When caring for an infant w/an upper respiratory tract infection & elevated temperature, an appropriate nursing intervention is to:
Give small amounts of fluid frequently to prevent dehydration
A parent whose 2 school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend
Swimming
When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should be based on which principle?
The child may think the equipment is alive
A parent asks the nurse about negativism in toddlers. The most appropriate recommendation is to
Reduce the opportunities for a 'no' answer
Imaginary playmates are beneficial to the preschool child because they
become friends in times of loneliness
Which strategy would be the least appropriate for a child to use to cope
having parents solve problems
What information could be given to the parent of a 12-month old child regarding appropriate play activities for this age?
Give large push-pull toys for kinetic stimulation
The nurse is caring for a neonate w/suspected tracheoesophageal fistula. Nursing care should include
elevating the head but not giving nothing by mouth
An infants parent asked the nurse about preventing otitis media (OM). What should the nurse recommend?
Avoid tobacco smoke
A school-age child w/diarrhea has been rehydrated. The nurse is discussing the child's diet w/the family. Which statement by the parent would indicate a correct understanding of the teaching?
I should have my child eat a normal diet w/easily digested foods for the next 48hrs
Which statement best describes fear in school-age children?
Most of the new fears that trouble them are related to school & family
In terms of gross motor development, what would the nurse expect a 6-month old infant to have accomplished? CHOOSE ALL THAT APPLY:
A. Sit while propped
B. Roll from back to abdomen
C. Roll
from abdomen to back
Matthew, age 18 months, has just been admitted w/croup. His parent is tearful & tells the nurse, 'This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here.' What is appropriate in the care plan for this parent who is experiencing guilt?
Clarify the misconception about the illness
Kimberly's parents have been using a rearward-facing convertible car seat since she was born. Most car seats can be safely switched to the forward facing position when the child weighs
20 lbs
What is most characteristic of the physical punishment of children, such as spanking?
Misbehavior is likely to occur when parents are not present.
A child weighs 38.5 lbs & is 3'8" tall. Calculate the
child's BSA. Do not round until finished w/all calculations.
**Round to the nearest hundredth place. Remember the rule of
leading and trailing zeros.
0.74
The parents of a 2 year old tell the nurse that they are concerned because the toddler has started to use 'baby talk' since the arrival of their new baby. The nurse should recommend that the parents
ignore the 'baby talk.'
What is probably the single most important influence on growth at all stages of development?
Nutrition
A 10-year old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, 'wait a minute, 'and, I'm not ready.' The nurse should recognize that
This is normal behavior for school-age child
When teaching injury prevention during the school-age years, the nurse should include
teach basic rules of water safety
Caring for the newborn w/a cleft lip & palate before surgical repair includes
providing satisfaction of sucking needs
A child comes to the clinic and needs a prescription of an
antibiotic. There is no pediatric dosage for this antibiotic. The
child has a BSA of 0.68 & the adult dose is 1500mg. What is the
pediatric dose
* DO NOT ROUN UNTIL ALL CALCULATIONS ARE
COMPLETE. ANSWER W/A WHOLE NUMBER
600
When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. The best explanation for this is
Infection or inflammation proximal to the site
The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include
Cleansing suture line, supine & side-lying positions, arm restraints.
An objective of care for the child w/nephrosis is to
reduce excretion of urinary protein
A child weighs 5kg & 59cm long. The adult dose is 250mg. Determine the pediatric dose. Do not round until all calculations are complete. Round to a whole number
42
The nurse encourages the mother of a toddler w/acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that
The mother's presence will reduce anxiety and ease child's respiratory efforts
Which is characteristic of physical development of a 30-month old child? *CHOOSE ALL THAT APPLY
b. Primary dentition is complete
e. Sphincter control is
usually achieved
Which statement best describes the infant's physical development?
Birth weight doubles by age 6 months & triples by 1 year
A 3 month old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as
normal development
The nurse is assessing a 6 month old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately
15 pounds
In providing nourishment for a child w/cystic fibrosis (CF), which factor should the nurse keep in mind?
Diet should be high in carbohydrates and protein
The nurse discussing w/a parent group the importance of fluoride for healthy teeth. The nurse should recommend that the parents
determine whether their water supply is fluoridated
What behavior indicates that an infant has developed object permanence?
Actively searches for a hidden object
The nurse has just started assessing a young child who is febrile & appears very ill. There is hyperextension of the child's head (opisthotonos)w/no pain on flexion. The most appropriate action is to
refer for immediate medical evaluation
The nurse is caring for a 5yr old child who is scheduled for a tonsillectomy in 2hrs. Which actions should the nurse include in the child's postoperative care plan? (Choose all that apply)
a. Notify the surgeon if the child swallows frequently
b. Place the child on the abdomen until fully awake
d. Allow the child to have diluted juice after the procedure
Determine a child's BSA based on the following measurements: Height,
66 cm & weight 6.8kg
* Do not round until finished w/all
calculations. Round to the nearest hundredth place. Do not forget the
rule of leading and trailing zeroes.
0.35
Which factor is most important in predisposing toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections?
Short, straight internal ear/throat structures & large tonsillar tissue
The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety?
I hope my friends don't forget about visiting me
A young child is brought to the emergency department who has lost 7lbs in the last week secondary to acute diarrhea & vomiting. The child has sunken eyes & dry mucous membranes. Therapeutic management of this child will begin with
Intravenous fluids
The nurse is caring for an infant w/suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis?
Visible peristalsis and weight loss
An appropriate nursing intervention when caring for a child w/pneumonia is to
encourage rest
The nurse is caring for a 10 month old infant w/respiratory syncytial virus (RSV)bronchiolitis. Which intervention should be included in the child's care? (Choose all that apply)
a. Cluster care to encourage adequate rest
c. Encourage
infant to drink 8oz of formula q 4hrs
e. Place on
noninvasive oxygen monitoring
Therapeutic management of nephrosis includes
Corticosteroids
A mother tells the nurse that she doesn't want her infant immunized because of the discomfort associated w/injections. The nurse should explain that
A topical anesthetic (like EMLA)can be applied before injections are given
The nurse is doing a routine assessment on a 14 month old infant and notes that the anterior fontanel is closed. This should be interpreted as
a normal finding
The best play activity for a 6 month old infant to provide tactile stimulation is to
allow to splash in bath
A 3YO child comes to the clinical w/complaints of coughing and
purulent drainage from the nose. Medication dosage is determined based
upon the child's body surface area. The child weighs 25 lbs & is
30in tall. Calculate the child's BSA.
*Do not round until you
finish all calculations. Round to the nearest on hundredth place.
Remember the rule of leading and trailing zeroes.
0.49
The nurse closely monitors the temperature of a child w/nephrosis. The purpose of this is to detect an early sign of
infection
The nurse observes some children in the playroom. Which play situation exhibits is the characteristics of parallel play?
Brian playing w/his truck next to Kristina playing w/her truck
Kawasaki Disease: Implementation
* Temp ↑104°
1. Monitor I&Os
2. Provide Passive ROM
3. ****Administer ASA****
4. ***Administer IV immune globulin***
5. Educate parent/patient
Growth & development: Weight
A: From 1-2 yrs
B: From 2-3 yrs
C: By 2 1/2 yrs
A: 1/2lb a month
B: 3-5lbs per year
C: 4x birth weight
Growth & development: Height
A: From 1-2 yrs
B: 2yrs
C: From 2-3 yrs
A: 3-5" yr
B: 50% of adult height
C: 2-2.5" yr
Growth & development: 15 mos
- Walks w/out help
- Uses cup well
- Builds tower of 2 blocks
- Binocular vision
Growth & development: 18 mos
-Jumps in place
- Identifies geometric forms (18-24mos)
- Uses short sentences (18-24mos)
Tonsillitis: Implementation
* Larger than adults
Manifestations:
- Inflammation (obstruction)
- Self limiting
Mgmt:
-Minimize discomfort
-Tonsillectomy (malignant or obstructive)
Post-op:
Side lying & watch for excessive swallowing
Bacterial Endocarditis: Assessment
* Infections of valves & inner lining of heart
~Clinical manifestation~
- Unexplained fever
- anorexia
- Malaise
- Weight loss
- Extracardiac emboli (Splinter hemorrhages, Osler nodes, Janeway lesions, Petechia)
Hospitalized Child/School age
* Major fears
- Pain & bodily injury
- Loss & bodily injury
- Loss of control
- New fears r/t school, peers & family***
Hospitalized Child/School age: Nursing interventions
* More realistic understanding of disease
* Wants to know why
* Become distressed over separation
- Be honest
- Clarify misconceptions
- Encourage child's participation
- Allowing visiting of peers
- Therapeutic play
- Art therapy
- Provide explanations
- Praise child
Discipline/ Analysis/ Evaluation
- Consistency
- Timing (don't wait for dad to come home)
- Commitment/follow through
- Unity (with grandparents on same page)
- Flexibility
- Planning
- Behavior orientation
- Privacy
- Termination
POSITIVE / NEGATIVE REINFORCEMENT
Child assessment/ Television
American Academy of Pediatrics
- Limit TV to no more than 2hrs/day
- Sedentary
- Interferes w/play
- Cannot tell difference between ads & shows
- Substance use, violence, sex
Bronchitis
4 or less
Usually viral
Persistent dry hacking cough (worse @ night)
Nonproductive, becomes productive in 2-3 days
Treatment for bronchitis
- Cough suppressants
- Monitor for respiratory distress
- Cool humidified air
- Monitor for dehydration- increase fluids
- Tylenol if febrile
Bronchiolitis
< 2 yrs
* Virus (RSV usually)
- Symptoms-
- Labored respirations
- Tachynea
- Retractions
- Rhinorrhea
- Wheezing
- Fever
Bronchiolitis Treatment
Supplement O2
Bronchodilators
Suction
Adequate fluid intake ** If not contraindicated (tachypnea- they can aspirate)**
Tonsillitis
* Larger than adults ( protective mechanism)
- Manifestations-
1. Inflammation (obstruction)
2. Self limiting
Tonsillitis treatment
- Minimize discomfort
- Tonsillectomy (malignant or obstructive)
~Post-op~
- Side lying
Bacterial endocarditis
Definition: Infections of valves & inner lining of heart
Clinical manifestations:
- Unexplained fever
- Anorexia
- Malaise
- Weight loss
- Extracardiac emboli
-Splinter hemorrhages, Osler nodes, Janeway lesions, Petechia
Hospitalized child- School-age
Major fears
* New fears r/t school, peers, & family
* Pain & bodily injury
* Loss of control
Hospitalized child- School-age
- More realistic understanding of disease
- Wants to know why
- Become distress over separation
Hospitalized child- School-age: Nursing Intervention
- Be honest
- Clarify misconceptions
- Encourage child's participation
- Allow visiting of peers
- Therapeutic play
- Art therapy
- Provide explanations
- Praise child
Pertussis
* Acute respiratory infection: Bordetella pertussis
- Normally in non-immunized children <4
- Highly contagious
- Clinical manifestations-
- Catarrhal stage: 1-2 weeks, regular cold
- Paroxysmal stage: Cough at worst, not communicable
- Convalescent stage: Cough is less severe
Pertussis treatment/management
- Pertussis immunoglobulin
- Reduce environmental factors causing cough
- Encourage fluids
- Humidity
PREVENTION:
Vaccination
CHF Assessment:
Early signs
- Tachycardia
- Tachypnea
- Respiratory distress
- Profuse scalp sweating
- Fatigue
- Irritability
- Sudden weight gain (edema)
CHF Assessment:
Right side
Increased pressure in right atrium & the systemic venous system
CHF Assessment:
Left side
Increased lung congestion
CHF assessment & treatment
Assessment:
- Edema
- Cardiac enlargement
- Gallop
- Tachypnea
- SOB
- Fatigue
- Poor appetite
- Sweating w/poor activity
CHF treatment
Maintain oxygenation
↓ fatigue
Monitor I&Os
Monitor lung sounds & supplement O2
Hypercyanotic spells: Implementation
1st: Knee to chest position
2nd: Give O2
3rd: Give morphine
4th: Give IV fluids
CHD: Hypoxia
Severe- worse than hypoxemia
Low O2 to tissue
Poor perfusion
* You will see child squat (tripod position) trying to relieve hypoxia
CHD: Hypoxemia
Arterial O2 ↓
severe condition
poor feeding, leading to poor weight
tachypnea
dyspnea
polycythemia
Clubbing of fingers (should return to normal when fixed)
tissue hypoxia
Cardiac cath manifestations/implementation: School age
- Accurate height & weight
- Hx of allergies
- S/S of infection
- Assess & mark distal pulses before procedure (which pulse depends on entry site)
- Baseline oxygen saturation
- Prepare child / family
Cardiac cath manifestations/implementation: School age & adolescents
- Description of the catheterization lab (tour, pics)
- Explain procedure
- Emphasize what they will see, feel, and hear (can wear headphones)
- Let pt. know they will be NPO @ midnight
- Let pt. know there may be a tube down their throat to help them breath & their throat may be sore afterwards
Rheumatic fever: Clinical manifestations (Assessment) pg 242
Inflammatory autoimmune disease
Affects: Connective tissue of the ♥, joints, subcutaneous tissue, blood vessels of the CNS.
Complications: Cardiac valve disease (mitral valve stenosis)
2-6 weeks post GABHS infection
Cystic fibrosis: Implementation pg 203-205
Maintain airway
Provide Pulmonary hygiene
Chest physiotherapy
Postural drainage (allow gravity to work/move the bronchi and be coughed out)
Chest percussion
Vibration
Coughing & deep breathing (incentive spirometer)
Help to mobilize and eliminate secretions
Cystic fibrosis:Medications
Aerosolized meds, low flow humidified air, beware of giving too much oxygen as it can depress respiratory drive to chronically hypoxic children.
Monitor for infections
- Give pulmozine= this out mucous
- Goal= prevent respiratory infections
- GI= can't poop meconium
- Malnutrition due to inability to process nutrients, supplement w/vitamins A,D,E,K
- Give pancreatic enzymes before they take food= kind of like a powder
- ↑ protein ↑calorie diet, fat soluble nutrients
- Infertile secondary to mucous in cervix
NEVER GIVE ANTIHISTAMINES TO CF pt.'s AS THEY HAVE A DRYING EFFECT, MAKING EXPECTROATION OF MUCOUS MORE DIFFICULT.
General aspects of care for child w/respiratory issues: Implementation
- Promote rest
- Promote comfort
- Prevent spread by washing hands
- ↓ temp which can cause dehydration or seizure
- Promote hydration
- Provide nutrition
- Educate on ABX
- Support family & give instructions
Croup: Epiglottis
Acute epiglottis (2-8 YO): inflammation of larynx & epiglottis. Can be life threatening, usually bacterial. *Rapid onset*
S/S:
- Dysphagia (difficulty swallowing)
- Stridor
- Drooling
- ↑ Fever
- ↑ Pulse
- ↑ Respirations
* Sitting up, leaning forward, lower jaw thrust forward in tripod position.
Croup: Epiglottis- Implementation
If you suspect epiglottis, never inspect by hand or intubation kit in hand as it can cause bronchospasm & airway occlusion.
Always use gloves.
Monitor respiratory status
Avoid letting them cry
Hydrate them
Palivizumab prophylactically & Abx
***GIVE HIB VACCINE= H. influenza ***
Acute LTB (<5YO):
Viral
S/S: Stridor, brassy cough, hoarseness, dyspnea, restlessness, irritability, low grade fever, seal call.
Tx:
Give racemic, epinephrine, corticosteroids & fluids
Asthma: Triggers
- Smoking
- Cold air, food/drinks
- Viral infections
- Stress
- Pet dander
- Exercise
Asthma: manifestations
- Wheezing
- Broncospasms
- Hyperinflation
- Dry cough
- Tachypnea & retractions
Asthma: Exercise
Exercise is still necessary- baseball, gym, sprints & SWIMMING
Asthma: Tx
- Chest PT after edema is gone to rid mucous & open airway
- Put in high fowlers position
- xray
- parenteral fluids to thin mucous
- O2 therapy
- Avoid cold
- Swimming helps
- Albuterol
Pneumonia: Implementation- Viral
Wheezing, tachypnea, pt. looks very ill, lasts about 5-7 days.
Give: O2, mist, suction, ↑ fluids, antipyretics, chest PT & postural drainage
S/S: Wheezing is more common w/RSV. Consolidation on xray, HA, fatigue & malaise
Pneumonia: Implementation-Bacterial
S/S: ↑Fever, productive cough, ill looking, retractions, grunting, chest pain, significant RDS, consolidation on xray.
* Recent upper respiratory infection
* Cough may linger for a few weeks
Implementation:
Monitor oxygenation, hydrate, monitor resp. status, Abx for bacterial pneumonia. Elevate HOB, avoid over feeding, burp frequently if bottle feeding.