Peds Test 2
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The abnormal "sucking in" of the space between the ribs or under the sternum:
(?) trachea rises during inspirations and lowers during expirations
__________ is an obstructive respiratory process characterized by periods of exacerbation and remission.
What is the most common chronic illness in childhood?
Asthma is caused by a:
hypersensitivity immune response
Asthma usually manifests by age ___.
Commonly affects which gender?
Asthma flare-ups are usually associated with:
Ways to allergy proof the house:
- avoid odors and sprays
- have air ducts cleaned annually
- wash bed linens every 7-10 days in hot water
- keep child indoors while lawn is being mowed
- wet-mop bare floors weekly
- use washable window shades
- avoid using cellar/basement as a play area
- irritants (tobacco/wood smoke, odors, sprays)
- cold air
- strong emotions: (fear, anger, laughing, crying)
- foods: (nuts, milk, dairy)
- conditions: (GERD, tracheoesophageal fistula)
Ways to prevent URI (infection control):
- wash hands
- avoid smoke and Lysol sprays
- in the hospital: contact precautions and limited contact with others; do not share meds from others
The most common, serious, chronic, life-threatening, genetic disorder of US Caucasian children:
common systems affected:
- Cystic fibrosis
- common systems affected: respiratory & GI
- airway clearance: mucus clearance device (flutter device) & somersaults/headstands therapeutic for resp system; teach infection prevention/home care such as chest PT, breathing exercises
For a patient with cystic fibrosis, you should direct tx towards organs involved including:
- airway assessment
- freq resp assessment
- isolation if infection
- antibiotics after C&S, CPT, & postural drainage
- resp tx's (aerosols, Pulmozyme)
- humidified O2 via croupette or mask
- pulse ox
- monitor WBC
- pancreatic enzymes w/ meals/snacks
- high cal/high protein diet
- daily weight
- electrolyte levels (Na & Cl)
- provide salt w/ meals prn
- PO & IV fluids
- tx constipation/fecal impaction prn
An inflammatory viral infection of the bronchioles commonly caused by RSV:
- characterized by: mucosal edema, increased mucus secretion, bronchiolar obstruction, and over distention of the alveoli
- s/s: begins as URI, then apnea, fever, shallow resp, cough, tachypnea, dyspnea, tachycardia, irritability, fatigue, feeding difficulty
- dx: nasal wash/swab, for RSV (specimen on ice & immediately transported to lab), testing for serum RSV antibodies, CXR, WBC, pulse ox
RSV tx is used for:
- antiviral med used for severely ill infants or infants who have heart/lung problems that place them at high risk for serious complications
- admin. by fine-droplet aerosol mist while infant is in mist tent; leaves white mist in tent
- if infant is on vent, must monitor vent tubes (may be warped by ribavirin)
- teratogenic effects reported
- can cause preccipitation on surface of plastics
- caregivers w/ contacts may develop conjunctivitis
- turn off neb to allow mist to settle before opening tent
__________ causes a sudden, unexpected death of an apparently healthy infant.
Infants at higher risk:
Most infants affected have been sleeping __________.
- 2-4 months
- male, Native American/African Americans, low birth weight, lower SES, mother is less than 20, mother smoked during pregnancy, passive smoke exposure, multiple births, infants not firstborn, sibling of SIDS victims
CPR for infant:
- CAB- circulation, airway, breathing; 30:2
- 2 rescuers- 15:2
What is the priority for a pt with croup?
What should you have close by?
- airway management (ABCs)
- intubation/emergency equipment
What could a parent do at home to help manage the symptoms of croup?run hot water in bathroom w/ door closed to create steam; let child inhale moist air for 2 mincool mist humidifier at bedsideno improvement? take to ER
- run hot water in bathroom w/ door closed to create steam; let child inhale moist air for 2 min
- cool mist humidifier at bedside
- no improvement? take to ER
__________ is an obstructive airway infection caused by swelling of the tissue above the vocal chords characterized by rapidly occurring inflammation of the epiglottis.
It is a life-threatening __________!
Often caused by:
It is not common, but when it does occur, it most frequently affects children ages __________ and occurs any season.
When does this usually happen? (?)
- medical emergency
- Hib & PCV (vaccinations decrease incidence)
- at night
Passive smoke effects:
- ↓ birth weight/growth rate
- ↑ risk of SIDS
- ↑ # of resp/ear infections
- ↑ stillbirths/premature births
- ↑ asthma s/s & attacks
- precursor to chronic lung disease
A colorless, odorless, tasteless gas that causes injury and death by interfering with cellular respiration:
How does carbon monoxide poisoning occur?
- interferes w/ cellular resp
- enters bloodstream & combines w/ hemoglobin which causes tissue hypoxia.
What is responsible for over 1/2 of all fatal poisonings in the US?
What are sources of CO?
- poorly ventilated vehicles
- gas lamps, stoves, grills
The failure of eyes to direct gaze at the same object simultaneously can be defined as:
Strabismus is caused by an imbalance of __________.
A pt with strabismus may appear to be __________.
Inward deviation (toward the other eye) is:
Outward deviation (turns away from the other eye)
__________ is a common cause of the "lazy eye"
If a pt has strabismus, what could you do to try to help the affected eye to improve through use?
- cover unaffected eye with patch
- eye exercises
Strabismus may require __________ before the child starts school.
Early tx of strabismus is necessary to prevent:
amblyopia and blindness
What is the newer tx for strabismus?
inject botulinum toxin in small doses to weaken rectus muscle to align
__________ impairment is mistakenly labeled as inattentive/ less intelligent.
Hearing assessment starts at __________ by assessing the __________ reflex.
- startle (Moro) reflex
Hearing loss that involves mechanical interference with transmission of sound (e.g. ear wax, otosclerosis, infection); most common
Hearing loss that involves inner ear problems like damage to the organ of Corti, optic nerve, or brain:
How to communicate with a pt with hearing loss:
- approach with smile
- face child while speaking; stand close
- keep hands away from face
- no gum/candy
- speak toward unaffected ear
- eye level
- eye contact
- shorten sentences
- speak clearly without over-enunciating
- sign language
Inflammation and infection in the middle ear:
What are some s/s of otitis media?
- severe pain in ear/earache
- pulling/tugging at ear or rolling head side to side
- interference in hearing
- high fever (febrile seizures)
- feeding problems
Spontaneous __________ of the eardrum may cause a decrease in s/s of otitis media and drainage from the ear.
__________ is the microscopic incision to relieve pressure from fluid buildup in the middle ear. (incision heals better than tear)
Complications of strep throat:
- rheumatic fever
- meningitisotitis mediasinusitis
- peritonsillar abcess
T&A Post-op management:
- observe for hemorrhage
- keep throat moist
- liquid diet (no red dye)
- rinse mouth after milk products
- no straws
- no citrus fruits, carbonated beverages, hot fluids, rough foods, sour liquids
- avoid gargling, coughing, clearing throat, sneezing, blowing nose, and overexertion
- may give gum but no Aspergum
- no aspirin
Over-use/long term use of nasal decongestants can lead to __________ congestion.
Diaper rash prevention:
- frequent diaper changes
- keep skin clean and dry
- use mild soap when cleansing/rinse well
- disposable diapers are best
- avoid fastening diaper too tightly
- rinse all baby clothes/cloth diapers throughly to decrease irritants
- avoid overdressing/over-warming baby
Eczema: 4 tx goals:
- relieve pruritus: avoid irritants, tight clothes, overheating; admin colloid baths, dry method vs wet method
- hydrate skin: fluids, topical emollients, room humidifier, baths with oil
- decrease inflammation: topical steroids, hypoallergenic diet- add one food at a time, severe cases- antihistamines or mild sedative
- prevent/control secondary infection: hadnwashing, good hygiene, nails trimmed short and clean, elbow restraints prevent scratching, antibiotics as needed
Eczema tx: dry method vs wet method
- dry method: infrequent bathing area, apply cetaphil
- wet method: frequent baths, cetaphil, moist compress
Eczema tx: colloid bath
A staph/strep skin infection characterized by macules and ruptured vesicles that ooze and form honey-colored crust around the mouth and nose is:
If impetigo is caused by strep, you should monitor the __________ and __________ closely.
heart and kidney
A pt with impetigo should be put on contact precautions because it is __________.
Impetigo tx involves careful cleansing to remove __________ tid-qid and __________ ointment if it is ordered.
What is the priority of the emergent phase of a burn?
ABCs, keeping alive, prevent shock, prevent resp distress, initial wound assessment/care, detection and tx of injuries, fluid therapy
What is the priority in the acute phase of a burn?
wound care/closure, prevent infection, prevent/tx complications, nutritional support, grafting
What is the priority in the rehab phase of a burn?
prevent scars/contractures, PT/OT/rehab, functional and cosmetic reconstruction, psychosocial counseling
3rd and 4th degree burns need __________ to heal.
The Parkland formula for fluid resuscitation:
- 4 mL X wt in kg X % of body burned
- monitor sun/UVR exposure
- long sleeves
- high SPF lotion
- avoid sun between 10a-4p
Warning: Administer O2 with caution to children because high concentrations may lead to:
carbon dioxide narcosis & retinopathy
A 1 year old has about ___ teeth.
__ above and __ below.
You can use the -6 rule up to __ months of age.
The Academy of Pediatrics Dentistry recommends that the 1st visit occur by the age of __, but most children begin seeing a dentist between 2 and 3 years. Healthier baby teeth=healthier permanent teeth.
__________ is a normal response to a new baby in the house.
Examples of behavioral patters that may happen when a new sibling arrives:
- temper tantrums
- breath holding
- thumb sucking
- biting or pinching
Car seats: infants to 1 year & 22 lbs seats should be:
facing backwards and in the middle back seat
Car seats: 22 lbs & up should be in a
forward car seat
Car seats: the youngest child should be in the __________.
The posterior (triangle) fontanel should be closed at __ months.
The anterior (diamond) fontanel should be closed around __ to __ months.
What are some common allergens in children?
- cow's milk
- citrus fruits (strawberries, oranges, tomatoes)
Based on a 1,200 cal diet:
- Grains: 4 oz
- Veggies: 1½
- Fruits: 1 cup
- Dairy: 2 cups
- Protein: 3 oz
Piagets theory: __________ stage.
- preoperational stage
- egocentrism, concrete thinkers, magical thinking
Freud's theory: __________ stage.
Erikson's theory: __________ stage.
- autonomy vs shame and doubt stage
- limit choices
Kohlberg's theory: __________ stage.
- moral stage
- egocentric point of view, tests boundaries, don't know the difference between right and wrong
Toilet training begins at about __ to __ months.
- voluntary control of anal and urethral sphincters beginning at about 18-24 months
- bladder control and myelin sheath not fully developed until about 1 1/2 -2 years of age
- must be willing to sit on the potty for several minutes at a time
- use a potty chair or standard size toilet with a stool for toddler to put feet on to feel secure
- 5-10 min practice sessions
- bowel training usually easier
- hand washing
- praise for going and trying
- do not punish for accidents
- frequent reminders and trips to the bathroom
- more consistency the easeir routine will be and the toddler will adapt
What is the age range of a toddler?
2 years of age:
A toddler gains about __ to __ lbs a year.
A toddler's birth weight is quadrupled by __ years of age.
Separation anxiety and stranger anxiety is at its peak in __________
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