Chapter 35
What are the rights of pediatric medication administration
Right patient, right med, right route, right dose, right time
BOX 35.1 PAGE 1104
What are the guidelines for applying EMLA?
Eutectic mixture of local anesthetics (EMLA). The mix is of lidocaine and prilocaine. It achieves anesthesia to a depth of 2 to 4 mm. 60- to 90-minute application time to intact skin using an occlusive dressing for superficial procedures ( intramuscular injection or a venipuncture) and up to 2 to 3 hours for deeper, more invasive procedures (lumbar puncture or bone marrow aspiration)
EMLA is approved for use in infants born at 37 weeks’ gestation or more
PAGE 1159, BOX 36.1 1160
Assess apical pulse for 1 full minute prior to dosing. Withhold if apical pulse is <60 in an adolescent, <90 in an infant.
Monitor serum digoxin levels (therapeutic range: 0.8–2 ng/mL).
PAGE 1351-1352
Which injection site is contraindicated due to risk of damaging nerves/vasculature and possibility of suboptimal immune response?
Dorsogluteal TAKE NOTE 1111
Preferred injections sites: infants 12 months and less vastus lateralis or anterolateral thigh muscle
In infants and children greater than 12 months, the vastus lateralis or anterolateral thigh muscle remains the preferred site, but the deltoid can be considered if sufficient mass is present
CDC and the Advisory Committee on Immunization Practices (ACIP) no longer recommend aspiration before injection of vaccines
If a tablet or capsule is the only oral form available for medication (and it is appropriate to crush medication) what should the nurse choose to mix with said medication
A pleasant-tasting liquid or a small amount (generally no more than a tablespoon) of a nonessential food such as applesauce
PAGE 1107
What are 2 behavioral cognitive strategies for pain management? & explain how they work
Common behavioral cognitive strategies include relaxation, distraction, imagery, biofeedback, thought stopping, and positive self-talk.
PAGE 1153
A child presents to the school nurse frequently for vague complaints of dizziness and headaches. The child is brought in after fainting in the hallway following a nosebleed. The blood pressure is 128/85 and has bounding radial pulses. The nurse suspects which cardiac condition?
Corarcation of the aorta
HX frequent epistaxis, dizziness, fainting, HA
BP and pulses in upper extremities maybe higher than normal/bounding.
PAGE 1369-1370
What is amblyopia?
Poor visual development in the otherwise structurally normal eye. The vision in one eye is reduced because the eye and the brain are not working together properly. While the eyes are fighting to focus differently because of their differences in visual acuity, one eye is stronger than the other. This is why amblyopia is often referred to as “lazy eye.”
PAGE 1281
What is the sequence for administering a gavage feeding?
& what are 2 methods for verifying placement?
Check tube for placement
Measure the amount of gastric residual
Flush the tube with water and administer the feeding
Flush the tube with water
Methods for verification BOX 35.4 PAGE 1126
What examples of nociceptive & neuropathic pain etiology and where would somatic vs visceral pain be located.
Nociceptive: noxious stimuli damaging normal tissues = sharp/dull, aching/cramping examples = burns, cuts, appendicitis, bladder distention
Neuropathic: malfunctioning of the PNS or CNS = burning, tingling, shooting, squeezing or spasm like pain examples = post surgical PNS injuries, spinal cord injury pain, phantom limb pain, post stroke pain
Somatic = pain in the tissues, superficial = sharp, pricking subcutaneous or mucus membranes Deep = tendons, joints, bone, muscles: dull, aching, cramping
Visceral = organ pain, heart, lungs, deep ache, sharp stabbing (maybe referred to other areas of the body)
PAGE 1137 & 1138
The tumbling "E" or LEA symbols or Allen figures
PAGE 987-988
Anaphylaxis is in response to which immunoglobulin?
IgE
PAGE 1651
How often are blood glucose levels initially checked when providing TPN & what solution should be used if for any reason the TPN infusion is interrupted or stopped?
& dextrose 5% or 10% at the same rate as the TPN infusion
PAGE 1129
What are some behavioral indicators that a newborn is experiencing pain & what are some physiologic indicators that a newborn is experiencing pain?
Behavioral: facial expression, such as furrowed brow eyes contracting and chin quivering; stiffing body movements; and crying
Physiologic: heart rate, respiratory rate, blood pressure, oxygen saturation levels, breathing pattern, skin color, pupillary size, intracranial pressure, vagal tone, and palmar sweating
PAGE 1139
A 4 y/o likes to please their parents, begins to plan activities and makes up games. Which developmental stages supports these behaviors?
Autonomy vs shame and doubt OR Initiative vs guilt
the toddler is in Initiative vs guilt (3-6 y/o)
PAGE 884-885
What are some nursing implications with be aware of when providing NASIDs to patients?
Administer with food to decrease GI upset.
May cause gastric bleeding, increased liver enzymes, decreased kidney function
Monitor liver enzymes.
Do not crush or chew extended-release or timed-release preparations.
PAGE 1632
What would be the preferred injection site, length and gauge of needle when giving a 1ml IM injection to a preschool age child?
Vastus Lateralis (anterolateral), 5/8 to 1 in 22-25 gauge.
The goal is to use the smallest length and gauge that will deposit the medication in the muscle.
PAGE 1111 & 1112
What are the 6 self reporting pain scales mentioned in the book & how do each of them work
Faces, Oucher, Poker chip, visual analog, numeric scale, adolescent pediatric pain tool
PAGE 1143-1145
When administer ear drops in a child who is 2 y/o which way do you pull the pinna?
Administering ear drops.
For the child younger than 3 years, the nurse pulls the pinna of the ear down and back.
For a child older than 3 years, the nurse pulls the pinna of the affected ear up and back.
PAGE 1110
A child is receiving chemotherapy the nurse must be aware of the multiple adverse effects this can cause.
Please name 3 concerns and nursing management strategies.
Prevent infection, hemorrhage, anemia, nausea vomiting and anorexia
PAGE 1589-1590