Peds ATI Study Guide Review

•Establishing Priorities - (1)

oAcute and Infectious Respiratory Illnesses: Recognizing Epiglottitis (Active Learning Template -

System Disorder, RM NCC RN 10.0 Chp 17)

oUsually caused by Haemophilus influenza

▪Dysphonia (thick, muffled voice and froglike croaking sound)

▪Dysphagia (difficulty swallowing)

▪Inspiratory stridor (noisy inspirations)

▪Suprasternal and substernal retractions

▪Sore throat, high fever, and restlessness

Acute Infectious Gastrointestinal Disorders: Priority Action for Acute Diarrhea (Active Learning Template - System Disorder,

RM NCC RN 10.0 Chp 22)

▪Acute diarrhea is a sudden increase in frequency and change in consistency of stool. It is usually

secondary to an infectious agent in the GI tract, upper respiratory infection, urinary tract infection,

antibiotic use, or laxative use.

▪lf-resolution occurs in less than 14 days if dehydration does not occur. Acute infectious diarrhea is

caused by a variety of viral, bacterial, or parasitic pathogens.

▪Start dehydration therapy with oral agent (priority)

Acute Infectious Gastrointestinal Disorders: Precautions for Rotavirus (Active Learning Template - Basic Concept, RM NCC

RN 10.0 Chp 22)

MANIFESTATIONS

●Most common cause of diarrhea in children younger than 5 years

●Affects children of all ages

●Fever

●Onset of foul-smelling, watery stools

●Diarrhea for 5 to 7 days

●Vomiting for approximately 2

days TRANSMISSION: fecal-oral

INCUBATION PERIOD: 48 hr

▪Get Vaccination

Communicable Diseases: Identifying a Client Who Needs Droplet Precautions (Active Learning Template - Basic Concept,

RM NCC RN 10.0 chp 36)

Droplet

•Erythema infectiosum (Fifth disease)

•Mumps

•Pertussis

•Rubella

•Accident/Error/Injury Prevention - (1)

oHealth Promotion of Toddlers (1 to 3 Years): Injury Prevention (Active Learning Template - Basic

Concept, RM NCC RN 10.0 Chp 4)

▪Suffocation

▪Plastic bags should be avoided.

▪Crib mattresses should fit tightly.

▪Crib slats should be no farther apart than 6 cm (2.375 in).

▪Pillows should be kept out of cribs.

▪Drawstrings should be removed from jackets and other clothing.

▪Aspiration or foreign objects

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Establishing Priorities - (1) o Acute and Infectious Respiratory Illnesses: Recognizing Epiglottitis (Active Learning Template - System Disorder, RM NCC RN 10.0 Chp 17) o Usually caused by Haemophilus influenza ▪ Dysphonia (thick, muffled voice and froglike croaking sound) ▪ Dysphagia (difficulty swallowing) ▪ Inspiratory stridor (noisy inspirations) ▪ Suprasternal and substernal retractions ▪ Sore throat, high fever, and restlessness Acute Infectious Gastrointestinal Disorders: Priority Action for Acute Diarrhea (Active Learning Template - System Disorder, RM NCC RN 10.0 Chp 22) ▪ Acute diarrhea is a sudden increase in frequency and change in consistency of stool. It is usually secondary to an infectious agent in the GI tract, upper respiratory infection, urinary tract infection, antibiotic use, or laxative use. ▪ lf-resolution occurs in less than 14 days if dehydration does not occur. Acute infectious diarrhea is caused by a variety of viral, bacterial, or parasitic pathogens. ▪ Start dehydration therapy with oral agent (priority) Acute Infectious Gastrointestinal Disorders: Precautions for Rotavirus (Active Learning Template - Basic Concept, RM NCC RN 10.0 Chp 22) MANIFESTATIONS ●Most common cause of diarrhea in children younger than 5 years ●Affects children of all ages ●Fever ●Onset of foul-smelling, watery stools ●Diarrhea for 5 to 7 days ●Vomiting for approximately 2 days TRANSMISSION: fecal-oral INCUBATION PERIOD: 48 hr ▪ Get Vaccination Communicable Diseases: Identifying a Client Who Needs Droplet Precautions (Active Learning Template - Basic Concept, RM NCC RN 10.0 chp 36) Droplet
Erythema infectiosum (Fifth disease)
Mumps
Pertussis
Rubella
Accident/Error/Injury Prevention - (1) o Health Promotion of Toddlers (1 to 3 Years): Injury Prevention (Active Learning Template - Basic Concept, RM NCC RN 10.0 Chp 4) ▪ Suffocation ▪ Plastic bags should be avoided. ▪ Crib mattresses should fit tightly. ▪ Crib slats should be no farther apart than 6 cm (2.375 in). ▪ Pillows should be kept out of cribs. ▪ Drawstrings should be removed from jackets and other clothing. ▪ Aspiration or foreign objects

▪ Toys that have small parts should be kept out of reach ▪ Clothing should be checked for safety hazards (loose buttons). ▪ Balloons should be kept away from toddlers ▪ Bodily Harm ▪ Toddlers should not be left unattended with any animals present. ▪ Burns ▪ Thermostats on hot water heaters should be turned down to less than 49° C (120° F). ▪ Toddlers should wear sunscreen when outside. ▪ Pot handles should be turned toward the back of the stove. ▪ Drowning ▪ Toilet lids should be kept closed.

Standard Precautions/Transmission-Based Precautions/Surgical Asepsis - (1) o Acute Neurological Disorders: Priority Actions for Bacterial Meningitis (Active Learning Template - System Disorder, RM NCC RN 10.0 Chp 12) ▪ A topical anesthetic (EMLA cream) can be applied over the biopsy area 45 min to 1 hr prior to the procedure
Developmental Stages and Transitions - (1)
Health Promotion of Toddlers (1 to 3 Years): Developmental Findings to Report (Active Learning Template
- Growth and Development, RM NCC RN 10.0 Chp 4)
- 1. toddlers sleep 11-12 hours a day
- 1. toddlers should be walking without help, throwing a ball, stand on one foot, hops
- 1. watch for choking, burns and aspiration of foreign objects
Health Promotion of Adolescents (12 to 20 Years): Expected Developmental Changes During Early Adolescence (Active Learning Template - Growth and Development, RM NCC RN 10.0 Chp 7) ▪ Girls stop growing at about 2 to 2.5 years after the onset of menarche. In girls, sexual maturation occurs in the following order. ▪ Breast development ▪ Pubic hair growth (some girls experience hair growth before breast development) ▪ Axillary hair growth ▪ Menstruation In boys, sexual maturation occurs in the following order. ▪ Testicular enlargement ▪ Pubic hair growth ▪ Penile enlargement ▪ Growth of axillary hair ▪ Facial hair growth ▪ Vocal changes o Health Promotion of Adolescents (12 to 20 Years): Nutrition Guidelines (Active Learning Template - Growth and Development, RM NCC RN 10.0 Chp 7) ▪ During times of rapid growth, additional calcium, iron, protein, and zinc are needed ▪ Inadequate intake of folic acid, vitamin B6, vitamin A, iron, calcium, and zinc is common

Potential for Complications of Diagnostic Tests/Treatments/Procedures - (2) o Head Injury: Caring for a Child Who Has Increased Intracranial Pressure (Active Learning Template - System Disorder, RM NCC RN 10.0 Chp 14) ▪ Ensure the spine is stabilized until a spinal cord injury is ruled out. ▪ Use the Glasgow Coma Scale ▪ Maintain a patent airway. Provide mechanical ventilation as indicated ▪ Administer oxygen as indicated to maintain an oxygen saturation level greater than 95%. ▪ Use padded restraints for clients who have agitation to prevent injury Implement actions that will decrease ICP. ▪ Keep the head midline with the bed elevated to 30°, which will also promote venous drainage. ▪ Avoid extreme flexion, extension, or rotation of the head and maintain in midline neutral position. ▪ Keep the client’s body in alignment, avoiding hip flexion/extension. ▪ Minimize oral suctioning. Nasal suctioning is contraindicated. ▪ Instruct the client to avoid coughing and blowing the nose, because these activities increase ICP. ▪ Provide a calm, restful environment (limit visitors, minimize noise). ▪ Use energy-conservation measures, such as alternating activities with rest periods and cluster nursing activities ▪ Implement seizure precautions ▪ Insert and maintain an indwelling urinary catheter o Oxygen and Inhalation Therapy: Performing Tracheostomy Care (Active Learning Template - Nursing Skill, RM NCC RN 10.0 Chp 16) ▪ Provide adequate humidification and hydration to thin secretions and decrease the risk of mucus plugging ▪ For cuffed tubes, keep the pressure below 20 mm Hg ▪ Provide tracheostomy care every 8 hr (3x) and oral care every 2hr ▪ Change nondisposable tracheostomy tubes every 6 to 8 weeks ▪ Keep an emergency tracheostomy tube (one size smaller) at the bedside ▪ Reposition every 2 hr
Potential for Complications from Surgical Procedures and Health Alterations - (2) o Gastrointestinal Structural and Inflammatory Disorders: Priority Assessment Findings (Active Learning Template - System Disorder, RM NCC RN 10.0 Chp 23) ▪ Vomiting aspiration o Chronic Neuromusculoskeletal Disorders: Providing Teaching About Increased Intracranial Pressure (Active Learning Template - Therapeutic Procedure, RM NCC RN 10.0 chp 29) Increased intracranial pressure ▪ Caused by shunt malfunction or hydrocephalus. ▪ Prepare for surgery for shunt or shunt revision. MANIFESTATIONS INFANTS: high-pitched cry, lethargy, vomiting, bulging fontanels, and/or widening cranial suture lines, increased head circumference CHILDREN: headache, lethargy, nausea, vomiting, double vision, decreased school performance of learned tasks, decreased level of consciousness, seizures NURSING ACTIONS ▪ Use gentle movements when performing ROM exercises. ▪ Minimize environmental stressors (noise, frequent visitors). ▪ Assess and manage pain. CLIENT EDUCATION:

Teach the client about manifestations of shunt malfunction and hydrocephalus and when to notify the provider.
Health Promotion/Disease Prevention - (1) o Immunizations: Appropriate Immunization Schedule for an Infant (Active Learning Template - Growth and Development, RM NCC RN 10.0 chp 35 ▪ hep b, rota virus, dtap, tdap from 2-4 months
System Specific Assessments - (1) o Fractures: Priority Action for a Child in Skin Traction (Active Learning Template - Therapeutic Procedure, RM NCC RN 10.0 chp 27) NURSING ACTIONS ●Maintain body alignment. ●Provide pharmacological and nonpharmacological interventions for the management of pain and muscle spasms. ●Notify the provider if the client experiences severe pain from muscle spasms that is unrelieved with medications or repositioning. ●Assess and monitor neurovascular status ●Routinely monitor skin integrity and document findings. ●Assess pin sites for pain, redness, swelling, drainage, or odor. Provide pin care per facility protocol. ● Assess for changes in elimination, and maintain usual patterns of elimination. ●Ensure that all the hardware is tight and that the bed is in the correct position.
Alterations in Body Systems - (2) o Burns: Appropriate Nursing Interventions (Active Learning Template - Basic Concept, RM NCC RN 10. chp 32) Minor Burn ▪ Apply tepid water soaks or run water over the injury. Do not use ice. ▪ Cover the burn with a clean cloth to prevent contamination ▪ Cleanse with mild soap and tepid water (avoid excess friction) ▪ Use antimicrobial ointment ▪ Apply dressing. ▪ Nonadherent: fine-mesh gauze ▪ Hydrocolloid: occlusive dressing Major Burn ▪ Airway ▪ Provide humidified 100% supplemental oxygen ▪ Maintain cardiac output. ▪ Initiate IV access with large-bore catheter ▪ Fluid replacement is important during the first 24 hr ▪ 0.9% NS/LR for early phase ▪ Colloid, plasma, albumin after 24-48hr of burn recovery o Asthma: Lesions in the Mouth (Active Learning Template - Medication, RM NCC RN 10.0 Chp 18) ▪ Instruct the child to rinse her mouth after the use of corticosteroid inhaler. ▪ Instruct the child and family to watch for redness, sores or white patches in the mouth, and report them to the provider ▪ Take oral corticosteroid with food.

▪ Facial edema that is worse in the morning but then spreads to extremities and abdomen with progression of the day ▪ Mild to severe hypertension

Unexpected Response to Therapies - (1) o Fractures: Monitoring for Postoperative Complications (Active Learning Template - Basic Concept, RM NCC RN 10.0 chp 27) NURSING ACTIONS ▪ Monitor for findings of infection at the incision site. ▪ Encourage mobilization as soon as prescribed. ▪ Medicate for pain as needed. ▪ Provide crutch training for lower-extremity fractures. ▪ Instruct the client and parents that weight-bearing to ▪ the affected extremity is limited.
Family Dynamics - (1) o Family-Centered Nursing Care: Assessing the Needs of a Single Parent (Active Learning Template - Basic Concept, RM NCC RN 10.0 Chp 1) ▪ History: Medical history for parents, siblings, and grandparents ▪ Structure: Family members (mother, father, son) ▪ Developmental tasks: Tasks a family works on as the child grows (parents with a school- age child helping her to develop peer relations) ▪ Family characteristics: Cultural, religious, and economic influences on behavior, attitudes, and actions ▪ Family stressors: Expected (birth of a child) and unexpected (illness, divorce, disability, or death of a family member) events that cause stress ▪ Environment: Availability of and family interactions with community resources ▪ Family support system: Availability of extended family, work and peer relationships, as well as social systems and community resources to assist the family in meeting needs or adapting to a stressor
Grief and Loss - (1) o Death and Dying: Family Support During Terminal Illness (Active Learning Template - Basic Concept, RM NCC RN 10.0 Chp 11) ▪ Use books, movies, art, music, and play therapy to stimulate discussions and provide an outlet for emotions ▪ Give reassurance that the client is not in pain and that all efforts are being made to maintain comfort and support of the client’s life ▪ Encourage discussion of special memories and people, reading of favorite books, providing favorite toys/objects, physical contact, sibling visits, and continued verbal communication, even if the client seems unconscious ▪ Provide consistency among nursing staff caring for the client and family
Assistive Devices - (1) o Cognitive and Sensory Impairments: Testing a Preschool-Age Child's Visual Acuity (Active Learning Template - Diagnostic Procedure, RM NCC RN 10.0 Chp 15) ▪ Visual screening ▪ This is completed using the Snellen letter, tumbling E, or picture chart ▪ Partial visual impairment is classified as visual acuity of 20/70 to 20/200. ▪ Legal blindness is classified as visual acuity of 20/200 or worse or a visual field of 20 degrees or less in the child’s better eye. ▪ Color vision: Evaluated using the Ishihara or Hardy-Rand-Rittler test.

▪ The client is shown a set of cards and asked to identify the number embedded in the confusion of colors. ▪ The client should identify all of the numbers on the cards with correct color vision

Elimination - (1) o Dermatitis and Acne: Evaluating Parent Understanding of Diaper Rash (Active Learning Template - System Disorder, RM NCC RN 10.0 chp 31) ▪ Advise parents that their child should avoid bubble baths and harsh soaps ▪ Encourage children to wear long sleeves and pants when there is risk of possible exposure to irritants ▪ Educate parents to remove an offending agent as soon as exposure takes place ▪ Promptly remove the soiled diaper. ▪ Clean urine the perineal area with a nonirritating cleanser. ▪ Expose the affected area to air. ▪ Use superabsorbent disposable diapers to reduce skin exposure. ▪ Apply a skin barrier, such as zinc oxide. Do not wash it off with each diaper change
Mobility/Immobility - (1) o Fractures: Caring for a Child Who Is in 90°/90° Skeletal Traction (Active Learning Template - Basic Concept, RM NCC RN 10.0 chp 27) ▪ Assess and monitor neurovascular status ▪ Provide pharmacological and nonpharmacological interventions for the management of pain and muscle spasms. Notify MD if meds don’t relieve muscle spasm. ▪ Assess pin sites for pain, redness, swelling, drainage, or odor. ▪ Ensure that all the hardware is tight and that the bed is in the correct position ▪ Assess and maintain weights so that they hang freely and the knots do not touch the pulley ▪ Consult with the provider for an overbed trapeze to assist the client to move in bed. ▪ Encourage deep breathing and use of the incentive spirometry ▪ Promote frequent position changing within restrictions of traction. ▪ Remove sheets from the head of the bed to the foot of the bed, and remake the bed in the same manner.
Changes/Abnormalities in Vital Signs - (1) o Physical Assessment Findings: Vital Signs to Report (Active Learning Template - Growth and Development, RM NCC RN 10.0 Chp 2) ▪ Know vitals
Potential for Complications of Diagnostic Tests/Treatments/Procedures - (2) o Cardiovascular Disorders: Cardiac Catheterization Postprocedure Care (Active Learning Template - Diagnostic Procedure, RM NCC RN 10.0 Chp 20) ▪ Assess heart and respiratory rate for 1 full minute ▪ Assess pulses for equality and symmetry. ▪ Assess temperature and color of affected extremity. A cool extremity with skin that blanches can indicate arterial obstruction. ▪ Prevent bleeding by maintaining the affected extremity in a straight position for 4 to 8 hr ▪ Encourage the child to void to promote excretion of the contrast medium. ▪ Encourage oral intake, starting with clear liquids
System Specific Assessments - (2) o Diabetes Mellitus: Assessing Hyperglycemia (Active Learning Template - System Disorder, RM NCC RN 10.0 chp 33)

o Fractures: Teaching Cast Care (Active Learning Template - Therapeutic Procedure, RM NCC RN 10. chp 27) ▪ Instruct the client not to place any foreign objects inside the cast to avoid trauma to the skin. ▪ Reinforce skin and perineal care with a spica cast ▪ Instruct the client to soak the extremity in warm water and then apply lotion after the cast has been removed o HIV/AIDS: Client Teaching About HIV (Active Learning Template - System Disorder, RM NCC RN 10. chp 38) ▪ Instruct the parents when to notify the provider. Manifestations requiring medical care include headache, fever, lethargy, warmth, tenderness, redness at joints, and neck stiffness ▪ Identify stressors affecting the family, and make appropriate referrals (school/community response to child, finances, access to health care ▪ Discuss with adolescents the various routes of HIV transmission, including sexual transmission and IV substance use. Ensure the adolescent understands safe sex practice

Medical Emergencies - (1) o Asthma: Priority Finding for a Child Who Has Asthma (Active Learning Template - System Disorder, RM NCC RN 10.0 Chp 18) ▪ Assess airway patency, respiratory rate, symmetry, effort, and use of accessory muscles ▪ Administer oxygen therapy as prescribed. Keep endotracheal intubation equipment nearby ▪ Assess breath sounds in all lung fields. ▪ Monitor VS and Spo ▪ Check CBC and chest x-ray results, possible ABGs
Pathophysiology - (2) o Cushing's Disease/ Syndrome: Manifestations (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 80) ▪ Bruising and petechiae (fragile blood vessels ▪ Hypertension (sodium and water retention ▪ Dependent edema: Changes in fat distribution, including the characteristic fat distribution of moon face , truncal obesity, and fat collection on the back of the neck ( buffalo hump ) ▪ Hirsutism ▪ Striae (reddened lines on the abdomen, arm, thigh)
Unexpected Response to Therapies - (3) o Acute and Infectious Respiratory Illnesses: Postoperative Findings to Report to the Provider (Active Learning Template - Basic Concept, RM NCC RN 10.0 Chp 17) ▪ notify the provider if bright red bleeding occurs ▪ Monitor for difficulty breathing related to oral secretions, edema, and/or bleeding
Non-Pharmacological Comfort Interventions - (1) o Pain Management: Assessment Technique (Active Learning Template - Basic Concept, RM NCC RN 10. Chp 9) ▪ FLACC (0-2)(0/10): 2mo-7 yrs ▪ FACES (0-5):3yrs + ▪ Numeric tool : 5yr + ▪ Oucher (0-5):3yrs- 13yrs

▪ Take pulse prior to medication administration. Notify provider if pulse is lower than specified rate ▪ Administer digoxin every 12 hr. ▪ Direct oral elixir toward the side and back of mouth when administering. ▪ Give water following administration to prevent tooth decay if the child has teeth ▪ If the child vomits, do not re-administer the dose oAcute Infectious Gastrointestinal Disorders: Caring for a Child Who Has Rotavirus (Active Learning Template - Basic Concept, RM NCC RN 10.0 Chp 22

Nutrition and Oral Hydration - (1) ▪ LOOK in BOOK oCardiovascular Disorders: Evaluating Parent Understanding of Digoxin Administration (Active Learning Template - Medication, RM NCC RN
Medication Administration - (2) ▪ Provide frequent oral care ▪ Use a soft-bristled toothbrush or a soft, disposable toothbrush for oral care. ▪ Lubricate lips with lip balm to prevent cracking ▪ Offer foods that are soft and bland. ▪ Assist the child to use mouthwashes (such as 1 tsp salt mixed with 1 pint of water or 1 tsp baking oPhysical Assessment Findings: Evaluation of Cranial Nerve Function (Active Learning Template - Nursing Skill, RM NCC RN 10.0 Chp 2
System Specific Assessments - (2) oBlood Neoplasms: Planning Care for a Toddler Who Has Oral Ulcers (Active Learning Template - Therapeutic Procedure, RM NCC RN 10.0 c
Unexpected Response to Therapies - (1) Diagnostic Tests - (1) oCardiovascular Disorders: Laboratory Tests for Confirmation of Rheumatic Fever (Active Learning Template - System Disorder, RM NCC RN 10. o Lab results ▪ ▪ ▪ ▪ o Testing ▪ Throat culture for GABHS Serum antistreptolysin-O titer: Elevated or rising titer, most reliable diagnostic test C-reactive protein (CRP): Elevate Cardiac function ECG and Echo Jones criteria Must meet 2 major criteria & 1 minor or 1 major and 2 minor following acute infection ▪ Oral rehydration therapy ▪ Give infants water, breast milk, or lactose-free formula if supplementary fluid is needed ▪ Administer antibiotic as prescribed (Shigella, C. difficile, and G. lamblia) ▪ Avoid antibiotics (C. botulinum, E. coli, Salmonella). ▪ Avoid antimotility agents (E. coli, Salmonella, Shigella) ▪ Avoid taking rectal temp ▪ Obtain daily weight ▪ Replace each diarrheal stool with 10 mL/kg of ORS for ongoing diarrhea

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Peds ATI Study Guide Review