Peds Exam 1

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Peds Exam 1
2015-02-08 00:55:33
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  1. What is it called when light rays focus posterior to retina resulting in an inability to focus on near by objects
  2. What is the normal age range for kids who may have hyperopia
    up until age 8-9
  3. What is it called when light rays focus anterior to the retina resulting in an inability to see objects far away
  4. What is far-sightedness
  5. What is near-sightedness
  6. At what age does myopia usually develop if a child is going to have it
    around age 8
  7. What would a child with myopia complain of
    headaches and may squint
  8. What is inward deviation of the eye (cross-eyed)?
  9. What is wall eyes?
  10. What are the signs and symptoms of a child with strabismus
    • eyes appear misaligned
    • may only occur when child is tired
    • Squinting/frowning when reading
    • Closing one eye to see
    • Trouble picking up objects
  11. What diagnostic tests are used to detect strabismus
    • Corneal light reflex
    • cover-uncover test
  12. What is the goal in treating strabismus
    Prevent amblyopia
  13. What types of treatment help prevent strabismus from turning into amblyopia
    • Occlusion therapy 1-2 hrs/day
    • Compensatory lenses
    • Surgery of rectus muscles
    • Eye drops to cause blurred vision of good eye
    • Prisms
    • Eye exercises
  14. How do you perform the corneal light reflex
    • Position child for test (if glasses, wear)
    • Hold target object/penlight 14-16 in from eye
    • Use object to attract childs attention
    • Place penlight directly above or resting on object
    • Shine light at center of forehead directly above child's eyes
    • Light should be symmetric
  15. What causes possible pseudo-strabsimus in infants? What ethnic group is this more common in
    • epicanthal folds
    • Asian children
  16. What is reduced visual acuity, inability to focus one eye as well as the other causing the child to see a blurry image
  17. What is the most common cause of Amblyopia
    Untreated strabismus (turning out)
  18. Name 3 types of amblyopia
    • strabismic
    • deprivation
    • refractive
  19. What type of amblyopia develops when eyes are not straight? Brain turns off the eye that is not straight
  20. What type of amblyopia is caused by cataracts or similar conditions that deprive the eye of image, can affect both eyes
  21. What type of amblyopia occurs when there is a large of unequal amount of refractive error? Brain will turn off eye with more farsightedness or more astigmatism
  22. What is the second most common form of blindness
    Retinopathy of Prematurity (ROP)
  23. When would ROP occur in the 12% of infants that have it
    23-26 weeks gestation
  24. What is abnormal blood vessel growth that occurs from exposure amount of oxygen that produces hyperoxima
  25. What are the risk factors for ROP
    • Infants <28 weeks gestation
    • Weight <3.5 lbs
    • White infants
  26. What is the treatment for 90% of infants with mild ROP
    They do not require treatment
  27. When is screening for ROP
    4 weeks of age
  28. What does the stage depend on for ROP
    degree of involvement
  29. What are the stages for ROP
    1 (mild) to 5 (severe)
  30. What does ROP put infants at a higher risk for
    • retinal detachment
    • myopia
    • strabismus
    • amblyopia
    • glaucoma
  31. What is the treatment for ROP
    • laser or oryotherapy
    • surgery
  32. How can ROP be prevented
    Keeping saturation in target range
  33. How do infants up to 6 months breathe?
    nose (don't know how to mouth breathe)
  34. Difference in tonsil size for child verses adult
    child's are relatively large
  35. What is the difference of eustachian tube in child verse adult
    shorter, wider, and more horizontal in kids
  36. When is auditory nerve function mature?
    5 months
  37. What are the size of the ear canals in children
    • external: small at birth
    • internal/middle: large at birth
  38. What is inflammation of the MIDDLE ear sometimes associated with infection
    Otitis Media (OM)
  39. What percent of infants have OM by 1 year? By 7 years?
    • 70
    • 93
  40. What is Otitis media often preceded by?
    Upper respiratory infection
  41. What is caused when tissues of the eustachian tube swell and air that usually flows into the middle ear is blocked and air is reabsorbed into the blood stream
    Otitis media
  42. Why is it easy for pathogens to be able to grow rapidly during a child with otitis media?
    Fluid is pulled into the former air space which provides the medium for growth
  43. What three organisms are usually behind infection of the tympanic membrane and the fluid behind it
    • Strep
    • H. Influenza
    • Moraxella
  44. What is otitis media with effusion (OME)
    Fluid on middle ear without infection
  45. A 1 year old child presents to the ER with a T: 100.5 with diarrhea and vomiting. During the intake, the mother states the child has been pulling on her ear and is very irritable. What disease does the nurse suspect and what treatment options should she anticipate?
    • Otitis Media
    • Antibiotics for 10 days (Amoxicillin)
    • Ibuprofen/tylenol for pain
    • Topical anesthetic drops (prescribed)
  46. What interventions will the nurse implement for a child with pain r/t inflammation and pressure on the tympanic membrane?
    • Oral analgesic or anesthetic drops
    • Have child sit up, position on pillow (unless infant)
    • Heating pad or warm compress
    • Chew gum or blow on balloon to relieve pressure in ear
  47. What interventions should the nurse implement for a child with infection r/t presence of pathogen
    • Encourage breast-feeding
    • Obtain hx of allergies to give antibiotics
    • Instruct parents to administer meds exactly as prescribed
    • Phone parents 2-3 days after initial evaluation
    • Examine ear 3-4 days after treatment with antibiotics completed
  48. What would you educate the parent's on for children to prevent otitis media
    • Avoid smoking in car/house
    • Avoid wood burning stoves
    • Avoid prolonged pacifier use
    • Never prop the bottle
    • immunize
  49. What is inflammation of skin in the external ear canal also known as swimmer's ear
    Otitis externa
  50. A 4 year old child reports to the ER. The mother states he has been scratching his ear and she noticed drainage. When the nurse pulls on the tragus, the child immediately cries out in pain. What condition does the nurse suspect and what interventions should she implement?
    • Otitis Externa
    • Remove dried, flaky skin cells and ear was using irrigation of Buraw's solution or NS if TM is intact
    • Steroid or antibiotic ear drops as prescribed
  51. What would the nurse teach the parent's to do in order to treat otitis externa
    • No swimming for 5 days
    • Consider ear plugs for swimming
    • after swimming, dry ear with gentle blow dryer
    • avoid cotton tipped applicators
  52. What interventions should be taken for minor cuts and abrasions to the Pinna of the ear
    • Wash with soap and water, rinse well and dry
    • Leave exposed to air if possible or apply bandage
  53. What intervention should the nurse implement to treat hematomas of the Pinna of the ear
    • Needle aspiration to drain and avoid fibrosis "cauliflower ear"
    • Apply pressure dressing
  54. What interventions should the nurse implement to treat cellulitis or abscesses of the pinna of the ear
    • Intermittent moist heat
    • antibiotics
    • possible surgery
  55. What interventions would the nurse implement for a child with a foreign body in the ear canal
    • Have child lie on back
    • turn head over edge of bed (affected sign down)
    • Wriggle the ear lobe and have child shake head
  56. What interventions would the nurse implement for a child with an insect in the ear canal
    • Shine flashlight in ear to attract insect
    • Instill a few drops of olive/mineral oil or alcohol
    • Gently irrigate ear
  57. What steps should be taken in case a TM is ruptured
    • Call PCP (child has persistent pain after a blow, injury, or insertion of foreign object)
    • Cover external ear loosely w/ sterile cotton or gauze
    • Give antibiotics if prescribed
  58. What is the visual acuity of a neonate
    20/100 to 20/400
  59. What is involuntary rapid eye movement and at what age is it common for children?
    • Nystagmus
    • 3-6 months of age or less
  60. What is turning inward of eyes, common up to a few months of age
  61. What occupies the larger portion of the orbit in infants and young children
  62. What is the visual acuity of a 2-3 year old
  63. What is the visual acuity of school-age children
  64. What is ophthalmia neonatorum
    conjuctivitis in neonates
  65. What causes ophthalmia neonatorum
    acquired from mother when passing through birth canal
  66. 6 year old presents to the clinic with swelling of the eye lid, red conjunctiva, muopurulent drainage. The child complains of itching, burning, and says his eyes hurt in the light. What does the nurse suspect he has and what interventions will she implement?
    • Conjunctivitis
    • Instill antibiotic drops as prescribed
  67. How will a nurse teach the parents to instill the antibiotic eye drops
    • wash hands
    • assure medicine is warm
    • remove drainage from eye
    • wash hands again
    • Lay supine with eyes closed
    • Gently pull down lower eyelid and drop drops into or apply thin ribbon of ointment
    • Allow eye to return to normal position
    • Have child keep eye closed several seconds
  68. When will nurse instill antibiotic for conjuntivitis for a neonate
    within 4 hrs after birth
  69. What would the nurse teach parents about preventing and caring for conjunctivitis
    • Strict hand washing
    • No school till 24 hrs on antibiotics
    • No shared towels
    • Teach child no rubbing eyes (mittens on infant)
    • How to instill drops
    • Cool compress to help itching
    • Remove drainage w/ clean/sterile, warm, moist cloth or gauze
  70. Name 3 types of hearing impairment
    • Conductive
    • Sensorineural
    • Mixed
  71. How does hearing impairments affect infnts and young children
    affects language development
  72. What signs and symptoms would be observed for a toddler or preschooler having a hearing deficit
    • communicate with gestures
    • little to no intelligible speech
  73. What signs and symptoms could be observed for school-age and adolescents who have a hearing impairment
    • sit close to TV
    • turn up volume loudly
  74. What is used to diagnose hearing impairment for children
    • otoscopic exam
    • tympanography
    • audiography
  75. What device is used for significant sensorineural loss or profound deafness
    cochlear implants
  76. What is an infection of the throat often involving tonsils, common in children 4-7 years of age?
  77. What is approximately 80% the cause of pharyngitis
    viral infection
  78. If pharyngitis is a result from a bacterial infection, what is the most common organism responsible
    group A beta-hemolytic streptococcus
  79. What is nasopharyngitis known as
    common cold
  80. What are interventions for viral pharyngitis
    • relieve symptoms
    • soft or liquid diet
    • no citrus juices or foods (burn/irritate)
    • Acetaminophen
  81. What interventions are used to treat bacterial pharyngitis
    • Analgesics (acetaminophen)
    • Antibiotics (Amoxicillin)
  82. What are the two major things to monitor and manage for a child that had a tonsillectomy
    • Pain
    • Bleeding
  83. What is the most common complication of a tonsillectomy
  84. What are signs that there is a complication of bleeding after a tonsillectomy
    • frequent or continual swallowing
    • vomiting of bright red blood
    • changes in VS (hypotension/tachycardia)
  85. What is the diet following a tonsillectomy
    • clear, chilled fluids when awake and alert
  86. How long is a sore throat expected following a tonsillectomy
    1 week post-op
  87. What do you educate parents on in caring for a child with epistaxis
    • humidify air (especially in winter)
    • Have child sleep with head elevated
    • No bending forward
    • No hot liquids
    • No excessive exercise or hot tub bath or shower for 3-4 days after episode
  88. What do you teach parent in regards to treating an active nosebleed
    • sit child in lap
    • Have child tilt head forward
    • Squeeze firmly above nostrils
  89. What is a disease directly transmitted, acquired from a person or vector by direct contact with body fluids or indirect contact with contaminated surfaces
    Communicable diseases
  90. What is any communicable disease caused by a microorganism
    Infectious diseases
  91. What vaccine involves a dead virus capable of inducing the body to make antibodies
    Killed virus vaccine
  92. What is a toxin treated by heat or chemicals to weaken the toxin effects but retain the ability to produce an antigen
  93. What is an organism genetically altered to produce an antigen
  94. What is an organism altered and joined with another substance to heighten immune response
  95. What is a foreign substance that triggers an immune response
  96. What are proteins capable of responding to an infection
  97. What is a bacteriostatic agent that was previously used in vaccines to prevent contamination? (No longer used except in the influenza vaccine b/c of possible association with brain and nerve damage)
  98. Name 6 adverse effects to vaccines
    • anaphylaxis
    • encephalopathy
    • Bacterial Neuritis
    • Chronic arthritis
    • Thrombocytopenia purpura
    • Death
  99. What are localized reactions to immunizations
    • redness
    • mild pain
    • swelling
    • induration
  100. What are systemic reactions of immunizations
    • fever
    • fussiness/irritiability
    • Malaise
    • Anorexia
  101. How long should the nurse observe the patient after an immunization injection
    15 min
  102. How long does the nurse apply pressure after immunization injection
    10 seconds
  103. What type of spray is used on the skin just before the objection
  104. What does the nurse do if 2 injections are required
    Give 2 simultaneously by 2 different people at 2 different sites
  105. What needs to be documented following an immunization injection
    • month/day/year
    • name of vaccine
    • manufacturer
    • Lot number & expiration date
    • name, title, address of person who adminstration
  106. Where does the nurse document the immunizations
    • medical record
    • parents record
  107. What should the nurse do following anaphylaxis after a vaccine
    • Have on hand epinephrine (1:1000)
    • Give 0.01 mL/kg IM (repeat q 10 min up to 3 doses)
    • Have emergency O2 and airway kit ready
  108. How often should the nurse recommend tylenol or ibuprofen following vaccination
    q 6 hrs for every 24 hrs
  109. What should the nurse teach the parents following their child's immunization
    • observe for localized reactions, ICE may help
    • fever, joint pain, muscle ache, fatigue common for a few days
    • A few hives around site might mean mild allergic reaction
    • Call 911 for flushed face, swelling of face, mouth, or throat, difficulty breathing or shock, change in consciousness
  110. What is the source of infection for varicella
  111. How is varicella spread
    • direct contact
    • airborne
    • skin lesions
  112. What is the incubation period for varicella
    14-21 days
  113. How long is a child with varicella contagious for
    Until all lesions are crusted over
  114. Child presents to the clinic with a t: 100.5 and is very irritable. The mother states the child won't eat and lays around. Upon further examination, the nurse notices a macular rash with pruritic vesicular lesions. What should the nurse suspect and what are her anticipatory interventions?
    • Varicella
    • Airborne/Contact precautions
    • Document on any admission to hospital
    • Isolate kids at home from others who are immunocompromised
    • meds to treat fever
    • oral antihistamine for itching
    • Oatmeal baths, Calamine lotion to skin
    • Trim fingernails
  115. What virus causes erythema infectiosum (5th disease)
    Parvo Virus B-19
  116. What age has the highest incidence of 5th disease
  117. How is 5th disease transmitted
    Respiratory secretions and blood
  118. What is the incubation period for 5th disease
    4-21 days
  119. 7 year old presents to the clinic with a lace-like erythematous, maculopapular rash sparing the hands and feet. The face appears red as thought they were slapped. The mother said the child had been sort of ill and got worried when she noticed the rash develop. What condition should the nurse suspect and what are her anticipatory interventions?
    • Erythema Infectiosum (5th disease)
    • Standard/Droplet precaution
    • Nonaspirin antipyretic
    • Oatmeal or Aveeno bath for rash
    • Rest and fluids
    • Stay out of direct sunlight or cover skin with light, loose clothing
  120. What is the main virus that causes influenza
    • Orthomyxovirus A, B, C
    • H1N1
  121. What months does influenza appear
    October to March
  122. Child presents to the ER with a t: 102.9, chills, runny nose, sore throat, malaise, aches, headache, anorexia, nausea and diarrhea. What does the nurse suspect and what are her anticipatory interventions
    • Influenza
    • Droplet/contact precautions
    • Good hand hygiene
    • Fluids/rest
    • Nonaspirin antipyretics
    • Antivirals (can cause n/v and worsen asthma)
  123. What type of influenza is most common in spring and summer
  124. How is H. Influenza transmitted
    direct contact with respiratory secretions or droplets
  125. What leads to H. Influenza
    URI invading bloodstream
  126. What severe illnesses can H. Influenza lead to?
    • Meningitis
    • Epiglottis
    • Pneumonia
    • Septic arthritis
    • Cellulitis
  127. What are complications of influenza in children
    • Otitis media
    • secondary infections
    • febrile seizures
    • encephalitis
    • pneumonia
    • croup
  128. What are nursing interventions for H. Influenza
    • Droplet precautions 24 hrs after initiation of antibiotics
    • Identify potential contacts and check immunization status
    • Antipyretics
    • Treat symptoms
  129. How is H. Influenza diagnosed
    • Blood
    • CSF
    • Middle ear aspiration culture
  130. How long would a child be on invasive H. Influenza
    10 days
  131. What medication is given prophylactally to protect others in household from H. Influenza
  132. What should the nurse teach family members about rifampin
    Turns urine and other bodily fluids orange and can cause stains
  133. What medication is given to reduce neurological damage from H. Influenza
  134. What causes Rubeola (measles)
  135. How is Rubeola transmitted
    • direct contact with respiratory droplets
    • Airborne
  136. What is the incubation period for rubeola
    8-12 days
  137. How long is the prodromal phase of rubeola
    3-5 days
  138. Child presents to the ER with fever, conjunctivitis, coryza, cough, anorexia, and koplik spots. What should the nurse suspect and what are her anticipatory interventions
    • Rubeola
    • Airborne precautions
    • Cool mist humidifier
    • Suction gently as needed
    • Nonaspirin pyretics
    • Antitussive for coughing
    • Dim lights, cover windows
    • Bedrest (diversional activities)
    • Elevate HOB
    • Avoid soaps, keep skin clean and dry
    • Small, cool liquids
    • blended or pureed food
  139. What type of bacteria causes meningcoccus
    Neisseria (gram-neg diplococcus)
  140. When does meningococcus usually present
    winter to early spring
  141. What age group is meningococcus most common in
    • < 2yrs
    • 15-18 yrs
  142. How is meningococcus transmitted
    respiratory droplets
  143. What is the incubation period for meningococcus
    2-10 days
  144. 16 year old presents to the ER with a t:101.3, chills, malaise, aches, vomiting and prostration (extreme exhaustion). Upon inspection, the nurse notices a petechial, maculopapular rash with slight progression to purpura. What should the nurse suspect and what are her anticipatory interventions?
    • Meningococcemia
    • Standard/droplet precautions (until 24 hrs on antibiotic)
    • Observe for shock/resp failure
    • Identify close contacts and provide prophylaxis
    • Educate about med side effects
    • Teach signs of illness and when to call dr
    • coordinate rehab for child
  145. What is the treatment for meningococcemia
    • blood culture, CSF, gram stain of lesion
    • IV penicillin 5-7 days
    • Aggressive ICU care to maintain airway and treat shock
  146. What medications are given prophylactically to close contacts of child with meningococcemia?
    • Rifampin
    • Ceftriaxone
    • Cipro
    • Z pack
  147. What are complications of meningococcus
    • Septic shock
    • Necrosis w/ gangrene and loss of tissue/limb
    • DIC
    • Hearing loss
    • Neuro disabillities
    • Scarring
  148. What causes pertusis
  149. What age group is pertussis most common in
    < 6 months
  150. A 4 month old is brought into the ER with nasal congestion, runny nose, and a cough that causes gagging, apnea, gasping, cyanosis, vomiting, and profuse mucous production. What should the nurse suspect and what are her anticipatory interventions
    • Pertusis
    • Droplet precaution until 5 days of antibiotics
    • Resp assessment
    • Monitor with pulse ox
    • Stay with child during coughing spells
    • Give oxygen if ordered
    • Have emergency equipment ready
    • provide humidification
    • Rest
    • Smell frequent feedings of desired food
  151. How is Pertusis treated
    • NP culture or PCR
    • Macrolide antibiotics
  152. What are complications of Pertusis
    • Pneumonia
    • Atelectasis
    • Encephalopathy
    • Death
  153. What is the incubation period for pertusis
    7-10 days
  154. What is an inherited autosomal recessive disorder (inherited by 2 copies of inherited genes with a defect in the 7th chromosome) in children and is the most common cause of chronic lung disease in children
    Cystic Fibrosis
  155. What disease is caused by a defective gene (chromosome 7) related to protein involved in chloride ion transport? Clogs the lungs and obstructs the pancreas
    Cystic Fibrosis
  156. What disease has symptoms of meconium ileus (late passage of meconium) that appears at birth, salty-tasting skin, Steatorrhea, poor growth/weight gain in spite of good appetite, chronic coughing at times with phlegm, and frequent lunch infections?
    Cystic Fibrosis
  157. What will the general appearance and color look like for a kid with cystic fibrosis
    • dyspnea
    • cough/type of sputum
    • Edema
    • Distended neck veins
  158. What will breath and heart sound like upon auscultation of a child with cystic fibrosis
    • Abnormal breath sounds
    • Tachycardic with a gallop
  159. What will it sound like upon percussion of a child with cystic fibrosis? Why does it sound that way?
    Hyperresonance due to air trapping
  160. What might you observe about the chest of a kid with cystic fibrosis
    asymmetric chest excursion
  161. How is Cystic Fibrosis diagnosed?
    • IRT on newborn screening
    • Sweat Test (measure sodium or chloride in person's sweat, requires two samples, not reliable on newborns)
    • Genetic Analysis (blood test for newborn)
  162. What interventions will the nurse implement in caring for a child with cystic fibrosis with ineffective airway clearance
    • Chest physiotherapy
    • flutter-valve device
    • positive expiratory pressure therapy
    • chest compression vest
    • breathing/physical exercises
    • meds
    • hypertonic aerosols
  163. How do you teach the parents to perform chest physiotherapy on a child with cystic fibrosis
    • Percuss each segment for 1-2 min
    • Position child appropriately
  164. What interventions will the nurse implement for a child with cystic fibrosis with imbalanced nutrition r/t inability to digest food and/or absorb nutrients?
    • Evaluate growth
    • Administer pancreatic enzymes with every meal
    • High caloric, high protein diet
    • supplements as needed
    • Gavage feedings for infants
    • Administer agents to suppress GI acid
    • Salty snacks
  165. What interventions will the nurse implement when caring for a child with cystic fibrosis for risk of infection r/t pulmonary disease
    • Vigorous pulmonary hygiene
    • Aerosolized antibiotics (inhaled tobramycin)
    • Prolonged IV antibiotics
    • Hand washing
    • Immunizations important
  166. What medication is used before CPT for a child with cystic fibrosis
  167. What medication loosens, liquefies, and thins secretions that is given to a child with cystic fibrosis
    Dornase Alfa (aerosol)
  168. What should be monitored for Dornase Alfa and how should it be stored
    • Refridgerated until use
    • Monitor for sputum clearance
  169. What medication assists in digestion, decreases fat, and forms bulky stool and is given for a child with cystic fibrosis
    Pancreatic enzymes (Pancrease)
  170. How should Pancrease be given when administered to child with cystic fibrosis
    • Give before food ingestion
    • Give with meals and snacks
  171. How often should vit A, D, E, and K be given for a child with cystic fibrosis
  172. What medication slows rate of pulmonary decline in a child with cystic fibrosis
  173. What should be monitored for a child on long-term ibuprofen
    GI bleeding
  174. What are the structural differences from child to adult in relation to respiratory diseases
    • Larger head
    • Infants are nose breathers
    • Larger, flaccid tongue
    • Cricoid cartilage is narrowest
    • Larynx more superior/anterior
    • Larger occiput
    • Epiglottis more cephalid, elongated, flexible
    • Loosely attached mucous membranes
    • Infants and young children rely on diaphragm more than adults do
  175. Differences between pediatric and adult airway structure
    • Larger head
    • bigger tongue
    • Narrowest region: subglottic airway
    • Poor cervical spine support
    • Epiglottis more floppy, U shaped
    • Smaller trachea length
  176. What should the nurse do for a newborn that has acrocyanosis??
    Nothing, this is a normal finding
  177. Kids with severe anemia may not show cyanosis, true or false.
  178. What are 3 different sounds and associated noises of a cough
    • Wet, dry, and barking
    • stridor, wheezing, grunting
  179. What are the earliest signs of respiratory distress
    Anxious, restless
  180. What occurs with fingers when there is increased capillary growth as the body attempts to supply more oxygen to blood cells
  181. Child is happy, playful, and engaged in surroundings. HR and RR is normal. Good air entry. No or minimal retractions. SAT >92 on room air. What level of respiratory distress is this?
    mild to none
  182. Child has slightly less energy, not as playful, coughing and wheezy. Not feeding well. Elevated HR and RR. Air entry diminished. Moderate retractions with some accessory muscle use. Sat <92% in room air. What level of respiratory distress is this?
  183. Child has a lack of energy, inconsolable, weak cry. Not feeding well. Cant get comfortable, history of not sleeping well, fussy. Audible wheezing. Poor air entry with severe retractions, use of accessory muscles to breathe, head bobbing. Sat <92% via nasal cannula. What level of respiratory distress is this?
  184. What type of mask provides 35-60% oxygen at 6-10 L/min and requires a snug fit?
    Simple mask
  185. What type of mask provides 95% oxygen and prevents exhalation back into mask?
  186. What type of oxygen administration provides 22-44% oxygen
    Nasal Cannula
  187. What type of oxygen administration provides up to 50% oxygen and is good for humidity? Tuck in edges and is difficult to visualize?
    Oxygen tent
  188. What type of oxygen administration provides up to 80-90% of oxygen and is used for infants only. Allows easy access to body.
  189. What should be used to determine oxygen concentration
  190. How do you care for the stoma of a trach
    sterile water and cotton swab BID
  191. What do you watch for under trach ties
    skin breakdown
  192. How often should trach tube be changed
    q 1-2 weeks and PRN
  193. When suctioning, what would be used if a child is congested with thick secretions (trach care)
    Normal Saline
  194. What strength of suctioning is needed for infants? for children?
    • 60-100 mm
    • 100-110 mm
  195. Name 3 types of humidification devices
    • Jet nebulizer
    • Artificial nose
    • Pass-over or bubble
  196. What type of humidification device requires a gas source?
  197. What type of humidification is used with ventilation or CPAP
    Pass-over or bubble
  198. What are some complications after trach insertion
    • Mucus plugging
    • bleeding
    • bronchospasm
    • aspiration
    • accidental decannulation
    • mechanical malfunction
  199. What are the side effects of short-acting beta agonists, beta-adrenergics, rapid acting bronchodilator? (albuterol, racemic, epi, MDI)
    • Tachycardia
    • dizziness
    • HA
    • Nausea
  200. How soon will short-acting beta agonist/adrenergics and bronchodilators provide relief? How long will effects last?
    • 30 min
    • 2 hrs
  201. What type of drug is dexamethasone, prednisone, prednisolone that reduces inflammation
  202. How should corticosteroids be given, when?
    with food, early in morning
  203. What do you teach the patient to do when their on inhaled corticosteroids
    • Use spacer or holding chamber
    • rinse mouth, gargle after use
    • separate parts and clean daily
    • prevent eye exposure
    • Monitor HA, GI upset, dizziness, infection
  204. What should the nurse teach the patient about the use of methyxanthines (theophylline)
    • Follow levels to maintain 10-20 mcg/L
    • limit caffiene
    • SE: >HR, tremors, HA, insomnia...
  205. What age is MDI use appropriate
    Children over 5 yrs
  206. How do you teach a patient to use MDI
    • shake canister
    • Breathe out
    • Take puff
    • Breathe in deeply
    • Hold for 10 seconds
  207. What medications prescribed for asthma relax smooth muscles? Give 2 examples
    • Bronchodilators
    • Albuterol and Epinephrine
  208. SE of Bronchodilators
    tachycardia, restlessness, increased activity
  209. What type of medication for asthma reduces inflammatory response during or to prevent an attack? Give two examples
    • Anti-inflammatory agents
    • Prednisone
    • Budesonide
  210. What are SE of Anti-inflmmatory agents
    • growth retardation
    • fluid retention, increased appetite, mood changes
  211. When using a peak flow meter, what do the clor scales mean?
    • Green: 80-100%
    • Yellow: 50-80%
    • Red: <50%
  212. What viral respiratory infection causes inflammation, edema, and narrowing of larynx, trachea, and bronchii
    Acute Laryngotracheobronchitis
  213. What 5 things does Westley Croup Scoring System record?
    • Stridor
    • Retractions
    • Air entry
    • Cyanosis
    • Level of Consciousness
    • Higher the score, worse it is
  214. What medications are used for laryngotracheobronchitis
    • Corticosteroids
    • Dexamethosone 3 x/day for 72 hrs to decrease inflammation and edema
  215. What do you teach parents in the care of their child with laryngotracheobronchitis?
    • sx worse at night for several nights
    • Care at home if taking PO fluid and no stridor at rest
    • Cool mist humidifier
    • If breathing labored, seek medical attention immediately
  216. Child presents to the ER with fever of 102.2, c/o extremely sore throat on swallowing, anxious, looks ill, insists on sitting upright leaning on arms with chin thrust out and mouth open (tripod), dysphagia, drooling, distressed respiratory effort, and dysphonia. What does the nurse suspect?
  217. What is the most reliable diagnostic sign but examination of throat is contraindicated
    Edematous, cherry-red epiglottis
  218. Where are all invasive procedures done for a patient with epiglottitis
  219. What needs to be kept at bedside of a patient with epiglottitis in case emergency ventilation is needed before going to OR
    • ET and T tubes
    • Suction
  220. What medications are used for epiglottitis
    • Antibiotics (after cultures)
    • Antipyretics
    • Dexamethasone (24 hr before extubation)
  221. What do you educate the parents on in caring and preventing epiglottitis
    • Finish antibiotic
    • Hib vaccine
    • Reassure recurrence is uncommon
    • Mucus membranes pink, breathe without difficulty
    • Maintain relaxed posture and sleep quietly
  222. What is inflammation of the lungs that occurs most often in infants and young children, affects bronchioles and alveolar spaces
  223. What is the most common organism of pneumonia in children
  224. Child presents to ER with mild fever, nonproductive cough, rhinitis. Chest xray reveals PATCHY infiltrates. What type of pneumonia is diagnosed
  225. Child presents to ER with high fever, productive cough, and ill appearance. Has retractions, grunting, chills, CP, resp distress with anxiety. Chest xray shows density of lung tissue and increased fluid. What type of pneumonia can be diagnosed.
  226. How long does viral pneumonia usually last
    5-7 days
  227. What should child be taught to do to ease pain with coughing who has pneumonia?
    splinting (hug teddy bear or lie on affected side)
  228. How often should respiratory assessment be done for patient with bronchiolitis
    q hr
  229. What will chest xray indicate for patient with bronchiolitis
    nml or hyperinflation or nonspecific inflammation
  230. What medications are used to treat Bronchiolitis
    • palivizumab
    • bronchodilators/steroids
  231. What is the leading cause of death for children under 1 yr
  232. Where does foreign body usually occur in children
    r main bronchus because it's shorter and wider than left
  233. Name the complications of partial/complete aspiration due to foreign body.
    Atelectasis, Air trapping, Hyperinflation distal to site of obstruction
  234. Name 4 Cyanotic Heart defects
    • Pulmonic stenosis
    • R ventricular hypertrophy
    • Ventricular Septal Defect
    • Overriding Aorta
  235. What can deficient O2 lead to in relation to the blood gases?
  236. What can transient periods when there in an increase in R>L shunting of blood cause
    Hypercyanosis (TET)
  237. What do children with Tetralogy of Fallot exhibit
    bluish skin during episodes of crying or feeding (tet spell)
  238. What interventions will the nurse do when a child has ineffective cardiopulmonary tissue perfusion?
    • monitor H&H
    • Keep child calm
    • Assist to squatting or knee position with TET
    • oxygen and morphine as ordered
  239. When a child with a cardiac defect is at risk for decreased cardiac output what does the nurse monitor and what are some interventions
    • VS, CHF, Peripheral Edema, Daily Wt, Strict I&O
    • Diuretics, oxygen, digoxin
    • Palpate live q 4-12 hrs to assess for R sided heart failure
  240. What is essential when teaching parents emergency CPR
  241. What is a condition in which the aorta is connected to the right ventricle instead of the left, and the pulmonary artery is connected to the left ventricle instead of the right, a septal defect or a PDA must exist in order to oxygenate the blood
    Transposition of the great arteries
  242. What are some clinical manifestations of transposition of the great arteries
    • murmur
    • severe to less cyanosis
    • cardiomegaly
    • heart failure
  243. What is a condition in which the left side of the heart is underdeveloped. An ASD or foramen ovale allows for oxygenation of blood
    Hypoplastic Left heart syndrome
  244. What are sx of hypoplastic left heart syndrome
    • mild cyanosis
    • heart failure
    • lethargy
    • cold hands/feet
    • CHF
    • increased RV impulse
    • decreased pukses
    • tachypnea, chest retractions, dyspnea
    • Leads to cardiac collapse
  245. What is given to prevent closure of PDA in hypoplastic left heart syndrome
    Prostaglandin E1
  246. What interventions will the nurse take to treat rheumatic fever
    • Bedrest till ESR nml
    • ASA and prednisone
    • Cardiac function
    • Penicillin
    • Maintain BP and BRP
  247. What is a multisystem disorder involving vasculitis (inflammation of tunica intima or inner lining of arteries and veins)
    Kawasaki disease (mucocutaneous lymph node syndrome)
  248. What is the leading cause of acquired heart disease in children
  249. Stages of Kawasaki disease
    • Stage 1 (1-2 week)
    • Subacute (2-4 week)
    • Convalescent (6-8 week)
  250. What stage of kawasaki involves fever lasting >5 days, unresponsive to antipyretic, conjunctivitis, crusted and fissured lips, swelling of hands/feet, erythema, and lymphadenopathy
    Stage 1
  251. What stage of Kawasaki has diminished fever, irritability, anorexia, desquamation of hands/feet, arthritis, cardiovascular manifestations
  252. What stage of Kawasaki has a drop in ESR and diminishing signs of illness
  253. What medication and amount of that med is given to child with Kawasaki diease
    • ASA (80-100 mg)
    • IVIG x 1
  254. What are some interventions a nurse can implement for a child with Kawasaki disease
    • comfort
    • monitor temp
    • small, frequent feeding
    • Passive ROM on all joints
    • cool bath
    • oral care (gentle)
    • Fluid intake
    • Monitor for bleeding, chest tightness from IVIG
  255. What connects the umbilical vein to the fetal interior vena cava allowing blood to by-pass the liver? (functional closure at 1 week of age)
    Ductus Venosus
  256. What connects main pulmonary artery to descending aorta diverting blood away from the lungs. Muscular structure about 10 mm in diameter. Functional closure: 3-4 days. Anatomical Closure: 2 months
    Ductus Arteriosus
  257. What can cause Ductus Arteriosus to reopen after birth
    • Hypoxemia
    • Increased prostaglandin E1
  258. What is the flap between the right atrium and left atrium that shunts blood from right to left. Persists in infancy, especially NAS babies
    Patent Foramen Ovale
  259. What is the pressure as measured by the size of the arteries and arterioles in the pulmonary vascular bed
    Pulmonary Vascular Resistance (PVR)
  260. What is the pressure as measured by the size of the arteries in the peripheral vascular bed
    Systemic Vascular Resistance (SVR)
  261. What governs resistance of blood flow
    Size of blood vessels
  262. Whats the difference in the ventricles between adults and newborns
    RV dominant in newborn, left in adults
  263. In Fetal circulation is PVR high or low? SVR?
    • PVR: high
    • SVR: Low
  264. What effect does PVR being high have on blood shunting
    Keeps blood shunted away from lungs
  265. What causes a sudden increase in SVR following clamping of umbilical cord
    Umbilical veins/arteries construct and blood no longer is shunted through fetal circuit
  266. Describe neonatal circulation
    • DA closes> increase PO2, absent prostaglandin
    • PFO shuts > SVR rises > LA rises and slams shut PFO
    • PFO later sealed by fibrin
    • Can reopen if RA increases significantly
  267. What maternal illnesses may result in congenital heart disease in fetus
    • Diabetes
    • Transposition of Great vessels
    • Coarction of Aorta
    • Lupus
    • Viral diseases
    • Obesity
  268. What is key in infants with congenital heart disease
    tachypnea without dyspnea
  269. What is the first sign of CHF in infant
  270. What is the hallmark of hypoplastic left heart disease
    decreased or absent pulses
  271. What should the nurse suspect if there are no lower extremity pulses but there are upper pulses
    Coarctation of the aorta
  272. If pulses 0 = absent what should the nurse suspect? If +4 = bounding?
    • 0 = hypoplastic left heart
    • 4 = PDA
  273. What is a late sign of CHD that is caused by dilation of ventricles? (BAD SIGN)
  274. What is a late sign of CHF
  275. Whats the most common murmur
  276. What is cardiac enlargement that occurs due to ventricular dilation or hypertrophy in response to a volume or pressure overload
  277. What test is done with a pulse off to pick of coarction of Aorta before signs present. Had to be done after 24 hrs of age but before discharge. Mandated by law
    CCHD test
  278. What is the best tool for definitive diagnosis of CHD
  279. What is caused by lesions with increased pulmonary blood flow in CHD
  280. What is caused by lesions with decreased blood flow in CHD
    Cyanotic diseases (Tetralogy of Fallot)
  281. What is caused by obstructive lesions inhibiting blood flow in CHD
    Coarction of the aorta
  282. What is caused by mixed lesions in CHD
    Transposition of Great Vessels
  283. What disease presents 4-7 days after birth causing a left to right shunt and floods the lungs causing CHF
    Patent Ductus Arteriosus
  284. What are some signs and symptoms of PDA?
    • Increased lung markings/enlarged heart on xray
    • Bounding pulses
    • Machinery continuous heart murmur
    • Worsening respiratory distress
    • Metabolic acidosis
  285. How us PDA treated? What meds are given?
    • Fluid restriction, diuretics, CPAP
    • Indomethacin and ibuprofen
    • Surgical ligation if medical treatment fails
  286. What disease presents with a loud, harsh murmur with fixed S2 and heart failure
    Atrial Septal Defect
  287. What provides the ONLY cardiac output of Hypoplastic Left heart syndrome? What will happen without it?
    • PDA
    • Cardiovascular collapse
  288. What are the hallmarks of HLHS
    • Decreased pulses in ALL extremeties
    • Tachypnea (day 3)
  289. How is HLHS managed?
    • Prevention of hypoxemia
    • Correct metabolic acidosis
    • Keep PDA open with prostaglandin E1
    • Surgical correction in stages
  290. What is narrowing of plumonary valv or PA that results in obstruction of blood flow from ventricles
    Pulmonary Stenosis
  291. What is narrowing of valv obstructs flow from LV to aorta and out of the body (tricuspid may be bicuspid)
    Aortic stenosis
  292. What are symptoms of aortic stenosis
    • infants: faint pulse
    • Low bp
    • tachycardia
    • feeding intolerance
    • Child: exercise intolerance, dizziness, chest pain
  293. What is absence of tricuspid valve that involves ASD/VSD for survival to allow mixing, flow to pulmonary arteries occurring through PDA
    Tricuspid Atresia (Hypoplastic Right Heart)
  294. What disease has cyanosis at birth, tachypnea, CHF, acidosis, continuous murmur, single S2 and harsh systolic murmur? What can be given to save the person's life with this condition
    • Tricuspid Atresia
    • Prostaglandin E1 and surgery
  295. What disease is single vessels arises from the RV and LV supplying both pulmonary and systemic blood flow
    Truncus Arteriosis
  296. What disease causes cyanosis at birth, severe CHF, poor feeding, growth failure, harsh systolic murmur, and cardiomegaly
    Truncus Arteriosis
  297. What medications are used to treat decreased tissue and/or cardiac perfusion
    • Dopamine: mcg/kg/min (administered/hr)
    • Usual dose: 5-10 mcg/kg/min DONT FLUSH SITE
    • Ace inhibitor: Captopril, enala
    • Promotes Vascular relaxation
    • Decrease PVR
    • Propranolol: increase contractility
    • Carvedilol: Improve LV function
  298. What is the most effective way to improve contractility (medication)
  299. What is the first sign of digoxin toxicity
  300. What medication can be administered for decreased tissue perfusion r/t acidosis and/or decreased cardiac output with infants with Ductal Dependent CHD
    Prostaglandins (PGE1)
  301. Two most common side effects of prostaglandins
    • hyperthermia
    • apnea
  302. What does the nurse monitor for following a heart catheterization on an infant
    • Monitor arrhythmias, bleeding, hematoma, infection
    • Check dressing q 15 min X 4, then q 30 min X 2
    • Check under butt for blood
    • Assess V/S, perfusion of LE
    • Bedrest 4-6 hrs (HOB flat, limit activity 24 hrs, provide diversional activities, encourage fluids as tolerated)
  303. What to teach parent's in regards to their child with CHD
    • Meds
    • Feeding: wt gain slow
    • Breast feed
    • Defect/Patho knowledge
    • More prone to infections (especially pneumonia)
  304. What is the primary growth for preschool ages
    long bones
  305. How much does a preschooler gain per year
    4.4-6.6 lbs
  306. How fast does preschooler grow per year
    2.5-3.5 in
  307. At what age is a child able to brush teeth, button clothes, tie shoes, drawy 6 part person, draw circles, cross, square, use a fork
    Preschool age 3-6 yr
  308. At what age to children begin to compare themselves with peers
    5 yrs
  309. How many words does a preschooler know
    over 2000
  310. What age is a child able to speak in short sentences, grasping of meaning faulty, and may have collective monologue
  311. What age is a child in Piaget's intuitive stage (moves from egocentric thought to social awareness and ability to understand the viewpoint of others)
  312. What is animism
    objects are alive
  313. What is centration
    focus on one aspect instead of the whole
  314. What type to play is preschool?
    Associative (interacts with others during)
  315. What age group enjoys motor activities, develops fine motor skills with simple materials, dolls, furniture, dramatic play
  316. What immunizations are required for preschoolers (4-6 yr)
    • DTaP
    • MMR
    • Varicella
    • IPV
    • Flu
  317. How much sleep does a preschooler need
    12 hrs
  318. What are some safety concerns for preschoolers
    • Car seat (20-40 lbs) forward facing
    • Booster seat (over 40 lbs
    • Supervise around water
    • Falls common
    • Gun safety
    • Poison
    • Burns
    • choking
  319. How much does a school-age child grow per year? How much do they gain per year?
    • Grow 2 in/yr
    • Gain 4-6 lb/yr
  320. At what age do children understand concept of treating others as you wish to be treated, gain confidence, understand personal values?
    School age
  321. When is the growth spurt for a girl? a boy?
    • girl: 10 yr
    • Boy: 13 yr
  322. At what age is children at greatest risk for dental caries
  323. What age group includes Piagets idea of concrete thought
    School age
  324. What kind of play is for school age
    cooperative and competitive
  325. How much sleep is required for school-age children
    9 hrs
  326. What immunizations are required for 6-12 yrs
    • Tdap
    • HPV
    • Meningococcal
  327. At what age group to girls reach their adult height
    adolescents (by 18 yrs) 2.5 yrs after menarche
  328. At what age do boys stop growing
    18-20 yrs
  329. What age group requires more calcium, iron, folic acid
  330. What is the sequential and orderly sequence of growth patterns for infant and toddler
    • cephalocaudal
    • proximodistal
  331. What is the weight, ht, and head circumference of Neonate (birth-1mo)
    • wt: 6-8 lbs, 5-7 oz/wk X 6 mo
    • Ht: 20 in, 1 in/mo X 6 mo
    • HC: 33-35 cm, greater than chest
    • Head 1/4 body length
  332. Wt, ht, head growth of infant
    • wt: double birth wt by 6 mo, tripple by 1 yr
    • Ht: increase 50% by age 1
    • HG Rapid, soft, flat, and ant pulsatile with sitting position
  333. At what age does posterior fontanel close? Anterior?
    • P: 2-3 mo
    • A: 12-18 mo
  334. When does the moro reflex disappear
    4-6 mo
  335. When does tonic neck reflex disappear
    3-6 mo
  336. When does grasp reflex disappear
    3 mo
  337. When does rooting reflex disappear
    4 mo
  338. When does babinski reflex disappear
    1-2 yr after walking
  339. At what age can baby lift head
    4 mo
  340. At what age can baby roll back to side
    4 mo
  341. At what age can baby roll abd to back
    5 mo
  342. At what age can baby roll back to abd
    6 mo
  343. At what age can baby sit alone without support
    8 mo
  344. At what age can baby stand holding furniture
    9 mo
  345. At what age can baby crawl with abd on floor
    10 mo
  346. At what age can baby creep with abd off floor
    11 mo
  347. At what age can baby cruise holding furniture
    10-12 mo
  348. At what age can baby walk well with hand held
    12 mo
  349. When can baby be introduced to citrus fruit, meat, and eggs
    after 6 mo
  350. When can baby have chopped table food by
    9 mo
  351. When are babies at risk for falls
    3-4 mo (roll)
  352. How far apart should slats be on bed rails?
    2 3/8 in apart
  353. Type of play for an infant
  354. Wt, ht, head circumference of toddler
    • wt: 30 mo 4 X birth weight
    • Ht: 3 in/yr
    • Head circum = chest by 1-2 yr
  355. How many teeth does a toddler have by age 2.5-3yr
  356. What should milk be limited to per day for toddlers to prevent iron deficiency
    <32 oz
  357. At what age can toddler feed self completely
  358. Type of play for a toddler
  359. What age group does Piaget say is Sensorimotor (learns best through senses and motor, cause/effect)
    birth-2 yr
  360. At what age is object permanence fully developed
  361. What does Piaget's preoperational stage consist of and what age group
    • 2-7 yr
    • Egocentrism
  362. How many words does a 2 yr old know roughly
  363. By what age can a child combine several words to create simple sentences using grammatical rules
  364. When does seperation anxiety occur? When does it peak
    • 6-30 mo
    • 15 mo
  365. Stages of separation anxiety
    • protest
    • despair
    • detatchment
  366. How do we know infants are in pain? Toddlers?
    • I: vitals increase, oxygen decreases, crying
    • T: verbalize, restless, clingy, regression