Pediatric Nursing Growth and Development

PEDIATRIC NURSING GROWTH AND DEVELOPMENT: 1. When does birth length double? = by 4 years 2. When does the child sit unsupported? = 8 months 3. When does a child achieve 50% of adult height? = 2 years 4. When does a child throw a ball overhand? = 18 months 5. When does a child speak 2-3 word sentences? = 2 years 6. When does a child use scissors? = 4 years 7. When does a child tie his/her shoes? = 5 years CHILD HEALTH PROMOTION: 1. List 2 contraindications for live virus immunization. - Immunocompromised child or a child in a household with an immunocompromised individual. 2. List 3 classic signs and symptoms of measles. - Photophobia, confluent rash that begins on the face and spreads dowward, and Koplik’s spots on the buccal mucosa. 3. List the signs and symptoms of iron deficiency. - Anemia, pale conjunctiva, pale skin color, atrophy of papillae on tongue, brittle/ridged/spoon-shaped nails, and thyroid edema. 4. Identify food sources for Vitamin A. - Liver, sweet potatoes, carrots, spinach, peaches, and apricots. 5. What disease occurs with vitamin C deficiency? - Scurvy. 6. What measurements reflect present nutritional status? - Weight, skinfold thickness, and arm circumference. 7. List the signs and symptoms of dehydration in an infant. - Poor skin turgor, absence of tears, dry mucous membranes, weight loss, depressed fontanel and decreased urinary output. 8. List the laboratory findings that can be expected in a dehydrated child. - Loss of bicarbonate/decreased serum pH, losso f sodium (hyponatremia), loss of potassium (hypokalemia), elevated Hct, and elevated BUN. 9. How should burns in children be assessed? - Use the Lund-Browder chart, which takes into account the changing proportions of the child’s body. 10. How can the nurse BEST evaluate the adequacy of fluid replacement in children? - Monitor urine output. 11. How should a parent be instructed to “child proof” a house? - Lock all cabinets, safely store all toxic household items in locked cabinets, and examine the house from the child’s point of view. 12. What interventions should the nurse do FIRST in caring for a child who has ingested a poison? - Assess the child’s respiratory, cardiac, and neurological status. 13. List 5 contraindications to administering syrup of ipecac. - Coma, seizures, CNS depression, ingestion of petroleum-based products, and ingestion of corrosives. 14. What instructions should be given by phone to a mother who knows her child has ingested a bottle of medication? - Administer syrup of ipecac if the child is conscious. Bring any emesis or stool to the emergency room. Bring the container in which the medicine was stored to the emergency room. RESPIRATORY DISORDERS: 1. Describe the purpose of bronchodilators. - Reverse bronchospasm 2. What are the physical assessment findings for a child with asthma? - Expiratory wheezing, rales, right cough, and signs of altered blood gases. 3. What nutritional support should be provided for the child with cystic fibrosis? - Pancreatic enzyme replacement, fat-soluble vitamins, and a high carbohydrate, high protein, moderate fat diet. 4. Why is genetic counseling important for the cystic fibrosis family? - The disease is autosomal recessive in its genetic pattern. 5. List 7 signs of respiratory distress in a pediatric client. - Restlessness, tachycardia, tachypnea, diaphoresis, flaring nostrils, retractions, and grunting 6. Describe the care of a child in a mist tent. - Monitor child’s temperature. Keep tent edges tucked in. Keep clothing dry. Assess child’s respiratory status. Look at child inside tent. 7. What position does the child with epiglottis assume? - Upright, sitting, with chin out and tongue protruding (“tripod” position). 8. Why are IV fluids important for the child with an increased respiratory rate? - The child is at risk for dehydration and acid/base imbalance. 9. Children with chronic otitis media are at risk for developing what problem? - Hearing loss 10. What is the most common post-operative complication following tonsillectomy? Describe the signs and symptoms of this complication. - Hemorrhage; frequent swallowing, vomiting fresh blood, and clearing throat. a CARDIOVASCULAR DISORDERS: 1. Differentiate between a right to left and left to right shunt in cardiac disease. - A left to right shunt moves oxygenated blood back through the pulmonary circulation. A right to left shunt bypasses the lungs and delivers unoxygenated blood to the systemic circulation causing cyanosis. 2. List the 4 defects associated with Tetralogy of Fallot. - VSD, overriding aorta, pulmonary stenosis and right ventricular hypertrophy 3. List the commons signs of cardiac problems in an infant. - Poor feeding, poor weight gain, respiratory distress/infections, edema and cyanosis 4. What are the 2 objectives in treating congestive heart failure? - Reduce the workload of the heart and increase cardiac output. 5. Describe nursing interventions to reduce the workload of the heart. - Small, frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutral thermal environment. Organize activities to disturb child only as indicated. 6. What position would best relieve the child experiencing a “tet” spell? - Knee-chest position, or squatting. 7. What are common signs of digoxin toxicity? - Diarrhea, fatigue, weakness, nausea and vomiting. bradycardia prior to administration. The nurse should check for 8. List 5 risks of cardiac catheterization. - Arrythmia, bleeding, perforation, phlebitis, and obstruction of the arterial entry site. 9. What cardiac complications are associated with rheumatic fever? - Aortic valve stenosis and mitral valve stenosis. 10. What medications are used to treat rheumatic fever? - Penicillin, erythromycin, and aspirin. NEUROMUSCULAR DISORDERS: 1. What are the physical features of a child with Down syndrome? - Simian creases of palms, hypotonia, protruding tongue, and upward/outward slant of eyes. 2. Describe “scissoring.” - A common characteristic of spastic cerebral palsy in infants. The legs are extended and crossed over each other, the feet are plantar flexed. 3. What are 2 nursing priorities for a newborn with myelomeningocele? - Prevention of infection of the sac and monitoring for hydrocephalus (measure head circumference; check fontanel; assess neurological functioning). 4. List the signs and symptoms of increased ICP in older children. - Irritability, change in LOC, motor dysfunction, headache, vomiting, unequal pupil response, and seizures. 5. What teaching should parents of a newly shunted child receive? - Signs of infection and increased ICP (decreased pulse, increased blood pressure). Shunt should not be pumped. Child will need revisions due to growth. Provide guidance for growth and development. 6. State the 3 main goals in providing nursing care for a child experiencing a seizure. - Maintain patent airway, protect from injury, and observe carefully. 7. What are the side effects of Dilantin? - Gingival hyperplasia of the gums, dermatitis, ataxia, and GI distress. 8. Describe the signs and symptoms of a child with meningitis? - Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig’s sign, positive Brudzinski’s sign. Infant does not show all classic signs, but is very ill. 9. What antibiotics are usually ordered for bacterial meningitis? - Ampicillin, penicillin, and/or Chloramphenicol. 10. How is a child usually positioned after brain tumor surgery? - Flat on his/her side. 11. Describe the function of an osmotic diuretic. - Osmotic diuretics remove water from the CNS to reduce cerebral edema. 12. What nursing interventions increase intracranial pressure? - Suctioning and positioning/turning. 13. Describe the mechanism of inheritance for Duchenne muscular dystrophy. - Duchenne muscular dystrophy is inherited as an X-linked recessive trait. 14. What is “Gower’s sign?” - Gower’s sign is an indicator of muscular dystrophy. The child has to “walk” up legs using hands to stand. RENAL DISORDERS: 1. Compare the signs and symptoms of acute glomerulonephritis (AGN) with nephrosis. - AGN: gross hematuria, recent strep infection, hypertension, and mild edema. Nephrosis: severe edema, massive proteinuria, frothy-appearing urine, anorexia. 2. What antecedent event occurs with acute glomerulonephritis? - Beta-hemolytic strep infection 3. Compare the dietary interventions for acute glomerulonephritis and nephrosis. - AGN: low-sodium diet with no added salt. Nephrosis: high-protein, low-salt diet. 4. What is the physiologic reason for the lab finding of hypoproteinemia in nephrosis? - Hypoproteinemia occurs because the glomeruli are permeable to serum proteins. 5. Describe safe monitoring of prednisone administration and withdrawal. - Long term prednisone should be given every other day. Signs of edema, mood changes, and GI distress should be noted and reported. The drug should be tapered, not discontinued suddenly. 6. What interventions can be taught to prevent urinary tract infections in children? - Avoid bubble baths, void frequently; drink adequate fluids especially acidic fluids such as apple or cranberry juice, and clean genital area from front to back. 7. Describe the pathophysiology of vesicoureteral reflux. - a malfunction of the valves at the end of the ureters allowing urine to reflux out of the bladder into the ureters and possibly the kidneys. 8. What are the priorities for a client with Wilms’ tumor? - Protect the child from injury to the encapsulated tumor. Prepare the family/child for surgery. 9. Explain why hypospadias correction is done before the child reaches preschool age. - Preschoolers fear castration, are achieving sexual identity, and acquiring independent toileting skills. GASTROINTESTINAL DISORDERS: 1. Describe feeding techniques for the child with cleft lip or palate. - Lamb’s nipple, or prosthesis. Feed child upright with frequent bubbling. 2. List the signs and symptoms of esophageal atresia with TEF. - choking, coughing, cyanosis, and excess salivation. 3. What nursing actions are initiated for the newborn with suspected esophageal atresia with TEF? - NPO immediately and suction secretions. 4. Describe the post-op nursing care for an infant with pyloric stenosis. - Maintain Iv hydration and provide small, frequent oral feedings of glucose and/or electrolyte solutions within 4-6 hours. Gradually increase to full strength formula. Position on right side in semi-Fowler’s position after feeding. 5. Describe why a barium enema is used to treat intussusception. - A barium enema reduces the telescoping of the intestine through hydrostatic pressure without surgical intervention. 6. Describe the pre-op nursing care for a child with Hirschsprung’s disease. - Check vital signs and take axillary temps. Provide bowel cleansing program and teach about colostomy. Observe for bowel perforation; measure abdominal girth. 7. What care is needed for the child with a temporary colostomy? - Family needs education about skin care and appliances. Referral to an enterostomal therapist is appropriate. 8. What are the signs of anorectal malformation? - A newborn who does not pass meconium within 24 hours, meconium appearing from a fistula or in the urine, or an unusual appearing anal dimple. 9. What are the priorities for a child undergoing abdominal surgery? - Maintain fluid balance (I&O, NG suction, monitor electrolytes), monitor vital signs, care of drains if present, assess bowel function, prevent infection of incisional area and other post-op complications, and support child/family with appropriate teaching. HEMATOLOGICAL DISORDERS: 1. Describe what information families should be given when a child is receiving oral iron preparations. - Give oral iron on an empty stomach and with vitamin C. Use straws to avoid discoloring teeth. Tarry stools are normal. Increase dietary sources of iron. 2. List dietary sources of iron. - Meat, green leafy vegetables, fish, liver, whole grains, legumes. 3. What is the genetic transmission pattern of hemophilia. - It is an X-linked recessive chromosomal disorder, transmitted by the mother and expressed in male children. 4. Describe the sequence of events in a vaso-occlusive crisis in sickle cell anemia. - A vaso-occlusive crisis is caused by clumping of red blood cells which cannot get through the capillaries, causing pain and tissue/organ ischemia. Lowered oxygen tension affects the HgbS, which causes sickling of the cells. 5. Explain why hydration is a priority in treating sickle cell disease. - Hydration promotes hemodilution and circulation of the red blood cells through the blood vessels. 6. What should families and clients do to avoid triggering sickling episodes? - Keep child well hydrated. Avoid known sources of infections. Avoid high altitudes. Avoid strenuous exercise. 7. Nursing interventions and medical treatment for the child with leukemia are based on what 3 physiological problems? - Anemia (decreased erythrocytes). Infection (neutropenia). Bleeding thrombocytopenia (decreased platelets). SKELETAL DISORDERS: 1. List normal findings in a neurovascular assessment. - Warm extremity, brisk capillary refill, free movement, normal sensation of the affected extremity, and equal pulses. 2. What is compartment syndrome? - Damage to the nerves and vasculature of an extremity due to compression. 3. What are the signs and symptoms of compartment syndrome? - Abnormal neurovascular assessment: cold extremity, severe pain, inability to move the extremity, and poor capillary refill. 4. Why are fractures of the epiphyseal plate a special concern? - Fractures of the epiphyseal plate (growth plate) may affect the growth of the limb. 5. How is skeletal traction applied? - Skeletal traction is maintained by pins or wires applied to the distal fragment of the fracture. 6. What discharge instructions should be included for a child with spica cast? - Check circulatio. Keep cast dry. Do not stick anything under cast. Prevent cast soilage during toileting or diapering. DO NOT TURN with abductor bar. 7. What are the signs and symptoms of congenital dislocated hip in infants? - Unequal skin folds of the buttocks, ortalani sign, limited abduction of the affected hip, and unequal leg lengths. 8. How would the nurse conduct scoliosis screening? - Ask the child to bend forward from the hips with arms hanging free. Examine the child for a curve of the spine, rib hump, and hip asymmetry. 9. What instructions should the child with scoliosis receive about the Milwaukee brace? - Wear the brace 23 hours per day. Wear t-shirt under brace. Check skin for irritation. Perform back and abdominal exercises. Modify clothing. Encourage the child to maintain normal activities as able. 10. What care is indicated for a child with juvenile rheumatoid arthritis? - Prescribed exercise to maintain mobility, splinting of affected joints, and teaching medication management and side effects of drugs.