2513 Exam Blueprint
Modules:
Dosage calculation
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
○ For children 2 and under, pull pinna down and back
○ For children over the age of 2, up and back
○ Administer at room temperature or warm- preventing severe vertigo
○ Instill drops into ear canal
○ Hold child’s head in that position to ensure it fills entire canal
● What are tips for helping a child take oral medication?
○ In infants, oral medication can be given with a medicine dropper or a unit-dose
oral syringe
○ Gently restrain the child’s arms/head by holding the child against your body with
the head raised. gently open the mouth by pressing on the child’s chin or gently
squeezing the child’s cheeks. Be certain the end of the syringe or dropper rests
at the side of the infant’s mouth to help prevent aspiration
○ Infants may be given with a small spoon or cup
■ May associate syringes with needles
○ Preschoolers and early school-age children respond well to rewards such as
stickers or small prizes each time they take their medicine.
○ Older children- hand them the cup of liquid or tablet medicine and offer favorite
fluid
● What are teaching tips for use of a metered-dose inhaler?
○ 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
○ Younger children can use an MDI attached to an aerochamber with a mask.
○ All children taking inhaled corticosteroids need to use aerochamber to avoid
thrush
● 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;
○ To avoid discomfort, assess patency momentarily
,● What are signs of dehydration? (see below)
○ Prolonged capillary refill- more than 2 seconds
○ Absence of tears
○ Dry mucous membranes
○ Sunken eyes
○ Abnormal skin turgor- tenting
○ Abnormal respiratory pattern
● What are interventions for mild/moderate versus severe dehydration from
gastroenteritis? pp. 1062-1063; https://www.aafp.org/afp/2009/1001/p692.html
○ Mild/moderate dehydration- oral rehydration therapy
○ Severe dehydration- IV fluids until stable
■ NS or Lactated Ringer’s
■ Should also do electrolyte measurement
● What are therapeutic interventions to manage croup (bronchiolitis)?
○ Laryngotracheobronchitis (croup)- inflammation of the larynx, trachea, and major
bronchi usually caused by parainfluenza virus. Develop barking cough,
inspiratory stridor, and marked retractions.
○ Cool moist air combined with a corticosteroid or racemic epinephrine given via
nebulizer
○ Supplemental oxygen
○ Antipyretics as needed
○ Provide measures for a child to remain calm using distraction, toys, etc.
■ Stridor can worsen with agitation
○ Place child semi-upright
● What are symptoms of streptococcal pharyngitis and complications/risks?
○ More severe and present more suddenly than viral pharyngitis
○ Symptoms:
■ Back of throat and palatine tonsils are markedly erythematous (bright red)
■ Enlarged tonsils
■ White exudate in the tonsillar crypts
■ Petechiae on the palate
■ Child appears ill- fever, sore throat, headache, stomach ache, difficulty
swallowing
■ Some develop a sandpaper line rash (scarlatiniform rash)
■ Usually no cough, congestion, rhinorrhea, or conjunctivitis
○ Complications/Risk
■ Acute rheumatic fever
■ Glomerulonephritis
● What are post-tonsillectomy nursing cares?
○ Removal of the palatine tonsils due to tonsillar hypertrophy or frequent throat
infections
○ Observe for loose teeth before surgery
○ After- observe vital signs for indications of hemorrhage
■ Increased pulse or respirations
, ■ Frequent swallowing/throat clearing
■ Feeling of anxiety
○ Liquid analgesics
○ Frequent sips of clear liquid, popsicles, or ice chips
■ Avoid acidic and citric juices, carbonated beverages, and red fluids
○ If site is bleeding- elevate the child’s head and notify provider
○ Instruct parents to watch for danger signs
■ Frequent swallowing, clearing of throat, bleeding, increasing restlessness,
severe pain
■ Restrict activity for a period of time until follow-up
■ Eat only soft foods after initial post op period after 24-48 hours
● What are signs/clinical manifestations/assessment findings in a child with pneumonia?
○ Infection and inflammation of the alveoli
○ Productive, harsh cough
○ Decreased breath sounds
○ Elevated fever
○ Appear acutely ill
○ Tachycardia
○ Chest or abdominal pain
○ Chills
○ Signs or respiratory distress
○ Breath sounds often diminished, crackles may be present
○ Dullness on percussion- total consolidation
○ Initial 24-48 hours- may have blood-tinged sputum that transitions to thick,
purulent sputum
● What are signs/symptoms and treatments of viral pneumonia?
○ Generally caused by viral infections of the upper respiratory tract progressing to
diminished breath sounds and fine rales on auscultation
○ Rest and antipyretics
● What are treatments and teaching topics for management of cystic fibrosis?
○ Treatments
■ Pancrelipase enzyme replacement
■ Humidified oxygen
■ Aerosol therapy for antibiotics, bronchodilators, and mucolytics
■ Chest physiotherapy 3-4 times a day
■ Encouraging activity- frequent position changes
■ Adequate dental hygiene for respiratory hygiene
○ Teaching
■ High-calorie, high-protein, moderate-fat diet
■ Supplement vitamins A, D, E
■ May add salt on hot months of years to replace lost salt through
perspiration
■ Breastfed infants may supplement with a high-protein formula
■ Do not add enzymes to hot food or bottle of formula
■ Administer enzymes before or with meals and snacks
■ Adolescents will need additional caloric intake due to growth
■ Monitor for overheating and offer water frequently
Modules:
Dosage calculation
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
○ For children 2 and under, pull pinna down and back
○ For children over the age of 2, up and back
○ Administer at room temperature or warm- preventing severe vertigo
○ Instill drops into ear canal
○ Hold child’s head in that position to ensure it fills entire canal
● What are tips for helping a child take oral medication?
○ In infants, oral medication can be given with a medicine dropper or a unit-dose
oral syringe
○ Gently restrain the child’s arms/head by holding the child against your body with
the head raised. gently open the mouth by pressing on the child’s chin or gently
squeezing the child’s cheeks. Be certain the end of the syringe or dropper rests
at the side of the infant’s mouth to help prevent aspiration
○ Infants may be given with a small spoon or cup
■ May associate syringes with needles
○ Preschoolers and early school-age children respond well to rewards such as
stickers or small prizes each time they take their medicine.
○ Older children- hand them the cup of liquid or tablet medicine and offer favorite
fluid
● What are teaching tips for use of a metered-dose inhaler?
○ 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
○ Younger children can use an MDI attached to an aerochamber with a mask.
○ All children taking inhaled corticosteroids need to use aerochamber to avoid
thrush
● 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;
○ To avoid discomfort, assess patency momentarily
,● What are signs of dehydration? (see below)
○ Prolonged capillary refill- more than 2 seconds
○ Absence of tears
○ Dry mucous membranes
○ Sunken eyes
○ Abnormal skin turgor- tenting
○ Abnormal respiratory pattern
● What are interventions for mild/moderate versus severe dehydration from
gastroenteritis? pp. 1062-1063; https://www.aafp.org/afp/2009/1001/p692.html
○ Mild/moderate dehydration- oral rehydration therapy
○ Severe dehydration- IV fluids until stable
■ NS or Lactated Ringer’s
■ Should also do electrolyte measurement
● What are therapeutic interventions to manage croup (bronchiolitis)?
○ Laryngotracheobronchitis (croup)- inflammation of the larynx, trachea, and major
bronchi usually caused by parainfluenza virus. Develop barking cough,
inspiratory stridor, and marked retractions.
○ Cool moist air combined with a corticosteroid or racemic epinephrine given via
nebulizer
○ Supplemental oxygen
○ Antipyretics as needed
○ Provide measures for a child to remain calm using distraction, toys, etc.
■ Stridor can worsen with agitation
○ Place child semi-upright
● What are symptoms of streptococcal pharyngitis and complications/risks?
○ More severe and present more suddenly than viral pharyngitis
○ Symptoms:
■ Back of throat and palatine tonsils are markedly erythematous (bright red)
■ Enlarged tonsils
■ White exudate in the tonsillar crypts
■ Petechiae on the palate
■ Child appears ill- fever, sore throat, headache, stomach ache, difficulty
swallowing
■ Some develop a sandpaper line rash (scarlatiniform rash)
■ Usually no cough, congestion, rhinorrhea, or conjunctivitis
○ Complications/Risk
■ Acute rheumatic fever
■ Glomerulonephritis
● What are post-tonsillectomy nursing cares?
○ Removal of the palatine tonsils due to tonsillar hypertrophy or frequent throat
infections
○ Observe for loose teeth before surgery
○ After- observe vital signs for indications of hemorrhage
■ Increased pulse or respirations
, ■ Frequent swallowing/throat clearing
■ Feeling of anxiety
○ Liquid analgesics
○ Frequent sips of clear liquid, popsicles, or ice chips
■ Avoid acidic and citric juices, carbonated beverages, and red fluids
○ If site is bleeding- elevate the child’s head and notify provider
○ Instruct parents to watch for danger signs
■ Frequent swallowing, clearing of throat, bleeding, increasing restlessness,
severe pain
■ Restrict activity for a period of time until follow-up
■ Eat only soft foods after initial post op period after 24-48 hours
● What are signs/clinical manifestations/assessment findings in a child with pneumonia?
○ Infection and inflammation of the alveoli
○ Productive, harsh cough
○ Decreased breath sounds
○ Elevated fever
○ Appear acutely ill
○ Tachycardia
○ Chest or abdominal pain
○ Chills
○ Signs or respiratory distress
○ Breath sounds often diminished, crackles may be present
○ Dullness on percussion- total consolidation
○ Initial 24-48 hours- may have blood-tinged sputum that transitions to thick,
purulent sputum
● What are signs/symptoms and treatments of viral pneumonia?
○ Generally caused by viral infections of the upper respiratory tract progressing to
diminished breath sounds and fine rales on auscultation
○ Rest and antipyretics
● What are treatments and teaching topics for management of cystic fibrosis?
○ Treatments
■ Pancrelipase enzyme replacement
■ Humidified oxygen
■ Aerosol therapy for antibiotics, bronchodilators, and mucolytics
■ Chest physiotherapy 3-4 times a day
■ Encouraging activity- frequent position changes
■ Adequate dental hygiene for respiratory hygiene
○ Teaching
■ High-calorie, high-protein, moderate-fat diet
■ Supplement vitamins A, D, E
■ May add salt on hot months of years to replace lost salt through
perspiration
■ Breastfed infants may supplement with a high-protein formula
■ Do not add enzymes to hot food or bottle of formula
■ Administer enzymes before or with meals and snacks
■ Adolescents will need additional caloric intake due to growth
■ Monitor for overheating and offer water frequently
