NR 328 PEDIATRICS FINAL REVIEW COMPLETE & RELIABLE

  6 -8 weeks of age When does the posterior fontanel close? 12-18 months When does the anterior fontanel close? Height, weight & head circumference What 3 things are continuously measured in the infant to keep track of their size? Doubled by 6 months & tripled by 1 year When is birth weight doubled? Tripled? Between 6-10 months When do the first teeth in the infant erupt? 7 months At what age should the infant be able to bear full weight on their feet? 8 months At what age should the infant be able to sit unsupported? 11 months At what age should the infant be able to walk while holding on to something for stabilization? 12 months At what age does an infant unsuccessfully build a two-block tower? 6 months At what age does an infant successfully hold a bottle? Crying What is the first form of communication for infants? Trust vs Mistrust What is the Erikson stage from birth to one year? Comfort, feeding, stimulation and caring needs What needs have to be met to establish trust from birth to one year of age? At birth- Hepatitis B 2 months- DTaP (Diptheria, tetanus & pertussis), RV (Rotavirus), IPV (Inactivated poliovirus), Hib (Haemophilus type B), PCV (Pneumococcal vaccine) & Hep B 4 months- DTaP, RV, IPV, Hib, PCV 6 months- DTap, IPV, PCV, Hep B, RV, Hib 6-12 months- Seasonal influenza yearly What immunizations are recommended by the CDC for infants less than 12 months of age? Breastfeeding What type of nutrition provides infants with a complex diet for the first 6 months? Iron-fortified formula What is an acceptable alternative to breast milk? Until 2 years of age How long should infants and toddlers be rear facing in the car seat while in the car? Tachycardia, repeated swallowing/clearing of throat, hemoptysis (coughing up blood) What are signs of hemorrhage following a tonsillectomy? Incubation Stage of infection where there is an interval between the pathogen entering the body and the presentation of the first symptom Prodromal stage Stage of infection where the interval from onset of general symptoms to more distinct symptoms. Pathogen is multiplying. Illness stage Stage of infection when symptoms specific to the infection occur Convalescence Stage of infection when acute symptoms disappear. Total recovery could take days to months. Health care associated infection (HAIs) formerly nosocomial infections A type of infection acquired while receiving care in the health care setting Iatrogenic infection A type of infection resulting from a diagnostic or therapeutic procedure Rheumatic fever Defined as a disease that occurs as a reaction to group A beta hemolytic streptococcus infection of the throat; Usually occurs 2-6 weeks following an untreated/partially treated upper respiratory infection (strep throat) Kawasaki disease A disease also known as acute systemic vasculitis High dose aspirin: 80-100mg/kg/day divided q6hr and IVIG How is kawasaki disease treated? 2-3kg (4.4-6.6lb) How much weight should a preschooler gain per year? Initiative vs Guilt What is the Erikson stage for preschoolers (3-6 years)? DTap, MMR, Varicella, IPV and seasonal influenza What immunizations are recommended by the CDC for children ages 4-6 years? Average daily intake should be 1,800 calories What should the nutrition for preschool-aged children include? Magical thinking Preschool aged children believe their thoughts can cause events to occur. What is this called? Animism Preschool aged children believe that intimate objects are alive. What is this called? Centration Preschool aged children focus on one aspect instead of considering the whole picture. What is this called? Brain, muscles, joints and skeletal structures of the body What areas of the body do chronic neuromusculoskeletal disorders affect? Cerebral palsy (CP) Characterized as progressive impairment of motor function, especially that of muscle control, coordination and posture Administer muscle (Valium, baclofen) relaxants to prevent spasms Administer antiepileptic to control seizure activity Prevent aspiration (Keep head of bed elevated, keep suction at bedside) Recognize fall risk (raise bed rails, secure child in wheelchair, encourage safety equipment at home seat belt etc What are nursing responsibilities when caring for a patient with CP? Spina Bifida Defined as the failure of the osseous spine to close, caused by neural tube defects Constant newborn assessment Maintain skin integrity Assessment of head circumference & fontanels Assess for increased ICP Protect sac (if present) from injury Monitor I&O post op Assess for CSF leakage post op Monitor for signs of infection post op What are nursing responsibilities when caring for a patient with spina bifida? Down Syndrome Defined as a chromosomal abnormality of the 21st chromosome Juvenile idiopathic arthritis (JIA) Defined as a chronic autoimmune inflammatory disease in children, affecting joints and other tissues Erythrocyte sedimentation rate (ESR) may/may not be elevated CBC with differential may show elevated WBCs What laboratory values would be of interest when diagnosing JIA? Methtrexate (DMARD), Enbrel (DMARD)-- monitor liver function tests & CBC Deltasone (Corticosteroid) -- taper dose when d/c What medications could be prescribed for treating JIA? Contact dermatitis Defined as an inflammatory reaction of the skin, caused when the skin comes into contact with chemicals or other irritants (faces, soap, poison, dyes, meds) Remove wet diaper Clean perineal area with nonirritating cleanser Wash skin folds & genital area Expose effected area to air Apply skin barrier (zinc oxide) do not wash off with each diaper change What are nursing responsibilities when treating diaper dermatitis? Remove irritant & limit further exposure What are nursing responsibilities when treating contact dermatitis? Antihistamines (Benadryl) - for allergic reaction Antibiotics - used to treat secondary infection, from scratching etc Antifungal ointments What medications are used when treating contact dermatitis? Acne What is the most common skin condition during adolescence? The cause is unknown & the condition is not contagious What is the cause of seborrheic dermatitis (Crusting on scalp)? Lack of clean water, poor hygiene, crowded living arrangements, poor sanitation and nutritional deficiency What are some risk factors for contracting a GI disorder in children? Obtain baseline height/weight Avoid rectal temperature Assess I&O Assess bowel sounds Monitor elimination patterns Initiate IV fluids Administer antibiotic What are nursing responsibilities when caring for a child with a GI disorder? Increase stool bulk Stimulate peristalsis Prevent constipation Protect against colon cancer What do diets high and fiber do? Reduce frequency and volume of fecal output Slow transit time of food through the GI What do diets low in fiber do? For clients who have diarrhea or malabsorption syndrome When are low fiber diets implemented? For clients with constipation When are diets high in fiber implemented? Blood in the stool What does coffee-ground like emesis indicate? Easy to digest carbs, including: crackers, toast, oatmeal, pretzels, plain bread and bland fruit What foods are recommended for a client experiencing nausea/vomiting? Anorexia Defined as a lack of appetite, caused by certain medications or physical conditions Decrease stress at meal times Assess for AE of medications Administer meds to stimulate appetite Remove any soiled linens or garbage that may decrease desire to eat Assess and manage anxiety/depression Provide small/frequent meals Position to increase gastric motility Oral care post eating What are some nursing interventions to implement for a child experiencing anorexia? Hypokalemia, Hyponatremia, Hypovolemia as well as nutritional complications What electrolyte imbalances can diarrhea cause? Dysphagia Defined as an alternation in the client's ability to swallow Obstruction Inflammation Certain neurologic disorders Dry mouth What are possible causes of dysphasia? Alleviate dry mouth Provide frequent oral care to enhance client's sense of taste Arrange consult with speech therapist Allow adequate time for eating Encourage small bites Avoid thin liquids and sticky foods MONITOR FOR ASPIRATION What are nursing responsibilities when caring for a patient with dysphagia? Dumping syndrome Caused by surgical removal of a portion of the stomach, causing stomach contents to be rapidly emptied into the small intestine Encourage small, frequent meals Recommend consumption of protein/fat at meal time Restrict lactose intake Instruct client to lay down 20-30 minutes after meals to delay gastric emptying Monitor client for mineral deficits such as iron and vitamin b12 What are nursing interventions for a patient with dumping syndrome? GERD- Gastroesophageal reflux disease This GI disorder occurs as a result of the abnormal reflux of the gastric secretions up the esophagus, leading to indigestion and heartburn Instruct client to avoid situations that increase abdominal pressure (tight-fitted clothing) Avoid spicy foods, citrus juices and carbonated beverages *triggers Advise client to avoid eating 2 hours or less before lying down Avoid large meals/bedtime snacks Encourage weight loss (if client is overweight) What are some nursing interventions when caring for a patient with GERD? Acute/chronic gastritis This GI disorder is defined as inflammation of the gastric mucosa causing a decrease in acid production and an overabundance of mucus Suggest client avoid eating frequent meals Tell client to avoid smoking, alcohol and NSAIDS, coffee, black pepper, spicy foods & caffeine Monitor client for vitamin b12 deficiency What are some nursing interventions when caring for a client with acute/chronic gastritis? Peptic ulcer disease (PUD) this GI disorder is characterized by an erosion of the mucosal layer of the stomach or duodenum, caused by H. pylori infection or chronic NSAID use Lactose intolerance This GI disorder is defined as an inadequate supply of lactase in the intestine Encourage client to avoid foods high in lactose (milk, cheese, ice cream, chocolate etc) Recommend a lactase enzyme Monitor client for vitamin D and calcium deficiency What are nursing interventions for clients with lactose intolerance? Illeostomies and colostomies Defined as a surgically created opening on the surface of the abdomen from either the end of the small intestine (ileostomy) or from the colon (colostomy) Fluid and electrolyte maintenance What is the primary concern for clients who have illeostomy/colostomy? Diverticulitis This GI disorder is defined as inflammation that occurs when fecal matter becomes trapped in the diverticula Diverticulosis This GI disorder is defined as a condition characterized by the presence of diverticula Crohn's disease and ulcerative colitis What are two examples of chronic inflammatory bowel disease? Cholecystitis This GI disorder is characterized by inflammation of the gallbladder Pancreatitis This GI disorder is defined as inflammation of the pancreas Celiac disease This GI disorder is also known as gluten-sensitive enteropathy (GSE) and is a chronic, inherited disorder with autoimmune characteristics Acute glomerulonephritis (AGN) This renal disorder is defined as inflamed glomeruli, which impairs the kidneys to filter the urine properly Proteinuria or hematuria Elevated BUN & Creatinine Positive ASO titer What are some clinical findings shown for a diagnosis of acute glomerulonephritis to be made? Monitor I&O Weight patient daily Monitor all vital signs Monitor neurologic status and observe for behavior changes Encourage adequate nutritional intake Monitor skin for breakdown What are some nursing responsibilities when caring for a patient with acute glomerulonephritis? Diuretics and antihypertensives - will remove accumulated fluid and manage hypertension What medications are prescribed for patients with acute glomerulonephritis? Nephrotic syndrome This renal disorder is defined as alterations in the glomerular membrane to allow proteins (especially albumin) to pass into the urine, resulting in decreased serum osmotic pressure Hypoalbuminemia - reduced albumin due to the molecules readily passing through into urine (poor filtration by kidneys) Hyperlipidemia Hemoconcentration - elevated Hbg, Hct and platelets Hyponatremia - reduced Na GFR- will be normal or high What are some lab values consistent with a nephrotic syndrome diagnosis? Provide rest Monitor I&O - Monitor urine for protein Monitor vitals continuously Weigh child daily Prevent infection Assess skin for breakdown What are some nursing responsibilities when caring for a patient with nephrotic syndrome? Prednisone (Corticosteroid) Lasix - Loop diuretic 25% albumin What medications would be prescribed to treat nephrotic syndrome? The child's cognitive, emotional and physical development For children, what does pain assessment depend on? FLACC - pain rated on scale of 0-10 based on nursing assessment What is the pain scale used for children 2-7 months of age? FACES - pain rated on a scale of 0-5 using a diaphragm of 6 faces What is the pain scale used for children 3 years and older? Oucher - pain rated on a scale of 0-5 using 6 photographs What is the pain scale used for children 3-13 years old? Numeric - pain rated on a scale from 0-10 What is the pain scale used for children 5 years and older?