NCLEX Tip of the Day 2/8

[SkateBetty]

Pediatric Tips:

What is an intraosseous infusion? In pediatric life-threatening emergencies, when iv access cannot be obtained, an osseous (bone) needle is hand-drilled into a bone (usually the tibia), where crystalloids, colloids, blood products and drugs can be administered into the marrow. It is a temporary, life-saving measure, and I have seen it once! (Gruesome.) When venous access is achieved it can be d/c'd. One medication that cannot be administered by intraosseous infusion is isoproterenol, a beta agonist. (I don't know more about that drug; it was just pointed out on a practice exam.)

During sickle cell crisis there are two interventions to prioritize: fluids and pain relief.

With glomerulonephritis you should consider blood pressure to be your most important assessment parameter. Dietary restrictions you can expect include fluids, protein, sodium, and potassium.

Remember yesterday when I mentioned how congenital cardiac defects result in hypoxia which the body attempts to compensate for (influx of immature rbc's)? Labs supporting this would show increased hematocrit, hemoglobin, and rbc count.

Did you know there is an association between low-set ears and renal anomalies? Now you know what to look for if down's isn't there to choose.

School-age kids (5 and up) are old enough, and should have an explanation of what will happen a week before surgery such as tonsillectomy.

If you gave a toddler a choice about taking medicine and he says no, you should leave the room and come back in five minutes, because to a toddler it is another episode. Next time, don't ask.

The first sign of pyloric stenosis in a baby is mild vomiting that progresses to projectile vomiting. Later you may be able to palpate a mass, the baby will seem hungry often, and may spit up after feedings.

We know Kawasaki disease causes a heart problem, but what specifically? Coronary artery aneurysms d/t the inflammation of blood vessels.

A child with a ventriculoperitoneal shunt will have a small upper-abdominal incision. This is where the shunt is guided into the abdominal cavity, and tunneled under the skin up to the ventricles. You should watch for abdominal distention, since fluid from the ventricles will be re-directed to the peritoneum. You should also watch for signs of increasing intracranial pressure, such as irritability, bulging fontanels, and high-pitched cry in an infant. In a toddler watch lack of appetite and headache. Careful on a bed position question! Bed-position after shunt placement is flat, so fluid doesn't reduce too rapidly. If you see s/s of increasing icp, then raise the hob to 15-30 degrees.

What could cause bronchopulmonary dysplasia? Dysplasia means abnormality or alteration. Mechanical ventilation can cause it. Premature newborns with immature lungs are ventilated and over time it damages the lungs. Other causes could be infection, pneumonia, or other conditions that cause inflammation or scarring.

It is essential to maintain nasal patency with children

Watch out for questions suggesting a child drinks more than 3-4 cups of milk each day. (Milks good, right?) Too much milk reduces intake of other essential nutrients, especially iron. Watch for anemia with milk-aholics. And don't let that mother put anything but water in that kid's bottle during naps/over-night. Juice or milk will rott that kids teeth right out of his head.

What traction is used in a school-age kid with a femur or tibial fracture with extensive skin damage? Ninety, ninety. Huh? I never heard of it either. The name refers to the angles of the joints. A pin is placed in the distal part of the broken bone, and the lower extremity is in a boot cast. The rest is the normal pulleys and ropes you're used to visualizing with balanced suspension. While we're talking about traction, a kid's hinder should clear the bed when in Bryant's traction (also used for femurs and congenial hip for young kids).

If you can remove the white patches from the mouth of a baby it is just formula. If you can't, its candidiasis.

Just know the MMR and Varicella immunizations come later (15 months).

Undescended testis or cryptorchidism is a known risk factor for testicular cancer later in life. Start teaching boys testicular self exam around 12, because most cases occur during adolescence.

Not pediatrics but have to throw it in - A guy loses his house in a fire. Priority is using community resources to find shelter, before assisting with feelings about the tremendous loss. (Maslow).

No aspirin with kids b/c it is associated with Reye's Syndrome, and also no nsaids such as ibuprofen. Give Tylenol.

CSF in meningitis will have high protein, and low glucose.

It is always the correct answer to report suspected cases of child abuse.

No nasotracheal suctioning with head injury or skull fracture.

Feed upright to avoid otitis media.

Position prone w hob elevated with gerd. In almost every other case, though, you better lay that kid on his back (Back To Sleep - SIDS).

Pull pinna down and back for kids

Kids with RSV; no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hoot, tent, etc.

Positioning with pneumonia - lay on the affected side to splint and reduce pain. But if you are trying to reduce congestion the sick lung goes up. (Ever had a stuffy nose, and you lay with the stuff side up and it clears?)

A positive ppd confirms infection, not just exposure. A sputum test will confirm active disease.

Coughing w/o other s/s is suggestive of asthma. Speaking of asthma, watch out if your wheezer stops wheezing. It could mean he is worsening.

You better pick 'do vitals' before administering that dig. (apical pulse for one full minute).

Tet spells treated with morphine.

Group-a strep precedes rheumatic fever. Chorea is part of this sickness (grimacing, sudden body movements, etc.) and it embarrasses kids. They have joint pain. Watch for elevated antistreptolysin O to be elevated. Penicillin!

Don't pick cough over tachycardia for signs of chf in an infant.

That's it for today. Happy studying! :loveya:

[nursemomruns]

Pediatric Tips:

No aspirin with kids b/c it is associated with Reye's Syndrome, and also no nsaids such as ibuprofen. Give Tylenol.

You're right to avoid aspirin with children, particularly under the age of 12 years and during a febrile illness, because of its association with Reye's. However, keep in mind that some children DO take aspirin for arthritis.

Also, it is acceptable to give children ibuprofen. It come's in liquid children's formulas for those that can't swallow tablets. Parents are frequently instructed to alternate acetaminophen with ibuprofen to treat a child's fever. The alternating allows an antipyretic to be given more frequently.

Make sure you know generic names of medications.

[napoca]

thanks Betty! Great!

Good for study!

[SkateBetty]

For the purposes of the NCLEX Tylenol is the fever reducer of choice in children. Test-takers, don't forget it.

[oldnurse newnurse]

Thanks again Skatebetty

[nursemomruns]

For the purposes of the NCLEX Tylenol is the fever reducer of choice in children. Test-takers, don't forget it.

As an employee of NCSBN, I cannot confirm or refute your statement. But please consider what I do for a living when I comment on your information

[seiko]

HI BETTY

thanks for the tips.

when r u taking nclex or u already passed??

about me i have scheduled for march 22.

thanks again and keep posted.

[SkateBetty]

HI BETTY

thanks for the tips.

when r u taking nclex or u already passed??

about me i have scheduled for march 22.

thanks again and keep posted.

My exam is 2/15, one week from today.

[crb613, BSN, RN]

As an employee of NCSBN, I cannot confirm or refute your statement. But please consider what I do for a living when I comment on your information

I appreciate any & all help from you & SkateBetty.....Please keep commenting! You are both GEMS! :bowingpur

[bigmona]

Did you know there is an association between low-set ears and renal anomalies? Now you know what to look for if down's isn't there to choose.

This is a great tip- just to expand on it a little, the kidneys and ears develop around the same time in utero. Hence, they're shaped similarly. Which is why when doing an assessment of a neonate, if the nurse notices low set or asymmetrical ears, there is good reason to investigate renal functioning. Knowing that the kidneys and ears are similar shapes helped me remember this.

I test this coming Tuesday. Yikes!!!

[wannabeEDnurse]

Hi Mona & Betty! I test Tuesday, too! These tidbits from SkateBetty are soooo helpful! Thanks, Betty!

I better get to my Kaplan book and get off this site now! I'll be back at breaktime!

Jodi