NUR 425 Peds Exam 1 Study Outline PDF

NUR 425 PEDS Study Outline for Exam 1 B FALL 2024 There will be 50 questions: multiple choice, select all that apply (SATA), categorization, bowtie, drop down, and matching. Module 1 Safety and Patterns of Development (4-5 questions) Learning Outcomes: Compare the physiological differences between...

NUR 425 PEDS Study Outline for Exam 1 B FALL 2024 There will be 50 questions: multiple choice, select all that apply (SATA), categorization, bowtie, drop down, and matching. Module 1 Safety and Patterns of Development (4-5 questions) Learning Outcomes: Compare the physiological differences between the very young and the older child for pharmacodynamics. tylenol Q 4 hr, ibuprofen for > 6 months Q 6 hr What are the pediatric considerations with medications for the infant and the child? - SAFE DOSE RANGES for ALL meds - WEIGHT-BASED DOSAGES (ex. mg/kg/dose) - Children start to level out with adults around 2-3 years old Infants Children ~ start equaling adult by around 2 years Absorption (movement of drug into blood): Absorption: alterations due to… - Gastric pH equal to adults by 2-3 years - ↓ Gastric acid secretion Distribution: - Irregular gastric emptying - ↑ Intestinal motility - Plasma protein levels at adult by age 1 - Frequent feedings - Skin and BB barrier more effective Distribution: (movement of blood into tissues) Metabolism: - Limited binding of drugs to plasma - ↓ BMR after age 2 = ↓ effects of drugs protein due to low albumin - BB barrier not fully developed until 1 Excretion: year - Adult levels of renal function by age 2 - Total body water = 80% versus adults = 50% - May need ↑ dose for water-soluble drugs Metabolism (Enzymes to break down drug) - Enzymes in liver are immature, drugs cannot be broken down Excretion (Byproducts) - Immature renal function - ↓ dose of drugs excreted by kidneys Identify the variations in medication administration between infants/children and adults. Review the safe medication administration in Chapter 8 in ATI from Module 1 for all routes. - PO - Do not measure with spoon - Can use medicine cup (typically for more mLs), orange PO syringe, enteral syringe - Place on side of mouth in small amounts - Upright or in feeding position - Stroke chin to promote swallowing - Hold cheeks to prevent from spitting out med - IM - Vastus lateralis - Apply lidocaine to site 60 min prior - Supine, side-lying, sitting, therapeutic hugging - Can put sucrose on pacifier - Praise child! - Ear: Under 3 then pinna DOWN and back, Bigger than 3 then pinna UP and back - Massage ear after to comfort and help med penetrate ear canal - Nose: Lie back with head tilted back, maintain position for 1 minute - Eye: if closed, drop in inner canthus to let pool, when eyes open drops will go in - Massage inner canthus to keep from tasting/entering lacrimal ducts and into nasal pharynx - PR: If half dose, cut suppository in half lengthwise (hot dog style), lubricate - Insert ½ - 1 inch beyond sphincter and hold buttocks for 5-10 minutes - ½ inch = base of nail - 1 inch = first joint Identify emergency equipment that should be maintained in the environment when a pediatric patient is in the hospital. - 360 Assessment - Suction working - Oxygen working - Ambubag with correct fitting mask - Code sheet with 2 RN signatures and correct wt in kg  - Fluids running - Fall prevention - Humpty Dumpy Scale - Side rails and crib safety - ALWAYS have hand on child if side rail is down - Medications, AMS, alterations in mobility, Hx of falls, neuromuscular defects - Child will try to get out of crib if needed to use bathroom frequently to avoid accidents - Types of cribs - Climber cribs - Vail beds - may need Rx, considered restraints - For older children with cognitive impairments - Infant cribs - Windows secured - Strangulation and choking hazards - If something can fit down a paper towel roll, it is a choking hazard - Window, electrical cords - Don’t tie pacifiers around neck - Removal of syringe covers, caps, temp probes - Don’t leave child alone to eat - Latex balloons - if they pop, latex can be swallowed - Water safety - NEVER leave child alone in or around water - Temperature of bath water Compare the patterns of development and growth as related to the pediatric client. Growth is quantitative, development is qualitative Understand how growth for children is differentiated, sequential, unique, and directional. - Differentiated: general to specific, simple to complex - Child can scribble before they can write letters - Orderly and sequential: roll, crawl, walk, run - Unique: every child develops at own pace - Directional: cephalocaudal and proximodistal, down and out Module 2 Growth and Development Milestones/Play (9-11 questions) Learning outcomes: Apply expected developmental milestones when caring for infants and children at the following ages: 2 months, 4 months, 6 months, 9 months, 12 months, 18 months, 2, 3, 4, 5 years, school-aged and adolescents. Use the developmental milestones table to understand at which age specific milestones would occur. Preschoolers understand sequences of time Differentiate the theoretical frameworks of Erikson and Piaget to plan nursing interventions for infants and children that are appropriate for the child's developmental state. Use your G&D PPT you created for Peds assignment 1 to study Think of examples of the developmental needs of the child in each stage according to these 2 developmental theorists. Differentiate the terms: Object permanence/Animism/Magical Thinking/Ritualism Conservation/Classification/Abstract thinking/Make Hypotheses Know the stages of development for both Piaget and Erikson. Piaget’s Cognitive Theory of Development - Sensorimotor Stage (Birth - 2 yr) - Respond to stimuli - Repeat pleasing behaviors - Recognizing familiar objects - Understands causality: “If I drop something, someone will pick it up” - Object permanence (9 months): an object still exists even when you cannot see it - Object permanence; anticipates other’s actions; differentiates familiar/unfamiliar objects - Interventions: fulfill several senses, allow exploration - Preoperational Stage (2 yr - 7 yr) - Animism: everything is alive, even inanimate objects - Egocentric: inability to see from other’s POV - Magical thinking: thoughts are powerful and cause things to occur - Very literal, cannot generalize - Interventions: allow them to be imaginative and imitative - Concrete Operations (7 yr - 12 yr) - Understands relationships - Conservation: volume and wt are the same despite different container - Classification - Seriation, reversibility - Schemas: organization, building blocks - Need concrete evidence - Can see other’s POV  - Interventions: allow them to see relationships, classify and sort objects - Formal Operations (13 yr+) - Abstract thought: not tied to concrete ideas - Scientific reasoning: make and test hypotheses - Deductive: if A=B and B=C, then A=C - Look to the future Erikson’s Psychosocial Theory of Development - Trust vs Mistrust (Infants: Birth - 12 mo) - Trust if basic needs are met - Diaper changes, feedings, comfort - Virtue: hope - Autonomy vs Shame and Doubt (Toddlers: 1 yr - 3 yr) - Independence through feeding, dressing, exercises - Shame/doubt if not encouraged - Virtue: will - Initiation vs Guilt (Preschoolers: 3 yr - 6 yr) - Exploring, imaginative - Initiation when beginning an activity instead of coping - Guit when reprimanded - Virtue: purpose - Industry vs Inferiority (Schoolagers: 6 yr - 12 yr) - Self-worth - Less family-oriented, more school/peer focused, like recognition - Inferiority when standards are set too high or they struggle in skills - Virtue: competence - Identity vs Role Confusion (Adolescence: 12 yr - 18 yr) - Develop a sense of who they are - Maturity - Gaining independence, peers important - Identity formation affects commitments and decisions later in life - Confusion when unable to solve these conflicts: “Who am I?”, many roles to explore - Virtue: fidelity Review the milestones table-compare the age of the child to their developmental abilities. 2 months: - Gross: lifts head - Fine: brings hand to mouth - Language: coos - Social/Emotional: social smile 4 months: - Gross: lifts head and chest, rolls back to side - Fine: grasps object with both hands - Language: laughs  - Social/Emotional: enjoys social interaction 6 months: - Gross: sits with support, rolls back to tummy - Fine: grasps bottle with both hands, rakes - Language: babbles with 1 syllable - Social/Emotional: holds arms to be held, begins to fear strangers - Play: onlooker 9 months: - Gross: sits without support, crawls, pulls to stand - Fine: crude pincer, dominant hand preferred - Language: responds to commands - Social/Emotional: separation anxiety, object permanence, lifts arms to be held 12 months: - Gross: sits down from standing, cruises - Fine: neat pincer, releases cube in a cup, turns many pages at a time - Language: mama, dada - Social/Emotional: favorite objects, hugs and kisses 18 months: - Gross: walks, stand without support, throws ball overhead, upstairs with assistance - Fine: build a tower of 3, feed self with spoon, takes of shoes/socks, scribbles - Language: 3 or more words, follows one step directions - Social/Emotional: temper tantrums 24 months: - Gross: runs, upstairs without assistance, kicks a ball - Fine: build a tower of 6, turn one page at a time, dress self w no regard to L or R, turns a doorknob - Language: 2-3 word phrases, knows first name, points to at least 2 body parts - Social/Emotional: increased independence - Play: parallel 3 years: - Gross: rides a tricycle, broad jump, stand on 1 foot for 1 second - Fine: copies a circle, build a tower of 9-10 - Language: complete sentences, 900+ words, asks many questions - Social/Emotional: “mine”, “his”, “hers” - Play: associative 4 years: - Gross: skip and hop on one food, catches ball well  - Fine: copies a square, uses scissors, stick figure with 2+ body parts - Language: knows simple analogies - Social/Emotional: cannot tell what is real and make-believe, imaginary friends 5 years: - Gross: jump rope, walk backward, throws and catches easily - Fine: tie shoe laces, stick figure with 7-9 parts, copies diamond or triangle - Language: says name and address - Social/Emotional: can tell what’s real and make believe Schoolage: - Gross: slowed growth (wt and ht), puberty: 10 for girls, 12 for boys - Fine: complete ability for ADLs - Cognitive: masters conservation at 9 yr, sees POV of others, tells stories, can tell time - Social/Emotional: Aware they are separate from others, best friends, sometimes steals, difficult to own up to misdeeds Adolescent: - Gross: puberty continues - Cognitive: personal fable - one’s feelings and experiences are completely unique - One is all-knowing or invulnerable - Doesn’t understand potential risk - “It won’t happen to me” - Imaginary audience - everyone is watching them 24/7 ~ egocentrism - Social/Emotional/Play Language/ Gross Motor Fine Motor Self-Help Communication & Cognitive Milestones 2 mo social smile coos lifts head brings hands to mouth calms self turns toward sound hands often vocalizes, distinct open from crying crying becomes differentiated begins to follow things grasp reflex fading 4 mo enjoys social laughs lifts head and grasps objects tries to reach interaction chest when with both for things consonant sounds prone hands bored if left alone anticipates rolls back to inspects and feeding when side plays with seeing hands bottle/breast  balances head 6 mo recognize familiar babbles with 1 sits with rakes faces syllable support holds bottle starts to fear imitates sound rolls back to with both strangers tummy hands looks in mirror grasps feet to pull to mouth holds arms out to be picked up reaches for toy onlooker can transfer 9 mo separation anxiety responds to sits without crude pincer holds arms in command support front of face to reacts when you dominant hand avoid having it leave lifting arms to be crawls preferred washed picked up pulls to stand object permanence comprehends “no” starts saying mamamama, dadadada 12 mo hugs and kisses mama, dada cruises neat pincer favorite objects waves bye sits down from turn many standing pages at once emotions - anger, imitates animal affection, jealousy sounds first steps releases cube in a cup clings to parents in new situations begins to drink from a cup 18 mo temper tantrums 3+ words walks, runs scribbles feeds self with clumsily a spoon imitator follows one-step build tower 3-4 directions stand without takes off shoes, explore with parents support socks, unzips nearby walks upstairs with help throws ball  overhead 2 yr increasing knows name runs turn one page dresses self independence at a time 2-3 word phrases kicks a balls puts on shoes parallel play without regard points to at least 2 upstairs to L or R body parts without build tower 6-7 assistances turns doorknob walk on tippy toes 3 yr understands “mine”, knows name, age, rides a tricycle copies a circle dresses and “his”, “hers” - no sex feeds self more “hold you” broad jump build tower complete 9-10 works toys with associative play sentences 3-4 stand on one moving parts words foot for one second helps with 900+ words dishes asks questions 4 yr cannot tell what’s says first and last skip and hop copies a real and make name on one foot square believe colors stick figure with imaginary friends 2+ parts understands selfish - egocentric simple analogies uses scissors sing from memory 5 yr can tell what’s real knows name and jump rope copies a ties shoelaces and make believe address diamond or somersaults triangle goes to toilet wants to please counts to 10+ without help swings stick figure with knows about 7-9 parts everyday things School best friends masters puberty begins complete heightened age difficult to own up to conservation (9 physical ability for ADLs concern about misdeeds yr) growth slows body integrity sometimes steals tells time classify, sort tell stories Adoles personal fable puberty cents continues imaginary audience Compare the benefits and types of play relating to growth and development stages and milestones. Types of play primarily for which age groups? - Unoccupied play: looking around, taking in environment - Not involved or engaged in any active play - Age: ? - Onlooker play: observe other children play - Not actively playing, may look or talk to other children - Age: 6 months - Solitary play: play alone with toys that are different from those used by others (creativity) - Interest on own activity - Age: 15 months - Parallel play: play independently but alongside other children - No group association - Age: 24 months - Associative play: play together and engage in similar activities, no goal - Behavior contagion: one initiates task and others follow - Age: 3 years - Cooperative play: organized, plan to achieve goals - Leader-follower relationship - Age: ? - Benefits: - Sensorimotor development - Intellectual development: learn colors, shapes, textures, up, down, over - reality v fantasy - Socialization: learn right from wrong, interest in company of others - Creativity: experiment - Self-awareness: test roles - Therapeutic value: express emotions, communicate - Morality: peers are less tolerant of violations than adults Module 3 Assessment, Communication, Pain, Neurodiversity and Maltreatment (11-15 questions) Learning Outcomes: Choose developmentally appropriate approaches for the assessment and teaching of the pediatric patient to include play, their stages of development and family-centered care. G&D considerations for assessing a toddler? A preschooler? A school-age child? - Least invasive to most invasive first - Infant: - Sequence: auscultate heart, lungs, abdomen, - Dependent on parents - Least invasive first - Before stranger danger: can be on the table but after 6 mo best in parents' arm - Toddlers: - Sequence: Warm up child using toys, let them touch equipment, assess on parents first then toddler, then auscultate heart, lungs, abdomen - Utilize parents as safety, but independent - Start with sitting in parents’ lap - Preschoolers: - Sequence: Assess parent first then child, use play to become acquainted, auscultate ASAP since they are busy - Intentional limit pushing - May want to be sitting in parents’ lap or holding hands - School-Age: - Sequence: Can begin head-to-toe, examine genitalia last - Seeking autonomy - They like to try and answer questions about themselves - Position sitting alone - Worried about body integrity - Adolescent: - Sequence: head-to-toe, - AUTONOMY - Let them speak for themselves - Clarify questions/allow parents to add at the end - Ask parents to step out if needed - Sitting alone, may have parent leave room Use and benefits of Pediatric Assessment Triangle. - Appearance: - Tone, interactiveness, consolability, look/gaze, speech/cry - Work of Breathing: - Abnormal breath sounds, abnormal positioning, retractions, nasal flaring - Circulation to the Skin: - Pallor, mottling, cyanosis Identify expected and abnormal vital signs in the pediatric client. Know expected normal vitals for ages/vital signs table. HR (Awake) HR (Sleeping) RR HYPOTENSION Neonate: birth - 100-205 90-160 30-60 < 60 1 mo Infant: 1 mo - 12 100-180 90-160 30-53 < 70 mo Toddler: 1 - 3 yr 98-140 80-120 22-37 < 70 + (2 x age in yrs) Preschool: 3 - 6 80-120 65-100 20-28 yr Schoolage: 6-12 75-118 58-90 18-25 yr Adolescents: > 60-100 50-90 12-20 < 90 12 yr Benefits for trending vital signs. Identify common responses to pain at various developmental ages. G&D appropriate use of pain scales - FLACC - Faces: - Legs: - Activity: - Cry: - Consolability - Self-report  - Wong-Baker FACES - Numeric Review expected pain responses by age group and the age-appropriate therapeutic interventions. - If sleeping, look at vitals and don’t wake them - Infants: use whole body to show (generalized to localized), loud crying, facial expressions, physical resistance - Not always crying because pain - hunger, want to be held - Toddlers: loud crying, screaming, verbal expression, thrashing arms and legs, lack of cooperation, pointing to where it hurts, clings to others - “Owie”, “booboo” - Behaviors begin in anticipation of pain - Schoolage: Same as young child but not so in anticipation - STALLING - “I will give you 5 minutes” - Muscle rigidity - Adolescents: Less vocal and motor response = more verbal expression - Increase muscle tension, body control Develop a plan of care for a child in acute pain that integrates pharmacologic interventions and developmentally appropriate nonpharmacologic therapies. Age-appropriate non-pharm interventions for the age groups for coping with pain. - Don’t delay pain management - Nonpharm in conjunction with pharm if pain present - Nonpharm if no pain or short-term - Topical pain meds Classify the different types of child maltreatment and associated assessments What assessments are suspicious for at-risk populations for non-accidental trauma? - Risk factors: - Unrelated partner - Lack of income, education self-esteem - Substance abuse - Hx of being abused - Lack of support - Assessments: - Vague explanations of injury - Delay in seeking care - Inconsistencies in story - Inappropriate response from child or caregiver - Malnutrition - Dull affect - School absences - Munchausen syndrome by proxy - Bruising in a non-mobile patient  - Burn, circumferential - Injuries - Enuresis - Lack of social smile - Attempted suicide - UTIs/STDs - Bleeding from genitalia, anus, or mouth - Interventions: - Mandatory reporting EVEN suspected - Multidisciplinary team Compare the nursing assessment and interventions of a patient with autism spectrum disorder and attention deficit hyperactivity disorder. Both: - Family - Support groups - Evaluation parents understanding - Safe med storage Autism Spectrum Disorder - Assessment: - Delays in social interactions, communication, behavior - Failure of social interaction and communication development = hallmark - Verbal, motor delays, abnormal eye contact, decreased response to name, repetition, decreased imitation - Hyper or hypo reactivity - Excel in art, music, math, memory, puzzle building - Toddlerhood: not babbling by 12 months, only single words 16 months, 2 word phrases by 24 months - Autism regression = red flag, developing normally then regress in expressive language - Treatment: - 2 Screenings: 18 and 24 months, Checklist for Autism in Toddlers (CHAT) - EARLY RECOGNITION = greatly improves outcomes/completely overcome symptoms - PT/OT, speech, language therapy - Structure - Positive reinforcement - Realistic goals - Teach verbal communication - Increase social awareness - Assist with nutrition - Provide support - Meds for insomnia, anxiety, attention, or aggression  - Involve caregiver - triggers? best communication? pain symptoms? - Consistent staff - Decrease stimulation - what are their sensitivities? - Normalize environment - PJs, belongings - Speak slowly, one request at a time - Undesired behaviors? No reaction, reward for good behavior, minimize restraints Attention Deficit Hyperactivity Disorder - developmentally inappropriate degrees of inattention, impulsiveness, hyperactivity - Assessment: apparent at early age, more evident when school - Inattention: easily distracted, forgets, loses things, day dreams - Impulsivity: patience, interrupts - Hyperactivity: squirms, talks excessively, has trouble playing quietly - Distractibility from stimuli either external or internal sources - Comorbidities? Anxiety, depression, oppositional defiance disorder, language and learning disorders, tics, sleep apnea - R/O lead poisoning, seizures/medical problems, traumatic experiences - Treatment: - Determine areas of weakness and compensate them - Behavioral therapy is first line - Pharm determined by age not wt - Multimodal: therapy and medication - Fidget toys Medication side effects used for ADHD Meds are like “wearing glasses” to focus attention, stimulants - Appetite loss, abdominal pain, headaches, sleep disturbances, decrease in growth velocity - Methylphenidate hydrochloride (Ritalin) - 5 yr + - Lisdexamfetamine dimesylate (Vyvanse) - Tricyclic antidepressants and clonidine ER - S/E - dental caries from dry mouth, encourage PO fluid intake - Atomoxetine (Strattera) - wt-based - Avoid stimulants if Hx of tic-like behaviors, family Hx Tourettes syndrome Learning needs of children with ADHD - Reinforcement, rewards, age-appropriate consequences - Environmental: to promote success, low distractions w homework, parents model positive behavior - Nutritional: appetite decreased, give meds AFTER meals and early in day, monitor growth and BP, encourage healthy “on the go” snacks and nutritious snacks in evening Considerations for hospitalized children with ASD Module 4 Accidental Ingestion and Skin Issues (4-5 questions) Learning outcomes: Braden-Q Scale - 21 days to 8 years Contrast the manifestations of bacterial, and fungal infections and infestations of the skin in children (impetigo, furuncle (boil), candidiasis, atopic dermatitis). Differentiate bacterial and fungal skin issues. - Atopic dermatitis ~ eczema: neither bacterial nor fungal, abnormal function of the skin - Lesions: erythema, weeping, oozing (infants), thickened skin (children + preadolescent and adolescent) - Most common inflammatory skin disease, no cure - Allergies and asthma associated - Bacterial: - Impetigo: S. aureus - contagious: contact - Hand, nose, mouth are common - Rupture then dries to form honey-colored crust - Furuncle → Carbuncle: S. aureus, MRSA - contagious: exudate - Folliculitis - Boil, red, swollen, firm, painful - Furuncle: 1 lesion, can lead to ↓ (autoinoccuable) - Carbuncle: more than 1 - Fever, fatigue - Fungal: - Thrush, diaper or vaginal candidiasis: candidiasis - not contagious - Inflamed area with white exudate, peeling, bleeding - Pruritis - Moist areas - Cannot brush thrush off Outline a plan of care to prevent and treat bacterial, and fungal infections and infestations of the skin in children (impetigo, furuncle (boil), candidiasis, atopic dermatitis). Education and care for atopic dermatitis. - Atopic dermatitis: 5 As: - Avoidance - Apply cleanser and moisturizer over wet skin - Anti-inflammatory - Anti-itch - Anti-bacterial - Worse in winter - Do not fully towel dry skin, then place steroid cream FIRST if moisturizer is ointment-based, apply moisturizer FIRST if cream-based - Seals in moisture - Cotton clothing - Avoid excessive heat and irritants  - Keep nails short - Antihistamines - Topical steroids - Emollients - Antibacterials - For diaper dermatitis: - Frequent diaper changes - Pat skin clean, air dry - Use cream-zinc oxide - Avoid talcum powders! Don’t breath in - Corn starch is a safer option but still don’t breathe in - Daily tub bathes, leave skin open to air - Impetigo - Remove crusts after warm bath and apply bacterial ointment - Hand hygiene - Separate towels/washcloths - Change clothes daily and wash in hot water - Disinfect toys and mats - Possible IV antibiotics if severe - Furuncle/Carbuncle - MRSA needs bleach bath - couple times a week, half cup bleach in bath, ¼ filled with warm water - Warm compress - Keep covered to contain contagious drainage - Topical, PO, IV antibiotics - Possible I & D - DO NOT open or squeeze - Candidiasis - Thrush: topical antifungal - nystatin, miconazole after feedings and before bed! rinse mouth then Q-tip/swallow - Amphotericin IV for esophagitis - Frequent diaper changes open to air - zinc oxide Analyze why infants and young children are more susceptible to unintentional ingestion. Which developmental stages specifically? Exploring the world through their mouths, sensorimotor stage 1. They have different and unique exposures to environmental hazards a. Don’t understand danger b. Closer to ground c. Hands to mouth d. What mother eats translates to in utero/breast milk e. Larger body surface area to absorb 2. Dynamic developmental physiology  a. More need for water, energy, oxygen b. Absorb nutrients efficiently i. Eat and poop a lot c. Curious, think magically, lack understanding d. Taste not as developed - tastes bad to us but not to them 3. Longer life expectancy a. Longer time to live with disabilities b. Lead increases potential for HTN c. Asbestos increase potential for lung cancer/mesothelioma 4. Politically powerless a. Defenseless b. Don’t vote i. Ex. E-cigarettes, secondhand smoke Choose appropriate nursing assessments and interventions relative to the specific item or substance ingested. Model good behavior, store meds and household products in original containers, don't measure with household spoons, child-proof home, lock medicine, don’t take meds in front of children, do not call medicine candy, teach children to ask permission before drinking or eating anything until they know what’s safe or not, communicate with people giving children medicine Assessment priorities with ingestions. - Interventions: - ABCs - 5 W’s - Who - others? - What and how much - route? - When - duration? - Where? - Why - on purpose, error, curiosity? - CPR less than 60 BPM - X-rays for FB - Labs - CBC, CMP, toxicology, ABGs, coags/PT/PTT - Remove clothing - Dermal - flush with water for 15-20 minutes - Ocular-Morgan lens flushing - NS/LT to pH of 7.0 - Gastric decontamination: benefits decrease as duration increases ~ within 1 hour - PREVENT ABSORPTION - Activated charcoal - binds with substance, poor palatability - Gastric lavage - try to avoid - Treat patient first not poison! - NEVER tell children meds are candy - Be a good role model: they will imitate drinking alcohol, doing drugs - Call poison control for medical direction  - If substance is unknown… assess: - LOC - Seizures - Abnormal vitals - Cardiac dysrhythmias - Vital signs - Antidotes: - Naloxone - opioids - Acetylcysteine - Tylenol - Flumazenil - benzodiazepines - Calcium sodium edetate - heavy metals - Oxygen - CO poison - Hemodialysis and sodium bicarbonate - aspirin - IV glucose - hypoglycemics - Elimination: - Diuresis - Urine alkalization - Hemodialysis - Exchange transfusion - Chelation therapy - high doses of lead exposure - Organophosphates ~ pesticides - SLUDGE: - Salvation - Lacrimation - Urination - Defecation - Emesis - Paint thinner - prepare for intubation - Bleach - observation and fluid - Plants: - Assessments: - Irritation in throat & GI tract - Topical dermatitis - Serious respiratory, renal, CNS symptoms - Interventions: - GO TO ED - CALL POISON CONTROL - CALL 911 - Acetaminophen: toxic dose is 150 mg/kg - MORE THAN 500 MEDS CONTAIN ACETAMINOPHEN - Interventions: - Antidote: acetylcysteine - Don’t take meds in front of child - Cannabis:  - Assessments: - Vomiting, dizziness, difficulty walking, rapid HR, drowsiness, confusion, respiratory difficulties - SEVERE: Low HR, RR, and BP, hallucinations and seizures - Lead: - Decreased iron makes lead easier to absorb! - Stored in bones and teeth - Assessments: - Interventions: - - Beta-blockers, CCB - can be deadly - Oral hypoglycemics - hypoglycemia, decreased LOC - Aspirin - tastes like candy - Antidepressants - neuro and heart Identify the signs, symptoms, and treatment of anaphylaxis. - The sooner the onset, the more severe the symptoms - S/S: increased cap permeability - Itching, hives, angioedema - Uneasiness, impending doom, irritability - Restlessness, HA, anxiety, disorientation - Anaphylactic shock: massive vasodilation - Decreased BP, perfusion - Treatment: - Mild: treat with antihistamines - Benadryl - EDEMA - CALL 911 - Epinephrine pen - DO NOT DELAY - Chest tightness - Barky cough - Dysphagia - Wheezing, cyanosis - Loss of consciousness - Severe bradycardia, hypotension - Fist to thigh - Wear a medical bracelet - Prevention: breastfeed 4-6 mo, desensitize by giving common allergen foods - Nutritional assessment Module 5 Gas Exchange Day 1 (6-8 questions) Learning Outcomes: Identify the unique characteristics of the pediatric respiratory system anatomy and physiology. Normal characteristics of a small child’s respiratory system. - Short neck: easily dislodge trachea  - Smaller nasopharynx: Easily occluded during infection - Lymph tissues grow readily in early childhood: Easily occluded - Kissing tonsils - Smaller nares: Easily occluded - Small oral cavity and large tongue: Risk of obstruction - Long, floppy epiglottis: Risk of obstruction - Larynx and glottis are higher in neck: Increase risk of aspiration - Immature cartilage: Easily collapsible when neck is flexed - Fewer functional muscles: Less able to compensate for edema, spasm, trauma - Poorly developed muscles: Tire out easily - Premature cilia: Can’t move secretions as easily - Lots of soft tissue loosely anchored: Risk for edema and obstruction - Infants are nose breathers until around 4 months - Infants, prominent occiput = neck flexes forward - Funnel shaped airway - Belly/diaphragmatic breathers - they breath with their abdomen, look at abdomen for respirations = normal - Fewer smaller alveoli: Increase in number first 5-8 yr then increase in size - Walls are thicker - Increased risk for atelectasis - Less alveolar surface area for gas exchange - Increased compliance - Higher RR - Children sleep a lot: Decreased residual capacity - Blunted ventilatory response in newborns - Newborn and child airway smaller in diameter ~ 4mm in newborns: Amount of swelling affects ages differently - Similar diameter to little finger of child Analyze how these characteristics affect the pediatric patients’ respiratory function. Anatomy and physiology risks for respiratory distress - Atelectasis and obstruction Assess the child’s respiratory signs and symptoms to determine if the child is in respiratory distress. How would you prioritize interventions for clients with respiratory distress? ABCs Decreased compliance → Increased resistance → Increased WOB → Retractions → Increased RR → Respiratory fatigue Least invasive to most invasive = elevate HOB, suction nose, apply O2 via NC then NRB - Treatment - Mild:  - O2 via nasal prongs - Elevate HOB - Rolled towel under shoulders - Suction - Moderate: - O2 via NRB or humified via high flow nasal cannula - Reposition PRN - BBG or NP suction - Severe: - Emergent - Ambubag/oral airway then ntubation and ventilation - X-Ray - Let child try to find position of comfort (unless infant) Specific assessment findings for mild, moderate or severe respiratory distress 🧡is fine, 🫁are the problem - Restlessness/irritability/anxiety - Tachypnea = early - Tachycardia = early (HR is #1 vital sign that indicates stress on body) - Diaphoresis - HTN at first - LOC: Stupor, coma - Head bobbing (occurs on inspiration) - Grunting (occurs on expiration) - Wheezing (inspiration and expiration) - Stridor (inspiration and expiration) - Nasal flaring - Retractions - Supracavicular - Intercostal - Suprasternal - Substernal - Subcostal - Adventitious breath sounds - Mottling - Cyanosis/pallor - Nasal discharge - Tripoding - Poor feeding - Dyspnea with exertion - Hypotension = late sign Identify appropriate nursing interventions for respiratory distress/failure. Positioning needs for infants  - Rolled towel/blanker under shoulders to open airway Oxygen adjuncts needs for mild, moderate, severe distress - Mild: O2 via nasal prongs - Moderate: O2 via NRB or humidified via high flow nasal cannula - Severe: Ambubag/oral airway then ntubation and ventilation Which vaccinations to help prevent severe respiratory diseases - Hib - Palivizzumab - DTaP Discuss the pharmacokinetic and pharmacodynamic concepts of drugs used for the ATI upper respiratory medications. Medications: Brand/Generic names ATI Upper Respiratory Medications-drug classifications & mechanism of action diphenhydramine (Benadryl) ○ Classification: First generation/Sedating Antihistamines ○ Mechanism of Action: Bind to histamine receptors to block release, mild anticholinergic effects, can cross BBB - H1 antagonist ADRs: Constipation, dry mouth, sedation, drowsiness ○ Uses: Treats mild allergic reactions, motion sickness, and insomnia (short-term) cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra) ○ Classification: Second-generation/Nonsedating Antihistamines ○ Mechanism of Action: Antagonize histamine receptors without binding, longer-lasting, more selective with minimal ability to cross BBB ADRs: less than first generation; Mild anticholinergic, drowsiness ○ Uses: allergic rhinitis, chronic idiopathic urticaria ○ Once a day dosing phenylephrine (Neo-Synephrine) ○ Classification: Sympathomimetics ○ Mechanism of Action: Activate alpha1-adrenergic receptors in nose, vasoconstriction of blood vessels → nasal turbinates shrink → nasal passageway opens ADRs: can result in rebound congestion with overuse PO: agitation, anxiety, HTN Topical: rebound congestion, tolerance Short term, no more than 3 days ○ Uses: allergic rhinitis, sinusitis, common cold codeine (Bromanyl) [opioid], dextromethorphan (Delsym) [non-opioid] ○ Classification: Antitussive, Opioid ○ Mechanism of Action: Suppress cough reflex in brain ADRs (opioid): CNS depression, abuse, classic opioid S/E ○ Uses: suppresses chronic, nonproductive cough  Guaifenesin (Mucinex) ○ Classification: Expectorants ○ Mechanism of Action: Reduction of surface tension of secretions, thins thick mucus ADRs: do no often cause S/E, N/D, dizziness, drowsiness, HA, rash ○ Uses: colds, URIs, bronchitis ○ Increase fluids if possible acetylcysteine (Mucomyst) ○ Classification: Mucolytics ○ Mechanism of Action: break down disulfide linkages in proteins in mucus, decreasing viscosity ADRs: bronchospasm, GI distress, rotten egg smell/ingestion of secretions - N ○ Uses: decrease mucus secretions, also used for acetaminophen OD Module 6 Gas Exchange Day 2 (9-10 questions) Learning outcomes: Describe the pathophysiology of respiratory syncytial virus Which children are more at risk? - Children more at risk: - Boys, twins, < 6 mo at the start of the RSV season, smoker moms, not breastfeeding Select appropriate nursing assessments and interventions required when caring for a patient with respiratory syncytial virus - Dx: nasopharyngeal (NP) swab Assessment findings and treatment interventions. - < 1 mo: apnea Plan of care for patient with RSV - Interventions - Contact droplet precautions - can be contracted indirectly with surfaces - Assess: - Vital signs - LOC - Retractions present? Lung sounds? - I & O because client is likely not eating much - Dehydration - Congested cough - Oxygen: heat humified based on wt and FiO2 - Suction: can use BBG, remember the 60, HOLD feedings due to aspiration risk - Medications - IVF, antipyretics, bronchodilators - maybe - No antibiotics - it’s viral, or antihistamines - not an allergic reaction - May need to be hospitalized if RD, dehydration, or other health issues - Educate mom to keep pumping breast milk if infant is not feeding - Prevention: HAND HYGIENE, keep kids away from sick people, avoid passive smoke like on clothes, breastfeed! Describe the pathophysiology of epiglottitis - Obstruction of supraglottis - Inflammatory process caused by Haemophilus influenzae (HiB) or ingestion of hot fluids, foreign bodies, smoke, crack cocaine Select appropriate nursing assessments and interventions required when caring for a patient with epiglottitis - 2-5 years of age - BACTERIAL - HiB - Rapid Assessment findings and priority treatment interventions - Assessment: - Stridor - Froggy “croak” cough - High fever - Toxic appearance - Drooling - Dysphagia - Tripod - High HR and RR - Sore throat - Dyspnea - Muffled voice - Treatment: Medical emergency - Contact droplet precautions - CALL FOR HELP - Protect airway - go straight to OR to be intubated - NPO - Maintain calmness, do not do anything that will upset the child - Defer temp, BP - Medications - IV since it’s a systemic issue - Corticosteroids - Fluids  - Antibiotics - ceftriaxone - X bronchodilator won’t help Describe the pathophysiology of acute laryngotracheobronchitis ~ Croup - Infant or child < 5 years of age - Viral - Slow Assessment findings and treatment interventions. - Assessment: BEGINS with an upper respiratory infection (i.e., parainfluenza, RSV, rhinovirus, enterovirus) - Stridor (inspiratory) - Barky cough - Low fever - Non-toxic appearance - Hoarseness - Dyspnea - Restlessness - Assess vitals (RR, O2, temperature) - Lung sounds: stridor at rest? crying? coughing? - Retractions - Restlessness (hypoxia) - Skin color - Ability to drink - If they respond to treatment? i.e., steamy shower then cool air - Treatment: - Contact droplet precautions - Humidified oxygen - Cold mist or steamy bathroom - Corticosteroids - dexamethasone - then SVN epinephrine - Antipyretics - Fluids - No antibiotics - it’s viral - Prevention: - Hand hygiene! - No vaccine Select appropriate nursing assessments and interventions required when caring for a patient with acute laryngotracheobronchitis Medications and treatment interventions Education for caregivers - Good hand hygiene - Steamy shower, cool mist Describe the pathophysiology of pertussis  - Bordetella pertussis bacteria: paralyzes cilia and causes inflammation - Contagious - Get vaccines! What are assessment findings for infants? - Assessment: - LOC - Color of skin - Vaccine status - < 2 months old cannot receive vaccine - Apnea < 6 months - Persistent cough - Vomiting after - Infants: airway obstruction, restlessness, apprehension, retractions, cyanosis - URI - Lung sounds, retractions - Treatment: - Contact droplet precautions - Adequate hydration - Meds - Antibiotics - Antipyretics - Hospitalized: dehydration or inadequate hydration oxygenation - Side-lying while coughing to prevent aspiration - DTaP Describe the pathophysiology of foreign body ingestion Which age group and assessment cues? - 1-3 years because they are exploring the world - Assessment: - Respiratory status - LOC - Unilateral nasal drainage: trying to expel the foreign body - Choking - Gagging - Wheezing - Paroxysmal coughing: coughing fits - Stridor - Hoarseness - Cyanosis - Treatment: - Location, type of object, aspiration, extent of obstruction - Oxygen, BVM if severe, allow child to find their own position of comfort - Radiology - Bronchoscopy for objects in larynx and trachea  - Endoscopy for objects lower than the above - Back thrusts for infants, Hemlock for older - Prevention: - Education - Be a good role model! - Cut up foods Vaccinations: Why are they given and age recommendations for administration? Palivizumab (Synagis) ○ Why: RSV ○ Age recommendations: IM Q month for at risk DTaP ○ Why: diphtheria, tetanus, pertussis ○ Age recommendations: 2, 4, 6, 15, 18 months (5 ages), 4-6 years TdaP 13-18 years, for mom when preggers > 20 wks H influenza type B (Hib B) ○ Why: epiglottitis ○ Age recommendations: 2, 4, 12, 15 months (4 ages) Pertussis Acute Respiratory Epiglottitis Foreign Body Laryngotrach Syncytial Emergency eobronchitis Virus (RSV) (Croup) Causative Bacteria Virus Virus Bacteria N/A Agent Vaccine DTaP N/A Palivizzumab Hib N/A 2, 4, 6, 15, 18 (Synagis) 2, 4, 12, 15 months, 4-6 IM Q month months years Common Age < 5 years 2-5 years 1-3 years Cough -Whooping/c -Barky seal -Congested -Froggy -Stridor to ongested moist cough croak cough absent cough breaths Other -Apnea < 6 -Worse at -Apnea < 1 mo -Drooling -Abrupt onset Symptoms mo night -Nasal -Dysphagia secretions -Dystonia Treatment -Antibiotics -Dexamethaz -Suction -Intubation -ABC one -Radiology -Moisturized -Thrusts air