Chapter 35
What is the difference between pharmacodynamics and pharmacokinetics?
Pharmacodynamics: drugs behavior in the body (immature immune system - body may not respond normally or have diminished effects - increases risk of toxicity)
Pharmacokinetics: movement of drugs through the body (absorption, distribution, metabolism, excretion)
Describe the different types of pain (acute, chronic, nociceptive, neuropathic, somatic, visceral).
Acute: rapid onset, lasts a few days
Chronic: pain that continues past expected point of healing
Nociceptive: damage to normal tissue
Neuropathic: due to malfunctioning of the nervous system
Somatic: develops in the tissues
Visceral: pain that develops within the organs
Which childhood diseases are preventable by vaccinations?
rubella, measles, chickenpox, diphtheria, pertussis, tetanus, mumps
What is the key symptoms of meningitis?
photophobia (sunlight is too bright)
What teaching should be taught for nasolacrimal duct (tear duct)?
how to gentley massage the duct that has an obstruction
Should you mix oral medications with foods?
No, because it can cause the child to refuse to eat
What are some common symptoms of nociceptive and neuropathic pain?
Nociceptive: sharp, achy, cramping, stabbing
Neuropathic: tingling, shooting, burning, spasm-like
rubella: 12-23 days
measles: 10-12 days
chickenpox: 10-21 but usually 14-16
diphtheria: 2-5 days
pertussis: 7-10 days
tetanus: 3-21 days
mumps: 12-25 days
poliomyelitis: 3-6 days
Name some nursing considerations for a child who has epilepsy?
safety, stay calm, if child is standing or sitting ease them to the ground, time the seizure, remove or loosen clothes and jewelry around the neck, place child on their side and do not restrain them, maintain a patent airway, remain with the child until they are fully conscious
Care for myopia, amblyopia, and hyperopia.
Myopia: nearsightedness - glasses or contacts
Amblyopia: lazy eye - patch
Hyperopia: farsightedness - glasses or contacts
What position does a child need to be in to get a suppository?
Side-lying with leg bent towards chest
Name some of the pain assessment scales used.
FACES: for children 3-8 years old
Ouchers: photos of crying to create pain scale
Numeric
Word-Graphic: ages 8-15
Infants: facial expressions, crying, breathing patterns, state of arousal
Kolpik spots are shown in which childhood disease?
Measles
(bright red spots with white centers in the mouth)
name the cranial nerves and assessments for them.
Olfactory (I): smell - ability to recognize common smells
Optic (II), Oculomotor (III), Trochlear (IV), Abducens (VI) - vision - motor control, movement of eyes, pupil reaction
Trigeminals (V): facial sensations - sucking and bite strength
Facial (VII): facial muscles, salivation, taste, symmetry of facial expression
Acoustic (VIII): hearing - response to voice, whisper test
Glossopharyngeal (IX), Vagus (X): motor impulses to organs - swallowing and gag reflex
Accessory (XI): head and shoulder symmetry in sitting position
Hypoglossal (XII): motor impulses to tongue and skeletal bones
education related to myringotomy tubes.
wear protective ear plugs when going into water and do not attempt to clear the ear
What is the preferred location for an IM injection in a child?
Vastus Lateralis
Name and describe different types of pain management in pediatrics?
Behavior-Cognitive: relaxation, distraction, imagery, biofeedback, thought stopping, positive self-talk
Biophysical interventions: sucking and sucrose, heat and cold applications, massage and pressure, transcutaneous electrical nerve simulations (TENS)
Nonopioid: acetaminophen, NSAIDs (ibuprofen, ketorolac, naproxen)
Opioid: norphine, fentanyl, oxy
Adjuvant Drugs: benzos, anticonvulsants, local anesthesia, epidural, analgesics, conscious sedation
True or False:
You should always obtain blood culture after the first round of antibiotics.
False
you should always obtain blood cultures before administering antibiotics
Key s/s of hydrocephalus.
sunset eyes, increased ICP, bulging fontanel
What are the surgical options for infantile glaucoma?
Goniotomy (removal of obstruction of the aqueous humor), laser surgery, ongoing medication therapy
What are some important teaching points about TPN?
1. should not hang longer than 24 hours
2. can cause hyperglycemia if administered too quickly
3. HOB needs to be at least 30 degrees to prevent aspiration
4. Monitor vitals closely, use occlusive dressings, assess I&O, monitor glucose closely
Age appropriate teaching or assessment in pediatrics.
pain can lead to alterations in blood glucose, children with different temperaments more likely to have increased distress response to pain, newborns can feel pain, just because a child is sleeping or playing does not mean they do not have pain, dependence can develop within a week
How does rubella affect pregnant woman?
rubella during pregnancy can cause miscarriage or congenital malformations
What are the different classifications of a patient's level of consciousness?
Fully: awake and alert, appropriate behaviors
Confusion: slightly disoriented, alert but responds innapropriately
Obtunded: limited responses to the environment and falls asleep unless stimulated (more depressed LOC, cannot be fully aroused)
Stupor: child only responds to vigorous movements
Coma: cannot be aroused, even with painful stimuli
What are the levels of hearing loss?
0-20 db: normal
20-40 db: mild
40-60 db: moderate
60-80: severe
greater than 80: profound loss