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PEDS Exam1 notes

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cdunbar4's version from 2017-02-02 17:32

legalities

Question Answer
consent vs. assentconsent: must be >18 to get consent. Assent (around age 7): something we use in research to get child's consent, but parent still has to consent (usually parents have right to refuse).
mature minor14-18, they can get BC, seek tx for STI’s, pregnancy testing, blood donation, drug/etoh testing and seek mental health care.
negligenceconduct that falls behavior that is expected of nursing care (i.e. checking IV sites hourly, 5 rights, for peds check dose range every time, every kid); learn to delegate appropriately. RN does the cognitive, critical thinking assessments and LPN’s can do a focused assessments.
futilityw/holding med tx on a child when whatever they have is not compatible with life.
Research /Evidence-Based Practice / Quality Improvement (QI): You never look at one study, you look at many different studies. Make decisions based on evidence, not what is popular. “Distraction Cart” for the treatment room was thought up based on evidence.
Identify health issues through active listening and “fact finding”: try to point out strengths, do not tell them what to do, but teach.
The family is the expert on the child!!! *NTKthey know what baby likes/don’t like. If you can have them giggle, their sphincter opens for a straight cath. Know who are the caregivers of the family.
handoffusing the sheet is important that the sheet gets passed on from nurse to nurse; the standardized sheet helps set the next nurse up for success. Ex: is this how a patient normally breathes, or is this new?
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newborn

Question Answer
Bottle propping: biggest reason for vomiting is overfeeding
Safetyburns, drowns (can drown in 1” of water), most common is at family gatherings, be sure someone is “on” the kid. Car seat is rear-facing until they are 2, or weight based. Walkers are not used anymore because of accidents…use gates above stairwells, etc.
disciplinecreating a positive, reward-based environment 0-12 months
hospitalizationmake sure rails are up, make sure no bumpers in crib, see how they do when they are flat in crib with no props or anything.
crib safetyco-sleeping is not recommended, but if they do it, better to teach them safer ways.
home safetyhot water heater should be set at 120
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toddler

Question Answer
dentitionno free water or honey until 1 year old., nutritious snacks, non hormonal milk, picky eaters
nutritionmeal time; socioeconomic status whether or not meals are eaten together; avoid battles over food, do not force it (they know when they are full)
sleep12-14 hours of sleep; nap until age 3; some kids need naps later
safetyput them in a toddler bed and make that space safe; keep things in original container so if swallowed you can tell Poison Control what is in there. Watch hot items on stove, cups, supervise them if they are participating; can drown in 1” of water; Firearm safety-different convos depending on state, generally you want to put ammo separate from guns, guns shouldn’t be loaded.
disciplinetime-out depends on their age (may not work with a 1 year old, maybe by age 2); discipline should be consistent; *distraction is usually the best; reward-based; “123 Magic” works well for pre-school → consequence is when you get to 3 and do the consequences right away. When they get older you can make the consequences long-term.
screeningLed; anemia; Pika; TB is not a universal screen, in AK you have to have a TB test in Kindergarten (AK is #1), universally TB is tested for high-risk populations.
hospitalizationtry not to separate kids from parents, they have separation/stranger danger; if they don’t have that attachment with their parents, could queue you into something going on b/t the relationship; give them; give them a task to do, be consistent.
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preschool

Question Answer
Psychosocial developmentinitiative vs. guilt: promote initiative w/o impinging on the rights of others; “Magical Thinking;” Preoperational; Social Emotional: people pleasers (reward them for wanting to be good), fears, body integrity, pain, loss of control.
Pain scale usedFLACC, based on what you observe, ask parents
playfoster imagination, elaborate games
Parents should teach child rules of how to be safe with adults using 3 principles1 no adult should tell a child to keep secrets from parents 2 no adult should express interest in private parts 3 no adult should ask a child for help with his/her private parts
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school age 6-12

Question Answer
erikson's psychosocialindustry vs. inferiority: school achievement, friendships, competition & cooperation, learning rules
Piagetconcrete operations
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GI

Question Answer
dehydration degree–Mild 5% weight loss or 50ml/kg –Moderate 10% weight loss or 50‐90 ml/kg –Severe 15% weight loss 15 ml/kg
dehydration causes Causes: Diarrhea #1, Vomit, burns Causes: watering down or stretching baby formula Causes: sweating, ketoacidosis, malnutrition, neglect, DI
severe dehydration tx IV fluid MAX amount20ml/kg 3x max of isotonic NS or LR
vomitshould never have bile or blood in vomit, notify PCP asap
cleft lip and palatealways check it, even if someone else has.
post op care cleft lip/palatecan do syringe feedings, but you do want the open cup. Will have speech therapy and will heal very well, but is very painful. Best thing for them is to get them out of the PACU and to their parents. Can use no-nos, face guard.
peritonitis/appendicitis*Board-like rigid abdomen is Bad. Tend to sit really still and do not want to move. All of sudden they feel relief and then they feel diffuse pain around it. Semi fowlers, no heat, NG tubes
celiacs2nd leading cause of malabsorption syndrome 

celiacs interventionGluten free diet [elimination of wheat, rye, barley, oats] [substitute corn, rice, millet] –Vitamins; multi, folic acid, IRON
 –Avoidance of high‐fiber foods during periods of bowel inflammation

hirsch sprung diseasemechanical problem, doesn’t push stool along. NO meconium w/in 1st 1-2d
Intussusception "the anti slinky"Bowel goes inside itself-Tx is the test as well: air/barium enema will unslinky the bowel. M>F 90% of the time there is no other issue. *Looks like current jelly stools (also is a late sx); inconsolable crying, draw knees up, bilias vomiting.
Ulcerative Colitis & Crohn'sAutoimmune: tx corticosteroids or immunomodulators can affect their growth potential.
neonatal jaundicecan cause severe neurologic deficit
biliary atresiawill need liver transplant
biliary boxOk to put baby on belly- they are on a monitor. Check bilimeter and distance between baby and light. If light isn’t working, you may have to go get a new light. Limit being out to about 15 minutes. Eat then go back into isolette. Check baby’s temperature and make sure they do not get too hot.
biliary atresiaDo not have extra hepatic biliary structures. Kasai-at 10 weeks, gets them through until they can get a liver transplant. Itching, dark urine, pale stool, failure to thrive, poor weight gain and can’t absorb fat soluble vitamins, ↑LFT’s, bleeding problems
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