NUR2513 Exam 3 Blueprint FINAL

2513 Exam Blueprint Modules: Dosage calc 7 (Chp 34, 38, 40, 41): Interventions for hospitalized peds client, Respiratory, Cardiac Diseases/Disorders ● What are techniques for administration of ear drops (less than 2 versus older than 2) Turn the child or ask the child to turn onto his or her back or use restraint as necessary. Turn the child’s head to one side. The slant of the ear canal in children. If the child is younger than 2 years of age, straighten the external ear canal by pulling the pinna down and back. If the child is older than 2 years of age, 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 to ensure the medication fills the entire ear canal. Praise the child for cooperating during this difficult procedure ● What are tips for helping a child take oral medication? Available in preparations (liquids, chewables, and meltaways). Determine the child’s ability to swallow pills. Use the smallest measuring device for doses of liquid medication. Use an oral medication syringe for smaller amounts, and a medication cup for larger amounts. Avoid measuring liquid medication in a teaspoon or tablespoon. Use rigid plastic cups instead of paper cups for liquid medications. Avoid mixing medication with formula or putting it in a bottle of formula because the infant might not take the entire feeding, and the medication can alter the taste of the formula. Hold the infant in a semi-reclining position similar to a feeding position. Hold the small child in an upright position to prevent aspiration. Administer the medication in the side of the mouth in small amounts. This allows the infant or child to swallow. Only use the droppers that come with the medication for measurement. Stroke the infant under the chin to promote swallowing while holding cheeks together. Teach the child to swallow tablets that aren’t available in liquid form and can’t be crushed. Teach in short sessions using verbal instruction, demonstration, and positive reinforcement. Provide atraumatic care. Mix the medication in a small amount of sweet nonessential food (applesauce or sherbet). Offer juice, a soft drink, or snack after administration. Add flavoring to medications as available. Use a nipple to allow the infant to suck the medication. Reward small child with a prize or sticker afterwards. Administer medications via a feeding tube. Confirm placement. Use liquid formulation. Do not add medication to the formula bag. If administering several medications, flush tubing with water after the administration of each medication. ● What are teaching tips for use of a metered-dose inhaler? A metered-dose inhaler (MDI) is a handheld device that provides a route for medication administration directly to the respiratory tract. The child inhales while depressing a trigger on the apparatus. For successful use, children need to follow five general rules: shake the canister, exhale deeply, activate the inhaler and place it in their mouth as they begin to inhale, take a long slow inhalation, and then hold their breath for 5 to 10 seconds. Caution them to take only one puff at a time, with a 1-minute wait between puffs. Coordinating inhalation with MDI use can be difficult; therefore, use of an aerochamber (spacer) is generally recommended to prevent deposition on the posterior pharynx. Younger children can use an MDI attached to an aerochamber with a mask. All children using inhaled corticosteroids need an aerochamber to prevent deposition of the medication in the mucous membranes of the mouth and pharynx, which can contribute to the development of thrush. Instruct the child and guardians to clean the MDI and spacer after each use and to have the child rinse out the mouth and expectorate. -Do not shake the device. -Take the cover off the mouthpiece. -Follow the directions of the manufacturer for preparing the medication (turning the wheel of the inhaler). -Exhale completely. Place the mouthpiece between the lips and take a deep breath through the mouth. -Hold breath for 5 to 10 seconds. -Take the inhaler out of the mouth and slowly exhale through pursed lips. Resume normal breathing. -If more than one puff is prescribed, wait the length of time directed before administering the second puff. -Remove the canister and rinse the inhaler, cap, and spacer once a day with warm running water. Dry the inhaler before reuse. ● What’s important to know about the newborn/infant nose and breathing? What assessments are important? p. 932 Infants are obligate nose breathers. They cannot coordinate mouth breathing, so they become disturbed when the nose is temporarily blocked to check for patency; do this only momentarily to avoid discomfort. Most newborns have milia (i.e., small white papules) on the surface of the nose, which are of no consequence and disappear without treatment. Observe the nose for flaring of the nostrils (a sign of a need for oxygen). Using an otoscope light, observe the mucous membrane of the nose for color—it should be pink; pale suggests allergies, and redness suggests infection. Note and describe any discharge. Document the septum is in the midline because a displaced septa such as those that occur after facial injuries can interfere with respiration and make nasal intubation in emergencies difficult. Gently press one nostril closed and ask the child to inhale. Repeat on the opposite side to ensure both sides of the nose are patent; that is, no choanal atresia or membrane obstructing the posterior nares exists. Sinuses do not fully develop until about 6 years. ● What are signs of dehydration? (see below) -Mild WEIGHT LOSS 3% to 5% in infants, 3% to 4% in children MANIFESTATIONS: Behavior, mucous membranes, anterior fontanel, pulse, and blood pressure within expected findings, Capillary refill greater than 2 seconds, Possible slight thirst -Moderate WEIGHT LOSS 6% to 9% in infants, 6% to 8% in children MANIFESTATIONS: Capillary refill between 2 and 4 seconds, Possible thirst and irritability, Pulse slightly increased with normal to orthostatic blood pressure, Dry mucous membranes and decreased tears and skin turgor, Slight tachypnea, Normal to sunken anterior fontanel on infants -Severe WEIGHT LOSS Greater than 10% in infants, 10% in children MANIFESTATIONS: Capillary refill greater than 4 seconds, Tachycardia present, and orthostatic blood pressure can progress to shock,Extreme thirst, Very dry mucous membranes and tented skin, H