Pediatric Nursing Study Guide: Vital Signs, Dehydration, Respiratory Conditions PDF

Module 2 Exam Study Guide The following are recommended concepts to review in preparation for the Module 2 exam. The questions will be in the multiple choice, true and false, multiple answers and short answer. There will be 50 questions; time limit 75 minutes. This is not meant to be an ‘all encompa...

Module 2 Exam Study Guide The following are recommended concepts to review in preparation for the Module 2 exam. The questions will be in the multiple choice, true and false, multiple answers and short answer. There will be 50 questions; time limit 75 minutes. This is not meant to be an ‘all encompassing’ list- because of the nature of question formats, additional knowledge may be necessary. One example is that for multiple choice exams, knowledge is needed to select the best option, but additional knowledge is needed to identify the incorrect or less than optimal choices. Also, knowledge from prerequisite courses may be needed. General: Analyze vital signs- identify normal from abnormal vital signs with nursing interventions. Heart Rate: Newborn-3 months: 82-205 3 months-2 years: 100-190 2 years-10 years: 60-40 More than years: 60-100 Respiratory Rate: 1 day-1 year: 30-60 1 year-3 year: 24-40 3 years-5 years: 22-34 5 years-12 years: 18-30 12 years and older: 12-18 Analyze assessment findings- identify normal from abnormal with nursing interventions. Math: Fluid Balance I &O o Infant output: 2-3 ml/kg/hr o Toddler output: 1-2 ml/kg/hr o Adolescent/ School Age output: 0.5-1 ml/kg/hr Daily maintenance fluid o 100 ml-10 kg o 50 ml-11-20 kg o 20 ml- anything over 20 IV fluids, bolus administration o Pediatric weight-based medications- single doses o Take safe dose range and multiply by weight Chapter 18. F&E. Page 409- Definitions and examples of types of extracellular fluid volume deficits & s/s o Isotonic Dehydration ▪ Fluid is not balanced by intake and the loss of water and sodium are in proportion S/S: vomiting and diarrhea o Hypotonic Dehydration (Hyponatremic) ▪ Fluid loss is characterized by proportionately greater loss of sodium than water (compensatory fluids shift occurs from extracellular to intracellular) Cause: severe and prolonged vomiting, diarrhea, burns, and renal disease, admin of IV fluids w/o electrolytes o Hypertonic Dehydration (Hypernatremia) ▪ Fluid loss is characterized by proportionately greater loss of water than sodium (compensatory fluids shifts occur from intracellular to extracellular) S/S: neurologic symptoms Cause: diabetes insipidus, admin of IV or tube feedings with high electrolyte levels Table 18-3. Severity of Clinical Dehydration o Signs and symptoms: elevated BUN, low serum bicarbonate, elevated urine specific gravity, skin turgor, urine color, dry mucous membranes, decreased I/O ▪ Mild Dehydration S/S: restless and thirsty, everything else is normal ▪ Moderate Dehydration S/S: irritable or lethargic, thirsty, restless, pulse high, BP normal or low, poor skin turgor, mucous membranes are dry, decreased urine output, which is dark, delayed cap. Refill (>2), respirations usual or rapid, decreased tears ▪ Severe Dehydration S/S: lethargic to comatose, BP low to undetectable, pulse weak and nonpalpable, mucous membranes parched, urine absent or  very little, thirst is great, extremities cool and discolored, cap. Refill (>3- 4), respirations changing rate and regularity Overhydration in kids o Causes: fluids with too many electrolytes, too much water in formula, CHF, and chronic kidney failure o Treatment: restrict water, give diuretics Interpret risk factors for fluid and electrolyte imbalance in children. o Vomiting (most common), diarrhea (most common), NG suction, hemorrhage, burns, type one diabetes, wound drainage, renal insufficiency Assessment Guide: The Child with a Fluid, Electrolyte or Acid-Base alteration. o Body Weight: has weight decreased since the last measurement or weight reported by the family, if so, how much, what percentage of body weight is the weight loss o Skin and mucous membranes: what is the temperature, turgor, and moistness of the skin, describes moistness of oral mucous membranes, describe moistness of the eyes and presence of tears, is edema present in any body parts o Cardiovascular and respiratory systems: what are pulse and blood pressure, test cap refill and small-vein filling times, what is the RR, what is the regular rate o GI system: N/V or diarrhea, if so, how often and for how long has t continued, is the child eating and drinking, how much and what types of foods and fluids o Urinary system: what is the child’s urinary output, number of wet diapers/ days, urine specific gravity o Musculoskeletal system: describe muscle tone and symmetry o Neurological system: describe the child’s state of alertness, LOC, is the anterior fontanelle at the skin surface or does it appear sunken Integrate assessment information to plan appropriate nursing interventions for children experiencing fluid, electrolyte, and acid-base imbalance. o Acid-base imbalance ▪ Normal blood ph is 7.27-7.49 (acidic if higher than top number) ▪ Respiratory acidosis-caused by anything which hinders the lungs releasing CO2, kidneys will try to compensate (cardiac/resp arrest, decreased aeration, respiratory muscle injury, head injury) s/s: CNS depression (confusion, lethargy, increased ICP, tachycardia, low BP, decreased LOC) ▪ Respiratory alkalosis-decreased CO2, PH elevated (hypoxia, asthma, sepsis, hyperventilation) s/s: paresthesia ▪ Metabolic acidosis-caused by imbalance in production and excretion of acid or excess loss of bicarb→ respiratory will compensate (DM, ingestion of antifreeze, ASA, renal failure, diarrhea, starvation) s/s: RR increase, kussmaul’s respirations ▪ Metabolic alkalosis-caused by loss of acid or too much bicarb (prolonged vomiting, NG suction, antacids, diuretics, reconstitution of powder formula o Hypernatremia (s/s): thirst, low urine output, decreased LOC, confusion, lethargy coma, seizures  o Hyponatremia (s/s): decreased level of consciousness, anorexia, N/V, headache, muscle weakness, decreased deep tendon reflexes, agitation, lethargy, confusion, coma, seizures o Hyperkalemia (s/s): muscle dysfunction, hyperactivity of GI smooth muscles, intestinal cramping, and diarrhea o Hypokalemia (s/s): abd distention, constipation, or paralytic ileus, cardiac arrhythmias, respiratory muscles may be impaired, polyuria o Hypercalcemia (s/s): constipation, anorexia, N/V, fatigue, skeletal muscle weakness, confusion, lethargy o Hypocalcemia (s/s): twitching, cramping, tingling, carpal or pedal spasm, seizures, cardiac arrythmias o Risk factors Assessment for Electrolyte Imbalances: ▪ Electrolyte intake and absorption, electrolyte shifts, electrolyte excretion, electrolyte loss by abnormal route (vomiting, diarrhea, NG suction, wound, burn), rapid changes in weight, vascular volume, interstitial volume (skin turgor, edema), cerebral function (LOC), skeletal muscle function (muscle strength), neuromuscular excitability, GI function, cardiac rhythm Remember that as newborn body is 75% water, and as time goes on, infant has 65% water, and child/adolescent is 50% water o There are two types of fluid loss ▪ Sensible fluid loss: measurable such as through urine or wound drainage ▪ Insensible fluid loss: immeasurable such as through skin and respiratory tract Stages of Dehydration (table 18-3) o Mild: 3-5 % total weight loss-→oral rehydration (no juice, cola, or sugary drinks which may cause more dehydration) o Moderate: 6-10% o Severe: over 10%-→ give IV hydration (Bolus= 20 ml/kg/hr/20-30 min) ▪ Check for skin turgor, mucous membranes, I/O’s, B/P, weight Normal Output Ranges: o Infant: 2-3 ml/kh/hr o Toddler: 1-2 ml/kg/hr o Adolescent: 0.5-1 ml/kg/hr Overhydration o Signs and symptoms: weight gain (.5 lbs in one day), edema, tight clothes, shoes, bounding pulse, respiratory difficulty (dyspnea, orthopnea, crackles) Chapter 15. Pain Identify physiologic and behavioral manifestations of pain. o Physiological ▪ Respiratory: shallow breathing, inadequate lung expansion, poor cough ▪ Neurologic: tachycardia, HTN, change in sleep, irritability, perspiration ▪ Metabolic: perspiration, increased BG, decreased insulin ▪ Immune: increased risk for infection/delayed wound healing ▪ GI: delayed GI function, anorexia, poor nutritional intake o Behavioral  ▪ Short attention span, posturing (guarding a painful area by not moving or protecting), drawing up knees, lethargy, withdrawal, remaining quiet, sleep disturbances, depression, aggressive behavior, knitted eyebrows, squinted yes, eyes, closed, crying, jerky or flailing movements, anxiety, Identify misconceptions about pain in infants and children. o Children don’t feel pain like adults, there’s no consequences to children’s pain o Pain facts: ▪ Infants display behavioral and psychological cues, children remember painful experiences which can affect pain responses in the future, children who repeatedly experience pain tend to report pain at higher levels, Children may not complain of pain due to limited vocab, fear of doctor, fear of more pain, fear of repercussions, and bravery, After giving pain meds, recheck pain levels after 1 hour, if it’s still high, distract them Integrate cultural influences on pain into nursing interventions for children with various health alterations. o Children learn how to express pain by observation and imitation, stoic, nonverbal and verbal expression o African Americans and Latino’s perceive greater pain o Children will have individualized responses to pain based on past experiences Identify pain assessment tools used for infants and children. o Newborn Scales: ▪ Neonatal infant pain scale (NIPS)→ preterm to up to 6 weeks Facial expression, cry, breathing patterns, arm and leg positional, state of arousal ▪ CRIES scale-→ preterm and full term in ICU Facial expression ▪ Neonatal pain, agitation, and sedation scale (N-PASS)-→neonates and infants VS, cries, expression o Preschooler Scale: ▪ Oucher→ 6 pictures based on ethnicity (3-13 years) ▪ FACES (3-7 years) ▪ FLACC→ nonverbal, sedated (3-18 years) Based on face (expression), legs, activity, cry, and consolability  ▪ Poker chip→ more chips means higher pain (4-12 years) ▪ Numerical rating→ not ideal for younger school age (7-9 years or higher) ▪ Visual Analog→ (9-18 years)—highly subjective eval of pain o Newborn/Infant (0-1 years old) ▪ NIPS o Toddler (1-3 years old)) ▪ FLACC, Oucher, FACES o Preschooler (3-6 years old) ▪ Oucher, FACES, FLACC, Poker chip o School Age (6-12 years old) ▪ FACES, Oucher, Poker chip, Visual Analogue o Adolescent (12 or older) ▪ Oucher, FACES, Poker chip, Numeric Pain Scale, word graphic rating Describe methods for alleviating pain in children, utilizing both pharmacologic and non-pharmacologic methods. o Pharmacological ▪ Mild to moderate (Non-opioids): Tylenol, NSAIDS ▪ Moderate to Severe (Opioids): Morphine, Dilaudid, Codeine, Oxy s/s: sedation, n/v, urinary retention, itching (main things are respiratory depression and constipation) methods of administration: oral (slower absorption) and IV (quicker absorption) preferred, Topical: EMLA cream tends to hide vein, EMLA spray is quicker and doesn’t cover veins PCA pump→6 years old is the youngest, no one can press this pump but patient o Non-pharmacological ▪ Comfort measure, CBT (cognitive behavioral therapy): distraction, guided imagery, relaxation techniques, breathing techniques, hypnosis, take them  out of room , get specialists involved, cutaneous stimulation, heat and cold, acupuncture Nursing priority upon arrival is assessment: ADPIE Chapter 20. Respiratory Describe assessment methods to evaluate the infant and child with a respiratory condition o Position of comfort: is the child comfortable lying down, do they prefer to sit up or in tripod position o Vital Signs: assess rate and depth of respirations, is tachypnea present, assess pulse for rate and rhythm o Lung Auscultation: are breath sounds bilateral, diminished, or absent, are adventitious(wheezes, crackles, rhonchi) present o Respiratory effort: is stridor or wheezing present, is grunting heard, is breathing easy or labored, is nasal flaring present, are retractions present, are accessory muscles being used, can the child say a full sentence or is a breath needed, is the cry weak or strong o Color: what is the color of the mucous membranes, nail beds, or skin, does crying improve or worsen the color o Cough: is it productive, dry, brassy, or croupy, is it forceful or weak o Behavior Change: are they irritable, restless, or is there a change in the level of responsiveness Describe unique characteristics of the pediatric respiratory system anatomy and physiology and apply the information to the care of children with respiratory conditions. o Bronchioles in children are smaller and thinner which lead to more severe asthmatic attacks, children consume more O2, alveoli are still developing, children > 6 use diaphragm to breathe, so when in respiratory distress, it causes retractions Differentiate pathophysiology, clinical manifestations, medical and nursing treatment to the care of infants and children with upper and lower airway alterations. Apply chronologic and developmental age principles to the nursing care of infants and children with respiratory conditions: Viral nasopharyngitis o Common cold Bronchiolitis/ RSV: airway lining swells and excessive mucous produced ( 60) o Symptoms: fatigue, chronic cough, recurrent URI’s, abd distention, digital clubbing, fatty stinky stools o Treatments: ▪ Chest physiotherapy: percussion and vibration of multiple areas of lung (cup hands and tap on lungs to loosen secretions) ▪ Flutter: handheld plastic pipe with ball inside used to loosen secretions ▪ Chest Therapy Vest: provides high frequency chest wall oscillation Give medications before and food after ▪ Aerosol Medications Bronchodilator, hypertonic 7% Normal Saline (increases hydration—a must), Dornase Alfa (loosens, liquifies, and thins secretions) ▪ Nutritional Therapy Replace pancreatic enzymes with food  o Taken with all meals/snacks High calorie diet, high fat diet o Fat-Soluble vitamin supplements plus multivitamins Chapter 17. Describe environmental hazards (exposure to substances and potential for poisoning) and their effect on child and adolescent health; relate to nursing care: Lead Poisoning: Chelation therapy o Agent binds to lead and releases it through urine Aspirin and Acetaminophen ingestions o Acetaminophen ingestion ▪ S/S: N/V, sweating, pallor, hepatic involvement ▪ Treatment: administer antidote, charcoal o Aspirin ingestion ▪ S/S: N/V, disorientation, dehydration, diaphoresis, Hyperpnea, Hyperpyrexia, bleeding tendencies, oliguria, tinnitus, convulsions, coma ▪ Treatment: induce vomiting, administer IV bicarb, fluids, and vit K Chapter 19 Recognize anatomic and physiologic differences in EENT of children as compared to adults o Eyes: underdeveloped structure, increased risk for injury, vision, uncoordinated muscle coordination o Ears: Eustachian tube is more horizontal, shorter, and wider so it’s easier to get things stuck in there ▪ During sucking, yawning, and other movements, the tube opens for milliseconds allowing free passage of air between nasopharynx and middle ear which leads to infections ▪ o Nose, Throat, and Mouth ▪ Up to the age of 6 months, infants are primarily nasal breathers Describe visual disorders found in children and their manifestations o Hyperopia: far sited o Myopia: near sited o Astigmatism: blurry vision (light rays do not meet in the eye) o Retinoblastoma: cancer of the retina→ if you shine light at eye, it will have “white reaction” (normal is red) Describe disorders of the ear unique to children and their accompanying impairments o Otitis Media: inflammation of the middle ear (one of the most common childhood illnesses o Otitis Externa: inflammation of the skin and surrounding soft tissue of the ear canal (“swimmer’s ear”) o Hearing Loss:  ▪ Conductive: when conditions in the external auditory canal or tympanic membrane prevent sound from reaching the middle ear ▪ Sensorineural: when the hair cells in the cochlea or along the vestibulocochlear nerve are damaged (leads to permanent hearing loss) ▪ Mixed: hearing loss happening due to a combo of conductive and sensorineural Describe the nursing care for infants and children with sensory deficits. o Sight impairments: encourage the use of all senses, utilize touch and speak through procedures o Hearing impairments: obtain child’s visual attention by lightly touching the child and so they can read lips, position yourself 3 to 6 feet from the child and make sure they are focused on you, rephrase sentences as needed, give time to understand, be familiar with types of hearing aids Describe disorders of the nose, throat and mouth found in children and relate to nursing care: o Strabismus ▪ Cross eye→ can lead to amblyopia Types: o Esotropia: inward deviation of eyes o Exotropia: outward deviation of eyes o Amblyopia ▪ Lazy eye→ if you shine light in eye, it will reflect in a different place Treatment: patches (2-6 hours a day) and atropine in unaffected eye o Infectious conjunctivitis (pink eye) ▪ S/S: redness of the eye, pain, discharge from eye ▪ Wash your hands o Periorbital cellulitis ▪ Bacterial infection of the eyelid and surrounding tissues presents with inflammation of eyelid o Retinopathy of prematurity (ROP) ▪ Retinal damage from increased O2 pressure→ may lead to retinal detachment ▪ Stages: 1-3: surgery 4-5: laser o Retinal Damage caused by increased O2 and premature birth Injuries of the Ear o External Ear: lacerations, infections, hematomas, cellulitis o Ear Canal: Foreign Body (insects, corn, anything small) o Tympanic membrane: ruptures Disorders of the ear o Otitis media (one of the most common childhood illnesses) ▪ Inflammation of the middle ear sometimes accompanied with infection Manifestations: pulling at the ear, fussiness, presence of fever, and night awakenings Treatment: anesthetic ear drops  o Hearing loss ▪ Conductive: problem transmitting sound from out to in ▪ Sensorineural: problem inside the ear Manifestations: o Infant: by 3-4 months, does not turn head to sound, babbles little to none (speaking and hearing go together, bb doesn’t speak, bb can’t hear) o Toddler: appears developmentally delayed o School Age: speech problems, sits close to TV Disorders of nose, throat & mouth o Epistaxis: nose bleeds o Nasopharyngitis ▪ Upper respiratory infection (common cold Causes inflammation and infection of the nose and throat S/S: lethargy, irritability, fever, vomiting, diarrhea, sneezing, fever, headache, muscle aches o Sinusitis (bacterial or viral) ▪ Inflammation of sinus ▪ S/S: pressure in eyes, cheeks, face, and headache o Pharyngitis (most common in 4-7 years old) ▪ Inflammation of pharynx including the tonsils ▪ Bacterial pharyngitis is known as strep throat o Bronchitis (lower respiratory disorders) ▪ Inflammation of the trachea and bronchi ▪ S/S: dry hacking cough which increases in severity at night o Rhinitis ▪ Inflammation and swelling of the mucous membranes of the nose ▪ S/S: runny nose and stuffiness o Tonsilitis/Tonsillectomy ▪ Scale: 1-4 (four being worst) Tonsillectomy-removal of tonsils Interventions after a tonsillectomy and watchful warning signs o Monitor VS, observe for respiratory distress, hemorrhage, and dehydration o Teach families: drink adequate fluids, apply ice around neck, give acetaminophen, gargle salt water, o Watchful warning signs: seven episodes of tonsillitis in the past year, at least five episodes per year for 2 years, or at least three episodes annually for 3 years ▪ Tonsillitis diagnosis requires a sore throat and one of the following; temp above 101, cervical adenopathy, tonsillar exudate, positive strep, sleep disordered breathing, poor school performance, enuresis, or behavioral problem o Luxation: dislodgment of tooth from original place o Avulsion: complete removal of tooth ▪ Fast care is important→ put tooth in milk or water, DO NOT use running water, handle by crown, not root NUR325 Exam 1 Review FACES, OUCHER, Poker chip, know the ages for each -Remember pain is subjective and we have to treat accordingly and we always want to stay on top of pain control so it does not get out of hand. Ie giving pains meds on schedule -hyphemia (blood within the anterior chamber of the eye), astigmatism, amblyopia, myopia -remember to read the question and its entirety and address what it is asking watch for key words -remember language and hearing can go hand in hand -remember we have to respect different cultures and their treatment options, our job is to just educate -at what age is it a developmental concern toddlers not walking?—2 yrs -interventions after a tonsillectomy and watchful warning signs -definitions and s/s of sinusitis, bronchitis, rhinitis, asthma -interventions for a patient with epiglottitis -interventions for a patient with pneumonia -interventions for a patient with LTB -what position allows for optimal chest expansion?—tripod position -what plan and education do you provide for patients with asthma -sweat chloride test -what does racemic epinephrine do? -interventions for bronchiolitis -interventions for communicating with a pediatric patient -diet for CF—high fat, high calorie, -chest physiotherapy -isotonic, hypertonic, hypotonic dehydration definition and s&s -monitoring parameters for fluid with KCl Kidney function -chelation therapy -aspirin overdose s&s 1. What would be a priority for someone with epiglottitis? 2. What is the treatment plan for LTB? 3. What test diagnosis CF? 4. What is myopia? 5. When should babies begin to walk? 1. Sometimes when a baby has delayed speech that can be indicative of what?-hearing impairment 2. Classic symptoms of asthma are: 3. A nebulizer changes______ into particles; avoid using when crying as it alters the breathing leading to decrease medication deposit into lungs…fill in blank 4. LTB is also known as what? 5. Tripod position is used with what dx? 1. What is the percentage for: Mild, moderate and severe Dehydration 2. Hyper, hypo and isotonic definition. 3. Urine output for all age groups: 4. Oral vs iv rehydration when? 5. cardiac/resp arrest, decreased aeration, respiratory muscle injury, head injury are all examples of respiratory what? And why? 6. deep rapid breathing, body’s way of getting rid of the access is what type of breaths?-- kussmauls 7. usually occurs with metabolic alkalosis as respirations decrease, is this hypo or hyperkalemia? 1. T/F: Children may not report pain because of fear that the treatment will be worse than enduring the pain 2. A person that’s stoic means what? 3. Faces is used predominantly in what age group? 4. What is VAS and what age? 5. Why is Visual analog scale (numeric, no pain to most)- not ideal for younger school age children?