Week 2 Content Flashcards
1
Q
IM injections for kids 3 years+ location
A
deltoid
2
Q
Preschooler Growth
- More _______ posture
- Each year gains about ___ lbs
- Each year gains about ___ inches in height
A
- More slender posture
- Each year gains about 5 lbs
- Each year gains about 2.5 inches in height
3
Q
Preschoolers SOCIAL/Cognitive progession
Learns ______ and shapes
Learns ________ identity
A
Learns colors and shapes
Learns sexual identity
4
Q
Preschoolers: Physical: LEARN
Learns to ____ jump skip and hop
Rides a ________ -3yr
Can use ________ 4yr
A
Learns to run jump skip and hop
Rides a tricycle -3yr
Can use scissors 4yr
5
Q
3-6 y.o safety
- _______ safety
- Helmets
- _______ safety
- ________ safety
- Appropriate ____ Seat
- Nutrition
- _______ Times
A
- Traffic safety
- Helmets
- Water safety
- Stranger safety
- Appropriate Car Seat
- Nutrition
- Screen Times
6
Q
Preschooler DEVELOPMENT (theories)
SOCIAL - Erikson’s __________________
COGNITIVE - Piaget’s - _______________
A
SOCIAL - Erikson’s Initiative Vs Guilt
COGNITIVE - Piaget’s - Still pre-operational
7
Q
Erikson—SOCIAL- Initiative vs Guilt
Example: Small successes with performance for example “when playing games” builds confidence and supports initiative to __________________ - When a child fails due to inappropriate expectations leads to _____ and loss of initiative
A
Example: Small successes with performance for example “when playing games” builds confidence and supports initiative to try new activities- When a child fails due to inappropriate expectations leads to guilt and loss of initiative
8
Q
Piaget—Cognitive- Preoperational Thought (last 2-7 years)
Varying development during preschool years.
Pretends, ___________ is developing
Separation from Parents during Hospitalization
huge _______ during this stage.
A
Varying development during preschool years.
Pretends, Imagination is developing
Separation from Parents during Hospitalization
huge FEARS during this stage.
9
Q
Preschooler : CARE ISSUES
Very ___________ : Thinks they cause their own illnesses by being bad
Thinks painful procedures are ___________
Fear of mutilation: BANDAIDES ARE GOOD
A
Very egocentric: Thinks they cause their own illnesses by being bad
Thinks painful procedures are punishment
Fear of mutilation: BANDAIDES ARE GOOD
10
Q
Preschooler - ______________ is beneficial- for example show IV procedure using a doll .
Also helps for them to handle medical equipment
A
Medical play is beneficial- for example show IV procedure using a doll .
Also helps for them to handle medical equipment
11
Q
Preschool age - pain tool
_________________
A
Wong Baker Faces
12
Q
Well Preschooler visits:
Goal - pick up _______ _______: Interventions EARLY
A
Goal - pick up delays early: Interventions EARLY
13
Q
Instructions for Use of FACES Pain Tool
Explain to the child that each face represents a person who has no pain (hurt), or some, or a lot of pain.
“Face 0 doesn’t hurt at all. Face 2 hurts just a little
bit. Face 4 hurts a little bit more” and so on.
A
Explain to the child that each face represents a person who has no pain (hurt), or some, or a lot of pain.
“Face 0 doesn’t hurt at all. Face 2 hurts just a little
bit. Face 4 hurts a little bit more” and so on.
14
Q
Preschooler and Pain
- ___________ can be a useful tool at this age- books, music, IPAD… for painful procedures
- May ______ pain if they fear a shot
A
- Distraction can be a useful tool at this age- books, music, IPAD… for painful procedures
- May deny pain if they fear a shot
15
Q
Pain - Children as young as ___ years of age are able to report the location and degree of pain
A
3
16
Q
Remember that Chronic Pain such as Sickle Cell Pain
does not always present with _______________________________________
A
physiologic responses such as ↑RR and HR.
17
Q
Leukemia - Cancer of the :
A
Blood and Bone Marrow
18
Q
__________ - Among children (ages 0 to 14 years), the most common types of cancer
A
Leukemia
19
Q
Leukemia is the Most __________ ___________ _________
A
Common Childhood Cancer
20
Q
Leukemia: 4 Major Types- all have proliferation of immature WBCs
Type of Leukemia based mainly on whether:
*the leukemia is _______ or ________
*where the leukemia starts in ____________ or _____________
A
Type of Leukemia based mainly on whether:
*the leukemia is acute or chronic
*where the leukemia starts in myeloid cells or lymphoid cells.
21
Q
Leukemia : 4 Major Types
- __________________ This is the most common type of leukemia in young children. (most commonly dx 2-5 years of age)
- ___________________ is the most common acute type of leukemia in adults
- Chronic lymphocytic leukemia (CLL)
- Chronic myelogenous leukemia (CML)
A
- Acute lymphocytic leukemia (ALL). This is the most common type of leukemia in young children. (most commonly dx 2-5 years of age)
- Acute myeloid leukemia (AML) is the most common acute type of leukemia in adults
- Chronic lymphocytic leukemia (CLL)
- Chronic myelogenous leukemia (CML)
22
Q
Blood Cell Types: effected by Leukemia
Platelets: Also known as Thrombocytes
Platelets play a major role in ____________.
Low platelet count is ________________.
A
Platelets play a major role in blood clotting.
Low platelet count is THROMBOCYTOPENIA
23
Q
Untreated Leukemia
* White blood cells never reach maturity and have no ability to fight infection
* The ___________ of white blood cells will invade (basically clog up) the liver , kidney and spleen and cause multi _______ _________
* Spleen over reacts removing good red blood cells and platelets
A
- White blood cells never reach maturity and have no ability to fight infection
- The proliferation of white blood cells will invade (basically clog up) the liver , kidney and spleen and cause multi organ failure
- Spleen over reacts removing good red blood cells and platelets
24
Q
Lifespan of a platelet is ________
A
5-7 days
25
Blood cell types: effected by Leukemia
* RBC’s are responsible for _____________ _____________________. (lifespan is about 120 days)
oxygenation of bodily tissues
26
Blood cell types: effected by Leukemia
* WBC’s responsible for __________ ________:
* Neutrophils – (lifespan is 6-8 hrs)
* Monocytes- (lifespan is 8 hrs.)
* Eosinophils-mount the __________ response- (lifespan is 5-24 hrs
* WBC’s that make antibodies
* Lymphocytes – B and T cells (lifespan 1 week to a few months)
* Monocytes –kill and eats micro organisms and also boost immune system (lifespan 1-5 days)
* WBC’s responsible for fighting infection:
* Neutrophils – (lifespan is 6-8 hrs)
* Monocytes- (lifespan is 8 hrs.)
* Eosinophils-mount the allergic response- (lifespan is 5-24 hrs
* WBC’s that make antibodies
* Lymphocytes – B and T cells (lifespan 1 week to a few months)
* Monocytes –kill and eats micro organisms and also boost immune system (lifespan 1-5 days)
27
CBC : Patient with ALL
Patients present with signs of bone marrow failure
________- Pallor, weakness, persistent fatigue lethargy
______________ – bruising, petechial and bleeding
__________-fever and infection
Bone and joint pain
↑Liver and lymph nodes
Bone Marrow Aspirate will 80-90% immature Blasts (normal is 5%)
Anemia- Pallor, weakness, persistent fatigue lethargy
Thrombocytopenia – bruising, petechial and bleeding
Neutropenia-fever and infection
Bone and joint pain
↑Liver and lymph nodes
Bone Marrow Aspirate will 80-90% immature Blasts (normal is 5%)
28
______ _________ __________
*Will diagnose the type of Leukemia
*Once type of Leukemia is determined specific treatment can begin.
Bone Marrow Aspirate
29
Chemo and Radiation effects:
* The Hematopoietic system –bone marrow ___________
* The Gastrointestinal and the integumentary system
Both are composed of rapidly dividing cells. Therefore they are susceptible to the ________ effects of chemo and radiation.
* The Hematopoietic system –bone marrow suppression
* The Gastrointestinal and the integumentary system
Both are composed of rapidly dividing cells. Therefore they are susceptible to the cytotoxic effects of chemo and radiation.
30
The provider tells you to take a rectal temp on Bethany, because he wants the most accurate data possible. Your response is:
a) As you wish.
b) It could get messy; I really rather not.
c) She is too old for rectal temps.
d) It’s contraindicated for a patient in Bethany’s condition.
d) It’s contraindicated for a patient in Bethany’s condition.
31
SEVERE Neutropenia is defined as an absolute neutrophil count (ANC) < ____
500
32
Worse-case scenario from F&N
* _______ shock
* ____________ medicine.
* Septic shock
* Resuscitation medicine.
32
__________ Puncture - if meningitis is suspected
Lumbar
33
Thrombocytopenia
* ___________ suppression also results in decreased platelet count.
* Normal platlet count ___________________
* Bone marrow suppression also results in decreased platelet count.
* Normal platlet count 150,000-450,000 (150k-450k)
34
Mucositis (GI)
* ______ that have developed in the oral mucosa.
* Occurs in pts who have had _______ or radiation.
* Cell __________ occurs consequent to chemo and
radiation--initiates inflammatory response.
* Mucosa is vulnerable to trauma, ulceration and
infection.
* Sores that have developed in the oral mucosa.
* Occurs in pts who have had chemo or radiation.
* Cell destruction occurs consequent to chemo and
radiation--initiates inflammatory response.
* Mucosa is vulnerable to trauma, ulceration and
infection.
35
diarrhea treatment...
* Avoid ____ foods, and those high in ______ (osmotic).
* Avoid fatty foods, and those high in sugar (osmotic).
36
SICKLE CELL ANEMIA
AUTOSOMAL _____________ INHERITED DISEASE
RECESSIVE
37
______ AFRICAN AMERICANS CARRY THE SCD TRAIT
1 IN 13
38
SICKLE CELL ANEMIA
HEMOGLOBIN ___ REPLACES NORMAL HEMOGLOBIN
* HEMOGLOBIN S IS VULNERABLE- LIFESPAN <___ DAYS- CHRONIC ANEMIA
* ↑__________ OCCURS
-DEHYDRATION
-COLD WEATHER (CAUSES VASOCONSTRICTION)
-STRESS
HEMOGLOBIN S REPLACES NORMAL HEMOGLOBIN
* HEMOGLOBIN S IS VULNERABLE- LIFESPAN <40 DAYS- CHRONIC ANEMIA
* ↑SICKLING OCCURS
-DEHYDRATION
-COLD WEATHER (CAUSES VASOCONSTRICTION)
-STRESS
39
VASA OCCLUSIVE CRISIS
SICKLING RBCS ___________ AND _________
* BONE INFARCTS
* NECROSIS OF FEMORAL HEAD
* ISCHEMIC STROKE
* ACUTE CHEST SYNDROME
* PULMONARY HYPERTENSION
* PRIAPISM
SICKLING RBCS CLUMP UP AND OBSTRUCT
* BONE INFARCTS
* NECROSIS OF FEMORAL HEAD
* ISCHEMIC STROKE
* ACUTE CHEST SYNDROME
* PULMONARY HYPERTENSION
* PRIAPISM
39
SCD - PAIN CRISIS
* _______ 10/10 PAIN
* ABDOMEN
* THORACIC
* MUSCLE
* BONE
SEVERE
40
____________
* A MYELOSUPPRESSIVE AGENT; THE ONLY EFFECTIVE DRUG PROVEN TO REDUCE FREQUENCY OF PAINFUL EPISODES. (SCD)
* IT RAISES THE LEVEL OF NORMAL HEMOGLOBIN F AND THE HEMOGLOBIN LEVEL. IT USUALLY DECREASES THE RATE OF PAINFUL EPISODES BY 50 %.
HYDROXYUREA
41
IRON DEFICIENCY ANEMIA
DUE TO _________________, CHILDREN NEED MORE IRON THAN ADULTS
RAPID GROWTH
42
IRON HELPS RBCS _______ __________
CARRY HEMOGLOBIN
43
IRON DEFICIENCY ANEMIA
SERUM _____________ LEVELS ARE LOW
HEMOGLOBIN
44
IRON DEFICIENCY ANEMIA CAUSES:
INADEQUATE FETAL _______
LIMITED _________ INTAKE
CHRONIC _______ LOSS
POOR ____________ BY THE BODY- (CELIAC’S, CRONE’S, ULCERATIVE COLITIS)
INADEQUATE FETAL STORES
LIMITED DIETARY INTAKE
CHRONIC BLOOD LOSS
POOR UTILIZATION BY THE BODY- (CELIAC’S, CRONE’S, ULCERATIVE COLITIS)
45
MOST COMMON AGES - IRON DEFICIENCY ANEMIA
* AGE 12-36 MONTHS OLD
* ADOLESCENT FEMALES
* AGE 12-36 MONTHS OLD
* ADOLESCENT FEMALES
46
CBC with Iron Deficiency Anemia
↓ Low ________
↓ Low mean corpuscular volume (MCV)
↓ Low mean corpuscular hemoglobin concentration (MCHC)
↑ Elevated platelet count (>450,000/μL) in many cases.
↓ Low Hemoglobin
↓ Low mean corpuscular volume (MCV)
↓ Low mean corpuscular hemoglobin concentration (MCHC)
↑ Elevated platelet count (>450,000/μL) in many cases.
47
COW’S MILK AND IRON DEFICIENCY ANEMIA
* AT ABOUT ___ MONTHS MOST INFANTS CAN CHANGE FROM FORMULA TO WHOLE MILK
* COW’S MILK INTERFERES WITH IRON ABSORPTION
* IRON SUPPLEMENTS SHOULD NOT BE GIVEN WITH COW’S MILK
* LIMIT COW’S MILK INTAKE TO 24-32 OZ PER DAY
12
48
Otitis Media
* Infection of ______________
* Common illness, highest incidence 6 months to 2 years
* Accumulation of pus and mucus behind _________, blocking eustachian tubes causing pain, swelling
* Decreased risk of otitis media with pneumococcal and influenza vaccinations, breast feeding and
avoiding tobacco smoke
* Infection of the middle ear
* Common illness, highest incidence 6 months to 2 years
* Accumulation of pus and mucus behind eardrum, blocking eustachian tubes causing pain, swelling
* Decreased risk of otitis media with pneumococcal and influenza vaccinations, breast feeding and
avoiding tobacco smoke
49
Otitis Media
Risk ________ ______ if chronic/persistent condition untreated
hearing loss
50
Tonsillitis
* Tonsils ________ from viral or bacterial infections
* Sore throat can interfere with breathing, nasal and sinus drainage, sleeping, swallowing, speaking and hearing.
* _________ treatment necessary if related to
streptococcal infection (strep throat) can lead to rheumatic heart disease and glomerulonephritis
* Refer all children with sore throats for throat _________ to prevent complications from step infection
* Tonsils inflamed from viral or bacterial infections
* Sore throat can interfere with breathing, nasal and sinus drainage, sleeping, swallowing, speaking and hearing.
* Antibiotic treatment necessary if related to
streptococcal infection (strep throat) can lead to rheumatic heart disease and glomerulonephritis
* Refer all children with sore throats for throat cultures to prevent complications from step infection
51
Chronically enlarged tonsils can cause upper airway obstruction that leads to ____________
sleep apnea
52
___________ for multiple recurrent infections as well as sleep apnea
Tonsillectomy
53
Laryngotracheobronchitis (croup)
* A _____ infection that leads to swelling of the throat
viral
54
Epiglottitis - Severe life-threatening __________ _________ of the epiglottis
* Progresses rapidly, causing acute upper airway ____________
Severe life-threatening bacterial infection of the epiglottis
* Progresses rapidly, causing acute upper airway obstruction
55
Epiglottitis
Do not examine throat (no tongue blade or any object in throat) because of risk of :
obstructing the airway completely
56
_________ : Prevented by DTaP- Violent “Staccato” Coughing
* Whooping Cough
* Highly Contagious
* Bacterium Bordetella Pertussis
* Droplet Isolation
* Still around most likely due to waning immunity in adults
* Deadly risk for newborn too young for immunization
Pertussis
57
Bronchiolitis
Prolonged ___________ _______ of respiration
expiratory phase
58
___________ ________ is the largest cause of Cardiac Arrest in children
Respiratory Arrest
59
Pneumonias
* Localized Infection of _______ Immune response causes ____________
Alveoli become filled with fluid/mucous
* Results in _________ of alveoli
* The more alveoli effected the worse the symptoms.
* Causes:
Bacterial/Viral
Fungal
Aspiration
* Localized Infection of alveoli Immune response causes inflammation
Alveoli become filled with fluid/mucous
* Results in collapse of alveoli
* The more alveoli effected the worse the symptoms.
* Causes:
Bacterial/Viral
Fungal
Aspiration
60
Asthma - ___________ Inflammatory and reactive airway disease that is commonly chronic
Leading cause of disease related school __________
A combination of genetic and environmental factors
Diagnosis based on pattern of symptoms and response to treatment
Generalized Inflammatory and reactive airway disease that is commonly chronic
Leading cause of disease related school absenteeism
A combination of genetic and environmental factors
Diagnosis based on pattern of symptoms and response to treatment
61
ASTHMA: Nursing Assessment
Breath sounds:
Early ___________ wheezing;
Inspiratory wheezing occurs with __________ condition-
_______ of Breath sounds is ominous
Early EXPIRATORY wheezing;
Inspiratory wheezing occurs with worsening condition- Loss of Breath sounds is ominous
62
Cystic Fibrosis (CF) - Autosomal-recessive disease causes dysfunction of the __________ glands
* Tenacious ________ production obstructs vital structures
Multiple problems from the exocrine dysfunction
* Lung insufficiency (most critical problem)
* Pancreatic insufficiency
* Increased loss of sodium and chloride in sweat
Cystic Fibrosis (CF) - Autosomal-recessive disease causes dysfunction of the exocrine glands
* Tenacious mucus production obstructs vital structures
Multiple problems from the exocrine dysfunction
* Lung insufficiency (most critical problem)
* Pancreatic insufficiency
* Increased loss of sodium and chloride in sweat
63
Immunizations at 4-6 years
DTaP
IPV
Influenza yearly
MMR
Varicella
64
Wong baker is used
to assess preschool age kids for pain
[faces scale]
65
Fever in immunosuppressed kid -
> 38 celcius (axillary)
66
Differences in kids
* Diameter of airways ________
* Distance between structures is ________, allowing organisms to rapidly move down
* Short more horizontal Eustachian tubes
* Diameter of airways smaller
* Distance between structures is shorter, allowing organisms to rapidly move down
* Short more horizontal Eustachian tubes
67
Babies and young children will use their __________ muscles much more than adults in order to pull the diaphragm down for breathing.
* After about 3 years the rib orientation changes to more of a lateral insertion – breathing becomes more efficient .
* Because of the importance of the abdominal and other muscles used to breathe, babies can become _________ quickly.
Babies and young children will use their abdominal muscles much more than adults in order to pull the diaphragm down for breathing.
* After about 3 years the rib orientation changes to more of a lateral insertion – breathing becomes more efficient .
* Because of the importance of the abdominal and other muscles used to breathe, babies can become fatigued quickly.
68
SIGNS OF RESPIRATORY DYSFUNCTION
* Irritability /Agitation
* Nasal Flaring
* Tachypnea
* Increased Belly Breathing
* Use of accessory muscles (retractions)
* Inability to lie down
* Irritability /Agitation
* Nasal Flaring
* Tachypnea
* Increased Belly Breathing
* Use of accessory muscles (retractions)
* Inability to lie down
69
Wheezing
heard on ___________ due to bronchial obstruction, with extreme disease will also include inspiration- _______ airway sound
heard on expiration due to bronchial obstruction, with extreme disease will also include inspiration- lower airway sound
70
Rales/Crackles - Heard on __________ suggests ______ in alveoli- lower airway sound
Rales/Crackles - Heard on inspiration suggests fluid in alveoli- lower airway sound
71
Stridor - heard on inspiration; _______ airway sound
upper
72
Grunting (young infants)
an expiratory sound caused by sudden closure of the glottis during expiration in an attempt to maintain FRC and prevent alveolar atelectasis. BAD sign-infant close to ________
arrest
73
MOST COMMON CONGENITAL CAUSE OF RESPIRATORY DYSFUNCTION - Congenital _____________ Hernia
Diaphragmatic
74
STANDARD INTERVENTIONS [respiratory]
* Patient _________
* Oropharyngeal suction
* Nasopharyngeal suction
* __________ – Blow By or Nasal Canula
* Non invasive positive pressure (High Flow Nasal Canula, CPAP BiPapp
* Invasive Positive Pressure (Intubation)
* Patient position
* Oropharyngeal suction
* Nasopharyngeal suction
* Oxygen – Blow By or Nasal Canula
* Non invasive positive pressure (High Flow Nasal Canula, CPAP BiPapp
* Invasive Positive Pressure (Intubation)
75
Decreased risk of otitis media with
pneumococcal and influenza ____________
_______ feeding
avoiding ________________
pneumococcal and influenza vaccinations
breast feeding
avoiding tobacco smoke
76
After tonsillectomy, monitor for:
postoperative bleeding
77
Croup has classical symptoms of
barking cough
inspiratory tridor
77
If you are wheezing only on one side, probable cause is
aspiration of foreign body
78
What isolation is Pertussis?
droplet
79
Bronchiolitis isolation precautions
Droplet and contact
80
Bronchiolotis nursing care -
Suction airway secretions
81
Asthma is ___________
generalized
82
Pneumonias are __________
localized
82
Thrombocytopenia – __________, petechial and _________
bruising, petechial and bleeding
83
Normal platlet count :
150,000-450,000 (150k-450k)
84
________ is a serotonin antagonist and most often given for N/V
Zofran
85
PO ________ is usually more effective and less expensive vs IV
Zofran
86
Give antiemetics ____ mins prior to chemo
30
87
Hydroxyurea is used to treat
sickle cell
88
Iron supplement S/E
N/V
Constipation
Diarrhea possible
89
Take iron supplement with _______ for better absorption
vitamin C
90
An infant until around 6 months, usually breathe through
their nose
91
A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was bad. The nurses best interpretation of this comment is that it is:
A sign of stress.
Common at this age.
Suggestive of maladaptation.
Suggestive of excessive discipline at home
B. Common at this age.
Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of thisage show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.
92
During the preschool period, the emphasis of injury prevention should be placed on:
Constant vigilance and protection.
Punishment for unsafe behaviors.
Education for safety and potential hazards.
Limitation of physical activities
C. Education for safety and potential hazards.
Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate
93
A 4-year-old child tells the nurse that she does not want another blood sample drawn because I need all my insides, and I don’t want anyone taking them out. Which is the nurses best interpretation of this?
Child is being overly dramatic.
Child has a disturbed body image.
Preschoolers have poorly defined body boundaries.
Preschoolers normally have a good understanding of their bodies
C. Preschoolers have poorly defined body boundaries.
Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.
94
Imaginary playmates are beneficial to the preschool child because they:
Take the place of social interactions.
Take the place of pets and other toys.
Become friends in times of loneliness.
Accomplish what the child has already successfully accomplished.
C. Become friends in times of loneliness.
One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interactions but may encourage conversation. Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what has already been accomplished.
95
Which type of croup is always considered a medical emergency?
Laryngitis
Spasmodic croup
Epiglottitis
Laryngotracheobronchitis (LTB)
C. Epiglottitis
Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory infection symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.
96
A school-age child has had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of:
Bronchitis.
Viral-induced asthma.
Bronchiolitis.
Acute spasmodic laryngitis.
Bronchitis.
Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years.
97
A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests:
Asthma
Bronchiolitis
Pneumonia
Foreign body in the trachea.
Asthma
Children with asthma usually have these chronic symptoms. Pneumonia appears with an acute onset and fever and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea will manifest with acute respiratory distress or failure and maybe stridor.
98
In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind?
Diet should be high in carbohydrates and protein
Diet should be high in easily digested carbohydrates and fats
Most fruits and vegetables are not well tolerated
Fats and proteins must be greatly curtailed
Diet should be high in carbohydrates and protein
Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.
99
The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup?
Wheezing is heard audibly.
It is bacterial in nature.
It has a harsh, barky cough.
The child has a high fever.
It has a harsh, barky cough.
Spasmodic croup is viral in origin, is usually preceded by several days of symptoms of upper respiratory tract infection, and often begins at night. It is marked by a harsh, metallic, barky cough; sore throat; inspiratory stridor; and hoarseness. Wheezing is not a distinguishing manifestation of croup. It can accompany conditions such as asthma or bronchiolitis. A high fever is not usually present.
100
Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system?
They have a widened, shorter airway
There is a defect in their sucking ability
The gag reflex increases mucus production
Mucus and edema obstruct small airways
Mucus and edema obstruct small airways
The airway in infants and young children is narrower, not wider, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways. Sucking is not necessarily related to problems with the airway. The gag reflex is necessary to prevent aspiration. It does not produce mucus.
101
A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient?
Antibiotic administration
Bone marrow transplant
Chemotherapy
Liver transplant
Chemotherapy
The most common type of childhood cancer is acute lymphocytic leukemia (ALL). First-line treatment forALL is inducing remission with chemotherapy. Antibiotics are not used unless the child has an infection. Bone marrow transplant may be considered later in the child’s course of care. A liver transplant would not be a treatment for ALL.
102
A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse tell the family to help maintain a safe environment for the child?
Do not let the child have chewing gum
Flowers, plants, and produce are not allowed
The child can only have one visitor at a time
Toys and items from home cannot be brought in
B. Flowers, plants, and produce are not allowed
The neutropenic child should not have fresh flowers, plants, fruits, or vegetables because they can harbor infectious microorganisms. The other instructions are not needed.
103
The parents of a child with cancer ask the nurse why the child is losing weight even though he is eating what he normally does. Which response by the nurse is the most appropriate?
Cancer consumes body tissues, causing weight loss.
He may be going through a growth spurt right now.
How do you know he is eating like he normally does?
When you are sick, you need more nutrition than usual.
When you are sick, you need more nutrition than usual.
The demands of illness lead to increased nutritional needs. A child with cancer needs increased nutrition.Cancer does not consume body tissues. The child may be going through a growth spurt, but this is not always the case and is not the best answer. Asking the parents how they know the child’s eating habits have changed may put them on the defensive.
104
A nurse works on the pediatric oncology floor. After receiving the handoff report, which child does the nurse assess first?
Child on protective isolation
4 hours post bone marrow biopsy
Not eating an hour after chemotherapy
Temperature of 101.5F (38.5C)
Temperature of 101.5F (38.5C)
This fever indicates a probable infection. The nurse will see this child first and provide report to the physician, if this has not already been done. This child is the sickest and should be seen first; one might be tempted to see the child in protective isolation first to avoid cross-contamination, but by following isolation precautions, this risk is minimized. Not eating after chemotherapy is not cause for concern, and the child 4 hours post bone marrow biopsy should be stable.
105
An accurate description of anemia is:
Increased blood viscosity.
Depressed hematopoietic system.
Presence of abnormal hemoglobin.
Decreased oxygen-carrying capacity of blood.
Decreased oxygen-carrying capacity of blood.
Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition depends on the deceased oxygen-carrying capacity of the blood
106
Which statement best explains why iron deficiency anemia is common during toddlerhood?
Milk is a poor source of iron.
Iron cannot be stored during fetal development.
Fetal iron stores are depleted by age 1 month.
Dietary iron cannot be started until age 12 months.
Milk is a poor source of iron.
Children between the ages of 12 and 36 months are at risk for anemia because cow’s milk is a major component of their diet, and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.
107
The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should she or he suggest?
Iron (ferrous sulfate) drops after age 1 month.
Iron-fortified commercial formula can be used by ages 4 to 6 months.
Iron-fortified infant cereal can be introduced at age 2 months.
Iron-fortified infant cereal can be introduced at approximately 6 months of age
Iron-fortified infant cereal can be introduced at approximately 6 months of age.
Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated. Introducing iron-fortified infant cereal at 2 months should be done only if the mother is choosing to discontinue breastfeeding.
108
A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is:
Aplastic anemia.
Thalassemia major.
Sickle cell anemia.
Iron deficiency anemia
Sickle cell anemia.
Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for coagulation. Iron deficiency anemia affects size and depth of color of hemoglobin and does not involve abnormal hemoglobin.
109
Although _____ , croup can lead to resp. acidosis, failure, and death
rare
110
Epiglottitis- make sure to AVOID
scaring/agitating Pt as airway can become completely obstructed
111
Onset of Croup VS Epiglottitis
Croup- gradual onset
Epiglottitis- rapid onset
112
Croup VS Epiglottitis cough
Croup- barking cough
Epiglottitis- NO cough
113
Pertussis- _______ effects upper and lower airways
toxins
114
______________
* Inflammation of the bronchioles characterized by thick clear secretions can lead to upper and lower airway obstruction
Bronchiolitis
115
_________- Number 1 cause of hospitalization in infants < 12 months
Bronchiolitis
116
70% of bronchiolitis in children cased by :
respiratory syncytial virus (RSV)- common cold virus
117
Pathologic Process of Asthma
* Airways become ________
inflamed
118
ASTHMA
* Is a _________ (increase CO2) problem
Becomes an oxygenation problem (decrease 02) with severe asthma
ventilation
119
_______ should be used with inhaler
spacer [allows for medication to disperse & go down into lungs]
120
Cystic Fibrosis (CF) Sx
_____________ (excessive fat, greasy stools)
* Foul-smelling bulky stools
Steatorrhea
121
Kids with CF should take _______ enzymes
pancreatic
122
the replacement rate (how fast you give ) blood is determined by __________________________
how fast the blood is lost.
123
the replacement rate (how fast you give ) blood is determined by how fast the blood is lost.
An acute hemorrhage or blood loss will be replaced ________ (rate ordered by MD or provider)
Chronic Blood loss is slow. The blood needs to be replaced slowly. This is ordered and is usually 2-4 hours. (NO longer than 4 hours due to risk of infection)
Blood replaced too quickly in this situation could put the peds patient at risk for heart failure.
quickly
124
Chronic Blood loss is slow. The blood needs to be replaced _________. This is ordered and is usually 2-4 hours. (NO longer than ___ hours due to risk of infection)
Blood replaced too quickly in this situation could put the peds patient at risk for heart failure.
slowly
125
Chronic Blood loss is slow. The blood needs to be replaced slowly. This is ordered and is usually 2-4 hours. (NO longer than 4 hours due to risk of infection)
Blood replaced too quickly in this situation could put the peds patient at risk for _______________
heart failure
126
Preschooler Growth:
More slender posture
Each year gains about ___ lbs
Each year gains about 2.5 inches in height
Need a ton of sleep ~ _____
More slender posture
Each year gains about 5 lbs
Each year gains about 2.5 inches in height
Need a ton of sleep ~12hrs
127
IM injections for kids > 3 years: __________ ; Max: 1mL
DELTOID
128
4 – 6 y/o vaccine mnemonic:
“I don’t inject my vaccine”
I - IPV
Don’t - Dtap
Inject - Influenza
My - MMR
Vaccine - Varicella
129
Anticipatory guidance for parent of a preschooler
TRAFFIC SAFETY
HELMETS
WATER SAFETY
STRANGER SAFETY
APPROPRIATE CAR SEAT
NUTRITION: 1800 calories/day
SCREEN TIMES
130
Developmental Theories
Erikson vs Piaget
Erikson-SOCIAL - INITIATIVE VS GUILT
Piaget- COGNITIVE - PREOPERATIONAL THOUGHT (LAST 2-7 YEARS)
131
Children as young as ___ years of age are able to report the location and degree of pain
3
132
Remember! ________ Pain such as Sickle Cell Pain does not always present with physiologic responses such as ↑RR and HR.
Chronic
133
preschool resp. rate
18-30
22-34?
134
Rule of thumb: Respiratory Rate > ______ in infants should be NPO and placed on Maintenance IV fluids
Goal is to be NPO if BiPAP or Intubation is indicated - *Big risk of aspiration with these procedures – better to be NPO!
60-70
135
Interventions for ________________ - Regardless of Cause!
Patient position
Oropharyngeal suction
Nasopharyngeal suction
Oxygen – usually nasal cannula is most tolerated
Non-invasive positive pressure: High Flow Nasal Cannula (Infant: Nasal CPAP; older children: BiPAP)
Intubation
More specific:
Antibiotics
Bronchodilators
Racemic Epinephrine
Steroids
Diuretics
Chest Tube
Respiratory Distress
136
Nasopharyngitis (common cold) URI: Upper Resp
Acquired from close contact with an infected individual
Primary prevention = __________________
HAND WASHING!!
137
Treatment of Croup
minimize _______
_________ oxygen
_______ – reduce inflammation
Nebulized racemic epinephrine – vasoconstrictor, reduce capillary blood flow
Treatment is effective if: decrease in RR & stridor, less evident retractions
If response is poor – admit to ICU for observation
Consider BiPAP
If intubation required, select a tube that is smaller than normal for pt’s age
*Constantly reassess for respiratory failure!
minimize stress
blow-by oxygen
steroids – reduce inflammation
Nebulized racemic epinephrine – vasoconstrictor, reduce capillary blood flow
Treatment is effective if: decrease in RR & stridor, less evident retractions
If response is poor – admit to ICU for observation
Consider BiPAP
If intubation required, select a tube that is smaller than normal for pt’s age
*Constantly reassess for respiratory failure!
138
Epiglottitis: Upper Resp
Severe life-threatening bacterial infection of the epiglottis. Serious and communicable (droplet + standard precautions).
Progresses rapidly, causing acute upper airway ___________.
Signs & Symptoms: tachypnea, respiratory distress, increase _____ & _____, drooling, ______ throat, high ______
Most common cause historically: Haemophilus influenzae type B (Hib); less common due to Streptococcus pneumoniae (is rarely caused by other organisms)
Vaccines: Hib and PCV = epiglottitis incidences have decreased
Severe life-threatening bacterial infection of the epiglottis. Serious and communicable (droplet + standard precautions).
Progresses rapidly, causing acute upper airway obstruction.
Signs & Symptoms: tachypnea, respiratory distress, increase RR & HR, drooling, sore throat, high fever
Most common cause historically: Haemophilus influenzae type B (Hib); less common due to Streptococcus pneumoniae (is rarely caused by other organisms)
Vaccines: Hib and PCV = epiglottitis incidences have decreased
139
Epiglottitis: Upper Resp
Nursing Interventions: MEDICAL EMERGENCY
_______ oxygen. No IV, No BP, No Temp (Axillary/Lympanic)
DO NOT examine throat with tongue blade or any object because of risk of obstructing the airway completely
Maintain child in _________ position with parent
Prepare for possible tracheostomy (is there a kit in the room?) and/or prepare to transfer to OR for intubation
Administer IV __________ after intubation
Swelling usually will decrease in 24hrs and after 24hrs on antibx epiglottitis d/t Hib will no longer be communicable
Blow by oxygen. No IV, No BP, No Temp (Axillary/Lympanic)
DO NOT examine throat with tongue blade or any object because of risk of obstructing the airway completely
Maintain child in upright position with parent
Prepare for possible tracheostomy (is there a kit in the room?) and/or prepare to transfer to OR for intubation
Administer IV antibiotics after intubation
Swelling usually will decrease in 24hrs and after 24hrs on antibx epiglottitis d/t Hib will no longer be communicable
140
Cause of LTB (Croup) VS Epiglottitis
LTB (Croup): viral
Epiglottitis: bacterial
141
With ________ there is drooling
epiglottitis
142
majority of bronchiolitis is caused by a virus known as _____
RSV
143
Bronchiolitis (RSV): Lower Resp
cough, runny nose (lots of _______ secretions), sneezing, sore throat, eye/ear infection with _________, usually preceded by a _______ & s/s of URTI
tachypnea, tachycardia, adventitious breath sounds, __________
cough, runny nose (lots of nasal secretions), sneezing, sore throat, eye/ear infection with drainage, usually preceded by a fever & s/s of URTI
tachypnea, tachycardia, adventitious breath sounds, retractions
144
RSV SIGNS AND SYMPTOMS
145
Pathologic Process of Asthma:
Airway becomes _______
Bronchial smooth _________ (narrow)
Air trapping occurs in the _________ – difficult to ventilate (exhaleCO2)
Airway becomes inflamed
Bronchial smooth constrict (narrow)
Air trapping occurs in the alveoli – difficult to ventilate (exhaleCO2)
146
Asthma is a ventilation problem (increase in _____) – becomes an oxygenation problem with severe asthma
Prolonged expiratory phase due to attempt to exhale CO2
Asthma is a ventilation problem (increase in CO2) – becomes an oxygenation problem with severe asthma
Prolonged expiratory phase due to attempt to exhale CO2
147
Asthma: Lower Resp- Include teaching for home:
Know _________ – viral infections, exercise, dust mites, smoke, cockroaches, grasses, pollen, pets, mold, etc.
Reduce exposure to triggers
Remove _______
Stop indoor _________
Know triggers – viral infections, exercise, dust mites, smoke, cockroaches, grasses, pollen, pets, mold, etc.
Reduce exposure to triggers
Remove carpets
Stop indoor smoking
148
Asthma Education:
Use of peak expiratory flow meter:
1) Take a breath, 2) Close lips around device, 3) Blow out as hard & fast as possible
Teach importance of Control Medications
Use of MDI metered-dose bronchodilator inhaler for _______ – dose NOT prevent asthma
Use a “_______” for children
Hold MDI upright, shake inhaler, exhale slowly, press inhaler, breathe in slowly (3-5 seconds), hold breath for 10 seconds, exhale slowly, rinse mouth out with water afterwards to avoid fungal infection
Use _________ first and then corticosteroid
Use of peak expiratory flow meter:
1) Take a breath, 2) Close lips around device, 3) Blow out as hard & fast as possible
Teach importance of Control Medications
Use of MDI metered-dose bronchodilator inhaler for rescue – dose NOT prevent asthma
Use a “spacer” for children
Hold MDI upright, shake inhaler, exhale slowly, press inhaler, breathe in slowly (3-5 seconds), hold breath for 10 seconds, exhale slowly, rinse mouth out with water afterwards to avoid fungal infection
Use bronchodilator first and then corticosteroid
149
Cystic Fibrosis: Lower Resp
Autosomal-recessive disease causes dysfunction of the ___________ glands
Tenacious mucus production ___________ vital structures
Cystic Fibrosis: Lower Resp
Autosomal-recessive disease causes dysfunction of the exocrine glands
Tenacious mucus production obstructs vital structures
150
Cystic Fibrosis - Skin that taste _______ – sweat chloride test most reliable diagnostic test
salty
151
What is ANC?
Absolute Neutrophil Count
152
SEVERE Neutropenia is when ANC < _____
500
153
FEVER + NEUTROPENIA= _________ NEUTROPENIA
FEBRILE
154
fever and neutropenia Worst case scenario
Patient gets ______________
_____________________ is needed
Patient gets septic shock
Resuscitation medicine is needed
155
Sickle Cell Anemia
Inherited ____________ __________ disorder of hemoglobin resulting in sickled hemoglobin, chronic hemolytic anemia and ischemic tissue injury
While sickle cell disease is more common in African-Americans, it can affect people of any race or ethnicity.
autosomal, recessive
156
*1 in ___ African Americans carry the SCD trait
*1 in ___ African Americans have SCD
*1 in 13 African Americans carry the SCD trait
*1 in 365 African Americans have SCD
157
SCD Pathophysiology
Partial or complete replacement of normal Hgb with abnormal HgbS causes red blood cells to ______
*Clinical features: ___________ by sickled RBCs, vascular inflammation, increased RBC destruction.
*Abnormal adhesion of RBCs results in blocked microcirculation, hypoxia and organ failure
*HgbS has a less than normal life span (less than 40 days) which leads to chronic sickling
*Tissue __________ causes widespread pathologic changes in spleen, liver, bones and CNS
*Dehydration, cold weather (d/t vasoconstriction), stress promotes sickling
*Crisis often precipitated by infection
Partial or complete replacement of normal Hgb with abnormal HgbS causes red blood cells to sickle
*Clinical features: obstruction by sickled RBCs, vascular inflammation, increased RBC destruction.
*Abnormal adhesion of RBCs results in blocked microcirculation, hypoxia and organ failure
*HgbS has a less than normal life span (less than 40 days) which leads to chronic sickling
*Tissue ischemia causes widespread pathologic changes in spleen, liver, bones and CNS
*Dehydration, cold weather (d/t vasoconstriction), stress promotes sickling
*Crisis often precipitated by infection
158
Breast Fed Baby > 6 months Supplement with ______
IRON
159
Formula Fed BABY Starting at Birth _____ _________ Formula
iron Fortified
160
________ very important in the treatment of sickle cell disease, promotes hemodilution and circulation of red cells through the blood vessels
Hydration
161
Vaso Occlusion Crisis (SCC) nursing care
hydration
analgesics
blood transfusion
Hydroxyurea
162
Hydroxyurea [SCC]
Myelosuppresive agent: only effective drug proven to reduce freq of painful episodes
_______ the level of normal hemoglobin F and the overall hemoglobin level
Usually decreases rate of painful episodes by _____
Also used to tx chronic myeloid Leukemia
Myelosuppresive agent: only effective drug proven to reduce freq of painful episodes
Raises the level of normal hemoglobin F and the overall hemoglobin level
Usually decreases rate of painful episodes by 50%
Also used to tx chronic myeloid Leukemia
163
Thrombocytopenia occurs when platelet levels are low, leading to impaired blood ________ and increased ________ risk. Causes include decreased platelet production (e.g., bone marrow disorders), increased destruction (e.g., autoimmune conditions), or platelet sequestration in the spleen.
Thrombocytopenia occurs when platelet levels are low, leading to impaired blood clotting and increased bleeding risk. Causes include decreased platelet production (e.g., bone marrow disorders), increased destruction (e.g., autoimmune conditions), or platelet sequestration in the spleen.
164
Nursing care [Thrombocytopenia] focuses on preventing bleeding, monitoring for signs of __________ (like bruising or blood in urine/stool), and administering _______ transfusions if needed. Patients should be educated on bleeding _________, such as using soft toothbrushes and avoiding activities that could cause injury.
Nursing care [Thrombocytopenia] focuses on preventing bleeding, monitoring for signs of bleeding (like bruising or blood in urine/stool), and administering platelet transfusions if needed. Patients should be educated on bleeding precautions, such as using soft toothbrushes and avoiding activities that could cause injury.
165
Anemia Sx
* PALLOR
* PALE LIPS AND MUCOUS MEMBRANES
* FATIGUE
* INCREASE HEART RATE
