EXAM 4 CONTENT

Hydrocephalus

* Imbalance in the production and absorption of CSF in the ventricular system u Produces excess of CSF in ventricles u Causes passive dilation of the ventricles u Causes head enlargement w/ fontanelles open u Communicating- CSF ventricles to subarachnoid space u Obstructive passage blocked u Congenital or acquired u Shunt procedure- drains into peritoneal cavity. Largest concern is infection/blockage w shunt. Early signs of increased ICP- go to dr. u As they grow they have to change the shunt. Hydrocephalus Assessment u Prominent scalp veins (all the fluid) u Forehead "bossing" u Enlarged fontanelles u "Sunset" eyes u Shrill cry u Hyperactive reflexes u Separated suture line u Increased OFC u Lethargy/irritability u VS changes

things to know

*** Rashes know different phases: incubation phase, etc. Infection: portal of entry, exit, all ***Know fever management + teach Exanthems: rash Mumps are not an exanthem Knowing bacterial, viral, etc. CDC guidelines for vaccines: when they should be getting them ABC's + neurological Know differences between shocks - hypovolemic is most common in kids Know 6 cardiac congenital defects MMR + varicella don't give pregnant women Digoxin, HR greater than 60+ toxicity NPH- intermittent Lispro- rapid

Hand, Foot, and Mouth Disease, or Herpangina (if only mouth involvement)

*****Blisters

Leukemia: Pathophysiology

1/3 of childhood cancers Leukemia = group of malignant diseases of the bone marrow and lymphatic system *cancer of the blood-forming tissues Unrestricted proliferation of immature WBCs in the blood-forming tissues u Most common childhood cancer u Not a tumor- demonstrate the same neoplastic properties as solid cancer • Fever, pallor • Excessive bruising • Bone or joint pain • Lymphadenopathy • Hepatosplenomegaly • Abnormal WBC counts Radiation: localized Leukemia Age- 2-5 u Consequences of Leukemia } Anemia from decreased RBCs } Infection from neutropenia } Bleeding tendencies from decreased platelet production } Spleen, liver, and lymph glands show marked infiltration, enlargement, and fibrosis

Atrial septal defect

3 years to close on its own, usually asymptomatic, usually only seen on echocardiogram

Burns

3rd leading cause of accidental death in children Young children have thinner skin, deeper burns Nursing Management Comfort management Care of the wound Nutrition to promote wound healing Prevention of complications-secondary infection Psychosocial support of child and family Prevention- turn water heater to 120 degrees (2 seconds = 3rd degree burn at 150 degrees)

Practice ?'s

A child in the early stages of impaired gas exchange will often have which of the following nursing diagnoses? Anxiety related to hypoxia Fatigue related to air trapping Injury related to fatigue and dehydration Delayed Development related to hypoxia A 12-year-old is being treated for acute respiratory distress syndrome (ARDS). Which assessment finding would be indicative of the nursing diagnosis: Impaired Gas Exchange? Oxygen saturation of 62% Heart rate of 100 bpm Respiratory rate of 30 breaths/minute Bicarbonate level of 38 The nurse is mentoring a new graduate who is completing a respiratory assessment on a client with suspected epiglottitis. Which action by the new graduate would require clarification? Humidified air Continuous pulse oximetry Parenteral antibiotic administration Assessment of the nasopharynx

Tonsillectomy

AIRWAY: SIDE LYING after procedure UNTIL FULLY AWAKE Once they are alert, sit them up Maintaining fluid volume + relieve pain. Be able to tolerate PO fluids before they go home. • Monitor bleeding • Post-op hemorrhage is rare but can occur • Signs of hemorrhage? • Provide comfort • Ice • Cool fluids • Pain meds • Prevent dehydration Just suction cheek if suctioning. AVOID straws for a few days after. AVOID coughing, blowing their nose first few days. DO NOT GIVE RED POPSICLES!!!!!!! NO RED ANYTHING.

Congenital Heart Disease Acyanotic

Acyanotic Lesions § Acyanotic § Left-to-right shunting lesions § Patent ductus arteriosus § Atrial septal defect § Ventricular septal defect § Atrioventricular (AV) septal defect § Obstructive or stenotic lesions § mostly- large lesions may present as acyanotic § Pulmonary stenosis § Aortic stenosis § Coarctation of the aorta

Cushing's Syndrome: excess of glucocorticoids

Addison's: decrease in glucocorticoids-> give steroids. Wasting away Adrenal crisis/insufficiency: stop med abruptly and is medical emergency. Taper meds slowly.

Spina Bifida Cystica Nursing Management

After Delivery u Family support & education u Preserving the "sac" until repaired~keep moist u Positioning on stomach u Preventing infection u Assessing movement of lower extremities u Assessing anal wink After Surgical Repair and Throughout Childhood u Latex Precautions, assess for latex allergy u Assessment of bowel/bladder function u Assessment of movement of lower extremities u Assessment of hydrocephalus u Prevent infection

Pediatric Respiratory Tract Differences

Age Infants & Young Children w/ increased risk of severe respiratory illness Hyper-responsiveness of the airways Size Smaller airways Shorter path for pathogens to travel Resistance & Susceptibility Day care, immune deficiency, Malnutrition, Anemia, Chronic Illness Seasonal Variations Winter and Spring = most common

Pediatric Leukemia Nursing Care

u Educate Child and Family u Relieve pain u Prevent complications u Infection: hand hygiene + gloves + clean stethoscope + thermometer designated for them u Hemorrhage u Anemia: iron supplements with orange juice/vitamin C. DON'T give w/ milk. Foods rich in iron: leafy greens, organ meats, fortified cereals u Petechiae, any bleeding u Chemotherapy u Manage drug toxicity: doxorubicin- cardiac toxicity + lifetime limit. Dose based on weight. u Physical care and emotional support u Greif and Loss associated with diagnosis

CHD Nursing Care

Assessments:Cardiac Pulmonary Systemic: weight, peripheral edema, feeding issues, urine output, restlessness/ irritability Monitor for age-appropriate G&D Provide Holistic Care: Ø Help family adjust Ø Educate family Ø Help family cope Ø Prepare child and family for surgery Ø Plan for discharge and home care Pediatric Cardiac Nursing care Assist to improve cardiac function § Digoxin: MONITOR SAFETY! Decrease cardiac demands § Rest, cluster care, hunger signs, avoid crying, stress reduction, temperature monitoring Reduce respiratory distress § Elevated HOB, O2 warmed and humidified, monitor for infection Maintain nutrition and Avoid excess fluid loss § Well rested before feeding, faster flow, increase caloric density, gavage feeding § Diuretics, monitor I&O § Child and family support Check HR before administering digoxin

The child with Sickle Cell Anemia (SCA)

Biggest complication: PAIN, extreme PAIN Acute Issues: SCA Severe pain related to ischemia of involved area(s) caused by sickling vaso-occlusion Rest/pain management Rehydration (oral/IV) Electrolytes prn Blood replacement prn Treat any infections Chronic Issues: SCA • Probable growth retardation • Chronic anemia • Increased susceptibility to infection • Ongoing chronic issues from injuries in acute SC crises • Possible delayed sexual maturation • Aim of therapy: prevent sickling and SC crisis Triggers such as stress, cold environment. Prevent by staying hydrated, infection prevention- hand hygiene, vaccines, report any low grade fever, avoid too hot temps or too cold temps. *****Visual changes, listless, unresponsive- go to ER. Cluster care + explain procedures.

Human Immunodeficiency Virus

• Majority of children with HIV acquire the disease perinatally • Clinical manifestations Failure to thrive Recurrent bacterial infections Opportunistic infections Chronic or recurrent diarrhea Recurrent or persistent fever Developmental delay Prolonged candidiasis • Therapeutic management goals Slow the growth of the virus Prevent and treat infection- Educate teens Nutritional support Symptomatic treatment Contract perinatally or w/ needles, sex Pediatric HIV Nursing Care u Risk for infection u Altered nutrition u Impaired social interaction u Altered sexuality pattern u Altered family processes u Antiviral compliance

Rubella

Caused by virus, causes rash, if women are nonimmune to rubella, it can cause negative effects, live virus so you cannot give vaccine when pregnant, can give when they're leaving hospital. MMR is subcut injection. Pruritus, rash, spread to others self limiting/resolving.

Rubeola/ Measles

Caused by virus, highly contagious, rash which looks like red or dark spots, large spots all over the body. Self limiting but takes around a month to resolve. Can cause immune issues if you get it.

Cerebral Palsy (CP)

Causes u Anoxia plays a major role u Severity of conditions variable, assess history u 4 classifications of CP u Spastic u Dyskinetic/athetoid u Ataxic u Mixed type/dystonic Usually caused by hypoxic event Usually hypotonic, muscles get contracted bc theyre not being used Characterized by: u Early onset of impaired movement and posture u May be accompanied by: u Perceptual problems u Language deficits u Intellectual impairments u Most common permanent physical disability of childhood u Etiology, features and course vary in nature Physical findings that suggest Cerebral Palsy: • Delayed motor development • Abnormal head circumference • Abnormal postures • Abnormal reflexes • Abnormal muscle performance and tone Nursing Management u Early recognition/diagnosis u Monitor for attainment of developmental milestones u Range of motion u Prevention of contractures u Support of the child and family Outcomes for CP u Child achieve independent self-care by puberty u Child feeds & dresses self u Child manages elimination independently u Child demonstrates age-appropriate developmental milestones within limits of disease u Child receives environmental stimulation (interest in people, activities, school) with minimal restrictions

SKIN

Causes of Integumentary Disorders in Children • Infant: o Epidermis thinner, blood vessels closer to the surface • Loses heat more readily through skin surface • Substances are more easily absorbed through skin o Skin contains more water • Epidermis Loosely bound to the dermis • Friction more easily results in blistering or skin breakdown o Less pigmented • Increased risk for UV damage • Reaches adult thickness in late teen years • Darker skin: more hypertrophic scarring and keloids Differences in Dark-Skinned Children Have more pronounced cutaneous reactions Hypo or hyperpigmentation following healing More prominent papules Follicular responses Vesicular or bullous reactions Hypertrophic scarring Keloid formation

Viral Infections varicella

• Varicella-zoster virus • Crops of vesicles usually confined to a dermatome following along the course of affected nerve • Usually preceded by neurological pain, itching • Management: o Symptomatic tx o Local, moist compresses o Drying lotions o Prevent secondary infections

Diabetic Ketoacidosis (DKA)

u Elevated blood glucose u Low blood pH (acidic) u Ketonuria (large+++) u S/S dehydration u Abd/chest pain u Nausea/vomiting u Fruity breath/Kussmal breath u Decreased LOC u S/S infection Intervention: hydrate, regular insulin IV, balance potassium/ regulate. Hydrate, insulate, regulate. Diabetic KetoAcidosis u Cerebral edema is the most serious complication of DKA in children u Hourly neuro checks u Early symptoms including headache, confusion, lethargy u Treating cerebral edema once present may not improve outcome and mortality rates may be as high as 50% u It is most common in young, newly diagnosed children; rare in adults u Rapid neurological deterioration and death can occur u Early diagnosis is critical Management: u Insulin administration u Fluid replacement u Electrolyte replacement ABC's and then neuro, then Vitals

Pediatric Cardiovascular Differences w/ acyanotic and cyanotic

Circulatory Changes From Gestation to Birth § The fetal heart rate is present on about postconceptual day 17. § The four chambers of the heart and arteries are formed during gestational weeks 2 through 8. § During fetal development, oxygenation of the fetus occurs via the placenta; the lungs, though perfused, do not perform oxygenation and ventilation. § The foramen ovale, an opening between the atria, allows blood flow from the right to the left atrium. § The ductus arteriosus allows blood flow between the pulmonary artery and the aorta, shunting blood away from the pulmonary circulation. Smoking, chemicals, smog can cause issues, anything that limits oxygenation

Risk Factors for Epilepsy

u Family history of seizures or epilepsy u Any complications during the prenatal, perinatal, or postnatal periods u Changes in developmental status or delays in developmental milestones u Any recent illness, fever, trauma, or toxin exposure Diagnose: 2 or more seizures with more than 24 hrs apart Aura before seizure When you have seizure, you can't drive for 6 months Seizure questions: when it started, how long, what were they doing, did they lose control of bowel/bladder, characteristics Can be treated with diet: keto diet, meds

Erythema Infectiosum

Complications: Fetal death assoc w/ 2nd trimester exposure, arthritis, arthralgia myocarditis (rare) Aplastic crisis w/ hemolytic disease or immunodeficiency Symptomatic & supportive tx Antipyretics Analgesics Anti-inflammatory meds prn

Acute Lymphatic Leukemia (ALL)

Curability: 70-90% Most common form of cancer in children (most common ages 2-10) Classified according to types of cells involved ◦ T cell ◦ B cell ◦ Early pre-B cell ◦ Pre-B cell Cure rate 90% (St.Judes, 2020) The higher the WBC count at diagnosis, the worse the prognosis Abnormal lymphoblasts are abundant Immature/lack ability to fight infection Growth of lymphoblasts are excessive and the abnormal cells replace the normal cells Chemotherapy tx: neutropenic precautions (risk for infection), nausea, GI issues, low appetite- high protein food, eat small frequent meals Body image issues Pain: nonpharm- distractions w/ games, coloring, watching a movie. Mild analgesics- acetaminophen, ibuprofen

Viral Infections

Herpes Simplex Virus Type 1- oral Type 2- genital Can transfer! Grouped burning, itching vesicles on inflammatory base Vesicles dry- crust over Management: Comfort care Prevent secondary infections Antiviral tx: Acyclovir w/ initial or severe cases, Valtrex- ease of dosing

Fractures

u Fractures = Emergency care u Types: u Greenstick- break through one side u Transverse- crosswise u Oblique- slanting u Spiral- slanting, circular; caused by twisting u Compound- breaking through the skin u Abuse red flags = mult fx- old, new, *Spiral fx u Casts u Nursing management- pain, perfusion u What s/s would concern you post casting?

Cardiac Catheterization

Diagnostic or Interventional § Pre-procedural § Post-procedural § Home Care

Pediatric Neurological & Musculoskeletal Chronic Illness & Disability,

Differences in Anatomy and Physiology of the Neurologic System of Children u First 3 to 4 weeks' gestation u Infection, trauma, teratogens, and malnutrition can cause physical defects and may affect normal CNS development. u Birth u Cranial bones well developed, but not fused: increased risk for fracture u Brain is highly vascular: increased risk for hemorrhage u Child u Spinal cord is mobile: high risk for cervical spine injury

Spinal Cord Injuries

u Generally, the result of indirect trauma u Motor vehicle collisions u Vertebral compression from blows to the head or buttocks (diving, surfing, falls from horses) u Birth injuries from traction force on spinal cord u Therapeutic management: stabilization and transport to pediatric trauma center u Nursing care management: u Stabilization, careful assessment, prevention of complications, maintain maximum function u Rehabilitation: evaluation and support

Neurological Nursing

u Health history u Neuro examination u Cerebral function-LOC, memory, language, sensory, motor u Cranial nerve function u Cerebellar function-balance & coordination u Motor, sensory, and reflex function u Posture u Pediatric Glascow Coma Scale u Diagnostic testing u LP, X-ray, MRI, Nuclear med, EEG Treatment

Childhood Cancer

u Neoplastic disorders = leading cause of death from disease in children past infancy u Half of childhood cancers involve blood or blood forming organs u Arise from primitive embryonal and neuroectodermal tissues u Leukemia u Lymphomas u Sarcoma u CNS Tumors u Adult cancers arise from epithelial cells resulting in carcinomas Warning signs: abnormal bruising, frequent infections, brain tumor- headaches, vision changes, pain, blood- easy bruising, fatigue. Pain in bone if osteosarcoma. Random bleeding, weight loss.

Common Types of Structural Defects

u Neural tube defects u Microcephaly u Hydrocephalus

Adventitious Breath Sounds

• Wheezing: usually indicates obstruction, narrowing o High-pitched sound on expiration o May occur with obstruction in lower trachea or bronchioles • Rales: usually crackles meaning fluid o Crackling sounds heard when alveoli become fluid filled o May occur with pneumonia BOTH VERY CONCERNING Crackles + rales FIRST sit them up, even tripod position THEN call for oxygen if position doesn't work

Musculoskeletal Dysfunction The Immobilized Child

•* One of the most difficult aspects of illness on a child is immobility •Frequent reasons are: •Congenital defects •Degenerative diseases •Infections or injuries that impair integumentary, neurologic, or musculoskeletal systems •Therapies

Types of Infectious Disorders of the Neurologic System

•Aseptic meningitis (viral) •Encephalitis •Reye syndrome (rare)

Congenital/Developmental Neuromuscular and Musculoskeletal Disorders

u Neural tube defects including u Spina bifida occulta: closed hole u Cystica- visible hole u Meningocele u Myelomeningocele u Structural disorders of the skeleton u Pectus excavatum and carinatum, limb deficiencies, polydactyly/syndactyly, metatarsus adductus) u Congenital club foot u Developmental dysplasia of the hip u Torticollis u Tibia vara u Genetic disorders u Osteogenesis imperfecta u Various types of muscular dystrophy u Spinal muscular atrophy

Muscular Dystrophy

•General term for a group of inherited types of neuromuscular disorders that affect voluntary muscles •Symptoms not always evident at birth; may manifest later in childhood •May limit lifespan due to compromised ability to adequately support ventilation •Spinal muscular atrophy is a rare similar type of neuromuscular disease that affects the motor neurons in the spinal cord, rather than the muscle fibers themselves. Symptoms are similar to those of muscular dystrophy Genetic hx

Roseola

Exanthem Subitum (Roseola) Human Herpesvirus, type 6 Persistent high fever for 3-4 days in child who looks well Drop in fever to normal w/ appearance of rash Discrete erythmatous macules or maculopapules Appear on trunk- spread to face and extrem; non pruritic Lasts 1-2 days Complications: Febrile seizures Encephalitis (rare)

Risks Factors for Respiratory Arrest in Children versus Adults

•Have smaller airways than adults •Have underdeveloped immune systems •Lack motor coordination to save self after falling into water •Susceptible to choking on food and small objects •Higher risk for sudden infant death syndrome

Infants & Small Children: Respiratory Disorders S/Sx

Fever Anorexia Vomiting, Diarrhea Abdominal Pain Nasal blockage & Discharge Cough, Respiratory sounds Sore throat Ear Pain

Congenital Hypothyroidism

First 6 weeks w no treatment will result in severe mental retardation u Thyroid gland does not produce sufficient thyroid hormone to meet metabolic need u 1 in 4000 births u Dx: T4 level with newborn screening u Clinical Manifestations: u Skin mottling, large fontanel, large tongue, hypotonia, slow reflexes, distended abdomen u Prolonged jaundice, lethargy, constipation, fdg problems, hoarse cry, excessive sleeping, umbilical hernia u Nursing: u Newborn screen (x2 in the state of AZ) u Growth and Development u Education and Family Support u Treatment: lifelong thyroid hormone replacement (levothyroxine)

Seizure Disorders

Focal, generalized, and unknown Nursing management Observation and documentation Protect from injury Long-term care Drug therapy Emotional support SAFETY IS MAIN PRIORITY - Injury, lasting longer than 5 min, stops breathing- call 911

Cystic fibrosis

• A hereditary disorder in which a defective gene and its protein product cause the body to produce thick, sticky mucus that clogs the lungs and obstructs the pancreatic enzymes • Lung congestion & infection • Malabsorption of nutrients by the pancreas • Causes a generalized dysfunction of the exocrine glands • Respiratory & GI tracts are especially affected leading to increased viscosity of mucus-exocrine glands CF: Pulmonary Patho Thick pooled secretions: • Obstruct airways • Increase incidence of respiratory infection • Leads to air trapping behind obstruction CF: GI Patho • Obstruct pancreatic ducts • Results in inadequate enzymes for digestion and absorption of nutrients, especially fat soluble vitamins • May ultimately develop Type I DM

Blood Transfusions

u Nursing: Administration Guidelines u Take VS: prior to and ongoing u Check ID: recipient, donor and TYPE u Administer slowly; stay with child for the first 20% or 50ml of blood transfused (whichever is smaller) u Use blood within 30 minutes of arrival u Infuse within 4 hours u Administer w/ NS ONLY! u MONITOR for reactions!!! RH negative patients can only get negative blood Blood tubing w filter + NORMAL saline Blood Transfusions u Reaction symptoms: severe HA, chills, shaking, fever, pain, n/v, red or black urine u Nursing u If a reaction is suspected = STOP TRANSFUSION! u Take VS, maintain a patent IV line with NS and new tubing, notify provider u Do not restart until child has been medically evaluated u Hemolytic reactions are RARE u ABO incompatibility remains most u Stay in room for first 15 mins common cause of death from transfusions (human error) Usually premedicate w/ Benadryl + acetaminophen Interventions for reaction: STOP transfusion immediately, Vitals, maintain patent IV with saline, disconnect old tubing *** ABO compatibility is most common cause of transfusion reaction

BLOOD GLUCOSE MONITORING

u Obtain glucose levels before meals and bedtime snacks. u Perform monitoring more often during prolonged exercise, if you are ill, if you have eaten more food than usual, or if you suspect nighttime hypoglycemia. u Use the manufacturer's recommendations and perform quality control measures as directed. u Look for patterns. For example, 3 to 4 days of a consistent pattern of glucose values above 200 mg/dL before dinner indicates a need to adjust the insulin dose. u Blood glucose measurements are the best way to determine daily insulin dosages. u Normal levels are as follows: nondiabetics: 70 to 110 mg/dL; toddlers and children with type 1 DM younger than 6 years old: before meals 100 to 180 mg/dL, at bedtime 110 to 200 mg/dL; children with type 1 DM ages 6 to 12: before meals 90 to 180 mg/dL, at bedtime 100 to 180 mg/dL; adolescents 13 to 19 years of age, before meals 90 to 130 mg/dL, at bedtime 90 to 150 mg/dL (American Diabetes Association, 2014).

Hyperthyroidism

u Peak incidence between 12-14 years u Therapeutic management u Antithyroid drugs u Subtotal thyroidectomy u Ablation with radioiodine u Nursing u S/S: Weight loss, academic difficulties, unexplained fatigue, difficulty with fine motor skills u Rest & Routine u Education S/S: • Nervousness/anxiety • Diarrhea • Heat intolerance • Weight loss • Smooth, velvety skin

SIADH

u Posterior pituitary hyperfunction u Infection, tumors & trauma to CNS u Fluid retention & hypotonicity, low serum sodium u Nursing u Recognition u Signs of Fluid overload u Seizure precautions Hear crackles

Diabetes Insipidus

u Posterior pituitary hypofunction u Result of hyposecretion of ADH u Polyuria & polydipsia u DDAVP (vasopressin) for rest of their life u Nursing u Education

Foreign Body Aspiration

Highest Risk at 6 month-3 years of age Recognize signs, React quickly, Prevention Diagnosis via history & physical, chest X-ray, bronchoscopy Partial Cough, Wheeze, Stridor Decreased breath sounds in one lobe Breath sounds" wet" or crackles Complete Unable to speak or breathe Cyanotic Unconscious Chest thrust, back blows Prevent: CHILD PROOFING

Musculoskeletal Developmental Disorders

u Scoliosis u Limb differences u Developmental dysplasia of the hip u Clubfoot

Brain Tumors in Children NO RADIATION

u Second most common childhood cancer u Manifestations u Headaches u Morning vomiting u Seizures u Focal symptoms u Neurologic deficits u Complications: hydrocephalus, increased ICP, neurologic issues

Croup (Laryngotracheobronchitis) 3 months- 3 years, rarely affects 6 y/o

Inflammation of larynx, trachea and major bronchi Viral - Parainfluenza, Bacterial - H. flu o Vaccine (4 doses needed) Worsens at night Seal like, barky cough Increased HR + Increased RR Retractions, restlessness, nasal flaring Hospitalized if can't manage at home, stridor significant, severe retractions Continuous respiratory assessment High humidity with cool, moist air Dexamethasone & Nebs: Epi, Albuterol Encourage PO intake NPO if RR>60 to prevent aspiration Parent support & education LOOK ILL, IMPENDING DOOM TEACH: have them not cry because causes more congestion, keep child sitting up most of the time, sleep upright bc of gravity, sitting in shower w/ steam, rest + fluids. If they breathe super-fast + retractions + bluish tint + restless, confused, drooling, can't swallow go to ER.

Systemic Lupus Erythematosus

u Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder u rarely diagnosed before age 9 years Treat the symptoms Present with butterfly rash + photophobia- sunscreen use, issues w everything lungs, kidneys, etc. Prevent infection bc immunocompromised.

Shock Hypovolemic shock

Hypovolemic shock is most common in kids u Result of dramatic respiratory or hemodynamic compromise u Classified as compensated or decompensated u Caused by impaired cardiac output, impaired systemic vascular resistance (SVR), or a combination of both u Infants and young children differ from adults in that their cardiac output depends on their heart rate, not their stroke volume u Types of shock: u Hypovolemic ("cold shock") u Septic ("warm shock") u Cardiogenic u Distributive u Signs and symptoms: u Pallor u Hypotension u Brady- or tachydysrhythmia u Respiratory distress u Delayed capillary refill u Weak distal pulses

Hemophilia

Inherited Disorders of Coagulation u Inherited deficiency of coagulation factor u AFFECTS THE JOINTS- pain + damage u Leads to longer bleeding times u Diagnosis identifies which factor is deficient—usually Factor VIII or Factor IX u Factor can be replaced u Most cases are X-linked recessive u mother carries and sons inherit the disease, daughters may inherit the trait. Priority if they fall bc of extreme swelling + bruising. Hemophilia's: Nursing implications No high impact sports: swimming is fine u Prolonged bleeding & excessive bruising even from "minor" injuries u Bleeding into joints, subcutaneous hemorrhages, bleeding gums, spontaneous hematuria, hematomas } Prevent bleeding: Replacement of missing coagulation factor } Recognize and control bleeding } Prevent crippling effects of bleeding (safe, regular exercise) } Family support/ education/genetic screening

Scoliosis

u Therapeutic Management u Observation u Bracing u Exercise u Surgery u Nursing Management u Emotional support u Pre-op care u Post-op care Where brace all the time except for showering, check skin integrity

Near-Drowning

•Hypoxia, asphyxiation, aspiration & hypothermia •Clinical manifestations: A, B, C •Prognosis •Length of submersion, temp of water, sinus rhythm, neurologic status •Nursing Management •Respiratory support •Physical care of child in a coma •Parent support

Infectious process

Incubation: enters and starts to grow/multiply Prodromal: nonspecific symptoms Period of illness: s/s specific infections Convalescence: s/s disappear

Tonsillitis

Infection & inflammation of palatine tonsils "Kissing" tonsils appearance Mouth breathing Tonsillar tissue erythematous, edematous, w/ or w/o exudate, Nursing Management: Symptoms Fever, sore throat, difficulty swallowing Antipyretics Antibiotics if Streptococcal infection Tonsillectomy - chronic infections and/or obstruction 3-6 or more infections of tonsils in a year: criteria for surgery Maintain hydration status Ask about reoccurrence, how long it lasts

Mumps

Inflammation in testicles in males which can lead to infertility Highly contagious for first week, viral, supportive care. CDC recommends vaccine for MMR at 12 months and second at 4 years

Developmental Dysplasia of the Hip

u Therapeutic Management u Pavlik harness has to stay on all the time except for bath time, Educate on checking skin integrity when harness is on, educate on not adjusting harness, bc only dr. does this, educate on diapering, back to sleep, if straps are too tight/ extremities are blue, rash/raw skin, baby is not actively moving legs or toes: call dr. , traction, surgery u Once a week/2 weeks wash harness in mild detergent u Usually fixes at around 6 months u Nursing Management u Assessment u Nursing diagnoses u Plan of care u Education u Cleanliness u Developmental care and play u Evaluation Rotate up and out for hip clicking: Barslow and Ortolani maneuvers

Diaper Dermatitis

Irritant Diaper Dermatitis • Erythematous, maculopapular exanthem • Management: o Remove irritant source o Barrier cream- A&D o Open to air SITTING IN DIRTY DIAPER CAUSES

Lead Poisonings

u Usually found in children 1-5 yrs old Complications: u Lower levels u Behavioral problems u Learning difficulties u Higher levels u Encephalopathy u Seizures u Brain damage

Myelomeningocele

Lack of folic acid u 1 per 4,000 births due to the inclusion of folic acid in foods Definition u Neural tube defect u Failure of the neural tube to close Sterile gauze or sterile bag before surgery NO BACK TO SLEEP, PRONE to sleep Ruptured sac= risk for infection

Management of Primary Hypertension

Last resort is medications, try other interventions first 60 mins a day of activity •Weight reduction •Physical conditioning •Dietary modification •Relaxation techniques •Pharmacologic treatment

Pediatric Cancer, Hematology, Immunological, and Endocrine disorders

Leukemia- number 1 childhood cancer Childhood Cancers u Childhood cancer tends to develop from embryonal tissue; in general, it is more responsive to therapy than adult cancers, which tend to be derived from epithelial tissue. u In adults, cancer is influenced to a large extent by environmental factors. Cancer in children is most often not attributed to environmental factors, so generally there are no routine screening measures or prevention strategies for childhood cancer. u Most common childhood cancers, in order of frequency, are leukemia, CNS tumors, lymphoma, neuroblastoma, rhabdomyosarcoma, Wilms tumor, bone tumors, and retinoblastoma

Chapter 37: Immunizations & Communicable Disease Pediatric Physiology and Immune System

v Due to the immature responses of the immune system, infants and young children are more susceptible to infection. v The newborn displays a decreased inflammatory response to invading organisms, contributing to an increased risk for infection. v Cellular immunity is generally functional at birth, and humoral immunity occurs when the body encounters and then develops immunity to new diseases. v Since the infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies, the risk of infection is higher.

Rheumatic fever

} Inflammatory disease following a strep pharyngitis caused by streptococcal antibodies } Multiple systems may be affected: CV, skin, brain, immune/lymph nodes, joint pain, weakness } Red rash all over } #1 Goal: prevent permanent cardiac damage: giving antibiotics } Eradicate hemolytic streptococci } Prevent reoccurrences of Strep- prophylactic antibiotic treatment } Palliation of other symptoms

Erythema Infectiosum (fifth disease)

May get seizures, fever, rash.

Eczema /ATOPIC DERMATITIS

• A pruritic chronic inflammatory disease • Pathophysiology- inflammatory dendritic epidermal cells and plasmacytoid dendritic cells play a key role o Triggered by genetics and environment • Nursing assessment o Health history o Physical examination o Laboratory and diagnostic tests • Nursing management o Promoting skin hydration o Maintaining skin integrity, prevent secondary infection

Hyperglycemia S/S

Mental status changes, fatigue, weakness Dry, flushed skin Blurred vision Abdominal cramping, nausea, vomiting, fruity breath odor

Pediatric Congenital Heart Disease: An Overview

•Incidence 6-13 per 1000 live births •Major (other than prematurity) cause of death in the first year of life •Ventricular Septal Defect (VSD) most common •Etiology unknown •Risk factors: family history, maternal chronic illness, maternal alcohol consumption, maternal exposure to environmental toxins and infections TOF, tricuspid PDA, ASD

Acquired Heart Diseases

•Infective endocarditis •Dysrhythmias •Rheumatic fever •Kawasaki disease •Hypertension •Cardiomyopathies

Bronchiolitis: LOWER resp infection

Most common in children less than 2 years RSV is most common organism of bronchiolitis infections Inflammation of fine bronchioles & small bronchi Edema! Mucus! Symptoms Rhinorrhea, pharyngitis, cough, sneeze, LOUD wheezing, ear or eye drainage, intermittent/low-grade fever, SOB, respiratory distress Go into respiratory distress if not treated ASK if they were born premature, if they have fever they could start dehydrated, males - premature more at risk, did mom smoke when baby was in utero. Bronchiolitis: Nursing Care • Culture: nasopharyngeal wash: nasal swab • Frequent respiratory assessment • Humidification • Nasal Suctioning • Hydration • Oxygen

Bacterial Meningitis

Most common in children younger than 1 and young adults 15-24 Neisseria meningiditis, Streptococcus pneumoniae, Group B Streptococcus, E. Coli, Pseudomonas, Hemophilus influenzae Spread by infection into bloodstream, drainage from sinus, or direct introduction by skull fracture or LP Complications- brain abscess, cranial nerve invasion (blind, deaf, facial paralysis), hydrocephalus, SIADH BIGGEST THING IS WATCH THEIR LOC ? How do children 3 months-2 years present with Meningitis? Bacterial MeningitisAssessment u 2-3 days of URI (upper respiratory infection) u Irritability u Headaches u Seizures u + Brudzinski, + Kernig u Opisthotonic (back arched, neck extended) u Fontanelles bulging u Papilledema u Septic arthritis (H. flu) u Purpura, petechiae u NB- poor suck, weak cry, lethargy, apnea, shock u LP-cell count, protein, glucose, GS, culture

Iron Deficiency Anemia: Nursing Implications

} Overall physical assessment, weight & growth curve, activity } Dietary assessment & modifications as needed } Supplemental iron ◦ Ferrous preparations are more easily absorbed ◦ Vitamin C enhances absorption } Ongoing monitoring of Hgb/Hct, weight, activity, etc. } Side effects of oral iron supplements: nausea, vomiting, diarrhea, teeth stains (temporary) } Tarry green stools indicate adequate dosing of iron supplement Was mom anemic when pregnant, how much cow's milk they intake. 4-6 months iron stores deplete, and breast milk is not enough iron, so you start fortified cereals Introduce each vegetable for 3-5 days. Iron mixed with orange juice + straw. S/E are constipation, green stools- fluids, fiber, stool softener if needed.

Focus of Nursing Care of the Child with a Neuromuscular or Musculoskeletal Disorder

•Maximize physical mobility •Promote adequate nutrition •Promote effective elimination •Promote skin integrity •Maximize self-care •Promote development •Prevent injury •Providing support and education to the child and family

Tetralology of Fallot (TOF)

§ 4 Defects: VSD, pulmonic stenosis, overriding aorta, R ventricle hypertrophy § L to R shunting § Decreased pulmonary blood flow = cyanosis § Nursing: § Prostaglandin E § TET spells (hypercyanotic spells) rt infundibular spasm: all blue, any type of activity causes them to be blue § Support surgical repair § Squats in corner bc low oxygen •Severe hypoxic/anoxic spells with feeding/crying/other exertion •Knee-chest or squat will slow venous return to heart and decrease workload, allowing child to slowly recover—an instinctive response in most affected children

Kawasaki disease

§ A systemic vasculitis § Strawberry tongue, sores in mouth, rash § Age: Typically, children 2-5 years of age § Cause: Unknown § Importance: Approximately 25% of untreated patients will develop coronary artery aneurysms § Therapeutic: § IVIG § High-dose Aspirin § Nursing Care: § Monitor cardiac status § Monitor I&O § Administration of gamma globulin (Blood product) § Comfort § Irritability § Mouth and skin care § Discharge teaching § Follow-up § Continued aspirin therapy (6-8 weeks) § Resolving of symptoms § vaccines § Risk of myocardial infarction

Neutropenia

Neutropenic 7-28 days after initial dose Neutropenic precautions: no fresh flowers/fresh fruits, hand hygiene, No one who is sick or people who have been sick in last 3-5 days, worry when they have a low-grade fever. Monitor vitals ESPECIALLY temp. SOFT BRISTLE toothbrush. Mask on child. Screening visitors.

Infants with cyanotic lesions

§ Children may need to supplemental oxygen due to over circulation of the lungs. § De-Saturation § Supplemental O2 § Vasodilation of pulmonary vessels § Increased blood flow to lungs § Pulmonary edema § This is a never-ending cycle, the best way to end the cycle is to wean children off supplemental oxygen to room air as soon as possible.

Digoxin therapy in children

Nursing: Assess for common signs of digoxin toxicity in children Apical heart rate before dose: § minimum 90-100 for infants § Minimum gradually increases to 60 as child grows Nursing: Teaching priorities of digoxin therapy § Regular consistent dosing (ie, 8 a.m. and 8 p.m.) § Safety concerns include safe storage of medicine, not giving extra doses

Nutrition and Exercise for the Child with Type 1 Diabetes Mellitus Nutrition

Nutrition u Meals and snacks are balanced with insulin action u Both the timing of the meal or snack and the amount of food are important in avoiding hyperglycemia or hypoglycemia. u Adherence to a daily schedule that maintains a consistent food intake combined with consistent insulin injections aids in achieving metabolic control. Have snack before exercise: complex carbohydrate-> protein + carbs: peanut butter and jelly sandwich Nutrition and Exercise for the Child with Type 1 Diabetes Mellitus (cont.) Exercise u Avoid exercising during insulin peak. u Add an extra 15- to 30-g carbohydrate snacks for each 45 to 60 minutes of exercise.

Congenital Heart Disease Cyanotic Malformations

§ Cyanotic lesions § Too little or too much blood flow! § Decreased pulmonary blood flow § Tetralogy of Fallot § Tricuspid atresia § Pulmonary atresia with intact ventricular septum Increased pulmonary blood flow § Truncus arteriosus § Hypoplastic left heart syndrome § Transposition of the great arteries

Common Nursing Diagnosis For Congenital Heart Disease (CHD)

§ Decreased cardiac output § Imbalanced nutrition: less than body requirements § Activity intolerance § Deficient knowledge § Anxiety § Interrupted family processes § Risk for infection § Risk for ineffective health maintenance Develop less if you protect the child too much

Review of Fetal Circulation

§ Foramen Ovale: § Joining of L & R atria § Allows for more than half of the blood entering the right atrium to bypass the pulmonary circuit § Ductus Arteriosis: § Joins the pulmonary artery & aorta § Allows bypassing of the pulmonary § circulation § How are oxygen requirements met in utero?

Febrile Seizures

One of the most common neurological conditions of childhood, 3-8% of children, 6 mo-5 yrs Lasts 1-3 minutes in length Benign in nature Seizure occurs during temperature rise Treatment: antipyretics, safety NOT recommended = tepid water baths u Febrile seizure > 5 minutes = notify EMS

Atrioventricular (AV) Canal Defect common in children with Downs Syndrome

§ Incomplete fusion of the endocardial cushions § Low ASD that is continuous with a high VSD and clefts the mitral and tricuspid valves § Allows blood flow between all four chambers of the heart § Nursing: § moderate to severe CHF § loud systolic murmur

Coarctation of the Aorta

§ Localized narrowing near the insertion of the ductus arteriosis § Increased pressure proximal to the defect (upper extrem) § Decreased pressure distal to the obstruction (lower extrem) § Nursing Care: § 4-point BPs § Femoral pulses

Transitional and Neonatal Circulation

§ Major changes in the circulatory system occur at birth after the first breath. § Gas exchange changes: placenta to the lungs § Fetal shunts close § Systematic resistance increases § Pulmonary vascular resistance decreases § Marked increase in pulmonary blood flow follows

Common Signs and Symptoms Related to Neurologic Disease in Children

•Nausea, vomiting •Headaches (early morning, frequent, or persistent) •Changes in gait •Loss of motor function •Visual disturbances •Changes in level of consciousness (LOC) or confusion •Increased irritability •Altered muscle tone

Transposition of the Great Vessels

§ Pulmonary artery leaves the L Ventricle; Aorta exits the R Ventricle § No communication between the systemic and pulmonary circulations § Associated defects must be present (VSD, ASD, PDA) to allow for blood to mix § Nursing: § Prostaglandin E § Symptoms of CHF and cardiomegaly evident if untreated after a few weeks of life Aorta and pulmonary artery are switched

Infant Congestive Heart Failure

§ Tachypnea, often unlabored § Feeding difficulties § Sweating during feedings § "Poor feeder" § Failure to thrive/weight loss § Enlarged liver § Tachycardia at rest § Edema, periorbital Infants shouldn't sweat- over exertion § Manifestations § Poor weight gain § Failure to thrive § Tachycardia § Cardiomegaly § Galloping rhythm § Poor perfusion § Liver and spleen enlargement § Weight gain

Hypoplastic left heart syndrome s/s

§ Underdevelopment of the L side of the heart § results in small L ventricle and aortic atresia § Nursing: § Mild cyanosis and CHF until the PDA closes § After PDA closure, progressive deterioration with cyanosis and decreased cardiac output § Fatal in the first months of life w/o intervention

Acne

Pathophysiology: • Excess sebum production of sebaceous glands • Outlet obstruction of the sebaceous follicle • Increased proliferation of the bacteria Propionibacterium acnes • Inflammation caused by sebum Therapeutic management Nursing assessment Nursing management Child and family education

Parasitic Infections: Lice

Pediculosis Capitis (Head Lice) Parasitic infestation of the scalp Pruritus- due to crawling insects and saliva of insects on skin Distribution: Occipital area Behind ears Nape of neck Tx = Pediculicide and manual removal of nits

Pertussis

Pertussis (whooping cough) Secretions Antibiotics depending on age

Poisoning

Poison Control AZ: (800) 222-1222 Emergency response ABC's Terminate exposure Identify poison Remove poison & prevent absorption Assessment Life support FIRST (ABC's!!) u Identify poison and amount Gastric decontamination- u Treatment varies, close monitoring is recommended in some cases. u Activated charcoal u Gastric lavage or catharsis (to speed through lower GI tract) u Diuretics -for substances eliminated by kidneys Nursing management u Prevention!! u Child-proofing u Medication storage u Medication safety u Instruct caretaker: u Call Poison Control u Substance-Name, time, amount, route u Child-Condition, age, weight

ventricular septal defect (VSD)

Ø Abnormal opening between the ventricles § ASD = Atrial Septal Defect § Abnormal opening b/t atrium • Left to Right shunting • VSD: 20-60% resolve spontaneously w/in 1year • CHF is common w/ moderate to large defects § Nursing: • May be asymptomatic • Loud murmur LLSB • Support surgical tx prn

REYE syndrome

ì Acute, rapidly progressing encephalopathy and hepatic dysfunction ì Causes: preceded by a viral infection (i.e. influenza, chicken pox) & associated w/ ASPIRIN use ì Nursing Assessment/Interventions: ì Lethargy or coma-r/t cerebral edema- monitor ICP ì Vomiting- monitor I&O ì Hypoglycemia ì Maintain ventilation, monitor cardiac parameters

Communicable Disease

ì An infectious disease is any communicable disease caused by microorganisms that are commonly transmitted from one person to another, or from an animal to a person. ì A communicable disease is an illness directly or indirectly transmitted from one person or animal to another by contact with body fluids, contaminated items, or by vectors such as ticks, mosquitoes, etc. Communicable Disease ì For a communicable disease to occur, three links need to be present: ì an infectious agent or pathogen, ì an effective means of transmission, ì a susceptible host. ì The pathogen must also have a suitable reservoir, or habitat, that can be living or non-living. ì Transmission may be direct or indirect.

Hyperlipidemia

Primary: no known causeSecondary: identifiable causePediatrics: Hypertension generally secondary to structural abnormality or underlying pathologyrenal diseasecardiovascular diseaseEndocrine or neurologic disorders } Identify children at risk and treat early } NEW AAP guidelines= test all kids at 9-11 yo } Treatment: dietary ◦ Restrict intake of cholesterol and fats } If no response to diet→Rx } Increase physical activity Refer to myplate

Endocarditis

Prophylaxis antibiotics before procedures such as dental work •Bacterial endocarditis, infective endocarditis, or subacute bacterial endocarditis •Streptococcus •Staphylococcus •Fungal infections •Prophylaxis: 1 hour before procedures (intravenously) or may use orally in some cases

Respiratory Structures Differences

• Airway lumen is smaller in infants and children than in adults and when edema, mucus, or bronchospasm is present, the capacity for air passage is greatly diminished • Small reduction in the diameter of a child's airway will result in an exponential increase in resistance to airflow, causing increased work or breathing • Congenital laryngomalacia due to the funnel shape and location of the larynx, increases the chance of aspiration of foreign material into the lower airways

CCHD screening

Pulse ox on right wrist and either leg for CCHD testing

--------Bacterial Infections---------- Scarlet Fever

Rash assoc. w/ Group A streptococci infection Sandpaper-like feel-papular exanthem on face, upper chest, back- spreads to body Progresses to deep red "Strawberry" tongue Rash lasts x 5 days followed by desquamation of fingers/toes Treatment: Penicillin/Amox w/ little to NO tx resistance Droplets is how it's spread, onset is quick Fever more than 101, pharyngitis as well. N/V, diarrhea, no appetite; KEY IS HYDRATION + NUTRITION.

----------Viral Exanthems----------------

Rash in 3 stages: Erythema on face Maculopapular erythematous rash symmetrically distributed on upper and lower extremities Rash subsides- can reappear if skin irritated or traumatized

Nursing Process: Vaccines

ì Assessment and diagnosis by the nurse are the first steps in the care of a child needing immunizations. ì Diagnosis: Risk for infection ì Planning involves advocating for immunization, informing parents about side effects, and obtaining consent. Ensure proper storage/use of vaccines. ì Implementation includes administration of the vaccine, as well as documentation. Adverse events must be reported by law. ì Evaluation serves as a way for the nurse to verify that nursing care was complete and thorough. Nursing Process: Home Care ì Children with a communicable disease are usually cared for at home ì Parents require education related to symptom management, when to call the healthcare provider, and limiting spread of infection. ì Nursing care for treatment of fever includes administering antipyretics, removing unnecessary clothing, and careful continued monitoring of the child's temperature. Identify clear fluids the child prefers to drink and encourage the intake of extra fluids.

Chain link

Reservoir: food, water, humans, animals, inanimate objects Portal of exit: sneezing, coughing Mode of transmission: direct- body to body; indirect- vector, Susceptible host- broken skin, immunocompromised

CF: Therapeutic Management

Respiratory: • humidification • aerosol/neb txs • oral/pulmonary hygiene • chest physiotherapy with postural drainage several times daily to mobilize secretions from the lungs GI: • oral pancreatic enzymes w/ all meals • careful monitoring of growth, nutritional status High protein diet, increased calories Cystic FibrosisNursing Management Hospital care Infection prevention, Isolation Breathing treatments, chest physiotherapy, breathing exercises Nutritional support Skin care Home care Home care equipment Antibiotic administration early with illness Education: Nutrition & CPT/ breathing exercises PREVENTION OF INFECTION + humidification of oxygen

Infectious Process

ì Cellular response ì Arrival of WBCs to area ì Types of WBCs ì Neutrophils ì Lymphocytes ì Monocytes ì Eosinophils ì Basophils ì Phagocytosis ì Ingest and destroy the pathogen ì Antibodies ì Specialized immune proteins ì Bind to and neutralize a specific antigen ì Antigens ì Substances that the body recognizes as foreign ì Natural killer cells ì Third type of lymphocyte ì Part of the innate immune system ì Function to destroy foreign material

Children & Exposure to Disease

ì Children get exposed to diseases through interactions with other children and adults. ì This exposure to illness allows them to naturally develop antibodies to these diseases, which prevents subsequent infections from the same organism. ì Many behaviors of children contribute to the ease with which infections are transmitted, including poor hygiene and handwashing.

Pediatric Trauma

SAFETY Prevention is KEY! u Development affects types of injuries in children u Appropriate monitoring of young children u Protective gear w/ bikes, skateboards, etc MVAs u appropriate car seats for age and wt u Children to sit in back seat until 12 years of age Head Injury: u Monitor neuro u LOC/ development u Inconsolable crying w/ infants is a sign of ICP Hangings u Cords on blinds u Curtains Falls u Anticipatory guidance- window falls u Age-appropriate activities ABC's first then LOC/ Neuro

Respiratory Distress Syndrome

SEEN IN PREMATURE BABIES • Respiratory distress syndrome (RDS) is a respiratory disorder that is specific to neonates • It results from lung immaturity and a deficiency in surfactant, so it is seen most often in premature infants

Fever Management: Nursing Interventions/Patient Education

ì Fever is a sign of illness; body's weapon to fight infection ì Antipyretics ì Used if child demonstrates discomfort ì Check correct doses before administration ì No ASA to children under age 19 ì Febrile seizure education ì Monitor for s/s dehydration: rehydrate with oral fluids ì Call HCP for danger s/s If lethargic w temp, temp longer 3-5 days, temp greater than 105, kid is immunocompromised -------> take to hospital

Infants & Infection Infants are particularly vulnerable to diseases for several reasons.

ì Immune systems are not fully mature at birth ì Displays a decreased inflammatory response ì Antibodies that are passively acquired from their mothers have limited protection, and this protection further decreases over time. ì Infants have incomplete disease protection until they receive immunizations.

Infection Control

ì Infection control aims to interrupt the chain of transmission, or eliminate either the reservoir or the habitat

KNOW EARLY AND LATE ICP

Signs of Increased ICP: Infants & Children u Increased head circumference u Bulging fontanelles, separation of sutures, distended scalp veins u Vomiting u Irritability, sleepiness, Glasgow Coma Scale (52.1) u Headache-awakening/standing u High-pitched cry u Reflexes u Slurred speech Late signs: u Elevated temperature u Elevated BP, decreased RR & HR (Cushing's triad) u Diplopia, sunset eyes, limited vision, papilledema u Posturing

Inspection and Observation

• Anxiety and restlessness: one of first indicators • Color: pallor, cyanosis • Hydration status: tachypnea causes insensible loss, dehydration • Clubbing • Breath sounds: wheezing • Rate and depth of respirations: tachypnea- normal RR for infant 30-60 • Respiratory effort: respiratory distress- nasal flaring, grunting, retractions • Nose and oral cavity • Cough and other airway noises: stridor

Asthma's 3 Components

• Bronchoconstriction • Airway Edema • Mucus Inflammation + Mucus TRUE asthmatics use inhaler every day- rescue one with exacerbations

Pharyngitis

Sore throat, very red pharynx + edematous, inflamed Throat culture Comfort care Viral - erythema, fever, malaise Bacterial - bright red pharynx, exudate, enlarged tonsils, headache, abdominal pain 90% is related to Group A Strep - 10 days of Penicillin to eliminate risk of : acute rheumatic fever acute glomerulonephritis Questions: anyone you know have strep recently, how long their throat has been sore, have they had a fever, have they been tired, have they been at school or daycare TEACH PARENTS: give them popsicles, cold fluid. DON'T GIVE RED POPSICLES FOR THESE KIDS. Keep them away from other kids, lasanges or something to suck on, ice chips. Risk for dehydration. Humidifier use + gargle with warm salt water- will help with inflammation. Discard the toothbrush. Ask about throwing away the toothbrush each time if they have recurrent infections. NO SURGICAL PROCEDURES CAN BE DONE

Two Main Types of Spina Bifida

Spinal bifida occulta u Not visible externally u May not be apparent unless there are other manifestations Spina Bifida Cystica u Visible defect with an external "sac" u Two forms: u Meningocele u Encases the meninges and spinal fluid by no neural elements u Myelomeningocele (or meningomyelocele) u Contains meninges, spinal fluid and nerves

Candidiasis

• Candida albicans • Moist area growth • Inflamed areas w/ white exudates, peeling • Pruritic • Management: topical antifungal/ Nystatin oint., oral antifungal, may require IV meds

Contact Dermatitis

• Causes o Response to an antigenic substance exposure o Allergy to nickel or cobalt in clothing, hardware, or dyes o Exposure to highly allergenic plants: poison ivy, oak, and sumac • Complications o Secondary bacterial skin infection o Lichenification or hyperpigmentation AVOID THE ANTIGEN + WASH SKIN.

Impetigo contagiosa

Staphylococci bacteria Begins as erythematous macules- becomes vesicular- ruptures- crusts over (honey colored crusts) Management: Topical antibiotics Systemic antibiotics when extensive or severe infections Proper hand washing/good hygiene WONT GO AWAY WITHOUT ANTIBIOTICS

Cellulitis

Streptococci, staphylococci, Haemophilius influenzae Inflammation- intense erythema, edema, firm infiltration "Streaking" frequently seen May progress to abscess formation Systemic effects: fever, malaise Nursing Management: • oral or parental antibiotics, rest, immobilization of affected area and child, and hot, moist, compresses to area

Nursing Respiratory Care:Acute Respiratory Infections

Support/ease respiratory effort Promote rest & comfort Provide humidification Promote nutrition & hydration Prevent spread of infection Reduce temperature prn Family support and home care

Hypothyroidism

TSH elevated, T3, T4 decreased u May be congenital or secondary to thyroidectomy u Decelerated growth, dry skin, eye puffiness, sparse hair, constipation, sleepiness, mental decline u Treated with thyroid hormone replacement (synthroid) u Nursing u Metabolic screening of newborn u Monitor growth on growth curve u Education re: therapy Weight gain, fatigue, cold intolerance Levothyroxine for treatment: cannot eat 30-60 mins after; take when first wake up Hypothyroidism u Tiredness/fatigue u • Constipation u • Cold intolerance u • Weight gain u • Dry, thick skin; edema of face, eyes, and hands u • Decreased growth

Surgical Removal

The child is at risk for increased intracranial pressure (ICP). • Edema • Hydrocephalus • Hemorrhage Nursing care • Frequent vital signs • Mental status • Neurologic status

Asthma Symptoms

• Chest tightness or chest pressure • Difficulty breathing or shortness of breath • Wheezing- heard most with exhalation • *Air exchange must occur to appreciate wheezing • Cough- worse at night • Tachypnea • Retractions or sucking in of the skin against the chest wall • Nasal flaring Infants/young children: Grunting Difficulty feeding Ask if they were born premature, did you breastfeed, do they cough, allergies, family history

Psoriasis

• Chronic inflammatory skin disease • Periods remission and exacerbation • Control possible with conscientious therapy • Incidence depends on climate and genetics MOISTURIZE!!!!!

Nose, Throat, & Mouth

• Common disorders of the nose, throat, and mouth include epistaxis, nasopharyngitis, sinusitis, tonsillitis, adenoiditis, and trauma to the mouth and teeth. • Recommendations for management of nasopharyngitis, pharyngitis, tonsillitis, and sinusitis should be focused on supportive care and alleviation of the associated symptoms. o Antibiotic therapy is not indicated unless there is a known bacterial cause or confirmation. o A tonsillectomy is often recommended when children have recurrent throat infections, chronic tonsillitis, or obstructive sleep apnea. Kissing tonsils- so bad they touch

Fetal Circulation- Ductus failure to close

• Ductus arteriosus connects the aorta to the pulmonary artery • Patency allows blood flow from aorta to the lower pressure pulmonary artery • Left to Right shunting • Additional blood is re-circulated through the lungs • Indomethacin (prostaglandin inhibitor) treatment, surgery prn

Factors Respiratory Illness

• Exposed to environmental smoke have an increased incidence of respiratory illnesses such as asthma, bronchitis, and pneumonia • Breath sounds heard over the anterior and posterior chest and axillary areas including wheezing and rales. Note that breath sounds should be equal bilaterally, and prolonged expiration is a sign of bronchial or bronchiolar obstruction • Percussion of the chest, sounds that are not resonant in nature should be noted

Type II diabetes in childhood

• Gestational history • Current physical/medical history • Family history: Type II DM • Activity level • Height/weight, BMI • Cardinal signs DM:3 P's

Sick day rules: Type I DM

• Give Always give insulin • Test Test Blood sugar q4h • Test Test urine for ketones • Encourage Encourage liquids • Follow Follow usual meal plan; substitute simple carbs as needed • Encourage Encourage rest • Notify Notify provider: n/v, s/s DKA, persistent high BS

BOX 46.1 Pediatric Assent

• Give consideration to each child's developmental capacity, rationality, and autonomy. • Help each child to achieve a developmentally appropriate understanding of the illness. • Tell the child what he or she can expect regarding testing procedures and treatments. • Assess the child's understanding of the situation and how he or she is responding. • Note if there is inappropriate pressure to assent to testing or treatment. • Seriously solicit the child's expression of willingness to accept the proposed plan of care.

Verruca (Warts) /viral

• Human Papillomavirus (various types): CAUSES CERVICAL CANCER!!!! • Well circumscribed, grey or brown elevated firm papules with a roughened texture • Multiple or single • Asymptomatic • Management: often will self resolve in 1-3 years, cryotherapy, salicylic acid

Asthma Medication Delivery Devices

• Inhaler - use alone or with spacer or aerochamber • Diskus - dry powder inhaler • Nebulizer - provides aerosolized medicine Medication Delivery • Spacer- holds medicine only • Aerochamber- valve controlled delivery device

Immunizations (Vaccines)

ì Many diseases have been nearly eliminated or significantly decreased due to vaccinations. Overall, there are many benefits to vaccination. ì Types of vaccines used in the United States include killed virus vaccines, toxoids, live virus vaccines, recombinant forms, and conjugated forms. Vaccines ì vaccines introduce an antigen into the body. An antigen is a foreign substance that triggers an immune response, and an antibody is a protein produced by the body in response to the antigen. ì There are numerous barriers to vaccination, including limited access to health care and inadequate education about the importance of vaccination. Role of Immunizations in Preventing Childhood Infections v Many childhood diseases (both viral and bacterial) can be prevented with adequate immunization v Many vaccinations require multiple doses v Immunizations can prevent: ○ Diphtheria, pertussis, tetanus (DTP) ○ Mumps, measles, rubella (MMR) ○ Varicella ○ Poliomyelitis

Hypoglycemia symptoms

• Irritability • Pale • Diaphoresis • Jittery • Tachycardia • Apprehensive • Slurred speech • Tearful • Later -drowsy, confused, seizures or coma Treatment: • Simple carbohydrate:10-15g • Glucogan: IM or sub-q prn

Decreasing Workload on the Heart

• Limit feeding time. • Elevate the head of the bed. • Provide uninterrupted rest. • Engage in self-limiting activities. • Provide oxygen (depending upon the lesion).

Terms to Describe Skin Findings

• Macule • Papule • Annular • Pruritus • Vesicle, pustule • Scaling, plaques • Hypo-, hyperpigmented • Erythematous

Fever

ì Medication: Antipyretics ì lower fever-decrease the temperature set point ì Inhibiting the production of prostaglandins ì Encourages vasodilation and sweating ì Increase comfort: lukewarm bath, washcloth on forehead, cold drinks ì Never give ASA to children to reduce fever, due to risk of Reye Syndrome ì Cardiac kids get aspirin ì See box 37.3 Dose recommendations for Oral Tylenol and Ibuprofen pg. 1287 ì MEDS every 4 hours- write it down, make sure weight based dose is given ì Definition of Fever ì A fever is defined as a temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) and higher. ANYTHING OVER 105- brain damage Causes dehydration- fluid status /insensible loss NO meds till around 101 fever ì What is the difference between hyperthermia and fever?

Bacterial Meningitis Management

Therapeutic u Isolation u Antimicrobial tx u Hydration u Ventilation u Reduce ICP u Manage bacterial shock u Control seizures u Control of extreme temperatures u Correct anemia Nursing u Infection prevention u Decrease stimulation u Physical assessment & monitoring u Fluids and nutrition u Family support

Fever: Use of Tylenol and Ibuprofen

ì Medication: Tylenol ì Pros: antipyretic ì Cons: too much, toxic levels ì Medication: Ibuprofen ì Pros: inflammation process ì Cons: too much, toxic levels

Viral Infections Occurring in Children

ì Mumps ì Zoonotic infections ì Cat scratch fever ì Rabies ì Viral Exanthems ì Mumps ì Rubella ì Rubeola ì Varicella Zoster (chickenpox) ì Erythema Infectiosum (fifth disease) ì Hand, Foot, and Mouth Disease, or Herpangina (if only mouth involvement) Higher risk of shingles if you have had chicken pox

Fever: The Basics

ì Release of Endogenous pyrogens ì Stimulated by bacteria, virus, or pathogens ì Interleukins, tumor necrosis factor, interferon ì Act on hypothalamus (TANHATS)* ì Trigger prostaglandin production ì Increases body temperature set point ì Cold response ì Shivering ì Vasoconstriction ì Decrease in peripheral perfusion ì Goal: to help decrease heat loss ì Allows body's temperature to rise to new set point=fever

Frequently seen in children

ì Scabies: mites that bit and tunnel in skin and lay eggs + die + poop tracks -> highly contagious ì Head lice: parasite lays eggs, lice jumps, itchy head. Tea tree oil, mayonnaise, wash everything in hot water, pop any eggs on scalp. Fine tooth comb to go through hair.

Approach to Management: Rashes

ì Skin rashes accompany many infectious or communicable diseases ì Rashes can be difficult to identify ì Nursing Management Allergies, new medication, what they have been playing in, new soaps or detergent, when did it start, is it itchy, have they been in grass.

Sepsis

ì What is Sepsis? Systemic infection, bacteria, or virus in the bloodstream. ì What can sepsis lead to? Organ failure, septic shock. ì Pathogens based on age ì Sepsis in infants less than 3 months old: How can some neonates respond to sepsis? Low temperature ì Nursing Management GBS is #1 cause of neonatal sepsis: educate, antibiotics, hand hygiene, assess temp. MORE common in neonates, younger infants.

Vaccine Preventable Disease

ì varicella, diphtheria, Haemophilus influenzae type B, influenza, measles, mumps, pertussis, poliomyelitis, rotavirus, rubella, tetanus, hepatitis B, Pneumococcal disease, human papilloma virus, meningococcal disease

Psychosocial Impact

u Cancer is a significant stressor for children and families. Families need support and education throughout the diagnostic process, treatment and cure, or palliative care. u The child with cancer should lead as near-normal a life as possible. When physically able and cleared by the oncologist, the child should resume usual activities such as school. Camps for children with cancer provide an excellent opportunity for children to enjoy everyday activities and meet children experiencing similar alterations in their lives. EDUCATION FOR FAMILIES OF CHILDREN WITH CANCER • Obtain a printed or written copy of the child's treatment plan • Keep a calendar of all appointment times, blood count lab draws days, and phone numbers of all physicians and nurse practitioners, home care companies, the laboratory, and the hospital • Seek medical care IMMEDIATELY if the child's temperature is 38.3°C (101°F) or higher • Call the oncologist or seek medical care if any of the following occur: Cough or rapid breathing Increased bruising, bleeding or petechiae, pallor, or increased levels of fatigue Earache, sore throat, nuchal rigidity Blisters, rashes, ulcers Red, irritated skin on the child's buttocks Abdominal pain, difficulty or pain with eating, drinking, or swallowing Constipation or diarrhea For children with central venous catheters: Pus, redness, or swelling at the site Breakage of the catheter • Do not give the child aspirin

Fractures info

u Cast u Application & Removal u Home care u Traction u Used to reduce or realign fx site u Halo vest- for cervical traction u Nursing care u Assess child and traction device u Prevent skin breakdown u ? How would you prepare a preschooler for cast application? Removal? DON'T put anything in cast, DON'T get it wet, able to move extremities, no numbing or tingling

Side Effects of chemotherapy and Radiation

u Chemotherapy u Bone marrow suppression u Alopecia u Malaise/fatigue u Nausea u Vomiting u Anorexia u Stomatitis u Radiation u Skin reactions u Fatigue u Bone marrow suppression u Nausea u Vomiting u Anorexia u Mucositis- painful inflammation/ ulcerations of the mucosa Treat the sx: antiemetics, neutropenic precautions, fatigue- rest periods, low grade fever- treat bc risk of infections.

Hydrocephalus Management

Tx = surgical (few exceptions) Obstruction repair Removal of tumor Ventriculoperitoneal shunt (VP shunt)- drains CSF into peritoneum May become infected or obstructed Changes in size Acetazolamide- carbonic anhydrase inhibitor, promotes bicarb excretion which reduces intracranial pressure First 24 hrs after surgery is highest risk of infection Hydrocephalus:Nursing interventions u Observe for increasing ICP u Infants u Older children u Nutrition u Prep for procedures u Postoperative care u Family support

Therapies for Pediatric Cancers

u Chemotherapy u Surgery u Radiation therapy u Hematopoietic stem cell transplantation (HSCT) u Steroid therapy u Complementary and alternative therapies Blood/lymph- chemo Bone Marrow Transplantation (BMT) • HSCT and BMT have become accepted therapy for childhood cancers. • Allogenic bone marrow (matched donor) • Autologous peripheral stem cells (child's own) • Umbilical cord blood stem cells • The decision for appropriate therapy is based upon the disease process and availability of hematopoietic cells.

Type 1 DM: Symptoms

u Classic 3 Ps u Polyuria- increased glucose in blood exerting osmotic effect and pulling fluid into extravascular space-is then excreted via kidneys-may present in child as bedwetting u Polydipsia-dehydration results in increased thirst u Polyphagia-body can't use glucose as fuel so breaks down fats and protein (glucogenesis) leading to a starvation state u Nausea and vomiting u Weight loss u Blurred vision-fluid pulled from lens u Weakness, fatigue u Irritability and mood swings u May resemble flu, may be missed

Varicella (chicken pox)

Varicella/ Chicken pox Herpes virus, self limiting, highly contagious, cannot get varicella when pregnant cus its live. May be transmitted to baby.

Iron-rich foods

red meat, tuna, salmon, eggs, tofu, enriched grains, dried beans and peas, dried fruits, leafy greens, iron fortified cereals

Posturing

u *Primitive postural reflexes emerge as cortical control over motor function is lost w/ brain dysfunction u Decorticate-Flexion- indicates cerebral loss or lesions above the brainstem u Decerebrate-Extension- indicates dysfunction at the midbrain or lesions to brainstem u Posturing may not be evident when child is quiet- usually elicited by painful stimuli u Flaccid paralysis = continued deterioration

Juvenile Idiopathic Arthritis

u Autoimmune disorder u Targets joints u Low impact sports!!! u Inflammatory changes in the joints cause pain, redness, warmth, stiffness, and swelling.

Endocrine System

u Composed of glands, tissues, or clusters of cells that produce and release hormones u Influences all physiologic effects u Growth and development u Metabolic processes related to fluid and electrolyte balance and energy production u Sexual maturation and reproduction u The body's response to stress

Insulin pumps

u Continuous subcutaneous insulin infusion (CSII) has improved metabolic control and reduced risk of severe hypoglycemia in adolescents u Must be filled, programmed and adjusted u Requires glucose monitoring

Common Food Allergens to Avoid in Children Younger Than 1 Year

u Cow's milk u Eggs u Peanuts u Tree nuts u Sesame seeds u Kiwi fruit u Fish and shellfish Peanuts, tree nuts, fish and shellfish you don't outgrow.

Hypopituitarism

u Deficient secretion of growth hormone (GH) u Treated with replacement of GH u Get them as tall as they can Nursing Establish diagnosis Enhancing the Child's self esteem Support to pt & family Hyperpituarism- gigantism if before puberty and acromegaly if after puberty

Transposition of the great arteries

aorta and pulmonary artery are switched: mixed defect. Significant cyanosis without murmur. Tx is corrective surgery within first week of life.

Ventricular septal defect-

down syndrome kids, chromosomal defect

Signs and Symptoms of Cancer in Children

u Difficult to diagnose because relief may be attributed to common childhood illness u Vary according to: u Child's age u Type of tumor u Extent of the disease

PDA

heard under left clavicle: machine like murmur

Hypoplastic left heart syndrome

heart transplant tx is first choice. If diaphoretic when feeding- tube feeding bc expending too much energy

Coarctation of the Aorta

narrowing of aorta. 4-point blood pressure after surgery

Nose, Throat, & Mouth p 2

• Mouth ulcers are treated symptomatically, and encouragement should be given to keep the mouth clean until healed. • Use oragel for pain, constant reapplying + cleaning. • Dental emergencies should be managed on an individual basis. • The mouth is highly vascular and may bleed with small injuries. • Depending on the severity, emergency medical treatment may be indicated or an emergency dental visit if possible. • Prevention and treatment of nose, throat, and mouth abnormalities should address the need to prevent the spread of communicable diseases such as nasopharyngitis and tonsillitis. • Home care such as humidification and proper use of over-the-counter medications should be discussed with caregivers. • Injury prevention and care for dental emergencies such as tooth avulsion is integrated into the care plan and education for caregivers.

Pediatric Respiratory Nose, Throat, & Mouth

• Nose o Infants: • Obligate nose breathers: up until 4 months • Use bulb syringe to get stuffy nose unplugged, saline drops before • Upper respiratory only in face, if you hear at chest, it's lower • Produce very little mucus: encourage use of humidifier so they don't dry out • More susceptible to infections bc mucus usually traps pathogens and can't blow their own nose, they don't have the immunity • Sinuses are not developed o Newborns: • Very small nasal passages • More prone to obstruction • Throat—increased risk for airway obstruction o Infants' tongues larger in relation to oropharynx o Children have enlarged tonsillar and adenoid tissue

Types of Anemia Decrease in RBCs

• Nutritional deficiency Iron deficiency, folic acid deficiency, pernicious anemia • Toxin exposure Lead poisoning • Aplastic anemia Adverse reaction to medication • Hemolytic anemia Sickle cell anemia, thalassemia Iron Deficiency Anemia in Childhood u The most common nutritional deficiency in the U.S. u Children 12-24 months of age at high risk and again at puberty u Cow's milk contributes to anemia- no longer use whole milk in children bc of obesity- too much fat

Parasitic Infections: Scabies

• PRURITIC!!! • Minute grayish brown, threadlike • Black dot at end of burrow • Distribution= interdigital, axillary-cubital, popliteal, inguinal o >2 yrs = hands and wrists o < 2 yrs = hands and feet • Tx: scabicide

Pneumonia

• Pneumonia is an inflammation of the lung parenchyma • Virus, bacteria, or a fungus • Self-limiting, usually resolves on their own Maintain respiratory status + hydration status

Nursing Interventions for Children with Extensive Burns

• Promoting oxygenation and ventilation • Restoring and maintaining fluid volume • Preventing hypothermia • Cleansing the burn • Preventing infection • Managing pain with atraumatic care • Treating infected burns • Providing burn rehabilitation

Complications of Diabetes Mellitus

• Retinopathy • Nephropathy • Dyslipidemia • Celiac disease • Hypertension

Upper Respiratory Infection: common cold is #1S/Sx

• Rhinorrhea • Pharyngitis • Cough • Sneezing • Ear or eye drainage • Intermittent/low-to moderate grade fever Duration of symptoms: Average 7-10 days Most meds say don't give if age is less than 2 or less than 4 PREVENT common cold; handwashing

Signs and Symptoms and Risk Factors for a Pneumothorax

• Signs and symptoms o Chest pain might be present as well as signs of respiratory distress such as tachypnea, retractions, nasal flaring, or grunting • Risk factors o Chest trauma or surgery, intubation and mechanical ventilation, or a history of chronic lung disease such as cystic fibrosis

Sinusitis: UPPER respiratory infection

• Sinusitis (also called rhinosinusitis) generally refers to a bacterial infection of the paranasal sinuses. • The disease may be either acute or chronic in nature. • Approximately 5% of upper respiratory infections are complicated with acute sinusitis. • Sx usually last less than 30 days- tx is antibiotics + netty pot- saline wash + saline drops + drink oral fluids + steamy shower + vix + humidifier • Pain meds (Tylenol + ibuprofen) • If they have chronic sinusitis usually, they have polyps Sinusitis sx • Cough • Fever • In preschoolers or older children, halitosis (bad breath) • Facial pain may or may not be present, so is not a reliable indicator of disease • Eyelid edema (in the case of ethmoid sinus involvement) • Irritability • Poor appetite

Classification of Burns *KNOW THESE*

• Superficial: involve only epidermal injury; heal without scarring in 4 to 5 days • Partial thickness: involve epidermis and portions of dermis; heal with minimal scarring in about 2 weeks • Deep partial thickness: take longer to heal; may scar; result in changes in nail, hair, and sebaceous gland function • Full thickness: result in significant tissue damage and extend through epidermis, dermis, and hypodermis; extensive scarring results; significant time to heal needed

Fungal Infections of the Skin

• Tinea pedis: fungal infection on the feet • Tinea corporis: fungal infection on the arms or legs • Tinea versicolor: fungal infection on the trunk and extremities • Tinea capitis: fungal infection on the scalp, eyebrows, or eyelashes • Tinea cruris: fungal infection in the groin Can last up to 4 weeks Ringworm- fungal infection

Interventions for Preventing Complications of Immobility

• Turning and repositioning every 2 hours • Assessing the skin for redness or breakdown • Performing range-of-motion exercises • Keeping the skin clean and dry • Encouraging intake of fluids to maintain hydration status • Encouraging coughing and deep breathing every 2 hours and as needed

Diabetes Mellitus

• Type 1: caused by a deficiency of insulin secretion due to pancreatic β-cell damage • Type 2: consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue with different degrees of β-cell impairment • Diabetes secondary to certain conditions such as cystic fibrosis, glucocorticoid use (as in Cushing syndrome), and certain genetic syndromes such as Down syndrome, Klinefelter syndrome, and Turner syndrome • Gestational diabetes (diabetes during pregnancy)

Acute Epiglottitis

• Usually 2-7 years • H. influenzae (Hib) • Sore throat, fever, tripod position, appears very ill (toxic), drooling, absence of spontaneous cough, agitation, hypoxia • Cherry red, edematous epiglottis DO NOT LEAVE THEIR BEDSIDE, they can die CONTINUOUS MONITORING WILL END UP IN ICU Nursing Management Acute Epiglottitis DO NOT attempt to visualize the epiglottis directly o NO tongue depressor or throat culture!!! X-ray "thumb" sign Continuous monitoring of respiratory status Hydration- IV, NPO How will you care for a child with epiglottitis without eliciting fear and crying?

Malignant Lymphomas &Tumors In Children

•Non-Hodgkin's lymphoma •Hodgkin's disease lymphoma •Neuroblastoma- nerve cell tumor •Osteosarcoma •Wilms Tumor Hodgkin's- B lymphocyte 1 area: more superficial Non-Hodgkin's- more common in kids and affects B and T lymphocytes - causes overgrowth that spreads. Tx is chemotherapy for both. Osteosarcoma- PAIN. Biggest fear is amputation. Wilms tumor: most common solid tumor of the abdomen, Ages 2-5. Do NOT palpate the abdomen after you determine there is a tumor bc highly vascular and can result in metastasis. Radiation and/or surgery is treatment. Also, may use chemo. Surgery must be done. Shortness of breath- concern is metastasis.

Assessment of Fractures: KNOW The 5 P's

•Pain and point of tenderness •Pulse: distal to the fracture site •Pallor •Paresthesia: sensation distal to the fracture site •Paralysis: movement distal to the fracture site Pain or a burning sensation may indicate tissue ischemia. Prompt intervention is crucial!

Factors Affecting Neurologic Disease in Children

•Prematurity •Difficult birth: trauma •Infection during pregnancy •Nausea, vomiting, headaches •Changes in gait •Falls •Visual disturbances

The Child Undergoing Cardiac Surgery

•Preoperative preparation •Measure vitals, ensure no fever; medications have been held. •Assess for allergies •Base-line pulse assessment and neuro check. •Education to parents and child to ease anxiety •Postoperative management •Monitoring cardiac output •Supporting respiratory function •Monitoring fluid and electrolyte balance •Promoting comfort •Healing and recovery

Nursing Management Goals for a Child with Muscular Dystrophy

•Promoting •Promoting mobility •Administering medications •Performing passive stretching and strengthening exercises •Managing •Managing elimination •Maintaining •Maintaining cardiopulmonary function •Teaching deep breathing exercises •Performing chest physical therapy •Preventing •Preventing complications and maximizing quality of life •Developing a diversional schedule •Providing emotional support

Acute Myeloid\ Myelogenous Leukemia (AML)

•Second most common type of leukemia in children •Common in adolescents •Cure rate 50 % •Less responsive to treatment •Affects myeloid cell precursors in the bone marrow resulting in malignant cells

Educating Parents

•Signs and symptoms of heart failure •Increased cyanosis •Dehydration •Infection •Dysrhythmias •Decreased nutritional intake

Growth and Development Issues in Emergency Care

•Size •The nurse must be knowledgeable regarding growth and development. •Medication dosing •Equipment •Careful organization of pediatric equipment can improve care. •Age-related psychological differences u Use the mnemonic AVPU to quickly determine level of consciousness: u A - Alert u V - Responsive to Voice u P - Responds to Pain u U - Unresponsive

Types of Neurologic Disorders in Children

•Structural disorders •Seizure disorders •Infectious disorders •Trauma to the neurologic system •Blood flow disruption disorders •Chronic disorders

High Cholesterol Risk Factors During Childhood & Adolescence

•Tobacco use •Dyslipidemia (elevated LDLs and cholesterol and decreased HDLs) •Hypertension •Decreased physical activity •Obesity •Family history •Type 1 or 2 diabetes

Secondary Assessment in Pediatric Emergencies

•Vital signs •History •Head-to-toe assessment •Diagnostic tests •Weight •Parent-child relationship Roll a towel/blanket under neck to keep airway open + resuscitate

Seizure precautions

•• Padding of side rails and other hard objects •• Side rails raised on bed at all times when child is in bed •• Oxygen and suction at bedside •• Supervision, especially during bathing, ambulation, or other potentially hazardous activities •• Use of a protective helmet during activity may be appropriate •• Child should wear a medical alert bracelet Common cause is febrile seizures

Causes of CHF

↑Pulmonary Blood flow (aka left to right shunt) } Blood is forced from higher pressure left side into lower pressure right side—re-circulates into pulmonary systems } Through atrial &/or ventricular defects, PDA } Leads to congestive heart failure (CHF) Obstruction of blood flow from ventricles } Obstruction of blood flow from left-side causes CHF } Ex: coarctation, aortic stenosis } Obstruction of blood flow from right side may lead to cyanosis, &/or shunt from right to left

CHD (Congenital Heart Defects)

↓ Pulmonary blood flow Obstruction of blood flow to the lungs Impaired oxygenation/cyanosis Chronic hypoxia clubbed fingers, ↑Hgb/Hct/strokes, poor feeding/growth, etc. Ex: Tetralogy of Fallot, tricuspid atresia Mixed blood flow } Mixed defects allow for mixing of oxygenated blood with unoxygenated } Varied clinical symptoms depending on amount of pulmonary blood flow } Ex: Transposition of GV, Truncus, Hypoplastic Left Heart Syndrome