PEDS- hesi 2
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Faces pain scale and poker chip scale can be utilized by child of _____ age and older
Numeric pain scale can be used by children _____ years of age and older
A nonverbal child can be assessed using the _____ pain assessment tool.
FLACC- facial expression, leg movement, activity, cry, adn consolability
Which age is distraction as a non-pharmacologic pain management tool used for?
toddlers and preschoolers- books, music, television, bubble blowing
Which age is guided imagery as a non-pharmacologic pain management tool used for?
school age and adolescents
What is the youngest age a PCA pump is used?
When does birth length double?
When does the child sit unsupported?
When does a child achieve 50% of adult height?
When deos a child throw a ball overhand?
When does a child speak two to three word sentences?
when does a child use scissors?
When does a child tie his or her shoe?
When does the fine pincer grasp appear?
What toys are appropriate for an infant?
mobiles, rattles, squeaking toys, picture books, balls, colored blocks, and activity boxes
What toys are appropriate for a toddler (1-3 years)?
board and mallet, push-pull toys, toy telephones, stuffed animals, and storybooks
What toys are appropriate for a preschool child (3-5 years)?
coloring books, puzzles, cutting and pasting, dolls, building blocks, clay, and toys that allow prescholer to work out hospitalization experiences
How much weight and height does a preschooler gain per year (3-5)?
Each year child gains 5 pounds and grows 2 1/2 to 3 inches
How much weight and height does a school age child gain each year?
4-6 pounds and about 2 inches in height each year
What toys are appropriate for a school age child (6-12)?
board games, card games, and hobbies, such as stamp collecting, puzzles, and video games
Which age child fears body mutilation?
Preschoolers (3-5 years)
What is contraindication to MMR?
History of anaphylactic reaction to eggs or neomycin
What is contraindication to DTaP?
history or reactions, seizures, neurologic symptoms after previous vaccine, or systemic allergic reactions
Which two vaccines must be given together or >30 days apart
MMR and Varicella
What are some foods high in Iron?
- Infant rice cereal, liver, beef, pork, eggs
- Iron fortified formula, infant high-protein cereal
If child is severely dehydrated, what IV solution will be prescribed?
Isotonic- Normal saline/ lactated ringers
What are the 3 classic signs and symptoms of measles?
- Confluent rash that begins on the face and spreads downward
- Koplik sports on the buccal mucosa
What are some food sources high in vitamin A?
- Sweet potatoes
How can the nurse best evaluate the adequacy of fluid replacement in children?
What nutritional support should be provided for a child with cystic fibrosis?
Pancreatic enzyme replacement, fat-soluble vitamins, and a moderate to low carb, high protein, moderate to high fat diet
List 7 signs of respiratory distress in a pediatric client
Restlessness, tachycardia, tachypnea, diaphoresis, flaring nostrils, retractions, and grunting
What should families be taught about administration of digoxin?
- Administer on a regular basis; do not skip or make up for missed doses
- Give 1 hour before or 2 hours after meals. Do not mix with formula or food
- Take child's pulse prior to administration and know when to call providor
- Keep in safe place (locked cabinet)
What is the therapeutic blood level for digoxin?
0.8 - 2.0 ng/ml
What are the four defects associated with tetralogy of Fallot?
- Overriding aorta
- pulmonary stenosis
- Right ventricular hypertrophy
Describe nursing interventions to reduce the workload of the heart (CHF treatment)
- Give small, frequent feedings or gavage feedings
- Plan frequent rest periods
- Maintain a neutral thermal environment
- Organize activities to disturb child only as indicated
What medications are used to treat rheumatic fever?
Feed infant or child with cerebal palsy using nursing interventions aimed at preventing aspiration. How should the child be positioned?
Position child upright and support the lower jaw
Every child who has spina bifida should be screened for what?
What are the signs of shock? signs of increased ICP?
- Shock: increased pulse, decreased bp
- Increased ICP: decreased pulse, increased bp
What is a common medicine prescribed to decrease cerebral edema?
Mannitol (osmitrol)- monitor for hypokalemia & hyponatremia
What is the most common presenting symptom of a brain tumor?
Headache upon awakening
How is the child usually positioned after brain tumor surgery?
Lie flat- may turn to either side.
What are two nursing priorities for a newborn with myelomeningocele?
Prevention of infection of the sac and monitoring for hydrocephalus
What is Gower's sign?
Gower's sign is an indicator of muscular dystrophy; to stand, the child has to "walk" hands up legs
What is the first sign of renal failure?
Decreased urinary output
What causes Acute glomerulonephritis (AGN)?
- Streptococcal infection
- - (edema on face)
What is the priority nursing intervention with a wilms tumor?
No abdominal palpation!!!!
When is surgery usually performed for hypospadias?
Before preschool years, to allow for achievement of sexual identity, to avoid castration anxiety, and to facilitate toilet training
Compare the signs and symptoms of acute glomerulonephritis (AGN) with those of nephrosis
- AGN: gross hematuria, recent strep infection, HTN, and mild edema
- Nephrosis: severe edema, massive proteinuria, frothy-appearing urine, anorexia
What occurs before acute glomerulonephritis?
Beta-hemolytic strep infection
Compare the dietary interventions for AGN and nephrosis
- AGN: low sodium diet with no added salt
- Nephrosis: high-protein, low-salt diet
Describe safe monitoring of prednisone administration and withdrawal
- Long term prednisone should be given every other day (to avoid growth failure)
- Signs of edema, mood changes, and GI distress should be noted and reported
- Drug should be tapered, not discontinued suddenly
Describe feeding technique for a child with cleft lip or palate
Use lambs nipple or prosthesis. Feed child upright, with frequent bubbling
List the signs and symptoms of esophageal atresia with TEF:
Choking, coughing, cyanosis, and excess salivation
What nursing actions are initiated for the newborn with suspected esophageal atresia with TEF?
Maintain NPO immediately, and suction secretions
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
What are the signs of anorectal malformation?
A newborn that does not pass meconium within 24 hours; meconium appearing through a fistula or in the urine; an unusual appearing anal dimple
When is iron deficiency anemia commonly seen?
6-24 months old
What do you need to teach the family about administration of Iron?
- Give on empty stomach
- Give with citrus juice (vitaminc C)
- Use dropper or straw to avoid discoloring of teeth
- Stools will become tarry
- Iron can be fatal in severe overdose (keep away from other children)
- Do not give with any dairy products!
What are some dietarty sources of iron?
- green, leafy vegetables
- whole grains
- for infants: iron fortified cereals and formula
What is given to clients with sickle cell anemia?
Folic acid- orally to stimulate RBC synthesis
What is the genetic transmission pattern of hemophilia?
X-linked recessive chromosomal disorder transmitted by the mother and expressed in male children (25% of having child with hemophilia with each pregnancy)
Describe the sequence of events in a vaso-occlusive crisis in sickle cell anemia
A vaso-occlusive crisis is caused by the clumping of red blood cells, which blocks small blood vessels; therefore, the cells cannot get through the capillaries, causing pain and tissue and organ ischemia. Lowered oxygen tension affects the HgbS, which causes sickling of the cells
What should families and clients do to avoid triggering sickling episodes?
- Keep child well hydrated
- Avoid known sources of infections
- Avoid high altititudes
- Avoid strenuous exercise
Nursing interventions and medical treatments for a child with leukemia are based on what three physiologic problems?
- Anemia (decreased erythrocytes)
- Infection (neutropenia)
- Bleeding thrombocytopenia (decerased platelets)
What foods are high in phenylalanine? low in phenlalanine?
- High: high protein foods, such as meat, milk, dairy products, and eggs; and nutrasweet (aspartame)
- Low: vegetables, fruits, juices, cereals, breads, and starches
What IV is given to the child in ketoacidosis?
Regular insulin IV in normal saline
What are the symptoms of congenital hypothyroidism in early infancy?
- Large, protruding tongue
- Coarse hair
What are the outcomes of untreated congenital hypothyroidism?
Mental retardation and growth failure
What are two formula's prescirbed for infants with PKU?
Lofenalac and Phenex-1
Differentiate signs of hypoglycemia and hyperglycemia:
- Hypoglycemia: tremors, sweating, headache, hunger, nausea, lethargy, confusion, slurred speech, anxiety, tingling around mouth, nightmares
- Hyperglycemia: polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, and syncope
Describe developmental factors that would impact the school-age child with diabetes
Need to be like peers; assuming responsibility for own care; modification of diet; snacks and exercise in school
What is compartment syndrome?
Damage to nerve and vasculature of an extremity due to compression
What are the signs and symptoms of compartment syndrome?
- Abnormal neurovascular assessment
- Cold extremity
- Severe pain
- Inability to move the extremity
- Poor capillary refill
How is skeletal traction applied?
Skeletal traction is maintained by pins or wires applied to the distal fragment of the fracture
What are the s & s of congenital dislocated hip in infants?
- Unequal skin folds of the buttocks
- Ortolani sign
- Limited abduction of the affected hip
- Unequal leg lengths
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