Pediatrics HESI Review

Nutrition

  • tx infantile GERD with rice cereal to prevent losing nutrition

  • fruit, veggies, whole-grain breads, low-fat dairy, beans, lean meat, fish to heal osteomyelitis

  • tx IV antibiotics and rest for osteomyelitis

  • what can we do without hurting their belly, preventing diarrhea, abdominal pain

  • for obesity/underweight

    • have child write down everything they eat (24 hr food diary)

    • monitor physical activity

    • is there PE in school?

  • remove any gluten from lunch tray for celiac kids

  • white patches on tongue (thrush) will be tx with nystatin

  • diaper rash can cause infant to not sleep at night (sign that food may not be tolerated)

  • introduce solids at 6 months (introduce in 4-7 day intervals)

Infants

  • assessment

    • measure head circumference

    • assess fontanelles for hydrocephalus (bulging), dehydration (sunken in)

  • aspirations can be seen with esophageal atresia (make sure to give them pacifier)

  • explain to parents that every child is different when they are concerned about why their new infant is not progressing as quickly as other child

  • tx failure to thrive with high-calorie formula

  • toddler assessment

    • use doll to teach/show equipment in non-threatening way

    • get to their level of development

    • always stay at eye level/below

  • preschoolers should be speaking in 4+ sentences

Autism

  • diagnosed no earlier than age 2

    • assess 2 year old with Ages and Stages Questionnaire (ASQ)

  • dont like eye contact or respond to name

  • repetitive behaviors

School-aged Children

  • always look at height of family members before raising concern about decreasing percentile of height and weight

  • provide items to keep siblings occupied while child is in hospital (coloring books, writing cards for patient)

  • never assume that frequently hospitalized children will have a better reaction to surgery

  • try to find out if there were any negative incidences in the past and help patient through it

Adolescents

  • schedule time with other adolescents/friends with those who have chronic disease

  • counsel patient on benefits and risks of oral contraceptives (orally and written) if they ask

    • parents do not need to know about this

Erikson

  • infants know someone will come if they start crying, needs will be met

  • school-aged children

    • offer them things to do that can be achieved to develop sense of accomplishment during long hospital stay (industry vs inferiority)

  • adolescent

    • have parents leave room during assessment

    • talk about identity and body image

Hematology

  • pad sharp furniture and stop hemophilic toddlers from running

  • use RICE when treating a hemophilic patient with severe knee trauma

  • pinch nose and bend forward to tx nosebleed

    • seek medical attention if it lasts more than 10 minutes (could be a sign of idiopathic thrombocytopenia)

  • low platelet count

    • bleeding precautions

    • soft toothbrush, no razors, no IV/injections

    • monitor CBC

    • give IVIG

  • sickle cell disease

    • keep them hydrated

    • treat pain

    • dress warm in cold weather to prevent sickle cell crisis

  • acute lymphocytic leukemia (ALL)

    • priority is to prevent infections

    • keep in private room d/t immunosupression

  • iron deficient anemia

    • drink iron supplement through straw (prevents teeth from discoloration)

      • drink with orange juice

Orthopedics/juvenile idiopathic arthritis (JIA)

  • encourage medication/ care plan compliance with rewards

  • check for neurovascular signs, capillary refill if child fell off monkey bars

  • strengthen and mobilize joints through swimming

  • when moving a child with rod in spine to tx scoliosis, use log roll method

  • ask about recent infections with osteomyelitis

Cardiac

  • Kawasaki Disease

    • symptoms

      • cracked lips

      • blistered palms/feet

      • strawberry tongue

      • red eyes

      • fever

    • priority

      • do echocardiogram to determine presence of aneurysm

      • give aspirin to prevent clotting

      • IVIG

  • bradycardia is a side effect when prostaglandins are used to tx patent ductus arteriosus (PDA)

    • may need to decrease amount given

  • give three doses of IV indomethecin to decrease murmur

    • listen for murmurs before each dose

  • congenital heart disease (CHD)

    • tachypnea, fluid in lungs

    • measure I/O and weight

    • listen to lungs and assess respiratory status

  • cardiac catheterization

    • assess pressure dressing post-op

    • risk for bleeding

    • encourage 24 hr bed rest, nutrition

    • keep leg straight

    • may have decreased pulses

  • digoxin

    • check HR, potassium level

    • do not give if vomiting

  • rheumatic fever

    • sore throat, general malaise, fever

    • caused by bacterial infection (strep)

    • tx with antibiotics

    • causes damage right mitral valve

Urinary

  • new onset of bedwetting is a sign of UTI

  • put those with cryptochidism in warm room

  • long-term use of antibiotics (vancomycin) cause hearing loss and kidney damage

    • assess urine output

  • nephrotic syndrome

    • has nothing to do with kidney failure

    • protein lost through urine

    • tx with fluid overload with albumin

      • assess effectiveness with decreasing edema

  • hypospadias

    • foreskin used during procedure

    • surgery done before being potty trained

      • catheter is placed for 7-10 days post-op

    • priority is to protect penis

  • wilm’s tumor

    • can cause metastasis if it bursts through manipulation

    • no pre-op biopsy or palpating

  • chronic kidney disease

    • can cause osteodystrophy

      • give slow growth erythropoietin, calcium, vitamin d

  • glomerulonephritis

    • red brown, and foamy urine, fluid retention, HTN, weight gain, edema

    • give antibiotics

  • report testicular pain to HCP immediately

Respiratory

  • epiglottitis

    • epiglottis protects larynx and helps with swallowing

    • infection causes inflammation and swelling

      • causes respiratory distress (stridor)

      • tx with tracheostomy tray, intubation tray

  • asthma

    • make sure child has a spacer and aerosol mask

  • croup

    • return immediately if patient cannot swallow secretions

    • if racemic epi aerosol was given, stronger steroids are needed if symptoms dont improve

  • RSV (bronchiolitis)

    • suction nose with saline before eating

    • too much suctioning can overstimulate infant

    • give synagis vaccine monthly

    • must be put in own room if immunization status is unknown

  • nose flaring, grunting, and retractions are a sign of respiratory distress in children

  • cystic fibrosis

    • give chest physiotherapy

    • skin tastes salty (do sweat-chloride test)

    • pancreatic enzymes needed before eating

GI

  • check for skin breakdown on a child with diarrhea

  • assess location of abdominal pain

  • paralytic ileus may occur after abdominal surgery

    • check bowel sounds, passing flatus

    • can cause N/V, abdominal distention

  • pyloric stenosis

    • assess for dehydration, irritability, excessive hunger, palpable olive-sized mass in RUQ

    • projectile vomiting

  • intussusception

    • tx using IV fluids

    • NPO status

    • can be lethargic

  • GERD

    • spit-up in infants

    • serve bland foods

  • biliary atresia

    • symptoms

      • jaundiced, yellow sclera

      • tea-colored urine

      • pale stools

Neuro

  • assess for ringing or foreign objects in the ear (first assessment)

  • use lumbar puncture to determine meningitis

  • safety is first priority for seizures

  • ask about history of epilepsy for febrile seizures

  • myelomeningocele

    • priority concern is urinary retention

      • frequent catheterization every four hours

    • high risk of developing latex allergy

  • duchenne’s muscular dystrophy

    • boys 3-7 years

    • progressive muscle loss

    • use electromyelogram (EMG) to assess

      • give pain meds before procedure

    • patients can be cognitively delayed

    • hypertrophic calves

  • patch both eyes with fox shield for eye injury

  • nystagmus

    • perform eye exam (six cardinal positions of gaze)

  • hydrocephalus

    • put ventriculoperitoneal shunt (VP shunt)

    • headache and vomiting means shunt immediately

    • nurse’s job is to measure head and abdominal circumference

Endocrine

  • check height and weight for patients with hypo/hyperpituitarism

  • administer calcium for hypoparathyroidism to tx muscle weakness

  • monitor insulin and adjust infusion rate for DKA

  • diabetes

    • take glucose before playing sports

    • hypoglycemia- sweating, shaking, nausea, headache

    • rotate injections

  • if TSH is high T4 is low (and vice versa)

  • kids with high BMI may have frequent urination from UTI/diabetes

    • check electrolytes

impetigo

  • administer antibiotics orally and topically

  • do not pop fluid from lesions

conjunctivitis

  • ointment may cause temporary blurry vision, will disappear when it melts

  • check immunization status, clean with soap and antibiotic ointment for tetanus

  • assess for lyme disease if patient has fever after tick is removed

  • chicken pox are infectious when rash seen two days prior

    • no longer infectious when lesion is crusted over

  • inspect hair follicle for head lice

  • breastfeeding and avoiding smoke exposure reduced occurrence of otitis media

  • tx adhd with stimulant meds, consistent schedule, organizational charts (make one area for homework)

Infection control

  • make patients with neutropenia a priority

  • wash hands, use proper equipment

  • teach parents to stay in room during isolation

  • get temperature on immunosuppressed child

  • give cool pack, tylenol/motrin after having immunizations

    • pedal legs to increase movement

  • give MMR vaccine at 12 months and another at 4-6 months

  • rheumatic fever caused by strep throat

  • chorea cause sudden aimless movement of extremities, will disappear with tx

Acid base

  • respiratory alkalosis

    • anxiety, fear, hyperventilation

  • metabolic acidosis

    • diarrhea

  • metabolic alkalosis

    • vomiting

  • Kussmaul respirations

    • respiratory alkalosis to compensate for metabolic acidosis