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Flashcards in Peds Deck (49):
1

What are the most important considerations in the provision of a framework regarding instruction to parents on safety & risk-reduction in the home?

Priority should be given regarding the age and developmental level of the children at home when teaching safety

2

What are the common types of Acyanotic defects?

Common types of Acyanotic defects are:

Increased pulmonary flow = Atrial Septal Defects, Ventricular Septal defect, Patent Ductus Arteriosus defect

Decreased Pulmonary flow = Coarctation of aorta, Aortic stenosis, pulmonary stenosis

3

Atrial Septal Defect S/S:

ASD: asymptomatic or mild HF (increased 02 bld into R heart = systolic murmur)

4

Ventricular Septal Defect S/S:

VSD (abnormal opening between the ventricles): HF, murmur, increased bld volume to lungs (CHF, B. endocarditis)

5

Patent Ductus Arteriosus S/S:

symptomatic during infancy, mild HF, machinery-like murmur, dyspnea, bounding rapid pulse on exertion

6

What are the types of cyanotic defects?

Types w/decreased pulmonary Flow = tetralogy of Fallot (TOF), VSD, pulmonic stenosis

Types of mixed Blood Flow = Transposition of the Great Vessels (TOGV)

7

Tetralogy of Fallot, VSD, pulmonic stenosis S/S:

Cyanosis, murmur, failure to thrive, clubbing, exertion causes dyspnea & cyanosis, systolic murmur

8

Transposition of the Great Vessels S/S:

cyanosis and cardiomegaly

9

LHF in children:

pulmonary edema, crackles, tachypnea, dyspnea, retractions, nasal flaring, cough, cyanosis, grunting, wheezing, hypotension, tachycardia, decreased play, fatigue

10

RHF in children:

edema of the face, papilledema, peripheral edema, liver enlargement, ascites, JVD, weight gain even w/poor appetite, hypotension, tachycardia, decreased play, fatigue

11

What are the Four T's of cyanotic defects?

Tetralogy of fallot, truncus arteriosus, tricuspid atresia, transportation of the great vessels

12

What is the proper position to put babies in with cyanotic defects:

Put babies in slanted position w/head elevated, older babies in infant seats or knee-chest position

13

What are the findings for respiratory distress syndrome:

tachypnea w/increases RR effort, paradoxical "seesaw" RR, nasal flaring, substernal retractions, expiratory grunt, cyanosis, hypoxia

14

What is bronchopulmonary dysplasia:

Bronchopulmonary dysplasia (BPD) is a chronic lung condition that affects newborn babies who were either put on a ventilator or born prematurely = lungs develop cystic sacs and atelectasis (collapsed alveoli)

15

Bronchopulmonary dysplasia S/S:

tachycardia, tachypnea, retractions & nasal flaring, pallor, cyanosis w/activity, restlessness

16

What are some NSG interventions post tonsillectomy:

Assess for frequent swallowing (may be bleeding), vomitus; place child on side, avoid offering fluids with red/brown color or acidic, give soft foods not highly seasoned, quiet activity, no ASA d/t Reyes syndrome, recovery takes 1-2 wks, no school for 7-10 days, no exercise/swimming for 3 wks

17

What are the croup syndromes:

laryngitis, tracheitis, epiglottitis

18

Croup S/S:

Classic "barky" cough, stridor, hoarseness, fever, purulent secretions, dyspnea if severe, if epiglottitis = 4 D's

19

Epiglottitis four D's:

drooling, dysphagia, dysphonia (hoarse voice), distressed inspiratory efforts

20

Respiratory Syncytial Virus (bronchiolitis) s/s:

mild RR infection; cough, wheezing, SOB, crackles; intercostal retractions, tachypnea; nasal flaring in infants, fever

21

NSG interventions w/respiratory syncytial Virus:

admit pt in single room or w/other RSV pts, contact precaution, immunization (RSV-IVIG) and no vaccine after 9 months post RSV-IVIG), no smoking, rest w/humidifier to loosen sticky mucus

22

NSG intervention for aspiration of foreign body:

administer back slaps & chest thrusts or heimlich maneuver for children as indicated, teach parents to avoid causes of aspiration (peanut butter, balloons, aluminum tabs from cans, paper clips

23

What meds are used for Asthma:

CCLLNM:

C = corticosteroids (anti-inflammatory)
C = cromolyn sodium (nonsteroidal anti-inflammatory)
L = long acting beta adrenergic (Albuterol) for acute exacerbations
L = leukotriene modifiers (Zileuton) mediator of inflammation
N = nedocromil (anti-allergic & anti-inflammaotry)
M = methylxanthines (theophylline) bronchodilator

24

Asthma rescue meds for acute & exacerbations:

short acting beta adrenergics, anticholinergics, systemic corticosteroids

25

NSG interventions for acute asthma or exacerbations:

monitor for RR distress & need for nebulizer, semi-high Fowler's, stay w/child during acute stage, teach correct use of metered-dose inhaler (MDI) w/spacer, risks of overuse of bronchodilators, teach about self use of peak flow meter

26

How to use a peak flow meter:

slide marker/arrow to the bottom of numbered scale, stand/sit up straight & take a deep breath, put mouth piece in mouth w/tongue down and lips closed tightly around, in one breath blow as hard and as quickly as possible to empty your lungs, repeat routine 3 times and record the highest number in diary

27

A mother wants to know what cystic fibrosis is. You explain that it:

Cystic fibrosis is an inherited Dz that causes the body to produce abnormally thick & sticky mucus that builds up in the lungs & digestive tract (esp the pancreas)

28

Cystic Fibrosis S/S:

GI S/S: meconium ileus, steatorrhea, rectum prolapse, failure to grow

RR S/S: thick tenacious mucus causes atelectasis cough, barrel-shaped chest, finger/toe clubbing

29

What laboratory tests would you expect the MD to order for cystic fibrosis:

Sweat chloride test (shows high levels of NaCl in sweat), immunoreactive trypsinogen test (IRT) standard newborn screening test, stool analysis

30

Diet for cystic fibrosis:

high protein/calorie, vitamin supplements (A, D, E, K)

31

What type of exercise should a pt with cystic fibrosis do?

exercise 2-3 times per wk. Do swimming, jogging, cycling. Avoid contact/endurance sports

32

An infant w/increased intracranial pressure will have what S/S:

bulging fontanelles, increased head circumference, separated sutures, "setting sun" eyes, pupils slow to constrict to light, eats poorly, high-pitched cry, variable pulse, changes in RR

33

An older child w/increased intracranial pressure will have what S/S:

HA, dizziness, vomiting, diplopia, ataxia, confusion

34

Hydrocephalus NSG interventions:

position pt on un-operated side to prevent pressure on operative side, monitor for ICP, measure head circumference, observe for abd distention (d/t possible cath complication from VP shunt), NPO until bowel sounds return, keep diaper off perineal dressing;

Teach parents s/s infec: elevated temp, poor feeding, irritability, ALOC

35

What are the two types of neural tube defects:

Anencephaly (degeneration of the brain to a spongy mass w/no bony covering) and spina bifida (incomplete closure of vertebrae & neural tube

36

Chickenpox teaching:

Contagious 1-2 days before blisters appear & remain contagious until the blisters have crusted over, NO ASA d/t Reyes syndrome, use hydrocortisone for itchy skin, papules/vesicles/crusts will all be present at one/same time

37

The nurse is evaluating a developmentally challenged 2 year-old child. During the evaluation, what goal should the nurse stress when talking to the child's mother?

A: Help the family decide on long-term care

B: Prepare for independent toileting

C: Teach the child self-care skills

D: Promote the child's optimal development

D: Promote the child's optimal development

The primary goal of nursing care for a developmentally challenged child is to promote the child's optimal development.

38

The mother of a 4 month-old infant asks the nurse about the dangers of sunburn while they are on vacation at the beach. Which of these statements is the best advice about sun protection for this child?

A: "Liberally apply a sunscreen with a minimum sun protective factor of 15 all over the body.

B: "Sunscreen should not be used on children."

C: "You should keep the baby inside unless it's cloudy outside."

D: "Dress the infant in lightweight long pants, long-sleeved shirts and brimmed hats."

D: "Dress the infant in lightweight long pants, long-sleeved shirts and brimmed hats."

Infants under 6 months of age should be kept out of the sun or shielded from it. Even on a cloudy day, the infant can be sunburned while near water. A hat and light protective clothing should be worn. Sunscreen is not generally recommended for infants under the age of 6 months; however, the American Academy of Pediatrics states that it can be applied to small areas of the baby's skin that are exposed to the sun (such as the baby's face or the back of the hands).

39

The nurse is caring for a child diagnosed with Kawasaki disease (mucocutaneous lymph node syndrome or infantile polyarteritis). The nursing care plan should be based on the knowledge that this child is at risk for developing what complication?

A: Coronary artery aneurysm

B: Chronic vessel plaque formation

C: Pulmonary embolism

D: Occlusions at the vessel bifurcations

A: Coronary artery aneurysm

Kawasaki disease affects the mucus membranes, lymph nodes, walls of the blood vessels and the heart. It can cause inflammation of the arteries, especially the coronary arteries of the heart, which can lead to aneurysms and possible heart attack in the child.

40

The parents of a 5 month-old report that the infant has "vomited nine times in the past six hours." Based on this information, the nurse should observe for which fluid and electrolyte imbalance?

A: M. acidosis

B: M. alkalosis

C: Hemoconcentration effects

D: Hemodilution effects

B: M. alkalosis

Vomiting results in a loss of acid from the stomach. Prolonged vomiting results in excess loss of acid and leads to metabolic alkalosis. Findings include irritability, increased activity, hyperactive reflexes, muscle twitching and elevated pulse. Hemoconcentration due to fluid loss may occur, but is not the best answer because it does not answer the question about an imbalance.

41

An 18 month-old child is on peritoneal dialysis in preparation for a renal transplant in the near future. When a nurse obtains the child's health history, the mother indicates that the child has not had the first measles, mumps, rubella (MMR) immunization. What should the nurse understand about the child's situation and administration of the immunization?

A: An inactivated form of the vaccine can be given at any time

B: Live vaccine are w/held in children w/renal chronic illness

C: The measles, mumps and rubella (MMR) vaccine should be given now, before the transplant

D: The risk of the vaccine side effects precludes the administration of the vaccine

C: the MMR vaccine should be given now

MMR is a live virus vaccine, and should be given at this time. Post-transplant, immunosuppressive drugs will be given and the administration of the live vaccine at that time would be contraindicated because of the compromised immune system.

42

The nurse is providing discharge teaching to the parents of a 15 month-old child diagnosed with Kawasaki disease (mucocutaneous lymph node syndrome or infantile polyarteritis). The child has received immunoglobulin therapy. Which instruction point would be appropriate to include during the discussion?

A: Complete recovery is expected within several days

B: The measles, mumps and rubella vaccine should be delayed

C: Active range of motion exercises should be done frequently

D: High doses of aspirin will be continued for some time

B: The measles, mumps and rubella vaccine should be delayed

Discharge instructions for a child with Kawasaki disease should include the information that immunoglobulin therapy may interfere with the body's ability to form appropriate amounts of antibodies. Therefore, live or attenuated (weakened) immunizations should be delayed. The MMR vaccine contains three live attenuated viruses and should be delayed until the child's immune system recovers from this treatment.

43

The nurse is caring for a child who is diagnosed with coarctation of the aorta. Which finding would the nurse expect when assessing the child?

A: Strong pedal pulses

B: Normal femoral pulses

C: Bounding pulses in the arms

D: Diminished carotid pulses

C: Bounding pulses in the arms

Coarctation of the aorta, which is a narrowing or constriction of the descending aorta, causes increased blood flow to the upper extremities, resulting in a bounding pulse in the arms. Cardinal signs include resting systolic hypertension, absent or diminished femoral and pedal pulses, and a widened pulse pressure.

44

The nurse is caring for a toddler who is diagnosed with an infection and whose temperature is 103 F (39.4 C). Which intervention would be most effective in lowering the client's temperature?

A: Immerse the child in a tub containing cool water

B: Give a tepid sponge bath prior to giving an antipyretic

C: Use medications to lower the temperature and improve comfort

D: Apply extra layers of clothing to prevent shivering

D: Use medications to lower the temperature and improve comfort

Fever is not the primary illness; it is a physiologic mechanism the body uses to fight an infection. The best response is to administer an antipyretic to normalize body temperature and improve the overall comfort of the child. Tepid sponge baths can lower the body temp, but they don't necessarily improve comfort, and you have to be careful not to chill the child because shivering would only increase the body temperature.

45

The parents of a 7 year-old tell the nurse that their child has started to "tattle" on siblings. In interpreting this new behavior, how should the nurse explain the child's actions to the parents?

A: Insecurity and attention getting are common motives

B: The ethical sense and feelings of justice are developing

C: Complex thought processes help to resolve conflicts

D: Attempts to control the family using new coping styles

B: The ethical sense and feelings of justice are developing

The child is developing a sense of justice and a desire to do what is right. At 7, children are increasingly aware of family roles and responsibilities. They also do what is right because of parental direction or to avoid punishment. This age group, 6 to 12 years of age, is called the school-aged group.

46

The parents of a 6 year-old child who normally enjoys school tells a nurse that the child has not been doing well since a grandmother died two months ago. Which statement most accurately describes thoughts on death and dying at this age?

A: The child feels guilty for the grandmother's death
B: Death is perceived as being irreversible
C: Death is personified as the bogeyman or devil
D: The child is worried that the child, too, might die

C: Death is personified as the bogeyman or devil

Personification of death is typical of this developmental level. Recall that this age is at the end of the preschool period where magical thinking for the animation of inanimate objects is present.

47

A nurse is performing physical assessments on adolescents. What finding should the nurse anticipate concerning female growth spurts?

A: Start just prior to the onset of puberty
B: Begin about the same time for males
C: Characterized by an increase in height of 4 inches each year
D: Occur about two years earlier than for males

D: Occur about two years earlier than for males

Normally, females in their teenage years experience a growth spurt about two years earlier than their male peers.

48

The parents of a 4 year-old hospitalized child tell the nurse, “We are leaving now and will be back at 6:00 pm.” A few hours later the child asks a nurse when the parents will come again. What is the best response by the nurse?

A: "In about two hours, you will see them."
B: "When the clock hands are on the numbers 6 and 12."
C: "They will be back right after you eat supper."
D: "After you play awhile, they will be here."

C: "They will be back right after you eat supper."

Time is not completely understood by preschoolers. Preschoolers interpret time with their own frame of reference of activities that they have experienced. Thus, it is best to explain time in relationship to a known and common event.

49

A child is sent to the school nurse by a teacher who has a written note that fifth disease is suspected. Which of the following should the nurse expect to find if the child has this condition?

A: Discrete rose pink macules will appear first on the trunk and fade when pressure is applied

B: Bright red cheeks, with a "slapped face" appearance

C: Koplik spots appear first followed by a rash that appears first on the face and spreads downward

D: Macule that rapidly progresses to papule and then vesicles

B: Bright red cheeks, with a "slapped face" appearance

Fifth disease is also referred to as parvovirus infection or erythema infectiosum. Some people may call it slapped-cheek disease because of the face rash that develops resembling slap marks. It is also commonly called fifth disease because it was fifth of a group of once-common childhood diseases that all have similar rashes. The other four diseases are measles, rubella, scarlet fever, and Dukes' disease. People will not know that a child has parvovirus infection until the rash appears, and by that time the child is no longer contagious.