peds exam 2

• Exam 2 Review for Modules 3, 4, and 5 in Pediatric Health Theory & Application

Med Math

• IV fluid maintenance for the first 10 kg is 100 mL/kg/hr
• IV fluid maintenance for the next 10 kg is 50 mL/kg/hr
• IV fluid maintenance for every kg over 20 kg is 20 mL/kg/hr
• Calculate the following IV fluid maintenance:
• Child weighing 6 kg = 600 ml / 25 ml/hr
• Child weighing 20 kg = 1500 ml / 62.5 ml/hr
• Child weighing 15 kg = 1250 ml / 52.08 ml/hr
• Child weighing 4 kg = 400 ml / 16.6 ml/hr
• Divide the hourly rate by 24 hours

Munchausen by Proxy

• Also known as factitious disorder imposed on another based on DSM-5 criteria.
• It involves a caregiver, often the mother, attempting to make the child appear ill.
• This may include adding blood to the child's urine, stool, or vomit, or fabricating symptoms

Autism Spectrum Disorder

• Care for children with this disorder includes consistency, positive reinforcement, patience, and gradually introducing new situations.

Oppositional Defiant Disorder

• Argumentative, disobedient, hates rules, stubborn, provokes others, angry, temper tantrums last hours, touchy, easily annoyed.
• Characterized by a pattern of disobedience, argumentativeness, angry outbursts, frustration, with tendency to blame others.

Medical Abuse

• Also referred to as pediatric condition falsification.
• The child is needlesly exposed to diagnostic therapeutic interventions for symptoms or conditions that have been exaggerated, fabricated or purposefully induced.
• May have multiple physicians involved

ADD and ADHD Medications

• Methylphenidate and Dextroamphetamine are used as treatment.
• Psychostimulants work to increase dopamine and norepinephrine levels
• Medications are used to treat the disorder and should be continued per physician's orders.
• Avoid abrupt discontinuation due to the risk of serotonin discontinuation syndrome, which can be fatal.
• Lifelong medications may need adjustments as the patient gets older.

Signs of Child Abuse

• Patterns from cords, rope, hands, or wire
• Bruising in different phases of healing
• Bruising on non-ambulatory children
• Bed wetting
• Developmental delays

Anorexia and Depression

• Health issues as a result of anorexia include anemia, heart problems, bone loss, and GI problems.

ADHD, Bullying, and Suicidal Ideation

• Concerns arise with statements indicating harm to self/others, or unhappiness at school.

Attachment Disorder

• Includes severe colic, difficulty feeding which leads to failure to weight gain, detachment, difficulty in social situations, failure to thrive, and anxiety.
• Reactive attachment disorder is characterized by the failure of a child younger than 5 years to initiate or respond appropriately to caregivers and or social situations, which leads to caregivers disregarding the child's physical or emotional needs.

MacDonald Triad

• Includes pyromania, cruelty to animals, and enuresis.

Stress and Coping in Adolescents

• A concern is when a child no longer finds excitement in things they once did, necessitating investigation into the cause, such as bullying or home difficulties.

Cystic Fibrosis

• It can be diagnosed via a sweat test

Otitis Media

• There is concern for Otitis media with or without effusion.
• WITH effusion is the collection of non-infected fluid in the middle ear space.
• Treatment for OM with effusion:Antibiotics, topical antibiotics, analgesics, antipyretics, and adequate hydration
• Nurse concern with OM with effusion is loss of hearing with fluid build up

Priority Assessments

• ABCs are always first

Metered Dose Inhaler (MDI)

• Remove cap from inhaler and shake it 5-6 times. Connect the spacer for inhalation. Hold inhaler with mouthpiece. Form a seal and take inhale. Press inhaler by being a slow deep breath, hold for approximately 5-10 seconds. Wait 1 minute for additional puff if needed.

Epiglottitis

• The 4 D's of epiglottitis are drooling, dysphagia, dysphonia, and distress with respiratory effort.
• NEVER examine the child's throat when epiglottitis is suspected

Down's Syndrome

• Features include small, dysplastic ears, a flat nasal bridge, small mouth with relative macroglossia, and short stature with a short neck and large nuchal fold.
• Other features visible: epicanthic folds, upward slanting palpebral fissures brushfield spots, brachycephaly, and Single palmar crease

Antibiotics

• A common side effect for administration includes risk of candida due to antibiotics disrupting the normal balance of bacteria.
• Yeast infections include treatment for thrush (use Nystatin)

Respiratory Infections

• Interventions include rest, fluids, medications (Tylenol), suction, and HOB (Head of Bed) elevated

Trisomy 21

• A genetic disorder that results in extra genetic material from chromosome 211.

Asthma

• Signs and symptoms: SOB, airway obstruction, wheezing, prolonged expiration, nasal flaring, and retractions.
• Treatment includes bronchodilators and steroids

STI's (Sexually Transmitted Infections)

• Risky behaviors include any sexual activity at an early age and with many different partners, and oral/anal sex does not protect from STI's.

Peak Meter Flow

• A portable handheld device that measures ability to push air out of the lungs

Hypospadias

• A condition where the urethra sits on the underside of the penis instead of being properly located on the tip
• It requires surgery to correct the flow of urine; best for surgical repair from age 6-12 months.

Chest X-Ray

• Ground glass indicates pneumonia or respiratory distress

Emergency Department Priority Patients

• Respiratory distress, shock, appendicitis, RSV, cyanosis

Croup

• Inflammation in upper airways: can be treated with cool moist air and antipyretics

RSV and Bronchiolitis

• Acute inflammation of the bronchi and usually caused by virus.
• Treatment includes suction, humidification, and I&Os (Input and Output monitoring)

Infant Cyanosis

• A medical emergency includes medical emergency, administering oxygen, and resuscitative equipment

Testicular Torsion

• Internal twisting of the testicles; most commonly affects adolescent boys ages 12 to 18.
• Signs/symptoms: Sudden severe pain in scrotum lower abdomen, and groin area, swelling, N/V, and discoloration.
• This is a surgical emergency within 6 hours of onset of symptoms to preserve testes.

Uncircumcised Males

• Common problems includes cleanliness of foreskin, do not force the foreskin back as it may cause swelling to the penis not allowing the foreskin to be placed back in pre-retracted position; in most cases the foreskin will expand with age.

Syphilis

• Why we are concerned: Neurological issues, stillbirth, prematurity, rash, congestion, rhinitis

Turner's Syndrome

• Lose an entire X chromosome, so that it only effects girls.
  • Signs/Symptoms: Prematurity; Feeding difficulties, with spitting, emesis, and difficulty latching on, GERD
  • Treatment: Hormones such as estrogen

FASD

• FASD infants struggle to suck, swallow and breath all at the same time

Inguinal Hernia

• Protrusion of contents through a defect or opening through intra-abdominal contents; Caused by weak abdominal wall, straining, pressure, lifting

Pediatrics Education

• Pay attention to what the parents and caregivers are saying, as a nurse may need to follow up with additional information to ensure a clearer understanding.
• Example: "My child no longer needs the medication because they feel better."

Steroids Use

• Steriods should be used when there is inflammation (as example a child fully responding to their nebulizers).

Varicocele

• A painless collection of dilated and twisted veins in scrotum, only need surgery when caused pain or swelling.
  • May be asymptomatic, dull ache or fullness of scrotum

Epispadias

• When the bladder is on the outside of the body and must be surgically repaired
• Needs surgery during the first year of life; when surgery is done make sure bladder is covered and kept moist

Questions

• The nurse should assess a child that had a tonsillectomy for: Frequent swallowing
• A parent of a toddler calls the nurse asking about croup, what is a distinguishing manifestation of spasmodic croup: Barking cough
• 9-year-old girl diagnosed with cystic fibrosis which of the following must the nurse keep in mind when developing a care plan for this child: Pulmonary secretions are abnormally thick
• DO NOT WANT TO GIVE THEM ZYRTEC OR MEDS TO DRY UP SECRETIONS
• Veronica's parents were told that their daughter needs Ribavirin, this drug is used to treat which of the following: RSV
• Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia which of the following would the nurse expect to assess: Chest pain
• When planning care for a 4-month-old child admitted for resp. distress caused by RSV and bronchiolitis it is essential to include which of the following: Ensure adequate hydration
• A humidified atmosphere is recommended for a child with an upper respiratory tract infection because: Soothes inflamed mucous membranes
• An appropriate nursing intervention when caring for a child with pneumonia is which of the following: Monitor resp. status frequently
• Which statement accurately expresses the genetic implications of cystic fibrosis:* If it is present in a child both parents are carriers of the defective gene*
• What behavioral factors cause adolescents to be at a higher risk of STIs SATA: Multiple partners, new partners, partners with multiple other partners, inconsistent use of condoms.
• What is the purpose of a peak flow meter: To measure the ability of the lungs to push air out
• What test confirms cystic fibrosis: Sweat test
• What are the characteristics of a hydrocele SATA: Scrotum is fluid filled, in most cases resolves by 1 year of age