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Galen College of Nursing Pediatrics rotation, Exam 1 study guide

Name 2 live vaccines

Chicken Pox, MMR

When is DTAP absolutely contraindicated

When seizure occurred after previous DTAP

Peanuts can be easily ___________


In terms of nutrition, toddlers are considered ___________


In terms of nutrition the ____________ of food is more important than the _____________ of food for preschoolers.

quality; quantity

If lighter fluid (hyrdocarbon) is ingested what symptoms will the child present with?

respiratory symptoms (think fumes)

If a corrosive poison is ingested what symptoms will the child present with?

tongue edema, mouth sores, pharynx problems

Tip for parents with children diagnosed with Failure to thrive:

be persistent through 10-15 minutes of food refusal

Teaching for family after child underwent high rectum malformation surgery:

report changes in stool patterns to doctor, do not want firm stools

The neonatal period is the first _____ days


The postnatal period is days _________ through __________

28 days; 1 year

What is the major determinant of neonatal death in the US?

Birth weight

Low birth weight is < ______ g?


What is the #1 cause of death in children > 1 year?


What is family centered care?

Recognizing the family as the constant in a child's life

What does family centered care strive to do?

address the needs of all family members


families are given the opportunity to display caring


giving the family the skills to care

Atraumatic care goal

first do no harm

3 principles of atraumatic care:

prevent separation, promote sense of control, minimize bodily injury


is part of primary prevention of disease

Rubella (measles)

flushed cheeks, white strawberry tongue, rash shows increased density on neck and groin and transverse lines on elbow, Koplik's spots

Koplik's spots

Small, irregular red spots with a bluish-white center appearing on the buccal mucosa in association with measles

Vitamin A

decreases morbidity and mortality in rubella (measles)

Rubella (measles) is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.

viral; droplet; 10-20

Mumps is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.

viral; droplet or contact; 14-21

Whooping cough (pertussis) is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.

bacterial; droplet or contact; 6-20

Chicken pox(varicella) is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ weeks.

viral; airborne; 2-3

German measles is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.

viral; direct; 14-21


fever, headache, malaise, parotitis (may lead to orchitis & meningoencephalitis

Whooping Cough (pertussis)

short rapid cough followed by crowing of "whoop" sound

Usual cause of death with pertussis (whooping cough)?


Greatest danger of German measles if nurse or family member is pregnant?

teratogenic effect on fetus

Chicken Pox (varicella) complications

secondary bacterial infections, encephalitis, pneumonia, hemorrhage and chronic or transient thrombocytopenia

What vaccines should not be given to immunocompromised patients?

Live vaccines (Varicella and MMR)

Denial of chronic illness by family member is considered maladapative only if ...

it delays treatment

Protest stage of separation anxiety

cry and scream, cling to parent

Despair stage of separation anxiety

crying stops, evidence of depression

Detachment phase of separation anxiety

denial or resignation but not contentment; may seriously affect attachment to parent after separation

A child's concept of illness is more important than intellectual maturity in predicting __________.


The F in the FLACC pain scale for infants stands for:

facial expression

The L in the FLACC pain scale for infants stands for:

legs (normal, relaxed, tense, kicking, drawn up)

The A in the FLACC pain scale for infants stands for:

activity (quiet, sqirming, arched, jercking)

The first C in the FLACC pain scale for infants stands for:

cry (none, moaning, whimpering, scream)

The second C in the FLACC pain scale for infants stands for:

consolability (content, easy or difficult to console)

Physiological anorexia occurs at what age?

18 months

What is physiological anorexia?

picky eaters with strong taste preferences, 18 months of age

The incidence of Vitamin C deficiency is increased with exposure to what?

tobacco smoke

What autosomal disorder is similar to Type 2 diabetes mellitus?

Maturity Onset Diabetes of the Young (MODY)

What should be tested during illness and whenever glucose is greater than or equal to 240 mg/dL without illness?

urine testing for ketones every 3 hours

What leads to cretinism, mental retardation and growth retardation?

congenital hypothyroidism

Failure to thrive

< 5th percentile in weight

Manifestations of failure to thrive

developmental delays, apathy, withdrawn behavior, no fear of strangers, avoidance of eye contact, wide eyed gaze & continual scan of environment, stiff & inyielding or flaccid & unresponsive, minimal smiling

Guidelines for feeding a child with failure to thrive

primary core staff to feed child, quiet, unstimulating atmosphere, calm, even temperment throughout meal, give directions, be persistent (10 -15 min of meal refusal), rhythm of feeding, develop a structured routine

Normal HgbA,C


Good control of HgbA,C


Poorly controlled HgbA,C

greater than equal to 8

Isotonic dehydration

equal loss of fluid and electrolytes

Hypertonic dehydration

lose more fluid than electrolytes

Hypotonic dehydration

lose more electrolytes than fluid

Treat mild to moderate dehydration with

ORS (oral rehydration solution)

Treat severe dehydration with

IV rehydration is necessary

To determine daily maintenance fluid requirement calculate child's weight in kg and then:

allow 100 mL/Kg for first 10 Kg of body weight
allow 50 mL/Kg for next 10 Kg of body weight
allow 20 mL/Kg for remaining body weight

BRATT diet

bananas, rice, applesauce, toast, tea

BRATT diet is contraindicated for

diarrhea due to poor nutritional value

Primary etiology of cleft lip/cleft palate

maternal drug use or poor maternal nutrition

Avoid what in the mouth for patients with cleft lip/palate following a palatoplasty to maintain the integrity of the surgically repaired palate?

suction, tongue depressors, themometers, pacifiers, spoons, straws

Hirschsprung Disease

congenital aganglionic megacolon, accumulation of stool with distension

Esophageal Atresia (EA)/Transesophageal Fistual (TEF)

failure of esophagus to develop as a continuous passage

An infant with an excessive amount of frothy saliva in the mouth or difficulty with secretions and unexplained episodes of cyanosis should be suspected of?

Esophageal Atresia (EA)/Transesophageal Fistual (TEF)

Clinical manifestations of Esophageal Atresia (EA)/Transesophageal Fistual (TEF)

3 C's: coughing, choking, cyanosis

If Esophageal Atresia (EA)/Transesophageal Fistual (TEF) is suspected, place child on immediate ____________.

NPO (child may need intubated)

Hypertrophic Pyloric Stenosis (HPS)

constriction of pyloric sphincter, palpable as an olive like mass in the upper abdomen

Primary clinical manifestation of Hypertrophic Pyloric Stenosis (HPS)

projectile vomitting


telescoping or invagination of one portion of intestine into another

Primary clinical manifestation of intussusception?

currant jelly stools

Classic triad of intussusception signs and symptoms

abd pain, abd mass, bloody stools

The classic triad of intussusception signs and symptoms is only present in what percent of cases?


A patient with intussusception may present initially with ...

screaming, irritability, lethargy, vomitting, diarrhea, constipation, fever, dehydration and shock

Intussusception is an ___________.


If child waiting for intussusception surgery passes a normal stool what should a nurse do?

Inform the physician immediately, it may have resolved itself

Celiac disease signs and symptoms

steatorrhea (fatty stools), general malnutrition, abdominal distension, vitamin deficiencies (A,D,E,K)

Celiac disease definition

intolerance to gluten, BROW (barley, rye, oat, wheat)

Identifying kids with GERD

frequent spit ups or acid smelling breath, some have respiratory symptoms instead of any of these symptoms

Positioning for GERD

elevate HOB 30 degrees during feeding and for 1 hour after

If poisoning is suspected ...

do NOT induce vomiting

Signs a corrosive poison has been ingested

severe burning pain with swelling in the mouth, throat and stomach, violent vomiting, hemoptysis

Treatment for a corrosive poison ingestion

dilute with water or milk

Signs a hydrocarbon poison has been ingested

altered sensory, respiratory symptoms due to pulmonary involvement, primary danger is bronchitis and chemical pneumonia

Treatment for a hydrocarbon poison ingestion

maintain airway

Antidote for acetaminophen

acetylcysteine (mucomyst)

Toxic dose of acetaminophen is

150 mg/kg

Aspirin poisoning

bleeding tendency, coma, diaphoresis, tinnitus

Iron chelation therapy

may turn urine red or orange, mush have working kidneys, may cause hypotension or shock if given quickly

Diagnostic level for lead poisoning is

10 mcg/dL

If shock is imminent what should a nurse do?

elevate the legs, restrict activity and keep warm

Sickle cell anemia

splenic sequestration, RBC's clump in the spleen and it may become engorged and rupture

What organ needs close monitoring with sickle cell anemia?


Sickle cell patients are at increase risk for what?

bacterial infections due to immunocompromise (especially after splenectomy)

What test is a definitive test for sickle cell anemia?

Hgb electrophoresis

Sickle cell crisis is caused by:

increased oxygen demands, trauma, infection/fever, physical and emotional stress, dehydration or hypoxia

What sports would be good for a sickle cell patient?

golf, bowling, baseball (low oxygen requirements)

Type of sickle cell crisis: Vasa-occlusive thrombolytic crisis (VOC)

severe joint, chest and leg pain, high spiking fever, tissue engorgement

Type of sickle cell crisis: Splenic sequestriation crisis

profound anemia (pallor), hypovolemia (decreased blood pressure), shock, medical emergency

Type of sickle cell crisis: Aplasic crisis

profound anemia, pallor, can't be treated with antibiotics because it is viral, treatment is packed RBC's

Prophylactic antibiotics are given for what ages in sickle cell kids as the immune system develops?

2 months to 5 years

If given early in a sickle cell crisis this may help to reduce ischemia

blood transfussion

What count should be monitored with sickle cell?

reticulocyte count (bone marrow)

Frequent blood transfusions may increase __________.

hemosiderosis (iron)

What is the treatment for hemosiderosis?

Iron chelation - feroxamine plus Vitamin C

Hydroxyurea handling caution

wear gloves

Demerol is contraindicated for use in what disease?

Sickle cell due to risk for seizures

Hemophilia signs and symptoms

hemarthrosis, ecchmosis

Hemophilia may not occur until what age?

6 months of age

Despite the pain it may cause a patient with hemophilia needs to do what exercises?

ROM and joint moving to prevent contractures

A prolonged PTT may indicate what disease?



drug for mile hemophilia


blood in a joint cavity

During episodes of hemarthrosis a nurse should ...

elevate and immobilize the joint, ROM after bleeding stops to prevent contractures

Most common type of leukemia with best prognosis

ALL acute lymphoid leukemia

Most rare type of leukemia with poor prognosis

AML acute Myelogenous leukemia

What organs are most severely affected with leukemia?

liver and spleen

What is leukemia?

overproduction of WBC's but low leukocyte count, it leads to anemia, infection and bleeding as well as infiltration, enlargement and fibrosis of liver, spleen and lymph nodes

Induction therapy is what phase of therapy for leukemia and occurs for how many weeks?

the first stage occurring for 4-6 weeks

What phase of therapy for leukemia is needed if there is CNS involvement?

CNS prophylactic therapy or intrathecal chemotherapy

What does the 3rd phase of leukemia therapy, Intesification (consolidation) therapy do?

eradicate residual leukemic cells

At home PO Methotrexate is given when to a leukemia patient?

During the Maintenance therapy to preserve remission

Who is the most likely match for hematopoietic stem cell transplantation (HSCT)?

a sibling

After HSCT, red patch rash on palms and feet means what?


What should be done prior to HSCT?

A round of induction therapy to wipe out WBC's

What is contraindicated for visitors to bring to a patient with leukemia?

Fresh flowers and fruit

What is kept at a leukemia patients bedside to treat anaphylaxis?


Why should weight loss be reported for a patient with leukemia?

chemotherapeutic agents are dosed by weight, to prevent overdose

When should antiemetics be given for chemo patients?

Reglan, Zofran 30 minutes prior to starting, ran continuously with and then 1 more dose afterwards

Anemia manifestations

irratibility, pica, malnourishment, exercise, intolerance, inattentive/cognitive delays, beeturia, bluish sclera

Length of time between S1 and S2 should ____________ on inspiration?


If there is fixed time between S1 and S2 what could this indicate?

congenital anomaly

Since children have arrhythmias normally how to you tell if it is a "real" arrhythmia?

Have child hold their breath when auscultating, normally there is an increase in HR during inspiration and a decrease in HR during exhalation

Congenital Heart Defect (CHD) clinical manifestations

cyanosis, decreased oxygen saturation, lethargic or restless, may have murmur, abnormal or arrhythmic HR, CHF s/s, tachypnea, retractions, nasal flaring

Normal signs and symptoms of CHF

crackles in lungs (fluid), SOB, edema, poor tissue perfusion

Interventions for CHD

Oxygen administration, thermoregulation, cardiac medications, special feeding

Name 3 Increased Pulmonary Blood Flow Defects

Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA)

What is an Increased Pulmonary Blood Flow Defect?

an abnormal connection between 2 sides of the heart, it leads to increased blood volume on the right side of the heart and too much blood to the lungs causing right sided CHF

Atrial Septal Defect (ASD)

Blood shunts from left to right, hypertrophy of Right Atrium

Signs and symptoms of ASD

s/s of CHF, murmur over area of shunting, atrial arrhythmias (b/c of SA mode is in RV), poor activity tolerance, poor nutrition, poor growth, pulmonary manifestations later

Treatment for ASD

may wait unitl 18 months to allow hole to close on it's own before surgery is performed to repair

Ventricular Septal Defect (VSD)

Blood shunts left to right, hypertrophy of Right Ventricle

Signs and symptoms of VSD

s/s of CHF, murmur, high risk for endocarditis, Eisenmenger syndrome in severe cases

Eisenmenger syndrome

When the left to right shunts cause pulmonary hypertension, vascular hypertrophy, and eventually shift the L=>R shunt to a R=>L shunt, and cause late cyanosis.

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