HESI PEDIATRICS HESI Guide 2. Questions And Answers.

Pediatrics HESI Guide 2 1. Remember: If you know the normal; you are then able to identify what is not normal. Age Pulse Resps. Blood Pressure Temperature Newborn 100 to 160 30 to 60 Systolic: 65-95 Diastolic: 30-60 97.7-99.1 (axillary) 1 to 11 months 100 to 150 25 to 35 1 to 3 years (toddler) 80 to 130 20 to 30 3 to 5 years (preschooler) 80 to 120 20 to 25 Girls: 91-104/52-66 Boys: 93-107/ 50-65 97.5-98.6 (axillary) 6 to 10 years (school age) 70 to 110 18 to 22 Girls: 102-115/60-74 Boys: 102-115/61-75 97.5-98.6 (oral) 10 to 16 years (adolescent) 60 to 90 16 to 20 Girls: 111-124/66-80 Boys: 116-130/65-80 97.5-98.6 (oral) - Safety basics/various facts: Airway and breathing are always first!! • Remember the ABCs: ◦ A- airway: patent airway always priority #1, age regardless ◦ B- breathing ◦ C- circulation ◦ D- disabilities (LOC) ◦ E- exposure • Feeding: 108kcal/kg/day • Child falls & bumps head: NEURO ASSESSMENT FIRST • Preferred IM site: Vastus Lateralis • Poison Ingestion: NO syrup of ipecac to induce V (RT rebound corrosion on throat); typical treatment: activated charcoal, may need gastric lavage 2. Review G&D (Milestones, Theorists)-------chapter 4, Pg 55 a. 4mo old—what is expected i. Social smile occurs at 2mo ii. Head turns to locate sounds at 3mo iii. Moro & other primitive reflexes (aside from Bartaloni disappear) iv. **Steady head control (hold head and chest upright while lying on stomach during tummy time); kick & push with their feet 1. Roll from BACK to SIDE v. Hands work together to move toy/shake rattle—readily grabs objects close by and puts them in mouth b. Rolls from ABD to BACK (5mo) AND BACK TO ABD (6mo) i. Sit unsupported at 8mo; crawl at 9/10mo; walk at 10-12; 15-18mo ready to run c. When should a child self feed with a spoon and cup? 2yo d. Gesell’s theory of development: biophysical development based on child’s genetic blueprint and influenced by experiences, therefore unique and individualized. 3. Maslow’s hierarchy: Basic needs come first. a. Physiological: water, sleep, food, breathing, excretion, homeostasis, sex b. Safety: security of resources, body, health, home, etc. c. Love/belonging d. Esteem e. Self-actualization: morality, acceptance of facts, etc. 4. Delegating: Understand the nursing process. Assessment, planning care, education must be by the RN. NOTE: health hx is only subjective data (what is reported by parents) a. What is the nursing process? i. a five-part systematic decision-making method focusing on identifying and treating responses of individuals or groups to actual or potential alterations in health 1. Assessment a. Collection of subjective & objective data; qualitative and quantitative 2. Diagnosis a. Analyzing assessment data to determine a label for the nursing diagnosis b. Provides focus for nursing 3. Planning a. Strategies to use to lead to expected outcomes: establish priorities, client goals, expected outcomes and interventions, then communicate the plan of nursing care 4. Implementation a. Carry out the plan to promote health & SAFE environment b. Start with interventions most likely to achieve goals & expected outcomes that are needed to support or improve status 5. Evaluation (ONGOING) a. Determine if conditions are improving, outcomes met, make clinical decisions/redirect care to meet client needs • RN: task delegation ◦ Specialty care ◦ Severe cases ◦ Sterile procedure ◦ Assessment ◦ Planning care (i.e care plans) ◦ Teaching ◦ Evaluation ◦ IV meds • UAP- more like a CNA ◦ Routine Procedures & ADLs • LPN- licensed practical nurse- does more than a UAP ◦ Chronic cases; Stable clients; routine procedures 5. Lyme Disease [red bull’s eye rash w/in 3-30days] a. When do you check for ticks? i. April to October is tick season. ii. CHECK RIGHT AWAY- after playing or being outside (head to toe), especially if your skin was exposed. b. Contact PCP if the tick is not completely removed. c. What signs and symptoms indicate need for medical attention? i. Medical attention is needed when the first set of symptoms occur! 1. Fever, malaise, rash/bullseye, flu-like S&S 2. Later on: NEURO [catch early and treat w/ antibiotics] ii. There are 3 stages of symptoms of Lyme disease: 1. Early localized stage: vague flulike symptoms (malaise, fever, headache, chills, fatigue, and vague muscle aches and pains.) a. Doxycycline is given when these symptoms start to appear. Though they may not have been diagnosed with Lyme disease, this antibiotic is cheap, and it does not hurt to start using it anyways. 2. Early disseminated stage: 1-4 months after bite. Neurologic symptoms may be the first to occur. CNS symptoms- severe headaches, with myelitis, nausea, vomiting, facial nerve paralysis (Bell’s Palsy), forgetfulness, decreased concentration, cerebral ataxia; lymphadenopathy, joint and muscle pain. 3. Late disseminated stage: months to years after bite. Chronic arthritis, profound fatigue, and chronic neurologic manifestations. 6. Child admitted for persistent V & D. What acid-base imbalance is likely? a. Metabolic alkalosis (RT excessive loss of hydrochloric acid from stomach) b. TX: may be giving D5W NS w/ KCL: get BUN & creatinine prior—ensure child is urinating before KCL admin. c. What assessment is most important? i. Measure the apical pulse (HR increase) 7. Epiglottitis is a respiratory emergency: Know the identifying symptoms and emergency action you should anticipate. a. Symptoms: Sudden onset i. Restlessness ii. High fever (100.4 q1hr OR 101.3 1x= BAD) iii. Sore throat, dysphagia iv. Bulging tympanic membranes (inflamed) v. Drooling vi. Muffled voice vii. “frog-like croaking” ---cyanotic viii. Tripod position: upright w/ chin out & tongue protruding (trying to breath) b. Emergency action: i. Prepare for intubation or tracheostomy: mostly tracheostomy because you probably will not be able to pass a tube. ii. Bring to hospital right away. iii. Check lung sounds. iv. Check temperature, blood pressure, and tympanic membrane. Checking their ears is important because they will have bulging ear drums. v. Encourage prevention with Hib vaccine. vi. Maintain child in upright sitting position. vii. Administer IV antibiotics as prescribed. viii. Prepare for hospitalization in ICU. ix. Restrain as needed to prevent extubation. x. Employ measures to decrease agitation and crying. xi. Do not examine the throat because of risk of obstructing the airway! c. Post intubation, take blood cx; IV antibiotic: cefotaxime; rifampicin prophylaxis to household contacts 8. Croup: what advice can you offer parents as an intervention at home? • Bring them into a really steamy bathroom or the co