Intro to peds
Give me three examples of techniques for providing atraumatic care for a pediatric patient.
Therapeutic communication
Therapeutic play
Child education (age appropriate)
Distraction
Parental presence
Offering choices
Name five newborn reflexes and tell me what they are.
Root
Moro
Palmar
Plantar
Babinski
Fencing
Sucking
What are signs and symptoms of severe dehydration?
sunken fontanels
deeply sunken orbits
dry oral mucosa
skin tenting
delayed cap refill
cool extremities
urine output <1mL/kg/hr
What is the nursing assessment and management of croup?
•Nursing Assessment – note age of child, history of cough in night or barking cough, presence of URI s/s, listen for inspiratory stridor and observe for suprasternal retractions, dx based on history and clinical presentation
•Nursing management – if at home – teach s/s of respiratory distress and when to seek treatment
Teaching--- keep child quiet and discourage crying, allow the child to sit up in arms, encourage rest and fluids, if stridor occurs take the child into a steamy bathroom for 10 minutes, administer medication (corticosteroid) as directed
Resp distress: child breathes faster, has retractions, or has any other difficulty breathing, the nostrils flare or lips turn bluish tint, the cough or stridor does not improve with exposure to moist air, restlessness incresaes or the child is confused, the child begins to drool or cannot swallow.
Give me three early signs and three late signs of Increased ICP.
Late: lowered LOC, decreased motor and sensory response, bradycardia, irreg resp, cheyne stokes resp, decerebrate or decorticate posturing, fixed and dilated pupils
At what months is the DTap vaccine recommended to be given?
2, 4, 6, 15-18m, 4-6y
Name three gross motor and three fine motor skills of a toddler.
Gross motor
-Initial walking with “toddler” gait
-Pushing or pulling a toy
•Later includes:
-Running
-Climbing
-Jumping
-Throwing a ball
-Pedaling a tricycle
•Fine motor
-Progresses from holding and pinching
-Manages utensils
-Holds crayon
-Strings a bead
-Works a puzzle
-Uses a touch screen
What is nursing management for enuresis?
Nursing management – with diurnal enuresis – encourage to increase fluids consumed during the day in order to increased freq of the urge to void. Set a schedule for attempts to void. This can help retrain the voiding pattern. Over age 6 with nocturnal enuresis without a physiological cause may require varied approach – EBP box about medications for enuresis pg 1568
Educating – teach that the child is not lazy, they do not wet themselves on purpose. Encourage parent to limit intake of bladder irritants such as chocolate and caffeine. Teach to limit fluid after dinner and make sure they void prior to bedtime. Waking the child to void at 11pm may also be helpful. Teach to used bed pads and make bed with two sets of sheets/pads. When sleeping at home the child should wear normal underwear and pjs. If away on a trip, pull-ups may decrease stress on both child and parent.
Provide support – make sure they know they are not alone. Parents should include the child in plans for nighttime control. This will increase motivation. Set up a reward system. Include them in linin changes, but as a matter-of-fact way NOT in a punitive or punishment way. Avoid punishment for bedwetting!! Patience, consistency, and time.
What are the four physical characteristics for Tetralogy of Fallot?
•Pulmonary stenosis
•Right ventricular hypertrophy
•Overriding aorta
•Ventricular septal defect
What are the steps to teach parents if their child has a seizure?
Remain calm
ease child to the ground, if possible
time seizure episode
tight clothing and jewelry around neck should be loosened if possible
do not restrain the child
remove hazards in the area
do not forcibly open jaw with fingers
document length of seizure and movements noted (also cyanosis or loss of bladder or bowel control)
Call EMS if: child stops breathing, injury, lasts longer than 5 min, first seizure, unresponsive to painful stimuli after seizure
What is one aspect of the pediatric health history that is important for this population but would not need to be asked in an adult patient?
Prenatal history
What is Erikson's Development theory for the Preschool child (age 3-6 years)?
Initiative versus guilt
Likes to please parents Begins to plan activities, make up games Initiates activities with others Acts out the roles of other people (real and imaginary) Develops sexual identity Develops conscience May take frustrations out on siblings Likes exploring new things Enjoys sports, shopping, cooking, working Feels remorse when makes wrong choice or behaves badly Cooperates with other children Negotiates solutions to conflicts
Name three fungal infections and what it is?
tinea pedis- feet
tinea corporis- arms or legs
tinea versicolor- trunk and extremities
tinea capitis- scalp, eyebrows, eyelashes
tinea cruris- groin
What is the nursing management for Juvenile Idiopathic Arthritis?
NSG Management – focus on managing pain, maintain mobility, and promoting a normal life. Refer to peds rheumatologist so they receive the most updated treatment plans. Administer disease-modifying medications and teach children and families how to do so as well. Encourage regular eye exam/vision screening to allow for early treatment and prevention of blindness.
Promoting Normal Life – provide adequate pain relief. Promote compliance with disease modifying medications. Encourage adequate sleep. Warm baths at bedtime and warm compresses to the affected joints. Prevent social isolation, make sure school is aware of diagnosis and limitations. May have two sets of books – one for school and one for home so they don’t have to carry heavy books, possibly have extra time when changing classrooms. Encourage to be involved with local support groups.
What are teaching guidelines to give parents or caregivers of children with osteogenesis imperfecta?
• Never push or pull on an arm or leg.
• Do not bend an arm or leg into an awkward position.
• Lift a baby by placing one hand under the legs and buttocks and one hand under the shoulders, head, and neck.
• Do not lift a baby’s legs by the ankles to change the diaper.
• Do not lift a baby or small child from under the armpits.
• Provide supported positioning.
• If fracture is suspected, handle the limb minimally.
What are the dose recommendations for Oral Acetaminophen?
Hint: _______mg/kg/dose
10-15 mg/kg/dose
No more than every 4 hours
No more than 5 doses in 24 hour period
What are four signs of vision problems in school age children?
eye rubbing or squinting
avoiding reading
frequent headaches
holding reading materials close
Problems with depth perception or hand–eye coordination
What are risk factors for retinopathy of prematurity (ROP)?
Low birth weight
Early gestational age
Sepsis
High light intensity
Hypothermia
Hypoxia
Duration and concentration of supplemental oxygen
What are important teaching guidelines for cancer and chemotherapy?
infection control measure- hand hygiene, avoid contact with ill people, avoid crowds, no live vaccines, no rectal temps or rectal medications
family education- obtain written copy of child's treatment plan, calendar of all appointments, call if child's temp is above 101F, call for cough or rapid breathing, increased bruising, blisters, rashes, ulcers, red irritated skin on the child's buttocks, abd pain, constipation or diarrhea
What are some warning signs of autism, found in infants and toddlers?
Does not imitate
lack of interest in joint attention
eye contact abnormalities
delayed language development
failure to develop symbolic- imaginative play
losing language or social skills at any age
What is the IV fluid calculation formula for pediatric body weight?
100 mL per kg of body weight for the first 10 kg
50 mL per kg of body weight for the next 10 kg
20 mL per kg of body weight for the remainder of body weight in kilograms
Name 5 ways to improve communication with adolescent/teens.
•Allow sufficient time for conversation
•Speak respectfully as you would to a colleague
•Talk face to face; be aware of body language (yours and the teen’s)
•Ask open-ended questions to clarify and promote understanding
•Reflect back what you think you heard so that he or she feels heard
•Choose words carefully so that message and intent are clear
•Be honest; don’t be afraid to say you don’t know
•Be liberal with praise; acknowledge effort
•Solicit the teen’s input in decision making as often as possible
•Clearly state expectations and set limits fairly
What are the differences with DI and SIADH?
ADH causes the kidneys to retain water.
DI- hyposecretion of ADH (kidneys are not reabsorbing enough water)
Polyuria, thirst, dehydration, diluted urine, dry mucous membranes
SIADH- hypersecretion of ADH (body is retaining to much water)
fluid overload, weight gain, low urinary output, concentrated urine, hyponatremia
Compare childhood cancer vs adult cancer
childhood cancer: usually in tissues, common sites are blood, lymph, brain, bone, kidney, muscle; little known prevention, usually incidental or accidental detection, metastasis often present at diagnosis
adult cancer: usually in organs, most common sites are breast, lung, prostate, bowel, bladder; environment/lifestyle factors are strong influences on cancer development, 80% preventable, can detect early with screenings, metastasis less often present at diagnosis
What is the difference between spina bifida occulta, meningocele, and myelomeningocele?
spina bifida occulta- Defect of the vertebral bodies without protrusion of the spinal cord or meninges. Not externally visible, Need no immediate medical intervention, Complications are rare but may include tethered cord, syringomyelia, or diastematomyelia, May have noticeable dimpling, hairy tuft, or discoloration of skin at defect site
meningocele- The less serious form of spina bifida cystica, Meninges herniate through a vertebral defect, Spinal cord is usually normal, Minor to no neurological deficits generally, Treatment is surgical correction of the lesion site
myelomeningocele- Most severe form of neural tube defect; Type of spina bifida cystica, but most people clinically term this “spina bifida”; Spinal cord usually ends at the point of the defect, Absent motor and sensory function beyond that point, Long-term complications of paralysis, orthopedic deformity, and incontinence