Unit V & VI PEDS

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Unit V & VI PEDS
2013-02-18 13:18:16

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  1. What factors decrease resistance to pathogens in children?
    Deficient immune system, anemia, chilling of the body, malnutrition, fatigue
  2. What conditions weaken the respiratory defenses?
    Allergies, bronchopulmonary dysplasia, history of RSV, cardiac anomalies, pre term birth, asthma and CF
  3. What factors increase the likelihood for infections in children?
    Daycare attendance, second hand smoke
  4. Know the anatomical differences in infants and children that put them at a higher risk for respiratory infections
    Smaller airway size, orientation and pliability of ribs, cartilaginous airway, fewer alveoli, increase O2 consumption, higher respiratory rate
  5. Which of these anatomical differences put a child at a higher risk for croup (LTB)?
    Smaller airway size and cartilagious airway
  6. Stridor
    Croup, upper airway, crowing, collapse of far airway lobes, it is usually heard when taking in a breath
  7. Wheezing
    High pitched, whistle like most obvious when breathing out (exhaling) but may be heard when taking a breath (inhaling)
  8. Grunting
    Deep guttural can be heard each time person exhales. This grunting is the bodes way of trying to keep air in the lungs so they will stay open
  9. Retractions
    Using accessory muscles to breathe, The chest appears to sink in just below the neck and or under the breastbone with each breath-one way of trying to bring more air into the lungs
  10. Rales
    Crackling or rattle sound
  11. If a child has an URI and a temp how can we ensure the child does not get dehydrated?
    Hydrate, pedialyte, no caffeine
  12. What type of actions can we take to decrease O2 demands?
    Promote rest, decrease anxiety, small frequent feedings, temperature regulation, decrease infection exposure
  13. Should we encourage cool mist or warm mist to treat a child's mild respiratory infection at home and why?
    Cool mist for safety, add moisture to the air which helps ease coughing and congestion
  14. How do steam showers work to relieve congestion?
    Loosen mucous, open the bronchi's and moisten the mucus
  15. What other treatments can be done at home to treat mild respiratory infections?
    Cool mist, steam shower, rest, saline nasal drops, decrease body temp, promote hydration, nutrition, prevent spread of infection
  16. If a young child is ordered an MDI how could we improve the use of the medication if the child is not using it correctly?
  17. How would a nurse or a child evaluate if a rescue inhaler has been effective?
    Improvement in oxygen saturation
  18. What is the layman's term for pharyngitis and what complications can occur in this condition goes untreated?
    Acute strep throat-if untreated--scarlet fever, rheumatic fever, acute glomerular nephritis
  19. Are rapid strep tests reliable?
    yes, if comes back negative will be sent off for a culture that comes back in 24 hr to 48 hrs.
  20. How long is a child contagious with pharyngitis and how long should they be kept out of school?
    Until they have been on an antibiotic for 24 hrs, can not return till on medication for 24 hrs also.
  21. Which tonsils are removed with T&A?
    Palatine and Pharyngeal (adenoids)
  22. What is the proper nursing assessment for hemorrhage after a T&A?
    Bright red, swallowing continuously, metallic taste, vomiting bright blood
  23. How long does the risk of hemorrhage present itself after T&A?
    10-14 days
  24. What positioning should be used for a child post op from a  T&A?
    Side or stomach until awake for drainage
  25. What home instructions should be given after a T&A?
    No citrus, no milk, no ASA, straw drinking, coughing, yelling, gargling, nose blowing, plenty of fluids, soft bland food.
  26. What risk factors should a nurse educate parents about when talking about otitis media?
    Pacifiers (gone by 10 months), bottle feeding, second hand smoke, day care, anatomical (Eustachian tube is shorter)
  27. What is the difference between AOM & OME in regards to what they are, symptom differences and treatment differences?
    • AOM: acute otitis media it has a rapid onset, effusion and infection, red or pale yellow, decreased motility of TM, TM full/bulging, dull, may be pus or perforation. Tubes for treatment, antibiotics
    • OME: Otitis media with effusion (Fluid) is fluid with no signs of infection, fluid middle ear, orange discolored membrane, immobile TM, bubbles, TX with antihistamines.
  28. What post op instructions should parents be given after myringotomies with insertion of tubes in regards to activity, ear drainage, diet and temperature?
    Pain is minimal and can be controlled with Tylenol, children may run a low-grade fever-100 degrees for one or two days following tube surgery, return to activity when feels up to it, will see an increase in drainage.
  29. Why are contact sports discouraged with a diagnosis of mononucleosis?
    Possible spleen rupture
  30. What is a typical type of cough with croup?
    Barking cough, inspiratory stridor
  31. Is acute epiglottis an emergency?
    Yes because of rapid onset
  32. What is the typical noise made of these children (acute epiglottis)?
    Inspiratory stridor
  33. What other symptoms do they exhibit (acute epiglottis)
    Sore throat, pain, tripod position, retractions, mild hypoxia, distress.
  34. What is the key nursing action to be taken if a child comes into the ED with symptoms of acute epiglottis?
    Maintain open airway, do not use tongue blade could cause airway to close.
  35. What is the priority nursing assessment and management for a child with croup (LTB)
    Maintain airway management, hydration
  36. If the child is hospitalized with croup and is having respiratory difficulty do you want the parents with the child in the hospital/ED and why or why not?
    Yes to help lessen the childs anxiety
  37. What treatments would be used to treat croup at home and what should the parent be watching for to know if they should call the doctor or go to the hospital?
    Humidity, if struggling to breathe, retractions, stridor
  38. How contagious is RSV and is isolation required in the hospital?
    Very contagious, Cough up to 3 ft, skin 20 mins, Kleenex 30 mins, surface 24 hrs. Contact Isolation required.
  39. Can we prevent RSV? If so how and how would it be done?
    Hand washing and synagis (RXV antibodies) which is an injection for children under 2
  40. How are PERF's used to manage asthma?
    Peak expiratory flow rate= detecting changes or trends in asthma control
  41. What is atopic march or the allergic triad in regards to asthma?
    Progression- Eczema, cough, and congestion, asthma
  42. What is the pathophysiology surrounding asthma?
    Allergen exposure-histamine response-bronchoconstriction-inflammation-respiratory acidosis-dehydration
  43. What type of chromosomal abnormality is Cystic Fibrosis?
    Autosomal recessive "Recessive" means that two copies of the gene are necessary to have the trait, one inherited from the mother and one from the father. 25% chance with each subsequent pregnant to passing it on.
  44. How would we educate parents who passed the disorder to the child and how they could tell if it would be passed to successive children?
    Both parents are carries of the defective genes. There is a 25% chance a child will be affected, a 25% change a child will not be affected and a 50% chance of the child being a carrier. Prenatal and carrier testing are available
  45. How is CF diagnosed?
    72 hr stool for fat and trypsin, Immunoreactive Trypsinogen Assay, sweat rest, prenatal and carrier testing
  46. What is the pathophysiology of CF?
    • Low or missing CF transmembrane regulator, disturbance in Cl ion, transfer in sweat and mucus, increased viscious mucus, respiratory changes, gastrointestinal changes, reproductive changes, pancreatic changes (enzymes can't reach duodenum, growth problems, sperm can't get through cervix)
    • A sweat producing chemial is applied to a small area of skin, The collected sweat is then tested to see if it's saltier than normal. Genetic testing: DNA samples from blood or saliva can be checked for specific defects on the gene responsible for CF.
  47. What is the patho of CF?
    Chloride get trapped in epithelial cell membrane in mucus and sweat glands, increased viscious mucus, respiratory changes, gastrointestinal changes, reproductive changes, decreased fertility, pancreatic changes.
  48. What is the cornerstone of pulmonary therapy? (what is the priority treatment regimen)? How should this treatment be performed?
    ACT's (airway clearnace therapies) Percussion,, and postural drainage, positive expiratory pressure (PEPS), active cycling of breathing technique, atogenic drainage, oscillatory PEP, high frequency chest compressions, and exercise, twice daily (on rising and evening)
  49. When educating parents about giving the enzyme mucolytic, pulmozyme, when should it be given to most effective?
    In the morning, with meals and snacks
  50. Why is inhaled Tobi given?
    To decrease the amount of bacteria in the lungs
  51. What type of diet should CF children be on?
    High calories, diet including protein, carbs, and fats, free use of salt
  52. When giving pancreatic enzymes such as Pancrease to children with CF how is it to be given?
    Before each meal or snack within 30 min of eating
  53. When a child is admitted with gastroenteritis, nurses must make certain they are  not missing a diagnosis of appendicitis. What symptom would indicate a possible appendicitis?
    N/V, loss of appetite, low grade fever, constipation, inability to pass gas, diarrhea, Abdominal swelling, pain in the peri-umbilical that radiates down to rt abdomen
  54. What is rotavirus vomitting?
    Followed by extremely watery and forceful stools
  55. When is rotavirus communicable?
    before diarrhea and 20 days after onset
  56. How do we prevent rotavirus?
    Universal precautions, good hand washing
  57. What are the symptoms of dehydration?
    Weight loss, change in consciousness, decreased skin elasticity, increased HR and respirations, sunken eyes and fontanels, thirst, dry mucous membranes, no tears, oliguria, anuria
  58. How do we treat dehydration?
    At home with fluid or IV in hospital
  59. What percentage of weight loss indicate each level of dehydration?
    • 3-5% mild
    • 6-9% moderate
    • >10% severe
  60. What is ORT?
    Oral replacement therapy used to treat mild or moderate dehydration, electrolyte solution with glucose
  61. What is the goal for home care to rehydrate a child?
    To rehydrate in 4 hours 40-50 cc/kg
  62. In providing rehydration to children, what nursing assessments and care should be done?
    Observation, capillary refill, fontanel, thirst, skin turgor, vital signs, accurate I&0, skin, body weight
  63. What measurement should be done if an infant is receiving potassium IV for Diarrhea induced dehydration?
  64. What is a BRAT diet?
    Banana, rice, applesauce, toast or tea
  65. If school age child has been rehydrated and ready to start food what types of food should be offered and what should be avoided?
    Soft bland food when rehydrated. No roughage, spicy, or fried foods or milk.
  66. How do we figure fluid maintenance requirements for infants and children?
    First 10 kg x 100 + 2nd 10 kg X 50 + rest of Kg X 20= # for 24 hours intake
  67. What intestinal condition can occur in an infant who has hirschsprungs disease and how should the nurse assess for this?
    Constipation, intestinal obstruction, stool softners, mineral oil enema, auscultate bowel sounds
  68. What is the patho surrounding  surrounding hirschsprungs disease?
    Congenital, 90% males, a disorder of the abdomen which occurs when all or part of the large intestine has no nerves and therfore cannot function, part of the colon lacks the nerve bodies that regulate the activity of the colon. The affected segment of the colon cannot contract and therfore pass stool through the colon, creating an obstruction
  69. After surgical correction for hisrschsprungs disease what important nursing assessment should be completed?
    Asucultate bowel sounds, check for bowel functions
  70. What is the difference between GER adn GERD?
    50% of newborns have GER, it becomes a disease when complications develp, dysphagia, bleeding, failure to thrive
  71. What is the gold standard in diagnosing Ger/D in infants?
    24 hour intraesophageal pH monitor study.
  72. What treatment can be used for an infant with GER/D?
    head up or prone 1 hr after feeding, thick formula, hypoallergenic formula, small frequent feedings, burp well, medication to decrease acid or increase GI motility
  73. What types of feeding adaptions should nurses teach parents with infants who have cleft lip/cleft palate?
    Enlarge nipple, stimulate suck, swallow, rest
  74. What is the association between cleft lip/palate and otitis media?
    those with cleft or lip palate or more prone because of the opening and bacteria going straight in.
  75. Postoperatively after a cleft lip, cleft palate repair a child may need elbow restraints. What care is given by the nurse in caring for this child regarding the restraints?
    Take off periodically
  76. What are the long term complications of cleft lip/palate?
    Speech, hearing, orthodontia (braces) and body image (scars)
  77. The nurse should suspect pyloric stenosis with what type of symptoms?
    Projectile vomitting, hunger, wt loss, dehydration, distended upper abdomen, olive shape mass right of umbilicus
  78. What type of fluid and electrolyte imbalance can the symptoms of pyloric stenosis cause?
    upper Gi shows severely decreased or No fluid going into intestines
  79. What are the feeding and positioning guidelines for a child who is post op after repair of pyloric stenosis?
    Small progressive feedings 4-6 hours after surgery, glucose H20 first, right side and head up after feeding, minimal handling
  80. What is intussusecptions and what is the classic triad of symptoms in the condition?
    Acute intestinal obstruction, bowel slides inside itself, SX: vomitting, pain, redu currant jelly looking bloody stool.
  81. Where is the PMI for an infant?
    3rd to 4th intercostal space near the sternum
  82. What is the PMI for a child?
    5th left intercostal space in the midclavicular line
  83. What heart rate is considered bradycardia for an infant? Child?
    Below 100 for infant below 60 for child
  84. What are indicators of cardiac dysfunction in children?
    Poor feeding, fast breathing, heart, Failure to thrive, poor weight gain associated with heart disease
  85. If a young child does not have a appetite due to a cardiac defect how might you get them to eat?
    small meals
  86. Review cardiac catherization. What should be included in pre-op teaching for school aged child?
    Describe or visit the cath lab, explain the procedure chronologically, emphasize what they will see, hear and feel. Bring earphones because the equipment is loud. May make up picture books, videos and tours.
  87. What should be included post-op teaching for school aged children in cardiac catherization?
    Pulses especially below cath site, for equality adn symmetry (pulse distal from cath site may be weaker for the first few hours but should gradually increase) Temp and color of affected extremity-because coolness or blanching may indicate arterial obstruction. Vital signs-taken frequently 15 mins with special emphasis on heart rate, which is counted for 1 full min for evidence for dysarrhythmia or bradycardia. BP espcially for HTN (may indicate hemorrhage for cardiac performance or bleeding at the site of initial cath) Dressing: for evidence or hematoma formation in the femoral or anticubital area. Fluid intake: both IV and oral, to ensure adequate hydration (blood loss in the cath lab, child NPO's status, diuretic actions of dyes can put child at risk for hypovolemia or dehydration) Blood glucose levels-for hypoglycemia, especially in infans, who should receive dextrose-containing IV fluids.
  88. What types of home care instructions should be given after cardiac cath?
    Remove dressing 24 H post op, keep clean and dry, no baths, watch for infection, may atend school, but no heavy activity, Regular diet, Tylenol
  89. What is the most common congenital heart disease
    Ventricular Septal Defect?
  90. What two openings close at or shortly after birth that are present in prenatal circulation?
    Ductus Arteriosus closes 10-15 hrs after birth, Foramen Ovale closes at birth due to increase pressure in cardiac chamber
  91. Defect present in Patent Ductus Arteriosus
    Failure of ductus arteriosus to close within first weeks of birth
  92. Defect present in Ventral Septal Defect?
    Abnormal opening between right and left ventricles
  93. Defect present in Tetralogy of Fallotf
    Ventricular septal defect and pulmonic stenosis and overriding aorta and right ventricular hypertrophy
  94. Defect in Coarctation of the Aorta
    Narrowing of the aorta near the insertion of the ductus arteriosis
  95. symptoms differences between Patent ductus arteriosus
    asymptomatic signs of CHF, machine like murmur, widened pulse pressure, bounding pulses
  96. symptoms difference between Ventral Septal Defect
    CHF common, loud holosystolic (hollow) murmur
  97. symptoms difference between Tetraologyof Fallot
    , may be acutely cyanotic @ birth or mild cyanosis that progresses, characteristic moderate systolic murmur “blue spells or tet spells”
  98. symptoms difference between Coarctation of the Aorta
    high blood pressure and bounding pulses in the arms, weak or absentpulses with cool lower extremities and lower blood pressure, infants maydeteriorate quickly with severe acidosis and hypotension, older children dizzy,headache, fainting, epistaxis (nose bleeds)
  99. Right to left shunting in the heart will carry an air embolus or clot directly where
    Heart or Brain
  100. What are tet spells or blue spells and what defect do we see those with?
    Tetrology of Fallot, acutely cyanotic at birth or mild cyanosis thatprogresses, characteristic moderate systolic murmur
  101. What nursing interventions can a nurse use to decrease the cardiac demands in an infant/childwith congestive heart failure?
    Decrease cardiac demand, remove excess sodium and fluid, improve cardiacfunction, family support.
  102. When a child is receiving diuretics for congestive heart failure, what nursing care/management and teaching for the parents are you going to provide
    Assess heart rate don’t give if under 100 in infant and under 70 forchild, adolescent under 60, watch for signs of toxicity N&V, Dizzy, HA,weakness, don’t give with food, give water after
  103. What precautions should be taken when administering Digoxin to an infant/child?
    Safe dosage calculations, rarely get more than 1 mL, assess heart rate
  104. How are nurses going to make it a priority to help parents who have children with heartdefects to prevent endocarditis?
    Identify high risk invasive procedures, prophylactic penicillinadministration, educate parents of children at risk.
  105. What are the clinical manifestations of endocarditis
    Slow, muscle aches, fever
  106. What are the different types of shock?
    Hypovolemic: blood volume/fluid volume lossCardiogenic: heart damage (MI)Distributive: anaphylactic/septic shockNeurogenic: arterial dilatation (BP drops)Sequesteration crisis: sickle cell anemia (blood pools in liver/spleen)
  107. What are Hgb levels with mild, moderate and severe anemia in children?
    Mild: 9.5-11 g/dl Moderate: 8-9.5 Severe: less than 8....2 year old: Hct less than 33, Hgb less than 11
  108. What are the symptoms of anemia?
    ALL TYPES: Pallor, tachycardia, HA, fatigue Increased blood loss: cool skin, decreased peripheral pulses, decreased BP Increased RBC destruction: dark urine, icteric sclera, enlarged spleen/liver Decreased RBC production: SOB, muscle weakness, heart murmur, pica
  109. Know the etiology of iron deficiency anemia and why toddlers are at higher risk forit.
    Caused by inadequate supply of dietary iron, impaired absorption, increase in the bodies need for iron, affected synthesis of Hgb, excessive milk. How can we prevent it? Maternal: poor maternal iron and cross over during pregnancy so encourage iron supplements for pregnant moms. Decrease amount of milk (24 ounces/per day)
  110. What is the medical management of mild iron deficiency anemia?
    Dietary counseling and administration of oral supplements Prophylaxis: 1-2 mg/kg/d (up to 15 mg/ d)Mild to moderate: 3-6 mg/kg/d (in 1-2 doses)Severe: 6+ mg/kg (3 doses) *may need transfusion of packed RBC’s
  111. What types of nutritional counseling could you offer to parents of a toddler with iron deficiency anemia to increase effectiveness of treatment?
    Encourage Fe in diet: Infants: Give iron-fortified cereals/formula, Toddlers: decrease milk intake by bottle (no more than 24 ounces of milk/day), Adolescents: better eating habits (red meat, beans, raisins, green veggies, tuna, dried fruit. Limit caffeine, it interferes with iron absorption).Give oral iron with orange juice or Vitamin C (NOT MILK) on empty stomach. Vitamin C increases absorption of iron.
  112. Review nursing implications when giving oral iron supplements to children.
    Give with citrus juice, empty stomach, with a dropper or straw, rinse teeth (will stain), causes tarry green stools, constipation. Comes in drops, elixir, tabs. IM iron given Z track, don’t massage site (causes discoloration to skin).
  113. What type of hereditary disorder is sickle anemia?
    Autosomal recessive disorder (hereditary hemoglobinopathy)
  114. What does that mean as far as risk of a child being affected? Sickle Cell Anemia
    25% chance of getting it.
  115. What is the pathophysiology of sickle cell anemia?
    Partial or complete replacement of normal Hgb with abnormal hemoglobin S (Hgb S).Hemoglobin in RBCs are elongated “sickle” shape, rigid and obstruct capillary blood flow, lead to engorgement and tissue ischemia (clump prevents O2 from getting through), hypoxia occurs and causes sickling.
  116. What are precipitators of sickle cell crisis’?
    increased O2 demand, altered transport of O2, trauma, infection, fever, increased need O2/fluid, physical/emotional stress, increased blood viscosity r/t dehydration, hypoxia r/t high altitude, poorly pressurized airplanes, hypoventilation, vasoconstriction due to hypothermia, alcohol, smoking, acidosis
  117. What are the main objectives in the treatment of sickle cell disease crisis?
    Hydration (oral or IV), rest (minimize energy expenditure/O2 use), electrolyte replacement, analgesics (Morphine) for severe pain from vasococlusion, blood replacement, antibiotics to treat infection
  118. During a sickle cell crisis what nursing interventions should the nurse take regarding hydration?
    Oral or IV Hydration, electrolyte replacement
  119. What is a vaso-occlusive crisis in a child with sickle cell crisis and what medication can be given to decrease the frequency of the crises?
    painful, clumping of cells, ischemia, infarction, common in joints.signs: fever, pain, tissue engorgement.
  120. What is the main side effect with the medical management of blood transfusions with Thalasemia major?
    hemosiderosis (iron overload)
  121. hemosiderosis (iron overload) What can this side effect lead to?
    cardiac failure
  122. cardiac failure  How can this side effect be prevented?
    treat with iron chelating drugs such as deferoxamine (Desferal): sub Q by pump for 10 hours, deferasirox (Exjade): tablet 1 daily, dissolve in orange juice without food. Binds excess iron for excretion by kidney
  123. What nursing care management should be taken when attempting to prevent hemorrhage in children with leukemia and a low platelet count?
    No rectal temps, soft foam brushing, no picking nose
  124. What are the symptoms of leukemia when there is bone marrow dysfunction involvement?
    Anemia, infection, bleeding, severe joint pain, enlargement of spleen, liver, lymph glands, increased intracranial pressure (HA), pallor, fatigue, fever, petechiae, irritability, Wt loss, anorexia, weakening of bone and fractures.
  125. One of the treatments for leukemia in children is chemotherapy. What side effects should be expected?
    Aplastic anemia, Infection, N&V, anorexia, mucosal ulcers, cystitis, FTT, Neuropathy, constipation, ototoxicity, dec. cognition, delayed development, Alopecia, photosensitivity, renal failure, hepatotoxity, infertility
  126. When there is alopecia, what education should the nurse provide in regards to the hair coming back in?
    Hair may come back in thicker, darker and curlier
  127. With HSCT, what is the goal of therapy?
    Establish healthy cells in both malignant and nonmalignant disease
  128. What is lymphoma?
    Tumor in lymph system
  129. Tumor in lymph system What are the symptoms?
    Enlarged lymph nodes, fever, wt loss, night sweats, cough, abdominal discomfort, anorexia, nausea, pruritis
  130. Tumor in lymph system What is the expected treatment?
    Early stage Survival rate > 90%, Advanced stage survival rate b/w65-75%
  131. What type of genetic disorder is Hemophilia A and what does this mean as far as passing onthe gene to the child?
    Sex linked recessive, mom carries, pass on to son 50/50 change of getting disease
  132. What factors are deficient with Hemophilia A & B, and Von Willebrands?
    A: deficiency in Factor VIII, B: deficiency in Factor IX and IIX, VonWillebrand: Deficiency in vWB factor and mild factor VIII
  133. What is hemarthrosis and what is the treatment?
    Bleeding into joint spaces, Factor VIII given
  134. What blood test for coagulation can assist us in diagnosing Hemophilia A
    PTT reveals deficiency factors 7-12
  135. If a child with hemophilia sustains a minor injury such as falling on his arm or leg, what treatment should be done first by the caregiver?
  136. Know how to mix and administer Factor VIII. What are the nursing implications?
    Administer immediately after constituted (IV Push), let dilutent  run down sides of vial, don’t shake or heat. Monitor BP, pulse, and respirations. If tachycardia occurs, slow or stop infusion rate and notify physician.
  137. What are the recommendations for treatment of a pregnant women with HIV?
    antiretroviral prophylaxis
  138. What is the most common complication of HIV in children?
  139. What is the treatment for aninfant that tests negative for HIV but the mother is HIV positive?
    Antivirals  for 6 weeks (Zidovudine & Nevirapine)
  140. Can VZV and MMR immunizations be given to a child who is HIV positive?
    Yes as long as their immunity is not low and are not running a high fever or ill
  141. What is acute chest syndrome in regards to sickle cell crisis, what are the symptoms, and what is the first nursing action that should be taken when the symptoms are recognized by the nurse?
    Pneumonia like symptoms coughing, wheezing, hypoxia, dyspnea, call Dr. right away...will need order for blood transfusion and antibiotics