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Peds - NUR 122 > Test 1 > Flashcards

Flashcards in Test 1 Deck (184):
1

What is the nurse's role in health promotion?

Assessments, Emotional support, anticipatory guidance, teaching, child and family advocate, implement prevention strategies, and partner with families.

2

What are the components of Health Promotion/Maintenance visits?

General observations, Physical assessment, growth, development, nutrition, physical activity, oral health, mental health, address parental concerns, and disease and injury prevention strategies.

3

What occurs on the first HPM visit?

establish relationship, explain importance of regular visits, explain what will be done at each visit, and encourage parents to express concerns.

4

What is done at a HPM visit for infants?

measure length, weight, HC
assess developmental milestones
provide anticipatory guidance
support development, promote safety.

5

When does an infants weight double from birth weight?

5 months old

6

When does an infants weight triple from birth weight?

1 year old

7

What is a red flag in weights in infants?

a drop in percentile range for weight

8

What is done at a HPM visit for young children?

weight and height, HC.
BMI starting at 2 years olds
Assess developmental milestones - developmental testing if needed

9

What is percentile of growth is considered consistent growth?

5th-85th percentile

10

What is done at an HPM visit for school age children?

weight, height, BP, BMI
vision, hearing screening
developmental milestones

11

What are some developmental milestones for school age children?

school performance
rides 2-wheeler
jumps rope
can focus on any activity for longer periods

12

What is done at an HMP visit for adolescents?

weight, height, BP, BMI
same growth percentile as childhood
assess- scoliosis, cholesterol, tanner staging, hct for females, sexual activity
teach BSE, TSE

13

What are nutritional considerations with children?

transition from breast milk or formula - 1 year
introduce new foods gradually
avoid choking hazards
limit fruit juices
decreased intake normal for young child
obesity and eating disorders are concerns
teach healthy choices

14

What to remember with physical activity of infants?

needs stimulating environment
activity helps develop muscles
encourage parents to play with infant
opportunities to interact with family

15

What to remember with physical activity of young children?

these age groups normal active
toddlers- further motor development
preschoolers- gain coordination
discourage inactivity, limit "screen time"
need 60 minutes each daily - structured & unstructured
teach benefits of activity

16

What to remember with physical activity of adolescents?

helps develop social skills, self esteem
60 minutes vigorous activity daily
encourage family participation
teach use of safety equipment

17

What is the goal of physical activity in adolescents?

establishment of lifetime exercise routines
maintain healthy weight

18

What to remember with oral health in infants?

nutrition important for teeth
wipe gums with moist gauze 1-2/day
no bottle at bedtime - prevent ECC
2 front teeth at 6 months
teething comfort measures

19

What to remember with oral health in young children?

start oral hygiene habits early
first dentist visit by 1 year old, then Q 6 months
brush twice, floss once a day
assess teeth - 20 by age 2
sugar exposure?

20

What to remember with oral health in adolescents?

lose teeth starting by age 6
continue to brush 2x & floss daily
see dentist Q 6 months
braces need extra care
wisdom teeth evaluation

21

What assess with mental health?

normal growth & development
family relationships, interactions, and communications
self-regulation behaviors & temperament
child's social skills
self-concept/ self esteem

22

What should you teach about mental health of children?

establishing routines and sleep patterns
managing temper tantrums
positive discipline
providing socialization opportunities
increasing independence

23

How to prevent disease in infants?

monitor for infections - provide immunizations, reduce risk of SIDS
screenings for - metabolic & genetic diseases, vision & hearing, anemia, lead poisoning.
discourage parental smoking
goal is to prevent or treat diseases early

24

How to prevent disease in the young child?

immunizations up to date
screenings continue
environmental hazards? smoking, lead exposure, drugs and alcohol
monitor for acute and chronic illnesses

25

How to prevent disease in school age children?

immunizations and screenings continue
personal hygiene practices
child more active in own health
teach how to prevent illness and injury

26

How to prevent disease in adolescents?

screening and follow up
stress, depression, suicide risk, substance abuse

27

What are some teaching topics in adolescents for disease prevention?

risks of smoking, alcohol, drugs
prevention of STDs and pregnancy
BSE, TSE
use of sunscreen
prevention of diabetes and heart disease

28

What are common childhood injuries?

choking hazards: infants, young toddlers
falls
burns
drowning
poisoning
motor vehicle accidents

29

How to prevent injuries in infants?

avoid small toys and choking foods
baby proof house early, gates on stairs
don't place unsecured on high surfaces
temp of bath water and formula, outlet covers
don't leave alone in bath, monitor closely around water
secure medications/harmful chemicals

30

How to prevent injuries in young children?

supervise closely! safe climbing toys
turn pot handles inward, use screen on fireplace
preschool = teach "stop, drop, roll" 911
monitor near H2O, empty buckets, pool covers, and swim lessons
preschool = teach not to go in H2O
child-resistant containers and cabinets
preschool = safety with strangers

31

How to prevent injuries in school age children?

know emergency phone numbers
leave guns alone
stranger safety
protective sporting gear
safety with matches, fire
know how to swim well
safe outside play, bike safety

32

How to prevent injuries in adolescents?

MVC- never text and drive, don't drive tired. use seat belts
Sporting injuries- protective gear, helmets, knee pads
Drowning- buddy system, don't overestimate abilities, use caution with diving

33

What is the primary purposes of HP activities?

prevent disease and injury
detect and treat disease early

34

Why is hospitalization a stressful time for child & family?

disruption of routine and health status
involves many fears and emotions

35

A child's response to hospitalization is related to...

child's developmental age
previous experience
coping skills
seriousness of diagnosis
support people available

36

What are some child responses to hospitalizations?

aggression, regression, nightmares, irritability, bed-wetting, altered sleep

37

What is the general pediatric RN role?

understand development and understand stressors & how child views illness

so we can: use a family-centered approach to care, provide developmentally appropriate care, and reduce the stress of hospitalization of child and family

38

How does an infant understand illness?

no awareness of illness.
sense parent's anxiety.
more traumatic if parent is not present.
if mom is not right, baby can feel and react, causing stress.

39

How do toddlers understand illness?

fear pain and changes to their bodies.
realize change in routine but do not know why.
view pain as punishment.
reduce anxiety with parent around.

40

What is the developmental stage of infants?

trust vs mistrust

41

What is the developmental stage of toddlers?

autonomy

42

How do preschool age children understand illness?

greatest stressors are their fears
rituals/routines sill important
intrusive procedures threatening
use play to explain
be careful how you word things
teach what to expect
make it more like home

43

What is the developmental stage of preschool age children?

initiative

44

How do school age children understand illness?

better understanding of causes of illness
usually very cooperative
still needs parent's support
privacy important
build trust

45

What is the developmental stage of school age children?

industry/inferiority

46

How do adolescents understand illness?

understands complexities of illness
perceives illness as it effects body image
independence and privacy important
may be frustrated with dependence on parents
appearance is important
should be an active participate in care

47

What is the developmental stage of adolescents?

identity/role confusion

48

What are common stressors for hospitalized children?

separation from family
loss of control, autonomy, privacy
painful and/or invasive procedures
fear of bodily injury and disfigurement

49

What can nurses do to reduce fear?

prepare child for procedures
explain on child's level
do procedure quickly
use treatment room
comfort measures during
comfort, praise, reward afterwards

50

What are strategies to promote coping, enhancing hospitalization?

preparation for hospitalization & procedures
rooming in - parent involvement in care
child life programs
therapeutic play

51

Why is play so important?

play is the work of children.
it is absolutely essential for growth and development
during the acute phase of illness, children don't usually wan to play

52

What are the functions of therapeutic play?

helps child feel more secure in strange environment
provides a means of accomplishing therapeutic goals
allows expression of feelings

53

What are some opportunities for therapeutic play?

incorporate play into care
allow time just for play
age-appropriate toys
consult child life specialists

54

How can nurses reduce stress of hospitalization?

family centered care
developmentally appropriate care

55

What are some issues with medicating children?

increased number and more unusual side effects
less able to tolerate adverse effects
many drugs not yet approved for pediatric use
communication issues

56

What is the difference in pharmacokinetics related to?

muscle mass
% body fat
% body water
liver and renal function
permeability of skin

57

What increases the risk of med error in children?

no standard dose
wide range of weights
dosage calculations more complex
misplaced decimal = possible OD -> death
measurement of liquid meds

58

How are pediatric meds dosed?

by weight
by age
body surface area

59

How are pediatric doses calculated?

mg/kg/dose
mg/kg/day

60

Why are children under medicated?

complexities of pain assessments in children.
misconceptions about pain in children

61

What are some truths about pain in infants?

nerve pathways intake by 20 weeks gestation
have behavioral and physiologic cues indicating pain
newborns and premature infants may have greater sensitivity

62

What is the requirements for using self-report pain assessment tools?

needs to be conscious and verbal
must understand concept of more/less
must understand concept of larger/smaller
must understand numbers/language skills

63

What age can the FACES pain rating scale be used?

age 3 and up

64

What age can the oucher scale be used?

ages 3 and up

65

What age can the poker chip tool be used?

ages 4 and up

66

What age can the numeric scale be used?

5 and older

67

What age can the word graphic rating scale be used?

school aged child - must read

68

When can self report pain scales not work?

<3 years old
preverbal
uncooperative child
unresponsive child

69

What are behavioral indicators of pain?

facial grimacing, irritability, posturing, restlessness or agitation, lethargy or withdrawal, sleep disturbances, and short attention span.

70

What are the nurse report pain scale used for nonverbal children?

neonatal infant pain scale (NIPS)
FLACC

71

When is the Neonatal infant pain scale used?

28 days of life, used longer in the NICU

72

When is the FLACC pain scale used?

children 2 months to 7 years.
can be modified to use in children with intellectual disability

73

What does the CRIES pain scale use?

combine physiologic and behavioral cues to assess pain

74

What is an at risk newborn?

one who is susceptible to illness or even death because of dysmaturity, immaturity, physical disorders, or complications during or after birth.

75

What puts a newborn at risk?

SGA/IUGR
LGA or IDM
Pre-term
post-term
pregnancy or birth complications
exposure to drugs, toxins, infections
congenital abnormalities

76

What are common NICU diagnoses?

prematurity
respiratory distress (RDS, TTN, apnea, MAS)
infections
hypoglycemia (SGA, LGA, IDM, preterm)
drug withdrawal (NAS)
seizures
IUGR

77

What are common concerns with preterm infants?

immature systems put infant at risk for numerous problems.

78

What happens during a newborns first breath?

fills lungs with air, gets fluid out

79

What is the respiratory rate of an infant?

30-60 breathes per minute

80

What is normal breathing for infants?

periodic breathing
obligatory nose breathers
apnea less than 20 seconds is normal

81

What is the cause of respiratory distress syndrome?

low-level or absence of surfactant - common in preemies

82

What are signs and symptoms of respiratory distress syndrome?

nasal flaring, retractions, grunting, tachypnea, cyanosis, apnea = causes severe distress, preventing exchange of o2 and co2, leading to hypoxia, respiratory acidosis, metabolic acidosis

83

What is the treatment for respiratory distress syndrome?

prevent if possible
surfactant replacement - survanta, exosurf, curosurf
support oxygenation and ventilation- oxyhood, nasal CPAP, ventilator
UAC for ABG monitoring
correct acid base abnormalities
supportive care

84

What are complications of RDS?

respiratory failure, bronchopulmonary dysplasia (BPD), Patent Ductus arteriosus (PDA), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH)

85

What is Apnea of Prematurity (AOP)?

no breath for 20 seconds, common in preemies

86

What is the nursing care for Apnea of Prematurity?

monitor closely. document all A and B events. gentle stimulation. blowby or bag oxygen if needed.
methylxanthine meds help prevent apnea

87

What is transient tachypnea (TTN)?

> 60 breathes per minute.
usually around 80.
seen in C-section babies

88

What is the cause of transient tachypnea?

slow absorption of lung fluid or excess fluid in lungs

89

What is the signs and symptoms of transient tachypnea?

grunting, nasal flaring, mild retractions, mild cyanosis, tachypnea

90

What is the treatment for transient tachypnea?

oxygen, possible IVFs, time, NPO if RR >60

91

Who is more likely to experience transient tachypnea?

c/s infants, large infants, and babies born to diabetic mothers

92

What is the general respiratory nursing care?

monitor respiratory status frequently
cardiac/resp and O2 sat monitors
O2 therapy - warmed and humidified
chest PT and suction
monitor blood gases
monitor UAC, IVs

93

What is the major concern of thermoregulation?

heat loss

94

What is heat loss in preemies related to?

greater body surface area to weight
thinner skin
reduced subcutaneous fat
extended posture
decreased vasoconstriction

95

What is the effects of hypothermia (cold stress)?

pulmonary vasoconstriction
increase O2 demand
leads to hypoglycemia
metabolic acidosis can result in death

96

What is the best prevention for hypothermia?

keep baby warm

97

What is importance of a neutral thermal environment?

minimizes energy expenditure
minimizes O2 consumption
facilitates growth

98

What are the hepatic/hematologic concerns with preemies?

immature liver:
hypoglycemia, low iron stores, elevated bilirubin levels

99

What is the cardiac problems with preemies?

ductus arteriosus may remain open = PDA

100

What is the normal heart rate of a newborn?

120-180 bpm

101

What is the normal resting/sleeping heart rate of a newborn?

100-120 bpm

102

What is the blood volume of an infant?

80-100 mL/kg

103

What is hypoglycemia of a newborn?

<40-45

104

What are symptoms of hypoglycemia?

jitteriness - full term
lethargy - pre term
poor feeding
hypothermia

105

What are some concerns with the renal system in preemies?

risk for fluid overload
risk for dehydration
risk for metabolic acidosis
reduced ability to excrete drugs

106

What are some GI concerns with preemies?

higher caloric need
numerous feeding issues
can't break down protiens
calcium & phosphorus deficiency

107

What are some feeding issues with preemies?

small stomach, coordinating suck, swallow, breathe, and GERD.

108

What is a GI complication of preemies?

necrotizing enterocolitis

109

What are feeding methods of the high risk neonate?

TPN
gavage feedings - OG or NG
nipple or breast

110

What is necrotizing enterocolitis?

inflammatory bowel disease.
potentially life threatening
can deteriorate rapidly

111

What is necrotizing enterocolitis related to?

ischemia & inflammation - hypoxic event
bacterial colonization
enteral feedings
immature GI mucosa - premature gut

112

What are some assessment findings of necrotizing enterocolitis?

abdominal distention
residuals/vomiting
instability of temp, BP, and apnea
xray = air in bowel wall

113

What is the treatment for Necrotizing enterocolitis?

NPO, IVFs, TPN.
N to decompress stomach
antibiotics
supportive care
possible surgery

114

What is the concerns with the immunologic system of a preemie?

increased risk of infection related to decreased immunity, increase in invasive procedures, and thin skin surface.

115

How do you prevent infection in a preemie?

handwashing, careful assessment, prophylactic antibiotics. strict asepsis with IVs, oxygen tubing changed frequently. isolettes and warmers changed frequently. use of scrubs, gowns, & gloves.

116

What are some concerns with the neuro/sensory of a preemie?

Intracranial hemorrhage, intraventricular hemorrhage. hydrocephalus. ROP. CP or LD.

117

What is Retinopathy of prematurity related to?

use of oxygen & prematurity

118

What is a complication of retinopathy of prematurity?

retinal detachment & blindness

119

What is the treatment of ROP?

cryotherapy or laser treatment.
scleral buckling for detachment.

120

What is the priority assessment needs of high risk neonates?

respirations, circulation, control of body temp, nutrition/fluids, prevent infection, family support, and developmental care/teaching

121

What are common NICU medications?

antibiotics - prophylactic
Caffeine- for AOP
Surfactant- for RDS, reduces surface tension
steroids- to get off ventilator
sedation- pain relief
volume expanders- albumin & packed RBCs, decrease BP
inotropic drugs - dopamine & dobutamine, increase contractibility of heart to maintain BP

122

What are the principles of nursing care for high risk neonates?

decrease physiologic stressors
increase growth and development
constant observation for subtle changes
interpretation of lab data & coordinating interventions
conserve infant's energy
provide developmental stimulation & sleep cycles
assist family in attachment behaviors
support and teach families

123

What are examples of communicable diseases?

whooping cough - pertussis
measles - rubeola
chicken pox - varicella
mumps - parotitis
fifths disease - erythema infectiosum

124

What to remember about live injected vaccines?

if not give together, should be separated by atleast 4 weeks.

125

What are some reactions to vaccines?

local - pain, swelling, redness at injection site
systemic - fever, irritability, malaise, HA, rash, anorexia
allergic or severe - can be life-threatening, anaphylaxis, seizures, paralysis

126

What is the role of the nurse in immunizations?

encourage vaccination.
screen patients to identify contraindications.
identify vaccines indicated.
education - VIS and consent signed
administer vaccines
treat and report adverse reactions to VAERS
follow up

127

What is assessed in the screening for immunizations?

serious medical condition. problems with immune system. allergies to food or meds. reactions after previous vaccines. steroids, chemo, radiation in last 3 months. close contacts with immune deficiency. blood products in last year. pregnancy.

128

What are contraindications of immunizations?

acute illness with HIGH fever 103 <
hx of hypersensitivity reaction to that particular vaccine or components.
MMR & Varicella vaccines - immunoglobulin treatment in last 3-11 months, immunodeficiency, or pregnancy

129

When is it safe to immunize?

mild to moderate illness
disease exposure
antibiotic therapy
breast feeding
premature birth
most allergies
family history of vaccine reaction

130

What is included in parent education on vaccines?

recommendations for vaccines, possible side effects, contraindications, management of reactions, and when to call 911.

131

When do you call 911 after vaccines?

facial or throat swelling, respiratory symptoms, child unresponsive.

132

What to remember when administering vaccines?

restrain safely.
25% sucrose water and pacifier for infants
pressure at site 10 second before injection
EMLA or vapocoolant spray
offer distraction
two nurses at same time, over quickly
older child can choose which arm or leg
comfort and praise afterwards

133

When is HepB vaccine done?

birth,
1-2 months
6-18 months

134

When is the Rotavirus vaccine done?

2 months
4 months
6 months

135

When is the DTaP vaccine done?

2 months
4months
6 months
15-18 months
4-6 years

136

When is the Hib vaccine given?

2 months
4 months
6 months
12-15 months

137

When is the pneumococcal vaccine given?

2 months
4 months
6 months
12-15 months

138

When is the polio vaccine given?

2 months
4months
6-18 months
4-6 years

139

When is the influenza vaccine given?

6 months +
yearly

140

When is the MMR vaccine given?

12-15 months
4-6 years

141

When is the varicella vaccine given?

12-15 months
4-6 years

142

When is the HepA vaccine given?

12-24 months

143

How do you document vaccines?

dose, route, site.
vaccine, manufacturer, lot #, expiration
name & address of provider; name & title of nurse
record for clinic & parent

144

What is some general nursing care common to all infections?

prevent spread of infection
rash care
manage fever
provide comfort, encourage rest
assess for and manage symptoms
encourage fluids
diversional activities.

145

What is included in rash care?

prevent scratching
oral antihistamines
aveeno baths (oatmeal)
caladryl lotion (calimine)
change linens frequently
keep fingernails clean & short

146

What is the most common symptom of infection in children?

fever

147

What is the definition of fever?

body temp over 101.4

148

What is the benefit of fever?

low grade, body fighting infection

149

How do you treat a fever?

antipyretics - acetaminophen or ibuprofen, NOT NSAIDs
remove unnecessary clothing
encourage increased PO fluid intake - offer favorites, small amounts frequently

150

When do febrile seizures occur?

in infants & young children
due to rapid rise in temperature
brief
do not recur with the same illness

151

What happens if you give aspirin to a child with a viral infection?

reyes syndrome

152

How is varicella (chicken pox) spread?

airborne or direct contact with lesions

153

When is varicella contagious?

1-2 days before rash until all lesions are crusted over

154

What symptoms are associated with varicella?

acute onset, mild fever, malaise, anorexia, HA, mild abdominal pain, and skin rash

155

What are some complications of varicella?

secondary infection, thrombocytopenia, reyes syndrome.

156

What are some characteristics of varicella rash?

rash begins on truck, scalp, face
macule -> papule -> vesicle -> crust over
1-5 days of eruption = itchy
lesions at all stages
oral lesions affect PO intake
crusts can last 1-3 weeks

157

What is the nursing care of varicella?

airborne and contact precautions
rash care
change linens frequently
acyclovir for immunocompromised
vaccination
immunoglobin for exposed NB & unimmunized children

158

How is fifth disease spread?

respiratory secretions & blood

159

When is fifth disease contagious?

week before symptoms

160

When is fifth disease no longer contagious?

once rash appears

161

What are the symptoms of fifth disease?

2-3 days = mild symptoms, HA, fever, malaise
then 1-7 days no S&S
then slapped face appearance
1-4 days later = lace-like symmetric erythematous, maculopapular rash on trunk and limbs
1-3 weeks rash fades

162

What are complications of fifth disease?

patients with hemolytic conditions (SCA) can have transient crisis

163

What is the nursing care of fifth disease?

standard and droplet precautions
oatmeal/aveeno baths for pruritus
protect from sunlight

164

How is measles (rubeola) spread?

direct contact w/droplet or airborne

165

When is measles contagious?

4 days pre rash to 4 days after rash appears

166

What are symptoms of measles?

prodrome: anorexia, malaise.
koplik's spots appear in mouth. high fever, conjunctivitis, coryza, cough, rash

167

What characteristics of measles?

maculopapular rash 4-7 days after prodrome
starts on face, spreads to trunk and extremities.
symptoms gradually subside in 4-7 days

168

What are complications of measles?

diarrhea, OM, pneumonia, bronchitis, LTB, encephalitis, death.

169

What is the nursing care for measles?

airborne precautions
careful respiratory assessment
cool mist vaporizer
suction gently
photophobia- dim lights, shades
skin care- clean and dry, no soaps

170

What is mumps (parotitis)?

inflammation of parotid gland

171

How is mumps spread?

contact with or inhalation of respiratory droplets

172

When is mumps contagious?

up to 7 days before swelling until 9 days after

173

What are some signs and symptoms of mumps?

malaise, fever, & parotid gland swelling
earache, HA, pain w/chewing, decreased appetite, and activity.

174

What are complications of mumps?

orchitis in post pubertal males
viral meningitis
stiff neck, photophobia, HA

175

What is the nursing care for mumps?

standard and droplet precautions
soft & blended foods - avoid foods that increase salivary flow
warm or cool compresses to parotid area
assess for meningeal irritation
scrotal support if testicular swelling

176

How is pertussis (whooping cough) spread?

respiratory droplet & contact with secretions

177

When is pertussis contagious?

1 week after exposure until 5 days into antibiotic treatment
most contagious before paroxysmal cough

178

What are the complications of pertussis?

pneumonia, atelectasis, OM, encephalopathy, seizures, death.

179

What are the stages of pertussis?

catarrhal stage 0-2 weeks
paroxysmal stage 1-6 weeks
convalescent stage 6-10 weeks

180

What are the symptoms of the catarrhal stage of pertussis?

runny nose, low grade fever, mild nonproductive cough

181

What are the symptoms of the paroxysmal stage of pertussis?

whooping cough, more severe at night

182

What are the symptoms of the convalescent stage of pertussis?

coughing spells gradually subside

183

What is the treatment of pertussis?

macrolide antibiotics - erythromycin, azithromycin
corticosteroids prn
treat close contacts

184

What is the nursing care for pertussis?

droplet precautions until antibiotics for 5 days
cardiac monitor and pulse ox
observe coughing spells - O2 prn
crash cart?
humidification, gentle suctioning prn
reduce crying
teach parents s/s of respiratory failure and dehydration