XVII.

PEDIATRICS
A. ASSESSMENT:
1. OBSERVATION:
Always begin with observation.
a. Behavior:
Are they happy, friendly, scared,
sad, or withdrawn?
b. Appearance:
Are they well cared for? (hair clean
and cut, hygiene, dressed
appropriately
for weather)
c. Nutritional status:
Are they skinny or obese?
d. Affect:
Is it RIGHT for the situation?
e. Consolability:
Is the child CONTENT and relaxed?
A normal HEALTHY baby should
be consolable.
f. Position:
Are they guarding in pain, do they
assume a position that helps them
breathe?
2. Distraction Techniques:
a. This is done to make sure we get
the most accurate PHYSICAL
assessment
and vital signs.
b. Dont forget to talk to PARENTS
even before you talk to the child.
3. Vital Signs:
LEAST invasive first
Observe before TOUCHINGor even
talking to them.
a. Order of obtaining vital signs:
1) Respirations
2) Heart Rate
3) Blood Pressure
4) Temperature
b. Always count RR and HR for one
full minute because of
IRREGULARITIES.
c. If vital signs cannot be taken
without disturbing the child, then
record the
BEHAVIOR with the measurements.
d. Temperature:
1) Rectal: Do not use in children over
3 MONTHS months.
Most reliable measurement of
CORE temperature.
2) Axillary: All ages may be done
when an ORAL route is not possible.
3) Oral: Start at age 3.
4) Tympanic: All ages.
e. Oxygen saturation: Used to obtain
a picture of blood oxygen level
through the
skin.

1) Check perfusion, skin temp, and

edema to determine the best location
for
sensor probe.
2) Common sites are ORAL and
AXILLARY.
3) Record what is going on at the time
the pulse ox is measured.
Will activity level affect the oxygen
level? YES
4) The pulse wave form/intensity
display on the oximeter machine
should
correlate with the childs RADIAL
pulse.
4. Nutritional Assessment:
a. General growth within ________
to__________ percent for height,
weight and
head circumference is desired.
1) The fiftieth percentile is the LEAST
growth.
2) What happens to the growth rate
between 6 and 12 years of age?
SLOWS DOWN
3) How much earlier do girls
experience the onset of
adolescence?___________
b. Lab Values:
1) Hemoglobin/Hematocrit
2) __________________
3) Creatinine
4) Nitrogen
Hint: Always document where
temperature was taken, do not add a
degree.
5. Physical Assessment:
a. Hair
1) Want hair to be _______________
and soft to touch.
2) Poorly nourished it will be
_________ and course.
b. Fingernails
1) Tell you about hygiene
2) Emotional status
c. Skin
If skin is pale, it could be a sign of
anemia.
d. Eyes
If eyes are sunken, could be a sign
of DEHYDRATION.
e. Mouth
Assess mucosa color and moisture.
f. Teeth
Assess hygiene and check their
gums.
6. Pain Assessment
a. The name of the pain scale is
CRIES, its an acronym for:
Crying (0-2)
Requires increased oxygen (0-2)
Increased vital signs (0-2)

Expression (0-2)
Sleepless (0-2)
The __________________ the score
the __________ pain in all the scales.
b. FLACC
Face, Legs, Activity,
______________, Consolability.
0-10 scale: 0 no pain, 10 worst pain
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c. Wong-Baker rating scale is used
on children at what age? Any age
but
usually 3 years and older.
Make sure child has cognitive
development and is not
developmentally
delayed.
Scale is 0-5.
d. Numerical scale is used at age 5
and older.
B. Respiratory System:
1. General Assessment:
a. Accessory muscle use.
b. Flaring __________
c. Pallor
d. Sternal ________________
e. Consolability crying, restlessness
and agitation may mean hypoxia.
f. Capillary refill greater
than________ seconds.
2. Upper Respiratory Disease:
a. Laryngotracheobronchitis:
Most ________________ type of
Croup experienced by children
admitted to
the hospital and primarily affects
children under 5.
1) Causes:
Parainfluenza, adenovirus, and RSV
2) S/S:
Slight to severe diarrhea
________________ or brassy
cough.
Increased temperature.
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3) Tx:
Mild croup can be treated at home
with steam (hot showers), cool mist
humidifiers, car rides with windows
down.
If symptoms worsen or do not
improve, hospitalization is required
with
corticosteroid therapy.
b. Epiglottitis:
1) Causes: H. influenza
2) S/S:
Absence of cough
Drooling
Agitation with the rapid progression
to severe respiratory distress.

3) Tx:
This is an emergency
May require intubation or trach
IV antibiotics and corticosteroids
c. Tonsillitis:
1) S/S:
Difficulty swallowing and breathing
so child is a _____________ breather
and they have bad breath.
Impaired taste and smell, voice has
nasal/muffled quality.
Persistent couch
Swollen tonsils can block drainage
of the ear canal and cause otitis media.
2) Tx:
Tonsillectomy
How should a client be positioned
after a tonsillectomy? Place on side
with elevated head of bed or
__________.
Why are brown and red fluids not
given post op? We do not want
anything
to be confused with ___________.
What would indicate that
hemorrhaging is occurring?
______________
swallowing
How many days post op is the client
at risk for hemorrhage?
Hint: Children with Epiglottitis
usually look worse than they sound,
and the kid with LTB sounds
worse then they look.
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Complaint post op? Sore throat and
slight _______ pain
Low grade temp
Bad breath
d. Otitis Media:
1) Patho:
What part of the ear is affected?
__________ ear
The Eustachian tubes are blocked.
It usually follows an upper
respiratory infection.
2) S/S:
What does the tympanic membrane
look like with otitis? Bulging and
bright ______
3) Tx:
Do heating pads help with the pain?
_________
Avoid ________________. And
provide soft foods.
Lie on the ___________________
side.
May not hear you.
Avoid smoke.
May require PE tubes to keep the
middle ear ________________.

The ear tube (grommet) stays in

about 6 months and then falls out.
4) Prevention:
While tubes are in wear ear plugs
when bathing or swimming.
Have baby
_______________________ for
feedings.
No bottle propping.
AVOID nose blowing.
Avoid smoke.
3. Lower Respiratory Tract Disease
a. RSV Respiratory Syncytial
Virus:
1) Causes:
An acute viral infection that affects
the bronchioles and includes RSV
bronchiolitis or RSV pneumonia.
Leading cause of Lower Respiratory
Tract Illness in children less than
________ years.
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2) Risk Factors:
Prematurity
Congenital disorders
Smoke
Focus is on _________________
(high risk will get RSV vaccine)
3) S/S:
URI
Nasal ____________________
Mild fever
Dyspnea
Nonproductive ________
Tachypnea with flaring nares
Retraction and _________________
It is important to know the onset of
s/s because the disease will become
worse on days _________________.
4) Dx:
Nasal ________________.
5) Tx:
Transmission
_________________ precautions.
Teach good hand washing
Mild
Treat symptoms (supportive care:
antipyretics)
Severe
Oxygen: may need mechanical
ventilation
IV fluids
Suction
Antipyretics
Antiviral (Ribavirin)
Hint: Sign and symptoms can range
from mild to severe; can go from
cough, runny nose with copious
amounts of
mucus, to severe respiratory distress!

b. Pneumonia:
1) Causes:
Viral (RSV, adenovirus or
parainfluenza)
Bacterial (Culprit is ____________
pneumonia) children <4 yrs
Mycotic (walking pneumonia)
primarily in adolescents.
Aspiration pneumonia (something
other than air gets in the lung)
2) S/S:
Fine ____________ or rhonchi with
a cough that is productive or
nonproductive.
Abdominal distention
Back pain
Fever that is usually high.
Chest pain from coughing
3) Tx:
Oxygen
Fluids
Antibiotics
Antipyretics
Nebulizer
Cough suppressant
c. Asthma: (see 5th day material)
d. Down Syndrome:
1) What type of infection are Down
Syndrome children prone to
developing?
_______________________ Why?
Because they have a poor
_________________ system
2) The most common type of defect
associated with Down Syndrome is
___________ ______________.
3) The primary aim in genetic
counseling is to inform the parents of
their
_____________.
e. Cystic Fibrosis:
1) Causes: ____________ trait, and
must get trait from _______ parents.
2) S/S:
___________, _________________
secretions.
Characterized by ____________
gland dysfunction. (These secrete
mucus)
Thick, sticky secretions are found in
the _____________ and GI tract.
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3) Dx:
Diagnostic test for cystic fibrosis?
Positive __________ chloride test
At risk for ___________________.
The earliest sign in the newborn is
the meconium, called _____________.
They will have steatorrhea stools,
which means ________ and
_________.

4) Tx:
Enzymes that help improve
digestion are the ______________
enzymes.
Take _______ minutes prior to eating,
do not crush or chew.
Need a well balanced, low fat, high
calorie, ________ protein diet.
Require _______% of the
recommended daily allowance.
They need to take ________ soluble
vitamins including A, D, E, and K.
C. Cardiac:
1. Heart Failure:
a. Causes: Usually due to congenital
defects.
b. S/S:
1) Lips turn blue when taking a
______________.
2) Increase pulse at rest, or with slight
_______________.
3) Increased respiratory rate
4) Scalp sweating
5) Fatigue
6) Sudden weight _______
c. Tx:
1) Ongoing assessment
2) Control room temperature
3) Sit them up
4) Rest
5) __________ stimuli
6) Cool, humidified oxygen
7) Uninterrupted sleep
Fluid retention think heart problems
first!
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2. Cardiac Medications for pediatric
clients:
a. Digoxin:
1) Infants rarely get more than
_______cc.
2) Give ______ hour before and
_____ hours after feedings.
3) DO NOT mix with medicine,
___________ or fluid.
4) Always check the dose with another
nurse.
5) Check the apical pulse for
__________________.
b. Ace Inhibitors: enalapril
(Vasotec), captopril (Capoten)
1) Side effects:
____________ blood pressure
Kidney problems
________ cough
2) Action: They block
__________________.
c. Lasix: To decrease the volume.
3. Nutrition in HF Pediatric Client:
a. Well rested prior to eating.
1) Feed them when they wake up or
show signs of hunger.

2) ______________ crying.
b. Small frequent feedings every
__________, no longer than
________________.
c. High calories.
d. We want to use a ________nipple
with a __________ opening so the
baby wont
have to work so hard to get the
formula out.
e. May require gavage feedings.
f. Usually dont require sodium and
water restrictions because of
decreased intake.
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4. Acquired Cardiac Disease:
a. Rheumatic Fever is an
inflammatory disease that occurs after
an infection with
___________ beta hemolytic
streptococcus.
1) Major cardiac clinical manifestation
is _____________.
2) Therapeutic management is
________________, if they are
allergic then
erythromycin is the drug of choice.
b. Kawasaki Disease is characterized
by wide spread ______________ of
the small
and medium sized blood vessels.
Coronary arteries are most susceptible.
Treatment:
High dose IV immune-globulin
_______________ therapy
_____________ environment.
D. GI System:
1. Cleft Palate/Cleft Lip:
a. What is the top nursing diagnosis?
Alternation in __________________
1) Feed with an ______________
nipple or medicine dropper down the
side of
the mouth.
2) Burp frequently so they will not
swallow a lot of _____________.
b. Cleft Lip Repair:
1) Position on back or side lying to
protect the ___________________.
2) Do not place them
________________.
3) Clean the suture line with
______________ post op.
c. Cleft Palate Repair:
1) Place them prone to promote
drainage.
2) Avoid putting things in their mouth
(thermometers, straws).
3) Soft diet until well healed
4) Are speech defects common?
_______

5) When is the best time to do this?

Before ___________ development.
6) What type of restraints would be
used? ____________
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2. GER, GERD: GER becomes
GERD when complications such as
failure to thrive,
bleeding, or difficulty swallowing
(dysphagia) occurs.
a. Positioning:
1) ____________ position with
feedings and at night.
2) 30 degree elevated prone position
to _________ reflux and improve
stomach
____________.
b. Feedings:
1) Small frequent feedings of
____________ formula.
2) Breast feeding continues with more
frequent feedings or expressing the
milk
for thickening with rice cereal.
c. Medication: H2 blockers, Proton
pump inhibitors
3. Esophageal Atresia/T-E Fistula:
a. Causes:
The saliva cannot make it to the
stomach because the esophagus ends
in a
blind ____________.
b. S/S:
1) Why do babies with esophageal
atresia not have meconium? Because
they
never swallowed _____________
fluid.
2) How are they feed?
_____________ tube
3) T E Fistula watch for
C_____________
Chocking especially while drinking
Cyanosis
The first feeding needs to be
____________.
The top nursing diagnosis is
potential for ________________.
c. Tx:
1) They will do corrective surgery and
the infant is placed on their back with
_________ and ________________
elevated.
2) It is not uncommon to see
polyhydramnios in pregnancy when
the infant has
GI problems. The infant does not
swallow any amniotic fluid so it just
builds
up.
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4. Pyloric Stenosis

a. S/S:
1) Projectile VOMITTING usually
after eating.
2) Very hungry
3) OLIVE shaped mass in epigastric
region.
4) Peristalsis is obvious.
b. Dx:
Pyloric ultrasound
c. Tx:
1) Hydration
2) Intake and OUTPUT
3) Daily WEIGHT
4) Monitor urine specific gravity
5) _________________
5. Intussusception: (When a piece of
bowel goes backwards inside itself
forming an
obstruction)
a. S/S:
1) Sudden ______________
2) Cramping
3) Abdominal _____________
4) Inconsolability
5) Drawing up _____________
6) Currant ____________ stools
(monitor stools)
b. Dx/Tx:
The definitive diagnosis is through a
_________ __________ and this will
sometimes fix the problem.
Teach sign and symptoms of
reoccurrence.
6. Hirschsprungs Disease: a
congenital anomaly also known as
aganglionic
megacolon that results in a mechanical
obstruction along the bowel (sigmoid).
a. S/S:
1) The presenting symptom is
_______________________.
2) Abdominal distention.
3) ____________- like stools that
have a foul smell.
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b. Tx:
1) Remove the portion of the bowel
that is diseased.
2) May require two surgeries to give
the intestines time to heal.
7. Imperforate Anus:
There is no __________________
opening, therefore the baby will not
pass the
_______________.
They will do surgery, so they may
come back with a ________________
colostomy.
8. Celiac Disease:
a. Causes:
A genetic malabsorption disorder
where there is a permanent intestinal

intolerance to ______________.
b. Tx:
1) No food with
___________________. (Vegetable
proteins)
2) They cannot have BROW.
B____________
R____________
O____________
W___________
3) They can have RCS.
R____________
C____________
S____________
9. Genitourinary:
a. UTI-Urinary Tract Infection:
1) S/S:
In newborns and children <2, the s/s
may be nonspecific- might even seem
to be a GI problem.
Failure to thrive
_________ problems
Vomiting and __________
If left untreated kidney becomes
small, tissue may be destroyed and
scarring occurs and then the kidney
could lead to ______________.
Urine smells fishy
Predisposing factors (renal
anomalies, constipation, bubble baths,
poor
hygiene, pin worms, sexual abuse)
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Classic symptoms in children >2:
Frequency
Dysuria
Fever
___________ pain
Hematuria
2) Dx:
Properly collected urine specimen
Most accurate method is
_______________.
3) Tx:
Antibiotic therapy: PO or IV
b. Testicular torsion: surgical
emergency
Painful condition caused by the
sudden twisting of the spermatic cord
which
results in the loss of blood flow to the
___________.
Occurs in 1 out of every 40,000
males with a peak onset of _______
years of
age.
Most common cause of __________
loss in adolescent males.
If not diagnosed in a timely manner,
they can ________ the affected
testicle.

1) S/S:
Unilateral pain to affected testicles
Edema
May experience __________ and
vomiting
_______________ of the testicles
2) Tx:
Surgery
E. Hematology:
1. General Information:
When caring for a client with a
hematologic disorder, always include
______________ isolation as part of
their plan of care.
High risk for _________________
Encourage __________
__________
Always use sterile technique.
2. Sickle Cell Disease (SCD)
This is a hereditary disorder in
which the ___________________ is
partly or
completely replaced with sickleshaped hemoglobin.
Sickle shaped hemoglobin or Hgbs
cannot carry _________ like normal
Hgb.
a. S/S:
1) __________ in the areas of
involvement.
2) Anorexia.
3) Exercise _____________________.
b. Tx:
1) _________ __________
2) HYDRATION
3) Analgesics
4) Antibiotics
5) ___________ transfusions and
6) Oxygen
F. Childhood Cancer:
1. Leukemia:
a. This is cancer of the blood forming
tissue and proliferation of
_____________
white cells.
b. When thinking of leukemia always
remember immunosuppression,
thrombocytopenia,
________________.
c. Two types ALL (acute lymphoid
leukemia) and AML (acute
myelogenous)
d. S/S:
Fever
Pallor
Anorexia
Petechiae
Vague abdominal pain
Easily acquired infections

2. Now, Wilms tumor or

nephroblastoma are found where?
_________________
a. Most common presenting sign is
___________________ or non-tender
mass on
one side of the abdomen.
b. Dont palpate the ______________.
c. ____________ _____________
while bathing or moving the client.
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G. Neurology:
1. Hydrocephalus:
A disturbance of the ventricular
circulation of the cerebral spinal fluid
in the
__________________.
Increase of cranial pressure.
a. S/S:
1) Bulging of the _____________
fontanel
2) Dilated scalp veins
3) Depressed ________
4) Irritability and changes in the
__________
5) High-pitched cry
b. Tx: Insertion of a VP
(ventriculoperitoneal shunt)
1) Measure the __________ occipital
circumference
2) Fontanel and
cranial_______________ line
assessment
3) Monitor the temperature
4) ___________ position
2. Seizure Disorders:
Should consider as a symptom of an
underlying disorder rather than a
disease.
May have a short term memory
lapses.
School work deteriorates which may
be ___________ indicator of a
problem.
a. Classification:
1) Partial:
Limited to a particular location of
the brain.
An ___________ may be the only
manifestation.
Simple partial means without loss of
consciousness with various
sensations: Numbness, tingling,
prickling, or pain.
Complex partial means they have
______________ consciousness and
may be confused and unable to
respond.
2) Generalized:
Loss of ________________.
Types:

Tonic-clonic (formally known as

grand mal)
Myoclonic (sudden, brief contractures
of a muscle or group of muscles;
may look like a startle reflex)
Absence (formally called petit mal
and characterized by a brief loss of
consciousness)
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b. Tx:
Diagnostic testing: EEG,
Ultrasound, CT/X-ray
Anticonvulsants
Airway, Breathing and Circulation
DO NOT put anything in the childs
_______________.
H. Musculoskeletal System
1. Scoliosis is a lateral curvature and
___________ of the spine.
Seldom apparent before age 10, and
can be genetic.
a. Contributing factors:
Heavy __________________
(suitcases, grocery, etc.)
Carrying children on hips
b. Tx: The 3 Os
Observation
Orthosis (supports and braces)
O ______________ which usually is
spinal fusion with rod.
I. Early Childhood Conditions:
1. Pin Worms:
How are they spread?
__________________________
How are they diagnosed?
_________________________
a. S/S:
Intense rectal _________________
General irritability
Restlessness
Poor sleep
Bed wetting
Distractibility
Short attention span
b. Tx:
Mebendazole (Vermox)
Hand ______________
Keep fingernails ______________
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2. Chicken Pox:
Prevent ___________ in the lesions.
Home remedies that alleviate itching
are ___________ bath, __________
___________ paste.
Is it contagious? ________
If they have an increased risk for
severe varicella, Acyclovir is
prescribed.
J. Middle Childhood Conditions:
Head Lice:

Common symptom:
_________________
How are lice spread?
_________________ contact
K. Adolescent Conditions:
Mononucleosis:
What is the name of the virus that
causes infectious mononucleosis?
_____________
How is it spread? ____________
intimate contact
Tx:
Rest, analgesics and fluid
The spleen will be enlarged so you
dont want them to participate in
contact sports.