Pediatric Nursing study guide review 2023-2024, Exams of Nursing

Download Pediatric Nursing study guide review 2023-2024 and more Exams Nursing in PDF only on Docsity! 1 / 57 Pediatric Nursing study guide review 2023-2024 1.Pediatric History Taking: Involve child Be honest with child Open ended questions Observe nonverbal communication 2.History of present illness: Birth history Prenatal history Intrapartum-history of delivery Condition of baby at birth Postnatal condition 3.Physiologic data: Current health data Medications Health providers Allergies Immunizations Family history 4.Familiar or Hereditary diseases: See power points (9-14) 5.Psychosocial data: •Family composition • Financial resources • Home environment, housing, neighborhood 2 / 57 Pediatric Nursing study guide review 2023-2024 • School or child care • Daily routines Sleep, wake pattern, activities 6.Nutritional Assessment: •Dietary intake • Clinical examination of nutrition • Hair, skin, mouth, eyes • Evaluation of nutritional assessment • Malnourished • At risk • Well nourished Overweight or obese 7.Cultural Considerations: •Amount of eye contact • Interactions with healthcare providers • Physical touch • May say "yes" to be polite • Use of silence 8.General Approaches Toward Examining the Child: •Sequence of the examina- tion • Head-to-toe sequence for assessing adult clients 5 / 57 Pediatric Nursing study guide review 2023-2024 12.Facilitating Examination of Toddlers: •Provide a security object. • Demonstrate instruments on parent or other before examining child. • Allow child to have as much control and choice as possible. • Examine ears, eyes, mouth at end of the exam. 13.Facilitating Examination of Preschoolers: •Consider what sequence is best. • Allow children to touch and play with equipment. • Use games to reduce anxiety. • Give positive feedback. 14.Facilitating Examination of Older Children and Adolescents: •Ensure mod- esty and privacy. • Offer choices. • Explain body parts and functions. • Decide on parental presence or absence. • Consider need for nonparent chaperones. • Reassure adolescents of normalcy. 15.Sequence of Examination: •Young children • Foot-to-head sequence allows least distressing parts of the exam to be completed first. • Older children 6 / 57 Pediatric Nursing study guide review 2023-2024 • Head-to-toe approach • Sequence may vary due to preferences, sleep, cooperation. 16.Examination Techniques: Inspection Palpation Percussion Auscultatio n 17.Physical Examination: •Growth measurements • Growth charts • Length • Height • Weight • Skin full thickness and arm circumference • Head circumference 18.•Temperature: •Oral if child can keep mouth closed- >3 years • Temporal • Axillary • Rectal- traumatic (if no other route possible) 19.•Pulse 7 / 57 Pediatric Nursing study guide review 2023-2024 • Radial • Apical Respiration Pediatric BP: •Pediatric blood pressure (BP) • Measurement devices • Selection of cuff • Cuff placement • Right arm preferred • BP measurement and interpretation • Orthostatic hypotension 20.Eyes: External structures Internal structures Preparing the child Funduscopic examination Vision testing Occular alignment Visual acuity in children 10 / 57 Pediatric Nursing study guide review 2023-2024 Course crackles- air passing through thick secretions Sibilant wheezing-air through mucous (asthma) Rhonchi (sonorous wheezing)- thick bronchioles Stridor- Whistling sound as air passes through a narrowed trachea and larynx, associated with croup 25.Genitalia and Perineal Areas: Tanner and sexual maturity scales 26.Normal Development of Posture and Spinal Curves: Age Posture and Spinal Curves 2-3 months- Holds head erect when held upright; thoracic kyphosis when sitting 6-8 months- Sits without support; spine is straight 10-15 months- Walks independently; straight spine Toddler-Protruding abdomen; lumbar lordosis School-age child Height of shoulders and hips is level; balanced thoracic convex and lumbar concave curves 27.scoliosis screening: Adams forward bending test - standing and forward bend- ing; check hip and shoulder levels, lateral creases, humps 28.Age-Specific Procedures for Assessment of Cranial Nerves in Infants and Children: I Olfactory 11 / 57 Pediatric Nursing study guide review 2023-2024 Infant: Not tested. 12 / 57 Pediatric Nursing study guide review 2023-2024 Child: Not routinely tested. Give familiar odors to child to sniff, one naris at a time. Identifies odors such as orange, peanut butter, and chocolate. II Optic Infant: Shine a bright light in eyes. A quick blink reflex and dorsal head flexion indicate light perception. Child: Test vision and visual fields if cooperative. Visual acuity appropriate for age. (III Oculomotor) (IV Trochlear) (VI Abducens) Infant: Shine a penlight at the eyes and move it side to side. Focuses on and tracks the light to each side. Child: Move an object through the six cardinal points of gaze. Tracks object through all fields of gaze. All ages: Inspect eyelids for drooping. Inspect pupillary response to light. Eyelids do not droop and pupils are equal size and briskly respond to light. 29.Assessment Findings That Are Normal in Children: Epicanthal eye folds Sucking pads in infant's mouth Rounded chest in infants Breath sounds heard over entire 15 / 57 Pediatric Nursing study guide review 2023-2024 Latency-School age Genital-Adolescence Application to nursing care 34.Erikson Stages of Infant, Childhood, and Adolescent Development: Eight psychosocial stages Focus on lifespan development Developmental crises Healthy vs. unhealthy outcomes 35.Erikson's Psychosocial Stages: The Infant: Trust vs Mistrust The Toddler: Autonomy vs. Shame/Doubt 36.Piaget's Stages: Sensorimotor Preoperational Concrete operational Formal operational 37.Kohlberg Stages of Moral Development: 1. Pre-conventional 4 to 7 years 2.Conventional 7 to 11 years 3.Post-conventional 12 years and older 38.Developmental delay risks: Inadequate respiratory function 16 / 57 Pediatric Nursing study guide review 2023-2024 Inability to suck Inadequate kidney function Lowered immune protection Neurologic immaturity 39.Patterns of Temperament: 1. easy child- approximately 40% 2.difficult child-approximately 10% 3.slow-to-warm-up child approximately 15% 4.mixed- approximately 35% 40.Bronfenbrenner's Ecologic Theory of Development: Views the Individual as Interacting Within Five Levels or Systems 41.resilience: the rate at which an ecosystem returns to its original state after a disturbance 42.Developmental Periods: Newborn (0 to 1 month old) Prenatal influences on growth and development Infant (1 to 12 months of age) Toddler (1 to 3 years of age) Preschooler (3 to 6 years of age) School-age child (6 to 12 years of age) Adolescence (12 to 18 years of 17 / 57 Pediatric Nursing study guide review 2023-2024 age) Influences on growth and development 20 / 57 Pediatric Nursing study guide review 2023-2024 50. Pediatric Differences in electrolyte balance: •Percentage of body weight com- posed of water varies with age 21 / 57 Pediatric Nursing study guide review 2023-2024 • Infants have high daily fluid requirement with little fluid volume reserve • Vulnerable to dehydration • Infants and children under 2 years lose greater proportion of fluid each day • More dependent on adequate intake 51.extracellular fluid: intravascular fluid (fluid in blood vessels) and interstitial fluid (fluid between cells and outside the blood and lymphatic vessels). 52.Intracellular fluid: inside the cell 53.•Intracellular fluid (I C F): •2/3 of body water, •Between compartments • Response to body changes 54.•Extracellular fluid (E C F): •1/3 of body water, •Intravascular, Interstitial, •At- tempt to maintain homeostasis 55.Infants and children under 2 years: •greater body surface area (BSA) • Greater insensible water loss through skin 56.•Respiratory and metabolic rates: •High during early childhood • Leads to greater water loss from the lungs • Greater water demand to fuel the body's metabolic processes 57.Under 2 years: •glomeruli, tubules and nephrons of kidneys are immature 22 / 57 Pediatric Nursing study guide review 2023-2024 • Unable to conserve or excrete water and solutes effectively •More water excreted • Difficulty regulating electrolytes such as sodium/calcium • Become dehydrated more quickly 58.•Urine output: •Normal • 0.5 to 1 mL/kg/hr for children • 2 mL/kg/hr for infants 59.•Chloe is a 2 month old admitted with a 2 day history of diarrhea and dehydration. She has a temperature of 38.9 degrees Celsius. Heart rate is 188. Respiratory rate is 62. Her skin is cool, poor skin turgor with > 5 second capillary refill. She has not had a wet diaper today. Her fontanel is sunken and she does not cry tears. Mucous membranes are dry. She is lethargic. • •Which of her symptoms are related to dehydration?: •Alert, restless to irritable and lethargic (depending on degree of dehydration) •Tachycardia, tachypnea, fever (may or may not be present in dehydration- indicates an infectious cause for the illness) •Skin turgor poor. Decreased capillary refill; > 3 seconds •Mucous membranes dry •Sunken fontanel •Eyes sunken; no tears 25 / 57 Pediatric Nursing study guide review 2023-2024 LOC-irritable or lethargic BP-normal or low, postural hypotension in older Pulse-rapid Skin turgor-poor Mucous membranes- dry Urine-decreased output Thirst-moderately increased Fontanelle- sunken Delayed cap refill Resp-usual or rapid eyes-slightly sunken, decreased tears 62.severe dehydration: 10% or more body weight loss lethargic to comatose low BP rapid, weak pulse poor skin turgor parched 26 / 57 Pediatric Nursing study guide review 2023-2024 membranes absent urine output cool, mottled skin deeply sunken fontanel & eyes 63.Extracellular Fluid Volume Deficit (Dehydration): •Occurs when not enough fluid in extracellular compartment (intravascular and interstitial) • Depending on cause, sodium may be normal, low or high 27 / 57 Pediatric Nursing study guide review 2023-2024 • Prolonged vomiting and diarrhea, burns and IV fluid without electrolytes Percent of weight loss major indicator of degree of dehydration 64.Dehydration Diagnostic Tests: •Clinical observations • History of illness • Weight • Electrolyte panel • Elevated BUN >17 mg/dl • Low serum bicarbonate <17meq/L Elevated urine specific gravity 65.•Which is indicated? • Oral rehydration or IV rehydration? • Why?: •IV rehydration. This infant is showing signs of severe dehydration. A weight would confirm this diagnosis. • Oral rehydration solution therapy is indicated for mild dehydration and possibility moderate. As the infant is lethargic, has a high respiratory rate- oral fluids would not be safe to attempt. 30 / 57 Pediatric Nursing study guide review 2023-2024 signs of mild dehydration) • Pedialyte or Infalyte • Frequent small amounts • 1-3 teaspoons every 10-15 minutes • Education on signs and symptoms of worsening dehydration ÒNo juice, cola or sugary drinks. 68.Dehydration Nursing Management: •Daily weights • Strict I & O- weigh diapers; Check urine; Color, Amount • Vital signs • Frequent Assessment: Level of consciousness, skin turgor, mucous membranes, fontanel, tears, capillary refill, eyes • Monitor IV therapy (box 23-3, p. 696) • Safety • Education with family for prevention in future • Immunizations, illness prevention 69.Extracellular Fluid Volume Excess(overhydration): •Too much fluid in extra- cellular compartment • Cause: a condition that causes retention of sodium or water • Adrenal tumors which cause excessive aldosterone secretion 31 / 57 Pediatric Nursing study guide review 2023-2024 • Aldosterone causes the kidney to retain saline • Congestive heart failure Chronic renal failure 70.Extracellular Fluid Volume Excess(overhydration): •Clinical Manifestations • Weight gain: .5 kg suddenly gained in one day is due to fluid accumulation • Edema • Infants-generalized over body • Children-dependent areas of body • Tight clothes, shoes • Bounding pulse • Respiratory difficulty • Dyspnea, orthopnea, crackles • Clinical Therapy Determine cause and treat 71.Nursing Management: •Daily weights-rapid weight gain most sensitive indicator (.5 kg suddenly gained in one day is due to fluid accumulation) • Strict I & O-successful treatment causes output to be greater than intake 32 / 57 Pediatric Nursing study guide review 2023-2024 • Assess pulse • Respiratory Assessment 35 / 57 Pediatric Nursing study guide review 2023-2024 • Causes • Renal insufficiency, too much potassium in IV, blood transfusions, cell death (sickle 36 / 57 Pediatric Nursing study guide review 2023-2024 cell crises), injuries • Clinical Manifestations • Hyperactivity of GI smooth muscle causing intestinal cramping & diarrhea • Skeletal muscles become weak • Lethargy • Arrhythmias • Clinical Therapy • Treatment of cause • Potassium removed from body by dialysis, potassium wasting diuretics, Kayexalate • Nursing Management • Monitor potassium levels • Systems assessment • Monitor heart rate and arrythmias 75.Hyperkalemia: •Any child receiving IV therapy is at risk • Check for established urine output prior to implementing Potassium in IV fluid 76.Hypokalemia: •Causes • Diarrhea and vomiting are major causes, self induced vomiting, 37 / 57 Pediatric Nursing study guide review 2023-2024 excessive stooling in bulimia, NG suction Clinical Manifestations • GI smooth muscle slowed causing abdominal distention, constipation and ileus • Skeletal muscle weak and unresponsive • Cardiac arrythmias • Respiration may be affected • Polyuria from kidney changes • Clinical Therapy • Identify cause and treat • Potassium replacement • Nursing Management • Monitor potassium levels • Assess for muscle weakness • Systems assessment • Diet high in potassium 77.Acid-Base Imbalances: Respiratory Acidosis: •Normal blood pH is 7.27-7.49 • Respiratory Acidosis • Accumulation of carbon dioxide in blood • Caused by anything that interferes with lungs excretion of CO2 40 / 57 Pediatric Nursing study guide review 2023-2024 • Clinical Therapy: treatment of cause • Nursing Management • Assessments • monitor labs 81.Metabolic Acidosis: •Metabolic Acidosis: excess of any acid other than carbon- ic acid • Caused by imbalance in production and excretion of acid or by excess loss of bicarbonate • When Ph of the blood decreases below normal, the chemoreceptors in brain and arteries are stimulated causing respiratory compensation • Rate and depth of respirations increases and carbonic acid is removed from body • Diabetes Mellitus, ingestion of antifreeze, ingestion of ASA, renal failure, diarrhea, starvation 82.Metabolic acidosis, cont.: •Clinical manifestations • Decreased Ph • Decreased HCO3 • Decreased PCO2 • Kussmaul respirations-hyperventilation • Clinical Therapy 41 / 57 Pediatric Nursing study guide review 2023-2024 • Treat cause 42 / 57 Pediatric Nursing study guide review 2023-2024 • Nursing Management • assessments 83.Acid-Base Imbalances: Metabolic Alkalosis: •Alkalosis: caused by loss of acid or too much bicarbonate • Prolonged vomiting (pyloric stenosis), NG suction, antacids, diuretics, reconstitu- tion of powder formula • Clinical Therapy: treat cause • Nursing Management: assessments 84.Indications for special attention for need to assessing fluid balance: •IV therapy • Age or weight of patient • Fluid restriction • Major surgery • Dehydration • Tube feeds • NG tubes • Diuretics • Renal disorders • Cardiac disorders 45 / 57 Pediatric Nursing study guide review 2023-2024 • What orders do you expect to initiate?: •Lab work: electrolyte panel, CBC • IV fluid bolus: what fluid • IV maintenance fluid • Monitor intake and output: weigh diapers • Weight Stool culture, ova and parasite 88.•Labwork results • Sodium: 145 mEq/l • Potassium: 5.4 mEq/l • Chloride: 109 mEq/l • CO2: 15.7 mEq/l • Urea Nitrogen: 18 mg/dl • Glucose: 80 • Matt's weight is 5.45 kg (11 lbs 9oz.) • Mom states he normally weighs 13 lbs What is the significance of the lab work results?: •Sodium and potassium elevated due to hypovolemia • CO2 low: metabolic acidosis • He has had a 8% weight loss: 46 / 57 Pediatric Nursing study guide review 2023-2024 • Prior weight = 13 pounds = 5.9 kg • Current weight = 5.45 kg. • 5.9 kg- 5.45 kg = 0.472 kilograms • Showing signs of moderate dehydration with lethargy • • Outline the Plan of care for Matt. Prior weight = 13 pounds= 5.9 kilogram. 5 % weight loss= 0.295 kilograms 6% weight loss= 0.354 kilograms 7% weight loss= 0.413 kilograms 8% weight loss= 0.472 kilograms 9% weight loss= 0.531 kilograms 10% weight loss= 0.59 kilograms His current weight is 5. 45 kg. He has lost 0.45 kilograms which equals an8 % weight loss. 89.•Initiate IV fluid bolus x3 • Reassessment: When? After each fluid bolus 47 / 57 Pediatric Nursing study guide review 2023-2024 • After bolus complete, IV maintenance, do not add potassium chloride until adequate urine output is established. • Nursing care- frequent reassessments; watch for signs of return of adequate fluid volume. Urine output. • Additional lab work: When? Every morning or as needed for signs of not re- sponding to clinical management.: •Reweigh: When? Same time every morning. • Education with family. NPO for now, save all wet diapers. Protect IV site. • What do you expect the stool culture to show? Viral or bacterial pathogen. • Hand hygiene • Safety- keep siderails up unless held or parents at side of crib. Sleep on back. Safe sleep practices. 90.Vital signs for age parameters: See word document 91.Pediatric pain: Acute versus chronic (-Exists beyond normal healing time Nociceptive Normal processing of pain caused by tissue injury or damage Neuropathic Abnormal processing of pain stimuli by the central or peripheral nervous systems). 92.Children & Pain: pain tends to be 50 / 57 Pediatric Nursing study guide review 2023-2024 obstruction) Pain Altered pain response, increased pain sensitivity, exaggerated memory of previous pain experiences, lower pain threshold 94.Physiological results of pain: •Depression of immune and anti-inflammatory response • Causes increased risk of infection/delayed wound healing • Delayed return of GI function, • Anorexia, poor nutritional intake, • Ileus Altered pain response 95.Pain facts: •Infants display behavioral and psychologic cues • Children remember painful experiences and this can affect pain responses during future procedures • Distraction may help children cope with pain but this is physiologically taxing on their systems- become exhausted and may fall asleep • Children who repetitively experience pain tend to report pain at higher levels and children experiencing pain for the first time. • Children have increased potential for healing but do experience pain at the same level as adults. 51 / 57 Pediatric Nursing study guide review 2023-2024 • Children may not report pain because of fear that the treatment will be worse than enduring the pain 96.Newborn pain expression: bulged brow, eyes squeezed shut, furrowed na- solabial creases, open lips, pursed lips, stretched mouth, taut tongue, and a quiver- ing chin 97.Pediatric pain assessment: •Use a variety of words: owie, booboo, hurt, ouch, feel funny, point to where it hurts • Play, toys 98.Newborn behavioral scales: •Neonatal infant pain scale (NIPS) • Procedural pain; Preterm, term up to 6 weeks • Facial expression, cry, breathing patterns, arm & leg position, state of arousal • CRIES scale • Procedural and surgical pain; Preterm and full term in ICU • Behavioral indicators of infant pain (BIIP) • Acute pain in preterm infants • Premature infant pain profile (PIPP) • Evaluate procedural pain 28- 40 weeks gestation • Neonatal pain, agitation and sedation scale (N-PASS) 52 / 57 Pediatric Nursing study guide review 2023-2024 • Ongoing or acute pain and sedation levels in neonates and infants 99.CRIES pain scale: Evaluates post op pain in ICU 100. NIPS (Neonatal Infant Pain Scale): •Evaluates procedural pain 101. PIPPS (Premature infant pain profile): •Evaluates procedural pain • Used for infants between 28 & 40 wks gestation 102. Pain Assessment Tools: Preschooler: -Oucher -Faces Pain Relating Scale -FLACC -Body outline 103. FACES pain scale: Child as young as 3 -7 can use. Six cartoon faces range smile- cry child chooses face that best describes how they feel . 104. Oucher pain scale: Children 3-12 years of age with culturally specific pho- tographs showing different levels of pain and discomfort 105. •Visual Analogue Scale: •0 = no pain, 10 = worst pain • 9 yrs to adult 106. Pain Assessment Tools Summary: •Newborn/infant • Neonatal Infant Pain Scale (N I P S) • Toddler • Face, Legs, Activity, Cry, Consolability (F L A C C) 55 / 57 Pediatric Nursing study guide review 2023-2024 • Adolescent Pediatric Pain Tool 108. Drugs used for Pain management: •Opioids • Morphine, codeine, dilaudid • No Demerol (meperidine) • NSAIDS -Nonsteroidal anti-inflammatory drugs • Toradol, ibuprofen • Non-narcotic analgesics • Tylenol 109. •Mild to Moderate: •Non opioids •Tylenol, NSAIDS 110. •Moderate to Severe: •Opioids-•Morphine sulfate, dilaudid 111. Titration for effect: •Morphine sulfate: 0.05 mg/kg up to 6 months* • Morphine Sulfate: 0.1 mg/kg greater than 6 months* 112. Methods of administration: •Oral (preferred) • Subcutaneous • Intramuscular • Intravenous (preferred) • Topical • EMLA 113. Pharmacologic Pain Management: Right Time: PCA basal/demand, sched- uled every 2 hours/prn 56 / 57 Pediatric Nursing study guide review 2023-2024 114. Pharmacologic Pain Management: Side Effects: Respiratory Depression: most serious side effect May have increased risk with addition of other sedating drugs By age 3-6 months healthy infants metabolize opioids as efficiently as older children 115. Treatment for Chronic Pain: •Analgesics, often in combination • Additional medications for acute flares • Tricyclic antidepressants • Exercise and physical therapy to promote function • Cognitive-behavioral therapy to increase coping 116. Nursing Management of the Child Having Sedation/Analgesia for a Med- ical Procedure: •Nursing management -Intraoperative Cardiovascular assessment Respiratory assessment Vital signs Complications assessment -Respiratory depression 57 / 57 Pediatric Nursing study guide review 2023-2024 -Deepening sedation -Antagonist agents -Resuscitation equipment usage -Recovery -Postoperative • Discharge criteria 117. cephalocaudal development: Development that occurs from the top of the head down to the extremities. 118. proximodistal development: Pattern of development that occurs from the body core to the extremities.