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Peds Exam 2 Study Questions
1. Pain: Whatever person says it is; existing whenever the person says it does, the "fifth vital
sign."
2. Pain perception in newborns: They can feel pain!
3. Why can newborns feel pain?: Newborns have fully developed neurologic and hormonal
systems needed for the transmission of pain
4. Complications from unrelieved pain- Short-term: Prolonged healing Decreased GI
motility Decreased ambulation Atelectasis Increased hospital stay
5. Complications from unrelieved pain- Long-term: Decreased patient/parent satisfaction
Complaints to providers/hospital Poor reputation Legal action Cost (Millions are spent annually on persistent pain management, time lost from work, etc.)
6. Complications from unrelieved pain in Neonates- Physiological: Increased ICP, HR, BP, RR
Decreased SaO
7. Complications from unrelieved pain in Neonates- Behavioral: Muscle rigidity Facial expressions
Crying Withdrawal Sleepiness
8. Acute Pain: - Rapid onset of varying intensity
- Indicates tissue damage and resolves with healing of the injury
- Usually lasts a few days (< 3 months)
- Caused is KNOWN
- Focus of the treatment is on the cause of the pain (eliminate pain)
9. Chronic Pain: - Pain that continues past the expected point of healing for injured tissue (>
months)
- No protective function
- Continuous or Intermittent
- With or Without remission
- Interferes with sleep and ADLs
- Goal is to decrease pain and increase coping, improve quality of life
10. What might chronic pain in children be associated with?: Abdominal pain, headache, limb
pain, chest pain
11. What conditions have characteristics of both acute and chronic?: Sickle cell disease &
Migraines
12. Key principles of pain assessments (QUESTT)?: - Question the child and parents
- Use a reliable and valid pain scale
- Evaluate the child's behavior and physiologic changes (establish a baseline, determine effectiveness of interventions)
- Secure the parent's involvement
- Take the cause of pain into account when treating
- Take action
13. What is an example of "take action"?: "If you can take 1 finger and show me where your pain
is."
14. Behavioral pain assessment- Age
Indicators: Infants to 4 years Vocalization, facial expression, and body movements with a specific tool (Ex: New- born screening)
15. Behavioral Pain- Infants (most reliable vs less reliable): Most reliable for short, sharp pain
Guided imagery Cutaneous stimulation Positioning Non-nutritive sucking (pacifier)
33. Pain- Special Considerations: Children may deny pain because they fear receiving an
injection or believe they deserve to suffer (e.g., as punishment for some misdeed).
34. How could a nurse encourage a child to talk about their pain?: Have the parent ask; children
readily admit to parent that they are hurting. This should not be interpreted as seeking attention from the parent but as a valid indication of pain.
35. T/F Child who is sleeping is NOT in pain: False
36. The nurse is caring for a 6-year-old child with burns on both hands. When assessing this child's
pain, which technique would be most appropriate for the nurse to use?
**- Obtaining a self-report
- Evaluating physiologic indicators
- Observing behavior
- Assessing the burns:** Obtaining a self-report
37. The nurse is caring for a 14-year-old child with cerebral palsy who is unable to communicate
verbally. When assessing this child's pain, which assessment tool would the nurse most likely use?
**- Pain diary
- Face, legs, activity, cry, and consolability (FLACC) descriptors
- Adolescent Pediatric Pain Tool (APPT)
- Numeric rating scale:** Face, legs, activity, cry, and consolability (FLACC) descrip- tors
38. A child is in the intensive care unit after a motor vehicle collision. The child has numerous
fractures and is in pain that is rated 9 or 10 on a 10-point scale. In planning the care, the nurse recognizes that the indicated action is to:
**- Give only an opioid analgesic at this time.
- Increase the dosage of analgesic until the child is adequately sedated.
- Plan a preventive schedule of pain medication around the clock.
- Give the child a clock and explain when she or he can have pain medica- tions.:** Plan a preventive schedule of pain medication around the clock
39. T/F (Explain) When taking care of a 12-year-old who is using the 0-10 scale during the day, it's better
to switch to the FLACC at night while he's asleep so a number is documented.: False Should stay consistent with pain scale that you're using
40. What can low doses of NARCAN in conjunction with opioids prevent?: Itch- ing d/t opioids
41. 1 mg =? mcg
1 kg =? lbs 1 tsp =? mL: 1000 mcg 2.2 lbs 5 mL
42. Atraumatic care with medications: - Using comforting positions
- Encourage the child to participate in care
- Give child developmentally appropriate options
- Using topical anesthetic prior to injections
43. When is it okay to crush a medication?
When is it NOT okay to crush a medication?: J tube or G tube ’ call the pharmacy Extended-release or Enteric coating
44. What are different routes of medication administration?: Oral Rectal
Inhaled Transdermal/Topical Otic (ear)
- How the parents can participate and support their child (do you want your mom to do it, or do you want me to do it?)
54. What size needles for IM, 1-12 months?
What size needles for Deltoid, after 12 months? What size needles for the VASTUS LATERALIS, in 3-10 y/o? What size needles for SQ in all ages?: 22-25 gauge, 1 inch 22-25 gauge, ]-1 inch 22-25 gauge, 1-1.25 inch 23-25 gauge, ] inch
55. Safe dosage calculations: - Weight-based
- Need to know how much medication to give
- Can the patient tolerate higher doses based on the diagnosis (i.e. psychiatric)?
- Sometimes start high (loading dose)
56. What happens if there is too little or too much medication administered in a child?: Too little ’
Medication won't work as expected Too much ’ Increased side effects
57. Case Study 1: Kyle is a 10-year-old patient admitted to the hospital with an asthma exacerbation
who weighs 90 lbs. The dose is 1-2 mg/kg/day with a max dose of 60 mg/day. The provider orders prednisolone 40 mg po bid. What is the lowest recommended dose?
a. 20 mg po bid
b. 30 mg po bid
c. 40 mg po bid
d. 45 mg po bid
2. What is the highest recommended dose?
a. 30 mg po bid
b. 40 mg po bid
c. 80 mg po bid
d. 90 mg po bid
3. Is this dose safe and therapeutic?
a. Yes, this dose is in the recommended range b. No, this dose is less than the recommended range c. No, the dose exceeds the recommended range: 1) a. 20 mg po bid
2) a. 30 mg po bid
3) c. No, the dose exceeds the recommended range
58. We have a 9 kg child. Doctor orders 120 mg of acetaminophen PO. Safe dose is
10-15mg/kg/dose every 4-6 hours as needed for pain. Is this dose safe? Explain: Yes Low dose (10) x weight (9) = 90mg; 90-135 = 120
59. We have a 3-year-old child who weighs 13 kg. He has an order for 120 mg of amoxicillin po three
times daily. The range is 25-50 mg/kg/day Is this dose safe? Explain: Yes 25 x 13= 325/day 50 x 13= 650/day
60. The doctor orders 120 mg of acetaminophen. You have acetaminophen available as 160 mg/
mL.
What are the causes of increased ICP?: Pressure inside the skull; imbalance of CSF Neurological disorder Head trauma, birth trauma, hydrocephalus, infection, brain tumors
69. What are early signs and symptoms of elevated ICP?
What are late signs and symptoms of elevated ICP?: Headache, Vomit, Changes in LOC, Seizures, Bulging fontanel/increased head circumference (infants) Decrease motor/sensory responses, Bradycardia, Cheyne-Stokes respirations, De- cerebrate postures, Fixed and dilated pupils
70. How is elevated ICP treated?
What level do we want ICP to be at?: Reduce stimulation, avoid interventions that cause stress, ventriculostomy, VP shunt, craniotomy, external ventricular drains Want the ICP to be BELOW 20
71. Hydrocephalus- Def
What are s/s of hydrocephalus? How is hydrocephalus treated?: Excessive fluid in the brain due to blockage flow of CSF; can be congenital or acquired Increase head circumference, loss of development, change in personality, increase ICP VP shunt
72. VP shunt
What does the nurse need to know about a VP shunt malfunction? S/s of VP shunt infection What happens when the child grows with a VP shunt?: Catheter inserted into brain ventricle to be absorbed into normal body circulation. Infection (1-2 months after placement) ’ ask about headache, neuro check, vomiting, possible culture EMERGENT, elevated VS, poor feeding, seizure, decreased responsiveness The VP shunt needs to be replaced
73. Does having one seizure increase their risk of developing a disorder?: No
74. Classifications of Seizures: Partial (focal) Tonic-
Clonic Atonic Absence Febrile
75. Febrile Seizure- Age
Related to? What is important to know about with people diagnosed with Febrile Seizure and their family?: Most common in < 5 years old Related to viral illness. It can be very frightening for both the child and family. In most cases the prognosis is excellent.
76. Atonic Seizure
S/s What is it called?
- Secure airway, turn the child on the side
- Time seizure
- Protect head
- Remove hazards
- IV access
- Stay calm, engage parent
80. When should you use force on a patient having a seizure?: Use force only in an emergency to
protect the person from immediate harm
81. When to not approach a person who is having a seizure?: Do not approach, a person who
appears angry or combative
82. Teaching Guidelines for Parents/Caregivers: - Remain calm.
- Ease child to the ground
- Time seizure episode.
- Tight clothing and jewelry around the neck should be loosened, if possible.
- Place child on one side and open airway, if possible.
- Do not restrain the child.
- Remove hazards in the area.
- Do not forcibly open jaw with a tongue blade or fingers.
- Document length of seizure
- Remain with child until fully conscious.
83. Call EMS if:: - The child stops breathing
- Any injury has occurred
- Seizure lasts for more than 5 minutes
- This is the child's first seizure
- Child is unresponsive to painful stimuli after seizure
84. What is Breathing-Holding Spells: NOT a seizure
85. Epilepsy
What is the cause of epilepsy?: Recurrent, unprovoked seizure Imbalance of neurotransmitters, excessive neuronal firing, and changes in brain channels.
86. Status Epilepticus
How long does Status Epilepticus last? What influences the prognosis of Status Epilepticus? What medications are used to treat status epilepticus?: Neurologic emergency in children; prolonged seizures where consciousness does not return More than 5 minutes -Age of the child, Cause of seizures, Duration ABCs, Anticonvulsants, Benzodiazepines
87. Benzodiazepines How to
insert in infants? Examples: Most common type of medication to treat seizure (seizure rescue) Rectal insertion Lorazepam, Diazepam, Fosphenytoin
88. Pre-ictal (aural)
Ictal Post-ictal: Before a seizure Seizure, attack Symptoms that occur after a seizure
89. Nursing interventions for post-ictal: - Pulse Ox (s/s of hypoxia)
No threat to the child, assess sac and neuro status, prevent rupture/infection, provide nutrition and hydration
97. Myelomeningocele S/s
What are newborns at risk for? Nurse Interventions: Most severe; protrusion of the meninges, spinal fluid, and spinal cord. Visual at birth. Paralysis, orthopedic deformities, bladder/bowel incontinence Meningitis, hypoxia, hemorrhage Prevent infection/trauma, keep sac moist, prone position, promote urine/bowel elim- ination (self-cath), nutrition, no latex allergy
98. Positional Plagiocephaly
What causes it?: "Flat head syndrome:' Asymmetry of head shape without fused sutures. Positional, Sleep on back
99. What to watch for if pt. admitted for observation after a head injury?: Signs of increased
intracranial pressure
100. Inspection and Observation of a Child With a Neurologic Disorder: - Level of
consciousness (LOC)
- Babies should NOT have a preferred hand yet!
101. Electroencephalogram (EEG): - Placed on head of infant
- Looking at any signs of seizures
102. Magnetic resonance imaging (MRI): Need to be still (can be hard)
103. Medications Used to Treat Neurologic Disorders: - Antibiotics
- Analgesics (Ibuprofen)
- Osmotic diuretics (Mannitol)
- Corticosteroids (Decadron)
104. Mannitol
Teaching: Increase plasma osmolality, reduce intracranial pressure Make sure you have a Foley in a patient when giving it b/c the patient will pee a lot
105. Which of the following is the most essential part of the nursing assess- ment to detect
early signs of increased ICP?
1. Posturing
2. Vital signs
3. Focal neurologic signs
4. Level of consciousness: 4. Level of consciousness
- A 4 yo has had a VP shunt in place since birth. The parents call the triage nurse at the child's primary health provider and stated that when the child awoke he complained of a bad headache and vomited shortly thereafter. Which of the following actions by the nurse is appropriate?
1. Advise the parents to have the child seen in the emergency department.
2. Make an afternoon appointment for the child to see a HCP
3. Tell the parents to give electrolyte replacement instead of food
4. Ask the parents to call back if the child develops diarrhea: 1. Advise the parents to have the
child seen in the emergency department.
- A child has been diagnosed with febrile seizures. Which of the following should you include in your teaching session?
1. Whenever your child develops a fever, place him in a warm bath and pur the water over his
arms/legs.
2. Make sure to give your child high dosages of acetaminophen when his temp goes above 104.
3. It is very important that your child have no more seizures to prevent him from experiencing
- Airway, head
- Nothing in mouth
- No restraints
- Meds (se, who to call)
113. The parents would like to enroll the child in swimming lessons. Is it ok for the child to
swim? To swim alone?: Yes, NOT alone
114. Can kids with seizure disorders drive?: Yes, but only if they have not had any
seizures in the past couple of years
115. What causes head trauma?: Falls, motor vehicle accidents, sport injuries, bicycle
accident, child abuse
116. What is most important to watch for in a patient admitted with a head injury?: Signs
of increase ICP
117. Cognitive Impairment (CI): Functional state in significant limitations in intel- lectual
status and adaptive behavior; before 18 yo
118. CI- Cause: Prenatal drug/alcohol exposure, brain damage (prenatal, perinatal,
postnatal), genetics, infection
119. Early behavioral signs of CI: Not meeting developmental milestones (lan- guage,
dressing, sitting/rolling)
120. What is the goal of caring for a child with cognitive impairment?: Provide appropriate
education experiences that allow them to achieve self-sufficiency and a level of functioning to be able to exist at home, in a community, at work, and leisurely
121. What is the goal of caring for a child with cognitive impairment during hospitalization?:
Assess their capabilities/function abilities, do they have pain, ask parent about behavior
122. What is the most common learning disorder?: ADHD (co-morbidities of: ODD,
conduct disorder, anxiety, depression)
123. Intellectual disability: IQ less than 70; cognitive impairment
124. Down Syndrome: Extra/translocation of chromosome 21.
125. What kind of condition is Down syndrome?: Chromosomal abnormality
126. What are the clinical features of down syndrome?: Mild- Moderate CI, social development
may be 2-3 years > mental age
127. What organ systems are involved?: Heart (septal defects) Renal
Intestine (hirschsprung: issue passing stool) Neck (Tracheoesophageal fistula, Hypotonic muscle, Hyper-extensive joints) Vision/Hearing (sensory defects) Growth (men 5'2" and women 4'6") Sleep apnea Decrease life expectancy
128. How should nurses communicate with children with vision or hearing impairments?:
Reassess for understanding, supplement instructions with visuals, communication devices (picutre boards, common words/needs: food, water, toilet)
129. Autism- Causes
Vaccine controversy "Red-flags" of children with autism: Unknown, Genetics Belief that vaccines cause autism, but publishings have been retracted Not responsive by 8-9 months, no interest in other by 2 y/o
130. Care modifications for working with children with autism: Be aware that the child gets
overwhelmed, likes consistency, communicate with parents (regular schedule, expectations, previous hospitalizations), anything the child likes, use simple language, reduce environmental stimuli
131. Co-morbid health conditions with autism: Seizure, constipation, obese, PICA, GERD,
accidental injuries, self-injury (cauliflower ear), swimmers ear, dental caries, abuse, paroxysmal aggretion
132. ABA Therapy: Intensive out-patient therapy; teaches communication, basic
tasks/chors, sitting still/waiting in line, daily care
