exam 5

can be done Can be made before birth via prenatal ultrasound* Increased material serum alpha fetal protein (aFp)

diagnosis Lab test woudl shou high levels of

§ abnormal intestinal water and electrolyte transport that can result in profound dehydration

diarrhea can cause

o Topical miconazole, clotrimazole *** azoles are used for fungal infections o Selenium Sulfide Shampoo (versicolor and capitis) -2 X per weeks o Topical 1-2 weeks continue to use evn after lesion resolves o Management/prevention o Don't share grooming items, Don't share towels, clothing items o Animal-human transmission o Tinea capitis-no school for 1 week after treatment started**

tinea medication

• Level of consciousness (LOC) • Vital signs • Head, face, and neck • Cranial nerve function- eye shifts speech pattern • Motor function • Reflexes • Sensory function- see, smell hear Increased intracranial function

things to look for in physcial exam

B) Allow the buttocks to dry E) Apply zinc oxide ointment to the affected area*

A nurse is caring for an infant who has diaper dermatitis. Which of the following should be included in the plan of care? (Select all that apply). A)Use talcum powder to dry diaper area B) Allow the buttocks to dry C. Use commercial baby wipes to cleanse area D. Use cloth diapers until rash is gone E. Apply zinc oxide ointment to the affected area

B The cause is unknown and not contagious*

A nurse is teaching the parent of an infant who has seborrheic dermatitis. Which of the following should be included? (cradle cap) A)The patches are from not washing the infant's head regularly B)The cause is unknown and not contagious C)The patches are due to an infection the infant has D)The cause is due to the infant acquiring it from another child at day care

• Sudden cessation of motor activity or speech- just freeze • Blank facial expression • Rhythmic twitching of the mouth, eyebrows, chin, eyelids, or other parts of the face • May experience countless amounts of seizures during the day • May go unrecognized/not associated with a postictal state- no postictal state • Minimum or no alteration in muscle tone • Often mistaken for inattentiveness • Brief loss of consciousness- may not remember episode (like flash knockout) • Seldom fall • Amnesia for the episode • May need to reorient self at end of episode

Absence Seizure

• postinfectious and are associated with prior history of pneumococcal, streptococcal, upper respiratory or skin infection Acute poststreptococcal glomerulonephritis is the most common of postinfectious renal diseases in childhood **

Acute glomerulonephritis often a result of

• Most common type of meningitis** • Majority of patients are younger than 5-years-old • Enterovirus accounts for mostly all cases* • Prompt assessment and diagnosis by provider • Antibiotics are given until cultures are back- but are given at least 48 hours • If is determined to be viral, antibiotics are stopped and antivirals may be started • Lasts 3-10 days usually discharged and continued on meds if ordered • Not as scary as bacterial

Aseptic Meningitis- Viral

• Comfort measures • Reduce pain and fever • **If patient LOC is stable and tolerating fluids, can be managed at home*

Aseptic Meningitis- Viral management

Chronic condition that occurs in response to an allergen- see a lot with celiac- gluten intolerance Common food allergens: eggs, wheat, milk, peanuts Common environmental: molds, dust mites, cat dander symptoms Itching Dry, red, scaly rash with lichenification (thickening of skin) On face, upper arms, back, thighs, hands and feet Has indistinct borders labs gE levels, skin prick allergen test(test not done until. 1-2 yr old)

Atopic Dermatitis (eczema) symptoms labs

Skin hydration, maintaining skin integrity, and prevention of infection ** priority o Oatmeal baths o After bath, pat dry and apply Eucerin while still moist-be liberal with Eucerin o Decrease pruritis (itching) o Decrease Inflammation o Prevent Infection Topical corticosteroids, immune modulators, antihistamines, antibiotics Should not be bathed every dries out skin Keep fingernails short Yellowing discharge - pay attention for development of impetigo for ex Limit things to avoud reaction No eggs until 2 yrs No peanuts o No fish until 2-3 yrs

Atopic Dermatitis (eczema) interventions

• LP (pressure, culture, WBC's, protein, and glucose)- done asap - brought directly to lab • CBC • Blood culture • Urine culture • Nasopharyngeal culture • Antibiotics first cultures after need to start asap is suspect bacterial meningitis

Bac. Menengitis Lab testing

• Administer antibiotics ASAP- this done first then culture • Obtain cultures as ordered • Isolation precautions** • Comfort measures- photophobia, loud noise, pain • Support ventilation and perfusion • Frequent vital sign measurements and trends • Administer anti-pyretics • Education and support to patient and family

Bac. Menengitis nursing managment

infection of the meninges (lining that surrounds the brain and spinal cord) • Serious illness that can result in brain damage, nerve damage, deafness, stroke, and death • Requires rapid assessment, diagnosis, and treatment • Occurrence has decreased dramatically due to what vaccine? Meningococcal • More serious of the 2 • Emergency when expected- give antibiotic asap

Bacterial meningitis

• Causes inflammation, swelling, purulent exudates from spinal cord will find with lumbar puncture, and tissue damage in the brain Can occur as a secondary infection

Bacterial meningitis patho

· bind to the surfaces of the bones and slow down the bone resorbing action of the osteoclasts (bone-eroding cells). This allows the osteoblasts (bone-building cells) to work more effectively. · Fosamax - alendronate · Actonel - risedronate · Boniva - ibandronate · Reclast - zoledronic acid

Bisphosphonates

·Report symptoms of hypocalcemia (muscle spasms, facial grimacing, convulsions, irritability, depression, and psychoses).* · Report symptoms of hypercalcemia (increased bone pain, anorexia, nausea/vomiting, constipation, thirst, lethargy, fatigue, confusion, and depression).** · Report any changes in urinary function

Bisphosphonates - Nursing Care***

Reclast or Zometa is a once-yearly IV infusion treatment.** know this · Fosamax can be taken daily or weekly in pill form. · Liquid Fosamax can be taken weekly. · Actonel can be taken daily, weekly, or monthly. · Boniva can be taken once a day or monthly in pill form. · An intravenous (IV) form of Boniva can be given once yearly.

Bisphosphonates Dosing

Dual Energy X-ray Absorptiometry(DEXA) A test that measures the density of minerals in your bones. It is painless, you remain fully clothed and it takes less than 15 minutes.** no metal Used to diagnose bone loss and osteoporosis Can predict risk of future bone fractures diagnosis of osteoperosis is based on Tscore

Bone Mineral Density Test (BMD)

hemorrhage* especially premi babies premature infant has more capillaries in the periventricular area of the brain, which is the brain tissue that lines the outside of the lateral ventricles. very fragile repsotion frequently so no misshaped heads

Brain is highly vascular, which leads to a high risk of _______especially in this population

Develops on intact skin* like to get between dermis and epidermis- leads to blister This form of impetigo is caused by staph bacteria* These bacteria produce a toxin that reduces cell-to-cell stickiness (adhesion) causing separation between the top skin layer (epidermis) and the lower layer (dermis) This leads to the formation of a blister often appear on the buttocks and trunk The bullae are delicate and often break and leave red, raw skin with a ragged edge A dark crust will commonly develop during the final stages of development With healing, this crust will resolve

Bullous Impetigo

Poor feeding, vomiting Failure to gain weight Frequent urination Screaming on urination* Jaundice, dehydration* Respiratory distress* Symptoms can be non-specific

CLINICAL MANIFESTATIONS - UTI Neonate

Poor appetite, vomiting Growth failure Excessive thirst Frequency or urgency Enuresis, incontinence in a child toilet-trained* Strong-smelling urine Pain on urination Fatigue, abdominal or back pain- if reach kidnies Swelling of face, pallor Blood in urine

CLINICAL MANIFESTATIONS - UTI childhood

Poor feeding, vomiting Failure to Thrive Excessive thirst* Frequent voiding Foul-smelling urine* Pallor, fever* Persistent diaper rash* Vague symptoms so have to rule out other things Straight cath urine specimen or clean catch bag (Ubag) and blood work and blood cultures

CLINICAL MANIFESTATIONS - UTI infant

• Non-specific clinical symptoms that are characterized by abnormal motor pattern and postures caused by non-progressive abnormal brain function • Disrupts the brain ability to control movement and posture** • Majority of cases occur before delivery • Most common movement disorder of childhood** • Lifelong condition, most common cause of physical disability* often in a wheel chair • Higher in premature and low birth weight infants*

Cerebral Palsy

• Respiratory status (cough, sputum production, increased work of breathing)- what was/is baseline • Motor function (change in muscle tone or spasticity) • Fevers • Feeding and weight loss • Changes in physical state or medications

Cerebral Palsy assessment

• Involves multiple disciplines- pt ,ot, speech , neuro dietician , PCP • Gain optimal development and function- and maintenance of • Preventative, supportive, and symptomatic • Promoting mobility by use of therapeutic modalities and medications- most cases don't have a normal gait and need aids - avoid regression • Promoting mobility** • Promoting nutrition** Providing support and education • Surgical management is used to correct deformities

Cerebral Palsy management

• Spasticity • Muscle weakness • Ataxia

Cerebral Palsy s+s

2-3 months of age

Cleft lip repaired around

· 6-9 months of age (best if before 18 months of age) · to protect tooth buds, allow for development of normal speech patterns

Cleft palate repaired around this helps_______

• Loss of appetite and fatigue • Vomiting/anorexia • Hypertension • Fever • Lethargy • Abdominal pain • Headache • Common vague symptoms make it tough -so need labs and pay attention to urine along with history

Clinical Manifestations acute glomerulonephritis

heart defects, ear malformations, skeletal deformities, and genitourinary abnormalities**

Common anomalies associated with cleft lip and cleft palate are

Penicillin's Sulfonamide- Bactrim is a big one (including trimethoprim-sulfamethoxaole) Cephalosporin- ceflex Nitrofurantoin- older child, doesn't come n liquid Docs may also give a broad spectrum until know the specific org

Common anti-infective agents used for UTI include

• Disruption of electrical communication among neurons • Condition in which seizures are triggered recurrently from within the brain • A common neurologic disorder discovered in childhood • Brain injury or infection can cause epilepsy as well

Epilepsy

Cleaning the hard stool out of the lower colon- enema Keeping bowel movements soft so the stool will pass easily- maybe stool softener Toilet sitting at least twice a day (if age appropriate) day for 3-5 minutes**, preferably 15-30 minutes after a meal. ** Retraining the intestine and rectum to gain control over bowel movements It is very important that the child has a routine and family sticks to it. Long-term success depends on how well they can follow the care plan. exercise

Constipation and Encopresis Treatment includes

• 1. Epilepsy is two or more unprovoked seizures occurring more than 24 hours apart • 2. One unprovoked seizure that occurs after the initial seizures have occurred that can happen within ten years time • 3. Diagnosis of an epilepsy syndrome

Diagnosis is based on 3 conditions

Confirmed by detection of bacteria in urine culture* looking for leukocytes bladder Bladder catheterization - try t exclude first few ml clean catch bags - prone to contamination Note AZO, Skin, Hair & Nails- may affect lab results ** antibiotic make sure the right antibiotic is sensitive to attack the bacteria present

Diagnostic Evaluations-UTI looking for? how done what may affect treatment

• Edema • Proteinuria- 2++ on urine dipstick* • Urine will be frothy * • Hypo albunimenia • Elevated cholesterol • Elevated triglycerides

Diagnostic evaluation-nephrotic syndrome

• Inject dye and watch through x-ray and watch how pt voids to see if urine backs up into the kidney

Diagnostic test (VUR)

Caused by prolonged exposure to urine and stool** change diapers frequently Diaper wearing increases skin pH, activating fecal enzymes which cause further irritation- Prevention: Gentle skin cleansers Prevent by using barrier creams or ointments containing vitamins A, D, and E, Zinc Oxide, or petrolatum Expose area to air- often helpful for red bums - diaper wearing just needs to air out and breathe Allow infant to go without a diaper for a period of time each day* Frequent diaper changes Treatment: NO air-dryers (book says to use, but not recommended), heat, talcum powder, wipes with alcohol and fragrances

Diaper Dermatitis causes prevention treatment

Add more fruits and vegetables Add more whole grain cereals and breads Encourage child to drink more fluids, especially water Diets high in fiber Limit drinks with caffeine- soda Limit whole milk to 16 ounces a day for the child over 2 years of age Meals should be on a regular schedule. Often, eating a meal will cause children to feel the urge a bowel movement. Serve breakfast early so the child does not have to rush off to school and miss the opportunity to have time to toilet.

Dietary changes to consider constipation

• Urethral defect in which the opening is on the dorsal surface of the penis • If left uncorrected, the boy may not be able to control aim of urine and can interfere with deposition of sperm- INFERTILITY o Usually repaired sometime after 1 yr of age

Epispadias

• Absence of dystrophin (protein that is missing), which is a protein that is critical for maintenance of muscle cells • X-linked recessive* (mainly boys are affected, and they receive the gene from their mothers who are carriers) • The disease progresses from the hips, thighs, pelvis, and shoulders and then moves on to the respiratory and cardiac system • Often late in learning to ambulate** • Preschool years they fall and are clumsy • May be difficult for the school aged child to raise their hand • Normal intelligence, some learning difficulties* very bright makes this very tough they know what happening

Duchenne's Muscular Dystrophy

• Promoting mobility- keep them moving • Maintaining cardiopulmonary function • Maximizing quality of life- bc not long and they know it

Duchenne's Muscular Dystrophy Nursing Management

• Steroids to slow progression of the disease (show improve strength and function) complications of long term use of steroids including weight gain, mood changes** , and osteoporosis* • Calcium supplements and Vitamin D are prescribed • Anti-depressants • Beta-blockers and ACE inhibitors to decrease workload of the heart Braces, orthotics, and positioning aids are used

Duchenne's Muscular Dystrophy Therapeutic Management

a result of chronic constipation or withholding of stool. Children with encopresis, also called soiling, have bowel movements or leak a small amount of stool in their underclothes or on themselves.

Encopresis

atopic dermatitis

Eosinophils may be elevated in

Caused by Parvovirus B19 20% will not have symptoms Symptoms: fever, runny nose, and headache, then you get a rash on face and body after several days "slapped cheek" rash* Rash may be itchy Transmitted through respiratory secretions or blood/blood products Usually not contagious after you get a rash*** No treatment Droplet precaustions Don't give this pt to a pregnant nurse

Erythema Infectiosum (Fifth Disease cause tranmission symptoms treatment

· maternal history of hydramnios (too much amniotic fluid)* o nowhere for amniotic fluid to go because baby cant ingest and excrete

Esophageal Atresia with or without Tracheo-esophageal Fistula common sign

• It is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A beta-hemolytic streptococci- strep throat • A latent period of 10-21days occurs between the infection and the onset of clinical manifestations*

Etiology Acute glomerulonephritis

· Health history · Dietary history · Activity level · Food allergies · Family structure/social assessment · Development of infant/child · Physical examination

Failure to Thrive (Assessment)

· Growth delay (failure) and weight (and possibly height) below 5th percentile ** · May be organic or inorganic · Growth failure is often times multifactorial

Failure to Thrive (FTT)

· Strict feeding schedule · Monitor daily weights- same time same scale same clothing, security bracelet · Education on feeding techniques- done by dietician reinforced by nurse · Education on formula preparation-done by dietician reinforced by nurse · Education on nutritional needs of the infant/child · Promote positive parenting skills · Calm environment · Observe feedings - baby able to suck swallow breath · interest vs aversion/oral motor coordination/swallowing ability/parent and child interactions) · May require enteral feedings for a period of time to help catch up the infant/child to appropriate growth percentiles o Want brain to develop accordingly

Failure to Thrive (Nursing Management

• Provide parental support and education • Reassurance to parent on the benign nature of this type of seizure • Control fevers- Tylenol/ ibuprofen • Safety during a seizure • Instruction and demonstration of rectal diazepam** important to know how to do before discharge • When to call provider • When to take to emergency room

Febrile Seizures Nursing Management

7mL/kg/24-hour period

Fevers increase fluid loss to

2/3

Fluid lost through the skin accounts for ____ how much insensible water loss

· Take on an empty stomach** · No food for 30-60 minutes(( · Large glass of water** · MUST stay upright for at least 30 minutes.** · Notify the provider reflux or epigastric pain

Fosamax

premature babies

GER/GERD very common in this population

Can be found on pre-natal ultrasound Increased maternal serum alfa fetal protein

Gastroschisis diagnosis labs will show high

Depends primarily on how swollen or inflamed the intestine is, how much is outside the abdomen and the size of the baby Primary repair • A primary repair is when all of the intestines back into the stomach and the hole is closed. - usually, small not super inflamed and body can take the intestine back • Staged surgery • Infants intestines are placed inside a protective pouch called a silo. • Over time, gravity will let the intestines drop down into the stomach. • Every day, the surgeon will gently push the intestines from the silo into the infant's stomach. When all of the intestines are inside, the surgeon will close the hole- can be lengthy process - keeping them stable - warm and hydrated and free from infection

Gastroschisis surgery

Sterile drawstring bowel bag is implemented Perfusing the herniated organs Thermoregulation

Gastroschisis treatment

The anterior abdominal wall remains open or separated during fetal development. During embryonic development the abdominal wall fails to close, and there is an opening through the rectus muscle typically to the right of the umbilicus. This opening allows the developing organs and bowels to protrude. Abdominal organs liver and spleen, and often the intestines protrude out, are exposed outside the body cavity without a peritoneal layer Bowels are exposed and not covered by the peritoneal layer Young maternal age* Consuming alcohol and tobacco during pregnancy.** Reduced blood supply during fetal development resulting in reduced blood supply to the abdominal wall.

Gastroschisis cause/ risk factors

Observe for pallor, fatigue, generalized edema, skin changes that may be s/s of kidney disease

General Appearance renal/ urinary pt

The nerves controlling the smooth muscle in the colon is not developed correctly during gestation. The rectal and distal sigmoid colon are usually affected

HIRSCHSPRUNG DISEASE

pain- consider ant/ post approach -ant less pain assess circulation address mobility- walk 3X day using assistive devices prevent infection- antibiotics, han hygiene , proper wound care adress injury risk- Home care, assistive device, living environment adaptive equipment no bending past 90 degrees no internal rotation- crossing legs, pillows between legs

Hip Replacement Post - op nursing care

· COX I and COX II · Cyclooxygenase - ENZYME required for formation of prostanoids. The three main groups of prostanoids -- prostaglandins, prostacyclins, and thromboxanes . · Prostaglandins protect the GI mucosa- cox 1 · Selective COX II inhibitor drugs safer for gastric ulcer patients · Non-selective have side effect profile · Inhibit prostglinds- prostaglands the inflammation cause the discomfort · Cox 1 helps with GI

How NSAIDS work

• Health history to include intrauterine infections, prematurity with a history of intracranial hemorrhage, meningitis, and mumps encephalitis • Description of current illness and chief complaint

Hydrocephalus assessment

diarrhea or gastroenteritis

Hyperactive bowel sounds think _______

obstruction process Think possible appendicitis

Hypoactive or absent bowel sounds think_______

• Assess urinary drainage • Ensure the urinary drainage tube remains carefully taped to prevent stress on the urethral incision • Compression-like penile dressing to decrease edema and bruising • Assess for pain • Antispasmotic medication may be prescribed (Oxybutynin q 8 hrs)- for spasms o no straining to move bowels • Prophylactic antibiotics will be prescribed - area naturally is dark moist and warm so need to make sure not to create infection • Want them to take it easy for 8-10 days to decrease stress on sutures and decrease pain

Hypospadias/Epispadias post-op care

• Urethral defect in which the opening is on the ventral surface of the penis rather than on the end

Hypospadias:

• delayed development of motor skills (sucking, swallowing, breathing=delayed physical growth and ability to eat orally to maintain nutrition)** • Apnea is also attributed to immature nervous system

Immaturity of the CNS in preterm infants results in

Bullous Oral first-generation cephalosporin- cefazolin** Good hygiene Non-bullous If limited amount: Topically with Mupirocin (Bactroban) ointment If numerous lesions: oral first-generation cephalosporin Clindamycin** if MRSA- vancomycin* Remove honey colored crust with cool compresses BID**** keep clean and dry For both types: No daycare/school for 24 hours!!! Good handwashing!!!****

Impetigo Treatment bollus non bulous

Abdomen size and shape (should be assessed while standing and supine)* should be flat while supine babies will be round while up and flat Protuberant abdomen (bulging outward abdomen) suggests ascites, fluid retention, gaseous distention, or a tumor Depressed or concave abdomen could suggest a high abdominal obstruction or dehydration Mental status (irritability and restlessness are early signs) ** awake and alert is good signs ***Lethargy (sluggish or abnormally drowsy) and listlessness can occur very rapidly in the Pediatric population***

Inspection of Abdomen

Referral to a tertiary center specializing in these conditions Prevent hypothermia* Maintain perfusion to the eviscerated abdominal contents by minimizing fluid loss Protect the exposed abdominal contents from trauma and infection Wrap in warm moist sterile saline gauze Sterile gloves etc. prevent infection Place the infant in a sterile drawstring bowel bag (feet first) that maintains a sterile environment for the exposed contents

Intervention Omphalocele

Occurs when a proximal segment of the bowel "telescopes" into a more distal segment. Most common intestinal obstruction in infants and small children under 3 years of age**

Intussusception

Ultrasound, x-ray usually visible or computerized tomography (CT)- avoid high radiation Air or barium enema Provide enhanced imaging Procedure actually fixes condition 90% of time in children and no further treatment is needed. If bariatric enema needs pedi surgeon incase perf bowel - will dump bowel content in peritoneum may become septic Intussusception can result in bowel ischemia. Rapid treatment is important If barium or air enema is not curative, surgery will be needed.**

Intussusception diagnostic tests

o Sudden onset of intermittent, crampy abdominal pain o Severe pain (child draws knees up to chest and screams) o Vomiting, diarrhea, fever, lethargy o Currant-jelly stools, gross blood or occult positive blood** halmark o Hard sausage-shaped mass in upper mid-abdomen is a hallmark sign.** o Intestinal edema, vascular compromise, partial or total bowel obstruction

Intussusception s+s

• Unknown cause • Males • Duplication Cysts • Cystic Fibrosis • Celiac Disease • Chron's Disease

Intussusception risk factors

Administer IV fluids and antibiotics before the diagnostic laboratory and x-ray studies are performed.* incase of perforation- lab draw first so don't affect Offer emotional support and provide appropriate preoperative and post-operative education to the family.

Intussusception nursing managment

Antibody testing including:** Auto-transmission transglutaminase (IgA ) antibodies* Anti-endomysium (EMA) IgA* *These tests are most reliable when performed while gluten is still in the diet. Intestinal biopsy Will reveal partial or subtotal villous atrophy or blunting of the villi of the small intestine Genetic testing Includes DQ2 and/or DQ8 human antigen (HLA) haplotypes.- don't worry about specific but know they may do genetic testing

Lab test/ diagnostics celiac

Caused by spirochete Borrelia Burgdorferi (bacteria) Blood test may not appear positive for 4-6 weeks after exposure** Characteristic bull's eye rash (usually occurs 7-14 days after bite, but can appear 3-32 days after) A tick needs to be attached for 36-48 hours in order to get Lyme disease**

Lyme Disease when will see pos blood test how long does a tick need to be attached

Most common among boys age 5-9yrs severe fatigue unrelieved by rest insomnia headaches nausea, abdominal pain impaired concentration poor short-term memory inability to sustain attention difficulty thinking and expressing thoughts difficulty reading and writing being overwhelmed by schoolwork difficulty making decisions confusion uncharacteristic behavior outbursts and mood swings fevers/chills joint pain dizziness noise and light sensitivity

Lyme symptoms

always done last · Lightly palpate initially assessing for areas of tenderness, lesions, muscle tone, turgor · Deeply palpate from the lower quadrants to the upper quadrants (this is best done with a patient on inspiration) o abdomen will be soft or firm and tenderness or masses may be indicative of stool or a mass - Kids are full of poop and are often constipated Tricks of the trade

Palpation of Abdomen

• Bacterial • Aseptic (viral)

Meningitis Types

Valproic Acid (Depakote, Depakene): • Monitor levels and can be sprinkled on foods* Levetiracetam (Keppra): • Monitor for gait disturbances**, B-vitamins can help with side effects** All meds can be given IV as well • Ex if have vomiting and diarrhea but has seizure disorder- can give IV • Give nuero meds and GI meds first- they are most important

Miscellaneous antiepileptics

Maintain a healthy weight Stop smoking Avoid excess alcohol consumption

Modifiable Risk Factors

Caused by a virus (wart-like)* Virus affects the outer layer of skin Causes small white, pink, or flesh colored raised bumps or growths with a dimple or pit in the center Usually painless Usually disappears within 6-12 months without treatment Most common in children 10-12 years old Prevention: good hand hygiene, cover bumps to prevent transmission

Molluscum Contagiosum cause symptoms treatment

rosy, maculopapular rash (drug reactions)

Morbilliform:

urinary stasis Decreased fluid intake- sometimes can be hard to get them to drink Incomplete bladder emptying may result from reflux anatomic abnormalities neurogenic bladder voiding dysfunction intrinsic ureteral bladder compression caused by constipation Infection of one or more structures of the urinary tract

Most important risk factor influencing UTI is

• Inherited condition that results in progressive muscle weakness and wasting* • Skeletal (voluntary) muscles are involved • The genetic mutation in muscular dystrophy results in an absence or decrease in a specific muscle protein that prevents normal functioning of the muscle* • Duchenne's Muscular Dystrophy (most common neuromuscular disorder of childhood) is fatal by age 20-25* • Medical advances are giving the life expectancy in some cases until 40's-50's Incidence is 1 in 3,500 male births* male specific

Muscular Dystrophy

inhibit cox 1 and cox 2 except celbrex- only inhibits cox2 mild- moderate pain

NSAIDS what to know

• This disorder is characterized by increased glomerular permeability to plasma protein, which results in massive urinary protein loss- often male • Forms 1. congenital- autosomal rcessive disorder 2. idiopathic- most common 3. secondary- associated with glomerular damage- 2ndary to something liek diabtes, lupus

Nephrotic syndrome

• Adjust activities according to tolerance level • Suitable recreational and diversional activities are an important part of pediatric care- don't want to tire too much and allow them to get sick • Irritability and mood swings that accompany steroid therapy are common and not unusual ** • Instruct parents to test and monitor urine for protein, proper administration of medications • Teach parents to detect signs of relapse- how to test and monitor for protein if old enough let pt do it support the child- appearence etc.

Nephrotic syndrome Nursing care

congenital problems, infections, or traumas

Neurological disorders can result from

· Surgical procedure that wraps and sews the fundus around the esophagus, which tightens the esophagus and prevents stomach acid from being able to flow upward

Nissen Fundoplication

Dowager's hump Decreased height 2-3 inches Fractures BMD <-1 BMI Kyphosis- risk for fall

Nursing Assessment Osteoporosis - physical changes

• Weight gain - recent • Puffiness of face - periorbital edema • Abdominal swelling (ascites) • Pleural effusion • Labial or scrotal swelling • Edema of intestinal mucosal, possibly causing diarrhea, anorexia, poor intestinal absorption • Irritability, fatigue, lethargy • Urine alterations: - Decreased volume - Frothy

Nursing Assessment nephrotic syndrome

prevention- education Pain- compression or spinal fx? Fall prevention- no rugs, personal items close , cords wires etc. Promote activity and exercise - weight bearing Calcium and Vitamin D Alcohol and Smoking Medications

Nursing Interventions

· pain management · Gastrostomy Tube Management- usually for chronic issues · drain care · assess for bowel sounds* · introduce feedings and assess tolerance* o absence of abdominal distension (assess abdominal girths every shift and trend) take at same place for consistency

Nursing Management following surgery Nissen Fundoplication

· Elevate head of crib · Avoid infant seats that bounce or vibrate · Avoid swings- will leave you feeling like crap and uncomfortable after eating · Hold upright for 30 minutes after feedings try to get at least · Smaller and more frequent feedings is preferable to thickening* · Thickened feedings*** - oatmeal, rice cereal, store bought thickener- depends on age of baby · ***If GERD cannot be medically managed or requires long term medication management, surgery can be performed***

Nursing Management of GER

Educate parents and patients of proper application of topical medication Educate about using medication properly Washing all bedding, pillows, blankets, stuffed animals, towels, etc. Should be changed daily and washed in hot water and dried in a high heat dryer** go to laundy mat Other items that cannot be washed must be bagged for 5-7 days** do not open Encourage close contacts of patient to be treated as well

Nursing Management: scabies

Umbilical Ring defect Trisomy 13, 18, 21 (Down Syndrome)

OMPHALOCELE associated with what other birth defects

If the omphalocele is very large, surgery may need to be staged progressively, If the baby's omphalocele is small, only one surgery will be necessary to fix it. Small omphaloceles are often fixed easily. Infants with damage to the abdominal organs may have long-term problems* like liver often end up very sick

Omphalocele surgery small large

IV fluids** often a central line Antibiotics- mostly prophylactic to prevent infection OG tube- decompress stomach - air swallowed from crying adds pressure to stomach and abdomen

Omphalocele treatment

o Oral nystatin 4X day

Oral Candidiasis (Thrush) medication

· Degenerative joint disease (DJD) · 50% people over 65 affected · Leading cause of disability* · Significant predictor for functional health in elderly · Primary osteoarthritis (idiopathic) - no prior event or disease. Secondary osteoarthritis - results from prior injury or inflammation

Osteoarthritis

· Painful and stiff joints - caused by inflamed synovium, stretching of the capsule, irritation of nerve endings over periosteum. Additional inflammation of bursa, tendons as well as muscle spasms. · Bony nodes or growths - often painless unless inflammation is present · Test not many for OA but are done to rule out other things like RA

Osteoarthritis - Assessment

· Acute / Chronic Pain · Impaired Physical Mobility · Self-Care Deficit § Inability to manage ADL. OT can be helpful · Disturbed Body Image

Osteoarthritis - Nursing Care

· Degenerative changes · Gradual loss of the articular cartilage · Thickening of subchondral bone · Bony outgrowths (osteophytes) at margins · Synovial inflammation

Osteoarthritis - Pathophysiology

· Exercise is helpful - mobilize joints · Help with weight loss- decrease load on joint · Maybe referred to OT for insoles, braces splints · Massage, TENS, acupuncture/pressures · Surgical procedural interventions- cortisone shot · Limited treatment only allow so many · Hyaluronic acids to help lubricate and cushion Joint replacement

Osteoarthritis treatment

like a pea small raised o Small, raised, reddish or purplish bumps less than 1 centimeter in diameter o Crusts or scales often accompany papular rashes o Papules may be flat topped, domed shaped or slightly sunken in the center o Examples include insect bites, acne and rosacea***

Papular rash

build bone and take calcium from blood

Osteoblasts

break down and absorb bone release calcium

Osteoclast

Low testosterone levels can increase risk of osteoporosis* Men who break a hip or wrist are less likely to get osteoporosis treatment Men have fewer treatment options than women Starting at age 65 both men and women lose bone at the same rate** If before 65 often don't link or treat for osteperosis

Osteoporosis in Men

Low estrogen levels lead to bone loss After menopause increase risk We have thinner bones then men and our bone density decline rapidly after menopause We can lose up to 20% of bone density following menopause

Osteoporosis in Women

· Transient relaxation of the lower esophageal sphincter · This can occur during swallowing, crying, and Valsalva maneuvers that increase intra-abdominal pressure · delayed esophageal clearance or gastric emptying · highly acidic gastric contents · hiatal hernia · neurologic disease · Signs and Symptoms of GER are often seen as a result of damaging components of the reflux

Pathophysiology of GER contributing factors

NOT A SIGN OF POOR HYGIENE* can happen to any one common area Occiput Behind ears Nape of neck Causes severe itching** Treat with pediculocides Permethrins, Pyrethrin's, Lindane, Malathion Natroba (Spinosad): targets resistant strains Medicince is left on for 10 min - its burns! Don't wash hair for 1-2 days will be washing out medicine Wet combing if less than 2 years of age*

Pediculosis Capitis- Lice

Avoid sharing personal items Wash (hot water) or bag anything that has come in contact with affected person (bedding, toys, etc.) Boil brushes or buy new ones- just throw it away Can also spray beds/furniture with Rid Spray Vacuum all furniture and bed

Pediculosis Capitis- Lice- education

· NSAIDS · Ibuprofen · Celebrex- only work son cox 2 which helps avoid the GI distress the other are indiscriminate of cox1 or cox 2 · Voltaren Analgesic · Acetaminophen Narcotics · Oxycodone · Hydrocodone

Pharmacology- osteoarthirtis

· palpate for a hard and moveable olive shaped mass in the right upper quadrant** · if a mass is found there is no further testing · if no mass is found a pyloric ultrasound is ordered

Physical Assessment pyloric stenosis

fungal infection

Potassium hydroxide (KOH_ prep) inditifies

o Congenital abnormality that results in incompetence of the valve of the vesicoureteral junction

Primary reflux (VUR)

small collections of pus (cloudy) on the epidermis that could extend into the dermis- starts at top and goes down into the second layer o Frequently form in sweat glands or hair follicles o Pus is a mixture of inflammatory cells and liquid* o Skin health deviations include acne and impetigo- impetigo bottom pic on nose

Pustular rash

non-bilious - (bilious means its coming from the small intestine) bounces out of the stomach - can't pass into the small intestine -unrelated to feeding position vomiting that occurs between weeks 3 and 6 of life vomiting becomes frequent and forceful and projectile exorcist type vomit weight loss dehydrtation and lethargy fam history

Pyloric Stenosis notible signs

because of fluid resp may increase vulneralbel to URI- ensure pneumococcal vaccine live vaccines shoudl be held for 2 weeks after steroid/ immunosepressant drugs

Respiratory assessment- nephrotic syndrom

• Seizures that are greater than 5 min - give diazepam • Prolonged seizure • Call for first seizure or new onset disorder where seizure go lone than 5 min • Injuries

S+s of a seizure to report

o Highly contagious infestation by the mite Sarcoptes scabiei** o Spread skin-to-skin direct contact** o Mites are so small, a microscope is needed to see them o Rash with various types of lesions, severe pruritus that worsens at night**, and restlessness o May appear as a widespread atopic dermatitis** o Mostly found in the webs of the fingers, gluteal folds, axillae, palms, wrists, elbows, inner thighs, and waist Contact precautions o Take note for pt that keep itching

Scabies how spread? presentation precautions

o Related to other structural or functional problems such as neurogenic bladder, bladder dysfunction, or bladder outlet obstruction • could it be and underlying cause? Ureters fail to angle, child bears down and reflux could occur. • Could be unilateral, bilateral, bilateral with different grades.

Secondary reflux (VUR)

• Sudden onset of symptoms* • Preceding respiratory illness or sore throat* • Fever/chills* • Headache* • Vomiting* • Photophobia* • Rigid/stiff neck* • Rash • Irritability/high pitched cry- can be confused with NAS - make sure don't have neuchal rigidity • Lethargy/drowsiness • Muscle rigidity • Seizures • In newborns, signs and symptoms can be subtle and atypical • Poor sucking and feeding • Weak cry • Lethargy • Vomiting

Signs and Symptoms: * classic signs Bac. Menengitis

shorter

Small intestine is significantly_____ than adult

1500 ml

Stomachs of 16 year olds can hold up to

200ml

Stomachs of infants 2 months of age can hold up

10-20 ml

Stomachs of newborns can hold

Minus 2 or lower greater risk for fx minus 2.5 osteoporosis

T-score

take with plain water need to asses ability to remain upright 30 min assess GI tolerance teach S+S of gastric irritation

fosamax what to know

ACD · Want to burmp throughout the feeding about every oz at a time. · Prokinetics- Metoclopramide (reglan) - get 30 min before et and again at bedttime · Given No more than 12 weeks

The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The child will be managed medically. What actions would the nurse incorporate into the teaching plan? (Select all that apply.) A. Giving the child small frequent feedings B. Burping the infant at the end of the feeding C. Keeping the child upright for 30 minutes after feeding D. Administering prokinetics to empty the stomach quickly E. Thinning the formula with water to ease flow

A

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? A. Mother age 42 with pregnancy- B. Maternal use of acetaminophen C. History of hypoxia at birth D. Preterm birth

• Focus is on controlling or reducing seizures o Can NOT interchange generic or brand name whatever the patient is on and works is what they must stay on. Changing may lower seizure threshold • Teaching child and family how to handle recurrent seizures- how to stay safe • Medical alert bracelet. • May lose bowel or bladder control - can be embarrassing • Teaching child and family about anticonvulsants • When how going to give , same times daily • Using the fewest drugs with fewest side effects as possible to control seizures**

Therapeutic Management epilepsy

• Corticosteroids- 2 mg/kg body weight/d for 6 weeks; followed by 1.5 mg/kg qod for 6 weeks • Side effects: increased appetite, weight gain, rounding of face, and behavior changes- may become moody and uncooperative- lily this change is from the medication - if dont respons to steroid therapy may need immunosuppressant meds - no school if immunocompromised may need albumin infusion diuretics - for edematous phase

Therapeutic management nephrotic syndrome First line therapy

o Oral antifungal § Nystatin** · 4 times per day after feeding*** · May swallow or use a cotton tipped applicator · burns and taste terrible § Fluconazole (Diflucan)- often b/c mom is the cause and mom takes wouldn't give until adolescence · Once per day · Monitor for hepatotoxicity · Administer with food to decrease side effects such as nausea and vomiting do not whipe off thrush patches

Thrush (Nursing Management)

Fungal infections are called mycoses (mycosis-singular) Mycoses are superficial, subcutaneous, or systemic Varying locations on body: Pedis (athlete's foot) Corporis (arms/legs) may occur on any part of the body Versicolor (trunk/extremities) Capitis (scalp/eyebrows/eyelashes) Cruris (groin) Diagnosed by microscopic exam of scrapings

Tinea

Knee arthroplasty - resurfacing Remove damaged cartilage surface and a small amount of bone from each end. Position the metal implants. These metal parts may be cemented or uncemented based on age/x-ray. Cemented- immediate bond but may loosen Uncemented- weaker at first but form a stronger permanent bond. Kneecap is either unaltered or resurfaced (surgeon attaches a separate piece to the back of the kneecap to fit smoothly. Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

Total Knee Replacement

• Urinalysis • BUN (indirect measurement of renal function) • Creatinine (direct measurement of renal function) • Creatinine Clearance • Urine & Serum - 24-hour urine o Kept on ice and in big container

Urine Tests of Renal Function

A condition in which urine from the bladder flows back up the ureters into the upper urinary tract Can occur in 1 or both ureters Classification system describes the degree of reflux ranging from Grande I to Grade V

VESICOURETERAL REFLUX (VUR)

clear fluid filled sacs on the skin, raised, and red o Vesicular rash could be caused because of heat, poison ivy, early chickenpox, herpes simplex***

Vesicular

Promotes calcium absorption from the gut.* Maintains adequate serum calcium and phosphate concentrations to enable normal mineralization of bone. Bone growth and bone remodeling by osteoblasts and osteoclasts. Without sufficient vitamin D, bones can become thin and brittle** Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis.**

Vitamin D

• Increase metabolism • Increase oxygen need • Reduced ability to ventilate • Risk for Aspiration • Breathing pattern is ineffective

What do seizures do to the body

water loss occurs rapidly and in large amounts important to trend I/O

When illness happens in relation to fluid loss in a child fluid loss occures_______ making it important to track

Spreads quickly This is the more common form,** caused by both staph and strep bacteria Usually follows some type of skin trauma This form initially presents as small red papules similar to insect bites- so slightly reaised These lesions rapidly evolve to small blisters and then to pustules that finally scab over with a characteristic honey-colored crust This entire process takes about one week These lesions often start around the nose and on the face, but less frequently they may also affect the arms and legs At times, there may be swollen, but non-tender lymph nodes (glands) nearby

With healing, this crust will resolve Non-bullous Impetigo- spreads

sustained or vigorous crying in the infant give pain medications- anticipate stay on top of pain comfort/distraction methods cuddling/rocking/anticipating needs dont want to stress suture lines

after repair prevent

• Frequent monitoring VS, especially BP * q-4-6 hrs • child may need antihypertensives manage edema daily weight I/O abdominal girth heart and lung sounds no added salt diet iron suppliments prevent infection reverse precautions rest -quiet diversional activities diuretics antibiotics of ongoing strepp NO NSAIDS- tylenol -NSAIDs may cause decrease in glomerular filtration rate

acute glomerulonephritis nursing care

Vague abdominal pain (periumbilical) occurs in initial stages. Pain gradually localizes to the right lower quadrant over a few hours and localizes to McBurney's point. Nausea and vomiting (may develop after the onset of pain) Small volume, frequent soft stools (often confused with diarrhea) § Fever (usually low grade unless perforation occurs which results in high fever)

appendicitis s+s

Appearance of protrusion Evidence of a sac- is it intact if not then bowel leakage may be present much worse Look for organs- liver?Usually, small intestine

assessment Omphalocele

On palpation of the abdomen: Rebound tenderness and abdominal guarding are signs of an acute abdomen and should be reported immediately to physician. Rigid tender, pain If the child's abdominal pain is suddenly relieved without intervention, suspect perforation; notify physician immediately.**

assessment findings appendecitis

prevention educate on rotovirus vaccine hand washing food prep

best intervention for diarrhea

Age - bone density declines over time Hormones - estrogen, increased thyroid hormone** estrogen protects bones - decreases with age Environment - decreased sunlight(decreased Vitamin D), changes with seasons** Genetics - family history of fractures Diet - adequate calories and nutrients (calcium and vitamin D) decreased absorption with age Lifestyle - Smoking and alcohol consumption, decreased physical activity- less stress on bones, less strength of bones Medications - steroids- weaken bones

bone density is affected by

Stored in bones, balanced by kidneys* Calcium level should be 8.5-10.2** Calcium is needed for the heart, muscles, and nerves to function properly Low calcium is a associated with low bone density* Most people are not getting enough calcium to maintain healthy bones Women 51 and older need 1,200mg per day** Men 51-70 need 1,000mg per day and >70 need 1,200 per day Don't like to be taken in single dose - at least split or increase doses in diet Yogurt milk, collard greens, spinach

calcium

• Rest- brain rest most important* , limit screen time, limit deliberate focus - reading • monitoring for neurological changes

concussion treatment

found in foods such as milk, yogurt collard greens, spinach, almonds and cheese** Salty foods can decrease your bones calcium reserves** Supplements can be taken if you have trouble consuming enough calcium rich foods such as Calcium Carbonate (tums) or Calcium citrate.

calcium intake

calcium supplement -treats osteoporosis assess calcium levels, kidney function BUN/Cr interactis with digoxin - caution w/ pt with dysrhythmias contraindicated - hypercalcemia, renal calculi antagonistic to calcium channel blocker zinc, alcohol, can carbonated drink hinder absorption

calcium salts what to know

May be caused by infection: A recent GI infection can move to the appendix May be caused by obstruction: A hard piece of stool (fecalith) may obstruct, and bacteria may become trapped and infect the appendix

cause appendicitis

Viruses: Rotavirus most common in young children (28% of all cases causing fatality) Norovirus more common in older children Bacteria: Salmonella Shigella Campylobacter Escherichia coli ( E. coli) Parasites: Giardiasis, Enterobiasis (Pinworms)

causes for diarrhea

immune disorders corticosteroid inhaler use therapy that suppresses the immune system antibiotic use transferred from the breastfeeding mother to the infant

causes for thrush

More women than men are diagnosed with celiac disease There is increased incidence in families with celiac disease, and in persons with other autoimmune or genetic disorders (Can be associated with Type I diabetes) A disease of the proximal intestine characterized by abnormal mucosa and permanent intolerance to gluten * Intolerance to GLUTEN The body mounts an immune response that attacks the small intestine when the person eats gluten These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption . • Nutrient absorption decreases significantly • Damage occurs to the intestinal mucosa that leads to malabsorption of nutrients • Celiac disease becomes apparent in infants when gluten ingestion begins.* when start regular foods

celiac Etiology / Risk Factors

Persistent diarrhea (or constipation) Steatorrhea (fatty stools) stools can be pale, light tan or gray, watery, frothy, and foul-smelling Weakness and fatigue May have a wasted-like appearance thin extremities, abdominal distention or bloating, and poor muscle tone Nutritional and vitamin deficiencies Anemia Irritability and listlessness Dental disorder-tooth discoloration and enamel loss; pale sores inside of mouth Delayed onset of puberty / amenorrhea Irregular menstrual periods Failure to Thrive Weight loss

celiac s+s

Can be unilateral or bilateral soft, hard both delayed speech- speech articulation should be clear by 4months of not surgery is needed

cleft palate laterality? involve soft palate hard palate? may lead to

Phenobarbitol (Luminal) Excessive sedation** • monitor levels, withdrawal can occur • Vitamin D supplement may be needed

common Barbiturates for seizures

Phenytoin (Dilantin) Monitor levels, can cause gingival hyperplasia*, monitor calcium and magnesium

common Hydantoins for seizures

• Diazepam (Valium) Used for status epilepticus- given rectal if longer than 5 min • Lorazepam (Ativan) Used for status epilepticus- thick like coming out of vial 1-1 mix 1ml of med 1ml saline • Can cause tachy cardia and hypotension and sometimes rep distress*

common benzodiazepines for seizures

• Intrauterine infections • Prematurity with intracranial hemorrhage • Difficult, prolonged, complicated labor and delivery • Multiple births • Anoxia* • Head trauma seizure activity

common health history finding in pt with CP

• Carbamazepine (Tegretol) Monitor levels, plasma concentration can decrease • Causes photosensitivity**

common iminodtilbenes for seizures

feeding difficulties- breast feeding is helpful breast fills a lot of space difficulty forming a seal around a nipple in order to create suction for feeding and thus take in an excessive amount of air For cleft palate gagging/choking/nasal regurgitation of milk- have a hole in roof of mouth **Excessive feeding time, inadequate intake, and fatigue contribute to poor growth altered dentition- with both clef lip and pallet primary or permanent teeth may be missing, malformed, or unusually positioned delayed or altered speech development usually with older children that don't get an early fix otitis media

complication of cleft lip palate

buildup of fluid in the middle ear (otitis media with effusion) hearing loss gagging/choking/nasal regurgitation of milk altered dentition primary or permanent teeth may be missing, malformed, or unusually positioned delayed or altered speech development **Excessive feeding time, inadequate intake, and fatigue contribute to poor growth

complications of cleft palate

dehydration growth failure surgery- essentially core out and widen the opening

complications of pyloric stenosis how treated

Infant's epidermis is thinner than the adults* o Blood vessels are closer to the surface of the skin due to a decreased amount of subcutaneous fat* (infant's lose heat more rapidly through the skin surface)* why bundled up so much thinness allows substances to be absorbed quickly into the skin Microorganisms are more likely to gain entry by the skin in an infant* Infant's skin has more water than adults Children who have darker pigmentation have more pronounced cutaneous reactions- ex keloid The sebum that is excreted functions to lubricate the hair and the skin* oily and greasy hair and skin Eccrine sweat glands are functional, will produce sweat in response to emotional stimuli or heat (fully functional in the middle childhood years)*- NAS babies are emotionally traumatized* Apocrine sweat glands are small and non-functional in the infant Apocrine sweat glands develop during puberty, body odor develops* in response to the fluid that is secreted by these glands 5 yr old shouldn't be smelling like BO little kids shouldn't be stinky - if do look into it

differences in skin adult vs infant

5 min

document as absent bowel sounds only after listening for

• Recent:** o Illness o Fever o Trauma o Toxin exposure

epilepsy risk factors : recent...

· · Try to do 30 minutes of weight bearing exercise most days of the week. Brisk walking Jogging Dancing Stair climbing · Do muscle strengthening exercise 2-3 times per week. · Use elastic exercise bands or light weights

exercise to avoid osteoporosis

• LP- can introduce bacteria by accident • Skull fracture/head injury • Neurosurgical intervention • Congenial structural abnormalities • Presence of a foreign body

factors they may cause Bacterial meningitis

Remove things that you can trip over from stairs and places you walk Keep items you use often in easily reachable places to avoid having to frequently use step stools Remove all small throw rugs Use non-slip mats in bathtub and shower floors Have handrails on all stairs and have areas well lit Wear good footwear have non slip soles Have your vision checked regularly

fall prevention

a bone fracture

first sigh of osteoporosis is often

structurally weak bones due to the aging process and bone loss- osteoporosis fx that is sustained from standing height or less. Should be able to handle a fall from this height normally Most common in hips spine and wrist?

fragility fracture

5-6th gestation

fusion of the lips occur at this age of gestation

7-9th week gestation

fusion of the palate usually happens at this many weeks

Eliminate current infection Identify contributing factors to reduce the risk of recurrence Prevent systemic spread of the infection Preserve renal function- prevent renal scarring Scarring is highest in children with an abnormal renal bladder ultrasound or with a combination of high fever .39C and an etiologic organism other than e.coli High grade VUR(VESICOURETERAL REFLUX) is a risk factor for scarring Antibiotics may be prescribed prophylactically

goals UTI

coughing, choking, cyanosis* · excessive salivation · respiratory distress Often end up with pneumo by the surgeon from move the lungs to see

halmark signs of Esophageal Atresia with or without Tracheo-esophageal Fistula as a result of surgery this often happens

X-ray with contrast dye/barium enema to r/o stricture Rectal suction biopsy- not done often

hirschsprung disease diagnostic

It sometimes occurs in families and might, in some cases, be associated with a genetic mutation. *Also, newborns who required rectal stimulation to pass their first meconium stool or who passed a meconium plug should be evaluated for Hirsch sprung disease. If diagnosed later, infant or child my have a chronic pattern of constipation.

hirschsprung disease risk factors

Failure to pass meconium within the first 24 hours Constipation builds up just before the affected area resulting in dilation, or MEGACOLON Abdomen becomes distended Risk for rupture Infant will exhibit feeding intolerance and vomiting

hirschsprung disease s+s

Surgical resection of the aganglionic bowel area- missing ganglion cells simple anorectal myomectomy proximal bowel pull-through If colostomy is necessary- Temporary ostomy will allow the resected area to heal.

hirschsprung disease treatment

• Tub baths prohibited until it is time to remove the penile dressing and provider has ok'd it o Don't want suture lines getting wet - sponge bath • Double diapering o This is a method to protect the urethra, stent and/or catheter after surgery. Keeps area clean and free of infections. See Ricci, p.1637 • Once dressing is removed, apply KY jelly to diaper to prevent penis form sticking and bleeding; increase comfort. • No ride on toys or activity that involves straddling for 2-3 weeks*- protect sutures don't want any tearing • No rough housing • Approach care giver role strain - promote social supports VNA(visiting nurse)

home care post surgery with catheter • Hypospadias/Epispadias

• Irritability- rapis change in personality • Lethargy • Poor feeding • Vomiting • Headaches • Altered, diminished, or changes in LOC Rapid increase in head circumference- circum taken regulary bulging fonteanels

hydrocephalus common s+s

• Maintaining cerebral perfusion • Minimizing neurologic complications • Maintaining adequate nutrition • Promoting growth and development • Supporting and educating the family • Preventing shunt infection and malfunction

hydrocephalus Nursing Management

• Skull x-rays • CT- only if really needed- too much radiation • MRI- used most often

hydrocephalus testing

decreased skin turgor and tenting absence of tears with crying decreased urine output in 24 hours decreased oral intake in 24 hours

indications of dehydration include

o poverty****** parent just can get /give enough formula food, or some family stretch formula with more water and less powder- lots of social work and case management to get involve. Unsafe can cause electrolytes to be out of whack and make baby very sick o incorrect formula intake- may parents are too black and white and are too specific- ie when baby gets bigger they need to eat more o abuse and neglect- withhold food and small children as form of punishment o behavioral problems- kids won't eat - trying o control and rebel o lack of parental interaction- don't eat together lack family structure o poor feeding techniques- o lack of education with parents o mental illness in parents

inorganic causues of Failure to thrive

Clostridium difficile (C. difficile)- need to replace normal flora

long term antibitics can cause this important to make sure to replenish

Doxycycline (not if pregnant or less than 8 years of age) Can cause permanent discoloration of teeth* Doxycycline, Amoxicillin, Erythromycin, or Cefuroxime used for early Lyme disease Treatment usually 14-28 days depending on stage of illness If not treated can cause many problems for a long time- joints heart nervous system If not caught early even several weeks of antibiotics may not be enough - may need second round of treatment

lyme disease treatment

flat A macular rash is a skin rash which presents in the form of a number of small, flat red spots It can appear anywhere on the body, and it may be caused by a variety of things, from allergic reactions to certain medications Less than 1 cm in diameter Examples include freckles, rubella, rubeola, petechiae

macular rash

underlying disorder of bone production and composition of the bone. Osteogenesis imperfecta

metabolic fracture

Increased Thirst Slightly dry buccal mucosal membranes

mild dehydration symptoms

Dry buccal mucosal membranes Loss of skin turgor Sunken eyes, sunken fontanel

moderate dehydration symptoms

Escherichia coli (E. coli)

most common organism - cystitis/ pylonephritis

concussion

mosto common head injury in pediatrics

not full developed until 1 month allowing backflow of stoach contents in to the esophagus and mouth

muscle tone of lower esophageal sphincter is ________ child prone to have

6 months because of renal immaturity

need to be this old to give Ibuprofen why?

excessive loss of albumin and protein • Decreased serum albumin level decreases the colloidal osmotic pressure in the capillaries • Fluid shifts from plasma to interstitial spaces

nephrotic syndrome patho

• Change in LOC may or may not occur • increased distractibility • difficulty concentrating

notable concussion symptoms

Oral Rehydration Therapy Oral Rehydration Solutions (ORS) provide proper electrolytes and glucose replacement For a young child, the caregiver may give the fluid with a spoon or small syringe in 5-10 ml increments every 1-5 minutes* small amount fo fluid aids in absorption and decrease chance of vomit Ongoing stool losses should be replaced approximately 10 ml/kg of ORS for each diarrheal stool.*

nurisng treatment dehydration

• Past medical history and risk factors • 1 month to 5 years (most cases younger than 1 year and between 15-24 years old)** • Fever or illness during pregnancy or around delivery (for infants younger than 3 months of age) ex GBS • Exposure to ill persons • Exposure to tuberculosis • Travel history • History of maternal illness • Recent neurosurgical procedure or head trauma • Foreign body • Immunocompromised state • Close contact living spaces- shelters • Child care

nursing assessment Bacterial meningitis

skin integrity Diarrheal stools are highly irritating to the perianal skin. Protect skin from excoriation ** Rotovirus Vaccine- oral vaccine Two rotavirus vaccines are currently licensed for use in infants in the United States: RotaTeq® (RV5) is given in 3 doses at ages 2 months, 4 months, and 6 months Rotarix® (RV1) is given in 2 doses at ages 2 months and 4 months

nursing consideration for diarrhea

§ Strict intake and output measurement § Daily weights § Monitor lab results- kidney function § Monitor IV therapy per hospital protocol (20ml/Kg)-in cases of severe diarrhea**

nursing intervention dehydration

Accurate assessment and description of the skin health deviation Infection prevention- wound sites as clean a dry as possible Wound Care: Clinical Tip! "Do not put anything into a wound that you would not put into the eye" ** Saline is safest* Moist, crust-free environment enhances wound healing

nursing interventions- rash

seizure precautions even if pt isnt admited with seizure issues:• illness may lower/ illicit seizure threshold • Pad side rails and other hard objects** • Oxygen and suction at bedside** • Observe and note time of onset to end of seizure** • If repeat episode, review description of seizure activity of this child The first thing the patient does includes gaze, position and head position identify possible triggers:Psychological disturbances, sleep or hyperventilation Type of movements, parts of the body involved

nursing interventions/ assessment for pt with seizure disorder

· NPO · elevate head of crib 30-45 degrees o prevent reflux and aspiration- orders will be in · orogastric tube to low suction- diagnostic tool as well because they hit a wall doesn't go anywhere o want to keep the pouch empty so don't aspirate · provide comfort (pain medications/IV fluids- b/c can't eat) · surgical repair education · oral feedings usually start 1 week after surgery*

nursing managment Esophageal Atresia when can start feeding?

Administer: 48-72 hours of ordered antibiotics (non-perforated appendix) Laparoscopic surgery has lowered infection rates 7-14 days of IV antibiotics if perforated Provide teaching because the child is often discharged home while still receiving IV antibiotic therapy. Perf longer hospital stay and may go home on IV antibiotics

nursing managment pre/ post surgical care appendicitis

Children with mild to moderate dehydration require 50-100 ml/kg of ORS over 4 hours. Tap water, milk, undiluted fruit juice, soup, and broth are NOT appropriate for ORT- jello, popsicles good source After reevaluation, ORT may need to be continued if the child is still dehydrated. When rehydrated, the child can resume a regular diet.

oral rehdration therapy requirments for moderate dehydration

Impaired ability to consume nutrition (cerebral palsy) Inability to suck or swallow (cleft lip/cleft palate/chronic lung disease) Inadequate absorption of calories (cystic fibrosis/celiac) trouble absorbing increase caloric intake Vomiting/Diarrhea- c-dif for example Increased metabolism (cardiac defects)

organic causues of Failure to thrive

decreased calcification of bone- precursor to osteoporosis

osteopenia

· Diet and Supplements · Fall Prevention · Cessation of smoking and excess alcohol · Exercise - weight bearing, anything is helpful walking just not sedentary · Talk to your doctor about monitoring labs and a DEXA scan Osteoporosis medications

osteoporosis Prevention and Treatment

where another disease process weakens the bone - ex cancer

pathologic fracture

• Complex disorder of the CNS • Disruption of electrical communication among neurons of the brain • Imbalance between the excitatory and inhibitory mechanisms, which causes neurons to fire when they are not supposed to or not fire when they should Cause • Acquired related to brain injury or family history • Unknown

pathophysiology of epilepsy cause?

• weakness of extremities, inability to speak, sleeping, cognitive status (confusion) o May be confused to what happened and will question what happened.

patient will exhibit_____post seizure

Small framed women - less bone mass Early menopause (prior to age of 45)* estrogen decrease Long term steroids use (3 months or longer) Diseases such as Crohn's or celiac - cause malabsorptionof vitamins and minerals* Family history of osteoporosis Rheumatoid arthritis - immobility Being underweight

risk factors for osteoporosis

maternal smoking prenatal infection advanced maternal age anticonvulsants/steroids/other medications during pregnancy late maternal age

risk factors that lead to greater risk of cleft palate/lip

pain- ice meds adress mobility-· Walk patient 3x per day using assistive device assist ROM prevent infection-· Assess site, IV antibiotics, hand hygiene, teach proper wound care, monitor for fever shaking chills help with self care

post op care- total knee

slow, gradual increase in feedings .5-1 oz q 2 hours work toward normal feed vomiting may still be present 24-48 hours after surgery due to edema **special feeding plan set up by surgeon** once infant is tolerating full strength formula or breastfeeding, may be discharged home Mom encouraged to pump so can measure amount being taken in

post operative management pyloric stenosis

breast feeding- breast fills gaps to help with suction burp frequently from extra air being swallowed porstetic device sometimes used to seal off palate special bottles

promote adaqute nutriton for the cleft palate lip by

• Giving meds same time, correct dose and how to give • Rectal diazepam - stick with brand or generic but don't mix and match • Follow up care with primary doc and neurology • Make sure have a neurologist- make sure they have an appointment before leaving

pt teaching for seizure disorder

Linear (round, oval (ex. poison ivy) annular (ring around central clearing, often fungal infection) target lesion- Lyme

rash shape

Pruritus (itching) is the most common complaint (cool baths and compresses) Prevent scratching: mitts, short nails, antipruritic meds Pain medications Soft light weight clothing helps with comfort Mitts - nails are sharp and can be long so don't scratch Benadryl, cool compress Topical/Systemic Therapy: Administer medication as prescribed Teach family about antibiotic administration and care of wound and or rash

rash symptom relief itching pain

• history of a URI or skin infection 1-3 weeks ago o Facial edema more prominent in the morning* o Spreads during the day to involve extremities, genitalia and abdomen* o Hematuria 3+ to 4+* o discoloration of urine (smoky brown, tea or cola in color) from blood o Severely reduced volume proteinuria

s+s of Acute glomerulonephritis

edema weight gain high BP flank pain

s+s renal dysfunction

o Application of a scabicide (5% permethrin lotion over entire body except the face) o Have patient take a warm soapy water bath and apply lotion after to dry, cool skin o Medicated lotion is to be left on usually 6 hrs. but up to 8-12 hours before washing it off o Second treatment is done 1 week later o All close contacts should be treated even if asymptomatic o Oral antihistamine can be used to relieve itching- don't want itching o Treatment failure can occur and can be treated with an oral anti-parasitic May need something stronger Itching can last up to a couple of weeks

scabies treatment

Women > 65 Women <65 at risk are screened earlier Family hx Low body weight Smoking, excessive ETOH use Comorbidities - malabsorption, renal disease, diabetes None recommended for men under 65

screening should start at ________ or

Barbiturates:** Benzodiazepine Hydantoins Iminostilbenes

seizure medications include

Rapid, thready pulse Cyanosis Rapid breathing Lethargy Coma

severe dehydration symptoms

o Skin is the largest organ in the body o Primary function is to protect the underlying tissues from any trauma or invasions of microorganisms o Reflects the internal well-being of the body- can tell a lot about a person by the appearance of their sin- pale cyanotic, pink warm dry, jaundiced, dru cracked signs of dehydration or poor wound healing o Used as a perception of pain/heat/cold and to regulate the body's temperature*

skin

• N/V • changes in gait • visual disturbances • headaches • trauma • cognition changes • change in consciousness • lethargy • increased irritability • poor feeding • fever • pain • muscle changes • growth and development delays • exposure to chemicals and toxins

symptoms related to neuro issues

Surgical intervention • Ureters resected from the bladder and re-implanted elsewhere in the bladder wall to regain functionality • Antibiotics may be prescribed to prevent pyelonephritis ** and renal scarring Developmental considerations o 51% spontaneously resolve over a mean duration of two years for all grades

treatment VUR

• To appropriately place the meatus to allow for normal voiding and ejaculation • Neonatal circumcision is avoided as foreskin may be used in reconstruction. • Repair may require urinary catheterization left in bladder for 5-10 days. o Need meticulous catheter and wound care from suturing o May use something like bacitracin so have barrio on suture line

treatment and goals Hypospadias/Epispadias

§ is a strict gluten-free diet.* Even small amounts of gluten in the diet can cause damage to the villi Abdominal cramping, diarrhea May need iron, folic acid and fat soluble vitamin supplements

treatment celiac

• Focal (previously known as a partial) • One hemisphere of the brain is involved* • Seen in 60% of patients with epilepsy* • Generalized (epileptic spasms) • Involve the entire brain • Seen in absence seizures, tonic seizures, clonic seizures, tonic-clonic seizures, myoclonic seizures, and atonic seizures • Unknown (epileptic spasms where the mode of onset is generalized or focal) Epilepsy

types of seizures (3)

stimulates calcium and phosphate absorbtion- help build bones assess GI intolerance assess blood levels and tolerance

vit D 3 cholecalciferol what to know

Lab test for vitamin D should be >30 ng/ml (50 better)** The body needs vitamin D to absorb calcium. Without enough vitamin D the body takes calcium from stores in the bones.* which make smore brittle* Deficiency can be treated with 50,000 IU weekly or 6000 daily for 8-12 weeks. After corrected keep on a maintenance dose of 1500-2000 IU/d We can get vitamin D from sun exposure, other sources include egg yolks, fish and fortified foods such as cereal or milk.** o Salmon , shitake muschrooms

vit D lab values treatment dose good cources

• Hypertension may indicate renal disease**

vital signs that may indicate renal disease

• Results from an imbalance in the production and absorption of the CSF • CSF accumulates within the ventricles of the brain and causes the ventricles to enlarge and increases intracranial pressure-Can be congenital or acquired congenital - intrauterine development aquired - at time of birthn infections, intravascular hemmorrage, injury or disease

what is Hydrocephalus can be _____ or _____

• Oxygen • Maintain airway- suction • Keep safe- turn on side Increase caloric intake

what the nurse should do when pt has a seizure

• awake and alert and can swallow • More calories- metabolism is increased

when can pt with seizure eat again