M/N Exam 2

The parents of an adolescent boy are concerned about the amount of sleep he seems to require. What advice would you give them?

"As long as he seems otherwise well, this sounds like a typical teenager." Rationale: Many teenagers feel fatigued from a combination of quick-food diets, many activities, and a rapid growth spurt.

A nurse is providing teaching to the caregiver of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include?

"Give the correct dose of medication at regularly scheduled times."

An infant's mother asks you, "When should I expect my daughter to begin to walk?" Which of the following is an appropriate response?

"Most children walk around 12 months." Rationale: Children typically walk by 12 months, although there is a wide range from 7 to 22 months.

A nurse is providing teaching to the parent of a child who has a new prescription for liquid oral iron supplements. Which of the following statements by the parent indicates a good understanding of the teaching?

"My child should take the supplement through a straw."

What would be a game you might play to urge a school-age child to ingest a high fluid intake?

"Simon says" Rationale: "Simon says" is a game that appeals to a school-age child's developmental needs because it is concerned with rules.

A child is to use an incentive spirometer four times daily. Which statement suggests that the child understands the purpose and correct technique of the procedure?

"To do this right, I take in a very deep breath."

A hospitalized 4-year-old cries and tries to bite during each physical assessment. Which statement by the parent would help the nurse?

"You are going to the 'timeout' chair if you try to bite again." Rationale: Limit setting is necessary with unacceptable behavior even though the child is hospitalized. Provision of behavioral guidelines helps the child to know what to expect.

Ventral suspension position

"flying baby" -very little neck control post-birth, by 3 months infant should be able to keep head lifted

Anthropometic Measurements

0-24 months: On board 24-old: Standing length Head Circumference: Mesure tice, up to age 2, supraorbital and occipital prominences

Neonate

0-28 days

Prone position (only under supervision):

1 month old can turn head side to side, by 3 months head and shoulders can be lifted to look around. At 4 months, most babies can roll from front to back. At 5 months, from back to front. At 6 months, lift to sphynx pose. By 9 months, start to lift abdomen to creep (pre-req) for crawling.

Toddler

1-3 years

Primary Circular Reaction

1-4 Months or by third month of life. Hand-mouth and ear-eye coordination develop. Enjoyable activity for this period: a rattle or tape of parent's voice

Object Permanence

10 months, object permanence is concrete, PEEK-A-BOO

Adolescent

13-17 years

Normal BP for children of different ages (BOYS)

1yr: 80-114/34-66 3yr: 86-120/45-75 6yr: 91-125/53-84 10yr: 97-130/58-90 16yr: 111-145/63-94

Normal BP for children of different ages (GIRLS)

1yr: 83-114/38-67 3yr: 86-117/47-76 6yr: 91-122/54-83 10yr: 98-129/59-88 16yr: 108-138/64-93

Normal Development of posture and Spinal Curves

2-3 Months: Holds head erect when held upright; thoracic kyphosis when sitting 6-8 Months: Sits without support; spine is straight 10-15 Months: Walks independently; straight spine Toddler: Protruding abdomen; lumbar lordosis School Age Child: Height of shoulders and hips is level; balanced thoracic convex and lumbar concave curves

Tasha is diagnosed as having bacterial meningitis, and her plan of care is being amended in light of this diagnostic finding. How long should the care team maintain respiratory precautions for this condition after Tasha begins an antibiotic?

24 Hours

Preschooler

3-5 years

Status Epilepticus

30 min Cant result in RR failure, brain damage, death Treatment: IV benzodiazepines (diazepam, lorazepam)

Epilepsy

5% of children will have at lease one seizure in their life 50% of sz are idiopathic (unknown etiology) The other half are caused by a wide range of problems: - Trauma - Infection - Tumors Typically seizures are symptoms of an underlying problem, so investigation of the cause is crucial

Certain surgeries like ASD can result in pericardial injury in?

50% of children. Relapses may occur up to 2 months after injury

School-aged Child

6-12 years

Normal BP for children of different ages (INFANTS)

65-78/41-52

Standing

6mo can almost support their weight, 7mo bounces when standing, 9mo can stand with support of a table if placed in that position, around 11mo they can cruise around crib or room with support of wall or crib rails. By 12 months, standing alone at least momentarily. Many people think child should be walking by 12 months but they have until 22mo and its still within the normal range.

Teeth

8 new teeth will erupt in the 2nd year. All 20 baby teeth are usually present by 2.5 or 3 years.

Language Development

900 word vocabulary on average but it will vary based one exposure Lots of questions....need simple answers...sound a like words are confusing Egocentrisim- it's a big part of pre-school and its normal ...everything is about how it relates to them personally

A nurse manager is providing an inservice for the nursing staff. Which of the following individuals is at greatest risk for developing beta-Thalassemia major disease?

A child of Mediterranean descent

Tricuspid Atresia

A complete closure of the tricuspid valve that results in mixed blood flow. An atrial septal opening needs to be present to allow blood to enter the left atrium.

Transportation of Great Arteries

A flipflop of aorta and pulmonary arteries off ventricles Oxygenated blood returns from the lungs to the left atrium, to the left ventricle, and then proceeds back through the pulmonary artery and to the lungs again, Deoxygenated blood goes to right atrium, right ventricle then to aorta for systemic circulation

The nurse is assessing a school-age child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?

A) Slightly yellow sclera

Abnormal Chest Shape

A, Pectus excavatum (funnel chest) in which the lower portion of the sternum is depressed, decreasing the anteroposterior diameter. B, Pectus carinatum (pigeon chest) in which the sternum protrudes, increasing the anteroposterior diameter.

Patent Ductus Arteriousus

ACYANOTIC DEFECT A patent ductus arteriosus (PDA) occurs when this fetal shunt fails to close after several days of life. Allows blood to flow from the aorta (area of high pressure) through the PDA and into the main pulmonary artery (area of low pressure). The shunted blood then returns to the left atrium of the heart and repeats the cycle. Occurs 20-60% of children born pre-maturely

Atrial Septal Defect (ASD)

ACYANOTIC DEFECT An ASD is created when a portion of the atrial septal tissue does not completely form which allows blood to flow from the high-pressure left atrium to the low-pressure right atrium and continue out to the lungs. ASD may not have a murmur associated with it; therefore, it may go unnoticed if no clinical symptoms exist.

Ventricular Septal Defect (VSD)

ACYANOTIC DEFECT: Allow blood to flow from left (oxygenated) to right. A hole in the septum between right and left ventricle that results in increased pulmonary blood flow (Left-to-right shunt) This increases pulmonary blood flow and ultimately increases the volume of blood returning to the left heart, causing left heart dilation over time. A murmur is always associated with.

BACTERIAL Meninigitis - nursing actions

ADMINISTER ANTI-BIOTICS - PRIORITY IS TO OBTAIN CSF CULTURE AND THEN GIVE ANTI-BIOTICS ASAP - Abx therapy may be adjusted pending results of CSF culture and sensitivity Droplet Isolation - 24 hours from initiation of droplet precautions - Family members may also need prophylactic antibiotics Monitoring - Vital Signs, ICP, I&O, pain, neuro exam - Decrease environmental stimuli, dim lights, limit visitors - Seizure precautions

A 2-year-old boy has a nephroblastoma (Wilms tumor). Which would the nurse expect his parents to report as the first symptom of this tumor?

Abdominal mass Rationale: A Wilms tumor grows on the anterior surface of the kidney, so it is felt as an abdominal mass.

CP Causes

Abnormal brain development or damage to a developing brain - Leads to cell destruction in the motor tracts - Nutrition deficiencies, maternal substance use, maternal infections (CMV or Toxo) - Direct birth injury such as nuchal cord - Head injury from maltreatment or MVA can also cause CP symptoms - Meningitis and encephalitis 2/1000 births

Dyskinetic CP

Abnormal involuntary movements - "worm-like" - flaccid and limp - May develop into slow, writhing movements in all extremities, head, and neck - Typically there is poor tongue and swallowing control - Involuntary movements may become irregular and jerky when distressed

Retropharyngeal abscess

Abscess form in lymph nodes that compromises airway - MEDICAL EMERGENCY Assessment - High fever, refusal to eat or drink, excessive drooling. Swelling to one side of the neck. Xray, IV antibiotics, Hydration, respiratory monitoring, surgical intervention

Clinical Examination of Left sided heart failure?

Accessory muscle to support their breathing Intercostal, substernal, and suprasternal retractions Rales (crackles)

The nurse notices Henry, a 2-month-old with a VSD, is using his accessory muscles while breathing. His mother states he is always breathing like that and sometimes it gets worse when he eats, but she is not concerned because he is not turning blue. What reasons for concern might the nurse identify? (Select all that apply)

Accessory muscle use while breathing Accessory muscle use while feeding Poor weight gain

Muscular Dystrophy treatment

Active and passive daily range-of-motion exercises; splinting, bracing if necessary; low-calorie, high-protein diet; high intake of fiber, fluids; corticosteroid therapy

Reye Syndrome

Acute encephalopathy with fatty infiltrations in the liver, heart, lungs, pancreas, and skeletal muscles Occurs children 1-18 years

Pericarditis

Acute pericarditis is an inflammation of the pericardial membrane with or without accumulation of excess pericardial fluid. There are a multitude of potential causes, but most are idiopathic and thought to be viral or post-viral in origin.

Chronic Infection Anemia

Admin of iron will not have effect until the infection is controlled

In developing a plan for perioperative teaching for an adolescent, which is important for the nurse to recognize?

Adolescents may act as if they know more than they actually do. Rationale: Adolescents may manifest an air of knowing more than they actually do as part of working through a sense of identity.

Treatment for status Epileptics and Tonic Clonic

Airway, suction, oxygen, consider blood glucose level to rule out hypoglycemia Pad sidrailes Place side lying Remove unnecessary items No restrains Nothing in mouth

The nurse working with adolescents understands which to be the most widely used drug among adolescents?

Alcohol Rationale: Alcohol is the most abused drug among adolescents because it is often readily available and is inexpensive compared to other drugs.

Teeth preschooler

All 20 decidous teeth are in place by age of 3 typically...important to preserve these teeth as long as possible because permanents will not start coming in until age 6 or 7 and baby teeth serve as placeholders while the jaw grows

Spitting Up

All babies spit up some, as it becomes more frequent or in larger volumes, we should assess the amounts, times, and contributing factors. This may be related to GERD.

Which patient education should the nurse provide a mother of a preschooler with broken fluency?

Allow the preschooler to have time to talk. Rationale: Children who do not feel rushed to speak have less broken fluency.

Febrile Seizure Treatment

Anti-pyretic Tepid sponge baths Rule out causes Reassure parents

Hypoplastic Left Heart Syndrome

Aorta is reduced in size, blood flow to the body is supplied by the ductus arteriosus, mitral valve closed, left ventricle cavity is underdeveloped

S2

Aortic and pulmonic valve closure

Complications

Apartment Syndrome: (5 P's): Pain, paresthesia, Pulselessness, Paralysis, Pale

Infantile Spasms 0-3 years

Are generalized seizures - Up to 50% associated with trauma or disease/infection - Up to 90% of children with infantile spasms will have developmental delay Treatment: - Anti-epileptic drugs (AEDs) are not effective - Parenteral adrenocorticotropic hormone (ACTH) is gold standard in treatment - Some high-dose newer anti-seizure medications such valproate or topiramate may be used as secondary therapy - Most children "grown out" of infantile spasms by 2y/o but the effects of the developmental delays may be ongoing

Infant safety

Aspiration prevention Fall prevention Car safety Safety with siblings Bathing and swimming safety Childproofing

Lumbar Puncture

Asses intracranial pressure (ICP) Needle into L4&L5 Contraindications: Skin infection at sight, expected high ICP which could cause sudden drop in ICP resulting brainstem herniation

Streptococcal Pharyngitis description

Assessment - More rapid and severe than viral pharyngitis. Other respiratory symptoms are generally absent, such as cough, congestion, rhinorrhea, or conjunctivitis. Treatment Implications - streptococcal infections can lead to acute rheumatic fever and glomerulonephritis if not treated. Antibiotic treatment may help decrease the occurrence of these diseases and shorten the duration of symptoms.

Laryngotracheobronchitis (Croup) description

Assessment - children typically have only minimal signs at bedtime. Temperature is normal or only mildly elevated. They may develop a barking cough (croupy cough), inspiratory stridor, and marked retractions from inflammation of the larynx, trachea, and major bronchi. Management - racemic epinephrine, given by nebulizer, usually reduces inflammation and produces effective bronchodilation to open the airway. The provider may prescribe dexamethasone for home administration but racemic epinephrine needs to be administered in a healthcare setting. Nurse monitor pulse oximeter, po fluids encouragement, O2 if needed.

VSD Assessment and Diagnosis

Assessment: Only a murmur, Tachypnea, Tachycardia, Accessory muscle use, Retractions, Rales, Poor feeding, Failure to thrive. Diagnosis: Echocardiogram

Asthma Risk Factors

Asthma is a chronic inflammatory disorder of the respiratory track and is the most common chronic illness in children. Typically before age 5 Can present as viral illness or virus can trigger asthma attack. Family history Sex (Boys > Girls) Low birth weight or obesity Allergens

Asthma

Asthma is a chronic inflammatory disorder of the respiratory track and is the most common chronic illness in children. Is one of the leading causes of hospitalization among kids. More common in boys.

Assessment for CP

Asymmetric shoe wear and tear - sign of gait issues Children with quadriplegic CP may also have speech and swallowing difficulties

Physical Growth for School-age child

At a set point in brain maturity, the hypothalamus transmits an enzyme to the anterior pituitary gland to begin production of gonadotropic hormones, which then activate changes in the testes and ovaries to cause puberty. Concerns for girls: height, breast development, menarche Boys: changing in genitals, gynecomastia for some (particularly obese), body image Transgender kids: gender identity is not congruent with sex assigned at birth. Higher incidence of mental health disorders including depression and anxiety. Limited research suggests more supportive families have better outcomes for kids

Hemoglobin

At birth, 40-70% of hemoglobin is fetal Hgb, this shifts in 1st 6mo to Hemoglobin A (adult hemoglobin) Majority of blood dyscrasias begin to show symptoms in 1st 6 months of life

Increased Pulmonary Blood Flow Disorders

Atrial Septal Defect, Ventral Septal Defect, Patent Ductus Arteriousus

Ataxia Telangiectasia

Autosomal recessive trait r/t a defect on chromosome 11 An immunodeficiency disorder that results in cerebellar degeneration Impacts neurological and immunology systems Increased risk of cancer (brain tumors)

Ataxic CP

Awkward, wide-based gait Neuro exam: lack fine motor skills such as finger-nose test, or rapid-repetitive functions

Evaluating Tamperature

Axillary or tympanic

Which assessment below would increase your suspicion that iron-deficiency anemia may be present in a child?

B. A 15-year-old girl constantly sucks ice cubes

To straighten the Auditory Canal

Back and up for Children over 3 Years of Age Pull the pinna down and back for children under 3 years of age.

Infections

Bacterial Meningitis Encephalitis Reye syndrom

Development of Daily Activities

Bathing Diaper-area care Dental care Dressing Sleep Exercise

Weight

Birth weight should double by 6 months, triple by 1 year**, average weight of a 1-year-old is about 10kg

Anemia

Blood loss, acute infection, inadequate nutrition (iron, folic acid, vitamin B12)

Cancer Treatment Side effects

Bone marrow suppression (low hub, thrmobocytopenia, neutropenia) Alopecia Constipaion/diarrhea Mucostitis/stomatitis

Thalassemia Major Assessment

Bone marrow: Is hyperactive to produce more RBC's, hypertrophies and bone pain. Bone changes in face and skull. Osteoporosis loss of bone density. Liver/Spleen Enlargement: Excessive iron deposits and scarring, abdominal pressure, vomiting/anorexia

9-11 years

Boys: Prepubertal weight gain occurs Girls: Breasts areolar diameter enlarges

12-13 years

Boys: Pubic hair present across pubis, penis lengths, dramatic linear growth spurt Girls: menarche occurs, axillary hair, breast enlargement

11-12

Boys: sparse growth of straight, downy, slightly pigmented hair at penis, scrotum becomes textured, growth of penis and testes beings, perspiration increases Girls: pH of vaginal secretions becomes acidic; slight mucous vaginal discharge is present

Structural Scoliosis

Bracing, halo traction, surgical intervention, spinal instrumentation

Oblique

Break is diagonal across the bone

Transverse

Break straight across the bone

VSD

Breastfeeding demands a significant amount of energy from the child, and mothers may need to manually express the breast milk so it can be fed through a bottle or nasogastric tube. If closure does not occur over time in a symptomatic child, or if the child experiences persistent failure to thrive, depressed myocardial function, or dilation of the left heart, they will be referred for closure.

Lower Respiratory Tract

Bronchi, bronchioles, and alveoli

A nurse is caring for a child who sustained a fracture. Which of the following actions should the nurse take? (Select all that apply.)

CORRECT: Elevating the affected limb can decrease swelling at the injury site. CORRECT: Assessing neurovascular status assists the nurse in determining if the affected limp has adequate blood supply. CORRECT: Stabilizing the injury will prevent further injury and damage.

Diagnosis Procedures for Bacterial Meningitis

CSF Sample: increased WBC, Increased protein, Increased ICP, Decreased glucose CBC, Blood Culture: Rule out bacteremia Head CT,MRI, U/S: Brain abcesses

Transportation of the great arteries Assessment

CYANOTIC Transposition of the great arteries is a cyanotic defect noted immediately after birth. Symptoms: Tachypneic, Accessory muscle, use, Cyanosis murmur A prostaglandin E1 (PGE1) infusion. Blood must mix to provide oxygenated blood to the systemic circulation The goal is to use the smallest amount of medication that keeps the duct open and has minimal side effects. Enlarge PFO at the bedside or in the catheterization lab through a balloon atrial septostomy

Tetralogy of Fallot

CYANOTIC Four defects that result in mixed blood flow 1. Pulmonary stenosis 2. Ventricular septal defect 3. Overriding aorta 4. Right ventricular hypertrophy

The nurse is caring for James, a 2-year-old boy who has been admitted to the pediatric floor after his parents noted a fever of 103°F (39.4°C) for 2 days. He had an ASD repaired approximately 4 weeks earlier and has since developed a pericardial effusion. The effusion was drained, and the fluid was purulent. He is now being treated with IV antibiotics. The nurse enters the room and notes that James is only breathing about 5 breaths/min and his heart rate on the monitor is 40 beats/min. What is the nurse's first action?

Call for help and begin providing compressions per basic life support (BLS) protocol (CPR).

Hydroxyurea

Can cause anorexia

Treatment for breaks

Casts Medical boots/splints Surgical correction Crutches

Postoperative Care

Central venous pressure monitoring Pulmonary artery pressure monitoring Preventing pooling of lung secretions

Types of Brain Tumors

Cerebellar astrocytomas: slow-growing, cystic tumors that arise from glial or support tissue surrounding neural cells Medulloblastomas: fast-growing tumors found most commonly in cerebellum Brainstem gliomas: often cause paralysis of the fifth, sixth, seventh, ninth, and tenth cranial nerves

Physiologic Data

Chief Complaint Past health and illness history Current health status Medications Allergies Immunizations Safety activity/exercies Nutrition Sleep Family History Review of systems

Deferred Imitation

Children at this stage are also able to remember an action and imitate it later

Aspiration

Children less than 1 yr are at high risk of choking. Round or cylindrical shapes are more dangerous than square shapes because of the design of the airway. Hot dogs and carrots are high choking risk foods. Balloon safety should also be emphasized. Teach parents not to prop bottles. Use a toilet paper roll to evaluate if something is a choking risk.

Obstruction To blood Flow Disorders

Coarctation of Aorta, pulmonary stenosis, aortic stenosis

Atelectasis

Collapse of lung alveoli Primary Atelectasis: newborns with limited surfactant, meconium Secondary: Mucus plug, foreign body, chronic respiratory disease

Buckle (torus)

Compression of the bone resulting in a bulge or raised area at the fracture site.

Anatomic abnormalities present at birth can lead to?

Congenital Heart Disease (CHD)

Congenital laryngomalacia/tracheomalacia

Congenital laryngomalacia means that an infant's laryngeal structure is weaker than normal and collapses more than usual on inspiration Assessment findings: Laryngeal stridor, retractions, tires with feeding Management: Feed slowly with rest periods, improves with age, early intervention with URI's bc it can be more intense and obstruction is more possible

Choanal Atresia

Congenital obstruction of the posterior nares by an obstructing membrane or bony growth. Respiratory distress NP and IVF until corrective surgery

Nursing Role for LP

Consent Preparing procedure Numbing cream Procedural position Recovery (flat for 30min)

Facilitating Exam of Preschoolers

Consider sequence Allow children to touch and play with equipment Use games to reduce anxiety Give positive feedback

Parental Concerns & Problems

Constipation Loose stools Colic Spitting up

Partial (Focal) Seizures

Contained to one area of the brain Can progress to general seizures, so it is important to monitor symptoms and compare with new episodes Typically do not result in LOC Initial signs can be numbness, tingling, or pain Noting symptoms and involved extremities can assist neurologist in pinpointing the involved area of the brain

Status Asthmaticus Management

Continuous inhaled SABA IV Corticosteroids/Magnesium Sulfate Heliox (Helium/Oxygen) - can be administered via a non-rebreathing mask to decrease airway resistance and work of breathing. Intubation - Ketamine is a smooth muscle relaxant that decreases airway resistance.

Functional (postural) Scoliosis

Correction of underlying cause, spinal fusion if needed

Evaluating Vomiting and diarrhea

Count the number of times it has happened. Examine contents and what the child ate. Vomiting and diarrhea is serious in infants and should notify HCP 6-8 wet diapers

Cognitive Development

Deferred imitation Preoperational thought Assimilation

A nurse is teaching a group of caregivers about fractures. Which of the following information should the nurse include in the teaching?

Detection and early treatment are crucial for an epiphyseal plate injury to prevent altered bone growth.

Emotional Development of preschooler

Developmental Tasks Initiative Imitation Fantasy

Transportation of Great Arteries Diagnosis and Management

Diagnosis Echocardiogram and/or cardiac cath Management This defect requires surgical correction within the first 14 days of life to ensure the most positive outcomes.

Pericarditis Diagnosis and Management

Diagnosis: EKG, Echocardiogram, xray Management:Anti-inflammatory medications, corticosteroids, colchicine. Pericardiocentesis must be performed. This fluid may be sent for cultures to further investigate for causative organism or malignancy

Endocarditis Diagnosis and Mangement

Diagnosis: Lab testing (ESR and + blood culture), Echocardiogram (vegetation, Chest Xray. Management: Aimed at underlying bacteria - IV antibiotics for 6 weeks. PICC Line. All children diagnosed with endocarditis must receive prophylactic antibiotics prior to some invasive procedures including dental work.

Myocarditis Diagnosis and Management

Diagnosis: Myocardial biopsy and MRI Management: Symptomatic. No real literature that supports anti-inflammatory or immunosuppressive therapy

Headache (diagnostic and treatment)

Diagnostic: Eye exam, BP, EEG Treatment: Rest, hydration, analgesics

Inspect Face Symmatry

Draw a line down middle of face and compare sides. Significant asymmetry may be caused by paralysis of cranial nerve V or VII, in utero positioning, or swelling from infection, allergy, or trauma.

Palperbral Slant

Draw an Imaginary Line Across the Medial Canthi and Extend It to Each Side of the Face DS may show upward slant

Health promotion: daily activities

Dress Sleep Exercise Hygiene Care of teeth

Health Promotion: Daily Activities

Dressing Sleep Bathing Care of teeth

Health promotion and daily actives for preschool

Dressing Sleep Exercise: Play is exercise Bathing: Can wash hands independently if water temperature is regulated. Still need supervised baths Teeth: Teeth grinding may begin

Tooth Decay Syndrom

Due to long periods of bottle feeding from sugars in formula

Emotional Development: Adolescents

Early adolescent developmental task: identity versus role confusion Body image Self-esteem Value system Early adolescent developmental task: identity versus role confusion—(cont.) - Career decisions - Emancipation Late adolescent developmental task: intimacy versus isolation - Sense of intimacy - Socialization

Coarctation of Aorta Diagnosis

Echocardiogram and Cardiac Cath

Diagnostic Tests for Cardiac Disorders

Electrocardiogram; Holter/event monitor X-ray Transthoracic echocardiogram Computed tomography/magnetic resonance imaging Exercise stress testing; laboratory tests Cardiac catheterization

Treatment for compartment syndrome

Elevate above hear, loosen dressing, fasciotomy, wound care

Seizures are a late symptom of?

Encephalopathy caused by led poisoning

Preparation thought and assimilation

End of toddler period, they enter the preoperational thought period and begin to use assimilation. Because they are not able to change their thoughts to fit a situation, they learn to change the situation (or how they perceive it). This ability is what causes toddlers to use toys in the "wrong" way. For example, if a child is given a toy hammer, instead of pounding with it, she may shake it to see if it rattles (i.e., the child has changed the toy's use to fit her thoughts, or used assimilation).

Non-Hodgin Lymphonma

Enlarged lymph glands of neck and chest; possibly of axillary, abdominal, inguinal nodes; if mediastinal lymph glands involved, cough or chest "tightness"; edema of face

Burkitt Lymphoma

Enlarged, painless lymph node of neck or abdomen blocking a body system; growth so rapid cell mass may double in size in as few as 24 hours

Facilitating Exam of older children and adolescents

Ensure modesty and privacy Offer choices Explain body parts and functions Decide on parental presence of absence Consider need for non parent chaperones Reassure adolescents of normalcy

Initiative vs. Guilt

Erikson's third stage in which the child finds independence in planning, playing and other activities Encourage activities that prompt initiative like creative play, arts & crafts, etc

Health promotion: nutrition

Establishing healthy eating patterns Fostering industry and nutrition Recommended dietary reference intakes Vegetarian diet

Kawasaki Disease And Anti-inflammatory properties

Evidence has shown that treating these children within the first 7 to 10 days of the fever with high-dose intravenous immunoglobulin (IVIG) and high-dose aspirin therapy has demonstrated a reduction in the appearance of coronary artery ectasia and aneurysms due to their anti-inflammatory properties.

Spastic CP

Excessive tone in voluntary muscles Hypertonic muscles, clonus, exaggerated DTRs Abnormal reflexes, + Babinski Tightening of connective tissue can present by school-age with tip-toe walking

A previously toilet trained 4-year-old child has many episodes of urinary incontinence while in the hospital for a fractured femur. Which of the following actions should the nurse implement?

Explain that children will usually quickly regain control over a previously mastered skill once home again. Rationale: Stressful events may cause a child to regress back from a previously mastered task. Hospitalization, trauma, and separation from parents are all examples of what may induce this.

Ataxic Disorders

Failure of muscular coordination or irregularity in muscle action Manifest as an awkward gait or lack of coordination Causes differ but ataxic disorders always involve degeneration of the cerebellar or vestibular functions

Truncus Arteriousis

Failure of septum formation, resulting in a single vessel that comes off both the ventricles. One valve that leads to both lungs and aorta. Basically no ventricular septum

Separation

Fear of separation is yet another major concern for preschoolers. Their sense of time is still so distorted that they cannot be comforted by assurances such as "Mommy will pick you up from preschool at noon." Their sense of distance is also limited, so making a statement such as "I work only a block away" is not reassuring. Relating time and space to something a child knows better, such as meals, television shows, or a friend's house, is more effective. For example, stating, "Mommy will pick you up from preschool after you have had your snack" is apt to be more comforting than "Mommy will pick you up at 3 PM."

Iron Supplement

Ferrous Sulfate 4-6 weeks initially - Empty stomach is best - Take with citrus juice to enhance absorption - Avoid taking it with milk or tea (decreased absorption) - Use a straw to prevent staining of teeth - Good dental hygiene - Side Effects: Black stools, constipation - Parenteral route: If given deep IM, use Z-track method to prevent leaking of fluid in SQ space which cause staining of skin. Do not massage.

24 Months

Fine Motor: Can open doors by turning doorknob, lids Gross: walks up stairs alone Language: 50 words, two ward sentences Play: Parallel play evident

18 Months

Fine motor: No longer rotates spoon to bring to mouth Gross motor: Can run and jump in place, walk up and down stairs holding persons hand, Language: 7-20 words Play: Intimates household chores such as dusting, playing along side with another child (NOT WITH)

15 months

Fine motor: Puts small pellets in bottles, scribbles voluntarily, holds spoon Gross motor: Walks alone well, can seat self in chair, creep up stairs Language: 4-6 words Play: Stack blocks, being read to, drops toys for adult to recover

4 years

Fine: Can do simple buttons Gross: Constanly in motion, jumps, skips Language: 1500 words Play: Pretending is major activity

5 years

Fine: Can draw a six-part figure, lace shoes Gross: Throws overhead Language: 2100 words Play: Likes games with numbers or letters

3 years

Fine: Undresses self, stacks, draws cross Gross: Alternates feet on stairs, rides tricycles, stands on one foot Langauge: 900 words Play: able to make turns, imaginative

30 Months

Fine: makes simple lines or strokes for cross with pen Gross: Can jump down from chair Language: Knows full name, one color, show age with fingers Play: Playing house, imitating parents,

Complex Partial Seizures

Focuses usually in temporal lobe Symptoms: Vary greatly some experience aura. - Change in posture - Pallor and apnea may be present (OXYGEN) Diagnostics: EEG,CT,MRI

Open or compound

Fracture with skin breakage

Closed or Simple

Fractures without skin breakage

Coarctation of Aorta Assessment

Frequently, children are not diagnosed with a coarctation until they grow and are noted to be hypertensive. Elevated blood pressures to be noted in the right arm. - Evaluate in the right arm and then either lower extremity systolic murmur heard along the left sternal border and the left midscapular area. Bounding pulses in the upper extremities Cool skin of lower extremities Weak or absent femoral/lower extremity pulses Heart failure in infants Dizziness, headaches, fainting, or nosebleeds in older children

Difference in respiratory system in children

Funnel shape, airway is more narrow, tongues are larger in proportion to mouth. Infants have small nares and are obligate nose breathers until 6 months Rapid growth in children causes larger lymphoid tissue, tonsillar tissue, in early school-age

Hemolytic Anemia

G6PD Sickle Cell

Weight & Height

Gains about 5 to 6 lbs In weight and 5 in of length/height per year during the toddler period.

Gender roles

Gender roles Preschoolers begin to be aware of the traditional differences in gender expression. These are not innate but are learned from society and parental influence. Socialization begins to occur at school or play groups as they learn about the world through social interaction.

Components of Health History

General information Physiological data Psychosocial data

Indomethacin

Given in three separate IV Doses to facilitate closure of ductus arteriousus

LP expected findings

Glucose 60-80% Protein 15-45 Cell Count 0-9 Decrease in glucose indicates bacterial infection.

Streptococcal Pharyngitis

Group B strep Enlarged tonsils, fever, sore throat, headache, tummy ache, difficulty swalllowing, SAND-PAPER RASH on body. Throat culture Treatment is penicillins or cephalosporins

Cerebral Palsy

Group of nonprogressive disorders of upper motor neuron impairment - Results in motor dysfunction Affected children may have speech or vision difficulties, siezures, cognitive difficulties, or hyperactivity. Muscle spasticity can lead to orthopedic or gait difficulties

Developmental Milestones for school-age

Growth changes can cause awkward feelings of uncoordinaiton can lead to kids quitting sports Tying shoe laces, cut and paste by hand well and drawing is good

Growth, Development, Maturation, Cognitive development

Growth: Physical Development: Function Maturation: (development) Optimal Cognitive development: the ability to learn or understand from experience, to acquire and retain knowledge, to respond to a new situation,

Dont give CHF digoxin in children if?

HR is less than 90 or 70 in adolescents. Digoxin slows HR , and increases myocardial contractility

A toddler seems unable to remain dry despite toilet training. Which patient teaching should be included in his plan of care?

He is probably not yet physically ready for toilet training. Rationale: Children must have both physical and mental maturity for toilet training. For many children, this point is not reached until they are 2½ or 3 years old.

Headaches for children could mean different reasons

Headache can be one of the early symptoms of other neurological issues such as bleeding, tumors, and seizures

Symptoms of Increased Intracranial Pressure

Headache occurs on arising; may be intermittent throughout day; intense on straining Vomiting occurs on arising; not nauseated, will eat immediately after; morning after morning, eventually projectile Diplopia, ptosis, or strabismus; papilledema Skull films, bone scan, ultrasound or MRI, cerebral angiography, or a CT scan; possibly myelography; lumbar puncture

Parental concerns during preschool

Health problems Fears: Dark, mutilation, separation of abandonment

Hearing

Hearing - responds to stimuli as early as at birth, by 4m/o will turn to localize a sound source, recognize name by 10m/o, developing vocabulary (imitation) also indicates hearing

Abnormalities result in?

Heart failure and hypoxemia

Trancus Arteriousis Assessment

Heart failure, Murmur, Variable cyanosis, Delayed growth, Lethargy, Fatigue, Poor feeding habits

Heart failure occurs when?

Heart is unable to pump adequate blood to meet the metabolic and physical demands of the body

Height

Height (aka length) should increase by 50% from birth to 1 year (birth length is around 20 in, 1 year is avg of 30 in)

Loss of extrusion reflex

Helps prevent infants from aspirating objects or swallowing solids before their GI tract is mature enough for digestions. Reflex resolves around 3 or 4 m/o.

Examination findings of CHF for right sided failure

Hepatomegaly Cardiac gallop Enlarged heart or chest radiograph +/- pulmonary edema

Rheumatic Fever Assessment

History of recent URI Fever, Tachycardia, cardiomegaly, new or changed heart murmur, muffled heart sounds, pericardial friction rub, and report of chest pain, which can indicate carditis Nontender, subcutaneous nodules over bony prominence Large joints (knees, elbows, ankles, wrists, shoulders) with painful swelling, indicating polyarthritis. Findings can be present for a few days and then disappear without treatment, frequently returning in another joint. Pink, nonpruritic macular rash on the trunk and inner surfaces of extremities that appears and disappears rapidly, indicating erythema marginatum CNS involvement (chorea) including involuntary, purposeless muscle movements; muscle weakness; involuntary facial movements; difficulty performing fine motor activities; labile emotions; and random, uncoordinated movements of the extremities Irritability, poor concentration, and behavioral problems

Developmental Task: Industry vs Inferiority

Home School Structured activities Problem solving Living with others

Parental Concerns during adolescent years

Hypertension Poor posture Body piercing and tattoos Fatigue Menstrual irregularities Acne Obesity

Adolecents

Hypertension is present if blood pressure is above the 95th percentile, or 127/81 mmHg for 16-year-old girls and 131/81 for 16-year-old boys for two consecutive readings in different settings. (Pulse, respiration, and blood pressure value charts are available at http://thePoint.lww.com/Flagg8e.) Adolescents who are obese, who are Black, who eat a diet high in salt, or who have a family history of hypertension are most susceptible to developing the condition. Important to reduce risk to prevent cardiac problems in adulthood.

Aortic Stenosis Assessment

INFANTS: Faint pulses Hypotension Tachycardia poor feeding tolerance CHILDREN: Intolerance to exercise Dizziness chest pain possible ejection murmur

Diaper Dermatitis

If a diaper area is covered with lesions that are bright red, with or without oozing, that last longer than 3 days, and appear as red pinpoint lesions, suspect a fungal (monilial or candidiasis) infection that will also need therapy (an antifungal medicine such as Nystatin). Redness that follows the outline of the diaper may indicate an allergy to the diaper materials and a product change may be necessary.

Coarctation of the Aorta

If the systolic pressure reading in the right upper extremity is 10 mmHg higher than that in the lower extremity, this is an indicator of potential CoAo and requires further evaluation.

Imitation

Imitation peaks now at in preschool age. Role modeling is important...good time to teach some helpful behaviors at home

Kawasaki Disease Management

Immediate symptom management to prevent long term complications Children are treated with 2 g/kg of IVIG. This dose may be repeated if the fever does not break. High-dose aspirin at 80 to 100 mg/kg divided four times a day is also continued for 48 to 72 hours after the fever breaks. Aspirin is continued at a low dose of 3 to 5 mg/kg/day once a day for 6 to 8 weeks with no evidence of coronary artery abnormalities.

Ataxia Telangiectasia Symptoms

Immunological - Reduced T-cell function - Frequent infections (respiratory) - Very little tonsil tissue Neurological - Degeneration noted early - Milestones not achieved - Rapid, purposeless movements develop - Difficulty tracking and following with eye movements

Blood Plasma

Important to cardiac system and fluid balance but largely uninvolved with issues of the hematological system

Diagnosis of Sickle Cell

In utero by cord sampling or newborn screen Fever, yellow sclera, vomiting, enlarged liver, acute back pain, enlarged spleen, kidney infarction, painful hands, abdominal pain and tenderness, joint pain

Differences in responses of children and adults to illness

Inability to communicate Inability to monitor own care and manage fear Nutritional needs Fluid and electrolyte balance Systemic response to illness Age-specific diseases

Greenstick

Incomplete fracture of the bone.

Congenital Heart Disorders

Increased Pulmonary Blood Flow Decreased Pulmonary Blood Flow Obstruction to Blood Flow Mixed Blood Flow

Symptoms of Increased Cranial Pressure

Increased head circumference Fontanelle changes Vomiting Eyes (diplopia) Vital sign changes (elevated temp & BP - decreased pulse & RR) Headache Mentation: Irritability

Assessment of CP

Infancy is difficult to determine, anoxia. Extent of disorder may be known until toddler/preschool age Sensory Alterations - Visual and speech difficulties - Association with ADD and ASD - Cognitive challenges and recurrent seizures are common

Evaluating degree of reduced activity

Infant has lack of interest in smiling or interaction; may lie supine with legs non flexed (frogged legged) as if exhausted

Secondary Circular Reaction

Infant learns to initiate, recognize, and repeat pleasurable experiences from environment. Good toy for this period: mirror; good game: peek-a-boo. Realize that that they can initiate reactions using motion.

Smell

Infants can smell accurately within 1 or 2 hours after birth. They respond to an irritating smell by turning their head away from it. They appear to enjoy pleasant odors and learn early in life to identify the familiar smell of breast milk. Teach parents to be alert to substances that cause sneezing when sprayed into the air, such as room deodorizers or cleaning compounds, and to keep irritating odors of this nature out of their child's environment.

Taste

Infants demonstrate they have an acute sense of taste by turning away from or spitting out a taste they do not enjoy. When infants are introduced to solid food at about 6 months, urge parents to make mealtime a time for fostering trust as well as supplying nutrition by being certain feedings are done at an infant's pace and the amount offered fits the child's needs and not the parent's idea of how much should be eaten.

Bathing

Infants do not typically need bathed daily unless its very hot weather. Face, hand, and perineal area should be cleaned daily. Bath time should be fun and social time for babies.

Touch

Infants need to be touched so they can experience skin-to-skin contact. Clothes should feel comfortable and soft rather than rough; diapers should be dry rather than wet. Teach parents to handle infants with assurance yet gentleness. Remind parents that right now their child is a baby; he or she will have time enough to become a strong man or woman later.

Tricuspid Atresia Assessment

Infants: Cyanosis Dyspnea tachycardia Older children: Hypoxemia clubbing of fingers

Pneumonia

Infection and inflammation of alveoli. Usually follows an URI from strep, staph, or mycoplasma. Assessment: High fever, tachycardia, chest or abdominal pain, retractions, accessory muscle use, decreased breath sounds Mangement: IV Antibiotics/fluids Antipyretics Hydration Repositioning Humidified Oxygen CPT and Postural drainage

Osteomyelitis

Infection within the bone secondary to a bacterial infection from an outside source (with an open fracture [endogenous] or from a bloodborne bacterial source [hematogenous])

Infective Endocarditis

Infective endocarditis is inflammation and infection of the endocardium or valves of the heart. Generally caused by Streptococcus viridans and Staphylococcus aureus, fungal organisms.

Laryngitis

Inflammation of larynx as complicated of pharyngitis over use

Bacterial Meningitis

Inflammation of meninges Typically seen in children less than 24 months

Laryngotracheobronchitis (Croup)

Inflammation of the larynx, trachea and major bronchi. Occurs in children between 6 months and three years. Caused by RSV, influenza, mycoplasma pneumonia, parable, diagnosed with culture

G6PD Assessment

Ingestion of fava beans, antipyretics, sulfonamides, antimalarials, and naphthoquinones Aspirin Exposure to Henna Educate allergies to include medications and products to avoid

Aspiration & Bronchial Obstruction

Inhalation of foreign body into airway with potential obstruction. After bronchoscopy assess for bronchial edema Continuous monitor Frequent vital signs NPO until gag reflex returns

Physeal (growth plate)

Injury to the end of the long bone on growth plate

Ewing sarcoma

Intermittent pain at site, becomes constant and severe; "onion-skin" reaction on X-ray Bone scan, bone marrow aspiration, biopsy, CT scan of lungs, and IV pyelogram or kidney MRI

Tips to help introduce solid foods to infants

Introduce one food at a time, 3-7 days between new items Introduce food before formula or breastfeeding Small amounts Respect infants food preferences

Strategies to Facilitate Rapport and Data Collection (1 of 2)

Introduction Purpose of interview Privacy Use of open and Closed ended questions Timing of questions, one at a time

Strategies to Facilitate Rapport and Data Collection (2 of 2)

Involve the child and be honest Use language appropriate terms Observe nonverbal communication Use an interpreter if needed

Hypochromic Anemias

Iron Deficiency Anemia Chronic Infection Anemia

The nurse is caring for a 3-month-old child with acute bronchiolitis; the child's parents are very anxious. When providing teaching, which topics are most important? Select all that apply.

It is caused by respiratory syncytial virus. Suprasternal and subcostal retractions are often present. Respiratory rate may be 60 to 80 breaths per minute.

Kawasaki Disease

Kawasaki disease (mucocutaneous lymph node syndrome) is defined as an acute febrile syndrome associated with generalized vasculitis (inflammation of blood vessels) affecting all blood vessels throughout the body, including the coronary arteries. Unknown Etiology Positive genetic disposition Diagnosed by exlusion Clinical criteria have been established to help with the diagnosis of kawasaki

Facilitating Exam of infants over 6 months

Keep infant close to parent Promote comfort Warm hands, stethoscope

Rheumatic Fever Diagnosis

LABORATORY TESTS Throat culture for GABHS: currently recommend screen all school-aged children who have sore throats Blood antistreptolysin O titer: Elevated or rising titer, most reliable diagnostic test C-reactive protein (CRP): Elevated in response to an inflammatory reaction Erythrocyte sedimentation rate: Elevated in response to an inflammatory reaction CXR for cardiomyopathy

Developmental MileStones

Language 2m/o differentiating cry 4m/o coos, babbles, laughs 6m/o imitating, vowel sounds "ooo---ooo" "ah-ah" 9m/o first word "da-da" 10m/o "bye bye" or "no" 12m/o 2 words besides ma-ma or da-da Play 1m/o mobiles with music black and white or bright colors for stimulation 3m/o small blocks or rattles 4m/o play pen or sheet for rolling over 6m/o teething rings 9m/o stackable rings 12 m/o toys with items in containers for organizing

Parental concerns during the school-age years

Language development Fears and anxiety - School phobia Home schooling Lack of adult supervision Sex education Stealing Violence or terrorism Bullying Recreational drug use

Developmental Milestones for Toddler

Language development Emotional Development - Autonomy - Socialization - Play behavior Cognitive Development

Developmental Milestones for Preschoolers

Language development & Play

A harsh holosystolic murmur is noted at?

Left loser sternal border for VSD. Many VSD's will close spontaneously

Play

Like imitation games, playing pretend....lots of imagination (imaginary friends). More group play is favored here as they become exposed to it at school

Types of Pediatric Cancer

Liquid: Leukemias, lymphomas Solid: Organs, bone, soft tissue Neuro

Thalassemia Major

Low Hgb Pallor, irritability, anorexia High iron levels, because iron is not being used in the Hgb

Diagnostic Test

Lumbar puncture Ventricular tap Radiology studies Electroencephalogram

Epiglottitis

MEDICAL EMERGENCY Epiglottitis is inflammation of the epiglottis, which is the flap of cartilage that covers the opening to the larynx to keep out food and fluid during swallowing. Rare, inflammation of the epiglottis is an emergency because the swollen epiglottis cannot rise and allow the airway to open. It occurs most frequently in children from 2 to about 8 years of age. Symptoms begin as those of a mild upper respiratory tract infection. After 1 or 2 days, as inflammation spreads to the epiglottis, the child suddenly develops severe symptoms.

Evaluating Pain

Manifestations of fussiness, crying if sharp. They reveal arm and leg pain by immobility of the body part, ear pain by brushing or tugging at the ear, and stomach pain by pulling up the legs against abdomen

What are the risk factors for congenital heart defects?

Maternal: Infection, alcohol/substance, diabetes mellitus Genetic: Syndromes (trisomy 21), History of congenital heart disease in family, presence of other congenital anomalies or chromosomal abnormalities

Atrial Septal Defect Assessment

May go unnoticed The turbulence created by the increased pulmonary blood flow produces a systolic murmur heard best at the left upper sternal border. ASD may have a fixed split-S2 heart sound. The child will present with symptoms of pulmonary over circulation: Rales, Congestion tiring with activity, or poor weight gain, Right sided heart enlargement

Ketogenic Diet

May help relieve seizures. High fat, low carb, low protein

Sickle-Cell Anemia

May not be symptomatic until 6 months when fetal Hgb is depleted 1/400 black infants

Post-itcal period

May sleep 1-4 hours (responsive to pain stimuli) Headache No memory

Atrial Septal Defect Management

Medical management of the symptoms with diuretics will be attempted first to allow the defect to close spontaneously. 5 mm or greater with persistent shunting after an observation period should be referred for closure. 8 mm or larger with evidence of increased pulmonary blood flow, the child will be referred for closure immediately. A secundum ASD is typically closed in the catheterization lab with a device that sits in the defect space. Primum defects typically cannot be closed in the catheterization lab because of their anatomy and are referred for surgical closu

Treatment for Complex partial Seizures

Medications: - Carbamazepine - Valproate Surgical: - Excision - Vagus nerve stimulator Anticipatory Guidance - Bracelet

Hypoplastic Left Heart syndrome assessment

Mild cyanosis Heart failure Lethargy Cold hands and feet Once PDA closes, progression of cyanosis and decreased cardiac output result in eventual cardiac collapse

Promotion of a positive hospital stay

Minimizing length of stay Providing continuity of care Decreasing separation anxiety Promoting visitation Encouraging parents to participate Supporting sibling and grandparent visitation Minimizing negative effects of procedures Reducing or eliminating pain Maintaining child's bed as safe area Helping children maintain control Adequate play facilities Setting limits on behavior

Nursing Care for Cardiac Disorders

Monitor VS/Cardio-Respiratory Monitor Pulse Oximetry BP x 4 extremities (CoArc) Monitor I&O Nutrition Support (enteral feeding when indicated) Prepare for Diagnostic Testing: EKG, Echo, CxR, Cardiac Cath Lab Provide Psychosocial support for family Prepare for surgery

Developmental milestones

More adult forms of recreation Team loyalty becomes intense Much time talking with peers, face to face or electronically Part-time job Charitable endeavors

Iron Deficiency Anemia

Most common anemia in infants and children Largely related to nutrition and insufficient iron intake

Acute Nasopharyngitis (common cold)

Most common infectious disease in children Best action to reduce is hand washing Toddlers can have as many as 10 to 12 colds a year. School-age children and adolescents have as many as 8 to 10 yearly because infection is spread so readily in classrooms.

Febrile Seizures 3-older

Most common type of sz seen in preschool children but can be seen from infancy - 7 y/o. Associated with high fevers (38.9 - 40 degrees C) May occur post immunizations with live vaccines in healthy children due to fever reaction Typically follows a generalized tonic-clonic pattern which lasts 15-20 seconds Familial history is common Work-up necessary to rule out other causes or underlying problems

Mycoplasma pneumonia

Mycoplasma pneumonia occurs more frequently in children over 5 years of age during winter months. Fever, cough, cervical lymphadenopathy, and rhinitis are common symptoms. Mycoplasmal organisms are generally sensitive to erythromycin or tetracycline.

Inflammatory Processess

Myocarditis Pericarditis Endocarditis

Myocarditis

Myocarditis is an acute or chronic inflammatory process affecting the myocardium. Specifically, there is an inflammation of the myocardium with necrosis or degeneration of adjacent myocytes. This disease can be caused by a wide variety of toxins, drugs, or infectious agents, most commonly viral agents such as coxsackievirus, adenovirus, or parvovirus.

Chemotherapy Side Effects

N/V Anorexia/dehydration/malnutrition

Aortic Stenosis Management

NONSURGICAL PROCEDURES THERAPIES: Balloon dilation with cardiac catheterization Administer beta blockers, calcium channel blockers SURGICAL PROCEDURES Norwood procedure Aortic valvotomy

Coarctation of Aorta Management

NONSURGICAL PROCEDURES/THERAPIES Infants and children: Balloon angioplasty Adolescents: Placement of stents SURGICAL PROCEDURE: Repair of defect recommended for infants less than 6 months of age

Oxygen Deliver

Nebulizer, nasal cannula, simple mask, non-rebreather

Pediatric Neurological Disorders

Neurons reach optima function at 12 y/o

Normal HR for Children of Different Ages

Newborn: 100-170 Infant - 2yr: 80-130 2-6yr: 70-120 6-10yr: 70-110 10-16yr: 60-100

Normal Respiratory Rate Ranges by Age

Newborn: 30-55 1 Year: 25-40 3 Year: 20-30 6 Year: 16-22 10 Year: 16-20 17 Year: 12-20

Choanal Atresia Description

Newborns up to approximately 6 months of age are naturally nose breathers, so infants born with choanal atresia almost immediately develop signs of respiratory distress after birth. Choanal atresia can also be assessed by holding the newborn's mouth closed and then gently compressing first one nostril and then the other. If atresia is present, infants will struggle as they experience air hunger when their mouth is closed. Their color improves when they open their mouth to cry.

Treatment for Ataxia Telangiectasia

None. Children often die

Thalassemias minor

Normal RBC Slightly decreased Hgb level No symptoms other than pallor No treatment necessary, normal life expectancy No iron supplementation

Upper respiratory tract

Nose, paranasal sinuses, Trachea, pharynx, larynx and epiglottis

Increased ICP

Not a single disorder, but a symptom of many neurological disorders Important to consider the skull as a closed vault with very little room Consider fontanelle status (closed vs. open)

A 6-year-old child receiving chemotherapy develops stomatitis. The physician prescribes Xylocaine to be used to decrease the discomfort associated with this. What teaching should the nurse provide first to the child?

Not to swallow the solution. Rationale: Swallowing lidocaine may cause paralysis of the gag reflex. Young children may just drink and swallow the solution if not taught what is to be done.

Coarctation of Aorta

Not typically Cyanotic on presentation

When planning the care for a child with Kawasaki disease, which of the following would be most important?

Observing him for symptoms of bowel obstruction

Fine Motor Development

One month old grasp reflex, hands always in tight fists, this fades by 3mo Thumb Opposition: (bringing the thumb and fingers together starts as a crude grasping, scooping, or raking Pincer Grasp: *10 m/o pincer grasp milestone* good for cheerios and puffs

Hodgkin Disease

One painless, enlarged, rubbery-feeling cervical lymph node followed by enlargement of other nodes and liver, spleen, bone marrow, CNS; anorexia; malaise; night sweats; elevated sedimentation rate; anemia

Disorders of Bone development

Osteogenesis Imperfecta Slipped capital femoral epiphysis Osteomyelitis Transient Synovitis

PGE1

PGE1 is started immediately after birth to maintain patency of the ductus arteriosus and encourage mixing of blood. Side effects of a PGE1 infusion can include apnea and hypotension. It is best for the child to remain on room air, spontaneously breathing, but the staff must be prepared to offer ventilator support should a child stop breathing

Sickle Cell Anemia Interventions

Pain relief (analgesics, heat packs "NEVER COLD PACKS") Hydration Oxygen Hydroxyurea Blood transfusion Hematopoietic steam cell transplant

Iron Deficiency Anemia Assessment

Pale conjunctiva (HALLMARK SIGN) Pallor, decreased activity, poor muscle tone

Assessing Leukemias

Pallor, low-grade fever, lethargy; low thrombocyte count, petechiae, bleeding from oral mucous membranes, easy bruising on arms and legs; abdominal pain, vomiting, anorexia; bone and joint pain; headache or unsteady gait; painless, generalized swelling of lymph nodes; elevated leukocyte count; lesions on long bones; blast cells in CSF

Neuroblastoma

Palpable abdominal mass after weight loss, anorexia; possibly excessive sweating, flushed face, hypertension; possibly abdominal pain, constipation; possibly loss of motor function in lower extremities

Nephroblastoma (wilms tumor)

Palpable firm, nontender abdominal mass; possibly hematuria, low-grade fever; anemia CT scan or ultrasound; glomerular filtration rate or blood urea nitrogen assays

Facilitating Examinations of infants under 6 months of age

Parental presence Physical comfort & Relaxation Distract infant with color Use gentle, warm hands and warm stethoscope Auscultate when sleep Do procedures that provoke crying at end

Mutilation

Part of this fear arises because preschoolers do not know which body parts are essential and which ones—like an inch of scraped skin—can be easily replaced. Preschoolers can be worried that if some blood is taken out of their bodies, all of their blood will leak out. They often lift a bandage to peek at an incision or cut to see if their body is still intact underneath. They dislike procedures such as needlesticks, rectal temperature assessments, otoscopic examinations, or having a nasogastric tube passed into their stomach. They need good explanations of the limits of healthcare procedures, such as clarifying a tympanic thermometer does not hurt or a finger prick heals quickly as well as distraction techniques in order to feel safe.

Rheumatic Fever Management

Penicillin therapy is immediately begun once throat cultures and blood work have been obtained. Oral non steroidal anti-inflammatory The prognosis for the child with rheumatic fever depends on the extent of myocardial involvement. Valve damage may continue over time, and some children with no initial presentation of valve damage will have it occur later in life. These children will be followed for life by a cardiologist and may require surgical intervention to repair or replace the valve.

The nurse is caring for a child with thickened pulmonary secretions. Which action(s) would the nurse use to assist the child breathe with less effort? Select all that apply.

Perform chest physiotherapy Encourage oral fluids

Ventricular Tap

Performed in infants with open anterior fontanelle or children with ventricular-peritoneum shunt Positioning and prep Remain in upright position after procedure to prevent leaking from CSF tap

Endocarditis PICCs

Peripherally inserted central catheters (PICCs) similarly may injure the endocardial or endothelial layer allowing for the deposition of red blood cells, platelets, and fibrin. Bacteria then can adhere to the damaged endothelial layer, with further fibrin and platelet deposition trapping the bacteria in the evolving vegetation. This results in localized endocardial injury and valvulitis.

Preschooler

Physical Growth: Height, weight, body mass index, and head circumference Teeth

Common Types of Fracture in children

Plastic deformation Buckle (torus) Greenstick Transverse Oblique Spiral Physeal (growth plate) Stress

Cardiac Cath

Pre-op: NPO for 12. Assess for allergies to iodine or shellfish. Post procedure: supine with their legs straight for 2 to 4 hours after the procedure. Oxygen for sedation/anesthesia recovery. Restrict physical activity while site heals.

Cardiac Surgery

Preoperative care: NPO status, Lab values, vital signs, illness, Post-op: ICU management, assess labs for complications, assess for dysrhythmias.

Pneumothroax

Presence of atmospheric air within the plural space causing atelectasis Assessment: Signs of respiratory distress, absent breath sounds on affect side Diagnosis: xray Management: Oxygen, needle decompression, coverage of site of trauma

Bronchopulmonary Dysplasia

Preterm infants who were received mechanical ventilation at birth for respiratory distress. Assessment: Tachypnea, retractions, nasal flaring, tachycardia and O2 dependence. Management: Oxygen therapy (Acute or Chronic) Tracheostomy and Mechanical Ventilation Bronchodilators (SABA) Corticosteroids

Which is the primary nursing responsibility when a 4-year-old child with a tracheostomy tube eats?

Prevent aspiration of food or fluids into the tube.

Iron Deficiency Anemia Interventions

Prevention in infants through breastfeeding or iron-fortified formula feeding; iron-fortified first foods, such as cereal Treatment of underlying cause in older children with an iron compound to replace iron stores, followed by diet change to one rich in iron and vitamin C

Tonic-Clonic Seizure

Prodromal period: Aura, prediction Tonic-clonic period: Full body muscle contraction 20s Postictal period: Muscle relax

Asthma Assessment

Prolonged expiratory phase Retractions Wheezing/chest tightness/cough Restlessness/irritability/anxiety Accessory muscle use or tripoding Inaudible breath sounds (Severe Obstruction)

Kawasaki Disease Diagnostic Criteria

Prolonged fever (>100.4°F [39°C]) of 5 or more days Four or more of the following symptoms: - Changes in hands and feet (erythema, edema, peeling) - Polymorphous exanthema (diffuse maculopapular rash of the trunk and extremities) - Bilateral conjunctivitis without exudates - Changes in lips and mouth (erythema, strawberry tongue, dry, cracked lips) - Cervical lymphadenopathy (>1.5 cm diameter, usually unilateral). Other Lymph nodes may swell.

Separation Effects

Protest Despair Detachment

Facilitating Exams of Toddlers

Provide security object Demonstrate on parent first before child Allow child to have as much control and choice possible Examine ears, eyes, mouth and nose at end of exam

When encouraging an adolescent who is hospitalized and physically challenged or chronically ill to develop and maintain a sense of identity, which is the best nursing action?

Providing the opportunity for individual decision making Rationale: Knowing who you are includes how to make decisions to advance your welfare. Providing opportunities to do this is important.

Freud

Psychoanalysis theory of development revolved around psychosexual gratification. His primary research was on mentally disturbed adults whose motivations were sexually driven. For children, developmental stages were organized by body part.

Theories of Development (ADOLESCENT) 12-20 Years

Psychosocial stage: (Genital Stage) sexual maturity & relationships Nursing Implications: Allow for friendship to develop Developmental Task: Identity vs role confusion Nursing Implications: Opportunities to discuss events and feelings. Support and praise decisions

Theories of Development (SCHOOL AGE) 5-12 Years

Psychosocial stage: (Latent stage) Personality development Nursing Implications: Positive experiences with learning for self-esteem Developmental Task: sense of industry vs inferiority Nursing Implications: Allow opportunities to start and finish projects

Theories of Development (TODDLER) 1-3 years

Psychosocial stage: (anal stage) Control of urination & defecation Nursing Implications: Importance of bathroom control Developmental Task: Form a sense of autonomy vs Shame Nursing Implications: Opportunities for independence decision making, Choosing clothes

Theories of Development (INFANTS) 0-1 year

Psychosocial stage: (oral stage) Child explores the world by mouth Nursing Implications: Provide pacifiers, allow thumb sucking Developmental Task: From a sense of trust vs mistrust Nursing Implications: Provide primary caregivers

Theories of Development (PRESCHOOLER) 3-5 years

Psychosocial stage: (phalic stage) Sexual identity by genital awareness Nursing Implications: Fondling and exploration Developmental Task: Sense of initiative vs Guilt (basic problem solving) Nursing Implications: Opportunities to explore new places/activities. Free play

Bilirubin

RBC destruction > hem portion breaks down > protoporphyrin > indirect bilirubin > immature newborn liver function > jaundice Can occur anytime there is excessive RBC destruction or insufficient liver function

Radiation Therapy Side Effects

Radiation sickness (fatigue, anorexia, nausea, vomiting) - Anti-emetics Skin reactions (erythema and tenderness) - Good skin care and hygiene Evidence of long term side effects evolving

Nutritional Health

Recommend Dietary Allowances Introduction of solid foods

ICP Management

Relieve pressure

Sexual Education

Reproductive organ function and physiology of reproduction, so children understand what menstruation is and why it occurs Secondary sexual characteristics, so children will understand what is happening in their bodies Male sexual functioning, including why the production of increased amounts of seminal fluid leads to nocturnal emissions The physiology of pregnancy and the possibility for unintended pregnancies, which will come with sexual maturity Social and moral implications of sexual maturity

Which is the best way for an infant's father to help his child complete the developmental task of the first year?

Respond to her consistently. Rationale: The infant is in need of development of trust. Responding to the infant on a consistent basis develops the trust needed to meet the developmental task of infancy.

Rheumatic Fever

Rheumatic fever is an autoimmune disease that occurs as a reaction to a group A β-hemolytic streptococcal infection, specifically, a pharyngitis. Inflammation from the immune response leads to inflammatory lesions being found in the heart, blood vessels, brain, and joints. It occurs most often in children 6 to 15 years of age, with a peak incidence at 8 years. Approximately 10 days after recovery from the pharyngitis, the autoimmune response begins, lasts many weeks and gradually damages the left heart valves.

Left sided CHF can ultimately lead to?

Right sided failure, as excessive pressure in pulmonary system prevents blood from leaving the right ventricle

Chemotherapy

Routes: IV,PO,Intrathecal Types: can effect cell-cycle specific, and cell-cycle non-specific

Medications for Asthma

SABA - Albuterol or levalbuterol. LABA - formoterol, salmeterol - used to prevent exacerabtions, especially at night, and decrease the need for SABA. But cannot treat acute exacerabtions. Cholinergics - monitor for dry mouth, give before exercise or activitiy, monitor for irritability, tremors, insomnia, nervousness.

Bronchiolitis

SPREADS READILY FROM PERSON TO PERSON, LAST ON SURFACES FOR 6 HOURS - ENCOURAGE CLEANING AND HAND HYGIENE. Bronchiolitis - Inflammation and edema of the fine/small bronchioles. Caused by respiratory syncytial virus Management: Antipyretics, adequate hydration, nasal suctioning, nasal saline

Body Mass Index

SQ fat begins to disappear and child will be more lean looking, toddlers tend to have less of an appetite so its important to maintain adequate nutrition

Tricuspid Atresia Management

SURGICAL PROCEDURES: Surgery in 3 stages: shunt placement, Glenn procedure, modified Fontan procedure

Truncus Arteriosis Management

SURGICAL PROCEDURES: Surgery in 3 stages: shunt placement, Glenn procedure, modified Fontan procedure

Rituals

Same cup, spoon, comfort items

Goal of medications for seizures

Seizure free for 2-3 years

Promoting adequate stimulation

Sensory deprivation Children on bed rest Children on transmission-based precautions Sensory overload

Complications of Sickle Cell Anemia

Sickle cell crisis Aseptic necrosis of femoral or humeral head Splenic sequestration - Splenectomy Acute Chest Syndrome Stroke (CVA)

Hemolytic Anemias

Sickle cell disease, thalassemia, and other autoimmune disorders

A 4-year-old boy will not stop throwing sand at his sister. Which of the following punishments would be most effective with this child? A.Send him to his room for 15 minutes. B.Restrict television viewing for a day. C.Sit him in "time-out" for 4 minutes. D.Spank him on his bottom.

Sit him in "time-out" for 4 minutes. Rationale: Trying to correct behavior while allowing the child the right to his or her opinion works best without use of physical punishment.

PDA Management

Small defects may close on their own Diuretic - Furosemide Indomethacin - If the PDA is noted immediately after birth, this nonsteroidal anti-inflammatory and prostaglandin inhibitor, can be utilized to facilitate closure. Increase caloric density of formula or breastmilk NG feeds Surgical Closure Cardiac Cath

VSD Management

Small defects may close on there own Diuretic - Furosemide Increase caloric density of formula or breastmilk NG feeds Surgical Closure - Pulmonary artery banding or Complete repair with patch (increased risk for heart block)

Stress

Small fractures/cracks in the bone due to repeated muscle contractions

Emotional Development Toddler

Socialization is part of learning, imitating behavior is common Play besides other children, but not with them (parallel play) - classic for toddlers. If you want them to play together offer similar toys as arguing may ensue Toys that give children control and autonomy are preferred so trucks that move, toy phones to answer, rocking horses to ride. With independence and exploration, safety is even more important.

Emotional Development

Socialization, or learning how to interact with others, is an extensive phenomenon. One-month-old infants show they can differentiate between faces and other objects by studying a face or the picture of a face longer than other objects. They are calm and feed well for the person who has been their primary caregiver. When an interested person nods and smiles at a 6-week-old infant, the infant smiles in return. This is a social smile and is a definite response to the interaction. By 3 months, infants demonstrate increased social awareness by readily smiling at the sight of a parent's face By 6 months, infants are increasingly aware of the difference between people who regularly care for them and strangers. Fear of strangers reaches its height during the eighth month, so much so that this phenomenon is often termed eighth-month anxiety, or stranger anxiety

Four Types of CP

Spastic (40%) Dyskinetic Ataxic Mixed

Sprial

Sprials around the bone

Hypoplastic Left Heart syndrome Management

Stage 1: Norwood Procedure Stage 2: Bidirectional Glenn Shunt Stage 3: Fontan Procedure

Fantasy

Starting in preschool, these children begin to differentiatie between fantasy (i.e. cartoons) and reality. Can sometimes get stuck in intense involvement of play called "magical thinking" - believing that thoughts and wishes come true

Thalassemia Major Interventions

Stem cell transplant Pre-tranplant: Routine PRBC hypertransfusion every 2-4 weeks - Chelation medications bind with iron to decrease iron concentration - Maintains hgb levels - splenectomy

Body Contour

Still have a prominent abdomen bc muscles are not strong enough yet to support them. Also noted by a forward curve of the sacral area of the spine (lordosis). With experience walking, this will correct itself

Suppose Tasha has a tonic-clonic seizure while in the hospital. Which of the following items should the nurse keep available near the bedside for a child known to have generalized seizures? (Select all that apply.)

Suction Oxygen Call bell

Tetralogy of Fallot Management

Surgical Repair Usually, 3 to 6 months of age Hypercyanotic spells interventions: 1st: Knee to Chest Position 2nd: Supplemental oxygen 3rd: Immediate ER intervention if no clinical improvement

Heart Failure is usually a cluster of?

Symptoms and physical findings that are secondary to an underlying process. The primary process can be systemic or directly related to heart.

Tasha's sister Wanda was diagnosed with CP as an infant. What information would the nurse want her parents to know about her prognosis?

Symptoms may seem to grow worse as fine motor skill is needed.

Bacterial Meningitis Assessment

Symptoms: Newborns: irritable, poor feeding, weak cry, lethargy, fontanelles may bulge and feel tense Children: arched back, hyperextended neck, joint pain, rash (N. meningitidis), + Kernig's sign, + Brudzinski's sign Shock, seizures, nuchal rigidity, apnea may occur

Encephalitis (symptoms, diagnostic studies, treatment)

Symptoms: fever, ataxia, muscle weakness, diplopia, confusion, irritability Diagnostic Studies: H&P, CSF w/ elevated WBCs and protein, EEG, brain biopsy Treatment: Primarily supportive, anti-pyretics for fever, antivirals (Acyclovir), anti-seizure medications, ICU and ventilator support may be necessary Permanent brain damage is possible

Reye Syndrom (symptoms, treatment)

Symptoms: lethargy, vomiting, confusion, combativeness usually after a recent viral infection such as chicken pox or flu that was treated with Aspirin Treatment: supportive. Left untreated, leads to coma and death. NO ASPRIN

PDA Assessment & Diagnosis

Systolic to continuous murmur as the child grows If the defect is large enough, the flow to the lungs will be significant and can: Rales Congestion, increased work of breathing difficulty feeding, or failure to thrive, left ventricular hypertrophy. The severity of the symptoms depends on the amount of blood shunting to the lungs. Diagnosis: Echocardiogram

osteogenic sarcoma

Taller than average; painful, swollen site; possibly inflamed, feels warm; report of recent trauma to site Elevated serum alkaline phosphatase; biopsy of site

Physical Growth of adolescents

Teeth Puberty Secondary Sex changes

Parental Concerns/Problems

Teething Thumb sucking Use of pacifiers Head banging Sleep concerns Go away on their own

As children get older, we expect the following VS changes

Temp: Maintains/ slight increase HR: Decrease RR: Decrease BP: Increase POX: Maintains

Decreased Pulmonary Blood Flow Disorders

Tetralogy of fallot, tricuspid atresia, hypo plastic left heart syndrome

Plastic Deformation (bend)

The bone is bent no more than 45° without breakage.

Body Systems

The brain is now 90% of adult size, respiratory pathways are larges so incidence of respiratory infections decreases, stomach secretions become more acidic and lessen risk of GI infections, stomach capacity increases to allow for three meals a day, control of the urinary and anal sphincters becomes possible so toilet training is possible.

A father brings his 18-month-old son to the clinic. He asks the nurse why his son is so difficult to please, has temper tantrums, and annoys him by throwing food from the table. Which principle of growth should the nurse explain?

The child is learning to assert independence, and his behavior is considered normal for his age. Rationale: At 18 months of age, the child is learning to become independent and express his feelings. He does not have full command of his words and may use actions to express his feelings, such as throwing items.

Tetralogy of Fallot cyanosis reason

The degree of cyanosis is directly proportional to the degree of pulmonary stenosis. Pulmonary stenosis can be noted at several sites along this right ventricular outflow tract; most typical is subpulmonary valve stenosis with anomalies of the actual pulmonary valve also seen. Significant narrowing produces increased resistance to blood flowing through the pulmonary valve and out to the lungs. Because of this increased resistance, the blood will shunt right to left through the VSD because the VSD provides less resistance, and this deoxygenated blood travels directly out through the aorta into the systemic circulation.

When assessing a child for cyanosis, which is important for the nurse to remember?

The degree of cyanosis is not an accurate indicator of the degree of hypoxia.

G6PD

The enzyme glucose-6-phosphate dehydrogenase (G6PD) is necessary for maintenance of RBC life lack of the enzyme results in premature destruction of RBCs. The disease is an X-linked recessive trait inheritance and is found most often in persons of African, Mediterranean, or Asian decent

Comminuted

The fracture includes small fragments of bone that lie in tissue

Complicated fracture

The fracture results in injury to other organs and tissue

Body Proportion

The head is the heaviest part of the of body and larger than the chest in circumference until about 1 year when they should even out. Abdomen protrudes typically, diaphragmatic breathing is prominent, head and neck support are developing in first year

Acute Nasopharyngitis (common cold) description

The mucous membrane of the nose becomes edematous and inflamed, constricting airway space and causing difficulty breathing. pharyngitis (sore throat). As upper airway secretions drain into the trachea, this leads to a cough. Cervical lymph nodes may be swollen and palpable. Although fever typically lasts only a few days, respiratory symptoms generally last for about a week. Previous viral upper respiratory infections can be a precursor to development of a secondary bacterial infection in young children, such as ear infections.

You learn that a friend's 4-month-old son rolled off a changing table. Which of the following would you conclude from this?

The parents lacked knowledge of infant development. Rationale: Most 4-month-olds are capable of turning over. If parents are not aware of this, "rolling over" accidents tend to happen during this month.

Retrophayngeal abscess discription

The retropharyngeal lymph nodes, which drain the nasopharynx, are located just behind the posterior pharynx wall. Although uncommon, an abscess can form in these lymph nodes and may constitute a medical emergency as it may impact the airway. Assessment - They begin to "snore" with respirations as the pharynx becomes further occluded. To allow themselves more breathing space, they may hyperextend the head, which is a very unusual position for infants. Treatment - IV antibiotic treatment and hospitalization is needed for these infants to monitor hydration and their respiratory status. Although some retropharyngeal abscesses will resolve with antibiotic treatment, some will need surgical drainage. KEEP THEM CALM.

Tetralogy of Fallot assessment

These children will have a systolic murmur noted at the left upper sternal border. Cyanosis at birth: progressive cyanosis over the first year of life. Episodes of acute cyanosis and hypoxia (blue, "Tet" spells, hypercyanotic spells). - child becomes distressed and irritable, possibly without reason.

You discover that an infant's mother is propping a bottle at bedtime to help her fall asleep. Which patient teaching would the nurse provide this mother?

This can promote tooth decay. Rationale: Falling asleep with a bottle of formula allows formula to remain in contact with teeth for an extended time, which leads to "baby-bottle syndrome," or tooth decay.

The parents of a 2-year-old child are concerned because their child's back seems curved. Which is the nurse's best response?

This is normal for this age. Rationale: Toddlers have a natural lordosis (forward curvature of the spine) that resolves as they grow. It is not within a nurse's scope of care to order radiographs.

Kawasaki disease lab changes

Thrombocytosis Leukocytosis Elevated ESR and CRP Elevated liver enzymes Mild anemia The platelet count rises, increasing the possibility of clot formation. If an aneurysm forms in a coronary artery, accumulating thrombi can dislodge and lead to obstructed blood flow distally in the coronary artery which will lead to myocardial ischemia and infarction.

Discipline

Time-outs

Inspecting the Tympanic Membrane

To restrain an uncooperative child, place the child on the parent's lap with the child's head and chest held firmly against the parent's chest. Keep your hands free to hold the otoscope and position the external ear.

Language Development Toddler

Toddler time is critical for language development. Should be talking in two-word simple sentences by age two, if not - refer for screening "No" is used commonly. Need exposure to learn other words. Autonomy vs. Shame or doubt - Erikson. Achieved through some Independence which may be hard for parents to balance with sound rules for safety`

Parental concerns during toddler years

Toilet training Ritualistic behavior Negativism Discipline Separation anxiety Temper tantrums

Tonsil Size with Infection

Tonsil size can be graded from 1 to 4 in relation to how much of the airway is obstructed. Tonsil size of 1 and 2 is normal. Tonsil size of 3 is common with infections such as strep throat. Tonsils that "kiss" or nearly touch each other (4) significantly reduce the size of the airway.

tonsillectomy and adenoidectomy

Tonsillectomy removal of palatine tonsils Andeniodectomy removal of pharyngeal tonsils Complications of hemorrhage or aspiration during and after procedure. Do not use straws, discourage coughing and clearing of throat and nose. No hard foods or red colored liquids

Transient Synovitis

Transient synovitis is an acute, nonpurulent inflammation of the synovial membrane of a joint that occurs most commonly in the hip joint in children, with an age of incidence between 2 and 10 years, peaking at age 6 years. The exact etiology is unknown; however, there is usually a prodrome of upper respiratory symptoms

Mixed Blood Flow Disorders

Transposition of great arteries, truncus, arteriosus, hypoplastic left heart syndrome

Chlamydia Pneumonia

Typically in infants under 12 weeks old and contracted from mother during birthing.

toddler's mother is concerned because her toddler takes her blanket everywhere. Which advice would be most appropriate for her regarding this?

Understand that this is probably a normal event. Rationale: Blankets or favorite toys serve as transitional objects or security objects.

General signs and symptoms of cancer

Unexplained fever Bleeding/brusing Morning headaches Palpable masses Swollen lymph node Bone/joint pain Fatigue

EEG

Use to diagnose and monitor abnormal electrical activity in children Stimulation, sleep deprivation, and presence or abstinence of medications may be used to help provoke seizure activity Up to 15% of children with no cranial trauma or seizure activity, may show abnormalities on EEG

An 8-year-old eats lunch daily in the school cafeteria. Which is the best way to feel assured that he will eat a balanced lunch daily?

Use visual aids to demonstrate appropriate food selections. Rationale: School-age children are concrete thinkers, so they respond best to concrete examples.

Teeth

Usually seen by 6 months, about 1 in 2,000 births will have natal teeth (born with teeth) or neonatal teeth (appear within 1st 4 weeks of life)

Motor Development (GROSS)

Ventral suspension position Prone position Sitting position Standing position

Development of Senses

Vision Hearing Touch Taste Smell

Vision

Vision - recognize familiar objects at 4 months, object permanence at 10 months

A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? Select all that apply. Select all that apply.

Weak femoral pulses High BP in right upper extremity

Physical Growth

Weight Height Head circumference Body proportion Body systems Teeth

Weight and height for preschooler

Weight and gain much slower now compared to infant years, only about 4-5 lbs and 2-3.5 inches per year.

Physical Growth

Weight, height, head circumference, and body mass index Body contour Body systems Teeth

Spinal Alignment

When Evaluating Spinal Alignment, Look at the Level of the Iliac Crests and Shoulders to See If They Are Level

Iron Deficiency Anemia affects

Without iron, hemoglobin cannot cannot be incorporated into RBCs Most commonly affects children between 9mo and 3y due to excessive milk intake instead of iron-rich foods Frequency in adolescent natal females post-menarche Associated with obese teenagers with low-iron intake Association with pica, ice chewers Consider GI tract lesion disorders (UC, Chron's) in children older than 2 yrs

Sequence of exam

Young Children: Foot to head Older: Head to toe

Vasculitis

a principal and life-threatening symptom because it can lead to the formation of coronary aneurysms which will predispose the child to thrombus formation and a high risk of myocardial infarction. No imaging or lab tests can diagnose it

Detachment

a time during which the child becomes more interested in surroundings than in visitors; coping mechanism only, not sign of acceptance of separation from parent

Protest

a time during which the child cries loudly and demandingly

Despair

a time when the child acts depressed and withdraws from parent and healthcare providers

Contractility

ability to modulate the rate and force of fiber shortening

Thrombocytosis

abnormally high platelet count

Afterload

amount of resistance met by the ventricles upon ejection

blood dyscrasia

any pathologic condition of the cellular elements of the blood

Miliaria (prickly heat)

appears as clusters of pinpoint, reddened papules with occasional vesicles and pustules surrounded by erythema over dressed and moisture cannot escape, important to bath twice a day on very hot days and to dress lightly.

Left-Sided heart failure

back pressure causes blood to accumulate in the pulmonary system, causing orthopnea (difficulty breathing except in an upright position because of increased pulmonary congestion).

Osteogenesis Imperfecta

brittle bone disease. Is an inherited connective tissue condition that results in bone fractures and deformity along the restricted growth. Children with severe subtype can be born with fractures from birth. Multiple fractures, blue sclera, early hearing loss

Dipers

changed at least every 2 - 4 hours but not while asleep. Diaper rash from overnight wetness can be treated with barrier creams sleeping without a diaper. Diaper care should include cleaning with water or a commercial alcohol-and-perfume-free wipe. Barrier creams with zinc oxide or petroleum jelly help protect the skin from urine and stool. NO BABY POWDER. Emphasize hand hygiene before and after each diaper change.

Pericarditis Assessment

chest pain which can be sharp, precordial, radiating, and worse with inspiration or cough, pericardial friction rub (Left sternal border), fever.

Myocarditis Assessment

chest pain, exertional dyspnea, fatigue, syncope, or palpitations in association with acute CHF

The most common cause of CHF in children are?

congenital heart defects that produce an excessive workload on the myocardium, cardiomyopathies due to metabolic disorders, infectious diseases, drugs, Kawasaki disease, and myocardial dysfunction after heart surgery.

Heart disease can be?

congenital or acquired

Loose stools

consider the entire picture (new meds, foods, related symptoms, hydration status)

Discipline

consistency is key. Time-outs are regularly used as discipline for toddlers

Infant Obesity

defined as greater than the 90-95th percentile of weight for their height and is typically associated with overfeeding. Difficult to reverse in childhood.

three meninges

dura mater, arachnoid mater, pia mater (inner most)

Hepatomegaly

enlargement of the liver

Piaget

explored cognitive development, how children think and learn. Piaget defined four stages of cognitive development, within the stages of growth, then finer units or schemas.

Decerebrate

extension away from body, pronation of arms/legs

Decorticate

flexion into body,

Dental

fluoride supplement should be offered starting at 6 months. If water supply does not have fluoride, a supplement should be used. Dental care is done through massaging the gums with a soft, wet washcloth. First dentist visit before age 2 and then every 6 months for life.

Absence Seizure

form of seizure consisting of momentary clouding of consciousness and loss of awareness of surroundings More often in girls Downplay the importance of episode to help child maintain positive self-image

Muscular Dystrophy

group of hereditary diseases characterized by degeneration of muscle and weakness. At 3 years, waddling, difficulty climbing stair, high school most become wheelchair dependent, tachycardia pneumonia

Head Circumference

he head is approx 2/3 of adult size by 1 year due to the rapid brain growth in the first year. Skull is somewhat moldable in the first year of life as the skull is not yet fused. The posterior fontanelle closes around 2 months but the anterior fontanelle is open until approximately 18 months to allow for further brain growth. As infants should spend most of their time laying down on their back, they sometimes have a flattened appearance to the back of the head. Parents should be encouraged to promote supervised "tummy time" in the prone position while the child is awake to help prevent this.

Right-sided heart failure leads to?

hepatomegaly, increased venous pressure noted in jugular venous distention in older children, or periorbital edema.

Nosocomial

hospital acquired infection

Breastfeeding is encouraged

if not possible, an iron-fortified formula for the first year. At 1 year, can wean to cow's milk.

Congestive Heart Failure is defined as?

inability of the heart to supply adequate oxygenated blood to meet the metabolic demands of the body. Either one or both sides of heart are unable to pump effectively and will eventually fail

Right-sided heart failure results in?

increased pulmonary pressures, rales, tachypnea, and shortness of breath.

Encephalitis

inflammation of the brain tissue caused by virus, bacteria, fungus, protozoan enterovirus is frequent culprit Also linked to mosquito viruses Nosocomial risk: LP MMR, Varicella: Decreases risk if immunization

Pharyngitis/tonsilitis

inflammation of the pharynx and tonsils. Usually viral pharyngitis. Mild sore throat, fever, rhinorrhea, cough, malaise Tylenol, Motrin, salt water

Colic

intense abd. Pain for infants less than 3 months with unknown etiology. May be related to eating too fast or swallowing too much air when eating quickly causing gastric inflation. Assess what infant is eating, how much, how fast, the position of the bottle, burping patterns, etc. Interventions can include smaller, more frequent feedings, a formula change, and medications such as simethicone. This disappears by 3 months of age for most infants.

Supraventricular Tachycardia (SVT)

is defined as a heart rate greater than 220 beats/min in an infant and greater than 160 beats/min in a child Treated with adenosine or synchronized cardioversion.

Electra complex

is the attachment of a preschool girl to her father.

Negativism

it happens...it will pass. Its developmentally appropriate. It can be mediated by reducing the number of questions you ask. Instead of asking about taking medication, simply say "its time for your medication" A great time to practice using forced choices vs. Open choices.

S1

mitral and tricuspid valve closure

Aortic Stenosis

narrowing of the aorta valve

Falls

never leave unattended. After 2m/o, infants can roll.

Water

never leave unattended. Consider early swimming programs to encourage water safety

Neoplasia

new growth can be triggered by genetics, environment, cell mutation, virus

Sitting

no head lag with pulling up to a sitting position by 4 months, at 6 months they can sit with support, by 8 months sit without support

Epistaxis

nose bleed

Head Circumference preschooler

not usually monitored

Outdoor time/Exercise

parents should use caution with sun exposure. Sunscreen applications starts at 6m/o

Types of Seizures

partial and generalized

Endocarditis Assessment

persistent low-grade fever, malaise, weight loss, arthralgias, fatigue, rigors, and diaphoresis. Can have high-spiking fevers and are severely ill and toxic in appearance. Symptoms of CHF

Erickson

psychoanalyst but developed psychosocial development theory. Focuses on development of personal view of self.

Constipation

rare with BF infants, formula-fed babies sometimes are but it can resolved easily with more fluid typically. Reassure parents that its expected to bear down, flushed face with BMs.

Car Safety

rear facing car seat in the back seat until at least age 2

Oedipus Complex

refers to the strong emotional attachment a preschool boy demonstrates toward his mother;

Complete

separated

Status Asthmaticus

severe and prolonged asthma attack that is not responsive to asthma therapy. It requires hospital evaluation and close cardiopulmonary monitoring. Assessment: Increased HR/RR, Decreased LOC, Elevated PCO2, Acidosis

Sibling Safety

siblings should not watch infants unless they are old enough and have demonstrated ability to be responsible for the infant without supervision.

Slipped Capital Femoral Epiphysis

slipping or displacement of the capital femoral epiphysis (femoral head) from the femoral neck (metaphysis) through the epiphyseal plate and can lead to epiphyseal plate destruction and necrosis of the bone. 2x more likely in young boys, than girls. Often they are over weight. Growth hormone and excessive weight bearing on the hip.

Solid Foods

start around 6 months. - limited evidence suggests waiting until at least 6 months may reduce prevalence of food allergies and childhood obesity Start with iron-fortified baby cereal mixed with breast milk or formula. Least allergenic Progress to vegetables, then fruits, the meats. Introduce new foods one at a time (one new food each week) to identify potential allergic reactions. Avoid common allergens such as wheat, tomato, egg, fish, and oranges if there is a family history of allergies to those items.

incomplete

still attached

Cancer Treatment

surgery, radiation, chemotherapy

Ataxia Telangiectasia is Distinguished by

telangiecstasias Red vascular markings on the conjunctiva and skin at flexor increases

Compliance

the ability of the ventricles to stretch and fill

Preload

the volume of blood in the ventricles at the point just before contraction; it is an indicator of circulating blood volume.

RBC

transport oxygen to and carry carbon dioxide away from body cells Formed in bone marrow under stimulation of erythropoietin

Sleep

usually 10-12 hours of sleep at night and at least one nap each day, usually more

Toilet training

very concerning to parents and they often compare milestones with friends and family. It is a highly individualized experience.

Radiology Studies

x-ray CT scant Nuclear Medicine Utrasound

To Check Knee Height Symmetry Flex the Infant's Hips and Knees So the Heels Are as Close to the Buttocks as Possible

●Place the feet flat on the examining table. The knees are usually the same height. A difference in knee height (Allis sign), as seen here, is an indicator of hip dislocation.

Sutures

●The sutures are fibrous connections between bones of the skull that have not yet ossified. ●The fontanelles are formed at the intersection of these sutures where bone has not yet formed. ●Fontanelles are covered by tough membranous tissue that protects the brain ●The posterior fontanelle closes between 2 and 3 months. ●The anterior fontanelle and sutures are palpable up to the age of 18 months.