Pediatric Pain & Care of Chronically Ill Child
Name 3 pediatric pain scales
FLACC, CRIES, FACES, Number, Word
What is the most common scoring system used to describe the level of consciousness of a person?
Glasgow Coma Scale
A 7 y/o tells you they have cancer in their muscles, what disease do they have?
Rhabdomyosarcoma
A 4 y/o with a recent diagnosis of UTI is readmitted with flank pain. What is the likely cause?
Pyelonephritis
Name 2 physiologic, psychologic, and family effects of the immobilized child.
Physiologic: GI, integumentary, cardiovascular, respiratory, developmental regression.
Psychologic: Altered perception of self and environment, increased frustration, helplessness, and anxiety, depression, anger, aggressive behavior.
Family: Disruption to family function, logistic management of ill child, support, coping skills.
This congenital heart disorder has 4 distinct defects.
What is Tetralogy of Fallot?
This postoperative development may indicate bleeding after a tonsillectomy.
What is frequent swallowing?
Name 2 causes of iron deficiency anemia.
What is decreased fetal iron stores and increased cow's milk intake?
When auscultating, you hear a machinery like murmur. What is most likely the congenital heart defect?
Patent Ductus Arteriosus
A 4 m/o is diagnosed with hearing impairment. What might be some clinical manifestations that eluded to this diagnosis?
No startle response; not cooing or babbling.
A small sac-like structure filled with meninges and spinal fluid often found on the low back.
Meningocele
What is the treatment of Acute Lymphocytic Leukemia (ALL)?
Bone Marrow Transplant
What is the cause and the concern of Hirschsprung's disease?
Genetic issue resulting in missing nerves in the large intestine muscle cells. Decreased motility through the large intestine resulting in blockages. Toxic megacolon.
An 8 m/o with Tetralogy of Fallot becomes irritated, upset, and inconsolable. They start turning blue around the mouth and in the fingers and toes. What interventions do you perform?
Knees to chest
Try to calm baby
Supplemental oxygen
IV fluids
This is an early sign of heart failure in infants.
What is tachycardia?
Sudden onset of harsh, barky cough, inspiratory stridor, and sore throat.
What is croup?
What is pancytopenia and what disorder is it found with?
What is profound anemia, leukopenia, thrombocytopenia? What is aplastic anemia?
Upon auscultation, you hear asymmetric breath sounds. There are no other symptoms. What is the likely cause?
What is foreign body aspiration?
What would be a nursing educational point to a parent who tells you "they don't need any lidocaine cream, they don't feel pain like we do," when their 4 y/o child is about to get an IV placed?
Children feel pain just like adults do.
Repeated painful experiences do not make children tougher.
Children can remember painful stimuli.
Lumbar puncture (meningitis)
A 15 y/o pt has a central line for chemotherapy. They come in with a fever of 102.1 F. What are two interventions you expect to do immediately?
Injury in children less than one year of age, commonly occurs as a result of child maltreatment due to shaken baby syndrome.
What is diffuse axonal injury?
What is the concern with QT prolongation?
Atrium contract before ventricles repolarize, leading to Vtach.
This serious infection is often caused by bacteria entering the bloodstream through dental procedures.
What is bacterial infective endocarditis?
Name 3 signs of epiglottitis that begin with the letter "D."
dysphonia
Dysphagia
Drooling
Distressed respiratory effort
A patient with sickle cell anemia is experience increased pain in joints, visual disturbances, swelling of hands. What is happening?
What is a vaso-occlusive crisis?
Description of convulsion that include rhythmic stiffening and jerking of trunk and extremities.
What is tonic-clonic activity?
You are discharging a family of a newborn with Trisomy 21. In addition to educating about the lifelong effects of this condition, list three things you might inform the family about/make sure they are thinking about for themselves?
Financial counseling, support group, likely not their fault, self-care, childcare, counseling.
Increased intracranial pressure
A patient is known to have nausea and vomiting with their chemotherapy administration. What are two medications you could consider giving?
Ondansetron(Zofran), Aprepitant (Emend), Proclorperazine (Compazine), Lorazepam (Ativan), Famotidine (Pepcid), Dexamethasone (Decadron)
Infection causing fever, irritability (or lethargy), and nuchal rigidity most commonly caused by Haemophilus influenzae type B, or Streptococcus pneumoniae.
What is bacterial meningitis?
A 1 y/o suffers a traumatic injury and fractures their femur. As a nurse, what questioning attitude do you practice? It was found to be accidental, what do you educate the parents about when they say "my baby will never be able to walk now."
1) Babies rarely fracture bones, especially femurs.
2) Bone healing in children happens quite rapidly. This pt, likely about 4-weeks.
This medication is prescribed for Kawasaki's disease for it's anti-inflammatory and anti-platelet effect.
What is aspirin?
This breath sound is commonly heard during an asthma attack.
What is wheezing?
Name the 3 major types of hemophilia and what factors they are deficient in?
What is VWD (vwf), hemophilia A (VIII), hemophilia B (IX)?
Characterized by recurrent unprovoked seizures and is not diagnosed until the patient has two or more afebrile seizures.
What is epilepsy?
You are caring for a 16 y/o pt who has a terminal disease and just signed on to hospice. What information is important to remember when communicating with a child in this developmental stage.
Value time with peers more than parents.
Just beginning to learn about themselves, major events (driving, dating, dances, graduation, work).
Increased body perception.
1-2 months after VP shunt placement is greatest risk for infection. Septicemia, bacterial endocarditis, meningitis.
Aggressive antibiotics, possible shunt removal.
What are three differences between pediatric and adult cancers?
Detection is usually accidental, Cannot be prevented, At detection about 80% metastatic, Response is very chemosensitive, Treatment has lower acute toxicity but higher long-term effects.
Name the onset, peak, and duration of humalog & of lantus.
Humalog: O: 15 min, P: 40-50 min, D: 3-5 hours
Lantus: O: 1 hour, P: 0, D: 24 hours
Why do holes in the heart (Atrial septal defect, ventricular septal defect, patent ductus arteriosus) lead to an increase in pulmonary bloodflow?
L to R shunt. L-side of heart has increased muscle, pressure, and contraction to supply the rest of the body.
Rheumatic fever is diagnosed using the modified Jones criteria. Name 2 of the 5 major criteria.
What is carditis, subcutaneous nodules, polyarthritis, rash, and chorea.
The term used for frothy and foul-smelling stools in children with cystic fibrosis.
What is steatorrhea?
ame the triad of problems associated with Wiskott-Aldrich Syndrome?
Thrombocytopenia, eczema, immunodeficiency of selective B and T lymphocytes.
Seizures typically occuring between 6 months to 5 years of age with the most common associated infectious illness being otitis media (34%).
What are febrile seizures?