Peds Final 2

Front 1

What are general guidelines to kids and dealing with death?

Back 1

o Follows Piaget’s stages
o Child wants to feel safe and does not want to be in pain or alone
o Spiritual beliefs may influence the child’s and may be reflected in conversations and actions

Front 2

What is the infants/sensorimotor stage concept of death?

Back 2

They have NO CONCEPT of death
They react to separation and loss, as well as changes in their routines and caregivers
React to parent;s emotions

Front 3

What is important nursing consideration for infants and death?

Back 3

Parents become the patients- we need to help guide them through this time
Find support/resources/referrals/advice

Front 4

For children in early childhood (2-7 preoperational thought), what is their concept of death?

Back 4

Sees death as TEMPORARY (reversible like sleep)
May see death as PUNISHMENT
Fears SEPARATION, ABANDONMENT, and PAIN

Front 5

Because kids in early childhood see death as temporary, what might they do when they lose a pet?

Back 5

May attempt to dig it up to see if it is still there

Front 6

In early childhood, when dealing with death, what may bring on feelings of guilt?

Back 6

They may feel that their bad behavior brought on death or illness

Front 7

Concrete operations-schoolage children 7-11, what is their concept of death

Back 7

Starts to see death as IRREVERSIBLE
May see death as DESTRUCTIVE, SCARY, VIOLENT
Unable to comprehend own mortality
See Death as naturalistic (part of life)
Identifies with spiritual beliefs regarding death and after-life

Front 8

Why may school age children see death as destructive, scary, violent?

Back 8

Can be due to movies and television
School age children don’t know where they are going so it is scary

Front 9

What does it mean that school age children cannot comprehend their own mortality?

Back 9

Think that death wont happen to them- just happens to other people

Front 10

Once a person reaches formal operations (11-adulthood) what is their concept of death?

Back 10

Finally see death as final, irreversible
Interested in details about biological death and funerals
May feel sad, afraid, lonely
May deny own mortality
Aware of the immensity of loss that comes with death
Terminal illness separates them from their peers

Front 11

How do Adolescents deny their own mortality?

Back 11

Taking risks

Front 12

What kind of guilt may adolescents feel when in the hospital?

Back 12

When in hospital due to taking a risk their parents warned them about, they feel extreme guilt

Front 13

What is the MOST DIFFICULT age group for coping with death?

Back 13

11-Adulthood (formal operations)

Front 14

Immunity is:

Back 14

Immunity is the bodies ability to Eliminate foreign substances efficiently

Front 15

When are immunities fully developed?

Back 15

Age 6

Front 16

What are the 4 types of immunity?

Back 16

Natural
Acquired
Active
Passive

Front 17

Natural Immunity

Back 17

is the state of being able to resist illnesses.

Front 18

Acquired Immunity

Back 18

occurs as a result of prior exposure to an infectious agent or its antigens (active),
or of passive transfer of antibody or immune lymphoid cells (passive).

Front 19

Active Immunity

Back 19

Body makes antibodies without presence of clinical disease.

Front 20

Passive Immunity

Back 20

Antibodies made by another human or animal and given to another person (vaccinations) – does not confer long-term immunity.

Front 21

What is an antigen?

Back 21

• An Antigen is any substance that causes your immune system to produce antibodies against it. An antigen may be a foreign substance from the environment such as chemicals, bacteria, viruses, or pollen. An antigen may also be formed within the body, as with bacterial toxins or tissue cells. (Work against antibodies) “Trigger” for immune response

Front 22

What immunizations are given at 12 months or under?

Back 22

HepB- at birth, 2 months, and 6 months (will needs 3)
Hib (H influenzae type b)
PCV (pneumococcal)
IPV (polio)
Flu (yearly)
MMR (Measles, mumps, rubella)
Varicella
Hep A (2 doses)

Front 23

What immunizations are given at 11-12 years?

Back 23

Tdap
HPV
MCV (meningococcal)
Flu (yearly)

Front 24

What are some local adverse reactions to immunizations?

Back 24

Erythema
Swelling
Pain
Induration at the site
wheal /urticaria within minutes to hrs

Front 25

What nursing interventions for local allergic reaction to an immunization?

Back 25

Cold packs to site
Analgesics
Reassurance

Front 26

What are some systemic adverse reactions to immunizations?

Back 26

Fever
Fussiness/Irritability
Malaise and/ or anorexia
Allergic Reactions

Front 27

What are some life threatening adverse reactions to immunizations?

Back 27

Anaphylaxis
Encephalopathy
Bacterial Neuritis
Chronic Arthritis
Thrombocytopenia purpura
Death

Front 28

can an immunization be given within 24 hours of having a fever or moderate illness?

Back 28

No

Front 29

What allergies to ask about before administering immunization?

Back 29

Allergies to medications, food, or any vaccine?
Allergies to components- egg, shellfish

Front 30

Can an immunization be given if pt is immmuno-compromised?

Back 30

Only not a good idea if giving them a live virus

Front 31

Can women get immunizations if they are pregnant

Back 31

no

Front 32

Can pt on steroid therapy receive immunizations?

Back 32

No

Front 33

What is the important message to teach about vaccinations?

Back 33

Vaccines stop diseases, If we stop immunizing our children the diseases will return, There are risks associated with vaccines but they are mild and the more severe reactions are rare

Front 34

Type 1 hypersensitivity reaction

Back 34

Antibodies bind to certain cells, causing release of chemical substances (histamine) that produce and inflammatory reaction.

Front 35

How long does it take for a Type 1 hypersensitivity reaction to occur?

Back 35

second to minutes after exposure.

Front 36

What are S/S of Type 1 hypersensitivity reaction?

Back 36

Hypotension, wheezing, spasm of smooth muscle, stridor, wheal, urticaria, edema, wheezing, vomiting, diarrhea.
(ie: Anaphylaxis and extrinsic Asthma)

Front 37

Type 2 hypersensitivity reaction

Back 37

Tissue Specific Reactions- after exposure to antigen, Antibodies cause activation of complement system leading to tissue damage

Front 38

How long does it take for a Type 2 hypersensitivity reaction to occur?

Back 38

15-30 minutes after exposure to antigen

Front 39

What are S/S of Type 2 hypersensitivity reaction?

Back 39

Symptoms vary.
(ie: Transfusion Reaction, ABO incompatibility, Hemolytic Anemia)

Front 40

Type 3 hypersensitivity reaction

Back 40

Immune complex Reaction, Immune complexes are deposited in tissues, where they are activate complement which results in generalized inflammation

Front 41

What are S/S of Type 3 hypersensitivity reaction?

Back 41

Urticaria
Fever
Joint pain
(ie: arthritis?)

Front 42

Type 4 hypersensitivity reaction

Back 42

Delayed reactions- Antigens stimulate T Cells that release lymphokines, which cause inflammation and tissue damage

Front 43

How long does it take for a Type 4 hypersensitivity reaction to occur?

Back 43

24-72 hours

Front 44

What are S/S of Type 4 hypersensitivity reaction?

Back 44

Symptoms vary, fever, erythema, pruritus, contact dermititis, and blistering.
(ie: Contact dermatitis, TB skin test, Graft vs Host disease, Stevens Johnson Syndrome)

Front 45

What is a primary immune response?

Back 45

Occurs after antigen invades body, Antibodies are reactive to specific antigens, Occurs within 3 days

Front 46

What is a secondary immune response?

Back 46

Subsequent encounter with an antigen, Triggers memory cells in immune system, Result is faster response – about 24 hours

Front 47

What is varicella commonly known as?

Back 47

chickenpox

Front 48

How is varicella spread?

Back 48

Direct contact of mucous membranes and lesions.
Also airborne.

Front 49

How long is varicella contagious?

Back 49

1-2 days before the rasha dn thenuntil all leasons crusted over

Front 50

What are S/S of varicella?

Back 50

Flu like symptoms
Pruitic macules that progress to a fluid filled vesicle that open and crust over.

Front 51

What are nursing roles for pts with Varicella?

Back 51

supportive
fluids
analgesic
antipyretic
Oatmeal bath,
keep fingernails short to prevent secondary infection.

Front 52

What happens if kid scratches chickenpox rash?

Back 52

secondary infection can occur and SCARRING

Front 53

Coxsackievirus is better known as...

Back 53

Hand, Foot, Mouth disease

Front 54

How is the Coxsackievirus transmitted?

Back 54

Fecal-oral and respiratory

Front 55

How long is the Coxsackievirus contagious?

Back 55

2 days before rash and 2 days after rash disappears

ALSO
Sloughs off in the stool for 2 months after an infection

Front 56

What are S/S of Coxsackievirus?

Back 56

lesions on buccal surface of cheeks, gums and tongue, hands and feet.

Front 57

What are nursing interventions for Coxsackievirus?

Back 57

Supportive
Contact precautions
Soft bland diet (due to sores in mouth)
If fever present- give pedialyte popsicles

Front 58

How is Coxsackievirus treated?

Back 58

Only treat symptoms- it is a virus, it will clear itself

Front 59

What is Erythmea Infectiosum (Fifth Disease)?

Back 59

"slapped face" rash

Front 60

How is Erythmea Infectiosum (Fifth Disease) transmitted?

Back 60

respiratory secretions and blood

Front 61

What are the S/S of the three stages of Erythmea Infectiosum (Fifth Disease)

Back 61

Stage 1- flu like illness for 2-3 days, then symptom free for 1-7 days.
Stage 2- fiery red rash on cheeks ”slapped face” , circomoral pallor, lacy rash on body.
Stage 3- lasts 1-3 weeks as the rash fades.

Front 62

What are nursing interventions for Erythmea Infectiosum (Fifth Disease)

Back 62

Nursing supportive, droplet precautions

Front 63

How is Haemophilus Influenzae (HIB) transmitted?

Back 63

Contact or Droplet

Front 64

How long is HIB contagious?

Back 64

3 days from onset of symptoms

Front 65

What are the S/S of HIB?

Back 65

Viral URI,
may lead to meningitis, epiglottitis, pneumonia, sepsis.

Front 66

What are nursing interventions for HIB?

Back 66

Blood and CSF culture,
Abx
droplet isolation until 24 hrs after initiation of Abx
supportive

Front 67

What can be done to prevent HIB?

Back 67

VACCINATION!

Front 68

How is Measles (Rubeola) transferred?

Back 68

contact and airborne

Front 69

What are S/S of measles?

Back 69

high fever, coryza, cough, Koplik’s spots on buccal mucosa, red, blotchy maculopapular rash that begins on the face.

Front 70

How is Meningococcus transferred?

Back 70

Contact

Front 71

What are Meningococcus S/S?

Back 71

Flu like symptoms
Prostration
May develop a petechial rash that turns into purpura if child becomes septic.

Front 72

What are nursing interventions for Meningococcus?

Back 72

Penicillin
Fluids
Maintain airway
Droplet precautions until 24 hours after start of Abx.

Front 73

How is mumps transferred?

Back 73

contact

Front 74

What are S/S of mumps?

Back 74

Malaise
Low grade fever
Pain with swallowing
Parotid swelling
May cause orchitis which can lead to sterility.

Front 75

What are nursing interventions for mumps?

Back 75

supportive
droplet isolation.

Front 76

How is Pertussis (Whooping cough) transmitted?

Back 76

Droplet and contact

Front 77

What are the three stages of symptoms for pertussis?

Back 77

Catarrhal stage
Paroxysmal stage
Convalescent stage

Front 78

Pertussis Catarrhal stage:

Back 78

URI symptoms for 1-2 weeks

Front 79

Pertussis Paroxysmal stage:

Back 79

whooping cough- 1-6 weeks

Front 80

Pertussis Convalescent stage:

Back 80

up to 6 weeks, until coughing subsides.

Front 81

What are nursing interventions for pertussis?

Back 81

macrolide antibiotic
Corticosteroid
Supportive treatment
Droplet isolation until 7 days after antibiotics initiated.

Front 82

In the case of pertussis, who all is treated?

Back 82

Anyone living in the home or in close contact with the affected person

Front 83

How is Roseola transferred?

Back 83

respiratory secretions of healthy individuals

Front 84

Why do healthy people spread Roseola?

Back 84

Because there is lifelong viral shedding. About 100% of the population has had Roseola.

Front 85

What are S/S of Roseola?

Back 85

sudden high fever for 3-8 days. When the fever subsides, a pale pink, maculopapular rash starts on the trunk and spreads to the face, neck, and extremeties.

Front 86

What is known th accompany the high fevers in cases of Roseola?

Back 86

febrile seizures

Front 87

How is the rotavirus transferred?

Back 87

fecal-oral

Front 88

What are S/S of rotavirus?

Back 88

low grade fever
vomiting
watery diarrhea

Front 89

Children in developing countries are known to die from rotavirus, why?

Back 89

Due to severe dehydration and lack of water supply

Front 90

What are nursing interventions for rotavirus

Back 90

F & E replacement
Contact isolation.

Front 91

How to prevent rotavirus?

Back 91

Prevention: Vaccine @ 2, 4, 6 mo orally.

Front 92

How is Rubella (German Measles) transferred?

Back 92

droplet, contact

Front 93

What are S/S Rubella?

Back 93

Pink, maculopapular rash that starts on the face.
Low grade fever
URI symptoms, lymphadenopathy
Forschheimer spots (erythmatous pinpoint, or larger, lesions on soft palate)

Front 94

What nursing interventions for Rubella?

Back 94

droplet & contact isolation.

Front 95

What is Wim's Tumor?

Back 95

most common primary renal tumor in children. Asymptomatic, fast growing- found as a firm lobulated mass in the kidney.

Front 96

How fast can Wilm's tumor grow?

Back 96

can double in size in 11-13 days

Front 97

What are S/S of Wilm's Tumor?

Back 97

Asymptomatic
Adominal mass
Hypertension\
Hematuria

Front 98

How is Wilm's tumor usually first noticed?

Back 98

Abdominal mass noticed by parents when dressing or bathing child

Front 99

What causes hypertension for kids with Wilm's tumor?

Back 99

d/t increased renin activity

Front 100

What diagnostic tests for Wilm's tumor?

Back 100

Abdominal US (kidneys)
CT kidneys (then CT scan of lungs, liver, spleen, and brain)
Labs: CBC, Electrolytes, BUN, Creatine, LFTs

Front 101

Why would a CT of the lungs, liver, spleen, and brain be performed in a case of Wilm's tumor?

Back 101

to detect metastasis

Front 102

Is it good nursing practice to palpate abdomen of child with Wilm's tumor?

Back 102

No! It can rupture!

Front 103

What special sign should be placed above the bed of a child with Wilm's tumor?

Back 103

PLACE A SIGN BY BEDSIDE THAT SAYS NOT TO PLAPATE ABDOMEN

Front 104

Treatment for Wilm's tumor?

Back 104

Based on stage
Requires surgical removal (excision of affected kidney)
Chemotherapy
Possible Radiation (except in stage 1)

Front 105

What are the outcome for children with Wilm's tumor?

Back 105

About 90% children have no metastasis spread and survival for 5 years.

Front 106

What is a Retinoblastoma?

Back 106

Intraocular malaginancy/tumor of the retina. 40% of cases are hereditary- autosomal dominant gene.

Front 107

What are S/S of Retinoblastoma?

Back 107

Leukokoria
Fixes strabismus
Inflammation of the orbit and glaucoma

Front 108

What is Leukokoria?

Back 108

White pupil and absent red reflex- child will exhibit no red eye in photos

Front 109

How is Retinoblastoma usually discovered?

Back 109

Most parents see that “red eye” is absent in pictures

Front 110

what age group most commonly affected by Retinoblastoma?

Back 110

1-2 years of age

Front 111

What is treatment for Retinoblastoma?

Back 111

Radiation
Surgery
Laster therapy
Possible chemotherapy

Front 112

What are outcomes for kids with Retinoblastoma?

Back 112

90% survival rate