NURS 3463 PEDS PROCTORED Study Notes

  Questions from test: KNOW LAB VALUES: BUN, creatine, respiratory rates, HR, serum glucose, phenaline, phenylketone 2 year old develpment, what woud you report to the provider? 30 words? -celiac disease menu, oj and eggs? or meats? Gramham crackers and peanut butter? -patient has 10% burn on body, finding report to provider. Urine output 35ml/hr Cycstic fibrousis, creatine or BUN monitor? Increase or decrease. Bun 6. BUN 12. Creatine 1.4. creatine 0.3. (note:creatine and bun determine kidney function) a nurse is caring for a child who is in the ER after ingesting a bottle of acetaminophen which of the following meds should the nurse plan to give acetylcysteine -antedote for acetaminophen overdose or poisoning a nurse is teaching the parents of a child who has rheumatic fever. which of the following statements by a parent indicates an understanding of the teaching my child may take aspirin for his joint pain -post cardiac cath, report to provider. Cool extermites below cath site. A: Weakend pedal pulses bilat. Findings in celiac - stetorhea -therapuetic effect for opiod pain? titrate till sedation (wrong)? After admin IV gentamacin for menningtits, following actions. Is and O's? Expected findings of appendicitis - The most common symptom of appendicitis is abdominal pain. Typically, symptoms begin as periumbilical or epigastric pain migrating to the right lower quadrant (RLQ) of the abdomen. Pt comes in with submersion injury, priority action. intubation? Iv? Priority Action for Submersion Injury - Signs and symptoms of near drowning include respiratory distress, tachypnea, rales, wheezing and possible hypothermia. Obviously, initial management includes the ABCs — Airway, Breathing and Circulation. Dornase alfa (pulmozyme) decreases viscosity of mucus and improves lung function. improvement monitored by pfts. use once daily. cycstic fib expected findings? absence of pancreatic enzymes, positive sputum culture, thick yellow-grey mucous, meconium ileus at birth, large loose fatty sticky foul smelling stools, distended abdomen, thin arm & legs, sweat tears saliva abnormally salty, viscous cervical mucous, absent/ decreased sperm. lab-sweat chloride test, normal 40 meq/l. stool analysis for azotorrhera (stinky from protein) and statorrhea (undigested fat). blood glucose. xray. -post tonsillectomy actions. straw? side lying? A: Comfort- ice collar/ keep throat moist/ pain meds. tonsil nursing actions: elevate head, asses for bleeding (clearing the throat, restlessness, bright red emesis, tachycardia/ pallor, frqt swallowing). Vitals/airways/ difficulty breathing. Comfort- ice collar/ keep throat moist/ pain meds. Diet- clear liquids/fluids after gag reflex returns. soft bland foods. No coughing/ throat clearing/ nose blowing/ no pointed object. Maybe blood tinged mucous or clots in vomit. -MMR at what age first. Answer: 12 months -manifest Otis medias A: tonislitits -management sleep terrors. Don’t wake patient? -Keep consistent bedtime routine -Use night-light in the room -Provide child with favorite toy -Leave drink of water by bed -Reassure preschoolers who are frightened, but avoid allowing them to sleep in parent's bed -diaper rash treatment. Antibacterial soap with each diaper change? Powder twice a day? -enteral feedings, flush tube or check gastric residual -epiglottis, what to do first. Contact/droplet precautions? -indicate protein deficiency? Dry, thinning hair -5 year old up to date with current immunizations get what at 5. Answer: VARICELLA (CORRECT). Others: dtap. Mmr, ipv a nurse is teaching parents of a 10 year old child who has iron deficiency anemia. which of the following statements by a parent indicates an understanding of the teaching. Will give with antacid. Will give with milk when can child with varicella come off droplet precautions. After lesions have scabbed. 24 after antibiotics when can patient come off precautions for menninggits. 24 after antibiotics. Negative blood culture. a nurse is caring for an 8 year old who has sickle cell anemia. which of the following actions should the nurse take A: give the child flavored popsicles -to maintain hydration to avoid sickling a nurse is assessing the pain level of a 3 year old child who is postop following abdominal surgery. which of the following pain scales should the nurse use FACES a nurse is caring for a 2 day old infant who has myelomeningocele. which of the following actions should the nurse take monitor the infant head circumference -increased risk for hydrocephalus a nurse is teaching the parents of a 4 month old infant who has gastroesophageal reflux which of the following statements by the parent indicates an understanding of the teachign i will add 1 tsp of rice cereal per oz to my babys formula -osteomyelitis intervention, diet?, physical activity? -sickle cell teaching parents, signs look for at home -atraumatic care IM injection? Pacifier with sucrose before injection or use 20 gauge -gas inhale, findings. Polyuria? -how to rehydrate patient vomiting for 3 days. Oral rehydration. Sodium 0.9 IV. -90/90 skeletal traction after scoliosis surgery. Use two people to turn patient? Air mattress? -question where one answer is facial twitching -pain scale for a 3 year old? Oucher? Visual pain scale? -acyt acid ingested, findings. -adloscent want to be screen for STI. Answer: have patient sign conscent form. Do not need parents conscent for STI’s -preschooler sibling dies. Curious what happens to the body after death A nurse is caring for a child who is postop following a tonsillectomy. which of the following findings is the nurses priority A: frequent swallowing a nurse is assessing a toddler who has measles (rubeola) which of the following findings should the nurse expect Koplik spots. Show on the diagram where kolpik spot found. A. Inside mouth a nurse is providing teaching to an adolescent who has scoliosis and a new prescription for a Boston brace. which of the following responses by the adolescent indicates an understanding of the teaching aA:i can take my brace off for about an hour daily to shower a nurse is assessing pain in a 3 year old child following a tonsillectomy. which of the following rating scales should the nurse use to determine the childs pain level? FACES - Word graphic rating scale (4-17) a nurse is providing nutritional teaching to an adolescent client who has celiac disease. which of the following breakfast foods should the nurse recommend? scrambled eggs a nurse is assessing a 2 month old infant who has a ventricular septal defect. which of the following findings should the nurse report to the provider weight gain of 1.8kg (4lbs) -indicates increase fluid and worsening of the childs heart failure -care post tonsillectomy. A nurse is checking the vital signs of a 2-year-old child during a well-child visit. Which of the following findings should the nurse report to the provider? Sleeps 12 hrs a day, 30 word vocab??? A nurse is checking the vital signs of a 3-year-old child during a well-child visit. Which of the following findings should the nurse report to the provider? A. Temperature 37.2˚ C (99.0˚ F) B. Heart rate 106/min C. Respirations 30/min D. Blood pressure 88/54 mm Hg C. CORRECT: Respirations of 30/min is above the expected reference range for a 3-year-old child and should be reported to the provider. a nurse is providing dietary teaching to the parent of a child who has cystic fibrosis. which of the following dietary recommendations should the nurse make increase the childs protein intake a nurse is caring for an infant following surgical repair of a cleft lip and palate. which of the following actions should the nurse take? A: suction the infant gently with a bulb syringe PRN A nurse is preparing a toddler for an intravenous catheter insertion using atraumatic care. Which of the following actions should the nurse take? (Select all that apply.) A. Explain the procedure using the child's favorite toy. B. Ask the parents to leave during the procedure. C. Perform the procedure with the child in his bed. D. Allow the child to make one choice regarding the procedure. E. Apply lidocaine and prilocaine cream to three potential insertion sites. A. CORRECT: Explaining the procedure using the child's favorite toy can assist the child to manage fears and provides atraumatic care. D. CORRECT: Allowing the child to make choices offers a sense of control over the situation and should be used to provide atraumatic care. E. CORRECT: A topical analgesic, such as lidocaine and prilocaine cream, decreases pain and should be used to provide atraumatic care. a clinic nurse is providing teaching to the parent of a 1 month old infant who has gastroesophageal reflux. which of the following statements by the parent indicates an understanding of the teaching i will add rice cereal to my baby's feedings a nurse is planning care for an adolescnet who has sickle cell anemia and is experiencing a vaso-occlusive crisis. which of the following interventions should the nurse include in the plan maintain the child on bedrest a nurse is assessing a 6 month old infant following a cardiac cath. which of the following findings should the nurse report to the provider BP of 86/40 -indicative of hypotension and bleeding in a 6month old a nurse at a clinic is preparing to administer immunizations to a 5 yr old child. which of the following immunizations should the nurse plan to give DTaP between 4-6 years old a nurse is teaching parents of a 10 year old child who has iron deficiency anemia. which of the following statements by a parent indicates an understanding of the teaching i will administer the iron tablet with orange juice - increases the irons absorption A nurse is caring for a 10-year-old child who has acute glomerulonephritis. Which of the following findings should the nurse report to the provider? A. Serum BUN 8 mg/dL B. Serum creatinine 1.3 mg/dL C. Blood pressure 100/74 mm Hg D. Urine output 550 mL in 24 hr B. CORRECT: Serum creatinine 1.3 mg/dL is out of the expected reference range for a 10-year-old child, and should be reported to the provider. A nurse is caring for an infant who has a hydrocele. Which of the following actions should the nurse take? A. Prepare the child for surgery. B. Explain to the parents that the issue will self-resolve. C. Retract the foreskin and cleanse several times daily. D. Refer the family for genetic counseling. B. CORRECT: Hydrocele is fluid in the scrotum and resolves spontaneously in the majority of cases. Not here but related: a nurse is reviewing the lab results of a child who has experienced diarrhea for the past 24 hrs which of the following values for urine specific gravity should the nurse expect? 1.035 a nurse is caring for a child who has suspected nephrotic syndrome. which of the following lab values should the nurse expect serum cholesterol 700 -is above the expected range because of increase in plasma lipids a nurse is caring for a child who has a possible intussusception. the parents of the child ask the nurse how the diagnosis is made. which of the following responses should the nurse make? an abdominal ultrasound will confirm the pocket in the intestine -confirmed by xray, ct or ultrasound a nurse is providing teaching to the parents of a school age child who has type 1 diabetes about management of hypoglycemia. which of the following responses by the parents indicates an understanding of the teaching i will make sure my child drinks 240mL of milk asap. -10-15 g of simple carbs will elevate the blood glucose level a home health nurse is developing a plan of care for the parents of a toddler who has hemophillia. which of the following instructions should the nurse include in the plan? inspect the toddlers toys for sharp edges a nurse is caring for a child who has cystic fibrosis and a pulmonary infection. which of the following findings is the nurses priority inability to clear secretions A nurse is planning care for a child following a surgical procedure. Which of the following interventions should the nurse include in the plan of care? A. Administer NSAIDs for pain greater than 7 on a scale of 0 to 10. B. Administer intranasal analgesics PRN. C. Administer IM analgesics for pain. D. Administer IV analgesics on a schedule. D. CORRECT: IV analgesics should be administered on a schedule to achieve optimal pain management. A nurse is caring for a 4-month-old infant who has meningitis. Which of the following findings is associated with this diagnosis? A. Depressed anterior fontanel B. Constipation C. Presence of the rooting reflex D. High-pitched cry D. CORRECT: The nurse should identify a high-pitched cry as a finding associated with meningitis between ages 3 months to 2 years. Tonsillitis - hx of otitis media, hearing difficulties, sore throat w/ swallowing. lab tests throat culture for group a strept. preop cbc to assess anemia/infections A HCP is caring for a pt who is about to receive gentamicin to treat a systemic infection. The healthcare professional should question the use of the drug for a pt who is also taking which of the following drugs? Furosemide (lasix) Diphenhydramine Acetaminphen Levothyroxine (synthroid) Furosemide (lasix) Gentamicin and furosemide are ototoxic drugs. PEDS ATI PROCTORED STUDE NOTES How to Prevent SIDS: Safety Tips • Always put your baby to sleep on his back. (supine) • Use a pacifier at sleep time. • Ury swaddling your child. • Have her sleep in a crib in your room. • Make sure the crib mattress is firm and tight-fitting WBC 4-11 Serum creatine (kidneys) 0.6-1 Normal BUN 7-20, elevated BUN means dehydration Mg 1.5-2.5 Rbc 4-5 Cal 9-11 Hemoglobin 12-18 Hemat 36-53 Bilrubin .2-1.2 Bilirubin in new born, below 5.2 BP 1-3 years : low 85/45 High 117/76 Says 3-5 words by 1 year Checkup 72 hours after discharge from birth -solids after 4-6 months -nocturnal sleep at 4 months -sleep 15 hrs day at 4 months Sleeps through night 1 year -rear facing car seat till 2 years 1-3 years: Chest and head circumferne equal by 2 years 3 years, gender identity 3 years: rides a tricycle, stands on one foot 4 years: jumpes rope, throws ball overhead 5 years: walks backward heel to toes, throws and catches easily Age Gross Motor Skills Fine Motor Skills 1 month Demonstrates head lag Has a strong grasp reflex 2 months Lifts head off mattress when prone Holds hands in open position Grasp reflex fading 3 months Raises head & shoulders off mattress when prone Only slight head lag No longer has a grasp reflex Keeps hands loosely open 4 months Rolls from back to side Grasp objects with both hands 5 months Rolls from front to back Uses palmar grasp dominantly 6 months Rolls from back to front Holds bottle 7 months Bears full weight on feet. Sits, leaning forward on both hands Moves objects from hand to hand 8 months Sits unsupported Begins using pincer grasp 9 months Pulls to a standing position. Creeps on hands & knees instead of crawling Has a crude pincer grasp Dominant hand preference evident 10 months Stands holding furniture. Changes form a prone to sitting position Grasp rattle by its handle 11 months Stands. Cruises/walks while holding onto something. Walks with one hand held Places objects into a container Neat pincer grasp 12 months Walks assisted. Sits down form a standing position without assistance Tries to build a two-block tower without success Can turn pages in a book 15 months Walks without help Uses a cup well Builds a tower of two blocks 18 months Runs clumsily; falls often. Throws ball overhead, Jumps in place with both feet, Pulls & pushes toys Manages a spoon without rotation Turns pages in a book, two or three at a time Builds towers of three or four blocks 2 years Walks up and down stairs by placing both feet on each step Builds a tower of 6 or 7 blocks Turns pages of a book one at a time 2.5 years Jumps across the floor and off a chair or step with both feet Stands on one foot momentarily Takes a few steps on tiptoe Draws circles Has good hand-finger coordination 3 years Rides a tricycle Jumps off bottom step Stands on one foot for few seconds 4 years Skips and hops on one foot Throws ball overhead Catches ball reliably 5 years Jumps rope Walks backward with heel to toe Throws and catches a ball with ease 4) When does the first teeth erupt? Between 6-10 months use pincer grasp – 9 months use pincer grasp – 9 months INFANT: Comprehends “no” by 10 months TODDLER: 300 words by age 2 1 year- using one-word sentences 2 years- using multiword sentences by combining two to three words 3 years- combining several words to create simple sentences using grammatical rules PRESCHOOL: KNOWS 2,100 words by age 5 3-4 years- speak in 3 to 4 word sentences 4-5 years- speak in 4 to 5 word sentences While assessing an infant, the nurse will examine the baby’s back: what is the nurse looking for? Mongolian marks -How is a child’s respiratory system anatomically different from an adult’s? What discharge education would the nurse provide to the family about caring for their child who just had a tonsillectomy? 1) No citrus juices, soda, milk, no using straws 2) Give ice chips Shorter and narrower airway 2. Higher trachea 3. Bronchial branching at different angles Symptoms of croup: 1) “barking cough” 2) Stridor 3) Hoarseness Epiglottitis croup: 1) MOST LIFE THREATENING – medical emergency 2) Rapid onset, hours, may progress to blocked airway 3) NO BARKING COUGH 4) CHILD PERFERS UPRIGHT POSITION 5) Ages 2-8 -resp infections can lead to ear infections -What is cystic fibrosis? How does a child get this disease? An inherited life-threatening disorder that damages the lungs and digestive system What treatment is done to close the ductus arteriosus? • Administer indomethacin or IV/oral ibuprofen if premature infants & no CHF What are the signs and symptoms of congestive heart failure in a child? • Tachycardia • Gallop rhythm (S3) • Diminished pulses Edema in hands, feet, • Crackles, rales or rhonchi • What are the most common causes for congestive heart failure in an older child/adolescent? • In older children/adolescents, caused by acquired heart disease such as: CREM 1) cardiomyopathy, 2) endocarditis, 3) myocarditis, 4) rheumatic fever OXYGEN TREATMENT IF NO CONGENITAL DEFECTS MONITOR HEIGHT AND WEIGHT, GROWTH DELAY INDICATES HEART DEFECT What is a ventricular septal defect? Ventricular – increased pulmonary • Abnormal connection between right & left VENTRICLES (Tet) spells—hypercyanotic, caused by crying, feeding, defecating What interventions would a nurse do if a child had a tet spell? • Place infant in knee-chest position Why does the nurse take blood pressures in the upper and lower extremities of a newborn or infant? • Noticeable difference in blood pressure between arms & legs (higher BP in arms, low BP in legs); Indicates: Coartation of the aorta Should right ventricular failure occur, what signs and symptoms would the nurse expect? Pale clammy skin Cyanosis Feeding problems What are the clinical manifestations of Kawasaki disease? • Red eyes w/out drainage • Bright red chapped lips • Strawberry tongue w/white coating or red bumps • What is rheumatic fever and what is the usual cause of this problem? • • autoimmune response from untreated or partially treated group A streptococcal What is digoxin given for? What should the heart rate be in order to administer it to an infant? Digoxin used to improve heart contractility Hold digoxin if HR: -Less than 90 in infant -Less than 70 in child Bronchitis – worse at night Influenza type B (HIB) vaccine – decreases epiglottis is children Preschool age 3-6: ag calorie intake 1800