127 Peds Final Study Guide

Front 1

BILATERAL CLEFT LIP:

What Interventions would be appropriate for the PARENTS?

Back 1

[McKinney p 1106]

Emotional Support [Parents]:
[]Encourage dicussion of feelings
[]Encourage Support Groups
[]Express acceptance of baby/encourage bonding.

Refer to reconstructive Drs.
[Repair done @ 3-6 mos old
& then @ 4-5 years]
[]Show Before & After Pictures of Repair

Front 2

CLEFT LIP REPAIR:

What would POSTOPERATIVE CARE involve?

Back 2

Assess for Color
Assess Swallowing
[Freq. Swallowing = bleeding]

Do NOT place prone.

Place on SIDE allows drainage
[for Palate repair]

Use Elbow restraints
aka "No-No's:
Tongue depressors taped on the front & back of elbow to restrict bending & prohibit infant to scratch surgical site. Remove for 10-15 mins q2h for ROM.

Diet: Clear liquids to formula.

Hint 2

Any injury or surgery on mouth will always involve risk for airway obstruction.

Front 3

TEF:

What MATERNAL DIAGNOSIS is related to TEF in the baby?

Back 3

POLYHYDRAMNIOS:

Excessive amount of amniotic fluid during pregnancy.

Hint 3

TEF = TracheoEsophageal Fistula:

a congenital malformation in which the esophagus terminates prior to reaching the stomach.

Condition Fatal without early Dx & Tx.

Front 4

GER: (GE Reflux)

What would Discharge Teaching for infant with GER include?

Back 4

McKinney pg 1119+
Teach parents about:

Medication:
[]Antacids: Sx releif.
[]H2-rcpt Antagonist
decrease acid secretion:
cimetidine, ranitidine
[]Mucosal barrier protectant:
sucralfate
[]Proton pump inbitors supress gastric acid secretion:
omeprazole
[]prokinetic agent speeds Gastric emptying:
metoclopramide

Diet:
[]Small, freq. feedings of predigested formula:
Nutramigen or Pregestimil
[]Feed in upright position.
[]Adequate burping.

Position for sleeping:
[*]HOB 30-45 degrees
[]Under 12 mos: Suppine

Surgery:
[]Fundoplication involves a wrap to stomach fundus, tightens LES, prevents reflux.

Hint 4

GE Reflux:
Condition which results from a weak LES resulting in regurgitation of gastric juice into the esophagus.

Amost All Infants with GER will present symptoms around 6 weeks old.

Hallmark S/Sx: Vomiting or spitting up after meal, hiccupping, and recurrent Otitis media r/t pooled secretions in nasopharynx during sleep.

Other S/Sx possible:
Wt Loss, FTT, irritability, discomfort, and AB pain.

Severe GER S/Sx:
Possible Hematemesis or melena & anemia.

Stomach Lavage (washing) via NG Tube is used to evacuate blood & clots in episodes of Upper GI bleeding.

Front 5

CELIAC DISEASE DIET:

What would be the Priority Nursing DIAGNOSIS?

Back 5

McKinney pg 1147

Imbalanced Nutrition Less than Body Requirements r/t malabsorption.

Hint 5

Celiac Disease is aka:
Gluten Enteropathy or
Tropical Sprue.

Pts with Celiac disease can NOT eat foods containing Gluten because they can NOT break it down.

Gluten is the protein of certain GRAINs. (Wheat, Barley, Rye, & Oat).

Foods containing Gluten:
pasta
baked products
breakfast cereals

Substitute these foods with:
Corn
Rice
Millet
& take vitamin supplements, especially FOLATE, and Vit A, D, E, & K.

Front 6

HIRSCHSPRUNG's DISEASE:

What would you expect to find on ASSESSMENT?

Back 6

McKinney pg 1142+

Abdominal Distention

Relief upon DRE:
[Digital Rectal Exam]

Loose Stools

Vomits Bile/Fecal material

Hx: No Meconium
[1st stool of NB]

Hint 6

Hirschsprung's disease results from absence of nerves in the colon.

Front 7

OMPHALOCELE:

What is it?

Back 7

McKinney p 1116

Large herniation of GUT into UMBILICAL CORD.

Viscera are outside the abdominal cavity but inside translucent sac, covered with peritoneum & amniotic membrane.

Associated with Beckwith's Syndrome (hypoglycemia, macrosomia, macroglossia).

Complications include:
Sepsis & intestinal obstruction.

Front 8

INTUSSUSCEPTION:

1.) What are the symptoms?

2.) What would the nurse watch for after administration of a Barium Enema?

Back 8

McKinney p 1140

1.) Classic Symptom:
"Currant Jelly" Stool
[Bloody mucus stool]

as well as a Sausage shaped AB mass.

Shock & Sepsis if obstructed for 12-24 hours.

Child may be Listless.

2.) If NO Sx of shock or sepsis:
Hydrostatic Reduction by Barium enema until flow of barium into the terminal ileum is evident.

The nurse would:
[]Observe for passage of barium
[]Document stool characteristics.

Hint 8

Intussusception: Bowel "Telescopes" inside itself => obstruction & ischemia

ALWAYS correlate INTUSSUSCEPTION with CURRANT JELLY STOOLS on NCLEX.

Front 9

NG Tube after Abdominal Surgery:

1.) Why would it be used?

2.) What purpose does it serve?

Back 9

McKinney 1141

1.) Used for Suction

2.) To evacuate Bile

Front 10

CROHN's DISEASE:

What are the SYMPTOMS?

Back 10

McKinney pg 1135
Crohn's Disease
Symptoms:
[]Abdominal Pain
[]Diarrhea/NO BLOOD
[]Fever
[]Palpapble AB Mass
[]Anorexia/wt loss
[]Sig. growth impair
[]Perianal/anal lesion
[]Fistulas/Obstruction
Extraintestinal Sx:
[]Arthralgia & Arthritis

Hint 10

Crohn's disease is an inflammatory Bowel disease that can affect ANY part of the GI Tract: from the mouth to anus. It involves ALL LAYERS of the intestine.

Front 11

GASTROENTERITIS:

What is the best way to prevent spreading of this?

Back 11

McKinney p 1131

HANDWASHING

Hint 11

Gastroenteritis: Infection of the stomach & intestines d/t viruses, bacteria or parasites.

Front 12

APPENDICITIS:

1.) What is the significance of SUDDEN Relief of Pain?

2.) How does HEAT affect the swollen appendix?

Back 12

McKinney p 1131+

1.) Sudden pain relief indicates that the appendix has PERFORATED (ruptured).

2.) Heat INCREASEs Risk of Perforation:
NO Heat should be applied to the abdomen.
It may increase the chance of perforation secondary to vasodilation.
(McKinney pg 1132)

Hint 12

Appendicitis S&Sx:
[]Early Pain -
around umbilicus.
[]Pain progresses to Lower Right Quad @ McBurney's Point.
[]N/V
[]anorexia
[]diarrhea or constipation
[]Fever and chills

Dx Testing:
[]Rebound Tenderness
[]WBC 15K-20K
[]Ultrasound
[]CT scan of AB

Therapeutic Mgt:
[]Appendectomy

Pre-op care:
[]IV fluids
[]Immobilize to control pain
[]NPO
[]Antibiotics

Front 13

HYPOTHYROIDISM:

Why do a mandatory screening for this condition in the Newborn?

Back 13

McKinney pg 1456

Untreated Hypothyroidism leads to mental retardation.

Initial Tests should be done @ 2 to 6 days of age.

Hint 13

Tests done sooner than 48 hours after delivery may give a false result
(b/c of the normal rise in TSH immediately after birth).

Lifelong thyroid hormone replacement is necessary, usually levotyroxin given in a single daily oral dose that varies with body size.

Front 14

SHORT ACTING INSULIN:

When is the best time to check for PEAK effectiveness of it?

Back 14

2 hours after administration.

Front 15

DIABETES:

What is the primary concern in concealing diabetes from school officials?

Back 15

RISK FOR INJURY

Hint 15

If child becomes hypoglycemic and no one is aware of the child's medical condition, the child is at risk for injury resulting from lack of medical attention

Front 16

HYPOGLYCEMIA:

1.) Lab results show?

2.) How would you treat the CONSCIOUS CHILD?

Back 16

McKinney pg 1469

1.) BG < 70

2.) Oral admin:
15g carbohydrate
(ie: Orange Juice)

Front 17

IDDM (Insulin Dependant Diabetes Melitus):

1.) What is the "HONEYMOON" Phase?

2.) What happens to insulin needs during the Honeymoon phase?

Back 17

McKinney pg 1448+

1.) Early phase in which RESIDUAL ENDOGENOUS INSULIN is produced.

2.) Need for Insulin decreases because the body is producing some.

Front 18

IDDM:

1.) How does it affect sports participation?

2.) How would this be handled?

Back 18

McKinney pg 1471

1.) Exercise LOWERS blood glucose levels.

2.) add 15 to 30g carbohydrate snacks for each 45 to 60 minutes of exercise.

Front 19

IDDM:

Review Teaching for IDDM.

What statements would indicate further teaching is necessary?

Back 19

(review IDDM teaching)
Outcome Evaluations:

Front 20

DIABETIC KETOACIDOSIS:

What Lab Values would indicate this condition in a child?

Back 20

McKinney pg 1469

Blood Glucose > 300

Urinary Ketones (+)

Serum pH < 7.25

Serum Ketones (+)

Front 21

CELLULITIS:

How is it Managed?

Back 21

McKinney pg 1367

Nurse administers an initial IM or IV dose of antibiotic
[IE: ceftriaxone]

Followed up at home with a 10-day course of Oral antibiotics:
Cephalosporin,
cloxacillin, or
dicloxacillin.

Warm compresses are applied to the affected area.

If child's joints or face is involved or if child presents acute fever, hospitalization and IV antibiotic therapy are required.
Incision and drainage of the affected area may also be necessary.

Hint 21

CELLULITIS is a bacterial infection of the subcutaneous tissue and the dermis, usually associated with a break in the skin.

s/sx:
affected area is red, hot, tender, and indurated.
H. influenza agent may cause a purplish tinge.
Lymphangitis seen with red "streaking" of surrounding area.
fever, malaise, & headaches are common sx in children.

Front 22

THRUSH:

How should medication be administered?

Back 22

Medication:
Mycostatin

Administer:
Use GLOVED Finger
Rub medication around gums & mouth.

Front 23

PEDICULOSIS: (Lice)

Serious potential side effect of Anti-Lice product?

Back 23

McKinney pg 1374

*****Prescription lindane (Kwell) can be NEUROTOXIC if absorbed through the skin.*****

Recently approved pesticide for Tx of Lice:
malathion (Ovid) requires prolonged contact (8 - 10 hrs). Caution: Ovid is FLAMMABLE. Do Not use Hairdryer or allow child near flames or heater while being treated.

Other treatments are safe & effective because they do not stay on the hair after treatment (must repeat treatment in 1 to 2 weeks):
RID
Triple X
R&C
Pronto

Front 24

ATOPIC DERMATITIS: (Eczema)

Most serious complication?

Back 24

McKinney pg 1377

Infection r/t itch-scratch-itch cycle & a higher than normal colonization of Staph aureus in pts with this disorder. Impetigo & viral infection occur freq. in these kids.

Hint 24

ATOPIC DERMATITIS: (Eczema) is an allergic skin condition.

Front 25

BURN INJURY CLASSIFICATION:

Back 25

McKinney pg 1391

SUPERFICIAL
[1st Degree]

PARTIAL THICKNESS
[2nd Degree]

FULL THICKNESS
[3rd Degree]
No Pain b/c nerves have been destroyed.

Front 26

BURN PAIN:

Drug of CHOICE:

Back 26

IV administration of MORPHINE

Front 27

BURN SHOCK:

1.) When does it STOP?

2.) What physiological mechanism occurs to stop burn shock?

Back 27

McKinney pg 1398+

Front 28

BURNS:

What is the best way to monitor adequate PERFUSION in burn patients?

Back 28

McKinney pg 1398?

Front 29

ACUTE GLOMERULONEPHRITIS:

What does the presence of CASTs in the URINE indicate?

Back 29

McKinney pg 1171+

Casts in the urine indicate that glomerule injury is occurring.

Front 30

PRIMARY NEPHROTIC SYNDROME:

What is the DIAGNOSTIC FINDING in this condition?

Back 30

McKinney pg 1175+

Proteinuria (3+)


[2 weeks negitive protein in urine indicates the condition is in Remission]

Front 31

NO ADDED SALT DIET:

What is it?

Back 31

REGULAR DIET
NO ADDED SALT
AVOID HIGH SODIUM PRODUCTS

Hint 31

Diet for Primary Nephrotic Syndrome & HTN

Front 32

EDEMA:

Appropriate Interventions for EDEMATOUS CHILD?

Back 32

Maintain Skin Integrity & monitor I&O and weigh daily:
Good skin care (dry & clean)
Turn & reposition q 2 hours

Front 33

HYPOSPADIAS:

When should it be corrected?

Back 33

McKinney pg 1170

Between 6 to 12 months of age. (Before the age of toilet training).

Infants should NOT be circumcised because the foreskin may be used in surgical reconstruction.

Hint 33

Hypospadias: Ventral
[Bottom side] placement of urethral opening on penis.


Epispadias: Dorsal (Top side) placement of urethral opening on penis.

Front 34

UTIs (Urinary Tract Infections):

Symptoms?

Back 34

Cystitis
LOW GRADE FEVER = KIDNEY Infection

Look up in text

Front 35

VESICOURETERAL REFLUX:

What would the TEACHING plan include?

Back 35

Good dipaer care etc

look up in text

Front 36

CRYPTORCHIDISM:

How to examine the infant for this condition?

Back 36

McKinney pg 1170

WARM ROOM
WARM HANDS

Calm infant
Milk testis downward from groin & document distal point.

Hint 36

Cryptorchidism: Undescended Testes.

Children with undescended testes are at increased risk for testicular cancer.

Front 37

ALL: Acute Lymphoid Leukemia

1.) Treatment:

2.) Outcome:

3.) Symptoms:

4.) History:

5.) Priority Nursing Dx for newly diagnosed child:

6.) Diagnostic Tests used to Confirm ALL:

Back 37

1.) Treatment
3 Phases:

Phase 1
Induction:
Chemo induced remission
[Immature Blast cells < 5%]

Phase 2
Consolidation:
Intense Therapy begins immediately after remission occurs

Phase 3 - Maintanance:
2-3yrs of Oral Chemo
to Maintain remission


2.) Outcome:

3.) Symptoms:

4.) History:

5.) Priority Nursing Dx
for newly diagnosed child:

6.) Diagnostic Tests used to Confirm ALL:

Front 38

AML:

What is the STANDARD Tx?

Back 38

Look up in text

Front 39

WILM's TUMOR:

Nursing care PRE-OP involves?

Back 39

DO NOT PALPATE THE ABDOMEN (Palpating the abdomen would risk RUPTURE of the ENCAPSULATED tumor)!

Front 40

TUMOR LYSIS SYNDROME:

What are they at risk for?

Back 40

Look up in book, probably related to metastasis?

Front 41

HODGKIN's DISEASE:

Physical assessment findings would include?

Back 41

McKinney pg 1348+

Front 42

BRAIN TUMOR:

Post-operative care plan for child having Brain Tumor Surgery?

Back 42

Look up in text

Front 43

CHEMOTHERAPY:

Teaching for ORAL HYGIENE would include?

Back 43

Use VERY SOFT TOOTHBRUSH / SWABS.
AVOID MOUTHWASH.

Front 44

Who are the "EXPERTS" in regards to a child with a profound Sensory impairment?

Back 44

THE CHILD's PARENTS

Front 45

COMMUNICATION:

What is the most important consideration for effective communication with a child?

Back 45

Look up in text

Front 46

COMMUNICATION:

What is the best way to get a child to express feelings?

Back 46

Look Up in text

Front 47

How would you assess a crying toddler's breath sounds?

Back 47

You wouldn't while the toddler was crying.

Allow parent to hold & calm the toddler.

Assess breath sounds when toddler is CALM.

Front 48

What is the site of choice to assess the Pulse rate of a 1 year old child?

Back 48

look up in text

Front 49

NEWBORNS:

When does the Anterior Fontanel Close?

Back 49

look up in text

Front 50

1.) Comfort measures to use for a small child in the ER?

2.) Normal behavior for a 3 year old when parents try to leave the room?

3.) Comfort measures for outpatient surgery?

Back 50

look up in text.

Front 51

Abdominal breathing in a 2 year old child.

Is it Normal or abnormal?

Back 51

It is NORMAL up to age 5.

Front 52

Low respiratory rate:

What does it mean?

Back 52

in child: low respiratory rate would be 8 to 10 bpm.

it may indicate that respiratory failure is ensuing.

Front 53

Review the ABC's of CPR:

What is critical element in emergency situation?

Back 53

AIRWAY

Front 54

What is the best way to remove ingestion/overdose of pills taken 1 hour ago?

Back 54

Lavage: Pump stomach to remove recent ingestion.

Front 55

Signs that would cause suspicion of child abuse/neglect?

Back 55

freq Hx of fractures
bruises in bathing suit areas
a child who does not show emotion when painful procedures are undertaken (shot or IV insertion. child will not cry because he/she has learned that crying may lead to a spanking/abuse.)
etc

Front 56

What vital sign is assessed FIRST in children?

Back 56

Respiratory rate (you can assess this from a distance)

Front 57

What is the primary DISADVANTAGE of outpatient and day care facility Treatments?

Back 57

There is no immediate backup available for emergency care. 911 must be called, which would delay BLS.

Front 58

What would be developmentally appropriate interventions when working with adolescents?

Back 58

ALLOW:
own clothing to be worn
availabitly of phone
choices in treatments

Front 59

How would you allow a toddler to feel a sense of control?

Back 59

Allow toddler to choose "flavors" for administration of anesthesia if necessary (chapstick is applied to the inside of the mask for anesthesia. the toddler can choose what flavor they would like). etc

Front 60

Stages of separation?

Back 60

look up in text

Front 61

What ages like to keep & organize hospital momentos?

Back 61

School age children

Front 62

Appropriate interventions for NEONATES include?

Back 62

look up in text.

Offer parents & encourage bonding

Front 63

Review Standard Precautions.

Back 63

look up in text

Front 64

What is the body's 1st line of defense?

Back 64

skin

Front 65

Type of infection occurring with Immunocompromised patients?

Back 65

OPPORTUNISTIC infections.

Front 66

Appropriate treatment for Fever?

Back 66

look up specifics in text.

Front 67

Why do children require more than 1 dose of Polio Vaccine?

Back 67

It is an INACTIVE Vaccine & requires boosters.

Front 68

Review Standard Precautions.

Back 68

look up in text

Front 69

What is the body's 1st line of defense?

Back 69

skin

Front 70

Type of infection occurring with Immunocompromised patients?

Back 70

OPPORTUNISTIC infections.

Front 71

Appropriate treatment for Fever?

Back 71

look up specifics in text.

Front 72

Why do children require more than 1 dose of Polio Vaccine?

Back 72

It is an INACTIVE Vaccine & requires boosters.