ATI PEDS: Quiz 2 Study Guide Chapters: ATI 15-19 & 42-44; Book 19-20 & 28I

ATI PEDS: Quiz 2 Study Guide Chapters: ATI 15-19 & 42-44; Book 19-20 & 28I   PEDS: Quiz 2 Study Guide Chapters: ATI 15-19 & 42-44; Book 19-20 & 28I Chapter 15- Cognitive & Sensory Impairments • Visual impairments • Myopia (nearsightedness) - Sees close objects clearly but NOT objects in the DISTANCE • Headaches, vertigo, eye rubbing, difficulty reading, clumsiness (freq. walking into objects) & poor school performance • Hyperopia (farsightedness) - Sees distant objects clearly but NOT object that are CLOSE • Because of accommodation, not detected until 7 yrs • Astigmatism - Uneven vision in which only parts of letters on a page can be seen • Headache, vertigo • Appearance of normal vision because tilting the head enable all letters to be seen • Anisometropia - Diff. refractive strength in each eye • Headache, vertigo, excessive eye rubbing & poor school performance • Amblyopia (lazy eye): reduced visual acuity in one eye • Strabismus: esotropia- (inward deviation of eye); exotropia (outward deviation of eye) • Abnormal corneal light reflex or cover test • Misaligned eye • Frowning or squinting • Diff. seeing print clearly, one eye closed to enable better vision, head titled to one side • Headache, dizziness, diplopia, photophobia & crossed eyes • Cataracts- decreased ability to see clearly • Possible loss of peripheral vision, nystagmus, strabismus, gray opacity of the lens, absence of red reflex • Glaucoma- buildup of pressure inside the eye • Loss of peripheral vision, perception of halos around objects, red eye, excessive tearing (epiphora), photophobia, spasmodic winking (blepharospasm), corneal haziness, enlargement of the eyeball (buphthalmos), possible pain • Visual screening- ** 20/20 reached by age 6** • Snellen letter • Tumbling E • Tracking – used in infants • Hearing Impairments ** can affect speech & ability to hear** • Hearing defects are associated w/ chronic conditions (down syndrome & CP) • Conductive loss – involve interference of sound transmission • Caused by otitis media, external ear infection, foreign bodies or excessive ear wax • Sensorineural losses- involve interference of the transmission along the nerve pathways • Caused by congenital defects or secondary to acquired conditions (infection, ototoxic med, exposure to constant noise) • Central auditory imperception – involves all other hearing losses (aphasia, agnosia [inability to interpret sounds]) • Expected findings: • Infants – lack of startle reflex, failure to respond to noise, absence of vocalization by 7 months, lack of response to the spoken word • Older children- using gestures rather than talking after 15 months, failure to develop understand speech by 24 months, yelling to express emotion, irritability due to inability to gain attention, seeming shy or withdrawn, inattentive to surroundings, speaking in monotone, need for repeated conversation, speaking loudly for situation • Nursing care • Assess children for hearing impairment • Promote speech development, lip reading & use of cued speech (hand gesture w/ verbal communication) • Assess gait/balance for instability • Encourage self-care & optimal independence • Make referrals – social services, speech therapy, PT, occupational therapy, teachers • Otitis Media – ** Pina; down & back [less than 3 yrs • Middle ear infection- • Expected findings • Fever, purulent drainage ( if the tympanic membrane is ruptured) & pain – demonstrated by the pt tugging @ the ear • Down syndrome – Trisomy 21 • Many medical conditions w/ down syndrome: • Congenital heart malformation, hypotonicity, dysfunction of the immune system, thyroid dysfunction, leukemia • Expected findings • Protruding tongue, separated sagittal suture, enlarged anterior frontanel, flattened forehead, upward & outward slant eyes, small ear w/ short pinna, transverse palmar crease, short stature, hyperyflexibility, muscle weakness & hypotonic musculature • Dx • Prenatal: testing for alpha fetoprotein in maternal serum • Infant: chromosome analysis & echocardiography • Complications: • Mental capacity varies typically from mild to moderate cognitive impairment • Social development can be 2 to 3 yrs beyond the mental age • Freq. resp tract infections • Increased incidence of leukemia • Thyroid dysfunctions • Sensory problems: • Ocular problems – strabismus, nystagmus, astigmatism, myopia, hyperopia, head tilt, excessive tearing & cataracts • Hearing loss- occurs in a large of children w/ down syndrome; freq. otitis media, narrow canals & impacted cerumen can contribute to hearing problems • Oxygen & Inhalation therapy [pg 83] • Nebulized aerosol therapy • Instruct the child & family that tx can take 10 – 15 min • Determine if the child should use a mouthpiece, mask or blow- by • Assess (v/s & oxygen saturation) • Pour the med into the small container & attach the device to an air or oxygen source • Instruct pt to take a slow, deep breathe by mouth • Monitor for local tracheal or bronchial effects (spams, edema) • Metered- dose inhaler or dry powder inhaler • Metered dose inhaler - “shake meter” • inhaling deeply & then exhaling completely is the (1st step) • the client should place her lips firmly around the mouthpiece to direct the spray to the airways, then breathe in deeply over 2 to 3 seconds while pushing down on the canister. • This slow, deep inhalation directs the medication down into the lower respiratory tract. • Holding her breath for 10 seconds is next; it allows time for absorption of the medication. 5. Then, pursed-lip breathing keeps the small airways open during slow exhalation. • And finally, waiting 60 seconds between puffs allows for deeper penetration of the medication into the respiratory tract. • Dry powder inhaler- “do NOT shake meter” • Do NOT shake the device • Exhale completely & place the mouthpiece between the lips & take a deep breath thru the mouth; hold breath for 10-15 sec • Take inhaler out of the mouth & slowly exhale thru pursed lips • Monitor for fungal infections & teach the pt to rinse mouth after each use • Spacer • Toddler; face mask w/ spacer • School age ; just use a spacer • Chest physiotherapy – manual/ mechanical percussion, vibration, cough, forceful expiration (huffing) & breathing exercises to loosen respiratory secretions. • Do NOT do this if pt has a pulmonary embolism, cardiac reserves or increased intracranial pressure • Sch tx before meals & @ least 1 hr after meals & at bedtime to decrease likelihood of vomiting or aspirating • Admin bronchodilator / nebulizer (tx prior to postural drainage • Suctioning – removal of mucus plug & excessive secretions • Endotracheal & tracheal suctioning • Step by step: • Nurse should adjust the suction • Don sterile gloves • Nurse should check the function of the suction catheter by suctioning a small amount of solution into the tubing • hyperoxygenate the pt using manual resuscitation bag • Insert suction catheter WITHOUT suction & apply suction for more than 10 sec while rotating the catheter pulling out • Limit suction time to less than 5 sec for infants & less than 10 for children • Allow the child to rest 30 to 60 sections after each aspiration for oxygen saturation to return to normal • Monitor for hypoxia – STOP procedure & hyperoxygenate the child • Acute & Infectious respiratory illness • Tonsillitis – inflammation & reddened of the tonsils (GABHS) • Expected findings- sore throat w/ dif. swallowing; hx of otitis media & hearing difficulties • Mouth odor, mouth breathing, snoring, nasal qualities in the voice, fever, tonsil inflammation w/ redness & edema • Throat culture for group A beta hemolytic streptococci (GABHS) • Provide symptomatic tx for viral tonsillitis • Warm fluids, rest, warm salt gargles • Admin abx therapy for bacterial tonsillitis • Medications • Acetaminophen – antipyretics • Abx – teach pt to take full course of tx • Tonsillectomy – surgery to remove tonsils • Assess for evidence of bleeding; freq. swallowing, clearing the throat, restlessness, bright red emesis, tachycardia &/or pallor • Assess airway & v/s • Hypotension is a late sign of shock!! • Monitor for diff breathing related to oral secretion, edema, bleeding • Monitor for hemorrhage, dehydration, chronic infection • Infected tonsils w/ GABHS can pose a threat to other parts of the body; some can develop rheumatic fever & kidney infection • Full recovery takes about 14 days • Comfort measures: • Admin analgesics or tetracaine lollipops • Provide ice collar, ice chips or sips of water to keep throat moist • Encourage clear liquids- AVOID red colored liquids, citrus juice & milk-based food initially • Discourage coughing, throat clearing & nose blowing in order to protect site • AVOID straws; can damage surgical site • Monitor clots or blood tinged mucus in vomitus • Acute streptococcal pharyngitis – infection of the upper airway (strep throat) • Expected findings- tonsils & pharynx can be inflamed & covered w/ exudate; headache , fever & abdominal pain • Throat culture or rapid antigen testing to determine GABHS infection • Admin IV abx & antipyretics for fever • Oral penicillin – admin for @ least 10 days • Amoxicillin once da day for 10 days is also effective • IM penicillin G benzathine is also appropriate • Oral erythromycin for children allergic to penicillin • Bronchitis (tracheobronchitis) – URI & inflammation of large airways • Most common cause is because a virus; cough occurs most @ night • Home management; give antipyretics for fever & cough suppressant ; provide increased humidity ( cool mist vaporizer) • Bronchiolitis – MOSTLY CAUSED BY RSV!! (affects the bronchi & bronchioles) ** most common hospitalization for infants • NO MED GIVEN; JUST SYMPTOM MANAGEMENT • Expected findings (INITALLY); rhinorrhea, intermittent fever, pharyngitis, coughing, sneezing, wheezing, possible ear or eye infection • w/ illness progression: increased coughing & sneezing, fever, tachypnea & retractions, refusal to nurse or bottle feed, copious secretions • severe illness: tachypnea (greater than 70/min) listlessness, apneic spells, poor air exchange, poor breath sounds, cyanosis • Test nasopharyngeal sections; RSV antigen detection - lab testing • Nursing care • Oxygen to maintain oxygen saturation • Fluid intake (oral) if unable – IV fluid intake • Corticosteroid use is controversial & bronchodilator are NOT recommended; abx if coexisting bacterial infection is present • CPT is NOT recommended • Nasopharyngeal or nasal suctioning as needed • Encourage breastfeeding • Allergic rhinitis – caused by seasonal reaction to allergens (autumn & spring) • Expected findings: watery rhinorrhea, nasal obstruction, itchiness of the nose, eyes, pharynx & conjunctiva, snoring fatigue, malaise, headache & poor performance in school • Transverse line on nose • Nursing care • AVOID allergens • Give nasal corticosteroids (1st line med used) • Give antihistamines (Claritin & Zyrtec), beta-adrenergic decongestants, mast cell stabilizers, leukotriene modifiers & ipratropium • Pneumonia • Expected findings: high fever, cough productive (white sputum) & unproductive, tachypnea, retractions & nasal flaring, chest pain, dullness w/ percussion, rhonchi (fine crackles) , pale color that progresses to cyanosis, irritability, restless, lethargic, abdominal pain, diarrhea, lack of appetite & vomiting • Lab testing: ( x-ray & culture) • Radiographic examination to detect presence of infiltrates • Gram strain & culture of sputum in older children • Nasopharyngeal specimens • Blood cultures • Occasionally lung aspiration & biopsy • Viral – most common • Admin oxygen w/ cool mist • Monitor continuous oximetry • Admin antipyretics for fever • Monitor I & O; CPT & postural drainage • Bacterial • Encourage rest & admin IV abx • Promote increased oral intake; monitor I & O • Admin antipyretics for fever • CPT & postural drainage • Admin IV fluids & oxygen; monitor continuous oximetry • Complications • Pneumothorax & pleural effusion (accumulation of fluid in the pleural space) • Acute spasmodic laryngitis – VIRAL! ** least dangerous** • Etiology – allergies • Paroxysmal attacks of laryngeal obstruction that occur mainly @ night; self-limiting & can result from allergens • Expected findings-croupy barky cough, restlessness, diff breathing, hoarseness & nighttime episodes of laryngeal obstruction • Nursing care • Humidity w/ cool mist, admin oxygen, monitor oximetry, admin nebulized racemic epi ; admin corticosteroids ; oral or IM ( dexamethasone) or nebulized (budesonide) , IV fluids, encourage oral intake • Acute laryngotracheobronchitis- VIRAL! ** croup** • Etiology- caused by RSV & parainfluenza • Expected findings- low grade fever, restlessness, hoarseness, barky cough, dyspnea, inspiratory stridor & retractions • Infants & toddler- nasal flaring, intercoastal retractions, tachypnea & continuous stridor • Nursing care • Humidity w/ cool mist, admin oxygen, monitor oximetry, admin nebulized racemic epi ; admin corticosteroids ; oral or IM ( dexamethasone) or nebulized (budesonide) , IV fluids, encourage oral intake • Bacterial tracheitis • Epiglottitis – MOST DANGEROUS – BACTERIAL! • Caused by Haemophilus influenza; MEDICAL EMERGENCY!!! • Expected findings- • Predictive sign; absence of cough, drooling & agitation • Tripod position- sitting upright w/ chin pointing out, mouth opened & tongue protruding • Dysphonia (thick, muffled voice & froglike croaking sound) • Dysphagia ( diff. swallowing) • Inspiratory stridor (noisy inspirations) • Suprasternal & substernal retractions • Sore throat, high fever & restlessness • Dx procedures – lateral neck radiograph of the soft tissues • Nursing care • Protect airway • AVOID throat culture or using tongue blade • Prepare for intubation • Provide humidified oxygen • Monitor continuous oximetry • Admin corticosteroids, IV fluids, admin abx starting w/ IV then transition to oral to complete 10 day course • Droplet isolation precautions for the 1st 24 hrs after IV abx initiated • Asthma [pg. 99] • Expected findings • Chest tightness, hx regarding current & previous asthma exacerbations • Physical findings- dyspnea, cough, audile wheezing, coarse lung sounds, wheezing thru out possible crackles, mucus production, restlessness, irritability, anxiety, sweating, use of accessory muscles, decreased oxygen saturation (low SaO2) • Medications- • Bronchodilator (inhalers) • Short acting beta – SABA – (albuterol, levalbuterol, terbutaline) Used for actute exacerbations & prevention of exercised induced asthma • Long acting beta – LABA (formoterol, salmeterol) Used to prevent exacerbations, especially @night & reduce use of SABA; must be used along side w/ anti-inflammatory therapy; CANNOT be used to treat acute exacerbations!! • Cholinergic antagonists- anticholinergic med; atropine, ipratropium) -blocks the parasympathetic nervous system , providing relief of acute bronchospasm • Teach proper use of metered dose inhaler or nebulizer; monitor for tremors & tachycardia when taking albuterol; observe dry mouth when taking ipratropium • Ipratropium- instruct child to suck on hard candies to help w/ dry mouth • Anti-inflammatory • Corticosteroids- methylprednisolone (parenterally) ; prednisone (oral) ; fluticasone (inhalation) Inhaled steroids are admin daily as a preventive measure Oral steroids can be given for short periods (3 to 10 days) • Cystic Fibrosis [pg 105]