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39 Cards in this Set
- Front
- Back
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Fluid Requirements Calculations
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<10kg
➧daily: 100mL/kg/day ➧hourly: 4cc/kg/hr 11-20kg ➧daily: 1000mL + 50mL/kg for each kg>10 ➧hourly: 40cc + 2cc/kg for each kg>10 >20kg ➧daily: 1500mL + 20mL/kg for each kg>20 ➧hourly: 60cc + 1cc/kg for each kg>20 |
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Average Daily Required Calories Calculations
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infant: 110-120kcal/kg
1-3yo: 100kcal/kg 4-6yo: 90kcal/kg 7-9yo: 80kcal/kg 10-12yo: 70kcal/kg 13-15yo: 60kcal/kg 16-19yo: 50kcal/kg |
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Newborn G&D
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nutrition/metabolic:
➧regain birth weight by 2-3wks ➧rapid growth 1kg & 2.5cm/mon ➧breast/formula q3-4hr elimination: unable to concentrate urine activity/exercise: reflex stage sleep/rest: varies to a series of naps around 10-22hrs/day coping/stress tolerance: cries vary (hunger, position change, attn, comfort) |
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Infant 3months G&D
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nutrition/metabolic: 1kg & 2.5cm/mon stabilizing
elimination: bladder capacity gradually ↑ activity/exercise: ➧improved head control: when prone, raises head & chest 40º-90º ➧follows past midline ➧fist to mouth, reflexes fading, swipes at objects, hands to midline, reaches for toy ➧head lag lessens when pulled to sit sleep/rest: sustained sleep seldom exceeds 4hrs; waking time increases coping/stress tolerance: ➧habituates to persistent stimuli ➧gives cues when stressed; does not always cry ➧activity releases tension |
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Infant 6months G&D
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nutrition/metabolic:
➧birth weight doubled ➧solids added (rice cereal) ➧1 new food q5days: peas, applesauce, pears; bananas, carrots, green beans, squash, spinach ➧teething bagels & biscuits ➧juice in cup ➧no stringy, sticky or pellet-sized food elimination: reabsorption & filtration levels attained activity/exercise: ➧sits (tripod position) ➧no head lag ➧rolls over both sides ➧begins to bear own weight when held to stand ➧transfers objects hand-to-hand ➧purposeful reaching ➧good hand-mouth coordination sleep/rest: sleeps 7-10hrs at night coping/stress tolerance: ➧distracted by novelty ➧curious ➧frustrated if movement restricted ➧cries, calls |
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Infant 9months G&D
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nutrition/metabolic:
➧↑0.5kg & 1.5cm/mon ➧3-4 meals/day ➧fingers own food; start of utensil use ➧add meat/protein (yogurt, cheese) ➧juice in cup ➧no chokables ➧no bottles in bed unless water elimination: larger bladder capacity activity/exercise: ➧stands holding onto objects ➧moves by rolling, hitching, crawling, creeping ➧may pull self to stand sleep/rest: 2-3naps; ↓total sleep coping/stress tolerance: ➧parent is primary coping resource ➧activity releases tension: cries, fusses, sleeps ➧still distractible |
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Infant 12months G&D
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nutrition/metabolic:
➧birth weight tripled ➧feeds self (fingers, spoon) ➧eats soft table foods; 3 meals, 2 snacks ➧add whole milk elimination: may indicate awareness activity/exercise: ➧pulls to stand ➧cruises furniture ➧stands alone ➧walks alone or w/ help ➧neat pincer grasp sleep/rest: rituals at bedtime; resists bed; may awaken at night; 1-2 naps coping/stress tolerance: ➧active searching for parent ➧extreme fussiness & resistance to comforting when separated from parent ➧handles new situations best if parent present |
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Infant 18months (G&D)
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nutrition/metabolic:
➧↓appetite ➧6-12 teeth ➧feeds self: 3 meals/snacks ➧whole milk only; limit empty calories elimination: may indicate early readiness activity/exercise: ➧15mon: removes socks/shoes; scribbles; turns thick pages; toss/roll ball; matches shapes ➧18mon: runs, climbs, stops/starts at will; rounds corners easily; well-controlled grasp-release ➧manipulates w/ good wrist control sleep/rest: stable sleep patterns of 11-12hrs; may nap coping/stress tolerance: ➧minimal tolerance for frustration: active vocals & phys response to tension ➧transitional objects/rituals for comfort/security ➧uses dictation & pretends to play w/ toys |
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Toddler 18mon-3yo G&D
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nutrition/metabolic:
➧half of adult height; gain of 1cm/mon (usually 12.5cm by 2yo & 7.5-10cm by 3yo) ➧gain 1/2lb (200g)/mon at 30mon; 5lbs (2.3kg)/mon at 2yo ➧3 complete meals w/ snacks ➧can feed self w/ utensils ➧has food preferences ➧may not stop play to eat elimination: ➧may show readiness for toilet training (bowel precedes bladder) ➧3yo: ok daytime control w/ some PM accidents activity/exercise: ➧2yo: stairs w/ 1foot; right/left handedness; draws vertical line; push-pulls toys; drinks from cup; takes off clothes ➧2.5yo: puts on easy clothes; brushes teeth; holds pencil with fingers ➧3yo: jump; walk backwards; climb stairs; pedals tricycle; stand on 1foot; uses blunt scissors; copies circle; points up/down sleep/rest: ➧2yo: may sleep thru night w/ some nightmares; may nap ➧3yo: less resistance at bedtime; may need light & routine/rituals coping/stress: ➧looks to parents for encouragement/protection ➧2yo: temper tantrums; routines important; transitional objects ➧3yo: specific behaviors of regression, denial, projection, attack, displacement |
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Early Childhood 3-5yo G&D
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nutrition/metabolism:
➧↑ht 2-3in (5.7.5cm)/yr ➧↑wt 5lb (2.3kg)/yr ➧3meals w/ snacks ➧food jags common ➧can use knife ➧poor manners; rushes eating for playtime elimination: toilet trained w/ some accidents activity/exercise: ➧4yo: balances on 1foot; hops; jumps; climbs jungle gym; draws person w/ 3 IDable parts ➧5yo: improved balance; bikes; jump rope; catches ball w/ 2 hands; dresses self; prints name; improved scissor use sleep/rest: needs vary 8-14hr/day; fatigue common at dinnertime; dislikes bedtime coping/stress: ➧verbalizes & starts to include feelings ➧play/fantasy as regression to cope w/ fears ➧projection, denial w/ new tasks ➧may attack in threatening positions ➧displays independence thru noncompliance; confused over inconsistent limits |
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Early Schoolage 5-8yo G&D
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nutrition/metabolic:
➧gain 1-2kg/yr & 1-1/4cm ➧slow, steady long bone growth; muscle replaces baby fat ➧less fussy about preferences ➧face grows outward at jaw ➧2ndary teeth come in elimination: manages toileting w/o help; very few night accidents activity/exercise: ➧steady ↑ in gross motor/strength & fine motor coordination/dexterity ➧6yo: ↑speed ➧7yo: ↑ in phys ability; ties shoe sleep: 12hrs; less resistant to sleep coping/stress: ➧easy frustration when tired/hungry but better control of emotions ➧early inability to tolerate criticism but tempered w/ ↑self-esteem/understanding ➧more selective in coping behaviors |
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Late Schoolage 8-12yo G&D
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nutrition/metabolic:
➧gain 3-3.5kg (5-7lbs) & 5-6.4cm (2-2.5in)/yr ➧even body ratio (more trunk/leg growth) ➧girls start growth spurts after 10yo elimination: self-care; may have constipation activity/exercise: ➧perfection of skill/coordination ➧cursive writing, craft skills, musical insturments sleep/rest: 8-10hr varies w/ activity; personal bedtime rituals coping/stress: ➧controls/expresses emotions more approp ➧coping reflects past strategies/behaviors |
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Early Adolescence 10-14yo G&D
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nutrition/metabolic:
➧mostly trunk growth, length triped by 13yo ➧girls: growth spurt 8.75cm (3.5in)/yr; Ca & Fe for post-menarche ➧boys: growth spurt 10cm (4in)/yr ➧irregular eating habits, snacks often elimination: patterns well est & r/t intake activity/exercise: ➧speed/accuracy improved ➧risk-taking behavior ➧awkwardness as hands/feet reach adult size ➧competitive sports/activities shape growth sleep/rest: varies; will sleep as late as possible coping/stress: ➧con't coping strategies ➧mood swings & somatic complaints when stressed ➧maladaptive: substance abuse & runaway behavior |
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Middle Adolescence 15-17yo G&D
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nutrition/metabolism:
➧differs w/ growth, activity & gender ➧fad diets ➧dental caries ➧less dramatic phys change; focus on improving phys appearance elimination: patterns well est; issues w/ hygiene & sexual activity activity/exercise: skill perfection r/t interest; con't risk taking behaviors sleep/rest: varies by indiv; goes to bed when thinks she/he needs sleep coping/stress: ➧uses mature skills, discussion ➧risk of developing maladaptives w/ experimentation & search for peer recognition |
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Late Adolescence 17-20yo G&D
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nutrition/metabolism: varies w/ growth & activity
elimination: patterns well est; issues w/ hygiene & sexual activity activity/exercise: skill perfection r/t interest; con't risk taking behaviors sleep/rest: varies by indiv; goes to bed when thinks she/he needs sleep coping/stress: ➧uses mature skills, discussion ➧risk of developing maladaptives w/ experimentation & search for peer recognition |
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Conversions
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5cc = 1tsp
1000mg = 1g 1cc = 1mL 100mg = 1mcg 2.2lb = 1kg |
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Asthma Problems & Sx
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problems: bronchoedema & bronchoconstriction
Sx: ➧wheezing on expitory ➧↑RR ➧dry, hacking cough usually at night ➧hypoxic <95%: dangerous for kids b/c of brain development ➧retractions on chest/ribs; nose flaring ➧longer expitory phase (classic air trapping sign) |
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Corticosteroids
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for asthma: bronchoedema
routes: ➧PO: Prednisone; systemic but targets bronchiols ➧IV: Methoprednisone (fastest); systemic but targets bronchiols ➧inhaler: Flovent; doesn't work acutely or systemically; takes 5days S/E: ➧immunosuppression: if taken too long ➧loss of appetite ➧growth stunting: height; systemic effect ➧pts feels loopy/gross intrvs: rinse mouth to prevent fungal infections notes: ➧inhaled Flovent for outpatient to handle maintenance of triggers/allergies ➧see chart of spirometer "zones"; "yellow" means 2x Flovent |
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Albuterol
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for asthma: bronchoconstriction
nebulizer (inpatient): ➧1cc max amt; 2cc saline as carrier fluid ➧wall unit of 8L O2 to make it a mist ➧better for hypoxia ➧can breathe on own with hospital devices ➧can be taken w/ Atrovent mixed in inhaler (outpatient): ➧need spacer to hold med & allow time to breathe ➧directions: breathe in deep & hold for 6-10s; take 6 breaths after spray; wait 30s-1min b/t the 2 sprays S/E: tachycardia, tremors notes: ➧the ONLY rescue drug ➧6yo can coordinate proper usage |
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Breathing Devices
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Face mask: can breathe in any way
Shovel mask/tent: humidified O2; up to 80% O2 Venti/Venturi mask Nonrebreather: wall unit at 8-10L, enough to keep bag inflated Ambu-bag ventilation if ↓RR |
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Upper Airway Conditions
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Obstruction
➧S/S: stridor on inhale; ↑RR; anxious ➧Tx: Hemlich; CPR Anaphylaxis from Swollen Edema ➧S/S: facial hives; edema ➧Tx: antihistamine or epinephrine injection Cold/Croup virus ➧3-6yo ➧S/S: barking seal cough worse at night ➧Tx: cold air; mist/steam from hot shower; steroids if stridor is persistent or resp dist |
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Lower Airway/Lung Tissue Conditions
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PNA
➧S/S: wet productive cough; rhonchi in infected lobe; fever ➧Tx: ABX; CPT; positioning Cystic Fibrosis Neuro: discoordinated breathing Carbon monoxide poisoning Narcotics use |
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Process of Dehydration
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1) HR ↑ as dehydration gets more severe
2) acidotic to compensate ⇒ ↑RR 3) orthostatic from vol depletion: will ↓BP as last sign 4) brain gets less blood ⇒ fatigue & cold S/S: skin dry; delayed cap refill; low turgor; weight loss Stroke volume ➧Preload is hydration status ➧Afterload is resistance ➧Contractility usually not an issue w/ kids |
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Treatment of Dehydration
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Isotonic solution of Normal Saline or Ringer's Lactate: b/c we worry for Na content
formula: 20cc/kg/bolus recovery S/S: HR improved; RR improved; consolable |
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Babies & Dehydration
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cause: often d/t diarrhea
Tx: Oral Hydration Therapy ➧PO isotonic soln ➧give in increments: ~5cc/min ➧if severe enough, give isotonic soln instead of breastfeeding |
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Nursing Priorities of Post-Operative Care
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Pain
Risk for atelectasis Bleeding from site Vital signs Paralytic ileus Constipation Venous clots |
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Pain Nursing Interventions
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assess FACES, FLACC, individualized rating scale (ie pt chooses colors assoc w/ pain)
PO narcotics better than IV b/c has less S/E |
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Risk for Atelectasis Nursing Interventions
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sit upright/positioning unless contraindicated
incentive spirometry playing & ambulating ↑temp on 1st day post-op = atelectasis (NOT fever) |
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Bleeding from Surgical Site Nursing Interventions
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reinforce surgical dressings with gloved hand & gauze
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Paralytic Ileus Nursing Interventions
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neg bowel sounds
advance diet as tolerated: ➧only advance to new foods when +bowel sounds ➧eating w/o bowel sounds ⇒ vomiting ⇒ aspiration PNA |
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Constipation Nursing Interventions
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from narcotics & little movement
check bowel sounds for ileus, flactulance, last BM DON'T withhold narcotics even with constipation |
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Venous Clots Nursing Interventions
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S/S: leg red, puffy, warm, painful
prevent w/ ambulation, neumoboots, heparin |
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Cardiac Catheter Reasons & Surgical Sites
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reasons:
➧biopsy, cardiomyopathy, angiogram ➧stent: to open area for stenosis ➧balloon: to open area for atresia ➧closing holes: for ASD/VSD ➧cardiac ablasion: when SA node is not starting ⇒ accessory pathway found and burned surgical site: femoral artery & vein of same side ➧artery side will likely bleed d/t ↑pressure ➧when bleeding, add pressure right over site for 15min & prevent clot & call MD |
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Nursing Priorities of Cardiac Catheter Care
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Positioning: <30º, no movement to prevent dislodging clot
Bleeding Surgical Site Bleeding into Periorbital Space: ➧↑HR, abd distension, dizzy, hypotension ➧BP calc: 1-10yo = 70 + 2xAGE = hypotensive BP Bleeding into Cardiac Wall: ➧pleural effusion: Tx w/ chest tube ➧cardiac tamponade: contractility affect w/ fluid sqeezing the cardiac muscle; ↑HR, poor perfusion, ↓pedal pulses; EMERGENCY!! Arterial Clot ➧cold feet, ↓pedal pulse/Doppler ➧if cold, call MD for thrombolytics Venous Clot ➧hot, good pulse, edema Hypovolemia: when ↓bilateral pulses Infection: prevent w/ ABX (3 doses) esp b/c of device insertion Sedation: conscious w/ morphine ➧S/E: nausea (does not affect by peristalsis) |
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RASS test
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used to check for excessive IgE presence in blood
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Skin test
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allergen test when the antigen is mixed with saline and put under the patient's skin
rxn is inflammed, indicating response to that allergen |
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Benadryl
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starts to work in 5min PO
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IV tubing duration
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lasts only four days
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Dehydration/Output Calculations
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norm: 0.5-2mL/kg
dehydration: <0.5mL/kg |
