NUR 425- Peds Exam #2 Blueprint PDF

NUR 425- Peds Exam #2 Module 7: Fluids/Electrolytes, Elimination & Dehydration (7&8: 16 questions) 1.​ Calculate the bolus and maintenance fluids for children at various weights and levels of dehydration. ​ Understand the difference between bolus and maintenance fluids and how t...

NUR 425- Peds Exam #2 Module 7: Fluids/Electrolytes, Elimination & Dehydration (7&8: 16 questions) 1.​ Calculate the bolus and maintenance fluids for children at various weights and levels of dehydration. ​ Understand the difference between bolus and maintenance fluids and how to use the pediatric weight to correctly calculate needs. ​ Practice the formulas to calculate both IV and PO fluid requirements. Bolus ​ Stable: 10-20 mL/kg over 5-20 min ​ Unstable: 20 mL/kg over 5-10 min Maintenance fluids: ​ First 10 kg: kg x 100 mL ​ Second 10 kg: kg X 50 mL ​ Additional leftover kg: kg X 20 mL ​ Understand RAPID negative (stable) and RAPID positive (unstable) patient findings for fluid replacement interventions. RAPID R= Rapid HR A= Altered color or cap refill P= Peeing nonexistant I= Inability to engage in enviornment D= Decreased/low BP (determines stable vs unstable) ****Hypotension means UNSTABLE*****  NUR 425- Peds Exam #2 ​ Knowledge of vital sign parameters to determine stable vs. unstable dehydration interventions. 2. Calculate the urine output of a pediatric patient at various ages. ​ What is normal urine output for an infant/young child vs older child? Infants and Young Children: 1.5-2mL/kg/hr ​ Diaper weights- 1mL urine = 1 gm ○​ Concerned if less than 4 yet diapers a day Older Children and Adolescents: 1mL/kg/hr 3. Recognize the signs and symptoms of dehydration in the pediatric patient. General S&S: ​ ELEVATED HR ​ Change in LOC (irritable, lethargic) ​ Decrease in skin turgor/elasticity ​ Sunken fontanel ​ Decreased # of wet diapers or increased # of liquid stool diapers ​ Abnormal breathing pattern ​ Prolonged cap refill/mottling/cool skin ​ Low BP General in Infants ​ Fever  NUR 425- Peds Exam #2 ​ Unusual tiredness ​ No tears ​ Dry mouth ​ No wet diapers General in Children ​ Constipation ​ Crankiness ​ Dark-colored urine ​ Tiredness ​ Dizziness ​ HA ​ Thirst ​ Dry mouth ​ Dry skin ​ Compare the pathophysiology and sodium level differences between isotonic/hypotonic/hypertonic dehydration. Isotonic Hypotonic Hypertonic [Isonatremic] [Hyponatremic] [Hypernatremic] Isotonic - stays in Hyposmotic Hyperosmotic Hypotonic - moves into Hypertonic - exits -​ More water = sodium -​ Less water = sodium dilution expansion → ← ← → → → - Na: 150 mEq/L - Most common in diluted) - Too much water loss! - Na: 130 - 150 mEq/L - Too much water intake! - Fluid shifts from ICF → (NORMAL) - Fluid shifts from ECF → ECF - Fluid is lost from ECF ICF - S/S delayed - Decrease in blood volume - Severe shock s/s - Neurological dysfunction (brain cells shrinking!) Causes: acute, shock Causes: prolonged Causes: - Gastroenteritis with V/D - Prolonged V/D - High protein NG feeds - SHOCK is greatest - Burns, renal disease, - Salt intake threat SIADH - Insensible loss: sweating, - Excessive water intake fever - Not replacing electrolytes - Severe excessive V/D w/o only water when replacement dehydrated - CNS changes - seizures  NUR 425- Peds Exam #2 Notes: - Antidiuretic hormone (ADH): body to reabsorb more water ​ Analyze the assessment cues for treatment of the degrees of dehydration: mild vs moderate vs severe dehydration Mild Moderate Severe LOC Alert Lethargic, sleepy, Lethargy, irritable (infants) unresponsiveness Alert, restless (older) (infants) Conscious, anxious (older) Mucous Moist Dry Parched, non-elastic Membranes skin turgor Urine Normal Dark and Decreased of diminished absent LOC No change ↑ HR, normal BP or ↑ HR, ↓ BP slightly ↓ Extremities Warm, cap refill < 2 Cap refill > 2 sec Cool, discolored, sec cap refill > 3-4 sec Thirst No thirst Thirsty Greatly increased unless lethargic Eyes Normal Slightly sunken, ↓ Sunken, ↓ or absent tears tears Fontanelle Flat Sunken Sunken % of dehydration 10% in infants 6% in older children children 4. Develop a plan of care for a pediatric patient who is dehydrated. ​ IV fluids vs PO fluids as an intervention IV bolus if unable to drink - assume isotonic dehydration ​ Use 0.9% NS, NEVER D5W ○​ LR for burns  NUR 425- Peds Exam #2 Reassessment after ever bolus ​ HR, BP, RR ​ Lung sounds ​ Cap refill, skin turgor ​ Skin color ​ Wet diaper? Tears? ​ LOC ​ Mucous membranes PO rehydration: 50-100mL/kg over 4-6 hrs ​ Only if pt able to drink ​ Avoid overly sugary beverages – use pedialyte or rhydralyte ​ Past medical history considerations for rehydration plan of care Consider hx of cardiac or renal issues ​ unstable rehydration→ 5-10 mL/kg over 10-20 min Module 8: Acute Glomerulonephritis, Nephrotic syndrome, UTI​ 5. Describe the pathophysiology of acute glomerular nephritis (AGN) and nephrotic syndrome (NS). ​ ​ Compare the patho as it relates to the lab findings for a pediatric patient diagnosed with NS versus AGN? Acute Glomerulohephritis (AGN) Nephrotic Syndrome (NS) Etiology Etiology ​ Occurs after strep infx w/ certain ​ Massive Proteinuria, strains of group A beta-hemolytic hypoalbuminemia, hyperlipidemia, streptococci edema ○​ 10-21 days between infx and Most common primary disease is onset of symptoms minimal-change Nephrotic syndrome ​ Inflammation of glomeruli (MCNS) ○​ Permeable to RBCs ​ Peak: 2-7 yrs, more common in boys ​ Peak 6-7 yrs ​ Glomerular membrane becomes ​ More common in boys (2:1) permeable to proteins (especially Patho albumin) → proteinuria ​ Immune complexes deposit in ​ ↓ serum albumin → ↓osmotic pressure glomeruli in capillaries → fluid accumulates in ​ ↓ plasma filtration interstitial spaces (edema) and abd ​ ↑ H2O and Na+ retention cavity (ascites) → hypovolemia ○​ ↑ interstitial fluid volume ​ RAAS stimulated→ secretion of ADH ○​ Edemous and aldosterone release (causing ○​ HTN retention) ​ Kideney try to reabsorb Na+ and water to ↑ intravascular volume NEPHROTIC: Na ↓, Albumin ↓, Proteinuria, Hyperlipidemia, Renal vein thrombosis,  NUR 425- Peds Exam #2 Orbital edema, Thromboembolism, Infection, Coagubility ​ 6. Compare the assessment and interventions of a patient with acute glomerular ​ nephritis to a patient with nephrotic syndrome. ​ Differences in assessment cues between AGN and NS ​ Education needs specific for NS vs AGN Acute Glomerulohephritis (AGN) Nephrotic Syndrome (NS) Assessment Assessment ​ Urine: cloudy, smoky brown (tea) ​ Hx of edema, proteinuria, ○​ RBCs/HGB 3+ hypoalbuminemia, hyperlipidemia, no ○​ ↓ amount of urine hematuria, no htn ○​ NO bacteria (NOT AN ​ Frothy yellow urine INFECTION) ​ Greater than 2+ in urine ​ BUN/Cr: ​ Serum protein and albumin low ○​ Elevated in at least 50% ​ Lipids ↑ ​ + ASO titer (means recent step infx) ​ Serum Na+ may be low ​ Serum complement 3 ↓ in early dz Symptoms Symptoms ​ Weight gain ​ Edema ​ Facial edema (subsides through day) ○​ Periorbital ​ Plural effusion ○​ Facial in morning ​ Abd ascites ○​ Can spread to extremities, ​ Diarrhea, anorexia, poor intestinal genitalia, & abd throughout absorption day ​ Fatigue ​ Pallor ​ Lethargy ​ Lethargy ​ BP normal or slightly ↓ ​ HA ​ Urine output ↓ and urine frothy yellow ​ Ill appearance ​ Mild to severe ↑ in BP Management/Education Management/Education  NUR 425- Peds Exam #2 ​ Treat at home if good urine output and ​ Goals: reduce excretion or protein, normal BP reduce edema, prevent infx, minimize ​ Hospitalization if oliguria, HTN, gross complications related to therapies hematuria, significant edema ​ Dietary restrictions in severe cases ​ Daily weight, vitals, strict ​ Diuretics measurement of I&Os ​ 25% albumin IV infusion ​ Dietary restrictions, electrolyte and BP ​ Corticosteroids = first line of therapy monitoring Prognosis ​ Diuretics or antihypertensives prn ​ ⅔ have relapse of MCNS w/ infxtion ○​ Can continue overal several years ​ Complications ○​ Infx, thromboembolism, circulatory insufficiency ​ 80% decrease relapse overtime and have favorable prognosis ​ Renal function is usually normal after treatment Management ​ Daily weight, check urine for protein, vitals, abd girth, assess edema/skin, address changes in appetite, home care preferred, can go to school but should avoid ill friends 7. Discuss assessment, interventions and prevention measures for a pediatric client with urinary tract infection (UTI). Assessment (S&S) ​ Poor feeding, vomiting, fever, cry when urinating, abd or back pain, strong smelling urine, frequent and urgent, incontinenece, + for leukocytes and nitrites Interventions ​ Collect sterile specimen ○​ Clean catch ○​ Avoid collection in urine collection bags ​ Diagnostic tests may be needed to detect anatomical defect ​ Goals: Eliminate current infx (antibitotics), Prevent sepsis, early id of S/S, Preseve renal function (avoid scaring) Prevention ​ Frequent diaper changes ​ Perineal hygiene (wipe front to back) ​ Cotton panties (NOT nylong, avoid tight) ​ Avoid holding urine, void to empty ​ Encourage fluid intake and avoid constipation ​  NUR 425- Peds Exam #2 8. Discuss the pharmacokinetic and pharmacodynamic concepts of upper GI drugs including: mechanisms of action, adverse drug reactions, drug and food interactions, nursing implications, and client education. ​ Therapeutic considerations for Upper GI meds ​ Mechanism of action for Upper GI meds Module 9: Congenital Heart Defects/CHF (15 questions) 1. Identify differences in cardiac assessment and hemodynamics between infant/children and adults. ​ Differences for infant cardiac system in regards to maintaining HR/BP ​ Fetal structures timeline for function ​ Foramen ovale → Closes in newborn heart ​ Ductus arteriosus → Ligamentum arteriosus ​ Ductus venosus → Ligamentum venosus o​ Receive blood from placenta -​ Infants -​ BP is the same between arm and thigh -​ SV is fixed, reliant on HR [CO = rate dependent] -​ This is why we do CPR when HR < 60 -​ > 1 yr -​ SBP in leg higher 10-40 -​ Ossification of foramen ovale around 5 years -​ Ductus arteriosus closes of around 24-72 hr to about a week 2. Explain the pathophysiology, manifestations, diagnosis, and management of increase pulmonary blood flow congenital anomalies (Ventricular Septal Defect-VSD, Patent Ductus Arteriosus-PDA) ​ Compare the assessment cues with large VSD and/or PDA ​ Common assessment cues with both of these congenital heart defects? Ventricular Septal Defect (VSD) patho ​ Opening between the ventricles, causes high pressure left side to push blood to right side of heart (left-to-right shunt) ​ Results in ↑ blood flow to and through the pulmonary system VSD manifestations ​ MURMUR (holosytolic- during squeeze) ​ Frequently associated w/ other defects ​ Widened pulse pressure ​ Rt arium hypertrophy ​ HF ​ Lung issues ○​ Retractions, lung cracjles, activity intolerance, etc  NUR 425- Peds Exam #2 VSD management ​ Can close on own in 1st year of life (20-60%) ​ Surgical treatments ○​ VSD patch to flose hole ​ Prognosis from VSD alone has