Pediatric Pharmacology Medications Fall 2024 Study Guide PDF

Study Guide for Final Exam Fall 2024 75 multiple choice questions (9 will be "select all that apply"), 5 medication calculations (remember safe ranges, how to calculate maintenance fluid, and 1.5 times maintenance. Also, always convert lb. into kg!!) and 20 matching (look in Canvas-> Final Exam modu...

Study Guide for Final Exam Fall 2024 75 multiple choice questions (9 will be "select all that apply"), 5 medication calculations (remember safe ranges, how to calculate maintenance fluid, and 1.5 times maintenance. Also, always convert lb. into kg!!) and 20 matching (look in Canvas-> Final Exam module-> Pediatric Pharmacology Medications) Growth and Development Order of infant development Gross motor skills develop in cephalocaudal fashion (Head to toe) (Large muscles such as head control, rolling, sitting, and walking) Fine motor skills develop in proximodistal fashion (Center to periphery) Gross motor development: 1 month (Lifts, turns head when prone, head lag), 2 months (Raises head and chest, improving head control), 3 months (Raises head 45 degrees in prone, slight head lag), 4 months (Lifts head and looks around, rolls from prone to supine), 5 months (Rolls from supine to prone and back, sits upright with support), 6 months (Tripod sits), 7 months (Sits alone with some use of hands), 8 months (Sits unsupported), 9 months (Crawls, abdomen of floor), 10 months (Pulls to stand “Cruises”), 12 months (Sits from standing position, walks independently) Fine motor development:1 month (Fists mostly clenched, involuntary hand movements), 3 months (Holds hands in front of face, hands open), 4 months (Bats at objects), 5 months (Grasps rattle), 6 months (Releases object in hand to take another), 7 months (Transfers object from one hand to the other), 8 months (Gross pincer grasp (Rakes)), 9 months (Bangs objects together), 10 months (Fine pincer grasp, puts objects into container and takes them out), 11 months (Offers objects to others and releases them), 12 months (Feeds self with cup and spoon, makes simple mark on paper, pokes with index finger) Toddler play behavior Parallel Play: Toddler plays alongside another child rather than cooperatively Dramatic play: Role playing Outdoor Play: Physical outdoor play (Playground and climbing) Egocentric: Makes it difficult to share  As they are developing a sense of self they may see their toys as an extension of themselves Learning to share occurs in later toddlerhood Short attention span leading to frequently changing toys and types of play Types of toys: Familiar household items and child sized household items (Blocks, Cars, Plastic figures, Stuffed animals, Dolls, Carriages), Manipulative toys (Knobs and buttons that can make things happen, shapes to insert into matching holes, puzzles, chalk, buckets and shovels, and floating toys), Gross motor toys (Gyms, tricycles, pull toys, and wagons). Adolescent development- i.e. compliance with medications and treatment, body image, importance of peers, etc. Compliance with medication and Treatment: Respect (Face to face conversing, honesty, praise, involve in decision making), Engage (Educate, Provide resources, Assess preferences such as Diet), Substance Abuse (Educate on dependency, healthy life style) Body Image: Sexual development (Contraceptives and education), Teach Hygienic care, Tanner Stages (Breast, Pubic hair, scrotum size, Stages 1-5), Height/Fat/Muscle mass increase. Educating Parents: Monitor for poor peer selection or influence (Friends, recreation, vent (Stress), social reinforcement), Positive/Negative and learn how to deal with conflict Piaget Theories Sensorimotor Stage: 0-2 years, Development through our 5 direct senses, Development through motor response and contact, Egocentric (Can only see the world from one’s own point of view), Object permanence is developed (Realizing that objects that are out of sight still exist), Separation anxiety develops. Preoperational Stage: 2-7 years, Symbolic thinking (Uses words and images to represent objects), Abstract thinking is still difficult (Does not reason logically), Asks a lot of questions (Intuition), Imagination (Magical thinking, Animism, Plays pretend) Concrete Operational Stage: 7-11 years, Develops concrete cognitive operations (Sorting blocks in certain order), Conservation is developed (Understanding that something stays the same in volume even when shape changes), Conductive reasoning (Mathematical advancements) Formal Operational Stage: >11 years, More rational, logical, organized, moral, and consistent thinking. Hypothetical thinking (Can think outside the present), Abstract concepts (Love, hate, failures, successes), Deductive reasoning Erikson’s Theories Infancy: 0-1 years, Trust vs Mistrust (Trust or mistrust that basic needs such as nourishment and affection will be met) (Positive outcome: Trust self and others) (Negative outcome: Demonstrates an inability to trust, withdrawal isolation) Early childhood Toddler: 1-3 years, Autonomy vs Shame/Doubt (Develop a sense of independency in many tasks) (Positive outcome: Exercises self-control and influences the environment directly) (Negative outcome: Demonstrates defiance and negativism) Play age Preschool: 3-6 years, Initiative vs Guilt (Take initiative on some activities may develop guilt when unsuccessful or boundaries overstepped) (Positive outcome: Begins to evaluate own behavior, learns limits on influence in the environment) (Negative outcome: Demonstrates fearful, pessimistic behaviors, lacks self-confidence) School age: 7-11 years, Industry vs Inferiority (Develops self-confidence in abilities when competent or sense of inferiority when not), (Positive outcome: Develops a sense of confidence, uses creative energy to influence the environment) (Negative Outcome: Demonstrates feeling of inadequacy, mediocrity, and self-doubt) Adolescence: 12-20 years, Identity vs Confusion, (Experiment with and develop identity and roles), (Positive outcome: Develops a coherent sense of self, plans a future of work and education), (Negative outcome: Demonstrates an inability to develop personal and vocational identity) Immunizations What immunization does an infant get before discharge? Hepatitis B: Given before infant leaves the hospital, contraindicated for people allergic to yeast What vaccines prevent childhood diseases? Dtap Vaccine: (Diphtheria, Pertussis, and Tetanus) Given at 2-4-6 months, Booster at 4-6 years, Don’t for children above 7 years of age Hib Vaccine: (Haemophilius Influenza type b) Protects against bacteria that causes epiglottitis, bacterial meningitis, and septic arthritis. Do not give with Dtap combination in infants 2-6 months. MMR Vaccine: (Measles, Mumps, and Rubella) Given at 12-15months, Rash is common 2 weeks after, Do not give if allergic to eggs or neomycin, clients with a depressed immune systems, and breastfeeding women. Polio Vaccine: Start to give at 2 months, Contraindicated with hx of anaphylactic shock to neomycin or streptomycin.  Varicella Vaccine: (Chicken Pox) School requirement, Safe to give to children with HIV if they have no active cold symptoms, Give with MMR vaccine on same day but not in same location. Respiratory Disorders Signs and symptoms of worsening respiratory distress (increased work of breathing) S/S: Tachypnea, Nasal flaring, Grunting, Chest Retractions, Paradoxical respirations (Chest falls on inspiration and rises with expiration), Accessory muscle use. Evaluate: Anxiety and restlessness, Color for cyanosis or pallor, Hydration status, Clubbing, Breath sounds, Rate and depth of respirations (Tachypnea), Nose and oral cavity, Cough and stridor, Pulse oximetry, Chest radiograph (Hyperinflation, atelectasis, Infiltration), Blood gases (Carbon dioxide retention and Hypoxemia) Epiglottitis Most often caused by Haemophilus influenzae type b Rare since 1980’s with use of Hib vaccine Respiratory arrest and death may occur if airway becomes completely occluded S/S: Dysphasia (Cant speak), Drooling, Anxiety, Irritability, Respiratory distress Complications: Pneumothorax and pulmonary edema Therapeutic management: Airway maintenance, IV antibiotics, Emergency tracheostomy, PICU admission. DO NOT: Attempt to visualize the throat as reflex laryngospasm may occur causing occlusion airway, No oral temperatures, Leave the child unattended, Place in supine position. DO: Provide 100% oxygen in the least invasive manner, ensure tracheostomy tray and emergency equipment readily available. Facts: Can occur from no illness before or mild upper respiratory infection, age group around 1 to 8 years of age, High fever, Dysphasia, Toxic appearance, Onset set is rapid within a few hours. Asthma Chronic lung disease that causes an inflamed, narrow, and swollen airway (Bronchi and Bronchioles), Characteristics include Airway hyperresponsiveness, edema, and mucus production. Causes: (Not completely known), Genetic, Environmental (Smoke, Pollen, Perfumes, Dust mites, Pet dander, cold or dry air, Mold, Cockroach Antigens), GERD, Exercise-induced asthma, certain drugs (NSAIDS and Aspirin)  S/S: Dyspnea, Tachypnea, Chest tightness, Anxiety, Wheezing, Coughing, Mucus production, Use of accessory muscles, Air trapping, Increased work of breathing. Classifications: Mild Intermittent (Less than 2x a week), Mild Persistent (2x a week but not daily), Moderate Persistent (Daily symptoms and exacerbations that happen 2x a week), Severe Persistent (Continually showing symptoms with frequent exacerbations) Medications: Bronchodilators (Short acting Albuterol for rapid relief, Long acting Salmeterol for preventing asthma attacks), Corticosteroids (ASONE & IDE ex: Beclomethasone) Sinusitis vs allergic rhinitis vs common cold Sinusitis: Length of illness is longer than 10-14 days, Nasal drainage is thick yellow or green, Nasal congestion present, Sneezing absent, Cough varies, Headache varies, Fever varies, Bad breath varies. Allergic rhinitis: Length of illness varies and may have year round symptoms, Nasal drainage is thin watery and clear, Nasal congestion varies, Sneezing varies, Cough varies. Headaches varies, Fever absent, Bad breath absent Common cold: Length of illness 10 days or less, Nasal drainage is thick or thin white yellow or green, Nasal congestion present, Sneezing present, Cough present, Headache varies, Fever varies, Bad breath absent. Tonsillectomy- complications, nursing management Promote airway clearance: Place child in side lying or prone position Maintain fluid volume: Discourage coughing, Use of straws, Clearing the throat, Blowing nose. Encourage fluids and ice, avoid citrus, brown, or red fluids. Relieving Pain: Ice collar and analgesics with or without narcotics Frequent Swallowing may indicate bleeding Hemorrhage can occur immediately postoperative to as late as 10 days after (Look for Tachycardia, Pallor, Restlessness, Frequent throat clearing, and emesis of bright red blood) Croup Most affected are children 3 months to 3 years of age Referred to as laryngotracheobronchitis (Inflammation and edema of the larynx, trachea, and bronchi) Parainfluenza cause of majority of cases (Viral infection of the upper airway) Audible inspiratory stridor (Barking seal cough) developing at night  Children may be hospitalized if they have stridor at rest or severe retractions after several hour period of observation Management: Corticosteroids (Single dose of dexamethasone), Racemic epinephrine aerosols, Exposure to humidified air (Cool mist or steamy bathroom) Cardiovascular Disorders What medications keep the PDA (Patent Ductus Arteriosus) open (patent) vs closed Indomethacin: Helps close the PDA (Inhibits prostaglandin synthesis) Prostaglandin: Helps keep PDA open (Vasodilation of ductus arteriosus smooth muscle) Nursing management of Tetralogy of Fallot/TET spells A TET spell is an episode in which a child or infant becomes extremely blue and frequently agitated and out of breath. Caused by tetralogy of Fallot (Decreased Pulmonary Blood Flow) S/S: Uncontrollable crying or irritability, Tachypnea, and Worsening hypoxia with cyanosis/pallor, Decreased intensity of heart murmur, Limpness, LOC, and Convulsions Treatment: Use a calm comforting approach, Place infant or child in a knee-to- chest position, Provide supplemental oxygen, Supply IV fluids, Administer morphine sulfate (0.1mg/kg Iv, IM, SQ), Administer propranolol (0.1mg/kg) IV Rheumatic fever Can result after not treating strep throat or scarlet fever correctly Causes total body inflammation, damaging the heart valves (Murmur) S/S: Fever, Joint pain, Sore throat within 2-3 weeks Treatment: Full 10-day course of penicillin therapy (or erythromycin) is used alongside corticosteroids and NSAIDS Children without valvular disease will receive continued prophylaxis with monthly IM injections of PCN-G or daily oral doses of PCN (Erythromycin) until adulthood. Nursing management after cardiac catheterization  Maintain bed rest Keep extremity in straight position for 4-8 hours Assess child’s distal pulses bilaterally for presence and quality Assess the color and temperature of the affected extremity Assess pressure dressing frequently & check if dry, intact, and not bleeding Monitor input and output Digoxin- safety measures, administration It is a cardiac glycoside that increases contractility within the heart Count apical pulse for 1 full minute, noting rate, rhythm, and quality Withhold if apical pulse is