Pediatric Nursing Flashcards2 - Quizlet

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Science / Medicine / Pediatrics
Pediatric Nursing
Terms in this set (294)
Pediatric Nursing
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An 18-Month-Old is
. 2. The route of roseola transmission is
discharged from the
unkown, and the disease is more
hospital after having a
commonly seen in children 6 months to
febrile seizure
3 years of age, so siblings do not need
secondary to
to be isolated.
exanthem subitum
(Roseola). On
discharge, the mother
asks the nurse if her 6-
year-old twins will get
sick. Which teaching
about the transmission
of roseola would be
most accurate?
1. The child should be

isolated at home until
the vesicles have dried.
2. The child does not

need to be isolated
from the older siblings.
3. Administer
acetaminophen to the
older siblings to
prevent seizures.
4. Monitor older
Pediatric Nursing
children for sei re
children for seizure
development.
Which would be the 2. Varicella (Chickenpox) is highly

priority intervention for contagious. Contact & Droplet
a child suspected of respiratory precautions should be
having varicella started immediately because the
(chickenpox)? primary source of transmission is
secretions of the respiratory tract
1. Contact Precautions (droplet) and also by contaminated
2. Contact and Droplet objects.
Respiratory
Precautions?
3. Droplet respiratory
precautions?
4. Universal
Precautions and
standard precautions.
A lotion containing diphenhydramine.

Should not be applied if child has
Caladryl already been given benadryl
(diphenhydramine) because it can
cause toxicity.
Pediatric Nursing
Which s&s would the Ankle and knee joint pain.

nurse expect with
rheumatic fever?
1. Ankle and Knee Joint

Pain.
2. Negative group A
beta strep culture.
3. Large, red "bulls
eye" - appearing rash.
4. stiff neck with
photophobia.
"You are concerned about your child

receiving immunizations. Let me explain
why your child will NOT receive routine
immunizations today"
The parents of a 12-
month old with HIV are
The nurse acknowledges a client's fears
concerned about him
and then discusses the concerns to
receiving routine
clarify any misconceptions.
immunizations. What
Immunizations and influenza vaccine
will the nurse tell them
are recommended to prevent infection.
about immunizations?
Immunocompromised HIV-infected
children should not receive MMR and
varicella live vaccines.
Pediatric Nursing
1&3
Cystic fibrosis is an inherited autsomal

Nursing Assessment trait, causing exocrien gland
suspects the newborn dysfunction. 7-10% present meconium
has cystic fibrosis. ileus, so assessing stool frequency and
Which interventions consistency is important.
would the nurse begin.
1. Observe frequency Assessing weight is important in
and nature of stools. newborns because they lose up to 10%
2. Provide Chest PT of their birth weight, and can take 2
3. Observe for weight weeks for them to regain their birth
gain. weight.
4. Assess parent's
compliance with fluid Assessing the newborn's respiratory
restrictions. system frequently would be monitored
5. Assess respiratory as frequently as other infants if the
system frequently. newborn has no respiratory symptoms.
Chest PT would not be initiated in a
newborn without a definitive diagnosis.
Yes. Breast milk has low amounts of

Can a mother
phenylalanine, so the mother can
breastfeed their infant
breast as long as the infants
if they have PKU?
phenylalanine level is monitored.
Pediatric Nursing
Vaccines given Hib & DTaP

routinely at 15 months.
Which priority The newborn should receive both

intervention for the hepatitis B vaccine and hepatitis B
newborn of a mother immune globulin within 12 hours of birth
positive for hepatitis to prevent hepatitis B infection.
antigen?
bloody stools or "currant jelly stools",

diarrhea, Large palpable sausage
signs of shaped mass in the abdomen,
intussusception abdominal distention, grunting,
dehydration Fever, and pain (legs
pulled towards abdomen)!
Flat Ribbon Stools Hirschsprung Disease

indicate
Treatment for Barium or air enema

Intussusception
Document I & O
Nursing Care for
Monitor for peritonitis & perforation
Intussusception
Monitor and record stools
Pediatric Nursing
Biggest complications Peritonitis and Perforation

of Intussusception
Risk factors for Cystic Fibrosis

intussusception Ages 3 months to 3 years old.
Pain related to rotation of intestines

Complication of Mal- around the mesenteric artery can cut
Rotation & Valvolus off circulation, leading to potential
septic intestinal necrosis.
Which pediatric GI Mal-Rotation and Valvolus

disorder presents with
green bilious vomiting?
GI disorders that Mal-Rotation/Valvolus &

present with bloody Intussusception.
stools?
Obstructive GI Mal-Rotation and Valvolus. Symptoms

disorders where a for these disorders are similar but Mal-
palpated sausage Rotation requires surgical intervention.
shaped mass is felt on
the abdomen.
Preoperative care for Hydration, IV antibiotics, NG tube.

Mal-Rotation/Valvolus
Pediatric Nursing
Post-Operative Care Bowel sounds should return in four

for Intussusception hours, progressive diet, hydration.
Priority nursing Acute Pain!

diagnosis for
intussusception
Pediatric Nursing
Which response about 1 & 3. Washing and drying hands and

safety measures is the face especially before eating,
most appropriate decreases lead ingestion. Hot water
advice for the 2 year absorbs more lead readily than hot
old's mother who had water. Diet does matter; regular meals,
her older home adequate iron and calcium, and less fat
remodeled to reduce help the child absorb less lead.
the lead level? Select Drinking 2 cups of milk per day is
all that apply. important for children but does not
help decrease lead level.
1. Wash & dry the
child's hands and face
before he eats.
2. it is best to use cold
water to prepate the
child's food to
decrease lead level.
3. diet does not matter
in reduce lead levels in
the child.
4. Drinking two cups of
milk per day helps
decrease lead levels.
Pediatric Nursing
Which would the nurse 2. If the child is born to a parent with CF

explain to parents and the other is a carrier, the child has a
about the inheritance 50% chance of acquiring the disease
of cystic fibrosis? and 50% chance of being a carrier of
1. The child of parents the disease.
who are both carriers
of the gene for CF has Number 1. is wrong. If a child is born to
a 50% chance of a parents who are both carriers of the
acquiring CF. CF gene, the child has a 25% chance of
2. The child of a acquiring the disease and a 50% chance
mother who has CF of being a carrier of the disease.
and a father who is a
carrier of the gene for
CF has a 50% chance
of acquiring CF.
Pediatric Nursing
Wheezing respirations and a dry

A 2 year old has just
nonproductive cough are common
been diagnosed with
early symptoms of CF.
CF. The parents ask the
nurse what early
A barrel shaped chest is a long-term
respiratory symptoms
respiratory problem that occurs with
they should expect to
recurrent hyperinflation. A chronic
see in their child.
productive cough is common as
Which is the nurse's
pulmonary damage increases.
best response?
Bronchiectasis develops in advanced
1. Barrel shaped chest
stages of CF.
2. Chronic productive
cough
Test taking hint: "chronic: implies the
3. bronchiectasis
disease process is advanced rather than
4. wheezing
in initial stages.
Pediatric Nursing
The parent of a child 3. MiraLAX will be ordered.

with Cystic Fibrosis
(CF) asks the nurse IV fluids may be ordered if the client is
what will be done to NPO for any reason. however, IV fluids
relieve the child's will not relieve the constipation. CF
constipation. Which is patient's commonly receive stool
the nurse's best softeners or osmotic solution orally to
response? relieve their constipation.
1. Your child likely has
an obstruction and will
require surgery.
2. Your child will be
given IV fluids.
given MiraLAX
placed on fluid
restrictions.
A school age child has Children with strep are no longer

been diagnosed with contagious 24 hours after initiation of
strep throat. The parent antibiotic therapy.
asks the RN when the
child can go back to
school. Which is the
nurse's best response?
Pediatric Nursing
4. Soft foods
The RN is revieing
discharge insturctuon
with a parent of a child
who has a
tonsillectomy a few
hours ago. The parents
tell the nurse that the
child is a big eater, and
they want to know
what foods to give
their child for the next
24 hours. What is the
nurses's best
response?
1. no restrictions at all
2. clear liquids only
3. restricted to ice
cream and cold liquids
4. restricted to soft
foods.
Pediatric Nursing
2. When the child is diagnosed with

Which ix the nurse's
asthma at any early age, the child is
best response to
more likely to have significant
parents who ask what
symptoms on aging.
impact asthma will
have on the child's
future in sports?
1. As long as your child
takes prescribed
medications, the child
will be fine.
2. The earlier the
diagnosis of asthma,
the more significant
the symptoms.
3. The earlier a child is
diagnosed with
asthma, the better the
chance the child has of
outgrowing the
disease.
4. Your child should
avoid playing contact
sports and sports that
require a lot of
running.
Pediatric Nursing
1. Diminished breathe sounds are a sign

Which of the following
of severe asthma.
children with asthma
should the nurse see
first?
1. a 12 month old who
has a mild cry, is pale
in color, has diminished
breathe sounds, and
has an O2 sat of 93%.
2. A 5 year old who is
speaking in complete
sentences, is pink in
color, wheezing
bilaterally, and has an
O2 sat of 93%,
quiet, pale in color,
wheezing biliaterally
with an O2 sat of 92%,
speaking in short
sentences, wheezing,
sitting upright, and has
an O2 sat of 93%,
Pediatric Nursing
4. Leather furniture is recommended

The parents of a 6 year
rather than upholstered furniture.
old who has a new
Upholstered furniture can harbor large
diagnosis of asthma
amounts of dust, whereas leather may
ask the nurse what to
be wiped off regularly with a damp
do to make their home
cloth.
more allergy-free
environment. Which is
household pets are not recommended
the nurse's best
for patient's with asthma. Humidifiers
response?
are not recommended because they
1. use a humidifier in
may harbor mold if not cleaned
your child's room.
properly.
2. Have your carpet
cleaned chemically
once a month.
3. Wash household
pets weekly.
4. Avoid purchasing
upholstered furniture.
Frog Like Croaking Epiglottitis, a medical emergency.

indicates
How to test for RSV Nasal Swab
Pediatric Nursing
Xray. A CBC would only show elevated

What would confirm
WBC count, it is non-confirmatory.
Epiglottis
What should be the 4.

nurse's first action with
action with a child who Immediate respiratory treatment may
has a high fever, agitate the child and progress the
dysphagia, drooling, inflammation, increasing risks.
tachypnea,
tachycardia, and
tachypnea?
1. Immediate IV
placement
2. Immediate
respiratory treatment
3. Thorough physical
exam
4. Lateral neck
radiograph.
Pediatric Nursing
4. Patient's should be treated as

The parent of a young
individuals. However, most children
child with croup tells
exhibit similar symptoms when they
the nurse that her
have the same diagnosis. Younger
other child just had
children have worse symptoms than
croup and it cleared
older children because their immune
up in a couple of days
systems are less developed.
without intervention.
She asks the nurse why
this child is exhibiting
worse symptoms and
needs to be
hospitalized. Which is
the nurse's best
response?
1. Some children just

react differently to
viruses. It is best to
treat each child as an
individual.
2. younger children
have wider airways that
make it easier for
bacteria to enter and
colonize.
3. Younger children
have short and wide
Eustachian tubes,
Pediatric Nursing
making them more
susceptible to
respiratory infections.
4. Children younger
than 3 years usually
exhibit worse
symptoms because
their immune systems
are not well
developed.
Are cough No. Coughing is a protective

suppressants given in mechanism so do not try to protect it
children? with a suppressant.
Is exercise prohibited Exercise is effective in helping CF

in patient's with CF? patient's clear secretions.
The definitive diagnosis of C is made

What chloride level is when the child has a sweat test level of
definitive of CF? 60 mEq/L or greater. A normal chloride
level is <40mEq/L.
What pediatric GI Tracheal Esophageal Fistula

Disorder may have
chest tubes placed
post-operatively
Pediatric Nursing
Usually occurs younger (infant fails to

Most common age for pass meconium in the first 48 hours of
Hirschsprung's Disease life). but can occur at any age.
A disorder related to the absence of

ganglion cells that results in decreased
What is Hirschsprung
motility; A condition that affects the
disease
large intestine (colon) and causes
problems with passing stool.
enterocolitis-inflammation of colon can

Complication of leadd to sepsis and death
Hirschsprung disease fever, explosive, foul smelling diarrhea
worsening abd distension
Pain Scale for NIPS (occurs most often in the first

gastroschisis, month of life [first 28 days]) PIPS for
omphalocele, mal- premature infants.
rotation/valvulus
A laxative is ordered Giving a laxative to a child with

for a child for Hirschsprung disease can cause
Hirschsprung disease. perforation or rupture of the colon
Why should the nurse /large intestine, leading to peritonitis
Pediatric
question thisNursing
order? and shock.
Symptomatic & Green-Bilious Vomit is only seen in mal-

Treatment difference rotation/valvolus. Both have bloody
between stools. Mal-Rotation and Valvolus
Intussusception and require surgical intervention, where
Mal-Rotation/Valvolus intussusception should only require a
is barium or air enema.
Green-Bilious Vomit, Lower GI Bleed

Symptom of Valvulus
(bloody stools)
String sign is a symptom of

String Sign is
Hypertrophic Pyloric. This will be seen
associated with what
during an upper GI series while using
GI disorder
barium dye.
Common viral cause of Rotavirus

Gastroenteritis
Risk factor for TEF Poly-hydramnios
Olive-Shaped mass is Hypertrophic Pyloric Stenosis

indicate of what GI
disorder
Pediatric Nursing
Cleft Lip, Cleft Palate

Folic acid deficiency
can cause _________ ,
_________, and neural tube
defects
What maternal drug Steroids and Anticonvulsants

prescriptions cause a
risk for CL/CP?
Non-Bilious Vomiting = pyloric stenosis
Sausage shaped mass, Volvulus/Mal-Rotation or

and bloody stools Intussusception.
Trisomy Children (13, Celiac Disease, Omphalocele, and

18, & 21) may be at risk Hirschprung Disease
for:
Lactose Intolerance is Celiac Disease

GI motility disorder?
Pediatric Nursing
Prevent Crying (Cuddling), Supine

position with elbow restraints, or on the
How to protect suture side with head elevated up right.
lines in Cleft Lip? Logan's bar. No sippy cups, toothbrush,
or straws.
Post-operative May lie prone (on the abdomen)

position for Cleft immediatley post-operatively
Palate Repair
Why is a cleft lip/cleft Oropharyngeal airways are exposed

palate child at risk for and dry, making them at risk for
infection infection.
Characteristic of Fatty Greasy, pale, and foul-smelling

Stools:
What congenital Cleft Lip & Cleft Palate

defect is associated
with inefficient
eustachian tube
function, Otitis Media,
and hearing loss
Pediatric Nursing
constipation, vomitting, abdominal

Symptom of swelling, growth retardation, failure to
Hirschsprung's pass meconium in first 48 hours of life,
disease? poor feeding
GI disorder requiring 1 Gastroschisis due to insensible fluid loss

1/2 fluid maintenance
FLACC (Surgery is done after first

pain scale for CP/CL
month of life)
Cystic Fibrosis is Intussusception

other GI disorder
When can juice be When the baby is at least 8 months old.

introduced into the
diet?
5-6 lbs/year (2.3-2.7 kg/year)

Toddler weight gain
per year
decreased caloric needs
Pediatric Nursing
Toddlers experience foods jags where

What age experiences
they only want to eat 1 type of food for
"Food Jags"
every meal.
Preschoolers experience appetite

Which age group fluctuation. They have periods of
experiences appetite overeating and then not eating at all.
fluctuation? Encourage nutritious nibbling & foods
they can eat on the go.
At what age is the School Age

digestive tract that side
of an adult?
School age weight 4-6 lbs/year (1.8-2.7kg/year)

gain per year.
When is pincer grasp Between 9 and 12 months.

mastered
Normal fine motor skill Points at objects

at 10 months
When can a child hop 4 years of age.

on one foot?
Pediatric Nursing
- reflux
- anatomic abnormalities
Causes of Urinary - voiding dysfunction
Stasis - Ureteral or bladder compression
caused by constipation
Children under _______ of 2 years of age.

age are placed on
daily prophylactic
antibiotics and
reevaluated for VUR.
results from a congenital anomaly; may

have familial pattern; 36% of siblings
Primary VUR
affected. Abnormal insertion of ureter
into bladder.
intact and healthy ureters. VUR caused

by acquired conditions such as
overwhelmed by raised vesicular
pressures associated w/ obstruction,
Secondary VUR
which distorts the ureterovesical
junction. underlying causes include
neurogenic bladder and chronic,
recurrent UTIs.
Pediatric Nursing
inflammation of renal parenchyma

- fever
- vomiting
- chills
pylenophritis
** calls for immediate administration of

IV antibiotics
swelling of the kidney related to

buildup of urine or water. Occurs when
water cannot drain properly
(obstruction, VUR).
- flank pain
hydronephrosis
- dysuria
- frequency & urgency
- fever
- Nausea
- increased blood pressure
- once daily (OD) prophylactic

antibiotics
- C/S done every few months
Treatment for VUR
- Surgical intervention if it persists after
puberty
- check for pinworms and vaginitis
Pediatric Nursing
- Avoid constipation and tight clothing

- void frequently, double void
Teaching for VUR - wipe front to back
- wear cotton panties
- increase fluids
Which grade(s) of VUR Grades 4 & 5

usually require surgical
intervention?
a newer treatment for VUR. A gel is

injected into the ureter(s) to prevent
Deflux
reflux in children who would normally
require surgery.
Epidydymitis Inflammation of the scrotum.
-antibiotics, scrotal elevation, scrotal

Treatment of ice packs, heat, scrotal support
epididymitis -can result in sterility if treatment is
delayed
Pediatric Nursing
Epididymitis is an infection of the

cordlike excretory duct of the testicle,
usually secondary to an infectious
process-STD's or non-STD's.
It is one of the most common infections
of the male reproductive tract.
The causative organisms are:
-S. aureus
-E. coli
Causes of epididymitis -Streptococci
-N. gonorrhoeae
The inflamation is associated with
urethral strictures, cystitis, and
prostatitis.
Symptoms can occur after trauma to
the genital area, after instrumentation
of the urethra and cystoscopy, and after
physical exertion and prolonged sexual
activity.
Orchiopexy is done for Testicular torsion and Cryptochordism
Pediatric Nursing
Congenital undescended tests or not

formed in utero.
- surgery done at 6-12 months of age
- infertility issues, fertility increases post
surgical repair.
- lifelong increased risk of testicular
Cryptochordism
cancer (higher if uncorrected by
puberty)
- do surgery by 12 months to prevent
infertility
- may treat with HCG in older children
foreskin adheres, narrowing or stenosis.

Phimosis Do manual retraction & cleaning, may
need circumcision if severe.
- moist non-adherent dressing

- may progress to renal failure
- eversion of the bladder through the
abdominal wall.
Bladder Extrophy
- surgery done early to preserve renal
function, prevent infection, attain
continence and preserve renal function
.
Pediatric Nursing
This is a clinical state or disorder, and

not a single disease. May follow a
previous upper respiratory condition.
Usually occurs between ages 2-8.
- May be caused by several diseases or
unknown.
- body is excreting too much protein.
glomeruli become very permeable to
protein.
- Causes change in osmotic pressure --
> fluid into tissues, perioribtal edema,
ascites (excess peritoneal fluid, 3rd
spacing.
Nephrotic Syndrome - Edema: swelling around eyes, hands,
and feet. Facial edema subsides in the
afternoon and replaced with
abdominal, genital and lower extremity
edema.
- decreased activity/fatigue
- foamy urine
- weight gain
- anorexia
- Labs: MASSIVE PROTEINURIA,
HYPOALBUMINEMIA,
HYPERLIPIDEMIA, & EDEMA, oliguria,
and hypercholestermia.
Pediatric Nursing
Can be from:
(1) MCNS: Minimal change nephrotic
syndrome. Do renal biopsy and find
that glomeruli look ok, but not
Primary Nephrotic
functioning correctly. No scarring or
Snydrome
damage.
(2) Inherited of from other cause of
glomerular change (meds, antibiotics)
- hyper-coagulability leading to blood

clot
- Fluid loss in vascular spaces causes
hypovolemia, stimulates renin-
Complication of angiotensin system. -- liquid portion of
Nephrotic Syndrome blood plasma is low. Symptoms are
weakness, dizziness, decreased urine
output. Treat with IV fluids, blood or
both.
- Infection
Pediatric Nursing
- steroids 1-3 weeks, then gradually

tapered. (prednisone [prednisolone]).
Prevents or delays loss of kidney
function; may reduce protein levels.
- ACE inhibitors: "prils". can reduce
proteinuria, but can cause hypotension.
- Immunosuppressive drugs if they do
not respond to steroids.
- Diuretics:
(1) thiazide/loop diuretics, also called
potassium sparing diuretics.
Treatment of Spironolactone (aldactone) &
Nephrotic Syndrome Triamterene (Dyrenium)
(2) Furosemide (Lasix): promotes
diuresis, can cause dehydration,
hypocalcemia and hypokalemia (low
potassium)
- Regular diet with water and sodium
restriction.
- Monitor I&O
- 1 1/2 X maintenance unless cardiac or
renal contraindications.
- Sometimes IV albumin
Contraindications - Live Vaccines (MMR & Varicella)

during corticosteroid - PCV13
therapy
Pediatric Nursing
- Common.
- If resolved by teenage years, usually
Relapse of Nephrotic no kidney damage.
Syndrome - relapses may be triggered by
infection.
- Strict I&O
- testing urine protein (at least once
daily)
- weights daily (same scale, time,
clothing)
Nursing Care for - skin care (will be stretched)
Nephrotic Syndrome - V/S
- Monitor temp for infection
- Good Nutrition (low salt, low fat)
- Modified activity (no sports) until
there is no more protein in the urine.
Can take up to a year.
Pediatric Nursing
Many types & causes, but most

commonly occurs post-streptoccocal
hemolytic group A, in children (immune
reaction)
- can also be chemical
Acute - follows impetigo or strep
Glomerulonephritis - More common in school age
(AGN) - 10-21 recovery time

- Characterized by OLIGURIA, EDEMA,
HYPERTENSION, INCREASED
SPECIFIC GRAVITY, NEGATIVE URINE
CULTURE, HEMATURIA, PROTEINURIA,
& CIRCULATORY CONGESTION
children under 2: 4-15 mg/dL

Older Individuals: 5-20 mg/dL
Normal BUN levels in

Good indication of renal function.
pediatrics
Elevated in kidney disease, dehydration,
hemorrhage, steroid therapy, and high
protein intake.
Normal Creatinine 0.2-1.0. Elevated in severe kidney

Levels in Pediatrics disease
Approximately 2-5.5 Also elevated in

Uric Acid
severe kidney disease
Pediatric Nursing
of the urine in a child is <1.015 and

infants <1.010. A specific gravity >1.025 in
Normal Specific any child is suggestive of dehydration
Gravity and >1.015 in infants as the infantile
kidney can only maximally concentrate
urine to
- Positive ASO titer (antistreptolysin

titer, indicating they recently had strep)
Diagnostics for AGN - mild proteinuria
- Chest X-Ray: possible cardiomegaly &
pulmonary congestion
- Moderate Na & H2O restrictions

- AVOID HIGH K+ FOODS (bananas)
- Monitor V/S frequently
- may need seizure precautions
- check for ICP, Encephalopathy, CVA
- daily weights
Management of Acute
- May be a standing order for an
Glomerulonephritis
Antihypertensive if BP is highL (ACE
inhibitors)
- Bedrest
- modified activity at home until no
blood in urine (may take up to 6
months)
Pediatric Nursing
generally good. normal kidney function

prognosis of acute is restored after time, rest, and salt
glomerulonephritis restrictions.
- in children due to minimal glomerular

change & responds to corticosteroids =
Prognosis of nephrotic
complete recovery
syndrome
- in adults usually a manifestation of
severe progressive renal disease
By adding the #2 to their age. For

Estimating Bladder
example a 3-year old has a bladder
Capacity in children
capacity of approximately 5 fl. oz.
Pediatric Nursing
Which statement by a 1. Nephrotic Syndrome usually follows

parent is most an upper respiratory infection. (around
consistent with Minimal 1-3 days).
Change Nephrotic
Syndrome (MCNS)?
1. My child missed 2
days of school last
week because of a
really bad cold.
2. After camping last
week, my child's legs
were covered in bug
bites.
3. My child came home
from school a week
ago because of
vomiting and stomach
cramps.
4. We have a pet turtle,
but no one washes
their hands after
playing with the turtle.
Pediatric Nursing
A 13-month old is 1. mucous plugs should be irrigated to
discharged following a prevent blockage.
repair of his
This dressing is usually a compression
epispadias. Which
type that help prevents edema.
statement made by the
parents indicates they
understand the
discharge teaching.
1. If a mucous plug
forms in the urinary
drainage tube, we will
irrigate it gently to
prevent a blockage.
2. if a mucous plug
forms in the urinary
drainage tube, we will
allow it to pass on its
own because this is a
sign of healing.
3. We will make sure
the dressing is loosely
applied to increase the
toddler's comfort.
4. If we notice any
yellow drainage, we
will know that
everything is healing
well.
Pediatric Nursing
Which medication is 4. Oxybutynine (Ditropan) is used to

mostly likely help control bladder spasms.
prescribed after a
bladder exstrophy
repair
1. Furosemide (lasix)
2. Mannitol
3. Meperidine
(Demerol)
4. Oxybutynine
(Ditropan)
- Cystic Fibrosis
- Bladder Exstrophy infants
Which two disaeases
Should stay away from playgrounds
are at risk for Latex
with rubber surfaces (turf), because
Allergy
they often contain latex.
- myelomeningocele patients
Both developed as chromosomal

mutations of normal hemoglobin,
Sickle Cell Anemia & therefore both are
Thalassemia hemoglobinopathies. Both are genetic
(hereditary disease). Both provide some
protection against malaria.
Pediatric Nursing
Autosomal recessive gene

SC trait is HgA and HbS where normal
Hg is A.
Genetic Inheritance of - Sickle Cell C & Thalassemia are other
SCD forms of SCD.
- mild symptoms (anemia) with trait, but
full life expectancy.
Sickle shaped RBC's obstruct flow,

leading to tissue hypoxia, ischemia,
infarction and necrosis. Ex:
- Vaso-occulusive crisis
- CVA
- Retinopathy
Pathophysiology of
- Renal Problems
Sickle Cell Disease
- Priapism (persistent painful erection)
(SCD)
- Leg Ulcers
- Ortho Changes
Body Recognizes Sickle Cell's as
abnormal and destroys them faster than
replacing them. - leads to fatigue &
susceptibility to infection.
Increase fluids to prevent/disrupt

First action to prevent
obstruction--Assists in circulation of
infarct in SCD
blood.
Pediatric Nursing
- Poor growth/growth retardation

- Chronic anemia (Hg 6-9)
General Symptoms of - Possible delayed sexual maturation.
SCD - marked susceptibility to infection &
sepsis
- risk for osteomyelitis
Blood Transfusions are 6g/dL

done periodically for
SCD when the
hemoglobin is at ______
g/dL.
inflammation of bone and bone

marrow.
- Treatment: is 4-6 weeks of IV antibiotic
Osteomyelitis
therapy for acute, and 6-8 weeks of oral
antibiotic for chronic. Localized wound
debridement as necessary.
Average Life On average is the 40's.

expectancy for Sickle
Cell Disease
What produces Red The spleen and bone marrow.

Blood Cells in the
Body?
Pediatric Nursing
happens when a lot of sickled red

blood cells become trapped in the
spleen. Splenomegaly and damage.
- May do a splenectomy
- most common place for occlusion
- auto-splenectomy:s a negative
Sequestrian Crisis outcome of disease and occurs when a
disease damages the spleen to such an
extent that it becomes shrunken and
non-functional.
- patient will appear hypovolemic
- difficulty breathing because spleen is
enlarged.
accelerated rate of RBC destruction

hyperhemolytic crisis characterized by anemia, jaundice, and
reticulocytosis
increased fibrinogen (acute phase

increased ESR due to.. reactant)
anemia
A condition in which the body stops

aplastic crisis producing red blood cells; typically
caused by infection. RBC count drops
Pediatric Nursing
is a leading cause of death for patients

with sickle cell disease (SCD) . Defined
as a new radiodensity on chest
radiograph accompanied by chest pain,
chest syndrome fever and/or respiratory symptoms
- EKG to r/o MI
- REST to decrease demands!
- Then fluid
- Then oxygen
inflammation of the fingers and/or toes

(hand foot syndrome)
- Painful!
dactylitis
- Treated with fluid and pain
medication..
- FIRST clinical sign of SCD.
- Hgb Electrophoresis
- Fetal Hg prevents symptoms until 6
Diagnosis of SCD months
- Prenatal D/x (Amnio, Chorionic Villi
Sampling, Pre-implantation, In Vitro)
Pediatric Nursing
- Prophylactic Penicillin from 2 mos to

age 6
- Folic acid everyday for life (1mg)
- Immunizations (especially Hib &
Pneumococcal Vaccine)
- Hydroxyurea/ Butyric acid: enhance
RBC production
Treatment for SCD - Erythropoietin
(Not in Crisis) - Gene Therapy/Stem Cell
- Clotrimazole: helps prevent water loss
from RBC's
- Nitric Oxide: helps keep blood vessels
open/dilated
- Splenectomy
- Bone Marrow Transplant
Clotrimazole Antifungal; helps prevent water loss

(Canesten) from RBC's
A hormone produced and released by

the kidney that stimulates the
Erythropoietin
production of red blood cells by the
bone marrow.
Pediatric Nursing
- an antineoplastic drug (anti-cancer

drug)
- used to reduce the number of painful
Hydroxyurea crisis in sickle cell anemia and
decreased need for transfusions in
adult patients with a history of recurrent
moderate to severe crises
butyric acid increases # of RBC's
vasodilator; improves oxygenation via

vasodilatation of the ventilated part of
the lungs, resulting in decreased
Nitric Oxide
shunting and improved ventilation-
perfusion matching.
- Used in SCD
When to call HCP in sick with even a low-grade fever or a

SCD disease cold.
Pediatric Nursing
- adequate hydration
- Promoting G&D
- Education (disease process, vaccines,
F/U, when to call MD
Nursing Care for SCD
- Anticipatory guidance (enuresis,
delayed sexual maturation)
- Recognizing and avoiding infections
- Emotional Support of pt & family.
bed wetting; normally stops at age 6,

enuresis
but may persist in Sickle Cell Disease.
What can cause - Dehydration

constriction/occlusion - Cold Weather
in SCD - Stress
- bed rest, decrease O2 demands

- hydration
- check electrolytes & maintain normal
pH.
- Analgesics : opioids, PCA pump over
Nursing Care During age 6, AVOID DEMEROL, toradol
SC crisis (ketorolac), acetaminophen & ibuprofen
when pain is less severe.
- Antibiotics
- O2 as indicated
- Comfort measures: heat , warm
Pediatric Nursing massage, IV fluids
inherited defect in ability to produce

hemoglobin, leading to hypochromia
- deficiency of b chain Hgb molecule
Thalassemia
from mutation of chromosome 11,
increase in alpha chain, defect hgb &
destruction of RBC's.
Cooley's anemia Thalassemia major
- chronic hypoxia (listlessness, pallor,

anorexia, FTT, decreased exercise
tolerance)
- bone changes (bossing/enlarged
cheek bones); bones that do not
If Thalassemia is left normally aid in RBC production start to
untreated do so.
- Delayed sexual maturation
- Bronze discoloration of skin
- If untreated leads to death in early
childhood from profound anemia &
septicemia.
Thalassemia
Pediatric Nursing
- Frequent blood transfusions for up to

3 weeks.
Treatment of - Splenectomy in presence of severe
Thalassemia splenomegaly.
- Monitor for iron overload.
pneumococcal conjugate vaccine

- give in sickle cell anemia unless there
Prevnar
is a splenectomy or administer before
splenectomy
- give in sickle cell anemia unless there

is a splenectomy or administer before
Hib Vaccine
splenectomy
- Prevents epiglottitis
- Pneumonia* (lung infection)

- Bacteremia (bloodstream infection)
- Meningitis (infection of the tissue
covering of the brain and spinal cord)
Disease caused by Hib
- Epiglotittis (swelling in the throat)
- Cellulitis (skin infection)
Infectious arthritis (inflammation of the
joi
Rotavirus causes what? Gastroenteritis

Pediatric Nursing
A highly contagious virus that causes an

infection of the upper and lower
Respiratory Syncytial
respiratory system.(Bronchiolitis,
Virus
Pneumonia, Croup)

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Science / Medicine / Pediatrics

1. The child should be

2. The child does not

Which would be the 2. Varicella (Chickenpox) is highly

A lotion containing diphenhydramine.

Which s&s would the Ankle and knee joint pain.

1. Ankle and Knee Joint

"You are concerned about your child

Cystic fibrosis is an inherited autsomal

Yes. Breast milk has low amounts of

Vaccines given Hib & DTaP

Which priority The newborn should receive both

bloody stools or "currant jelly stools",

Flat Ribbon Stools Hirschsprung Disease

Treatment for Barium or air enema

Biggest complications Peritonitis and Perforation

Risk factors for Cystic Fibrosis

Pain related to rotation of intestines

Which pediatric GI Mal-Rotation and Valvolus

GI disorders that Mal-Rotation/Valvolus &

Obstructive GI Mal-Rotation and Valvolus. Symptoms

Preoperative care for Hydration, IV antibiotics, NG tube.

Post-Operative Care Bowel sounds should return in four

Priority nursing Acute Pain!

Which response about 1 & 3. Washing and drying hands and

Which would the nurse 2. If the child is born to a parent with CF

Wheezing respirations and a dry

The parent of a child 3. MiraLAX will be ordered.

A school age child has Children with strep are no longer

2. When the child is diagnosed with

1. Diminished breathe sounds are a sign

4. Leather furniture is recommended

Frog Like Croaking Epiglottitis, a medical emergency.

How to test for RSV Nasal Swab

Xray. A CBC would only show elevated

What should be the 4.

4. Patient's should be treated as

1. Some children just

Are cough No. Coughing is a protective

Is exercise prohibited Exercise is effective in helping CF

The definitive diagnosis of C is made

What pediatric GI Tracheal Esophageal Fistula

Usually occurs younger (infant fails to

A disorder related to the absence of

enterocolitis-inflammation of colon can

Pain Scale for NIPS (occurs most often in the first

A laxative is ordered Giving a laxative to a child with

Symptomatic & Green-Bilious Vomit is only seen in mal-

Green-Bilious Vomit, Lower GI Bleed

String sign is a symptom of

Common viral cause of Rotavirus

Risk factor for TEF Poly-hydramnios

Olive-Shaped mass is Hypertrophic Pyloric Stenosis

Cleft Lip, Cleft Palate

What maternal drug Steroids and Anticonvulsants

Non-Bilious Vomiting = pyloric stenosis

Sausage shaped mass, Volvulus/Mal-Rotation or

Trisomy Children (13, Celiac Disease, Omphalocele, and

Lactose Intolerance is Celiac Disease

Prevent Crying (Cuddling), Supine