Flashcards in PEDI--EXAM 2--TEST BANKS Deck (138):
chain of infection
portal of exit
portal of entry
illness passed by direct or indirect contact
risk factors for communicable disease
-Immature immune system
-Limited prior exposure to communicable diseases
-Poor hygiene behaviors
-Poor health and immunodeficiency increase risk
Prevention of the Spread of Infectious Disease
Avoid exposure to infected individuals
in some cultures, infectious diseases are seen as?
punishmentor the result of curses or evil spirits.
monitoring patterns of disease occurrence
Outcomes of disease surveillance
Development of public health programs
Reduction or elimination of many infectious and communicable diseases
Antibody production stimulated by vaccine antigens without causing clinical disease
Antibodies produced in another host (human or animal) given when child needs antibodies faster than the body can make them
Includes immune globulins
Note—does not confer lasting immunity; child will need vaccine in future
Contraindications to vaccine administration
History of anaphylactic reaction to the vaccine or one of its components
Moderate to severe acute illness
For specific vaccines, pregnancy or allergy to some components
Agencies involved in development of immunizations
Limited access to health care
Lack of convenient primary care
Parental knowledge deficit
can be administered when children have a mild illness
give combinations of _____ at the same visit
must be obtained before immunization administration
Required documentation for immunizations
Date of administration
Lot number and expiration date of vaccine
Site and route of administration
Name, title, and address of person administering vaccine
A ____ of the administration should be given to the client's parent.
how to minimize pain during administration
Provide local anesthetic
Give child as much control as possible
Be honest with the child
Provide sucrose drink and pacifier if appropriate
Use age-appropriate distraction techniques
exposure to different temperatures may result in damage to vaccine ______.
sx of communicable disease
Fever (most common)
Nausea /vomiting/ diarrhea
cultures can test for?
clinical therapy of communicable diseases
Vector-Borne Illnesses are transmitted by
biting insects or animals
Microorganisms spread and multiply, initiating inflammatory response
prevent growth or destroy microorganisms of Vector-Borne Illnesses
Assess for and treat general symptoms of vector-borne illnesses
Altered nutritional status
how to Limit the spread of infection of vector-borne diseases
Isolate from other children
Clean shared items
Maintain a high level of suspicion when numerous individuals with similar signs and symptoms are seen
what to educate parents on about vector-borne illnesses
limiting spread of infection
when to consult the healthcare provider
fever management of vector borne illnesses
Removing unnecessary clothing
Encouraging extra fluids
how much acetaminophen
10-15 mg/kg/dose every 4-6 hours
not to exceed 5 doses in 24 hours
how much ibuprophen
4-10 mg/kg/dose every 6-8 hours
not to exceed 40 mg/kg daily
Systemic inflammatory response syndrome in the presence of infection
who is at a high risk for sepsis?
infants (perinatal through first year)
what else increases infants risk for sepsis
low birth weight
multiple invasive procedures
sepsis risk for older infants and children increases in presence of:
Compromised immune system
Long-term antibiotic use
Common causative microorganisms of sepsis
Group B streptococcus
Pathophysiology of sepsis leads to:
impeded blood flow
vasodilation and constriction
impeded blood flow leads to?
reduced delivery of oxygen & nutrients
leaking capillaries leads to?
peripheral edema & fluid accumulation in lungs
vasodilation and contraction results in?
hypoxia & organ dysfunction
Early signs of sepsis in children
Fever or hypothermia
late signs of sepsis in children
Prolonged capillary refill time
Mottled cool extremities
Progressive mental changes
Decreasing urine output
Fever or hypothermia
Clinical therapy of sepsis focuses on
how do they focus on organ preservation
Aggressive fluid resuscitation
little subQ fat
loosely attached cells
cells tightly bound
eccrine and apocrine glands mature
ex of dermatitis
an acute inflammation of the dermis and underlying connective tissue characterized by red or lilac, tender, warm, edematous skin
etiology of cellulitis
or recent otitis media
Initial response to injury
Swelling, blood clotting
Wound sealing to prevent bacterial invasion
Chronic, relapsing, superficial inflammatory skin disorder
of Atopic eczema
Hydrate and lubricate skin
Minimize inflammatory changes
Apply topical corticosteroids
Provide emotional support
Chronic, pruritic, papulosquamous skin condition
Nursing management of psoriasis
Application of topical steroids and vitamin D
Ultraviolet B phototherapy
Systemic drug therapy
Provide emotional support
• Correct way to determine daily weight of infant in diapers:
o Same scale, same clothes, same time q day
education to parents about oral rehydration of child
no diet colas
give in frequent small amts.
continue giving if child vomits
safety measures for child with IV?
o Don’t put in arm that child sucks thumb of/ school age writes with; if starting to walk don’t put it in feet.
o Use smallest bag of solution (500mL instead of 1,000mL)
o Use a pump
o Microdrip tubing
o Make sure tubing doesn’t wrap around them
o If IV is in a joint, may need to splint that joint to prevent problems don’t wrap too tight
o Try not to cover up actual site so you can assess
• Mother dilutes formula. Nurse educates mother that this can cause
• Child you are caring for has fluid restrictions. What are some methods nurse can use?
o When giving oral fluids, use cold fluids in an insulated cup (looks like theres more in it)
o Have child swish before swallowing (to relieve thirst)
o Let child choose fluids
o Before walking in with food tray, remove excess fluids
• which of the following are causes of hypernatremia?
o Inability to communicate thirst (developmentally delayed)
o Not diluting formula enough
o Inadequate amount of breast milk
o Tube feeding w/o water intake
o Not replacing fluids adequately when vomiting/diarrhea/sweating
• Child with hypokalemia should eat:
pizza & fruits
• Who is at most risk for hypocalcemia:
adolescent girl worried about her weight, diets (teens often avoid dairy products)
• Best way to administer Ca?
o 10% Calcium Gluconate IV (DO NOT GIVE IM B/C CAN CAUSE MUSCLE NECROSIS)
• Hyperventilation can cause?
o Respiratory alkalosis
• If the pH is decreased and the PCO2 is increased, what is going on?
o Respiratory acidosis
• Diabetic child is going into ketoacidosis. Also going into…
• Metabolic alkalosis caused by:
o Prolonged vomiting
o NG tube suction
o O.D. on sodium bicarbonate tums.
• Child comes in for 12m shots. Presents with mild ear infections and a fever that is 101F.
o Can still get shots (over 102F cannot)
• What would contraindicate that a child receive their hep B shot?
o Allergic rxn to baker’s yeast.
• Which is the only immunization that can be given SQ or IM?
o Polio (IPV)
• Only oral vaccine?
• Mother of child with chicken pox is inquiring about when her child will not be contagious anymore.
o Contagious until all lesions are crusted over (most contagious 1-2 days before rash)
CHICKEN POX CAN ONLY GIVE
• ORAL OR TOPICAL ANTIHISTAMINES
o DO NOT GIVE BOTH FORMS OF BENADRYL!!!!
• Child 12m old presents with bluish white spots on buccal mucosa. Diagnosed with measles.
What are these spots called?
o Koplik spots
• WBC count w/ differential of child with allergic rxn would show an increase in?
• A nurse is trying to get a small child to do deep breathing exercises. What are some things she could have them do?
o Blow a pinwheel
o Cotton ball race blowing through straws
o Blow bubbles
• Child has HIV, daycare workers should follow what precautions when changing diapers?
• Child has congenital immunodeficiency. Which immunization should you avoid?
varicella (live vaccine)
• Which of the following is a sign that teen is coping with dx of SLE
tells friends about it
• The nurse can help the child with Juvenile Idiopathic Arthritis manage pain and inflammation by :
o Applying warm wet rag to painful joints
• Child presents to the ED having an anaphylactic reaction. Priority nursing action is to:
o Get epinephrine!
• Child comes in with latex, wheat, and ____ allergy. Nurses first action should be to:
a) Assess room for latex products what I put
b) Talk to dietician
c) Put sign on door what I think was right.
d) Don’t remember…
• Child has exudative honey colored crusted lesions. Indicative of
o Impetigo very contagious.
• Burn severity is determined by:
o Percentage of BSA affected
o Body parts involved
• Child presents with mild burn.
o Apply antibiotic ointment and cover. DO NOT APPLY ICE
Which child is most as risk for f&e imbalances ?
18 month old with fever
Which child is most as risk for dehydration?
• Child that has pulmonary congestion and is tachypnea
which fluids to give?
o – Lactated Ringers
♣ start out normal with mild dehydration, sunken appearance as dehydration progresses
• Measuring output for children in diapers:
o Weigh dry diaper THEN weigh each subsequent wet diaper without wipes
♣ weigh children with same scale, clothes, & at same time every day. If they lost a kg, they lost 1L of fluid
• Calculating percent of weight loss
original weight - new weight.
take that answer and divide it by the original weight to get % of body weight loss
if parent is giving child sprite...what do you teach them
dilute it half and half with water
how much fluid to start with?
1-3 tsp of fluid every 10-15 minutes
gradually ___ fluids as child stops vomiting
if child has diarrhea--
continue with age appropriate diet
usually start with what IV fluid to replenish sodium?
isotonic (ringers lactate or NS)
TQ was LR @ 20 ml
(small infants may not have much of a neck to be able to tell ___ ___ ____.
nursing care for hyponatremia
check iv fluids type & rate
educate parents on fluid replacement when child is V&D
Parent came and saw all salt gone and the child was very lethargic, which level was affected?
potassium too high
♣ Educate them on K rich foods that we do NOT want them to eat such as
• Apricots, bananas, cantaloupe, cherries, dates, figs, molasses, orange juice, peaches, potatoes, prunes, raisins, strawberries, tomato juice
if you have hyperkalemia avoid
how to encourage deep breathing with preschooler in respiratory acidosis
causes of respiratory alkalosis
hyperventillation & anxiety
causes of metabolic acidosis
ingestion of aspirin or antifreeze
if ingested antifreeze assess what first?
respiratory and airway
A four-year-old child is admitted to the hospital secondary to dehydration. Lab tests indicate a high hemoglobin and hematocrit, and the serum sodium is below normal levels. This fluid loss is indicative of which condition?
A nurse is taking care of four different pediatric clients. Which of the following children is at greatest risk for dehydration?
18 month old with fever or 7 year old with tachypnea
In the morning, a nurse receives a report on four pediatric clients, each of whom has some form of fluid-volume excess. Which of the children should the nurse see first?
1. The child with tachypnea and pulmonary congestion
A nurse is planning care for a child with hyponatremia. The nurse, delegating care of this child to a licensed vocational nurse (LVN), cautions the LVN to watch for which clinical manifestation?
A child with croup has an increased pCO2, a decreased pH, and a normal HCO3 blood gas value. The nurse interprets this as uncompensated:
The nurse is expecting the admission of a child with severe isotonic dehydration. Which intravenous fluid should the nurse anticipate the doctor to order initially to replace fluids?
A six-year-old child is hypokalemic. The nurse is helping the child complete the menu. The nurse would encourage this child to select which menu items?
1. Pizza with a fruit plate
A child is admitted to the hospital for hypercalcemia and is placed on diuretic therapy. Which diuretic would the nurse expect to give?
1. Furosemide (Lasix)
The nurse is evaluating an infant for dehydration. Which assessment provides the most accurate information on dehydration?
check what first with Neumocystic Jyro pneumonia
cure for HIV
– What is not okay for hospital d/t latex allergies
toddlers with pneumonia can't
avoid what drugs for lupus?
o Increases susceptibility to infection
how to avoid triggers of SLE?
cover body with long sleeves and hats
joint deformities and pain all the time
juvenile idiopathic arthritis
was what should the nurse teach when child has no complaints on their meds with juvenile idiopathic arthritis?
regular exercise (swimming)
♣ Encourage adequate nutrition with juvenile idiopathic arthritis such as
adequate fiber & liquids
what to teach for allergic reactions
teach to put a plastic cover over the mattress
tx of anaphylaxis
if hypotensive how to treat anaphylaix
epinephrine, respiratory, fluids, supine