Pediatrics Exam 1

Cystic Fibrosis Goals of Tx

•Maximize pulmonary function •Minimize complications •Prevent infection •Facilitate growth

Smoke Inhalation Injury

•Severity depends on nature of substance, environment, and duration of contact •Heat - usually stops at epiglottis •Chemical - can go deep into lungs •Synthetic materials especially toxic •Pulse oximeter can't detect carbon monoxide poisoning •Therapeutic management •Humidifying oxygen at 100% •CPT •Bronchodilators Possible ventilation

Respiratory Infections

•Upper respiratory tract •Oronasopharynx, pharynx, Larynx, upper trachea •Lower respiratory tract •Lower trachea, bronchi, bronchioles, alveoli •Respiratory infections account for the majority of acute illnesses in children •Viruses are main cause

Causes/Pathophysiology of Eating Disorders

•Causes unclear •Distinct psychologic component •Common initiator: dieting •Relentless pursuit of thinness •Distorted body image •Media impact •Triggered by an adolescent crisis

Cystic Fibrosis Inhaled Meds

Albuterol, Atrovent, Pulmozyme, Tobramycin, Pulmicort

Upper Respiratory Tract

Nasal cavity, pharynx, larynx

Development

A gradual change and expansion; advancement from lower to more advanced stage of complexity; increased capacity through growth, maturation, and learning

Nasopharyngitis

"Common Cold" •Caused by numerous viruses •RSV, rhinovirus, adenovirus, influenza and parainfluenza •S/S: •Fever: varies with age •Cough •Irritability •Anorexia •Managed at home •No specific treatment Allergies vs cold

Self esteem and Culture

- Child's sense of self-esteem is influenced by his or her culture - May also be related to accomplishments of entire family or community - Child's sense of control may come from feeling of worth within community

Secondary Groups

- Groups have limited, intermittent contact - Generally less concern for members' behavior - Offer little support or pressure to conform - Example: professional associations

Primary Groups

- Intimate, continued, face to face contact - Mutual support of members - Ability to order or constrain behavior - Examples: Family and peer groups

Communities

- Support - care and love - Empowerment - feel value and contribute - Boundaries & Expectations - what is expected

Health Beliefs

-Natural forces - -Supernatural forces - Magicoreligious -Imbalance of forces - Naturalistic medicine

Health Practices

-Similarities among cultures regarding prevention and treatment of illness -Folk remedies - amulets or medals

The nurse is explaining the care guidelines to the parents of a newborn baby. Which information should the nurse include in the teaching? Select all that apply. 1 Avoid shaking the baby violently 2 Feed the baby at proper time intervals 3 Vaccinate the baby according to schedule 4 Put the baby to bed immediately after feeding 5 Expose the baby to sunlight for three hours daily

1, 2, 3 The nurse instructs the parents to avoid shaking the newborn baby violently because doing so may damage the brain. The baby is to be fed at proper intervals of every 3 to 4 hours because babies have rapid metabolism. The newborn should be vaccinated as per the given schedule to raise his or her immunity. Newborns are not used to the environment, so they should be exposed to sunlight for only few minutes at a time. Exposing the newborn to the sunlight for 3 hours in a day may cause skin rashes and irritation. The baby needs to be burped after every feeding to avoid vomiting. Putting the baby to bed immediately after feeding may cause aspiration.

Which activity does the nurse expect to observe in a 4-month-old infant? 1 The infant grasps an object by using both hands. 2 The infant grabs an object by pulling on a string. 3 The infant transfers objects between both hands. 4 The infant matches two cubes and brings them together.

1. A 4-month-old infant has the ability to grasp objects with both hands. A 4-month-old infant is unable to secure an object by pulling on a string due to lack of fine motor skills. The infant is unable to transfer objects from one hand to the other or compare two cubes by bringing them together due to lack of developmental skills. At this age, the infant's muscle coordination is not well developed for performing these activities. An 8-month-old infant is able to secure an object by pulling on a string. A 7-month-old infant is able to transfer objects from one hand to the other. A 9-month-old infant is able to compare two cubes by bringing them together

The parent of a 26-month-old child reports to the nurse that the child spends most of the time talking to a doll and cares for it as if it is a small baby. The parent also reports that sometimes the child throws toys around with force. What does the nurse interpret about the child's behavior? 1 The child has normal behavior. 2 The child has impaired thinking. 3 The child has impaired thoughts. 4 The child has impulsive behavior.

1. Children of 13 to 30 months old imitate elders while playing. The toddler spends most of the time talking to a doll and caring for it. The toddler inspects the toys and tests the strength and durability of toys by throwing them with force. It indicates that the child has normal behavior. Caring for the doll and talking with it for a long time does not indicate impaired thoughts or impaired thinking. Throwing the toys with force does not indicate impulsive behavior.

The parents of a 7-month-old infant report to the nurse that the solid food they feed to the baby passes through the gastrointestinal tract unchanged. Which response of the nurse would help to relieve the parent's anxiety? 1 "It is a normal finding at this age." 2 "It indicates an intestinal infection." 3 "The infant has slow development." 4 "The infant has a metabolic disorder."

1. In a 7-month-old infant, the digestive processes are immature and solid food is not completely digested. As a result of underdeveloped digestion, solid foods pass through without being digested into feces. It is a normal finding at this age. By the end of the first year, the infant will be able to digest food. Therefore it is not a symptom of an intestinal infection, nor does it indicate that the infant has metabolic disorder or slow development.

The parent of an 8-year-old child is worried about their child's stealing behavior. The parent informs the nurse that they have punished the child several times for stealing, but the child still repeats the act. What is the most appropriate nursing action? 1 Advise the parent to ignore this behavior and to not discuss it with the child 2 Advise the parents to give a reasonable punishment including returning the stolen item 3 Inform the parents that the child has antisocial behavior and needs psychiatric consultation 4 Advise the parent to tell the child that being jailed is possible if the child is caught stealing again

2. Stealing can be expected in children 5 to 8 years of age as their sense of property rights is limited. They may steal things simply because they are attracted to them. Parents should be advised to admonish such behavior and give a reasonable punishment like asking the children to return the stolen items. This would be enough for most children to learn from. Telling children that they could be jailed for the act of stealing may scare them. However, in some children this kind of behavior can indicate that there is something lacking in the child's life. For example, the child could be stealing to make up for a lack of love and affection. Therefore it is not recommended to ignore such behavior. It is also not appropriate to inform the parent that the child needs a psychiatric referral.

A 16-year-old girl tells the school nurse that she has not started to menstruate yet. Onset of secondary sexual characteristics occurred about 4 years ago. What should the nurse do? 1 Explain that this is not unusual 2 Refer the adolescent for an evaluation 3 Assume that the adolescent is pregnant 4 Suggest that adolescent stop exercising until menarche occurs

2. This meets the definition of primary amenorrhea and should be evaluated. Menstruation usually begins approximately 2 years after the beginning of secondary sexual characteristics. Although pregnancy is a possibility, the nurse should not assume it until further assessment is performed. There is no indication that the adolescent is exercising excessively.Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

A mother observes that her 7-month-old infant bears full weight on the feet when held in a standing position. What is the reason for this? 1 It indicates that the child will start walking within 2 months. 2 It indicates that the child's growth and development is normal. 3 It indicates that infant physical development is occurring slowly. 4 It reflects that the infant's upper limbs are not developing properly.

2. A 7-month-old infant bearing full weight on feet when held in a standing position is a normal developmental milestone. By 8 months the infant can readily bear weight on legs when supported and may stand holding onto furniture. It does not indicate that the infant may begin walking within 2 months. A 12-month-old infant can walk with one hand held. The observation does not indicate that the infant's physical development is slow. Nor do the assessment findings reflect that the infant's upper physical development has not occurred properly. The assessment findings are suggestive of age-appropriate development in the child.

The parent reports to the nurse that their child throws temper tantrums whenever the child wants something. Which instruction provided by the nurse is most likely to help? 1 "Offer the child whatever the child wants." 2 "Give comfort when the child calms down." 3 "Dole out any type of physical punishment." 4 "Praise the child for their negative behavior."

2. Temper tantrums are common during the toddler years and essentially represent the normal growth and development of the child. The nurse should instruct the parents to be calm and tell the child in a polite and positive way why the child cannot have what is desired. The parents should not praise the child for negative behavior as it would reinforce it. The parents should not give physical punishment to the child, as it would lower the child's self esteem. The parents should never give the child whatever the child wants; rather tell the child why the reason is no.Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or responses that appear to be degrading.

The nurse is caring for a toddler who is hospitalized. The nurse finds that the toddler is afraid of the new environment and gets cranky. What does the nurse tell the parents to do to make the toddler comfortable? 1 Leave the child alone for a few hours 2 Instruct the child to calm down in a firm tone 3 Give appropriate play objects to the child for comfort 4 Explain the reason for being in the hospital to the child

3. A toddler gains security and comfort in familiar objects; therefore the nurse should advise the parents to give the child an appropriate plaything such as a doll or a puppet. As the toddler is already cranky, reasoning or sweet talking may make the child crankier. The child may feel rejected and may cause harm to self if left alone. Instructing toddlers firmly may make them even more scared and increase their distress.Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses.

An adolescent female is unusually preoccupied by her appearance. When the nurse asks the adolescent, "Do you make yourself sick because you feel uncomfortably full?" the adolescent replies no. The nurse asks her if she has lost control over how much she eats; the adolescent says no. The child says that she has lost more than 8 kg of weight in the last 3 months and she believes that she is fat, whereas her parents tell her that she is too thin. She does not think that food dominates her life. What can the nurse interpret about this girl? 1 The child is normal and does not require any other treatment. 2 The child may have depression and needs psychiatric referral. 3 The child most likely has anorexia nervosa or bulimia nervosa. 4 The child needs further assessment for the presence of cancer.

3. Eating disorders like anorexia nervosa and bulimia nervosa are common in adolescents and can be seen in children as young as 10 years. It is important to conduct a screening test in all children who are at high risk. Screening can be done using medical interview such as a questionnaire like SCOFF, as physical findings could be normal in early stages of disorder. In SCOFF questionnaire, each question is scored as 1, if the child's response is yes, and a score of 2 or more indicates that he or she most likely has anorexia nervosa or bulimia nervosa. The score of the girl in the current scenario is 2. Though weight loss can be seen in cancer and depression, there are no other symptoms indicating the possibility of either of them. It would be incorrect to say that the child is normal.Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

The nurse is planning a diet chart for a child with diarrhea and dental caries. Which food does the nurse exclude in the child's diet chart? 1 Milk 2 Legumes 3 Fruit juices 4 Baked food

3. Fruit juices and sweet beverages contain high amounts of sugar and calories. Consuming fruit juices may worsen dental caries. Therefore they should be excluded from the child's diet chart. Milk and dairy products are rich sources of calcium. Calcium is required for optimal growth and development in the child. Therefore milk should not be excluded from the child's diet. Baked bread has high whole grain content and is a rich source of carbohydrates, so it can be given to the child. Legumes contain high amounts of proteins, which are building blocks of the body. Therefore they must be included in the child's diet.Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice.

The nurse is working with the parents of an 8-year-old child and discovers that the child has bedtime problems. The nurse instructs the parents to encourage a quiet activity before bedtime. Why does the nurse recommend this intervention? 1 The child often wets the bed. 2 The child snores during sleep. 3 The child does not go to sleep. 4 The child talks in his or her sleep.

3. When children have difficulty going to bed, they need quiet activities such as reading or coloring. These activities decrease the amount of stimuli and help them relax and be ready to go to sleep. This, in turn, helps resolve bedtime problems. Talking in the sleep is common in children and does not require intervention. Bed-wetting is normal in preschoolers and occasionally in young school-age children. However, if the problem continues in later ages, a medical consultation is necessary. The child may snore a little during sleep, but this does not necessitate quiet activities before bedtime.

Which statement about early childhood caries (ECC) is correct? 1 The syndrome can be prevented by breastfeeding. 2 Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome. 3 Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. 4 The syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple.

3. Sweet liquids pooling in the mouth during sleep cause dental caries. Protruding upper front teeth may result from pacifier use or thumb-sucking. Frequent breastfeeding before sleep can also cause bottle-mouth caries. Juice in bottles before sleep contributes to bottle-mouth caries.Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Although there is no penalty for guessing on the NCLEX examination, the subsequent question will be based, to an extent, on the response you give to the question at hand; that is, if you answer a question incorrectly, the computer will adapt the next question accordingly based on your knowledge and skill performance on the examination up to that point.

Cystic Fibrosis

>75% of CF diagnoses are made by the age of 2 Prenatal and Newborn Screening Sweat Chloride Test (≥ 60 is a likely diagnosis) Genetic Testing Normal sweat chloride level 40

You are discharging a 4 month old from the ER with a diagnosis of otitis media. Which of the following is appropriate discharge teaching? A.Administer Amoxicillin as scheduled, and give Tylenol as needed for fever. B.Administer Amoxicillin as scheduled, and give Ibuprofen as needed for pain. C.Do not take your child back to daycare until all antibiotic therapy is finished. D.Make sure your spouse smokes in another room.

A Tylenol is appropriate for a 4 month old Ibuprofen is NOT. Amoxicillin is the typical course of treatment for an ear infection. The child can return to daycare after 24 hours of antibiotics. Smoking should not occur in the house.

You understand a parent needs more dietary education when she states: A.My 8 month old is now eating baby food and whole milk. B.My 6 month old has just started solid food. C.My 11 month old won't drink from his bottle anymore. D.I only feed my 5 month old iron-fortified formula.

A. An 8 month old should be eating baby food. However, whole milk should NOT be introduced until the child is at least 12 months old. Solid food should be introduced at 6 months. An 11 month old is at the perfect age to transition from a bottle to a sippy cup (should happen at 12 months). A 5 month old should only be fed formula or breastmilk.

Growth

An increase in number and size of cells as they divide and synthesize new proteins; results in increased size and weight of whole or any of its parts

Which of the following does the nurse expect to observe in the toddler? A.Uses a pencil to trace his name. B.Uses a sippy cup to drink C.Pours his milk into a cup D.Uses a butter knife to cut food

B A, C, and D are all appropriate for preschool aged children. A toddler should have transitioned to a sippy cup.

Which action by the parent of a toddler is most appropriate to foster development? A.The parent speaks for the child when he is asked a question. B.The parent watches as the child puts on his new shoes. C.The parent brushes the child's teeth before bed. D.The parent snuggles the child before bed.

B All of these are typical parenting things and none is wrong per se. However, the question asks what fosters development best. Allowing a child to put on his/her shoes on their own allows them to gain independence. Speaking for a child takes away their independence (though in some cases, may be needed!) It may be best for a toddler to brush their own teeth FIRST, supervised, followed by the parent brushing to ensure a good job is done. Snuggling is always a great bonding activity - it just does not promote development.

A 5-year-old is brought to the ER with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for? A.Immediate IV placement. B.Respiratory treatment of racemic epinephrine. C.A tracheostomy set at the bedside. D.Informing the child's parents about a tonsillectomy.

B This is clearly croup. Racemic epi is given if the child is in some level of distress for croup. There is no indication for an IV placement. Trcheostomy set should only be available if there is concern for epiglottitis (there is no mention of drooling, tripoding, etc.) There is no indication that the child needs tonsils removed either.

Peer culture

Becomes more important as the child proceeds through school

A parent asks the nurse how it will be determined if their child has respiratory syncytial virus (RSV). Which is the nurse's best response? A."We will do a simple blood test to determine whether your child has RSV." B. "There is no specific test for RSV. The diagnosis is made based on the child's symptoms." C."We will swab your child's nose and send that specimen for testing." D."We will have to send a viral culture to an outside lab for testing."

C RSV is swabbed in the nose and is a fast test (does not require being sent out). Mono is tested via blood, not RSV.

A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include? A.Maintaining strict bedrest. B.Avoiding contact with family members. C.Instilling saline nose drops and bulb suctioning. D. Keeping the head of the bed flat.

C Saline drops and bulb suction will improve the child's ability to breathe and eat. The child doesn't need strict bedrest - play can be ad lib. They may still interact with family members, but good hand washing should occur. Head of the bed should be elevated, not flat.

Atraumatic care

Care that tries to minimize distress, consider sensory stimuli, and promote control

Anorexia nervosa

•Eating disorder: refusal to maintain normal body weight •Severe weight loss in the absence of obvious physical causes •Primarily in adolescent girls and young women •Mean age at onset: 13 years, ranging from 10 to 25 years or more •Life-threatening

Acute Streptococcal Pharyngitis

Group A streptococcal infection

Cystic Fibrosis Nursing Considerations

Health Hx - •Respiratory status, frequent respiratory infections •Weight gain/loss, appetite •Fever •Changes in CF medication use •Increased constipation Physical Exam Inspection RR, WB, accessory muscle use, cough (productive?), description of sputum, barrel chest, abdominal distention, clubbing Auscultation Breath sounds (crackles, wheezing); bowel sounds (hypoactive) •Percussion - hyperresonance of lung fields, dullness to abdomen •Palpation - asymmetrical chest rise, tactile fremitus, tenderness over liver

Infant Nutrition

•First 6 months of life: solely breast milk or formula • Second 6 months •Selection and preparation of solid foods •Introduction of solid foods, alongside breast milk or formula •Weaning from breast or bottle •No cow's milk before 12 months •6-8 wet diapers/day, at least 1 stool daily

Bulimia nervosa

•In older adolescents and young women •Eating disorder characterized by binge eating •May be followed by purging behaviors •Laxative abuse •Self-induced vomiting •Diuretic abuse •Rigorous exercise regimens •As many as eight or more cycles per day

Croup

S/s Hoarseness, "Barking" cough, Inspiratory stridor, Varying degrees of respiratory distress from swelling of layrnx Affects larynx, trachea, and bronchi (esp larynx) •Epiglottitis, laryngitis, laryngotracheobronchitis (LTB), tracheitis •Most often caused by H. influenzae type B; croups now related to viruses

A 10-year-old boy reports vomiting, diarrhea, and stomach pain for the past couple of days. The child does not go to school because of these symptoms. However, the child is usually healthy on weekends and whenever allowed to stay at home. On examination the nurse finds that the child's temperature is mildly elevated. What does the nurse inform the parents? 1 The child needs to be put on antibiotic treatment for a high temperature. 2 The child should be allowed to stay at home for as long as the child wants. 3 The child most likely has gastroenteritis and needs admission into a hospital. 4 The child has school phobia, which is the likely reason for the child's presentation.

School phobia can occur in children of all ages, but it is more common in those 10 years of age and above. It can be manifested by the child reporting vomiting, diarrhea, stomach pain, mild fever, and headache during weekdays. A striking feature of this condition is that the child is healthy on weekends and whenever the child is allowed to stay at home. It is also important to find out the reason behind it and eliminate the cause. Though the symptoms of the child are similar to gastroenteritis, the absence of symptoms during weekends indicates school phobia as the most likely diagnosis. Therefore antibiotics are not required in this case.

Acute Spasmodic Laryngitis

•Also known as "spasmodic croup" •Paroxysmal attacks of laryngeal obstruction •Occurs chiefly at night •Inflammation: mild or absent •Most often affects children 1-3 years of age •Therapeutic management •Similar to that for infectious croup

Bronchitis

•Also known as "tracheobronchitis" •Mild, self-limiting disease •Caused by ___ •Clinical manifestations •Nursing care •Cough suppressants •Fluids •Rest

Therapeutic Management of Apparent Life-Threatening Event (ALTE)

•Can include Apnea Theophylline/caffeine •Home apnea monitors •Family support/CPR Training

Lower Respiratory Tract

Trachea, Primary Bronchi, Lungs

Acute respiratory distress syndrome

•Characterized as respiratory distress and hypoxia within 72 hours after serious injury or surgery •Causes •Sepsis, trauma, drug overdose, near drowning •rognosis •Mortality rates remains high •Nursing care •Intensive care

infectious Conditions

•Communicable diseases •Incidence has declined with increase of immunizations •Complications have decreased with use of antibiotics and antitoxins •Important to assess •Recent exposure to infectious agents •Prodromal symptoms •Immunization history •History of having disease

Seborrheic Dermatitis

•Cradle cap (scalp) •Eyelids •External ear canal •Nasolabial folds around mouth •Inguinal region

Respiratory Illness Care management

•Ease respiratory effort •Promote rest/comfort •Prevent spread of infection •How? __ •Reduce temperature •Min. age for ibuprofen? __ •Promote hydration and nutrition •Output per hour in children <30kg? >30kg? __ •Antibiotics •Importance of timely, appropriate antibiotic dosage

Measures to put patient at ease

´Developmental: ´Infant - hold, cuddle, sing ´Toddler - establish trust, prepare immediately before ´Preschooler - simple words, eye level, calm voice ´School age - explain why & how ´Adolescent - open minded, encourage peer support

Stressors of hospitalization: Separation

´Separation anxiety in young children ´Protest phase ´Cling to parent ´Cry & scream ´Despair phase ´Stop crying ´Regress ´Detachment phase ´Denial ´Serious impact on parent attachment

Cystic Fibrosis Tx

• Can't absorb food well Fat Soluble Vitamins •A, D, E, & K •Minerals •Ca, Fe, NaCl, Zn •High Calorie, High Protein Diet or High Calorie Formula (TPN may be required) •Pancreatic Enzymes with every meal and snack •Antibiotics tube feeding overnight

Scabies

•: infestation by a mite; lesions are from the female depositing her eggs •Causes significant itching •Treated with permethrin

Cystic Fibrosis

•A genetic disorder affecting mainly the lungs and digestive system •Affects about 30,000 adults and children in the U.S. •Cause: Gene Mutation •CFTR protein becomes dysfunctional •It is unable to help move chloride -- a component of salt -- to the cell surface. Without the chloride to attract water to the cell surface, the mucus in various organs becomes thick and sticky

Attention Deficit Hyperactivity Disorder and Learning Disability

•ADHD: inattention, impulsiveness, & hyperactivity •Typical onset before age 7 Vanderbilt Assessment

Acute Epiglottis

•Abrupt onset; medical emergency •Clinical manifestations •Sore throat, pain, tripod positioning, fever, irritability, anxiety •Muffled, hoarse, or absent speech •Drooling, difficulty swallowing •Inspiratory stridor, mild hypoxia, distress •Cherry red epiglottis (don't inspect airway without ___ nearby)

Asthma

•Mechanism leading to airway obstruction •Hypersensitivity - inflammatory response to stimuli •Airway edema and accumulation and secretion of mucus •Spasm of the smooth muscle of the bronchi and bronchioles •Normally airway elongates and dilates on inspiration and contract on exhalation (in asthma airway has the above problems so air trapping occurs) •Wheezing vs. no breath sounds •Drug Therapy •Status asthmaticus

Acute Laryngotracheobronghitis (LTB)

•Most common of the croup syndromes •Generally affects children 6mo-3yo •Caused by parainfluenza virus, M. pneumoniae,RSV, influenza A and B, rhinovirus, adenovirus •(Croup arises after URI begins) •Inspiratory stridor, suprasternal retractions, barking or "seal-like" cough, increasing respiratory distress and hypoxia •Nursing Care •Maintaining the airway •Maintain hydration, orally or intravenously •Nebulized mist with supplemental O2 •Nebulizer treatment? ___ •Steroids

ADHD managment

•Not all children benefit from pharmacologic therapy •Stimulants •Dexedrine, Adderall •Ritalin •Tricyclic antidepressants •Clinidine •Guanfacine •Norepinephrine transport inhibition •Atomoxetine (Strattera) •Side effects of meds •Insomnia, anorexia, weight loss, hypertension, tachycardia

Diaper Dermatitis

•Peaks at 9-12 months old •Often from prolonged contact with irritant •Address: wetness, pH, and fecal irritants •Avoid: candida albicans

Acute Epiglottis therapeutic management

•Prevention of progressive respiratory obstruction •Intubation or tracheostomy

Respiratory Assessment

•Rate, depth, ease, labored, rhythm, sounds •Evidence of infection •Cough •Cyanosis •Chest/abdominal pain •Sputum •Bad breath •Fever •Anorexia

Feeding Difficulties

•Regurgitation or "spitting up" •Simple measures: •frequent burping during and after feeds •Position child on right side with head slightly elevated •Minimal handling during and after feeds

Eating Disorder Therapeutic Management

•Reinstitution of normal nutrition and reversal of malnutrition •Resolution of the disturbed pattern of family interactions •Individual psychotherapy to correct deficits and distortions in psychologic functions •Nutrition therapy •Refeeding syndrome •Cognitive-behavioral therapy, Pharmacotherapy, Family Therapy •Behavioral contract

Toddler Safety Promotion and Injury Prevention

•Safety education - emphasis shifts from protective supervision to teaching simple safety rules •Preschoolers are the "great imitators" of parents, who now serve as role models •Car Safety •Water Safety •"Stranger Danger" •Bike Safety (helmets)

Cystic Fibrosis S/S

•Salty-tasting skin •Chronic cough •Recurrent lung infections •Wheezing •Shortness of Breath •Inadequate growth and weight gain •Greasy stools •Meconium ileus (or late passage) in the newborn Sweat crystallizes into salt in the skin

Managing Colic

•Swaddling: Decreases startling, increases sleep. Use during fussing/sleep •Side/stomach position: Hold baby on side, on her stomach, or over your shoulder. HOWEVER, Sudden Infant Death Syndrome (SIDS) is linked to stomach-down sleep positions. When a baby is in a stomach down position do not leave them even for a moment. •Shushing sounds: These imitate the continual whooshing sound made by the blood flowing through arteries near the womb. (Sound of blood flow in womb is louder than a vacuum) •Swinging: Newborns are used to the swinging motions within their mother's womb. (Do not shake.) Sucking: Calm easier with sucking (including pacifier)

Pertussis (Whooping Cough)

•aused by Bordetella pertussis •In United States, occurs most often in children who have not been immunized •Highest incidence in spring and summer •Highly contagious; transmitted via contact, droplet, and contaminated articles •Risk to young infants •Vaccines

Pediculosis Capitis

•incredibly common parasite particularly in school age children! •Seen particularly in hair, behind ears, nape of neck •Use permethrin rinse twice, 7-10 days apart