PEDIAT R IC S T UDEN T WOR K B OO K

A Message from the Author

Quick Facts for Pediatrics® is an essential resource for every
nursing student and a part of our comprehensive nursing
curriculum! This study guide is designed to give you core content
in a simple, easy-to-understand, “no nonsense” structure that will
help you quickly identify your strengths and analyze areas of
weakness. With Quick Facts, you will immediately begin to
comprehend many of the major areas of Core Content that are
essential to Pass NCLEX® RN & PN.

YOUR SUCCESS IN NURSING

Your success in nursing is determined by your ability to think, plan, decide, and act based on knowing
the fundamental practices of the field. These same skills are necessary when preparing to take
NCLEX®. The stronger you are with the fundamentals, the faster you will learn how to critically think.

With Quick Facts as your primary study guide, you are on the right track to achieve the same types
of results as our students who have passed NCLEX® and are now living out their dreams.
Whether you’re starting nursing school tomorrow or graduated years ago, I want to encourage you
to stay focused on your goals. Let’s put pride to the side, cast away doubt, feelings of inadequacy,
and anything that does not support this one effort here and now. I have personally beaten the odds
and have helped thousands of nurses just like you to do the same.

I’ve created several resources to help you along this journey including my live classes, Quick Facts for
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exclusive access to the ReMar Nurse NCLEX Study Group on Facebook with a worldwide community
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I know that studying for NCLEX can be challenging. My goal is to help you study the content and make
this process as simple as possible. If you have any questions as you study I want you to contact me
directly, my email is Support@ReMarReview.com. Stay focused; put FAITH over fear and continue to
invest in yourself because YOU CAN, YOU WILL, and YOU MUST Pass NCLEX!

Regina Callion MSN, RN

ReMarNurse.com

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 Table of Contents
A Message from the Author...... …i 1

Asthma ............................ 2 Otitis Media ..................... 12

Bacterial Meningitis ............... 2 Pain Assessment & Management 12

Bronchiolitis ....................... 3 Piaget’s Cognitive Stages ........ 13

Celiac Disease ..................... 3 Poisonings ....................... 13

Cerebral Palsy ..................... 4 Pyloric Stenosis .................. 14

Congenital Aganglionic Megacolon 4 Renal Disorders .................. 15

(Hirschsprung Disease)............. 4 Rheumatic Fever ................. 15

Croup .............................. 5 Seizures.......................... 15

Cystic Fibrosis...................... 5 Sickle Cell Anemia ............... 16

Down Syndrome ................... 6 Spina Bifida ...................... 17

Epiglottitis ......................... 6 Tonsillitis ........................ 18

Hydrocephalus..................... 7 Vesicoureteral Reflux ............ 18

Hypospadias ....................... 7 PHARMACOLOGY SECTION ....... 19

Infant Heart Defects ............... 8 Adrenergics ...................... 20

Intussusception .................... 8 Anticonvulsants.................. 20

Immunization Chart ............... 9 Diuretics ......................... 20

Iron Deficiency Anemia .......... 10 Immunizations ................... 21

Kohlberg’s Moral Stages ......... 11 Opioid/Narcotic type ............ 21

Muscular Dystrophy ............. 11

3
 Asthma
An obstructive airway disease caused by Spasms, inflammation
_____ and _____ of the bronchioles?

What are the signs of asthma? SOB, tachycardia, expiratory

wheezes, and possibly a cough

When will the client experience the cough? At night

Is there mucous production with asthma? Yes there is mucous

What is the primary treatment goal? To identify allergen

Which medications work best for treatment? Anti-inflammatory,

Corticosteroids bronchodilators
leukotriene modifiers
Metered dose inhalers

Which should you give first—the steroid or Bronchodilator

bronchodilator—when treating asthma?

What are leukotriene modifiers? They are drugs used to block the
chemical leukotriene, which reduces
inflammation.

Bacterial Meningitis
What is the cause? Streptococcus pneumoniae

What are the signs:

Increased ICP-See hydrocephalus

Neck stiffness
Children
Kernig’s sign-inability to extend leg when thigh is flexed at hip
Brudzinski’s sign-neck flexion caused by adduction and flexion of lower extremities

*Classic signs are absent

Infants
Poor feeding , Vomiting
Irritability, Seizure, and
(3 months to 2 years old)
*Bulging fontanel when not crying but at rest

Hard to diagnose
Neonates
Refuses to eat
Movement to decrease
(Birth to 2 months)
Restless, sleep pattern

How is it diagnosed? Lumbar puncture

What laboratory values are present? Decreased: glucose

Increased: protein, WBCs Cloudy

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What is the treatment? Droplet isolation-24 hours
Antibiotics, Antipyretics
Monitor vital signs

What other condition may follow SIADH

bacterial meningitis?

What is another type of meningitis? Viral it is less severe requires

no isolation or antibiotics.
Clients get better on their own

Bronchiolitis
Peak Age Young infants

Clinical Presentation Viral infections, Thick secretions

Upper respiratory symptoms
Paroxysmal coughing
Shallow rapid respirations
Nasal flaring

Most common cause? Respiratory syncytial virus

Vaccine Available No
But there is a medication called
palivzumab

Management Contact isolation, Hydration,

Mist tent with oxygenation,
Clear airway of secretions,
Assign nurses who are not caring for
other children if possible.

Celiac Disease
Foods containing _________ must not be eaten. Gluten (This is a protein.)

In Celiac’s disease, malabsorption of _____ occurs. Fats

What foods contain gluten? B.R.O.W. (barley, rye, oats, wheat)

The client’s abdomen is often _______. Distended

What does the client’s stool look like? Smelly, pale, bulky; expect lots of gas
with some diarrhea.

The best food substitutes are ______ Corn, rice

and _________.

Can a client on a gluten free diet have No all these products have cookies,
spaghetti, or waffles? grain in them.

What is another name for celiac disease? Celiac sprue

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 Cerebral Palsy
What is it? Chronic nonprogressive
Disorder of the motor center
of the brain before, during,
or after birth

What is the cause of cerebral palsy? Anoxic injury

Maternal infections
Kernicterus
Low birth weight

What are the assessment signs? Seizures, poor suck, tongue

thrust, scissoring of legs

What newborn reflexes will remain after 6 months? Moro, tonic neck

What is the major concern with feeding? Food aspiration

What position should be used for feeding? Feed upright supporting the jaw

What is the pattern of the symptoms? They get better or worse

Congenital Aganglionic Megacolon

(Hirschsprung Disease)
What is it? The absence of
parasympathetic
Cells in the distal portion of
colon and rectum

What does that mean? It means part of the bowel

is unable to move

What are the clinical symptoms? Feces accumulates in the

bowels, failure in newborn to
produce meconium
Ribbon like stools

Temporary Colostomy Until the age of 1

What is the treatment? Abdominal surgery - Rectal

tube may be prescribed

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 Croup
Peak Age 6 months to 3 years

Clinical Presentation Barky, seal like cough

Inspiratory stridor
Low-grade fever
“Child does not look sick”

Most common cause Parainfluenza

Vaccine available No

Treatment Oxygen, Humidifier,

Steroids (dexamethasone)

Will the child be able to speak? Yes, with a hoarse voice

Will the child be able to swallow? Yes, they are able to swallow

Cystic Fibrosis
In cystic fibrosis, the _____ _____ or exocrine glands Mucous-producing
are affected.

How does cystic fibrosis abnormally The mucous will become thick,
change mucous gland secretions? Sticky, and cause obstructions.

What are the two systems most affected by Respiratory- mucous gets
cystic fibrosis? trapped in the lungs.

Digestive- mucous blocks the pancreas

and digestive enzymes, making the
absorption of nutrients very difficult.

What three insufficiencies are present? Lung insufficiency

What is the most accurate test for cystic fibrosis? Sweat test - the chloride level
will be >60 mEq/L

What are other ways to diagnose cystic fibrosis? Chest x-ray, stool analysis, pulmonary
function test

How does poor absorption of fat in the digestive It causes steatorrhea

tract change the appearance of stool? (greasy, foul-smelling, pale stool)

_____ _____ are given with each meal to help Pancreatic enzymes
with the absorption of nutrients.

What is the most appropriate diet for cystic fibrosis? High calorie, high protein

5
_____ _____ is a common technique used to clear Postural drainage
thick mucus from the lungs. This is important for
preventing respiratory infections.

What should parents who already have a child They should get genetic counseling
with cystic fibrosis, do before having another child? because cystic fibrosis is hereditary.

Down Syndrome
What is it? The most common chromosomal
abnormality in children

Which chromosome is affected? 21

Physical Changes Simian creases in palms

Inner epicanthal eye fold upward
Slant of eyes, Small head
Low set ears, Short neck

Cardiac Changes Heart defects

Respiration Changes Mucous production

Frequent infections

Neurological Changes Mental retardation

Low IQ range 20-70

Endocrine Changes Hypothyroidism

Diabetic muscular infarction-
painful swelling in the legs

How should parents be taught to feed their To the back and side of the mouth
child with Down syndrome? due to thrust.

What is the major nursing goal for a child To help him or her reach their
with Down syndrome? their optimal level of functioning

Epiglottitis
Peak Age 3 to 7 years

Clinical Presentation Rapid high fever, drooling, stridor

“Child does look sick and toxic”

Most common cause H. influenza

Vaccine Available Yes - (H. influenza)

Management Airway management (intubation)

Oxygen
Antibiotics

Will children with epiglottitis have a cough? Usually there is not a cough

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Will the child be able to speak? No- voice will be muffled

What position should the child remain in? Upright

Should the child be restrained? Yes, to prevent extubation

What position will the client be in? Tripod

Hydrocephalus
What is it? Condition of an abnormal
accumulation of cerebral
spinal fluid in the ventricles
of the brain.

What will the client have signs of? Increased intracranial

pressure (ICP)

What are the signs of ICP in children? Change in LOC, irritability,

vomiting, unequal pupil
response, change in
personality, headaches

What are the signs of ICP in infants? Irritability, increased head

circumference, bulging
fontanels, widening suture
lines, high pitched cry,
feeding difficulties

Will the infant or child’s head circumference It will be increased

be increased or decreased?

Which infant condition is most associated Spina bifida

with hydrocephalus?

What is the treatment Ventricular shunt placement-

to drain fluid

What are signs that the shunt is malfunctioning? Red, tender, swollen
Appearance, stiff neck and
headache, vomiting

What infection can be present after surgery? Meningitis

Will the shunt need to be replaced? Yes child will out grow shunt.

Hypospadias
What is it? Opening of the urethra
is underneath the penis
instead of on top

Is this a birth defect? Yes

7
What is the treatment? Surgery- a urethral stent
may be placed

What is chordee? Tip of penis is curved

downward child may
have this sign

Client education Child may be sent home with

catheter in place for
approximately 1 week.

Do not give with dairy

products

Infant Heart Defects

Blue Baby Pink Baby
Cyanosis Yes No
Shunting Direction Right to Left Left to Right
Types Tetralogy of Fallot Ventricular Septal Defect
Truncus Arteriosus Atrial Septal Defect
Transposition of Great Vessels Patent Ductus Arteriosus
Signs Fatigue Heart murmur
Squatting position Fatigue
Fatigue Small weight and height
Treatment Surgical closure Surgical correction

Intussusception
What is it? Intestines telescoping into
each other usually the ileum
into the colon.

Will there be bowel obstruction? Yes partial to complete

At what age does this occur? Children under 1

What are the clinical signs Jelly-like stools

(blood mixed with mucus)
Sausage shaped mass
in right upper quadrant

What position will the child take? Legs drawn up to abdomen

What is the treatment? Monitor for shock,

Bowel perforation
Monitor for 1 & O
Child will receive a
Barium enema as initial
treatment then surgery

8
 Immunization Chart
What do you get at each age?
Birth Hep B #1
2 months Hep B #2, DTap, Hib, IPV, PCV
4 months All 2-month immunizations except Hep B
6 months All 2-month immunizations
12 months MMR #1, Hib, PCV, varicella
*some resources say Hep B #2 can be given at 1 month.
Tetanus and diphtheria are optional vaccinations; 2 months
what is the earliest age they can be given?

What is a booster shot? An additional dose of

vaccination to increase
effectiveness.

What are the side effects of immunizations? Low-grade fever, tenderness,

swelling at the site, child may
become irritable

What medication should be given for these effects? Acetaminophen

Never give ____ to children experiencing these effects. Aspirin

When should the meningitis vaccination be given? Before going to college

If an adult woman receives an MMR shot, what Wait three months before
should you teach her? pregnancy

How soon can a child get the influenza vaccination? Not until six months

Do not give MMR if the client is allergic to ___ or ___. Eggs or Neomycin

What is active immunity? Stimulating the body to produce

antibodies by giving a vaccine

What is passive immunity? Antibodies that are formed

In another body but passed
down for short-term use
(e.g., breast milk)

Why should a nurse hold vaccines? Allergy to eggs

Allergy to neomycin
Febrile illness

If a child has never had any vaccinations DTap, IPV, Varicella

which will they need for kindergarten?

Should the nurse hold a vaccine No the common cold is not a

due to common cold? reason.

What temperature is common 38.9 C or 102 F along with

after an immunization? Redness and swelling at
injection site for 2-3 days
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Is aspiration of the needle required Do not aspirate
before vaccine administration?

What medication can be given Acetaminophen

before an immunization?

Iron Deficiency Anemia

What is it? Hemoglobin levels

are below normal
range

What are normal levels of hemoglobin? Newborn: 14 to 24

Infant: 10 to 17
Child: 9.5 to 15.5

What are the causes of iron deficiency anemia? Poor nutrition

Chronic blood loss
Body improperly
using iron

What are the clinical signs? Tiredness, fatigue

Overweight baby
Pica habit

What are the expected laboratory results? Decreased Hgb

Low serum iron level
Elevated total iron
Binding capacity

What are food sources with iron? Meat, green leafy

Vegetables, fish,
Liver, iron fortified
cereals

What is the treatment? Oral iron

How do you administer oral iron? Give on empty

Stomach
Give with citrus juice
Use dropper to avoid
staining the teeth

10
 Kohlberg’s Stages of Moral Development
How many levels are there?
How many stages are there?
Level
1 - Preconventional
Up to the Age of 9
Level
2 - Conventional
Most adolescents & Adults
Level
3 - Postconventional
0 to 15% of those over 20
years old
What is it?
What kind of disorder is it?
What is the most serious form?
What are the clinical signs?
What are the interventions?
3 Levels
1. Preconventional
2. Conventional
3. Post-conventional
6 Stages
Stage Characteristics
1. No difference between doing the right
1 Punishment & Obedience thing and avoiding punishment
2 Instrumental Exchange 2. Interest shifts to rewards rather than
punishment. Thoughts on how to secure
greatest rewards for self.
Stage Characteristics
3. “Good boy/girl” Effort is made to secure
3 Good Boy/Nice Girl approval from others. Does not want to
dislike by others.
4 Law & Order
4. Orientation toward fixed rules.
Stage Characteristics
5. Right and wrong determined by personal
values. When laws infringe on social justice
5 Legal Contract we ignore them. Individual rights
6. Live in accordance with deeply held moral
6. Universal Principle principles. Moral principles are seen as more
important than the law of the land.
Muscular Dystrophy
Inherited disease of the muscles
client is weak
X- linked recessive disorder
Duchenne muscular dystrophy which
appears at 3 to 5 years of age. By age
9 to 11 the child loses ability to walk
Delayed walking
Frequent falls
Gowers sign: difficulty rising to
standing position
Allow child to do as much as possible
Provide supportive care and exercises
11
 Otitis Media
What is otitis media? Inflammatory disorder of the middle ear

What are the symptoms? Fever, pulling at the ear, enlarged

lymph nodes, vomiting & diarrhea

What is the treatment? Antibiotics, Tylenol, Tepid baths for fever

What position should the child be placed in? On affected ear side

What does it mean if there is a discharge? It means the ear drum has ruptured

For infants with otitis media what is the feeding position? Avoid supine position when bottle feeding

What should the parents/ child be told to avoid? Second hand smoke

What problem are children with otitis media at risk for? Hearing loss

Pain Assessment & Management

Pain is often called which vital sign? The fifth vital sign

At what age can a child give a verbal pain report? 3

Should a child’s parents be included in the Yes

pain assessment?

What are non-verbal signs of pain? Facial grimacing, Irritability, restlessness,

difficulty sleeping

What are physiological responses to pain? Increased heart rate,

Increased respiratory rate
Diaphoresis, decreased
Oxygen levels.

List some examples of pain scales: CRIES pain scale

FACES pain rating
FLACC pain assessment
Numeric pain scale
Oucher pain scale

Scale Age Group

CRIES 32 to 60 weeks old
Numeric 9 years & older
Oucher 3 to 12 years old - Uses cultural photos describing
pain
FACES “Poker Chip Scale” - Preschool age
FLACC *Nonverbal children
Facial Expression
Leg movement
Activity
Cry and Consolability

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Why do children deny having pain? Fear of injection

Can a 5-year-old use a PCA pump? Yes, children as young as 5

can be educated.

What should a nurse do before giving a Check to see if the dose is

pain medication? correct and safe.

Which word should the nurse NOT use when Pain or painful
describing a procedure or surgery.

Age Group Best Nonpharmacological Interventions

(No Medications to Treat Pain)
Infants Oral sucrose, pacifiers, holding, and rocking
Toddlers/ Preschoolers Distraction-television, music, books, bubble blowing
School-age Guided imagery

Piaget’s Stages of Cognitive Development

Age Range Stage Cognitive Milestones
1. Curiosity about world
2. Coordination of senses with motor response
0-2 years old Sensorimotor
3. Language is used for demands
4. Object permanence is developed
Symbolic thinking
Uses proper grammar
2-7 years old Preoperational Conservation present-amount of an object remains the same even if
the container changes sizes.
No abstract thought
Concrete Concepts attached to concrete situations.
7- 11 years old
Operational Time, space, quantity are understood.
Abstract logic and reasoning are present
Formal
11 years old Strategy and planning become possible
Operational
Theoretical, hypothetical, and counterfactual thinking present.

Poisonings
What age range is most at risk? Less than 6-years old with
2-years old as the peak

Where do 90% of poisonings occur? At home

What are the common symptoms? Gastrointestinal disturbance

Nausea, diarrhea, vomiting
Burns of the mouth/pharynx-
depending on solution
Altered level of consciousness

What is the treatment? Identify poison quickly

Call Poison Control Center or 911
Gastric lavage

Medications
Activated charcoal
N-acetylcysteine or naloxone
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Should parents make child vomit? No - Do not use ipecac syrup

What is the major cause of lead poisoning? Lead based paint, lead paint is sweet tasting

What systems are most affected by lead poisoning? Renal, neurologic, and hematologic

What are some diagnostic tests for lead? Blood lead level (BLL) (all kids at 1 years old
should be tested) Erythrocyte protoporphyrin EP

What are the medications for lead Chelating agents (unless allergic to peanuts)
Dimercaprol, Calcium disodium EDTA

What should the nurse monitor Renal function

when a child is on a chelating agent? Complete blood count

What medication should not be given Iron due to interaction

with cheleating agents?

Which contains more lead Hot water

hot or cold water? *Clients are taught to use cold water for
feeding infants and children.

Pyloric Stenosis
What are the clinical symptoms? Vomiting bile, occurs in first born males
Palpable olive shaped mass in upper right
Quadrant, projectile vomiting after eating

What is client at risk for? Dehydration

What is the cause of the dehydration? Vomiting

What acid base imbalance will be present? Metabolic alkalosis

How should feedings occur? Small frequent feedings. Place client on

the right side after feedings, burp frequently.

What is the treatment? Surgical correction

14
 Renal Disorders
Acute Glomerulonephritis Nephrotic Syndrome

Cause After Streptococcal infection Unknown

Immune system response

Renal Symptoms Inflammation of glomerulus Changes to glomerulus

Leaking red blood cells & proteins Proteinuria

(Hematuria and proteinuria) Hypoalbuminemia
Decreased GFR
*Tea-colored urine *Foamy frothy urine
Other symptoms Edema around face, eyes Anorexia

Hypertension Generalized Edema

Hyperlipidemia
Elevated Antistreptolysin (ASO) titer
Blood pressure Elevated Normal

Treatment Provide skin care to areas of swelling Provide skin care to areas of swelling

Steroids Steroids
Antihypertensive medications Low salt diet
Low salt diet Daily weights
Daily weights

Rheumatic Fever
What are the signs? Fever with rash, chorea, elevated
Chest pain -tachycardia
What kind of tissue is most affected? Connective tissue, especially in the
mitral valve, blood vessels, joints
What is the age range most affected? School age children

What laboratory values are elevated? Erythrocyte sedimentation rate

Antistreptolysin) titer
Rheumatic fever is the most common: Acquired form of heart disease

What is a prevention medicine? Benzathine penicillin

Seizures
What is it? Uncontrolled electrical neuron discharge
Classification of Seizures
Partial (or Focal) Seizures Generalized Seizures
Simple Partial- Awareness not impaired Absence-Petit mal (see below)
(90 seconds, no loss of consciousness, sudden jerking) Myoclonic-sudden, brief contractions of muscles
Clonic-spams followed by relaxation
Complex Partial Tonic-stiffness of entire body
(1 to 2 minutes, may have aura, automatisms Tonic Clonic*GRAND MAL consciousness is lost Lasts 1-
unaware of environment) 3 minutes. Atonic
Partial seizures arise from specific areas of the brain. *Status Epilepticus

At what age are seizures most common? Under the age of 2 years.

15
What does aura mean? A warning sign of impending seizure

What are petit mal seizures? Momentary loss of consciousness

like daydreaming

Are there convulsions in petit mals? No

How long do petit mal seizures last? 5 to 10 seconds

At what age does petit mal seizures appear? 4 and 12 years of age

What is the difference between petit mal Nothing they mean the exact same
and absence seizures? thing.

Are there convulsions in myoclonic No these are nonconvulsive types

or atonic seizures?

Are there convulsions in tonic clonic, tonic Yes there are convulsions
and clonic type seizures?

How do clients feel after a seizure? Clients feel disoriented and sleepy

What are nursing interventions for seizures? Pad floor, pad side rails (HESI)
maintain patent airway, protect
client, avoid neck flexion, have
oxygen and suction at the bedside

Should a nurse use a padded tongue blade No there should be no tongue blade
during a seizure? used during the seizure.

What is the most common cause of clients Medication noncompliance

having increased seizure activity?

Seizure Type Medications

Absence/ Petit Mal Ethosuximide, valproic acid, clonazepam
Tonic-Clonic (Grand Mal) Phenytoin, carbamazepine, phenobarbital, fosphenytoin, primidone
Status epilepticus Phenobarbital, phenytoin

Sickle Cell Anemia

Is this autosomal trait recessive or dominant? Recessive; most commonly seen in
African Americans

When does it appear? After 6 months of age

How is this condition inherited? A child receives the gene from both
parents.

How long do sickled RBCs live 6-20 days; normal is 120

compared to normal RBCs?

What does this put the client at risk for? Anemia

16
What test determines sickle cell anemia? Hemoglobin - shows anemia
Sickle testing of blood

The acute exacerbation of sickle cell Sickle cell crisis or

anemia is called ___ ____ ____. vaso-occlusive crisis

The most common cause is ________. Dehydration

This causes the sickled blood to do what? Clot

How do you treat a sickle cell crisis? Hydrate with oral and fluids give
O2 to increase tissue perfusion; a
blood transfusion may be needed; give
pain medications

During a sickle cell crisis, which intervention Hydrate with IV fluids;

is done first—give O2 or hydrate with IV fluids?
remember, during a crisis the blood
is clumped together, so the goal is to
decrease the viscosity of the blood. O2
will not reverse the cause; it will only
prevent more clumping.

Should children take iron supplements? No; it will build up in blood

and damage organs

Should children take folic acid? Yes; because it helps to stimulate

healthy red blood cells

Spina Bifida
What is it? Malformation of the vertebrae and
Spinal cord. There are various
Degrees.

What are the types of spina bifida? 1. Spinal bifida occulta

2. Meningocele
3. Myelomeningocele

Type Features
Spina bifida Occulta Defect of vertebrae only
There is no sac
Looks like a dimple at the base of the spine
Meningocele Sac contains only meninges & spinal fluid
There are no nerves in the spinal sac
Myelomeningocele Sac contains spinal fluid, meninges, and nerves
Sensory and motor defects

What position should the client be in? Prone

How should the fluid be monitored Measure head circumference every 8-hours
and check fontanels

What should the sac be kept free from? Urine and stool
17
 Tonsillitis
What is tonsillitis? It is an inflammation of the tonsils

What is the cause? It could be bacterial or viral infection

Bacteria: streptococcus pyogens

Viral: adenovirus, influenza

What are the symptoms? Fever, sore throat, painful swallowing,

dysphagia

What are the peak age groups? Less than 5 and young adults

What is the treatment? Acute tonsillitis usually resolves

with no treatment
Surgery if recurrent infections occur
Client doesn’t respond to antibiotics

What laboratory value should be monitored? PTT & PT before surgery

When is bleeding most likely to occur? 1st 24 hours after surgery

5-10 days postoperative

What medication is avoided due to increased NSAIDS

risk of bleeding?

What are signs of potential bleeding? Frequent swallowing

Vomiting bright red blood
Frequently clearing throat

Can clients use a straw after tonsillectomy? No

What other medication is included in the pain medications? Cough suppressant

Vesicoureteral Reflux
What is it? A reverse of urine into the ureters

What are the symptoms? Recurrent urinary tract infections

What is the treatment Ureteral reimplantation

What are the nursing interventions? Maintain hydration with IV or oral fluids
Monitor post-operative urinary drainage

18
PHARMACOLOGY SECTION
Featuring Pediatric Medication

19
 Adrenergics
Medication Indication Client education

Epinephrine Asthma Give Subcutaneous

Bronchodilator IV, and nebulizer

Anticonvulsants
Drugs Therapeutic level Client education

Carbamazepine 6-12 mcg/mL Can cause hepatitis

Monitor liver function
Do not abruptly stop
Clonazepam 20-80 mcg/mL Monitor liver and renal function
Causes drowsiness

*Fosphenytoin Given IV must dilute

Can give as an IM injection
Lamotrigine None given Stop if rash develops
Do not stop abruptly
Phenobarbital 15-40 mcg/mL Monitor blood pressure
PO, IM, IV
Do not give with milk
Phenytoin 10-20 mcg/mL Watch oral hygiene
Report rash
Routes available PO, IV
Causes hepatotoxicity in children less than 2
Valproic Acid 50-100 mEq/mL
Monitor liver function
Potentiates phenobarbital and dilantin

Diuretics
Type Examples NCLEX Tips
Carbonic -Blocks carbonic anhydrase in the proximal tubes.
Anhydrase -Not used much as a diuretic; better for open angle glaucoma when
Acetazolamide
Inhibitors the ocular pressure needs to be down.
*Increased loss of bicarbonate can lead to metabolic acidosis.
Loop -Most efficient & fast acting.
-Can be given PO or IV.
Furosemide -Watch for a decreased potassium levels.
Bumetanide -May cause ototoxicity (the chance will increase when given with an
Aminoglycoside).
-Used for acute edema (pulmonary or CHF).
Osmotic -Used to get rid of water instead of sodium.
Mannitol
-Best for increased intracranial pressure.
Potassium-sparing -Used orally, not as powerful as loop diuretics.
-Watch for an increase potassium level.
Spironolactone -Do not give to patients with diabetes mellitus.
-Best diuretic for hyperaldosteronism.
-May cause agranulocytosis.
Thiazide -Acts on the distal tubes.
-Used for chronic hypertension
Hydrochlorothiazide -Slow acting diuretic.
-Increases toxicity with heart meds: quinidine and digoxin.
-Decreases the effectiveness of antidiabetic agents.

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 Immunizations

Vaccine Client Education

DTaP Vaccine
*Diphtheria, Pertussis, Tetanus
Hib
Haemophilus influenza type B
Given 2-4-6 Months
Booster at 4-6 years old before kindergarten entrance
*DO Not Give:
to children above 7
encephalopathy within 7 days of past DTap vaccines
Teach parents to give acetaminophen
Protects against the bacteria that causes epiglottitis, bacterial
meningitis, and septic arthritis
Do not give with DTap combination in infants 2-6 months

Can give before newborn leaves the hospital

Hepatitis B
Contraindicated for people allergic to yeast
Given at 12-15 months
MMR Do not give if allergic to eggs or neomycin, clients with a depressed
Measles, mumps, rubella immune systems, and breastfeeding women
Rash is common two weeks after administration
Start to give at 2 months
Polio Vaccine Contraindicated with history of anaphylactic shock to neomycin or
streptomycin
*School requirement
Varicella Safe to give to children with HIV if they have no active cold
Chickenpox symptoms
Give with MMR on same day but not in same location

Opioid/Narcotic type

Butorphanol Fentanyl
Hydromorphone Citrate
Medication Morphine Tartrate or
Nalbuphine
-Hold med if -Reduce -Give IM or IV May cause
respirations are below respirations. Woman with pre- respiratory
12; will cause -This is not existing narcotic depression
respiratory depression. morphine; you dependency will Resuscitation
-Watch for cannot interchange experience equipment
NCLEX Tips constipation. them. withdrawal should be at
-Addiction may occur -Hydromorphone is the bedside
with long term use. many more times
stronger than
morphine.

*For narcotic administration have naloxone HCL available. Naloxone is a narcotic

antagonist used to counteract the effects of opioids. Pain will return after administration.

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