NURS 225 Midterm: PedsExam1StudyGuide

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31 May 2018

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Lecture1:TheSynergyModel

DescribethenursecharacteristicsandthePatient/FamilyCharacteristicsincontextoftheSynergyModel

PatientCharacteristics:

● stabilityabilitytomaintainasteadystate

○ stabletounstable

● complexitytanglementontwoormoresystems(body,family,therapy)

○ simpletocomplex

● predictabilityexpectation

○ predictabletounpredictable

● resiliency

○ resilienttonotresilient

● vulnerabilitysusceptibilitytostressors

○ minimallytohighlyvulnerable

● participationindecisionmaking

○ hightolow

● participationincare

○ hightolow

● resourceavailabilitywhatpatient,program,orsystembringstoasituation

○ hightolow

Describethefamilyandcaregivers’rolesinthehospitalizedchild

Describethedevelopmentalstagesfromnewborntoadolescentandhowtoworkwiththechild/teenager

duringtheirillnessand/orhospitalization



Lecture2:

Whyarekidssodifferent?:

● Vitalsignrangesfordifferentages

○ BP:

■ childolderthanoneyear:(90plus2xage)/(70plus2xage)

○ HR:

○ RR:

● Sodiumnormals

○ Hypernatremia:Na>150

■ Causes:

● breastfed

● developmental

● incorrectformulaprep

● prolongeddiarrhea,vomiting

● tubefeedings

● IVprep

■ Symptoms:

● neuro:seizures

● lowurineoutput

■ Nursingmanagement

● Breastfedmothereducation

● Weightchecksdaily

● Assessurine,normal=1.010/salt

● IVreplacement(ifdiarrheaandvomiting)

○ Hyponatremia:Na<130

■ Causes

● IVsolutionsw/D5W

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● tapwaterenemas

● dilutingformula

● swallowingbool/bathwater

● excessivesweatingwithincorrectfluidreplacement(marathon)

■ Symptoms

● LOC

● seizures

● vomiting/diarrhea

■ Nursingmanagement

● stopexcesswater

● replacefluidlosswithappropriatefluidwhentraining

○ goodgatoradeorpedialyte

● poolinstructionwhendevelopmentallyappropriate

● Potassiumnormals

○ Primaryfunctions:nervetransmission,musclefiring

○ MostKINTHECELL

○ Hyperkalemia:>5

■ Causes:

● Burns

● Trauma

● Bloodtransfusion

● Renalfailure

● IVwithK

● Sicklecellcrisis

■ Symptoms:

● palpitations

● weakness

● arrhythmias

■ Nursemanagement:

● DriveintocellD50andinsulin

● Assesscardiacstatus

● StopK+

○ Hypokalemia:<3.5

■ Causes:

● diarrhea

● wounddrainage

● eatingdisorders

● renaldisease

■ Symptoms:

● neurological

● weakness

● arrhythmias

■ Nursingmanagement:

● slowlyreplaceK+

● assesscardiacstatus

● reassess

○ imbalance=cardiacrhythms

■ hyperbloodtransfusion,burns,sicklecell

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■ hypoprolongedvomitinganddiarrhea,dehydration,CF,oncology

● Oxygennormals

● Dehydration

○ Assessment:

■ MMs

■ tearproduction

■ skinturgor/perfusion

■ VS

■ wetdiapers,bottles/cupsdrinkingin6hrperiod

■ labsforelectrolytelevels

■ Is/Os,urineSG

○ OralRehydration:

■ Pedialyte

■ 100ml/kgover24hrs

■ 1tsp(5mLs)tostart,repeateveryfewminutes

■ 120mLforeachdiarrhealorvomitingepisode

○ Feverincreasesfluidneeds>shouldhaveoneteaspoonevery20min

● Spinalcord:stilldeveloping

○ extraweightinhead

○ donothaveabdominalmuscles/shoulderstobalanceouthits

○ childrendonotunderstandconsequences

○ >sportsputchildatrisk

● Givefiveexamplesofhowchildrenarephysiologicallydifferentthanadults.

○ Airway

○ Circulation

■ CO=HRxSV

○ Breathing>babiesarebellybreathers

○ Fluiddistributedextracellularyuntilage2

■ sweatandbreathefaster

○ HigherBMR

■ tempaffectsenergyexpenditure

● Assessmentdifferences

○ MMs

○ Skinturgor

○ Fontanelles

○ Behavior/levelofactivity

○ Abdomen:

■ Musclesnotdevelopedlessorganprotection

■ Bladderprotrudesinbellymoreatriskfortrauma

■ Spleenshouldnotbepalpablecanfeelinmono,sicklecell,chemopts

○ IVmoreatriskforinfiltration,movearoundmore

● Kidneysnotfullydevelopedatbirth>watchurineoutput

○ Minimumrequirements:

■ infant:2mL/kg/hr

■ child:12ml/kg/hr(minof1)

■ adolescent:.51ml/kg/hr

● Developmentaldistraction

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NURS 225 Midterm: PedsExam1StudyGuide

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