NCLEX: Pediatric Key Terms

• Reviewing the NCLEX book helps with exam preparation.
• The orange section of the book focuses on pediatrics.
• A podcast was created from the NCLEX book content.

Key Terms

• On page 539, objective number one highlights key terms.
• There will be two questions related to those key terms on the next test.

Objectives on page 539

• Prevention, treatment, and care for Pan (likely referring to Pancreatitis) is important.
• Understanding symptoms of meningitis
• Recognizing signs of intracranial pressure
• Understanding seizure disorders and nursing responsibilities
• Understanding cystic fibrosis, including the nursing care involved
• Recognizing types of posturing that indicate brain damage
• The ear is responsible for hearing and balance.
• It has three divisions: external, internal, and middle ear.
• Middle ear problems are common.

Ear Issues & Infections Basics

• Congestion and middle ear fluid can cause sinus problems and ear pain.
• The station tube helps protect from viruses and bacteria.
• It aids in drainage and ventilation.
• Swimmer's ear, or otitis externa, affects the external ear.
• It causes pain on the outside of the ear.
• Manipulating the ear can cause pain.
• The tympanic membrane will look normal with otitis externa.
• Other conditions to rule out include cellulitis, diabetes, herpes zoster, etc.
• Treatment involves irrigation.
• Topical antibiotics or antivirals aren't effective, but a topical treatment is appropriate.
• Acute otitis media is an infection of the internal ear.
• Inflammation occurs in the middle ear.
• Sinusitis may also be present.
• It might be related to an upper respiratory infection.
• Middle ear fluid can cause the station tube to be plugged.
• A red and bulging appearance can be seen inside the ear.
• Symptoms may include decreased appetite.
• Infants are more prone to middle ear fluid.
• Children under three are at higher risk for ear infections.
• Chronic ear problems might require referral to an ENT specialist.
• PE tubes (pressure equalizing tubes) or temp tubes could be necessary
• PE tubes act as a vent.
• They usually fall out within a year to a year and a half.
• They help with drainage and pressure equalization.
• Kids with PE tubes can now get their heads wet and swim
• Routine ear infections are usually treated with oral antibiotics after inspection.
• Ear drop antibiotics may also be used
• For ear drops, pull down and back for a child or infant, up and back for an older child.
• Parents need to ensure the full regimen of drops and oral medication is completed.
• Hotitis media is considered chronic if it lasts more than three months, not just the number of infections.
• Prescribers often follow up to ensure the infection has resolved.
• If not, another antibiotic or referral may be needed.
• Hearing is tested at birth with newborn screening.
• Failure leads to rescreening, then referral to an audiologist if it continually fails.
• Parents should watch for lack of response to sound or startle reflex in infants younger than four months.

Considerations for Hearing Loss

• Hearing aids and colloquial implants are interventions.
• Kids with hearing loss often excel with visual aids.
• Picture boards can be used if nurses don't know sign language.
• As they get older, kids can read lips.
• Fluid buildup can lead to barotrauma, where the ear can burst.
• This can be caused by atmospheric pressure.
• Yawning, coughing, sneezing, or blowing the nose can help equalize pressure.
• Children with sinus issues may have problems.
• Preventative measures when traveling with children include pacifiers, bottles, gum, or suckers.
• Decongestants can be used to ensure peak effect during travel and descent.
• Scar tissue from a broken tympanic membrane can heal itself or be patched if needed.
• Similar to when PE tubes are taken out.
• If PE tubes fall out, the ear heals spontaneously.

Eye Development

• Eye development starts around four weeks of gestation.
• Folic acid intake is important during child-bearing range.
• Newborns have immature eyesight and can only see 6-8 inches.
• Depth perception develops at nine months.
• Babies' tear ducts are often not open at birth.
• The black hole duct in the inner eye corner is often not open.
• It can be probed to open if it doesn't open on its own.
• Tears aren't produced until later.
• Testing can occur after two years old.
• Developmental screenings track a child's ability to follow a red ball of yarn.
• By six weeks, they should be able to fixate on something.

Reading Disability & Amblyopia

• Dyslexia is a reading disability due to a brain defect in the cortex, not a vision issue.
• Treatment involves reading coaches and IEPs.
• Amblyopia, screened for on 545, is a reduction in vision, usually in one eye.
• Treatment is glasses and patching the stronger eye to make the weaker eye work harder.
• Self-consciousness can occur with eye patches.
• Correction by age nine is desired to prevent long-term vision issues.

Eye related terms

• Cross-eyedness occurs when a child can't direct their eyes in the same direction.
• There is a lack of coordination between the eyes.
• Untreated eyes can develop visual impairments and sensory interdepression deprivation.
• Squinting and head tilting are common symptoms.
• Older children may complain of headaches or dizziness.
• Infants may grab at things due to poor vision.
• Glasses, eye exercises, or surgery can be used for treatment.
• Permanent vision loss can occur if not treated.
• Early intervention is important before age seven.
• Programs exist to pay for eye exams for children, even without vision insurance.

Eye Strain & Additional Terms

• Headaches, squinting, burning eyes, and difficulty in schoolwork.
• Observation, teaching, and prevention are crucial.
• Conjunctivitis is common, especially for children.
• Snellen Chart and Health Assessment are used for vision testing.
• E-charts and picture charts can be used for younger children.
• Keystone and Broken Wheel are examples of testing tools.
• Computerized machines, like the one the Lions Club uses, can also be used for assessment.
• The Lions Club tests first and second graders for vision problems in some districts.
• Conjunctivitis is often bacterial and can be viral.
• Symptoms include itchy, yucky eyes, redness, and peri-orbital redness.
• Bacterial conjunctivitis is treated with antibiotic drops or ointment.
• Symptoms of conjunctivitis include itchy, tearing eyes and irritability.

Congestion & Eye Matters

• Sinus pressure can affect the eyes, causing the lacto duct to get clogged.
• Bacteria thrive in moist, warm areas
• Warm packing helps with conjunctivitis.
• Wash from inner to outer and avoid sharing towels.
• Bacterial cases should stay out of school for 24 hours after starting antibiotics.
• Eye ointment is often preferred over drops.
• Parents should ensure the full dose is given.
• Ema, blood in the eye, is usually from an ocular injury.
• Blood can be bright red or a dark red spot, usually on the lower front portion of the iris.
• Treatment involves decreasing pressure by elevating the head of the bed to 30-45 degrees.
• Semi-Fowler's position can help.
• Topical medication may be prescribed.
• Athletes should protect their eyes with gear like a catcher's mask.
• Referrals to eye doctors or ophthalmologists are often needed.
• Retina blastoma is a malignant tumor.
• A cat eye reflex, yellow-white, is often present.
• The tumor is located behind the lens of the eye.
• Some providers may notice on assessment, but it's often during an eye exam.
• Vision loss, strabismus, blood in the eye, and pain.
• Laser surgery, chemo, and prosthetic replacement.

The nervous system

• The focus is on disease processes like seizure disorders, meningitis, and eye issues.

Altered Level of Consciousness

• Altered level of consciousness can stem from head injury, disease, or infection.
• Fever, medications, and seizures are early indicators of problems.

Reyes Syndrome

• Reye's syndrome is linked to viral infections and aspirin use.
• Aspirin should not be given to children under 18
• Give kids Pepto-Bismol or Acetaminophen for a headache
• Reye's syndrome involves inflammation of the brain and liver after a viral infection.
• Baby aspirin is for cardiac health in adults, not for babies
• The only exception is for Kawasaki disorder.
• Symptoms include vomiting, headache, and changes in consciousness.
• Labs will show elevated ammonia levels, indicating liver involvement.
• This can lead to seizures and coma
• Treatment focuses on reducing intracranial pressure.
• Check ABCs, maintain airway, ensure oxygenation, and balance fluids and electrolytes.
• Watch for bleeding, especially if there's liver involvement.
• Apply five minutes of pressure to IV sites.
• There's no specific diagnostic tool; labs are run.

Meningitis

• Meningitis can be bacterial or viral.
• It's an infection of the central nervous system.
• Meningitis can be a primary disease, come from trauma, or a sinus infection.
• Diagnosis via lumbar puncture
• Elevated white blood cell count, elevated protein, and decreased glucose.
• Bacterial meningitis is often caused by staph or imatosis
• It's treated with antibiotics.
• Babies with meningitis will be irritable and have a high-pitched cry.
• Adults/older children may have headaches, drowsiness, confusion, fever, and stiff neck.
• Seizures can occur.
• Treatment should be quick.
• Droplet isolation precautions are needed.
• Seizure precautions.
• Antibiotics are given for the first 24 hours, then precautions can be lifted after.
• Monitor vital signs Q4 hours, maintain INO, and use dim lights.
• Low sensory input helps with headaches.
• Neuroassessment includes blood pressure, consciousness level, heart rate, and pupil response.
• NPO with IV fluids may be needed.
• Report weakness of limbs, speech difficulties, mental confusion, or behavioral problems.
• Rashes should also be reported.
• Monitor changes in consciousness and pupillary responses.
• Report any changes in vital signs.
• Pediatric Early Warning (PEW) criteria is based on numbers indicating decompensation.
• PEW is in the copyright policy and in the electronic record.
• Check for fever, chills, tactopenia, tachycardia, high heart rate and respirations, and neurological response.

Additional Pediatric Information

• Sepsis and systematic inflammation can result from infections that occur.
• Untreated septic shock can lead to multiple organ dysfunction.
• Check vitals, hourly rounding, PEW, and neurological status.
• Septic shock in infants initially presents with increased heart rate, not decreased blood pressure.
• Infants are more vulnerable to dehydration and sepsis due to their body's limited capacity to compensate.
• Encephalitis is brain inflammation that can affect the spinal cord.
• Older kids may complain of headaches and may have fever, cramping, abdominal pain, rigidity, and delirium.
• Symptoms include confusion, muscle twitching, abnormal eye movements, restlessness, anger, and headache.
• Sluggish pupil response causes increased intracranial pressure.
• Seizure precautions are needed.
• This requires INO, hourly rounding, and neurological checks.

Brain Tumors

• Discussed next in the book
• Second most common type of cancer in children.
• It's more common in school-aged children.
• Symptoms depend on the tumor location.
• Diagnosis involves MRI
• EEG surgery.
• Treatments include chemo and radiation.
• May have increased intracranial pressure
• This can lead to nausea, vomiting, and changes in equilibrium.
• Enlarge sutures often appear.
• Fontanels still open and may cause changes in their head shape with that.
• Febrile seizures are common in children under five, especially with rapid temperature increases.
• Often occurs between six months to five years and when they are over 102
• Managing temperatures for children over 125 as that puts them more at risk for having a febrile seizure.

Seizures & Treatment

• A table on page 555.
• Tonic-clonic or grand mal seizures involve convulsions.
• The main concern is to protect them.
• Protect the head.
• To protect them from any injury.
• After the seizure, roll to recovery position to prevent aspiration.
• Multiple seizures can occur as a status elective.
• Document events prior to the seizure.
• Was there an aura?
• What were they doing or thinking?
• How long did it last?
• Did they lose consciousness, were they incontinent of bowel and bladder?
• Did they remember it?
• Multiple seizures are a medical emergency requiring oxygen and 911 for outside the hospital
• Aura is a subjective sensation.

Seizures & Additional Topics

• People will know one is coming because of a change in that sensory.
• Absence seizures (pity mall) cause staring into space.
• The person will not respond.
• Teachers and school nurses often notice this.
• Medical professionals assess for those.
• Other seizures can result from brain injury or infection
• Electrolyte imbalances play a part.
• Patients preparing for may be at risk.
• Metabolic disorders, hypokalemia, hypoglycemia, malnourishment, or dehydration.
• Diagnosis usually involves MRI or EEG.
• Loud values are something that can be drawn as well.
• Dilantin (phenytoin) and Phenobol Arbutol are medication choices.
• Vitamin D and folate acid supplements are needed to supplement medication breakdown.
• It should also not be given with milk.
• Watch for long-term effects, on page 558, generic name needed is Phenotol.
• Side effects include astigmatism, gum overgrowth, rash, nausea, vomiting, vitamin D deficiency, and nosebleeds.
• Medication should be taken same time every day and side effects need to be reported.
• Ketogenic diets are a diet change that has high fat/low carbohydrates.
• Evidence proves this helps activity, especially on those ones that don't really respond well to medication.
• Oral care is more important.
• Safety alerts on maintaining precautions on 557 during a seizure include keeping safety rails up, padding sharp objects, having medical ID, and providing supervision, like swimming.
• Triggers should be avoided like flashing lights.
• Make sure that medications are taken.
• Triggers include the flashing lights, over hydration, and photosensitivity
• Drowsiness is a common side effect of any anti-seizure medication should be given at the same time every day and to not stop abruptly in that ketogenesis that can help reduce convulsion episodes.
• Stopped on cerebral palsy.