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216 Cards in this Set
- Front
- Back
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A nurse is discussing health promotion topics w/ the parents of a 6-month old infant. Which of the following should the nurse include in the discussion? [select all that apply] |
D. Teach the family about anticipated developmental milestones |
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A 10-day-old newborn is weighed at the physician's office. The baby is breastfed and weighed 7 pounds, 8 ounces at birth. How much would the nurse expect the baby to weigh now? |
a. 7 lbs, 8 oz |
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A nurse is doing a health promotion teaching for a family of a newborn. All of the following are included in the teaching except: |
C. Avoid alternating the head position from left to right during sleep |
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A parent of an 8-month-old infant complains to the nurse during a routine checkup that the baby always cries and screams whenever she leaves the baby at the child care center before work. The nurse’s response should be based on which of the following? |
A. Separation anxiety is common for infants of this age |
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Health promotion interventions for a young toddler include all of the following except: |
D. Limiting daily fruit juice intake |
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Which developmental milestone should the nurse expect to see on a 5-month-old infant? |
C. Rolls over, sits w/ support |
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During a well-child visit, the parents complained to the nurse that their 3-year-old child sometimes “won’t sit still” during meal times and eats only 1 or 2 foods. Which of the following is the appropriate response by the nurse? |
B. Recognize and inform that the behavior is common for children of this age |
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The nurse instructs the parents of a 3-year-old child that the most representative type of play usually seen in toddlers would be: |
A. Two children sitting side by side, each playing w/ a toy truck |
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The nurse instructs the parents of a 5-year-old child that the most representative type of play usually seen in preschool children would be: |
C. The child who dresses up like a fireman |
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The nurse is preparing a 4-year-old for surgery. Which technique is most appropriate? |
B. Allow child to handle safe medical equipment |
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Which developmental considerations about pain should the nurse anticipate in a 4-year-old preschool child? |
D. Often believes pain is punishment |
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An 18-year-old patient who is 3 months pregnant is in the local health center for her routine immunizations. Which of the following vaccines is contraindicated for the patient? |
A. Measles, mumps, rubella (MMR) |
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A 14-year-old patient is in the pediatric hospital for his chemotherapy. The patient’s parent informed the nurse that there was an outbreak of chickenpox in the patient’s school and is concerned about possible exposure to the disease. Which of the following should the nurse recommend to the patient’s parent? |
A. Varicella-zoster immune globulin |
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A 6-year-old child is to receive regularly scheduled immunizations. The parent states the child is not feeling well, and asks the nurse to defer the immunizations until next week. The nurse's best response is to: |
A. Check the child’s temperature |
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A nurse is providing patient care teaching to the parent of a child w/ chickenpox. Which of the following statements by the parent indicates accurate understanding of the teaching? |
D. “I can send her back to school when she has dry, crusted lesions” |
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A 6-year-old child is admitted to the pediatric hospital for sore throat and high fever. Further assessment shows red “sandpaper-like” rash in the neck, groin, and axillary area. Lab results show presence of group A streptococci bacteria. Which of the following would be the expected diagnosis for the patient? |
C. Scarlet fever |
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A nurse is ordered to administer medications to a patient diagnosed w/ mononucleosis. Which of the following medication orders for the patient should the nurse question? |
D. Amoxicillin |
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A pediatric nurse is ordered to administer scheduled immunizations for a 4-month-old well child. Which of the following should the nurse prepare to administer? [select all that apply] |
a. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine |
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A pediatric nurse is ordered to administer a combination MMR/Varicella vaccine (a live attenuated virus vaccine) to her patients. Which of the following patients should not receive the live virus vaccine? [select all that apply] |
B. Patient who has a severe allergic reaction to neomycin |
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The nurse is doing an assessment of a patient presented w/ signs and symptoms of rubeola (measles). Which of the following assessment findings would help confirm the patient’s diagnosis? |
B. Small bluish-white spots in the buccal area |
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A pediatric nurse is performing developmental assessment on a 6-month old well-child. Inability to perform which developmental task by the child would indicate a need for further evaluation of a possible developmental delay? |
A. Holds object in both hands |
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A nurse is ordered to administer an IM medication for a 2-year-old child. Which of the following is the most appropriate way of explaining the procedure to the patient? |
C. Give explanation just before administering the medication |
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The nurse is performing educational teaching to the parents of a child w/ asthma. Which of the following statement by the parents would require additional teaching? |
B. “continues medication therapy prevents development of chronic asthma” |
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A 7-year-old child is being seen after a month of starting her asthma medications. Which of the following reports by the parents indicate well control of the child’s asthma symptoms? |
A . Child is experiencing symptoms once or twice a week |
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A nurse is teaching the parent of a child w/asthma about medication administration. Which of the following should the nurse include in the teaching? |
A. Use a long-acting beta-agonist (salmeterol) 30-60 minutes before exercise |
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The parent of a child w/ asthma asks her nurse what the purpose of the peak expiratory flow meter is. Which of the following should be the nurse’s response? |
D. it assesses the severity of asthma |
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A nurse is caring for a 7-month-old infant admitted for an apparent life-threatening event (ALTE). Which of the following assessment findings would indicate an impaired gas exchange? |
D. Oxygen saturation = 70% |
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A nurse is caring for a 2-year-old patient in the ER who is presenting signs and symptoms of bronchiolitis. Which of the following symptoms presented by the child indicate a need for an immediate intervention? |
B. Diminished breath sounds |
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A nurse is ordered to administer scheduled immunizations for a 4-month old child. The mother reported that the child received the 1st dose of palivizumab, an RSV prophylaxis one week ago. Which of the following should be the nurse’s action? |
C. Administer immunizations as scheduled |
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Which vaccine prevents development of epiglotitis in young children? |
B. HiB |
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The nursing student assigned to the ER is tasked to do assessments on the following patients. Which of the following should the nursing student assess first? |
D. A 4-year-old who is drooling, anxious, and refuses to lie down |
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Which respiratory findings would be present in patients diagnosed w/ cystic fibrosis? [select all that apply] |
a. Wheezing |
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A pediatric nurse is teaching a patient about needed supplementation of fat-soluble vitamins. The nurse would include which of the following? |
B. Vitamins A, D, E, K |
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The parent of a 10-year-old child w/ cystic fibrosis just received teaching instructions about administering medications for the child. Which of the following statements by the parent indicate a need for further teaching? |
D. My child should take his enzymes after eating |
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When creating a health care plan for a patient w/ cystic fibrosis, all of the following should be considered, except: |
A. Avoid prolonged or long-term antibiotic treatment |
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A nurse is administering a nebulizer treatment of tobramycin for a patient w/ cystic fibrosis. Tobramycin is given to treat which specific type of bacteria? |
C. Pseudomonas |
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A nurse is administering a nebulizer treatment of tobramycin for a patient w/ cystic fibrosis. Which of the following is a potential side effect of the drug? |
D. Hearing loss |
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A patient w/ cystic fibrosis just received discharge teaching about her nutritional needs. Which statements by the patient would indicate a need for further teaching? |
D. I should avoid all foods that have fat |
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A nurse received medication orders for an infant born at 30 weeks gestational age diagnosed w/ bronchopulmonary dysplasia (BPD). Which of the following medications from the order should the nurse question? |
A. Prednisone |
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Which of the following is manifested on a patient w/ bronchopulmonary dysplasia (BPD)? |
B. Tachypnea |
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Which collaborative care intervention is appropriate for an infant w/ bronchopulmonary dysplasia (BPD)? |
B. Tracheostomy insertion |
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A mother had a prenatal exposure to rubella. Which of the following conditions would be caused by a prenatal infection from rubella? |
C. Visual impairment |
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Which actions by the nurse are appropriate when caring for a visually impaired child? [select all that apply] |
B. Tell the child when you are entering or leaving the room |
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The parent of a child who had a tonsillectomy 1 week ago calls the nurse and reports that the child has a sore throat. Which of the following should be the nurse’s response? |
A. Advise parent to give cool liquids for the child |
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Which of the following foods isn’t appropriate for a patient who had a recent tonsillectomy? |
C. Orange juice |
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A home care nurse visits a child who had a tonsillectomy 1 week ago. During assessment, the nurse noted foul mouth odor and white patchy areas at the back of the throat. The child’s temperature is 100F. What should be the nurse’s best action? |
C. Document finding |
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Which assessment finding would be present in a patient diagnosed w/ congenital heart disease experiencing obstructed systemic blood flow? |
B. Decreased urine output |
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A nurse is caring for a child post-cardiac catheterization. Which intervention isn’t appropriate for the patient? |
C. Keep head of bed at fowler’s position |
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Heart defects that increase pulmonary blood flow include: |
D. Atrial septal defect (ASD) |
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A nurse is ordered to administer medications to a child w/ congestive heart failure. To improve the child’s systemic blood circulation, the nurse will administer: |
C. Digoxin |
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A child is receiving digoxin treatment for CHF. Which of the following assessment findings from the child should the nurse note as an early sign of digoxin toxicity? |
A. Arrhythmia or vomiting |
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Which if the following interventions are included in the nursing care plan for decreased cardiac output in a patient w/ CHF? [select all that apply] |
B. Provide for rest periods each hour |
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A nurse is caring for a child who had persistent fever lasting for 5 days. Assessment findings include swollen bright red tongue, diarrhea, peripheral edema, and an oral temperature of 103F. Which medication should the nurse administer for the child? |
B. Aspirin |
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Surgery is performed on a child w/ a patent ductus arteriosus (PDA) to prevent which of the following complications? |
Surgery is performed on a child w/ a patent ductus arteriosus (PDA) to prevent which of the following complications? |
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Which of the following assessment findings should the nurse note in a child diagnosed w/ an acute stage Kawasaki disease? |
D. Diarrhea |
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When caring for a child diagnosed w/ tetralogy of fallot (TOF), the nurse noted increased depth and rate of respirations. The child’s SpO2 is 88%, what should be the nurse’s next action? |
B. Place child to a knee-chest position |
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Which of the following assessment method should be used to determine presence of hip dysplasia in a 3-month-old child? |
B. Ortolani-Barlow maneuver |
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The nurse is performing discharge teaching to the parents of a child wearing a Pavlik harness. Which of the following instructions should not be included in the teaching? |
B. Harness should not be worn during bedtime |
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Which assessment finding would be present in a patient diagnosed w/ scoliosis? |
A. Uneven shoulder / hip height |
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A parent of a child w/ osteogenesis imperfecta just received proper care instructions for the child. Which of the following statements of the parent require further teaching? |
C. I have to feed my child calorie-rich foods |
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Which interventions should be included in a nursing care plan for a child diagnosed w/ muscular dystrophy (MD)? [select all that apply] |
C. Teach ROM exercises |
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The parent of a child diagnosed w/ type 1 diabetes received teaching about “sick day” care. Which of the following statements by the parent require further teaching? |
B. I have to limit my child’s fluid intake to prevent polyuria |
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When teaching about diabetes management to the parent of a child recently diagnosed w/ diabetes, what should the nurse educator do first? |
B. Answer questions regarding the condition |
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A nurse is closely monitoring a child w/ type 1 diabetes. Which of the following signs and symptoms would the nurse note as indication of presence of diabetic ketoacidosis (DKA)? |
C. Dehydration |
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A child is admitted to the emergency department w/ severe abdominal pain, irritability, and fever. Further assessment findings are 400 mg/dL blood glucose, deep / rapid respirations, fruity breath odor, and hypotension. Which action should the nurse do first? |
A. Prepare to administer IV insulin |
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When planning care for a child with ketoacidosis, which consideration is highest in priority? |
A. Assess neurological status |
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A newborn experiencing difficulty breathing and cyanosis soon after birth is ordered to receive supplemental oxygen and Prostaglandin E1 (PGE1). PGE1 is given to the patient for: |
b. Maintaining systemic blood flow |
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Which of the following nursing diagnosis for a child with severe combined immunodeficiency disease (SCID) should be the nurse’s top priority? |
B. Risk for infection |
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A nurse is assessing a child with signs and symptoms of Wiscott-Aldrich syndrome (WAS), which of the following assessment findings would be present in the child with the condition? |
C. Ecchymosis |
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A nurse is caring for a pre-school age child diagnosed with AIDS. To prevent pneumonia, which of the following technique would the nurse utilize for the child to promote effective lung expansion? |
A. Blowing bubbles |
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All of the following are included in the plan of care for a child diagnosed w/ AIDS, except: |
B. Administer initial treatment of Nevirapine |
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A nurse is reviewing lab values for a patient w/cancer receiving chemotherapy. The nurse noted that the patient’s platelet count is 20,000/microliter (low). Based on the finding, what would be the nurse’s next action? |
C. Administer stool softener |
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Which of the following assessment findings would not be present in a patient w/ neuroblastoma? |
C. Tender, soft abdomen |
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Which of the following should be the priority for a child w/ Wilm’s tumor who just underwent a left nephrectomy? |
A. Monitor fluid level |
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The parent of a child w/ biliary atresia asked the nurse how the surgery (hepatoportoenterostomy) would help her child. The nurse would state that the primary purpose of the procedure is to: |
D. Promote biliary flow |
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The nurse is providing discharge care instructions for a parent of a child w/ gastroesophageal reflux (GER). Which of the following should the nurse include in the teaching? [select all that apply] |
C. Hold and cuddle child during all feedings |
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Which of the following assessment findings isn’t present for a child w/ pyloric stenosis? |
D. Hypoactive bowel sounds |
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A nurse is assigned to care for a child diagnosed w/ pyloric stenosis. Which of the following should be the nurse’s top priority when caring for the child? |
D. Prepare child for surgery |
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A nurse is providing post-op care for a child with a cleft lip. Which interventions are included in the plan of care for the child? [select all that apply] |
A. Remove soft elbow immobilizers every 2 hours |
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Assessment findings for a child w/ biliary atresia include |
A. Clay colored stools and bruising |
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A nurse is assigned to care for a child admitted for lead poisoning. Which of the following should the nurse anticipate to administer for the child? |
B. Chelating agents |
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Interventions included in the plan of care of a child admitted for severe extracellular fluid volume deficit includes: [select all that apply] |
A. Take daily weights |
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A 2-year-old child is brought to the ER by her parents for nausea and vomiting, unresponsiveness, and a recent seizure episode. A lumbar puncture is ordered for the child together with other diagnostic tests. The primary reason the lumbar puncture is ordered is to: |
C. Assess CSF glucose level |
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A 2-year-old child is brought to the ER by her parents for nausea and vomiting, unresponsiveness, and a recent seizure episode. The parents reported to the nurse that the seizure lasted about 2 minutes, and involved stiffness and eventually lead to jerking motions over the entire body. The nurse would note that the child experienced what type of seizure? |
D. Generalized |
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A nurse performed home care teaching to the parents of a child who had a febrile seizure. Which statement made by the parent indicates a need for further teaching? |
A. Anticonvulsants can help reduce my child’s seizure episodes |
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When performing assessment of a patient w/ meningitis, the nurse noted resistance when extending the patient’s leg at the knee. The nurse would document the finding as: |
B. Positive Kernig sign |
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The nurse is preparing the plan of care for a patient who suffered a traumatic brain injury (TBI) from a motor vehicle accident. Which of the following should be included in the plan of care for the patient? [select all that apply] |
C. Administer Lasix as scheduled |
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A nurse instructor is reviewing a nursing student’s care plan for a patient w/ acute bacterial meningitis. Which of the following care plan notes should the instructor question? |
A. Administer PO antibiotic as scheduled |
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A nurse is caring for a child who is suspected to have acute bacterial meningitis. Which of the following should be the nurse’s top priority? |
B. Administer antibiotics as scheduled |
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Which of the following interventions should not be included in the plan of care for a newborn w/ myelomeningocele? |
D. Position newborn in supine position |
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A nurse is tasked to perform assessments on a 3-year-old child being evaluated for possible hydrocephalus. Which of the following signs and symptoms should the nurse note as an early sign of the condition? |
D. Nausea and vomiting |
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The home care nurse is caring for a 4-year-old child with sickle cell disease who is scheduled for her scheduled immunizations. The parent is concerned about possible complications of administering immunizations for the sick child. How should the nurse respond? |
B. Regular scheduled immunizations are safe to administer |
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A child w/ sickle cell disease is scheduled for a blood transfusion. The nurse should anticipate which blood product to administer for the child? |
A. Packed red blood cells |
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A nurse is assigned to care for a child diagnosed w/ hemophilia. Which of the following interventions should not be included in the plan of care for the patient? |
B. Administer ordered Motrin PRN for pain |
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The parent of a terminally ill child expressed concern to the nurse that the child’s sister believes that it’s her fault that the child is hospitalized. Which of the following should the nurse tell the parent? |
B. Ask the child why she believed it’s her fault |
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The parents asked a charge nurse information about their child 17-year-old who was admitted earlier due to an accident in school. The charge nurse found out that the child died 5 minutes ago due to a massive hemorrhage. What should be the charge nurse’s next action? |
D. Escort the parents to a quiet private room |
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A nurse is developing the plan of care for a 5-year-old child admitted following extensive leg surgery. The parents asked the nurse that they wanted to help take care of the child during their stay. All of the following activities can be implemented for the parents, except: |
A. Avoid repeatedly giving information to help reduce stress |
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The parents of a terminally ill child asked the hospice nurse about signs of approaching death. Which of the following would be a sign of imminent death? |
A. Change in respiratory pattern |
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Which of the following best describes an 8-year-old child’s understanding of death? |
B. Death is irreversible |
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In caring for a preschool-age child with terminal illness, which of the following behavior responses should the nurse expect for the child? |
D. Seems morbidly fascinated w/ death |
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A nurse is performing assessment on a child presented with complains of severe vomiting, the child has been seen in the facility several times per week with the same presenting symptoms. The child’s lab values are within normal limits, and the child shows no signs of illness. To determine Munchausen syndrome by proxy, which of the following from the parent’s history would help indicate confirmation of the condition? |
B. The parent is a nursing student in the local college |
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A nurse working in the local community clinic noted bruises on a 3-year-old child’s leg, arm, and buttocks. The parents reported that the child has been very clumsy and bumping on furniture a lot. In assessing the child, which behavior is most indicative of abuse? |
D. The child is extremely compliant during assessment |
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A nurse is caring for a 5-year-old child is assigned for a palliative care program. The parents asked the nurse if the child has become terminally ill and now requires extensive care. In responding to the parents’ concern, the nurse should know that palliative care is: |
D. Focused on symptom management |
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An infant is being discharged after hypospadias repair. Which of the following discharge care instructions should the nurse tell the parents of the infant? |
C. Limit the child’s activity for at least 2 weeks |
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A nurse is providing post-op care for a child with a cleft lip. Which interventions are included in the plan of care for the child? [select all that apply] |
A. Remove soft elbow immobilizers every 2 hours |
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A nurse is reviewing the recent lab results of a child admitted for nephrotic syndrome. Which of the following lab values would be present in the child with the condition? |
B. Reduced serum albumin |
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A nurse is performing discharge teaching to the parents of a 3-year-old child diagnosed w/ minimal change nephrotic syndrome (MCNS) about corticosteroid therapy. Which of the following statements made by the parents indicate understanding of the teaching? |
B. Blood glucose should be monitored while taking the medication. |
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A nurse is preparing a care plan for a child with minimal change nephrotic syndrome (MCNS). Which of the following nursing diagnosis would be appropriate for the child? |
A. Risk for impaired skin integrity |
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Which of the following should be included in the plan of care for a child newly admitted with nephrotic syndrome? [select all that apply] |
B. Administer corticosteroid as scheduled |
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Which developmental considerations about pain should the nurse anticipate in a 4-year-old preschool child? |
D. Often believes pain is punishment |
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Which interventions should be included in a nursing care plan for a child diagnosed w/ muscular dystrophy (MD)? [select all that apply] |
C. Teach ROM exercises |
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which of the following are severe symptoms of Hib?
a. malaise, fever, aches b. epiglotitis, meningitis, pneumonia c. OM, bronchitis, sinusitis d. sore throat, fever, lymphadenopathy |
B. epiglotitis, meningits, pneumonia
Hib is transmitted via direct contact with droplet organisms. C, OM, bronchitis, and sinusitis are mild symptoms and D, sore throat, fever, and lymphadenopathy are signs of Mono/Epstein Barr Virus. |
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Symtoms of Rubella (German Measles) and important patient teaching |
Symptoms: pink maculopapular rash starting on face and moving down body, low grade fever, sore throat. Teaching: danger to fetus, transmitted via droplet and contact |
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Which of the following are symptoms of Rubeola (Measles): [select all that apply]
a. koplik spots b. red, blotchy dashing starting on face, moving down body c. sore throat d. photophobia, high fever e. conjuctivitis f. beefy red tongue |
A, B, D, E: koplik spots, red, blotchy rash starting on face, moving down body, photophobia, high fever, conjunctivitis.
F, beefy red tongue is indicative of scarlet fever |
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What type of isolation precautions should a patient with Rubeola (Measles) be on? |
Airborne. It is transmitted via respiratory tract droplets. |
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How long is a child with varicella contagious for? |
5 days before rash. Varicella is not contagious once lesions crust. |
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Treatment for varicella? [select all that apply]
a. antipyretics, oral benedryl b. warm, soothing bath c. asprin d. oatmeal or cool bath e. calamine lotion |
A, D, E: antipyretics, oral benedryl, oatmeal or cool baths, and calamine lotion.
Aspirin is not used due to the risk of developing Reyes Syndrome and a warm bath is not indicated. |
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A patient comes into the ER with a beefy, red tongue and an erythematous rash that is darker in the axilla, groin, and neck and is gritty like sandpaper. What are they suffering from? What isolation precautions would you implement? What complication are you worried about the patient developing? |
Patient is suffering from Scarlet fever. The nurse would implement contact and droplet isolation precautions, and would be worried about the patient developing glomerulonephritis. |
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A patient comes into the ER with pertussis, what 4 interventions would the nurse anticipate for the patient? |
1. droplet isolation 2. azithromycin antibiotics 3. oxygen therapy 4. antibiotic prophylaxis for family and close contacts |
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A 1 year old comes into the doctor's office with his mother who is complaining of her child having a fever for the past 2 days and this morning having an erythematous rash on his abdomen and back. What should the nurse conclude this patient has? |
Roseola (baby measles). Roseola is manifested in kids under 2 years old with symptoms of a sudden high fever for 3-5 days followed by an erythematous rash starting on trunk, lasting 1-2 days. The child may also suffer from febrile seizures |
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Fifth disease occurs in 3 stages, what are the symptoms for the 3 phases? |
stage 1: fever, headache, nausea, a "slapped face rash" on cheeks 1 week later stage 2: lacy rash appears on body stage 3: for 1-3 weeks, lacy rash fades and reappears |
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When is Fifth Disease contagious and what is the treatment? |
Contagious before onset- not contagious once rash appears Treatment is NON-ASPRIN antipyretics, antipruritics for itching, and oatmeal baths |
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What is the most important treatment for Rotavirus? |
Oral rehydration. Rotavirus is a fecal-oral disease that is characterized by extreme watery diarrhea that lasts for 3-8 days, so hydration and fluid and electrolyte imbalances are the main priority. Treatment for a child should be pedialyte in small amounts (1 tsp every 5-10 mins) and NO antidiarrheals. |
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Patient comes in to ER with a thick, bluish-white membranous lesion on the pharynx and a swollen neck, what can the nurse conclude the patient has? |
Diptheria |
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What symptoms are manifested in a patient 30 mins to 1 hour after acetaminophen toxicity? a. RUQ pain, liver tenderness b. oliguria, elevated LFTs c. A/N/V/diaphoresis d. hepatomegaly |
C. anorexia, nausea, vomiting, diaphoresis
A and B occur in phase 2 (24 hrs after ingestion) and D occurs in phase 3 (3-5 days after ingestion |
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Symptoms of acetaminophen toxicity in a patient 3-5 days after ingestion? |
liver malfunction, elevated LFTs, bilirubin, and PT time, jaundice, hepatomegaly |
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Symptoms of acetaminophen toxicity in a patient 24 hours after ingestion? |
RUQ pain, liver tenderness, oliguria, elevated LFTs |
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Treatment for acetaminophen toxicity? |
acetylecystine (Mucomyst) IV, PO, or NG tube |
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Characteristics of a mild level of lead poisoning (10-19 mg/dL) |
anorexia, vomiting, irritable, behavior changes
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What intervention is implemented for a patient with a blood lead level of 19-60 mg/dL? |
Hospitalization (over 45), and giving a chelating agent (for over 19 or 45). A chelating agent would be Succimer (Chemet) po, Dimercaprol (BAL) IM, or EDTA given IM or IV. Also, give high doses of Vit D |
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Discharge teaching for a patient who came in with lead poisoning? |
Diet high in calcium and iron, avoid using unglazed pottery, do not dry sweep or dust, and encourage fluids. |
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Developmental milestone for a 1 month old? |
Can lift head on own |
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Developmental milestone for a 2 month old? |
Roll front to back, social smile |
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Developmental milestone for a 4 month old? |
Can lift body up with arms from floor |
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Developmental milestone for a 5 month old? |
roll back to front |
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Developmental milestone for a 6 month old? |
sit with support |
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Developmental milestone for a 7 month old? |
can sit alone and transfer objects between hands |
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Developmental milestone for an 8 month old? |
pincer grasp begins and begin to develop stranger anxiety |
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Developmental milestone for a 9 month old? |
pincer grasp in achieved, begin creeping and crawling |
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Developmental milestone for an 11-12 month old? |
cruising, walking, can sit from standing, and can stand alone |
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Developmental milestone for a 15 month old? |
stack 2 blocks |
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Developmental milestone for an 18 month old? |
stack 3 blocks |
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Type of play an infant up to 1 year old uses? |
solitary play- grasping, banging blocks, examining things, putting them in mouth |
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Type of play a toddler, ages 1-3 engages in? |
Parallel play- plays with similar objects side by side, imaginative, make believe play; imitates adults |
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Type of play a preschooler, ages 3-6 years old engages in? |
Cooperative/associative play- interacts with friends, imaginative, dramatic play |
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Type of play a school-aged child, ages 6-12 years old engages in? |
Formal/competitive play- form teams, follow rules, athletic play |
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When is the NIPS scale used? |
For preterm-6 weeks old |
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What does the FLACC scale look at and who is it used for? |
Looks at: -face -legs -activity -cry -consolability Used for kids 6 weeks-2 or 3 year old (nonverbal) |
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Special considerations for pain in toddlers? |
like distraction |
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Special considerations for preschoolers in pain? |
-can tell you where it hurts -hear bodily harm or injury -pain is punishment -more blood = worse injury -like bandaids |
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Special considerations for pain in school aged kids? |
-fear mutilation -understand cause and effect |
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What is the best non-pharmacologic pain reliever for children? |
Parental presence |
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Post cardiac cath for a child, what nursing interventions will the nurse anticipate? |
-flat/supine for 4-6 hours* -CV monitor -frequent VS and neurovascular checks* -assessing for bleeding* -assessing for perfusion (CMS, mottled skin)* -pedal pulses -looking for dehydration (urine output is best indicator) -quiet games for 24 hours |
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MAJOR nursing assessments for a pt post cardiac cath? |
1. perfusion: CMS, cap refill, mottling, pedal pulses -urine output hourly (min. 1 ml/kg/hr) 2. bleeding 3. airway: lung sounds, 02 sats |
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Post cardiac cath home care teaching |
-sponge baths only -dont hold child under arms for 6-8 weeks -acetaminophen/ibuprofen for pain -postpone live virus vaccines if blood products are given (MMR/varicella) -increase activity gradually |
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CHDs that increase pulmonary blood flow |
PDA, ASD, VSD: blood shunts L --> R |
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PDA s/s |
blue baby, pale blue feet, decreased leg/pedal pulses |
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PDA tx |
PDA ligation, IV ibuprofen or Indomethacin, coil in older kids |
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ASD tx |
surgical closure with patch/septal occluder (Amplatzar device) |
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CHDs that decreased pulmonary blood flow and important characteristics |
pulmonary stenosis, TOF, and pulmonary or tricuspid atresia -causes cyanosis --> polycythemia, TET spells -blood shunts R --> L |
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pulmonary stenosis s/s |
periorbital edema |
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4 defects present with TOF |
1. pulmonary stenosis 2. right ventricular hypertrophy 3. VSD 4. overriding aorta these allow the blood to bypass the lunger and enter the left side of the heart, sending deoxygenated blood into the body's circulation, leading to cyanosis |
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s/s of TOF |
cyanosis, decreased level of consciousness, polycythemia, clubbing, TET spells |
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tx of TOF |
prostaglandins, palliative surgery before corrective surgery, and corrective surgery to repair the stenosis, close the VSD, and move the aorta over |
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PA/TA tx |
balloon in cardiac cath to open the foramen oval (ASD) to get blood to left side and prostaglandins to keep the PDA open to get blood to the lungs until palliative surgery |
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Characteristics/blood flow in TGA |
1. pulmonary artery connected to L vent -blood goes L vent > plum artery > lungs > L atrium 2. aorta connected to R vent -blood goes R vent > aorta > body > vena cava > R atrium |
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tx of TGA |
prostaglandins to get blood from right side to lungs (until surgical repair), balloon atrial septostomy to open foramen oval in cardiac cath to connect the right and left atrium, and surgery to do arterial switch |
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CHDs that obstruct systemic blood flow |
aortic stenosis, COA, and HLHS |
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symptoms of CHDs that obstruct systemic blood flow |
-decreased pulses, cap refill, urine output -stronger pulses and BP in UE than LE -necrotizing enterocolitis d/t decreased GI flow |
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Aortic stenosis tx |
prostaglandins, balloon dilation during cardiac cath, surgical valvotomy, and valve replacement |
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COA characteristics |
narrowed descending aorta, decreased blood flow to LE and increased blood flow to the brain, increasing the risk for a stroke |
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s/s of COA |
-BP and pulse lower in LE than UE -necrotizing enterocolitis -poor feeding/FTT -renal failure |
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tx of COA |
prostaglandins, balloon dilation in cardiac cath (but has a high risk of reoccurrence), and surgical repair with anastomosis |
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characteristics of HLHS |
-mitral and aortic valves absent or stenosed -small left vent and aortic arch, hypertrophy of R vent -decreased peripheral pulses -poor peripheral perfusion -tachypnea, retractions, SOB |
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tx of HLHS |
prostaglandins, 3 staged surgery, heart transplant |
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cadiomyopathy |
4 chamber dilate and systolic contraction is weak |
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tx of cardiomyopathy |
ACE inhibitors, digoxin, and heart transplant |
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what is infective endocarditis |
bacterial infection in heart associated with foreign body, damaged heart tissues, CHD, and post op cardiac cath |
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how is infective endocarditis diagnosed? |
-elevated ESR/SED -anemia -elevated c reactive protein -increased WBC |
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symptoms of infective endocarditis |
petechiae, splinter hemorrhages under nails |
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treatment of infective endocarditis |
antibiotics, removing infected hardware, and antibiotics prophylactically before dental procedures |
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Kawasaki Disease is what? |
acute, febrile, inflammatory disease that affects small to medium sized arteries, including the coronary arteries which causes decreased blood flow |
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symptoms of Kawasaki |
high fever for over 5 days, conjunctivitis, red throat, dry, cracked lips, swollen, red hands and feet, desquamation of toes and fingers, enlarged cervical lymph nodes, and a macupapular rash on the trunk/peri area |
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treatment of Kawasaki |
IVIG high does aspirin corticosteroids |
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important nursing care for kawasakis |
1. monitor for blooding d/t high dose asprin 2. diet of soft, cool fluids and foods, high cal, low cholesterol 3. provide comfort |
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home teaching for kawasaki |
-monitor temp and bleeding with aspirin therapy -avoid contact sports -give tylenol/ibuprofen for fevers -postpone live virus vaccines for 11 months after IVIG therapy |
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OI |
not enough collagen to support bone |
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focus of care for pt with OI |
-increased independence while decreasing risk of injury -prevent fractures (use blanket to transfer, don't hold by ankles when changing diapers- lift under butt) -prevent complications, treat fractures |
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diet for patient with OI |
high in vitamin D and calcium, keep cals low |
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Meds for patient with OI |
biphosphate (Pamidronate) iv |
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symptoms of OI |
freq fractures, blue tinged sclera, thin, soft skin, increased joint flexibility |
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clinical characteristics of hip dysplagia |
asymmetric gluteal folds and a positive ortolan and barlow maneuver |
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parent teaching related to Pavlik harness |
-give sponge baths -assess skin under stapes daily -wear shirt and socks under brace |
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most important patient/parent teaching for infant with hip dysplagia? |
dont swaddle baby |
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post op interventions for patient with scoliosis |
-bedrest for 1-2 days -log rolling -neurovascular checks frequently
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superior mesenteric artery syndrome |
artery is stretched post op causing collapse or narrowing leading to decreased blood flow to gut and ileum |
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nursing intervention for superior mesenteric artery syndrome |
knee-chest position |
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DMD characteristics |
-x linked recessive, boys, 3-5 years old -missing dystrophin -begins in LE, trip more, awkward gait -calves hypertrophic -gower's sign |
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diet for kids with DMD |
-high fiber -high protein -low cal -high fluids |
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tonic clonic/ grand mal seizures |
-over 6 months old, abrupt -lasts 1-2 mins -LOC, aura -incontinent, drooling, foaming -hard to arouse, confused, amnesia |
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absence/ petit mal seizure |
-3-12 years old -LOC for 5-10 seconds -no aura -frequent attacks (50-100 a day) -zones out/stares with glazed eyes -amnesia, no confusion |
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partial/focal seizure |
-in 1 hemisphere -no LOC - <30 seconds -no aura -no confusion |
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infantile spasms |
-4-8 months -clusters (50-150 a day) -can lead to developmental delays -treated with anticonvulsants and diet |
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febrile seizures |
-3 months- 5 years -no anticonvulsants -only tylenol to decreased temp |
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first signs of increased ICP |
-headache -visual disturbances -nausea, vomiting -change in behavior |
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signs of increased ICP in infants |
-shrill, high pitched cry -sunset eyes -difficulty feeding |
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late signs of increased ICP |
-decreased LOC -cushings triad: increased systolic BP with widened pulse pressure, bradycardia, and irregular respirations -fixed, dilated pupils |
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diet for seizures |
ketogenic: HIGH FAT, ADEQ PROTEIN, LOW CARB |
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signs of meningitis in infants |
-bugling fontanels -shrill cry with rocking -opisthotomic head position -pos kernigs sign (leg) -pos brudzinski sign (head/leg) |
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signs of meningitis in children |
-photophobia -nuchal rigidity -delirium -fever, chills |
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treatment for meningitis |
1. droplet precautions 2. lumbar punture 3. iv antibiotics |
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nursing interventions for meningitis |
-monitor neuro status -reduce ICP with corticosteriods/mannitol -manage bacterial shock -treat family with antibiotics prophylactically -anticonvulsants, antipyretics -avoid neck flexion/extrension (HOB 30 degrees) |
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meds for cerebral palsy |
-botox or valuim -baclofen oral or intrathecal pump |
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treatment of a head injury |
-EVD -Meds: mannitol and decadron, anticonvulsants, sedatives, NO corticosteriods -respiratory assessments |
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care for patient with an EVD |
-monitor neuro and VS q1hr -keep level with pt's ear -monitor insertion site and CSF for infection -output of CSF |
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post VP shunt nursing interventions |
-dont elevate HOB -keep pt flat -observe for signs of infection |
