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Child Health Nursing > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

What is the management of amblyopia?

A

(this is when one eye is lazy)
-patching the stronger eye for several hours a day
-or atropine drops in stronger eye daily
-vision therapy
-eye muscle surgery

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2
Q

What is conductive hearing loss?

A

-transmission of sound through the middle ear (TM) is disrupted
**commonly cause by frequent ear infections (AOM)

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3
Q

What is sensorineural hearing loss?

A
  • damage to the hair cells in the cochlea or along the auditory pathway
    **commonly caused by ototoxic medications, neuro infections like meningitis, CMV, rubella & excessive noise
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4
Q

What is mixed hearing loss?

A

attributed to both conductive and sensorineural problem

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5
Q

Tips for interacting with visually impaired children

A

-use their name to gain attention
**identify presence before touching child
-discuss upcoming activities
-use touch and tone appropriately to situation
-use childs body as reference points for location of items
-encourage exploration of items through touch

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6
Q

What is acute otitis media?

A

-sudden ear infection typically in infants and young children
-usually accompanied with upper respiratory infections
-cause rubbing and pulling of ears
-causes TM to be dull,red,and bulging
-if often; hearing difficulties and speech delays

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7
Q

What is the management of acute otitis media?

A

-symptomatic management of otalgia (ear pain) and fever
-tylenol and ibuprofren for mild to moderate pain but narcotic analgestics may be if severe
*benzocaine if TM is not ruptured
-warm heat or cold compress
*antibiotic therapy

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8
Q

what is an pneumatic otoscope?

A

used to visualize the TM and assess its movement

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9
Q

What is otitis media with effusion (OME) non infectious

A

-non-infectious condition that causes fluid to build up behind the eardrum
-make the ear feel full
*makes air bubbles
-TM looks dull, orangish, and decreased movement
-can make you say “huh”
-usually goes away on own

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10
Q

What is OME management?

A

antihistamines, steroids, and decongestion DO NOT help
-usually resolves on own, but should be checked every 4 weeks
-do not feed in supine position and avoid bottle propping
-if it lasts >3 months, refer to ENT and assess for hearing loss and speech delay

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11
Q

What is otitis externa?

A

“swimmers ear”
-inflammation and infection of the ear canal due to bacteria or fungus
-reports significant pain and itching
-recent swimming/bathtub
-red,edematous ear canal
-ear drainage (white or colored)
-pain w palpation of tragus

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12
Q

What is the management of otitis externa “swimmers ear”?

A

Antibiotic otic drops
*Ciprodex (4 gtts into affected ear BID x7 days)
-analgesics for pain
-warm compress
-wick placement to facilitate admin of antibiotic drops is canal edematous

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13
Q

What is some education points for otitis externa “swimmers ear”?

A

-keeping ear canal dry after bathing
-hair dryer on low setting
-Domeboro soln. or rubbing alcohol & vinegar soln.

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14
Q

What is a tympanostomy?

A

“Pressure equalizing (PE) tubes’
-removes pressure
-needed with frequent OM
-allows infection to exit
-fall out on own

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15
Q

What is a myringotomy?

A

-a surgical procedure that involves an incision in the eardrum to drain pus/fluid or insert tubes

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16
Q

What is the nursing management for tympanostomy and myringotomy?

A

-scheduled as out pt surgery, under general anesthesia
-lasts less than 15 mins
-PACU recover, discharge same day
*postop pain is NOT common

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17
Q

What is the education for tympanostomy and myringotomy?

A

-ear plugs while swimming
-if water enters, allow to drain out or use hairdryer on low setting
-if there is drainage while PE tubes are in place, NOTIFY PROVIDER
-the tubes remain in place for several months but fall out 8-18 months after placement

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18
Q

What are the symptoms of hearing loss in an infant?

A

-wakes only to touch, not room noise
-does not babble by 6 months

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19
Q

What are the symptoms of hearing loss in younger child?

A

-does not speak by age 2
-Communicates needs through gestures
-focuses on facial expressions when communicating
-does not respond to the doorbell or the telephone

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20
Q

What are the symptoms of hearing loss in older children?

A

-often asks for statements to be repeated
-inattentive or daydreams
-poor school performance
-monotone speech

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21
Q

Age related ear drop administration

A

<3 years old: pull pinna down and back
>3 years old: pull pinna up and back

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22
Q

Steps of ear drop administration

A

1lean head to side with ear upright
2 position ear appropriate for age
3 roll and bring to room temp, then instill # of drops
4 “pump” tragus
5 keep on side or upright for 2-5min

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23
Q

What is an abrasion?

A

Superficial rub or wearing off of the skin usually due to friction; mainly limited to the epidermis

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24
Q

What is a laceration?

A

injury that penetrates skin and soft tissue

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25
What is a bruise?
caused by a blow or impact to skin rupturing underlying vessels
26
Burn process
capillaries become more permeable>vasodilation>H20,electrolytes, protein leak out of vasculature>edema
27
Location of intentional skin injuries
buttocks, back & thighs -pattern markings key**
28
what are the risk factors of intentional skin injuries?
-poverty -prematurity (<1yo) -chronic illness -intellecual disability -parent w abuse history; unrelated partner -alcohol/substance abuse -extreme stressors
29
When should you be suspicious of skin injury?
-in uncommon locations -bruises in infants <9 months (immobile) -multiple injuries other than lower extremities -frequent ED visits; delay seeking care -inconsistent stories -unusual caregiver child interaction
30
Sun education
infants <6 months out of direct sunlight -limit sun exposure between 10am-4pm -use on sunny and overcast days
31
Sunscreen education
-use broad spectrum -fragrance and oxybenzone free -SPF 30 or higher -zinc for nose, cheeks, ears, and shoulders -apply 30 min prior and reapply every 2 hours or every 60-80 min in water
32
Primary assessment/survey of burns
Airway-patent,maintainable or unmaintainable Assess for s/s of airway injury or smoke inhalation Respiratory effort, symmetry of breathing,breath sounds, pulse 02, ABG, carboxyhemoglobin levels Skin color, pulse strength, HR, perfusion status, edema: ECG if electrical burn
33
Secondary assessment/survey of burn
-burn depth -body surface area -other traumatic injuries
34
1st degree burn
Superficial -painful, pink to red with NO blisters, blanches
35
2nd degree burn
Superficial partial thickness: -painful, moist, red w blisters, edema, blanches Deep partial thickness: -painful,mottled, red to white blisters and moderate edema, blanches
36
3rd degree burn
full thickness red to tan,black,brown or waxy white, dry, leathery, NO blanching
37
4th degree burn
Deep Full thickness burn down to bone dull and dry charring visible bone tendons
38
Nursing care for burns
Fluid Resuscitation pain management prevent hypothermia prevent infection wound care Total Body Surface Area is necessary to critique to know what to treat
39
Non-Candida Diaper Dermatitis
-red,shiny -affects skin on buttocks, thighs, abdomen and waist, usually not on creases and folds *use skin barriers (zinc, A,D,E ointments, petroleum)
40
Candida Diaper Dermatitis
-deep red lesions -scaly w satellite lesions (outside of diaper area) -usually in creases and folds -antifungal needed (nystatin) -less diaper time to allow healing -blow dry diaper area/rash with dryer on warm (no hot) for 3-5 mins
41
Diaper Dermatitis interventions
-change diapers frequently -avoid rubber pants, harsh soaps, and baby wipes w fragrance or perservatives
42
What is impetigo
common infection of superficial layers of epidermis that is highly contagious. pustule or vesicle>ruptures>exudate forms honey crust w erythematous base -often on face and extremities
43
Impetigo often apperas with
staph
44
Impetigo extra
itchy, painful very contagious fill w fluid then erupt
45
Impetigo management
-contact precautions -remove crust w soap and water before applying antibiotics -topical ointment or oral (>5 lesions) -change linens/clothes in contact
46
Acne Vulgaris Appearance
-areas of comedones on forehead and cheeks -scattered pustules on back with hypertrophic scaring
47
Acne Vulgaris Education
-Avoid oil based cosmetics and hair products -headbands, hats, and helmets can make it worse -clean w mild soap and water -eat a balanced diet -avoid picking/squeezing -emotional counseling if severe
48
Acne Vulgaris medications
*may take 4-6 weeks for improvement -Tretinion – interrupts abnormal keratinization that causes microcomedones -Benzoyl peroxide (OTC products) – inhibits growth of P. acnes -Topical antibacterials (Clindamycin); Oral – Tetracycline, Erythromycin -Isotretinoin – for severe cases, dermatologist prescribed, teratogenic -Oral contraceptives – decreases endogenous androgen producti
49
Neutrophil lab cues
Increased with acute bacterial infection
50
Eosinophil lab cues
increased with allergic reactions
51
B-lymphocyte T-lymphocyte lab cues
increases with viral infections
52
IgA Characteristics
1st line of defense against respiratory, GI, GU pathogens -infants begin producing at 3 months of age
53
IgG Characteristics
Protects against viruses, bacteria, and toxins *only immunoglobulin that crosses the placenta and transferred via breastmilk -lack of IgG causes severe immunodeficiency -infants produce own at 6-12 months of age
54
IgE characteristics
-increases in allergic states, parasitic infections, and hypersensitivity reactions -measured during allergy testing
55
IgM characteristics
-most important component in a primary immune response -presence indicates active infection -infants produce own IgA
56
What is severe combined immune deficiency
-body cannot produce T or B cells -frequent infections and persistent thrush *infection prevention required!! IVIG can help but bone marrow transplant desired
57
HIV in children
CD4 (T-helper) cells are my aim, replication is my game
58
HIV treatment of HIV
Antiretroviral Therapy (ART) drugs are given to slow progression of disease -Zidovudine: suppress synthesis of DNA and used to prevent perinatal transmission of HIV S/E: muscle weakness, SOB,HA, insomnia,rash, unusual bleeding
59
HIV priorities of care
-perinatal testing and ART drugs -TMP-SMZ given to infants from infected mother -discourage breast feedings -educate sexual active adolescents -Avoid IV substance misuse and rouge tattooing
60
Elisa & western blot
-used to diagnosis HIV >18 months old -can detect early
61
PCR and Viral culture
-detects viral genetic material (DNA/RNA) <18 months
62
What is Juvenile Idiopathic Arthritis (JIA)?
An autoimmune disease that causes the body to release inflammatory chemicals that attack the synovium (lining of joints) -make getting out of bed no fun -ESR and CRP increased -NSAIDS and steroids help
63
Juvenile Idiopathic Arthritis Lab cues
CBC: Mild to moderate anemia: Elevated positive ANA (young children w particular type) positive rheumatoid factor (indicate serious case)
64
Juvenile Idiopathic Arthritis Management Priorities
-focuses on inflammation, pain relief, and promotion of remission, and mobility maintenance -NSAIDs are a continuous treatment -methotrexate -physical therapy
65
Juvenile Idiopathic Arthritis nursing actions
-regular vision screenings -admin NSAIDs and coricosteriods -warm bath at night with compress and massage -moderate fitness activity --swimming is best for decrease strain on joints -promote pain management and psychological health
66
Latex Allergy
IgE response to balloons, gloves, peaches, and avocados S/S: hives, flushing, angioedema (swelling), mouth/throat itching, swelling of throat, runny nose, GI distress, Wheezing=compromised airway
67
What is anaphylaxis
-allergic reaction -IgE -hives and hypotension -Epi pen ( blue to sky and orange to thigh)
68
Anaphylaxis physical cues
*two or more after exposure -skin-mucosal tissue involvement -respiratory compromise -redcued BP or associate s/s -persistent GI s/s
69
Anaphylaxis Nursing actions
-admin histamine blockers and Epipen jr -airway management -comfort measures -written emergency plan for child allergy -dietary consult -educate family on s/s -plan for school/teachers
70
Rubeola (Measles) Physical Cues
-koplik spots -rash from head to toe Prodromal Phase (4-6 days) **3 C's- Cough, Conjunctivitis, Coryza Eruptive phase: rash goes down body on hairline Convalescence phase: rash disappears and leaves brown spots and peeling skin
71
Rubeola (measles) management
-MMR vaccine -antipyretic, bedrest, fluids, humidification -Vitamin A for hospitalized 6 months to 2 years or if immunocompromised *Airborne precautions until 4 days after onset of rash -Post-exposure vaccination within 72 hours or immune globulin (IgG) within six days may reduce severity
72
Pertussis history and physical cues
-vaccine status? -sick contacts? -*paroxysmal cough (10-30 times in a row) with red face, cyanosis, and protruding tongue "whooping cough" -tearing eyes, drooling, copious secretions -swelling and irritation of airways
73
Pertussis Management
Macrolide ("mycins") for >1 month Azithromycin if <1 month -droplet precautions -high humidity environment DTap vaccine <7 for all contacts that are unvaccinated
74
Managing fever in a child
-Assess temperature 30 to 60 minutes after antipyretic is given -Use same site and device for temperature measurement
75
Lyme Disease Physical cues
-erythema migrans (bullseye) at site of bite -fever, HA, neck stiffness, and joint pain -History of tick bite; firm, discrete, urticaria
76
What is the management of lyme disease?
-most are cured by doxycycline if started early for >8yrs -amoxicillin <8yrs -treatment lasts 14-28 days
77
What is Pediculosis Capitis
Lice
78
Pediculosis Capitis (lice) physical cues
extreme pruritus is the most common symptom -nits or lice seen behind ears or at nape of neck -Dx w identification of lice
79
Pediculosis Capitis (lice) management
follow directions EXACTLY on pediculicide comb out every 2-3 days treat all items w hot water *contact precautions
80
What is acute lymphoblastic leukemia (ALL)?
Malignancy of B or T lymphoblasts -over production of immature WBC lymphocytes (leukoblasts) with neoplastic characteristics which leads to infiltration of organs and tissues
81
Acute Lymphoblastic Leukemia (ALL) physical cues
-palpable liver -palpable spleen -pallor -low grade fever -bruising
82
Acute Lymphoblastic Leukemia (ALL) lab cues
Bone Marrow Aspirate (BMA)- most definitive; will determine if lymphoid or myeloid and cell type CBC blood smear LP Chest Xray
83
What is neuroblastoma
-arises from embryonic neuroblasts (nerve cells)- considered a type of neuroendocrine cancer
84
neuroblastoma physical cues
**symptoms depend of location of tumor -swollen asymmetric abdomen -watery diarrhea -edema/bruising around eyes, proptosis -Horner syndrome: - partial ptosis (drooping of eyelid), miosis (constricted pupil), and facial anhidrosis (absence of sweating) due to a disruption in the sympathetic nerve supply
85
neuroblastoma lab cues
elevated HVA & VMA
86
Brain Tumor facts
ex) medulloblastoma, astrocytoma, glioma -increased ICP -surgery and chemo
87
Brain Tumor Pre-Op
-monitor for increased ICP and manage -steroids decrease intracranial swelling
88
Brain Tumor Post-Op
monitor increased ICP -I&Os -frequent assessments (LOC, pupils) -treat fever w tylenol -pain managent (HA common) -position on unaffected side -JP drain -keep head midline
89
What is a Wilm’s tumor
a rare type of kidney cancer that primarily affects children, typically before the age of 5
90
Wilm's tumor physical cues
-asymmetric, firm, swelling, mass on abdomen -hematuria -hypertension
91
Wilm's tumor lab cues
CT/MRI of abdomen CBC UA **24hr urine negative for HVA and VMA (rule out NEUROBLASTOMA )
92
Nursing actions for Wilm's tumor
Pre-Op: do not palpate abdomen> CAN RUPTURE TUMOR> place sign on door and above bed -prepare for surgery (nephrectomy) Post-Op: care and chemo education
93
bone marrow aspirate (BM)?
-prone position -iliac crest is bone of choice -BM procedure w needle and tray -anesthetic and conscious sedation meds used -pre-op: explain, comfort, infection prevention -post-op: hold pressure and monitor for bleeding/infection
94
What are General Neutropenic Precautions
-private room -specific hand washing -VS Q4H -avoid rectal temp,enema, visitors, flowers, fruit -mask when outside room -soft toothbrush
95
Chemotherapy Adverse Effects
-anemia -thrombocytopenia -neutropenia (ANC <1000) -N/V/anorexia
96
Radiation therapy education
Complication: altered skin integrity -wash w mild soap and water -avoid lotion/ointments -avoid sun or heat exposure -moisturize w aloe vera
97
Iron Deficiency Anemia physical cues
-irritability -HA -Unsteady gait, weakness, fatigue -dizziness -SOB -pallor -spooning nails
98
iron deficiency anemia management
Feed only formula fortified with Fe+ Fe+ supplementation for breast-fed infants by 4-5 months Encourage breastfeeding mothers to increase Fe+ in their diet Limit cow’s milk in children >1yr. to 24oz/day
99
Fe+ Supplements
-place behind teeth w juice thru straw to avoid teeth stains -give w Vitamin C foods -cause constipation (increase fluids) -dark,green stools
100
iron deficiency anemia lab cues
RBC, Hgb, Hct, MCV, MCH, Ferritin decreased RDW (red cell distribution width) increased
101
What is Hemophilia A
-deficiency of factor VIII which is essential to activate factor X -converts prothrombin to thrombin (platelets cant make clots)
102
Hemophilia A Physical cues
-Swollen or stiff joints (Hemarthrosis) -Multiple bruises -Hematuria -Bleeding gums -Bloody sputum or emesis -Black tarry stools -Chest or abdominal pain (internal bleeding)
103
Hemophilia A cues
increased PTT -swollen/stiff joints -multiple bruises -hematuria -bleeding gums -bloody sputum or emsis -black tarry stools -chest or abd pain
104
Hemophilia A Management
FIRST: factor VIII admin (slow IV push) -appy ice and elevate extremity -direct pressure if bleeding
105
What is sickle cell disease
When the circulation of blood vessels is obstructed by abnormally shaped RBCs causing ischemia & infarction
106
Sickle Cell cues
Extreme fatigue or irritability Pain: abdomen, thorax, joints, digits Dactylitis (severe swelling in fingers/toes) Cough, ↑WOB, fever, tachypnea, hypoxia (ACS s/s) Splenomegaly Jaundice (from hemolysis) or pale conjunctiva/palms/soles/skin
107
Sickle Cell management
pain management hydration hypoxia
108
SIckle Cell lab cues
Decreased Hgb, Hct, ESR Increased Platelets, Bilirubin, Reticulocyte count
109
Lead poisioning risk factors
Age Live in older home (paint, pipes, soil) Live near busy road Toys/Imported products Poverty/malnutrition Pica
110
Lead poisioning
Un-coordinated gross motor movements Serum lead level of 48 ug/dL History of developmental delay Irritability
111
Lead poisioning management
*Chelation therapy used if >45 ug/dL removes leads and excretes through kidnyes ex) succimer, Dimercaprol, adetate calcium disodium -ensure hydration and strict I&Os
112
What increase during a viral infection
Lymphocytes
113
Trentionin for acne
Stops the abnormal kertanization process

Child Health Nursing (3 decks)

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