Misc
Name available vaccinations given in childhood for respiratory and integumentary conditions.
Respiratory: HiB, Influenza, Pertussis, COVID, Pneumococcal, RSV,
Integumentary: Rubeola (measles), mumps, rubella (MMR), varicella (chicken pox), HPV
Other: Hep A, Hep B, Meningococcal, Rotavirus, Tetanus
Match the following CHD conditions described below.
1. Aortic valve (between left ventricle and aorta) is narrowed.
2. Hole in ventricular septum
3. 4 defects--ventricular septal defect, pulmonary valve stenosis, aortic override, hypertrophied right ventricle.
1. Aortic stenosis
2. VSD (ventricle septal defect)
3. Tetralogy of Fallot
Age specific exam considerations for infants (and age range for infant)
Allow parent to hold them/place on soft, comfortable surface.
Start with non-invasive procedures (auscultation, inspection) before invasive (temp, weight). Warm equipment if possible.
Assess fontanelles. Be aware of Moro reflex.
Age range: birth to 1 year old
A 4 year old presents to family clinic with a large insect bite on their shin. Describe teaching for insect bite management, and when to return for care.
Use anti itch lotions, cool compress, and anti histamines to prevent itching/redness.
Draw circle around redness. If redness spreads beyond 1 inch of circle, return for care.
The oncology nurse sees three patients. What is the expected Dx?
Patient A: 6 year old with new onset limping and complaints of severe "growing pain".
Patient B: 9 year old with enlarged, single lymph node, itching, and fever
Patient C: 2 year old with new squinting and white patch within eye.
Patient A: Osteosarcoma
Patient B: Lymphoma
Patient C: Retinoblastoma
Name FAS signs and symptoms.
Microcephaly (head circumference in 10th percentile), hypoplastic mid face--upper eyelid skin folds, narrow set eyes, flattened or absent maxilla, smooth, long philtrum. Short upturned nose, joint and limp defects, altered palmer crease (hockey stick like), growth in 10th percentile or less.
Signs of withdrawal after birth (72 hrs): agitation, marked hyperactivity, marked tremors.
Match the following CHDs to their definitions.
1. Closure of ductus arteriosus does not occur--causes extra blood from aorta to shift to lungs, causing SOB, poor weight gain, pulmonary edema
2. Passage between right and left atrium
3. Absence of blood passage between right atrium and right ventricle.
4. Aortic narrowing, causing hypertension above constriction point and hypotension below.
1. PDA (patent/persistent ductus arteriosus)
2. ASD (atrial septal defect)
3. Tricuspid atresia
4. CoA (co-arctation of aorta)
At what age is ____ assessed?
1. BMI
2. Blood pressure
3. Head circumference
4. Oral temperature
1. BMI: beginning at age 2
2. Blood pressure: after age 3, unless indicated by pathology
3. Head circumference: from birth to age 2 (closure of anterior fontanelle)
4. Oral temperature: Age 4 and older, 3 and under use axillary temp.
Describe the difference between omphalocele and gastroschisis, and indicated management of both conditions.
Omphalocele: abdominal organs outside abdominal wall muscles, encased in umbilical cord.
Gastroschisis: Abdominal organs outside abdomen, open to air.
Management: Dress exposed organs with warm, wet sterile dressing. Do not feed. Insertion of orogastric tube for gastric decompression before surgical intervention. IV dextrose/fluid replacement.
The oncology nurse sees three patients. What is their expected Dx?
Patient A: 5 year old that reports severe headache and persistent vomiting upon rising in the morning.
Patient B: 2 year old with large, round, distended abdomen and bumps under skin.
Patient C: 7 year old with weight loss, persistent fatigue, and petechial rash.
Patient A: CNS tumor
Patient B: Neuroblastoma
Patient C: leukemia
Name initial and worsening signs of cardiac compromise in newborns, and treatment options.
Initial: tachypnea, tachycardia
Worsening: cyanosis, respiratory distress, abnormal heart sounds/rhythm/rate, new signs of HF: edema, diminished peripheral pulses, pallor, irritability
Describe expected gross motor skills for a 6 month old infant and a 12 month old infant.
12 month: Pulls up to stand, walks using furniture to hold, grasps items with pincer grip
Age specific exam considerations for toddlers (and toddler age range)
Use play--demonstrate procedures on stuffed animals, dolls
Explain assessments in simple terms.
Allow participation in exam (hold the thermometer, stethoscope, etc)
Age range: 1-4 years old
Cleft palette education for parents of a newborn.
Feed upright, greater than 60 degrees
Use pigeon feeder nipple, place at back of throat. Baby may gag the first few times the nipple is used.
Keep at 30 degrees after feeding. Oral/nasal suctioning if indicated, washing suction bulb after each use.
May breastfeed after surgery as normal.
A 2 year old presents to ED with swelling of soft tissues in the throat--suspected croup. Sticking items like tongue depressors into the airway for examination could lead to what medical emergency?
Epiglottitis
Risk factors for newborn sepsis (both maternal and fetal), and when to start Abx treatment.
Do we wait for blood culture confirmation of pathogen before starting Abx?
Risk factors (maternal): GBS+, PROM, antenatal/perinatal infection, choreoamnitis
Risk factors (fetal): Birth interventions, preterm, NICU stay, SGA/IUGR, multifetal gestation, postnatal distress.
Start Abx immediately--Gentamycin and Ampicillin. If ineffective within 48 hrs, use cephalosporin
Identify the stage in Piaget's theory of Cognitive development for a 1 year old and a 3 year old, and features of both stages.
1 y/o: sensorimotor. Interaction with environment, vocalizations for demands and cataloguing. Object permanence develops.
3 y/o: preoperational. Capable of symbolic and imaginative thinking. Complex abstract concepts too difficult. Conservation develops.
Age specific exam considerations for school age children (and age range).
Explain procedures with simple terms. Ask them questions and involve them in exam. Allow them to ask questions.
Give child as much control/options as possible to promote feeling in control.
Age range: 4-11 years old
Teaching for parents of an active 4 y/o with Hemophilia A, including injury precautions and treatment.
Skinned knee, minor scrapes--hold pressure on bleeds for 2-10 minutes.
Do not use heat on sore joints, ice only
Injuries with potential for internal bleeding--blunt impact, head trauma--go to ER for evaluation.
Tx: iron replacement, clotting factor replacement, blood transfusion for severe anemia.
A 4 y/o patient presents with Sx of mild respiratory distress. Name key findings that differentiate mild respiratory distress from severe respiratory distress, and indicated treatment for mild respiratory distress.
Mild respiratory distress Sx: SpO2 at or above 94%, acrocyanosis, pallor, tachypnea, tachycardia, nasal flaring.
As opposed to severe distress: SpO2 below 92%, central cyanosis, severe retractions, stridor.
Tx for mild respiratory distress: Oxyhood/NC (whatever is tolerated best), Albuterol (neb), treatment of fevers, dexamethasone for reduction of inflammation of airway. Think non-invasive procedures done at outpatient clinic.
Differentiate early vs late signs of newborn sepsis, and treatment (both curative and supportive).
Early Sx: HYPOthermia, poor feeding, bradycardia, lethargy
Late Sx: HYPERthermia, petechial rash, jaundice, billious vomiting, umbilical redness, tachypnea, bulging fontanelles, bounding pulse, central cyanosis, grunting, convulsions or hyperreflexia.
Tx: Abx, breastfeeding, O2, prevention of hypoglycemia and hypothermia, frequent re-assessment.
Describe the stage of Erikson's theory of development for adolescents, including expected impact on behavior.
Ego identity vs role confusion. The adolescent is forming a personal identity outside of parents, with emphasis on peer socialization. The adolescent will rely most on peer input. May become concerned with appearance, body image. Starts thinking about identity in the world--career, dreams, social group.
Age specific exam considerations for adolescents (and adolescent age range).
What are the components of the HEADS exam? SHADESS?
Provide privacy--do not ask sensitive questions with parents present.
H-home life, E-education, A-alcohol D-drugs S-Sexual activity/Suicidal ideation
S-School, H-home, A-activities D-drug use E-emotions (depression), S-sexuality S-safety
A 1 y/o presents to the ED with a fever after parents report jerking, seizure like movements. They express concern for their 8 year old child, who is also fevering at home. They ask if the seizure had anything to do with the vaccination their infant had a week ago. What teaching would the nurse provide regarding their other child, vaccination, and long term management of febrile seizure?
Febrile seizure presents within 6 months to 5 years of life, the other child is not at risk for seizure.
Seizure results for fever above 101, may be related to immune response after vaccination or community acquired illness. Requires anti-pyretics before and after vaccination to prevent seizure.
Mgmt: Treat fevers with NSAIDs/acataminophen, cool child down during seizure, keep airway clear.
A 5 year old presents with a fever and is treated with ASA. Later, the nurse notes severe, continuous vomiting and acute changes in mental status. What condition does the nurse suspect, and what other symptoms may present with this condition?
Reye's syndrome: Affects children under age 15 recovering from viral illness. Pathology=treatment with ASA after viral illness, causing alteration of GI, liver, and brain function if ASA is continued.
Sx: severe vomiting, changes to LOC, lethargy, irritability, confusion, hyperreflexia, seizures.
History: recent viral infection, use of ASA
Tx: stop ASA, seizure precautions, monitor ICP