Nurs 254 Child Caring Exam 3 Galen College 2025

Nurs 254 Child Caring Exam 3 Galen College 2025 Pain scale= NIPS - -used for 2 months or less Pain scale= Flacc - -used for more than 2 months old Pain scale= Wong Baker - -used for 3-4 year olds ( preschooler) Pain scale =Numeric - -used for 8 year old and up ( as young as 5 if the understand value of numbers) School age (6-12) nursing considerations - -Ask why?; let them contribute; they understand cause and effect; Don't need to be bribed Adolescent nursing assessment finding (Erikson) - -expected= they are finding themselves; friends are very important; Confidentiality and privacy important Erikson Adolescent - -Age 12-18 Identity vs role confusion Nutritional assessment of Adolescent - -Ask Patient what they ate; also assess weight (body issues are common) Erikson Preschooler - -Age 3-6 Initiate vs guilt Parallel play - -Play side by side NOT with each other. (Toddlers 1-3) Associative play - -NO group goal ( preschooler 3-6) ; example kicking ball around Cooperative play - -Sports; common goal ( School age 6-12) Preparing School age patient for procedure - -Age 6-12; Answer why questions, allow them to contribute ; explain cause and effect Appropriate skill set based on age= 6 months - -should sit up unsupported; tripod position Appropriate skill set based on age = 3 years old - -should walk up stairs with alternating feet NURS 254 NURS 254 NURS 254 Appropriate primative reflex should disappear at= 3-4 MONTHS - -Rooting, sucking; Palmar; Tonic neck reflexes Appropriate primative reflex should disappear at = 1 month - -Stepping reflex Appropiate primative reflex should disappear at= 6 MONTHS - -Moro reflex Appropriate primative reflex should disappearat= 8 MONTHS - -Plantar reflex Appropriate primative reflex should disappear at= 1 year - -Babinski Natural immunity - -breast feeding / contact with virus Acquired immunity - -vaccines Assessment finding = Child with tet spell (Cyanosis) - -1. Knee to chest 2. Administer o2 3. Morphine 4. IV fluids Assessment finding to tell HCP - -Abnormal finding Tachycardia at rest Assessment : child with dx of asthma hearing NO wheezing - -Tell HCP; Status asthmaticus; MEDICAL EMERGENCY Assessment: Child dx with croup; Epiglottis - -Tell HCP prepare trach and intubation ; MEDICAL EMERGENCY Intervention needed when observing: Patient with epiglottis = student nurse is taking oral temperature - -Nothing in Mouth ; NO oral temp, no tong blade; do not visualize PDA Patent Ductus arterioles S/S - -Machine like murmur Bounding pulse Poor weight gain Tired after feeding RSV Respiratory Syntactical Virus S/S - -Rhinorrhea ( runny nose) Drainage from eyes & ears Wheezing Fever Coughing Sneezing Left sided heart failure S/S - -frothy pink sputum Crackles Dry; hacking cough NURS 254 NURS 254 Paroxysmal nocturnal dyspnea Orthopnea Right sided heart failure S/S - -peripheral edema, Hepatomegaly, Splenomegaly JVD Abd distention Weight gain Tetrology of Fallot S/S - -clubbed fingers Poor growth Cyanosis Tet spells Plan of care development = RSV - -Assess O2 stat Based on finding Administer humidified o2 PRN, Suction, Give fluids Plan of care development= Croup - -Assess respiratory Status Based on finding Cool air vaporizer No cough suppressant ( unless @ night trouble sleeping due to cough) Cardiac Medication Management: Digoxin If infant Apical HR is LESS than 90 If Adolescent Apical HR is less than 60 - -Hold Med Signs of Digoxin Toxicity (remember Normal level 0.8-2.0) - -anorexia Poor feeding N/V Bradycardia Disrrhythmia Cardiac Medication Management= Lasix aka Loop ( diuretics) Example Furosamide - -electrolyte imbalance Low K; 3.5-5....arrhythmia Low Na; 135-145...... LOC Low ca; 8.5-10.2 Low mg; 1.7-2.2 Nursing care after cardiac Cath - -assess distal pulses bilaterally Nuero assessment NURS 254 NURS 254 Vs every 15 mins Leg straight for 4-8 hrs Lay flat on effected side ( stops bleeding) Discharge teaching after cardiac cath - -Change bandage within 24 hours No tub bath for 72 hours Diet and activity not restricted Let HCP know of oozing, fever ( infection) Teaching Home care patient with cystic fibrosis - -Autosomal recessive disease; progressive Enzyme medication take WITH meals Diet= high calorie, high protein, low fat Teaching Atrial Septal defect - -Foreman ovule didn't close properly Murmur is normal Defect can be closed using cardiac cath Teaching Otitis media discharge instruction - -Feed upright NO bottle proping If fluid ; affected ear down Prevention= no 2nd hand smoke; breastfeed Teaching Kawasaki disease - -unknown orgin Krazy inflammation; strawberry tongue; peely skin Treatment IVIG 7 days; high dose aspirin (With IVIG no live vaccines 11 months) Prevent Respiratory Infections - -wash hands Cough etiquette Breastfeed Vaccinate Discharge instructions patient with Asthma - -avoid triggers Administer SABA during asthma attack Maintenance drugs are steroids ( rinse mouth; monitor for infection,thrush, cushing syndrome) Cyanotic heart defects - -Tetrology of Fallot Tricuspid atresia 3 conditions caused by Group A strep - -Rheumatic fever Acute Glomernerphritis Pharyngitis NURS 254 NURS 254 Discharge instructions for patient with rheumatic fever - -prophylactic antibiotic 1 hour before dental work Complication: rheumatic heart disease ( valve damage) Tracheoesphageal Fistula (TEF) S/S - -abd distention Apnea more than 15 mins Drooling vomiting Cough Choking Cyanosis Celiac disease S/S - -Fatty stool (steatoreah) Muscle wasting failure to thrive Anemia Diarrhea FTT ( failure to thrive) Acute glomernulonephritis S/S - -oliguria ( low urine) Hypertension Hematuria ( cola colored urine) Fever Positive AST O titer test Nephrotic syndrome S/S - -massive proteinuria Edema, Anorexia, Ascites Nephrotic syndrome Labs - -Decreased protein Elevated lipid levels Treatment for nephrotic syndrome - -Diet= Low salt; high protein Corticosteriods Duiretics Patient care for acute diarrhea and dehydration - -Mild to moderate dehydration= PO ( by mouth) Severe dehydration IV (oral rehydration even if vomiting) Contact HCP based on finding: Intussusception - -Passage of Normal brown stool; Good thing Surgery no longer needed Teaching Intussusception - -telescope bowel NURS 254 S/S= currant jelly stool; sausage shaped mass on abd Treatment- air enema, saline enema Teaching Enuresis risk factors - -UTI, diabetes, Sign of regression Teaching Enuresis life style changes - -limit evening liquids Empty bladder before bedtime Wake them up at night to remind them to pee Cleft lip repair teaching - -surgery can be done 2-3 months old Petroleum jelly over site Elbow restraints for 2 weeks Only Haberman bottle in mouth til healed (no breastfeeding; can pump) Celiac disease teaching - -genetic component Avoid= wheat, barely and rye Can eat- wild rice; corn Diet= simple carbs; high calorie, high protein,low fat UTI prevention teaching - -caused by E.coli Wipe front to back Cotton underwear Change wet clothing Hand wash Avoid sugar Cranberry juice can help prevent Do not hold urine for long periods Hirschsprung's disease teaching - -No ganglion in colon/ large intestine S/S - no mecomium 1st 24-28