Pediatric Nursing Final
Injuries associated with the adolescent group
#1 MV safety (wear seat belt, don't ride with people who have been drinking, don't drink and drive, don't text and drive) 11% never/rarely use seat belt 30% rode with driver under the influence 3.5% driven under the influence #2 Homicide Involve firearms; #1 for African Americans Bike safety (helmet, ride with traffic, walk bike across intersections, reflectors, see in the dark clothing) All terrain vehicles (seat belts, head lights, ride in areas you know during the day, 1 seat/only 1 person) Injuries occur more during recreational sports than organized sports Don't think before acting even though capable of logical thought Take risk because they feel indestructible Well rested, have energy & strength, need to release physical/ psychomotor functions
Steps of health assessment (adolescent
(Pre-teen, about ten on) Allow the child the option of parents staying in the room or leaving, but communicate with both parties Can react to healthcare with fear, cooperation, hostility, anger, or braveness Allow time to express their feelings Ask if they are having sex with anyone Provide privacy Consider developmental level and allow input of care Confidentiality is of great importance when interviewing adolescents, explain that info will not be shared unless in the case of suicidal behavior Make sure to introduce ourselves to the child and parent first and foremost
How to examine ears of child based on age.
3 or older: pull pinna up and back. Younger than 3: pull pinna down and back.
Tx of puncture wounds-starts
A puncture is a wound that has a small opening compared with depth. Maintaining a moist wound bed and a dry periwound area that protects the skin and wound from maceration is the optimum treatment goal. Dry gauze dressing should not be used, since it allows the wound surface to dry, does little to prevent bacterial invasion, and adheres to the dry scab so that removal disturbs the newly regenerating epithelial cells. Exam 4-Cleanse a puncture wound initially with sterile saline, then soaked in basin of warm, soapy water for several minutes before applying a clean dressing. (page 617) Clean mild scrapes with soap and water, deep wounds and laceration with NS.
Post-op care for cleft lip
Assess airway patency, and VS; observe for edema and respiratory distress. Use mist tent; minimize edema, liquefy secretions, and minimize distress. Positioning: place child on his/her back in an infant seat, or propped on side to avoid injury to operative site. If prescribed by physician; apply thin layer of antibiotic ointment to suture line. Use elbow restraints to maintain suture line integrity (some surgeons don't support this.) Remove every 2 hours for ROM and opportunity for cuddling and body contact. Keep Logan's bow in place - appliance to prevent tension on suture line when crying, or other facial movement. Taping would work also. Narcotics for post-op pain. Rinse mouth with water after feedings. Clear liquids with special needs feeder, then when the lip is healed may use bottle
Review growth charts (what is normal vs abnormal)
BMI > or = 95th percentile is obese BMI > or = 85th and < 95th percentile is at risk of obesity Between the 5th and 85th percentile is considered normal
Causes and tx of cellulitis
Can be caused by Staphylococci, Streptococci, and Haemophilus influenzae. It is inflammation of the skin and subq tissues with intense redness, swelling, and firm infiltration. Tx- oral or parenteral ABX. rest and immobilization of both affected area, and the child. Limited cellulitis is usually managed at home with oral abx, and WARM compress. Teach the parents procedures and instructions of medications. If admitted to the hospital, it usually involves parenteral abx, incision, and drainage. Nurses are responsible for teaching the family to administer medication and apply compress.
Alternative foods for child who is lactose intolerant
Child given casein hydolysate milk formula in which protein has been predigested and broken down into amino acids Deficiency of enzyme needed for digestion of lactose- can be congenital or late onset Use soy based formulas- more cost efficient S&S: diarrhea, abdominal pain, distention and flatus after ingestion of milk products Yogurt is a good milk substitute as it contains inactive lactase enzyme. Need a small amount of dairy products to assure bones can mineralize need to discuss "hidden" sources of lactose (bulk agent in certain medications)
Nursing interventions for someone with a latex allergy
Children should not be exposed to latex from birth onward to minimize the occurrence of latex hypersensitivity Avoid bananas, avocados, kiwis, chestnuts Use latex-free environment, allergy history given to all personnel Med alert bracelet Quality pt outcomes: Recognize early symptoms of anaphylaxis, maintain airway patency, maintain or restore adequate circulation, prevent further exposure to allergic agent Epinephrine given for anaphylaxis
Therapeutic communication regarding sexuality in spinal cord injury pt
Development of secondary sexual characteristics does not seem to be altered by SCIs In females, if the injury occurs after the onset of menstruation, there is usually a temporary cessation and irregularity in menstrual flow, but menstruation resumes in the majority of cases Ovulation and conception are possible, but only 50% experience orgasms Would be unaware of labor Now possible for males to have sexual incercourse and produce offspring with pharmacologic and mechanical devices Health care professional should take initiative in discussing the topic, provide them with information
Effective communication with very young children
Developmental level is most important factor to consider Nonverbal communication conveys the most significant messages The nurse cannot disguise feelings Tell them what they can do or what they feel Allow them to touch and examine articles they will come in contact with Everything is direct and concrete with small children (they are egocentric) Take things literally. So, avoid common phrases that may be misinterpreted by a small child Use games, magic tricks to establish rapport and distract them Stoop to eye level of child Focus communication on them
Health assessment of adolescents - Communication
Ensure confidentiality and privacy; interview without parents Explain limits of confidentiality (legal duties to report) Show concern for adolescent perspective Offer nonthreatening explanations for questions you ask Maintain objectivity; avoid assumptions, judgements, and lectures Ask open-ended questions when possible, move to more direct when necessary Begin with less sensitive issues and progress Use language that both you and the adolescent understand Restate: reflect back to the adolescent what he or she has said, along with feelings that may be associated with that description
Care of child with poison ivy
Flush area immediately with cold running water to neutralize the urushiol not yet bonded to the skin (w/in 15 minutes if possible) If outdoors, wash/flush oils from exposed skin and clothing in a running stream of water, or shower with soap and water Use of harsh soap and scrubbing exposed skin is contraindicated because it removes protective oils and dilutes the urushiol, allowing it to spread Remove all clothing that came into contact with the plant, thoroughly wash in hot water and detergent Once rash has erupted, attempt to keep child from scratching Teach all children how to recognize the plant, especially those sensitive to it Calamine lotion, soothing Burow solution compresses, or Aveeno baths to relieve discomfort Topical corticosteroid gel is effective for prevention or relief of inflammation, especially if applied before blisters form Oral corticosteroids may be needed for severe reactions and those affecting face, throat, or genital region Sedative like diphenhydramine may be ordered Full blown reaction is about 2 days, with fluid-filled vesicles, swelling, itching---then serum oozing blisters after a few days---then lesions dry and heal, itching stops by 10-14 days
What to do if child has an avulsed tooth
Hold tooth by crown, avoid touching the root area, rinse with water or saline (make sure sink drain is plugged so you don't lose tooth) Insert tooth into socket and have child hold into place (avoid making sharp turns or stopping abruptly in car, to avoid child swallowing tooth) If reluctant to re-implant tooth, place tooth in cold milk or saliva or under tongue Water is least desirable storage medium (hypotonic environ causes cell lysis) Child to see dentist immediately (within 30 min to have a 70% chance of reattaching) If tooth replaced w/in 15 min of injury, there is better chance of full recovery w/out erosion/discolor Nurse should help control bleeding, pain, and re-implantation of tooth (use calm, confident, reassuring approach toward child and parents)
Care of child with hypo/epispadias (describe each)
Hypospadias-urethral opening on ventral/underside of penis. Epispadias-opening on dorsal/top of penis. Recommend early repair (6-18 mos) to promote normal body image. Done outpatient. Child not circumcised to save foreskin for repair.
When to seek a referral based on pt assessment
If head lag is present at 6 months, need developmental/neuro evaluation. (Exam 2 pp p.3) School nurses should refer children with sore throat for strep test to prevent rheumatic fever. When to call MD for fever: child is < 3 months, fever is above 105, child is difficult to awaken, neck is stiff or cries when you touch him/her, breathing is difficult or child is unable to swallow, or child looks or acts very sick. (Exam 5 pp p.14) Hearing impairment affects speech development; important to discover within the first 6-12 months of life to prevent social, physical, and psychological damage to the child. - gw Nursing Alert: if a child fails to form syllables of "da", "na" and "yaya" (ie. Babbling) by 11 months of age the child should be referred immediately to have hearing tested. (page 841 of Wong's Nursing Care of Infants and Children, 10th ed., year 2015.) - gw If anyone has anything to add, please do. I've gone through the power points looking for any other specific assessment findings requiring a referral
Body image perceptions based on child's age
Infancy - Learn to smile & to receive return smile. Social smile at 6-8 weeks. Like looking in mirror at 9 months. Learn hands bring things to mouth, and legs help them move. Toddler - know names for parts of body. Thinking may lead to inaccuracies - fat ladies are pregnant, fat men are pregnant. See stool/feces as essential body part, upset when flushed. Preschooler- know people have desirable and undesirable appearances. Very concerned with body integrity so incredibly fearful of intrusive procedures. Need anticipatory explanation of hospitalization.
Appropriate discipline of children based on their age
Infancy: negative voice, stern eye contact, time-outs. Teach parents behavior is exploratory, not oppositional in infants. Fussy/irritable babies at risk for shaken baby syndrome. Children are spoiled when parents fail to enforce consistent, age appropriate limits.
Different aspects of safety for school-aged years
Injuries most prevalent in school-aged children reflect their developmental level Injury during middle childhood is significantly higher in boys than girls The incidence of transportation-related injuries is higher in school-aged kids than younger children, and bike injuries are higher than that of teenagers & preschool Stress safety because this age group is more physically active and incidence of fractures, cuts, and sprains increases School-aged kids often participate in dangerous activities to prove themselves worthy of acceptance (achieving acceptance is primary objective) May attempt certain activities w/out planning or evaluating consequences d/t concrete operational thinking and are only beginning to understand causal relationships Most common cause of accidental injury and death is involvement in MVA's (as a pedestrian or as a passenger)
How to appropriately examine the abdomen.
Inspect, auscultate, percuss, palpate. Have child "help" you to prevent the feeling of being tickled
Gynecomastia or breast development of males
Is common during puberty Occurs in up to ⅓ of boys and is usually temporary. For most boys, breast enlargement disappears within 2 years
Childhood fears and how to deal with them effectively
Provide atraumatic care - need to prepare the child before any unfamiliar tx to eliminate or minimize psychological and physical distress. Allow use of therapeutic play to exhibit fear & aggression. Stranger fear - 6-8 months. Factors that affect this include: gender, age and size of stranger, approach (loud/intrusive) and proximity of parent Toddler - fear their insides will leak out - provide a bandaid! Preschooler - Have greatest number of real and imagined fears. Concept of animism - ascribing life like qualities to inanimate objects. Nightmares - scary dream followed by full awakening. Sleep terrors - partial arousal from sleep, unaware of parents presence when they check on them. Develop consistent bedtime ritual, have transitional objects and a nightlight.
Types of play (identify what kind is being observed)
Parallel play: The child plays alongside but not with other children Associative play: group play without rigid organization pp pg 4 Onlooker play: do not want to participate Solitary play: play alone with own toys Cooperative play: loosely formed group with a leader (ex. Putting on a play)
Timing of closure of fontanels
Posterior- 2 months Anterior- 12-18 months
Best way to deal with temper tantrums:
Remain close to ensure no injury, but avoid eye contact. Holding breath, fainting normal in toddler - should grow out of this by school years:
Complications associated with spina bifida
Severity from sensory loss and partial paralysis to complete flaccid paralysis (including bowel and bladder sphincters) Hydrocephalus in 80-85% of children. May have neurogenic bladder and orthopedic anomalies Need daily head circum. And observation of bulging fontanels Can develop latex allergies with all the surgeries (latex free) Chiara malformation - downward herniation of the brain into the brain stem
Discussion of adolescence regarding homosexuality
Sexual orientation - sexual arousal or romantic attraction toward persons of the opposite gender (heterosexual), same gender (homosexual/gay/lesbian), or both genders (bisexual). Sexual orientation is an important aspect of sexual identity Sexual identity is how one identifies theirself Person may be attracted to same gender, fantasize about both genders, have sexual activity with opposite gender, and identify as gay/lesbian. Person may engage in same-gender sexual behavior, fantasize about both genders, but identify as heterosexual. Bisexual usually refers to the ability to be attracted to either gender, but does not imply that the person requires partners of both genders, or that the person is equally attracted to and has sexual experience with both genders in order to be bisexual. Alway use the term "partner" rather than "boyfriend/girlfriend" when asking child about sexual activity, in order to not offend someone's sexual preference
Review terms and severity of stages in spina bifida
Spina bifida is the most common defect of the CNS. It is categorized into two types: SB occulta: defect that is not visible externally. It occurs most commonly in the lumbosacral area (L5 and S1). It may not be apparent unless there are associated cutaneous manifestations or neuromuscular disturbances. Superficial cutaneous indications include a skin depression or dimple (which may also mark the outlet of a dermal sinus tract that extends to the subarachnoid space); port-wine angiomatous nevi; dark tufts of hair; and soft, subcutaneous lipomas. These signs may be absent, appear singly, or be present in combination. SB cystic: a visible defect with an external saclike protrusion. The two major forms are: Meningocele: encases meninges and spinal fluid but no neural elements; usually not associated with neurological deficit Myelomeningocele: contains meninges, spinal fluid, and nerves; neurologic deficit occurs in varying, often serious, degrees in this
Effects of teasing within school-aged years
Teasing is a source of stress for a 6 year old. They engage in teasing but become upset when on the receiving end.
Communication for a child born with cleft lip (surprise to parents)
Tell parents that it appears to be a cleft lip, don't make them wait for the doctor Show before and after pictures Surgical correction in several stages, repair typically occurs at age 2-3 months May have dental malformations, speech problems, frequent otitis media
Safe levels of alcohol consumption in a pregnant woman
There is no known safe amount of alcohol to drink while pregnant. Also, no known safe time during pregnancy to drink alcohol.
Characteristics of toddlerhood and helping parents deal with them
Toddlerhood- 12 mos-36mos; they are determined, strong-willed, and volatile behavior, want to be independent and help (set table, do dishes) Sibling rivalry- often feel resentment toward a new child, most often in first born or youngest child, provide tasks for the child to do while the mother is with the baby, have participated in sibling care with parent, may regress (how they deal with stress. Ignore), give them one on one parent time and have relatives include toddler when bringing baby gifts Temper tantrums- when they lie on floor, kick feet, and scream. Remain close to assure no injury will occur without eye contact. Normal in toddler but abnormal in school age years. Aggressive or violent and holding breath and fainting. Negativism "no"- always saying no, parents need to reduce opportunity for "no" answers, its time to go to bed instead of, do you want to go to bed?, maintain humor, try games to distract Toilet training- major task of the toddler, usually between 18-24 mos, assess readiness, select potty chair, limit trying to 10-20 min, teach sanitary practice, bowel accomplished before bladder, may wet bed until 4-5 years, daytime accidents Play- love parallel play (alongside but not with other children), like creative play, push-pull toys, gym and slides, fingerpaints, play doh, crayons, blocks and dress up. Also like to talk and hear, musical toys, dolls, and telephones
Tx of lice
Treatment consists of the application of pediculicides and manual removal of nit cases. The drug of choice for children is permethrin 1% cream rinse (Nix), which kills adult lice and nits. Most experts advise a second treatment at 7-10 days to ensure a cure. PP-Child's non-washable items should be placed in a plastic bag and sealed for 14 days. If unable to dry clean, vacuum, or placed in a hot dryer for 30 minutes. All recently worn clothing, hats, bedding, and towels can be washed in hot water, or dry cleaned. Personal care items such as combs, brushes and clips should also be washed in boiling water for 10 minutes. Strongly cautioned against cutting child's hair, or shaving head.
Shunting procedures for hydrocephalus
Used to drain CSF into a body cavity (usually peritoneal, sometimes atrium). Valve or regulator on catheter prevents excess fluid build up or drainage. Most common tx: ventriculoperitoneal shunting (VP) (the standard for neonates/young infants) - it has excess tubing, which minimizes revisions as the child grows Observe for s/s of infection. If it becomes infected and needs removed, an external device is used to drain. Place on nonoperative side. Need revisions as kids grow. Shunt malfunction or infection is a medical emergency. Headache and loss of appetite is earliest sign of malfunction.
Tx of bee/wasp stings
Usually treated with cold compresses, calamine, and prevention of secondary infection. Household products: baking soda, lemon juice, paste from ASA or Adolph's meat tenderizer. Remove stinger ASAP. Cleanse with soap and water. Administer antihistamines. Severe reactions: epinephrine, corticosteroids, treat for shock
Normal wt gains through first year of life
Weight doubles at 5-6 months and triples at one year. Average weight at one year is 21 pounds.
When menstruation should start and when secondary sex characteristics begin
rapid increase in height and weight, growth of pubic hair, axillary hair, menstruation (2 years after the first signs), abrupt deceleration of linear growth Initial indication is breast development (usually in girls 8-12 ¾ years of age) Rapid increase in height and weight Growth of pubic hair Appearance of axillary hair Menstruation (usually begins 2 years after first signs) Abrupt deceleration of linear growth Average age range for menarche(onset of menstruation) to begin is 10 ½ years - 15 ½ years Menarche has been reported to occur at about 17% fat, with 22% body fat reported to be required to maintain menstruation
Different types of cognition development of adolescents vs middle childhood
Adolescents are no longer restricted to the real and actual; they are concerned with the possible. They think beyond the present and are capable of using a future time perspective. They are able to imagine possibilities, such as a sequence of future events that might occur, including college or occupational opportunities, or current events. Emergence of formal operational thinking occurs between 11 and 14. Formal operational thought includes being able to think in abstract terms, think about possibilities, and think through hypotheses. Middle childhood- concrete operational stage takes place between 7-11 Their rigid, egocentric outlook is replaced by thought processes that allow them to see things from another's point of view They develop an understanding of relationships between things and ideas They progress from making judgments based on what they see (perceptual thinking) to making judgements based on what they reason (conceptual thinking) Being able to make judgements based on reason, the child can learn to see other's point of view and be less egocentric Their conceptual abilities become increasingly more flexible They start grouping and sorting objects, placing things in logical order, occupied with collections of rocks, stickers, cars, baseball cards, hot wheels, stuffed animals, dolls, horse collections. Aspects of masturbation during adolescence Masturbation provides an opportunity for sexual self exploration; boys typically begin this during early adolescence, while for girls it varies greatly. Male begin masturbation between 11-14
What children should be treated if exposed to chickenpox, and what to treat them with:
Antiviral agent acyclovir; varicella-zoster immune globulin or IV immune globulin after exposure in high-risk children (Unvaccinated
Parent teaching for child with apnea in infancy
Apparent life-threatening event - ALTE Pathologic condition in infants over 37 weeks gestation Apnea and color change - cyanosis or pallor with change in muscle tone to limpness Unknown cause - 7% SIDS victims Continuous home monitoring of resp rate and EKG and use of respiratory stimulant drugs (sometimes caffeine) If apneic, gently stimulate trunk by patting or rubbing on it, flick the feet, if no response, CPR. Keep track of apnea & bradycardia Parents don't go home without having CPR lessons
Play of child based on their age
Appropriate toys for infant as compared to 2 months of age (pp page 6, book page 428) Mobiles, unbreakable mirrors, music boxes, small handled clear rattles, and soft toys (stuffed animals, soft clothes, quilts), rocking crib or cradle, weighted or suction toy, and infant swing. Appropriate toys for infant as compared to 1 year of age (Book pg 428 Table 10-2) Toys for ages 6-12 months include colored blocks, nested boxes or cups, Books with rhymes and bright pictures, Strings of large beads, Simple take-apart toys, Large ball, cup and spoon, Large piece wood puzzles, and Jack-in-the-box. Rattles of different sizes and colors, squeaky animals and dolls, rhythmic music, different texted toys, teething toys, books with textures, push pull toys, wind up swing. Appropriate toys for preschoolers Easy construction sets, large blocks of various sizes and shapes, a counting frame, alphabet or number flash cards, paints, crayons, simple carpentry tools, musical toys, illustrated books, simple sewing or handicraft sets, large puzzles, and clay (book pg. 528) I think I remember a test question that had to do with farm animals and equipment for this age group
How to prevent sunburns in children
Keep children out of sun as much as possible (shade them from it, if outdoors) Avoid being outdoors between 10am-3pm (schedule activities before/after these hrs) Topical sunscreens - partially absorb UV light - the higher the #, greater the protection Waterproof sunscreens w/minimum SPF of 15 are recommended Apply 15-20 minutes before child goes outdoors Apply liberally, reapply often, q2-3hrs, and after child goes in water or sweats (always read manufacturer's label and follow directions) Apply sunscreen even if only in the shade, or in winter (snow reflects sun rays) Apply evenly to all exposed areas, pay attn to skinfolds Sunscreens not recommended for children <6 mos, however, may apply it over small areas of their skin (back of hands not covered by clothing) For best results, use sunscreen effective against UVA & UVB rays PABA and PABA esters are most effective - they penetrate the outer layer of skin and accumulate with repeated use, which provides protection while child is swimming or sweating (PABA may stain clothing, PABA esters less likely to do so)---also PABA's may cause allergic response in sensitive persons (s/s redness, itching in 24 hrs) Infants should be kept out of the sun, or shaded from it (stroller w/canopy) Cotton fabric offers good protection (tight-weave clothing) Protect child with clothing (hat, long-sleeved shirt, long pants), avoid sandals, wear closed shoes, avoid sheer bathing suits or clothing that allows sun's rays to penetrate fabric Sun-blockers block out UV light rays by reflecting sunlight (zinc oxide) Sun rays are stronger in mountains and tropics (be cautious when vacationing) Some meds may cause increased sunburn Be example for children - no tanning salons or sun lamps
Nursing interventions for child with failure to thrive
Limit juice intake until adequate wt gain has been achieved with appropriate milk sources (thereafter, give no more than 4 oz/day---book p465) Provide small, frequent, high calorie meals Fortified rice cereals may be needed Vitamin deficiencies - so may need multivitamin supplements, plus zinc and iron For toddlers - high calorie milk/formulas Routine, scheduled, structured feedings (also, same person to feed each time) Inadequate growth of infant, weight below 5th percentile (If height also below 5th percentile, sign of chronic malnutrition) May be very irregular in sleep patterns, intake and other ADL's Causes: inadequate caloric intake (neglect, behavioral problems, poverty), inadequate absorption, (CF, Crohn's) increased metabolism or defective utilization (genetic anomaly) Seen in preterm infants (VLBW or ELBW) use multidisciplinary team child may avoid eye to eye contact with parent/RN trying to feed him High calorie formulas are used Need structure routine and persistence!
Terminology for skin conditions (papule, macule, vesicle, etc)
Macule - flat area with change in skin color (freckles, petechiae, measles, flat mole) Papule - elevated, soft lesion (wart, elevated mole, basal cell carcinoma) Vesicle - superficial collection of serous fluid (varicella, herpes zoster, 2* burns) Pustule - elevated, superficial lesion filled w/purulent fluid (acne, impetigo) Wheal - firm, edematous, irregularly shaped area (insect bite, urticaria) Plaque - elevated, superficial solid lesion (psoriasis)
Ways to promote wound healing
Maintain a moist wound bed and a dry periwound area that protects skin from maceration Transparent and occlusive dressings promote wound healing These dressings cover the wound, provide a moist environment and allow exchange of gases (transparent dressings, thin film dressings, foam dressings, acuderm, hydrocolloids)--they are impermeable Adequate nutrition is essential for wound healing (sufficient protein, calories, vitamins C & D, and zinc are needed) Protect the wound from infection Use occlusive dressings instead of Band-aid Clean mild scrapes with soap and water, deep wounds/lacerations with NS NO peroxide, povidone-iodine, alcohol - these all disrupt wound healing Allow scabs to slough off on their own If a dressing sticks to a wound base when being removed, saturate with NS or clean water to loosen, then proceed with care
