Correct Answer: B.
1/2 cup cooked pinto beans
The nurse should recommend foods high in fiber for a child who has chronic constipation. A half cup of cooked pinto beans contains approximately 5 g of fiber. Therefore, the nurse should instruct the guardian to include this food in the child’s diet.
Incorrect Answers: A. A half cup of whole milk contains no fiber.
C. One cup of green leaf lettuce contains no fiber.
D. One cup of apple juice contains no fiber.
A nurse in an emergency department is assisting with the care of a 4-year-old child who ingested toilet bowl cleaner. The child has hemoptysis, is crying, and states, “It burns.” Which of the following actions should the nurse perform? (Select all that apply.)
A. Identify how much cleaner was in the bottle
B. Administer activated charcoal
C. Perform immediate gastric lavage
D. Insert an IV for morphine administration
E. Apply a pulse oximeter
Correct Answers: A.
Identify how much cleaner was in the bottle
D.
Insert an IV for morphine administration
E.
Apply a pulse oximeter
The nurse should ask the parent or guardian about the size of the container, its contents prior to ingestion, and its contents remaining following ingestion. This information provides an estimate of the amount of cleaner the child ingested and can assist the provider in directing treatment. A child who ingests a corrosive agent is likely to have intense pain due to burns in the gastrointestinal system. The nurse should administer morphine as prescribed via IV to provide pain relief. The child is also at risk for airway occlusion due to edema following ingestion of a corrosive agent. Monitoring the child’s oxygen saturation level will help the nurse recognize if the child’s airway is becoming obscured.
Incorrect Answers: B. Activated charcoal is contraindicated for the treatment of poisoning with a corrosive agent because these substances can burn tissue, which the charcoal could then infiltrate.
C. Gastric lavage is contraindicated for the treatment of poisoning with a corrosive agent because this could re-expose the upper gastrointestinal system to the corrosive substance, which can result in further injury.
A nurse is assessing the visual acuity of a group of school-aged children. Which of the following actions should the nurse take?
A. Position each child with their heels at a line that is 6 m (20 ft) away from the Snellen chart
B. Allow each child to wear his or her glasses during the exam
C. Start the screening by covering each child’s right eye
D. Begin by having each child read the largest line of letters at the top of the Snellen chart
Correct Answer: B.
Allow each child to wear his or her glasses during the exam
The nurse should allow each child to wear his or her glasses during a screening for visual acuity.
Incorrect Answers:A. The nurse should position each child so that the heels are at a line that is 3 m (10 ft) away from the Snellen chart.
C. The nurse should start the screening by testing each child’s right eye first.
D. The nurse should start the screening by having each child read the 20/20 line of letters on the chart. If they are unable to do so, the nurse should move up to the next larger line of letters on the chart until the child can read at least 4 out of 6 letters correctly.
A nurse in the emergency department is caring for a 12-year-old child who has ingested bleach. Which of the following statements by the nurse indicates an understanding of this ingestion?
A. “The absence of oral burns excludes the possibility of esophageal burns.”
B. “Treatment focuses on neutralization of the chemical.”
C. “Injury by a corrosive liquid is more extensive than by a corrosive solid.”
D. “Immediate administration of activated charcoal is warranted.”
Correct Answer: C.
“Injury by a corrosive liquid is more extensive than by a corrosive solid.”
The coating action of liquids permits larger areas of contact with tissues and results in more extensive injury.
Incorrect Answers:A. The absence of oral or pharyngeal burns does not eliminate the possibility of esophageal burns. The existence and extent of burns depend on the substance and the length of time it has been in contact with tissues. A burn may be present in the esophagus but not in the mouth.
B. Neutralization can result in heat injury to tissues due to an exothermic reaction. This might cause both chemical and thermal burns of tissues.
D. Activated charcoal is not administered to an adolescent who has ingested a corrosive substance because it can infiltrate any tissue that is burned.
A nurse is creating a plan of care for a preschooler who was admitted for the treatment of measles. Which of the following activities should the nurse include in the client’s care plan?
A. Constructing a model airplane
B. Playing a video game in the playroom
C. Pulling a wagon with toys in the hallway
D. Putting together a puzzle with large pieces
Correct Answer: D.
Putting together a puzzle with large pieces
The nurse should recommend putting together a puzzle with large pieces for a hospitalized preschooler. Other recommended activities for preschoolers on airborne precautions include playing pretend and dress up, painting, and looking at illustrated books.
Incorrect Answers:A. Constructing a model airplane is advanced for a preschooler’s fine motor skills. However, preschoolers do not have the skills or the attention span to build models. This activity is appropriate for a school-age child.
B. A preschooler who has the measles is on airborne precautions and should not be in the playroom, as this would expose other children to the disease. The particles can be dispersed widely throughout the air and could be inhaled by another child in the playroom.
C. A preschooler who has the measles is on airborne precautions and should not be outside of the hospital room. Pulling a wagon in the hallway would likely spread this disease by dispersing particles containing infectious agents to other children who are either in the hallway or have their room doors open.
A nurse is planning to implement relaxation strategies with a young child prior to a painful procedure. Which of the following actions should the nurse take?
A. Ask the child to hold a breath and blow it out slowly
B. Ask the child to describe a pleasurable event
C. Bounce the child gently while holding him upright
D. Rock the child using long, rhythmic movements
Correct Answer: D.
Rock the child using long, rhythmic movements
The nurse can implement relaxation strategies by sitting with the child in a well-supported position such as against the chest and rocking or swaying back and forth in long, wide movements.
Incorrect Answers:A. This is an example of a distraction strategy.
B. This is an example of guided imagery.
C. Evidence-based practice indicates that bouncing is not an appropriate action.
A nurse on a pediatric oncology unit is helping the parents of a child who is terminally ill to prepare for the impending loss of their child. Which of the following statements should the nurse make?
A. “The nursing staff will bathe your child and take care of his daily needs.”
B. “Your child will be most comfortable in a low-stimulation environment.”
C. “Would you like assistance in planning where your child will die?”
D. “Would you like hospice to continue providing curative care in your home?”
Correct Answer: C.
“Would you like assistance in planning where your child will die?”
The nurse should inform the parents that they can choose to keep the child in a hospital setting or take the child home to die. The nurse should be aware that active participation in planning for the location of the child’s death promotes positive bereavement outcomes. The nurse should provide assistance to the parents in making and implementing this plan.
Incorrect Answers:A. The nurse should ask the parents if they would like to participate in providing care for their child. Active participation in the child’s care promotes positive bereavement outcomes.
B. The nurse should support the parents’ and child’s decisions and should allow the parents to participate in activities of their choosing (e.g. having multiple visitors, playing games, and going on family outings). If the child and parents choose a low-stimulation environment, then the nurse should ensure it is provided.
D. The nurse should discuss the option of hospice care with the parents; however, the nurse should inform the parents that hospice care will provide palliative rather than curative care.
A nurse is caring for a child who has a possible intussusception. The parents of the child ask the nurse how the diagnosis is determined. Which of the following responses should the nurse make?
A. “An abdominal ultrasound will confirm the pocket in the intestine.”
B. “Genotyping will be done to identify this condition.”
C. “A biopsy will be done on a small amount of tissue from the colon.”
D. “An upper GI series should identify the area involved.”
Correct Answer: A.
“An abdominal ultrasound will confirm the pocket in the intestine.”
Intussusception is the invasion of a part of the intestine into another, creating a pocket. The presence of an intussusception is confirmed by an abdominal X-ray, ultrasound, or CT scan.
Incorrect Answers:B. Genotyping is performed to determine a child’s gene composition and is used for hereditary disease identification.
C. A biopsy is done to identify a defect of nerve innervation in the colon and is used for the diagnosis of Hirschsprung’s disease.
D. An upper gastrointestinal series focuses on an area that is too high to allow visualization of an intussusception and is used for the diagnosis of pyloric stenosis.
Correct Answer: C.
FACES pain rating scale
The FACES scale includes various faces, which represent various levels of pain. A 3-year-old child is able to identify faces that represent different pain levels.
Incorrect Answers:A. A word graphic rating scale uses a line with words identifying a scale of no pain to the worst possible pain. Children ages 4 to 17 place a line on the scale that describes their pain. Children who are 3 years old will have difficulty understanding this scale.
B. The color tool uses 4 markers for the child to represent pain at various levels. Children ages 4 and older can use this tool. Children who are 3 years old might have difficulty remembering what each marker represents.
D. Using a numeric scale from 0 to 10 to rate pain requires the child to understand numbers. This tool is helpful for children ages 5 and older.
Toddlers demonstrate parallel play.
Incorrect Answers:A. Infants demonstrate solitary play.
C. Preschoolers demonstrate associative play.
D. School-age children demonstrate cooperative play.
A nurse is assessing a 6-month-old infant who had a cardiac catheterization with right femoral entry to diagnose a possible congenital heart defect. Which of the following findings should the nurse report to the provider?
A. Cool toes on the right foot
B. Weak pedal pulses on both feet
C. Positive Babinski reflex on both feet
D. Erythema on the right foot
Correct Answer: A.
Cool toes on the right foot
The nurse should monitor the temperature of the infant’s right extremity and should report any indication of coolness distal to the entry site to the provider because this can indicate an obstruction of an artery.
Incorrect Answers:B. The nurse should monitor the infant’s pedal pulses for bilateral symmetry and equal strength. The nurse should expect the pedal pulse distal to the entry site to be weak after the procedure; however, it should gradually increase in strength.
C. The nurse should expect infants to have a positive Babinski reflex until about 12 months of age.
D. The nurse should monitor the color of the infant’s right extremity and should report any indication of pallor or blanching to the provider because this can indicate an obstruction of an artery.
A nurse is teaching to a group of parents of adolescents about developmental needs. Which of the following statements by a parent should the nurse investigate further?
A. “My child has frequent mood swings.”
B. “My child has a very messy bedroom.”
C. “My child takes 1 to 2 showers per day.”
D. “My child spends 4 hours per day using online chat rooms.”
Correct Answer: D.
“My child spends 4 hours per day using online chat rooms.”
Adolescents may spend time using a computer, but parents should know what they are doing and who they are communicating with and limit the time. The American Academy of Pediatrics guidelines recommends 2 hours of screen time daily.
Incorrect Answers:A. Adolescents strive for independence and have frequent mood changes.
B. Many adolescents assert their independence by controlling what they can. Their environment is an area where they feel they can assert control.
C. Adolescents are very preoccupied with body image and how they appear to others. Therefore, they may shower more than once daily to maintain their self-appearance.
A nurse is providing teaching to the guardian of a child who has Kawasaki disease. Which of the following statements by the guardian indicates an understanding of the teaching? (Select all that apply.)
A. “My child will likely be irritable for the next few weeks.”
B. “I will notify my child’s doctor if the skin on her hands or feet begins to peel.”
C. “I will ensure my child does not receive any live vaccines for at least 18 months.”
D. “I will keep a record of my child’s temperature until she has no fever for several days.”
E. “My child will have joint stiffness primarily at the end of the day.”
Correct Answers: A.
“My child will likely be irritable for the next few weeks.”
C.
“I will ensure my child does not receive any live vaccines for at least 18 months.”
D.
“I will keep a record of my child’s temperature until she has no fever for several days.”
A child who is diagnosed with Kawasaki disease will likely be irritable for up to 2 months. A child who has Kawasaki disease receives high doses of gamma globulin during the initial phase, which might result in the inability to produce adequate antibodies in response to a live vaccine; therefore, these vaccines should be delayed for 11 months. Also, the temperature of this child who has Kawasaki disease should be recorded until she has been afebrile for several days.
Incorrect Answers:B. Peeling of the skin of the hands and feet is expected for a child who has Kawasaki disease. The peeling does not cause any pain and usually occurs between the second and third week. There is no need to report this manifestation to the child’s provider.
E. A child who has Kawasaki disease will likely have joint stiffness and arthritis-related symptoms for several weeks. The joint stiffness is typically worse during cold weather and in the morning.
A nurse is creating a plan of care for a 6-month-old infant who requires continuous pulse oximetry monitoring. Which of the following interventions should the nurse include?
A. Reposition the sensor to a new site once every 24 hr
B. Secure the oximetry sensor to the infant’s wrist
C. Apply conduction gel to the skin before attaching the sensor
D. Cover the oximetry sensor with clothing
Correct Answer: D.
Cover the oximetry sensor with clothing
The nurse should cover the sensor with clothing to prevent outside light from causing an altered or false reading.
Incorrect Answers:A. The nurse should move the sensor to a new site every 4 to 8 hours. The pulse oximetry sensor should not remain in a single location for an extended period of time because of the risk of tissue necrosis.
B. The pulse oximetry sensor should be placed around the infant’s hand or foot to obtain an accurate reading.
C. The pulse oximeter uses a sensor to measure oxygen in the infant’s hemoglobin. Conduction gel would interfere with the reading because it would not allow the sensor to attach to the skin.
Correct Answer: A.
Dark urine
Dark urine can be an indication of myoglobinuria. It results from the elimination of waste products from muscle damage and can cause renal failure.
Incorrect Answers:B. Radial pulses of +2 are within the expected reference range. They are a reflection of circulatory status, not burn complications.
C. A respiratory rate of 20/min is within the expected reference range. It reflects respiratory status, not burn complications.
D. Electrical injuries can cause major, full-thickness burns that destroy the nerve endings in the skin, thus reducing the amount of pain the client feels.
A nurse is preparing to assess a 3-month-old infant during a well-child visit. Which of the following observations should the nurse expect?
A. The infant looks at his hands
B. The infant has a pincer grasp
C. The infant has no head lag when pulled to a sitting position
D. The infant can independently roll from his back to his abdomen
Correct Answer: A.
The infant looks at his hands
Infants usually start to look at their hands while lying down or sitting between 12 to 20 weeks of age. Convergence on near objects is usually well established by 3 months of age.
Incorrect Answers:B. By 3 months of age, infants’ hands should be mostly open, and they usually hold onto objects placed into their hands. Voluntary grasping of objects does not usually occur until 5 months of age. A crude pincer grasp usually develops by 8 to 9 months of age.
C. Infants usually have a partial to slight head lag when pulled to a sitting position at 3 months. By 4 to 6 months, infants gain full head control.
D. While some infants might independently roll from their back to their abdomen earlier than expected, a nurse would not expect an infant to be able to do this until 6 months of age.
A nurse is teaching the guardian of a preschooler. The guardian states that the preschooler has had an imaginary playmate for about 3 months. Which of the following pieces of information should the nurse give the guardian?
A. “Children commonly begin having imaginary friends when they reach school age.”
B. “Notify your provider if the imaginary friend persists longer than 6 months.”
C. “Have your child take responsibility for actions if he tries to blame the imaginary friend.”
D. “Set limits by not allowing your child to have the imaginary friend present during family meals.”
Correct Answer: C.
“Have your child take responsibility for actions if he tries to blame the imaginary friend.”
The nurse should inform the guardian that imaginary playmates are common during the preschool years due to the high level of imagination among this age group. Although having an imaginary friend is considered healthy, the preschooler might try to use this imaginary friend as a means of avoiding responsibility or punishment for unacceptable behavior. The nurse should inform the guardian of the need to have the preschooler take responsibility for his actions.
Incorrect Answers:A. Imaginary playmates are common during the preschool years due to the high level of imagination among this age group.
B. Imaginary playmates are common during the preschool years and are not a cause for concern as long as the preschooler also socializes with other children.
D. The nurse should instruct the guardian that this behavior is expected and that pretending with the preschooler is okay.
Correct Answer: A.
Fastening buttons on a shirt
The nurse should expect a 4-year-old child to have the fine motor ability to fasten buttons on a shirt; however, the child may have difficulty if the buttons are small.
Incorrect Answers:B. The nurse should expect a 4-year-old child to have the fine motor ability to lace shoes; however, tying shoelaces is a fine motor skill expected of a 5-year-old child.
C. The nurse should expect a 7-year-old child to have the fine motor ability to part and comb his/her hair without the need of assistance.
D. The nurse should expect a 7-year-old child to have the fine motor ability to cut tender pieces of meat with a table knife.
A nurse is providing teaching to a 12-year-old client who is recovering from an acute episode of hemophilia A. Which of the following statements should the nurse include in the teaching?
A. “Have your parent stretch and move your legs for you.”
B. “Apply heat to joints that become painful, stiff, and swollen.”
C. “Take aspirin at the first sign of a headache.”
D. “You will be able to participate in physical exercises.”
Correct Answer: D.
“You will be able to participate in physical exercises.”
Physical exercise is important for the maintenance of joint mobility and muscle strengthening. Participation in non-contact sports and the use of protective equipment such as knee pads are encouraged, although high-impact athletic activities such as karate should be avoided.
Incorrect Answers:A. Passive range-of-motion exercises are not done after a bleeding episode because rebleeding can occur. Active motion is best to allow activity to be tailored to the child’s pain level.
B. A manifestation of hemophilia A is hemarthrosis (bleeding into a joint capsule). This can result in numbness, tingling, or pain, along with discoloration, warmth, and swelling of the affected joint. The nurse should instruct the child to rest the joint, elevate it above the level of the heart, and apply ice to decrease the rate of bleeding into the joint capsule.
C. Intracranial hemorrhage is a leading cause of death in clients who have hemophilia A. The nurse should instruct the child to avoid the use of aspirin because it has antiplatelet properties that can increase bleeding.
A nurse is caring for an infant who has a cleft palate. The parents ask the nurse how long they should wait before the child can have corrective surgery. The nurse should explain that the parents should wait no longer than 6 to 12 months for surgery to prevent which of the following outcomes?
A. Repeated ear infections
B. Nutritional deficits
C. Immune system deficits
D. Difficulty with language acquisition
Correct Answer: D.
Difficulty with language acquisition
Clients who have a cleft palate can have difficulty acquiring language because they need to use the palate for vocalizing sounds. Because of the cleft in the palate, these infants could develop poor speech habits.
Incorrect Answers: A. Infants who have a cleft palate are at increased risk of ear infections; however, this can persist even after the repair of the palate.
B. Infants who have a cleft palate are at increased risk for poor nutrition due to feeding difficulties. However, there are multiple strategies to teach the parents to promote nutrition and to help the infant create a seal and generate suction to feed.
C. Repair of a cleft palate does not affect the child’s immune system. However, repairing the palate too soon can affect the skeletal growth of the mid portion of the child’s face.
A nurse in a pediatric clinic is assessing a toddler at a well-child visit. Which of the following actions should the nurse take?
A. Perform the assessment in a head-to-toe sequence
B. Minimize physical contact with the child initially
C. Explain procedures using medical terminology
D. Stop the assessment if the child becomes uncooperative
Correct Answer: B.
Minimize physical contact with the child initially
The nurse should initially minimize physical contact with the toddler and progress from the least traumatic to the most traumatic procedures.
Incorrect Answers:A. The nurse should start with the least invasive interventions and proceed to the more invasive. The head-to-toe approach is recommended for preschool-age and older children.
C. The nurse should describe procedures using age-appropriate language the child can understand.
D. If the child becomes uncooperative, the nurse should perform the procedures more quickly.
Correct Answer: C.
A plastic mirror
A 4-month-old infant can recognize herself and will also attempt to play with “the baby in the mirror.” A mirror is a bright object that provides appropriate visual stimulation for this age group. For the infant’s safety, however, the mirror must be unbreakable.
Incorrect Answers:A. This would be an appropriate choice for a 6- to 12-month-old infant. A 4-month-old infant cannot understand the pictures on a board book or hold the book by herself.
B. This would be an appropriate choice for a 6- to 12-month-old infant. A 4-month-old infant would not be able to manipulate the toy’s movable parts.
D. This is an appropriate toy for a 9- to 12-month-old infant. A 4-month-old infant would not be able to perform the actions of pushing and pulling the toy.
A nurse is preparing to obtain an antistreptolysin O (ASO) titer from a child who has acute glomerulonephritis. The child’s parent asks the nurse to explain the purpose of the test. Which of the following responses should the nurse provide?
A. “The test determines the level of antibiotics in your child’s blood.”
B. “The test tells us if your child ever had measles.”
C. “The test verifies the amount of albumin in your child’s blood.”
D. “The test shows us if your child had a recent strep infection.”
Correct Answer: D.
“The test shows us if your child had a recent strep infection.”
An ASO titer indicates the child had a recent strep infection. When determining a definitive diagnosis for acute glomerulonephritis, this must be documented because the condition is usually the result of this type of infection.
Incorrect Answers:A. A therapeutic blood level indicates a medication (e.g. an antibiotic) is effective.
B. A rubella titer indicates the presence of measles.
C. A serum albumin level is monitored in a child who has nephrotic syndrome.
A nurse is providing teaching to the parent of a 2-year-old toddler about nutrition. Which of the following statements by the parent indicates an understanding of the teaching?
A. “My child should consume 1,000 calories per day.”
B. “My child should have 4 oz of protein per day.”
C. “I should give my child 32 oz (4 cups) of milk per day.”
D. “I should feed my child 4 oz (1/2 cup) of vegetables per day.”
Correct Answer: A.
“My child should consume 1,000 calories per day.”
Toddlers who are 2 years old should consume 1,000 calories daily.
Incorrect Answers:B. Toddlers who are 2 years old should have 2 oz of protein daily.
C. Toddlers who are 2 years old should have no more than 24 oz (3 cups) of milk per day.
D. Toddlers who are 2 years old should consume 8 oz (1 cup) of vegetables per day.
Correct Answer: B.
RBCs 2.5 million/uL
An RBC count of 2.5 million/uL is below the expected reference range. A child who has acute lymphocytic leukemia has a low RBC count.
Incorrect Answers:A. A platelet count of 500,000 mm^3 is above the expected reference range. A child who has acute lymphocytic leukemia has a low platelet count.
C. A WBC count of 4,000/mm^3 is below the expected reference range. A child who has acute lymphocytic leukemia has a very high WBC count.
D. An Hct level of 60% is above the expected reference range. A child who has acute lymphocytic leukemia has a low Hct level.
A nurse is assessing a 9-month-old infant. Which of the following findings should the nurse report to the provider as a possible developmental delay?
A. Grasping a small object with just the thumb and index finger
B. Dropping a cube when passing from 1 hand to the other
C. Falling from a standing position to sitting
D. Losing balance when leaning sideways while sitting
Correct Answer: B.
Dropping a cube when passing from 1 hand to the other
The ability to pass a cube from a hand to the other is a fine motor skill expected of a 7-month-old infant. Therefore, the nurse should identify the 9-month-old infant’s inability to perform this task as a possible developmental delay and should report this finding to the provider.
Incorrect Answers:A. The pincer grasp is an expected fine motor skill for a 9-month-old infant.
C. Falling down to a sitting position from a standing position is an expected gross motor skill for a 9-month-old infant.
D. A 9-month-old infant should have the gross motor ability to maintain balance while leaning forward in a sitting position; however, the infant does not yet have the ability to maintain balance while leaning sideways.
A 9-month old infant should be able to bear weight on legs with support, sit with help, babble (“mama”, “baba”, “dada”), play games involving back-and-forth play, respond to own name, recognize familiar people, look where you point, and transfer toys from one hand to the other.
A nurse is teaching the parents of a toddler who has enterobiasis about managing this parasitic disease. Which of the following pieces of information should the nurse include in the teaching?
A. “You should encourage your child to take a tub bath daily.”
B. “You should keep your child’s fingernails trimmed short.”
C. “You should dress your child in a 2-piece outfit at bedtime.”
D. “You should expect your child not to have a recurrence of the parasitic disease.”
Correct Answer: B.
“You should keep your child’s fingernails trimmed short.”
The nurse should instruct the parents to keep their child’s fingernails trimmed short to minimize the collection of ova under the nails.
Incorrect Answers:A. The parents should encourage the toddler to take a shower instead of a tub bath.
C. The parents should dress the child in a 1-piece sleeping outfit.
D. Recurrence is common, and the disease should be managed and treated as it was previously.
What is a dictorial or authoritarian parenting style?
parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations
What is an authoriatitive parenting style?
also known as democratic, parents direct the child’s behavior by setting rules and explaining the reson for each rule setting
What is passive parenting?
parents are uninvolved, indifferent, and emotionally removed
A nurse manager on a pediatric floor is preparing an education program on working with families for a group of newly hired nurses. Which of the following should the nurse include when discussing the developmental theory?
A. describes that stress is inevitable
B. emphasizes that change with one member affects the entire family
C. provides guidance to assist families adapting to stress
D. Defines consistencies in how families change
D
A nurse is assisting a group of parents of adolescents to develop skills that will improve communication. The nurse heads one parent states “my son knows he better do what I say”. Which of the parenting styles is he exhibiting?
A. Authoritarian
B. Permissive
C. Authroitative
D. Passive
A
A nurse is performimg family assessment. Which of the following should the nurse include? (select all that apply)
A. medical history
B. parents’ education level
C. child’s physical growth
D. Support systems
E. Stressors
A, B, D, E
What is the expected pulse rate of a newborn?
80 to 180/min
What is the expected pulse of a baby 1 week to 3 months?
12 to 180/min
What is the expected pulse of a child 3 months to 2 years?
70 to 150/min
What is the expected pulse of a child 2 to 10 years?
60 to 110/min
What is the expected pulse of a child 10 years and older?
50 to 90/min
What are the expected respirations fo a newborn to one year?
30 to 35/min
What are the expected respirations of a 1 to 2 year old?
25 to 30/min
What are the expected respirations of a 2 to 6 year old?
21 to 25/min
What are the expected respirations of a child 6 to 12 years old?
19 to 21/min
What are the expected respirations of a 12 year old and older?
16 to 19/min
What are the normal vitals of an infant?
HR: 80-180
RR: 30-35
BP: 65-80/40-50
Fontanels
should be flat and soft, posterior closes between 6 and 8 weeks, anterior closes between 12 and 18 months
Teeth
6 to 8 teeth by 1 year of age, 20 baby teeth and 32 permanent teeth
How long is the Moro reflex present?
until 4 months of age
How long is the Tonic neck reflex present?
until 3 to 4 months of age
How long does the Babinski reflex last?
usually until a year
Expected findings of the olfactory (I) nerve in infants , children, and adolescents
Infants: difficult to test
Children and Adolescents: indentifies smell through each nostril individually
Expected findings of optic nerve (II)?
Infants: looks at face and tracks with eyes
Children and adolescents: has intact visual acuity, peripheral vision, and color vision
Expected findings for trigeminal nerve?
infants: has rooting and sucking relfex
children and adolescents: is able to clencg teeth together and can detect touch on face with eyes closed
A nurse is preparing to assess a preschool-age child. Which of the following is an appripirate action by the nurse to prepare the child?
A. Allow the child to role play using miniature equipment
B. use medical terminology to describe what will happen
C. separate th child from her parents during examination
D. keep medical equipment visible to the child
A
A nurse is checking the vital signs of a 3-year-old during a well child visit, which of the following findings should the nurse report to the provider?
A. temperature 37.2C (99.0F)
B. Heart rate of 106/min
C. Respirations 30/min
D. Blood pressure 88/54 mmHg
C
A nurse is assessing a child’s ears. Which of the following is an expected finding?
A. Light reflex is located at the 2 o clock position
B. Tympanic membrane is red in color
C. bone landmarks are not visible
D. Cerumen is present bilaterally
D
A nurse is assessing a 6-month-old infant. Which of the following reflexes shoudl the infant exhibit?
A. Moro
B. Plantar grasp
C. Stepping
D. Tonic necl
B
A nurse is performing a neurological assessment on an adolescent. Which of the following is an appropriate reaction by the adolescent when the nurse checks the trigeminal cranial nerve? (select all that apply)
A. clencing the teeth together tightly
B. recognizing a sour tast
C. identifying smells through each nostril
D. detecing facial touches when eyes closed
E. Looking down and in with the eyes
A, D
What happens to a baby’s birth weight?
it should double by 6 months and triple by 1 year
How do infants grow?
1 inch per month (2.5cm) for 6 months, then by 12 months, height/length should be doubled
When do the first teeth arupt?
between 6 and 10 months
Gross and fine motor by 3 months
only have slight head lag
Gross and fine motor by 4 months
should be able to roll from back to side
Gross and fine motor by 5 months
should be able to roll from front to back
Gross and fine motor by 6 months
should be able to roll from back to fron and hold a bottle
Gross and fine motor by 7 months
move object from hand to hand
Gross and fine motor by 8 months
sit unsupported
Gross and fine motor by 9 months
crude pincer grasp
Gross and fine motor by 10 months
prone to sitting positiion and grasp a ratty by the handle
Gross and fine motor by 11 months
puts objects into a container and have a neater pincer grasp
Gross and fine motor by 12 months
tries to build a 2 block tower and won’t succeed
What Piaget congitive development stafe are infants in?
Sensorimotor stage, birth to 24 months, separation, object permanence around 9 months, mental representation
How many words should the infant know?
3-5 words and has concept of numbers by 1 year
What is the Erikson’s stage of development for infants?
Trust vs. Mistrust, birth to 1 year, caretake meeteing the needs of the infant
When does separation anxiety begin to occur?
between 4 and 8 months
When is there stranger fear in infants?
6 to 8 months
What toys should be used for an infant?
rattles, blocks, brightly colored toys, mirrors, patty cake
Infant Immunizations
Birth: hep B
2 months: hep B, IPV, RV, PCV, dtap, HIB
4 months: all of the 2m, hep B
6 month: all the previous
Flu shots: 6m to 1 year
Infant Nutrition
breast milk first 6 months, solids 4 to 6 months and first solid is usually iron fortified rice ceral, no juice or water is needed for first year, foods introduced one at a time over 4-7 day period to monitor for allergies
What are infant safety concers?
choking/aspiration (grapes, coins, candy)
burns (sunscnreen, handles turned away from stove, electrical outlets are covered), drowning, rear facing care seat until 2 years, crib slats are no more than 6cm, no pillows, and sleep on back
A nurse is assessing a 12 months old infant during a well-child visit. Which of the following findings should the nurse report to the provider?
A. closed anterior fontanel
B. eruption of 6 teeth
C. Birth weight doubled
D. Birth length increased by 50 %
C
A nurse is performing a developmental screening of a 10-month old infant. Which of the following fine motor skills should the nurse expect to find? (select all that apply)
A. grasp a raddle by the handle
B. try building a two-block tower
C. use a crude pincer grasp
D. Place objects into a container
E. Walkes with one hand held
A, C
A nurse is conducting a well-baby visit with a 4 motnh old infant. Which of the following immunizations should the nurse plan to administer? (select all that apply)
A. MMR
B. IPV
C. PCV
D. varicella
E. RV
B, C, E
A nurse is providing education about introducing new foods to the parents of a 4 months old infant. The nurse should recommend that the parents introduce which of the following foods first?
A. Strained yellow vegetables
B. Iron fortified cereals
C. Pureed foods
D. Whole Milk
B
A nurse is providing teaching about dental care and teething to the parent of a 9-month-old. Which of the following statements by the parent indicates an understanding of the teaching?
A. I can give my baby a warm teething ring to relieve discomfort
B. I should clean my baby’s teeth which a cool, wet washcloth
C. I can give Advil for up to 5 days while my baby is teething
D. I should place diluted juice in the bottle my baby drinks while falling asleep
B
Weight gain of todder
4x their birth weight by 30 months
Height gain of toddler
3 inches per year (7.5cm)
Head and chest growth of toddler
head and chest circumference are abotu equal, compared to when they are born, and their head is wider than their chest
gross and fine motor skills of a 15-month toddler
expect walking without help, should be able to build a 2 block tower
gross and fine motor skills of 18-month toddler
can throw a ball over head
gross and fine motor skills of 2 year old toddler
can walk up and down stairs by placing feet on each step and build a 6-7 block tower
gross and fine motor skills of 2.5 year old toddler
can jump with both feet and draw circles
Language of a toddler
1 year = 1 word senteces/hollow phrases
2 year = 2-3 word senteces
Erikson’s stage of Toddlers
autonomy vs shame and doubt, independence, begin to express selves by saying no a lot, thrive on rituals, maintian routines
Toddler appropirate activities
blocks, push pull, thick crayons, puzzle
Bathroom needs of toddlers
toilet training begins when they have recognized the sensation that they need to go potty
Immunizations of a toddler
12-15 month: IPV, PCV, MMR, varicells, HIB
12-23 months: Hep A 2 doses 6 months apart
15-18months: dtap and annual flu
Nutrition of a toddler
breast milk or formula through 1 year, 1-2 year whole milk, after 2 can transition to low fat, limit juice consumption to 4-6oz per day, prevent choking, nuts, grapes, hot dogs, peanut butter, raw carrots, tough meat, popcorn
What are safety hazards of toddlers?
burns, drowning, falls, aspiration, prevention
A nurse is assessing a 2.5-year-old toddler at a well-child visit. Which of the following findings should the nurse report to the provider?
A. height increased by 7.5cm or 3inches in the past year
B. Head circumference exceeds chest circumference
C. anterior and posterior fontanels are closed
D. current weight equals four times the birth weight
B
A nurse is performing a develomental screening on an 18 month old. Which of the following skills should the toddler be able to perform? (select all that apply)
A. build a tower with 6 blocks
B. Throw a ball overhead
C. walk up and down stais
D. draw circles
E. use a spoon without rotation
B, E
A nurse is providing teaching about age-appropriate activities to the parent of a 2 year old. Which of the following statemetns by the parent indicates an understanding of the teaching?
A. I will send my child’s favorite studdef animal when she will be napping away from home
B. My child should be able tot stand on one foot for a second
C. The soccer team my child will be playing on starts next week
D. I should expect my child to be able to draw circles
A
A nurse is providing anticipatory guidance to the parents of a toddler. Which of the following should the nurse include? (select all that apply)
A. Develop food habits that will prevent dental caries
B. Metting caloric needs resulting in an increased appetite
C. expression of bedtime fears is common
D. Expect behaviors associated with negativism and ritualism
E. Annual screenings for phenylketonuria are important
A, C, D
Growth of preeschoolers
4.5-6.5 pounds per year
2.3-3.5 inches per year or 6-9cm
Gross motor skills of 3 year old preeschooler
can ride tricycle and jump off bottom step on stairs
Gross motor skills of 4 year old preschooler
can skip and hop on one foot and throw the ball over head
Gross motor skills of 5 year old preschooler
can jump rope
Cognitive development of the preschooler?
Piaget, preoperational phase 4-7 years, moving from preconceptual phase to the phase of intuitive thought, magical thinking, animisim, centration, time
Erikson, initiative vs guilt
Regression
in preschoolers, another baby in the family can cause the preschooler to regress to bed wetting or thumb sucking, to be expected
What are appropirate activities for a preschooler?
playing ball, puzzles, tricyles, dress up, role playing
Immunizations of preschooler
4-6 years, dtap, mmr, IPV and annual flu
What does the sleep schedule of a preschooler look like?
12 hours of sleep, bedtime routine
Teeth of preschooler
eruption of primary teeth is finalized by the beginning of the preshool years
What may be a safety initiative for preschooler?
protective gear with tricycles
A nurse is providing teaching to the parent of a preschool age shcil about methods to promote sleep. Which of the following statements by the parent indicated an understanding of the teaching?
A. I wil sleep in the bed with my child if she wakes up during the night
B. I will let my child stay up and additional 2 hours on weekend nights
C. I will et my child watch television for 30 minutes nust before bedtime each night
D. I will keep a dim lamp on in my child’s room during the night
D
A nurse is conducting a well child visit with a 5 year old child. Which immunizations shoudl the nurse plan to administer to the child? (Select all that apply)
A. DTaP
B. IPV
C. MMR
D. PCV
E. Hib
A, B, C
A nurse is preparing an education program for a group of parents of preschool-age children about promoting optimum nutrition. Which of the following information should the nurse include in the teaching?
A. saturated fats should equal 20% of total daily caloric intake
B. Average calorie intake should be 1800 calories per day
C. dailyintake of fruits and vegetables should total 2 servings
D. Healthy diets include a total of 8g of protein each day
B
A nurse is performing a developmental screening on a 3 year old child. WHich of the following skills should the nurse expect the child to perform?
A. ride a tricycle
B. Hop on one foot
C. jump rope
D. throw a ball overhead
A
A nurse is caring for a preschool age child who says she needs to leave the hospital because her doll is scared to be at home alone. Which of the following characteristics of preoperational thought is the child exhibiting?
A. Egocentrism
B. Centration
C. Animism
D. Magical thinking
C
Growth of school age children
4-6 pound weight gain per year and grown 2 inches (5cm) per year, permanent teeth start to come in
Piaget cognitive development of school age children
concrete operations, perceptual to conceptual thinking, learsn to tell time, see other perspectives, solve problems
Erikson’s stage of school age children
industry vs inferiority, trying to make meaning contributions to society and cooperative and compete with others, peer groups important, competitive and cooperative play
What types of activites are appropriate for school age children?
board games, hop scotch, bikes, jump rope, organized sports
Immunizations of school age children
11-12 years: DTaP, HPV vaccine (series of 3 shots)
How much sleep is recommended for a 12 year old?
9 hours of sleep
What is a safety measure for school age children?
helmets
A nurse is discussing prepubesence and preadolescen with a group of parents of school-age children. Which of the following information should the nurse include in the discussion?
A. initial phsyciologic changes appear during early childhood
B. changes in heigh and weight occur slowly during this period
C. growth differences between boys and girls become evident
D. signs of sexual maturation become highly visible in boys
C
A nurse is conducting a well child visit with a child who is scheduled to recive the recommended immunizations for 11 to 12 year olds. Which of the following immunizations should the nurse administer? (select all that apply)
A. TIV
B. PCV
C. MCV4
D. Tdap
E. RV
A,C, D
A nurse is teaching a course about safety during the school age years to a group of parents. Which of the following information should the nurse include in the course? (select all that apply)
A. gating stairs at the top and bottom
B. wearing helmets when riding bicyles or skateboarding
C. riding safely in bed of pickup trucks
D. implementing firearm safety
E. wearing seat belts
B, D, E
Growth in adolescents
girls stop growing 2-2.5 years after their period starts, boys stop growing abotu 18-20
Sexual maturation is adolescent girls
breast development, pubic hair growth, underarm hair, period
Sexual maturation in adolescent boys
testicular enlargement, pubic hair, penil enlargement, underarm hair growth, facial hair, vocal changes
Piaget cognitive stage of development for adolescents
formal operations
Erikson’s stage of development for adolescents
identity vs role confusion
What are appropriate activites for adolescents
video games, music, sports, pets, reading
Immunizations for adolescents
flu, 16-18 years, meningitis before college
Injury prevention for adolescents
helmet use, seat belts, driving, susbtance abuse
Safe medication administration for children
oral is preferred, smallest measuring device possible, dont mix oral meds in formula, put in side of mouth, hold cheeks, and stroke chin to swallow
Administration of ear drops
pinna down and back
IM injections
preffered route is vastus lateralis, then the ventral gluteal or in the deltoid, 22-25 guage with half inch to 1 inch needle
IV safe administration
procedure room, away from bed, EMLA cream to numb area is recommneded, avoid terms like bee stink or stick, keep stuff out of sit, parents can stay, swaddle the infant, non-nutritive sucking is offered before, during, and after to infants
A nurse is providing teaching about expected changes during puberty to a gorup of parents of early adolescent girls. Which of the following statements by one of the parents indicates and understanding of the teaching?
A. girls usually stop growning abotu 2 years after menarche
B. girsl are expected to gain about 65 pounds during puberty
C. girls experience menstartion prior to breast development
D. Girls typiucaly grow more than 10 inches during puberty
A
A nurse is providing anticipatory guidance to the parent of a 13 year odl adolescent. Which of the following screenings shoudl the nurse reccomend for the adolescent? (select all that apply)
A. body mass index
B. blood lead level
C. 24 hour dietary recall
D. Weight
E. Scoliosis
A, D, E
A nurse is caring for an adolescent whose mother expresses ocncersn about her child sleeping such long hours. Which of the following conditions shoudl the nurse inform the mother as requiring additional sleep during adolescnets?
A. sleep terrors
B. rapid growth
C. elevated zinc levels
D. slowed metabolism
B
A nurse is teaching class about puberty in boys. Which of the following should the nurse include as the first manifestation of sexual maturation?
A. pubic hair growth
B. voval changes
C. testicular enlargement
D. facial hair growth
C
A nurse is planning to administer the influenza vaccine to a toddler. Which of the following actions should the nurse take?
A. administer subq to the abdomen
B. use a 20guage needle
C. Divide the medicaiton into two injections
D. place the child in supine position
D
A nurse is preparing to administer an IM injection to a child. Which of the following muscle gorups is contraindicated?
A. Deltoid
B. ventrogluteal
C. vastus lateralus
D. dorsogluteal
D
A nurse is teaching a parent of an infant about administration of oral medications. Which of the following should the nurse include in the teaching? (select all that apply)
A. use a universal dropper for medication administration
B. as the pharamacy to add flavoringto the medication
C. add the medication to a formula bottle before feeding
D. use the nipple of a bottle to administer the medication
E. hold the infant in a semireclining position
B, D, E
A nurse is preparing to administer medication to a toddler. Which of the following actions should the nurse take? (select all that apply)
A. identiy the toddler by asking the parent
B. tell the parent to administer the medication
C. calculate the safe dosage
D. ask the toddler what toy he wants to hold during administration
E. offer juice after the medication
C, D, E
A nurse is caring for an infant who needs otic medicatioin. Which of the following is an appropirate action for the nurse to take?
A. Hold the infant in an upright position
B. pull the pinna downward and straight back
C. hyperextend the infants neck
D. ensyure that the medication is cool
B
Pediatric pain management
self report is only used for children 4 and older, FLACC scale is 2m to 7 years, pain rate ona scale of 0-10 assessing behaviors of the child
FACES: 3 years and odler
Oucher scale: 3-13
Numeric scale: 5 and older
use play therapy to epxlain procedures
ive medications to kids routinely versus prn
combining opioid and non-opioid medications
EMLA cream, apply 1 hour prior to small stick or 2.5 hours before a big stick, occlusive dressing over it
A nurse is competing a pian assessment of an infant. Which of the following pian scales should the nurse use?
A. FACES
B. FLACC
C. Oucher
D. Non-communicating childrens pain checklist
B
A nurse is planning care for achild following a surgical procedure. Which of the following interventions dhoul the nurse incldue in the plan of care?
A. administer NSAIDS for a pain grater than 7 on a scale fo 0 to 10
B. administer intranasal analgesics PRN
C. Administer IM analgesics for pain
D. administer IV analgesics on a schedule
D
A nurse is assessing an infant. Which of the following are manifestations of pain in an infant? (select all that apply)
A. Pursed lips
B. loud cry
C. lowered eybrows
D. Rigid body
E. pushes away stimulus
B,C,D
A nurse is planning care for an infant who is experincing pain. Which of the following interventions should the nurse include in the plan of care? (select all that apply)
A. offer a pacifier
B. use of guided imagery
C. use swaddling
D. initiate a behavioral contract
E. encourage kangaroo care
A,C,E
A nurse is preparing a toddler for an IV catheter insertion using atraumatic care. Which of the following actions shoudl the nurse take? (select all that apply)
A. explain the procedure using the child’s favorite toy
B. ask the paretns to leave during the procedure
C. perform the procedure with the child in his bed
D. allow the child to make on choice regarding the procedure
E. apply lidocaine and prilocaine cream to three potential insetion sites
A, D, E
Hospitalization, illness, and play for the infant
stranger anxiety 6 to 18 months
Hospitalization, illness, and play for the toddler
behavior may regress, separtion anxiety, intense reaction to procedure, parallel play
Hospitalization, illness, and play for the preschooler
magical thinking, they may think they caused an illness to happen, still experience separtion anxiety, explain the procedure in very simple clear language, give them a choise if possible (cup or spoon), associate play, paly together without much coordination
Hospitalization, illness, and play for the school age child
describe pain and increased ability to understand cause and affect, give factual info, tell the truth, encouage contact with peer groups, and express feelings, cooperative play, play in groups, more organized
Hospitalization, illness, and play in the adolescent
body image disturbance, feels isolated from peers, give factural info, tell the truth, encoruage contact with peer group, and express feelings, friends can come visit
A nurse is caring for a preschooler. Which of the following is the expected behavior of a preschool-age child?
A. Describing manifestations of illness
B. relating fears to magical thinking
C. understanding cause of illness
D. awareness of body functioning
B
A nurse on a pediatric unit is caring for a toddler. Which of the following behaviors is an effect of hospitalization? (select all that apply)
A. believes the experience is a punishment
B. experiences separtion anxiety
C. displays intense emotions
D. axhibits regressive behaviors
E. Manifests disturbance in body image
B, C, D
A nurse is teaching a parent about parallel play in children. Which of the following should the nurse include in the teaching?
A. children sit and observe others playing
B. Children exhibit organized play when in a group
C. the child plays alone
D. The child plays independently when in a group
D
A nurse is teaching a group of parents about separation anxiety. Which of the following information shoudl the nurse include in the teaching?
A. it is often observed int the school age child
B. detachment is the stage exhibited in the hospital
C. it results in prolonged issues of adaptibility
D. kicking a stranger is an example
D
anticipatory grief
when death is expected or a possible outcome
complicated grief
extends for more than 1 year following the loss
parenteral grief
intense, long lasting, and complex
sibling grief
differs from adult/parenteral; depend on age and developmental stage
Infant/toddler view of death/dying
no concpet of death
Preschoolers(3-6) view of death/dying
magical thinking, may feel guilt or shame, views dying as temporary
School age (6 to 12) view of death/dying
adult concept of death, express fear through uncooperative behavior
Adolescent (12-20) view of death and dying
adult concept of death, resul of peers vs parents, stressed out by changes in physical appearance
Physical manifestations of death
senstaion of heat when body feels cool, decreased sentation, loss of sesnes, decrease LOC, swallowing issues, bradycardia, hypotension, Cheyne stokes respirations
Nursing responsibilty after death
allow family to stay with body, rock infant/todderl, assist in post-mortem care
A nurse is caring for child who is dying. Which of the following are findings of impending death? ( select all that apply)
A. heightened sense of hearing
B. tachycardia
C. difficulty swallowing
D. sensation of being cold
E. cheyne-stokes respirations
C, E
A nurse is teaching a parent about complicated grief. Which of the following statements should the nurse make?
A. it is considred complicated gried if you are still grieving after 6 months
B. personal acitciites are affected wehn expericining complicated grief
C. parents will expeirce complicated grief together
D. complicated grief self-resolved in 12 months
B
A nurse is teaching a parent of a preeschol child about factors that affect the child’s perception of death. Which of teh following factors should the nurse include in the teaching?
A. Preschool children have no concept of death
B. Preschool children percieve death as temporary
C. preschool children often regress to an earlier stage of behavior
D. preschool children experience fear related to the disease process
B
A nurse often care for children who are dying. WHich of the following are approporate actions of rhte nurse to take to maintian professional effectivness? (select all that apply)
A. remain in contact with the family after thier loss
B. develop a professional support system
C. take time off from work
D. suggest that a hospital representative attend the funeral
E. demonstrate feelings of sympathy toward the family
B, C
A nurse is caring for a child who has a terminal illnes and revies palliative care with an assistive personel (AP). Which of the following statements by the AP indicates understanding of this review?
A. im sure the family is hopeful that the new medication will stop the illness
B. Ill miss wokring wit this client now that only nurses will be caring for him
C. I will get all the clients personal object out of his room
D. I will listen and respons as the family talks about thier child’s life
D
Meningitis
Viral often resolves with supportive care, bacterial is more dnagerous, PCV and Hib vaccine help prevent, s/s include photophobia, n/v, irritability, h/a
newborns: poor muscle tone, weak cry, refusal to eat, vomiting, diarrhea, poor sucking, possible fever or hypothermia, neck is supple without nuchal rigidity, buldging fontanels are a late sign
3m to 2years: siezures with a high pitch cry, fever and irritability, bulding fontanels, nuchal rigicity, poor feeding adn vommting
2 years to adolescents: siezures, nuchal rigicity, fever and chilld, headache, n/v, irritabiltiy, petechia, positive brudsinksi’s sign (puill head forward – extremities will also flex (bro why are you pulling on my neck)
positive kernigs signs – leg is flexed and you try to extend, it causes pain
Meningitis labs
CSF analysis through lumbar puncture, empty bladder before, EMLA cream, side lying position, after procedure remain in bed 4-8 hours in a supine position
Bacterial: cloudy, increased WBC, increased protein, decrease glucode and +gram stain
Viral: clear, slightly elevated WBC, noraml or slightly elevated protein, normal glucose, negative gram stain
Nursing managment for meningitis
it it is suspected put them into droplet precautions, decrease LOC = NPO, provide quite environment, dim the lights, siezure preautions, bacterial will need IV abx, maintian contact precautions for bacerial for 24 hours after abx treatment has started, monitori for increased ICP**
infants: bulging fintanels, increase in head circumference, high pitch cyr, bradycarida, adn respiraty changes
childre: irritability, headahce, n/v, siexures, braduycardia, adn respiratoruy changes
Reyes syndrome
liver dysfunction and cerebral edema, associated with giving hcildren aspirin for a fever, follows a viral illness like the flu, gasterentritis, or varicella, lab tests include: liver enzymes (AST/ALT increase), increased ammonia levels, liver biopsy for diagnosis, CSF analysis
s/s: lethargy, irritiabilty, confusion, deliriu, vomtimg, LOC
A nurse is caring for a client who has suspected meningitis and a decreased level of consiousness. Which fo the following actions by the nurse is appropriate?
A. place the patient on NPO status
B. prepare the client for a liver biopsy
C. position the patient in dorsal recumbent
D. put the client in a protective environment
A
A nurse is reviewing cerebrospinal fluid analysis for a client who has suspected meningitis. Which of the following findings shoudl the nurse identify as indicating viral mengingits? (select all that apply)
A. negative gram stain)
B. normal glucose content
C. Cloudy color
D. decreased WBC count
E. normal protein count
A, B, E
A nurse is caring fro a 4 month old infant who has meningitis, Which fo the following findings is associated with this diagnosis?
A. fepressed anterior fontanel
B. constipation
C. presence of rooting reflex
D. high pitched crying
D
A nurse is caring for a patient who possibly has Reye syndrome. Which of the following is a risk factor for developing reye syndrome?
A. recent hisotyr of infectious cystitis cauased by candida
B. recent hisotrial of bacterial otitis media
C. recent epidose of gastrenteritis
D. Recent episode of Haemophilus influenzae meningitis
C
A nurse is developing an inservice about viral and bacterial meningiting. The nurse shoudl include that the introduction of which of the following immunizations decreased the incidence of bacterial meningitis in children? (select all that apply)
A. IPV
B. PCV
C. Dtap
D. Hib
E TIB
B, D
Risk factors for siezures
cerebral edema, fever, trauma, bleeding, toxins in body (lead), hypoglycemia, electrolyte imbalance, infection
What are the three phases of tonic-clonic siezures
tonic- arms and legs flex up and head and neck extend; stiff, LOC
clonic- jerking movements
postical- awake and confused
absense seizure
school age childre (4-12), loss of consiousness 5-10 seconds, daydreaming look, drop whats in hands, lip smacking or twitching of face
myoclonic
no postical
seizure diagnosis
EEG to find cause, prior to EEG no caffien and wash hair
seizure medications
carbamasepine, valporic acid, phenytoin, and diazepam
Complications of siezures
status epilepticus which a a seizure lasting longer than 30 minutes, medical emergency
A nurse is caring for a child who has absence seizures. Which of the following findings should the nurse expect? (select all that apply)
A. loss of consciousness
B. appearance of daydreamimg
C. dropping held objects
D. falling to the floor
E having a piercing cry
A, B, C
A nurse is caring for a child who just experienced a generalized seizure. Which of teh following is the priority actio for the nurse to take?
A. Maintain the child in a side ying position
B. loosen the childs restricitve clothing
C. reorient the hcild to the environment
D. not the time and characteristics of the seizure
A
A nurse is providing teaching to the parent of a child who is to have an EEG. Which of the following responses hodul the nurse include in the teaching?
A. decaffieicated beverages should be offred on the morning of the procedure
B. do nto wash your child’s care the night before the procedure
C. withold all foods the morning of the procedure
D. give your child an analgesic the night before the procedure
A
A nurse ic teaching a group of parents about the risk factors for seizures. Which of the following factors shoudl the nurse include in the teaching? (select all that apply)
A. febrole episodes
B. hypoglycemia
C. sodium imbalances
D. low serum lead levels
E. presence of diphtheria
A, B, C
A nurse is reviewing treatment options with the parent of a child who has worsening seizures. Which of the following treatment options shudlt hte nurse include in the discussion? (select all that apply)
A. vagal nerv stimulator
B. additional antiepeltic medications
C. corpus callosotomy
D. focal resection
E. radiation therapy
A, B, C, D
minor head injury
confusion, vomiting, pallor, irritability or drowsiness, irritability is sually one of teh first signs of increased ICP
infant signs of head injury
buldging fontanels, high pitched cry, poor feeding, increased sleeping, reslessness, setting sun sign, distended scalp veins
children signs of head injury
nausea, vomtiing, headache, seizures, blurred vision
late signs of head injury
delayed or impaired pupillary responses, posturing, decreased response to painful stimuli, cheyne-stokes respirations, optic dis swelling, decreased in LOC
interventions for head injury
stabalize the spine first, then vital signs, GCS, keep HOB 30, maintin head in midline/neutral position, minimize oral or endotracheal suctioning, avoid coughing or blowing their nose, foley catheter, stool softeners, implemet seizre precautions
medications for head injuries
corticosteroids, mannitol (diuretic), anti-epileptics
surgical interventio for head injury
craniotomy, complications include hemorrhage, brain herniation, s/s of hernia include loss of blinking, loss of gag reflex, unreactive pupils, coma, or resp arrect
A nurse is in the emergency department assessing a child following a motor vehicle crash. The child is unresponsive, has spontaneous respirations of 22/min, adn has a laceration of the forehead that is bleeding. Whic of the following nursing actions should be first?
A. Stabalize the neck first
B. cleanse the child’s laceration with soap and water
C. implement siezure precautions for the child
D. initiate Iv access for the child
A
A nurse is caring for an adolescent who has a closed head injury. Which of the following findings are indications of increased ICP? (select all that apply)
A. report of headache
B. alteration in pupillary response
C. increase motor response
D. increased sleeping
E. increased senory response
A, B, D
A nurse is caring for a child with ICP. Which of the following actions shudl the nurse take? (select all that apply)
A. suction the endotracheal tube every 2hours
B. maintian a quiet environment
C. use two pillows to elevate the head
D. administer a stool softener
E. maintian body alignment
B, D, E
A nurse is assessing a child who has a concussion. Which of the following findings should the nurse expect. (select all that apply)
A. amnesia
B. systemic hypertension
C. bradycardia
D. respiratory depression
E. confusion
A, C, D, E
A nurse is caring for a child who is taking mannitol for cerebral edema. Which of the following adverse effects shoudl the nurse monitor the child for and report to the provider?
A. bradycardia
B. weight loss
C. confusion
E. constipation
C
snelling test
stand 10 feet away
myopia
near sightedness
hyperopia
far sightedness
strabismus
inward or outward deviation of one of the eyes, treatment is to patch the good eye
acute otitis media
middle ear infection, common under 7, their tubes are shorter and more horizontal than adults, give pain meds, abx, and if surgery is needed, tube is put in the middle ear, myringotomy, and the placement of tympanoplasty tubes, tubes will fall out on their out in 2-6 months and tel HCP when they come out, dont get thier ears wet
Desired SpO2
95-100%
Metered dose inhalers
shake 5-6 times, spacers make them more effective, hold inhaler up, whil pressing in, take a slow deep breath, and hold breath for 10 seconds before exhaling.
dry powder inhaler
don’t shake
Chest physiotherapy
schedule 1 hour before or 2 hours after a meal to prevent vomiting, give bronchiodilator or nep treatment prior
Hypoxemia
s/s include tachypnea, tachycardia, restlessness, accessory msucles, nsal flaring
O2 toxicity
leads to hypoventilation and maybe LOC
suctioning
clean technique fo nasal and oral
ET tube and trach tube suctioning
high fowlers or fowlers, catheter one half of the diamete, hyperoxygenation and hyperventilate with 100%, surgical aspetic, limit suctioning to 5 seconds for infants and 10 seconds for children, rest for 30to60 seconds in between passes
tonsilittis
fever meds, abx to cure the infection, culture to test for strep, tonsilectomy, side lying position initially, assess for bleedig, frequent swalloing and clearing of the throat, clear fluids afer hag reflex has returned, no citrus juices, no milk products, discourage coughing or nose blowing, warn parten that there may besome blood clots, limit strenious acitivty, full recovery in about 2 weeks, grow beta of strep ca laeas to kidney infection or rheumatic fever
bacterial epiglottitis
drooling, hoarseness, difficulty speaking and swallowing, and high fever, most important, do not put anything in their throat, no throat culture, or tongue balses, cause airway to lcose up, abx therapy, intubation supplies ready
influenza
fever, body aches, congestion, antiviral (usually within first 48 hours)
complications of acute and infectious respiratory illnesses
pneumothorax and pleural effusion
bronchodilators for asthma
albuterol -> s/e is tachycardia and temors
anticholinergic like ipotropirum for asthma
s/e cant see, cant see, cant pee, cant spit, and shit
steroid for asthma
prednisode, rinse mouth after steroid inhaler because they can get a fungla infection
peak flow meters
stand up, 0 out machine, lips around device, blow out hard, 3x, highest reading
complications of asthma
status asthamticus, not relived by medications, intubation
cystic fibrosis
caused by a genetic mutation, autosomal recessive, both parent shave to carry recessvie traits, iincreased thick tenacious mucous, pancrea, lings, liver, small intestines, and reporductive organs
-carrel chest, finger clubbing, large loose fatty fould smelling stools (steatorrhea), not gain weight, delayed growth, failure to thrive, deficieny of fat-soluble vitamines (ADEK), sweat and tears are salty
diagnosis of cycstic fibrosis
sweat chloride test and DNA testing
cystic fibrosis treatment
Iv abx, and o2 therapy, diet high in calories, and protein, pancreatic enzymes with thier meals to help with digestion, pancrelipase and vitamin supplements, albuterol, anticholinergics, dornase afa (decreases the viscocity of the mucous), chronic managing, prents find support groups
Congenital heart defects usually result in 2 things
hypoxemia and heart failure, s/s include tachypnea, dyspnea, tachycardia, peripheral edema, cyanosis, exercise intolerance, and polycythemia (increase in rbcs)
Increasing pulmonary blood flow defects
- ventricular septal defect (VSD) a. creates a harsh murmur that can be heard at the left sternal border 2. atrial septal defect (ASD) a. loud hard murmur; split sound 3. patent ductus arteriosus (PDA) a. creates bounding pul
Obstructive blood flow defects
- pulmonary stenosis a. systolic ejection murmur 2. aortic stenosis 3. coarctication of the aorta * a. upper body: bounding pulses and high pressure, flushed warm skin b. lower body: low pressure, faint pulses, cool skin
decreasing pulmonary blood flow defects
- tricuspid atresia a. complete closure of the tricuspid valve also have to have an ASD 2. tet of fallot * PROV a. pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy
Mixed blood flow defects
- transposition of the great arteries a. sx within first 2 weeks of life – major cyanosis 2. truncus arteriosus a. no spetum between the ventricles b. requires sx after birth 3. hypoplastic left heart syndrome
EKG, echo, cardiac catheterization
-Allergies to shellfish or iodine
-NPO 4-6 hours prior to procedure
-Both pedal pulses located
-Assess insertion site for bleeding
-Flat position 4-8 hours post-op
Nursing care of cardiovascular disorders
o Frequent rest periods; cluster care
o Small frequent meals
o Crying kept to a minimum
o Encourage semi-fowlers or fowlers
o Car seat at 45-degree angle vs flat
o Feed Q3 hours
o Enlarged opening on bottle nipple
Medications for cardiovascular disorders
o Digoxin – help improve contractility of the heart Toxicity – n/v, halo. Decreased HR and appetite o ACE (Aprils) – help provide vasodilation o Beta blockers – helps decrease HR, BP, and causes vasodilation o Lasix – K levels High potassium foods *** look in nutrition Severe hypoxemia episode knee to chest to calm them down High risk for bacterial endocarditis – abx prior to dental and surgical procedures
Rheumatic fever
Inflammation of the heart, blood vessels, and joints Caused by a strep throat infection untreated or partially treated o 2-6 weeks following Lab tests – throat culture, serum ASO titer, EKG, diagnosis based on the jones criteria (pt. needs to have 2 major criteria or 1 major and 2 minor) o Major criteria: carditis, subcutaneous nodules (non-tender), polyarthritis, rash (pink-non pruritic on the trunk and the inner surfaces of the extremities), Chorea – involuntary muscle movements o Minor: fever + pain in one joint
Kawasaki disease
Acute systemic vasculitis – inflammation of the blood vessels Acute phase o Onset of high fever that is unresponsive to meds, with development of other cm’s o Irritability, red eyes without drainage, bright red chapped lips, strawberry tongue, red oral mucosa, red palms and feet, joint pain, enlarged lymph nodes, etc, Subacute phase o Resolution of fever and gradual subsiding of other cm’s o Peeling skin Convalescent phase o No cm’s seen except abnormal labs o Resolution 6-8 weeks from onset Treatment – IV Igg ** (gamma globulin) o + aspirin o Avoid live immunizations for 11 months after the onset of the disease
Epistaxis
nose bleeding Sit upright and lean forward, pinch the nose for 10 min until bleeding stops, ice on the nose, or cotton or tissue in the nare After the bleeding stop – Vaseline in the nose to help prevent re-bleeding + recommend parent uses cool mist humidifier
Iron deficiency anemia
Poor diet, drink a lot of cow milk (low in iron) Lab work – RBC, hbg & hct low Diet in iron, protein, and vitamin C Iron supplement 1 hour before or 2 hours after milk or antacids, vitamin C, straw, IM injection use z track method, stool is expected to turn tarry green color if dose is adequate, brush teeth after Prevent overdosing of iron – locked in cabinet
Sickle cell anemia
Autosomal recessive genetic disorder HbS is produced Increased blood viscosity, obstruction of blood flow, tissue hypoxia Painful af Crisis – exacerbation African American highest risks Fam history, reports of pain, SOB, pallor, jaundice (destruction of RBC’s) Vasoclusive crisis 4-6 days painful ischemia in the tissue Treatment: fluids *** and pain control o Blood products Complications CVA and any reactions to the blood products
Hemophilia
Prolonged bleeding time due to lack of a specific factor that’s needed to clot properly A = lack of factor 8 B = lack of factor 9 Excessive bleeding, joint pain and stiffness, bruising Labs: prolonged PTT, platelets and prothrombin will be normal No rectal temps, avoid skin punctures when necessary, hold pressure 5 min, painful joints = elevate and apply ice to that area Replace the factors that are missing Minimize the risk of bleeding o RICE Complications: joint deformity
Rotavirus
- most common cause of diarrhea in kids <5 o Vaccine available o s/s: watery diarrhea, vomiting, and fever
Pin worm (Enterobius vermicularis)
- cause perianal itching o Tape test for diagnosis while sleeping
When a kid has diarrhea, you need to know what foods/drinks they should and shouldn’t have *
o Should have oral rehydration therapy drink (ORT) o Shouldn’t give fruit juices, carbonated drinks, jello, caffeine, chicken or beef broth & no BRAT diet
Dehydration
o Mild – slight thirst and capillary refill is a little longer o Moderate – cap refill between 2-4 seconds, thirst and irritability, dry mucous membranes, tears and skin turgor are decreased o Severe – cap refill >4 seconds, tachycardia, extreme thirst, mm very dry, tented skin, no tearing, sunken eyes, sunken anterior fontanel, oliguria or anuria
Cleft lip
repaired in 2-3m o Before sx: use a wide based nipple for feeding, encourage breastfeeding, squeeze cheeks together to decrease gap o After sx: back and upright, elbow restraints, ns water or diluted hydrogen peroxide to clean the suture line, antibiotic ointment if prescribed
Cleft palate
repaired in 6-1m o Before sx: upright for feeing, one-way valve bottle with specially cut nipple for feeding, burp frequently o After sx: prone position, IV fluids then clear liquid for first 24 hours, nothing in mouth that could mess up the sutures, elbow restraints
Complications of cleft
ear infections and hearing loss – seen by specialists, Speech therapists o Dental problems – teeth may not erupt normally
GERD – gastrointestinal reflex disease
Usually self resolves by 1 year of age s/s with infants – spitting up, irritability, excessive crying, blood in the vomit, arching of back, stiffening, resp. problems, FTT, apnea s/s with children – heartburn, abd pain, difficulty swallowing, chronic cough, noncardiac chest pain nursing care small frequent meals, thicken infant’s formula with rice cereal, avoid foods that can make it worse, head elevated for 30 at least 1 hour after eating o meds: PPI (omeprazole, pantoprazole); H2-receptor antagonists (famotidine or ranitidine) Sx – nissen fundoplication
Pyloric stenosis
thickening of the pyloric sphincter = obstruction Projectile vomiting, dehydration and constant hunger, olive shaped mass in the RUQ Sx – pylorotomy
Hirschsprung’s Disease
congenital aganglionic megacolon structural anomaly of the GI tract caused by lack of ganglion cells in the segments of the colon resulting in decreased motility and mechanical obstruction Ribbon like stool, vomiting bile, abd distention Risk factor infant fails to pass meconium in 24-48 hours of life Nursing interventions – high calorie, protein & low fiber diet o Surgery remove bad portion of the colon & may need a colostomy for a while
Intussusception
- proximal segment of the bowel telescopes into a more distal segment, resulting in lymphatic and venous obstruction causing edema in the area with progression, ischemia and increase mucous into the intestine will occur Common in infants and children 3m-6 years Red currant jelly stool, sausage shaped abd mass CF at risk Air enema is therapeutic procedure
Appendicitis
Avg age is around 10 years Abd pain in the RLQ, ↓ or absent bowel sounds, fever, WBC ↑and inflammatory markers Diagnosis with CT Avoid heat to the abd Fluids, abx prior to the stomach Suddenly feeling better – ruptured appendix medical emergency
Enuresis
uncontrolled or unintentional urination after the age of 5 years for at least 3m’s Primary – never had control of bladder Secondary – have been potty trained and now they are wetting their bed o Regression from stress of emotional trauma Self-esteem and coping strategies Restrict fluids in the evenings, avoid constipation, etc.
UTI’s
Frequent urination, foul smelling urine, fever, pallor, poor appetite, vomiting, increase in thirst, swelling of the face, and seizures Diagnosis – urinalysis nitrates and leukocytes elevation Educations – females wipe front to back, cotton underwear, avoid bubble baths, void more, empty bladder fully Important constipation – high fiber diet
Bladder exstrophy
the bladder/urethra/ureteral orifices are coming through the suprapubic area – medical emergency; requires immediate surgery Sterile gauze over that area and prepare for sx
Hypospadias
Urethral opening is on the underside (ventral) side of the penis No circumcision
Epispadias
Urethral opening on the upper part of the penis (dorsal) side No circumcision
Phimosis
narrowing of the opening of the foreskin can’t retract the foreskin
Cryptorchidism
undescended testes Sx at 6 and 24m’s
Hydrocele
fluid in the scrotal sac
Testicular torsion
- medical emergency Enlargement of the effected testical and severe and sudden onset of pain
Acute glomerulonephritis [AGN]
Associated with a strep infection Cloudy tea colored urine, dec urine output, periorbital edema, facial edema that’s worse in the am and then spreads down over the day, mild -severe HTN, oliguria Proteinuria and Smokey or tea colored urine, hematuria, increased specific gravity, ASO titer – for strep infection Nursing care o Restrict sodium and fluid o Edema risk for skin breakdown o Diuretics, anti-hypertensives, abx for strep infection
Nephrotic syndrome
alteration in the glomerular membrane that allows proteins [esp. albumin] to pass through to the urine resulting in decreased serum osmotic pressure Facial and periorbital edema, dec urine, frothy urine, norm BP, >2+ protein, hypoalbuminemia, hyperlipidemia, hemoconcentrion, hyponatremia maybe Daily weights – same scale, same time, same amount of clothing on everyday Monitor edema – measure abd girth @ the level of the umbilicus Restrict fluids and salt Skin breakdown Meds – steroids monitor for GI bleeding, hyperglycemia, etc o Albumin and diuretics help increase the plasma volume and decrease edema in the pt.
Fractures
Open or compound – bone is sticking out of the skin Closed or simple – bone not sticking out Complicated – organ or tissue is also damaged ABC’s + elevated the extremity, apply ice, stabilize the injured area & a complete neurovascular check o Sensation o Skin temp. o Skin color o Cap refill o Pulses o Movement Casting – elevate the cast above the level of the heart for the first 24-48 hours, apply ice for 24 hours to dec swelling & turn and position the pt. every 2 hours to help dry the cast, assess for inc warmth or hot spots on the cast – hot spot indicated infection Plaster casts use the palms of your hands to avoid denting Expose all surfaces to promote drying Don’t put anything in the cast to itch
Traction care
Align, mobilize, and reduce muscle spasms in patients who have fractures Maintain body alignment, give meds to help prevent muscle spasms and pain, neurovascular checks, pin sites for s/s of infection, make sure the weights hang freely & not on the bed or floor, do not lift or remove weights unless ordered Halo tractions – wrench attached to the vest if needed for CPR
Compartment syndrome
compression of the nerves, blood vessels, and muscle within a confined space Tissue necrosis can occur Very intense pain unrelieved with meds, numbness, pulselessness, inability to move digits, pallor, cool extremities Fasciotomy muscle compartment is cut open to allow tissue to swell, decrease pressure, and restore blood flow 5 P’s – pain, paresthesia, pulselessness, paralysis, and paleness
Osteomyelitis
open/compound fractures – infection of the bone Fever, pain, tachycardia, edema Bone biopsy Abx therapy to treat
Clubfoot
Treatment is serial casting
Legg-calve-perthes disease
aseptic necrosis of the femoral head (uni or bi) Intermittent painless limp, hip stiffness, shortening of the effected leg, limited ROM Bracing, casting, or traction or replacement of the hip joint
Developmental dysplasia of the hip [DDH] *
Infants – asymmetry of the gluteal and thigh folds, limited hip abduction o + ortolani test hip is reduced by abduction o + barlow test hip is dislocated by adduction Children – one leg is shorted than the other, walk with a limp, + tendelenberg sign [while bearing weight on the effected side, the pelvis tilts down], walks on tippy toes on one foot Newborn to 6 months = Pavlik harness o 12 weeks o Check straps every 1-2 weeks for adjustments by HCP o Preform neurovascular and skin checks o Use an undershirt and wear knee socks o Gently massage under the straps o No lotion or powders o Put diaper on under the straps Over 6 months o Bryant harness Hips flexed at a 90-degree angle with the butt raised off the bed Maintain traction & assure alignment Skin care o Hip spica cast Neurovascular checks Position casts on the pillow & keep elevated until dry Frequent position changes to promote even drying Handle casts with palm of hands to prevents dents until dry Give sponge baths to avoid wetting the cast Use waterproof barrier around the genital opening so nothing gets in there Complications from casts and harnesses – bowel and bladder eliminations Fiber to help pooping and fluids
Osteogenesis imperfecta
an inherited condition that results in bone fractures and deformity along with restricted growth Heterogeneous autosom dominant Brittle bone disease Multiple bone fracture, blue sclera, early hearing loss, small discolored teeth No cure – treatment is supportive Medication pamidronate: can be used to increase bone density o s/e: hypocalcemia, hypomagnesia, low phosphate, low K, thrombocytopenia, dysrhythmias, kidney failure encourage the child to do low impact exercises – braces and splints for support
scoliosis
lateral curvature of the spine and spinal rotation that causes rib asymmetry diagnosis – bend at the waist with arms hanging while assessing for asymmetry of the rubs and flank treatment – bracing or spinal fusion with rod placement
Cerebral palsy
impairment of motor function, coordination, and posture Abnormal perception and sensation, visual, hearing, and speech impairments; seizures, and cognitive disabilities Cause is unknown – correlated with prenatal risk factors Assessment findings: o Spastic hypertonicity o Dyskinetic (non-spastic, extrapyramidal) – jerking movements that appear slow and wormlike of the trunk neck face and tongue o Ataxic s/s – wide based gait and difficulty with coordination, difficulty with precise movements, and low muscle tone Treatments – skeletal muscle relaxants [Baclofen] + valium [diazepam] Complications – aspiration *, elevated HOB, handle secretions, risk for injury
Spina bifida
failure of the osseous spine to close Neural tube defects are present at birth and effect the CNS and osseous spine Occulta – not visible Cystica – protrusion of the sac is visible Meningocele – contains spinal fluid and the meninges Myelomeningocele – contains spinal fluid, meninges, and nerves Associated with a lack of folate acid during pregnancy s/s: o cystica – protruding sac midline of the spine o occulta – dimpling of the lumbosacral area + port wine angioma + dark hair tufts, subcutaneous lipoma interventions – close asap o sterile moist non-adherent dressing and change Q2 hours o prone position with hips flexed and legs abducted o no pressure on the sac complications – skin ulceration, latex allergies *, increased ICP, bladder issues, and orthopedic issues
down syndrome
chromosomal abnormality small round head, flattened forehead, small nose with depressed nasal bridge, small ears with short pinna, protruding abd, hypotonia and hyper flexibility manage secretions and help prevent respiratory infections cardiac defects and strabismus rinse mouth after feeding and throughout the day cool mist humidification and use bulb syringe prn
juvenile idiopathic arthritis
chronic autoimmune inflammatory disease affecting the joints and other tissues joint swelling, stiffness, redness and warmth worse in morning or after naps apply a splint for sleeping encourage use of a firm mattress and discourage use of pillows apply heat or warm moist packs to the affected joints encourage warm baths NSAIDS, methotrexate, steroids
Muscular dystrophy
group of inherited disorders with progressive degeneration of symmetric skeletal muscle groups causing progressive muscle weakness and wasting Most common Duchenne’s MD – onset within 3-7years s/s: muscle weakness, unsteady gait, waddling, lordosis, and delayed motor skills development o frequent falling, learning difficulties, progressive muscle atrophy resp. and cardiac difficulties around age 20 corticosteroids complications: resp. compromise progressive weakening of the resp. muscles
Impetigo
Caused by staph Reddish macule that becomes vascular and can erupt forming dry crusty’s + itchy Direct contact Abx ointment, burow’s solution
Cellulitis
Firm swollen red area of the skin and subcutaneous tissue Fever Abx and warm moist compresses
Tinea
fungal, Round red scaley patches, itchy in warm and moist areas Head – selenium sulfide shampoo Topical antifungal Treat infected pets as well
Lyme disease
Bit by a tick carrying borrelia burgdorferi Stage 1 – 3-31 days: flu like s/s * bullseye rash at the bite area Stage 2 – after 31 days more systemic issues – paralysis, swelling in joints, weakness Stage 3 – deaf, encephalopathy, arthritis, weakness, numbness and tingling, and speech issues
Scabies
Itchiness, rash, thin pencil mark lines, pimples on trunk, blisters on palms and soles Apply 5% permethrin cream everywhere + family + wash everything in hot water
Pediculosis capitits (lice)
Small red bumps on the scalp, nits (white specks) on the hair shaft Shampoo containing 1% permethrin + remove nits with special comb + wash everything in hot water Can’t wash? Bag for 14 days Boil hair products for 1 hour in lice killing solution
Dermatitis
- diaper rash Washing with warm water and mild soap Expose to air Encourage parents to use good diapers + frequent changes No bubble baths Skin barrier – zinc oxide containing Corn starch to reduce friction NOT TALCUM POWDER
Poison ivy
Plant exposure – treat area with alcohol followed by water then mild soap and water Then apply a calamine lotion Or a burrow solution Steroid gel
Seborrheic dermatitis
cradle cap Scaly and greasy thick flakes Not contagious Gently scrub the scalp with mild shampoo or special treatment Fine tooth comb Keep nails trimmed short for skin issue kids + gloves or socks over hands for sleeping Cotton clothing Avoid excessive heat Avoid irritants
Atopic dermatitis – eczema
Intense itchy Damage from so much itching Antihistamines + topical steroids
Acne
Good diet, exercise, mild cleanser, don’t pick Meds
Nursing interventions for burns:
ABC’s IV access with lg bore catheters Immunization status – tetanus in last 5 years = they are going to get one Advise family nothing greasy on burn
Fluids based on urine output Kids <30 kg (66 pounds) 1-2ml/kg/hour >30 kg 30ml/hour LR and NS sometimes Manage pain – IV opioid’s Nutrition – increase protein and calories + vitamin A, C, and Zinc Restoring mobility – active and passive ROM Silver sulfadiazine – 2 nd and 3rd degree transient neutropenia Allograft – cavader Xenograft – animals Autograft – own skin
Hypoglycemia s/s: cold and clammy need some candy <60 blood sugar
Hunger Shakiness Diaphoresis Irritability Pale cool skin Possible in LOC Slurred speech, HA, seizures Tachycardia and palpitations Normal to shallow respirations
Hyperglycemia s/s: hot and dry, sugar is high
Polyuria Polydipsia Polyphagia Dehydration Tired/fatigued Weak Nausea, vomiting, abd pain Weak pulse and diminished reflexes Warm, dry, and flushed skin Rapid, deep respiration – kussmauls respirations – fruity smelling breath
Diabetes mellitus diagnostic criteria
8-hour fasting blood glucose of 126 or higher o No antidiabetic meds until after the procedure A random blood glucose of 200 or more + classic s/s of diabetes Oral glucose tolerance test of 200 or more in a 2-hour sample o Balanced diet for 3 days prior o Fast for 8 hours o A fasting level is drawn at the start of the test o Then instructed to consume a specific amount of glucose – and blood levels are drawn every 30 minutes for 2 hours o Assess for hypoglycemia throughout the procedure HbA1c [glycosylated hemoglobin] o Expected range is 4-5.9% but an acceptable range for a child with diabetes can be 6-5-8% with a goal of <7% Less than 7% indicates that DM is being well managed Self-monitored blood glucose – before meals and at bedtime
Foot care of Diabetes Mellitus
Pt. inspects feet daily for wounds Dry feet completely after showers Mild foot powder – corn starch Never use commercial remedies for removing calluses or corns Cut toenails straight across Separate overlapping toes with cotton or lamb’s wool to avoid injury Avoid open toe and heel shoes Leather is preferred to plastic Wear slippers with soles and never go barefoot Check shoes and shake them out Clean absorbent socks made of cotton or wool Not use hot water bottles or heating pads Check water temps with hands, not feet
Management of DM when a pt. is sick
Monitor BG every 3 hours Continue to take insulin or oral meds Encourage sugar free non-caffeinated liquids to prevent dehydration Test urine for ketones Q3 hours Rest Call HCP if BG >240 or with a fever 102 & if ketones are in urine, rapid breathing, or confusion
Hypoglycemic patients [<60]
Treat with 10-15-gram simple carbohydrates [1 table spoon of sugar] o 4 oz. of orange juice, 8 oz. of milk, 3-4 glucose tablets, 4 oz. regular soft drink Unconscious patients glucagon IM or subq + give a simple carb once they wake up
Complications of diabetes mellitus
DKA life threatening condition when BG is over 330 & usually due to an acute illness, non-compliance, or stress o Ketonemia + glycosuria + ketonuria + acidosis [pH 7.30 and bicarb 15] resulting in the breakdown of body fat for energy and an accumulation of ketones in the blood, urine, and lungs o Rapid onset o Fruity breath, deep breathing, kussmauls, confusion, dyspnea, n/v, dehydration, and electrolyte imbalances o Metabolic acidosis – hyperkalemia o Treatment – as we are bringing the glucose levels down, the potassium levels may switch from hyper to hypo Cardiac monitor Sodium bicarb for metabolic acidosis slow IV infusion When BG levels get around 250 – add glucose to IV fluids in order to maintain 120-240 BG Give IV insulin continuously Monitor levels hourly
growth hormone deficiency
short stature, delayed bone closure, and delayed sex development
growth hormone treatment
- somatropin subcutaneous injections until the bones have closed
Immunizations
Common cold or minor illness – not contraindications for getting vaccinated Severe acute illness – contraindicated Immunosuppression – contraindicated from a few Flu vaccine – hypersensitivity to eggs = c/a Varicella – corticosteroids = c/a IPV – allergy to neomycin = c/a MMR – allergy to gelatin & neomycin = c/a DTAP – occurrence of encephalopy, seizures, or inconsolable crying that lasted a long time previously = c/a VL or ventral gluteal for smaller children Older children – deltoid muscle Charting include date, route, site, type, manufacture lot number, and expiration Low grade fever (common s/e) – don’t give aspirin = Reyes syndrome Babies vaccine can give concentrated oral sucrose solution on a pacifier 2 min before and for 3 min after the injection