When preparing the room for an infant with bronchiolitis, which equipment is most important?
Oxygen tubing and facemask
Explanation: The treatment used for bronchiolitis is oxygen therapy, respiratory support, and fluid support.
What is a complication of cystic fibrosis?
Pneumothorax
Explanation: A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age.
What are some asthma triggers?
dust, mold, inhalants, chemicals, and pollen
Examples of children who are considered high risk and could benefit from the influenza vaccine
- immunocompromised
- have a chronic pulmonary
disease
- have had a congenital abnormality
- chronic renal or metabolic diseases
- sickle-cell disease
- HIV
- any type of neurological disorder (seizures).
The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breath. The signs the nurse noted indicate the child likely has:
Epiglottitis
Explanation: The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary.
The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family?
Encourage everyone in the family to use good hand-washing techniques.
Explanation: The child with cystic fibrosis has low resistance, especially to respiratory infections. For this reason, take care to protect the child from any exposure to infectious organisms. Good hand-washing techniques should be practiced by the whole family; teach the child and family the importance of this first line of defense. Practice and teach other good hygiene habits.
The nurse knows that when coughing and wheezing seems to be directly related to exercise, it is likely that the child will be able to be treated with:
a bronchodilator and mast cell stabilizers.
Explanation: Mast cell stabilizers are used to help decrease wheezing and exercise-induced asthma attacks. A bronchodilator often is given to open up the airways just before the mast cell stabilizer is used. Corticosteroids are anti-inflammatory drugs used to control severe or chronic cases of asthma. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma.
In the treatment of asthma, how are corticosteroids most often delivered?
Metered-dose inhaler (a hand-held plastic device that delivers a premeasured dose)
The school nurse is caring for a 12-year-old boy with a bloody nose. Which action would be most appropriate for the nurse to do?
Seat the child leaning forward and pinch the anterior portion of the nose closed.
Explanation: The child should sit up and lean forward. Apply continuous pressure to the anterior portion of the nose by pinching it closed. The bleeding usually stops within 10 to 15 minutes.. Lying down or tipping the head back may allow aspiration of the blood and should be avoided.
A child with a severe lower respiratory tract infection has been prescribed an antibiotic and a bronchodilator. Which treatment would be best for delivering the medication directly into the respiratory tract, as well as providing moisture to promote removal of mucus?
Nebulizer
Explanation: Nebulizers are mechanical devices that provide a stream of moistened air directly into the respiratory tract. Nebulizers also serve as an important means for the delivery of respiratory tract medications. Drugs such as antibiotics or bronchodilators can be combined with the nebulized mist and sprayed into the lungs.
What are signs/symptom of bacterial pharyngitis?
- fever
- elevated white blood count (WBC)
- abrupt onset
- headache, sore throat
- abdominal discomfort
- enlargement of tonsils
- firm cervical lymph nodes.
Pancreatic enzymes are part of the treatment in cystic fibrosis. When should the nurse administer the enzymes?
Before meals and snacks with milk
Explanation: Enzymes should be administered before all meals and snacks to help in normal absorption of nutrients from the food.
The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease?
Open capsule and sprinkle on food
Explanation: Pancreatic enzymes come in capsules that can be swallowed or opened and sprinkled on the child's food.
How long are newborns obligatory nose breathers?
Newborns are obligatory nose breathers until at least 4 weeks of age
What can cause bronchiolitis?
Acute bronchiolitis is caused by a viral infection, most often, respiratory syncytial virus. Viruses are often spread between groups of people in close contact.
Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of a child with possible cystic fibrosis?
Sweat sodium choloride test
What is a common, serious complication of epiglottitis?
Respiratory distress
Explanation: If the airway becomes completely occluded due to epiglottitis, respiratory distress may lead to respiratory arrest and death.
What is most important for the treatment and management of asthma?
Prevention by eliminating allergens
Explanation: Families must make every effort to eliminate any possible allergens from the home. Prevention is the most important aspect in the treatment of asthma. Learning how to use a peak flow meter, using a peak flow and symptom diary, and having the medications available are important aspects of treatment, but prevention is the best.
What is the most common debilitating disease of childhood among those of European descent?
Cystic fibrosis
Explanation: Cystic fibrosis is the most common debilitating disease of childhood among those of European descent. Medical advances in recent years have greatly increased the length and quality of life for affected children, with median age for survival being the late 30s.
The nurse is caring for a 6-month-old infant who has chronic apneic episodes. Which intervention should the nurse place in the plan of care?
Place on a cardiopulmonary monitor and do frequent assessments.
Explanation: The optimal treatments for kids with chronic apnea are hospitalization, frequent monitoring and observation, and parent education. The nurse should continuously monitor the infant on a cardiopulmonary monitor; frequently assess color, breathing patterns, and effort; and assess tone.
How does a pediatric patient's trachea compare to an adult?
Pediatric airways are much smaller in diameter and shorter in length than in adults.
Explanation: A newborn trachea is 4 mm long, a toddler's is 7 mm long, and a teenager's is 12 mm long.
A child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Which breath sounds are congruent with the clinical presentation of the child?
Respiratory stridor
Explanation: Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. The child presents in severe respiratory compromise and struggles to breathe.
A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. What would the nurse instruct the mother to do first?
"Have him use his short-acting bronchodilator right away."
Explanation: The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the HCP's office or emergency room.
Pneumonia is a disorder involving infection and inflammation of the ________
Alveoli
Explanation: Pneumonia is a disorder involving infection and inflammation of the alveoli. Bronchitis is inflammation and infection of the fine bronchioles and bronchi.
What happens when edema, mucus, or bronchospasm is present in the infant's trachea?
The capacity for air passage is greatly diminished. A small reduction in the diameter of a child's airway (resulting from the presence of edema or mucus) will result in an exponential increase in resistance to airflow. Increased work of breathing (effort or labor associated with respiration) then occurs.
What is the primary goal of therapeutic management of children with an intellectual disability?
To provide appropriate educational experiences that allow the child to achieve a level of functioning and self-sufficiency needed for existence in the home, community, work, and leisure setting
What are some risk factors for developmental disabilities?
- preterm or postterm birth, low birthweight
- birth injury
- prenatal or neonatal infection
- prenatal alcohol or drug exposure
- genetic syndrome, chromosomal alteration,
- metabolic disease
-
exposure to toxins (e.g., lead)
- head injury or other trauma
- nutritional deficiency
- cerebral malformation, and other brain disease or mental health disorder
What is the most sensitive early indicators of intellectual disability?
Delayed language development
Explanation: Due to the extent of cognition required to understand and produce speech, the most sensitive early indicator of intellectual disability is delayed language development.
What is the goal of therapeutic management for children with autism?
There are no medications or treatments available to cure autism. The goal of therapeutic management is for the child to reach optimal functioning within the limitations of the disorder.
What are some warning signs of autism for infants and toddlers?
Not babbling by 12 months
Not pointing or using gestures by 12 months
No single words by 16 months
No two-word utterances by 24 months
Losing language or social skills at any age
What is a genetic disorder caused by the presence of all or part of an extra 21st chromosome?
Trisomy 21 (Down syndrome)
Some early signs of down syndrome
- Flattened nose, and face
- Upward slanting eyes
- Single palmer crease (Simian
crease)
- Short 5th finger that curves inward
- Widely separated first and second
toe
Early behavioral signs of cognitive impairment
- Non-response to contact, voice, movement
- Irritability
- Poor/slow feeding
- Poor eye contact
-
Diminished spontaneous activity
What is a syndrome?
A recognized pattern of malformations with a single, specific, anatomic, physiologic or biochemical cause
Rank the order in which the nurse should administer asthma medications as the child's condition worsens.
1) Albuterol as needed
2) Low-dose inhaled corticosteroid
3) Medium-dose inhaled corticosteroid
4) Medium-dose inhaled corticosteroid and salmeterol
Explanation: The first step is to administer a short acting beta 2-agonist as needed. The second step is to administer a low-dose inhaled corticosteroid. The third step is to administer a medium-dose inhaled corticosteroid. The fourth step is to administer a medium-dose inhaled corticosteroid and a long-acting beta 2-agonist.
The nurse suspects epiglottitis based on which signs and symptoms?
- High fever
- Muffled voice
- Sever sore throat
- Dysphagia
- Drooling
- Sitting with neck distended
- Severe respiratory distress
Explanation: Epiglottitis is manifested by a sudden onset of symptoms and high fever. The child has an overall toxic appearance and may refuse to speak or speak only in a very soft voice. The child may assume the characteristic position of sitting forward with the neck extended. Drooling may be present but a cough is usually absent. The child may appear frightened or anxious.
What is the shape of the larynx in infants?
Funnel
Explanation: In infants and children (younger than the age of 10 years), the cricoid cartilage is underdeveloped, resulting in laryngeal narrowing and a funnel-shaped larynx. In teenagers and adults, the larynx is cylindrical and fairly uniform in width.
A 2-year-old boy is seen for acute laryngotracheobronchitis. What observation would lead the nurse to suspect airway occlusion?
Respiratory rate is gradually increasing, retractions, nasal flaring
Explanation: Acute laryngotracheobronchitis is also know as croup. It produces edema of the larynx, trachea and bronchi. An increasing respiratory rate, retractions and nasal flaring are signs of major respiratory distress and occlusion. The child is breathing faster because less air is received with each breath. The cough of croup is due to the inflammation in the larynx and trachea and it is a barking cough (sounds like a seal). A 2 year old will become tired and fall asleep or be irritable and unable to fall asleep.
Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis?
Assisting with racemic epinephrine nebulizer therapy
Explanation: Croup is a viral infection which causes inflammation and edema of the larnyx, trachea, and bronchi. One form of treatment is the use of nebulized racemic epinephrine. Racemic epinephrine is a alpha adrenergic agent. It works on the mucosal vasonstriction to reduce the edema.This increases the lumen of airways allowing for bettter intake of air.The child should not be offered fluids as this is an aspiration risk and analgesics will not reduce swelling
Signs of pneumonia in children
Children with pneumonia may exhibit the following: a chest x-ray with perihilar infiltrates, an elevated leukocyte level, an increased respiratory rate, and a productive cough. The child with pneumonia typically has a fever.
Which acute respiratory condition is the most common in early childhood?
Croup
Explanation: Croup is the most common acute respiratory condition in early childhood (3 months to 3 years). The cardinal sign is a "barking cough." Croup is an upper airway obstruction caused by some type of inflammation.
The caregivers of a 2-year-old who has had a common cold for 4 days calls the nurse in the emergency department at 2 AM on a cold winter night to say that the child has awakened with a barking cough and an elevated temperature; she seems blue around her mouth. The nurse would most appropriately recommend what action to the caregiver?
"Bring the child to the emergency room immediately."
Explanation: Acute laryngotracheobronchitis generally occurs after an upper respiratory infection with fairly mild rhinitis and pharyngitis. The child develops hoarseness and a barking cough with a fever that may reach 104° F (40° C) to 105° F (40.6° C). As the disease progresses, marked laryngeal edema occurs and the child's breathing becomes difficult; the pulse is rapid and cyanosis may appear. Heart failure and acute respiratory embarrassment can result. The child needs to be treated immediately.
A 5-year-old girl who was already admitted to the hospital for an unrelated condition suddenly becomes irritable, restless and anxious. These may be early signs of respiratory distress in a child if accompanied by:
Tachypnea
Explanation: Restlessness, irritability, and anxiety result from difficulty in securing adequate oxygen. These might be very early signs of respiratory distress, especially if accompanied by tachypnea (an increased respiratory rate).
A worried mother calls the nurse and tells her that her son has developed a horrible croup cough and is having trouble breathing. What would be the best intervention for the nurse to recommend to the mother?
Run a hot shower to fill the bathroom with steam and have the boy stay there.
Explanation: One emergency method of relieving croup symptoms is for a parent to run the shower or hot water tap in a bathroom until the room fills with steam, then keep the child in this warm, moist environment as this relaxes the airway tissues and widens the bronchi lumens. If this does not relieve symptoms, parents should bring the child to an emergency department for further evaluation and care. Caution parents not to give cough syrup routinely to children as many produce little effect and the risk of overdose, incorrect dosing, and adverse events is greater than the benefit of the syrup.
A dramatic increase in head circumference is a could indicate?
Hydrocephalus
A patient is 6 weeks' pregnant. She reports that over the last 2 months she has been drinking excessive amounts of alcohol every weekend and smokes a half-pack of cigarettes per day. What is the nurse concerned with given this information?
Brain development in the fetus
Spinal cord development in the fetus
Explanation: The brain and spinal cord make up the central nervous system (CNS). Development of these structures begins in the first 3 to 4 weeks of gestation from the neural tube. Infection, trauma, teratogens (any environmental substance that can cause physical defects in the developing embryo and fetus), and malnutrition during this period can result in malformations in brain and spinal cord development and may affect normal CNS development.
The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess?
- Eye opening
- Verbal response
- Motor response
Explanation: The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor response.
A 2-year-old boy with hydrocephalus has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?
"Watch for changes in his behavior or eating patterns."
Explanation: Changes in behavior or in eating patterns can suggest a problem with his shunt, such as infection or blockage. Irritability, lack of appetite, increased crying, or inability to settle down may indicate increased intracranial pressure.
The nurse is examining a child with fetal alcohol syndrome (FAS). Which assessment finding should the nurse expect?
Typical FAS facial features include a low nasal bridge with short upturned nose, flattened midface, and a long philtrum with narrow upper lip. Microcephaly rather than macrocephaly is associated with FAS.
T or F: a child with Down Syndrome should delay immunizations
False
Explanation: Down syndrome children are at higher risk for infection because of a lowered immune system. Delaying immunizations may expose the child to illnesses that could have been prevented. Down syndrome children are at greater risk for developing thyroid disorders, 1st and 2nd vertebrae disorders, and respiratory infections.
Infants and young children have increased absorption of topical medications due to
Infants and young children have a greater body surface area, leading to increased absorption of topical medications.
When preparing to administer medication to an infant, the nurse should utilize which device?
Oral syringe without a needle
Explanation: When administering medication to an infant an oral syringe without a needle or a dropper may be used. Medication should not be mixed with the infant's formula.
While teaching parents how to effectively reduce the child's fever, the nurse should emphasize avoiding which medication?
acetylsalicylic acid
Explanation: Caution parents to never give acetylsalicylic acid (aspirin) to children with fever because aspirin is associated with Reye's syndrome, a severe neurologic disorder.
The nurse is preparing to administer a medication via a syringe pump. Which is the priority nursing action?
Verify the medication order
Explanation: The priority nursing action is to verify the medication ordered. The first step in the eight rights of pediatric medication administration is to ensure that the child is receiving the right medication. After verifying the order, the nurse would then gather the medication, the necessary equipment and supplies, wash hands and put on gloves.
The nurse is preparing to administer a vaccine to a 6-month-old child. The medication is to be given intramuscularly. The nurse is correct in choosing which administration site?
Vastus lateralis site
Explanation: The preferred injection site for infants less than 7 months old is the vastus lateralis muscle. In infants and children greater than 7 months old the ventrogluteal site should be considered. The dorsogluteal site, often used in adults, is not recommended in children younger than 5 years of age.
An infant is to receive a hepatitis B vaccine within a few hours after birth. What is the best approach for the nurse to take when giving this medication?
Administer the medication in the infant's vastus lateralis with a 25-gauge needle.
Explanation: The vastus lateralis site is a safe choice for IM injections in an infant. A 25-gauge needle is recommended for infants. The dorsogluteal site should not be used until the child has been walking for 1 year.
As the nurse prepares to administer a medication to a preschooler, she realizes that the child is extremely underweight for her age. What action would the nurse take?
Measure her height and weight, and check whether the dose is correct for her.
Explanation: Before any medicine is administered, it should be confirmed that the dose is correct for the child's weight and height because of the great variability in these areas.
A nurse is administering ear drops to a 7-year-old girl. What should the nurse do?
Pull the pinna of the ear up and back to straighten the external ear canal.
Explanation: Remind the child ear drops can feel odd, as if someone were tickling the ear. Ear drops must always be used at room temperature or warmed slightly as cold fluid, such as medication taken from a refrigerator, does cause pain and may also cause severe vertigo as it touches the tympanic membrane. If the child is older than 2 years, pull the pinna of the ear up and back. Instill the specified number of drops into the ear canal. Hold the child's head in the sideways position while you count to 60 to ensure the medication fills the entire ear canal
The distribution (movement of a drug from the blood to interstitial spaces and then into cells) of medications is altered in infants and young children. Medication distribution in children is affected by:
- Higher percentage of body water than adults
- More rapid extracellular fluid exchange
- Decreased body fat
- Liver immaturity, altering first-pass elimination
- Decreased amounts of plasma proteins available for drug binding
- Immature blood-brain barrier, especially in neonates, allowing permeation by certain
medications
How is metabolism of medications altered in children when compared to adults?
Differences in hepatic enzyme production and the child's increased metabolic rate.
In infants and young children, the absorption of orally administered medications is affected by:
slower gastric emptying, increased intestinal motility, a proportionately larger small intestine surface area, higher gastric pH, and decreased lipase and amylase secretion compared with adults.
What are guidelines to determine the correct dose by body weight?
1. Weigh the child.
2. If the child's weight is in pounds, convert it to kilograms (divide the child's weight in pounds by 2.2).
3. Check a drug reference for the safe dose range (e.g., 10 to 20 mg/kg of
body weight).
4. Calculate the low safe dose
5. Calculate the high safe dose
6. Determine if the dose ordered is within this range.
FLACC stands for
Face, legs, Activity, Crying, Consolability
The two most common methods for determining pediatric drug doses involve the use of the child's
weight and BSA
Why should a child younger than the age of 5-6 receive medications in liquid form?
Children younger than the age of 5 to 6 are at risk for aspiration when receiving tablets or capsules because they have difficulty swallowing them; liquids may be more appropriate.
Why is IM administration in children often avoided?
IM administration is used infrequently in children because it is painful and children often lack the adequate muscle mass.
The nurse working in pediatrics is aware of the special needs of children related to pain assessment. What is the highest priority for the nurse to consider when completing a pain assessment?
Developmental age of child
Explanation: The highest priority to provide an appropriate pain assessment is knowing the developmental age of the child. The chronological and developmental ages may differ and care needs to be based on both, but the type of pain assessment tool used will be based on the developmental age. For children who are nonverbal the nurse needs to also consider the mother's statement of pain in the child.
A nurse is preparing to give an injection to a 7-year-old who appears afraid and hesitant. The nurse tells the child that it is OK to say "ouch" when the shot is given using which client pain control technique?
Distraction
Explanation: Telling a child to say "ouch" while an injection is administered is the simplest use of distraction.
How old should a child be to use the numerical pain scale?
8 years old