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COD N2 Unit II

COD N2 Pediatrics

Question	Answer
Infant: Nursing Implications	Encourage parental presence (all ages), adhere to infants home schedule, Utilize topical anesthetics or pre-procedural sedation, quiet environment
Infant: Stressors	Separation anxiety, Stranger anxiety, painful, invasive procedures, immobilization, sleep deprivation, sensory overload
Infant:Responses	sleep wake cycle disrupted, feeding routines disrupted, displays excessive irritability
Toddler: Nursing Implications	Encourage Parent presence, allow parents to hold child as much as possible, allow choices when possible, explain procedure in simple terms
Toddler: Stressors	Separation anxiety, loss of self control, immobilization, painful invasive procedures, bodily damage of mutilation, FEAR OF THE DARK
Toddler: Responses	Cries if parent leaves the bedside, is frightened if forces to lay supine, wonders why parents don’t come to their rescue, associates pain with punishment
Preschoolers: Nursing Implications	Encourage parental presence, allow choices when possible, utilize topical anesthetics, EXPLAIN ALL PROCEDURES AND PROVIDE A NIGHT LIGHT
Preschoolers: Stressors	separation anxiety & fear of abandonment, loss of self-control, bodily injury or mutilation, painful invasive procedures, fear of the dark and MONSTERS
Preschoolers: Responses	Displays difficulty separating reality from fantasy, fears monsters & ghosts, fears body parts will break when skin is not intact, demonstrates withdrawal aggression projection and regression
school-age child Nursing Implications	Enc. Parent participation, allow choices when poss. explain all procedures and offer reassurance, utilize proper sedation, encourage peer interaction via internet phone call ect.
The only safe and effective way to administer an analgesic	1. Calculate a safe does 2. Administer it 3. monitor the patients response to the medication
What is the Wong-Baker pain rating scale	FACES
what is the pain scale for patients that are unresponsive	The FLACC Scale
What does FLACC stand for	F: Face L: Legs A: activity C:cry C: consolability
How often show you re-assess after pain medication is administered IM or IV	30 min
How often show you re-assess after pain medication is administered PO	One hour
Children’s behavior that may indicate pain	Restlessness, Agitation
Poker chip tool:	Four poker chips are used. One chip represents a little hurt and four chips is the most hurt your child could experience.
Oucher scale	A vertical numerical scale from 1 to 10 for children who can count. With a picture of different ethnicities according to the patient. patient must have concept of numbers. 0= no hurt, 10= severe hurt.
Why is scheduling important in pain management	Better to medicate around the clock than PRN when pain is already severe
Co-Analgesics include	NSAIDS Tricyclic antidepressants: Amitriptyline: Desipramine Anticonvulsants: Neurontin,Lyrica, Klonopin, Tegretol Corticosteroids Local Anesthetics Anxiolytic drugs
What age are PCA pumps used	as young as 3 yrs, but not usually until 6 yrs
Children may see pain as a form of	punishment
Behaviors indicating pain	Restlessness hyper alertness difficult to distract irritability facial grimacing posturing anorexia lethargy sleep disturbances depression aggression
What word can you use besides "poke" when giving a child an injection.. you may feel a_______	a slight Pinch or pressure
Always encourage __________ to stay with the child	Family
When assessing a child perform ____ and ____ assessments last	painful and invasive
An infant older than ____ months is afraid of strangers	after 6 months
Which age group is hardest to assess	toddler 1-3 yo, can't sit still, put on a parent's lap and start with feet (toe to head)
what kind of questions would you ask the family to get a medical history of patient	open ended questions
To help make the child comfortable with assessment, let them play with ____	equipment
When assessing a child don't offer a ____ if there is not one and enlist ____ help	don't offer a choice and enlist parents help
Check for turgor on ____	ABD
Posterior fontanel closes at ____ where the anterior should close ____	between 2 & 3 months, 12 & 18 months
The fontanels on the head should be ____	flat
what makes a Childs heart rate rapid (until late school age)	cardiac output is rate dependent not stroke volume dependent
until 12-18 months of age kidneys:	do not concentrate urine effectively and do not exert optimal control over electrolyte secretion and absorption
What would you do if an infant in your care had a HR of 130?	Nothing it is normal
How do you check an infant’s HR?	Apical... emergency brachial, femoral
if a child has vasoconstriction the concern is	dehydration
Sign of central cyanosis is a sign of:	Late ominous sign, or if they have no Hx of Cardiac it could be a sign of eminent cardiac arrest.
what is Munchausen by proxy	When a person inflicts something on a child or exaggerates or fabricates illnesses or symptoms usually primary caretaker. A individual — usually a mother — deliberately makes another person sick or convinces others
what is nuchal rigidity	Stiffness in the nape of the neck, often accompanied by pain and spasm on attempts to move the head; the most common sign of meningitis.
Until the age of 4-5 what is the primary breathing muscle?	Diaphragm
Effects of hospitalization on an Infant: Nursing Implications	Encourage parental presence (all ages), adhere to infants home schedule, Utilize topical anesthetics or pre-procedural sedation, quiet environment
Effects of hospitalization on an Infant: Stressors	Separation anxiety, Stranger anxiety, painful, invasive procedures, immobilization, sleep deprivation, sensory overload
Effects of hospitalization Infant: Responses	sleep wake cycle disrupted, feeding routines disrupted, displays excessive irritability
Effects of hospitalization Toddler: Nursing Implications	Encourage Parent presence, allow parents to hold child as much as possible, allow choices when possible, explain procedure in simple terms
Effects of hospitalization Toddler: Stressors	Separation anxiety, loss of self control, immobilization, painful invasive procedures, bodily damage of mutilation, FEAR OF THE DARK
Effects of hospitalization Toddler: Responses	Cries if parent leaves the bedside, is frightened if forces to lay supine, wonders why parents don’t come to their rescue, associates pain with punishment
where can you go to see the current updates for immunizations	www.cdc.gov/vaccines
when do we hold immunizations?	allergies, reactions, Given blood, immunoglobulin, vaccines (past 4 weeks), Steroids, chemo-therapy, HIV, SZ, CA
A mother asks the nurse what caused her infant’s respiratory infection. The nurse explains that the organism that is the most common cause of lower respiratory tract infections in infants and young children	Pneumonia
a mother states that her child has had to use an albuterol inhaler at least once a day for the past week and a half, and has been awakened by coughing at night at least 2 times this week. W an appropriate priority nursing diagnosis for this child would be	Impaired gas exchange due to bronchial constriction
When teaching the mother about the positive outcomes of caccinations, the nurse explains that widespread vaccinations against Haemophilus influenza type b has lead to the decrease tenfold in the incidence of	Epiglottitis
An infant is diagnosed with apnea of prematurity. The best explanation to give parent would be that apnea of prematurity	It is pathologic with no definable cause that affects infants younger than 37 weeks gestational age
In the child with cystic fibrosis, the finding that would indicate an inadequate dosing of pancreatic enzymes would be	Stools have become frothy, greasy and foul smelling
Name strategies for communicating with an infant:	Hold them for feedings Hold, Rock, and talk to them talk and sing during care Tell names of objects use high pitched voice with newborns when infant is upset swaddle and hold securely
how do new borns communicate?	Coos, babbles & cries
An Infant believes that his parents will feed him.	Trust vs. Mistrust
Sense of Initiative versus Guilt	Preschooler: Age 3 to 6
A 10 Year old boy proudly displays his principal's award	Industry vs. Inferiority
13 y.o. girl fights with her mother about appropriate dress.	Identity vs. Role Confusion
A 2 year old boy expresses interest in dressing himself.	Autonomy vs. Shame and Doubt
A 15 year old boy worries about how his classmates treat him.	Identity vs. Role Confusion
Sense of Industry vs. Inferiority	School Aged : Age 6 to 12
Sense of Identity vs. Role Confusion	Adolescent: Age 12 to 20
Sense of Trust vs Mistrust	Infant : Birth to age 1 year
A Kindergarten student learns the ABC's.	Initiative vs.Guilt
Physical growth: birth-1 month	Gains 140-200g(5-7oz) a wk grows 1.5cm (1/2in)in first month head circumfrence increases 1.5cm/month
Physical growth: 2-4 months	Gains: 140-200g (5-7oz) / wk Grows 1.5cm (1/2in) /mth Head circumference increases 1.5cm (1/2in)/mth Posterior fontanelle closes Eats 120mL/kg/24hr (2oz/lb/24hr)
Physical growth:4-6 months	Gains: 140-200g (5-7oz) / wk Doubles birth weight 5-6 mths Grows 1.5cm (1/2in) /mth Head circumference increases 1.5cm (1/2in)/mth Teeth may begin erupting by 6 mths Eats 100mL/kg/24hr (1 1/2oz/lb/24hr)
Physical growth: 6-8 months	Gains: 85-140g (3-5oz) / wk Grows 1cm (3/8in) /mth Growth rate slower than first 6 months
Physical growth: 8-10 months	Gains: 85-140g (3-5oz) / wk Grows 1cm (3/8in) /mth
Physical growth: 10-12 months	Gains: 85-140g (3-5oz) / wk Grows 1cm (3/8in) /mth Head circumference equals chest circumference Triples birth weight by one year
a 8 month old infant is sitting on the floor, grasping blocks and banging them on the floor. He is engaging in ________ play	solitary
By the age of 2 yrs old, the birth weight has __________ and the child is _________ of the adult height	quadrupled, half
adverse reaction to vaccinations	Anaphylaxis, Hives, lethargy, tachycardia, itching–Can happen minutes to hours after administration
you need ___________ before vaccination and ___________ after.	Consent, doccumentation
What is proximodistal development	refers to the development of motor skills from the center of the body outwards.
What is cephalocaudal development	Head is large and lifts it first. It is also the trend of infants learning to use their upper limbs before their lower limbs
What is Associative Play	Child may interact with one another
What is Reyes Syndrome	It is a deadly disease,ncan attack any child, teen, or adult without warning. All body organs are affected, with the liver and brain suffering most seriously. Unk cause and no cure,linked to use of Asprin children <16 most at risk
How is breast milk stored in the hospital?	plastic bottles, can be stored for 24hrs, NO Glass it destroys antibodies
This is how much the nurse will put in the buretrol	enough for 2 hours + 10mL
what is the IV infusion rate if the IV infusion pump rate if running at 25 ml/hr	25mL/hr
What is the VTBI when running at 25 ml/hr	50mL
What type of IV solution given to a patient with an uncomplicated appy	NS
The fontanel that remains open til about 2-3 mths	posterior
Nurse’s next action when she observes that the anterior posterior diameter is smaller than the lateral diameter of the chest of a 5 year old	continue her assessment, this is normal
Examples of Abnormal heart sounds	murmurs, muffled S1 and S2
Pain assessment tool appropriate for a 5 year old	faces, oucher, poker chips
Dada, mama, what age when the child verbalizes this	9-12 mths
object permanence	When analyzing a 9 month old, if you cover an object does the baby know it’s still there?
Concrete operational-Piagets stage of cognitive development	the concrete operational stage is a period between 7-11 during which children gain a better understanding of mental operations. Children begin thinking logically about concrete events,have difficulty understanding hypethitical concepts
Easy, Difficult, Slow to warm up:	Patterns of temperament in an infant
Newborns & young infants more susceptible to infection	immune system is not fully mature
until what age is the aveoli smaller and faster	10 y/
Meds to look for serum levels in	Lithium, Digoxin, Vancomycin, gentamycin, dilantin
what is peak, and when is it obtained	1/2 hr after med is given
what is trough	before then next medication is given
who was the theorist who introduced the concept of including women in to these dev studies?	Gilligan
SIADH is a excessive amount of which hormone	ADH antidiuretic hormone
what can cause SIADH	Brain tumors, PN, chemo, and pulmonary disorders
What hormone is low in diabetes insipidus	ADH
if a patient previously Dx with DM becomes symptom free, are the cured and what is that period called	they are not, it will return and it is called the Honeymoon period
what are some characterisitc of GHD in children	Cherubis faces, high pitched voices, ripply abd fat
Hypothyroidism can be _______ and _______________?	congenital and acquired
what are some ways that children can maintain a healthy blood glucose?	Diet, anticpate, consistently count carbs
how can you check for pinworms	taps test, visual inspection
difference between shigella and salmonella	SAL: watery Diar. SHIG: bloody diar
what are some signs and symptoms of DM 2 in children?	polydipsia, polyuria, thickening of the skin w/ velevet irregularities in skinfolds
growth refers to the ______________ ability	quantitative
development refers to the ________abiltity	qualitative
What is VSD?	Ventricular Septal Defect: a hole in the septum between the low to chambers
Kawasaki disease	the leading cause of acquired Hrt disease in kids is US under 4 y/o
What are the 3 shunts in the fetal circulation that close 10-15 hours after birth	Ductus arteriosus Foramen ovale Ductus venosus
How is VSD diagnosed	Echo, EKG, Heart catheterization
Some S/S of VSD with large defects	S/S CHF, Failure to thrive, fatigue, review history
Treatment for VSD	Artery Banding, Some have closing by age 3
What is a cyanotic heart defect	Polycythemia: high Hgb, Chronic hypoxia
In a Cyanotic heart defect what lab will be high	Hgb
What position is the child in for Cyanotic heart defect	Squatting
What causes CHF in children	Secondary to heart defect
what are the assessment findings on a child with CHF	Cough, increased pulse, blood back up into the liver, poor growth
what can tachycardia also be a sign of	Mild dehydration, also respiratory
What is the treatment for the child with CHF	o Diuretics  Check for renal  Electrolytes o Digoxin: pulse rate and increase cardiac contractions o Reduce o2 by clustering tasks o Hi calorie foods o Maintain normal body Temp
S/S of Hypovolemic shock	Hypotension, thready pulse, clammy skin (diaphoesis, tachycardia, Tachypnea, Reduced UO
What might be some causes of hypovolemic shock	burns, GI bleeding, hemmorage, reduced plasma volume & body fluids, dehydration
What is the treatment for hypovolemic shock	Warmed IV Crystalloids,blood trasfusion, ID bleeding sites, control bleeding
what are the S/S of cardiac conditions on an infant	Tachecardia, irritability, retractions, weight loss, tires easily
What are S/S of cardiac conditions in a child	Exercise intolerance, ABD pain, perpherial edema, mottling or pallor, JVD, Perioral/facial edema
How do you manage pediatric cardiac patients	daily weight, educate, small feedings, turn frequently, don't smoke (parents too)
What is Cystitis	Bladder infection
What is pyelonephritis	Kidney infection
S/S of UTI	frequent urge to urinate/ void
test for strep	ASLO/ASO Anti-streptolysin O

Created by: jaymee4647

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