When does birth length double 5 years

When does the child sit unsupported

When does a child achieve 50% of Girls: as early as 10 years of age
adult height
When does a child throw a ball Temper tantrum
overhand When does a child speak
two to three word sentences
When does a child use scissors Adolescence
When does a child tie his or her shoes
Which gender's growth spurt occurs Adolescence
first?
What kind of behavior is considered
common in the toddler? After 6 months, their cognitive
When does a child form his or her development allows them to remember
identify? Rebellion against family pain
values is common for which age
group?
Concepts of bodily injury: Infants
Concepts of bodily injury: toddlers
Concepts of bodily injury:
Preschoolers Concepts of bodily
injury: School age children
Concepts of bodily injury:
Adolescents What is a major cause of
death in children and adolescents?
What kind of children pose a serious
threat to their unborn siblings?
HESI Pediatric Study Notes

4 years

8 months

2 years

18 months

2 years

4 years
They fear intrusive procedures Children with German measles

They fear body mutilation

Fear loss of control of their bodies

Major concern is a change in body

image Accidents

What kind of hx should Hx of reactions, seizures, neurologic symptoms after

be obtained prior to administration Should you examine the throat of a
of child with epiglottitis?
DPAT? Which is the priority of care
What kind of hx should be obtain regardless of age?
prior to the administration of previous vaccine, systematic allergic
MMR? reactions
Pertussus fatalities continue to occurr
in which group in the US? Which
type of Hx of anaphylactic reactions to eggs, or
administration method invalidates neomycin
the mantoux test?
Is the common cold a
contraindication for immunization?

Nonimmunized infants
What type of teaching should be
provided following
immunization? subQ rather than ID

No

How do you cook

vegetables to preserve potency?
Is it recommended to induce vomiting
in children? Irritability
Fever (<102) Where should milk be stored? In an
Redness and soreness at injection site opaque
for 2-3 days are normal for DTaP and container
IPV Cook in a small amount of liquid
Call HCP if seizures, high fever, or high
pitched
No, it may cause more damage

No, there is the risk of completely

blocking the airway Patent airway!

crying occurs
Warm washcloth on thigh injection site
and bicycling the legs with each diaper
change decreases soreness Tylenol is
administered every 4-6 hrs
(10-15mg/kg)

Prior to tonsillectomy, PT/PTT: in addition to this, its important to know if

which labs should be known common
What is the difference between
With cyanotic defects, what condition acyanotic and cyanotic?
is
Are acyanotic or Reduce the workload of the heart and
cyanotic defects more common with increase CO
CHF children
To conserve energy in children with Weighing the child on the same scale at
heart defects, what may be necessary the same time of day so accurate
to conserve energy? comparisons can be made
What are two objectives of tx CHF?
What should be
consistent when
frequently weighing a child?
When feeding a child with cerebral
palsy, what nursing
interventions should be implemented
there is a hx of bleeding, prolonged or
excessive, and whether there is a hx of
any bleeding disorders in the family

polycythemia

Acyanotic: abnormal circulation but all

blood entering the systemic circulation
is oxygenated

Cyanotic: abnormal circulation with

unoxygenated blood entering the
systemic circulation

Preventing aspiration:
Position child upright and supporting the
lower jaw

What is the nursing goal in caring for

a down syndrome child?
Acyanotic
Help the child reach his or her optimal
level of functioning

Tube feedings
What are the s/sx of IICP? Opposite of shock:
Decr
 ease
d
puls
e,
decreased blood
pressure
What is essential so changed early?
associated with IICP can be detected Baseline of child's behavior and level of
development
Should a shunt be pumped? No, the shunt has
delicat
e
valves
and
pumping can change
pressures within the
ventricles
What is the most common cause of How should post-op patients with
increased seizure activity? infratentorial tumors be positioned?
Medication
noncompliance

What should the nurse monitor

carefully with meningitis?
Hydration status and IV therapy.

With meningitis, there may be

inappropriate ADH secretions causing
cerebral edema and dilutional
hyponatremia
Headache

What is the most common presenting

symptom with a brain tumor? Patients should be flat or turned to
either side, a large tumor may require a
child not be turned to the operative side
What is the first sign of renal failure Decreased urinary
o
u
t
p
u
t

When is the correction of hypospadias done? It is usually

 don
e
befo
re
pres
cho
ol
years to allow for
the achievement of
sexual identity, to
avoid castration
anxiety and to
facilitate toilet
training
What are typical patient and family diagnosis r/t cleft lip/palate & pyloric
reactions to a child with a stenosis?
malformation? Guilt
Disappointment Grief
Sense of loss
Anger
What is an important nursing Alternation in nutrition: less than body
requirements
Cleft lip/palate: r/t
decreased ability to
suck
Pyloric Stenosis: r/t
frequent vomiting
What are big problems for children with GI problems? Nutrition
needs
&
electr
olyte
balan
ce

Younger children
are more vulnerable
to these problems
Where should you take Child
the temp of a child with Axillary temp
megacolon?
What are the Hgb norms for a:
Newborn Newborn: 14-24
Infant Infant: 10-15
Child: 11-16
 What are teaching point of administering iron? 1. Give on an
e
m
pt
y
st
o
m
a
c
h
2. Give with citrus
juice
3. Use dropper or
straw to avoid
discoloring teeth
4. Stools will be
tarry
5. Iron can be fatal
in severe doses
6. Do not give with
dairy products
What supplement is not given to sickle cell anemia?
Supple
mental
Iron;
instea
d folic
acid is
given to stimulate
RBC synthesis
What needs to be available when administering l asparaginase?
Epi and O2 to treat anaphylaxis
What is used to reduce the mitosis of lymphocytes? Prednisone
is
frequ
ently
used
in
combination with
antineoplastic drugs
What is used to prevent renal damage? Allopurinol - an
xan
thin
eox
ida
se
 inhibitor
How can you describe an infant with hypothyroidism? Good,
quiet baby How should insulin be administered when a child is
in Administer it in
DKA? normal saline
What type of fractures are related to child abuse? Spiral
fractures What type of fractures put limb growth at risk?
Fractures involving the epiphyseal plate
What do you want to monitor with pin sites? s/sx of infection
Does a brace correct or slow the the parents.
progression of scoliosis? It slows the
An infant with ________is often progression
described as a "good, quiet baby" by Hypothyroidism

What do you see in children fasting blood sugar is greater

with than_____mg/dl.
hypothyroidism? sleepy, poor feeders, flat
What are the outcomes of expression, constipations,
untreated congenital hypoactive
hypothyroidism? Mental retardation, growth failure
What is
phenylketonuria? An autosomal recessive disorder
where the body cannot metabolize
What is the result of PKU? the aa phenylalanine

The buildup of phenylalanine leads to

CNS damage (mental retardation) and
decreased melanin
On assessment of a child with Newborn screening using Guthrie test
PKU what do you see? is positive when serum phenylalanine
is
4mg/dL or higher. Vomiting, failure to
gain weight,
What are foods high in hyperactive, musty urine odor high
phenylalanine (which should be protein foods including meat, dairy,
avoided if you have PKU)? eggs, aspartame.
This low protein diet should be done
What 2 formulas are prescribed until brain growth is complete (6-8
for kids with PKU? years old). Lofenelac and PKU-1
What are the 3 classic signs of
diabetes?
Polydipsia, polyuria (including
Diabetes is diagnosed if the bedwetting-"enuresis"), polyphagia
120+
What do you do child is in What are the signs
if a diabetic ketoacidosis? and symptoms of
 hypOglycemia? unconscious child, childbearing years
administer REGULAR Height and head
insulin IV in Normal circumference
What are the signs Saline,
and symptoms of monitor blood gases, plasma, blood cells,
hypERglycemia? maintain strict I&O urine, tissues from
tremors, sweating, bone, hair or
What is the headache, hunger, fingernail, hgb/hct,
relationship nausea, lethargy, albumin, Cr, nitrogen
between confusion, slurred
hypOglycemia and speech,
exercise? anxiety, tingling
What is a around mouth,
complete nightmares
fracture? polydipsia, polyuria,
What is an polyphagia, blurry
incomplete vision, weight loss,
fracture? weakness,
What is a syncope
comminuted During exercise insulin
fracture? uptake is increased and
the risk for
hypOglycemia occurs.
When bone fragments
completely separate
When bone fragments
What type of remain attached
fractures have When bone fragments
serious of the bone shaft break
consequences in free and lie in
terms of growth of surrounding tissue. Rare
the affected limb? in children.

When is iron Fractures involving

deficiency most the epiphyseal
common? (growth) plate
What is the best
indicator of past
nutrition?
How do you What re the 5 "P's"
measure that may indicate
nutritional ischemia in the pain, pallor, pulselessness,
status? fractured limb? paresthesia (pins and
Provide care for 12 -36 months and in needles), paralysis
females during
Signs of iron deficiency anemia, pale conjuctiva,

Signs of B2 (riboflavin) deficiency redness of eyelid corners, burning,

pallor, brittle/ridged nails, thyroid itchy, tearing eyes, photophobia
edema
Source of Iron fortified formula,
fortified cereal,
liver, beef,
pork, eggs
Sources of B2 leafy green vegetables (broccoli,
(riboflavin) spinach, green beans), enriched cereal
dry, rough skin, night
Signs of Vitamin A (retinol) blindness, defective tooth enamel,
deficiency retarded growth and bone formation,
decrease thyroid hormone formation
liver, carrots, sweet potatoes, spinach,
peaches, apricots scurvy, bleeding,
Sources of Vitamin A (retinol) receeding gums, dry rough skin,
Signs of Vitamin C deficiency decreased wound healing, increased
infection risk, irritability
Sources of Vitamin C strawberries,
oranges,
tomatoes,
broccoli,
cabbage,
cauliflower, spinach
Signs of Vitamin B6 (pyridoxine) Which happens first, respiratory
deficiency failure or cardiac failure
scaly dermatitis, weight loss, anemia,
irritability,
Sources of B6 convulsions, peripheral neuritis
(pyridoxine) meats, cereal, yeast, soybeans, peanuts,
tuna, chicken, bananas
Signs of respiratory distress restlessness, increased resp. rate,
increased pulse rate, diaphoresis
respiratory failure

Asthma airway become edematous,

becomes
congested
with
mucous, smooth muscles
constrict, air trapping occurs in
alveoli
Nursing interventions for acute asthma exacerbations
 rapid acting bronchodilators and interventions
steroids identify triggers, reduce allergens, use
Nursing interventions for asthma MDI, monitor through peak flow
maintenance at home meter, Asthma Action Plan
autosomal recessive disease that
What type of disease is Cystic causes dysfunction of exocrine glands
Fibrosis? lung insufficiency (most critical),
pancreatic
Systemic effects of cystic insufficiency, increased loss of sodium
fibrosis and chloride in sweat meconium ileus at
birth, recurrent respiratory
infections, pulmonary
Signs and symptoms of Cystic congestion, steatorrhea, foul smelling
Fibrosis bulky stools, poor weight gain, salty
tasting skin IV abx, pancreatic
enzymes given with food/applesauce,
fat soluble vitamins, teach postural
drainage and
Cystic Fibrosis nursing percussion

Cystic Fibrosis diet Pts will need 1.5x

normal caloric
intake, high
calories,
high protein, moderate fat
content, moderate
carbohydrates
Causes of epiglottitis rapid acute airway
obstruction
usually
caused by H.
influenzae type B
Signs and symtoms of sore throat, dysphagia, drooling,
epiglottitis muffled voice, tripod position
Never put anything in the mouth
because of the risk of complete airway
What intervention is obstruction
contraindicated in epiglottitis? encourage prevention with HiB
Nursing interventions in vaccine, upright position, NPO, IV
epiglottitis abx, prepare for
rapid onset, restlessness, high fever, intubation/tracheosomy, prepare for
ICU admit
Bronchiolitis viral infection of the
bronchioles
caused by RSV
characterized by thick
 Signs and symptoms of upper respiratory symptoms, irritability,
bronchiolitis paroxysmal cough, poor eating, nasal
congestion,
nasal flaring, prolonged expiration,
wheezing and rales Synagis
What is given to prevent RSV (palivizumab)
infections in
immunocompromised patients?
Nursing interventions for
Bronchiolitis isolation, assess respiratory status, mist
secretions tent, maintain hydration, evaluate
respiratory treatment effectiveness
HR RR: 30-60 HR:100-160
Infant RR, HR RR: 25-35 HR:
1
0
0
-
1
5
0

HR RR: 20-30 HR: 80-130

HR RR: 20-25 HR: 80-120
HR RR: 18-22 HR: 70-110
HR RR: 16-20 HR: 60-90
Why are young children prone to The eustachian tubes are flattened
ear infections? Otitis Media signs fever, pain, infant may pull at ear,
and symptoms enlarged lymph nodes, drainage from
ear (if eardrum is ruptured), vomiting
and diarrhea
Abx as prescribed, Tylenol, reduce
Nursing interventions for otitis body temperature (warm tepid bath),
media monitor hearing loss
Tonsillitis inflammation of tonsil
(viral or
bacterial)
related to strep
Risks of untreated Tonsillitis may lead to acute
glomerulonephritis or rheumatic heart
Signs and symptoms of tonsilitis disease sore throat, fever, enlarged
tonsils, possible obstructed breathing
Nursing interventions throat culture to determine
for tonsillitis cause, warm salt gargles,
ice chips,
possible
surgery, abx,
 Tylenol
Post-surgical care of hemorrhage after tonsillectomy?
tonsillectomy Monitor for post-op bleeding (frequent
swallowing,
vomiting fresh blood, clearing throat),
soft foods and fluids, ice collar for
comfort
When is highest risk of
first 24 hours, 5-10 days after surgery

Acyanotic heart defects VSD, ASD, PDA,

AS Cyanotic heart defects tetralogy of
Fallot, TA, transposition of great vessels
Increased pulmonary blood flow ASD, VSD, PDA
defects

Obstructive defects coarctation of aorta, AS

Decreased pulmonary blood flow TGV, TA
Mixed blood heart defects
Atrial Septal Defect (ASD) Increased pulmonary blood flow. There
is a hole between the atria, oxygenated
blood from LA is shunted to the RA
and lungs.
Treatment and Surgical closure before school age
consequences of ASD recommended. Can l/t CHF and atrial
dysrhythmia. Increased pulmonary
Patent Ductus blood flow. Hole between aorta and
Arteriosus (PDA) pulmonary artery, usually closes within
72 hours. Oxygenated blood from the
aorta returns to the pulmonary artery.

Increased blood flow to the lungs l/t

pulmonary
hypertension. Require
Indomethacin or surgical closure.
Treatment and
Obstruction of blood flow from
consequences of PDA ventricles c/b narrowing of aorta.
Classic signs of coarctation of aorta
Hypertension of upper extremities and
decreased or absent pulses in lower
Coarctation of the Aorta extremities, requires surgery.
Tetralogy of Fallot
Aortic Stenosis (AS) Obstruction of blood
flow from
ventricles
immediately
before/at/after aortic valve.
 Oxygenated blood from LV to
body is diminished
Three T's of cyanotic heart disease Arteriousus, Transposition of the great
arteries
What is tetralogy of Fallot? combination of four defects: VSD,
Tetralogy of Fallot, Truncus overriding aorta, pulmonary stenosis,
right ventricular hypertrophy
Truncus Arteriosus One artery (truncus)
rather than 2
arteries
(aorta and
pulmonary artery) arises from
both ventricles
Transposition of the Great unoxygenated blood is
Arteries pumped into the systemic
circulation, decreased
Signs and symptoms of Tetralogy pulmonary circulation.
of Fallot Experiences tet spells or hypoxic
Pulmonary artery leaves the left episodes and relieved by squatting or
ventricle and the aorta exits from the put in the knee chest position.
right ventricle. Cyanosis because
Truncus Arteriosus Pulmonary artery and
aorta do not
separate. Blood
mixes in
the R and L ventricles through
a large VSD l/t cyanosis and
increased pulmonary
resistance.
Transposition of the Great Vessels and acyanotic defects.
Mixed blood flow.Pulm circulation
arises from L vent and systemic
circulation arises
from R vent. Incompatible with life -->
medical Therapeutic digoxin levels
emergency give prostaglandin to keep Check for murmur, cyanosis, clubbing
ductus open. (>age 2), poor feeding, FTT, fatigue,
Assessment of child with CHD respiratory infections
Maintain nutrition status with small
frequent meals with high-calorie
Feeding a child with CHD formula. Maintain hydration to prevent
thrombus formation.
arrhythmias, bleeding,
perforation, phlebitis, arterial
Risks of cardiac catheterization obstruction at entry site
Cyanotic: abnormal
Basic differences between cyanotic circulation, all blood entering
circulation is oxygenated Acyanotic: entering the systemic system
abnormal 0.8-2ng/ml
circulation with unoxygenated blood

Digoxin administration Check for

bradycardia and
hold. Do NOT
skip doses, not
miss with meals
Digoxin toxicity Vomiting is early sign,
also,
anorexia,
diarrhea, and
abdominal pain, fatigue,
muscle weakness
What exacerbates Digoxin toxicity?
Hypokalemia