Care and Assessment
Name the three components of the pediatric assessment triangle (PAT)
1. Appearance
2. Work of Breathing
3. Circulation
At what age is a child able to use their pincer grasp?
12 months old
Name two ways in which pediatric anatomy differs from that of adults.
- infants are obligate nose breathers (until 6 mo)
- sinuses less developed
- more narrow airway (specifically more narrow/funnel shaped larynx)
- pliable chest wall (causing increased retractions when in distress)
What is the treatment protocol for pediculosis capitis (head lice)?
- Washing hair and scalp with pediculicide with a second treatment 9-10 days after the first
- Inspect and treat close contacts
- Wash frequently used materials (pillow cases) in hot water
- Non-washable items sealed in a plastic bag for 10 days
- Contact precautions
At what age do the anterior and posterior fontanelles close?
Anterior: 9-18 months old
Posterior: 2-3 months old
(Note: Some sources are different with this. Our lecture had 12-18 months and 6-8 weeks. I personally would memorize what is in Maddie's lecture [what I included here])
At the age of one-year-old (12 months), the infant should weight ___ times their weight at birth.
Three times. (Tripled weight).
The infant should double their age by 6 months old.
What Erickson's stage is the toddler (1-3 y/o) in?
Bonus: What does that mean?
Autonomy vs. Shame and Doubt
Toddlers want to start doing things by themselves (dressing, potty training, etc.). You will often hear negativism at this age as a way to show independence. This is normal and expected.
Bronchiolitis is caused by which pathogen and is characterized by which symptoms?
Respiratory syncytial virus (RSV)
Characterized by runny nose, sore throat, and low grade fever that develops into cough, wheeze, and copious nasal secretions
What is the treatment plan for a patient with measles?
- Airborne and droplet precautions
- Rest
- Fever management
- Vitamin A supplementation
- O2 support
- vaccine education
- notify public health officials
Note: There is no FDA approved antiviral treatment for measles
At what age can children safely start having ibuprofren?
6 months or older
A three-year-old patient is being seen for a well-child visit. Their vital signs are as follows:
T 98.4 F
P 90
R 22
BP 92/62
SpO2 99%
Are these normal findings for this child?
Yes!
P: 65-110
R: 20-25
BP:(89-112)/(46-72)
What are some of the safety concerns for the adolescent patient?
- firearm safety
- driving
- substance use
- mental health
- sexual health
- online safety
Briefly describe the pathophysiology of cystic fibrosis
- autosomal recessive disease caused by deletion in the CFTR gene
- mutation causes exocrine gland dysfunction
- more specifically, causes dysfunction of chloride transport channels which causes abnormally thick secretions in glandular tissues (respiratory, GI, and reproductive tracts)
What are the signs and symptoms of acute otitis media? (try to list at least 4)
Bonus: What are some risk factors for development of acute otitis media?
RF: Young age, day care attendance, second hand smoke exposure, history (especially before 3 mo old), URI (Note: Breast feeding is a protective factor)
Please provide the maintenance fluid rate for a child who weighs 35kg.
75mL/hr
4mL/hr for first 10 kg = 40 mL
plus 2mL/hr for second 10kg = 20mL
plus 1mL/hr for remaining weight -> 15*1 = 15mL
40 + 20 + 15
Name the pain scale you would use for a toddler older than a year who does not have the verbal language yet to describe how they are feeling
FLACC (Face, Legs, Activity, Crying, Consolability)
NIPS <1 y/o, FACES 2-8 y/o, Oucher 3-12 y/o, numerical scale >7
Name at least 5 normal developmental expectations at 9 months of age.
- sits without support (and can get to a sitting position)
- passes an item between hands
- babbles in strings (mamamama)
- lifts arms to be picked up
- looks for objects when dropped out of site
- bangs toys together
- stranger danger
- smile/laughs
- responds to name
What is the treatment plan for a patient with laryngomalacia?
Upright feeding and reflux treatment
Infants who experience significant distress (apnea, failure to thrive, severe retractions, hypoxia) will require a supraglottoplasty
What pathogen causes hand-foot-and-mouth disease and how is it most commonly spread?
Coxsackie A viruses
Usually spread by saliva (fecal and oral secretions)
A parent brings their patient to the ED for a high fever and sore throat. When the nurse comes in, they notice the child is in a tripod position and drooling. What should the nurse do next, what should they avoid, and what do they expect the child has?
Epiglottis.
Provide oxygen, allow child to remain comfortable, give IV antibiotics, prepare for PICU admission and intubation. Have supplies ready for emergency tracheostomy.
Do NOT leave the patient or examine the throat! Airway may close suddenly.
Name three ways to help make a hospital visit more comfortable for a toddler
- Maintain their home routine
- Encourage parental involvement during exams
- Complete procedures in a different area than where they stay
- Allow them to touch equipment before it is used on them (ie. hold the stethoscope before listening to heart and lung sounds)
- Offer medical play equipment
- Demonstrate procedure on doll (older toddlers more responsive)
A mom brings her 5-year-old into the clinic and is concerned about their development. What are some things that the nurse should tell her to expect? (AKA what are the expected findings for a 5 year old)
Motor: Hop and balance on one foot, draw some letters, fasten buttons, dresses and toilets without assistance
Cognitive: Count to 10, understands time, names some letters
Language: Intelligible speech, tells stories
Social/Emotional: Follows rules, take turns, performs simple chores
Name three signs of respiratory distress and three signs of respiratory failure
Respiratory Failure: Decreased level of consciousness, decreased breath sounds (absent breath sounds in asthma = BAD), bradypnea or apnea, bradycardia, cyanosis/pallor, low SpO2
What are the treatment considerations for a patient diagnosed with varicella zoster?
- Fever management (acetaminophen)
- Skin care and antipruritics
- Contact and Airborne precautions
- High risk populations may get immunoglobulin and antivirals
- CAN return to school after lesions have crusted
You are part of the NICU team called to the birth of an infant at 34w 4d gestation. When the infant is taken for assessment, you notice that their trunk is pink while their peripheral extremities (hands/feet) are blue. What is this called and how should the nurse intervene?
Acrocyanosis.
The nurse should continue to monitor. If showing other signs of respiratory distress, the nurse may choose to provide respiratory interventions but alone, this is a normal sign after birth.