Peds Final

S/S of heart failure in children

- Adventitious lung sounds - Easily fatigued - Weight loss - Most will have some pulmonary congestion: nasal flaring, retraction of ribs when breathing. Grunting when breathing is how we know baby is struggling. Common complaints reported during the health history might include: -Failure to gain weight or rapid weight gain -Failure to thrive -Difficulty feeding -Fatigue -Dizziness, irritability -Exercise intolerance -Shortness of breath -Sucking and then tiring quickly -Syncope -Decreased number of wet diapers Infants with heart failure often display subtle signs such as difficulty feeding and tiring easily. Pay close attention for reports of these problems from the parents. Also be alert for statements such as "The baby drinks a small amount of breast milk (or formula) and stops, but then wants to eat again very soon afterward"; "The baby seems to perspire a lot during feedings"; or "The baby seems to be more comfortable when he's sitting up or on my shoulder than when he's lying flat." In addition, the parents may report episodes of rapid breathing and grunting. The child's current and past medical history also provides additional clues. Question the parents about any history of congenital heart defects and treatments such as surgery to repair the defect. Determine the current medication regimen. Also ask about any recent or past infections, such as streptococcal infections or fever.

Normal pediatric vital signs

- PR higher than an adults - RR higher than an adults - BP lower than adults

A newborn with hypoplastic left heart syndrome is to have surgery in a few days. What is the appropriate statement the nurse makes to the infant's parent regarding the baby's treatment? -"Indomethacin, an NSAID, will be given to your baby to close the opening between the upper chambers of his heart" -"Your baby's heart defect will be completely repaired after this surgery" -"It is necessary to give your baby prostaglandins to ensure the PDA closes as it should." -"Medication will be given to keep the passage way open between the right and left atria until the surgery can be performed."

"Medication will be given to keep the passage way open between the right and left atria until the surgery can be performed."

A mother is worried about her 4-month-old son's missed mile stones of development. Which of the following statements made by her would indicate that the child may have cerebral palsy? -"He holds his left leg so stiff that I have a hard time putting on his diapers." -"My baby won't lift his head up and look at me; he's so floppy." -"My baby's left hip tilts when I pull him to standing position." -"I'm very worried because my baby has not rolled all the way over yet."

"My baby won't lift his head up and look at me; he's so floppy."

Most Common Accidents in Children by Age Group Know safety measures for different age groups

-0-4 more at risk for drownings, -teenagers more apt to get in a vehicle accident, -younger kids more prone to falling and getting hurt -Airway obstruction is the leading cause of unintentional injury-related death among children younger than 1 year of age. -American Academy of Pediatrics (AAP)recommends children younger than 4 years old should not be fed any round, firm food unless the food is cut into small, non-round pieces. DROWNING= age, over confident while swimming, little or no supervision near water, child abuse. It is vital to obtain accurate information about how long the child was submerged and the temperature of the water. Complications: Hypothermia, brain anoxia, asphyxiation, injuries. Cerebral edema, respiratory distress, Diagnosis: ABGs, Chest x-rays Treatment: the type and amount of treatment is dependent upon the severity of the anoxic brain injury. Perform CPR immediately.

Capable of evaluating the quality of their own thinking. -Preschool (3-6 yrs) -Toddler (1-3 yrs) -Adolescence (12-20 yrs) -School Age (6-12 yrs) -Infant (2 days-1 year)

-Adolescence (12-20 yrs)

· Care for a patient with a cast (s/s of what to watch for)

-Assess frequently for neurovascular compromise, skin impairment at cast edges. -Protect cast from moisture. -Teach family how to care for cast at home. Perform frequent neurovascular checks of the casted extremity to identify signs of compromise early. These signs include: -Increased pain -Increased edema -Pale or blue color -Skin coolness -Numbness or tingling -Prolonged capillary refill -Decreased pulse strength (or absence of pulse) Casts are used to immobilize a bone that has been injured or a diseased joint. When a fracture has occurred, a cast serves to hold the bone in reduction, thus preventing deformity as the fracture heals. Casts are constructed of a hard material, traditionally plaster but now more commonly fiberglass. The hard nature of the cast keeps the bone aligned so that healing may occur more quickly. In a fracture that would heal on its own without specific immobilization, a cast may be used to reduce pain and to allow the child increased mobility. The choice of cast material and type of cast will be determined by the physician or nurse practitioner or orthopedic surgeon. Figure 44.4 shows selected casts used in children

Diagnostic tests for Leukemia (1st test they do)

-CBC first test they do -Leukemia is the #1 most common kid cancer (ALL is the most common w/ best prognosis) -Leukemia is a primary disorder of the bone marrow in which the normal elements are replaced with abnormal WBCs. Common laboratory and diagnostic studies ordered for the assessment of ALL include: -CBC: abnormal findings include low hemoglobin and hematocrit, decreased RBC count, decreased platelet count, and elevated, normal, or decreased WBC count -Peripheral blood smear may reveal blasts. -Bone marrow aspiration: stained smear from bone marrow aspiration will show greater than 25% lymphoblasts. Bone marrow aspirate is also examined for immunophenotyping (lymphoid versus myeloid, and level of cancer cell maturity) and cytogenetic analysis (determines abnormalities in chromosome number and structure). Immunophenotyping and cytogenetic analysis are used in the classification of the leukemia, which helps guide treatment. -Lumbar puncture will reveal whether leukemic cells have infiltrated the CNS. -Liver function tests and blood urea nitrogen (BUN) and creatinine levels determine liver and renal function, which, if abnormal, may preclude treatment with certain chemotherapeutic agents. -Chest radiography may reveal pneumonia or a mediastinal mass.-Prognosis is based on the WBC count at diagnosis, the type of cytogenetic factors and immunophenotype, the age at diagnosis, and the extent of extramedullary involvement. -Generally, the higher the WBC count at diagnosis, the worse the prognosis. Children between 1 and 9 years of age and with a WBC count less than 50,000 at diagnosis have the best prognosis. When a child experiences a relapse, the prognosis becomes poorer. Complications include infection, hemorrhage, poor growth, and CNS, bone, or testicular involvement.

A 12 year old boy has a fractured tibia which was stabilized in a below-the-knee fiberglass cast. It is important to do the following nursing measures: (Select all that apply). -Circulation checks 15 to 30 minutes after casting a limb. -Report limb pain unrelieved by analgesics. -Elevate the limb for 10 minutes once every three hours. -Patient (and family) teaching about how to perform neuro checks

-Circulation checks 15 to 30 minutes after casting a limb. -Report limb pain unrelieved by analgesics. -Patient (and family) teaching about how to perform neuro checks

The nurse is assessing a client who had a fractured femur repaired with an external fixator device. Which assessment finding would cause the nurse concern regarding the development of compartment syndrome? Select all that apply: -Diminished pulse in affected leg. -Paresthesia distal to area of injury. -Toes on affected leg cool to touch and edematous. -Complaints that pins are hurting. -Complaints of leg pain unrelieved by analgesics or repositioning.

-Diminished pulse in affected leg. -Paresthesia distal to area of injury. -Toes on affected leg cool to touch and edematous. -Complaints of leg pain unrelieved by analgesics or repositioning.

· Know what to do with Hazardous drug waste (urine, vomit, etc....)-

-Hazardous drugs will be prepared and labelled by pharmacy & alert placed in Medication Administration Record (MAR). -Whoever is administering hazardous medications is responsible for knowing handling precautions. -Extra caution should be taken when administering a hazardous medication via IM/subcutaneous routes as there is increased risk of aerosolization and exposure. Ensure proper PPE is used. -Dispose of any injection site dressing in cytotoxic waste. -All body fluids are considered hazardous when a patient is receiving hazardous medication. -Label all drainage collection devices with cytotoxic label. -Discard all contaminated disposable material and disposable PPE in cytotoxic waste. -PPE should always be worn when handling any body fluid (blood, vomitus, urine, saliva, sweat and stool) from patients treated with hazardous drugs and precautions continued for 48 hours following last dose.

· Best exercises for a child with Juvenile idiopathic arthritis (info about disease)

-Maintain joint range of motion and muscle strength via exercise (physical or occupational therapy). Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. -Teach families appropriate use of splints prescribed to prevent joint contractures. Monitor for pressure areas or skin breakdown with splint or orthotic use. -Is an autoimmune disorder in which the autoantibodies mainly target the joints. Inflammatory changes in the joints cause pain, redness, warmth, stiffness, and swelling. -Therapeutic management focuses on inflammation control, pain relief, promotion of remission, and maintenance of mobility..

s/s spina bifida types

-Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse effects. Spina bifida occulta is a common anomaly. Children with spina bifida occulta need no immediate medical intervention. Complications are rare but may include more significant abnormalities of the spinal cord such as tethered cord, syringomyelia, or diastematomyelia. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs. Meningocele, the less serious form of spina bifida cystica, occurs when the meninges herniate through a defect in the vertebrae. The spinal cord is usually normal and there are typically minor or no associated neurologic deficits. Treatment for meningocele involves surgical correction of the lesion. Initial assessment after delivery will reveal a visible external sac protruding from the spinal area. It is most often seen in the lumbar region but can be anywhere along the spinal canal. Most are covered with skin and pose no threat to the child. However, assessment to ensure that the sac covering is intact remains important. Assess neurologic status carefully. Before surgical correction the infant will be thoroughly examined to determine whether there is any neural involvement or associated anomalies. Diagnostic procedures such as computed tomography (CT), MRI, and ultrasound may be performed. Myelomeningocele, the most severe form of neural tube defect, occurs in approximately one in 4,000 live births (Kinsman & Johnston, 2016). Myelomeningocele is a type of spina bifida cystica, and clinically the term "spina bifida" is often used to refer to myelomeningocele. It may be diagnosed in utero via ultrasound. Otherwise it is visually obvious at birth. The newborn with myelomeningocele is at increased risk for meningitis, hypoxia, and hemorrhage. Initial assessment after delivery will reveal a visible external sac protruding from the spinal area. Observe the baby's general appearance and assess whether the sac covering is intact. Assess neurologic status and look for associated anomalies. Assess for movement of extremities and anal reflex, which will help determine the level of neurologic involvement. Flaccid paralysis, absence of deep tendon reflexes, lack of response to touch and pain stimuli, skeletal abnormalities such as club feet, constant dribbling of urine, and a relaxed anal sphincter may be found.

s/s of of a reaction to blood transfusions and what interventions should be done

-The most common signs and symptoms include fever, chills, urticaria (hives), and itching. Some symptoms resolve with little or no treatment. However, respiratory distress, high fever, hypotension (low blood pressure), and red urine (hemoglobinuria) can indicate a more serious reaction. -Follow institution's transfusion protocol -Double-check blood type and product label with a second nurse-If adverse reaction is suspected, immediately discontinue transfusion, run normal saline IV, reassess the child, and notify the physician -Some children require premedication with diphenhydramine and/or acetaminophen before receiving blood products -Stop the transfusion. -Keep the I.V. line open with normal saline solution. -Notify the physician and blood bank. -Intervene for signs and symptoms as appropriate. -Monitor the patients vital signs

Know what IVIG is used for and what pre-meds are given

-Therapeutic management of acute KAWASAKI disease focuses on reducing inflammation in the walls of the coronary arteries and preventing coronary thrombosis. Chronic management of children developing aneurysms during the initial phase is directed toward preventing myocardial ischemia. In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin (IVIG) are used. Teach parents to continue to monitor the child's temperature after discharge until the child has been afebrile for several days. Children with prolonged or recurrent fever may require a second dose of IVIG. Instruct parents to avoid measles and varicella vaccination for 11 months after high-dose IVIG administration. -ITP pts. ITP is thought to be an immune response following a viral infection that produces antiplatelet antibodies. For children with platelet counts below 10,000/mm3, corticosteroids may be administered for 2 to 3 weeks. A single dose of intravenous immunoglobulin (IVIG) may be used as an adjunct (Ambruso et al., 2018). Platelet transfusions are not indicated unless life-threatening bleeding is present. Refer the child for follow-up care with a pediatric hematologist. ITP is usually self-limiting, but if it persists for a year or longer, splenectomy may be indicated. -Hypogammaglobulinemia refers to a variety of conditions in which the child does not form antibodies appropriately. It results in low or absent levels of one or more of the immunoglobulin classes or subclasses. -Treatment:IVIG Premedication prior to IVIG infusion is often necessary because the potential exists for severe hypersensitivity reactions or anaphylaxis and/or more common side effects. (Benadryl and aspirin)

Parents are told their infant has a hypoplastic left heart. How would the nurse explain this condition to the family? -This is a problem where the right side of the heart did not develop properly. -This is a problem where the left side of the heart did not develop properly. -There are no surgeries that can help the child live with this heart defect. -The infant will have immediate surgery to completely correct the heart defect.

-This is a problem where the left side of the heart did not develop properly.

Types of fractures

1. Comminuted: the bone is crushed and/or shattered. 2. Compression: the fractured area of the bone collapses on itself. 3. Colles: the break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his/her fall. 4. Complicated: the bone is broken and pierces an internal organ. 5. Impacted: the bone is broken and the ends are driven into each other. 6. Hairline: a minor fracture appears as a thin line on an x-ray and may not extend completely through the bone. 7. Greenstick: the bone is partially bent and partially broken; common in children because the bones are still soft. 8. Pathologic: any fracture occurring spontaneously as a result of disease. 9. Salter-Harris: a fracture of the epiphyseal plate in children. 10. Sprain: traumatic injury to a joint involving the soft tissue. Includes muscles, tendons, and ligaments. Usually as a result of overuse or overstretching. s/s=uDecreased range of motion -Pain -Edema -Deformity -Crepitus -GUARDING -Warmth/redness -Ecchymosis (bruise) -Decreased use of area

Physical Developmental Milestones Age 3, 4, 5, 6

3 YEAR OLDS - "Age of three's" ♦ Draw a Circle (think "360 degrees" ♦ Can ride a tricycle ♦ 3-word sentences 4 YEAR OLDS • Copy a Cross (i.e., a plus sign) • Can skip/hop on one foot • Brush teeth • Plays WITH kids 5 YEAR OLDS • Draw a Square • Throws/catches a ball • Walks backward heel to toe 6 YEAR OLDS • Draw a Triangle • Ties shoelaces • Rides a bicycle • Counts 10 objects

Can solve moral dilemma's using their sense of morals; questions relevance of existing moral values as compared to society and other individuals. -Toddler (1-3 yrs) -Adolescence (12-20 yrs) -Preschool (3-6 yrs) -Infant (2 days-1 year) -School Age (6-12 yrs)

Adolescence (12-20 yrs)

Cast Care

After Casting Perform Neurovascular Assessment •Turn child every 2 hour •Keep area above heart x 24-48 hr to prevent swelling can also apply ice •Monitor cast for warm areas after cast is dry (may be infection) •Keep cast dry •Observe for drainage (mark area with pen) Neurovascular Assessment of Casted Area Sensation Skin temp Skin color Cap refill Pulses Movement Types of Casts: •Plaster, heavy, not durable. •Fiberglass, Light, durable, cool. Reduce a fracture = putting it into proper alignment. Closed reduction, to bone is able to manually be re-aligned. Open reductions require surgery, debridement of dead or damaged tissue The most common treatment for fractures is Casting!

Hypoplastic Left Heart Syndrome

An OBSTRUCTIVE or MIXED heart congenital heart defect. TOO LITTLE blood travels to the body A combination of several abnormalities of the heart and the great blood vessels. In hypoplastic left heart syndrome, most of the structures on the left side of the heart (including the left ventricle, mitral valve, aorta, and aortic valve) are small and underdeveloped. The degree of underdevelopment differs from child to child. The functional ability of the left ventricle can be reduced to the extent of not being able to pump an adequate blood volume to the body. Once the PDA closes within about two months after birth, progression of cyanosis and decreased cardiac output result in eventual cardiac collapse. Hypoplastic left heart syndrome can be fatal without treatment. In this congenital disease, an ASD or Patent Foramen Ovale (PFO) is actually beneficial because the opening between the ventricle and atria allows for oxygenation of the blood. ● Mild cyanosis ● Heart failure ● Lethargy ● Cold hands and feet

Coarctation of the aorta demonstrates few symptoms in newborns. Which of the following is an important assessment to make on all newborns to help reveal this condition? Observing for excessive crying Assessing for the presence of femoral pulses Recording an upper extremity blood pressure Auscultating for a cardiac murmur

Assessing for the presence of femoral pulses

Mason fractured his left wrist when falling from his bicycle. The physician applied a thumb-spica cast two days ago and now Mason is complaining that his hand is cold and he cannot feel his fingers. His mother calls the physician assistant and is correctly told to: -Apply heat to the arm to increase circulation for better healing -Bring the child to the physician's office immediately -Carefully monitor the child for signs of infection -Give Mason his pain medications as prescribed

Bring the child to the physician's office immediately

Compartment Syndrome

Casting can result in this -This is a serious condition that if not treated may result in neurological and vascular damage, which may result in the inability to use the casted area or amputation 5 P'S •PAIN •PARESTHESIA •PULSE •PARALYSIS •PALLOR Notify MD STAT

A child is admitted to the hospital for treatment of DKA. She will receive the standard DKA treatment protocol. As the child's nurse you know that if a patient's blood sugar level decreases too rapidly, they are at risk of developing which of the following conditions: Hyperkalemia Hyperglycemia Cerebral Edema Hypovolemia

Cerebral Edema

What statement is INCORRECT regarding Diabetic Ketoacidosis? Cheyne-stokes breathing can be present in DKA. This condition will be treated with insulin in a solution of D5W. DKA occurs mainly in Type 1 diabetics Ketones are present in the urine in DKA.

Cheyne-stokes breathing can be present in DKA.

A 9-month-old baby who is wheezing and coughing is admitted to the pediatric unit with Respiratory syncytial virus (RSV). Which of these indicate the infant's condition is worsening? Respiratory rate of 38 breaths/min Decreased inspiratory breath sounds, retractions in 3 areas Crying Dysphasia and loss of appetite

Decreased inspiratory breath sounds, retractions in 3 areas

The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as: Duchenne Facioscapulohumeral Limb-girdle Myotonia Pallor

Duchenne

Jorge was recently diagnosed with cerebral palsy and his parents are discussing his treatment plan with the nurse. Which of the following interventions will take highest priority? -Perform range of motion exercises to optimize mobility -Assess the client's developmental level to ensure he is meeting cognitive milestones -Move the child to a different position every two hours to prevent skin breakdown -Elevate the head of the bed during feeding or if child has increased/heavy secretions.

Elevate the head of the bed during feeding or if child has increased/heavy secretions.

The nurse is educating a group of caregivers about fractures seen in children. One of the caregiver states: "I have heard that if a bone breaks it can cause permanent damage and stop the growth of the bone. "This statement is accurate if the break occurs in the: Humerus Joint Xiphoid Process Epiphyseal Plate

Epiphyseal Plate

s/s of poisoning

If a normally healthy child (particularly a young child) suddenly deteriorates without a known cause, suspect a toxic ingestion. -low respirations, abd pain, diarrhea, excessive salivation, nausea When poisoning occurs, give priority to the child's ABCs. Did the child experience nausea, vomiting, anorexia, abdominal pain, or neurologic changes such as disorientation, slurred speech, or altered gait? Determine the progression of the symptoms. The suspected poison may direct the laboratory and diagnostic testing. A variety of blood tests may be performed: -Chemistry panel: to detect hypoglycemia or metabolic acidosis and assess renal function -ECG: to identify arrhythmias or conduction delay -Liver function tests: to assess for liver injury -Urine and blood toxicology screens (available for a limited number of medications; may vary per institution) -Specific drug levels if the substance ingested is known or highly suspected Perform a thorough physical examination, noting alterations that may occur with particular ingestions, such as: -Hyper- or hypotension -Hyper- or hypothermia -Respiratory depression or hyperventilation -Miosis (pupillary contraction) or mydriasis (pupillary dilation) -Pay particular attention to the child's mental status, skin moisture and color, and bowel sounds

The adolescent patient in the emergency department is given a nebulizer breathing treatment of epinephrine to treat a severe asthma attack. Because this medication is a beta-adrenergic agonist, what response to the medication will the nurse tell the patient to expect? -Bronchodilation and decreased heart rate -Increased heart rate and respiratory rate -Increased ease of breathing and increased heart rate -Decreased inflammation and increased heart rate

Increased ease of breathing and increased heart rate

Mistrust is developed if needs are not adequately met or parenting is inconsistent -Toddler (1-3 yrs) -School Age (6-12 yrs) -Preschool (3-6 yrs) -Adolescence (12-20 yrs) -Infant (2 days-1 year)

Infant (2 days-1 year)

Separation, object permanence, and mental representation are the three important tasks accomplished in this stage. -Preschool (3-6 yrs) -Infant (2 days-1 year) -School Age (6-12 yrs) -Toddler (1-3 yrs) -Adolescence (12-20 yrs)

Infant (2 days-1 year)

Which of the following condition in the pediatric patient are you going to be administering high doses of aspirin to treat the child? Kawasaki's Disease Kwashiorkor Disease Kennedy's Disease Korsakoff's Disease

Kawasaki's Disease

s/s of Systematic Lupus Erythematous and interventions that can be done

Most Common Clinical Manifestations of Systemic Lupus Erythematosus -Alopecia • Anemia • Arthralgia • Arthritis • Fatigue • Lupus nephritis • Photosensitivity • Pleurisy • Raynaud phenomenon • Seizures • Skin rashes, including malar rash • Stomatitis • Thrombocytopenia The malar or butterfly rash (erythema over the cheeks in the shape of a butterfly) is typical in systemic lupus erythematosus (SLE). In children, the most common initial symptoms are hematologic, cutaneous, and musculoskeletal in origin. The disease is chronic, with periods of remission and exacerbation (flares). -Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that affects both humoral and cellular immunity -in SLE, autoantibodies react with the child's self-antigens to form immune complexes. The immune complexes accumulate in the tissues and organs, causing an inflammatory response resulting in vasculitis. Injury to the tissues and pain occur.

· Most common and severe type of Muscular Dystrophy

Most common type: Duchenne (it is X-linked) -Duchenne is the most common and severe form of MD among children, and it accounts for approximately half of MD cases. Muscular dystrophy •May be X-linked, autosomal dominant, or recessive •A group of inherited conditions that result in progressive muscle weakness and wasting. •The muscles affected are primarily the skeletal (voluntary) muscles. •Nine types of muscular dystrophy exist. • All include muscle weakness over the lifetime; it is progressive in all cases but more severe in others.

An infant is born with a sac protruding through the spine, containing cerebrospinal fluid (CSF), a portion of the meninges, and nerve roots. This condition is referred to as: Myelomeningocele Anencephaly Meningocele Spina bifida occulta

Myelomeningocele

What does the PERIOD of Purple Crying stand for? -Peak of crying, Unexpected, Resists soothing, Pain like face, Long lasting, Evening -Peak of Crying, Unusual, Resists, Purple, Long lasting, Events -Peak of Crying, Unexpected, Recommending Rest, -Pain, Long, Evening

Peak of crying, Unexpected, Resists soothing, Pain like face, Long lasting, Evening

Cannot tell time but they do have an understanding of time-related words. -Toddler (1-3 yrs) -School Age (6-12 yrs) -Preschool (3-6 yrs) -Infant (2 days-1 year) -Adolescence (12-20 yrs)

Preschool (3-6 yrs)

A 3 month old infant presents to the clinic with these signs: visible peristaltic waves, non-bilious vomit, and an olive shaped abdominal mass. The nurse suspects this infant has: Hirschsprung's Disease Meckel's Diverticulum Pyloric Stenosis Intusseception

Pyloric Stenosis

S/S of type 1 diabetes

Rapid Onset, Fatigue, Increased Infections, Weight Loss, and the 3 Ps (Polyuria, Polydispia, and Polyphagia). -Destruction of Beta Cells = NO INSULIN PRODUCTION aka, T1D, IDDM (insulin dependent diabetes mellitus), or "juvenile diabetes" · Onset in childhood or teenage years · Autoimmune destruction of beta cells à insulin dependent. Genetic predisposition PLUS an environmental trigger, i.e., an infection. The T1D autoantibodies can exist for years before the onset of hyperglycemia. · At higher risk for other autoimmune diseases: Graves Disease, Rheumatoid arthritis, Addison Disease. · Requires life-long insulin injections (insulin-dependent) S/S of T1D: -"3 P's" - polyuria, polydipsia, polyphagia - Weight LOSS (because glucose is not being transported into cells - body "starves") - Frequent infections, wounds slow to heal (compromised immune system) T1D Risk Factors: - Family History: If a First Degree relative has diabetes (parent/sibling/child) - Age: T1D can develop at any age, but more likely to develop in children over 5 years old. - Race: In the United States, Caucasians are more likely to develop type 1 diabetes.

What is the most important vital sign to monitor to assess a child's respiratory status? A. Heart rate B. Respiratory rate C. Temperature D. Oximeter reading

Respiratory rate

A nurse is performing a developmental screening on a 3-year-old child. Which of the following skills should the nurse expect the child to perform? (Select-all-that-apply) 1. Hop on one foot 2. Jump rope 3. Ride a tricycle 4. Throw a ball overhead 5. Draw a circle

Ride a tricycle Draw a circle

Children are more likely to be hurt than adults b/c Risk Factors:

Risk Factors: •Obesity •Poor nutrition •Hereditary factors •Developmental stages (just being a kid)

Children in this age group should be challenged with tasks that need to be accomplished, and be allowed to work through individual differences in order to complete the tasks. -Preschool (3-6 yrs) -Toddler (1-3 yrs) -School Age (6-12 yrs) -Infant (2 days-1 year) -Adolescence (12-20 yrs)

School Age (6-12 yrs)

These children move from totally egocentric thoughts to social awareness and the ability to consider the viewpoints of others. -Infant (2 days-1 year) -Adolescence (12-20 yrs) -School Age (6-12 yrs) -Toddler (1-3 yrs) -Preschool (3-6 yrs)

School Age (6-12 yrs)

The nurse cares for a child diagnosed with pneumococcal pneumonia. The child receives oxygen per nasal cannula at 4 L/min. If the oxygen therapy is effective, what will the nurse expect to observe? -The child is able to expectorate secretions from the lower airways. -The nurse notes a decrease in crackles in the bases of the child's lungs. -The nurse notes the child is more alert and less agitated or restless. -The child's blood pressure is 114/72 while supine and 98/68 after moving to a sitting position.

The nurse notes the child is more alert and less agitated or restless.

A mother asks the nurse if the reason the infant has a congenital heart defect is because of something she did while pregnant. What is the best response by the nurse? -There are several reasons an infant can have a heart defect; let's talk about those causes. -Yes, there is a chance you caused this defect. -No, heart defects are mainly caused by genetic factors. -The studies show it is impossible to know what causes heart defects.

There are several reasons an infant can have a heart defect; let's talk about those causes.

s/s of bonne cancer -types and info

There is cancer in this joint Osteosarcoma Osteosarcoma, the most common type of bone cancer, is most common in older children, teenagers, and young adults. Risk Factors: growth spurts, Symptoms: pain, swelling, limp, referred pain to hip or back. Deep bone pains that awakens the child. The pain from both osteosarcoma and Ewing"s sarcoma are often dismissed as growing pain in the earlier stages. Commonly metastasis to lungs. Diagnosis: X-ray, bone scan and CT and bone biopsy Ewings sarcoma Ewing sarcoma is a bone cancer that typically affect Children and adults up to 30. Malignant, small, round tumor, usually located in the shaft portion of long bones. Common sites are femur, pelvis, tibia, fibula, ribs, hummerus, scapula and clavicle. Most common in 5-20 years old. Risk Factors: Symptoms: (deep bone pain that wakes a kid from sleep) Pain, swelling, fever, elevated WBC, elevated erythrocyte sed rate, elevated C-reactive protein. Child may develop a fracture that leads to the diagnosis. Diagnosis: X-ray, bone cans, CT and bone biopsy (looks like lesions on the x-ray) Most common bone cancer- adolescent boys; Pain is the most common symptom detected at time of rapid bone growth Distal portion of the femur most common; humerus, tibia, pelvis, jaw and phalanges Pain and swelling-initial symptoms X-ray, CT or MRI- detects area of met. Tx=treatment= Often - radical resection or amputation amputation--> (prosthetic), if metastisizes to lungs tx w/ chemo, surgery, and radiation- elevate stump for 24 hours and maintain proper body alignment and do sterile dressing changes and watch for s/s of infection

Solitary play evolves into parallel play. -Adolescence (12-20 yrs) -Toddler (1-3 yrs) -Infant (2 days-1 year) -Preschool (3-6 yrs) -School Age (6-12 yrs)

Toddler (1-3 yrs)

Margie is a 6-month-old child admitted for a scheduled procedure to treat her Tetralogy of Fallot heart defect. She has a sudden onset "Tet" spell. These unexpected attacks are characterized by all the following EXCEPT: Treated by lying in the supine position with limbs out-stretched Episodes of cyanosis Can lead to syncope and subsequent brain damage difficulty breathing

Treated by lying in the supine position with limbs out-stretched

It is mandatory for all health care providers to report suspected cases of child abuse. There are civil and criminal penalties for not reporting. True False

True

Side effects of chemotherapy

fatigue GI symptoms (anorexia, nausea, vomiting, diarrhea, ulcers, hemorrhage) bone marrow suppression (anemia, leukopenia, thrombocytopenia) skin rashes neuropathies phlebitis hair loss -affects cancer cells and regular cells that divide rapidly. Hair loss (b/c rapidly dividing cells) -pt is immunossupressed (high likely hood of getting an infection and hard time fighting it off), infection is huge risk and always want to think about that, maximum cell death happens in induction phase, PAIN maintenance is huge, manage bleeding, high risk for infection (educate and do stuff to prevent, limit visitors, wear masks, no flowers) -Unfortunately, chemotherapeutic medications disrupt the cell cycle of not only cancer cells but also normal rapidly dividing cells. This results in a significant number of adverse effects. The cells most likely to be affected by chemotherapy are those in the bone marrow, the digestive tract (especially the mouth), the reproductive system, and hair follicles. -Adverse effects common to chemotherapeutic drugs include immunosuppression, infection, myelosuppression, nausea, vomiting, constipation, oral mucositis, alopecia, and pain. Long-term complications include microdontia and missing teeth as a result of damage to developing permanent teeth; hearing and vision changes; hematopoietic, immunologic, or gonadal dysfunction; endocrine dysfunction, including altered growth and precocious or delayed puberty; various alterations of the cardiorespiratory, gastrointestinal (GI), and genitourinary systems; and development of a second cancer as an adolescent or adult (ACS, 2020b).

what vital signs are affected in kids with a fever?

· know what happens when a child has a fever, tachypneic (rapid breathing), tachycardic (rapid heart rate) As the body temperature increases with a fever, respiratory rate can also increase. The increase is the body's way of trying to get rid of the heat. Sweating. Chills and shivering. Headache. Muscle aches. Loss of appetite. Irritability. Dehydration. General weakness.

The nurse is working with a group of caregivers of children diagnosed with asthma. Which statement made by a caregiver is most accurate regarding the triggers that may cause an asthma attack? -My neighbor told me that asthma attacks are caused by hot weather." -"I always thought that a lack of exercise caused my child's asthma." -"My sister and her family love animals, and when we go to their house my daughter always has an asthma attack." -"One person told me that astterm-88hma is caused by using antibiotics for infection."

"My sister and her family love animals, and when we go to their house my daughter always has an asthma attack."

Erickson's Theory of Psychosocial Development -Stage 3

- Initiative vs. Guilt -preschool age (age 3 to 5) -During the preschool years, children begin to assert their power and control over the world through directing play and other social interaction. Children who are successful at this stage feel capable and able to lead others. Those who fail to acquire these skills are left with a sense of guilt, self-doubt and lack of initiative.

Causes of hyperthyroidism

- Most common cause is Grave's disease. Graves' disease, an autoimmune disorder, is the most common cause of hyperthyroidism. It causes antibodies to stimulate the thyroid to secrete too much hormone. Graves' disease occurs more often in women than in men. It tends to run in families, which suggests a genetic link. - Drugs that can cause hyperthyroidism include iodine, amiodarone, and interferons. -excess iodine, a key ingredient in T4 and T3 -thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland -tumors of the ovaries or testes -benign tumors of the thyroid or pituitary gland -large amounts of tetraiodothyronine taken through dietary supplements or medication - RAI-131 is the treatment of choice in Grave's disease - Beta blockers can be used first for symptom control (to reduce palpitations, tremors and tachycardia) - PTU or Methimazole can be used as temporary measure until surgery is complete - Initially, when treating with drugs, it takes 1-3 months at higher doses to control symptoms at which point the dose is reduced to prevent Hypothyroidism from occurring.

Erickson's Theory of Psychosocial Development

- personality theory stresses the role of social factors, and his stages of development each involve a different psychosocial crisis - places greater emphasis on the ego than the id - assumes people are basically rational and that behavior is due largely to ego functioning -Erik Erikson's theory of psychosocial development is one of the best-known theories of personality in psychology. Much like Sigmund Freud, Erikson believed that personality develops in a series of stages. Unlike Freud's theory of psychosexual stages, Erikson's theory describes the impact of social experience across the whole lifespan. One of the main elements of Erikson's psychosocial stage theory is the development of ego identity. -Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experience and information we acquire in our daily interactions with others. In addition to ego identity, Erikson also believed that a sense of competence also motivates behaviors and actions. Each stage in Erikson's theory is concerned with becoming competent in an area of life. If the stage is handled well, the person will feel a sense of mastery, which he sometimes referred to as ego strength or ego quality. If the stage is managed poorly, the person will emerge with a sense of inadequacy. -In each stage, Erikson believed people experience a conflict that serves as a turning point in development. In Erikson's view, these conflicts are centered on either developing a psychological quality or failing to develop that quality. During these times, the potential for personal growth is high, but so is the potential for failure.

PDA

-Acynotic left--> Rt shunt congenital heart defect -Too much blood passes through the lungs Patent Ductus Arteriosus - In the developing fetus, the ductus arteriosus connects the pulmonary artery to the descending aorta allowing most of the blood ejected from the right ventricle to bypass the nonfunctioning lungs. Endogenous prostaglandins are vasodilating chemicals produced within the lumen of the ductus to keep it open (patent). At birth, an increase in arterial oxygen saturation and a decrease in endogenous prostaglandins promote closure of the ductus. A patent (open) ductus arteriosus, or PDA, does not close as it normally should. If the ductus remains open, the direction of flow reverses and some of the oxygen-rich blood from the aorta flows to the pulmonary artery and into the lungs causing lung and heart congestion. Click here to see an animation: https://www.nemours.org/service/medical/heart-defects/pda/animation.html. The large volume overload may result in enlargement of the heart that then causes heart failure. PDA patients are also at risk for developing endocarditis. This increases mortality by 50% whereas the risk of a surgery to repair the PDA is almost zero. S/S: "MACHINE-LIKE" hum heart murmur; CHF; HTN. Treatment: A PDA may close spontaneously. If treatment is necessary, anti-prostaglandin drugs such as IV NSAIDs (indomethacin or the newer preparation of IV ibuprofen) are frequently effective in closing a PDA if it is administered in the first 10-14 days of life. Other options are catheter closure (via cardiac catheterization) or surgical ligation. PROSTIGLANDIN DRUGS: In some congenital heart conditions, it is important to KEEP the PDA OPEN so some blood can get to the body while waiting for surgery (see "Cyanotic" and "Obstructive" congenital heart disorders). Prostaglandin is a smooth muscle relaxer that causes dilation keeping the ductus arteriosus open. This allows some oxygenated blood to get to the rest of the body. Without this supply of blood, babies would die.

Erickson's Theory of Psychosocial Development -Stage 2

-Autonomy vs. Shame and Doubt -toddler age (age 1 to 2) -The second stage of Erikson's theory of psychosocial development takes place during early childhood and is focused on children developing a greater sense of personal control. Like Freud, Erikson believed that toilet training was a vital part of this process. However, Erikson's reasoning was quite different than that of Freud's. Erikson believed that learning to control one's body functions leads to a feeling of control and a sense of independence. Other important events include gaining more control over food choices, toy preferences, and clothing selection. Children who successfully complete this stage feel secure and confident, while those who do not are left with a sense of inadequacy and self-doubt. -Kids (especially elementary school age) need chores to feel good about themselves.

The school nurse talks to a group of kindergarten parents. The nurse is MOST concerned if which statement is made by a parent? 1."My 6-year -old will not share toys with my 4-year-old." 2."My child occasionally has difficulty clearly speaking some words." 3."My child insists on sleeping with someone in the family." 4."My child constantly argues with the older children."

1."My child insists on sleeping with someone in the family."

Piaget's Cognitive developmental theories -Stages

-Children think and process differently than adults. Therefore they perceive the world differently than their adult caregivers. The development of intelligence proceeds in a set sequence for all children, although the ages at which they reach the various stages may vary. 1. Sensorimotor stage (Infancy). -OBJECT PERMANENCE -In this period (which has 6 stages), intelligence is demonstrated through motor activity without the use of symbols. Knowledge of the world is limited (but developing) because it's based on physical interactions / experiences. Children acquire object permanence at about 7 months of age (memory). Physical development (mobility) allows the child to begin developing new intellectual abilities. Some symbolic (language) abilities are developed at the end of this stage. 2. Pre-operational stage -EGOCENTRISM - (Toddler and Early Childhood). In this period (which has two sub stages), intelligence is demonstrated through the use of symbols, language use matures, and memory and imagination are developed, but thinking is done in a nonlogical, nonreversible manner. Egocentric thinking predominates 3. Concrete operational stage -CONSERVATION -(Elementary and early adolescence). In this stage (characterized by 7 types of conservation: number, length, liquid, mass, weight, area, volume), intelligence is demonstrated through logical and systematic manipulation of symbols related to concrete objects. Operational thinking develops (mental actions that are reversible). Egocentric thought diminishes. 4. Formal operational stage - ABSTRACT THINKING -(Adolescence and adulthood). In this stage, intelligence is demonstrated through the logical use of symbols related to abstract concepts. Early in the period there is a return to egocentric thought. Only 35% of high school graduates in industrialized countries obtain formal operations; many people do not think formally during adulthood

·Types of hypothyroidism

-Congenital hypothyroidism, also known as cretinism, usually results from failure of the thyroid gland to migrate during fetal development. This results in malformation or malfunction of the thyroid gland, which leads to insufficient production of the thyroid hormones that are required to meet the body's metabolic and growth and development needs. Congenital hypothyroidism leads to low concentrations of circulating thyroid hormones (triiodothyronine [T3] and thyroxine [T4]). -due to a defect in the development of the thyroid gland in the fetus due to a spontaneous gene mutation, an inborn error of thyroid hormone synthesis resulting from an autosomal recessive trait, pituitary dysfunction, or failure of the CNS-thyroid feedback mechanism to develop. Acquired Hypothyroidism-This disorder most commonly results from an autoimmune chronic lymphocytic (Hashimoto) thyroiditis. As a genetic condition, antibodies develop against the thyroid gland, causing the gland to become inflamed, infiltrated, and progressively destroyed. It occurs more often in girls during childhood and adolescence.

s/s of electrolyte imbalances with DKA

-DKA is an acute, life-threatening condition characterized by hyperglycemia, ketonemia, glycosuria, ketonuria and acidosis. cause of hypokalemia caused by osmotic diuresis leading to a total body potassium deficiency of 3 to 6 mEq/kg. At presentation, potassium levels are typically "normal" due to the extracellular shift of potassium (K+) from insulin deficiency and acidosis. -hypokalemia=muscle weakness, cramping, fasciculations, paralytic ileus, and when hypokalemia is severe, hypoventilation, and hypotension. ECG changes typically occur when serum potassium is < 3 mEq/L (< 3 mmol/L), and include ST segment sagging, T wave depression, and U wave elevation. •Ketoacidosis 1)Ketones in urine and blood 2)Fruity breath (acetone) 3)Kussmaul Breathing -Potassium can be normal to high at presentation d/t extracellular shift of K+ from insulin deficiency and acidosis. -Once insulin is started the K+ shifts into the cell causing HYPOKALEMIA -Monitor K+ CLOSLEY throughout treatment!! -IMPORTANT NOTE: The most serious risk associated with TREATMENT of DKA is cerebral edema which occurs more often to infants and children and begins in the first 4 - 12 hours of treatment. -Cerebral Edema causes Increased Intracranial Pressure (IICP) s/s : o Headache o Change in level of consciousness o Cushing's Triad vital signs (increased B/P; decreased HR and Resp) Nursing Consideration: Monitor for fluid overload. Regularly assess the patient's respiratory status by auscultating the lungs. Nurse will also insert Foley catheter to measure I/O; weigh the patient daily; and assess for dependent edema.

Issues with a child that has a Human Growth Hormone Problem

-GH deficiency is also known as hypopituitarism or dwarfism -is characterized by poor growth and short stature. -GH stimulates linear growth, bone mineral density, and growth in all body tissues. -Possible complications related to GH deficiency and its treatment include altered carbohydrate, protein, and fat metabolism; hypoglycemia; glucose intolerance/diabetes; slipped capital femoral epiphysis; pseudotumor cerebri; leukemia; recurrence of central nervous system (CNS) tumors; infection at the injection site; edema; and sodium retention. -lack of GH impairs the body's ability to metabolize protein, fat, and carbohydrates. Primary causes of GH deficiency include injury to, or destruction of, the anterior pituitary gland or hypothalamus. Causes include a tumor (e.g., craniopharyngioma), infection, infarction, CNS irradiation, abnormal formation of these organs in utero, or damage or trauma during birth or after. It may also be part of a genetic syndrome, such as Prader-Willi syndrome or Turner syndrome, or the result of a genetic mutation or deletion. In some cases, the cause may be idiopathic, such as nutritional deprivation or psychosocial issues, and reversible. Psychosocial dwarfism results from emotional deprivation that causes suppression of production of the pituitary hormones, resulting in decreased GH. The child is withdrawn, has bizarre eating and drinking habits such as drinking from toilets, and has primitive speech. The treatment involves removing the child from the dysfunctional environment and providing normal dietary intake. With normalized eating and behavioral habits, pituitary secretion is restored and the child dramatically catches up in growth parameters. -The health history may reveal a familial pattern of short stature or a prenatal history of maternal disorders such as malnutrition. The past history may be significant for birth history of intrauterine growth retardation or past history of severe head trauma or a brain tumor such as craniopharyngioma. Evaluate previous and current growth patterns. Note history of chronic illness such as cardiac, kidney, or intestinal disorders that may contribute to a decreased growth pattern. Assess the child's feelings about being short. -In addition to the linear height being at or below the third percentile on standard growth charts, the physical assessment findings may show that the child has a higher weight-to-height ratio (Fig. 48.2). Other physical findings may include prominent subcutaneous deposits of abdominal fat; a child-like face with a large, prominent forehead; a high-pitched voice; delayed sexual maturation (e.g., micropenis and undescended testes in boys); delayed dentition; delayed skeletal maturation; and decreased muscle mass.

S/S of appendicitis

-Generalized abdominal pain, progressively worsening in RLQ at McBurney's point -Nausea, vomiting, fever, chills -Guarding, rigidity, rebound tenderness -Vomiting, diarrhea, constipation -Elevated WBC (15-20,000 cells/mm3) -X-ray or abdominal ultrasound - enlarged appendix -McBurney's point-RLQ. Sudden relief of pain=rupture. -Fever — If your temperature is at or over 103°F (40°C), go to a hospital immediately. If it's at 102°F (38°C) but you're experiencing several other symptoms, go to the hospital as soon as possible. -Chills -Constipation — If your constipation is paired with frequent vomiting, this strongly indicates appendicitis. -Diarrhea -Nausea -Vomiting -Shaking -Back pain -Tenesmus (the feeling that a bowel movement will relieve discomfort) Book s/s -Vague abdominal pain in the initial stages, localizing to the right lower quadrant over a few hours -Nausea and vomiting (which usually develop after the onset of pain) -Small-volume, frequent, soft stools, often confused with diarrhea -Fever (usually low grade unless perforation occurs, which results in high fever) -Note an ill appearance to the child. The child often cannot walk or climb up onto the examination table without assistance. -Upon palpation, maximal tenderness occurs over McBurney's point in the right lower quadrant (Fig. 42.11). -Diffuse abdominal tenderness or distention may indicate peritonitis. -Abdominal computed tomography (CT) scan: performed to visualize the appendix for further evaluation. -Laboratory testing: may reveal an elevated white blood cell count. -C-reactive protein: may be elevated.

What is tracked as far as growth in pediatric patients?

-Height and Weight (then they will put them on a growth chart so you can see if they are keeping to "their" normal) -The foundation of taking care of pediatric patients is an understanding of Developmental Milestones (expected physical, cognitive, and behavioral abilities).

Erickson's Theory of Psychosocial Development -Stage 5

-Identity vs. Confusion adolescence -(age 12 to 19) -During adolescence, children are exploring their independence and developing a sense of self. Those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and a feeling of independence and -"Failure to Launch", substance abuse to hide from problems, difficulty maintaining relationships

Erickson's Theory of Psychosocial Development -Stage 4

-Industry vs. Inferiority -early school years (age 6 to 11) -This stage covers the. Through social interactions, children begin to develop a sense of pride in their accomplishments and abilities. Children who are encouraged and commended by parents and teachers develop a feeling of competence and belief in their skills. Those who receive little or no encouragement from parents, teachers, or peers will doubt their ability to be successful.

Safety and Prevention for this age group include: Being at higher risk for drowning in bathtubs, cleaning buckets, or drainage areas. Crib mobiles should be removed during this stage also. -Preschool (3-6 yrs) -Infant (2 days-1 year) -School Age (6-12 yrs) -Toddler (1-3 yrs)

-Infant (2 days-1 year)

Medications for cystic fibrosis

-KNOW that enzymes are given BEFORE patient's eat) -Recombinant human DNase (Pulmozyme) is given daily using a nebulizer to decrease sputum viscosity and help clear secretions. -Inhaled bronchodilators and anti-inflammatory agents are prescribed for some children. -Aerosolized antibiotics are often prescribed and may be given at home as well as in the hospital. Choice of antibiotic is determined by sputum culture and sensitivity results -Pancreatic enzymes and supplemental fat-soluble vitamins are prescribed to promote adequate digestion and absorption of nutrients and optimize nutritional status. -Increased-calorie, high-protein diets are recommended, and sometimes supplemental high-calorie formula, either orally or via feeding tube, is needed. -Some children require total parenteral nutrition to maintain or gain weight. Lung transplantation has been successful in some children with cystic fibrosis. Antibiotics Mucolytics Bronchodilators Anti-inflammatory agents Ivacaftor (affects CFTR gene opening cl- channels) Ivacaftor/lumicaftor combo Pancreatic enzymes (lipase, pretease, amylase) Mucolytics (Acetylcysteine "mucomyst" and Dornase alfa for C.F.) ● Inhaled in cystic fibrosis to break down thick lung secretions ● Given orally for acetaminophen [Tylenol] overdose ● Monitor airway: the drug thins the viscosity of mucous which creates copious secretions which could lead to aspiration. Have SUCTION EQUIPMENT available to manage heavy secretions. ● Monitor breathing: listen for adventitious breath sounds that indicate secretions are still trapped in the lungs ● May also need a bronchodilator

s/s of Kawasaki's

-Leading cause of heart disease -there are no definitive tests...so s/s important -causes vasculitis (blood vessel inflammation) -Kawasaki disease often begins with a high and persistent fever greater than 102 F, often as high as 104 F. A persistent fever lasting at least 5 days is considered a classic sign. The fever may last for up to 2 weeks and does not usually go away with normal doses of acetaminophen (Tylenol) or ibuprofen. Other symptoms often include: · Extremely bloodshot or red eyes (without pus or drainage) · Bright red, chapped, or cracked lips · Red mucous membranes in the mouth · Strawberry tongue, white coating on the tongue, or prominent red bumps on the back of the tongue · Red palms of the hands and the soles of the feet · Swollen hands and feet · Skin rashes on the middle of the body, NOT blister-like · Peeling skin in the genital area, hands, and feet (especially around the nails, palms, and soles) · Swollen lymph nodes (frequently only one lymph node is swollen), particularly in the neck area · Joint pain and swelling, frequently on both sides of the body Key signs and symptoms may not all be present at the same time. In some very young infants, only a few of these actually develop. Other non-specific symptoms may also be present, such as vomiting, diarrhea, stomach ache, cough, runny nose, headache, or pain or swelling of the joints

s/s pyloric stenosis

-Progressive, projectile, non-bilious vomiting (pix) -non-bilious vomit is the initial s/s and manifest 2-4 old -Movable, palpable, olive shaped mass RUQ -Visible, deep peristaltic waves (pix) -Irritability, hunger & crying -Sunken fontanels, dehydration -As the obstruction worsens, dehydration occurs and electrolytes are depleted resulting in metabolic disturbances. -Usually occurs 2-4 weeks after birth. -Symptoms start with slight regurgitation after feedings, and then vomiting becomes projectile. (projectile-up to 3 feet from infant) Book s/s -Forceful, nonbilious vomiting, unrelated to feeding position -Hunger soon after vomiting episode -Weight loss due to vomiting -Progressive dehydration with subsequent lethargy -Possible positive family history -Palpate for a hard, moveable "olive" in the right upper quadrant (hypertrophied pylorus). If an easily palpable mass is felt, no further testing is necessary, and a surgical consult is called. If no mass is identified, a pyloric ultrasound may be ordered to identify a thickened hypoechoic ring in the region of the pylorus. Assess laboratory values to determine if the infant has metabolic alkalosis resulting from dehydration.

2-year-old Juanita has been diagnosed with bronchiolitis. Which of the following interventions should be included in her plan of care? -Performing chest physiotherapy (CPT) -Drawing blood for blood cultures -Administering a cough suppressant and bronchodilators -Promoting hydration, and supportive therapy including suctioning and possible o2 and pressure support

-Promoting hydration, and supportive therapy including suctioning and possible o2 and pressure support

s/s GERD

-Recurrent vomiting or regurgitation -Weight loss or poor weight gain -Irritability in infants -Respiratory symptoms (chronic cough, wheezing, stridor, asthma, apnea) -Hoarseness/sore throat -Halitosis (mostly in older children) -Heartburn or chest pain -Abdominal pain -Abnormal neck posturing (Sandifer syndrome) -Hematemesis -Dysphagia or feeding refusal -Chronic sinusitis, otitis media -Poor dentition (caused by acid erosion) -Note an underweight or malnourished appearance in infants and children with uncontrolled GER for a period of time -Note breathing patterns, because reflux-induced asthma may have developed -Observe the child for cyanosis, altered mental status, and alterations in tone. Inspect emesis for blood or bile. -Auscultate the lung fields for the presence of adventitious breath sounds related to GERD complications. -Use caution when palpating the abdomen, especially in infants with GERD, because it may induce vomiting. No abnormalities should be identified on palpation. -Upper GI series: though not sensitive or specific to GER, may show some reflux; studies are used to narrow down the differential diagnosis. -Esophageal pH probe study: quantifies GER episodes as they correlate to symptoms. -Esophagogastroduodenoscopy (EGD): shows esophageal and gastric tissue damage from GERD. -Complete blood count: may demonstrate anemia if chronic esophagitis or hematemesis is present. -Hemoccult: may be positive if chronic esophagitis is present. -regurgitation of gastric contents into esophagus -Incompetence of lower esophageal sphincter -Reflux (backward flow) damages esophagus -Typically self limiting by 1 yr -Rate ↑ with CP, Down's Syndrome & prematurity -Most common esophageal problem infancy -Pathologic when complications - 3% of infants, boys 3x more common -Some spitting up is normal in infants, but if it continues and increases in frequency, they should be evaluated. -Reflux of stomach contents can lead to aspiration-then, pneumonia, upper respiratory infection reactive airway disease, apnea, and cyanotic spells with feeding

What is Regression and what causes it?

-Some toddlers experience regression during a stressful event (e.g., the birth of a sibling, hospitalization). Stress in a toddler's life affects his or her ability to master new developmental tasks. During regression, the toddler may want to go back to an earlier stage. He or she may desire a bottle or pacifier forgotten long ago. The toddler may stop displaying previously achieved language or motor skills. A significant stress in the toddler's life may also disrupt the toilet teaching process (toilet teaching may not be achieved near the time a sibling is born). When regression occurs, parents should ignore the regressive behavior and offer praise for age-appropriate behavior or attainment of skills -A major medical problem (cancer) can cause regression. Regression can be a reaction to an illness and /or hospitalization

s/s epiglottis

-Sudden, high fever -Previously healthy child suddenly very ill -Severe sore throat -Four Ds- Drooling, dysphagia, dysphonia, distressed inspiratory air movement (stridor) -Anxiety -Sitting forward w/ lower jaw thrust forward -Tachycardia, tachypnea Carefully assess the child with suspected epiglottitis. Note sudden onset of symptoms and high fever. The child has an overall toxic appearance. He or she may refuse to speak or may speak only with a very soft voice. The child may refuse to lie down and may assume the characteristic position: sitting forward with the neck extended. Drooling may be present. Note anxiety or a frightened appearance. Note the child's color. Cough is usually absent. A lateral neck radiograph may be performed to determine whether epiglottitis is present. This is done cautiously, so as not to induce airway obstruction with changes in position of the child's neck. Therapeutic management focuses on airway maintenance and support. Intravenous antibiotic therapy is necessary. The child will be managed in the intensive care unit. See Comparison Chart 40.2 for information comparing croup to epiglottitis.

Diagnostic test for Cystic Fibrosis

-Sweat chloride test: considered suspicious if the level of chloride in collected sweat is above 50 mEq/L and diagnostic if the level is above 60 mEq/L. -genetic test, which detects chromosomal mutations associated with the disease. Because of the severity of CF and the need for proactive treatment, newborns are routinely screened. -Pulse oximetry: oxygen saturation might be decreased, particularly during a pulmonary exacerbation. -Chest radiograph: may reveal hyperinflation, bronchial wall thickening, atelectasis, or infiltration. -PFTs: might reveal a decrease in forced vital capacity and forced expiratory volume, with increases in residual volume.

Stoma Care

-The healthy stoma is pink and moist, demonstrating proper circulation to the intestine -Preoperatively: -High cal high protein low fiber diet -May be on TPN -Bowel prep and or antibiotics, -hydration Postoperatively: -assess stoma for color, bleeding, breakdown of surrounding skin -Keep child NPO until bowel sounds return -Pain management -Fluid management (I&O's), nutrition issues -Monitor for entercolitis and anal stricture or incontenence -Return of normal bowel function depends on amount of bowel involved. -May have recurrent issues with constipation and fecal incontinence -Most children can have the colostomy closed after healing of the intestine. -Teach ostomy care and s/s dehydration -pouches usually need to be changed every 1 to 4 days. -Ensure that the ostomy pouch fits closely around the stoma to prevent irritation of the surrounding skin. -Immediately notify the provider if the stoma is not moist and pink or red. Performing Ostomy Care 1. Set up the equipment: • Warm, wet washcloths or paper towels • Clean pouch and clamp • Skin barrier powder, paste, and/or sealant • Pencil or pen • Scissors • Pattern to measure stoma size 2. Take off the pouch (may need to use adhesive remover or wet washcloth to ease pouch removal). 3. Observe the stoma and surrounding skin. Clean the stoma and skin as needed, allowing it to dry thoroughly. 4. Measure the stoma, mark the new pouch backing, and cut the new backing to size. 5. Apply the new pouch.

Side effects of corticosteroids

-These are the side effects of it getting into your system (oral/ IM) -bruising -osteoporosis -stunted growth -glaucoma and cataracts -pneumonia (corticosteroids do diminish the immune response, so it's possible they might increase the incidence of pneumonia.) -are many, including weight gain, osteoporosis, and mood changes (Calcium supplements and vitamin D are prescribed to prevent osteoporosis, and antidepressants may be helpful when depression occurs related to the chronicity of the disease and/or as an effect of corticosteroid use. Medications to decrease the workload of the heart, such as beta-blockers and ACE inhibitors may be prescribed.) -Inhaled corticosteroids (ICS) are considered a top-line treatment for asthma. Side effects are generally considered rare or negligible. Still, some asthmatics do report that they have experienced one or another side effect. Here's all you need to know about ICS side effects. -oral thrush -dysphonia (harsh voice) -cough or throat irritation -contact hypersensitivity (Allergic Contact Dermatitis.)

Erickson's Theory of Psychosocial Development -Stage 1

-Trust vs. Mistrust -birth to 1 year -The first stage of Erikson's theory of psychosocial development is the most fundamental stage in life. Because an infant is utterly dependent, the development of trust is based on the dependability and quality of the child's caregivers. If a child successfully develops trust, he or she will feel safe and secure in the world. Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in the children they care for. Failure to develop trust will result in fear and a belief that the world is inconsistent and unpredictable. -[NOTE: Neglected/abused babies develop Reactive Attachment Disorder and have a dif icult time trusting others throughout their life]

S/S of UTI

-UTI is the most common cause of fever of undetermined origin in infants -Burning on urination -Changes in voiding patterns -Foul-smelling urine -Vaginal or urethral discharge -Genital pain, irritation, or discomfort -Blood in the urine -Edema -Masses in the groin, scrotum, or abdomen -Flank or abdominal pain -Cramps -Nausea and/or vomiting -Poor growth -Weight gain -Fever -Infectious exposure (particularly Streptococcus A or Escherichia coli) -Trauma -UTI presents differently in infants than it does in children. Infants may exhibit fever, irritability, vomiting, failure to thrive, or jaundice. Children may also experience fever and vomiting, but also may have dysuria, frequency, hesitancy, urgency, and/or pain.

Prevention of Neural Tube defects

-When folic acid was introduced as a treatment to prevent neural tube defects, orofacial clefts also decreased. -Folic Acid Aids in decreasing Cleft Palates -You can find folic acid in vitamins, fortified foods like rice, pasta, and bread, and some breakfast cereals that are labeled "enriched." -TAKE A PRENATAL VITAMIN (400 mcg of folic acid every day)

You should advise a patient who is using a Beclomethasone inhaler to monitor for which of the following possible indications of an adverse effect of the drug? 1. Abdominal pain 2. White coating in the mouth 3. Muscle twitching 4. Palpitations

-White coating in the mouth -Steroids are anti-inflammatory meds that suppress the immune system and allow yeast to grow

Usually the cause of cardiac arrest is due to an.....

-airway or breathing problem -In pediatric patients ALWAYS prioritize Airway, Breathing, then circulation (ABCs)

Nursing Care for Cleft Palates

-for cleft palate babies, must keep head upright during feeding to prevent aspiration and are more prone to getting ear infections because pathogens enter the Eustachian tubes easier (pg 241). -Assess abdomen and bowel movements in lower GI. -PROTECT AIRWAY for upper GI problems during feeding or vomiting -when feeding a baby with a cleft palate, keep baby at a 45 degree angle -There are Specialty feeding devices used for infants with cleft lip and cleft palate. An infant uses a Haberman feeder.

What is Gastroenteritis and s/s

-is an intestinal infection marked by watery diarrhea, abdominal cramps, nausea or vomiting, and sometimes fever. -your stomach and intestines are irritated and inflamed. The cause is typically a viral or bacterial infection. -s/s= Diarrhea, cramps, nausea, vomiting, and low-grade fever are common symptoms. -With gastroenteritis, the main symptoms you probably have are watery diarrhea and vomiting. You might also have stomach pain, cramping, fever, nausea, and a headache. -Because of diarrhea and vomiting, you also can become dehydrated. Watch for signs of dehydration, such as dry skin and a dry mouth, feeling lightheaded, and being really thirsty.

Hypospadius meatus

-located on ventral side of penis/ scrotum/perineum -Hypospadias-meatus underside of shaft (associated with congenital chordee which is fibrous line of tissue that results in ventral curvature of the shaft, and undescended testicles) Epispadius-meatus on upper side of shaft (associated with extrophy) Treatment is surgical repair Congenital genitourinary defect

15-year-old Stephen has an upper respiratory infection for which he is to be given Keflex 1.5 grams in 50 ml of a 5% Dextrose solution. According to the pharmacy, this preparation should be administered in 30 minutes. You would set your IV pump at __________mL/hour. 120mL/hr 110mL/hr 100mL/hr 115mL/hr

100mL/hr

Problems that can occur when lowering blood sugar too fast in DKA

-monitor the glucose level hourly to prevent it from falling more than 100 mg/dL/hr. A too-rapid decline in blood glucose predisposes the child to CEREBRAL EDEMA. -Fluid therapy is given to treat dehydration, correct electrolyte imbalances (sodium and potassium due to osmotic diuresis), and improve peripheral perfusion. -Administration of regular insulin, given intravenously, is preferred during DKA (only regular insulin may be given intravenously [IV]). -Any child exhibiting signs and symptoms of hyperglycemia requires insulin. The dosage is usually based on a sliding scale or determined after consultation with the physician or nurse practitioner.

treatment of hypospadias

-surgical correction -should not undergo circumcision until after surgical repair of the urethral meatus. -Extrophy-life threatening; repaired as soon as possible; prevent infection. Bladder Exstrophy: Bladder is open on the Abdominal wall -Cryptochidism -Obstructive Uropathy

Interventions that you should NOT do for a child with Epiglottis (Pic also has s/s pnemonic)

-you shouldn't use a tongue blade or take a throat swab for a culture -Do not under any circumstance attempt to visualize the throat: reflex laryngospasm may occur, precipitating immediate airway occlusion. -DO NOT SUCTION

Nursing management of child with renal dysfunction

-¨ Maintain on a LOW-PROTEIN diet - large protein molecules are hard on the kidney -When receiving dialysis, meds should be given AFTER dialysis or hours before so that the meds are not flushed out of the system. Meds should be taken with minimal fluid since the client is on fluid restrictions. If urine output drops, do not give meds and notify the physician nursing considerations common to all systemic kidney problems · Monitor I/O (input and output) · Electrolytes · CBC · Urinalysis · Acid/Base balance · BUN & creatinine · EKG (same as ECG) for heart problems caused by electrolyte, acid/base, or fluid imbalances. COMPLICATIONS common to all systemic kidney problems -Anemia (Erythropoietin is normally excreted from the kidney to stimulate the bone marrow to produce RBCs. When the kidney is damaged - no EPO is excreted). - Abnormal urine output = too high or too low - Full-body edema (due to back-up of fluids and loss of proteins in the urine). - Abnormal electrolytes - Hypertension (due to high vascular fluid volume) -Monitor fluid and electrolyte balance.. -Reducing metabolic rate. ... -Promoting pulmonary function. ... -Preventing infection. ... -Providing skin care. ... -Provide safety measures. Nursing goal of treating patients with acute renal failure is to correct or eliminate any reversible causes of kidney failure. Provide support by taking accurate measurements of intake and output, including all body fluids, monitor vital signs and maintain proper electrolyte balance. ◦Avoid nephrotoxic drugs, teach dietary management & symptoms of progressive failure -.....in order to be reclassified from acute to chronic renal failure about 50% of renal function remains and has lasted for several months.

A 13-year-old child recovering from an appendectomy surgery is ordered to have Ketorolac (Toradol) 18 mg every 6 hours IV. Ketorolac is available in a 30mg/mL vial. What volume will you administer in the next dose? 3 ml 0.6 ml 0.3 ml 6 ml

0.6 ml

You are to give your 55-pound pediatric patient with Kawasaki's disease an infusion of IVIG. The order reads: "10g gamma globulin IV by infusion pump set at 25 mL per hour." The pharmacy supplies you with 10g gamma globulin in 300 mL of normal saline. How many hours will it take for the medication to be infused? 8 10 12 4

12

The mother of a 3-year-old child and the nurse observe the child playing with a set of building blocks beside another child playing with blocks. The mother says, "I worry that my child is not interacting with the other child." Which response by the nurse is MOST appropriate? 1."Children this age enjoy being with each other during play time, even though they may not communicate with each other." 2."If we give the children a puzzle, they will talk as they work on the puzzle together." 3."The attention span of children this age is short. We need to give them different toys frequently." 4."If you start talking with the other child, your child will imitate you and join in the conversation."

1."Children this age enjoy being with each other during play time, even though they may not communicate with each other."

The nurse receives report on the client care area. Which client should the nurse see FIRST? -An 18-month-old boy with bronchiolitis caused by Respiratory syncytial virus (RSV) who requires oral suctioning every two to three hours. -A 16-year-old boy in balanced suspension traction for a left fractured femur appears pale. The client reports severe muscle spasms in the left leg. -A 4-month-old infant with a sweat chloride test result of 30 mEq/L and an axillary temperature of 99.0 F. -A 13-year-old boy with a tracheostomy is turning restlessly in bed. Vital signs are blood pressure 110/64, pulse 114, and respirations 28.

A 13-year-old boy with a tracheostomy is turning restlessly in bed. Vital signs are blood pressure 110/64, pulse 114, and respirations 28.

The nurse in the renal/urology unit is reviewing patient assignments for the day. Which of these patients should be evaluated by the nurse first? -9 year old who requires pre-op teaching -Child with nephroblastoma who requires an antibiotic by iv infusion -14 year old girl w/dysuria, frequency and retention of urine -A 6 month old baby with tachycardia, sunken eyes, and orthostatic blood pressure

A 6 month old baby with tachycardia, sunken eyes, and orthostatic blood pressure

What causes diabetes insipidus?

ADH deficiency Central DI results from a deficiency in the secretion of ADH. This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. ADH is involved in concentrating the urine from the kidneys by stimulating reabsorption of water in the renal collecting tubules through increased membrane permeability. This conserves water and maintains normal osmolality. With a deficiency in ADH, the kidney loses massive amounts of water and retains sodium in the serum. DI can be classified into two types—nephrogenic DI and central DI. Nephrogenic DI can be transmitted genetically (e.g., sex-linked, autosomal dominant, or autosomal recessive forms) or be acquired due to chronic renal disease, hypercalcemia, hypokalemia, or use of certain drugs such as lithium, amphotericin, methicillin, and rifampin (Breault & Majzoub, 2016a). This variant of DI is not associated with the pituitary gland and is related to decreased renal sensitivity to antidiuretic hormone (ADH). Central DI is a disorder of the posterior pituitary gland and is the most common form of DI (Children's Hospital of Boston, 2019). Therefore, central DI will be the focus of the remainder of this discussion. Central DI is characterized by excessive thirst (polydipsia) and excessive urination (polyuria) that is not affected by decreasing fluid intake. Typically, this disorder occurs in children as a result of complications from head trauma or after cranial surgery to remove hypothalamic-pituitary tumors such as craniopharyngioma. Some cases can be hereditary; however, 10% of central DI cases in children are idiopathic (Breault & Majzoub, 2016a). Other causes include genetic mutations, granulomatous disease, infections such as meningitis or encephalitis, vascular anomalies, congenital malformations, infiltrative disease such as leukemia, or administration of certain drugs that are associated with inhibition of vasopressin release, such as phenytoin (Breault & Majzoub, 2016a). DI is usually permanent and requires treatment throughout life.

TET spells

Babies who have tetralogy of Fallot will suddenly develop deep blue skin, nails and lips after crying or feeding, or when agitated. These episodes are called tet spells and are caused by a rapid drop in the amount of oxygen in the blood. Tet spells are most common in young infants, around 2 to 4 months old. Nursing intervention: Bend the babies knees up to their chest to increase blood flow to the lungs and reduce workload on the heart. Toddlers or older children might instinctively squat (referred to as "Tet Squat") when they're short of breath because squatting increases blood flow to the lungs and limiting cardiac workload by decreasing blood flow to the lower extremities.

What are some signs and symptoms of Cystic Fibrosis: (select all that apply) Clubbing of fingers and toes Barrel-shaped chest Hard, packed stools A history of meconium ileus at birth

Clubbing of fingers and toes Barrel-shaped chest A history of meconium ileus at birth

In which of the following CHDs would the nurse need to monitor for a difference in the blood pressure/arterial pulses in the upper part of the body as compared to blood pressure and pulses in the lower part of the child's body? Coarctation of the aorta Tetralogy of Fallot Transposition of the great arteries Truncus arteriosus

Coarctation of the aorta

Pre-adolescents are entering the stage of cognitive development in which they are able to see the perspective of others. This stage is called: A. Formal operational thought B. Pre-Operational stage C. Sensorimotor stage D. Concrete operational thought

Concrete operational thought To answer this question, it is important to understand that this question has a two-part topic: 1. Pre Op care (Nursing Goal: "Actively engage the patient in their learning and care.") 2. Developmental ability of a 5 year old

A child with aortic stenosis is scheduled for a procedure in the Cardiac Cath lab at your hospital. Since you will be doing the post procedure assessment for this patient, you will monitor the patient for all these complications EXCEPT: Hematoma at the insertion site in the groin Elevated blood pressure Diminished dorsal and pedal pulses A cool extremity with skin that blanches

Elevated blood pressure

· Environmental triggers of Asthma

Environmental Factors: Pets -No such thing as non-allergic dog or cat -No-pet rule or have pets outdoors only -Pet dander is STICKY Dust and Pollen -Recommend vacuuming and dusting often -Clean bedding often (wash pillows too) -Clean the blinds or don't have them Chemicals -Could include hair spray, perfumes, essential oils, strong odors, cleaning products -SECOND-HAND SMOKING ! ! ! Extremely inflammatory to lungs 1.Allergens (pets, mold, pollen) 2.Irritants (Cleaning supplies, smoke) 3.Drug-induced (ASA, NSAIDs) 4.Weather Mold, Pet dander, dust mites, colds, strong smells, pollen, cockroaches, weather, smoke, exercise

· Why is it important to monitor fluid balance closely in children with cardiac dysfunction?

Fluid Status - at higher risk for either FLUID OVERLOAD or Dehydration (which can be fatal for a CHD patient) · Fluid Overload à lung congestion, cerebral edema, HTN, cardiomyopathy (enlarged heart can't pump). · Dehydration à Low B/P, tachycardia (too much for damaged heart), and decreased organ perfusion. Dehydration causes hemoconcentration that can lead to strokes/aneurysms/blood clots.

The nurse plans preoperative care for a 5-year-old scheduled for a tonsillectomy. Which is the MOST important action for the nurse to take? 1.Gather a blood pressure cuff, stethoscope, pulse oximetry monitor, and ice pack for a play session with the child. 2.Show the child a short video about a tonsillectomy, which gives simple directions using cartoon characters. 3. Discourage the parents from allowing the child to tour the perioperative areas. 4. Ask the child's parents to read a story about a child preparing for surgery.

Gather a blood pressure cuff, stethoscope, pulse oximetry monitor, and ice pack for a play session with the child.

Doctor's order for the patient's morning dose: Humulin NPH 15 units and Humulin Regular 5 units SC. The a.m. blood sugar is 230. Based on the sliding scale below, what will the nurse do? Use this SLIDING SCALE for Regular Insulin to answer the problem If Blood Sugar is: Then give: 0 - 180 0 units 180 - 200 2 units 200 - 220 4 units 220 - 240 6 units >240 call physician -Do not give the insulin. Call the physician -Give 26 total units of combined NPH and regular insulin -Give 26 units of regular insulin only -Administer 21 units of combined NPH and regular insulin

Give 26 total units of combined NPH and regular insulin

Respiratory Drugs Bronchodilators, anticholiergics, anti-inflammatories, etc

Goal of DRUG Treatments for Respiratory Disorders STEP #1: Open the airways ("tunnel") with a bronchodilator STEP #2: Keep the airways open with an anticholinergic STEP #3: Clean out the airways with anti-inflammatories Beta2-adrenergic agonists (Albuterol - epinephrine) -OPEN THE TUNNEL -Fight or Flight action - Bronchodilator opens airway in 5 to 15 minutes - RESCUE INHALER. Must use this inhaler BEFORE using any additional inhalant treatment. -Albuterol will dilate the airways and increase the surface area in the lungs so other medication can attach and take effect. Side Effects: o Hypertension and tachycardia o Palpitations, anxiety, tremors o SERIOUS: bronchospasm, angioedema o Overuse of inhaler can cause rebound bronchoconstriction! Precautions (Can you guess why?) -Hypertension/Angina/Cardiovascular disease -Diabetes mellitus (B3 receptors in liver stimulate release of glycogen 🡪 hyperglycemia) - Hyperthyroidism (Makes everything speed up too fast) Inhaled anticholinergics (Ipratropium) -Keep the tunnel open ● Blocks cholinergic constriction of airways - "keeps lungs open" ● Side Effects: "Can't see, can't spit, can't pee, can't sh__t" ● NOT an emergency drug because it has a slower onset, but it lasts longer than albuterol. ● Must use AFTER using a rescue inhaler (albuterol). ● Can be used with or without a B2 Agonist - Additive effect with B2 Agonists - OR -Alternative for patients who cannot use B2 Agonists Glucocorticoids CLEAN out the Tunnel (Anti-inflammatory steroids like prednisone, fluticasone, and beclomethasone) can be given by INHALER, Oral (Pills/syrup), Parenteral (IV, IM), and Topical (creams and drops,etc.). ● Blocks chemical mediators (leukotrienes, prostaglandins, histamines) which then prevents edema in the airways. ● To be effective, steroids must be taken every day to build up in the tissue. o Steroids are NOT a PRN medication o Steroids are NOT an emergency drug ✴ All steroid medications must be slowly tapered off, never suddenly stopped to prevent withdrawal s/s. o Steroids signal the adrenal cortex to slow down production of corticosteroids. o Stopping the drug suddenly causes adrenal insufficiency. o Tapering off the drug slowly gives the adrenal glands time to ramp up their production of corticosteroids again. ● Patient teaching - DO NOT USE NSAIDS for pain (i.e., ibuprofen, aspirin) o Instead use acetaminophen (Tylenol). o NSAIDS will increase the effects of steroids o NSAIDS with steroids 🡪 more prone to bleeding and stomach upset/ulcers Mast Cell stabilizers (cromolyn) ● Suppress inflammation by blocking release of chemical mediators from mast cells ● Must use inhaled medication on a regular basis (everyday) to tissue load over time for effectiveness - NOT an emergency drug ● Bad "after-taste" makes compliance a problem in kids (give water/hard candy after using inhaler) ● Side Effects: o Headaches o Dry throat, cough and wheezing o Serious: Bronchospasm and anaphylaxis Leukotriene modifiers (montelukast - Singulair) ● Oral med - long term treatment for chronic asthma and allergic rhinitis ("hay fever") ● Suppresses inflammation caused by chemical mediator leukotriene ● Used in combination with inhaled medications above ● Side effects: o Headache, gastritis, pharyngitis, rhinitis, dizziness, N/V/D. o Serious: hepatic failure, vasculitis. ● Patient teaching: o Take daily to build up in the body. o Report abdominal pain, jaundice, dark urine (all s/s of liver damage) Mucolytics (Acetylcysteine "mucomyst" and Dornase alfa for C.F.) ● Inhaled in cystic fibrosis to break down thick lung secretions ● Given orally for acetaminophen [Tylenol] overdose ● Monitor airway: the drug thins the viscosity of mucous which creates copious secretions which could lead to aspiration. Have SUCTION EQUIPMENT available to manage heavy secretions. ● Monitor breathing: listen for adventitious breath sounds that indicate secretions are still trapped in the lungs ● May also need a bronchodilator

A mother of a 2 year old female with a previous history of prematurity birth at 26 weeks and a bilateral brain bleed, brings child in to Pediatrician with complaints that child is not growing. The Physician is concerned for what? Hypothyroidism Diabetes Growth Hormone Deficiency PKU

Growth Hormone Deficiency

Epiglottitis is most often caused by

Haemophilus influenza type b (Hib) bacteria

The nurse assesses the vital signs of a 3-year-old toddler with an upper respiratory infection and notes the following results. Which of these findings most concerns the nurse: A.Heart rate 127 beats per minute. B.Blood pressure 92/55mm Hg C.Respirations 20 per minute D.Temperature 100.1 F

Heart rate 127 beats per minute.

A nurse is providing discharge teaching for a child who has cystic fibrosis. Which of the following instructions should the nurse include? (Select all that apply) Monitor blood sugar Implement fluid restrictions during times of infection. Administer pancreatic enzymes at bedtime for more effective intestinal absorption. Provide a high-calorie, high-protein diet. Supplement with fat-soluble vitamins

Monitor blood sugar Provide a high-calorie, high-protein diet. Supplement with fat-soluble vitamins

Piaget's Cognitive developmental theories -Picture that has typical age range, description of stage, and developmental phenomena -object permanence -egocentrism -Conservation

Object Permanence: If not seen then it doesn't exist. Egocentrism: Can not see things from another person's perspective Conservation: children can now tell if two different containers have the same amount of fluid even though the containers are shaped differently

A pediatric patient has undergone surgery and has just been extubated. When the anesthesia wears off, what nursing action would promote comfort and facilitate breathing for this patient? A) Placing the patient in the lateral position B) Placing the patient in the prone position C) Placing the patient in Fowler's position D) Placing the patient in the supine position

Placing the patient in Fowler's position

You are reviewing records of patients who will be seen in the pediatric clinic today. You note that one patient on the schedule has Nephrotic Syndrome signs/symptoms, so when you do your nursing assessment you will expect to find all the following EXCEPT: Polyuria Pitting edema High Proteinuria Elevated blood pressure

Polyuria

Janey is a 5-year-old who is brought into the emergency department with suspected epiglottitis. The priority intervention for this child is to: Take vital signs Secure the child's airway Visualize the child's throat with a tongue depressor Obtain throat cultures

Secure the child's airway

Baby Agatha has been admitted to your unit for treatment of diarrhea due to infection with rotavirus. You know from your physical assessment and her lab results that she is dehydrated based on all of the following EXCEPT: Specific Gravity of 1.020 Hematocrit 55% Depressed Fontanel BUN 35

Specific Gravity of 1.020

A child is being evaluated for S/S that include swollen lymph nodes, joint pain, mid-body skin rash, and "strawberry" tongue. Treatment for this acquired heart and blood vessel condition includes all the following interventions, EXCEPT: -There is no effective treatment for this autoimmune condition -Aspirin therapy, given in high doses -Giving steroid medication may improve the child's outcome -Gamma globulin given by IV infusion (IVIG)

There is no effective treatment for this autoimmune condition

Type 1 diabetics typically have the following clinical characteristics: Overweight, young with no ketones present in the urine Thin, older adult with glycosuria Overweight, adult-aged with ketones present in the urine Thin, young with ketones present in the urine

Thin, young with ketones present in the urine

This child can use a cup, draw a circle, and take a few steps on tiptoe. -School Age (6-12 yrs) -Preschool (3-6 yrs) -Toddler (1-3 yrs) -Adolescence (12-20 yrs) -Infant (2 days-1 year)

Toddler (1-3 yrs)

Untreated UTI can lead to... s/s of this are-

acute pyelonephritis which can result in kidney scarring and damage. Early diagnosis and antimicrobial therapy will prevent or minimize permanent renal damage... -s/s of pyelonephritis are fever 38.3 (101) chills, back pain, appears ill.

Cause of Glomerulonephritis

group A β-hemolytic streptococcus. is a condition in which immune processes injure the glomeruli. Immune mechanisms cause inflammation, which results in altered glomerular structure and function in both kidneys. It often occurs following an infection, usually an upper respiratory or skin infection. APSGN is caused by an antibody-antigen reaction secondary to an infection with a nephritogenic strain of group A β-hemolytic streptococcus.

s/s hypoglycemia

hypoglycemia is the most dangerous!! COLD AND CLAMMY= NEED SOME CANDY -S/S: CNS changes à due to brain using glucose as its only source of energy. - S/S usually manifest when blood sugar level at or below 60 mg/dL. - Irritable, mental confusion, shaky/trembling, diaphoretic à ultimately leads to a coma when blood sugar reaches 40 - 50 mg/dL. - Treat w/oral glucose source if conscious or injectable/IV glucose/glucagon if unconscious (see "Hypoglycemia Treatment Protocol" in outline below. Glucose is the major source of energy for organ function. Typical characteristics: • Poor feedings • Jitteriness • Lethargy • High-pitched or weak cry • Apnea • Cyanosis and seizures Some newborns are asymptomatic. Low blood glucose levels are problematic during early post birth period due to abrupt cessation of high-glucose maternal blood supply and the continuation of insulin production by the newborn. Limited ability to release glucagon and catecholamines, which normally stimulate glucagon breakdown and glucose release Prolonged and untreated hypoglycemia leads to serious, long-term adverse neurologic sequelae such as learning disabilities and mental retardation. <40 mg/dL -If blood sugar levels become too low, signs and symptoms can include: An irregular or fast heartbeat Fatigue Pale skin Shakiness Anxiety Sweating Hunger Irritability Tingling or numbness of the lips, tongue or cheek -As hypoglycemia worsens, signs and symptoms can include: Confusion, abnormal behavior or both, such as the inability to complete routine tasks Visual disturbances, such as blurred vision Seizures Loss of consciousness

When receiving dialysis, meds should.....

meds should given after dialysis or hours before so that they are not flushed out of the system, they should be taken with minimal fluid since the client is on fluid restrictions. Big note.....if urine output drops the meds should be held and DOC notified.

Prevention of UTI

the goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Initially, most cases of VUR are managed medically. Teach the child to empty the bladder completely. Teach the child and parents appropriate perineal hygiene as well as toileting hygiene to prevent recurrence of UTI. Teach parents about the antibiotic therapy prescribed; the child will be maintained on a low daily dose to prevent UTI. The drug is most effective when given at bedtime because of urinary stasis overnight. Inform parents of the schedule for serial urine cultures and follow-up VCUG. Adequate fluid intake is necessary to flush the bacteria from the bladder. Goals for nursing management include eradicating infection, promoting comfort, and preventing recurrence of infection. Preventing Urinary Tract Infection in Females -Drink enough fluid (to keep urine flushed through bladder). • Drink cranberry juice to acidify the urine. • Avoid colas and caffeine, which irritate the bladder. • Urinate frequently and do not "hold" urine (to discourage urinary stasis). • Avoid bubble baths (they contribute to vulvar and perineal irritation). • Wipe from front to back after voiding (to avoid contaminating the urethra with rectal material). • Wear cotton underwear (to decrease the incidence of perineal irritation). • Avoid wearing tight jeans or pants. • Wash the perineal area daily with soap and water. • While menstruating, change sanitary pads frequently to discourage bacterial growth. • Void immediately after sexual intercourse.

What is the main cause of bronchiolitis?

•Almost always caused by RSV (Respiratory Syncytial Virus) •Acute inflammatory process of the bronchioles and small bronchi •Supportive Care is Key!

s/s of coarction of the heart

● Elevated blood pressure in the arms ● Bounding pulses in the upper extremities ● Decreased blood pressure in the lower extremities ● Cool skin of lower extremities ● Weak or absent femoral pulses ● Heart failure in infants ● Dizziness, headaches, fainting, or nosebleeds in older children The aorta is narrowed or constricted so blood flow to the lower part of the body is obstructed which increases blood pressure in upper extremities (the blood supply to the arms exits the aorta ABOVE the constriction). Blood pressure is lower in legs (because blood flow is restricted BELOW). Usually there are no symptoms at birth, but they can develop as early as the first week after birth. If severe symptoms of high blood pressure and congestive heart failure develop, surgery may be considered.