Nclex-RN Prep Study Guide 1 PDF

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NUR 4332 Child & Family Nursing NCLEX-RN Prep Study Guide Dropbox in Module 3

Question

Topic to Review

3 Critical Points

Unit I Example: Acute Respiratory Disorders: Reportable Findings for a Client Who Has Epiglottis

Example: Epiglottitis

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Hematological Disorders: Determining A Priority Client

Deciding Priority Patients

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Health Promotion of Infants (1 Month to 1 Year): Evaluating Teaching About Car Seat Use

Safety for Infants

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Infection Control: Nursing Action for an Infant Who Has Respiratory Syncytial Virus

Priority Actions for RSV

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 Communicable Diseases: Isolation Precautions for a Child Who Has Pertussis

Precautions for Pertussis

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The four D’s are clinical manifestations that alert the nurse to this medical emergency – verified by xray Keep patient calm by allowing to stay in caregiver’s arms. Do not assess v/s, start an IV, or obtain a culture until healthcare provider and emergency equipment (trach tray) are available Assess the pain level of each patient first. Be sure to take into account their subjective feeling of pain Monitor the oxygen saturation since this correlates with blood flow Assess the neurologic status of the patient. LOC and respiratory issues should come first. Always think “what would kill the patient the fastest, pain or not being able to breath” Newborns and infants need to be placed rear facing in preferably the back middle seat, until they are two years old or until 4 feet and 9 inches tall Parents have to be informed about the risks of injury to their infant when not in a safe car seat Introducing an infant early on to a car seat helps lessen resistance later on RSV is usually transmitted by surfaces carrying the virus and close contact (dirty hands) so educate family on ways of transmission and correct hygiene practices Maintain a close watch on the respiratory system and include all precautions that include that system such as: elevated HOB, O2 stats updated and apply oxygen if needed Be sure to maintain the correct fluid balance (by means of orally or IV depending on the status of the infant) and control the infants fever Whooping cough is transmittable through direct contact or droplets from coughing Be sure to check the admission statements and watch for symptoms such as: coughing, cyanotic episodes, and any other respiratory issues NCLEX-RN Prep.7.20.ka

 Hospitalization, Illness, and Play: Preschoolers' Understanding of Time

Cognitive and Sensory Development

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Health Promotion of Preschoolers (3 to 6 Years): Developmental Milestones of a 4-Year-Old Child

Health Promotion of a Child

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Hospitalization, Illness, and Play: Play Activities for a Preschooler

Preschooler Play

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Immunizations: Identifying Contraindications to Administering Immunizations

Precautions to Immunizations

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Safe Administration of Medication: Identifying Steps for Removal of a Peripheral Intravenous Catheter

IV Removal

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Hematologic Disorders: Screening for Sickle Cell Anemia

Sickle Cell Assessments

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Hematologic Disorders: Reportable Laboratory Values

Lab Values to Report

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Educate family on the ways of transmission and be sure to check any siblings for symptoms. Droplet precautions should be taken. Preschoolers depiction of time is still immature It is better to explain terms of time in ways of routines instead of an exact time Short amounts of time appear much longer than they really are Becomes more self-aware (even of gender differences) and is able to start problem solving Starts to understand time/size, and vocabulary grows to 1500 words Balance/coordination begins to improve and is able to hold and draw with crayons/pencils Preschooler play is very imaginative Preschooler years are an important time to begin to learn aspects of socialization Preschoolers begin to play in ways of cooperative (share) and associative (engage in mutual play but not working toward the same goal) play Be sure to assess any allergies the patient has had or may be at risk to have Look at medical history for illnesses and past reactions to certain immunizations Assess the current health, is there any current illnesses that may increase the likelihood of a severe reaction Recommendations have been updated to change the IV tubing no earlier than 96 hours and no later than 7 days (depending on the IV fluids used) Make sure to complete correct hand hygiene and apply gloves before touching the IV site Have a gauze and sometimes a bandage readily available to place once the IV is removed from the vein to help with any clean up needed from bleeding. Hold pressure on the site to encourage cessation of bleeding/leaking. Sickle cell is a type of hemolytic anemia that causes extreme pain with flareups Some early manifestations are delayed growth and delayed puberty. Assess for hypoxia, fatigue, pallor, jaundice and retinopathy Some diagnostics include looking at a CBC, looking at family history, isoelectric focusing, and hemoglobin electrophoresis CBC can give a lot of basic information right off the bat Those with low hgb levels (normal is 6-11)should be assessed for anemia You can also assess reticulocyte count, serum iron, NCLEX-RN Prep.7.20.ka

Oxygen and Inhalation Therapy: Identifying Patterns of Respiration

Patterns of Respiration

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Cardiovascular Disorders: Planning Care for a Child Who Has Heart Failure

HF Care in a Child

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Asthma: Evaluating Understanding of Asthma Attack Prevention

Asthma Attack Components

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Cardiovascular Disorders: Expected Findings for an Infant who has a Ventricular Septal Defect

Ventricular Septal Defect Findings

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Communicable Diseases: Creating a Plan of Care for a Child Who Has Varicella

Varicella Care in a Child

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 Cardiovascular Disorders: Clarifying a Digoxin Prescription

Digoxin Clarifications

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Health Promotion of School-Age Bicycle Safety

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HbA/HbF and TIB capacity Recognize the standard of respirations for each age group of patients from newborns to adulthood Look at the quality of respirations, is it deep or shallow Assess the sound of breathing by listening to respirations. Listen to wheezing, clarity, if breathing is equal throughout lobes of lungs on each side Make sure to plan out interventions in a manner that will allow the child time to rest Keep a close watch on perfusion by checking pulses and assessing color and capillary refill Monitor urinary output since HF can lower the renal system function due to decreased cardiac output Educate the child and parents about the triggers of asthma (pollens, animals, molds, air quality, etc) Be sure to teach how to treat flareups of asthma with the correct way to use an inhaler or whatever the prescribed medication is Teach the s/s to recognize when an asthma attack may occur Findings are commonly found within the first few says in an infant’s life but s/s can vary based on the severity of the VSD Common s/s are: decreased appetite, tachycardia and looking like SOB, easily fatigued Look at family history to observe for any defects that are in the genetics to assess the risk level Be sure to review the correct PPE for varicella since it is very contagious. Being proactive to prevent further spreading is key (airborne and contact) Medications such as antihistamines can decrease itching and help avoid secondary infections. An oatmeal bath can also be used to help soothe the child Acetaminophen is preferred to help control fever and be sure to place child in private room. Mainly focus on symptomatic and comfort care for the child Be sure to educate on when to give the digoxin. Needs to be given on a schedule and 20-30min before meals. Explain what digoxin does- increases the contractility of the heart which helps with increasing cardiac output Educate on signs of digoxin toxicity- vomiting, diarrhea, vision changes, and tachycardia. Call cardiology department immediately with any signs Always always always wear a helmet! Make sure NCLEX-RN Prep.7.20.ka

Children (6 to 12 Years): Teaching About Bicycle Safety

for Children  

Health Promotion of Infants (2 Days to 1 Year): Teaching About Teething

Teething Education

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Hospitalization, Illness, and Play: Planning Activities for a School-Age Child

School Age Activities

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Health Promotion of Toddlers (1 to 3 years): Anticipatory Guidance

Guidance for Toddlers

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 Pain Management: Minimizing Procedural Pain for an Infant

Lessening Infant Pain

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 Cystic Fibrosis: Planning Nutritional Interventions for a Child Who Has Cystic Fibrosis

Cystic Fibrosis Nutrition

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the helmet fits the child properly before beginning the activity Teach child about safe places to ride a bike (sidewalks, driveways, and approved paths) with the parent near until child is more experienced Teach children on traffic safety and how to watch for cars (looking both ways multiple times) and walking bike across road if needed to cross over Educate parents on s/s that may require a medical visit such as: ear tugging, increase in temperature, or diarrhea Teach about ways to minimize discomfort by using cool liquids, hard foods, and the use of cold/hard teethers Avoid home remedies and only use medications as directed that correlates with the child’s age/weight. Discomfort is normal so you just have to treat symptomatically (unless discomfort is excessive and includes s/s listed above) Allow child to explore interests and figure out some hobbies they enjoy School age children begin to be introduced to sports so ensure correct protective gear is worn Begin to explore activities such as drawing, games, pets, cooking, and sports Toddlers begin to try and learn the skill of walking so provide sturdy toys that promote push-pull actions Since toddlers are beginning to get super curious and full of energy toddler-proofing is necessary to prevent injuries from grabbing pots/pans, falling down stairs, etc.) Guide the toddler in activities that help them gain independence such as feeding, dressing, and certain play activities Be aware that infants and neonates do perceive pain and those that are not recognized have long term negative effects Use the COMFORT scale to assess pain and provide comfort measures to the infant such as providing a favorite blanket, calming music or stuffed animal Use the parents as a resource to help console the infant in ways they’ve learned works best. (massage, touching, holding, speaking softly) Causes malnutrition in ways that effect: fat-soluble vitamins (A, D, E, and K) The recommended nutritional values for CF are 150% of the normal values Provide a high-calorie, high protein, pancreatic NCLEX-RN Prep.7.20.ka

Sources of Nutrition: Food Choices for Iron Deficiency

Nutrition for IDA

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Safe Administration of Medication: Caring for a Child Who Has a Tunneled Central Venous Access Device

Tunneled CVA Care in a Child

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Oxygen and Inhalation Therapy: Monitoring Pulse Oximetry for an Infant

O2 Stat for Infant

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  Cardiovascular Disorders: Postoperative Care Following Cardiac Catheterization

Postop Cardiac Cath Care

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Communicable Diseases: Responding to a Parent About Varicella

Parent Info on Varicella

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Physical Assessment Findings: Eliciting the Biceps Reflex

Reflex Assessments

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enzyme replacement, vitamin supplements, and in severe cases a G tube or parenteral feeding may be necessary Educate on what IDA is and how to increase the intake of iron within the diet as well as teaching about an iron supplement Take vitamin C with iron supplement to increase absorption of iron Great food selections include: liver, dried beans, cream of wheat, iron fortified cereal, dried fruits, egg yolks, and dark green vegetables Educate child and parents on means of preventing infection (keep dressing clean and dry) Inform parents to notify the nurse or doctor if the dressing appears wet in any way Teach and have repeat demonstration on aseptic technique as well as how to use tools/medications The best placement to get an accurate measurement on O2 would be placing on the big toe or foot, if needed you can use the thumb or outer aspect of the infants hand Make sure the oxygen sensor is placed right on the skin, if there is a gap, the reading will not be accurate If the infant is moving around and crying the pulse ox will be alerted so to get a good reading try to take pulse ox when the infant is in calm state Keep an eye on cardiac output by means of peripheral pulses and overall appearance/temperature of skin, LOC and urinary output Make sure to manage pain properly to ensure no extra stress is placed on the healing process Provide education to the parents to help with anxiety of this surgery and make sure to teach and help the child feel comfortable in a way that is appropriate for the age of the child Varicella is a super contagious illness, educate the parents on the correct precautions (airborne and contact) If the child has siblings be sure to isolate the affected child to prevent spreading Educate on the medications that can be used to help thru the outbreak (acetaminophen, NOT aspirin, antihistamines, oatmeal baths) A type of deep tendon reflex that helps check the neurological status of an infant Performed by having the infants arm bent at the elbow and your thumb over the bicep in a to and NCLEX-RN Prep.7.20.ka

 Physical Assessment Findings: Identifying Adventitious Lung Sounds

Listen to the Lungs

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Asthma: Discharge Teaching About the Management of Moderate Persistent Asthma

Acute Otitis Media: Management of Fever

Asthma Management Discharge Teaching

Fever with Otitis

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Acute and Infectious Respiratory Illnesses: Evaluating Understanding of Postoperative Care Following a Tonsillectomy

Tonsillectomy Care PostOp

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Cardiovascular Disorders: Priority Finding for an Infant Who Has Heart Failure

Findings on Infant HF

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Acute and Infectious Respiratory Illnesses: Priority Finding of

Findings of Pneumonia

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from action Having an absence of DTR is way more urgent than hyperreflexia. Decreased DTR can mean the infant has a motor neuron defect. Adventitious lung sounds are additional sounds that are abnormal Adventitious lung sounds are observed and documented describing location, timing and intensity These sounds are audible thru a stethoscope. Be sure to listen to all lobes of the lungs and compare the right to left lung. Be sure to note the effects of coughing as well. Educate on early s/s of an asthma attack Teach and ask for a return demonstration on how to correctly use an inhaler Be sure to include patient and parents in teaching about medications, emergency information, and what can cause an exacerbation of asthma Otitis Media is very common- it is the fluid infection/blockage of the middle ear Acetaminophen needs to be given to relieve discomfort and if fever id present increase fluid intake. If within 48hrs the symptoms are not better, fever is still present they need to make a follow up appt. If fever and symptoms are still present antibiotics may be prescribed. Place the child in a prone/side-lying position to help encourage drainage. Teach parents to notify doctor is any postop bleeding occurs 24hrs and within 710days after Vomiting old blood is common. An antiemetic can be given to help decrease the emesis. If vomiting place NPO for 30min then give clear liquids as tolerated Nonaspirin analgesics are prescribed to pain control. A good nonpharmacological approach to lessen pain is an “ice collar” Observe the HR continuously and note any fatigue and tachycardia during times of rest and note any difficulty feeding (getting tired fast) Abnormal cardiac rhythms may be present (one commonly known as a “gallop” Note subjective symptoms such as decreased appetite, sweating, abdominal pain and fatigue more than usual Viruses are the most common cause of pneumonia in children younger than 5 years old (most commonly NCLEX-RN Prep.7.20.ka

Pneumonia   Cardiovascular Disorders: Caring for an Infant During a Hyper cyanotic Spell

Hyper cyanotic  spell in Infants  

Acute and Infectious Respiratory Illnesses: Caring for a Child Who Has Epiglottitis

Child Epiglottitis Care

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 Cardiovascular Disorders: Expected Findings of Kawasaki Disease

Kawasaki Disease Findings

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RSV) Assess the child’s respiratory status and listen carefully to all lung sounds as well as the current quality of breathing Report any signs such as: fever, increased HR, difficulty breathing, crackling in lungs and/or diminished breath sounds Watch for early onset of symptoms which usually follow crying, feeding and defecation. Immediate treatment would be to try and calm the infant and place the infant in knee-chest position and then place the infant on oxygen per orders Some medications that can be used to help hyperpnea and vascular resistance are: morphine, phenylephrine, and propranolol (to slow the HR) Be sure to assess frequently for any s/s of respiratory distress Monitor blood gas levels (ABGs) to see any significant changes and pulse ox (above 95%) and notify provider immediately of any sudden changes in respiratory status Keep the child as calm as possible and be sure to always have a patent airway (THIS IS ESSENTIAL) have emergency intubation equipment at the bedside This disease manifests in 3 different phases (acute, subacute and convalescent). This disease is brought on by something that triggers the immune system and effects arteries (specifically the coronary arteries) The first stage is seen by a fever that is unresponsive and symptoms like swollen lymph nodes, tachycardia, rash, and swelling of extremities Coronary aneurysm is marked by the second phase (be sure to keep an updated heart echo) and the last stage is when symptoms start to diminish. Deep transverse lines known as Beau’s lines may show up in the child’s nails.

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