Summary wong\'s nursing care of infants and children PDF

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Summary

This document is a study guide for the first exam in Marilyn Hightower's pediatric class (The Childrearing Family NUR 4339). It is based off the exam blueprint posted by the instructor, which listed the number of test questions that will cover each topic. It includes information from the Nursing Car...

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Pediatrics Exam 1 Physical Assessment/Pediatric Variations: 10 questions Physical Assessment—see PowerPoint Central/Peripheral pulses Signed Consent Temperature Pain: 5 questions FLACC Scale: (0-10) for post-operative pain or for children who are developmentally unable to respond  Facial expression  Leg movement  Activity  Cry  Consolability CRIES Scale—when working w/ premature or FT infants in NICU (0-10); A pain score greater than 4 is significant  Crying  Requiring increased O2  Increased vital signs  Expression  Sleeplessness Pharmacology  Nonopioids o For mild to moderate pain o Antipyretic, anti-inflammatory, analgesic o 1 hour to take effect o Acetaminophen (Tylenol, Paracetamol), NSAIDS  Opioids o Moderate to severe pain o Morphine = gold standard o Others: hydromorphone (dilaudid)  has a longer duration of action than morphine  less associated w/ nausea and pruritus o fentanyl (sublimaze)  more potent than morphine o Codeine = weak opioid; safety and efficacy problems Illness Prevention/Communicable Diseases: 12 questions Vaccination Schedule:

Dental Care: Prevention of Caries:  Greatest vulnerability: o Ages 4-8 for primary dentition o Ages 12-16 for secondary/permanent dentition o Apply fluoride dental varnishes o Restrict cariogenic foods  Infants: o Avoiding propping milk bottle or giving milk bottle in bed and avoid fruit juices in a bottle before 6 mo. (these contribute to enamel erosion and early caries) o Once primary teeth erupt, cleaning should begin; clean teeth and hums by wiping with a damp cloth; toothbrushes are too harsh until more teeth erupt o Use water instead of toothpaste (will probably swallow); a “smear” or toothpaste for those younger than 2, pea-seize for ages 2-5 o Fluoride is needed beginning at 6 mo. if not receiving water w/ adequate fluoride content

Potty Training:  Voluntary control of anal and urethral sphincters is achieved after walking between 18-24 mo.  Child must be able to recognize the urge to let go and hold on and let go and communicate to parent  Motivation to please the parent in achieving  5 markers that signal readiness to toilet train: bladder, bowel, cognitive, motor and psychological readiness  There is no universal right age  Nighttime bladder control takes months-years after daytime training begins  Bedwetting is normal in girls up to age 4 and boys up to age 5  Bowel training is achieved before bladder because the sensation is stronger and easier to recognize  Frequent reminders and trips to the toilet are necessary

Iron Deficiency Anemia  Encourage parents to limit quantity of milk, use iron-fortified infant formulas, and introduce solid foods  Overweight does NOT mean good health  s/s of anemia: pallor, listlessness, frequent infections, muscular weakness  Iron supplements administered in 2 divided doses between meals when HCl is greatest and are taken w/ citrus fruit or juice to help reduce iron to its must soluble state turns stool a tarry green or black color  Excessive iron can be toxic or fatal; keep no more than 1 mo. Supply in home and keep out of reach of children Burn Prevention:  Hot liquids kept out of reach  Tablecloths, dangling cords kept out of reach  Outlets protected  Never leave a child in a bath w/o supervision: small children are especially at risk for scald injuries from hot tap water because of their decreased reaction time and agility and the thermal sensitivity of their skin  Keep away lighters/matches

Communicable Disease: Pediculosis, Varicella, Pinworms, Cat Scratch, HPV, Strep, Pertussis, Fifth Disease, Scabies Communicable Disease Nursing Care Management Varicella  If hospitalized: maintain standard, airborne, and contact precautions until all lesions are crusted; for immunized child w/ mild varicella, isolate until no new lesions are seen  Keep in home away from susceptible ppl until vesicles have dried (1 week); isolate high-risk kids away from infected ones  Skin care: give bath and change clothes and linens daily; topical calamine lotion; keep fingernails short and clean; apply mittens for scratching  Keep cool temperature (may decrease # of lesions)  Lessen pruritus  Remove loose crusts that rub and irritate skin  Teach child to apply pressure to itchy area instead of scratching  Avoid use of aspirin Pertussis (whooping cough)  Standard and droplet precautions  Offer small amount of fluids frequently  Ensure adequate oxygenation; position infant on side to decrease change of aspiration with vomiting  Provide humidified oxygen; suction as needed  Observe for s/s of airway obstruction  Abx compliance  Pertussis booster HPV

Erythema infectiosum (5th disease)

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Caused by HPV

Pinworms

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Isolation not necessary Low risk of fetal death to those in contact w/ affected children

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Teach parents tape test: a loop of transparent tape, sticky side out, is placed around the end of a tongue depressor, which is then pressed against child’s perinanal area; specimens collected in the AM when child wakens BEFORE BM or baths. Prevent re-infection by washing all clothes and bed linens in hot water and vacuuming the house Recurrence is common since pinworms survive on many surfaces Permethrin 5% cream should be thoroughly and gently massaged into all skin surfaced (not just areas w/ rash) from head to toe Use a toothpick to apply underneath fingernails Cream should remain on skin for 8-14 hours, then remove by bathing Rash and itch will not be gone until stratum corneum is replaced (2-3 weeks) Soothing ointments can be used for itching Live lice survive up to 48 hours away from host but nits are shed into the environment and can hatch in 7-10 day—retreatment may be needed Spraying with insecticide is not recommended Caution against cutting hair or shaving head Caution against playing with aggressive kittens Wash wounds w/ soap and water Enlarged painful nodes may be treated w/ needle aspiration Abx do not shorten duration or prevent progressive but may be helpful in severe forms of dz

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Pediculosis

Cat scratch disease

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Growth and Development: 15 questions Health Promotion: Sleep, Safety, Language  Sleep o By 3-4 mo. most infants have developed a nocturnal pattern of sleep that lasts from 9-11 hours; total of 15 hours o Breastfed infants sleep for shorter periods w/ more frequent waking, especially during the night  Safety: 3 leading causes of accidental death injury in infants 1. Suffocation 2. MVI 3. Drowning  Other common infant injuries: SAFEPAD o S-suffocation o A-asphyxia, animal bites o F- falls o E-Electrical burns o P-poisoning, ingestions o A-automobile safety

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D-drowning

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Increasing level of comprehension = more striking characteristic of language dev. 1 year = 4 words acquired; can use one-word sentences 2 years = 300 words acquired; multiword sentences 3 years = simple sentences, learns grammatical rules, 5 or 6 new words daily, knows age, gender, can count 3 objects correctly Adult-child conversations w/ infants and toddlers positive affect language development; reading, storytelling, and interactive communication recommended Educational programs have NOT been shown to increase cognitive skills in young children

Language

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Communication  Communicating with parents: o Encourage parents to talk o Direct the focus o Listening and cultural awareness o Using silence o Being empathetic o Provide anticipatory guidance: providing information on normal growth and development and nurturing childrearing practices  Base interventions on needs identified by the family, not the professional  View family as competent  Provide opportunities for family to achieve competence o Avoid blocks to communication o Use an interpreter  Communicating with children: o Infancy: cuddling, patting, gentle physical contact + quiet, calm speech o Early childhood: focus communication on them (egocentric) avoid using phrases that may be interpreted literally o School-age years: they need to know what is going to take place and why it is being done to them o Adolescence: no single approach Infant Nutrition  1st 6 months: o Human milk is most desirable complete diet; or iron-fortified formula o All infants are recommended to take daily supplement of 400 U vitamin D in the 1 st few days of life to prevent rickets and vit D deficiency o If infant is exclusively breastfed after 4 mo. iron supplementation is recommended until ironfortified foods are introduced o Additional fluids are not needed (avoid water intoxication and hyponatremia) o NO skim or low-fat milk; NO cow’s milk o NO honey (risk of infant botulism) o Addition of solid foods before 4-6 mo. is NOT recommended; can lead to excessive weight gain  2nd 6 months: o Fluoride supplementation begins o Breast milk remains best source of nutrition but also iron-fortified formula = majority of caloric needs o Solid foods can begin to be introduced (iron fortified cereal first) or rice o Infant cereal can be mixed w/ formula in a bowl until whole milk is given o Fruit juices can be added (vit C helps iron absorption from cereal)

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Introduce one solid food every 5 to 7 days so that a reaction to a particular food can be distinguished

Breastfeeding: Care of Breast Milk  Expressed breast milk can be stored in the fridge for up to 5 days  May be frozen for up to 12 months  Warming expressed milk in a microwave decreases the availability of antiinfective properties and vit C— NEVER thaw or re-warm in the microwave  To thaw, place container under a lukewarm water bath  Pumping milk away from home may be needed every 3-4 hours to maintain an adequate supply Family with Hospitalized Child/ Coping: 10 questions Coping: Parental, Sibling Response to hospitalization Organ Donation DNR Fluid and Electrolyte Imbalances: 14 questions Infant Hydration Burns: Severe burns; Minor Burns; Fluid replacement; Complications Shock: Categories, Type, Stages Calculation of Fluid Maintenance Categories of Dehydration GU and Kidney Dysfunction: 9 questions  Calculation of Urine Output: o Infants – 2mL/kg/hr o Child – 1mL/kg/hr o Adolescent – 0.5 mL/kg/hr 

Acute / Chronic Renal Failure o Acute: kidneys suddenly unable to regulate the volume and composition of urine  Not common in children  Principle feature: oliguria  Complications: hyperkalemia, HTN, anemia, seizures, coma  Commonly caused by dehydration o Chronic: kidneys cannot maintain normal chemical structure of body fluids  Commonly caused by recurrent UTIs, chronic pyelonephritis, chronic glomerulonephritis  Before age 5 causes: congenital renal and urinary tract malformations

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Glomerulonephritis o Most common non-infectious renal dz in childhood o more common in winter and spring o Antecedent Streptococcus infection o Clinical manifestations:  Angioedema  Dark/tea colored urine; decreased UOP; increased UOP is 1st sign of improvement  Pallor  Irritability  Lethargy  Anorexia, loss of appetite  Mild-moderate BP elevation

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Interventions:  Fluid and Na restrictions  BP tmt Nursing care mgmt.:  Note volume and character of urine  Daily weight  Assess for cerebral complications  No foods high in sodium  Fluid restriction

Upper UTI o Pyelonephritis, glomerulonephritis (involves renal parenchyma, pelvis and ureters) o Can cause systemic sx (fever, chills, flank pain) Lower UTI o Cystitis, urethritis (involves lower urinary tract) o No systemic sx; frequency, dysuria, small amount of turbulent urine that may be grossly bloody

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UTI clinical manifestations o...