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Peds final exam study guide
Pediatric Nursing (Florida Gateway College)
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MICA Pediatric Final Exam Study Guide
1. The hospitalized child: ways to encourage fluid and food intake, atraumatic care,
methods to ensure safe medication administration in children, major stressor of
hospitalization for the various age groups.(S)
a. Atraumatic care:
i.
avoid procedure in the room/play spaces
ii.
offer choices to child
iii.
allow the parents to watch procedure or not
iv.
Use play therapy to explain procedure
b. Methods to ensure safe med admin in children:
2. Calculator safe dose base on weight. Notify if med dose is outside of safe dose range
i.
Use 2 pt identifies
3. Pediatric nursing vs adult nursing (1)
a. Frontal closure
b. Infant size (height, weight, head circumference)
c. Dentition (teeth)
d. Physical development (infants reflexes, fine/gross motor skills)
e. Cognitive development
f. Psychosocial development
g. Age-appropriate activities
4. Loss of control in the hospitalized adolescent: fears, concerns (2)
a. explain that they did not cause the illness and it isn’t punishment
b. Fear of mutilation by procedures
c. Allow therapeutic play, handle equipment (if safe)
d. Regression: a learned skill is often temporarily lost due to stress of hospitalization
e. Allow peers to come and visits
5. Psychosocial stages (1)
a. Adolescent
i.
moral and spiritual beliefs influence primarily by peers
ii.
Influence self-identify
iii.
Roles change from “protection dependency” to “mutual affection and
equality”
b. School age
i.
peer pressure begins
ii.
Temperament
1. easy and adaptable, slow to warm, difficult and easily frustrated
iii.
Judgment is guided by rewards and punishment
6. Object permanence (1)
a. the process by which infants learn that object still exists when it is out of view
b. occurs 9-10 month of age
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MICA Pediatric Final Exam Study Guide
7. Infant: Gross/fine motor development, safety concerning infant growth and
development that should be included in parent education.(3)
a. Gross/Fine development:
i.
2-3 months:*grasping object,*head lag, raise head and shoulder off
mattress
ii.
6 month: palmar grasp, rolling over from front to back
iii.
7 month: transfer obj from one hand to another, parachute reflex, sit
alone with support
iv.
8 months: sit alone unsupported
v.
9 months: pull to stand positions
vi.
10 months:Apincer grasp, move from prone to sitting positions
vii.
11 month: remove object from container
viii. 12 months:* build towers of 2 objects
8. Toddler: Describe the language development of the toddler, importance of rituals and
routines (2)
a. Comprehension of 300 words by age 2
b. 2 year old: two- or three word phrases
c. 3 year old: simple sentences and use five to six new words per day
d. 3-4 yo: 3-4 word sentences
e. 4-5 yo: 4-5 word sentences
i.
Warning signs:
1. mispronounce words
2. Speaking in nasally tone
9. School age child: Appropriate play activities (1)
a. Ride bicycles
b. Form groups, clubs, secret societies
c. Video games
10. Pyloric Stenosis: Clinical manifestations
a. S & S:
i.
Olive shaped mass
ii.
Protetacl vomiting
b. Care after surgery:
i.
they can eat right away!!
ii.
vomiting is decrease
a
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MICA Pediatric Final Exam Study Guide
11. GE Reflux: Complications11) pratitions!
a. Nsg care
i.
document and keep track of type of formula/when vomiting happens
ii.
feeding techniques
iii.
Gold standard: PH monitoring
b. Teaching:
i.
upright 30 min @ feeding
ii.
thicken formula with small amt of cereal
iii.
Elevate HOB 30 degree
iv.
Avoid caffeine, spicy, carbonated bevg, fatty, acidic foods
c. Meds:
i.
H2 receptors (pepcid)
ii.
Proton PUmp inhibitors (prilosec)
iii.
Prokinetic drugs (Reaglan or in TPN)
12. Asthma: Emergency care of asthma pt., medications used in the treatment and
mechanism of action (1)
-
a. Hyperresponsiveness of airway (air hunger, orthopnea)
b. Lining of airway becomes swollen (bronchospasm, inflammation, mucous)
c. Use peak flow meter
i.
same time each day
ii.
record numbers
iii.
2-3x/day
d. Multiple inhalers at multiple location for safety
e. Educate teacher, administrations, coaches of disorder
f. Use spacer for aerochamber: fast adm more 50% more effective
i.
teach good oral care, look for mouth sores
g. Avoid triggering agents:
i.
Mold, air pollution, dust mites, tobacco, cold air, animal hair, dander, tobacco
smoke
h. Cromolyn (mast cell inhibitor)
i.
prevents release of histamine
ii.
Inhaler that take several times a day
i. Albuterol (short acting beta agonist): acts within 10-15 minutes
i.
increase water into the mucus
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MICA Pediatric Final Exam Study Guide
13. Cystic Fibrosis: Medications used and mechanism of action
a. Copious mucus productions obstructs via structures (bronchi, small intest, panc
duct)
i.
Dysfunction of the exocrine glands/increase loss of Na and CI sweat
b. Medical/Nursing Management:
i.
Contact isolation, stay 6ft from others CF p/t
ii.
Postural drainage done to help resp secretions move up and out (vest)
iii.
Diet high in protein and calories
1. 3 meals a day with snack
iv.
Admin pancreatic enzymes within 30 min of meals or snacks
v.
No sodium restrictions diets
vi.
Fat soluble vitamins in water soluble form
1. Vitamins D, E, A, K
14. Diaper dermatitis: Methods of preventing and treatment(IS
Apply zinc oxide ointment/barrier ointment/desitin and A + D ointment
Avoid scrubbing, do not wash barrier cream off
Leave open air if possible 4 times a day for 15 minutes (no plastic pants)
Provide teaching aboutDoral/topical nystatin
i.
do not mix with food
15. Acne: Education for the prevention and treatment (1)
a. No il based face washes
b. do not pop pustules when on facts
c. Use mild soap and water
d.- Keep hair drawn back from around face
16. Cardiac defects: Identify the various structural defect by appearance(I
a.
b.
c.
d.
17. Coarctation of the aorta: Assessment findings(1)
a. Narrowing of lumen in aorta
b. S & S:
i. # increased BP and Pulse in upper extremities
ii.
decrease BP and Pulse in lower extremities
iii.
Exercise intolerance
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MICA Pediatric Final Exam Study Guide
18. Patent ductus arteriosus: pathophysiology, findings(1)
a. Patho:
i.
persistent opening between the two main blood vessels leaving the heart
(aorta and pulmonary artery)
b. S & S:
A
i.
This common is manifest by wide pulse pressure, bound pules
19. Defects of TOF, purpose/management of “tet” spells. (2)
a. 4 defects:
i.
ventricular septal defect
ii.
Pulmonary stenosis
iii.
overriding aorta
iv.
R ventricular hypertrophy
b. Management of “tets” spells
i.
Hypercyanosis experience
ii.
Knees to chest!!
iii.
Morphine
iv.
IV fluids
v.
O2
20. CHF: Parental education for the management of congestive heart failure(1)
a. We use the same medications for adults and children
b. Furosemide (monitor potassium levels)
c. Upright position (elevate HOB, use car seats)
d. NG tube feeding (reduce energy spent)
e. Digoxin
i.
less than 110 in infants and young children
f.
g.
h.
i.
fluid restrictions (strict I & O)
Ace inhibitors, afterload
Sodium restriction
Test (dig level, EKG, echo, Abg, BNP)
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MICA Pediatric Final Exam Study Guide
21. Hypoglycemia: Clinical manifestations, treatment(1)
a. S & S:
i.
Headache
ii.
Pallor, cool skin
iii.
Diaphoresis (sweating)
iv.
Irritability
v.
Decreased LOC
vi.
Blurred visions
vii.
Slurred speech
b. Tx.
i. R 10-15 g simple carbohydrate (1 TBSPof sugar)
1. 3-6 oz orange juice
2. 8 oz milk
3. 6 oz regular soft drink
4. cheese/PB sandwich
ii.
If unable to swallow:
1. admin glucagon IM or IC
22. Down’s Syndrome: Physical assessment findings(1)
a. * Protruding tongue (tongue thrust)
b. Simian crease
c. Low muscle tone (cheek/hypotonia)
d. Flattened occiput
e. small jaws
f. AAlpha Folds
g. short pinky
h. wider gap between the big toe and 2nd toe
i. low set ear
j. depressed nasal bridge and small nose
23. Reye’s Syndrome: Risk factors
By products
⑰
a. Aspirin use (salicylates)
b. Follow a viral infections (influenza, gastroenteritis, varicella)
24. Hydrocephaly: s/s (2)
a.⑰ Bulging fontanel
b. * Shrill, high-pitched cry/ apneic
c. * Wideneding suture lines
d.A Sunsetting eyes
e. Hypertension: LATE SIGN
Transversese!
Cry
States!!ismuths!!
of
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MICA Pediatric Final Exam Study Guide
25. Sickle cell: s/s, treatment, and education necessary for vaso-occlusive crisis (2)
a. Abnormal sickling of “S” hemoglobin
b. Lifespan is 10-20 days (body become anemic quickly)
c. Lab Test (screening in newborn is mandatory):
i.
Sickle turbidity (present: solution will turn cloudy/turbient color)
ii. AHemoglobin Electrophoresis: **golden standard for diagnosis**
d. Painful episodes occur when cells lodge and abstract large vessels
e. S & S:
i. *severe pain
ii.
SOB/Fatigue
iii.
Pallor/pale membrane
iv.
Jaundice
v.
Hand and feet cool to touch
vi.
Visual disturbances
vii.
Thicken blood viscosity
viii.
Tissue hypoxia=ischemia=pain
f. Vaso-occlusive crisis (painful episode):
-Su
i.
Related to dehydration
ii. >
Hydration is KEY to preventing this
g. Management:
i.
Rest
ii. AHydration and prevention
iii.
Blood products
iv.
Antibiotics/ vaccines up to date
v. ⑰Pain medicine (get PCA pump w/ morphine)
1. NO demerol (can cause seizures)
2. CAN do heat products (warm packs to painful joints)
3. Hydroxyurea
vi.
Avoid contact sports
vii.
Wear an ID medical alert bracelet
L
A
26. Hemophilia: Complications, appropriate play activities for the child with hemophilia (2)
a. Patho:
i.
is a group of bleeding disorder characterized by difficulty controlling bleeding
and low in clothing factors
b. Complications:
i.
bleeding in the bones and joints
c. No contact sport
i.
Acceptable sport (bowling, fishing, swimming, golf)
A
-
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MICA Pediatric Final Exam Study Guide
27. Discuss the necessary infection control measures when caring for a child with cancer at (1)
home.
a. Monitor for adverse effects of chemotherapy (mouth sores, loss of appetite, n/v,
hair loss, increase risk of infections, easy bruising or bleeding)
b. Receive immunizations and follow-up appointments
c. Perform good infection control practices
d. DO NOT WASH marks on skin that outline the target area
e. Avoid using hot or cold water
f. Avoid use of soaps, cream, lotions, and powder unless they are prescribed
g. wear loosen cotton clothing
h. keep the area protected by sun by wearing a hat and long-sleeved shirts
28. Lead Poisoning: Complications (1)
a. S & S:
i.
vomiting
ii.
poor eating
iii.
H/e
iv.
Fever
v.
abd pain
vi.
hyperactivity and impulsiveness/learning difficulties/hearing impairment
b. Screen
i.
no later than 12 mo
D
ii.
Lead level >45? Chelation therapy into large muscles, excreted in urine
iii.
can occur easier in iron deficiency pt
29. Nephrotic syndrome (not caused by infections disorders): Treatment goals (17
-
a. Alterations in the glomerular membrane allows proteins (albumin) to pass into urine,
resulting in decreased blood osmotic pressure. Which leads to:
i.
proteinuria, hyperlipidemia, and edema
b. Treatment:
i. XOral steroids for 1-2 months (prednisone is key)
ii.
IV albumin and diuretic
iii.
Strict I & O/Daily weights
c. Diets:
i.
NO added salt
-
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MICA Pediatric Final Exam Study Guide
30. Acute poststreptococcal glomerulonephritis (APSGN/AGN): Pathophysiology,(1)
treatment/management
a. Allergic reactions to a group A beta hemolytic
streptococcal infections
i.
Lupus, Sickle cell
b. S & S:
i.
Oliguric (less than 400ml/24 hr)
ii.
Periorbital edema (around the eye)
iii.
Facial edema (worse in AM) but spread to extremities and abdomen with
progression day
iv.
Irritability/lethargy
A
v. S
Cloudy, Tea-colored urine (Cola)
c. Management:
i.
Monitor strict I & O
1. volume and character
ii.
Daily weight (same scale, time of day, amount of clothing)
iii.
Caution for seizures, CHF, renal failure
iv.
Manage fluid restrictions during periods of edema and hypertension
v.
May need low protein diet for edema, restrict food high in K+ for oliguria
vi.
Usually last 1-2 wk but may progress to renal failure
vii.
Encourage rest
p!
31. How is Duchenne inherited? Who is most likely to get it? (1)
a. Inherited as an X-linked recessive trait, DMD has an onset between 3 and 5 yo
b. most affects person are male
c. Progressive weakness/wasting of the muscle degeneration
d. S & S:
i. D hypertrophy of calf
ii. D waddling gait
iii. A Gowers maneuver
iv. A Lordosis
32. Potential complications of fractures
a. Compartment syndrome
b. Volkmann Contracture (permanent)
c. Renal Calculi (kidney stones)
d. Embolisms (fat/pulmonary)
e. Osteomyelitis (infections)
-
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MICA Pediatric Final Exam Study Guide
33. Medications:
a. Digoxin
i.
used for CHF patients
ii.
check apical HR and hold if pulse:
1. <110 in infants and young children
2. <90 in older children
3. <70 in adults
a. knever brush teeth after med
b. Never give a repeat dose!
b. Glyburide
i.
Given for type 1 DM
ii.
it causes your pancreases to release more insulin into the bloodstream
c. Dornase Alfa
i.
decrease the viscosity of mucus and improves lung functions
ii.
Nursing actions:
1. monitor sputum thickness and ability of clients to expectorate
2. Monitor the children improvements in PFTs
iii.
Client educations:
1. understand how to use nebulizer
2. admin one or twice daily
3. Med used for laryngitis
d. Albuterol
i.
Short acting beta 2 agonists
ii.
used for asthma attacks its fasting acting
iii.
SE.
1. tachycardia and tremors
34. Any math calculations used in this class are fair game
35. (Approximately 6 math)
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