NURS 307 Final Exam Study Guide Graded A 2025

Growth & Development: • Physical and cognitive milestones by age • Erickson’s Stages of psychosocial development o Trust vs Mistrust (0-1 years old) o Autonomy vs Shame & Doubt (1-3 years old) o Initiative vs Guilt (3-6 years old) o Industry vs Inferiority (6-12 years old) o Identity vs Role Confusion (12-19 years old) • Leading cause of death among age groups o Unintentional injury (Highest in ages 1-4 & 15-19 years old): MVC, suffocation, drowning, poisoning, fires, & falls • Regression: A common defense mechanism where the child returns to an earlier behavior • Parenting styles (tantrum management) o If a child is throwing a tantrum, the best way to deal w/ it is by asking the child to stop & ignore the child’s behavior, but also making sure that the child is safe. • Normal vital signs by age Temp ▪ 3- 6 months- 99.5 ▪ 1 year- 99.5 ▪ 3 years- 99 ▪ 5 years- 98.6 ▪ 7 years- 98.2 ▪ 9-11 years- 98.1 ▪ 13 years- 97.9 Pulse ▪ Newborn- 110 to 160 ▪ 1 wk.- 3 months- 107 to 180 ▪ 3 months – 2 year- 70 to 150 ▪ 2-10 years- 60 to 110 ▪ 10 years & older- 50 to 90 Respirations ▪ Newborn to 1 year- 30-35 ▪ 1 to 2 years- 25 to 30 ▪ 6 to 12 years- 19 to 21 ▪ 12 years & older- 16 to 19 Blood pressure ▪ Infants- 65 to 78/ 41 to 52 ▪ 1 year- 80 to 114/ 34 to 67 ▪ 3 years- 86 to 120/ 44 to 76 ▪ 6 years- 91 to 125/ 53 to 84 ▪ 10 years- 97 to 130/ 58 to 90 ▪ 16 years- 108 to 145/ 63 to 94 lOMoARcPSD| Respiratory: • Larynogotracheobronchitis (Croup)- (ATI pg. 96, Ball & Bindler pg. 485): A viral infection that causes the larynx, trachea, and bronchi to become inflamed. It can become serious if left untreated. o Expected findings ▪ Low grade fever ▪ Restlessness ▪ Hoarseness ▪ Barky cough ▪ Dyspnea ▪ Inspiratory stridor ▪ Retractions o Nursing care ▪ Provide humidity w/ cool mist ▪ Admin oxygen PRN, nebulized racemic epinephrine, CCS (Oral/IM- dexamethasone or nebulized-budesonide), IV fluids ▪ Monitor cont oxygen ▪ Encourage oral intake if tolerated ▪ • Epiglottis (ATI pg. 96, Ball & Bindler pg. 485): A bacterial infection that is considered a medical emergency due to the tissue protecting the windpipe becoming inflamed. o Expected findings ▪ Absence of cough, drooling, & agitation ▪ Sitting upright w/ chin pointing out, mouth opened, & tongue protruding (tripod position) ▪ Dysphonia (thick, muffled voice & froglike croaking sound) ▪ Dysphagia ▪ Inspiratory stridor (noisy inspirations) ▪ Suprasternal & substernal retractions ▪ Sore throat, high fever, and restlessness lOMoARcPSD| o Diagnostic procedure ▪ Lateral neck x-ray of the soft tissues o Nursing care ▪ Protect airway ▪ Avoid throat culture or using a tongue blade ▪ Prepare for intubation ▪ Provide humidified oxygen ▪ Monitor cont oximetry ▪ Admin CCS, IV fluids, IV abx than transition oral for 10 days ▪ Initiate droplet precautions ofr first 24 hrs after IV abx • Acute Streptococcal Pharyngitis (ATI pg. 94, Ball & Bindler pg. 468): GABHS- an infection of the upper airway (Strep throat) o Expected findings ▪ Onset is abrupt & characterized pharyngitis, HA, fever, and abd pain ▪ Tonsils & pharynx can be inflamed and covered with exudate, usually appears by second day of illness ▪ Mild lymphadenopathy ▪ Purulent drainage & white patches aren’t always present in strep throat ▪ A child who finds swallowing difficult or extremely painful, who drools, or who exhibits signs of dehydration or respiratory distress should be seen ASAP for possible epiglottis, peritonsillar or retropharyngeal abscess, or diphtheria ▪ Anorexia, N/V ▪ Severe sore throat ▪ Malaise ▪ Petechial mottling of the soft palate o Diagnosis ▪ Throat culture o Treatment ▪ Penicillin (oral for 10 days or long-acting penicillin given in one shot) lOMoARcPSD| ▪ If child is allergic, azithromycin, erythromycin, or clarithromycin is given o Nursing care ▪ Provide nonacidic fluids, soft foods, ice chips, or frozen pops ▪ Provide humidification & gargle saltwater top help soothe irritated throat ▪ Encourage child to rest to conserve energy and promote recovery o Client education ▪ Emphasize importance of completing 10-day course of abx ▪ Reinforce to parents the importance of treating streptococcal infections because untreated infections may lead to rheumatic fever, cervical adenitis, sinusitis, glomerulonephritis, or meningitis. • Cystic Fibrosis: a respiratory disorder that results from inheriting a mutated gene o Nutrition ▪ A diet HIGH in protein & calories ▪ 3 meals a day w/ snacks ▪ Take pancreatic enzymes w/in 30 mins of eating a meal or snack ▪ Encourage oral fluids ▪ Admin possible formula supplements in addition to breastfeeding or via gastric tube • Tonsillectomy: A procedure done to remove the palatine tonsils o Therapeutic Procedure: Tonsillectomy ▪ Nursing Pre op actions • Maintain NPO status ▪ Nursing Post op actions • Positioning o Place in place to facilitate drainage and elevate HOB when child is fully awake • Assessment o Asses for evidence of bleeding (freq swallowing, clearing the throat, restlessness, bright red emesis, tachycardia, and/or pallor) lOMoARcPSD| o Assess the airway & VS o Monitor for diff breathing r/t oral secretions, edema, and/or bleeding • Comfort measures o Admin liquid analgesics or tetracaine lollipops, pain meds as prescribed o Provide ice collar o Offer ice chips or sips of water to keep throat moist • Diet o Encourage clear liquids and fluids after a return of the gag reflex, avoiding red-colored liquids, citrus juice, and milk-based foods initially o Advance diet with soft, bland foods • Instruction o Discourage coughing, throat clearing, & nose blowing in order to protect surgical site o Avoid straws o Alert guardians that there can be clots or blood-tinged mucous in vomitus o Client Education • Notify HCP if bright red bleeding occurs, child experiences difficulty breathing, lack of oral intake, increase in pain, and/or indications of infection • Get plenty of rest • Ensure child doesn’t put objects in the mouth • Intake plenty of fluids, advance to soft diet, and avoid foods that are irritating or highly seasoned • Full recovery occurs in approx. 14 days • Observe for S/S of hemorrhage, dehydration, and infection o Complications ▪ Hemorrhage ▪ Dehydration ▪ Chronic infection • Asthma lOMoARcPSD| o Prevention ▪ Avoid triggers ▪ Use medication as prescribed o Treatment ▪ Bronchodilators (Inhalers) • SABA (Albuterol, levalbuterol, terbutaline) o Used for acute exacerbations o Prevention of exercised induced asthma • LABA (formoterol, salmeterol) o Used to prevent exacerbations especially at night & reduce use of SABA o Must be used along with anti-inflammatory therapy o Cannot be used to treat acute exacerbations • Cholinergic antagonists (Atropine, ipratropium) block the parasympathetic nervous system, providing relief of acute bronchospasms ▪ Anti-inflammatory agents- decrease airway inflammation • CCS • Leukotriene modifiers • Mast cell stabilizers • Monoclonal antibodies • Combination medications • Theophylline • Mag Sulfate Psychosocial Issues: • ADHD: o Expected findings ▪ Difficulty paying attention Communicable Disease & Immunizations: