theory 4- acid base, RSV, children development, autism
Tools for kids with ASD
-empathy -emotional neutrality (neutral affect, neutral tone, stay calm, presume cog ability when communicating)
interprofessional collab for Down syndrome
-school support (individualized ed plan) -socialization support(social skills training) -activity -increased risk for abuse -support to parents -routine health visit -development support
S/Sx of RSV Bronchiolitis
-tachypnea -sore throat -Fever -Increase work of breathing -wheezing or crackles -intercostal or subcostal retraction w or w/o nasal flaring -cyanosis -dry cough -runny nose
Piaget's stages of cognitive development -Sensorimotor
0-2 year- explore thru sensory and motor contact; object permanence; seperation anxiety
Piaget's stages of cognitive development -Preoperational
2-6year old - use word and image to represent objects but does not reason logically; pretends- child is egocentric
Piaget's stages of cognitive development -Concrete operational
7-12 year- think logically about concrete objects; understand convo
Pediatric Assessment Triangle (PAT)
Appearance, work of breathing and circulation to the skin.
Care of Rsv at home and hospital
At home: fluids, suction, rest, USE DROP OF SALINE AND BULB SYRINGE TO SUCTION NOSE(AIRWAY OVER MEDS) Hospital: O2 therapy, nasal suction, respiratory scoring, hydration via po, ng, iv , elevate chest and head(positioning)
The nurse is caring for a client with a new tracheostomy. What nursing intervention will be used to provide safe tracheostomy care? Select all that apply. Avoid aerosol sprays in the client's room. Suction the airway every two hours. Secure the trach tube with trach holder. Keep replacement trach kit at the bedside. Maintain airborne precautions for twenty-four hours post insertion.
Avoid aerosol sprays in the client's room. Secure the trach tube with trach holder. Keep replacement trach kit at the bedside.
Respiratory difference in adult and children
Diameter in adult is like a cork whereas children is like straw Length in adult is longer of trachea Respiratory illness are more severe in children. Children are nose breather so secretions in trachea can occlude it. Adults can rest hydrate cough blow nose or use humidifier. Children breathe with irregular rhythm and abdominal and diaphragmatically Larynx more susceptible to a spasm
Prevention for rsv
Hand washing! Spread via direct and non direct conctact
Erickson's Theory of Psychosocial Development
Infancy-trust vs mistrust Early childhood-autonomy vs shame and doubt Preschool-initiative vs guilt School age-industry vs inferiority Adolescent-identity vs role confusion Young adult-intimacy vs isolation Middle adulthood-generatively vs stagnation Mature- ego integrity vs despair
Diagnostics for rsv
Nasal swab Sputum culture-sterile container, rinse mouth w water Thoracentesis- extraction of fluid, cells from pleural space using percutaneous needle Bronchoscopy- Thorascopy- camera via incision in chest
Patho of RSV Bronchiolitis
Upper respiratory infection in adults Kids- lower respiratory infection w small airway obstruction Spread thru mucus membranes and Abel to survive in fomites(kid with RSV coughs on table RSV able to live on table and if I touch it after it will come to me)
Milestones of infancy
birth- moro, tonic neck, root. palmar grasp, babinski, sucking 2month- smile spontaneously, follow face and object to midline, vocalize, life head 4months- smile responsively, grasp rattle, laugh and squeal, lift head an chest 45 to 90 6months- reach for toy, seek sounds, rolls over both direction, no head lag, 2X weight 9month- feed self finger food, imitate sound, sits w/o support, stand holding on, stranger anxiety 12month- 3x weight, stand alone, walk w/ help, feed self, babbling, vision 20/40
Cause of autism
etiology unknown, but may be genetic, brain abnormalities, altered chemistry, a virus, or toxic chemicals.
potential physical features of autism
most essential areas of variation in features include a broader top face, shorter middle face, wider eyes and mouth, and a shorter vertical groove between the bottom of the nose and the top of the upper lip(philtrum)
risk factor for down syndrom
unknown but mostly advance maternal age
A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse teaches the client how to do deep-breathing exercises after surgery. What should the nurse tell the client to do? "Sit in an upright position, and take a deep breath." "Hold your abdomen firmly with a pillow, and take several deep breaths." "Tighten your stomach muscles as you inhale, and breathe normally." "Raise your shoulders to expand your chest."
"Hold your abdomen firmly with a pillow, and take several deep breaths."
patho of down syndrome (trisomy 21)
-23 pairs of chromosomes in a normal person but person with down syndrome is born with extra chromosome #21 -3 type of genetic arrangement that can lead to Down syndrome -not usually inherited
possible plan of care needs for ASD
-Communication differences?-Developmental differences? -Past experiences with the hospital or clinic setting? -Sensitivities? (environmental, sensory, etc.) -Do they like touch or are they averse to touch? -Tolerances? (new people, transitions, etc.) -Triggers? (what are triggers
social communication sx of autism
-Doesn't initiate or initiates inappropriately (e.g., hugs, rather than saying "hi") -Leaves early; can't maintain engagement -Difficulty taking others' perspectives, reading others, and reading social situations -Difficulty with "back-and-forth" (like in conversations) -Poor eye contact, use of gestures, use of facial expressions -Poor body proxemics (body turned away; stands very close)
issues with asd
-Eating challenges: -GI issues - Sleep issues -Executive functioning challenges -Poor organizational skills -Limited attention spa -Poor planning/thinking ahead skills -Poor impulse control Play skills deficits (imaginary) -Poor safety awareness
medications for ASD
-HIGH RISK FOR POLYPHARMACY -SSRIs for depression, anxiety, panic attacks, aggression, tantrums e.g., fluoxetine (Prozac),sertraline (Zoloft) -Tricyclics for depression, anxiety, obsessive compulsive disorder (OCD) e.g., amitriptyline(Elavil) -Psychoactive drugs: May reduce aggression, stereotyped behaviors in adolescents e.g.,risperidone (Risperdal), aripiprazole (Abilify). These are the only FDA-approved drugs, buteffectiveness is not conclusive -Anticonvulsants: Approx. 1 in 3 people with ASD will have a history of seizures from mild tosevere. Also, may used for mood stabilization e.g., divalproex (Depakote) - Stimulants: For adjunct ADHD and hyperactive behaviors. Improves attention and focus
long term issues with ASD
-Higher rates of chronic medical illnesses; epilepsy, GI disorders, feeding/nutritional problems, metabolic syndrome, anxiety, depression, sleep issues, & exposure to abuse -greater social and economic exclusion
physical features of down syndrome
-flat facial features (bridge of nose espeically) -short neck -upward slanting of almond shaped eye -small ears -tongue stick out of mouth -white spots on iris of eye - small hands and feet -single line across palm -small pinky finger with curve toward -poor muscle tone -short height -decreased weight
How does the autism brain think?
-in black and white -in the moment -nonjudgemental -visual -attention to detail -great memory -critical thinking -deep knowledge
risk factor in people with down syndrome
-intellectual disability(mild to severe) -infertility -menarche -early menopause -congenital cardiac defects -celiac disease, excessive weight gain, hypothyroidism -ear infection -cataract, refractive error -sleep apnea -leukemia, hematology, transient myeloproliferative disorder -Alzheimer DS can lead to gas exchange or airway obstruction issues
interventions with autism
-limit choice -Use visuals to illustrate choices -Set the boundary and stick to it -Attempt to distract (replace child's desire with something else) - Use "first, then" visual to illustrate the reward for being flexible - Reward and praise flexibility -Utilize parents/caregivers They ARE your best resource! -preplanned visits
Presentation of autism
-often not distinguishable -hard to diagnose in kids under 2 -diagnosed by behavior and testing
Risk factor for rsv
-premature baby -young infants -congenital heart defect -respiratory or neuromuscular disorder
Piaget's stages of cognitive development -formal operational
12year- adult- reason abstractly and think hypothetical terms as well
Toddler and Preschool milestones
15-18 months-begins to imitate , feeds self, build tower,3-10 words, walks, fussy eating 2 years- remove one clothing, use fork or spoon, hold pencil and scribble, point to picture, two word sentence, run, walk up step, kick ball 3 years- brush teeth with help, put on clothing, build tower, point to and name picture, throw ball overhand, jump, kick a ball 4-5 years- put on T-shirt, wash and dry hands, name friend, imitate vertical line, wiggle thumb, knowns two adjectives, identify color, jump, balance on 1 foot
The nurse is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, thereby reducing swelling and facilitating passage of the stone? Morphine sulfate Aspirin Ketoralac (Toradol) Meperidine (Demerol)
Ketoralac (Toradol) Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac (Toradol) are effective in treating renal stone pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone.
A client is brought to the emergency department for an overdose of aspirin. The nurse caring for this client should anticipate which clinical manifestations? Select all that apply. Respiratory rate of 40 BP 100/72 mmHg ABG report: pH 7.50, PCO2 31 mmHg (4.12 kPa), HCO3 level 19 mmol/L Urine output ~100 mL/hr. Bilateral crackles (fluid) in the lungs
Respiratory rate of 40 ABG report: pH 7.50, PCO2 31 mmHg (4.12 kPa), HCO3 level 19 mmol/L The salicylates cross the blood-brain barrier and directly stimulate the respiratory center, causing hyperventilation and respiratory alkalosis. The blood pressure is a normal range and the urine output is normal or excessive depending on fluid intake. Bilateral crackles (fluid) in the lungs are usually a sign of heart failure.
Meds for RSV/bronchiolitis
Vaccine- palivizumab: antiviral that prevents rsv
