NURS 307 Peds Proctor BOOT CAMP, Exam (elaborations). GRADED A.

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Peds Boot Camp Prioritization • Pediatric Emergencies- Lab results to report- Abnormal • Do not call for expected findings • ABC • RN Interventions • Pediatric Emergencies- evaluat... ing client’s understanding SIDS • Can use pacifiers • Back to sleep • Pediatric Emergencies-priority action for choking infant • Back blows/ thrusts • Pediatric Emergencies-treatment for overdose of Tylenol • Antidote: Acetylcystine • Pediatric Emergencies-lead poisoning • Monitor, increase calcium and iron in diet <10, chelation therapy • Pediatric Emergencies-head injury priority action • Decrease ICP, ABC- spine immobilization, CSF, LOC, GCS • Pediatric Emergencies- Treatment for medication overdose • Phytonadione, salicylic acid, poison control • Pediatric Emergencies- submersion injury • Near drowning, ABC • Reportable Vital Signs • Respirations, Tachypnea, Tachycardia Health Promotion • Immunization Schedule for all developmental stages • Vaccine schedule (to prevent, or reduce problems) • Infant: • Health promotion for school age children- bicycle safety • Helmets, touch the ground with feet, no loose clothes • Health promotion of infants- home safety • No blankets, pillows in bed. Pad corners, lock cabinet • Health promotion- promoting sleep in preschoolers • Monsters, dark rooms, reassurance • Health promotion- healthy eating for adolescents • Increase Fe, Ca, Zi, and Protein; No more than 20-35% calorie should come from fat. <10% from saturated fat • Health promotion- informed consent for adolescents • If they are pregnant they can sign, but once they have the child they cannot sign • Grandparents can sign • Health promotion- appropriate discipline for preschoolers • Time out 1 min/ year, + reinforcement, consistent/ firm • Set a timer so that when it rings, punishment is over • Psychosocial issues of infants, children and adolescents- interventions for Failure to thrive • Habits, investigate small frequent meals, time, parents watering down formula, abuse? • Psychosocial issues of infants, children, and adolescents- planning care for a child who has autism spectrum disorder • Psychosocial cognitive disorder, teach one thing at a time, level in the spectrum, what’s appropriate, keep routine, try to decrease outburst, try to decrease stimuli, eye contact??? • Autism • Know level • Make things calm • Do one thing at a time • They get agitated and angry • Decrease anxiety and stimuli • Nutritional guidelines for all developmental stages • Breast milk, solids 4-6 months, veggies, fruits, meats, finger foods • Always start with veggies first • Every week food testing???? • Baby can have solid food à head control • Failure to thrive when you add water to formula, they are not getting nutrition they need • Ask them to demonstrate how they mix formula • Nurses do mL • Other people do Oz • Negativism in toddlers • Normal- autonomy vs shame/doubt, tantrums are normal à need coping mechanisms • They want your attention but your negative attention • Developmental findings in all ages • Milestones • Indicators of child abuse • Bruising in different stages of healing, not in expected areas, stories, old fx, burns (stove top, toaster oven), behaviors • Normal: hands • Abnormal: cigarette burn on back • Badà burn on back or in weird areas, perineal • Think what they are playing with at that age • Child abuse include sexual abuse • Listen to story child tells you, does it make sense? • Age appropriate response to family support during terminal illness • Therapeutic, open ended questions, do not “understand”, do not provide false reassurance • Be as honest as possible • Testing a preschooler’s visual acuity • Snellen chart (you need to know how to read) • School age, adolescent • Shapes • Toddler • Tumbling E (if they cannot read) • Preschooler • Assessing pain in all ages • Appropriate scale for growth and development • Non communicative, flacc scale • Smily adred? • Major depressive disorder- priority action • Suicidal, SAFETY, 1:1 sitter • Main thing to ask is if they have a plan • Sun protection in toddlers • UV, SPF 30 mins prior, q2-3 hours reapplication • Community resources for single parents • Respite care(day care, or a place for children with a chronic condition), WIC(income base level, for women who are pregnant), children and families, assess the needs • Single month of 3 needs help finding resources for the nearest daycare • Mom needs a break Hematological • Sickle cell anemia complications • SOB, chest pain, stroke, abdominal pain, vaso-occlusive crisis, splenic sequestration. • Pain management- warm compresses, morphine, fluids replacement, blood replacement, hydration therapeutic and supportive • Blood cells are in kidney shape, it doesn’t’t allow blood flow to go through • High roticulocyte?? count • Worst thing is à chest syndrome and stroke • SOB, chest pain, stroke like symptoms (abd pain) • Iron deficient anemia • You need to replace iron • Iron (Fe) rich foods, Fe fortified cereals, drops- stain teeth (OJ) • Take with straw/ dark stools, constipation, increase water, walking and fiber • Dark stools are expected (always remember iron supplements cause this and constipation) Cardiovascular • Rheumatic Fever lab confirmation • Aso titer • Rheumatic fever assessment and nursing interventions • Fever, rash, red tongue, joint pain • Rest, PCN, treat strep, ASA • No aspirin to prevent rye syndrome • Report tachycardia or bradycardia; nurse takes orders Kawasaki- aspirin, IVIG • Patent ductus Ateriosis (close on their own) • Indomethacin,/ PgE1 (prostilgatin) NOT naproxen or aspirin • If it doesn’t’t close on its own these meds can help • Post- Op Care for a toddler following heart surgery • Vital signs, I&Os, weights, infection of site, pain management • Cardiac surgery can lead to renal impairment • Cardiac Cath • OP, resume normal activities in 6 weeks, lay flat, check for bleeding, pressure 1 in above site, priority- stop the bleeding • Pre and post op care • Can be dx and therapeutic • Infant à i&o à wet diaper • Formula: 6-8 diapers • Ml per kilo? • Heart failure • Edema, weight gain, fatigue, poor feeding, crackles, sweating while eating, small frequent meals, I&Os (less wet diapers) Respiratory • Bacterial Pneumonia- labs assessment • Elevated WBC, retractions, (ABX), fever, crackles, wheezing, tachypnea, decreased O2, droplet precautions • Tonsillectomy • Evaluating and monitoring a child- swallowing, no milk, no red juice, no straws—bleeding • Keep mouth moist, if dry at high risk for bleeding • Infectious mononucleosis • Epstein Barr virus, kissing disease, weakness, bad odor, vitals, white patches, splenomegaly and hepatomegaly (liver enlarged)- 6 weeks no contact sports • May have no resp. symptoms; EEB test, no contact sports for weeks until they gain strength • Cystic Fibrosis • Increased production of mucous, chest PT., Dornase Alfa (keep med refrigerated), neb treatments, pancreatic enzymes, increase fat, increase calories, vitamins AE&K, fatty stools, multi organ implications • High protein meals and snacks • Epiglottitis (LTB) • Recognition (drooling), nursing interventionsà nothing in the mouth, not vaccinated, HIB, airway emergency, prepare for intubation • Frog like cough to drooling = emergent • Asthma • Nursing interventions and priorities- albuterol, rescue inh- atrovent, peak meters, monteleukast, flucticosone, solu- medrol, and spacer—all the way in • Canditisis • Upper airway constriction harder to breath in or out???????? • Measure with peak meter • Montelkulus (singular) helps with allergens • Fluticasone- steroid • Solumenderol IV for inflammation • Spacer- for the inhaler for absorption • Complications of pertussis • Whooping cough, vaccinations, tachypnea, retractions, whistling cough, trouble breathing • Children who are not vaccinated are at risk • Otitis media • Pulling ears, not eating (1st), fussing, irritable, don’t feed flat while feeding or after feeding, pacifiers to sleep after 6 months, 2nd hand smoking, hearing loss, ear tubes, no q tips in ears, no water after surg • From upper resp. illness • Feed flat, antibiotics, MT tubes open up to help fluid drain, myringotomy tubes (cannot submerge in water they need to wear ear plugs, and its normal for them to fall out), no q tips • Can cause a speech or hearing problem (tubes can help prevent) • Bronchiolitis • After RSV, treat symptoms, suction, increase fluids, rest, no resp treatments. • Premature à singinist (at risk for RSV) • Suction as needed to get rid of secretions • Nebulizer treatment (Not 1st line) • LTB (laryngal tracheal b) • Croup • Barking cough • Shower with hot water running, have them inhale warm steam • GI infections • Rotavirus precautions à contact precautions • GI disorders- Priority action for diarrhea- Fluids, % of weight loss, assessment, vitals, treat based on severity of dehydration (can lose consciousness; prevent dehydration) • Dietary teaching about Phenylketonuria- No protein- neuro complications • Diet low in PKU foods, if eaten can lead to brain damage • No artificial sweeteners • Pyloric stenosis • Olive shaped mas (palpable), forceful vomiting • Celiac Disease • Dietà no gluten • Anything processed, wheat, • Good: ice cream • Malabsorption, at risk for vitamin deficiency • NG Tube and enteral feedings • Action for the adolescent- pH paper check, no air for placement • Umbilical hernia in newborns • Can resolve on its own; Monitor • Look for bowel obstruction • Appendectomy • Findings to report post-op- infection, rigid/ distended abdomen Renal • Over active corticosteroidsà risk of infection • Foods to eat awake and alert: 10-15 grams of carbs • 8 oz milk • 4 oz juice • 4 oz soda • No bowel sounds • Meckel Diverticulum • Pouching can resolve or need surgery, bleeding- incidental finding • CT or u/s • Cleft palate repair- post op care • Elbows restraint, lay prone immediately then infants seat (not lips) ?? • Prone flat, lip only supine????? • Intussusception- assessing • Red currant jelly stools, air enema (dx and therapeutic) • Gastroenteritis- nutritional interventions • No BRAT, no fruity juices • No carbs, no sugar Endocrine • Diabetes mellitus • Evaluating client findings, assessment, priority- increase calories with increased exercise • Type 1: active child with activities they will burn more glucose; NEED insulin • Self administration with G&D • Cushing’s disease- clinical manifestations • Na retention, Hyperglycemia • Hyper responsive to glucocorticoids from a pituitary tumor typically called adenoma • Extra glucocorticoids • Moon face with prominent cheeks, HTN, hertusim, deep voice, obesity, acne • Cushioned syndrome from moderate to severe use of corticoidstroids ( with similar s/s but not caused by a pituitary tumor) • Assessing hyperglycemia- know signs and symptoms of hyper/ hypo?????? • Wt gain, fractures, growth stunts, mood swings • Acute glomerulonephritis • Assessment findings, htn, swelling, low urine output • Nephrotic syndrome • Facial edema, no htn • Intravenous pyelogram • Enuresis and UTI – contrast (make sure they get enough fluids afterwards), allergies, increase fluids after, procedure check for defects • Enuresis • Primary: no matter what • Secondary: could be caused by stress, hospitalization, • UTI • Hygiene methods • Cleanliness • Change diapers Neurological • Meningitis • Precautions droplet • Meningococoal vaccines, abx, sz precautions, minimize stimuli • Look out for seizures (worst thing that can happen before death) • Private, dark, low stimuli • Reyes syndrome • Caused by aspirin use • Diuretic mannitol and vitamin k • Increased ICP- assessment and parent teaching • Infantà fonteals • Teach parent how to know when it is coming back • Behaviors: • Seizures- types and treatment- priority nursing action • Airway needs to stay open , side lying to the right • Respiratory, safety, injury prevention • Pad bed????? Which is first??? • Brain Tumor- assessment findings • Headache, dizzy, vertigo, loss of consciousness, confusion, pain • Sensory • Communicating with a child with hearing loss • Do you have a hearing loss • 1st find out if they have any devices • Head Injury- assessment findings to report • LOC for the 1st 24 hours, are there neurological changes, any vomiting? • Are they having seizures • ADHD • Meds in the morning, weight loss • No later than 6pm dinner time to prevent insomnia (morning is better) • Meth, Adderall • Decrease appetiteà weight loss • Evaluating cranial nerve function • • Positioning for lumbar puncture • Empty bladder prior, emla cream on site to help with pain • Don’t lie flat???? • Sunset eyes • Manifestation for head injury or increased ICP Musculoskeletal • Prevent neurological loss à anesthesia, pallor • 5 p’s à • To determine compartment syndrome • Short leg cast- findings to report (CMS)(Ps) pain, pallor, paresthesia, paralysis, pulselessness • Hip dysplasia • Scoliosis- plan of care- • Involves lumbar spine • Rod inserted for treatment • More noted on the top • Loose clothes??? • Pavlik harness • Less than 6mo of age for babies with hip dysplasia • Straps over the diaper • Legs 90 degrees- diaper under the harness • Osteomyelitis • Bone infection from abrasion, puncture, close to make close to bone, bone fracture, open incision, surgical procedure, artheoplasty of rod placement • Prevent by cleaning pin sites • s/sà swelling, red, drain, or systemic effects (fever, not feeling well) • X-ray • Maintain traction • Maintain body alignment • Skeletal à alignment • Cast application- priority interventions • Maintain alignment and sign integrity • Post op complications à 5 p’s (prevent compartment syndrome) know what it looks like and what to assess to make sure it is not happening • Fractures- monitoring for post op complications • Compartment syndrome, fatty embolism, manipulation of bone fracture, osteomyelitis, tightening of fracture • Legg- Calve- Perthes Disease- developing a plan of care • Hip dysplasia • Juvenile idiopathic arthritis • Joint pain • Canes • Handle in tub • Low impact exercises • Administer prednisolone to help relieve joint pain Immune • Candidiasis- treatment and assessment • From over use: medications, reproductive yeast infection, antibiotic abuse • Treat: antifungal (use q tip and swab mouth) • Swish, swallow, spit is for an adult • HIV/ AIDS • Baby’s born with it, given prophylactic medications • Client teaching • Vaginal birth, no breast feeding • Make sure they take medications • You want to prevent AIDS • Leukemia- analyzing data • Highest rate of children dying from leukemia?? Reproductive • Teaching about vulvovaginitis • Inflammation of the vulva, bacterial/ yeast, trauma • Possible bacterial or yeast • Promote: cotton underwear, change frequently • Pad placedà to check for discharge to calculate amount Integumentary • Skin infections • Pediculosis capitis- (lice)ampoo, nix ( wash everything in hot water) 14 days in a bag • Pg. 196 • Dermatitis and acne- evaluating parent’s understanding diaper rash- barrier cream -zinc oxide, don’t leave on you need to wash off to prevent fungal infection, let area air out • Burns- priority action during initial treatment- fluids, isotonic/ crystalloid • After ABC à fluid replacement/ resuscitation • Direct à no order • Indirect à need an order • Burns- types and treatments- ABC treatments • Pictures????? • Koplik Spots – measles- white bluish dots on cheeks • Herpes simplex virus- for life- vesicles honey crusted type • Impetigo contagiosa • Strep or staph infection of skin, contact precautions, remove crust apply abx • MRSA • Check skin folds on infants • Remove crust and antibiotics • Varicella • Want to crust, oatmeal bath, MRSA precautions • Priority for skin traction à skin integrity Medication Administration • Administering Morphine- vitals, resp depression • Dilute to prevent respiratory depression • Therapeutic action of stimulant medications- ADHD • Take in the morning • Administering liquid ferrous sulfate • Straw; can cause discolored to OJ • Teaching about Dornase alfa in CF • Should be refrigerated &&&& • Evaluating Digoxin administration-] DON’T if q <70 in children <90 infants (2.2 dig level) • GI; don’t give more if they vomit • IV therapy- priority action for extravasation- stop the infusion, assessment • Phlebitis inflammation of vein and skin is red • Infiltration • Stop infusion, assess extremity • Restraining methods for medicating infants- • Best way is to have parents assist • Assessing pain at all levels of development • Medroxyprogesterone injection • Depo shots, BC, or hormonal, decreases bone density, weight gain • Prednisone administration • Increased risk of infection, increased blood sugars • Evaluation treatment of asthma medications- wheezing, increase labor of breathing, working à decrease in breathing • Decreased wheezing, effective breathing • Opioid administration • No Demerol, drug of choice morphine (increased risk of seizures), NO Dilaudid • Dry oxygen to dry up dermatitis • Zofran (Ondansetron) • You have to dilute it Skills • Obtaining vital signs (BP) on pre-schoolers • Dosage calculation • Performing tracheostomy care • Suction 5-10 seconds • Twirling motion coming out • Hyperoxygenate before • O2 therapy how to deliver • Dosage Calculation • Post op fractures • Epiligotiis • Injury prevention • Roto virus • Priority for diarrhea • Priority for meningitis • Nutritional guidelines • PDA • Opening obstruction • Immunizations • Infants 2 month olds • Ferrous sulfate • Rhumatic fever • Trach careà no pillow under neck, neck slightly flexed • Death and dying o Infant: o Adolescents: perceive it like an adult • Neoplasms o Can cause oral candiditis, the child will NOT want to eat Newborn Respiratory Rate: 30 to 50 Heart Rate: 120 to 160 Blood Pressure: 50 to 70 Weight Kilograms: 2 to 3 Weight Pounds: 4.5 to 7 Infant 1 to 12 months Respiratory Rate: 20 to 30 Heart Rate: 80 to 140 Blood Pressure: 70 to 100 Weight Kilograms: 4 to 10 Weight Pounds: 9 to 22 Toddler 1 to 3 years Respiratory Rate: 20 to 30 Heart Rate: 80 to 130 Blood Pressure: 80 to 110 Weight Kilograms: 10 to 14 Weight Pounds: 22 to 31 Preschooler 3 to 5 years Respiratory Rate: 20 to 30 Heart Rate: 80 to 120 Blood Pressure: 80 to 110 Weight Kilograms: 14 to 18 Weight Pounds: 31 to 40 School Age 6 to 12 years Respiratory Rate: 20 to 30 Heart Rate: 70 to 110 Blood Pressure: 80 to 120 Weight Kilograms: 20 to 42 Weight Pounds: 41 to 92 Adolescent 13 and older Respiratory Rate: 12 to 20 Heart Rate: 55 to 105 Blood Pressure: 110- 120 Weight Kilograms: greater that 50 Weight Pounds: greater than 110 • BUN 10-20 • Creatinine .5-1.2 • Platelets 150-400,000 • Glucose 70-105 or 80-120 • Hypoglycemia <60 • Hyperglycemia >250 • Hemoglobin 12-18 (low is anemia) • Hematocrit 35-45% • Leukocytes 4,500-13,500 WBC • WBC 5,000-10,000 • Lead <10 à chelation therapy (calcium &iron) • Sodium 135-145 • Potassium 3.5-5.0 • Urine specific gravity 1.005-1.015 (dehydration >1.025) • O2 95-100% • Albumin 3.5-5 • RBC 4.2-6.0 • I&Os o Infant: 2ml per kilo per hour o Children: 0.5-1ml per kilo per hour o Adolescents: 40-80ml per hour • U/O less than 30kg (66lb) = 1-2 ml/her ; over 30kg= 30ml/hr • Self report of pain à 4 years • CRIES à infants • FLACC: 2months – 7years (0-10) • FACES: 3 years and older • OUCHER: 3years – 13 years • Numeric: over 5 • Non communicating 3- 18 years à non communicating childs pain checklist (10 min) • 6 typesà body outline, faces, oucher, poker chip, numeric rating, world graphic rating • 1st days of life you give vit. D to prevent rickets • Toddlers have pot belly • Infant & toddlers cavity prevention à don’t let them fall asleep with milk or juice • Under 3 ear lobe is straight then it gets curved • Don’t mix formula with medications • Infant medicine: use a syringe to put medicine on side of cheek, hold cheeks together, stroke chin • Eye drops: hold lacramal punctum for 1 minute to prevent bad taste • Ear drops: med is room temperature, stay on that side, massage for a couple minutes • Rectal med: hold butt cheeks together for 5-10 minutes • IM site: vastus lateralis • IV: EMLA prior • Ibuprofen: after 6 months (NSAIDS metabolism in kidneys); give Tylenol • EMLA 1 hour before IV; 2 ½ before deep puncture • Painful procedures: perform in another room other than patient room • Severe diarrhea: focused assessment & vital signs • Gastroenteritis: preferred hydration route à oral • Mylomenengocele: moist dressing on sac to keep integrity of sac, no diaper, side lying position • Hair and dimples on lower back • Spina bifidaà allergy to latex • Spinal cord injuryà POC: weak gag reflex, absent bowel sounds, and HTN • Pain goes away appendicitisà ruptured • Cleft palateà elbow restraints • Wilms tumorà don’t put pressure on abdomen mass • Seuizure à turn to side, o2, plastic yanker suction, meds: diazepam, pad railing, loosen clothing • Glaswcow coma scaleà verbal response, eye movement, motor movement • Hirshbrum diseaseà 1st thing is you cant pass meconium, ostomy is only temporary • Fontanels: anterior (12-18mo); posterior (4-6wks) • Adolescents deathà motor vehicle accident • Seizure last more than 5 min, stops breathing, status elipticus occurs, pupils not equal after, vomits after, unresponsive to pain, cant be awaken, in water, 1st seizure à call doctor emergency • Status epiliptcus à more than 30 min, and doesn’t end a post itcal phase • Digoxin 2x daily à brush teeth after med • Allergy to neomycin with anaphylactic reaction is contraindicated to à MMR vaccine • 2 week old infant report à substernal retractions • Juvenile idiopathic arthritis à encourage independent self care, exercise large joints, firm mattress, discourage naps • “Your mom will be back after you eat”à preschoolers sense time when they associate it with a daily routine • Early septic shock à elevated temperature • Forceful vomiting à ICP in toddler with concussion • Eye medicineà administer eye drops 3 minutes before the ointment • Nephrotic syndrome à administer corticostrioids • Nephrotic syndromeà 25% albumin IV (thick), prednisone, diuretic; report low protein • Nephrotic syndrome à 4+ protein • Toddler diarrhea à monitor wet diapers to monitor output and hydration status • Head injury with diabetes insipidus à sodium 155 NOT low glucose • Celiac disease à steatorrhea (malabsorption, diarrhea) • Potty training à award child with sticker when he sits in the potty • Cheiloplasty à cleft lip repair, apply thin layer of antibiotic ointment on suture line daily for 3 days then petroleum jelly for weeks, clean suture with sterile water or diluted hydrogen peroxide after feedings • Excessive swallowing à indicates bleeding • Partial thickness burn à clean affected area with mild soap and water, no corticosteroid, more than 40% LR in 24 hours • Iron food à ½ cup raisins • Varicella no longer contagious à lesions are crusted, 6 days after they disappear • Appendix location à McBurneys point • Cystic fibrosis à high protein meals and snacks • Sickle-turbidity test for sickle cell anemia à perform a finger stick • Social development of preschooler à playing dress up • Infant à pat a cake • Toddler à push pull toy • School age à scrap book • Potential physical abuse à symmetric burns of the lower extremities • Recurrent UTI à sexual abuse • Osteomyelitis à antibitoics for 4 weeks • SIADH à altered pituitary function à mental confusion • Pneumonia priority à nasal flaring • Further hearing evaluation à an infant who is 8mo and hasn’t made babbling sounds • Neutropenia à 10 year old give a book about adventure • Sodium polystyrene sulfonate enema à effective if serum potassium is 4.1, treats hyperkalemia by exchanging sodium ions for potassium ions in the intestine • Removing IV: turn off pump à occlude tubing à remove tape secure catheter à apply pressure over site • Anaphylactic reaction (causes decreased blood return to heart) à administer IM epinephrine • Treatment for severe dehydration à effective if: sodium 140 • Prior to hydrotherapy treatment for wound debridement for burn à administer analgesic • Spastic (pyramidal) cerebral palsy à ankle clonus, exaggerated stretch reflex, contractures • Dyskinetic cerebral palsy non spastic à uncontrolled movements of the face • Moderate to severe dehydration à sunken anterior fontanel • Assess peripheral edema à palpate dorsum of the child’s feet with fingertips for 5 seconds • Moderate persistent asthma à pulmonary function test every 12 to 24 months to evaluate response to therapy • Peak expiratory flow meter à 2 times daily, 3 times, 30 seconds between each measurement and record the highest of the 3 • Pertussisà dry, hacking cough more severe at night, droplet precuations • Koplik spots à rubeola (measles) • Epiglottisà monitor oxygen saturation, no throat culture, facemask humidifier, upright position or lean over the bedside table to breath • Anemia à hematocrit 28% (low) • Physical abuse à denies discomfort during assessment of injuries (blunt response to painful stimuli) • Wilms tumor à avoid palpating abdomen • Nephrotic syndrome taking prednisone effective if à decreased edema • Celiac disease good food à rice pudding o No: oats, rye, barely, wheat • Tinea pedis à wear sandals as much as possible • Immunization for a 4 year old à use a 24 gauge needle, upright position, rapid & avoid aspirating • Oral nystatin for candidiasis à shake medication prior, swish around before swallowing, no rinsing, don’t mix with foods • Moderate dehydration à oral rehydration solution • Dyspnea à wheezing • 8 month old à sit unsupported • 10 month old à stand holding to furniture, 1 to 2 words • 11 months à roll a ball • Cardiac catheterizationà wait 3 days before taking a tub bath, new bandage for 2 days • Superficial minor burn à use antimicrobial ointment, apply fine mesh gauze • Tetanus toxoid shot à every 5 years • Trach suctioning for 5 seconds or less, between 60 and 100 pressure, as often as needed • Mononucleosis à Epstein-barr virus, no known treatment, monospot blood test, can develop splenomegaly no activity for 2 to 3 months • Intussussception à vomiting, mucus currant jelly-like, lethargy, weight loss • VSD ventricular septal defect à loud, harsh murmur (right to left shunting of blood) • Coarctation of the aorta à weak femoral pulse, high BP • Post op open fracture repair complication à erythrocyte sedimentation rate 18 (osteomyelitis) • Tetralogy of Fallot hypercyanotic spell à knee to chest position, o2 100% face mask • Teething à baby pulls at ears, difficulty sleeping, increased drooling, increased fussiness • Chemotherapyà at risk for anemia, low hemoglobin • 4 year old à cuts a shape with scissors • 6 year old à utensil to spread butter, identifies right from left hand • 5 year old à stick figure with 7 body parts • Diabetes à shot of regular insulin 30 min before breakfast, 15g carbs, 4oz juice, ½ cup icecream • Blood glucose à puncture skin to either side of the finger pad • Hypopituitarism à recombinant growth hormone • Slow prepubertal growth à luteinizing hormone realasin hormone • Strabismus disappears at 3 to 4 months old • Heart failure à digoxin toxicity report vomiting • When making room assignment à disease process comes first • Tunneled central venous access device à use a semipermeable transparent dressing over site • Bike safety à stand on the balls of feet when sitting on the bike, direction of traffic • Physical neglect à poor hygiene • Cystic fibrosis à increase fat content in diet to 40% total calories (unable to digest fats), pancreatic enzymes within 30 min of meals and snacks, if steatorrhea increase intake of pancreatic enzymes, increase fluids • Epiglottitis à prepare for nasotracheal intubation or tracheostomy if respiratory distress, nothing in mouth, Haemophilus influenza type B conjugate vaccine. • Kawasaki disease à fever lasting more than 4 days (unresponsive), increased temperature, xerophthalmia, cervical lymphadenopathy, strawberry tongue, cracked lips, edema of oral mucosa and pharynx • Phenytoin therapy à can develop gingival hyperplasia • Erythema infectiosum (fifth disease) à facial rash (cheeks), “slapped face”, rash last 1-4 days • Diphtheria à hoarseness • Monoà splenomegaly • Scoliosisà unilateral rib hump with hip flexion, asymmetry of ribs, shoulders, hips or pelvis • Kyphosis à rickets or posture related • Lordosis à toddlers • Diaper dermatitis à zinc oxide • Pavlik harness to treat developmental dysplasia of the hip à diapers under harness, 6 -12 weeks • Diabetic ketoacidosis à deep rapid respirations • Hypospadias repair with a stent placement à allow the stent to drain into your infants diaper, allows the body to drain urine, apply antibacterial ointment to the penis daily • Oliguric phase of acute kidney injury (AKI) low sodiumà initiate seizure precautions • Lower child’s temperature à dress in minimal clothing, no cooling blanket it causes shivering • ICP à decreased attention span • Peritonitis from ruptured appendix à abdominal distention, hypoactive bowel sounds, tachycardia • Infant heel stick à administer sucrose prior, breastfeeding immediately decrease pain • Anaphylactive reaction à epinephrine • Chemo priority to report à urticarial (an anaphylactic reaction), monitor during and 1 hour after infusion is complete • Postictal period à place in a lateral position • Appendicitis à give morphine, no enema, no laxative, no heating pad • Asthma prevention à keep child indoor while mowing lawn, no room humidification, no cough suppressants, wet mop floors instead of sweeping • Bacterial meningitis à increased protein concentration, decrease glucose, increase WBC, increase CSF • Hep B vaccine to a 1 month old à vastus lateralis or anterolateral thigh muscle • IM à for 18 months and older • Infant pulse ox à great toe then place a snug sock over • Kidney rejection à Creatinine 3.0 • Rheumatic fever à bed rest to prevent cardiac damage, not contagious, administer salicylates • Lower leg cast à report restricted ability to move the toes • Swelling of casted foot when the leg is dependent is an expected finding • Chemotherapy and immunocrompromised à screen visitors for indications of infection • MMR vaccine contraindicated when immunocrompromised • Epinephrine à use a second dose if the 1st does not completely reverse the symptoms • Who has hearing loss à toddler received tobramycin during hospitalization 2 weeks ago • Heart failure à provide small frequent meals, restrict play, weight daily, semi fowlers • Hemolytic transfusion reaction à flank pain caused by break down of RBC • Pyloric stenosis repair post op à monitor infant following feedings for vomiting • Monthly assessment for methlphenidate (Ritalin) ADRs à weight loss • 6 months à should bable one syllable • Bereavement referral à parent has not returned to work (complicated grief reaction) • Worsening diarrhea/ dehydration à decreased tear production • Asthma reports chest pain à auscultate breath sounds • Pediculosis à remove nits after treatment, treatment is not 100% effective • Poorly controlled seizure à have oxygen available • Mom doesn’t want adolescent to study with music à let her make her own choices • Epiglottitis à monitor oxygen saturation • Cerebral palsy à use pictures & objects when talking to child, encourage child to move lips and tongue when eating, allow child time to articulate at his own pace • Acute lymphocytic leukemia with severe stomatitis poc à help brush teeth with soft sponge toothbrush • Methotrexate (MTX) pre first dose (arthritis) à liver function test • POC for juvenile idiopathic arthritis à monitoring students for presence of communicable disease • Bryant traction à maintain the hips at 90 degree angle to body • Impetigo à remove crust after soaking with 1:20 burows solution • Famotidine (Pepcid) à bruising • Halo brace à provide pin site care • Large sacral myelomeningocele pre op to prevent complications à keep newborns prone with legs abducted with the pad between the knees with hips flexed (risk of hip subluxation due to paralysis of LE) • Myelomeningocele sac contains à meninges, spinal fluid, and nerves; dimpling on lumbosacral area, protruding sac midline of osseous spine; alpha feto protein test • CP à baclofen for muscle relaxant, diazepam for muscle spasms, botulinum reduce spasticity in lower extremities and temp weakness • Pulmonary stenosis area of ejection murmur heard loudest à 2nd intercostal left sternal boarder • Respiratory syncytial virus in mist tent infection control à keep stethoscope in room • Lyme disease à skin rash • Glomerulonephritis & is edemos à restrict sodium intake • Mononucelosis à take ibuprofen for headaches • Aspirin à bayer, bufferin, Excedrin • Infant pain à bludge between eyes and vertical furrows, raised cheeks, broadened and bludging nose • No acetaminophen for post op pain, or migraine; take ibuprofen after 6 months • Diaper dermatitis à allow butt to air dry, apply zinc do not wash it off, corn starch, super absorbant diapers • Heart failure à peripheral edema (systemic venous congestion) • Pneumonia à crackles • Toddler with foreign body aspiration à endoscopy • Growth hormone injections à serum calcium levels drawn periodically • Confirmation of bacterial meningitis from lumbar puncture à increased protein • Stares into space & grunts à lower to floor, place pillow under head, loosen clothing, assess mouth for injuries • Cyclosporine à prevents organ rejection with transplant • Adolescent à meningococcal polysaccharide vaccine • Left sided heart failure à dependent edema • TB à rifampin adverse effects: body secretions turning a red orange color • Von willebrand is missing a cloting factor à nose bleeds • Diaphragmatic breathing à place both hands on the side of rib cage • Aortic stenosis à murmur • Idiopathic thrombocytopenic purpur à bleeding or fever • Cystic fibroris à increase protein, carbs to promote weight gain, pancreatic enzymes, no fiber, additional salt • Koplik spots à maculopapular rash and fever, oral lesions from rubeola (measles) on buccal mucosa • Kawasaki (scarlet fever)à strawberry tongue, sloughed off normal coating, swollen prominent papillae • VSD à murmur heard over left sternal border • Glomerulonephritis & rheumatic fever à ASO titer • Myelomeningocele à hydrocephalus, measure head circumference • Intussussception à barium enema or air enema • Nephrotic à prednisone, weight loss • Scoliosis à Milwaukee brace from neck to pelvis; scapula rubs • Sickle cell à increase fluids • Mebendazole (Vermox) used to treat pinworms; 2 doses 2 weeks apartà come out of the anus at night, shower in the AM, underwear should be changed while standing, school is fine, hygiene, pinworm paddle lab test • Tape test for pinworms à tape on anus at night and remove in AM examine with microscope • Tonsillectomy à hoarse voice, sore throat, thirsty is expected • Leukemia à cancer of the bone marrow, increase WBC, decrease RBC, decrease platelets and granulocytes • Dressing changes à meds 30 min before, do not change dressing close to feedings, perform 1 hour before or after meals • Rheumatic fever à causes carditis • Bucks traction à pull is exerted on one plane, skin break down, circulatory impairment, nerve damage; alignment • Autism à stereotyped movements, self injurious behaviors as a form of auto-stimulation • Bone marrow aspiration à lie on abdomen, specimen is obtained from the iliac crest • Acromegaly à too much growth hormone in the body, tumor of the pituitary gland • 4 month reflex à sucking rooting, moro, startle, tonic-neck • School age child death and dying à provide consistency among nursing personnel • Bacterial meningitis à decrease enivormental stimuli • Clavical à most frequent bone broken in children • Fracture à brusing, ridgidity, crepitus à DVT, embolism • Club foot à 6 weeks • NSAIDS à with meals • Osteogenesis imperfect à multiple and frequent bone fractures; hearing loss, blue tinged color scleara of eye • Duchene muscular à bone wasting • Muscular dystrophy à late sign is gowers • Weight doubles at 6 months & triples at a year • No flu shot if allergic to eggs • MMRà 2 does • Crying can act like buldging • Head injury complication à increased sleeping • Jack in box à • Pat a cake à infant • Enuresis à oxybutynin chloride for spasms • Infant uti à irritability • Education on dornase alfa à how to use a nebulizer • Post cardiac cauterization à assess color of extremity • Rheumatic fever à O titer, CRP, erythrocyte sedimentation rate • Hemolytic disorder à pale mucus membranes • Vaso occulusive crisis à bed rest • GERDà weight loss, recurrent pneumonia, failure to thrive • Enterocolitis à air enema; decreased urine output • Glomerulonephritis à streptococcal infection • Nephrotic à hypoalbumen, hemoconcentration, GFR à cluster care • Post op care for scoliosis à log rolling • Diabetes à diminished reflex, dry mucous, warm flush skin, n/v • Finger foods 12 months à banana, toast strip, graham cracker, cheese cubes, noddles, peeled apple, pears, and peaches, mash potato, green beans, bread, chopped meats • Allergy to neomycin and streptomycin à contraindicated to IPV, MMR, Varicella • Intusseception à contraindicated to RV rotavirus • Immunocrompromsied contraindicated à RV, MMR, VAR • Gelatin à contra to MMR, VAR • Bakers yeast à contra to HepB • Toddlers hospitalization à consistent caregivers, regression, autonomy • Preschool à magical thinking • School ageà peer group, sepeartion from peers • Cows milk sensitive to casein • Eggwhites contain albumin • By 2 years à birth weight 4x • 18 months à crayon • Mesna (mesnex) protect bladder from àhemorhage cystitis [Show More]

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