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NR 328 / NR328 Exam 1 Study Guide
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NR 328 / NR328 Exam 1 Study Guide
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Pediatrics Exam 1 Study GuideInfant Health Promotion Teaching on Leading Cause of Death
Leading Cause of death: LBW, congenital anomalies, disorders relating to short gestation and
unspecified LBW, SIDS, and newborn affected by maternal complications of pregnancy. Access
to and use of high-quality prenatal care decrease early delivery and infant mortality. Teach parents
about prenatal care, placing infant on back to sleep. Assist family on making informed decisions
and that they are aware of all available health services, treatments and procedures.
S/S of Pain in Infant
Physiological Responses
Vitals: Increased HR, Increased BP, rapid/shallow respirations
Oxygenation: Decreased tcPo2, decreased Sao2
Skin: Pallor or flushing; diaphoresis; palmar sweating
Other Observations: Increased muscle tone; dilated pupils; decreased vagal nerve tone;
increased ICP; metabolic or endocrine changes; hyperglycemia; lowered pH, elevated
corticosteroids.
Behavioral Responses
Vocalizations: Crying, whimpering, groaning
Facial Expression: Grimaces, brow furrowed, chin quivering, eyes tightly closed, mouth
open and squarish
Body Movements and Posture: limb withdrawal; trashing; rigidity; flaccidity; fist
clenching
Changes in State: Changes in sleep-wake cycles; changes in feeding behavior; changes
in activity level; fussiness, irritability; listlessness.
Abuse Indicators
Physical Abuse
Physical Findings
Bruises and Welts (May be in various stages of healing)
Face, lips, mouth, back, buttocks, thighs or areas of torso.
Regular patterns descriptive of object used, such as belt buckle, hand,
wire hanger, chain, wooden spoon, squeeze or pinch marks.
May be present in various stages of healing
Burns
On soles, palms, back, or buttocks.
Patterns descriptive of object used.
Absence of “splash” marks and presence of symmetric burns
Stun gun injury; lesions circular, fairly uniform.
Fractures/Dislocations
Skull, nose, or facial structures.
Injury denoting type of abuse (spiral fracture or dislocation from twisting
an extremity or whiplash from shaking a child)
Multiple new or old fractures in various stages of heeling
Lacerations and Abrasions
On backs of arms, legs, torso, face, or external genitalia
Unusual symptoms abdominal swelling, pain, and vomiting from
punching
Descriptive marks such as human bites or pulling out of hair
Chemical
Unexplained repeated poisoning, especially drug overdose
Unexplained sudden illness (hypoglycemia form insulin admin.)
, Suggestive Behaviors
Wary of physical contact with adults; apparent feat of parents or going home;
lying very still while surveying environment; inappropriate reaction to injury,
such as failure to cry from pain; lack of reaction to frightening events;
apprehension when hearing other children cry; indiscriminate friendliness and
displays of affection; superficial relationships; acting-out behavior, such as
aggression to seek attention; withdrawal behavior.
Emotional Abuse and Neglect
Physical Findings: Growth failure, eating disorder, enuresis or sleep disorder.
Suggestive Behaviors: Self-stimulatory behaviors; during infancy; lack of social smile
and stranger anxiety. Withdrawal form environment and people; unusual fearfulness.
Antisocial behavior; extremes of behavior; lags in emotional and intellectual
development; suicide attempts.
Sexual Abuse
Physical Findings: Bruises, bleeding, lacerations, or irritation of external genitalia, anus,
mouth or throat. Torn, stained, or bloody underclothing. Pain on urination or pain,
swelling, and itching of genital area. Penile discharge. STD. Difficulty walking or sitting,
unusual odor in the genital area, recurrent UTIs, presence of sperm, or pregnancy in
young teen.
Suggestive Behaviors: Sudden emergence of sexual problems; withdrawn behavior;
preoccupation with fantasies; poor relationships with peers. Sudden changes in weight or
behavior; excessive anger at parents. Regressive behavior; sudden onset of phobias.
Running away from home, substance abuse, personality changes. Rapid declining school
performance; suicide attempts.
Nursing Care: Priority is removing child. Care for child the same way as any other; do not treat
them as a victim. Implement teaching through demonstration.
Infant’s Vital Signs
Temperature: 97.7-99.7 F. Axillary temp is lower than rectal temp.
Heart Rate: 120-140 bpm; Bradycardia <80-100 bpm; Tachycardia 160-180 bpm.
Respirations: 30-60 breaths/min
Blood Pressure: 65/41 in arm and calf. Systolic pressure greater than 90 considered
hypertension.
Indicator of Fluid Loss in an Infant
Changing sensorium, decreased response to stimuli, decreased turgor, prolonged capillary refill.
Increased HR, sunken eyes, sunken fontanels.
Psychosocial Needs of a Hospitalized School Age Child
Rely on what they know. They want explanations and reasonings. Concern about body integrity.
They are interested in the functional aspect of things. They are beginning to be aware of how their
body functions, they have an ability to describe pain and an increasing ability to understand
cause/effect. They fear loss of control in hospital, seek information as a way to maintain control.
They can sense when they aren’t being told the truth, and can experience stress of being separated
from peers and regular routine.
Diet in Preschoolers
Daily Intake: 1800 calories
Protein: 13-19 g/day
Fiber: Child’s age + 5 grams
Saturated Fatty Acids: Less than 10% of total caloric intake
Cholesterol: <300 mg/day
Calcium: 700 mg for ages 1-3; 1000 mg for ages 4-8.
Juice: 4-6 oz/day for children 1-6
Age 4: May become picky eaters.
, Impetigo Contagiosa
S/S: Begins as reddish macule; becomes vasicular; ruptures easily; tends to spread peripherally;
exudate dries to form heavy crust; pruritis common; system effects minimal or asymptomatic
Tx: Topical bactericidal ointment, oral antibiotics, vancomyacin
Comments: Heals without scarring, contagious, very common in toddlers and preschoolers
Pediculosis Capitis (Head Lice)
Female: Lives only 48 hours away from human host. Lays eggs at night. Nits hatch in 7-10 days.
S/S: Itching
Dx: Site of nits
Tx: Pediculicides and manual removal. Permethrin 1% cream, repeat in a week, treat affected
family. Pyrethrin products contraindicated for individuals with contact allergy to ragweed or
chrysanthemums. Malathion must remain in contact with scalp for 8-12 hours; not recommended
for children younger than 2. Benzyl alcohol children as young as 6 months, should be applied to
dry hair and rinsed off after 10 minutes and repeat after 7 days.
Nursing Care: Do not share combs, caps, scarves, coats. Nurses should wear gloves. Lice are
small and gray-tan.
Erythema Infectiosum (Fifth Disease)
Transmission: Droplet or direct contact
Precautions: Standard
S/S: Persistent fever for 3-7 days in child who is otherwise well appearing; “slapped
cheek” appearance; mild URI symptoms; cough
Rash Stages
1. Erythema on face, chiefly on cheeks. Disappears by 1-4 days.
2. 1 day after rash appears on face, maculopapular red spots appear,
symmetrically distributed. May last more than 1 week.
3. Rash subsides but reappears if skin is irritated or traumatized.
Symptomatic & Supportive Management: Antipyretics, analgesics, possible blood
transfusion.
Complications: Arthritis, arthralgia, may result in death, aplastic crisis in children with
hemolytic disease, myocarditis.
Nursing Care: Isolate hospitalized children, pregnant women should not care for
children in aplastic crises.
Mumps
Source: saliva of infected persons
Transmission: Direct contact
Prodromal S/S: fever, headache, malaise, and anorexia for 24 hours followed by earache that is
aggravated by chewing
Parotitis S/S: by third day, parotid glands enlarge (maximum size in 1-3 days), accompanied by
pain and tenderness.
Management: Analgesics, antipyretics, and IV fluids
Complications: Sensorineural deafness, postinfectious encephalitis, myocarditis, arthritis,
hepatitis, oophoritis, pancreatitis, sterility, meningitis
Nursing Care: Maintain isolation during contagious period, encourage rest and decreased
activity, give analgesics, encourage fluids and soft foods, apply hot or cold compression.
Pertussis
Precautions: Droplet
Transmission: Direct contact from droplets
Cararrhal Stage: URI Symptoms 1-2 weeks
Paroxysmal Stage: Short, rapid cough bought followed by high-pitched crowing, “whoop” or
gasp 4-6 weeks cyanosis may occur during episode.
Management: Hospitalization for infants; increased oxygen intake; mechanical ventilation
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