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PEDIATRICS > TEST 3 > Flashcards

TEST 3 Flashcards

1
Q

** expected findings in the client with major full thickness burns

A

damage to all layers of the skin that extends to the muscle, tendons, and bones.

looks like:

  • dull/dry
  • charred
  • visible ligaments, bone or tendons

sensation:

  • no pain
  • heals in weeks to months
  • scarring will be present
  • grafting is required
  • amputation possible
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2
Q

contraindications for MMR vaccine

A

live vaccine:

  • allergy to neomycin or streptomycin and polymyxin B
  • pregnancy
  • immunosuppression
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3
Q

appropriate sites for IM injection for the infant/toddler/school-age

A

infants/:
- vastus lateralis or

young children: ventrogluteal muscle

children/adolescents:
- deltoid muscle

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4
Q

expected findings int he child with varicella infection

A 
CHICKENPOX
symptoms 1 to 2 days prior to rash:
- high fever
- fatigue
- loss of appetite
- headache

rash:

  • macules start in trunk and face, then spreads
  • vesicles to follow, with crusts forming
  • scabs appear in 1 week
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5
Q

** expected findings in the child with otitis media

A

INFECTION OF MIDDLE EAR

subjective:

  • recent hx of upper respiratory infection
  • acute onset of changes of behavior
  • frequent crying, irritability, fussiness
  • inconsolability
  • tugging at ear
  • report ear pain, loss of appetite, n/v

objective:

  • rubbing/pulling of ear
  • crying
  • lethargy
  • bulging yellow or red tympanic membrane
  • purulent material
  • no tympanic movement
  • high temp
  • hearing difficulties
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6
Q

client tx for the child with infectious mononucleosis

A 
standard precautions
antiviral therapy
good hand hygiene
cover mouth and nose when sneezing
wash bedding with mild detergent
if immunocompromised, seek prompt tx
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7
Q

differentiate between which immunizations given IM and SQ

A

IM:

  • varicella
  • MMR
  • zoster

SQ:

  • Hib
  • PCV
  • IPV
  • HepA
  • HepB
  • MCV4
  • HPV
  • Influenza
  • DTap
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8
Q

** plan of care for the client with infectious mononucleosis

A
  • antipyretic for fever, non aspirin
  • analgesics for pain
  • good oral hygiene
  • rest and lots of fluid
  • no sharing personal items/ or kissing
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9
Q

** immunizations that should be given to the client at 4 months of age

A
  • RV
  • DTaP
  • Hib
  • PCV
  • IPV
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10
Q

expected findings in the child with synthroid toxicity

A
  • irritability
  • rapid pulse
  • diarrhea
  • weight loss
  • fever/sweating
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11
Q

immunizations that should be given to a 2 month old

A
  • RV
  • DTaP
  • Hib
  • PCV
  • IPV
  • HEPATITIS B
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12
Q

care of the child immediately after a burn

A
  • stop burning process
  • ABC’s
  • cover burn area with clean cloth
  • provide warmth
  • take to medical facility
  • initiate fluid resuscitation
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13
Q

teaching regarding the different types of immunity

A
  1. active natural: child gets disease, body develops antibodies naturally
  2. active artificial: immunization vaccine
  3. passive natural: from mother to baby. placenta
  4. passive artificial: immunoglobulins administered. antitoxin.
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14
Q

client teaching for the child with varicella infection

A
  • spreads with DIRECT CONTACT/DROPLET
  • antipyretics for pain, no aspirin
  • nutrition/fluids
  • calamine lotion for topical relief
  • keep skin clean and dry
  • tepid water baths/oatmeal soaks
  • fingernails clean and short
  • adequate rest
  • clean sheets daily
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15
Q

teaching regarding prevention of communicable diseases

A
  • # 1 keep up with immunizations
  • hand hygiene
  • adherence to med therapy
  • cover nose and mouth when cough/sneeze
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16
Q

care and treatment for the child with growth hormone deficiency

A
  • check growth/weight every visit to PCP
  • measure children under 3 every 6 months
  • monitor effects of GH replacement
  • administer thyroid replacement
  • provide support for body imaging
  • realistic expectations
  • somatotropin SQ injections daily
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17
Q

care of the client with contact dermatitis

A
  • remove irritant and limit exposure
  • poisonous plant exposure:
    • rinse w/cold water
    • cleans w/isopropyl alcohol, then soap/water
    • clothes cleaned with alcohol and hot water
    • apply calamine lotion, Burow’s solution, aveeno baths
    • oral corticosteroids for sever reactions
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18
Q

recommended immunizations for the client with immunosuppression

A
  • dtap
  • hib
  • ipv
  • pct
  • hep a
  • hep b
  • mcv4
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19
Q

expected findings in the client with herpes zoster infection

A
  • itching
  • neurologic pain
  • hyperesthesias
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20
Q

care of the client with impetigo

A

BACTERIAL (staphylococcus)

  • use topical antibacterial ointment
  • oral or parenteral antibiotics for severe case
  • good hand hygiene
  • don’t squeeze vesicles

clean toys with hot soapy water

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21
Q

care of the client with oral candidiasis

A

FUNGUS (candida albicans)

  • oral/antifungals (amphotericin B, nystatin wash)
  • older children taught to swish
  • sterilize bottle nipples and pacifiers fro 20 min in boiling water
  • nystatin on nipples for breast feeders
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22
Q

care of the client with pediculosis capitus

A

HEAD LICE

  • shampoos w/1% permethrin as prescribed
  • remove nits with nit comb, repeat in 7 days after shampoo
  • washing clothing, bedding in hot water/detergent
  • difficult cases: malathion 0.5% in isopropanol
  • avoid home remedies
  • items that cannot be laundered, must stay in a sealed bag for 2 weeks
  • no sharing items
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23
Q

risk factors for otitis media

A
  • common in 24 months of life and then 5-6yo
  • triggered by bacterial and viral infections, allergies, enlarged adenoids
  • high incidence in winter months
  • exposure to large numbers of children
  • exposure to secondhand smoke
  • cleft lip/palate
  • down syndrome
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24
Q

priority care/nursing diagnosis fro the client with a major burn

A
  • manage airway
  • prevent shock
  • monitor vs
  • maintain cardiac output
  • manage pain
  • increased calories/protein
  • restorm mobility: AROM, PROM
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25
Q

explaining the patho of diabetes mellitus to a client

A

characterized by a partial or complete metabolic deficiency of insulin

26
Q

isolation precautions for HIV/AIDS

A

standard precautions

27
Q

expected findings in the client with Lyme Disease

A

Stage 1:
- red ringed (target shape) rash occurs 3-31 days after tick bite, flu like symptoms

Stage 2:
- neurologic, cardiac, and musculoskeletal involvement

Stage 3:
- musculoskeletal pain in joints and supporting structures

28
Q

description of a deep partial thickness burn

A

SECOND DEGREE damage to the entire epidermis and some parts of the dermis. sweat glands and hair follicles remain intact

appearance:

  • red/white in color w/blisters and moderate edema
  • glances with pressure

sensation:

  • pain
  • sensitive to temp change
  • healing can extend past 21 days
  • scarring is likely
29
Q

care of the client with a circumferential burn

A
  • neuro checks #1
  • consider escharotomy
  • elevate limbs
  • ABC’s
30
Q

expected findings in the client with scabies infection

A
  • itchy at night
  • rash between fingers
  • thin pencil mark lines on skin
  • infants:
    • widespread on body
    • pimples on the trunk
    • blisters on palms of the hands and feet
  • young children:
    • most common on head/neck/shoulders/palms/soles
  • older children:
    • common on hands/wrists/genitals/abdomen
31
Q

care of the client with diaper dermatitis

A
  • remove wet diaper
  • clean urine off with nonirritating cleaner
  • wash skin folds frequently
  • expose area to air
  • super absorbent diapers
  • apply skin barrier such as zinc oxide
  • use cornstarch to reduce friction rub
32
Q

dosage calculation

A

.

33
Q

description of a full-thickness burn

A

THIRD THICKNESS nerve endings, hair follicles, and sweat glands are destroyed

appearance:

  • red to tan, black, brown, or white in color
  • dry, leathery appearance
  • no blanching

sensation:

  • as burn heals, painful sensations return
  • heals in weeks to months
  • scarring is present
  • grafting is required
34
Q

tx for the client with petechiae

A
  • monitor for thrombocytopenia

- avoid unnecessary punctures

35
Q

care of the client with seborrheic dermatitis

A
  • gently scrub at the scalp with mild pressure
  • shampoo daily w/mild soap
  • fine tooth comb to remove loosened crusts
36
Q

teaching a group of adolescents about acne

A
  • adherence to prescribed care
  • handwritten instructions
  • gently wash face, avoid scrubbing, no abrasive cleaners
  • take meds as prescribed
  • provide support and encouragement
  • watch suicide intention with accutane
  • watch body image change
37
Q

priority of care for the client with smoke inhalation

A

maintain airway and ventilation. provide 1–% o2

38
Q

expecting findings for the client 24 hours after a burn

A
  • increased hbg/hct due to loss of fluid volume
  • hyponatremia
  • hyperkalemia
39
Q

expecting findings for the client 72 hours after a burn

A
  • decreased hbg/hct from interstitial to vascular
  • hyponatremia
  • hypokalemia
  • increased WBC then decrease
  • hyperglycemia from stress response
  • hypoxia from metabolic acidosis
  • decreased protein
40
Q

care of the client with atomic dermatitis

A
  • keep skin hydrated w/tepid baths, then apply emollient within 3 mins of bathing
  • dress in cotton
  • avoid excess heat
  • avoid irritants
  • provide support
  • identify causative agent
41
Q

order of priority in the care of the client with a major burn

A
  • ABC’s first priority
  • LOC
  • Signs of inhalation injury
  • Carbon monoxide inhalation
  • determine location and extent of injury
42
Q

** care of the pediatric client with cellulitis

A
  • oral or parenteral antibiotics, as prescribed
  • rest and immobilize affected area
  • apply warm, moist compresses
43
Q

client teach for the child taking accutane

A
  • prescription strength
  • side effects:
  • -dry skin, eyes
  • -decreased night vision
  • -headaches
    • photosensitivity
    • elevated cholesterol and triglycerides
  • -depression/suicidal thoughts
  • monitor behavioral changes
  • must use 2 forms of contraceptives
44
Q

appropriate diet for the child with burns

A 
high protein
high calorie
vitamin A
vitamin C
zinc
fluids
45
Q

expected findings for the client with tinea pedis/corporis/capitus

A

pedis (athletes foot):
- maceration and fissuring between toes or plantar surface of the feet

corporis (body ringworm):

  • round erythematous scaling patch
  • spreads peripherally
  • clears centrally

capitus (head ringworm):
- scaly, circumscribed lesion with alopecia

46
Q

care of the client having a hypoglycemic reaction

A
  • give 10-15g simple carbohydrate
  • 4oz OJ
  • 8oz milk
  • 2-4 glucose tablets
  • 4oz regular soft drink
  • monitor BG frequently
  • follow with complex carbohydrates
  • 7g protein when glucose is WNL
  • unconscious: glucagon SC or IM
47
Q

** treatment for the client with atopic dermatitis

A
  • antihistamines
  • antibiotics for secondary infections
  • topical corticosteroids
  • non steroidal agents
48
Q

** indication of complications in a client with major burns

A
  • VS
  • discoloration
  • edema
  • odor and drainage
  • cap refill poor
  • intake/output
49
Q

teaching for the client needing self-blood glucose monitoring

A
  • check accuracy of strips with control solution

- keep records of date, time, levels, activity

50
Q

**expected findings in the client having a hypoglycemic reaction

A

hot and clammy, need some candy

  • shakiness
  • diaphoresis
  • anxiety
  • nervousness
  • chills
  • headache
  • confusion
  • labile
  • difficulty focusing
  • pallor
  • palpitations
51
Q

care of the client with diabetic ketoacidosis

A
  • monitor cardiac
  • check for ketone in blood and urine
  • monitor IV site
  • monitor BG hourly
  • monitor serum potassium with fluid absorption
  • sodium bicarb for severe acidosis
  • reinforce directions to manage diabetes
52
Q

potential causes of hypoglycemia

A
  • inadequate insulina production
  • endocrine disorders
  • medications
  • LGA
  • diabetic mother
  • SGA
  • premature brith
  • babies born under stress
53
Q

client teaching about HbA1c

A
  • tells numbers from last 2-3 months. RBC’s last 120 days.

- range between 4-6%. target for children with diabetes is 6.5-8%. goal of less than 7%

54
Q

**transmission of HIV

A
  • mothers transmit virus prenatally and through breast milk
  • blood products that contain HIV
  • sexual abuse
  • risk behaviors (drug IV use)
  • STI/STD
  • lack of awareness
55
Q

expected findings in the client with hypopituitarism

A
  • short stature but proportional height/weight
  • delayed epiphyseal closure
  • increased insulin sensitivity
  • delayed dentition
  • underdeveloped jaw
  • delayed sexual development
56
Q

contraindication for live vaccines

A
  • pregnancy
  • allergies to gelatin, neomycin, eggs
  • immunosuppression
  • recent transmission of blood
57
Q

** care of the client with hyperglycemia

A
  • oral fluid increase
  • administer insulin
  • test urine for ketones
  • consult HCP if symptoms progress
  • restrict exercise when levels >250
58
Q

expected findings in the client with DM

A
  • 3 P’s
  • -Polyphagia
  • -Polyuria
  • -Polydipsia
  • BG greater than 126 with two occasions
  • inadequate insulin secretion
59
Q

expected findings in the client with congenital hypothyroidism

A
  • decreased activity
  • poor suck
  • coarse hair
  • large anterior fontanel
  • poor feeding/weight gain
  • poor growth/small stature
  • jaundice/pallor/hoarse cry
  • dull expression
  • mottled cool and dry skin
  • “good babies”
60
Q

** health prevention teaching for the client with DM

A
  • rotate sites
  • inject at 90 degrees
  • snack 30 minutes before activity
  • when sick check BG more often
  • suggest sugar free non caffeinated beverages
  • meet carbohydrate needs
  • test urine for ketones
  • rest
61
Q

** expected findings in the client with DKA

A
  • ketons in blood and urine
  • fruity scent to breath
  • mental confusion
  • dyspnea
  • n/v
  • dehydration
  • weight loss
  • electrolyte imbalances
  • untreated leads to coma

PEDIATRICS (3 decks)

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