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348 Cards in this Set
- Front
- Back
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General Considerations for Pediatric Care
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1. Age appropriate principles
2. Psychosocial needs of child & family 3. Necessity of acute setting 3. Safety/hygeine 4. Atraumatic Care 5. Parent/family involvement |
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Needs of parents of hospitalized children
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1. pain control
2. information from providers 3. trust in providers 4. trust from providers |
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Admission History unique to pediatric
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1. Prenatal history
2. words for bathroom 3. favorite foods 4. cup vs. bottle 5. preferred medication route 6. Coping response to stress 7. Immunizations and recent exposures 8. childhood illnesses 9. development history |
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Three stages of separation anxiety
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1. Protest Phase: crying, yelling, clinging
2. Despair Phase: withdrawn, depressive symptoms, lack of interest 3. Denial or Detachment Phase: superficial adjustment to loss of parental presence |
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Helpful Interventions for Anxious Infant
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1. Rooming of parent in hospital
2. Minimize number of caretakers 3. Comfort Volunteers 4. Tactile, auditory, and visual comfort stimulation 5. Minimize restraining equipment (IVs, Monitors) 7. Alter environment and allow exploration |
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Helpful Interventions for Anxious Toddler
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1. Rooming of parents
2. Include transitional objects in room (favorite blanket, stuffed animal) 3. Plan parent visiting around toddler's routine 4. Teach parents to assess for stress 5. Follow home routine if possible 6. Plan playtime outside of room 7. Roleplay medical roles with stuffed animals 8. Adjustment for regressive behavior |
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Helpful Interventions for Anxious Pre-schooler
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1. Offer choices, allow participation
2. Plan playtime outside of room 3. Medical & Therapeutic play 4. Be truthful with explanations of interventions |
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Helpful Interventions for Anxious School Age Child
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1. Foster communication with parents/friends
2. Promote home routine and sense of normalcy 3. Listen to child and respond to their feelings 4. Explain medical interventions 5. promote developmental goals 6. allow for real choices |
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Helpful interventions for Anxious Adolescent
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1. promote peer interactions
2. encourage parental visitation 3. develop plan of care with adolescent 4. respect needs for independence 5. privacy with bathing and dressing 6. open and direct about medical care |
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Safety Consideration for infancy
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1. side rail up at all times
2. back to sleep, infant on back in crib 3. no bottle or pacifier with string in bed 4. no medical equipment in bed 5. bubble top for infants +6 months 6. Safety straps across belly and between legs if in an infant seat |
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Safety Considerations for Toddler
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1. All objects out of reach
2. bubble top crib 3. IV pole out of reach 4. Supervise feedings 5. Safety straps across belly and between legs when in high chair 6. Never alone while bathing |
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Safety considerations for Pre-school child
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1. all meds out of reach
2. side rails up in bed 3. all small chairs, stools, climbable objects out of room 4. supervise bathing |
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Safety considerations for Adolescent
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1. monitor for thrill-seeking or self-harm behavior
2. monitor for drug/smoking/alcohol abuse 3. assess safety when leaving the unit |
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What is therapeutic play?
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activity directed by health care team to promote emotional and physical well-being. It is goal-oriented
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Proper pre-operative teaching time for pediatric patient
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1. infant = during procedure
2. toddler = immediately before procedure 3. Child <7 ~~ 1 hr. before procedure 4. Older children= days in advance/when decision is made |
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Pre-operative teaching methods
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1. medical and therapeutic play
2. honesty about procedure 3. seek demonstration of patient understanding 4. Observe for over-information or signs of stress |
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Pediatric Medication Administration concerns
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1. Focus must be on safety
2. developmental considerations 3. parent involvement 4. description of side effects |
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Medication Administration NEVERS
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Never mix with formula, mix with food, deceive child, or use as reward/punishment
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Oral Medication concerns for infants
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1. smallest amount possible
2. oral syringe or nipple 3. explain medication to guardians 4. ask parent involvement 5. control limbs 6. administer before feeding 7. comfort after adminstration |
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Oral Medication Considerations for toddlers
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1. explain in simple terms
2. use oral syringe 3. may require parental assistance 4. possible restraining 5. allow crying 6. verbal praise afterwards |
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Oral Medication Considerations for Preschoolers
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1. Simple explanations
2. Offer real choices 3. can use medicine cup 4. Ask for patient assistance 5. Lot's of verbal praise |
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Oral medication considerations for School age
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1. Concrete explanations
2. give choices as possible 3. allow independence 4. acknowledge cooperation with praise |
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Oral medication administration for adolescence
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1. Early, middle, late stage adolescent considerations
2. base explanations on thinking capabilities 3. allow privacy 4. give control to patient |
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Assessing patient hydration status
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1. weight**
2. Urine Specific Gravity 3. intake and output 4. tear production when crying 5. Anterior fontanel status for infants 5. Skin Turgor 6. Mucous membrane status |
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Proper specific gravity of urine
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1.015 or greater
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Sunken Fontanel in Infants indicates?
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dehydration
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Developmental Concerns for Toddler understanding
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1. words for pain, ways to identify location
2. object permanence 3. Egocentric and autonomous needs 4. |
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Developmental concerns for preschooler understanding
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1. language that differs from adults
2. pain equals punishment 3. magical thinking 4. Beginning of time conception 5. fear of body mutilation 6. blood is bad |
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Developmental concerns for school-age child understanding
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1. body mutilation fear
2. concrete logical reasoning 3. understanding time 4. less dependent on parents |
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developmental concerns for adolescent understanding
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1. understands abstraction
2. self-esteem and self-control issues 3. behavior modification for pain relief 4. imaginary audiences 5. personal fables |
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Comprehensive pain assessment includes:
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location, quality, duration, and response to treatment
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What is Maslow's hierarchy of needs?
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Physical needs, safety, love/belonging, esteem, self-actualization
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What are the determinants of health?
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1. delivery method, availability
2. environmental pressure 3. lifestyle 4. inherited biology 5. Education and Understanding |
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What is Cephalocaudal and Proximodistal?
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Head to tail, and inner to outer
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Is development predictable? order? random?
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progressive and building, but not orderly or predictable
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What are erikson's developmental stages?
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infancy, early childhood, early school, school age, adolescence, young adult, maturity, old age
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Piaget's developmental stages
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Sensorimotor, preoperational, concrete operational, formal operational
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6 questions for a parent interview about development?
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1. concerns about hearing or vision?
2. What changes are you noticing? 3. What kind of child are they? 4. What do you and the child enjoy doing together? 5. What are their favorite play activities? 6. Have there been any stressful family events? |
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When is corrected age used?
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under age 2
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What is corrected age?
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Current age - weeks pre-mature
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What is head lag? when should it be completed?
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1. The ability to hold one's head up
2. partial by 2, complete by 4 |
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When can an infant sit with hand support?
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7 months
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When is finger/pincer grasp developed?
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7-8 months
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When can an infant "cruise the furniture"?
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11 months
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Caloric needs of an infant?
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108kcal/kg/day
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Best source of nutrition for an infant?
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human milk of formula
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When should new foods be introduced to infants?
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5-7 days
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Can honey be given to infants? Why?
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NO because of infant botulism
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Age specific issues for infants
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immature immune systems and a lack of thermoregulation
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Number of teeth for an infant?
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Age in months minus 6
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Oral health concerns for infant?
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No bottle propping and no juice bottles
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how much do babies sleep by 4 months?
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9-11 hrs a night plus naps
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How much do babies sleep by 1 year?
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sleep through night w/ 2-3 naps a day
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Infant Safety Concerns
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1. choking
2. SIDS 3. Falls, burns, drowning 4. Motor vehicle safety |
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When does potty training occur?
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1-3 years
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Nutrition considerations for toddler
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1. picky and fussy eating
2. two-three cups of milk a day (skim by 2 years) 3. Limit juice to 4-6 oz per day |
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Oral health considerations for toddler
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1. Dentist Visits
2. Small, soft, brushing 3. Fluoride in water? 4. Nothing but water in long-term bottles 5. bottle isn't a pacifier 6. no bottle during bedtime and naptime |
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Growth and development for age 3
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rides tricycle, walks on tiptoe, 1 person balances
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Growth and development age 5
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skips on alternate feet, jumps rope, swims
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What age is critical for speech developments?
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2-4
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When do nightmares occur?
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age 3-5
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Nightmare vs. night terror
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Nightmare = scary dream with less movement, patient remembers, seeks comfort
Night Terror= thrashing violently w/ no memory next morning |
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Nutritional needs of preschooler
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picky eating and caloric decrease
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Sleep concerns for school age kids
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1. 9-10 hrs of sleep by age 12
2. fatigue is not adequately recognized 3. reminded to go to prepare for bed |
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Psychosocial development during school age years
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1. other people have different perspectives
2. recognize parents are people too 3. concept of best friends 4. loves activities of social involvement |
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Bullying during school age years
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1. awareness of bullying behavior
2. bulling occurs physically, emotionally, and psychologically 3. Changes in behavior indicate bullying 4. Extra-curricular activities prevent bullying |
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What is the acronym for dealing with development in adolescents?
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HEADSSS
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what does HEADSSS stand for?
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home, education, activities, drugs, sex, suicide, safety,
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Tips on talking to kids about sex
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1. figure out what they already know
2. arrange information for developmental levels 3. Encourage questions 4. acknowledge feelings |
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Nursing considerations for Adolescents
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1. role play discussions internally first
2. be prepared to answer tough questions 3. do not blur the role of the nurse in their life 4. Attempt to understand pop culture |
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Considerations for child with special needs
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1. be knowledgeable about child's limitations
2. be flexible 3. kids may lag in some milestones that are not obvious 4. Disability in one area does not mean disability in all areas 5. Be sensitive to family dynamics |
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Nurse's role in a healthy child?
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assess the child/family dynamics and promote healthy practices
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What are the leading Healthy People 2020 concerns for children?
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1. Physical activity and overweight/obesity
2. Environmental quality 3. immunizations 4. health care access 5. Injury and Violence |
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when does BMI start being calculated?
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after 2 years of age
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When does type 1 diabetes typically peak?
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ages 4-6 and 10-14
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Causes of iron deficiency anemia in children
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1. inadequate iron supply
2. impaired absorption 3. increased need |
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How iron deficiency affects children?
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low energy => poor school performance and social skills
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Preventing iron deficiency in infants?
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1. encourage breastfeeding
2. Iron fortification of formula and cereal 3. discourage cows milk below 1 year of age r/t to stomach bleeding and low iron content 4. 16-24 oz of cows milk a day after 1 year |
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Preventing iron deficiency in children/adolescents?
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1. children absorb only 10% of iron ingested
2. 8-10 mg per day |
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Vaccinations at birth?
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Hep B
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Vaccinations at 1 month?
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Hep B
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Vaccinations at month 2?
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1. Hep B
2. Rotavirus 3. Dipheria/tetanus/Pertusses (DTaP) 4. Haemophilus influenzae (hib) 5. Pneumococcal conjugate 6. polio |
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Vaccination at month 4?
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1. Rotavirus
2. Dipheria/tetanus/Pertusses (DTaP) 3. Haemophilus influenzae (hib) 4. Pneumococcal conjugate 5. polio |
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Vaccination at 6 months?
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1. Hep B (6-18)
2. Rotavirus 3. Dipheria/tetanus/Pertusses (DTaP) 4. Haemophilus influenzae (hib) 5. Pneumococcal conjugate 6. polio 7. influenza |
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Which vaccines are finished during 6-18 months?
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1. Hep B
2, Hib 3. PCV13 4. Polio |
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Which vaccinations start at 1 year?
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1. MMR (measles, mumps, rubella
2. Varicella 3. Hepatitis A |
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Which vaccinations at 4-6 years?
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1. DTaP
2. Polio 3. MMR 4. Varicella |
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Which vaccinations at age 11-12?
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1. DTap
2. Polio 3. MMR 4. Varicella 5. HPV 6. Meningococcal |
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When do yearly flu shots begin?
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6 months
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When is the meningococcal booster?
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16-17 years old
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Most effective prevention of Pertussis?
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Whooping Cough
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Treatment of pertussis?
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antibiotics treat symptoms
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Side effects of inactivated vaccines
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tenderness, swelling, fever, rash all within hours or days
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Side effects of live attenuated vaccines?
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reactions can occur 30-60 days later
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Contraindications for Vaccines
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1. Anaphylactic reaction to previous dose to vaccine or components of vaccine (flu shot = eggs)
2. moderate/sever illness |
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Contraindications to MMR an IVIG?
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MMR for pregnancy
passive immunity administration for IVIG |
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Is HIV a contraindication?
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not necessarily, but possibly
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Describe Rotavirus vaccine
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1. live-attenuated oral vaccine
2. given at 1,2,6 months 3. contraindicated with immune deficiency syndroms or intussesception |
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What the HPV vaccine is for?
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1. prevalent cause of STI that can cause cervical cancer
2. Penile cancer 3. 3 does IM over 6 month period around 9-13 4. does not mean teen is sexually active |
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Car Seat recommendations
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1. Rear-facing for infants
2. rear facing for toddlers until they outgrow car seat 3. forward facing for preschool till 7 with harness until outgrowing car seat, then a booster seat 4. booster seat until lap seat belt is across thighs 5. back seat is always safer |
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What accounts for the majority of acute illnesses in children?
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REspiratory infections
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What is the most common chronic illness in children?
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asthma
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What kind of environmental factors create respiratory infection risk?
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1. cigarette smoke
2. pets 3. dust mites 4. cockroaches 5. school |
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What risks does second hand smoke bring for kids?
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cancer risk, SIDS, URI, otitis media, asthma
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How does second hand smoke increase respiratory infection risk?
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It causes hyperplasia of mucus glands, inflammation, and *increased permeability of lungs to antigens
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What kind of health care activities reduce risk for childhood respiratory infection?
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1. parent education, clear-air homes,
2. non-smoking, 3. genetic counseling before pregnancy, prenatal care during |
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Five objective assessments of respiratory function?
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1. inspection
2. auscultation 3. diagnostic tests 4. palpation 5. percussion |
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What are some subjective assessments for respiratory function?
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1. child's report
2. family hisotry 3. PMH |
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What is WOB?
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Work of breathing
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What are signs of WOB?
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1. tachypnea,
2. retractions, nasal flaring, 3. accessory muscle use, tripod position |
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Assessment differences in infants with respiratory difficulty?
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1. fever may be absent <28 days old
2. abdominal pain 3. nasal blockage 4. sore throat |
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What are some nursing diagnosis related to respiratory infection?
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1. potential for impaired airway clearance
2. potential for impaired gas exchange 3. Potential for infection 4. Impaired fluid/electrolyte status 5. Risk for caregiver stress r/t chronic illness |
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What interventions prevent potential for impaired gas exchange?
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1. Monitor RR and Sp02
2. humidified oxygen via mask or nasal tubing 3. suctioning nasal secretions 4. positioning 5. chest physiology |
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What interventions prevent potential for respiratory infection?
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1. handwashing
2. isolation 3. Special considerations for chronic illness and asthma |
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What type of isolation for (1) Pertussis and (2) RSV?
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1. droplet
2. contact precaution |
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What interventions help prevent fluid/electrolyte imbalance?
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1. Clear, cool liquids given tepid (assess swallowing)
2. IV fluids that maintain balance (D5/0.2NSS + K) 3. I/Os 4. Assessment for dehydration |
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What interventions decrease caregiver stress?
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1. Assess parent's ability to handle situation
2. frequently communicate 3. Encourage rest and relaxation for both parent and patient 4. Appropriate and timely education 5. Referrals as appropriate (chaplain, social services, etc.) |
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What is asthma?
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chronic inflammation of the airways characterized by obstructed flow
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Which cells play a role in asthma?
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mast cells, eosinophils, and T-cells
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What type of disease is asthma besides chronic respiratory?
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immune-mediated
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Symptoms of asthma?
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wheezing, breathlessness, chest tightness, and cough
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What is bronchial hyperresponsiveness?
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the inherent tendency of the aiway to narrow in response to stimuli
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What is the most common chronic disease of childhood?
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asthma
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What is the leading cause of school absences?
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asthma
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What is the third leading cause of hospitalized children under the age of 15?
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asthma
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What are some of the psychosocial effects of asthma?
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1. school performance
2. child may self-limit activity 3. obesity 4. caregiver stress 5. financial burden |
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What are the Healthy People 2020 goals for asthma?
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1. reduce hospitalization
2. reduce deaths 3. reduce emergency department visits 4. reduce activity limitations 5. reduce school and workdays missed 6. increase formal patient education about treatment, symptoms, risk factors, etc. |
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What are some common triggers of asthma?
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1. allergens
2. exercise 3. infection 4. weather 5. emotions (indirectly) |
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Causes of asthma?
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1. genetic disposition
2. 75% of patients have significant allergies 3. early RSV plays part |
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Pathophysiology of asthma?
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1. inflammation and edema of mucous membrane
2. accumulation of thick secretions from mucous glands 3. spasm of the smooth muscle of bronchi and bronchioles |
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How is Asthma severity classified?
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by the frequency of daytime and nighttime symptoms
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What is mild intermittent asthma?
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1. less than 2 daily episodes per week
2. less than 2 nightly episodes per month |
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What is mild persistent asthma?
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1. three to four daily episodes per week
2. three to four nightly episodes per month |
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What is moderate persistent asthma?
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1. episodes daily
2. greater than 5 nighttime episodes per month |
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What is severe persistent asthma?
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1. continual daily episodes
2. frequent nightly episodes |
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Symptoms of asthma/RAD?
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1. prolong expiration
2. wheezing 3. accessory muscle use 4. nasal flaring 5. cyanosis 6. diaphoresis |
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What are the cardinal signs of respiratory failure?
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1. restlessness
2. tachypnea 3. tachycardia 4. diaphoresis |
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How does one manage asthma or RAD?
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1. complete respiratory assessment
2. objective measures of lung function such as peak flow measures 3. bronchodilators and anti-inflammatory agents based on acute vs. chronic 4. assess environmental factors 5. patient and parent education |
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B-adrenergic agonists; acute or chronic control? Examples?
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1. quick relief and prevention of exercise-induced asthma
2. albuterol, terbutaline |
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What is salmeterol used for?
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children over 12
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is salmeterol a rescue med?
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no
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What medications prevent asthma?
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1. inhaled steroids
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what are some examples of inhaled steroids?
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flovent, advair
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What do inhaled steroids do?
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prevent inflammation that causes chronic asthma
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Nursing considerations for inhaled steroids?
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1. side effects discussion with parents
2. patent/family education 3. rinse mouth after use |
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What are leukotriene modifiers?
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they block leukotrienes that mediate inflammatory response
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What is montelukast?
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a single daily dose for children over 12
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Major caution for asthma medications
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do not mistake rescue meds with control meds
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What is status asthmaticus?
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1. comes in through ED
2. usually secondary to respiratory infection 3. life-threatening 4. persistent hypoventilation causing increased CO2, blood acidosis, and vomiting |
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Nursing care for status asthmaticus?
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1. frequent assessments
2. continuous monitoring 3. Bronchodilators continuously q2hours or q4 4. corticosteroids 5. CPT when cough loosens 6. IV fluids 7. humidified oxygen to keep Sp02 over 90% |
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How are bronchodilators included in status asthmaticus care?
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continuous albuterol when severe, weaning to q2 and q4
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side effects of bronchodilators?
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1. tachycardia
2. restlessness 3. hypertension, shaking, insomnia |
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What IV steroid is used for asthma?
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Methylprednisolone IVSS
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How long is a methylprednisolone IV infusion?
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15-30 minutes
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Nursing considerations for oral asthma medications?
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1. usually prednisone q12
2. not to exceed 60 mg/kg/day 3. do not stop abruptly 4. Give with food and/or ranitidine |
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Do patients need to continue chronic medications when asymptomatic?
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yes
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What is a good action plan for asthma patient?
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1. Green (less severe, 80-100%) = routine treatment
2. Yellow (cautioning, 50-79%) = increase therapy, call provider 3. Red = (below 50%) emergency, medical alert, rescue med needed and doctor called |
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What is rhinovirus?
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common cold, treated with fluids and careful use of OTC
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What is pharyngitis?
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sore throat
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What is the most common cause of pharyngitis?
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a virus
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Treatment of pharyngitis?
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1. pain control, hydration, rest
2. culture needed if possibly bacterial |
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How is strep throat treated?
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full course of antibiotics
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What are the clinical manifestations of tonsillitis?
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1. fever, sore throat
2. mouth breathing, irritability 3. Red throat, coating on throat 4. enlarged tonsils |
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Treatment for sore throats
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1. cool, icy liquids
2. salt water gargle 3. analgesics 4. honey for children older than 1 |
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Analgesia/antipyretics for sore throat
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1. acetaminophen for children >5months, q4-6 hr
2. ibuprofen for 6 month - 12 year q6-8 hr |
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What is otitis media?
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infection of the middle ear
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what bacteria causes otitis media?
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streptococcus pneumoniae and hemophilus influenzae
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how is otitis media transmitted?
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droplets and contact
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Clinical manifestation of otitis media?
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1. malaise
2. irritability 3. restlessness 4. sleep issues 5. affected ear pain and color change |
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Complications of otitis media?
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1. hearing loss
2. mastoiditis 3. intracranial infections 4. eardrum scarring |
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treatment for otitis media?
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1. antibiotic (amoxicillin) q12 hrs with food
2. acetaminophen or NSAIDS |
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What is epiglottitis?
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1. acute inflammation & swelling of the epiglottis
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etiology of epiglottitis?
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caused by HiB organism, but preventable with immunization
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Clinical manifestations of epiglottits?
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1. sudden onset
2. difficult or painful swallowing 3. drooling 3. distressed inspiration effort 4. high ever 5. stridor |
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Specific nursing care for epiglottits?
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1. maintain airway
2. frequent close observation 3. DO NOT INSPECT w/o ability to intubate immediately 4. maximize comfort 5. cool mist and oxygen as tolerated |
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What is acute laryngotracheobronchitis (croup)?
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1. a common respiratory disease
2. inflammatory response w/vascular congestion and edema 3. The **subglottic** region is narrowed 4. Viral or Bacteria 5. self limiting, gone in a few days 6. most common 6month-6 years |
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Clinical manifestation of laryngotracheobronchitis?
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1. **barking, brassy cough**
2. **Inspiratory stridor** 3. lower accessory muscle use 4. hoarseness |
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What is bronchiolitis?
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1. LRTI
2. most common LRTI in infants 3. caused by many viruses |
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Effects of bronchiolitis?
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1. acute inflammation
2. edema 3. mucus production 4. bronchospasms 5. necrosis of epithelial cells lining small airways |
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Etiology of RSV bronchiolitis?
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1. upper and lower respiratory tract
2. inflammation and increased mucus leads to obstruction leading to air trapping 3. possible a major role in creating asthma or COPD |
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What is responsible for 45-75% of bronchiolitis cases?
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RSV
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How is RSV diagnosed?
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NP swab culture-rapid test results in 20 minutes
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How is RSV transmitted?
|
1. person to person through respiratory secretions easily
2. causes significant death in immunosufficient patients |
|
|
Clinical manifestations of RSV?
|
1. pharyngitis
2. rhinorrhea 3. cough 4. wheezing 5. diffuse rhonci, fine rales/crackles and wheezing |
|
|
Later manifestations of RSV?
|
1. cyanosis
2. retractions and dyspnea 3. poor feeding |
|
|
Late stage RSV complications?
|
1. chest hyperexpansion
2. listlessness 3. apnea & hypoxemia 4. tachypnea > 70/min |
|
|
Prognosis of RSV in infants?
|
1. two percent mortality
2. Most death are in high risk groups |
|
|
What are some high risk pediatric patients?
|
1. premature infants
2. neuromuscular/pulmonary/cardiovascular diagnoses 3. immunologic dysfunction |
|
|
Treatment for RSV?
|
1. supportive airway clearance such as suctioning
2. CPT not recommended 3. oxygen therapy 4. NO evidence of benefits from medications |
|
|
RSV and immunocompromised child?
|
1. very severe
2. mortality post transplant is 50% 3. not severe for HIV |
|
|
Candidates for immunoprophylaxis?
|
1. infants w/ lung disease
2. prematurity 3. BPD 4. Infants with CHD |
|
|
What immunity is provided for RSV?
|
1. not a vaccine, but it helps
2. Synagis 3. monthly IM injection 4. expensive, so only for high risk groups |
|
|
Preventing RSV?
|
hand-washing, contact isolation, focus on nosocomial infection
|
|
|
What are the respiratory complications of seasonal flu?
|
1. Otitis media, sinusitis
2. Bacterial pneumonia |
|
|
How to prevent complications of flu?
|
1. immunization
2. early detection 3. aggressive care 4. family education |
|
|
What is pertussis?
|
1. whooping cough
2. highly communicable and vaccine preventative |
|
|
Clinical manifestation of whooping cough?
|
1. persistent cough for > 2 weeks
2. rhinnorhea 3. sore throat 4. whooping cough in later stages |
|
|
How is pertussis transmitted?
|
1. easily by droplets
2. incubation period of 3-21 days 3. occurs in unvaccinated children under 4 years old |
|
|
How to treat pertussis?
|
1. Erythromycin for 14 days
2. trimethoprim/sulfamethoxazole for 14 days 3. azithromycin 5-7 days (can cause GI side-effects) |
|
|
Nursing intervention for family of pertussis patient with infant <6 months ?
|
pertussis prophylaxsis
|
|
|
Complications of pertussis?
|
1. secondary bacterial pneumonia
2. seizures secondary to hypoxic encephalopathy 3. apnea 4. dehydration 5. malnutrition 6. reactive airway disease |
|
|
What is cystic fibrosis?
|
1. exocrine glands produce thick mucus in bronchioles, small intestines, and bile ducts
2. dysfunction causes multi-system problems |
|
|
How is cystic fibrosis transmitted?
|
1. inherited recessive trait
2. defected gene from both parents |
|
|
What is the most common lethal genetic disease among white pediatric patients?
|
cystic fibrosis
|
|
|
Clinical presentation of cystic fibrosis?
|
1. sweat gland dysfunction resulting in increase salty sweat
2. pancreatic enzyme deficiency r/t duct blockage 3. progressive chronic obstructive lung disease |
|
|
Diagnostic tests for cystic fibrosis?
|
1. sweat test
2. 72 hr fecal fat 3. chest x-ray 4. genetic testing 5. prenatal testing |
|
|
Effects of cystic fibrosis?
|
mechanical obstruction of bronchi, small intestine, pancreatic ducts, and bile ducts
|
|
|
Cystic fibrosis signs in infants?
|
1. malnutrition
2. salty skin 3. frothy, foul smelling stool that floats |
|
|
cystic fibrosis signs in toddlers?
|
1. poor weight gain
2. chronic dry cough 3. frequent respiratory infections |
|
|
Cystic fibrosis in late childhood/adolescence?
|
1. barrel-shaped chest
2. clubbing of toes and feet 3. delayed puberty 4. fertility issues |
|
|
Nursing interventions for Cystic fibrosis?
|
1. high-level contact precautions
2. Higher antibiotic doses through PICC line 3. Enzyme replacement PO before meals 4. respiratory therapy 5. high salt, high calorie meals 6. education about progression, treatments |
|
|
What kind of respiratory therapy for cystic fibrosis?
|
1. percussion and postural drainage
2. inhaled medications 3. Oxygen to maintain adequate 02 |
|
|
Complication of Cystic Fibrosis?
|
burkholderia cepacia complex
|
|
|
What is burkholderia cepacia complex?
|
1. pathogens in an immunocompromised host
2. results in rapidly progressive, invasave, and fatal bacteremic disease 3. opportunistic pathogen found in normal places like soil 4. mode of transmission both from other patients and from the environment |
|
|
What type of medications for Cystic Fibrosis?
|
1. pancreatic enzymes
2. antibiotics 3. bronchodilators |
|
|
What nutritional needs for cystic fibrosis patient?
|
1. calories
2. protein 3. fluids |
|
|
What type of parent teaching for cystic fibrosis?
|
1. life expectancy is 37 years
2. follow up with CF center 3. genetic counseling |
|
|
What is apnea in infants?
|
cessation of respiration for >20 sec or any duration w/ bradycardia and cyanosis
|
|
|
What are some causes of apnea r/t prematurity?
|
neurologic, immunologic, neuromusculoskeletal
|
|
|
What is bronchopulmonary dysplasia?
|
chronic lung disease caused by infant respiratory distress syndrome
|
|
|
etiology of BPD?
|
1. scarring of lung walls
2. shrinkage of gas exchange area 3. caused by high 02 levels and long-term ventilation 4. **from lung disease therapy** |
|
|
Nursing interventions for BPD?
|
1. noninvasive positive pressure ventilation (NPPV)
2. Nasal prongs or oral mask attached to a ventilation system 3. CPAP 4, CIPAP 5. incentive spirometer |
|
|
What is the 2nd leading cause of death in kids 1-14?
|
cancer
|
|
|
What are some indicators of a pediatric cancer prognosis?
|
1. type
2. age 3. primary site 4. progression 5. genetics |
|
|
What is acute lymphoblastic leukemia?
|
1. abnormal lymphoid stem cells that infiltrate bone barrow, blood, and organs
2. 80-90% of leukemias 3. 90-95% remission |
|
|
What is acute myelogenous leukemia?
|
1. more aggressive than lymphoblastic leukemia
2. bone marrow transplant during remission 3. 20-50% survival with BMT |
|
|
What is the "good leukemia"?
|
Lymphoblastic Leukemia
|
|
|
Clinical presentation of ALL?
|
1. Sx = fatigue, fever, pallor, petechiae, bleeding, bruising, bone pain, lymphadenopathy
2. anemia 3. thrombocytopenia 4. neutropenia 5. hepatosplenomegaly 6. bone pain |
|
|
What does a CBC look like with ALL?
|
1. elevated WBC
2. decreased Hgb, platelets, and neutrophils 3. blast cells present |
|
|
What is the single most important predictor of a prognosis?
|
neutropenia present
|
|
|
Diagnostic procedures for ALL?
|
1. bone marrow biopsy
2. lumbar puncture to rule out CNS |
|
|
Nursing Care for bone marrow biopsy and lumbar puncture?
|
1. conscious sedation protocol
2. assist & position 3. Vital assessment 4. Provide information 5. apply dressing |
|
|
Treatment for ALL?
|
1. eradicate leukemia blast cells to allow normal cell growth
2. CNS prophylaxis chemotherapy 3. intensive support care for family and patient 4. chemotherapy, steroids, LP's 5. infection control |
|
|
What are the phases of ALL treatment?
|
1. induction
2. consolidation 3. intensification 4. maintenance |
|
|
What is the induction stage of ALL treatment?
|
1. 28 day treatment
2. three different chemotherapy drugs 3. four drug induction treatment for high risk patients |
|
|
Nursing care during induction ALL therapy?
|
1. bone marrow aspirate/spinal tap with sedation
2. Sodium Bicarbonate IVF to **prevent tumor lysis syndrome** 3. transfusion of PRBC (Hgb > 8.0) 4. platelets 5. blood cultures and antibiotics 5. allopurinol oral TID 6. weights and strict I&O 7. q4 hr blood draw with CBC and fluids |
|
|
What is the consolidation stage during ALL therapy?
|
1. 2-3 month treatment
2. kills 99% of leukemic cells, but that 1% is still dangerous 3. intensive treatment of CNS with IT chemotherapy and cranial radiation |
|
|
What is the maintenance stage of ALL therapy?
|
1. two-three year treatment
2. maintain remission, prevent drug-resistance forms developing 3. daily and weekly chemotherapy 4. CNS prophylaxis usually continues through maintenance |
|
|
What is hodgkins disease?
|
malignancy of lymphoid system
|
|
|
Progression of hodgkins disease?
|
1. painless regional lymph node enlargement
2. extension to contiguous nodes 3. metastasis to other organs |
|
|
Which lymph node is most commonly enlarged in Hodgkins disease?
|
cervical nodes
|
|
|
How does hodgkin's lymphoma present clinically?
|
1. peaks in adolescence
2. cervical lymphadenopathy (painless, rubbery, firm, fixed node) 3. fever higher than 38 4. unintentional weight loss 5. night sweats 6. fatigue |
|
|
What are the clinical manifestations of hodgkin's lymphoma?
|
1. anorexia, malaise, lassitude
2. unexplained fevers 3. pain worsens with alcohol ingestion 4. anemia |
|
|
Prognosis of hodgkin's disease: A versus B?
|
1. A symptoms are local and better
2. B symptoms are systematic and bad |
|
|
Diagnosis hodgkin's disease?
|
1. examination with careful measurement of lymph node
2. chest x-ray to rule out a mass 3. full blood work 4. lymph node biopsy 5. bone marrow biopsy |
|
|
What is the hallmark of HD?
|
a lymph node biopsy revealing a reed-sternberg cell
|
|
|
what is a reed-sternberg cell?
|
large with abundant cytoplasm with either multiple or multi-lobed nuclei
|
|
|
What are the treatment strategies for hodgkins disease?
|
1. four drug combination therapy
2. six month treatment 3. one chemo cycle per month |
|
|
What is the combined modality treatment for HD?
|
chemo with low dose radiation in lower stages
|
|
|
What are some properties of cancer cells?
|
1. no regulation of cell replication
2. no programmed cell death 3. rapid division 4. creates new blood vessels |
|
|
How does the body stop tumors?
|
suppression genes and proto-oncogenes
|
|
|
What is sandwich therapy in HD?
|
involved field radiation between courses of chemotherapy
|
|
|
What is the treatment for relapsed HD?
|
bone marrow transplant
|
|
|
What is the most common extracranial tumor?
|
neuroblastoma
|
|
|
Benign CNS tumors vs. Malignant tumors?
|
1. benign are insidious w/ gradual symptoms
2. malignant have sudden onset and intense symptoms |
|
|
Presenting symptoms of CNS tumors?
|
1. headache, visual disturbances
2. nausea, vomiting 3. seizures |
|
|
What do you have to remember for CNS tumors?
|
headache, nausea, vomiting (All FROM INCREASED ICP)
|
|
|
What are the two classifications of CNS tumors?
|
1. supra tentorial = anterior 2/3 of brain
2. lower 1/3 of the brain |
|
|
What structures contain supratentorial tumors?
|
cerebrum, basal ganglia, thalmus, hypothalamus, pituitary
|
|
|
Symptoms of supratentorial tumors?
|
increased ICP, vision changes, headache, emesis, seizures, behavioral issues
|
|
|
What structures have infratentorial tumors?
|
cerebellum and brainstem
|
|
|
What are the symptoms of infratentorial tumors?
|
ataxia, head titlt, cranial nerve palsy, increased ICP, back pain
|
|
|
Diagnostic tests for CNS tumors?
|
1. MRI head/spine
2. CAT scan of head to check for hydrocephalus 3. Myelography = radiographic exam using contrast medium 4. EEG for seizures 5. assess hearing 6. CSF analysis |
|
|
Treatment strategy for CNS tumors?
|
1. surgical removal
2. surgery decompresses tumor for other treatments 3. radiation 4. chemotherapy |
|
|
How is radiation therapy used for CNS tumors?
|
1. after surgical attempt
2. small uses r/t decreased tolerance of brain to radiation 3. standard with hyperfractionation schedule |
|
|
Problems with chemotherapy used for CNS tumors?
|
limited effect r/t blood brain barrier
|
|
|
What are some common CNS tumors?
|
1. astrocytomas
2. ependymoma 3. brain stem glioma 4. medulloblastoma 5. cerebellar astrocytomas |
|
|
What is given during CNS tumor radiation therapy to reduce edema?
|
Decadron
|
|
|
What is the estimated CNS tumor survival rate?
|
about 50%
|
|
|
What is a Type I hypersensitivity reaction?
|
immediate antibody allergic reaction (anaphylaxis)
|
|
|
What is a Type II hypersensitivity reaction?
|
Cell incompatibility (mismatched blood transfusion)
|
|
|
What is a Type III hypersensitivity reaction?
|
Immune complex production (lupus, rheumatoid arthritis)
|
|
|
What is a type IV hypersensitivity reaction?
|
cell mediated (dermatitis)
|
|
|
What is anaphylaxis?
|
1. acute systemic allergic reaction
2. caused by exposure to an antigen 3. mastive histamine release from mast cells 4. life threatening 5. Atopy = the hereditary condition of overproduced IgE antibodies |
|
|
Assessment findings for anaphylaxis?
|
1. urticaria (hives)
2. Angioedema from vascular permeability 3. Bronchospasms 4. laryngeal edema 5. hypotension 5. cardiac arrthymias |
|
|
Nursing management of anaphylaxis
|
1. ABC assessment w/ oxygen administration
2. remove/stop possible antigens 3. administer epinephrine 4. start IV fluids (NSS) 5. administer antihistamines (benadryl) 6. administer vasopressors (dopamine) if epinephrine doesn't work |
|
|
Proper health education for anaphylaxis?
|
1. identify allergens
2. notify primary health provider 3. epi pens 4. teach signs & symptoms |
|
|
What is dermatitis?
|
inflammatory skin condition from exposure to an allergen
|
|
|
What bacteria is cultured from dermatitis in infants 40-75% of the time?
|
candida albicans
|
|
|
Assessment for diaper dermatitis?
|
1. bright red skin with swelling
2. irritability 3. pain during diaper changes 4. poor infant care |
|
|
Prevention and treatment of diaper dermatitis?
|
1. frequent diaper changes
2. avoid baby wipes 3. super-absorbent diapers 4. barrier cream 5. no plastic pants 6. no chalk based powders 7. antifungal |
|
|
What is Atopic dermatitis (eczema)?
|
1. pruritic eczema beginning in infancy
2. has three forms based on location and age 3. unknown cause, but probably immune reaction 4. infantile AD noted with erythema, papules, weeping, oozing, crusting 5. intense itching |
|
|
Nursing care for infant with Eczema?
|
1. hyrdate skin
2. relieve puritis 3. reduce flares and inflammation 4. prevent infection 5. prevent exposure 6. provide moisture 7. improve hydration 8. antihistamines, topical steroids, mild sedatives |
|
|
What is the proper hydration of infant with atopic dermatitis?
|
1. tepid bath with mild or no soap
2. bath followed immediately after an emollient 3. no bubble baths or harsh soap 4. bath multiple times |
|
|
How to relieve pruritis in eczema infants?
|
1. colloid baths (cornstarch in warm water)
2. Oral antihistamines |
|
|
What are some oral antihistamines that relieve pruritis in eczema infants?
|
hydroxyzine, diphenyhydramine, claritin, and allegra
|
|
|
How the nurse reduces flare and inflammation in eczema infants?
|
1. topical steroids (first)
2. systemic antibiotics 3. coal tar preps to hydrate skin 4. wet wraps after light application of topical steroid for 10 minutes, then removed |
|
|
How the nurse prevents and controls infection in infants with atopic dermatitis?
|
1. limits exposure to allergens
2. breast feeding 3. topical immunomodulators 4. tacrolimus |
|
|
Name two immunomodulators?
|
tacrolimus and pimecrolimus
|
|
|
Miscellaneous nursing interventions for preventing rashes?
|
1. soft cotton clothing
2. neutral ph soaps 3. meticulous hygiene 4. wet soaks for compresses |
|
|
What is juvenile rhematoid arthritis?
|
chronic inflammation of the joints and connective tissue
|
|
|
What is the onset of JRA?
|
2-16 years of age, peaking at 1-3 and 8-10
|
|
|
Cause of JRA?
|
unknown, but speculated as an agent activated autoimmune response
|
|
|
What are the three types of JRA based on?
|
1. number of joints involved
2. rheumatoid factor positive or negative (90% negative) 3. presence vs. absence of anti-nuclear antibodies 4. age of onset 5. gender predominance 6. systemic mannifestations |
|
|
What are the three types of JRA?
|
1. Systemic Onset
2. Pauciarticular 3. Polyarticular |
|
|
Pathophysiology of JRA?
|
1. inflamed synovial membrane in joint capsules causes increase in fluid
2. which causes swelling and effusion 3. which increases lymphocytes and plasma 4. leads to erosion of joint structures |
|
|
Physical symptoms of JRA?
|
1. swelling/pain
2. swollen, warm to touch 3. fever 4. stiffness of joint 5. growth retardation |
|
|
Diagnosis of JRA?
|
1. no test
2. increased erythrocyte sedimentation rate 3. anemia 4. changes in joint structure during advanced stage 5. unusual amount of antibodies in joint serum 6. antinuclear antibodies present |
|
|
Goals of treatment with JRA?
|
1. prevent joint deformity
2. keep discomfort limited 3. allow little or no restriction of activity 4. preserve activities of daily living |
|
|
Nursing interventions for JRA patients?
|
1. medications to decrease inflammation
2. PT and OT 3. non-drug pain management like baths, heat application, keeping joints warm at night 4. nutrition high in iron 5. emotional support 6. encourage regular sleep, but no naps |
|
|
Drug therapy for JRA patients?
|
1. NSAID's, monitor for GI effects (not for long term)
2. slow-acting antirhematic drugs to suppress autoimmune response 3. steroids as a very last resort 4. biologic agents such as etanercept |
|
|
What is systemic lupus erythematosus?
|
1. a multi-system autoimmune disorder of the blood vessels and connective tissue
2. antibodies created against one's own DNA and RNA 3. variable and unpredictable 4. onset 10-19 years of age |
|
|
Clinical manifestations of Lupus?
|
1. butterfly rash
2. photo-sensitivity leading to rash 3. patches of red lesions on skin 4. painless ulcers in nose and mouth 5. arthritis with effusion or tenderness in 2 joints 6. pleuritis or pericarditis 7. renal disorders from proteinuria 8. psychosis and seizure activity 9. hematologic disorders 10. immunologic disorders with presence of autoantibodies 11. anti-nuclear antibodies |
|
|
What is a butterfly rash?
|
face rash over the bridge of the nose and cheeks
|
|
|
What is the main pharmacological treatment for lupus?
|
systemic steroids dosed enough to control symptoms, but weaned slowly to the least amount necessary
|
|
|
What are some holistic approaches to treating lupus?
|
1. well balanced diet during steroid use including low sodium
2. exercising to maintain weight, fitness, bone density 3. eight to ten hours of sleep per night with napping 4. avoid sun exposure |
|
|
How to promote health for a patient with lupus?
|
1. education and ensuring compliance with drug therapy
2. limit sun exposure 3. responsible sexual activity |
|
|
What accounts for 90% of children with HIV?
|
perinatal transmission
|
|
|
What maternal factors influence perinatal transmission of HIV?
|
1. CD4+ count
2. viral load 3. presence of STIs 4. retroviral therapy |
|
|
Clinical Categories of Pediatric AIDS?
|
1. N = no signs
2. A = mild signs 3. B = moderate 4. C = severe |
|
|
How long is a child's latency period if they are HIV infected?
|
much shorter than an adult's
|
|
|
What are the two patterns of clinical course for HIV children?
|
1. 20% become seriously ill by age 1, dead by 4
2. 80% have slower progression with AIDS by school-age |
|
|
Clinical assessment findings for HIV children?
|
1. repeated respiratory infections and otitis media
2. unexplained diarrhea 3. loss of developmental milestones 4. Failure to thrive (FTT) 5. Oral Thrust 6. Enlarged Liver and Spleen |
|
|
Diagnostic values for HIV?
|
1. below normal CD4 count
2. WBC below 1500 3. T4 cell count below 300 4. disruption of T-helper cells to T suppressor cell ratio with more suppressor cells 5. positive ELISA 6. Positive Western Blot Test 7. 24 antigen detection 8. Polymerase chain reaction for detection of proviral DNA |
|
|
Pharmacological management of HIV?
|
1. antiretroviral drugs
2. 2 NRTIs plus efavirenz for children >3 3. 2 NRTIs plus nevirapineqa for children <3 4. Gamma Globulin through IV to prevent bacterial infections 5. Full Immunizations for HIV children as long as severe immunocompromise hasn't occured yet 6. prophylaxis treatment for PCP infections with bactrim for all infants born to HIV mothers during first year of life |
|
|
Nutritional nursing interventions for HIV patients?
|
1. frequent measures of weight gain and nutritional status
2. high-calorie foods |
|
|
What is the most common disease in african-americans?
|
sickle-cell anemia
|
|
|
What is the genetic transmission of SCA?
|
auto-recessive
|
|
|
What is the pathophysiology of SCA?
|
hemoglobin replaced with defective hemoglobin
|
|
|
What happens to people with the recessive SCA trait?
|
almost half of their hemoglobin is defective
|
|
|
What conditions can cause the hemoglobin to put the SCA patient into a crisis?
|
1. elevated temperature
2. dehydration 3. acidosis 4. hypoxia 5. exercise |
|
|
What are the four types of crisis in SCA?
|
1. Vasoocclusive
2. acute spleenic 3. Aplastic crisis 4. Hyperhemolytic |
|
|
What is vasoocclusive crisis?
|
tissue ischemia that causes pain
|
|
|
What is acute spleenic sequestration?
|
blood pools in the spleen, causing enlargement
|
|
|
What is aplastic crisis?
|
production of red blood cells decreased by a viral infection
|
|
|
What is Hyperhemolytic crisis?
|
massive destruction of RBCs
|
|
|
How is the spleen affected by SCA?
|
1. the spleen is engorged with sickle-cells and can cause loss of function by age 5
2. lack of function causes susceptibility to infections |
|
|
How is the liver affected by SCA?
|
1. chronic destruction of RBCs causes enlargement from capillary obstruction
2. eventually jaundice, gallstones, necrosis, and liver scarring occurs |
|
|
How is the kidney affected by SCA?
|
1. intravascular congestion of glomerular capillaries
2. ischemia causes hematuria, enuresis |
|
|
How is the CNS affected by SCA?
|
1. ischemic strokes are common ages 2-10
2. TIAs are common among children |
|
|
Signs of TIA in SCA patient?
|
sudden onset of numbness or weakness in an extremity on one side of body
|
|
|
How does SCA affect the cardiovascular system?
|
1. chronic anemia
2. risk of pulmonary arterial occlusion and myocardial damage 3. CHF and MI can occur by age 5 |
|
|
What is the lifespan of a sickle-cell RBC?
|
7-20 days
|
|
|
How is the respiratory system affected by SCA?
|
acute chest syndrome is leading cause of morbidity and death
|
|
|
what is acute chest syndrome?
|
similar to pneumonia w/ pulmonary infiltrates causing chest pain, fever, tachypnea, wheezing, and hypoxia
|
|
|
How are the bones affected by SCA?
|
necrosis of the humeral and femoral heads can occur along with pain and immobility
|
|
|
What is priaprism?
|
a painful, persistent erection that can last for hours/days/weeks
|
|
|
How is the immune system affected by SCA?
|
1. bacterial infections from septicemia r/t pneumonia is leading cause of death in young children
2. increased heart rate, RR and temperature |
|
|
What is hemoglobin electrophoresis?
|
high-voltage microscope examines blood and gives definitive diagnosis of trait or disease
|
|
|
How often is a CBC done in pediatric SCA patients?
|
routinely
|
|
|
What is a reticulocyte count?
|
percentage of newly formed RBCs in circulation
|
|
|
How to manage an acute SCA crisis?
|
1. bed rest to minimize energy use and oxygen needs
2. adequate hydration, respiratory assessments, and antibiotic use to prevent acute chest syndrome 3. hydration at 1.5-2x the maintenance fluid requirement 4. control pain 5. monitor CBC and reticulocyte count to respond to hemoloysis |
|
|
What is hemophilia?
|
a group of bleeding disorders in which there is a deficiency that prevents coagulation of blood
|
|
|
Genetics of hemophilia?
|
1. 60% are hereditary sex-linked recessive
2. unaffected male with a trait-carrying female |
|
|
What are the two types of Hemophilia?
|
1. Classic, Hemophilia A, Factor VIII deficiency
2. Christmas Disease, hemophilia B, factor IX deficiency |
|
|
which type of hemophilia accounts for 80% of all cases
|
classic/hemophiliaA
|
|
|
How does factor activity relate to severity of hemophilia?
|
1. Severe = <1% of activity = spontaneous bleeding
2. Moderate = 1-5% activity = bleed w/ trauma 3. Mild = 5-50% activity = bleed w/ severe trauma |
|
|
Diagnostic evaluation of hemophilia?
|
1. platelet function unaffected in children with hemophilia
2. prothrombin time is increased (PT) 3. partial prothrombin time (PTT) is increased |
