CH Exam 1

Why is pediatrics different from adult?

-less procedurally oriented and less prescriptions

-focus on growth and development and education

-no action is sometimes the best action but requires good communication skills

What does pediatric nursing prefer?

education, observation, anticipatory guidance, and behavior management

What are the parts of the family assessment?

history, structure, characteristics, stessors, environment, and support

What are the guidelines for promoting acceptable behavior?

-Clear and realistic limits and expectations​

-Validation of feelings​

-Role modeling good behavior and reinforcement​

-Focus on the child’s behavior when disciplining​

-FOCUS ON THE POSITIVE​

-Ignore the negative

What are the five stages of grief that the parents of a hospitalized child go through everyday?

denial, anger, bargaining, depression, acceptance

When do we stop seeing patients in the pediatric setting?

based on diagnosis/chronic illnesses

What are the three principles of atraumatic care?

-prevent/minimize separation from the family

-promote a sense of control

-prevent/minimize bodily injury and pain

What are the goals/concepts of pediatric care?

-use developmentally appropriate approach and care

-use important assessment and observtion skills

-minimize distress

-use of play to interact, teach, assess and to help with coping

-respect of family as experts of their child

-safety

-health promotion

-education and psychosocial support

-be clear, respectful in communication

-listen

The _____ year has rapid growth.

first

Birth weight doubles by _____.

6 months

Birth weight triples by _____.

12 months

How often should height and weight be checked?

every appointment

How long should you measure head circumference?

up to 36 months

When should you start measuring BMI?

after 2 years old

What is the age group of newborns?

0-28 days

What is the age group for infants?

0-1 year

What is the age range of toddlers?

1 up to 3 years

What is the age range of preschooler?

3 years to 6 years

What is the age range of school age?

6 years to 11 years

What is the age range of adolescent?

12 years to 20 years

What is the progression for a physical assessment of a child?

least invasive to most invasive (RR-HR-temp-BP-weight)

How should you complete a physical assessment for a child?

-Let the child guide you, participate in their care​

-Ask family for assistance to make VS less traumatic​

-Follow their lead with assessment they are the expert​

-A good nurse hones their assessment skills​

-Look at the room for clues regarding coping, family dynamics

How long should you count respirations?

1 minute

How should you count HR?

auscultate apical pulse for 1 minute

Radial pulse is not accurate until after _____.

2 years old

What are the ways to measure temperature?

rectal, oral, axillary, temporal (not that accurate)

Where can you take BP?

upper arm, lower leg, upper leg

What is a tempa-dot?

one time use intrument most commonly used for taking temperatures due to low risk for sharing infection

What is a rectal thermometer?

-touted as most accurate but rarely used in pediatrics

-most frequently in ICU’s​

-contraindicated for immunocompromised children​

-most invasive​

-risk of causing anal tear-route for infection​

What is fever defined as?

> 38 C or 100.4 F

Fevers are helpful in…

increasing WBC and interferon effectiveness

What are most fevers like?

brief with limited consequences and are viral in origin

What is the treatment for a fever?

-aimed at relieving/lowering discomfort

-medications to lower the set point

-home treatments

-parental support and education

What are the medications for fever treatment?

-acetaminophen 10-15 mg/kg per dose; no more than 5 doses in 24 hours

-ibuprofen 5-10 mg/kg per dose (after 6 months) no aspirin

What does febrile mean?

showing s/s of fever

Any infant < 3 months old need to be evaluated _____ if febrile.

immediately

Any child with a fever > _____ needs to be evaluated immediately.

105

A child that “looks” or “acts” very sick needs to be evaluated _____.

immediately

When should a child be evaluated in 24 hours for a fever?

-fever 104-105

-younger than 2 years

-fever > 3 days (or > 24 hours without a reason)

-fever gone for 24 hrs and then returns

-parental concerns

BP should be compared with…

standard measurement

What influence blood pressure readings?

age, height, and gender

How should you measure height?

if they can stand then stand against wall with standometer; if they can't stand, make a mark at top of head and bottom of feet

Measure head circumference until _____.

age three (36 months)

Where should you measure chest circumference?

nipple line

Why has there been a dramatic decline in infectious diseases?

due to widespread use of immunizations

What is the difference between recommended and required immunizations?

-required is determined by the state for school attendance

-recommended is the entire schedule and recommended by the AAP

What is hep A immunization?

fecal-oral (food handlers)

What is hep B immunization?

starts at birth

How do you give polio immunizations?

give IPV no longer use OPV

PCV is given to children _____.

under 2

Pneumococcal is given to _____.

over 2 years old

When is flu season?

october to march

When is influenza given?

given during flu season, give if > 6 months old

MMR is a _____ virus.

live (only given in combo now)

Varicella is a _____ virus.

live

What is rotavirus vaccine?

oral, defined time period for administration

What is HPV?

-controversy

-more than just cervical cancer

-boys as well as girls should recieve

Why are live vaccines given after a year?

before a year they have no immune system

_____ used to be a live vaccine but switched to inactive.

polio

MMR and varicella are given _____ and the others are given _____.

subq; IM

When is it ok to give a vaccine?

-Mild to moderate local reaction to past vaccine (ask what the symptoms of the reaction were)​

-Mild, acute illness with or without low grade fever​

-Current antibiotic therapy​

-Prematurity​

-Family history of seizure, SIDS, or adverse reaction to vaccine​

-TB test​

-Breastfeeding or household contact with pregnant woman​

-CAN receive if HIV+ and asymptomatic

What are the contraindications for vaccine administration?

-Severe febrile illness (It is NOT a fever unless >38)​

-Past SERIOUS adverse reaction to the vaccine or vaccine component​

-Stopped breathing, throat closed up​

-Long-term (>2 weeks) use of SYSTEMIC steroids. ​

-They decrease your immune system​

-Pregnancy—no live vaccines​

-Recent blood, plasma, or IgG for live virus vaccines—wait a minimum of 3 months​

-Seizure within several days of receiving a prior dose of vaccine.​

-Immunosuppression

-Transplantation: Generally no live virus vaccines if undergoing immunosuppression therapy​

-HIV: Can receive live virus vaccines if asymptomatic​

-Chemotherapy:  wait at least 6 months usually to restart vaccination schedule​​

What are the developmental considerations for administering medications to school age?

-Explain procedure, allowing for some control over body, timing, situation​

-Set appropriate behavior limits​ (It’s OK to cry, resist using phrases such as “be a big girl/boy”)​

-Acknowledge that immunizations HURT. But much less so than the illness.​

-Teach about how medications help with illness​

-Expect a wide range of reactions based on earlier experiences.​

-Provide activities for releasing aggression and anger.

What are the developmental considerations for administering medications to adolescents?

-Explain procedure, allowing for control over body and situation (mom or dad in or out of room)​

-Explore concepts of illness, hospitalization, correct misconceptions​

-Encourage self expression, individuality and self care needs​

-Encourage participation in the procedure

What is the IM injection site for newborns (0-28 days)?

anteriolateral thigh muscle

What is the IM injection site for infants (1-12 months)?

anteriolateral thigh muscle

What is the IM injection site for toddlers (1-2 years)?

-anteriolateral thigh muscle

-alternate site: deltoid muscle of arm if muscle mass is adequate

What is the IM injection site for children (3-10 years)?

-deltoid muscle (upper arm)

-alternate site: anterolateral thigh muscle

What is the IM injection site for children and adults (11 years and older)?

-deltoid muscle (upper arm)

-alternate site: anterolateral thigh muscle

What is the subcutaneous injection site for birth to 12 months?

fatty tissue overlying the anterolateral thigh muscle

What is the subcutaneous injection site for 12 months and older?

fatty tissue overlying the anterolateral thigh muscle or fatty tissue over triceps

Biggest muscle infants have is the _____.

thigh muscle

Why don’t you use the gluteus maxamus in infants?

the muscle isn’t developed yet (not developed until they start walking)

Why do children more often respiratory arrest then they do cardiac arrest?

-children < 3 years old react more severely to a respiratory infection

-less able to fight infections

-have had less exposire = less resistance = increased incidence of respiratory infections

-preschoolers are building up their immunity

What are the chest structural differences in children?

-more rounded at birth

-infant: abdominal/diaphragmatic breathers (as opposed to thoracic

-fewer alveoli = decreased surface for gas exchange

What are the airway structural differences in children?

-decreased smooth muscle in airways at birth

-diameter of airways is smaller (infant: 1mm of edema = 50% reduction; older child: 1mm of edema = 20% reduction)

-supporting cartilage is softer and less developed (floppy airways)

-nasal passages are narrow (nose breathers until 3-4 months)

How do you maintain a patent airway for a child?

-positioning

-clear secretions

-cough

-decrease airway swelling

-decrease risk of foreign body aspiration

How do you promote gas exchange for a child?

-decrease infection

-clear secretions

How do you improve oxygenation for a child?

-positioning

-comfort

How do you promote rest/comfort and ease respirations for a child?

-anxiety/fear

-reduce environmental stress

-tylenol (comfort, reduce fever → decrease fever and HR)

What is the normal infant respiratory pattern?

-irregular respirations

-short apenic episodes less than 10-15 seconds

-diaphragmatic/abdominal breathing

-nose breathers

What are retractions?

-using accessory muscles to breath

-not normal

-increased work of breath

What is a pulso oximetry?

non invasive oxygen saturation monitoring

What is the positioning of the nebulized medication administration in children?

-Sitting upright​

-Position of comfort​

-Distraction as needed

What is the administration of nebulized medication administration in children?

-Can take up to 10-15 minutes​

-Use mouthpiece, mask of blow-by​

-Vital signs and O2 saturation​

-Medication mixed or added to container​

-Encourage child to take slow, deep breaths​

What is the teaching of nebulized medication administration in children?

-Show family how to use the nebulizer

-Adverse effects

What is the positioning of the metered dose inhaler?

sitting upright

What is the administration of the metered dose inhaler?

-Create a seal with mouth around the spacer or use a mask​

-Can also use “open mouth” depending on dispenser​

-Tilt head back SLIGHTLY to open airway and improve delivery​

-Shake medication​

-“actuate” or activate medication by pressing once for each breath (depends on how many “puffs” are prescribed)​

-Begin slow, deep breath that lasts 3-5 seconds​

-Hold breath after administration for 5-10 second

What is chest physiotherapy?

manual or mechanical percussion, vibration, cough or forceful expiration

When do you use chest physiotherapy?

thick secretions are present

What is the positioning of chest physiotherapy?

to promote drainage pt to stay in each position for 20-30 minutes

What is the administration of chest physiotherapy?

-Schedule an hour before or after a meal​

-Administer medication to loosen secretions before treatment​

-Emesis basin and tissues for expectorate 

When do you stop chest physiotherapy?

-patient reports dizziness

-lightheadedness

-bloody sputum is produced

What are the types of oxygen therapies?

-oxygen tent (all four sides)

-nasal cannula

-pediatric face mask

-oxygen hood (three sided)

What is the oxygen tent?

less ready access to the patient and usually provide only 21% to 50% oxygen

What is a nasal cannula?

1-6 liters/minute providing 24% to 44% oxygen

What is a pediatric face mask?

-6 to 10L/minute

-35% to 50% oxygen

What is the oxygen hood?

-80% to 90% oxygen

-good humidification and controlled temperature

-allow easy access to the child for other care

What are the types of suctioning?

nasal, oral, et, and tracheal

What is nasal suctioning?

-clean technique

-bulb

-neosucker

-suction with mushroom tip