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PEDS test 1 Flashcards

1
Q

Trust vs mistrust

A

birth to 1 year

Infants need consistent, loving care by a motherinf person.

mistrust results when their is deficient or lacking of trust in the infants life, or their basic needs are not met.

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2
Q

Autonomy vs shame and doubt

A

1 to 3 years

autonomy - the child is able to control their new physical abilites as well as mental abilities

shame and doubt happens when they are made to feel small, are forced to be dependent in areas they capable of being in control.

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3
Q

initiative vs guilt

A

3 to 6 years

initative, children are able to have their own mind and control their actions with being aware of threats.

If they are bad to feel their actions are bad, they will start to feel a sense of guilt

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4
Q

industry vs inferiority

A

ages 6 to 12

industry- feel the need to work, want to carry activites that they can finish or complete. start to compete and cooperate with others and learn rules.

if too much is expected of them or they feel they cannot measure up they have feelings of inferiority and inadequacy.

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5
Q

identity vs role confusion

A

ages 12 to 18

start to become very concerned with their appearances and discovering their role in life.

if they have trouble discovering their role they end up in role confusion.

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6
Q

Vaccines with live viruses

A

Varicella

influenza (intranasal) - live attenuated

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7
Q

Vaccines given IM (vastus lateralis until 18 months or older, then can be given deltoid as well)

A

DTap, Tdap, hep A, hep B, Hib, IPV, PCV, influenza, MCV4, HPV

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8
Q

c Vaccines given SQ

A

MMR, MMRV, MPSV4, Varicella

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9
Q

when will you know that varicella (chicken pox) is not contagious?

A

When the vesicles have all crusted.

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10
Q

Pertussis ( whooping cough)

A

Resp symptoms seen first

cough until they vomit, usually.

direct or droplet spread, or contact with contaminated objects

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11
Q

nursing care for pertusiss

A

obtain nasopharyngeal culture for diagnosis

encourage oral fluids, offer small amounts frequently/

during paroxysms ensure adequate O2 (put infant on side to decrease risk of aspiration if vomit)

provide humidified O2, suction PRN

observe signs of airways obstruction (increased restlessness, apprehension, retractions, cyanosis)

encourage compliance with AntiBX for household contacts

encourage booster in adolescents

use standard precautions and a mask.

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12
Q

Rota vaccine

A

Rotavirus

first does should be age 6-12wks, shouldnt be given first does after 12wks, should be done with doses at 32 wks, no dose later than 32 wks.

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13
Q

DTap vaccine

A

Diphtheria and tetanus toxoids and acellular pertussis

min age: 6 wks

final does between 4-6 yrs

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14
Q

Hib vaccine

A

haemophilus influenzae type b

min age: 6 wks

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15
Q

PCV

A

pneumococcal vaccine

min age: 6 wks

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16
Q

PPV

A

pneumococcal polysaccharide vaccine

min age: 2 yrs

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17
Q

MMR

A

measles, mumps, rubella vaccine

min age: 12 months

2nd dose usually between 4-6 yrs

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18
Q

MCV4

A

meningcoccal vaccine

min age: 2 years

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19
Q

Nasopharyngitis (common cold)

A

caused by many different viruses (RSV, influenza, rhinovirus)

more severe in infants and young children

fever is common in younger children

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20
Q

nasopharyngitis care

A

rest, fluid, stay home

motrin and tylenol, decongestant if over 6 months, buld syringe

avoid milke products = increase secretions

wash hands !

elevate HOB - helps breathing

premi with underlying cardiac issue or decompensate with RSV- admit to hosp

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21
Q

Acute epigoltitis (type of croup)

A

EMERGENCY - swollen epiglottis cannot rise and allow airway to open

obstructive inflammation (occlusion of trachea)

happens between 2-8

common cause - Hib - get child vaccinated

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22
Q

Acute epiglotitis care

A

DO NOT INSPECT THROAT or do with GREAT caution, complete obstruction can occur, should only be done if intubation can be performed immediately if necessary.

Airway management:

watch for obstruction of epiglottis

have intubation or trach equipment ready

drugs- antibiotics can be used-usually see decrease swelling after 24 hrs, steriods and IV fluids are also used.

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23
Q

Acute laryngotracheobronchitis (LTB)

A

most commone of croup syndromes

usually caused by viral infection

ages 6 mnt - 8 yrs

inflammation of the mucosa lining the larynx and trachea cuase narrowing of airway

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24
Q

LTB s/s

A

s/s usally at night and go away in cold

inspirator stridor and retractions, barking or seal-like couch, tachypnea, hypoxia if unable to inhale enough air, resp acidosis may occur if unable to exhale CO2, may have fever

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25
LTB care
montior resp status - rate, retractions, listen to breath sounds before and after and tx try to keep child calm supplement O2, maintain cool mist hydrate parents can run shower and allow child to breathe warm, moist air high humidity with cool mist can provide relief maybe ne nebulized tx corticosteriods can be used to decreased inflammation
26
Cystic fibrosis
Autosomal recessive trait - one gene from both parents most common diease to affect white children disorder of Resp, GI and exocrine glans
27
most of kids with cystic fibrosis had what as a newborn
meconium ileus
28
most common pathogens responsible form pulmonary infections with cystic fibrosis..
staph and pseudomonas
29
GI problems with CF:
need to replace pancreatic enzymes with all food - sprinkle on food before eating need a well balanced, high protein, high calorie diet give fat soluble vitamins in the water miscible form
30
Assessment with cystic fibrosis
lung sounds, couch, clubbing, frequency and nature of stools, abdmoinal distention, failure to thrive
31
S/s cystic fibrosis
frequent upper resp infections bulky, foul stools that float non productive cough Have thick, viscous, tenasious secretions - use chest physical therapy to help break this up
32
when should chest PT be done on a cystic fibrosis child
NOT before they eat or after, wait 30 mins or so after eat to do it.
33
diagnosis for cystic fibrosis
sweat electrolyte test - simple painless test for chloride stool analysis for enzymes
34
Digoxin ingestion remember..
cardiac issues
35
Varicella is not given until when..
after 1 year
36
IPV can not be given when..
with immunocompromised sibling.
37
social-affective play
infant play - they enjoy interactions with adults - when you smile, coo, or talk to the infant
38
sense-pleasure play
nonsocial stimulation - light, color, tastes, odor, textures and consistencies attract childrens attention, stimulate their senes, and give pleasures. Also handling raw material ( water, sand, food), body motion (swiming, bouncing, rocking) and other sense ablities (smelling, humming)
39
Skill play
after infants develop ability to grasp and manipulate, they demonstrate their ability by repeating and action over and over again.
40
unoccupied behavior play
not playful but focusing attention momentarily on something that stricts their interest.
41
Dramatic or pretend play
begins 11-13 months start to have imaginations act of events of daily living that they see from caregives - using a phone, driving a car, rocking a doll - eventually come more complex as they get older - playing house, police, teacher, nurse.
42
onlooker play
child watches other children play but makes no attempt to join them. ex: watching sibling bounce a ball
43
solitary play
children play with different toys then the toys used by others in same room. enojy the presence of other children but their interest is centered on their own activity.
44
parallel play
usually seen in toddlers play along side other children with similar toys but used in their own way. do not make any attempt to influence each other.
45
associative play
children play together and are engaged in similiar or even identical activites, but no organization, division of labor, leadership, or mutual goal. they borrow and lead play materials, follow each other, sometimes try to say who can and cannot play.
46
cooperative play
organzied, children play in a group. They had a plan and purpose of accomplishing an end- to make something, to attain a competitive goal, to dramatixe situations or adult or group life. requires organization of activities, division of labor, and role playing.
47
What meds need to be double checked..
heparin, insulin, digoxin, opiods, anti-arrythmics, chemo therapy drugs, sedatives (pain)
48
What is it okay to have mom do when giving meds?
Can have mom give the med, as long as you are there to watch, mom is more familiar to the child.
49
Giving Oral meds
in syringe on the cheek dont give if crying blow in face or pinch nose to get them to swallow usually in liquid form- most kids cant swallow pills - crush pills put in small amount of juice, applesauce or jelly. Infant needs to be upright
50
Injections
TB syringe when less then 1 mL need gauge 25 length - 5/8 - 1 in site vastus lateralis 0.5-1 ml in infants up to 2 ml in older children
51
IV medss
IV site needs to be checked every hour, they have little viens that clot off easily.
52
Rectal meds
use when child is vomiting, unconscious, unable to take oral med stay on child until med is in or they will expell it right away
53
eye medications
Child is supine or sitting with head extended, child is asked to look up, one hand pulls lower lid downward, hand hold med lays on childs forhead. solution is put in conjuctiva, never directly on the eyeball. also can from a cup with the lower kid, put med there. infants close eyes tightly - place eyedrop in nasal corner where lid meets, when eye opens med will go into conjuctiva young children - play game - close eyes until you count to 3 then open them and thats when you quickly instill the drops.
54
Ear drops
child is prone or supine and the head is turned so affect ear is up. 3 and younger - gently pull pinna downward and back, 3 and older - pinna pulled up and back. after instilled have lay on unaffected side for a few minutes cotton ball can be used
55
nasal drops
lay child flat with head extended back off bed or pillow, the must remain like this for 1 min after the drops instilled. use footbal hold for infants
56
injuries in infants (0 -12 months)
zero sense of danger Fall down stairs dont usually hurt themselves when fall pick things up and eat them suffocation is most common cause of death can burn easily - use tepid bath water they learn from our behavior
57
injury prevention with infants (0-12mnths)
clothing shouldnt have ties or buttons gates, plug covers, side rails on cribs, corner covers dont use baby powder- could aspirate it - get pneumonia dont leave alone in high-chair, or on changing table toys- plastic, washable, age appropriate, no smalle pieces
58
``` Injury in toddlers (1-3 yr) and preschooler (3-5yr) ```
Toddler are at highest risk for posion - can move quicker, open things easier. not aware of dangers, but can be taught 'NO" They tend to dart into the streets Can drown even in 2 in of water, no afraid of it. can open car doors while driving Odor and taste does not matter, will out anything in mouth.
59
injury prevention in toddler and preschooler
Do not put non-food items in food containers teach them 'NO' older they get the more they can be taught, they learn by what the see adults do.
60
Types of poisons
Cleaning supplies, corhesive substances - do not want them to vomit- burns when comes up, gases-inhale-effects lungs. food posion. lead, cosmetics.
61
TX when ingestion of poison
ABCs first, safe all urine, emesis, and containers and take to ER, to know what was ingested If on skin- flush skin with soap and water. CALL POISON CONTROL
62
injury in School age (6-12yrs)
Motor vehicles accidents, sport injuries, drugs, firearms, walking to school - avoid unsafe areas, ATVs-four wheelers.
63
injury prevention in school age children
teach and enforce safety measures wear helmets, seat belts role model- you have to wear the helmet and seat belt as well
64
Injury of Adolecents (13-18 yrs)
Motor vehicle, cars, AVTs, firearm, sport injuries, drugs, alcohol. they are risk takers need for approval of peers want freedom and independence
65
Prevention of injury in adolescents
enforce safety rules and be consistent use saftey equipment Teach about drug and alcohol abuse keep firearms under lock and key put them in safety classes
66
chemical antedotes for posion
neutralize milk of mag, sodium bi carb, baking soda
67
physiological antedotes
opposite affect of posion narcan
68
physical antedote
protects tissue activated charcoal - (absorbs everything but sianide) - removes posion from skin and stomach.
69
sources of Lead posioning
older cities- lead based paint used in house, peels off and children eat it. can also be inhaled
70
neurological lead posion
non-reversible can loose some IQ, mental retardation possible, paralyiss, blindness can lead to cerebral edema = death
71
renal lead posion
reversible affects proximal tubules
72
hematological lead posion
reversible hgb is decreased - become anemic
73
Treatment for lead posioning
want to get it out the system - mobilize the lead from the blood and soft tiuuse by enhancing deposition in the bones and excretion in the urine by chelation therapy 5-6 IM injections a day, rotate site, until the lead is out of system. Monitor BUN, Cr and I & O during tx
74
Thermal agents - burns
fire, hot water, steam, frost bite
75
chemical burns
cleaners, solvents, alkalies
76
radiation burns
sun, x-ray, radiation for cancer
77
electrical current
burns inside - follows up tendons - difficult to treat
78
Superficial (1st degree) burn
epidermis errythema, heals 5-10, hospitalization not needed scalds, sun burns
79
Partial thickness (2nd degree) burn
epidermis and dermis moist, moddled, redness, blisters (dont pop) - leakage of protein to burn site, will heal in time painful to air intense heat, emersion of hot liquids, contact with hot objects
80
full thickness (3rd degree) burn
entire skin/structure - life threatening, involve all organs black, leathery, no blisters, sometimes pearly white-frost treat with grafts, will not heal on own. no pain 1st 1 -2 days
81
4th degree burn
full thickness that also involves muscles, tendons, ligaments, or bones.
82
If larynx is damaged what will you hear?
stridor
83
Fluid replacement with burns
lots of fluid shifts, 3rd spacing (losing out of vascular beds) decrease urine output, CO decrease by 50% hgb decreased - RBCs are destroyed by heat, hct goes up hypovolemic - loss of plasma retain sodium and water potassium increase - massive cellular distrubtion, caught in extracelluar fluid
84
First thing to check with burn victims
ABCs establish airway - O2 100% remove clothing dont cool down too much treat burn site with sterile dressing
85
Nutrition for burns
Feer a burn child whenever they want to eat give protein - dont want in neg nitrogen ice cream, peanute butter, yogurt, shakes, eggs, meat high calories - butter, fats vitamin A and C - ephitheal cell production zinc- helps with healing dont want to give TPN - has sugars which can cause infection
86
Rehab stage - starting to heal
there will be an increase in urine output, hct decrease - blood diluyes, sodium decrease with water, potassium decreases mobility promotion and prevention of contractors is important
87
Medications for burn children
dont give injections - give meds IV the med sits right under skin until they recover then med gets in system all at once. give morphine sulfate for pain - it can be easily reversed and short acting Dont give ABX profilactic
88
Pulmonary complications of burns
PE, laryngeal edema, stridor, bact pneumonia
89
wound sepsis from burns
temp spikes - 24 hours before drop in bp the next day decrease in urine output TX with lots of fluids
90
CNS complications of burns
hallucinations, LOC changes, seziures and coma due to F&E changes.
91
when to suspect that someone may be getting a contracture.
when they are laying in the same comfortable position a lot.
92
what to remember about the recipient site of a graft..
DONT touch with out an order !
93
commone from of abuse that children under 5 die from?
shaken baby syndrome - brain gets bounced back and forth - get a closed head injury or eye hemorrhage
94
whats a normal stressful event that leads to abuse?
potty training
95
who is usually the abuser?
a male figure (maybe boyfriend) that is left in charge of the children They dont know normal growth and development
96
what to do when you suspect abuse?
Always report call child protective services, even if physcian doesnt agree and take pictures
97
suggestion to parents if cant get child to stop crying
put them in safe place, crib or pack n play, and walk away for a minute, child will eventually cry self to sleep can always walk over to neighbor or call friend to get a break, if you are stressed, the baby can tell and will also be stressed.
98
charcteristics of abused children
seeks material gain- will steal ask many questions when you reach out to them, they will shy away will not give up their parents - they are their support and all they know, will tell same story as parents.
99
How to work with an abused child?
Explain everything you are doing Be consistent with care - same care givers - to gain trust - notice abuse - watch parent/child interaction - so they cant manipulate us Use unbiased, factual charthing let the child vent about their care
100
who is usually the sexual abuser?
someone they know in an authoritive position - coach, priest usually someone in the family knows about it if it is incest
101
Characteristics of sexually abused children
child come homes with material gain complaints of being sick a lot grades will drop torn hymens, vaginas, STDs may grow up to abuse their kids or kill their abuser

Nursing 250- OB/Peds (3 decks)

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