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Child Health > Block #2 - Assessment, Psychosocial/Cognitive, Immunological, Infectious, Gastrointestinal > Flashcards

Block #2 - Assessment, Psychosocial/Cognitive, Immunological, Infectious, Gastrointestinal Flashcards

1
Q

What measurements best reflect the nutrition status of children?

A

Head circumference and Height

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2
Q

Where is BP assessed if an arm is unavailable?

A

The leg

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3
Q

What is the order of vitals assessment?

A

RR > Apical HR > BP > Temperature

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4
Q

When do the fontanelles close?

A
  • Posterior: 2-4 months

- Anterior: 12-24 months

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5
Q

Amblyopia and treatment

A

Lazy-eye

Patch over the good eye

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6
Q

Ear Assessment

A

Low ears = Down’s syndrome and/or liver problems

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7
Q

Which way should the ear be pulled to assess/give ear drops? (> or < 3 years)

A

<3: down and back

>3: up and back

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8
Q

Hemoglobin and Hematocrit Values in children

A

Hgb: <12
Hct: <36

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9
Q

What is the antidote for a Tylenol OD?

A

Mucomist

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10
Q

What damage can be caused by Tylenol?

A

Liver Damage

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11
Q

Who should the FACES scale be used to assess pain for?

A

English speakers, >3 yr

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12
Q

Who should the Oucher scale be used to assess pain for?

A

Non-English speakers

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13
Q

Which is worse and why? Ileostomy/Colonostomy

A

Ileostomy because the stool is more water

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14
Q

Shaken Baby Syndrome: red flags

A
  • Retinal bleeding

- Possible loss of consciousness

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15
Q

Munchausen Syndrome by Proxy: Definition

A

Caregiver fabricates the s/s of illness in the child to gain attention from the medical staff

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16
Q

Munchausen Syndrome by Proxy: Warning Signs

A
  • One or more illnesses that don’t respond to treatment or follow a puzzling course
  • S/S don’t make sense or disappear when caregiver is gone
  • Physical and lab findings don’t match story
  • Repeated admits with failure to find a diagnosis, transfers to other hospitals, leaves AMA
  • Parent refuses to accept a non-medical diagnosis
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17
Q

Warning Signs of Possible Autism

A
  • Not babbling by 12 months
  • Not maintaining eye contact
  • Not pointing or using gestures by 12 months
  • No single words by 16 months
  • No two word sentences by 24 months
  • Loss of language or social skills at any age
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18
Q

Behavior Management for Autism

A
  • Do not bargain
  • Consistency in caregivers and routine
  • Low pitched voice and remain calm
  • Redirect attention
  • Ignore inappropriate behavior (when possible)
  • Praise self control
  • Restraints only when absolutely necessary
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19
Q

Learning Disabilities: Types

A

Dyslexia: problems with reading, writing, and spelling (MOST COMMON)
Dyscalculia: problems with math and computation
Dyspraxia: problems with dexterity and coordination
Dysgraphia: problems producing the written word

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20
Q

Fetal Alcohol Syndrome: signs

A
  • Long Philtrum
  • Flattened midface
  • Small eye openings
  • Thin upper lip
  • Low nasal bridge w/ short upturned nose
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21
Q

Intellectual Disabilities: 3 Criteria

A
  • IQ <70
  • Limits in 2 skills of ADLs
  • Onset before 18 yrs
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22
Q

Intellectual Disabilities: Levels

A
  • Mild: IQ 50 - 70
  • Moderate: IQ 35 - 50
  • Severe: IQ 20 - 35
  • Profound: IQ <20
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23
Q

Chickenpox (Varicella): Treatment

A

Acyclovir - doesn’t cure, prevents further outbreaks

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24
Q

Chickenpox (Varicella): Precautions

A

Airborne

  • RN: N95 mask
  • Patient: surgical mask outside of room
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25
Q

Chickenpox (Varicella): Communicability

A

No longer contagious once lesions have crusted over

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26
Q

5th Disease: S/S

A
  • Red rash (face, then chest) [looks like child was slapped]
  • Mild fever
  • Runny nose
  • Contagious before rash appears
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27
Q

Scarlet Fever: Precautions

A

Droplet and Contact

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28
Q

Scarlet Fever: S/S

A

1st day- light rash, white strawberry tongue

3rd day- more profound rash, red strawberry tongue

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29
Q

Scarlet Fever: Sequelae

A

Can cause glomerulonephritis and rheumatic heart disease

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30
Q

Scarlet Fever: Treatment

A

Penicillin

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31
Q

Koplik’s Spots (Rubeola/Measles)

A
  • Red lesions in mouth with white spot in center
  • “Strawberry tongue”
  • Airborne precautions
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32
Q

Teratogenic Conditions

A

Conditions which are harmful to the fetus

Rubella/German Measles, 5th disease, and chickenpox

HIV is not teratogenic

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33
Q

Pinworms

A
  • S/S: rectal itching
  • Testing: tape test
  • Treatment: Vermox (treat whole family and wash clothes in hot water)
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34
Q

Tetanus “Lockjaw”

A

May occur through the umbilical cord

S/S: muscle rigidity (masseter and neck), accumulated secretions, atelectasis, pneumonia, respiratory arrest, tachycardia, diaphoresis, possible fever

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35
Q

Tetanus Booster Recommendations

A

1st dose
1-2 months after initial dose
6 months after initial dose

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36
Q

Vitamin D Requirements

A

400 mg/day (recently doubled from 200 mg)

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37
Q

Rabies Treatment Doses

A
  • Day of Event
  • Day 3
  • Day 7
  • Day 14
  • Day 28

Painful injection (HRIG), use local anesthetic (EMLA)

38
Q

What causes Mono?

A

Epstein-Barr Virus

39
Q

Lupus (SLE): Nursing Care

A
  • Manage pain and inflammation
  • Treat S/S
  • Prevent complications
  • Give antimalarial medications
  • Give corticosteroids
  • Give immunosuppressive agents
  • Give palliative care and psychosocial support
40
Q

Lupus (SLE): S/S

A
  • Fever
  • Malaise
  • Chills
  • Fatigue
  • Weight Loss
  • Butterfly Rash
  • Arthritis
41
Q

Lupus (SLE): Diagnostic Criteria - need at 4

A
  • Butterfly rash
  • Neuro disorder
  • Immunologic disorder
  • Discoid rash
  • Renal disorder
  • Oral ulcers
  • Arthritis
  • Serositis
  • Photosensitivity
42
Q

Cleft-Lip/Palate

A
  • Can only delegate care to RN
  • Cleft Lip cannot say “da da da”
  • Interferes with dental development
  • Large nipple needed on bottle
43
Q

Eating Disorders: Types

A

Anorexia: doesn’t eat
Bulimia: eats, then forces self to vomit (damage to esophagus and teeth)
Pica (Low iron): eats ice, chalk, mud, play doh, etc.
Rumination: chews food, spits out, chews again
Obesity: BMI >95th percentile

44
Q

Hirschsprung Disease

A

Large intestine ganglion dysfunction = constipation

Temporary colostomy (3 months) needed

Down’s = increased risk

45
Q

Appendicitis

A 
Pain in RLQ
Fever
Extreme pain
     -goes away = rupture
     -peritonitis/sepsis risk
Vomiting

WBC >10,000

46
Q

Meckel’s Diverticulum

A

Diverticula form during fetal development

Most common GI malformation

47
Q

Crohn’s vs. Ulcerative Colitis

A

Crohn’s - Diarrhea

UC - bloody/mucus diarrhea

48
Q

Intussusception

A

Intestine rolls over itself

Flat, jelly-like stools, fever, dehydration, abd distention, lethargy, and grunting, sausage protrusion in abdomen

Treatment: Barium Enema

49
Q

Celiac Disease: 4 Symptoms

A

Steatorrhea (fatty stools)
General malnutrition
Abdominal distention
Secondary vitamin deficiency

50
Q

Celiac Disease: BROW Diet (foods to avoid)

A

B- Barley
R- Rye
O- Oats
W- Wheat

51
Q

Rehydration

A

Offer electrolyte drinks (Pedialyte) of 1.5-2 oz. q15min, even if N/V persists

52
Q

Encopresis

A

Potty-trained child regresses

53
Q

Pyloric Stenosis

A

Pylorus: Opening of small intestine into duodenum

Projectile Vomiting after feedings

Requires surgery

54
Q

SODA (to assess daily activity)

A

S- Sleep
O- Output (BM, UOP, etc.)
D- Diet
A- Activity

55
Q

Communication: Infants

A

Different cries (caregiver knows the difference/meanings)

56
Q

Communication: Early Childhood (1-6 yr)

A

Egocentric- only talk about pt, be honest, let them touch equipment, pts. take things very literally

57
Q

Communication: School Age (6-12 yr)

A

Pts. want to know rationale, ensure modesty

58
Q

Communication: Adolescent (12-19 yr)

A

Modesty and privacy are key, regression possible during hospitalization

59
Q

What meds should be alternated for fever control?

A

Tylenol and Ibuprofen

60
Q

Lead Poisoning: S/S

A
  • Headache
  • Irritability
  • Abdominal Pain
  • Vomiting
  • Anemia
  • Weight loss
  • Poor attention span
  • Noticeable learning difficulty
  • Slowed speech development
  • Hyperactivity
61
Q

Lead Poisoning: Effects

A
  • Reading and learning disabilities
  • Speech and language handicaps
  • Lowered IQ
  • Neurological deficits
  • Behavior problems
  • Mental retardation
  • Kidney Disease
  • Heart Disease
  • Stroke
  • Death
62
Q

Which children are on strict Input/Output while in the hospital?

A

ALL CHILDREN ARE ON STRICT INPUT/OUPUT

63
Q

Starting an IV for pediatrics

A
  • Use EMLA at IV site
  • Hand and feet are good sites
  • Don’t change site, if possible
  • Have everything (and backups) in the room before starting
  • Monitor closely for infiltration
64
Q

Behavioral-Cognitive Pain Management Strategies

A
  • Relaxation
  • Distraction
  • Imagery
  • Thought Stopping
  • Biofeedback
  • Play
65
Q

Factors Influencing Children’s Behavior

A
  • Biologic/Genetic factors (1/5 kids)
  • Nutrition
  • Physical health
  • Developmental ability r/t bullying
  • Environmental or family interactions
  • Temperament
  • Caregivers’ responses to behaviors
66
Q

Suicide Risk: S/S

A
  • Depression
  • Other mental illness
  • Withdrawal from friends/family
  • Mental Health/Personality changes
  • Decline in School
  • Giving away possessions
  • Preoccupation with death/dying
  • References to dying
  • Access to methods of suicide
67
Q

Suicide: Risk Factors

A
  • Previous attempts
  • Change in school performance, sleep, or appetite
  • Loss of interest in previous interests
  • Feelings of helplessness or depression
  • Thoughts of self harm or suicide
68
Q

Pervasive Developmental Disorder Scale (Spectrum)

A
  • Autistic Disorder (lack of social and communication skills, repetitive behaviors)
  • Asperger’s (mild autism)
  • Rett’s Disorder (development normal until 6 months [female children])
69
Q

Subtypes of ADHD

A

Hyper-active Impulsive

Inattentive

Combination

70
Q

Complications of Eating Disorders

A
  • Fluid and Electrolyte Imbalance
  • Decreased Blood Volume
  • Cardiac Arrythmias
  • Esophagitis
  • Rupture of the Esophagus or Stomach
  • Tooth Loss
  • Menstrual Problems
  • 18% mortality
71
Q

Immunity: Mechanical Barrier

A

The mechanical action of lfuids (tears, urine, vaginal secretions, and semen) that flow out from the body and carry away unwanted intruders

72
Q

Immunity: Chemical Barriers

A

(Acidic secretions of the stomach and digestive enzymes) neutralize organisms taken into the body through the mouth

73
Q

Mumps

A

Incubation: 14-21 days

S/S: fever, malaise, orchitis (testicular inflammation -> may cause sterility), and meningioencephalitis

Dropplet and Contact Precautions

74
Q

Rabies

A

Transmitted by saliva after an animal bite

Managed with dose of HRIG (Human Rabies Immunoglobulin)
This is a painful injection, use EMLA at site

75
Q

Tick Removal Teaching Guidelines

A
  • Protect fingers with a tissue, paper towel, or latex gloves
  • Grasp tick as close to skin as possible and pull upward with steady and even pressure
  • Do not twist or jerk the tick
  • Once removed, clean the site with soap and water. Then, wash hands
  • Save tick for identification in case the child becomes sick
76
Q

Lyme Disease

A
  • Bull’s Eye Rash
  • Dysrhythmias
  • Nucchal Rigidity

Treat with PO antibiotics

May become chronic

77
Q

Rocky Mountain Spotted Fever

A
  • Sudden N/V, lack of appetitie, abdominal pain, malaise, deep muscle pain, severe headache
  • Blanchable red rash
  • Splenomegaly, Hepatomegaly, and Jaundice

Treat with: Tetracycline or Doxycycline (not in <8 yr old)

78
Q

Vaccines: IM Injection Routes

A 
Dtap, DT, Tdap
Hep A, Hep B
HiB
Influenza
Pneumococal
HPV
MCV4
79
Q

Vaccines: SubQ Injection Routes

A

IPV
MMR
Varicella
MPSV4

80
Q

Nursing Care for Anaphylaxis

A
  • Perform CPR
  • Activate the emergency system
  • Ensure airway
  • Adminster Epi
  • Tourniquet proximal to site
  • Keep pt. flat, warm, and feet elevated
  • Determine cause of attack
  • Adminster corticosteroids and anithistamines
81
Q

Swallowing: Reflex vs. Choice

A

Swallowing is a choice after 3-months-old.

Keep in mind for PO meds

82
Q

Cleft Lip/Palate Surgery Timing

A

Cleft Lip- 3 months

Cleft Palate- 18 months

83
Q

Inguinal Hernia

A

S/S: oainless swelling towards or into the scrotum

Complications: incarcerated/strangulated intestinal tract

5x more likely in males

84
Q

Umbilical Hernia

A

S/S: soft midline swelling in the umbilical area

Complications: incarcerated/strangulated intestinal tract

Most resolve by 3-5 yr

85
Q

Irritable Bowel Syndrome

A

S/S: abd pain, flatus, bloating, constipation or diarrhea, “nervous stomach”, and/or muscle spasms when exposed to triggers

Additional: HA, N/V, mucus stools, anorexa, and weight loss

86
Q

What is the most common cause of Diarrhea?

A

Rotaviruses

87
Q

Dehydration: Risk Factors

A
  • Diarrhea
  • Vomiting
  • Decreased PO intake
  • Sustained fever
  • DKA = polyuria
  • Extensive burns
88
Q

Vomiting: Nursing Care

A
  • Treatment of cause and prevention of complications
  • Bowel rest
  • Rehydration
  • Bland solid foods
  • Anti emetics
  • Monitor Input/Output
  • Oral hygiene
  • Zofran
89
Q

What medication treats Rocky Mountain Spotted Fever?

A

Tetracycline or Doxycycline

90
Q

Scarlet Fever

A

Penicillin

91
Q

Chickenpox (Varicella)

A

Acyclovir

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