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Comprehensive Pediatric & Adult Nursing Review

School-Age (6-12 yrs)

Motor Development

  • Fine motor refinement

    • Improved handwriting & detailed drawing

    • Mastery of ceramics, needlework, woodworking

    • Greater dexterity → tying shoes, buttoning clothes, manipulating small objects

  • Gross motor refinement

    • Better coordination for skipping, jump-rope, ball games

    • Enhanced balance, agility, stamina → complex sports & longer activity duration

  • Significance

    • ↑ Independence in ADLs, participation in team sports, supports academics (e.g., handwriting, art)

Bullying

  • Recognition

    • Physical (hitting, pushing, damaging belongings)

    • Verbal (name-calling, insults, threats)

    • Social (exclusion, rumor spreading)

    • Cyber (technology-based harassment; teach documentation)

  • Reporting

    • Identify trusted adults (parents, teachers, counselors)

    • Immediate reporting ≠ “tattling”

  • Coping

    • Assertive “stop” statement, stay calm, walk away

    • Stay with friends; build self-esteem via positive activities

    • Relaxation techniques for stress

  • Nursing role: develop anti-bullying programs & coordinate school/family support

Negative Body Image

  • Explain subjective nature of body image; media & cultural pressures

  • Build self-esteem

    • Focus on strengths, individuality, positive self-talk

  • Healthy body perception

    • Health > appearance, balanced diet, regular activity, discourage comparisons

  • Role-models

    • Teach parents to reinforce non-physical traits; respect cultural beauty norms

  • Nursing: school programs, counseling, family education

Nutrition Teaching

  • Balanced diet → fruits, veggies, whole grains, lean protein, low-fat dairy; nutrient roles in growth

  • Portion control → visual aids, hunger/fullness cues, small plates

  • Healthy snacks → label reading, limit sugary drinks, water priority

  • Key methods: involve kids in meal prep, model healthy eating, avoid food rewards, warn on excess junk food

Substance Use Prevention

  • Education: age-appropriate facts, myth-busting, legal & health risks, healthy coping

  • Resistance skills: “just say no,” alternate suggestions, role-play, build confidence, find trusted support adults

  • Broader strategies: open communication, address risk factors (family history, mental health), positive peer groups, Rx-drug dangers

  • School programs: evidence-based curricula, peer groups, counseling; nurses collaborate across systems

Encopresis (Functional Fecal Soiling)

  • Bowel retraining: scheduled toilet sits 10\text{–}15\,\text{min} after meals; footstool support; 10-min intervals

  • Diet: ↑ fiber, fluids; mineral oil if prescribed

  • Positive reinforcement: sticker charts, praise, special activities

  • Family education: normal physiology, developmental process, relapse expectations

  • Behavioral techniques: modify behavior, address anxiety, open discussion

  • Follow-up: regular monitoring, adapt plan, reassess persistent cases

Pediatric Gastrointestinal Issues

Inguinal Hernia

  • Most common hernia; mainly males (related to testicular descent)

  • Risk of incarceration/strangulation (look for distention, nausea, vomiting, pain, fever, tachycardia)

  • Tx: surgical herniorrhaphy (often laparoscopic, same-day); nursing pre/post-op care & complication watch

Intussusception

  • Telescoping intestine (infants/young kids)

  • S/S: severe colicky pain, vomiting, “currant-jelly” stools

  • Dx: ultrasound; Tx: air/liquid enema (first) or surgery; monitor for peritonitis/shock, teach recurrence warning

Cleft Lip/Palate

  • Surgery 3\text{–}6 mo, may be staged

  • Early speech therapy, parent-guided exercises

  • Feeding support: SLP & lactation consults, special nipples, possible prosthesis

  • Long-term: ear infection risk, appearance concerns, multidisciplinary follow-up

Appendicitis

  • Peak 12\text{–}18 yrs; periumbilical→RLQ pain, N/V, fever; perforation <48 h (esp <5 yrs)

  • Complications: abscess, peritonitis, obstruction

  • Nursing: history, pain scale, targeted exam, delay palpation until last

Celiac Disease

  • Autoimmune to gluten; lifelong strict gluten-free diet

  • Teach safe foods, label reading, cross-contamination, nutritional adequacy

  • Growth monitoring: height, weight, BMI; watch malnutrition, osteoporosis; multidisciplinary care

Eating-Disorder Risks & Anorexia Nervosa

  • Risks: body dissatisfaction, peer pressure, family dynamics, perfectionism, trauma

  • Anorexia support: CBT, FBT, IPT; gradual refeeding, monitor electrolytes & refeeding syndrome; long-term relapse prevention

Pyloric Stenosis

  • Infant boys 3\text{–}6 wk; projectile vomiting, “olive” mass

  • Dx: ultrasound; Tx: pyloromyotomy (laparoscopy)

  • Nursing: pre-op fluid/electrolyte correction, NPO; post-op feeding advance, wound/bleed watch, parent teaching

Genitourinary Topics

Testicular Cancer Self-Exam (Adolescents)

  • Monthly palpation for lumps; risks: cryptorchidism, family Hx; report changes fast

Cystitis

  • Common UTI in females; dysuria, urgency; teach front-to-back wiping, fluids, irritant avoidance

Suprapubic Aspiration

  • Sterile urine collection <2 yrs; strict asepsis; process sample <1 h (room T) or <4 h (refrigerated); prep family & assist

Circumcised vs. Uncircumcised Care

  • Circumcised: mild soap, dry

  • Uncircumcised infants: no forced retraction; older boys: retract, clean, dry, replace foreskin

  • General: hand hygiene, daily wash, non-irritant products, infection signs; respect cultural norms (e.g., Vietnamese/Cambodian delayed retraction)

Chronic Kidney Disease (CKD)

  • Protein 0.8\,\text{g/kg/day} if \text{GFR}<30; HD 1\text{–}1.3\,\text{g/kg}

  • Na restriction, individualized K/Phos limits, fluid as ordered, adequate calories

  • Med adherence: purpose, side-effects, drug interactions; use organizers, link to routines; monitor BP & labs; collaborate with RDN; promote lifestyle changes

Nephrotic Syndrome

  • Edema: Na <1500 mg, diuretics (furosemide ± metolazone), elevate limbs, daily weights

  • Moderate protein 0.8\,\text{g/kg}; corticosteroids first-line; immunosuppressants if resistant; ACE/ARB, anticoagulants, low-fat diet

  • Nursing: infection watch, steroid side-effect teaching, follow-up adherence

Neuromuscular & Musculoskeletal

  • Clubfoot → Ponseti casting 6\text{–}10 wk, tenotomy, bracing; surgery if needed

  • Juvenile Idiopathic Arthritis → NSAIDs, methotrexate, PT; goals: ↓ inflammation, prevent deformity

  • Rhabdomyosarcoma → chemo + radiation + surgery (location/stage specific)

  • Osteosarcoma → limb-sparing surgery, neo/adjuvant chemo, recurrence surveillance

  • Amputations: BKA preserves knee; AKA ↑ energy cost; rehab = wound care, prosthetic fit/train, gait, ADLs

  • Phantom Limb Pain: meds (anticonvulsants/antidepressants), mirror therapy, TENS; psych support

  • Prosthetic Leg: custom fit, progressive gait training, daily socket/liner cleaning, skin checks, timely adjustments

  • Duchenne Muscular Dystrophy: ROM, stretching, positioning, aquatic therapy, adaptive devices; resp support (CPT, incentive spirometry, cough assist, BiPAP, possible trach)

  • Lupus: NSAIDs, steroids, hydroxychloroquine, immunosuppressants; sun protection; med adherence tools

  • Osteogenesis Imperfecta: gentle handling, fall prevention, Ca/Vit D, bisphosphonates, weight-bearing as tolerated; mobility aids, scoliosis/hearing/dental monitoring, psychosocial help

Integumentary

  • Burns: clean, antimicrobial ointment, sterile dressings (≥2×/day); pain: acetaminophen → opioids; prevention (water heater <120°F, smoke detectors, escape plans)

  • Poison Ivy: calamine, hydrocortisone, cool compress; identify plant, protective clothing, barrier creams

  • Psoriasis: thick moisturizers post-bath, topical steroids/Vit D analogs/coal tar; manage triggers (stress, skin trauma, alcohol, weight)

  • Cellulitis: oral/IV antibiotics, wound care, limb elevation, monitor progress

  • Insect Bites: DEET, clothing, time avoidance; topical hydrocortisone/calamine/ice; allergy education & epinephrine for anaphylaxis

  • Diaper Dermatitis: frequent changes, warm-water cleaning, air dry, zinc oxide/petroleum barrier

  • Atopic Dermatitis: frequent emollients, avoid triggers, cool humid environment, topical steroids/calcineurin inhibitors

  • Thermal Injuries: remove heat, cool water 10\text{–}20\,\text{min}, cover, seek care; prevention: detectors, plans, PPE

  • Mosquito-borne Dz: repellents, long sleeves, no standing water, bed nets; recognize fever, rash, joint pain, neuro signs

  • Acne: gentle wash 2×/day, non-comedogenic moisturizer, benzoyl peroxide, retinoids, topical abx; self-esteem counseling

Adult Nursing Finals Breakdown

  • Exam: 100 Qs; GI 15 | Renal 15 | Cardiac 20 | Endocrine 15 | Hem/Onc 15 | Neuro 20

High-Level Topic Lists (see detailed sections below)

  • Neuro: seizure precautions, stroke types, headaches/migraines, Parkinson’s, peripheral neuropathy, TIA

  • GI: GERD, ulcerative colitis, oral cancer, PUD, hiatal hernia, NG tubes, celiac, colostomy, colon-cancer screening, abdominal quadrants

  • Renal: CKD, dialysis & access, PKD, pancreatitis, nephrotoxic meds, hepatitis, kidney labs, UTI, renal calculi

  • Cardiac: hyperlipidemia, HF, PAD, MI, dysrhythmias & EKGs, chest pain, pericarditis, murmurs, cardiac-cath care

  • Endocrine: diabetes (type 1 vs 2, A1C goal <7\%), thyroid, Addison’s, Grave’s, Cushing’s

  • Hem/Onc: DVT & bridge, anemias, transfusion reactions, radiation side-effects, tamoxifen, screenings (mammogram, colon, PSA, low-dose CT)

Detailed Adult Neuro

  • Seizure Precautions: padded rails, low bed, O2/suction, loosen clothes, no restraints, side-lying, time seizure, postictal care

  • Stroke

    • Ischemic: clot; S/S sudden neuro deficits; tPA \le4.5 h; antiplatelet/anticoag/statin; post-care swallow → rehab

    • Hemorrhagic: bleed; S/S thunderclap headache, N/V, LOC; BP control, aneurysm repair, ICP; avoid tPA

    • Shared risks: HTN, smoking, DM, obesity, age >55

  • Headaches: tension (bandlike, stress), cluster (unilateral orbital, tearing), migraine (pulsating, aura, triggers)

  • Parkinson’s: TRAP (tremor, rigidity, akinesia, postural instability); Tx levodopa/carbidopa, MAO-B inhibitors, DBS, therapies

  • Peripheral Neuropathy: diabetes, ETOH, chemo; “glove-stocking” numbness; gabapentin/pregabalin/duloxetine + safety edu

  • TIA: neuro S/S resolve <24 h; antiplatelets, risk-factor control, possible carotid endarterectomy

Detailed Adult GI (Quick Reference)

  • GERD: heartburn/regurgitation; PPIs > H2; lifestyle (weight↓, HOB↑, avoid late/spicy)

  • Ulcerative Colitis: bloody diarrhea; 5-ASA, steroids, immunomodulators, colectomy (curative)

  • Oral Cancer: smoking/ETOH/HPV; non-healing ulcer; surgery/radiation/chemo, feeding & speech support

  • PUD: gastric vs duodenal pain timing; causes H. pylori, NSAIDs; triple therapy (PPI+2 abx), stop NSAIDs

  • Hiatal Hernia: sliding vs paraesophageal; same Tx as GERD ± fundoplication

  • NG Tubes: Levin vs Salem; confirm by X-ray; pH <5.5; irrigate, monitor aspiration & skin

  • Celiac: lifelong gluten-free; supplement deficiencies

  • Colostomy Care: pink/moist stoma, empty \le 1/3 full, change 5\text{–}7 days, protect skin, limit gassy foods

  • Colon-Cancer Screening: colonoscopy q10 yr (average risk) starting 45; FIT yearly; stool DNA q3 yr; earlier if ↑risk

  • Abd Quadrants: RUQ (liver/GB), LUQ (stomach/spleen), RLQ (appendix), LLQ (sigmoid)

Detailed Adult Renal

  • CKD staging (GFR), manifestations (uremia, anemia, fluid/e-lyte imbalances); Tx diet, meds, dialysis; AV fistula thrill/bruit

  • Dialysis Access: chronic = AV fistula/graft; temporary = central venous catheter

  • PKD: genetic cysts; flank pain, hematuria, HTN; control BP, pain, eventual transplant

  • Pancreatitis: gallstones/ETOH; epigastric→back pain, NPO, IVF, opioids; Cullen/Grey-Turner signs; monitor necrosis

  • Nephrotoxic Meds: NSAIDs, aminoglycosides, contrast, vancomycin, amphotericin B, ACE-Is

  • Hepatitis: A (fecal–oral) supportive; B/C blood-borne antivirals; jaundice & RUQ pain; vaccines for A, B

  • Labs: BUN 7\text{–}20 mg/dL, Cr 0.6\text{–}1.2 mg/dL, GFR >90, UA protein/RBCs/casts abnormal

  • UTI: dysuria/urgency/hematuria; elderly confusion; TMP-SMX/nitrofurantoin, hydration, hygiene

  • Renal Calculi: severe flank pain; types (Ca, uric, struvite); ↑fluids, pain meds, lithotripsy, diet changes

Detailed Adult Cardiac

  • EKG Basics: NSR, A-fib (irregular, no P), A-flutter (sawtooth), VT (wide QRS), VF (chaos), asystole – know treatments (defib vs CPR)

  • HF: left (pulmonary) vs right (systemic); UNLOAD FAST mnemonic; BNP/echo labs

  • Murmurs: systolic (AS, MR) vs diastolic (AR, MS); grade I–VI; valve area listening

  • MI: chest pain >30 min, troponin ↑ (peaks 24 h); MONA-B, PCI <90 min or thrombolytics

  • Dysrhythmia Mgmt: brady (atropine), tachy (treat cause), VF/VT no pulse → CPR+defib

  • Hyperlipidemia: diet/exercise, statins (monitor LFTs, myopathy)

  • Chest Pain Protocol: assess OLDCART; MONA; rule-out MI

  • Pericarditis: sharp pain better leaning forward, friction rub, diffuse ST; NSAIDs/colchicine; watch tamponade (Beck triad)

  • PAD: claudication, cool hairless legs, toe ulcers; walking, aspirin, statins, avoid elevation

  • Cardiac Cath Post-Care: bleed & pulse checks, leg straight (femoral), watch AKI from contrast

Detailed Adult Endocrine

  • Diabetes: T1 (autoimmune, insulin-dep) vs T2 (resistance); 3 P’s; insulin, metformin, sulfonylureas; A1C goal <7\%

  • Thyroid: hypo (↑TSH, weight ↑, cold) → levothyroxine; hyper/Grave’s (↓TSH, heat ↑, exophthalmos) → methimazole/PTU, β-blocker, RAI, surgery

  • Addison’s: adrenal insufficiency → bronze skin, low BP/glucose/Na, high K; give hydrocortisone, salt, stress-dose education

  • Cushing’s: excess cortisol → moon face, buffalo hump, striae, HTN, ↑glucose; taper steroids or adrenal surgery

Detailed Adult Hematology/Oncology

  • DVT: Virchow triad risks; LMWH/heparin bridge to warfarin (INR 2\text{–}3); stockings, ambulation

  • Anemias: iron (microcytic) → iron + Vit C; B12 (macrocytic + neuro) → cyanocobalamin; folate (macrocytic) → folic acid

  • Transfusion Reactions: hemolytic (fever/back pain) stop transfusion; febrile, allergic, anaphylactic – manage accordingly

  • Radiation Side-Effects: skin burns, fatigue, mucositis, BMS, GI upset, alopecia; gentle skin care, sun avoidance

  • Tamoxifen: ER+ breast cancer; hot flashes, ↑DVT & endometrial Ca risk, menstrual changes

  • Cancer Screenings: mammogram start 40\text{–}50, colonoscopy 45 q10y, PSA shared >50, low-dose CT 50\text{–}80 smokers \ge20 pack-yrs

Pharmacology Master List

Cholinergic Agonists vs Anticholinergics

  • Bethanechol (urinary retention), donepezil (Alzheimer) – watch brady/hypotension, SLUDGE; avoid in asthma/obstruction

  • Anticholinergics: atropine, scopolamine, oxybutynin – dry mouth, urinary retention, tachycardia; avoid glaucoma; caution elderly delirium

Adrenergic Agents

  • Alpha agonist phenylephrine (decongestant, ↑BP) – HTN, rebound congestion

  • Beta agonists: albuterol (β2 bronchodilation), dobutamine (β1 HF)

  • Alpha blockers: prazosin HTN, tamsulosin BPH – orthostatic ↓BP

  • Beta blockers: metoprolol (β1), propranolol (non-selective) – bradycardia, mask hypoglycemia, asthma caution, taper slowly

Antiepileptics

  • Phenytoin 10\text{–}20 mcg/mL (gingival hyperplasia, rash)

  • Valproic acid (hepatotoxic, pancreatitis, weight gain, alopecia)

  • Carbamazepine (BM suppression, autoinduction) – monitor CBC/LFT

  • Gabapentin (sedation) – neuropathic pain, seizures

Parkinson’s Meds

  • Levodopa/carbidopa: dyskinesia, on-off, orthostatic ↓BP; take on empty stomach, low-protein

Alzheimer’s Meds

  • Donepezil, rivastigmine: cholinesterase inhibitors – GI upset, bradycardia, fall risk

HF Medications

  • ACE-Is (cough, \uparrowK, angioedema), ARBs, β-blockers (start low), loop diuretics (watch \downarrowK, ototoxic), digoxin 0.5\text{–}2.0 ng/mL (halo vision, brady, toxicity \uparrow if \downarrowK)

Antidysrhythmics

  • Class I lidocaine (CNS toxicity), procainamide

  • Class II β-blockers (rate control)

  • Class III amiodarone (pulmonary, hepatic, thyroid, cornea, blue skin)

  • Class IV CCB (verapamil/diltiazem) – avoid grapefruit

Diuretics & Electrolytes

  • Loop furosemide (hypo-K/Na, dehydration), thiazide HCTZ (hyperuricemia), K-sparing spironolactone (hyper-K, gynecomastia)

  • IV K: max 10\,\text{mEq/h}; never push

  • Mg: monitor reflexes & RR; used in torsades & preeclampsia

Antihypertensives & Antianginals

  • ACE/ARB basics; β-blockers caution; CCB edema/constipation; hydralazine reflex tachy

  • Nitrates: sublingual chest pain relief, headache/hypotension, daily nitrate-free interval

Anticoagulants/Antiplatelets

  • Heparin (aPTT 1.5\text{–}2.5×, antidote protamine); warfarin (INR 2\text{–}3, antidote Vit K, diet counseling); DOACs (no routine labs)

  • Aspirin (TXA2 blocker), clopidogrel (ADP blocker) – watch GI bleed/bruising

Thyroid & Antithyroid

  • Levothyroxine: morning, empty stomach, lifelong; overdose = hyper S/S

  • PTU/methimazole: agranulocytosis monitor CBC; PTU in 1st trimester; iodine pre-op

Diabetes Meds

  • Insulin types (lispro, regular, NPH, glargine); double-check doses

  • Metformin: GI, lactic acidosis, hold 48 h around contrast

  • Sulfonylureas (glipizide): hypo-gly, weight gain

Adrenal Steroids

  • Prednisone: long-term → Cushingoid, hyperglycemia, osteoporosis; taper slowly, infection monitor

CNS Depressants/Stimulants & Psych Meds

  • Benzos: lorazepam/diazepam – resp depression, dependence; antidote flumazenil

  • Barbiturates: phenobarbital – narrow TI, coma risk

  • Cyclobenzaprine: muscle relaxant, sedation, no EtOH/CNS depressants

  • Amphetamines (Adderall): insomnia, anorexia, tachy, abuse

  • Modafinil: wake-promoter with less dependence

  • SSRIs (fluoxetine): sexual dysfunction, serotonin syndrome; weeks to work

  • TCAs (amitriptyline): anticholinergic, fatal overdose

  • MAOIs (phenelzine): tyramine → hypertensive crisis

  • Typical antipsychotic (haloperidol): EPS, NMS

  • Atypical (risperidone): less EPS, weight/DM risk

Tip: Prioritize ABCs, safety, lab interpretation, and patient education for exam success.