Pediatric Nursing Review

When does birth length double?
By 4 years.

When does the child sit unsupported?
8 months.

When does a child achieve 50% adult height?
2 years.

When does a child throw a ball overhand?
18 months.

When does a child speak two- to three-word sentences?
2 years.

When does a child use scissors?
4 years.

Note: I had this question on my OB HESI.

When does a child tie his or her shoes?
5 years.

When does the infant develop stranger anxiety?
7 to 9 months.

Fine pincer grasp appears…?
…at 10 to 12 months.

When should the infant be expected to start crawling?
10 months.

The infant (birth to 1 year) is in what stage of psychosocial development?
Trust vs. Mistrust

The toddler (1-3 years) is in what stage of psychosocial development?
Autonomy vs. Shame and Doubt

The preschool child (3-6 years) is in what stage of psychosocial development?
Initiative vs. guilt.

The school-age child (6-12 years) is in what stage of psychosocial development?
Industry vs. Inferiority

The adolescent (12-18 years) is in what stage of psychosocial development?
Identity vs. role confusion

Concepts of bodily injury:

Toddlers (1-3 years) fear…?

…intrusive procedures.

Concepts of bodily injury:

Preschoolers (3-6 years) fear…?

…body mutilation.

Concepts of bodily injury:

School-age (6-12 years) children fear..?

…Loss of control of their bodies.

Concepts of bodily injury:

Adolescents (12-18 years) fear…?

…Major concern is change in body image.

Moro reflex disappears when?
Around 4 months of age.

Handedness is established during what age bracket?

(Infant, toddler, preschool, school-age, adolescent)

Handedness is established in the preschool-age child (3-6 years)

Appropriate toys and play for the hospitalized infant (birth to 1 year)?
Mobiles, rattles, squeaking toys, picture books, balls, colored blocks, activity boxes.

Appropriate toys and play for the hospitalized toddler (1 to 3 years)?
Push-pull toys, toy telephones, stuffed animals, etc

Toddlers benefit from being taken to the hospital playroom when able, because mobility is important to their development.

Appropriate toys and play for the hospitalized preschooler (3-6years)?
Coloring books, puzzles, cutting and pasting, clay… etc.

Appropriate toys and play for the hospitalized school-aged child (6-12 years)?
Board and card games, hobbies, video games.

Children can be expected to dress themselves completely when they reach what age group?
School-age children (6-12 years)

When can a child be expected to feed themselves with a spoon and cup?
2 years.

When does the anterior fontanel close?
12-18 months. (1 – 1 1/2 years)

When does the posterior fontanel close?
(2-3 months)

Which fontanel closes first?
POSTERIOR fontanel. 2-3 months. The anterior fontanel closes in 12-18 months.

A baby has a steady head by
4 months

How would you elicit the rooting reflex?
Touch infants lip, cheek, or corner of mouth with finger.

What would you expect to observe when eliciting the rooting reflex in an infant?
Infant turns head toward stimulus and opens mouth.

Note: Reflex is difficult to elicit when infant has been fed.

How would you elicit the palmar reflex?
Place finger in palm of hand.

How would you elicit the Tonic Neck or “Fencing” reflex, and what is the characteristic response?
With the infant supine, turn their head to one side. The arm and leg on that side should extend; opposite arm and leg should flex.

What is a positive Babinski reflex?
All toes hyperextended, with dorsiflexion of big toe.

When should the Babinski reflex disappear?
SHOULD disappear by 1 year of age.

Two to three word sentences should be expected when a child is how many years old?
2 years.

Three to four word sentences should be expected when a child is how many years old?
3 years.

Visual acuity approaches 20/20 when the child reaches what age group?

(infant, toddler, preschooler, school-age, adolescent)

Preschooler (3-6 years)

School age children are in Erickson’s stage of ________, meaning they like to do and accomplish things. _____ are also becoming important for children of this age
industry, peers

Age group concepts of bodily injury:
Age group concepts of bodily injury:
– Infants: after 6 months, their *cognitive* development allows them to *remember pain*
– Toddler: they fear *intrusive* procedures
– School-age children: they fear loss of control of *their bodies*
– Adolescents: their major concern is *change in body image*

__________ are a major cause of death in children and adolescents. Teach parents and children ________ _________ ________ and prevention techniques
Accidents, developmentally appropriate safety

Pertinent information should be obtianed prior to giving certain _________ because __________ to previous ________________ or current health condition may contraindicate current ______________
immunizations, reactions, immunizations, immunizations

What contraindicates administration of DTAP?
history of reactions, siezures, neurologic symptoms after previous vaccine, or systemic reactions

What contraindicates administration of MMR?
history of anaphylactic reaction to eggs or meomycin contraindicate administration

Pertussis fatalities continue to occur in
nonimmuniized infants in the US

Common cold does not contraindicate for
TB testing

Children with Rubella pose a serious threat to their unborn siblings.
Ruebella (German measles), the nurse should counsel all expectant mothers, especially those with young children, to be aware of the serious consquenses of exposure to German measles during pregnancy

Common childhood problems are encountered by nurses caring for children in community of hospital settings. The child’s AGE directly influences the severity and management of these problems

Add POTASSIUM to fluids in peds with diarrhea only when there is adequte urine output

Urinary output for infants and children should be
1-2 ml/kg/hr

The use of
ipecac syrup is no longer recommended

More Lead is absorbed on an empty stomach.
Hot water can contain higher levels of lead because it dissolves lead more quickly than cold water, so use only cold water for consumption (drinking and especially for making infant formula)

A child needs 150 % of the usual calorie intake for normal growth and development

Do not examine the throat of a child with
epiglotitis (i.e. do not put a tongue blade or any object into the throat) because of the risk of obstructing the airway completely. Prepare for intubation or trach

In planning and providing nursing care a
Patent airway is always the priority of care regardless of the age!

The nurse should be sure PT & PTT have been determined prior to tonsillectomy. More importantly, the nurse should ask whether there has been
history of bleeding (prolonged or excessive), and whether there is a history of any bleeding disorders in the family

A child from birth to two years conceptualizes the death process as
Cannot grasp the concept of illness and death

A preschool child conceptualizes the death process as
Involving physical harm

Involving death, a schoolage child can
begin to understand something is wrong

Involving death, an adolescent may
express fear, withdrawal, and denial

Rubeola (Measles)
1. Agent: Paramyxovirus (viral)
2. Incubation period: 10-20 days
3. Communicable period: from 4 days before to 5 days after rash appears.
4. Source: Respiratory tract secretions, blood, or urine
5. Transmission: Airborne particles or direct contact with infectious droplets; transplacental

Rubeola (Measles)
1. Fever
2. Malaise
3. The three “C’s” – coryza, cough, conjunctivitis
4. Red, erythematous maculopapular eruption starting on face and spreading down towards feet; blanches with pressure and gradually turns brownish color (1 week)
5. Koplik’s spots: small red spots with a bluish white center and red base, located on buccal mucosa
Remember: Three “Cs” & Koplik’s spots are the key for identifying measles.
-Airborne droplet precautions

Roseola (Exanthema Subitum)
1. Agent: Human herpesvirus type 6 (viral)
2. Incubation period: 5-15 days
3. Communicable period: unknown, but thought to be from febrile stage to time rash appears
4. Source & transmission : unknown

Roseola (Exanthema Subitum)
1. Sudden high (>38.8 C / >102 F) fever of 3 to 5 day’s duration in a child that appears well, followed by a rash (rose-pink macules that blanch with pressure.
2. Rash appears several hours to 2 days after fever subsides and lasts 1 to 2 days.
Disease is self-limiting and treatment is supportive. Remember: fever first, then rash.

1. Agent: Paramyxovirus (viral)
2. Incubation period: 14-21 days
3. Communicable period: Immediately before and after parotid gland swelling begins.
4. Source: Saliva of infected persons.
5. Transmission: Direct contact or droplet spread

1. Fever
2. Headache and malaise
3. Anorexia
4. Jaw or ear pain aggravated by chewing, followed by parotid gland swelling.
5. Orchitis (inflamed testes) may occur
Remember: Key is parotid gland swelling.
-Airborne droplet precautions

Pertussis (Whooping Cough)
1. Agent: Bordetella pertussis (Gram negative bacteria)
2. Incubation period: 5-21 days (usually 10)
3. Communicable period: greatest during the catarrhal stage
4. Source: Discharge from resp. tract of infected person
5. Transmission: Direct contact or droplet spread; indirect contact w freshly contaminated articles

Scarlet Fever
1. Agent: Group A beta-hemolytic streprococci (Gram positive bacteria)
2. Incubation period: 1 to 7 days
3. Communicable period: About 10 days during the incubation period and clinical illness; during the first 2 weeks of the carrier stage, although may persist for months.
4. Source: Nasophayngeal secretions of infected person and carriers.
5. Transmission: Direct contact or droplet spread; indirectly by contact with contaminated articles.

Scarlet Fever
1. Abrupt high fever, flushed cheeks, vomiting, headache, enlarged lymph nodes in neck, malaise, ab. pain
2. Red, fine, sandpaper-like rash develops in the axilla, groin, and neck that spreads to cover the entire body except face.
3. Rash blanches with pressure, except in areas of deep creases and folds of joints.
4. Desquamanation of skin on palms and soles appears by weeks 1-3
5. Tongue is initially coated by white, furry covering with red papillae; by fifth day, white coat sloughs off leaving red, swollen tongue (White strawberry tongue -> Red strawberry tongue)
6. Tonsils are reddened and covered with exudate.
7. Pharynx is edematous and beefy red
Remember: Key is the strawberry tongue

Erythema Infectiosum (Fifth Disease)
1. Agent: Human Parvovirus B19 (viral)
2. Incubation period: 4 – 14 days, may be 20 days
3. Communicable period: Uncertain, but before onset of symptoms in most children.
4. Source: Infected persons
5. Transmission: Unknown mode of transmission, possibly resp. secretions and blood.

Erythema Infectiosum (Fifth Disease)
Fifth Disease is marked by a rash that appears in three stages. Just prior to the rash appearance the child may experience mild fever, malaise, headache or runny nose.
Stage 1: Erythema on face, chiefly on cheeks. “Slapped cheek” appearance. Disappears by 1 – 4 days.
Stage 2: About 1 day after rash appears on face, maculopapular red spots appear, symmetrically distributed on the extremities; the rash progresses from proximal to distal surfaces and may last a week or more.
Stage 3: The rash subsides, but may reappear if skin becomes irritated by sun, heat, cold, exercise, or friction.
REMEMBER: Pregnant women need to avoid infected persons. Key to identification is “slapped cheek” appearance. Child is not usually hospitalized as disease is self-limiting.

Infectious Mononucleosis
1. Agent: Epstein-Barr virus (viral)
2. Incubation period: 4 to 6 weeks
3. Communicable period: Unknown
4. Source: Oral secretions
5. Transmission: Direct intimate contact

Infectious Mononucleosis
1. Fever, malaise, headache, fatigue, nausea, abdominal pain, sore throat, enlarged red tonsils.
2. Lymphadenopathy and hepatosplenomegaly
3. Discrete macular rash most prominent over the trunk may occur.
TEACH PARENTS TO MONITOR FOR SPLENIC RUPTURE: Marked by abdominal pain, left upper quadrant pain, referred left-shoulder pain.

Chickenpox (Varicella)
1. Agent: Varicella-zoster virus (viral)
2. Incubation period: 13 to 17 days
3. Communicable period: From 1 to 2 days before the onset of rash to 6 days after the first crop of vesicles, when crusts have formed.
4. Source: Respiratory tract secretions of infected persons; skin lesions.
5. Transmission: Direct contact, droplet, contaminated objects (strict contact and droplet precautions)
REMEMBER: Child is no longer contagious once lesions have dried and crusts have formed.

Chickenpox (Varicella)
1. Slight fever, malaise, and anorexia are followed by a macular rash that first appears on the trunk and scalp and move to the face and extremities.
2. Lesions become pustules, begin to dry, and develop a crust.
3. Lesions may appear on mucous membranes of mouth, genital area, or rectum.

Rubella (German Measles)
1. Agent: Rubella virus (viral)
2. Incubation period: 14 to 21 days
3. Communicable period: From 7 days before to about 5 days after rash appears.
4. Source: Nasopharyngeal secretions; virus is also present in blood, stool, urine.
5. Transmission: Airborne or direct contact w/infectious droplets. Indirectly via articles freshly contaminated. Also transplacental.

Rubella (German Measles)
1. low-grade fever
2. Malaise
3. Pinkish red maculopapular rash the begins on face and spreads to the entire body within 1 to 3 days.
4. Petechial, red, pinpoint spots may appear on the soft palate.
Key for identification is rash covering entire body and spots on soft palate.

1. Agent: Corynebacterium diptheriae
2. Incubation period: 2 to 5 days
3. Communicable period: Variable. Until virulent bacteria are no longer present (three consecutively negative cultures of pharyngeal secretions); usually 2 weeks, can be 4 weeks.
4. Source: Discharge from mucous membranes of nose and nasopharynx, skin and other lesions.
5. Transmission: Direct contact with infected person, carrier, or contaminated articles

1. low-grade fever, malaise, sore throat
2. Foul-smelling, mucoprurulent nasal discharge
3. Dense pseudomembrane formation of the throat that may interfere with eating, drinking and breathing.
4. Lymphadenitis, neck edema, “bull neck”
Interventions: Strict isolation for hospitalized child. Administer diphtheria antitoxin only AFTER a skin or conjunctival test rules out sensitivity to horse serum.

Rocky Mountain Spotted Fever
1. Agent: Rickettsia rickettsii (Gram negative bacteria)
2. Incubation period: 2 to 14 days
3. Communicable period: NOT CONTAGIOUS
4. Source: Tick bite from mammal, usually wild rodents and dogs.
5. Transmission: Tick bite

Rocky Mountain Spotted Fever
1. Fever, malaise, anorexia, vomiting, headache, myalgia
2. Maculopapular OR petechial rash primarily on the extremities (ankles and wrists), but may spread to other areas, characteristically on the palms and soles.
Key: Rash on ankles, wrists, palms and soles. Remember it is not communicable. Provide parents teaching about preventing tick bites.

H1N1 Vaccine: When are children old enough to receive it?
6 months. Children younger than six months are not old enough, but family members and caregivers should be vaccinated.

Human Papillomavirus Vaccine
How many injections comprise the full course of vaccination and at what age should girls receive it? What age should boys receive it?
HPV vaccine is administered in three injections over six months. First dose, then the second dose 2 months later, followed by the final dose 6 months after the first.
Girls can receive it around age 11 to 12.
Boys can receive it from age 9 to 18.

Guards against cervical cancer and genital warts in females and genital warts in males.

Contraindications for HPV vaccine?
1. Individuals with a reaction to a previous injection.
2. PREGNANT WOMEN should not receive HPV vaccine.

Pinworm Infection
Obtain rectal specimen by tape test in the morning when the child awakens

Simple fx
Fx of the bone across its entire shaft with some possibly displacement without breaking the skin

Greenstick fx
Incomplete fracture

Communated fx
Complete fx across the shaft of the bone with splintering of the bone fragments

Compound fx
Skin or mucous membrane has been broken

Birth weight DOUBLES at 6 months and TRIPLES 12 months

Birth length increases by 50% at 12 months

A baby will turn their head over at 5-6 months

Hand-to-hand transfers occur when?
7 months

An infant will crawl at
10 months

An infant will walk at
10-12 months

Cooing will be seen at
2 months

Monosyllabic Babbling will happen at 3-6 months. Links syllables at
links syllables at 6-9 months

Babies can say “mama” “dada,” plus a few other words at
9-12 months

Daytime toilet training should be taught at
18months to 2 years

Girls’ growth spurt as early as 10 years. Boys catch up around age ~14

Girls finish growing around 15. Boys finish growing ~17

Concerning new foods, babies should
Be introduced one new food at a time.

Autosomal Recessive Diseases
CF, PKU, Sickle Cell Anemia, Tay-Sachs, Albinism

Concerning Autosomal Recessive Diseases, there is a _____ chance a child will inherit the disease if the parents have: AS (trait only) X AS (trait only)

Concerning Autosomal Recessive Diseases, there is a 50% chance a child will inherit the disease if the parents have: AS (trait only) X SS (disease)

Some Autosomal Dominant Diseases are
Huntington’s, Marfans, Polydactyl, Achondroplasia, Polycystic Kidney Disease

If one parent has the disease/trait of Autosomal Dominant Diseases there is a 50% chance the child will inherit (and express) the disease.

X-linked recessive diseases are
Muscular Dystrophy, Hemophilia A

In X-Linked Recessive Diseases, females are ________ but ___________ have the disease.
carriers, dont ever

In X-Linked Recessive Diseases, males have the disease but cannot
pass it on

X-Linked Recessive Diseases there is ____ chance daughters will be carriers, even though they cant _______________
50%, have the disease

X-Linked Recessive Diseases there is ____ chance sons will have the disease, even though they cant ___________
50%, pass it on

X-Linked Recessive Diseases there is an overall 25% chance that each pregnancy will result in a
child that has the disease

With Scoliosis, the child should be in a Milwaukee Brace for 23 hrs/day, and Log rolling after Surgery

You would expect a child with Down Syndrome, or Trisomy 21, will have these characteristics
Simian creases on palms, hypotonia, protruding tongue, upward outward slant of eyes

You would expect a child with Cerebral Palsy to present with
Scissoring = legs extended, crossed, feet plantar-flexed

Hypothyroidism can lead to
Mental Retardation

PKU can lead to
Mental Retardation

Aspartame (NutraSweet) has ____________ in it and should not be given to a PKU patient

The ________ will test the dried blood heel stick and screen for PKU
Guthrie Test

In a child with _____________ the nurse should cover it with moist sterile water dressing, and ____________ of it.
Myelomeningocele, keep pressure off

In Hydrocephalus the signs of increased ICP are
Opposite of shock

Shock = Increased pulse and decreased BP
IICP = Decreased pulse and increased BP

The most sensitive sign of IICP is
+ Altered LOC

IICP can be caused by
suctioning, coughing, straining, and turning

Signs of IICP in infants include
Bulging fontanels, high pitched cry, increased hd circum, sunset eyes, wide suture lines, lethargy

For infants with IICP, treat with ____________ shunt. Do not _________ the shunt.
peritoneal shunt, do not pump

Older kids with IICP will have
a widened pulse pressure

Muscular Dystrophy is an _____________ diease characterized by
X-linked Recessive, waddling gait, hyper lordosis, and fat pseudohypertrophy of calves.

Children with Muscular Dystrophy will display ______ sign.
Gower’s Sign (walking up own body)

Bacterial Meningitis is diagnosed with a
Lumbar puncture which shows increased WBC, protein, IICP and decreased glucose

Bacterial Meningitis can lead to ___________ because of ___________. The following signs will be seen:
SIADH, too much ADH; Water retention, fluid overload, and dilutional hyponatremia

CF Kids taste _________ and need __________________ on their food.
salty, enzymes sprinkled

Children with Rubella can be a
= threat to unborn siblings (may require temporary isolation from Mom during PG)

No MMR immunization for kids with Hx of allergic rxn to ________ or __________
eggs or neomycin

Immunization Side Effects include _______________. For this, ____________________
T < 102, redness and soreness at injection site for 3 days; give Tylenol and bike pedal legs (passively) for child

After immunization, call the physician if the patient experiences
A seizure, high fever, or high-pitched cry

For all cases of poisoning,
Call Poison Control Center, No Ipecac!

Epiglottitis is caused by H. influenza B.,. The child will sit
upright with chin out and tongue protruding (maybe Tripod position)

For a patient with RSV, use a MIST Tent to provide O2 and

RSV with contact precautions.

Acute Glomerulonephritis: after Strep B antigen-antibody complexes clog up golmeruli and reduce GFR. This results in the presence of dark urine and proteinuria.

Wilm’s Tumor is a Large kidney tumor. If you know a patient has this
Don’t palpate

TEF = The 3 C’s of TEF
Tracheoesophageal Atresia, coughing, choking, cyanosis

For cleft lip and palate, the LIP will be corrected first. Post-op both procedures, place on side and maintain
Logan Bow & elbow restraints

If a child has no meconium within 24 hrs or ribbon-like foul smelling stools suspect Congenital Megacolon = Hirschsprung’s Disease. This is caused by a
; lack of peristalsis due to absence of ganglionic cells in colon.

With Iron Deficiency Anemia, nursing care should include Give Iron on empty stomach with citrus juice (vitamin C enhances absorption),. Be sure to use a straw to avoid
staining teeth.

With Iron Deficiency Anemia, expect stools to be TARRY and limit
milk intake to <32 oz/day

In Sickle Cell Disease, HYDRATION is most important inorder to avoid a
SC Crisis

Sickle Cell Crisis is characterized by
fever, abd pain, painful edematous hands and feet (hand-foot syndrome), arthralgia

In a Sickle Cell Crisis, the treatment is
Rest, hydration, and avoid high altitude and strenuous activities

Tonsillitis is usually caused by Strep. Pre-Op be sure to get
Strep, PT and PTT and ask about a history of bleeding.

Post-Op tonsillectomy if frequent swallowing, vomiting blood, or clearing throat
Suspect bleeding. The highest risk of hemorrhage is in the first 24 hours and 5-10 days post-op with the cloughing of scabs.

Primary meds in ER for respiratory distress
Sus-phrine (Epinephrine HCl) and Theophylline (Theo-dur) … Both bronchodilators

Primary reason for most medical/ER visits for kids is
Respiratory disorders

Normal respiratory rates-Newborn, 1-11 months, 1-3 yrs, 3-5 yrs, 6-10 yrs, 11-16 yrs
Newborn … 30-60
– 1-11 mo … 25-35
– 1-3 years … 20-30
– 3-5 years … 20-25
– 6-10 years … 18-22
– 11-16 years …16-20

Concerning Pediatric Cardiovascular Disorders, if the child is Acyanotic, suspect
VSD, ASD, PDA, Coarc of Aorta, Aortic Stenosis

Antiprostaglandins cause closure of PDA. (aorta – pulmonary artery)

Concerning Pediatric Cardiovascular Disorders, if the child is cyanotic, suspect
Tetralogy of Fallot, Truncus Arteriosis, TVG; Polycythemia is common in cyanotic disorders.

Truncus Arteriosis is when
one main vessel gets mixed blood

TVG is
Transposition of Great Vessels

The 3 T’s of Cyanotic Heart Disease
Tetralogy, Truncus, Transposition

Tetralogy of Fallot is when
Unoxygenated blood pumped into aorta

Tetralogy of Fallot can cause
Pulmonary Stenosis, VSD, Overiding Aorta, Right Ventricular Hypertrophy, TET Spells, and CHF

TET Spells are
Hypoxic episodes that are relieved by squatting or knee chest position

Digoxin is the treatment for CHF.
TR = 0.8-2.0 for kids

Ductus Venosus is when the
Umbilical Vein to Inferior Vena Cava

Ductus Arteriosus is when the
Aorta to Pulmonary Artery

Rheumatic Fever
Acquired Heart Disease, affecting the aortic and mitral valves.collagen disease that destroys the heart, blood vessels, joints, sc tissue

Rheumatic Fever is preceded by beta hemolytic strep infection.
Rheumatic Fever characteristic is erythema Marginatum = Rash; Other: Chest pain, shortness of breath (Carditis), migratory large joint pain, tachycardia (even during sleep), (chorea) involuntary movements

Rheumatic Fever labs show
Elevated ASO titer and ESR, treat w Penicillin G, which is a Prophylaxis for recurrence of RF

Blood shunts left to right, causing increased pulmonary blood flow and no cyanosis (Ventricular Septal Defect)
Pulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis

(Right to Left Shunt-bypasses the lungs and delivers UNoxygen blood to the systemic circulation, causing cyanosis
Left to Right shunt moves oxygenated blood back through pulmonary circulation

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