NCLEX-RN cheat sheet · Pediatrics
Pediatric GI, neuro, heme and renal
Dehydration, bowel blockages, febrile seizures, shunts, Reye syndrome, anemia, sickle cell, leukemia, Wilms tumor and two kidney diseases
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Children have small fluid reserves, so vomiting and diarrhea dry them out fast, and a few bowel problems are true emergencies. Blood, cancer and kidney problems often start with vague signs, like pallor, bruising or puffy eyes.
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At a glance
Dehydration and diarrhea
- Infants and children under 3 can become dehydrated quickly. Few or no tears, fewer wet diapers, dry mouth, irritability, skin that doesn't spring back, sunken eyes, a sunken fontanelle.
- Severe: no urine, fast heart rate and breathing, listlessness, shock. Needs IV fluids.
- Keep breastfeeding; mix formula full strength. Oral rehydration solution, about an ounce every 30 to 60 minutes; don't water it down. If the baby vomits: a teaspoon every 10 to 15 minutes, no solids.
- Avoid sports drinks for young infants, apple and full-strength juices, dairy and fried foods. No antidiarrheal medicine unless the provider says so.
- Call: diarrhea in a baby under 3 months; no wet diaper for 6 hours, no tears, a sunken soft spot; more than 8 stools in 8 hours; vomiting over a day; blood or mucus in the stool. Call 911 for loss of consciousness, confusion or seizures.
Febrile seizures
- A convulsion triggered by fever, most often between 6 months and 5 years. Usually in the first 24 hours of an illness, not always when the fever is highest.
- Not typical: a seizure in one part of the body, or one that repeats in the same illness. In young children with a first seizure, meningitis must be ruled out.
- During any seizure: don't hold the child down, don't leave, put nothing in the mouth. Lay the child on the floor in a safe area, clear sharp objects, loosen tight clothing. Turn to the side if vomiting or secretions build up.
- Fever medicine eases the child, but doesn't prevent future febrile seizures. Simple febrile seizures don't cause brain damage or epilepsy; most children outgrow them by age 5.
Three blockages
| Pyloric stenosis | Intussusception | Hirschsprung disease | |
|---|---|---|---|
| Usual age | Around 3 weeks (1 week to 5 months) | 5 months to 3 years | Present at birth |
| What | Thick pyloric muscle blocks the stomach from emptying; more common in boys | One part of the bowel slides into another, cutting off blood flow | Nerves missing from part of the large bowel; more common in boys and with Down syndrome |
| Key sign | Projectile vomiting, hungry right after. Wave-like belly motion; olive-shaped mass in the upper belly | Colicky pain, knees drawn up, currant jelly stools. Pain returns stronger and longer each time | No meconium within 24 to 48 hours, swollen belly. Older child: constipation that slowly worsens |
| Care | Pyloromyotomy cures it; small, frequent feedings within hours | An emergency. NG tube and IV fluids, then an air or contrast enema, or surgery. It can come back | Rectal biopsy confirms. Rectal irrigation, then surgery. Watch for enterocolitis: swollen belly, foul, watery diarrhea |
Brain and spine
| Look for | Care | |
|---|---|---|
| Bacterial meningitis | Fever, vomiting, light sensitivity, severe headache, mental status changes. Babies: bulging fontanelle, poor feeding, irritability, fast breathing; some arch backward (opisthotonos) | An emergency. You can't tell bacterial from viral by symptoms, so any suspicion goes to the emergency department. A lumbar puncture tests the spinal fluid |
| Hydrocephalus | Infant: soft spot bulges, head grows larger than expected, sutures separate, setting-sun eyes. Irritability, vomiting, high-pitched cry | Measure head circumference over time. A V-P shunt drains the fluid. Blocked shunt: headache and vomiting |
| Myelomeningocele | A sac on the lower back; leg weakness or paralysis, lost sensation, bladder and bowel problems. Eight in ten also have hydrocephalus | Repair usually in the first few days. Until then, handle carefully to protect the exposed cord. Folic acid helps prevent it |
| Reye syndrome | Brain and liver damage linked to aspirin during chickenpox or the flu. Persistent vomiting, then confusion, lethargy, seizures, coma | No aspirin or other salicylates, like bismuth subsalicylate, unless the provider says so |
| Cerebral palsy | Delayed milestones, usually before age 2. Spastic type: tight muscles, scissoring, toe-walking gait | No cure: therapists, braces, and medicines for spasticity and seizures support independence |
Anemia and sickle cell
- Iron deficiency is the most common anemia in children. Too much cow's milk means less iron absorbed. Pallor, irritability, tiredness, brittle nails, pica.
- Iron-rich foods: meats, beans, eggs, green leafy vegetables. Iron only as prescribed: too much is toxic to children. Oral iron is usually 3 to 6 mg/kg a day of elemental iron, in 1 or 2 doses.
- Sickle cell disease is inherited from both parents; one gene gives the trait, without symptoms. Sickled cells block vessels: pain crises.
- Crisis: pain medicine and plenty of fluids, sometimes a transfusion. Daily folic acid, hydroxyurea, preventive antibiotics, Hib and pneumococcal vaccines. Fever of 101.3 °F (38.5 °C) or higher: emergency.
Leukemia and Wilms tumor
- Acute lymphoblastic leukemia: the most common childhood cancer, usually at ages 3 to 7. Bone and joint pain, easy bruising, petechiae, pallor, fever, swollen lymph nodes.
- A bone marrow biopsy and a lumbar puncture help diagnose it. Low neutrophils, especially under 500 cells per microliter: strict hand hygiene, limit visitors, report any fever at once.
- Wilms tumor, kidney cancer, usually around age 3 or 4: a belly mass or swelling, belly pain, blood in the urine, high blood pressure.
- Once Wilms tumor is suspected, don't press on the belly; handle and bathe the child gently.
Two kidney diseases
| Nephrotic syndrome | Post-strep glomerulonephritis | |
|---|---|---|
| Typical child | Ages 2 to 6; usually minimal change disease | Ages 6 to 10; 1 to 2 weeks after strep throat, or 3 to 4 weeks after a skin infection like impetigo |
| Urine and signs | Foamy urine, heavy protein. Heavy swelling, first in the face and around the eyes; high cholesterol | Rust-colored or bloody urine, less urine, high blood pressure. Swelling often worst in the face |
| Treatment | Steroids. A low-sodium diet and diuretics ease swelling | Penicillin, blood pressure medicine, diuretics, less salt; steroids generally don't help. Watch for heart failure, fluid in the lungs, high potassium |
Cleft lip and palate, celiac disease
| Key points | |
|---|---|
| Cleft lip and palate | Feeding problems (milk through the nose), poor weight gain, ear infections, hearing and speech problems. Lip repaired at 2 to 9 months, palate within the first year. Follow-up: speech therapy, orthodontics, repeated hearing tests |
| Celiac disease | Autoimmune reaction to gluten that damages the small intestine. Gluten: wheat, rye, barley, possibly oats. Diarrhea or constipation, fatty, foul stools, poor weight gain. Lifelong gluten-free diet; read food and medicine labels |
Priority and safety calls
- ★ Intussusception is an emergency: the bowel can die or tear, and shock can follow quickly. Stabilize with an NG tube and IV fluids.
- No wet diaper for 6 hours and no tears: dehydration signs, so the baby needs the provider now.
- ★ Shunt: get emergency care for extreme sleepiness, a high-pitched cry, seizures, fever or a stiff neck.
- Wilms tumor: don't palpate the abdomen; handle and bathe gently.
- Hypospadias: don't circumcise the baby, because the foreskin is used for the repair (usually at 6 to 12 months).
How the NCLEX tests it
- Traps: sports drinks or juice for an infant, antidiarrheal medicine, assuming regular oats are gluten-free.
- Febrile seizures: usually harmless; side-lying, nothing in the mouth. No aspirin for children.
- Traps: something in the mouth during a seizure, and blaming shunt-failure vomiting on a stomach bug.
- Nephrotic: protein and puffy eyes; post-strep: rust-colored urine and high pressure.
- Traps: palpating a Wilms tumor, iron without a prescription, circumcising a baby with hypospadias.
Practice it next
This sheet comes from Pediatric GI conditions and fluid balance and Pediatric neurological conditions and Pediatric hematology, oncology and renal conditions in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- Pyloric stenosis usually shows around ___ weeks of age.
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3 - Gluten is in wheat, rye, barley and possibly ___.
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oats - Febrile seizures: most often 6 months to ___ years.
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5 - A blocked shunt brings headache and ___.
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vomiting - Sickle cell trait comes from ___ gene, without symptoms.
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one - Nephrotic syndrome in children is usually from ___ disease.
Show answer
minimal change
Sources
- MedlinePlus, Diarrhea in infants
- MedlinePlus, Intussusception - children
- MedlinePlus, Febrile seizures
- MedlinePlus, Sickle cell disease
- MedlinePlus, Wilms tumor
- MedlinePlus, Nephrotic syndrome
More pediatrics cheat sheets
- Pediatric respiratory and cardiac NCLEX cheat sheet
- Immunizations and communicable diseases NCLEX cheat sheet
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.