NURS 5432 Final Exam Review
PEDIATRICS
Child health: iron storage in infants and how to assess dehydration in infants and children
Dehydration in infants:
Findings Mild Moderate Severe
Anterior Fontanelle Normal Sunken Markedly sunken
Eyes Normal Sunken Markedly sunken
Skin Normal Cool Cool, mottled
Pulse Normal Increased Increased, weak
Urine output Mildly reduced Markedly reduced Little to no UOP
iron storage:
depleted by age 4-6 months requiring supplementation through iron-fortified cereals, pureed
meats, and iron-rich vegetables (spinach, lentils, beans, tofu); Iron supplementation
1mg/kg/day full term/breastfed babies.
Iron deficiency:
Infants & Children (<12 years old)
• Screening:
• 12 months and 24 months
• Dietary Recommendations:
, • Limit cow’s milk to 20 oz/day (excess milk decreases iron absorption)
• Encourage iron-fortified foods
• Iron Supplementation:
• Ferrous sulfate 3-6 mg/kg/day (elemental iron)
• Give every other day with orange juice (to enhance absorption)
Adolescents
• Screen menstruating females at 12 years old • Encourage at least 3
servings of iron-rich foods daily
• Supplementation:
• Ferrous sulfate 65-130 mg elemental iron every other day for 3 months
• Recheck CBC 3 months after treatment
Lead Intoxication Overview
• More common in children with iron deficiency anemia (IDA) due to
increased GI absorption of lead when iron levels are low
• Lead and iron share the same GI transporter, so low iron leads to
increased lead absorption
• Common sources of lead exposure:
• Lead-based paint chips (especially in older homes)
• Water contamination (lead pipes)
• Parental occupational exposure (e.g., machine shops, construction)
• Eating utensils and bowls containing lead
• Children with pica may ingest lead-containing substances
Screening Recommendations
• Routine lead screening:
• At 12 and 24 months
, • All refugee children must have an initial lead screening (higher risk)
Symptoms of Lead Intoxication
• Nonspecific symptoms (even at high levels > 45 mcg/dL)
• Mild to moderate symptoms:
• Anorexia
• Headache
• Abdominal pain
• Constipation
• Severe symptoms (very high lead levels):
• Vomiting
• Agitation
• Somnolence (excessive sleepiness)
• Incoordination & confusion
• Seizures (extremely high levels)
Management of Lead Intoxication Education &
Prevention
• Eliminate sources of lead ingestion (paint, pipes, utensils)
• Ensure adequate iron levels (treat underlying iron deficiency anemia)
• Conduct environmental investigations (to identify lead exposure sources)
• Assess developmental progress (neurological complications possible)
, • Chelation Therapy:
• Required for lead levels ≥ 44 mcg/dL
• IV treatment that binds to lead and facilitates excretion
• Reduces neurological & systemic complications
Vaccinations and immunizations
Name SQ or Frequency
IM
Influenza IM Yearly, beginning at 6 months
In children 6-35 months of age, the dose=0.25 mL IM;
for children 3 years=0.50 mL IM
Children younger than 9 years receive two doses 1
month apart
• may be contraindicated in those with
anaphylactic reaction to eggs
PEDIATRICS
Child health: iron storage in infants and how to assess dehydration in infants and children
Dehydration in infants:
Findings Mild Moderate Severe
Anterior Fontanelle Normal Sunken Markedly sunken
Eyes Normal Sunken Markedly sunken
Skin Normal Cool Cool, mottled
Pulse Normal Increased Increased, weak
Urine output Mildly reduced Markedly reduced Little to no UOP
iron storage:
depleted by age 4-6 months requiring supplementation through iron-fortified cereals, pureed
meats, and iron-rich vegetables (spinach, lentils, beans, tofu); Iron supplementation
1mg/kg/day full term/breastfed babies.
Iron deficiency:
Infants & Children (<12 years old)
• Screening:
• 12 months and 24 months
• Dietary Recommendations:
, • Limit cow’s milk to 20 oz/day (excess milk decreases iron absorption)
• Encourage iron-fortified foods
• Iron Supplementation:
• Ferrous sulfate 3-6 mg/kg/day (elemental iron)
• Give every other day with orange juice (to enhance absorption)
Adolescents
• Screen menstruating females at 12 years old • Encourage at least 3
servings of iron-rich foods daily
• Supplementation:
• Ferrous sulfate 65-130 mg elemental iron every other day for 3 months
• Recheck CBC 3 months after treatment
Lead Intoxication Overview
• More common in children with iron deficiency anemia (IDA) due to
increased GI absorption of lead when iron levels are low
• Lead and iron share the same GI transporter, so low iron leads to
increased lead absorption
• Common sources of lead exposure:
• Lead-based paint chips (especially in older homes)
• Water contamination (lead pipes)
• Parental occupational exposure (e.g., machine shops, construction)
• Eating utensils and bowls containing lead
• Children with pica may ingest lead-containing substances
Screening Recommendations
• Routine lead screening:
• At 12 and 24 months
, • All refugee children must have an initial lead screening (higher risk)
Symptoms of Lead Intoxication
• Nonspecific symptoms (even at high levels > 45 mcg/dL)
• Mild to moderate symptoms:
• Anorexia
• Headache
• Abdominal pain
• Constipation
• Severe symptoms (very high lead levels):
• Vomiting
• Agitation
• Somnolence (excessive sleepiness)
• Incoordination & confusion
• Seizures (extremely high levels)
Management of Lead Intoxication Education &
Prevention
• Eliminate sources of lead ingestion (paint, pipes, utensils)
• Ensure adequate iron levels (treat underlying iron deficiency anemia)
• Conduct environmental investigations (to identify lead exposure sources)
• Assess developmental progress (neurological complications possible)
, • Chelation Therapy:
• Required for lead levels ≥ 44 mcg/dL
• IV treatment that binds to lead and facilitates excretion
• Reduces neurological & systemic complications
Vaccinations and immunizations
Name SQ or Frequency
IM
Influenza IM Yearly, beginning at 6 months
In children 6-35 months of age, the dose=0.25 mL IM;
for children 3 years=0.50 mL IM
Children younger than 9 years receive two doses 1
month apart
• may be contraindicated in those with
anaphylactic reaction to eggs
