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178 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Before administering DPAT what should in the child's history should the nurse assess for?
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History of reactions, seizures, neurologic symptoms after previous vaccie or systematic allergic reactions
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Before administering MMR what should the nurse assess for in the child's history
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History of anaphylactic reaction to eggs or neomycin
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What type of injection invalidates the Mantoux test?
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Subcutaneous rather than intradermal injection
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What is not a contraindication for immunization?
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The common cold
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Following immunization what teaching should he nurse provideto the parents regarding DTAP and IPV?
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1. Irritability, fever < 102, redness, and soreness at injection site for 2-3 days are normal side effects of DTAP and IPV
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When should a parent of a recently immunized child call the MD?
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If the child has seizures, high fever, or high pitched crying occurs
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What can a parent due to decrease soreness in an infant after vaccination?
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Place a warm washcloth on the thigh injection site and bicycling the legs with each diaper change
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How often and how much acetiminophen (tylenol) should be administered following a immunization?
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Administer oraly 4-6 hours (10-15 mg/kg)
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What should a nurse teach a pregnant mother about German Measles?
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Chidlren with German measles pose a serious threat to their unborn siblings and the consequences of being exposed to German Measles
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How much urinary output should an infant or child have?
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1-2 ml/kg/hr
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What should a parent be taught about ipecac and induced vomiting?
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The ipecac is no longer recommended and induced vomiting can cause more damage than good
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How should milk be stored?
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In an opaque container
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How should vegetables be cooked to preserve potency?
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In small amounts of liquid
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What should parents be taught regarding hot and cold water?
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That lead is absorbed more on an empty stomach
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Hot water absorbs lead more quickly so use cold water for drinking, cooking, and when making infant formula
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List two contraindications to live virus immunization
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Immunocompromised child or a child in a household with an immunocomprimised individual
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List three classic signs of mealses
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1.Photophobia
2. Confluent rash that begins on the face and spreads downward 3. Koplik spots on the bucal mucosa |
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List the signs and symptoms of iron deficiency
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Anemia; pale conjuctiva, pale skin color, atrophy of papillae on tongue, brittle, rigid or spoon shaed nails, thyroid edema
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Identify food sources wih vitamin A
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Liver, sweet potatoes, carrots, spinach, peaches, apricots
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What disease occurs with vitamin c deficiency?
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Scurvy
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What measurements reflect present nutritional status?
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Weight, skinfold thickness, and arm circumference
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List the signs and symtoms of dehydration in an infant
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Poor skin turgor, absence of tears, dry mucous membranes, weight loss, depressed fontanel, and decreased urinary output
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List the laboratory findings that can be expected in a dehydrated child?
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loss of bicarbonate/decreased serum pH, loss of sodium, loss of potassium, elevated Hct, and elevated BUN
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How should the burns in children be assessed?
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By using the Lund-Browder chart which takes into account the changing proportions of the child's body
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How can the nurse best evaluate the adequacy of fluid replacement in children?
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By monitoring the urine output
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How should a parent be instructed to childproof a house?
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Lock all cabinets, safely store all toxic household items in locked cabinets, and to examine the house from the child's point of view
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What interventions should the nurse perform first when caring for a child who has ingested poison?
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Assessment of the child's respiratory, cardiac, and neurologic status
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What early signs should the nurse asssess for if lead poisoning is suspected?
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Anemia, acute cramping, abdominal pain, vomiting, constipation, anorexia, headache, lethargy, hyperactivity, aggression, impulsiveness, decreased interest in play, irritability, short attention span
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What should be used to provide supplemental oxygen to an infant?
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Oxygen Hood
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Nursing interventions for a child using tent oxygen?
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It provides mist and oxygen; Monitor the child's temp, Keep edges tucked in, keep child dry
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Wha type of oxygen does Nasal Prongs provide?
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Low to moderte concentrations of oxygen
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What percentage of caloric intake does a child need for normal growth and development?
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150%
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How should the nurse assess a child with epiglottitis?
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The nurse should not examine the throat of a child with epiglotitis
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Do not put a tongue blade or any object into the throat for risk of obstructing the airway completely
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Signs and symptoms of epiglotitis?
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Sore throat, dysphagia, muffled voice, drooling, child assuming upright sitting position (tripod) with chin and tongue protruding
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What can be done to prevent epiglotitis?
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Hib vaccine
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What usually causes broncholitis?
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RSV (respiratory syncytical virus)
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High risk category for RSV
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young infants
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Nursing Interventions for child with RSV
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1. Isolate child/ Contact isolation b/c readily transmitted by close contact with hospital personnel, families, and other children
2. Assign nurses to the care of an RSV client to a nurse that does not care for other children 3. Airway secretions should be cleared by using a bulb syringe |
4. Ribavirin aerosol may be prescribed
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What should be administered to provide passive immunity to high risk children?
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Palivizumab (Synagis)
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What classifies as a high risk child?
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Child less than 2 years of age with a history of prematurity, lung disease, or congenital heart disease
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Signs and symptoms of Otitis Media
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1. Upper respiratory symtpoms
2. Fever, pain, may pull at ear 3. discharge from ear if drum is ruptured |
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Nursing interventions for a child with Otitis Media
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1. Reduce body temp via tempid bath, and tylenol
2. Position child on affected side 3. Give warm compress on affected ear for comfort 4. Monitor for hearing loss |
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What should a nurse assess for prior to a child having a tonsillectomy?
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1. PT and PTT
2. More important a history of prolonged or excessive bleeding 3. A history of bleeding disorders in the family |
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Homecare of a child with a tonsillectomy?
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1. Encourage warm saline gargles
2. Provide ice chips 3. Manage fever with tylenol |
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Signs of post operative bleeding in a child with a tonsillectomy?
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1. Frequent swallowing
2. Vomiting Fresh blood 3. Clearing of throat |
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Teaching regarding foods for a child post tonsillectomy
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Soft foods, no fluids that are red, do not use straws
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What can be used for pain and vasocontrictyion of a child post tonsillectomy?
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Ice Colar
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What the highest risk periods for hemorrhage regarding a post tonsillectomy of a child?
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1. First 24 hours
2. 5-10 days after surgery |
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What are the purpose of bronchodilators?
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To reverse Bronchospasms
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What are the physical assessment findings of a child with asthma?
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Expiratory wheezing, rales, tight coughs, signs of altered blood gases
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What nutritional support should be provided for a child with cystic fibrosis?
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Pancreatic enzyme replacement, fat soluble vitamins, and a moderate-low carbohydrate, high protein, moderate-to high fat diet
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List seven signs of respiratory distress in a pediatric client
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1.Restlessness
2.Tachycardia 3. Tachypnea 4. Diaphoresis 5. Flaring nostrils 6. Retractions 7. Grunting |
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Why are IV fluids important for a child with an increased respiratory rate?
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Because the child is at risk for dehydration and acid base balance
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Children with chronic otitis media are at risk for developing what problem
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Hearing Loss
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What is common in children with a CHD?
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Polycethemia, so require hydration to prevent thrombus formation
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What may be required to conserve an infants energy with CHD?
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Tube feedings, but need to still satisfy sucking needs
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What are the basic differences between cyantotic and acyantoic defects?
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Acyanotic- has abnormal circulation but all blood entering the systemic circulation is oxygenated
-CHF is more associated with |
Cyanotic- has abnormal circulation with unoxygenated blood entering the systemic circulation
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Why is CHF the most common complication of CHD?
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Because it reflectes the workload of the heart caused by shunts or obstructions.
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Objective in treating CHF is to reduce the workload of the heart and increase cardiac output
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What are the therapeutic blood levels of digoxin?
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0.8-2.0 ng/ml
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Teaching strategies of at home adminstration of Digoxin?
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1. Do not skip or make up for missed doses
2. Give 1 hour before or 2 hours after meals 3. Do not mix with forumla or food |
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What is an early sign of digoxin toxicity?
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Vomiting, spit up is commonly overlooked in infants
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Other GI sxs of Digoxin Toxcity
-anorexia, diarrhea, and abdominal pain |
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Neurological signs of Digoxin toxicity
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Fatigue, Muscle weakness, and drowsiness
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What can increase digoxin toxicity?
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Hypokalemia
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Why is Penicillin G given in patients with CHD?
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To prevent recurrence of Rheumatic Fever
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Pen G is release very slowly over several weeks giving sustained levels of concentration
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List four Defects associated with tetralogy of Fallot
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VSD, overriding aorta, pulmonary stenosis, righ ventricular hypertrophy
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List the common signs of cardiac problems in an infant
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Poor feeding, poor weight gain, respiratory distress and infections, edema, cyanosis
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Describe the nursing interventions to reduce the workload of the heart
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Give small frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutral environment.
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What position would best relieve the child experiencing a tet spell
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Knee chest position or squatting
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List five risks in cardiac catheterization
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Arrhythmia, bleeding, perforation, phlebitis, and obstruction of the arterial entry site
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What cardiac complications are associated with rheumatic fever
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Aortac valve stenosis and mitral valve stenosis
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What medications are use to treat rhematic fever
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Penicillin, erythromycin and aspirin
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What is the nursing goal of a child with Down Syndrome?
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To help the child reach his or her optimal level of functioning
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How should an infant/child with cerebral palsy be fed?
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With the cild in an upright position and support to the lower jaw
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Signs of ICP vs Shock
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Shock= increased pulse, decreased blood pressure
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ICP= decreased pulse, increased blood pressure
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Pumping of a shunt
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Should only be done with specifically prescribed
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B/C the shunt is made of delicate valves and the pumping changes the pressures within he ventricles
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What is the most common cause of increased seizure activity?
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Medication Noncompliance
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What should be monnitored in patients with Menningitis?
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Hydration status and IV theraphy
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B/C there may be inappropriate ADH secretions causing fluid retention (Cerebral Edema) and dilutional hyponatremia
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What is the most common presenting symptom of brain tumors?
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Headache on awakening
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What position is most postoperative clients with infratentorial tumors ?
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To lie flat or turn to either side
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If it is a large tumor the child should not be turned to the operative side
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What actions can increase ICP?
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Suctioning, coughing, strainin, and turning
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What are the physical features of a child with Down Syndrome?
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Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes
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Describe scissoring
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A common characteristic of spastic cerebral palsy of infants legs are extended and crossed over each other, feet are plantar flexed
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What are the two nursing priorities for a newborn with myelomenigngocele?
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Prevention of infection of the sac and monitoring for hydrocephalus
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Which includes measure head circumference, check fontannel, assess neurologic functioning
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List the signs and symptoms of increased ICP in older children
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Irritability, change in LOC, motor dysfuntion, headache, vomiting, unequal pupil response and seizures
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What teaching should parents of a newly shunted child recieve?
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1. Signs of increased ICP
2. Understanding that shunt should not be pumped and that the child will need revisions with growth |
3. Guidance concerning growth and development
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State the three main goals in providing nursing care for a child experiencing a seizure?
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1. maintain patent airway
2. Protect from injury 3. Observe carefully |
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What are the side of effects of Dilantin?
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Gingival hyperplasia, dermatitis, ataxia, GI distress
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Decribde the signs nd symptoms of a child with meningitis?
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Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig signs, positive Brudzinski sign
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Infant may not show all classic symtpoms even though very ill
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What antibiotics are usually prescribed for bacterial meningitis?
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Ampicillin, penicillin, chloramphenicol
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How is a child usually positioned after brain tumor surgery?
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Flat or on either side
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Describe the function of an osmotic diuretic
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Remove water from the CNS to reduce cerebral edema
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Describe the mechanism of inheritance of Duchenne muscular dystrophy
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Inherited as an X-linked recessive trait
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What is the Gower's Signs?
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Is an indicator of muscular dystrophy; to stand the child has to "walk" hands up legs
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What is the first sign of renal failure
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Decreased urinary output
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When and why is surgical correction hypospadias?
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Usually done before preschool years
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to allow for the achievement of sexual identity to avoid castratio, anxiety, and to facilitate toilet training
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Compare the signs and symptoms of Acute glomeruloephritis with those of nephosis
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AGN
1. Edema=mild, usually around eyes 2. BP elevated 3. Dark, tea colored (hematuria) 4. Slight or moderate proteinuria |
Nephrosis
1.severe generalized edema 2.Normal BP 3. Dark, frothy yellow urine 4. Massive proteinuria |
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What antecedent even ccurs with AGN?
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Beta-hemlytic streptococcal infection
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Compare the dietary interventions for AGN an nephrosis
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AGN- low sodium diet with no added salt
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Nephrosis- High protein, low salt diet
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What is the physiologic reason for the lab finding of hypoproteinemia in nephrosis?
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B/c the glomeruli are permeable to serum proteins
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Describe safe monitoring of prednisone administration an withdrawal
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-Long term prednisone should be given every other day
-Signs of edema, moo changes, and GI distress should be noted and reported |
-The drug should be tapered not discontinued suddenly
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Acute Glomerulonephritis (AGN)
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Immune complex response to an antecedent beta-hemolytic strep infection
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Antigen-antibody complexes become trappe in the membrane of the glomeruli causing inflammation and decreased glomerular filtration
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Nephrotic Syndrome
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The basement membrane of the glomeruli becomes permeable to plasma proteins; most often idiopathic in nature
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What interventions can be taught to prevent urinary tract infections in children?
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Avoid bubble baths, void frequently, drink adequate fluids, especially acidic fluids such as apple or cranberry juice and clean genital area from front to back
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Describe the pathophysiology of vesicoureteral reflux
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A malfunction of the valves at the end of the ureters allowing urine to reflux out of the bladder into the ureters and possible into the kidney
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What are the priorities for a client with a Wilms tumor?
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Protect the child from injury to the encapsulated tumor
Prepare the family and child for surgery |
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What are the typical and family reactions to a child with an obvious malformation
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Guilt, disappoinment, grief, sense of loss, and anger
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When is closure of the Cleft and of the palate defect done?
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Closure of the cleft when infant weighs 10 pounds and Hgb is >10g
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Palae closure usually done before 1y/o to minimize speech impairment
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Why does a client with a cleft lip/palate and pyloric stenosis have the dx of "Altered Nutrition less tha body requirements"
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Lip/palate= decreased ability to suck
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Pyloric stenosis= frequent vomiting
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What are key problems for children with GI disorders?
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nutritional, fluid, and eletrolyte imbalances
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Congenital Agranglionic Megacolon AKA? and pathophysiology
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Hirschsprung disease
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Congential absence of autonomic para sympathetic ganglion cells in a distal portion of the colon and rectum
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Where should the temp be taken in children with Congenital Megacolon
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Axillary
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What are the physical features of a child with Down Syndrome?
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Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes
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Describe scissoring
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A common characteristic of spastic cerebral palsy of infants legs are extended and crossed over each other, feet are plantar flexed
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What are the two nursing priorities for a newborn with myelomenigngocele?
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Prevention of infection of the sac and monitoring for hydrocephalus
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Which includes measure head circumference, check fontannel, assess neurologic functioning
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List the signs and symptoms of increased ICP in older children
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Irritability, change in LOC, motor dysfuntion, headache, vomiting, unequal pupil response and seizures
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What teaching should parents of a newly shunted child recieve?
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1. Signs of increased ICP
2. Understanding that shunt should not be pumped and that the child will need revisions with growth |
3. Guidance concerning growth and development
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State the three main goals in providing nursing care for a child experiencing a seizure?
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1. maintain patent airway
2. Protect from injury 3. Observe carefully |
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What are the side of effects of Dilantin?
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Gingival hyperplasia, dermatitis, ataxia, GI distress
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Decribde the signs nd symptoms of a child with meningitis?
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Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig signs, positive Brudzinski sign
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Infant may not show all classic symtpoms even though very ill
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What antibiotics are usually prescribed for bacterial meningitis?
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Ampicillin, penicillin, chloramphenicol
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How is a child usually positioned after brain tumor surgery?
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Flat or on either side
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What are the physical features of a child with Down Syndrome?
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Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes
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Describe scissoring
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A common characteristic of spastic cerebral palsy of infants legs are extended and crossed over each other, feet are plantar flexed
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What are the two nursing priorities for a newborn with myelomenigngocele?
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Prevention of infection of the sac and monitoring for hydrocephalus
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Which includes measure head circumference, check fontannel, assess neurologic functioning
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List the signs and symptoms of increased ICP in older children
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Irritability, change in LOC, motor dysfuntion, headache, vomiting, unequal pupil response and seizures
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What teaching should parents of a newly shunted child recieve?
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1. Signs of increased ICP
2. Understanding that shunt should not be pumped and that the child will need revisions with growth |
3. Guidance concerning growth and development
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State the three main goals in providing nursing care for a child experiencing a seizure?
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1. maintain patent airway
2. Protect from injury 3. Observe carefully |
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What are the side of effects of Dilantin?
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Gingival hyperplasia, dermatitis, ataxia, GI distress
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Decribde the signs nd symptoms of a child with meningitis?
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Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig signs, positive Brudzinski sign
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Infant may not show all classic symtpoms even though very ill
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What antibiotics are usually prescribed for bacterial meningitis?
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Ampicillin, penicillin, chloramphenicol
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How is a child usually positioned after brain tumor surgery?
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Flat or on either side
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Describe the feeding techniques for a child with cleft lip or palate
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Use lamb's nipple or prosthesis. Feed child upright with frequent bubbling
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List the signs and symptoms of esophageal atresia with TEF
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Choking, coughing, cyanosis, and excess salivation
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What nursing actions are initiated for the newborn with suspected esophageal atresia with TEF
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Maintain NPO immediately and suction secretions
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Describe the postoperative care for an infant with pyloric stenosis
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Maintain IV hydration, provide small frequent oral feedings of gluocose or electrolyte solutions or both within 4-6hrs
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Gradually increase to full-stregnth formula. Position infant on right side in semi-fowler position
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Describe why a barium enema is used to treat intussusception
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Reduces the telescoping of the intestine through hydrostatic pressure without surgical intervention
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Describe the preoperative nursing care for a child with Hirshsprung disease
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Check vital signs, take temp, teach about colostomy. Observe for bowel perforation. Measure abdominal girth
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What care is needed for a child with a temporary colostomy?
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Family needs education about skin care, appliancees. Refer to an enterostomal
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What are the signs of anorectal malformation
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&who does not pass meconium within 24 hours; neconium appearing through a fistula,
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Or in the urine; an unusual appearing anal dimple
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What are the priorities for a child undergoaing abdominal surgery?
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1. Maintain fluid balance (I&O, nasogastric sunction, and monitor electrolytes
2. Vital Signs 3. Care for drains 4. Prevent infection 5. Assess bowel function |
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What the Hgb norms? Ages newborn, infant, child
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Newborn-14-24
Infant-10-17 Child 9.5-15.5 |
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What are the teaching points reagarding administration of oral iron
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1. Give on empty stomach
2. Give with citus juices for increased absorption 3. Use dropper or straw to avoid discoloration of the teeth |
4. Teach that stools will become tary
5. Iron can be fatal in severe overdoses 6. Do not give with any dairy products |
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Why are clients with sickle cell anemia not given iron?
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Because the anemia is not caused b iron deficiency.
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Instead give folic acid because it stimulates RBC synthesis
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What should be readily available when administering L-asparaginase
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Have epinephrine and oxygen
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What are some medications given to reduce renal damage caused by the buildup of uric acid and cellular lysis?
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Aloopurinol, xanthine, oxidase inhibitor
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What can be given to reduce mitosis of lymphocytes?
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Prednisone in combination with antineoplastic drugs
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List dietary sources of iron
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Meat, green leafy vegetables, fish, liver, whole grains, legumes
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What should families and clients do to avoid triggering sickling episodes?
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Keep child well hydrated. Avoid known sources of infections. Avoid high altitudes. Avoid strenous exercise.
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Nursing interventions and medical treatment of a child with leukemia are based on what three physiologic problems?
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1. Anemia
2. Infection (neutropenia) 3. bleeding thrombocytopenia |
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Describe how an infant iwth Hypothyroidism would be described?
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Good and quiet baby
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Phenylketonuria
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An autosomal recessive disorder in which the body cannot metabolize the essential amino acid Phenylalanine
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Leads to mental retardation if left untreated, Often these kids have blue eyes and blond hair due to lack of melanin
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What food should PKU clients avoid?
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NutraSweet(aspartame) b/c contains phenylalanine
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What are the nursing considerations for a school age child?
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1. Maintenance of contact with peers important
2.Explanation and participation important 3. Privacy and Modesty |
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When does adult-like thinking begin?
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15 years old
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Nursing implications for adlescents?
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1. Share room with another adolescent when possible
2. Parents rooming is discouraged 3. Some questions should be asked without the parents present |
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What should teaching focus on whith adolescents?
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Focus on the here and now "How will this affect me today?"
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What are the age group concepts of bodily injury?
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1.Infant
2. Toddlers 3. Preschool 4. School Age 5. Adolescents |
1. 6 months > can remember pain
2. Afraid of intusive behaviors 3. Afraid of body mutilation 4. Loss of control over their body 5. Major concern in change of body image |
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How is congenital hypothyroidism diagnosed?
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Newborn screening revealing a low T4 and a high TSH
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What are the symtpoms of congenital hypothyroidism in early infancy?
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Large, protruding tongue, coarse hair, lethargy, sleepiness, and constipation
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What are the outcomes of untreated congenital hypothyroidism?
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Mental retardation and growth failure
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What are themetabolic effects of PKU?
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CNS damage, mental retardation, and decreased melanin
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What two Formular are prescribed for infants with PKU?
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Lofenalac and Phenex-I
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List foods high in phenylalanine?
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Meat, milk, dairy products, eggs
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What are the three classic signs of diabetes?
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Polydipsia, polyphagia, and polyuria
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Differentiate the signs of hypoglycemia and hyperglycemia?
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Hypoglycemia-tremors, sweating, headache, hunger nausea, lethargy, confusion, tingling around mouth
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Hyperglycemia-polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, syncope
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Describe the nursing care of a child with ketoacidosis?
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Administer regular insulin IV in normal saline, monitor blood gas values,and maintain strick I&O
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Describe developmental factors that would impact the school age child with diabetes
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Need to be like peers, assuming responsibility for own care, modification of diet, snacks and exercise in school
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What is the relationship between hypoglycemia and exercise?
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During excercise insulin uptake is increased and the risk for hypoglycemia occurs
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What is the purpose of a brace in child with scoliosis?
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It is there to stop or slow the progression it does not cure it.
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List normal findings in a neurovascular assessment
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Warm extremity, brisk capillary refill, free movement, normal sensation of the affected extremity and equal pulses
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What is compartment syndrome?
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Damage to nerves and vasculature of an extremity due to compression
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What are the signs and symptoms of compartment syndrome?
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Abnormal neurovascular assessment; cold extremity; severe pain; inability to move the extremity; and poor capillary refill
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Why are fractures of the epiphyseal plate a special concern?
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B/c it may affect the growth of the limb
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How is skeletal traction applied?
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It is maintained by pins or wires applied to the distal fragment of the fracture
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What discharge instructions should be included concerning a child with a spica cast?
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Check child's ciculation; keep cast dry; do not place anything under cast; prevent cast soilage during toileting; do not turn child using an abductor bar
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What are the signs and symptoms of congenital dislocated hip infants?
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Unequal skin folds of the buttocks, ortolani sign, limited abduction of the affected hip, unequal leg lengths
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Ortolani Signs= a click heard in a test for a congenital dislocated hip. It is noted in infancy when the hip slips into or out of the socket
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How would the nurse conduct a scoliosis screening?
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Ask the child to bend forward from the hips with arms hanging free.
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Examine the child for a curve in the spine, a rib hump, and hip asymetry
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What instructions should a child with scoliosis recieve about the Milwaukee brace?
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Wear the brace 23 hours a day; Wear a tshirt under the brace; check skin for irritation; perform back and abdominal exercises and modify clothing
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The child should be encouraged to maintain normal activities as able
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What care is indicated for a child with juvenile rheumatoid arthritis?
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Prescribe exercise to maintain mobility; splinting of affected joints; teaching about medication management
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