Final Exam Flashcards
1
Q
What is solitary play and what age group is it seen in?
A
-When they engage in play alone without interaction w people
-INFANTS
2
Q
What is parallel play and what age group is it seen in?
A
-When they play near each other without interaction
-TODDLER
3
Q
What is associative play and what age group is it seen in?
A
-begin to interact with each other but is unorganized or focused
-PRE-SCHOOLER
4
Q
What is Cooperative play and what age group is it seen in?
A
-play together to meet a common goal w teamwork and communication
-SCHOOL-AGE
5
Q
Infant activities/atraumatic care
A
Play soothing music, Therapeutic hugging, speak in calming tone/Mobiles, Noise-making, Soft toys, Large blocks
6
Q
toddler activities/atraumatic care
A
Approach carefully, use toys/books to distract, parallel play with them/Push-pull toys, Lg-piece puzzles, Balls
7
Q
pre-schooler activities/atraumatic care
A
Use play, puppets, allow to touch equipment, Allow choices, Use simple terms, Count out loud, pretend play with them (give bear a shot)/Art & crafts, Playing pretend, Books
8
Q
school-age activities/atraumatic care
A
Encourage questions, Use diagrams, illustrations/Board games, Action figures, Models, Video games
9
Q
adolescent activities/atraumatic care
A
Respect privacy, Do not force to talk, Use appropriate medical terms/Reading, Listening to music, peer time
10
Q
Birth weight _____ by 5 months: and triples by ___________
A
doubles: 1 year
11
Q
birth height increases _____ per month for the first 6 months then occurs in _____
A
1in: spurts
12
Q
birth length increases about _____ by 12 months
A
50%
13
Q
Head circumference rapidly increases during the first _____ and about _____ by 12 months
A
6:10cm
14
Q
4 month old motor development
A
rolls back to side
head control
grasps objects w both hands
15
Q
6 month old motor development
A
rolls back to front
holds bottle
16
Q
9 month old motor development
A
sits unsupported
creeps on hands/knees
has crude pincer grasp
17
Q
12 month old motor development
A
sits down from standing
walks w one hand/on own
builds 2 block towers
makes simple marks on paper
feeds self w cup and spoon
18
Q
What does a infant have, relating to respiratory tract, that differs from adults?
A
Lack of IgA mucosal lining in URT
narrow nasal passages
trachea and chest wall more compliant
bronchi and bronchioles are shorter and narrower
larynx more funnel shaped
tongue larger
fewer alveoli
19
Q
breast feedings recommendations
A
-complete diet up to 6 months
-AAP recommends for first 6 months
-iron supplements is recommended for infants only drinking breast milk after 4 months
20
Q
bottle feedings recommendations
A
formulas provide 20 kcal/oz
iron-fortified formula should be used
no cow milk during 1st year
21
Q
progressing to solids
A
assessed for readiness at 4-6 months
iron fortified infant cereal first (rice, barley, oatmeal)
-easily digestible and low allergy
one new food every 3-5 days
-better to introduce veggies then fruit
22
Q
toddler nutrition
A
-food should be room temp,soft, small cuts
-finger foods
food jags (prefer certain foods for period of time)
ritualism- same dishes or wont eat
physiologic anorexia- growth rate slows, decreasing need for calories
23
Q
toddler language development
A
they can understand more words then they can say (receptive is greater than expressive)
*begin w short sentences to build a vocabulary of between 50-300 words by age 2
echolalia (repeating others)
24
Q
toddler car safety
A
after age 2, forward facing
-if no rear seat, airbag must be disabled
25
Pre-schooler cognitive development
Magical thinking
Imaginary friend
animism
Time (understand sequence of day)
26
Pre-schooler social development
Wide variety of fears due to imagination and animism
learn to take turns, listen to others, feelings, self control, over come fears
Imaginative play to develop social skills and sexual identity through role play
Dramatic play: try different characters or act out emotions
27
School age social development
Very interested in how others view their body, clothing, and body changes
May model themselves after peers, parents, or other personalities
Feeling accepted and not different is very important
Peer pressure begins to take effect
Clubs & BFFs are popular; most relationships come from school associations
28
school age PHYSICAL DIFFERENCES
RR decreases; Abdominal breathing disappears and is replaced by diaphragmatic breathing
Frontal sinuses developed by age 7
Tonsils decrease in size but remain large
HR decreases, BP increases
20 baby teeth replaced by 28-32 permanent teeth (except wisdom teeth)
29
What is the onset age of puberty for girls and boys
girls: 9-10
boys: 10-11
30
What two vitals decrease in school age ?
What increases?
RR + HR
BP
31
Adolescent nutrition
-anorexia and bulimia common
Calcium 1300mg daily
Iron males 11mg female 15mg
-average of 2000 calories
32
Hospitalization on an adolescent
-develops body image disturbance
-isolation
-worries about peers opinions
-allow them opportunities for independence
-encourage socialization
33
Hypoxia/Hypoxemia Cues
-grunting, flaring, restlessness, club fingers, use of accessory muscles
*tachypnea 1st sign
34
Hypoxemia management
Oxygen therapy
Pulse Ox (<91 intervene)
Chest Physiotherapy (on belly: gravity)
Suctioning
35
Asthma Medications
Prevention: Long-acting bronchodilators/B2-adrenergic Agonist (formoterol), Inhalation corticosteroid (Fluticosone), Mast-cell Stabilizer (Cromolyn), Leukotriene Receptor Antagonists (Montelukast)
Acute exacerbation: Short-acting bronchodilator (Albuterol) w/ Anticholinergic (Ipatropium), IV/PO corticosteroids (prednisone)
Status Asthmaticus - Possible intubation: Theophylline, Mg Sulfate IV, Heliox, Ketamine
36
asthma labs
CBC: ↑ WBC, ↑ Eosinophils
ABG: ↑ CO2, ↓O2
Allergy/RAST Testing: Identify triggers
SpO2: ↓ (normal if mild episode)
CXR: Hyperinflation/infiltrates
37
asthma tests
1 Pulmonary Function Test (PFT): measures lung volume capacity and overall lung function; not useful during acute exacerbation
2 Peak Inspiratory Flow Rates (PIFR): Uses a flow meter to measure the amount of air that can be forcefully exhaled in 1 second; used daily to monitor management & for signs of acute symptoms
38
What causes cystic fibrosis
Epithelial cells do not conduct chloride, altering water transport > thick, tenacious mucus in respiratory tract, pancreas, GI tract, & other exocrine tracts/ducts
39
Cystic fibrosis labs
Sweat Chloride Test
>40 in infant (<3m)
>60 all others
>90 sodium
KUB: detects meconium ileus
Stool analysis: presence of fat and enzymes
CXR: Hyperinflation, bronchial wall thickening, atelectasis, or infiltrates
PFT: ↓ forced vital capacity/expiratory volume
40
Cystic Fibrosis Findings
thick sputum
RHF
clubbing/barrel chest
dehydration
decreased pancreatic enzymes
abd distention
STEATORRHEA (fat in stool)
poor weight gain
41
Cystic Fibrosis management
Airway clearance therapy (ACT): Chest PT w/postural drainage to clear secretions and prevent infection
Aerosol therapy: Pulmonary enzyme (dornase alfa) – decreases the viscosity of mucus, improving lung function
-high protein and calorie diet
-supplement w A,D,E, and K fat soluble vitamins
-admin pancreatic enzymes within 30 mins of eating
-dose adjusted until 1-2 stools/day
-For infants, open capsule and sprinkle on an acidic-type food (applesauce)
42
CROUP (laryngotracheobronchitis) findings
- barking cough, inspiratory stridor, tachypnea, resp distress
Infants: nasal flaring, intercostal retractions
-Usually sudden onset at night, gone in the morning, self-limiting, and lasts 3-5 days
43
CROUP (laryngotracheobronchitis) findings management
Typically managed on OP basis; if home care, educate about symptoms of increasing respiratory distress
Cool mist humidifier or steamy bathroom
44
CROUP (laryngotracheobronchitis) findings medications
Administer dexamethasone (corticosteroid) to decrease inflammation
Racemic epinephrine (ᾀ-adrenergic effect of mucosal vasoconstriction to decrease edema); effects last up to 2H and symptoms may again worsen requiring another TX
45
Priorities of care for Heart Failure
Oxygenation/Ventilation
Promoting Rest
Adequate nutrition
-150 calories/kg/day
-formula 24-28 calories/oz
Human milk fortifier added to breast milk to increase calories
46
Pediatric Assessment Triangle Heart Failure
Appearance (abnormal tone)
Circulation (pallor, mottling, cyanosis)
work of breathing(abnormal, flaring,gasping)
47
Coarctation of the Aorta
Assess all pulses
Full bounding pulses in upper extremities
Weak or absent pulses in lower extremities
Soft or moderately loud systolic murmur at base or left axilla
48
Tetralogy of Fallot Findings
Fainting, difficulty breathing, easy fatigue, color changes w/ feeding, crying, activity
Loud, harsh systolic murmur
Polycythemia (elevated RBCs)
TET spells (Blue Baby) – especially in AM; cyanosis, hypoxemia, dyspnea, agitation >> progresses to anoxia and unresponsiveness
Knee/chest position or squatting
49
Tetralogy of Fallot nursing managment
Promoting oxygenation &ventilation: (Upright position, O2, suction)
Promoting nutrition: Small, frequent meals or OF/NG feeds; 150 calories/kg/day
50
Kawasaki Disease findings
History: Persistent fever, generalized malaise, HA or joint pain
High fever (>38.5°C) for at least five days unresponsive to antipyretics
Significant bilateral conjunctivitis without exudate
Edematous mouth & pharynx, cracked lips, strawberry tongue
Cervical lymphadenopathy (>1.5cm)
Generalized macular, erythematous rash
Swelling of hands/feet w/erythema of palms/soles
Desquamation (peeling) of fingers, toes and perineal areas
51
Kawasaki disease treatment
Immunoglobulin (IVIG)
High-Dose Aspirin followed by low-dose after fever breaks; indefinite if aneurysms develop
Administer IVF, IVIG and PO fluids as order; strict I&O
Acetaminophen for fever and cool cloths if tolerated
Daily weight, strict I&O
Irritability/Inconsolable – most challenging problem; need rest and quiet
Lip lubricants and mouth care
Clear liquids and soft foods
52
Sinus Bradycardia
is the most common bradyarrhythmia in children
No cardiac nodal abnormality
P wave and QRS remain normal on ECG
Susceptible to brief drops in HR – associated with vagal stimulation (passing orogastric tube); usually recover spontaneously
Children with a life-threatening bradyarrhythmia will have HR <60 with signs of altered perfusion (respiratory compromise, hypoxia, shock)
Sustained bradycardia is commonly associated with arrest and is an ominous sign
53
Sinus Tachycardia
usually associated with fever, pain, fear, fluid loss or hypoxia
In infants rate is <220 bpm (160-220), in children < 180 bpm (130-180) with a beat-to-beat variability, P wave are present & normal, QRS normal
TREATMENT IS FOCUSED ON THE UNDERLYING CAUSE
(Pain, Fever, Dehydration)
54
Supraventricular Tachycardia
Supraventricular tachycardia –a cardiac conduction problem where the HR is extremely rapid with a regular rhythm. In infants rate is >220 bpm, in children > 180 bpm with abrupt onset and termination, P wave are flattened, QRS narrow
55
Oral Rehydration
Attempted first for mild and moderate cases of dehydration
Oral rehydration solution (ORS) should contain sodium and glucose (Pedialyte)
Tap water, milk, undiluted fruit juice or broth are NOT appropriate as ORS
When rehydrated the child can resume a regular diet
56
Oral rehydration mild amount
50 ml/kg oral rehydration solution (ORS) within 4 hours
Replacement of diarrhea losses: 10 ml/kg for each stoo
57
Oral rehydration moderate amount
100 ml/kg ORS within 4 hrs
Replacement of diarrhea losses: 10 ml/kg for each stoo
58
IVF Rehydration
Initiated when child has severe case of dehydration or is unable to tolerate oral fluids to correct fluid losses (persistent vomiting)
20 ml/kg of NS IV bolus (may need to be repeated) in addition to maintenance IVF as prescribed (isotonic or hypotonic types)
59
what is HYPERTROPHIC PYLORIC STENOSIS
Pylorus muscle hypertrophies and thickens on the luminal side of the pyloric canal causing gastric outlet obstruction
60
HYPERTROPHIC PYLORIC STENOSIS cues
Forceful, projectile, nonbilious vomiting not associated with position
Hunger soon after vomiting; Weight loss with FTT
Dehydration with subsequent lethargy
Olive-shaped moveable mass in RUQ; if palpated, no further tests needed
Labs: Abnormal electrolytes & Metabolic alkalosis from dehydration and vomiting
61
HYPERTROPHIC PYLORIC STENOSIS care
IV fluids to correct electrolyte imbalance and dehydration
NGT for decompression, NPO, strict I/O
Post-op care wound care (four tiny incisions)
Resume PO feedings in 1-2 days
62
What is Hirschsprung Disease
Structural anomaly of GI tract caused by lack of ganglionic cells in segments of the colon resulting in decreased motility and mechanical obstruction within the intestinal tract
63
Hirschsprung Disease findings
Current and past medical HX for Down syndrome, other chromosomal abnormality, or family HX of Hirschsprung disease or Down syndrome
Newborn: Failure to pass meconium in 24-48H after birth; Episodes of vomiting bile; Refusal to eat; Abdominal distention
Infant/Child: FTT; Constipation; V/D; Abdominal distention; Visible peristalsis; Palpable fecal mass; Foul-smelling, ribbon-like stool
64
Hirschsprung Disease care
Pre-repair
Monitor/manage for malnourishment – high protein, high calorie diet
Observe for signs of enterocolitis: fever, vomiting, abdominal distention, explosive diarrhea or rectal bleeding – notify provider immediately → Broad-spectrum antibiotic therapy, IVF resuscitation, rectal washout
Post-op care; Ileostomy or colostomy care
Accurate I&O and measurement of stool output
IVFs and IV antibiotics
Provide education and support about further procedures; wound care consult
Post-op teaching about stoma care, enterocolitis, and medications
-Resection and re-anastomosis surgery is necessary to restore proper bowel function typically done in stages
65
What is ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS
Immune mechanisms injure glomeruli = inflammation resulting in altered glomerular function (decreased GFR)
66
ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS cues
Recent pharyngitis/strep throat or skin infection
Fever, lethargy, irritability, HA, ↓ urine OP, abdominal pain, vomiting and anorexia
Edema (general & periorbital); signs of fluid overload or CHF
Elevated Blood Pressure r/t poor kidney function & fluid elimination
67
ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS labs
Urine Dipstick: Hematuria, proteinuria
BUN/Creatinine: ↑
ESR: ↑
ASO Titer: + (presence of streptococcal antibodies)
68
Hemolytic Uremic Syndrome (HUS) findings
Watery diarrhea accompanied by cramping that becomes bloody over several days; Possible vomiting
Past HX for ingestion of ground beef, or visits to a water park, public pool, or petting zoo prior to developing diarrhea
Pallor and toxic appearance
Edema and oliguria or anuria
Irritability, altered LOC, seizures, posturing or coma
69
Hemolytic Uremic Syndrome (HUS) management
Priority of Care: Maintaining fluid balance, managing HTN, acidosis, & electrolyte abnormalities
Contact precautions for E. Coli (can be shed for up to 17 days)
Strict I&O evaluated progression of RF
Monitor for bleeding, fatigue, and pallor
PRBCs and platelets (only for active bleeding or severe thrombocytopenia); IVIG may be considered
70
What is hypospadias
Abnormal urethral opening on bottom surface of penis
71
hypospadias care
Post-Op Care
Urethral stent/drainage tubing taped with penis upright to prevent stress on urethral incision
Analgesics for pain management/bladder spasms
Double diapering to protect stent or catheter and prevent stool from touching catheter
EDUCATION: Care for catheter and drainage system at home
72
Growth Hormone Deficiency cues
Disruption of vertical growth; retarded bone growth
Large/prominent forehead; under-developed jaw
High-pitched voice
Delayed sexual maturation
Delayed dentition/skeletal maturation
Decreased muscle mass
73
Growth Hormone Deficiency management
Biosynthetic GH replaced via Sub-Q injections 0.18-0.3mg/kg/week divided in equal daily doses
Monitor for side effects of medication
Monitor effectiveness of hormone replacement; Measure height Q3-6 months
GH continued until growth rate of less than 1 inch/year, or bone age of >16 years (boys) or >14 years (girls)
Growth stops when epiphyseal plates close
74
Congenital Hypothyroidism cues
Poor sucking reflex
Hypothermia
Constipation
Lethargy/Hypotonia
Periorbital puffiness
Cool, dry, scaly skin
Bradycardia, RR distress
Lg fontanelles; delayed closure
*T4 low and TSH high
75
CONGENITAL HYPOTHYROIDISM management
Thyroid hormone replacement
L-Thyroxine (Synthroid, Levothyroid) administered daily
76
Diabetic Ketoacidosis S/S
BS >330 mg/dL
Thirst (polydipsia)
Hunger (polyphagia)
Polyuria (early), oliguria (late)
N/V; Abdominal pain
Warm, dry, flushed skin w/ poor turgor; Dry MM
Confusion; Weakness; Lethargy
Weak pulse
Diminished reflexes
Kussmaul respirations: Rapid, deep w/ fruity odor
77
DIABETIC KETOACIDOSIS labs
Fasting Glucose (>126 mg/dL)
Oral GTT (>200 mg/dL at 2 hrs)
HgbA1C: >6.5%
Elevated - BUN/Creatinine, Ca+, Mg+, PO4-, Na+, K
UA – glucosuria, ketonuria
ABG – metabolic acidosis
78
DIABETIC KETOACIDOSIS management
PICU admission
Hourly blood glucose monitoring to prevent BS falling more than 100 mg/dL/hr (can cause cerebral edema)
IVFs to treat dehydration, correct Na+ and K+, and improve peripheral perfusion
IV regular insulin via drip and sliding scale /protocol
79
what is hydrocephalus
Accumulation of excessive CSF within the cerebral ventricles and/or subarachnoid spaces = ventricular dilation & IICP
80
hydrocephalus cues
S/S vary by age
History: irritability, lethargy, poor feeding, vomiting (projectile), complaint of HA or vision or gait changes (older children), altered, diminished, or change in LOC
Physical:
Wide, open, bulging fontanels
Large head or recent change in HC
Thin, shiny scalp w/prominent, visible scalp veins
Sun-set eyes
CT/MRI – enlarged ventricles or obstructed CSF flow
81
Hydrocephalus Management
Ventriculoperitoneal (VP) shunt
-Signs of VP shunt infection/obstruction (↑ ICP)
Fever > 101F
Headache/stiff neck/bulging fontanelle
Poor feeding/vomiting
Increased HC
Dilated pupils on same side as pressure build-up
High-pitched cry; Change in behavior &/or sleep patterns
82
What to do during a seizure?
-protect during injury: do not restrian
-loosen restrictive clothing
-side lying position
-do not open jaw
-remove glasses
-remain w child
83
What to do after a seizure
-maintain side lying position
-monitor vs
-assess for injuries
-neuro checks
-dont offer foods or drinks until swallow reflex has returned
84
Seizure precautions
-padding on side rails
-all rails raised
-oxygen and suction at bedside
-supervision
-med bracelet
-helmet during activities
85
Increased ICP cues
Early: HA, Vomiting, blurred/double vision, dizziness, tachycardia
Late: low LOC, bradycardia, irregular rr, cheyne-stokes, decerebrate or decorticate posturing
-fixed and dilated pupils
86
Cushing Triad (ICP)
Hypertension
Irregular Breathing
Bradycardia
87
Ways to decrease ICP
Positioning: Keep head midline with bed 30°; avoid extreme flexion, extension or rotation of head; keep body in alignment
Calm quiet room; limit stimulation, visitors
Minimal oral suctioning; No nasal suctioning
Avoid coughing, blowing nose
Stool softener
Seizure precautions
Monitor I&Os
88
What is bacterial meningitis
Infection of the meninges surrounding the brain and spinal cord; Medical emergency requiring prompt hospitalization and TX
89
Bacterial Meningitis Diagnostics
CBC: WBCs ↑
Blood/Urine/NP CX: ID source of infection, rule out sepsis; blood CX+ if sepsis
LP: CSF Results: WBCs ↑ + ↓Glucose +↑Protein, cloudy in color
90
Bacterial Meningitis management
ICU admission with strict Droplet Isolation until 24H of antibiotics or orders to discontinue
IV broad-spectrum antibiotics after all CXs obtained
Ventilator support
Measures to reduce ICP and decrease environmental stimuli
Manage S/S of shock and strict I&O
Seizure precautions/Control seizures
Manage hyperthermia with NSAIDs, cooling blankets, cool compresses, and tepid baths
91
What is reye syndrome?
Causes swelling in brain and liver in kids who had influenza or chicken pox and have taken aspirin.
92
reye syndrome cues
Severe and continual vomiting
Lethargy, irritability, and confusion
Hyperreflexia
Red, macular rash may be present
Signs of IICP
Signs of liver failure (jaundice, ascites, poor appetite)
hyperammonemia, hypercoagulopathy hypoglycemia
93
reye syndrome labs
LFTs: ↑ , Serum Ammonia: ↑
94
reye syndrome nursing management
Nursing management focuses on measures to ↓ICP & supportive care for the sequelae r/t liver failure
95
What is SPINA BIFIDA (Cystica)?
Visible defect with saclike protrusion of meninges, spinal fluid, and nerves with varying degrees of neuromuscular, limb, and sensory deficits
Surgical closure needed as soon as possible after birth to prevent infection & trauma to the sac
96
SPINA BIFIDA (Cystica) sac care
Immediately report any leakage to the provider to prevent infection
Measures to prevent rupture of sac to include prone positioning before and after surgical repair
Monitor head circumference, and observe for signs of ↑ ICP
97
SPINA BIFIDA (Cystica) nursing actions
Frequent NS moistened dressings to keep sac moist and prevent rupture
Immediately report any leaking from sac
Position prone or supported on side pre- and post-op
Keep in warmer or in isolette; avoid swaddling and blankets (monitor sac continuously for drying out)
Prevent sac from being soiled by urine or stool pre- and post-op
Promote parent-child bond
98
cerebral palsy nursing care
Oxygenation/Ventilation
pain management (muscle spasms)
99
cerebral palsy medications
baclofen (muscle relaxer)
botox (quads)
carbidopa (relaxes muscles)
100
fracture considerations
often in forearm and wrist
midclavicular,humerus, or femur from birth trauma
heal w minimal tx: younger the faster
**Increased vascularity and decrease mineral content of bone cause flexibility resulting in buckle (compression injury – buckles rather than breaks) or greenstick (incomplete fx )
101
What is compartment syndrome and what are the 5 p's
Compression of nerves & blood vessels from swelling of muscles in a confined space
5 P’s
Pain – unrelieved with elevation or analgesics & increases with passive movement
Paresthesia – numbness, tingling (early sign)
Pulselessness – distal to the fx
Paralysis – inability to move fingers
Pallor – cold skin, cyanotic nail beds, delayed cap refill
*Pallor, paralysis and pulselessness are late signs
102
whats osteomyelitis
Infection within the bone secondary to a bacterial infection from an outside source or from a bloodborne bacterial source
Irritability
Fever
Tachycardia
Edema
Constant pain that increases with movement
Refusal to use affected extremity
Tenderness, swelling, warm
103
What are 2 complications of fractures
?
compartment syndrome
osteomyelitis
104
AMBLYOPIA management
Patching (the stronger eye) for several hours a day
Atropine drops in the stronger eye daily
Vision therapy
Eye muscle surgery
105
acute otitis media findings
rubbing/pulling ear
fever
red,dull,buldging membrane
swollen lymph nodes
106
acute otitis media management
tylenol and ibuprofen for mild to mod: narcotics if severe
benzocaine if TM not ruptured
warm/cold compress
antibiotic (PO 10-14 days, IM 1 dose)
107
ear drop administration
<3 pull pinna down and back
>3 pull pinna up and back
108
Rubeola (measles) cues
Prodromal phase (4-6 days) – 3 C’s – Cough, Conjunctivitis, Coryza & Fever (high),
- Koplik spots
Eruptive phase - Maculopapular rash: starts behind auricle > along hairline > down face > trunk > arms > legs
Convalescence phase – rash disappears leaving brown spots & peeling of skin
Complications: Diarrhea, Pneumonia, Myocarditis, Encephalitis & Otitis Media (AOM)
109
Rubeola (measles) priority of care
Preventative: MMR Vaccine (1st dose 12-15 mo./2nd dose 4-6 yrs)
Supportive: Antipyretics, bedrest, fluids, humidification
Post-exposure measles vaccination within 72 hours or immune globulin (IgG) within six days may reduce severity
Vitamin A for all children with measles, esp. if immunocompromised
Airborne Precautions until 4 days after the onset of rash
110
Pertussis cues
paroxysmal cough (10-30 time in a row)
whooping cough
sick contacts?
Immunization?
111
Pertussis medication
mycins >1 month
azithromycin <1 month
112
pertussis management
High humidity environment
Observe for airway obstruction
Push fluids
Antibiotic compliance
Droplet Precautions
113
Lyme disease cues
erythema migrans at site of bite
fever, malasie, HA, neck stiffness, joint/muscle pain
114
Lyme disease medication
>8 doxycycline
<8 Amoxicillin (teeth staining)
tx for 14-28 days
115
SCID management
INFECTION PREVENTION
116
Juvenile Idiopathic Arthritis
affects synovial joints
pain getting out of bed
guarding of joint
TX: NSAIDs and methotrexate
117
What do neutrophils indicate
acute bacterial infection
118
what do eosinophils indicate
allergic reactions
119
what do lymphocytes indicate
viral infection or chronic bacterial infection
120
what does ESR and CRP indicate
inflammation
121
IgG
crosses placenta and breast milk, protects against virus, bacteria, and toxins
122
IgA
defense against respiratory, GI, and GU
123
IgM
indicates active infection
124
IgE
allergic reaction
125
Fluid resuscitation principles for burns
important during first 24hrs
-isotonic LR used in early stages: dextrose added for small children
-maintain urinary output of 1-2ml/kg/hr
-daily weights
-monitor electrolytes
126
During a burn, adequacy of fluid replacement is determined by _______
urinary output
127
what is a complication of burns?
hypovolemic shock
128
nutritional support for burns (wound healing)
increase calories
increase protein
vitamin A+C and zinc
129
impetigo cues
-caused by staph
-honey colored crust
-itchy and painful
-regional lymphadenopathy
130
impetigo actions
-contact precautions
-remove crust before applying antibiotics
-topical or oral when >5 lesions
-clean linens
131
Skin injuries risk factors
-poverty
-prematurity (<1yr)
-chronic illness
-disabilities
-parent w abuse history
-alcohol/substance abuse
-stressors
132
Suspicious skin injuries
-bruises in infants <9 months
-multiple injuries not on LE
-inconsistent stories
133
Hemophilia A cues
swollen/stiff joints
bruises
hematuria
bloody gums/stools
chest or abd pain (internal bleeding)
INCREASED PTT
134
Hemophilia A Management
1st: FACTOR VIII admin (slow)
-direct pressure to bleeding, cold compress and elevate extremities
Prophylaxis for Mild Cases: Desmopressin (triggers release of factor VIII)
135
Iron Deficiency Anemia cues
Irritability, HA
Unsteady gait, Weakness, Fatigue
Dizziness, SOB, Pallor skin, MM, conjunctiva
136
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
Encourage Fe+ rich foods
137
Iron Deficiency Anemia labs
decreased RBC, Hgb, Hct, MCV,MCH, Ferritin
increased RDW
138
Sickle cell cues
Extreme fatigue or irritability
Pain: abdomen, thorax, joints, digits
Dactylitis
Cough, ↑WOB, fever, tachypnea, hypoxia
Splenomegaly (splenic obstruction)
Jaundice (from hemolysis) or pale conjunctiva, palms, soles, and skin
139
sickle cell management
pain control
hydration
hypoxia
140
Bone marrow aspirate
prone position
iliac crest
conscious sedation meds
after hold pressure and monitor bleeding/infection
141
absolute neutrophil count (ANC) for neutropenia
<1000
142
General Neutropenic Precautions
Private room
Meticulous hand hygiene before and after care
VS Q4H and assess for signs of infection Q8H and PRN
Avoid rectal temps, enemas, suppositories, urinary catheters, and invasive procedures
Restrict visitors
No raw fruits, vegetables, fresh flowers, or live plants in room
Mask on child when outside room
Soft toothbrush
143
Chemo Adverse effects
Anemia
Thrombocytopenia
Neutropenia
N/V/Anorexia
144
ACUTE LYMPHOBLASTIC LEUKEMIA
Palpable liver
Palpable spleen
Pallor
Low-grade fever
Bruising/petechiae/purpura
Signs of infection
Enlarged lymph nodes
145
ACUTE LYMPHOBLASTIC LEUKEMIA management
chemo or bone marrow transplant
preventing infection, treating pain, anemia, preventing bleeding
Atraumatic care - use of EMLA cream can reduce initial pain from BMAs, LPs, ABGs, accessing ports, and venipunctures
146
ACUTE LYMPHOBLASTIC LEUKEMIA lab cues
Bone Marrow Aspirate (BMA) – most definitive
CBC - Low Hgb, Low Hct, Low RBCs, low/normal/high WBCs, low platelets
Blood Smear - may reveal blasts
LP – whether leukemic cells in CNS
LFTs & BUN/Creatinine – helps guide chemo to use
CXR – to detect PNA or mediastinal mass
