Flashcards in Peds - Exam Two Deck (33)
How do you introduce solid foods to an infant?
Solids are introduced around 4 to 6 months of age
New foods should be introduced one at a time, over a 4 to 7 day period, to observe for signs of allergy or intolerance, which can include fussiness, rash, vomiting, diarrhea, and constipation
Vegetables or fruits are started first between 6 to 8 months of age
Citrus fruits, mean, and eggs are not started until after 6 months of age
Breast milk intake should decrease with the increased intake of solid foods
Table foods that are cooked, chopped, and unseasoned are appropriate by 9 months of age
What are some interventions to reduce unintentional injury?
Aspiration of foreign objects
o Small objects should be avoided
o Age-appropriate toys should be provided
o Clothing should be checked for safety hazards
o Sharp objects should be kept out of reach
o Anchor heavy objects and furniture
o Do not leave infants unattended with any animals present
o Check bath water temperature
o Working smoke detectors should be kept in the home
o Handles of pots and pans should be kept turned to the back of the stove
o Use sunscreen when outside
o Cover electrical outlets
o Do not leave infants unattended in the bath or near any water sources
o Keep crib mattresses in lowest position possible
o Restraints should be used in seats
o Place safety gates at the top and bottom of stairs
o Exposure to lead paint should be avoided
o Toxins and plants should be kept out of reach
o Keep cabinets with cleaning supplies locked
o Know the number for poison control
o Keep medications in child proof containers
o Use infant safe car seats
o Plastic bags should be avoided
o Keep balloons away from infants or keep an eye on infant if there is one around
o Keep pillows out of the crib
o Place infants on their back for sleep
What factors influence physiological response to medications?
Elimination of drug may take longer d/t immature liver enzyme system
Dosages are influenced by weight and height, differences in expected absorption, metabolism, and clearance
The nurse must calculate every medication to determine the safety of the dose before the medication is administered
What is implemented for airway obstruction?
Emergency abdominal thrusts and back blows are recommended to dislodge food or foreign bodies from the airway
o If object is visualized, it is removed trying not to push the object deeper into the throat
o If unsuccessful, infant is positioned prone with the head lower than the trunk, support head and neck, perform 5 forceful back blows, switch to have the infant on their back, deliver 5 thrust in the midsternal region
What restraints are used for IV insertion?
Mummy restraint is a short-term restraint that might be necessary for examination or treatments such as a venipuncture or placement of an NG tube
o Can be modified to expose an arm, leg, or chest as needed
How do you teach a parent to give medication?
Teach importance of administering the medication and completing the prescribed course of treatment
The use of teaspoon in the home is not advised for infants or children.
o Better to use a dropper, syringe, or measured cup
Do not mix the medication with formula, food, or water
Shake medication before giving it
Only scored tablets can be divided
Medications should be able to come in liquid, suspension, or chewable tablets
Do not chew ER tablets
Do not dilute medication in water
Never refer to medication as “candy”
Where should you assess a pulse rate?
Brachial artery, located inside the upper arm between the elbow and shoulder
What happens if you have an iron deficiency anemia left untreated?
In severe cases, the heart muscle becomes too weak to function. If this happens, heart failure follows
Children with long standing anemia may also show growth retardation and cognitive changes
Screening procedures are suggested at 9 and 24 months for full-term infants and earlier for low-birth-weight-infants
What do you administer ferrous sulfate with for a pediatric patient?
Vitamin C aids in absorption so it is suggested to administer the medication with juice
What foods are high in iron for infants?
Boiled egg yolk, liver, leafy green vegetables, Cream of Wheat, dried fruits, dry beans, crushed nuts, and whole-grain bread
What teaching would you give parents of a child with cryptorchidism?
Parents are told to teach the growing child the importance of self-examination of the testes
Why would a scrotum be enlarged unilaterally on a newborn?
Could indicate the presence of a hydrocele – excessive amount of fluid in the sac that surround the testicle, and it causes he scrotum to swell
What teaching would you give for a child with frequent UTI's?
Proper amounts of fluid to maintain sterility and flushing of the bladder
Encourage proper self-cleaning (wiping front to back)
Remind the child to void frequently
What interventions would be appropriate for a child with impetigo?
Parents are instructed to wash the lesion 3-4 times a day
Ointments may be used for topical application
Prevention of the disease by treating small cuts promptly is important
What assessment findings would you find for suspicion of Hirschsprungs?
Newborns – failure to pass meconium in first 24 to 48 hours
Infant – constipation, ribbon like stools, abdominal distention, anorexia, vomiting, and failure to thrive may be evident
What interventions for feeding a child with pyloric stenosis?
IV fluid to replenish fluid and electrolytes
Thickened feedings may be prescribed by the physician
The infant is burped before as well as during feedings to remove any gas accumulated in the stomach
Feedings are done slowly
The infant is placed on the right side after feedings to facilitate drainage into the intestines
Fowler’s position is preferred to aid gravity in passing milk through the stomach
What is the treatment of choice for intussusception?
Barium enema, with surgery scheduled if reduction is not achieved
o Recurrence rate after barium enema reduction is approx. 10%
What interventions are appropriate for GERD?
o Feedings can be thickened with cereal, which can help increase the caloric density
o After feeding, place in an upright position or propped on the left side
o The body is inclined about 30 – 40 degrees and the infant is held in place by a Fowler’s sling
What assessment finding would show ineffectiveness of treatment for gastroenteritis?
Bowel movements are not reduced by the interventions or medications given
What is the best way for a parent to prevent BPD?
Prevention of preterm births is the best way to prevent BPD
What is a preventative intervention for SIDS?
Infants should be placed on a firm mattress with no loose bedding surrounding the infant
The use of a pacifier may be protective
High risk infants – home apnea monitors have been used to warn parents of an impending problem and enable them to try and resuscitate the infant manually
Place child in a back-lying position
How would you clear an airway of an infant with a cold?
The nurse can teach the parent that instilling a few drops of saline solution into the nose and then suctioning with a bulb syringe is the best way to clear the nostrils.
What interventions would be effective for a child with meningitis?
Nursing responsibilities include performing frequent neurological checks and maintaining an accurate recording of the child’s vital signs and I&O
Room should be dimly lit and noise kept to a minimum
The nurse should carefully raise and lower the sides of the crib to avoid jarring the bed
The nurse avoids startling the child and so uses a soft voice and gentle touch
Frequent monitoring of the child’s vital signs is necessary
o A slow HR, irregular respirations, and increased BP may indicated an increased ICP
Why are infants susceptible to ear infections?
Their eustachian tubes are shorter, wider, and straighter
When infants lie flat for long periods, microorganisms have easy access from the eustachian tube to the middle ear
What immunizations should a 2 month receive?
Pneumococcal conjugate (PCV13)
What are signs of feeding readiness in an infant?
Interest in solid foods
Voluntary control of the head and turn
Disappearance of the extrusion reflex
How can a parachute reflex be assessed?
Thrusting the infant downward into the crib
o The infant will protectively extend the arms
How can you promote sensorimotor stimulation in a 1 year old?
What is a pincer reflex?
The use of the index finger and thumb to grasp an object