Peds final Flashcards
(137 cards)
1
Q
**
When do you check urine for ketones?
*Suspicion for DKA check urine FIRST
A
fruity smelling breath; confusion
2
Q
**
Classic symptoms of DKA
A
Kussmaul respirations
Fruity Breath (Sometimes smells like rotten apples)
Confusion (neuro changes)
*If suspicious of DKA check urine FIRST for ketones over glucose
3
Q
**
When would you test glucose first over checking urine ketones?
A
Pt with consistent sx of hyper/hypoglycemia (no kussmaul respirations or fruity breath odor)
4
Q
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Priority for patient with suspected DKA
A
Check ketones and send to ER- pt cannot go home.
5
Q
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When do you administer glucagon?
A
Hypoglycemic and unable to swallow or are unconscious
If able to eat: 15g of carbs (4oz of juice, whole milk, graham crackers)
6
Q
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Are children with diabetes ever told to restrict fluids?
A
No!
Dehydration is a huge complication; need to be evaluated if they have the stomach virus because dehydration is a big risk
7
Q
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What does the school nurse need to know with diabetics?
A
what the child is taking/what type of insulin
8
Q
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What should those with diabetes check regarding exercise
A
check glucose before, during and after exercise (if low they need to eat first- if too high they can exercise)
9
Q
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Why do we want to catch diabetes early?
A
Prevent from going into DKA
10
Q
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Pt comes in with unexplained weight loss and symptoms of increased hunger and thirst what should we test them for?
A
Diabetes
11
Q
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What causes T1DM?
A
Autoimmune disorder
Can happen after viruses
12
Q
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Nursing diagnosis that may be important for the school nurse regarding growth hormone deficiency
A
Low self-esteem
13
Q
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When is growth hormone deficiency commonly diagnosed?
A
online: typically diagnosed between 5 years old and puberty (10-16)
14
Q
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Does early diagnosis with growth hormone deficiency lead to more desirable outcomes?
A
The earlier treatment for growth hormone deficiency is started, the better chance the child will have of attaining her normal or near-normal adult height.
15
Q
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Is growth hormone deficiency typically genetic?
A
online: While not always, some forms of growth hormone deficiency (GHD) are genetically inherited. Congenital GHD, present at birth, is often caused by genetic mutations.
16
Q
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Does everyone that is short have a GHD?
A
No. Its rare to have GHD. about 1 in 4-10,000
17
Q
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What does a child receiving treatment for GHD need for f/u and monitoring?
A
stop GHD tx when endocrinologist has determined child has reached predicted adult height
*follow up for self-esteem
18
Q
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Nursing action for patients with GHD
A
manage low self-esteem and assess
19
Q
Insulin administration
A
see photo
20
Q
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Insulin management
A
- Monitor blood glucose using a sliding scale (Hyper/Hypo)
- Insulin administration
- Patient education- Diet/exercise, monitor feet and skin, foot protection
- Evaluating insulin effectiveness
- Managing side effects
21
Q
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What does a nurse educator need to do to successfully teach families about glucose management in newly diagnosed diabetics?
A
Teach back
Nutrition and Knowing how to use insulin/When and how to exercise
22
Q
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What is a big component to understanding glucose management
A
Nutrition; exercise patterns
23
Q
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What is a positive finding on physical exam that suggests possible DDH?
A
Positive Ortolani; positive barlow
24
Q
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When a patient has to wear a Pavlik harness, what is practical advice that can be given for skin care and protection?
A
put it over clothes; want something cotton between skin and harness
Need to assess for skin breakdown as parents: redness, skin peeling, blistering
- need to use mild soaps and lotions (vasoline is ok)
- Lotions should not have fragrance and should not cause stickiness to the actual harness (skin breakdown)
- need to make sure there is no soiling
Pavlik is worn 23 out of 24 hours- only take off to shower
25
# **
How might scoliosis impact the self-image of an adolescent?
Brace must be worn on top of clothing so it will be obvious to their peers- convincing children to wear their brace might be difficult.
26
# **
If a fracture requires complete immobilization of an upper or lower extremity, how do we instruct patients to reduce swelling?
Ice and elevation 15-20 minutes (not over the cast- only on the injury site and surrounding areas)
27
# **
If a fracture requires complete immobilization of an upper or lower extremity, how long and how much swelling is considered normal?
They should always have sensation in their extremities. If swelling increases after casting they should return to office.
28
# **
How do we care for skin while casted?
Padding with mole skin over hard spots
- Do not get cast wet
- Neurovascular checks
- Make sure they have sensation in all limbs and digits (they should be able to feel the cast on their skin)
29
# **
What is the biggest responsibility regarding casted limbs?
Neurovascular check: capillary refill
Making sure can slip a finger between skin and cast
If there are hard spots on cast from plaster, using moleskin around the edge of the cast to prevent breakdown
30
# **
What does it mean to be a mandatory reporter?
Nurses are require to report if there is suspicion of abuse (child and elder) no matter what. Do not investigate- just report the red flags.
31
# **
What age group having a fracture would be the most concerning regarding maltreatment?
Fractures for someone that isn't mobile; infant (baby who isn't rolling yet should not have a fractured limb)
32
# **
What is VAERS?
Vaccine Adverse Event Reporting System
33
# **
Who can report to VAERS?
anyone
34
# **
What does the pneumococcal vaccine protect against?
Meningitis and pneumococcus
35
# **
What does the DTaP vaccine protect against?
TDap?
Diphtheria, tetanus, pertussis
TDap is the same thing with different components. TDap is for adolescents becaue they need more tetatnus vs DTaP for babies which need more diptheria and pertussis
36
# **
What does the Hib vaccine protect against?
hemophilus influenza
37
# **
How do we explain the safety of MMR to patients?
MMR vaccine has 98% efficacy → get 90-95% after the first dose & 98% after 2nd dose.
○ One of our best vaccines but gets the worst rep out there → bc people believe
MMR vaccine is linked to autism which has been proven wrong
○ Let families know it is one of our best vaccines out there.
■ Tell them that even if they only did one dose they are going to achieve a decent amount of immunity & that there is truly no link between MMR
and autism
38
# **
How can we explain the risk vs benefit of vaccine to families?
More benefit than risk.
Fever is common in this afe and there is a small risk for febrile seizure. There can also be a skin reaction (like a bee sting) which can be treated with topical benadryl or hydrocortisone.
39
# **
How can you best explain herd immunity?
The more people vaccinated the less people will get it. Herd immunity is reached at approximately 85%
40
# **
When a patient has to go for a painful procedure or test, what is the nursing action that needs to be prioritized?
As nurses, we have to make the child as well as the family understand what is
going on
○ Even though it is the parents consenting for the procedures, the child has the right
to understand the procedure
○ **If you have a question where the child is getting ready to go through a
painful procedure your first nursing action is to speak to the child and make
sure they understand the procedure & make sure their questions are
answered**
○ There is a difference between consent and assent
■ Assent → making sure they understand what they are about to go through
■ **This is very important bc obviously both a 5 year old and a 16 year
old cannot give you consent, but the way you explain the procedure to
the 16 year old will be very different than the way you explain it to a 5
year old**
■ In pediatric hospitals child-life specialists help you with this process, but
nurses are responsible for making sure the info that is being told to them is
factual
41
# **
Where is most childhood cancer found?
In the tissues
Organs for adults
42
# **
What infection precautions should be taught to families with immunocompromised patients?
* Antibiotic prophylactic understanding
* Hand washing
* Infectious control (large groups and staying away from sick people)
43
# **
When considering nursing diagnoses for children starting chemo or radiation, what needs to be considered first when a child is facing a poor prognosis?
Ask open ended question to assess where they are in accepting their diagnosis
44
# **
When a child is undergoing treatment for pediatric cancer, how can we help them when they feel powerless?
Listen to them. Give them choices when possible- (what they want to eat, what arm their IV goes in etc)
45
# **
What skin care needs to be taught to patients/parents for radiation exposure?
*do not wash off marks on skin that outline the target areas*
- wash the marked areas with lukewarm water, use hands instead of washcloth, and pat dry
- avoid using hot or cold water
- avoid use of soaps, creams, lotions, and powders unless they are prescribed
- have the child wear loose cotton clothing
- keep the areas protected from the sun by wearing a hat and long-sleeved shirts
- seek medical care for blisters, weeping, and red/tender skin
46
# **
What are nutritional considerations that should be given to children undergoing chemo?
Need high calorie, high fat food
- hard to have children eat when they don't want to eat so assess what their favorite foods are and ways to add **protein and fat**
- may give them shakes
Higher risk for ulcerations in their mouths so eating can be difficult
- may need an NG tube
47
# **
What does it mean to have assent for a procedure?
Making sure the patient understands the procedure at an intellectual and emotional level appropriate for their age
48
# **
What precautions would be necessary if a child with impetigo was hospitalized?
Contact
49
# **
Classic appearance of impetigo/ How to treat mild vs severe
yellow, honey crusted pimples that ooze. Caused by bacteria
Mild: topical
Severe: Oral antibiotics
50
# **
What is the classic rash/appearance of scabies?
**pencil-like lines on a rash**
rash in folds; breakout to the mites' waste
-Creases in fingers and toes, underneath breast folds and arm folds, armpits, groin
## Footnote
pencil-like lines due to mites burrowing under the skin
51
# **
What precautions are necessary if a child with scabies is hospitalized?
contact
52
# **
How is scabies spread?
Direct contact; treat everyone in the house
- sexual partners too if active
53
# **
Classic rash/appearance of tinea corporis?
Ring worm
- ring with clearing in the center
- crusty around the edges
- "crusty donut"
Need to apply cream at least 1/2 inch from the edge of the ring because it can expand without being visible (Spores in the skin before visible)
54
# **
How is tinea corporis spread?
Contact both direct and indirect
(Ex. A wrestlers/Gymnastics mat)
Can spread by pets too (dander)
55
# **
Does the child need to avoid sports if they have ringworm?
Yes, they need treatment for at least 72 hours first
56
# **
What is a 1st degree burn
red, not blistered
Ex. sunburn
57
# **
What is a 2nd degree burn
blisters, some thickening or lifting
58
# **
What is a 3rd degree burn
charred center
59
# **
What is a sign on exam that means you need to check for inhalation injury due to a fire?
- SOB and increased respiratory rate
-
If you have a patient who was in a house fire , aside from skin burns you would also check for inhalation injury.
-Any type of smoke exposure - check inhalation
60
# **
Common symptoms of ADHD
- forgetfulness
- misplacing things
- poor test scores sometimes
- trouble focusing
- poor organization
61
# **
What do we need to do to support those with ADHD
break education into pieces
find something to entertain the child if needed so you can educate the parents
62
# **
Things to do with sleep disturbances and ASD
Altered sleep pattern- not safe to have child wandering the houes when parents are asleep. (Special beds for kids with autism)
63
# **
Safety and ASD
Making sure locks are high on the doors so they cannot become a flight risk.
-Sleeping tents to keep them confined
-Meds if necessary for sleeping and safety
64
# **
Healthy sleep habits for ASD
■ good sleep hygiene (no screens before bed i.e. iPad)
■ calming corners
■ low dim lights
■ low noise (white noise or brown noise)
■ calm environment (decrease environmental stimulation)
65
What does the IPV vaccine prevent?
inactivated polio virus: prevents polio
66
What does the MMR vaccine prevent?
measles, mumps, rubella
67
What does varicella vaccine prevent?
chickenpox
68
What does the meningococcal vaccine prevent?
illnesses caused by Neisseria meningitidis - meningitis, septicemia
- can cause long-term disabilities like hearing loss, brain damage, limb loss
69
What does the HPV vaccine prevent?
human papillomavirus; protects against genital warts and most cases of cervical cancer
Gardasil - 9 strains
70
What routine administration is not recommended prior to vaccinations?
Tylenol
71
What is given to parents to provide typical side effects and possible adverse reactions?
VIS sheets
72
What is needed prior to administer vaccinations?
written consent and/or signature of receipt of VIS education
73
Red flags of fractures that could be a sign of abuse
unexplained fractures in infants or non-mobile children, multiple or bilateral fractures, fractures in unusual locations like ribs, scapula, sternum
fractures that don't match given explanation
74
What is needed in a good assessment of injury or trauma?
- pain
- crepitus
- deformity
- edema
- ecchymosis
- warmth or redness
- decreased use of affected area
75
What is an open (compound) fracture?
the fracture occurs with an open wound or bone protruding
76
What is a closed (simple) fraction?
the fracture occurs WITHOUT a break in the skin
77
What is a complicated fracture?
the fracture results in injury to other organs and tissues
78
What is a comminuted fracture?
- the fracture includes small fragments of bone that lie in surrounding tissue
- associated with high impact forces
79
What is a spiral fracture?
- break spirals around the bone
- occurs when bone is twisted
80
What is an oblique fracture?
fracture that occurs at an angle, or diagonally, across the bone
81
What is a transverse fracture?
type of fracture that occurs when the fracture line runs perpendicular to the bone's long axis
82
Nursing care related to fractures
- immobilization
- elevation and ice to help reduce swelling
- assess for increasing swelling, numbness, tingling, or changing pain
- comfort measures
- patient education on compartment syndrome
Regular neurovascular checks:
- sensation
- skin temperature
- skin color
- capillary refill
- pulses
- movement
83
Nursing care post casting (5)
- assess for cast for increased warmth or hot spots = infection
- monitor for drainage on the cast
-- outline any drainage on the outside of the cast with a pen (note date and time) so it can be monitored for any additional drainage
- assess the skin condition and the area around the cast edges
- use moleskin to petal the edges over any rough area of the cast that can rub against the client's skin
- assist with proper crutch fitting and reinforce proper use
84
What is skin traction? Examples?
Uses a pulling force that is applied by weights
Examples:
- Buck (knee injuries, not fractures)
- Russell (femur)
- Bryant traction is used for treating fractures of the femur in children less than 2 years old or lighter than 20-30 pounds; legs are suspended
85
What is skeletal traction?
- attaches directly to the bone
- provides a strong, steady continuous pull and can be used for a prolonged period
- a pin or rod is inserted through into the bone
- force is applied using weights attached by rope
**the weights are never to be removed by the nurse**
86
What is most important with skeletal traction?
the weights are NEVER to be removed by the nurse
87
Nursing Management for Traction: TRACTION
T: temperature of the extremity and the body = infection
R: ropes should be hanging freely
A: alignment of the extremity and assess for swelling
C: compartment syndrome (6P's and 3A's)
T: type and location of fracture
I: increase fluid intake
O: overhead Trapeze bar to help with raising and lowering of the body - also allows for independence and muscle strength
N: never allows weights to rest on the bed or the floor
88
Compartment syndrome: What are the 6P's and 3A's?
6Ps:
- pain
- paresthesia
- poikilothermia
- paralysis
- pulselessness
- pallor
3As (not really sure about this - check it)
- anxiety, anger and anhedonia
OR agility, adaptability, action
89
Risk factors of Legg-Calve-Perthes Disease?
- 2-12 y/o; more common 4-8
- more common in males
- trauma decreased circulation, inflammation to the femoral head
90
Expected findings of Legg-Calve-Perthes Disease?
- intermittent painless limp
- limited ROM
- hip stiffness
- hip, thigh, knee pain
- shortening of the affected limb
- muscle wasting
- Xray hip and pelvis, MRI
91
Risk factors of Developmental Dysplasia of the Hip (DDH)?
- positive Ortolani and/or Barlow sign is a positive finding for DDH on exam
- breech presentation seems to increase the risk of Ortolani positive DDH
-- these patients likely to recover with initially started Pavlik harness treatment
- Positive family history and born female
-- are risk factors associated with the most severe cases of DDH
-- may predispose to the failure of the Pavlik harness treatment
92
Most common treatment of DDH?
Developmental dysplasia of hip
How long for treatment ?
Newborn to 6 months: Pavlik harness
- abduction device
- maintain harness placement for up to 12 weeks or until the hip joint is clinically and radiographically stable
- check straps every 1-2 weeks for adjustment
- perform neurovascular and skin integrity checks
93
Education with DDH?
- do not adjust the straps
- teach skin care
-- use an undershirt, wear knee socks, assess skin under the straps, gently massage skin under straps, avoid lotions and powders, place diaper under the straps
- after 6 months: child may be transferred to a protective abduction
94
What is OI (osteogenesis imperfecta)?
- also known as brittle bone disease
- autosomal dominant disease
- COLIA 1 and COLIA 2 gene
- type 1 collagen error in bone demineralization
Types: I, II, III, IV
95
Type I OI
- **is the most common and mildest type of this disease**
- little or no bone deformity, although the bones are fragile and easily broken
- effects of OI may extend to the teeth, making them prone to cavities and cracking
- white of the eyes may have a blue, purple, or gray tint
96
Type II OI
- **is the most severe form of the disease**
- bones may break even while the fetus is in the womb
- **many infants with type II OI do not survive**
97
Type III OI
- **often has severe bone deformities**
- **infant is often born with fractures**
- **sclera of the eyes may be white, blue, purple, or gray**
- people with type III OI are generally shorter than average
- may have spinal deformities, respiratory complication, brittle teeth
98
Type IV OI
- bones fracture easily, but the whites of the eyes are normal
- some people with type IV OI may be shorter than average and may have brittle teeth
- **bone deformities are mild to moderate**
99
Classic manifestations with OI?
- frequent fractures
- hyperextensible ligament
- **blue sclera**
- early hearing loss
- small and discolored teeth
100
Risk factors for scoliosis?
Age?
- genetic tendency
- **sex: more common in females**
- age: **highest incidence between 8-15 years of age**
101
Assessment for scoliosis?
- asymmetry in scapula, ribs, flanks, shoulders, and hips
- improperly fitting clothing due to one leg shorter than the other
102
What is scoliosis?
- a complex deformity of the spine that also affects the ribs
- characterized by a lateral curvature of the spine and spinal rotation that causes rib asymmetry
- idiopathic or structural scoliosis is the most common forms and can be seen in isolation or associated with other conditions
- bracing involves 23 out of 24 hours
- support in helping adolescent adjust to wearing brace all day long
103
Diabetes Mellitus
- characterized by a partial or complete metabolic deficiency of insulin
- contributing factor for the development of HTN, cardiovascular disease, blindness, stroke, and renal failure as individual's age
- best described to parents as the inability for the pancreas to create the child's own insulin
104
# **
Hypoglycemia s/s
Treatment.?
- sweating/diaphoresis
- lack of coordination and slurred speech
- hunger
- pallor
- tachycardia
- trouble with concentration
- blood glucose less than 70
- **treated with 10-15g simple carb (1 tbsp sugar) : 3-6 oz OJ, 8oz milk, 6 oz regular soft drink**
105
# **
How is hypoglycemia treated?
**treated with 10-15g simple carb (1 tbsp sugar) : 3-6 oz OJ, 8oz milk, 6 oz regular soft drink**
106
# **
Hyperglycemia?
- increased thirst
- increased urination
- increased hunger
- 3Ps: polyuria, polydipsia, polyphagia
- nausea/vomiting
- dry mucous membranes
- poor skin turgor
- confusion
An 8hr fasting blood glucose level of 126 mg/dL or MORE
Random blood glucose of 200 mg/dL or MORE
Oral glucose tolerance test of 200 mg/dL or more in 2-hour sample
107
# **
Patient education with DM
- self-monitored blood glucose (SMBG)
- check controls: accuracy of the strips with the control solution
- keep a record: date, time, blood glucose level, insulin dose, food intake, other events
108
Nursing care with DM
- monitor VS, blood glucose, I&O, weight
- skin integrity
- the child's proficiency at self-monitoring blood glucose and self-administering medication
- poor glucose control: paresthesia, recurrent infections, vision changes
- exercise patterns and dietary changes
- follow agency protocol for nail care
109
Illness management with DM
- rest
- monitor blood glucose and urinary ketones q3h
- dosages may differ, but continue to take antidiabetic agents
- prevent dehydration: encourage noncaffeinated and sugar-free liquids
- meet carbs by eating soft foods
- if unable to eat soft foods, consume liquids that are equal to the usual carb content
110
# **
What is DKA?
- acute, life-threatening
- **hyperglycemia > 300 mg/dL**
- acidosis (pH 7.30 and bicarb 15mmol/L)
- results in breakdown of body fat for energy and an accumulation of ketones from the blood, urine, and lungs
- rapid onset
111
# **
Nursing care for DKA
- if DKA suspected as possibility: **test for ketones**
- cardiac monitor
- venous access
- IVF, electrolytes, insulin
112
Growth hormone (GH) deficiency
(Follow ups and support)
- height and weight are plotted on the growth chart at every HCP visit
- assess and monitor effectiveness of GH replacement
- administer other hormone replacement as prescribed
- return to endocrinology every 3-6 months for evaluation (not a forever medication)
- provide emotional support
- realistic expectations: early detection gives best change of achieving normal adult height
- GHR is often given to help protect against low self-esteem due to short stature
113
Types of Cancer
- organ neoplasms
- blood neoplasms
- bone and soft tissue neoplasms (most pediatric cancers affect the tissues)
114
Caring for a patient on chemo
- the child have a long-term CVAD or PICC in place
- handle chemo agents carefully
- provide antiemetic prior to administration
- allow the child several food choices, including favorite foods
- observe mouth for mucosal ulcerations
- offer cool fluids to prevent dehydration and soothe sore mucous membranes
- receive immunizations and f/u appointments
- nutrition to support digestive changes
- monitor for adverse effects of chemo
115
What adverse effects of chemo should be monitored for?
- mouth sores
- loss of appetite
- nausea and vomiting
- hair loss
- diarrhea or constipation
- increased risk of infection
- easy bruising or bleeding
- fatigue
116
What good infection control practices should be performed for patients on chemo?
- no rectal temps
- good oral hygiene
- avoiding crowds
117
What is important with nutrition to support digestive changes for a patient on chemo?
- increased fiber
- increased protein
- increased whole food grains, vegetables, and fruits
118
Caring for a patient receiving radiation
- wear lead aprons when radiation is used
- educate the child and family about the procedure and provide support
- do not wash off marks on skin that outline the target areas
- wash the marked areas with lukewarm water, use hands instead of washcloth, and pat dry
- avoid using hot or cold water
- avoid use of soaps, creams, lotions, and powders unless they are prescribed
- have the child wear loose cotton clothing
- keep the areas protected from the sun by wearing a hat and long-sleeved shirts
- seek medical care for blisters, weeping, and red/tender skin
119
What is radiation
- radiation is dose-calculated and usually divided treatments over several weeks
- radiation affects rapidly growing cells in the body
- therefore, cells that normally have a fast turnover can be affected in addition to cancer cells
120
# **
Manifestations of impetigo?
- reddish macule becomes vesicular
- erupts easily, leaving moist erosion on skin
- **secretions dry forming honey-colored crusts**
- **contagious: spreads by direct contact peripherally**
- pruritis common
121
Causative organism of impetigo?
staphylococcus
122
Management of impetigo - Topical? Severe cases? Precautions?
- topical: bactericidal or triple antibiotic ointment
- severe cases: oral/parenteral antibiotics
- contact precautions
123
Causative organism of SSSS (Staphylococcal Scalded Skin Syndrome)?
staphylococcus aureus
124
Manifestations of SSSS (Staphylococcal Scalded Skin Syndrome)?
- rough-textured skin, macular erythema
- epidermis: wrinkled within 2 days, large bullae appearing
125
Management of SSSS (Staphylococcal Scalded Skin Syndrome)?
- systemic antibiotics
- Burow's solution or saline
- silver nitrate 0.25%
126
Causative organism of tinea capitis?
- tricophyton tonsurans
- microsporum audouinii
- microsporum canis
127
Manifestations of tinea capitis?
- scaly, circumscribed lesion with alopecia of the scalp
- pruritic
128
Management of tinea capitis?
- selenium sulfide shampoos
- oral: griseofulvin, Kerion-griseofulvin, and oral corticosteroids x 2 weeks
- complicated: oral ketoconazole
- **treat infected pets**, especially cats if necessary
129
Causative organism of tinea corporis?
- trichophyton rubrum
- trichophyton mentagrophytes
- microsporum canis
130
Manifestations of tinea corporis?
- oval or round erythematous scaling patch
- spreads peripherally and unilaterally
- clears centrally
131
Management of tinea corporis?
- oral: griseofulvin
- topical antifungal: tolnaftate, clotrimazole
- sitz bath
- warm compresses
- **treat infected pets**
132
# **
Manifestations of scabies?
Scabies mite
- especially itchy (intensely) at night
- rash: inguinal folds, between fingers, popliteal folds
- **thin, pencil-like marks on the skin**
- infants: widespread, blisters on palms of hands and soles of feet, pimples on trunk
- young children: head, neck, palms, shoulders and soles
- older children: hands, wrists, abdomen, and genitals
133
# **
Nursing interventions of scabies?
- scabicide: entire body 8-14 hours, repeat 1-2 weeks
- treat entire family and close contacts
- wash in hot water
- vacuum
- calamine lotion, cool compresses
- difficult cases: oral ivermectin
134
Manifestations of head lice?
- intense itching
- red, small bumps on the scalp
- nits (white specs): hair shaft
135
Nursing interventions of head lice?
- 1% permethrin shampoo
- remove nits with a nit comb
- repeat 7 days after shampoo treatment
- wash clothing and bedding: hot water and detergent
- sealed, plastic bag x 14 days
- difficult cases: malathion 0.5%
136
# **
What is important to watch with burns?
upper airway swelling
137
# **
Common symptoms of ASD?
sleep disturbances
