Peds Final Review

Peds Final Review 1. Diabetes- hypo and hyperglycemia a. Hypoglycemic- low blood sugar i. S/s- hunger, shakiness, dizziness, confusion, difficulty speaking, feeling anxious or weak TX- glucagon ii. Most common cause of hypoglycemia is physical activity without food b. Hyperglycemic- high blood sugar i. S/s- increase thirst, frequent urination, high levels of sugar in the urine, high blood glucose TX- insulin 2. Hypoglycemia-low blood sugar a. Give them sugar- simple carb i. Table sugar- apple juice, soft drinks, candy, brown sugar 3. Diabetic Ketoacidosis (DKA)- what does it look like? a. Ketones In the urine, metabolic acidosis b. Symptoms: thirst, dry mouth, frequent urination, high blood sugar, high ketones in the urine, tired, flushed, n/v, abdominal pain, FRUITY ODOR ON BREATH, confusion, difficulty breathing c. Can be caused from not getting enough insulin, or having a severe infection, becoming dehydrated. 4. (Psychosocial question) Child with type 2 diabetes- don’t be judgmental about their treatment approach- exercise, diet, MEDICATION, but don’t threaten or seem rude! Be polite 5. Adolescent developmental stage- teens want to fit in (psychosocial) 6. Least invasive to most invasive with children. a. You wan to listen to heart before doing a blood pressure 7. 18 month old development- autonomy vs. shame and doubt a. Walking, b. Pincer grasp c. Parallel play d. Should be sitting & walking e. Language- development up to 2-3 words must say momma, cup, more juice 8. Teach a mom to give medication at home - tell her to return demonstration but giving the meds 9. In the NICU- the nurses encourage skin to skin, educate the mom, and make her part of the care a. BONDING AND SKIN TO SKIN 10. Sickle cell crisis- we take care of it by “HOPS” a. Hydrogen, oxygen, pain medication 11. A child has leukemia- normal things they would have is bruising, sick, immunicompromised, not growing, lose 10% of their weight: good signs of leukemia and bad signs, things we should see and things we shouldn’t a. Good signs b. Bad signs c. Things we should see: i. Anemia and thrombocytopenia occur. ii. Proliferation of abnormal WBC’s. iii. SOB, pale, increase fever, iv. Decrease platelets so increase bleeding and bruising, decrease WBC so increase risk for infection, decrease RBC so increase risk for anemia. v. Spleen, liver, and lymph nodes become infiltrated and enlarged. Directly related to areas of involvement, CNS at risk for infiltration, fever, pallor, lethargy, bleeding, petechiae, anorexia, weight loss, enlarged spleen, and lymphadenopathy. vi. Side effects- mouth sores, n/v, anemia, anorexia, constipation, alopecia, emotions, immunosuppression, hairless- psychosocial with girls d. Things we shouldn’t see: 12. Bleeding precautions...? 13. How you get sickle cell? What triggers it? a. Genetically transmitted- when both parents have trait, 25% chance in offspring b. What triggers a Sickle Cell Crisis? Dehydration, fever, high altitude, hypoventilation and stress, cold and vasoconstriction, hypoxia. 14. How we give iron in the hospital? PO- with orange juice a. Patient educationi. Use only breast milk or iron fortified formula in first 12 months ii. FE supplements should be given b/w meals, where the presence of hydrochloric acid is the greatest and with citrus fruit or juice which helps reduce it to its most soluble state. Stools will turn tarry green or black in color. Liquid prep may stain teeth, but its reversible iii. Administers FE in back of mouth to prevent tooth discoloration. 15. Normal CBC be able to identify abnormal a. Hemoglobin- 12-17 b. Hematocrit-34-50 c. RBC- 4-6 d. WBC-3.5-10.5 e. Platelet- 150-450 16. Nursing actions for a child with Kawasaki a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. r. Nursing care focuses on promoting comfort Monitor for early signs of complications or disease progression Family support Take temperature Q4 hrs. and before each dose of aspirin. Assess extremities for edema, redness and desquamation Q8 hrs. Monitor I&O and nutrition strictly and obtain daily weights. Soft mild diet. FLUIDS Hydration and I&O- because their mouth is dry Administer Aspirin Q4h as ordered and monitor for possible side effects, such as bleeding and GI upset. We give aspirin because they have right risk for aneurism. Administer IV Immune globulin. Handle as if it were a blood product, carefully regulating the infusion rate and ensure the rate does not exceed 1ml/min. If any signs of reaction occur, stop the infusion immediately! Observe for signs of tinnitus Offer soft diet, keep mucous membranes moist, and take aspirin with food Pt. s/s: Rash, cracked lips, swollen red tongue, cardiac disease- give lip balm to moisten the lips Inform parents to reschedule any scheduled immunizations for 5 months after immune globulin administration, as the immune response of the vaccine may not be as effective Keep the child’s skin clean and dry, lips lubricated Promote child’s comfort (e.g. cool compress for fever, feed child soft foods and liquids that are neither too hot or too cold (strawberry tongue) Encourage parent’s to participate in child’s care as this comforts and reassures the child Teach them to take the temperature daily and report any fever above 100°F Emphasize the need for follow up care to monitor for possible cardiac complications 17. Interventions for child with CHF similar to adult a. Least invasive things first b. Listen to lungs or heart first before taking bp c. Administer prescribed medications; frequently monitor BUN, creatinine, K, NA, Cl, and Mg. d. Reinforce the importance of adhering to the prescribed diet e. Weigh the patient daily to assess for fluid overload f. To prevent DVT, assist Pt. with ROM exercise. Apply TED HOSE, and evaluate patient 18. How we fatten up a baby with cardiac defecta. N/I- they need to eat so give them a high calorie fortified formula; increase the density not the amount of feeding. b. GAVAGE: if they don’t finish their bottle you give it through OG or NG tube to ensure they get all the food necessary. c. Small frequent meals example: 15 minutes on each breast 19. Rheumatic fever s/s a. Causes changes in the heart, joints, brain, and skin tissue b. Ascoff’s bodies (hemorrhagic bullous lesions) develop in the connective tissue of the heart c. Endocarditis, which may lead to permanent mitral and aortic valve damage d. Inflammed and painful joints e. Fevers, lethargy f. Sore throat, joint pain g. Sydenham chorea: characterized by aimless movement of the extremities and facial grimacing h. Mild anemia i. Lab test: antistreptolysin-O, if elevated titer indicates a recent strep infection j. Online- fever, painful/ tender joints in the ankles, knees, elbows, and wrists. Pain in one joint that moves to another joint. Red, hot, swollen joints. Small nodules under the skin that don’t hurt, chest pain, chest palpitations, fatigues. 20. Kawasaki 2 drugs we treat it with: a. Aspirin- given to reduce the risk of cardiac complications. They go home on aspirin. Take the temp before each dose of aspirin. Monitor for side effects such as bleeding and GI upset. We give aspirin for inflammation and to keep the blood thin. b. Immune Globulin IBIG- Purified antibodies, it is an ingredient of blood that helps the child’s body fight off infection. They need more teaching about this drug. Administer IV Immune globulin. Handle as if it where a blood product, carefully regulating the infusion rate and ensure the rate does not exceed 1ml/min. If any signs of reaction occur, stop the infusion immediately! 21. Description between acute and chronic Kawasaki: Strawberry tongue & Rash a. Acute Stage: Characterized by fever over 102.2 for 5 days or more, conjunctiva hyperemia, strawberry tongue & red throat, swollen hands and feet, rash on the trunk, enlargement of the cervical lymph nodes, diarrhea and hepatic dysfunction b. Chronic Kawasaki- Doctors can manage the symptoms of Kawasaki disease if they catch it early. The symptoms typically disappear within just two days of when treatment begins. Usually, if Kawasaki disease is treated within 10 days of when the first symptoms begin, no heart problems develop. But if the illness goes untreated (time period can vary, but likely for 10-14 days and sooner in young infants), it can lead to more serious complications that involve the child's heart. Kawasaki disease can lead to vasculitis, which is an inflammation of the blood vessels. This can be particularly dangerous because it can affect the coronary arteries, which supply blood to the heart. In addition to the coronary arteries, the heart muscle, lining, valves, or the outer membrane that surrounds the heart can become inflamed. Arrhythmias (changes in the normal pattern of the heartbeat) or abnormal functioning of some heart valves can also occur. 22. Causes of Rheumatic Fever a. Etiology is unknown; possible causes include an autoimmune response in a genetically predisposed child 23. Foundations question- interventions for someone with a fracture a. Immobilization, elevation, ice, pain management, IV access, CMS checks b. Monitor for swelling and inflammation to prevent circulatory issues c. Monitor for skin integrity-skin breakdown d. Decrease pain 24. Importance of child with neuromuscular= make sure they are mobile and walk around. Fat people don’t like to move 25. Children with scoliosis: importance for self esteem independence and normal of a life as possible 26. Scoliosis Reason we use a brace- to straighten the spine a. Spine curves laterally with vertebral rotation b. Ribs inside curve forced together c. Ribs on outside of curve separate d. Results in asymmetric vertebral canal e. Test for it by telling the person to bend over and touch their toes f. Milwaukee Brace: i. Brace worn 23 hours a day ii. Brace is off to shower, bathe and swim iii. T-shirt to be worn under the brace iv. Consistent use of brace will provide maximum benefit v. Compliance with teenagers difficult 27. Pt. with no brace and SX scoliosis Education, supportive care, strengthen exercise, follow up and keep an eye on them a. Assessment: i. Painless and insidious is typical ii. Parent may notice skirt hanging unevenly iii. Truncal asymmetry iv. Unequal shoulder heights/hip, waist angles, scapula prominence, rib hump v. School screenings begin in 5th grade b. TX: i. If curve <15-20 degrees 1. Monitor every 3-6 months 2. Exercises to improve posture and muscle tone ii. If curve >24 degrees but, <40 degrees 1. Milwaukee brace iii. If curve >40 degrees 1. Surgery/spinal fusion 28. Nocturnal enuresis- Teaching- Double PP- fluids before, where you pee at night a. Occurs in children 5 and up. The child may wet the bed at least 2 times each week or may never have a dry night. b. Teaching: remind your child to urinate every 2 hours. Limit the amount of liquid and give your child a reward after a dry night. 29. Positioning for GERD a. Sitting upright position to prevent aspiration 30. Erikson’s infant stage- Trust vs. Mistrust i. Physical development- Birth weight doubles in 6 months and triples at 12 months. ii. Cephalocaudal-holds head upright before walking iii. Proximal to distal- center to periphery, control trunk and fine motor skills iv. Respirations of 30-60 are normal for infants. They are nose breathers. Don’t want the baby to stop breathing over 20 seconds. v. Growth: Head circumference is measured from birth until age 2 to make sure brain has room to grow. b. 3 month old: i. Psych: Smile , knows primary caregiver. ii. Toys: mobile, mirror. c. 6 month old: i. Psych: apprehension of stranger’s babbles and coos. ii. Motor: Laughs, rolls, sits, no head lag, hand-to-hand transfer. iii. Toys: rattles (palmar grasp), and soft toys d. 9 month old: i. Psych: waves, stranger anxiety, crying, object performance, peekaboo, ii. Motor: sits, (Pincer grasp), pulls to stand (Cruising) 1st steps of walking using furniture for support. 31. If you have a 14-year-old female- talk to her what’s going on? Have open communication with teens i. Psych: rebellious, peer pressure, body image, fearless, sneaking out, invincible, friends are the most important thing of life, first intimate relationship, heartbreak) 32. School age Erickson stage- Industry Vs. Inferiority i. Physical Development: permanent teeth, weight doubles between ages of 6 and 12 boys and girls close in size, 20/20 vision on Snellen chart, enuresis and sleepwalking are common issues. ii. Psych: same gender friends, collections, enjoys school (competition and cooperation), Develops morals bring schoolwork to hospital iii. Motor- refinement of coordination and balance, two wheeler, cursive writing 33. Why we stick to routine in the hospital a. To prevent regression 34. 4 month old milestones a. Steady head control is achieved at 4 months 35. How you explain things to a child in the hospital about timing. a. They don’t know about time so tell them mom and dad will be back when barney is on TV 36. Erickson’s school age and how you could best enhance it in the hospital i. Physical Development: permanent teeth, weight doubles between ages of 6 and 12 boys and girls close in size, 20/20 vision on Snellen chart, enuresis and sleepwalking are common issues. ii. Psych: same gender friends, collections, enjoys school (competition and cooperation), Develops morals bring schoolwork to hospital iii. Motor- refinement of coordination and balance, two wheeler, cursive writing b. Give them some control allow them to pick which juice to take their medications with. Would you like orange juice or apple juice with your medication? c. Bring their homework to the hospital. 37. JRA- juvenile rheumatoid arthritis a. Autoimmune disease more commonly seen in girl’s age 9-12 years old. b. Assessment: joint pain only OR joint pain and fever, rash and lymphadenopathy c. Management: stretching, range of motion, swimming, aspirin, steroids, NSAID, and avoid obesity d. Go to the pool stretch, non weight bearing 38. You think steroids you think immunosuppression 39. JRA a. b. c. d. e. f. Chronic joint inflammation before age 16 May have affects on heart, lungs, liver and eyes Pain, immobility and interference with normal growth and development May go in to remission (70%)or experience chronic disease Earlier onset=better prognosis Cause unknown…. autoimmune? 40. Nursing actions with a patient who has a VP shunt- Ventricle (in head) to peritoneal (in abdomen) a. Pre-operative b. Monitor head circumference c. Monitor for signs of ICP d. Small frequent feedings e. Good skin care b/c their head is big and heavy and putting pressure when laying down f. Position child carefully g. Post-operative i. Place child in flat position ii. Elevate HOB gradually iii. Avoid sedation iv. Monitor for signs of ICP and monitor VS v. Educate parents concerning signs and symptoms of shunt infection or shunt malfunction 41. Children with myelomeningeoceal- worry about infection a. Keep wet dressing over it b. Has to go to SX right away at risk for meningitis and skin issues c. Always go with multidisciplinary issues. d. Give children the chance for the best quality of life. e. Sac care i. Monitor for leakage of spinal fluid ii. Monitor skin integrity of sac iii. Assess for infection (especially meningitis) iv. Sac or systemic v. Position infant on side or abdomen (even for feeds) vi. Apply wet, sterile, saline dressing vii. Do not allow sac to dry out f. Nursing care/ home care: i. Latex precautions ii. Neurogenic bladder: straight catheterization iii. Neurogenic bowel: bowel management program iv. Monitor for signs/symptoms of hydrocephalus v. Good nutrition-prevent obesity vi. Promote safety, independence and muscle tone 42. S/s increase intracranial pressure in a baby a. Bulging fontanels* b. Separated cranial structures, high pitched cry, poor feeding 43. Spina bifida occulta a. Posterior vertebral arches fail to fuse b. No herniation of meninges or spinal cord c. May have a tuft of hair or dimpling over the lumbosacral area d. No loss of function/mildest form e. You don’t see it in assessment: you check for the dimple in the butt. Diagnose it by ultrasound 44. Asthma question a. Chronic inflammatory disorder of the airways b. Wheezing, breathlessness, chest tightness, cough, increase in brachial hyperresponsivness to a variety of stimuli c. Cough especially at night and early morning d. Risk factors: age, hereditary, gender, children of young woman <20 yr., smoking, ethnicity, previous life threatening attacks, lack of access to medical care, psychological and psychosocial problems e. Exacerbations are episodes of progressively worsening SOB, cough, wheezing, and chest tightness 45. Asthmatic should be taught: i. Peak flow meter- (use as a guide for treatment) tells you about your respiratory function. Tells you how your breathing If its within a certain range your in green (good) If its in the yellow zone (it gives you a plan on what to do) (if its red emergency) ii. Airway is important to kids, if a child is not wheezing, and now they are not this is bad we don’t like silent children. iii. Coughing, wheezing iv. Asthma is not controlled when the child is saying they can’t do sports or PE because of my asthma. v. Albuterol rescue inhaler More than twice a week is too much. 1. You don’t want them to use a rescue inhaler. A mild asthmatic doesn’t know symptoms are worsening vi. Educate pt. about reduced reduction of risk factors vii. Administer and monitor o2 viii. Increase fluids to liquefy secretions ix. Educate pt. about cough enhancement techniques, use of peak flow meter, use of metered dose inhaler or dry powder inhalers, anxiety reduction and rest during acute attack, education about exercise regimen. 46. Assessment of a patient with pneumonia a. Viral Pneumonia: Mild severe fever, slight cough, malaise, wheezing, fine crackles. b. Management- oxygen, antipyretics, steroids, bronchiodilators, fluids, abx c. AIRWAY is the most important with children d. Bacterial pneumonia: acute onset, fever, chills, h/a, chest pain, irritability, lethargy, respiratory distress 47. Infant safety with anticipatory guideline teaching of the parents a. Rapid G&D b. Falls especially when learning roll and learning to walk i. NO walkers! c. Car seats i. Rear facing to 1 one year or 20 pounds or as long as indicted by the car seat d. Sun protection i. Sunscreen after 6 months of age e. “BACK TO SLEEP” 48. Signs of coarctation of the aorta: a. Assessment- in the first few weeks of life: poor feeding, tachypnea, lethargy and progress to overt to CHF and shock. b. S/s: headache, nosebleed, leg cramps, and take BP in all 4 extremities: upper arms have higher blood pressure and higher pulses; lower extremities will have lower bp and lower pulses 49. Tetralogy of fallota. They experience trouble eating, remember feeding for an infant is their exercise we are concerned about them getting their nutritional intake, high calorie food b. Ventricular septal defect, pulmonary stenosis, Overriding aorta, right ventricular hypertrophy. c. Assessment: Causes cyanosis, clubbing, polycythemia, Tet spells (hypercyanotic spells) Calm child, squatting/ knee chest position, oxygen, morphine, fluids, neosynephrine. d. For a hyper cyanosis- put them in a knee chest position. It has to do with pressure changes to help the circulatory system. 50. Digoxin safety a. HR Less than 100 bpm we will hold digoxin Never redoes if they vomited they can get toxic. b. Why is my baby getting Digoxin? Helps with contractility of the heart, decreases the hr and increases blood flow to the heart. More effective pump. c. Observe for symptoms of toxicity, including: n/v, anorexia, dizziness, diarrhea, and arrhythmia. 51. Care of the child with rheumatic fever a. Kaplan: TX is penicillin; nursing considerations are instruct family about abx, provide emotional support. b. The most important role of the nurse is prevention of rheumatic fever! c. Culture throat of all children that present with a sore throat, specially if family reports other family members with strep throat infections d. If culture is positive, emphasize to family the importance of the completion of a full 10-day course of antibiotics e. Nursing care now focuses on promoting recovery and ensuring compliance with the treatment regimen f. Monitor vital signs and temperature Q4hrs g. If carditis develops, keep child on bed rest for 4 weeks. h. Auscultate heart tones for any unusual sounds i. Observe for changes in behavior, skin and joints j. k. l. m. Administer antibiotics and aspirin as ordered Position and handle joints carefully Provide quiet activities as they are usually confined to bed Teaching i. Once patient is in the recovery phase and goes home, teach parents: ii. The importance of continuing drug therapy iii. Limit activities iv. Plan quiet activities (e.g. board games, reading, computers, offer frequent rest periods) v. Provide emotional support, specially if child has symptoms of chorea vi. Advise dentists of history in order for them to provide prophylactic antibiotic therapy vii. Ensure their understanding on the importance of identifying that the child’s future sore throats may be strep and a culture should be done immediately in order to start antibiotic therapy viii. Emphasize on the importance of follow-up care to prevent new infections and to monitor heart function 52. Cardiac question 53. Teaching for Kawasaki disease a. Inform parents to reschedule any scheduled immunizations for 5 months after immune globulin administration, as the immune response of the vaccine may not be as effective b. Keep the child’s skin clean and dry, lips lubricated c. Promote child’s comfort (e.g. cool compress for fever, feed child soft foods and liquids that are neither too hot or too cold (strawberry tongue) d. Encourage parent’s to participate in child’s care as this comforts and reassures the child e. Teach them to take the temperature daily and report any fever above 100°F f. Emphasize the need for follow up care to monitor for possible cardiac complications 54. Therapeutic communication of child development 55. Don’t worry about immunization dates! But know allergies, check with the pharmacy, safety. When giving meds and they say no I don’t take that one it’s a blue pill go double check. If we need to call pediatrician a. There are 2 live vaccines: MMR and Varicella are to be given after 1 year. The baby needs 1 year to get their immune system. i. Example: 2 month old should NOT be given MMR or Varicella b. Contraindications for every vaccine is anaphylactic reaction c. 2,4,6 months: Select all that apply. DON’T PICK THE ANSWER WITH THE MMR. Remember MMR is to be given after 1 year. d. Know contraindications- example: DTaP: don’t give if there has been a neurological effect 56. 6 months old baby a. Doubles the birth weight 57. Delegation question- in pediatrics don’t pick the distractor 58. Know when the fontanels close a. Anterior fontanels- closes at 12-18 months b. Posterior fontanels- closes at 3 months