Tips for Answering ATI Capstone Content: Review of ATI Nursing Care of Children

Pediatric Laboratory Values: While lab values vary slightly according to the source, knowing an average range for the following common lab tests will be very helpful to you when answering questions.

Test                                                                  Age/Gender/Reference

Normal Ranges

Conventional Units

Acetaminophen                                               Toxic concentration                                                      >200 mcg/ml

Carbon Dioxide                                               Cord                                                                              14-22 mEq/l Premature 1 week                                                         14-27 mEq/l Newborn                                                                       13-22 mEq/l Infant, child                                                                  20-28 mEq/l

Chloride                                                          Cord                                                                              96-104 mEq/l Newborn                                                                       97-110 mEq/l Child                                                                             98-106 mEq/l

Conjugated direct Bilirubin                                                                                                                   0.0-0.2 mg/dl

Creatinine                                                        Cord                                                                              0.6-1.2 mg/dl

Reference: Wong’s Essentials of Pediatric Nursing (Hockenberry and Wilson) 8th ed.

Expected Blood Pressure Ranges for Both Girls andf Boys:

Ages                       Girls Systolic                       Girls Diastolic                        Boys Systolic                       Boys Diastolic

1 year                     83-114                                 38-67                                      80-114                                  34-66

Average Temperature Ranges:

Age                                                                                  Temperature in Celsius/Fahrenheit

Birth to 1 year (Axillary)                                                36.5 to 37.2 C  (97.7 to 98.9 F)

1 to 12 years (Oral)                                                         36.7 to 37.7 C  (98.1 to 99.9 F)

12 years and older (Oral)                                                 36.6 to 36.7 C  (97.8 t 98.0 F)

Average Resting Heart Rates:

Age                              Beats Per Minute (BPM)

Birth to 1 week

100-160/min with brief fluctuations above and below this range, depending on activity level (crying,

sleeping).

1 week to 3

months

100 to 220/min

3 months to 2

years

80 to 150/min

2 to 12 years                70 to 110/min

12 years and older       70 to 110/min

Average Resting Respiratory Rates:

Age                                               Respirations Per Minute

Newborn                                       30 to 60/min with short periods of apnea (less than 15 seconds)

Newborn to 1 year                        30/min

1 to 2 years                                   25 to 30/min

2 to 6 years                                   21 to 24/min

6 to 12 years                                 19 to 21/min

12 years and older                        16 to 18/min

Pain Assessment by Age:

Age                                                            Pain tool

2 months – 7 years                                    FLACC

3 years and older                                       Faces

3 years to 13 years                                    Oucher

5 years and older                                       Numeric Scale

3 to 18 years                                              Non-communicating Children’s Pain Checklist

Family Composition:

Type                                            Members

Traditional Nuclear                     Married couple and their biological children (full brothers and full sisters). Nuclear                                       Two parents and their children (biologic, adoptive, step, foster.

Single-parent                              One parent and one or more children

Blended (also called

Reconstituted)

At least one stepparent, stepsibling, or half-sibling

Extended                                     At least one parent, one child, and other individuals either related or not

Gay/Lesbian                               Two members of the same sex who have children and a legal or common-law tie

Foster

A child or children who have been placed in an approved living environment away from the family

of origin - usually one or two parents

Binuclear                                    Parents who have terminated spousal roles but continue their parenting roles

Communal

Individuals who share common ownership of property and goods and exchange services without

monetary considerations.

Stressors in Hospitalized Children:

Age                                          Stressors                                            Behaviors

Infant

Interrupted routines Parental separation Lack of stimulation

Poor feedings Irritability Crying

Altered sleep patterns

Toddler

Interrupted routines Separation from parents Loss of control

Fear of being hurt

Protest stage (Crying, fighting, tantrums) Despair stage

Developmental regression

Refusal to eat, sleep pattern disturbance

Pre-Schoolers

Pain/bodily injury Separation from parents Loss of control

Passiveness Withdrawal Poor appetite

Sleep disturbances

Magical thinking

Bed wetting

School Age Children

Guilty feelings Fear of pain Loss of control

Body image changes

Decreased self esteem

Anxiety

Fearfulness, stalling, bargaining

Withdrawal

Stages of Development:

Infant (Birth to 1 year)

Theorist                              Type of Development                                                           Stage

Erikson                               Psychosocial                                                                         Trust vs. mistrust

Freud                                  Psychosocial                                                                         Oral

Piaget                                  Cognitive                                                                               Sensorimotor

Toddler (12 months to 3 years)

Theorist                  Type of Development                                Stage

Erikson                   Psychosocial                                              Autonomy vs shame

Freud                      Psychosocial                                              Anal

Piaget                     Cognitive                                                   Sensorimotor transition to preoperational

Pre-schooler (3 to 5 years)

Theorist                               Type of Development                                                            Stage

Erikson                                Psychosocial                                                                          Initiative vs guilt

Freud                                   Psychosocial                                                                          Phallic

Piaget                                  Cognitive                                                                               preoperational

School-Aged (5 to 12 years)

Current Immunization Schedule and Immunization catch up schedule:

http://www.cdc.gov/vaccines/schedules/index.html

More test taking tips!

Tips on Delegation

A nursing assistant can perform tasks such as taking vital signs, range of motion exercises, bathing, bed making, obtaining urine specimens, enemas, and blood glucose monitoring. Nursing assistants cannot interpret results or perform any task beyond the skill level of the certification they received.

The PN is managed under the supervision of the RN. Certain higher level skills can be delegated after competency has been established by the RN (e.g., dressing changes or suctioning).

Use What You Know

Students have a tendency to focus on what they don’t know rather than on what they do know. The ramifications of this mental approach are devastating.

When you focus on your lack of knowledge about a particular topic, you are likely to become anxious and start guessing or changing answers. There is also a carry-over

effect that can reduce your ability to answer the items that follow the item causing you distress. You might start losing confidence. When that happens, suddenly the test

begins controlling you. You should pause, take a deep breath, try to relax, and move on. Stay focused.

Words of Magnitude

Read the question and options closely for words asking about direction or magnitude. For instance, stop and concentrate on the terms intra- versus inter- ; hyper- versus hypo

- ; increase versus decrease; lesser versus greater; and gain versus lose.

It is common to misread these terms by simply skimming over them too quickly.

This week’s drug tips:

Antigout Medications - What is gout?

Gout is a type of arthritis. In healthy people, the body breaks down dietary purines and produces uric acid. The uric acid dissolves and is excreted via the kidneys. In individuals affected with gout, the body either produces too much uric acid or is unable to excrete enough uric acid, and it builds up. High uric acid levels results in urate crystals which can now collect in joints or tissues. This causes severe pain, inflammation, and swelling. Treatment is both lifestyle adjustment and medication.

Medications

First Line: NSAIDs and prednisone (Deltasone)

Purpose: Used as a first line defense to treat the pain and inflammation of gout attacks. Colchicine (Colgout):

Purpose: Treat the inflammation and pain associated with gout.

Just like NSAIDs, these meds can lead to GI distress and should be taken with foods. HINT: The word gout is right in the name Colgout.

Allopurinol (Zyloprim): Purpose:

This is the only medical preventative treatment for gout. Allopurinal prevents uric acid production. This can be an effective means of preventing gout attacks when diet alone is not effective.

HINT: Examine the name allopurinol and you can see the word PURINE in the middle of the name.

Note: There are many drug and food interactions associated with allopurinol: Potential serious interactions with the use of saliscylates, loop diuretics,

phenylbutazone, and alcohol and potential for drug interactions with Warfarin

(Coumadin).

Teach client with gout to avoid the following:

· Anchovies, sardine in oil, fish roe, herring

· Yeast

· Organ meat (liver, kidneys, sweetbreads)

· Legumes (dried beans and peas)

· Meat extracts (gravies and consommé)

· Mushrooms, spinach, asparagus, cauliflower

Anti-reabsorptives

What is anati-reabsorptive?

Bone is a living organ which is continually being removed (resorbed) and rebuilt. Osteoporosis develops when there is more resorption than rebuilding. Antiresorptive medications are designed to slow bone removal and or improve bone mass.

Treating and preventing osteoporosis can involve lifestyle changes and sometimes medication. Lifestyle change includes diet and exercise, and fall prevention.

Prevention and treatment of osteoporosis involve medications that work by preventing bone breakdown or promote new bone formation.

Medications

Bisphosphonates prevent the loss of bone mass

Alendronate (Fosamax)

Monthly used to treat and prevent osteoporosis in menopausal women.

Facts: The benefits of Fosamax can even be seen in elderly women over 75 years of age.

Hint: Fosamax has been associated with severe esophagitis and ulcers of the esophagus. Should be avoided in clients with history of gastric ulcers.

Risedronate (Actonel): This is a newer drug and less likely to cause esophageal irritation

Hint: Teach clients taking either drug to take on an empty stomach with at least 8 ounces (240 ml) of water, while sitting or standing. This minimizes the chances of the pill being lodged in the esophagus. Clients should also remain upright for at least 30 minutes after taking these pills to avoid reflux in the esophagus.

For those clients who cannot tolerate the esophagus side effects of Fosamax, estrogen, etidronate (Didronel), and calcitonin are possible alternatives.

Teriparatide (Forteo): It acts like parathyroid hormone and stimulates osteoblasts, thus increasing their activity. Promotes bone formation.

Facts: This drug is associated with a risk of bone tumors so is only used when the benefits outweigh the risks.

Antirheumatics

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic disease that results in inflammation of the joints and surrounding tissues. RA affects the lining of the joints and the painful swelling can result in bone erosion and joint deformities. It is the small joints in hands and feet that are most often affected.

Treatment is designed to provide symptom relief and some delay in progression of the disorder but not a cure.

Medications

Disease-modifying Antirheumatic drugs (DMARDs), glucocorticoids, and non-steroidal anti-inflammatory drugs (NSAIDs) may be used individually or in combination to manage this chronic disorder.

The major categories of antirheumatics are: DMARDs I – Major Nonbiologic DMARDs

· Cytotoxic medications: Methotrexate (Rheumatrex), leflunomide (Arava)

· Antimalarial agents: Hydroxychloroquine (Plaquenil)

· Anti-inflammatory medication: Sulfasalazine (Azulfidine)

· Tetracycline antibiotic: Minocycline (Minocin) DMARDs II – Major Biologic DMARDs

· Etanercept (Enbrel)

· Infliximab (Remicade)

· Adalimumab (Humira)

· Rituximab (Rituxan)

· Abatacept (Orencia)

DMARDs III – Minor nonbiologic and biologic DMARDs

· Gold salts: Aurothioglucose (Solganal)

· Penicillamine (Cuprimine, Depen)

· Cytotoxic medications: Azathioprine (Imuran), cyclosporine (Sandimmune, Gengraf, Neoral)

· Glucocorticoids:

· Prednisone (Deltasone), prednisolone (Prelone)

● NSAIDs

Hints:

DMARDs slow joint degeneration and progression of rheumatoid arthritis. Glucocorticoids and NSAIDs provide symptom relief from inflammation and pain. Rheumatrex (  methotrexate ) is the most commonly used DMARD. This is because it

has been shown to work as well or better than any other single medicine. It is also relatively inexpensive and generally safe.

Methotrexate has many food and drug interactions especially affect digoxin and phenytoin. Very difficult to absorb and should be taken on an empty stomach.

Taking  folic acid helps reduce some of the side effects. Methotrexate's biggest advantage could be that it has been shown to be safe to take for long periods of time and can even be used in children.

Antineoplastics

Antineoplastics are used combat cancerous cells.

There are many kinds of anti-cancer drugs with a variety of actions. But in simple terms this category of drugs attacks cells that multiply and divide. This very action which can kill cancer cells can also do the same to healthy dividing cells. This is especially true of cells that need a steady supply of new cells such as skin, hair, and nails.

There are over 90 different kinds of chemotherapy agents and different drugs cause different side effects

Chemotherapy is associated with a variety of side effects:

§ Nausea and vomiting

§ Diarrhea and or constipation

§ Alopecia

§ Anorexia

§ Fatigue and exhaustion

§ Mouth sores

§ Easy bruising

Medications

Fluorouracil (5-fluorouracil, 5-FU) Warning - Hazardous drug!

5-FU is one of the oldest chemotherapy drugs and is used against a variety of cancers. Following are some of the most common and important ill effects:

· Soreness of the mouth, difficulty swallowing

· Diarrhea

· Stomach pain

· Low platelets

· Anemia

· Sensitive skin (to sun exposure)

· Excessive tear formation from the eyes

Nursing Hints:

Be aware of the importance of leucovorin rescue with fluorouracil therapy, if prescribed.

· The best treatment for extravasation is prevention.

· Extravasation can cause pain, reddening, or irritation on the arm with the infusion needle. In severe cases in can lead to tissue necrosis and even loss of an extremity.

· Check infusion site frequently

· Stop infusion immediately if suspected

· Slowly aspirate back blood back from the arm

· Elevate arm and rest in elevated position

· Check institution policies on how to remove catheter

Oral hypoglycemics

What is diabetes?

Diabetes is a disorder that affects glucose metabolism.

Type 1 diabetes: The client either makes no insulin or not enough insulin.

Type 2 diabetes: The client makes enough insulin at least early in the disease but is unable to transport glucose from the blood into the cells.

In both cases, the individual is unable to metabolize glucose. The purpose of oral hypoglycemics is to assist with glucose metabolism.

Medications

There are four classes of hypoglycemic drugs:

· Sulfonylureas

Tolbutamide (Orinase); glyburide; Micronase

Stimulates insulin  production

Associated with weight gain

· Biguanide: Metformin

o First line drug in type 2 diabetes

o Reduces the production of glucose within the liver o Associated with modest weight loss

o Less likely to cause hypoglycemia. o Significant lipid-lowering activity.

· Thiazolidinediones

o Reverses insulin resistance

o Increases glucose uptake and decreased glucose production o Associated with severe liver damage

· Alpha-glucosidase inhibitors. o Acarbose (Precose)

o Reduces the absorption of dietary glucose o Associated with flatulence and diarrhea Hints:

No matter which class the client will be taking there is always the risk of hypoglycemia

Be sure to teach client how to recognize early signs and symptoms of hypoglycemia as well as appropriate interventions.

"Success is determined by how determined you are to succeed." Inspirational Quotes by Unknown.