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Pediatric Study Guide - Exam 2 Notes

Foundational Knowledge

Some pediatric concepts are foundational due to lack of prior learning.
Expect questions requiring memorization of facts and understanding, similar to the first exam.
Disease processes will build on earlier foundational knowledge; focus shifts to application and higher-level thinking in later assessments.

GI Disorders

Omphalocele
- Understand congenital abdominal wall defects.
- Identify nursing priorities during birth, especially in NICU settings such as:
  - Thermal regulation
  - Moisture maintenance
  - Sterile handling of exposed organs.
Hirschsprung Disease – Currant Jelly Stools
- Recognize the signs and symptoms of intussusception.
- Understand the significance of currant jelly-like stools in young children.
- Differentiate this condition from other causes of pediatric GI bleeding.
Diaphragmatic Hernia – Delivery Preparation
- Review respiratory implications of diaphragmatic hernia.
- Prepare necessary emergency equipment before delivery.
- Emphasize the avoidance of bag-valve-mask ventilation in these newborns.
Hirschsprung Disease – Newborn Manifestations
- Learn typical symptoms in neonates, e.g., failure to pass meconium and distended abdomen.
- Understand the pathophysiology related to the absence of ganglion cells in the colon.
Imperforate Anus – Parental Education
- Know pre- and post-operative nursing care for imperforate anus.
- Review accurate vs. inaccurate parental understanding of the condition.
- Understand expectations for surgical correction and prognosis.
Meckel’s Diverticulitis – Diet Selection
- Understand dietary distinctions: high-residue vs. low-residue diets.
- Know dietary restrictions for GI inflammation and bleeding risks.
- Review assessment findings and laboratory results pertinent to this condition.
GI System – Key Terms
- Review essential terminology (non-exhaustive list):
  - Pyloric stenosis
  - Intussusception
  - Omphalocele
  - Gastroschisis
  - Volvulus
  - Hirschsprung disease
- Understand basic definitions and clinical presentations of these terms.
Gastroenteritis – Infection Control
- Know transmission routes for enteric infections.
- Review cohorting principles for pediatric units.
- Understand the importance of employing contact precautions in managing infections.
Diaphragmatic Hernia – Newborn Assessment
- Identify critical signs: cyanosis, absence of breath sounds, displaced heart tones.
- Understand the neonatal emergency status and immediate necessary actions.
Appendicitis – Clinical Findings
- Review early and late symptoms in children, including:
  - Right lower quadrant (RLQ) pain
  - Rebound tenderness
  - Fever
- Understand how pediatric symptoms vary from those in adults.
Appendicitis – Care Prioritization
- Know priority nursing actions while awaiting surgery:
  - Maintain NPO (nothing by mouth) status
  - Monitor pain
  - Manage fluids
  - Prepare for possible rupture
  - Provide post-surgical care and recognize signs of sepsis.
Lead Poisoning – Nursing Intervention
- Understand CDC thresholds for lead intervention:
  - Appropriate follow-up for Blood Lead Level (BLL) >5 µg/dL vs. high levels >45 µg/dL.
- Identify environmental sources of lead and strategies to educate parents about prevention.
Meckel’s Diverticulum – Priority Intervention
- Recognize signs of GI bleeding and obstruction.
- Prioritize stabilization measures, including IV access, maintaining NPO status, and conducting labs.
- Understand surgical consultation as the next likely step if complications arise.

Cardiac Conditions in Pediatrics

Disease processes include: Tricuspid atresia, Kawasaki disease, Digoxin use, classification of heart defects, feeding interventions, cardiac catheterization procedures, Tetralogy of Fallot, Tet spells, infective endocarditis, rheumatic fever, coarctation of the aorta, bilirubinemia.
Understand congenital heart defects, particularly those influencing pulmonary blood flow balance.
Review critical concepts related to Tetralogy of Fallot and associated Tet spells:
- Clinical manifestations.
- Nursing interventions specific to this condition.
Recognize clinical signs of congenital heart disease and necessary nursing interventions.
Understand special considerations for play activities among children with congenital heart conditions, including parental education.
Understand the role of Digoxin (Lanoxin) in pediatric heart failure and assessments for toxicity risks.
Learn the signs of Kawasaki Disease and prioritize necessary interventions.
Understand treatment avenues, precautions, and risks associated with Kawasaki Disease management.
Familiarize with abnormal lab values relevant to cardiac conditions and the importance of diagnostic tools such as:
- Echocardiograms
- Holter monitoring
- Stress EKGs
- X-rays
- CT scans.
Be aware of the screening guidelines for coarctation of the aorta.
Pediatric patients should avoid Aspirin due to the risk of complications (e.g., Reye's syndrome); preventative education is crucial.
Identify exceptions to the no-Aspirin rule within disease processes discussed in this chapter.

Gastrointestinal Disorders

Understand disease processes including:
- Omphalocele
- Hirschsprung’s disease
- Diaphragmatic hernia
- Imperforate anus
- Inflammatory Bowel Syndrome (IBS)
- Gastroschisis
- Transesophageal fistula
- Atresia
- Encopresis
- Gastroenteritis
- Appendicitis
- Meckel’s diverticulum
- Hyperbilirubinemia
- Lead poisoning
Review common congenital GI malformations, signs, and immediate surgical interventions required.
Study classic signs of appendicitis and how they differ from other GI conditions.
Understand pediatric concerns related to feeding, reflux management, and aspiration prevention strategies.
Differentiate causes of bloody stools in infants and children, alongside management protocols.
Familiarize with nutritional considerations for children suffering from inflammatory bowel disease.
Recognize signs of kernicterus.
Define low-residue diets, and conditions where such diets may be recommended.
Establish nursing priorities for treating inflammatory bowel diseases.

Hematologic Disorders

Identify common lab findings in pediatric bleeding disorders and their implications for treatment protocols.
Learn about various clotting disorders and key priority nursing interventions.
Understand the pathophysiology of pediatric leukemias and associated nursing responsibilities.
Develop strategies for preventing and managing complications associated with sickle cell anemia:
- Understand the three types of sickle cell crises.
- Identify the underlying causes of symptoms in these crises.
Review medications admin for blood disorders, including:
- Factor VIII replacement therapy in hemophilia cases.
Analyze Disseminated Intravascular Coagulation (DIC): Pathophysiology, recognition, diagnostics, and responses.

Immune and Autoimmune Disorders

Recognize signs indicative of immune system dysfunction in newborns and children.
Understand the necessity for heightened infection precautions in children with primary immunodeficiencies.
Familiarize with the complications related to Systemic Lupus Erythematosus (SLE), including the contraindicated medications in certain contexts.
Learn about Severe Combined Immunodeficiency (SCID), including parental education needs.
Review Rheumatic Fever’, prevention methods, and potential cardiac complications.
Understand signs and symptoms of juvenile idiopathic arthritis (JIA) and respective interventions.
Identify joint swelling and pain conditions in children, able to discern medical emergencies.
Develop skills to manage pain and mobility for children with chronic musculoskeletal conditions.
Review Graft Versus Host disease, including acknowledgment, necessary interventions.

Respiratory and Infectious Diseases

Identify warning signs indicating neonatal respiratory distress and congenital lung function abnormalities.
Understand strict infection control protocols for neutropenic patients.
Learn the reasons why newborns with jaundice receive phototherapy and the accompanying care protocols, including necessary precautions.
Study sepsis indicators in pediatric patients and recognize signs of worsening conditions.

Oncology

Review the pathophysiology of acute lymphocytic leukemia (ALL), particularly its effects on bone marrow.
Identify common symptoms such as fatigue, frequent infections, and bruising typically present in patients.
Understand essentials of chemotherapy treatment, potential side effects (e.g., stomatitis, immunosuppression).
Differentiate presentation of Neuroblastoma in infants, recognizing abdominal masses and catecholamine-related symptoms.
Wilms Tumor (Nephroblastoma):
- Key nursing intervention: Do NOT palpate the abdomen to prevent tumor rupture.
Distinguish Hodgkin’s vs. Non-Hodgkin’s Lymphoma, noting differences in lymph node involvement, symptoms, and treatment strategies.
Familiarize with Osteosarcoma & Ewing’s Sarcoma, including common presentations (bone pain, swelling) and treatment modalities (surgery, chemotherapy, radiation).
Understand chemotherapy and its side effects, notably neutropenia, anemia, thrombocytopenia, and mucositis.
- Grasp the principles of neutropenic precautions and infection control for immunocompromised patients.
Review indications for Hematopoietic Stem Cell Transplantation (HSCT) in pediatric oncology, including relevant nursing considerations post-transplant.

Pediatric Pharmacology & Pain Management

Know the safe administration protocols for NSAIDs, opioids, and non-opioid analgesics.
Review considerations for questioning medication orders based on lab values.
Learn proper application techniques for topical anesthetics, specifically EMLA cream.
Understand patient-controlled analgesia (PCA) use in older children, including monitoring strategies.
Review pediatric dosage calculations, emphasizing weight-based IV and oral medication administration.
Assess appropriate pain assessment strategies tailored to various age groups.

Fluid Balance & Medication Administration

Learn calculations necessary for safe pediatric medication dosages and assess the safety of prescribed dosages.
Understand how to perform Body Surface Area calculations.
Understand how to calculate percentage of weight loss accurately.
Recognize the necessity of IV fluids in the context of dehydration and how to assess for clinical improvement.
Learn to determine drip rates, IV pump rates, and effective fluid resuscitation strategies.

Additional Review Considerations

Develop strategies for age-appropriate communication and play interventions tailored for hospitalized children.
Educate parents on care instructions pertinent to chronic pediatric conditions.
Review topics added for comprehensive preparation, such as:
- Cardiology - PDA and Congestive Heart Failure (CHF)
- Hematology - Thalassemia
- Immunology - Pediatric HIV recognition
- Oncology - Oncological emergencies - recognition and prioritization
Emphasize the importance of recognizing Immunodeficiency conditions, specifically SCID.
Highlight effective pain management strategies, including PCA usage and distraction techniques.
Acknowledge the importance of basic care and comfort measures for pediatric patients.