Blueprint for peds Exam 3 NUR 425
‘Session A’ Spring 2021
Medications:
●Nystatin - drug of choice for thrush; may need to be applied with a Q tip if neonate,
encourage patient to hold it in their mouth as long as possible and discourage activities
that may remove it like eating after application
●Mannitol- a diuretic that decreases pressure off the brain by causing excess
urination, does not affect Na (works fast)
●N-acetylcysteine - antidote for acetaminophen/tylenol overdose
●Deferoxamine- used to treat those with iron and aluminium poisoning ● Epi-pen
- for anaphylactic reactions; available in two sizes, administration through clothes is
permitted
●Mupirocin- used to treat boils or impetigo
●Lorapplied-
●Naloxone - opioid reversal agent
●Keppra - for epilepsy, do not need anti seizure med for discharge, educate about how
to control fever
●Acyclovir - for viral meningitis
●Hydroxyzine - for atopic dermatitis/eczema, for itching but can cause sedation, use before
bedtime
●Diphenhydramine (benadryl) - for atopic dermatitis/eczema, for itching but can cause
sedation, use before bedtime
●Laratindine (claritin) - for atopic dermatitis/eczema, for itching, non-sedative
antihistamine
●Fexofendaine (allegra) - for atopic dermatitis/eczema, for itching, non-sedative
antihistamine
●Tacrolimus - for atopic dermatitis/eczema, topical immunomodulator for flare ups ●
Pimecrolimus - for atopic dermatitis/eczema, topical immunomodulator for flare ups
Vaccinations:
●Hib vaccine
○protects children against acute epiglottitis and bacterial meningitis
●DTap vaccine
○Protects against pertussis
●Pneumococcal conjugate vaccine-PCV13
○Give to prevent bacterial meningitis as infant
●Meningococcal polysaccharide vaccine-Menactra
, ○meningococcal disease in teens
NEW CONTENT
Neuro lecture - 19
questions Learning
outcomes:
●Describe the methods of assessing the neurologic function of a pediatric patient,
including use of the Glascow Coma Scale 3 questions
○If less than 8 on Glascow Coma Scale → intubate
○How to use the Glasgow Coma Scale
■ Know dev milestones!
■ Used to identify criteria for consciousness but not used for those with dev
delays or paralysis bec of false results even though they may be cerebrally
intact
■ Range from 3- 15 (3 lowest); the higher the better
■ Decorticate and decerebrate may be elicited with stimulation
●decorticate (flexion) → lesion above brainstem/ cerebral cortex
dysfx
●Decerebrate (extension) → lesion @ midbrain or brainstem →
worse (score less in GCS)
●Earliest indicator of change in neuro status
○VS:
■ Changes (variable) in HR/ RR/ BP (more important than direction)
●Ie Cheynes Stokes in DKA → apnea 10-60 seconds → increased
depth and rate of breaths
, ●MAP in peds should be > 50!
■ Cushing’s triad = VERY late sign in peds → high BP, low
HR/RR ○ Fontanels- Assess if less than 2 yrs old; posterior fontanelles closes
at 1-2 mos; anterior fontanelle usually closes @12-18 mos
○Head circumference- can bulge for high ICP → tense, tight, taut
■ Measured until 36 months (if w/o neuro issues); suture lines fused by 12
y/o ; head expansion due to suture lines and NOT by expanding cranial
bones ( cranial bones ossified at 8 y/o) → older → herniate into foramen
magnum instead of separating sutures
○Pupils
■ Pinpoint → OD (ie mydriatic Rx ind for low HR/ exposed to nerve
agents)
■ Dilated→ brainstem herniation
■ Bilateral fixed and dilated → brainstem herniation
●Terms used in assessment of neuro status
○Forgetful = Confusion
○Drowsy = Lethargy- just woke up from a nap,
○Arousable by stimulation = Obtunded- o comes before S, you gently stimulate
before you shake them to get up
○Arousable by vigorous stimulation = Stuporous
○Cannot arouse = Coma
●Indicators for Cushing’s triad
○Cushing’s triad: a VERY late sign in pediatrics: Increased BP, Decreased HR
and RR- slowing of pulse and increasing BP, irregular disease-
●Illustrate the effects and management of increased intracranial pressure in the
pediatric patient 3 questions
○Give meds, oxygenate, do not overhydrate
●What would you assess for in a patient with suspected increased ICP
○Tense, bulging fontanel
○Separated cranial sutures
○Macewen (cracked-pot) sign- feel the skull crinkling
○Irritability and restlessness
○Drowsiness
○Increased sleeping
○High-pitched cry- neural cry- ask if it is different
○Increased fronto occipital circumference
○Distended scalp veins
○Poor feeding
‘Session A’ Spring 2021
Medications:
●Nystatin - drug of choice for thrush; may need to be applied with a Q tip if neonate,
encourage patient to hold it in their mouth as long as possible and discourage activities
that may remove it like eating after application
●Mannitol- a diuretic that decreases pressure off the brain by causing excess
urination, does not affect Na (works fast)
●N-acetylcysteine - antidote for acetaminophen/tylenol overdose
●Deferoxamine- used to treat those with iron and aluminium poisoning ● Epi-pen
- for anaphylactic reactions; available in two sizes, administration through clothes is
permitted
●Mupirocin- used to treat boils or impetigo
●Lorapplied-
●Naloxone - opioid reversal agent
●Keppra - for epilepsy, do not need anti seizure med for discharge, educate about how
to control fever
●Acyclovir - for viral meningitis
●Hydroxyzine - for atopic dermatitis/eczema, for itching but can cause sedation, use before
bedtime
●Diphenhydramine (benadryl) - for atopic dermatitis/eczema, for itching but can cause
sedation, use before bedtime
●Laratindine (claritin) - for atopic dermatitis/eczema, for itching, non-sedative
antihistamine
●Fexofendaine (allegra) - for atopic dermatitis/eczema, for itching, non-sedative
antihistamine
●Tacrolimus - for atopic dermatitis/eczema, topical immunomodulator for flare ups ●
Pimecrolimus - for atopic dermatitis/eczema, topical immunomodulator for flare ups
Vaccinations:
●Hib vaccine
○protects children against acute epiglottitis and bacterial meningitis
●DTap vaccine
○Protects against pertussis
●Pneumococcal conjugate vaccine-PCV13
○Give to prevent bacterial meningitis as infant
●Meningococcal polysaccharide vaccine-Menactra
, ○meningococcal disease in teens
NEW CONTENT
Neuro lecture - 19
questions Learning
outcomes:
●Describe the methods of assessing the neurologic function of a pediatric patient,
including use of the Glascow Coma Scale 3 questions
○If less than 8 on Glascow Coma Scale → intubate
○How to use the Glasgow Coma Scale
■ Know dev milestones!
■ Used to identify criteria for consciousness but not used for those with dev
delays or paralysis bec of false results even though they may be cerebrally
intact
■ Range from 3- 15 (3 lowest); the higher the better
■ Decorticate and decerebrate may be elicited with stimulation
●decorticate (flexion) → lesion above brainstem/ cerebral cortex
dysfx
●Decerebrate (extension) → lesion @ midbrain or brainstem →
worse (score less in GCS)
●Earliest indicator of change in neuro status
○VS:
■ Changes (variable) in HR/ RR/ BP (more important than direction)
●Ie Cheynes Stokes in DKA → apnea 10-60 seconds → increased
depth and rate of breaths
, ●MAP in peds should be > 50!
■ Cushing’s triad = VERY late sign in peds → high BP, low
HR/RR ○ Fontanels- Assess if less than 2 yrs old; posterior fontanelles closes
at 1-2 mos; anterior fontanelle usually closes @12-18 mos
○Head circumference- can bulge for high ICP → tense, tight, taut
■ Measured until 36 months (if w/o neuro issues); suture lines fused by 12
y/o ; head expansion due to suture lines and NOT by expanding cranial
bones ( cranial bones ossified at 8 y/o) → older → herniate into foramen
magnum instead of separating sutures
○Pupils
■ Pinpoint → OD (ie mydriatic Rx ind for low HR/ exposed to nerve
agents)
■ Dilated→ brainstem herniation
■ Bilateral fixed and dilated → brainstem herniation
●Terms used in assessment of neuro status
○Forgetful = Confusion
○Drowsy = Lethargy- just woke up from a nap,
○Arousable by stimulation = Obtunded- o comes before S, you gently stimulate
before you shake them to get up
○Arousable by vigorous stimulation = Stuporous
○Cannot arouse = Coma
●Indicators for Cushing’s triad
○Cushing’s triad: a VERY late sign in pediatrics: Increased BP, Decreased HR
and RR- slowing of pulse and increasing BP, irregular disease-
●Illustrate the effects and management of increased intracranial pressure in the
pediatric patient 3 questions
○Give meds, oxygenate, do not overhydrate
●What would you assess for in a patient with suspected increased ICP
○Tense, bulging fontanel
○Separated cranial sutures
○Macewen (cracked-pot) sign- feel the skull crinkling
○Irritability and restlessness
○Drowsiness
○Increased sleeping
○High-pitched cry- neural cry- ask if it is different
○Increased fronto occipital circumference
○Distended scalp veins
○Poor feeding
