Peds Exam 3

NUR 336 – Exam 3 Complete Study Guide Modules 6–7

CLINICAL JUDGMENT FRAMEWORK

• How every question is built:

  • Recognize cues

  • Analyze cues

  • Prioritize hypotheses

  • Take action

  • Evaluate outcomes

• Critical questions to ask during assessment:

  • What finding is most concerning?

  • What is life-threatening?

  • What action comes FIRST?

COMMUNICABLE & INTEGUMENTARY DISORDERS (Module 6)

SKIN BREAKDOWN / PRESSURE INJURIES

• Assessment:

  • Look for signs of redness (nonblanching), warmth, drainage, odor, pain.

• Interventions:

  • Turn patient every 2 hours (q2h).

  • Maintain moisture control.

  • Apply barrier creams.

  • Ensure adequate nutrition/protein intake.

  • Use specialty mattress.

• Important:

  • Do NOT massage bony areas to prevent further skin breakdown.

DERMATITIS / ECZEMA / SEBORRHEIC DERMATITIS

• Characteristics:

  • Symptoms include dry, itchy, inflamed skin.

• Treatment:

  • Use moisturizers, topical steroids.

  • Avoid triggers and use mild soaps.

ACNE

• Treatments:

  • Benzoyl peroxide.

  • Retinoids.

  • Maintain proper hygiene and avoid picking at skin.

CELLULITIS

• Symptoms:

  • Warm, red, spreading rash along with fever.

• Actions:

  • Mark the borders of the infection.

  • Elevate the affected limb.

  • Administer antibiotics.

• Monitor for signs of sepsis:

  • Hypotension (low blood pressure), tachycardia (increased heart rate).

IMPETIGO

• Characteristics:

  • Presents as honey-colored crusts on the skin.

• Treatment:

  • Topical or oral antibiotics.

• Important Note:

  • Highly contagious; no school until 24 hours of treatment has occurred.

TINEA PEDIS (Fungal Infection)

• Management:

  • Keep feet dry.

  • Use antifungal medications.

  • Change socks regularly.

PEDICULOSIS CAPITIS (Lice)

• Treatment:

  • Use permethrin shampoo.

  • Employ a nit comb to remove lice and nits.

  • Wash linens in hot water.

• Caution:

  • Avoid sprays or foggers for lice management.

BURNS (HIGH YIELD)

• Initial Assessment:

  • FIRST: Secure the airway.

  • Administer oxygen.

  • Establish two large bore IVs and start fluid resuscitation (use Parkland formula).

  • Provide pain control.

  • Administer tetanus if necessary.

• Signs to report:

  • Hoarseness, soot in the mouth, stridor (indicating respiratory compromise).

• Important Note:

  • Avoid using ice or butter on burns.

EPIPEN / ANAPHYLAXIS

• First-line treatment:

  • FIRST: Administer intramuscular epinephrine (IM epinephrine).

  • Follow up with oxygen administration, IV fluids, antihistamines, and steroids.

SYSTEMIC / PEDIATRIC INFECTIONS + ISOLATION

• Infection control measures and isolation by disease:

  • Varicella (Chickenpox) – airbone + contact isolation.

  • Rubeola (Measles) – airborne isolation.

  • Scarlet Fever – droplet isolation.

  • Hand, Foot and Mouth Disease – contact isolation.

  • Conjunctivitis – contact isolation.

  • Mononucleosis, Fifth Disease, Roseola – standard precautions.

IMMUNIZATIONS

• General considerations:

  • Mild fever post-vaccination is normal.

  • Avoid live vaccines if the patient is immunocompromised.

  • Administer acetaminophen for discomfort from vaccines.

HEMATOLOGY (Module 7)

IRON DEFICIENCY ANEMIA

• Symptoms:

  • Fatigue, pallor (pale skin), low hemoglobin (Hgb) and hematocrit (Hct), low ferritin levels.

• Treatment:

  • Supplement iron with vitamin C to enhance absorption.

  • Avoid milk and antacids while taking iron as they can inhibit absorption.

  • Note: Dark stools as a side effect is normal; use a straw for liquid iron supplements to avoid staining teeth.

SICKLE CELL DISEASE (VERY HIGH YIELD)

• Crisis symptoms:

  • Severe pain, hypoxia (low oxygen levels), fever.

• Management:

  • FIRST: Administer oxygen, IV fluids, opioids for pain control.

  • Avoid dehydration and exposure to cold to prevent crisis.

HEMOPHILIA

• Characteristics:

  • Joint bleeding is a common symptom.

• Management:

  • Factor replacement therapy required.

  • No intramuscular (IM) injections.

  • Use a soft toothbrush to minimize bleeding from gums.

BLOOD TRANSFUSIONS (HIGH YIELD)

• Signs of transfusion reaction:

  • Fever, chills, back pain.

• FIRST action:

  • STOP the transfusion immediately.

  • Maintain a Normal Saline (NS) line, notify the provider, and send the tubing and blood back for analysis.

HIV

• Important considerations:

  • Risk of opportunistic infections.

  • Strict medication adherence is crucial for prevention.

  • Monitor CD4 counts to assess immune function and prevent infections.

NEOPLASTIC / ONCOLOGY

CHEMOTHERAPY

• Biggest risk factor:

  • Neutropenia (decreased white blood cells).

• Report immediately if temperature is ≥ 100.4°F.

• Important preventive measures:

  • Maintain hand hygiene.

  • Avoid crowds and raw foods to reduce infection risk.

RADIATION

• Care considerations:

  • Use gentle skin care only.

  • Do not apply lotions or perfumes; avoid scrubbing the skin.

LEUKEMIA

• Symptoms:

  • Fatigue, risk of infection, and bleeding tendencies.

• Priority:

  • Infection prevention strategies are paramount.

HODGKIN’S LYMPHOMA

• Key symptom:

  • Painless lymph node enlargement.

WILMS TUMOR (Pediatrics)

• Important management:

  • Do NOT palpate the abdomen to avoid rupture.

BRAIN TUMOR / INCREASED ICP

• Symptoms:

  • Headache, vomiting, lethargy.

• FIRST action:

  • Elevate head of bed (HOB) to 30° to help alleviate intracranial pressure.

LEAD POISONING

• Symptoms:

  • Abdominal pain, irritability, developmental delay.

• Treatment:

  • Chelation therapy is indicated to remove lead from the body.

PROCEDURES

BONE MARROW ASPIRATION

• Post-procedure care:

  • Apply a pressure dressing.

  • Monitor for signs of bleeding.

LUMBAR PUNCTURE

• Post-procedure care:

  • Maintain a flat position for 4–6 hours following procedure.

  • Encourage fluids and caffeine for headache management.

FIRST ACTION CHEAT SHEET

• Burn → Airway

• Anaphylaxis → Epinephrine

• Transfusion reaction → Stop transfusion

• Neutropenic fever → Notify provider

• Sickle crisis → Oxygen administration

• Increased ICP → Elevate HOB

• Cellulitis → Mark borders of infection

• Lice → Treat with permethrin.