RN Pediatric Nursing Practice 2023

Anaphylactic Reaction Management

• Priority action for a child in anaphylactic shock is administering epinephrine IM to counteract histamine-induced bronchoconstriction and vasodilation.

Pneumothorax Care

• Apply supplemental oxygen for breathing support in a potentially pneumothorax-afflicted adolescent.
• Prepare for chest tube insertion to promote lung re-expansion in case of air or fluid accumulation in the pleural space.

Epiglottitis Monitoring

• Monitor oxygen saturation in children with epiglottitis to assess treatment response and respiratory distress.

Developmental Play Activities

• Recommend dress-up play for preschoolers as it fosters social, mental, and physical development.

Priority in Sickle Cell Anemia

• A school-age child with sickle cell anemia reporting decreased vision should be prioritized due to the risk of vaso-occlusive crisis.

Digoxin Administration in Heart Failure

• Instruct parents to brush a heart failure child's teeth after administering digoxin to prevent dental decay from the sweet liquid form of the medication.

Diaper Dermatitis Treatment

• Use zinc oxide to create a protective barrier for infants battling diaper dermatitis, allowing skin healing.

IV Catheter Discontinuation Procedure

• Turn off the IV pump, occlude tubing, remove tape, and apply pressure to the catheter site for safe discontinuation.

Biceps Reflex Assessment

• Tap the appropriate area to elicit the biceps reflex in school-age children with spinal cord injuries.

Infection Control in Immunocompromised Children

• Screen visitors of severely immunocompromised children for infections to prevent overwhelming risk of contagion.

Oral Nystatin Administration

• Shake oral nystatin suspension before administration to ensure even distribution of medication.

Understanding Infectious Mononucleosis

• Mononucleosis is predominantly caused by the Epstein-Barr virus.

Heart Failure Dietary Care

• Provide small, frequent meals to a child with heart failure to help conserve energy.

Toddler Behavior Characteristics

• Expect toddlers to express likes and dislikes as they develop autonomy and self-concept.

Disease Process Considerations

• Prioritize the patient's disease process to minimize infectious disease transmission risks in hospitalized children.

Hydrotherapy Pain Management

• Administer analgesics prior to hydrotherapy for pain management in burn wound debridement.

Asthma Attack Prevention

• Advise parents to keep their asthmatic child indoors during activities like lawn mowing to limit exposure to allergens.

Iron-Deficiency Anemia Dietary Focus

• Encourage adolescents with iron deficiency anemia to consume non-heme iron-rich foods, with raisins being a top choice.

Encouraging Self-Care in Juvenile Idiopathic Arthritis

• Promote independent self-care in children with juvenile idiopathic arthritis to enhance mobility and self-esteem.

Preparing for Lumbar Puncture

• Apply topical analgesic cream to the lumbar site one hour before a lumbar puncture for pain relief.

Monitoring for Lead Poisoning

• Follow up on signs of lead poisoning in toddlers living in older homes, such as pale pink mucous membranes and decreased activity.

Cognitive Risk from Elevated Lead Levels

• Assess and address elevated blood lead levels (BLL) to prevent long-term cognitive impairment in children.

Anticipating Provider Prescriptions

• Expect prescriptive interventions for children with elevated BLL, including medications like succimer and ferrous sulfate, as well as dietitian consults.

Discharge Education for Parents

• Provide guidance on administering medications, monitoring hydration, and preventing lead exposure for toddlers with lead poisoning.

Indicators of Improved Health

• Identify improvements in a child's health related to lead poisoning, kidney function, exposure levels, and nutritional status.

Anemia Laboratory Findings

• Recognize hematocrit below the reference range (28% in a child) as an indication of anemia and its associated fatigue symptoms.

Immunization Administration Consideration

• Withhold the MMR vaccine for a toddler with a known allergy to neomycin, indicating contraindications in vaccine administration.

Managing Shock in Children

• After ensuring airway and respiratory stability in an 8-year-old child showing early shock signs, further assessment and intervention are essential.### IV Access and Kidneys
• Initiating IV access is crucial after establishing airway and respiratory stabilization in children to maintain circulatory volume.
• Elevated serum creatinine (3.0 mg/dL) indicates potential kidney rejection in adolescents post-transplant; normal range is 0.4 to 1.0 mg/dL.

Lead Screening and Appendicitis

• A toddler with a serum lead level of 4 mcg/dL requires yearly re-screening and education on exposure prevention.
• McBurney's point, located in the right lower abdomen, is significant for identifying appendicitis pain.

Vision and Neutropenia

• Presence of strabismus in a 6-month-old should be reported as it may lead to blindness if uncorrected.
• Guardians of a child with neutropenia should be advised to avoid daycare centers to minimize infection risk.

Hyperkalemia and Pertussis Care

• Serum potassium level of 4.1 mEq/L confirms effectiveness of sodium polystyrene sulfonate in treating hyperkalemia.
• Droplet precautions are necessary for children diagnosed with pertussis, as it's transmitted during coughing or sneezing.

Hydration Monitoring and Diabetes Insipidus

• Parents of a toddler with dehydration should monitor the number of wet diapers to assess hydration status.
• Sodium levels above 145 mEq/L can indicate impending diabetes insipidus after head injury.

Neurovascular Checks and Child Maltreatment

• Peripheral pulses should be assessed every 4 hours in children in Buck's traction to monitor neurovascular integrity.
• Symmetric burns on lower extremities may suggest physical abuse in children.

Bicycle Safety and Developmental Milestones

• For bicycle safety, children should be able to touch the ground with their feet while seated to ensure proper sizing.
• A 4-year-old should be able to cut an outlined shape using scissors, indicating appropriate developmental milestones.

Postoperative Assessment

• Absence of peristalsis is expected immediately following a perforated appendix repair as bowel function resumes.
• Erythrocyte sedimentation rate increased to 18 mm/hr (normal is up to 10 mm/hr) may indicate postoperative infection.

Physical Neglect and Nephrotic Syndrome

• Poor personal hygiene in toddlers can signal physical neglect due to insufficient supervision.
• Elevated temperature and BUN levels could point towards either acute poststreptococcal glomerulonephritis or hemolytic uremic syndrome.

Hemophilia Management

• Administering factor VIII is anticipated for toddlers experiencing acute hemophilia episodes due to recent falls.
• Ice packs can be beneficial in managing discomfort from hemarthrosis during acute episodes of hemophilia.

Signs of Improvement in Infants

• Improved status in an 8-month-old with laryngotracheobronchitis is indicated by the infant sleeping in parent's arms and improved SpO2 levels (96% with oxygen).
• Assessment should consider urine output, with 34 mL indicating better hydration status compared to prior absence of voiding.### Head Injury and SIADH
• A head injury in adolescents can disrupt pituitary function.
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH) can result from this disruption.
• SIADH leads to excessive secretion of antidiuretic hormone (ADH).
• Key indicators of SIADH include decreased urine output and hyponatremia (low sodium levels).
• Mental confusion is a critical symptom that may develop as hyponatremia worsens.
• Severe cases can cause additional neurologic manifestations, such as seizures.

Cheiloplasty Care for Infants

• Post-operative care for a 3-month-old infant following cheiloplasty is crucial for healing.
• Parents should apply a thin layer of antibiotic ointment daily on the suture line for three days.
• After three days, transitioning to petroleum jelly for an extended period is recommended.
• This routine helps in promoting effective healing of the surgical site.