Prevent RSV in High Risk Pt, Should Be Administered Monthly During RSV Season, Given IM

Nebulized Aerosol (Respiratory DO)

-May Use Mouthpiece, Mask, Blowby

-Takes 10-15min

-Need an Air/Oxygen Source

-Encourage Slow Deep Breaths

Metered Dose Inhaler (MDI)/Dry Powder Inhaler (DPI)

-Shake MDI, Not DPI

-Consider Spacer

-Breathe Out Before Use, Secure Mouthpiece, Slow/Deep Inhale, Hold Breath 10sec, Wait Atleast 1min Before Repeat Dose

Sinusitis

Bacterial Infection of Paranasal Sinuses:

-Risk Factors➡️5% of URI, Nasal Polyps

-Complications➡️Cellulitis, Intracranial Infections

-Etiology➡️Mucosal Swelling,⬇️Cilia Movement, Thickened Nasal Discharge

Assessment (Sinusitis)

-Persistent Rhinorrhea➡️No Improvement After 7-10 Days

-Cough

-Fever

-Halitosis

-Facial Pain

-Eye Edema

-Irritability

-Poor Appetite

Interventions/Education (Sinusitis)

-Saline Drops

-ABX

Tonsillitis

Inflammation of the Tonsils:

-Etiology➡️Viral, Bacterial