Flashcards in Pediactrics Deck (33):
Order of obtaining vital signs:
2) Heart Rate
3) Blood Pressure
b. Always count RR and HR for one full minute because of irregularities.
c. If vital signs cannot be taken with out disturbing the child, then record the
behavior with the measurements.
1) Rectal: Do not use in children over 3 months.
• Most reliable measurement of core temperature.
2) Axillary: All ages may be done when an oral route is not possible.
3) Oral: Start at age 5-6.
4) Tympanic: All ages.
Hint: Always document where temperature was taken, do not add a degree.
e. Oxygen saturation: Used to obtain a picture of blood oxygen level through the skin.
1) Check perfusion, skin temp, and edema to determine the best location for sensor probe.
2) Common sites are fingers and toes.
3) Record what is going on at the time the pulse ox is measured.
• Will activity level affect the oxygen level? Yes
4) The pulse wave form/intensity display on the oximeter machine should
correlate with the child’s radial pulse.
1. The name of the pain scale is CRIES, it’s an acronym for:
Requires increased oxygen (0-2)
Increased vital signs (0-2)
• The higher the score the worse pain in all the scales.
2months to 7 years
Face, Legs, Activity, crying, Consolability. 0-10 scale: 0 no pain, 10 worst pain
3. Wong-Baker rating scale is used on children at what age? Any age but usually 3 years and older.
• Make sure child has cognitive development and is not developmentally delayed.
• Scale is 0-5. Shows smiling faces.
d. Numerical scale is used at age 5 and older.
• Most common type of Croup experienced by children admitted to the hospital and primarily affects children under 5.
• Parainfluenza, adenovirus, and RSV
• Slight to severe diarrhea
• barking or brassy cough.
• Increased temperature.
• Mild croup can be treated at home with steam (hot showers), cool mist humidifiers, car rides with windows down.
• If symptoms worsen or do not improve, hospitalization is required with corticosteroid therapy.
1) Causes: H. influenza
• Absence of cough
• Agitation with the rapid progression to severe respiratory distress.
• This is an emergency
• May require intubation or trach
• IV antibiotics and corticosteroids
Hint: Children with Epiglottitis usually look worse than they sound, and the kid with LTB sounds worse then they look.
• Difficulty swallowing and breathing so child is a mouth breather and they have bad breath.
• Impaired taste and smell, voice has nasal/muffled quality.
• Persistent couch
• Swollen tonsils can block drainage of the ear canal and cause otitis media.
2) Tx: Tonsillectomy
• How should a client be positioned after a tonsillectomy? Place on side with elevated head of bed or prone.
• Why are brown and red fluids not given post op? We do not want anything to be confused with blood.
• What would indicate that hemorrhaging is occurring? frequent swallowing
• How many days post op is the client at risk for hemorrhage?up to 10
• Complaint post op? Sore throat and slight ear pain
• Low grade temp
• Bad breath
• What part of the ear is affected? Middle ear
• The Eustachian tubes are blocked.
• It usually follows an upper respiratory infection.
• What does the tympanic membrane look like with otitis? Bulging and bright red
• heating pads help with the pain
• Avoid chewing . And provide soft foods.
• Lie on the affected side.
• May not hear you.
• Avoid smoke.
• May require PE tubes to keep the middle ear drain. Wear ear plugs in water
• The ear tube (grommet) stays in about 6 months and then falls out.
• While tubes are in wear ear plugs when bathing or swimming.
• Have baby sitting up for feedings.
• No bottle propping.
• gentle nose blowing.
• Avoid smoke.
• An acute viral infection that affects the bronchioles and includes RSV bronchiolitis or RSV pneumonia.
• Leading cause of Lower Respiratory Tract Illness in children less than 2 years.
2) Risk Factors:
• Congenital disorders
• Focus is on prevention (high risk will get RSV vaccine)
• Nasal congestion
• Mild fever
• Nonproductive cough
• Tachypnea with flaring nares
• Retraction and wheezing
• It is important to know the onset of s/s because the disease will become worse on days 2-3
Hint: Sign and symptoms can range from mild to severe; can go from cough, runny nose with copious amounts of mucus, to severe respiratory distress!
• Nasal swab.
• contact precautions.
• Teach good hand washing
• Treat symptoms (supportive care: antipyretics)
• Oxygen: may need mechanical ventilation
• IV fluids
• Antiviral (Ribavirin) thru tent.
• Viral (RSV, adenovirus or parainfluenza)
• Bacterial (Culprit is strep pneumonia) children <4 yrs
• Mycotic (walking pneumonia) primarily in adolescents.
• Aspiration pneumonia (something other than air gets in the lung)
• Fine crackles or rhonchi with a cough that is productive or nonproductive.
• Abdominal distention
• Back pain
• Fever that is usually high.
• Chest pain from coughing
• Antibiotics for bacterial
• Cough suppressant only at night
1) What type of infection are Down syndrome children prone to developing? respiratory Why? Because they have a poor immune system
2) The most common type of defect associated with Down Syndrome is heart defect.
3) The primary aim in genetic counseling is to inform the parents of their risk.
1) Causes: inherited trait, and must get trait from both parents.
• thick sticky secretions.
• Characterized by exocrine gland dysfunction. (These secrete mucus)
• Thick, sticky secretions are found in the lungs and GI tract.
• Diagnostic test for cystic fibrosis? Positive sweat chloride test. Baby tastes salty
• At risk for hyponatremia.
• The earliest sign in the newborn is the meconium ileus.
• They will have steatorrhea stools, which means fatty and frothy.
• Enzymes that help improve digestion are the pancreatic enzymes. Take 30 minutes prior to eating, do not crush or chew.
• Need a well balanced, low fat, high calorie, high protein diet. Require 150% of the recommended daily allowance.
• They need to take water soluble vitamins including A, D, E, and K.
a. Causes: Usually due to congenital defects.
1) Lips turn blue when taking a bottle.
2) Increase pulse at rest, or with slight exertion. 3) Increased respiratory rate
4) Scalp sweating
6) Sudden weight gain
1) Ongoing assessment
2) Control room temperature
3) Sit them up
5) decrease stimuli
6) Cool, humidified oxygen
7) Uninterrupted sleep
Cardiac meds for infants
1) Infants rarely get more than 1 mL.
2) Give 1 hour before and 2 hours after feedings.
3) DO NOT mix with medicine, food, or fluid.
4) Always check the dose with another nurse.
5) Check the apical pulse for 1 minute.
b. Ace Inhibitors: enalapril (Vasotec®), captopril (Capoten®)
1) Side effects:
• low blood pressure
• Kidney problems
• dry cough
2) Action: They block aldosterone.
c. Lasix: To decrease the volume.
Nutrition for heart failure
a. Well rested prior to eating.
1) Feed them when they wake up or show signs of hunger.
2) decrease crying.
b. Small frequent feedings every 3 hrs, no longer than 30 min.
c. High calories.
d. We want to use a soft nipple with a large opening so the baby won’t have to work so hard to get the formula out.
e. May require gavage feedings.
f. Usually don’t require sodium and water restrictions because of decreased intake.
Rheumatic heart disease
a. Rheumatic Fever is an inflammatory disease that occurs after an infection with group A beta hemolytic streptococcus.
1) Major cardiac clinical manifestation is carditis.
2) Therapeutic management is PCN G, if they are allergic then erythromycin is the drug of choice.
b. Kawasaki Disease is characterized by wide spread inflammation of the small and medium sized blood vessels. Coronary arteries are most susceptible.
High dose IV immune-globulin
What is the top nursing diagnosis? Alteration in nutrition
1) Feed with an elongated nipple or medicine dropper down the side of the mouth.
2) Burp frequently so they will not swallow a lot of air.
Cleft Lip Repair:
1) Position on back or side lying to protect the suture line.
2) Do not place them prone.
3) Clean the suture line with saline post op.
Cleft Palate Repair:
1) Place them prone to promote drainage.
2) Avoid putting things in their mouth (thermometers, straws).
3) Soft diet until well healed
4) Are speech defects common? Yes
5) When is the best time to do this? Before speech development. 6) What type of restraints would be used? Elbow
GER, GERD: GER becomes GERD when complications such as failure to thrive, bleeding, or difficulty swallowing (dysphagia) occurs.
1) upright position with feedings and at night.
2) 30 degree elevated prone position to decrease reflux and improve stomach emptying.
1) Small frequent feedings of thickened formula.
2) Breast feeding continues with more frequent feedings or expressing the milk for thickening with rice cereal.
c. Medication: H2blockers, Proton pump inhibitors
Esophageal artesia/TE fistula
• The saliva cannot make it to the stomach because the esophagus ends in a blind pouch.
1) Why do babies with esophageal atresia not have meconium? Because they
never swallowed amniotic fluid.
2) How are they fed? Gastrostomy tube
3) T – E Fistula watch for
Choking especially while drinking
• The first feeding needs to be watched and sterile.
• The top nursing diagnosis is potential for aspiration
1) They will do corrective surgery and the infant is placed on their back with head and shoulders elevated.
2) It is not uncommon to see polyhydramnios in pregnancy when the infant has GI problems. The infant does not swallow any amniotic fluid so it just builds up.
1) Projectile vomitting usually after eating.
2) Very hungry
3) olive shaped mass in epigastric region. 4) Peristalsis is obvious.
• Pyloric ultrasound
2) Intake and output
3) Daily weights
4) Monitor urine specific gravity
5) surgery. Open sphincter
(When a piece of bowel goes backwards inside itself forming an obstruction)
1) Sudden onset
3) Abdominal pain
5) Drawing up knees
6) Currant jelly stools (monitor stools)
• The definitive diagnosis is through a barium enema and this will sometimes fix the problem.
• Teach sign and symptoms of reoccurrence.
a congenital anomaly also known as aganglionic megacolon that results in a mechanical obstruction along the bowel (sigmoid).
1) The presenting symptom is constipation .
2) Abdominal distention.
3) ribbon- like stools that have a foul smell.
1) Remove the portion of the bowel that is diseased.
2) May require two surgeries to give the intestines time to heal.
• A genetic malabsorption disorder where there is a permanent intestinal intolerance to gluten.
1) No food with gluten. (Vegetable proteins)
2) They cannot have BROW.
3) They can have RCS.
• In newborns and children 2:
• flank pain
• Properly collected urine specimen
• Most accurate method is catheterization.
• Antibiotic therapy: PO or IV depending on severity
• Painful condition caused by the sudden twisting of the spermatic cord which results in the loss of blood flow to the testicle.
• Occurs in 1 out of every 40,000 males with a peak onset of 13 years of age.
• Most common cause of testicular loss in adolescent males.
• If not diagnosed in a timely manner, they can lose the affected testicle.
• Unilateral pain to affected testicles
• May experience nausea and vomiting
• discoloration of the testicles
• This is a hereditary disorder in which the hgb is partly or completely replaced with sickle-shaped hemoglobin.
• Sickle shaped hemoglobin or Hgbs cannot carry o2 like normal Hgb.
1) pain in the areas of involvement.
3) Exercise intolerance.
1) bed rest
5) blood transfusions and
a. This is cancer of the blood forming tissue and proliferation of immature white cells.
b. When thinking of leukemia always remember immunosuppression, thrombocytopenia, anemia.
c. Two types ALL (acute lymphoid leukemia) and AML (acute myelogenous)
• Vague abdominal pain
• Easily acquired infections
a. Most common presenting sign is swelling or non-tender mass on one side of the abdomen.
b. Don’t palpate the abdomen.
c. Gentle while bathing or moving the client.
• A disturbance of the ventricular circulation of the cerebral spinal fluid in the brain.
• Increase of cranial pressure.
1) Bulging of the anterior fontanel
2) Dilated scalp veins
3) Depressed eyes
4) Irritability and changes in the LOC
5) High-pitched cry
b. Tx: Insertion of a VP (ventriculoperitoneal shunt)
1) Measure the frontal occipital circumference
2) Fontanel and cranial suture line assessment 3) Monitor the temperature
4) supine position
Spina bifida is prone and cover the sack
• Should consider as a symptom of an underlying disorder rather than a disease.
• May have short term memory lapses.
• School work deteriorates which may be first indicator of a problem.
• Limited to a particular location of the brain.
• An aura may be the only manifestation.
• Simple partial means without loss of consciousness with various sensations: Numbness, tingling, prickling, or pain.
• Complex partial means they have impaired consciousness and may be confused and unable to respond.
• Loss of consciousness.
Tonic-clonic (formally known as grand mal)
Myoclonic (sudden, brief contractures of a muscle or group of muscles;
may look like a startle reflex)
Absence (formally called petit mal and characterized by a brief loss of consciousness)
• Diagnostic testing: EEG, Ultrasound, CT/X-ray
• Airway, Breathing and Circulation
• DO NOT put anything in the child’s mouth
1. Scoliosis is a lateral curvature and rotation of the spine.
• Seldom apparent before age 10, and can be genetic.
a. Contributing factors:
• Heavy bags (suitcases, grocery, etc.)
• Carrying children on hips
b. Tx: The 3 O’s
Orthosis (supports and braces)
Operation which usually is spinal fusion with rod.
From dirt and dust
• How are they spread? Hand to mouth
• How are they diagnosed? Tape test in am
• Intense rectal itching
• General irritability
• Poor sleep
• Bed wetting
• Short attention span
• Mebendazole (Vermox®)
• Hand hygiene
• Keep fingernails short
• Prevent infection in the lesions.
• Home remedies that alleviate itching are oat bath, baking soda paste.
• Is it contagious? Yes
• If they have an increased risk for severe varicella, acyclovir (Zovirax®) is prescribed.