Pediatric Nursing Final Exam Study Set

At what age do children learn to imitate sounds?

8 months

What age should infants start eating meats?

8-10 months

When is an infants palmar grasp replaced with pincer grasp? (fine motor)

8-9months

When does the child crawl on hands and knees and pull self to standing?

9 months

How much do infants sleep each day?

9-11 hours/day usually good nocturnal pattern developed by 3-4 mons. Total sleep/day is 15 hours may take 1-2 naps /day by end of 1st year

How much should school aged children at age 12 sleep?

9.25 hours (8-9/11 yo resistant may not know sleepy)12yo look forward to bedtime

What do you want cholesterol levels in kids to be?

<170, LDL<110

What is an ANC level that would indicate the child is very prone to infections?

<500. They want it to be >500 to return to school

Signs a child with asthma is in severe respiratory distress?

A child with asthma who sweats profusely, remains sitting upright, and refuses to lie down is in severe respiratory distress. Also, a child who becomes agitated or an agitated child who suddenly becomes quiet may have serious hypoxia and requires immediate intervention.

Define Critical Reasoning

A cognitive process that uses formal and informal thinking to gather and analyze patient data, evaluate the significance of the information and consider alternative actions.

What is the treatment for children with inhalation/smoke injury?

Administer 100% humidified oxygen as quickly as possible and monitoring for signs of respiratory distress and impending failure. Fluid requirements are greater. Systemic injury can occur is cellular respiration is affected such as in CO2 poisoning. (Watch O2 sats - they can read normal but are not so ABGs should be used)

When can a child reason abstractly with any degree of competence?

Adolescence

When do naps usually become eliminated as the child gets older?

After 3 years old

When using the Denver II assessment for development on a preemie, what age does it begin to show accuracy?

After 6 months of age, should be accurate. (Otherwise give or take two months)

What are the age recommendations for the child requiring surgery of the genital area and why?

After extensive review of the emotional , cognitive and body image problems that may occur in children undergoing surgical reconstruction of a genital deformity, it is recommended that it be accomplished between 6 and 15 months of age to minimize the psychological effects of surgery and anesthesia.

What makes kids more or less susceptible to the effects of stress?

Age, Temperament, life situation, state of health,coping

What precautions in the hospital are taken with pts that have active contagious TB?

Airborne precautions and a negative pressure room, hospital personnel caring for these individuals should have fitted air purifying masks when in contact with pt.

Treatment for acute epiglottitis

Airway protection, racemic epinephrine, antibiotics, steroids, fluids, reassurance (swelling of the epiglottis usually subsides after 24 hours of antibiotic therapy)

What positions would be best for performing a physical assessment on an infant?

Before able to sit alone, supine or prone, preferably on parents lap, before 4-6 months can place on exam table. After able to sit alone, sitting in parents lap whenever possible, if on table place parent in full view

List the types of epilepsy syndromes that are partial seizures

Benign partial epilepsy of childhood, epilepsia partialis continua, (Unclassified - neonatal seizures, febrile seizures, pseudoseizures)

Name some bronchodilators used for asthma

Beta-agonists - inhaled - albuterol, serevent; metylxanthines - oral theophylline, anticholinergics - inhaled - ipratropium-atrovent

What are some alternative medicine therapies used with children? (for pain)

Biological, manipulative treatments, energy based, mind-body techniques, alternative medical systems.

Common signs of Acyanotic Heart defects?

Bounding pulse Fast breathing Poor feeding habits Shortness of breath Sweating while feeding Tiring very easily Poor growth`

Who does ADHD affect more - boys or girls?

Boy

How is retinoblastoma treated?

Brachytherapy (Radiation), laser photocoagulation (lasers blood supply to tumor), cryotherapy, thermotherapy, chemotherapy, eye removal in cases of advanced tumor growth (prosthesis will be put in place)

Late signs and symptoms of increased ICP

Bradycardia, lowered LOC, decreased motor response to commands, decreased sensory response to painful stimuli, alterations in pupil size and reactivity, flexion or extension posturing (Decorticate - flexion, Decerebrate - extension), cheyne-stokes respirations, coma Decerebrate is worse.

Second most common cancer to leukemia in children

Brain Tumors

what is indicated if pupils are fixed for greater than 5 minutes?

Brainstem damage

This lower airway infection has a very productive cough, very snotty, congested. Labored respirations, poor feeding, tachypnea (>60) Apnea may be the first symptoms in very young infants, emphysema type effects, affects bronchi and bronchioles, affects children 2-12 months of age, rare after age 2. Classic manifestations - wheezing, retractions, crackles, dyspnea, tachypnea diminished breath sounds

Bronchiolitis

This lower airway infection has a dry hacking cough, non productive that may change to productive is usually viral, self limiting , and is inflammation of the large airways (often accompanies URI), in the first 4 years of life, allergens can trigger symptoms, (worse at night)

Bronchitis

This is a positive sign of meningitis if automatic knee and hip flexion occurs when neck is flexed while pt in supine position

Brudzinski's sign

What is important to remember when communicating with an adolescent?

Build a foundation (Rapport) and then communicate

What happens to fontanels with increased ICP?

Bulge (increased ICP/ increased head circumference can also cause suture lines to separate)

When does a childs weight usually triple?

By 12 months

When does a childs weight usually quadruple?

By 2 or 2 1/2 years old.

When does a childs weight usually double?

By 4-7 months

When do children usually outgrow night terrors?

By 5-6 yo

What are the pain responses typical for an adolescent?

Concern over body image/scars, less vocal protest, less motor activity, more verbal expressions, such as "it hurts" or "you're hurting me" increased muscle tension and body control overall.

This cognitive development stage, thoughts become increasingly logical and coherent. Children can classify, sort, order and organize facts and information to problem solve. They develop conservation and permanence, learn to multi-task, they solve problems but not in abstract. thoughts are less self centered, they consider others points of view and are more socialized in thinking. Reasoning is inductive.

Concrete Operations (7-11yrs)

The is the most common type of head trauma

Concussion

What are the hallmark signs that a concussion has occured

Confusion, amnesia

This type of nephrosis usually requires dialysis or a renal transplant. Usually not good and does not respond well to therapy

Congenital Nephrosis

What are the three types of Nephrosis that a pt could have?

Congenital, Minimal Change nephrotic syndrome, or secondary.

This implies awareness, ability to respond to sensory stimuli and have subjective experiences (must have alertness of surroundings and cognitive power- process and produce responses)

Consciousness

Clinical manifestations of hirschsprung disease in children

Constipation, ribbonlike foulsmelling stools, abdominal distension, visible peristalsis, easily palpable fecal mass, undernourished anemic appearance.

This is damage remote from the site of direct trauma (think black eyes etc)

Contracoup injury (often occipital, frontal, and temporal lobes)

Basic treatments to remember for fractures

Control pain, hemorrhage and edema; relive spasms(valium ,traction), realignment of fractured fragments, promotion of bone healing, immobilization of fracture until adequate healing has begun, prevention of secondary complications, limitation of disuse syndrome, restoration of function

What is the goal of treatment for seizure activity?

Control the seizures or reduce frequency and severity, discover and correct the cause when possible, help the child to live as normal a life as possible.

These are petechial hemorrhages along the superficial aspects of the brain caused by trauma (bruising of cerebral tissue)

Contusion

What are some soft tissue injuries that a child could have?

Contusions, dislocations, sprains, strains

At this level of moral development the child is concerned with conformity and loyalty. They learn that approval is earned by "being nice" and that they should obey the rules and show respect for authority, the level is correlated with the concrete operations (Piaget 7-11yrs) in cognitive development theory.

Conventional level or moral development.(Kohlberg)

What is the treatment for club foot?

Correction of the deformity by serial castings begun shortly after birth until the defect is corrected, and successive casts to allow for gradual stretching of skin and structures around medial side of foot, maintenance of the correction until normal muscle balance achieved, follow up observation to avert possible recurrence. Surgery as last resort if castings unable to correct

Which poisons if ingested, is induction of vomiting Contraindicated?

Corrosives such as drain, toilet or oven cleaners, electric dishwasher detergent, mildew remover, batteries, clinitest tabs, denture cleaners, bleach. hydrocarbons-gas, kerosine, lamp oil, mineral seal oil, lighter fluid, turpentine, paint thinner/remover. Liquids more damaging than powders.

Why must supplemental oxygen not be given for long periods of time to a pt with sickle cell

Could decrease bone marrow production of RBCs to carry more oxygen

This is damage at the site of impact

Coup injury

Risk factors for developing Iron deficiency anemia

Cows milk consumption, lower income, pregnant women, women with heavy periods

What does Peripheral nervous system consist of?

Cranial nerves, Spinal nerves

This is a skull defect through which various tissues protrude

Cranioschisis

Types of neural tube defects

Cranioschisis, exancephaly, anencephaly, encephalocele, rachischisis(spina bifida), meningocele, myelomeningocele

This is premature closure of single or multiple sutures in the skull, the child will have an odd shaped head, and there may be increased ICP. Surgery is needed if increased ICP, high blood loss is associated with it, may need transfusions or harvest own blood- get donations from family etc

Craniosynostosis

True or false - antihistamines are helpful for nasopharyngitis

False - they are largely ineffective, they do have a very weak atropine (Drying out) effect but also can be sedative or conversely cause stimulatory effects in children

Nursing considerations for caring for a child with head trauma

Family support (encourage, listen), help with rehab if indicated (child needs assessment on physical, cognitive emotional and social levels), Teach Prevention (seatbelts/helmets/sports/supervision)

This is the treatment for compartment syndrome?

Fasciotomy, Bivalve the cast

This is the most common neurologic disorder in children from 6 months - 3 years old, and rare after 5 years old, mostly in boys.

Febrile seizures

Who has a slightly higher temperature throughout life, males or females?

Females

In an infant who is most at risk for hip dysplasia, male or female?

Females (possibly r/t estrogen)

Symptoms of kawasakis

Fever for 5 or more days, non-exudative conjunctivitis, strawberry tongue, fissures lips, periungual desquamination (skin peels), polymorphous rash, cervical lympadenopathy (must have 4 for dx) fever does not respond to antipyretics or antibiotics. Can lead to MI

What is a sign of an Upper UTI (renal involvement) in Older children/adolescents?

Fever, Chills, Flank Pain

Symptoms of meningitis in Children

Fever, chills, headache, vomiting, photophobia, positive kernigs and brudzinskis signs, seizures, diplopia

Symptoms of meningitis in infants

Fever, high pitched cry, nuchal rigidity, seizures with temp

What are some reasons for nonrecurrent acute seizures in children?

Fever, intracranial infection, intracranial hemorrhage(shaken baby), space occupying lesions leading to increased ICP, acute cerebral edema, anoxia, toxins, metabolic alterations

Predominant symptoms of Chickenpox(constitutional and prodromal signs)

Fever, malaise, anorexia, rash begins trunkal and progresses from papules to vesicles with fluid inside, breaks and forms crusts, present in varying degrees at one time. Rash located trunkal and spreads to face and proximal extremities, sparse on distal limbs. Heat prone areas worse breakouts.

Symptoms of respiratory infection in infants and small children

Fever, meningismus, anorexia, vomiting, diarrhea, abdominal pain, nasal blockage (easily blocked by swelling and exudate), nasal discharge, cough, adverse respiratory sounds, sore throat

Signs/ Symptoms of leukemia

Fever, signs of low blood counts, lymph node enlargement, enlarged liver and spleen, peripheral blood smear may reveal immature forms of leukocytes, frequently combined with low blood counts. Definitive diagnosis is bone marrow biopsy/aspiration. A lumbar puncture is done at diagnosis to confirm whether or not the CNS is involved.

Differences between fiberglass and plaster of paris casts

Fiberglass more light weight and dry quickly, more expensive but can get wet, edges are often rough and do not mold well and can come in many colors, Plaster of paris - heavier and takes longer to dry, mold easily to body part, can't get wet but has smoother edges (only white in color) wet cast can not be handled very much, may indent it.

What is the first line defense for JRA (juvenile rheumatoid arthritis) and Second?

First - NSAIDS second-Methotrexate

Examples of biological based alternative medicine therapies (for pain)

Foods, special diets, herbal or plant preparations, vitamins, other supplements

What is most important when caring for an infant with upper respiratory infection? Giving tepid baths to reduce fever, encourage food intake, have child wear heavy clothing to prevent chills, give the child small amounts of favorite fluids frequently to prevent dehydration

Giving favorite liquids !

What is good position for the child with pneumonia?

Good lung up - it splints the chest on that side and reduces the pleural rubbing that can cause discomfort.

What would be the treatment for a child 6-18 months for hip dysplasia?

Gradual reduction by traction (closed reduction), follow up cast or if the closed reduction is unsuccessful - open reduction surgery with reconstruction of acetabular roof with follow up cast for 12 weeks after.

What are the zones for asthma and PFTs

Green zone - 80-100% of best - asthma well controlled. Yellow Zone-50-79%, caution, may need to increase therapy. Red <50% of best - medical alert - give Tx and if no improvement call dr.

What bacteria causes bacterial meningitis?

Group B Strep and E Coli (neonates) S. Pneumoniae, H. Influenza, Neisseria, possibly some B.Hemolytic strep, and staph

This is a quantitative change

Growth

These are definite and predictable patterns, that are continuous, orderly, and progressive. They also are universal and basic to all humans, but each human accomplishes these in a manner and time unique to that individual.

Growth and Development

When there is interference of urine flow by a structural abnormality or obstruction, it can lead to back up of urine into the kidneys and renal pelvis resulting in this condition

Hydronephrosis (to treat, resolve infection or blockage)

This is a common hallmark sign of rabies caused by spasm of the pharynx neck and diaphragm muscles with swallowing attempts

Hydrophobia

Overall complications to watch for with Acute renal failure

Hyperkalemia (most immediate threat to life - kayexelate might be needed or dialysis); Hypertension - frequent bp checks, comes from activation of renin system; Anemia - transfusion not recommended until Hgb is less than 6; Seizures associated with failure leading to uremia, hypertension, hyponatremia and hypocalcemia; Cardiac Failure - pulmonary edema from hypervolemia.

What should the nurse watch for in the pt with Acute Renal Failure?

Hyperkalemia, hypertension, anemia, seizures and cardiac failure

This is far sightedeness

Hyperopia (can't see things up close)

This type of dehydration in a child is caused by loss of more water than electrolytes

Hypertonic-hyperosmotic/hypernatremic- has fewer symptoms so can be more dangerous because it takes longer to detect.

This type of dehydration in a child is caused by loss of more electrolytes than water

Hypotonic-hyposmotic/ hyponatremic - fluid shifts into cells so more severe symptoms.

Three main things that arise from a submersion injury (near drowning)

Hypoxia, Aspiration, hypothermia

Where does most of the nursing care for pulmonary edema take place?

ICU - fowlers position good to assist with lung inflation/expansion

What are some secondary prevention strategies for cognitive impairment?

ID early and institute treatment to avert cerebral damage, prenatal diagnosis/carrier detection, newborn screening for treatable inborn errors of metabolism

Which vaccination is given at 2 and 4 months of age then 6-18 months and 4-6 years.

IPV

What is egocentrism (often exhibited by toddlers 1-3)

Inability to envision situations from perspectives other than own

Causes of iron deficiency anemia`

Inadequate diet, Low iron intake, blood loss-teen girls, hookworms/parasites (3rd world countries)

Treatment for bacterial meningitis

IV Abx ASAP, resp/droplet iso for first 24-48 hrs, hydrate (low maintenance after initial fluid correction), Maintain ventilation and reduce increased intra cranial pressure if present (dexamethosone(to reduce inflammation, mannitol to diurese the brain), low stim environment, tx complications that may arrive and support family

How is bacterial endocarditis treated?

IV antibiotics for 2-8 weeks.

Treatment options for ITP (Immune thrombocytopenia)

IVIG, prednisone, Anti-D Antigen

How are tachydysrhythmias treated?

Ice to face, valsalva, meds, cardioversion, ablation

What is the only way to definitely diagnose osteomyelitis?

Incision and drainage (also done if rupture might be pending - to prevent spread of infection)

What are some clues in the very young child that might indicate a possible UTI?

Incontinence in a toilet trained child, strong smelling urine, frequency/urgency, rash, poor weight gain/appetite if ongoing.

What are some factors that control closure of the ductus venosus, foramen ovale, and ductus arteriosus after birth?

Increased oxygen concentration of the blood, fall in endogenous prostaglandins, acidosis

What are the early signs of impending airway obstruction?

Increased pulse, increased respiratory rate, substernal, suprasternal, intercostal retractions, flaring nares, and increased restlesness

This stage of development (Erikson), the child encounters rapid physical changes, leading to over-preoccupation with how others view them, struggle to "fit in", peer focused. If inability to resolve the "finding themselves stage" results, they will feel "lost" (Who am I, where am I going, where do I belong)

Identity vs Role Confusion (12-18yrs)

What is considered an emergency state during a seizure

If it lasts longer than 5 minutes, status epilepticus (seizing again without recovering from last), unequal pupils, can't wake pt up in postictal, continuous vomiting postictal, if it's the pts first seizure.

What is compartment syndrome, how would you know?

If pt is having pain and cast if bivaled to try to relieve the pressure and it is not relieved it could be compartment syndrome which occurs under the skin, not inside of the cast. (swelling of the muscles inside of their compartments leading to damage to blood vessels, nerves etc) May need fasciotomy to relieve this

What are the parameters when using the Denver II to assess a childs development levels are used to determine if there are delays or if the child is "on track" developmentally?

If the child is not doing a task on the chart by 90%, there is most likely a delay there. If one or more delays or 2 cautions occur(not doing a task by 75%) there is a suspected delay

During the Autonomy vs Shame and Doubt stage (1-3 years) the child learns best by doing what?

Imitating the activities and behaviors of others

What care is given for hemoarthrosis from hemophilia

Immobilize and elevate NO ASA for pain May give NSAIDS for swelling and pain May give DDAVP inhaler (to increase plasma factor VIII) Encourage exercise and physical therapy NO contact sports Wt control important since excess can put strain on joints

This is excessive destruction of platelets in toddlers/preschoolers, characterized by thrombocytopenia, this is the most common bleeding disorder in children, includes other symptoms such as purpura (purpleish bruising), normal bone marrow.

Immune Thrombocytopenia (ITP)

The possibility of many infectious agents can be eliminated when diagnosing possible causes of infection in a child by assessing these two things.

Immunization status, past history of diseases(infections)

This is the genetic predisposition that can cause a mediated response to allergens, such as asthma reactions

Immunoglobulin E. (although 20-40% of children have no allergies)

Heart failure signs/symptoms

Impaired myocardial funcion - tachycardia, gallop, cardiomegaly, decreased peripheral pulses, mottled extremities, Pumonary Congestion - tachypnea, retractions, grunting, nasal flaring, cough, cyanosis, othropnea, hepatomegaly, edema, distended neck and peripheral veins, Systemic venous congestion- decreased urine output, failure to thrive, decreased exercise tolerance

Goals of treatment for heart failure

Improve cardiac function, remove accumulated fluid and sodium, decrease cardiac demands, improve tissue oxygenation

Nursing interventions for failure to thrive

Improve familys interactions/relationships, improve familys ability to cope with stress, increase parent self esteem, discuss feeding techniques for ages of kids, praise positive parenting behaviors, review growth/dev with parents, encourage parents to foster growth/dev behaviors, provide nutritional teaching, demonstrate feeding positions, formula prep, age appropriate foods, help parents learn to interpret childs cues, promote adequate environmental stimulation, demonstrate techniques of stimulation that will improve growth and dev, teach why stimulation needed for growth, improve awareness of family of problem areas, allow parents to vent, assist with id ing infants attributes positives, teach about community support systems (family, friends, clergy, social worker, nurses), continue to counsel at home or through public health agency, refer out if needed to other resources

What is the difference between the absorption rates of IM in neonates vs infants?

In Neonates, IMs are absorbed very slowly and erratically. After that first month of life, in the Infant age - IMs are absorbed very quickly, even faster than adults.

When should antibiotics be administered in children with suspected bacterial otitis media?

In infants older than 6 months old, it is recommended to wait 72 hours to treat with antibiotics to see if it resolves on its own. If the symptoms are persistent or recurring in children 2 and younger - it is recommended to go ahead with antibiotics and all children under age 6 months with otitis media because of weakened immune systems should have antibiotics to treat.

Phases of treatment for chemotherapy sessions/radiation for leukemia

Induction, CNS prophylactic therapy, Intensification therapy, and maintenance therapy

In this stage of development (Erikson), the child is ready to be a worker/producer. They want to engage in tasks that they can carry through to completion, they crave real achievement and need it. They learn competition and cooperation and the rules, they may feel inadequate if too much is expected of them at this time or if they do not measure up to expectations of them.

Industry vs Inferiority(6-12yrs)

What are some nursing *diagnoses* for the child with respiratory infection?

Ineffective Breathing Pattern r/t inflammatory process Ineffective Airway Clearance r/t mechanical obstruction Activity Intolerance r/t inflammatory process, imbalance between oxygen supply and demand Altered Family Process r/t child's illness Risk for infection r/t presence of infectious organisms, presence of optimum medium (mucus, sputum) for growth of infectious agents

During this developmental stage the child establishes a basic trust in the world and a foundation for future personal relationships.

Infancy (1-12 months)

This type of primary generalized seizure disorder most commonly occurs in the first 6-8 months of life, and is two times more common in boys, numerous seizures during the day without postictal drowsiness and has a poor outlook for intelligence

Infantile spasms

List the types of epilepsy syndromes that are generalized seizure types

Infantile spasms, Lennox-gastaut syndrome, childhood absence epilepsy, juvenile myoclonic epilepsy

How do you help promote absorption in the pt with cystic fibrosis?

Infants may get pre-digested formula, kids will get high calorie, high protein, possibly increased fat plus fat soluble vitamins, will need supplemental pancreatic enzymes.

List some of the stages of body image realization

Infants-from self exploration, toddlers learn about their bodies, preschoolers discover their genitals, school age learn about function, and adolescents are the most self conscious.

What are some things that can cause cognitive impairment?

Infection, intoxication, trauma, physical agent, chronic lead ingestion, FAS, metabolism or nutrition issues, shaken baby syndrome, PKU, hypothyroidism, gross postnatal brain disease, gestational disorders, psychiatric disorders, environmental influences TORCH (toxoplasmosis, Other (hep B), Rubella, Cytomegalovirus infection, Herpes Simplex

Signs/ symptoms of Aplastic anemia

Infections, fatigue, SOB, bruising, petechiae

In this stage of development (Erikson), the child develops an inner voice (Conscience), often they have intrusive behaviors, They may undertake goals or activities that are in conflict with those of parents or others, if they are made to feel bad about their imaginings or activities they feel bad. They must learn to retain a sense of initiative without impinging on the rights and privileges of others.

Initiative vs Guilt (3-6yrs)

This is a MAJOR cause of death in children from age 6-12 months

Injuries (Accidents)

This is the leading cause of death in children over age 1

Injuries (accidents)

What should the nurse educate the pt with sickle cell about pain management?

Instruct pt to keep a flow sheet of pain; start out with minimal meds, then increase as needed; proof for ER that pt is NOT a drug seeker PCA for crisis in older kids

List some roles of the pediatric nurse

Involved in every aspect of growth and development, primary concern is child and family welfare while establishing well defined boundaries, advocate - helping them make informed choices, teach teach teach (promote disease prevention and health promotion), atraumatic care - do no harm.

Most common anemia in children

Iron deficiency

This anemia is an inadequate supply of dietary iron, (newborns might not have issues right away r/t maternal stores from being born)

Iron deficiency anemia

Treatment for iron deficiency anemia (prevention is key here)

Iron fortified formulas/cereals, iron supplements for preemies, Iron rich foods and vit C helps to absorb, limit 1L formula/day, may need oral supplements

This is the most common type of dehydration in a child

Isotonic/isomotic/isonatremic - water and salt lost in equal amounts, watch for hypovolemic shock

What occurs during the intensification therapy for leukemia?

It eradicates all residual leukemia cells, followed by delayed intensification, which prevents emergence of resistant leukemic clones.

What occurs during the induction phase of chemotherapy/treatment for Leukemia?

It is an intense 4-6 week therapy which achieves complete remission (less than 5% leukemic cells in bone marrow)

Should the throat of a child with suspected acute epiglottitis be inspected with a tongue depressor?

It is contraindicated unless in a setting where there is immediate tools for intubation or tracheostomy in the event the exam precipitates further or complete obstruction of the airway. The nurse should never attempt to visualize the epiglottis directly herself or take a throat culture- the child should be referred to Dr immediately for evalution.

When does Lymphoid (Thymus, lymph nodes, intestinal lymph masses) tissue growth seems to complete?(age)

It peaks at 10 years old, then drops off again. (fast growth curve then fast decline)

How does vagus nerve stimulation work to stop seizures?

It's like a pacemaker for the brain, can stimulate vagus nerve for about 30 seconds every 5 minutes, this can decrease need for meds by 50%.

This is autoimmune inflammation of the synovium in the joints in children. Causes joint to feel "Squishy" and can be infectious or environmentally triggered, hard to diagnose (may or may not have positive rheumatoid factor) and has unpredictable and exacerbations and remissions. Goal is preserve joint function

Juvenile Rheumatoid Arthritis

What is an effective way to ensure that the newborn does not suffer from hypothermia which can lead to metabolic acidosis and elevated bilirubin levels and hypoglycemia?

Kangaroo care/skin to skin contact.

This is a positive sign of meningitis that is when there is pain in the lower back or posterior(Back of) thigh that occurs when knee is extended while pt is lying in supine position and the hip is flexed at a right angle (pt can not straighten leg out if bent at knee when raised)

Kernigs sign

This man formulated the moral development theory

Kohlberg

This is abnormal painless increase in curvature of thoracic spine (HUMPBACK)

Kyphosis

What labs are important to monitor with the long term antibiotic therapy for osteomyelitis?

Liver function labs (AST, ALT) If these are found to be elevated - might need to switch to another antibiotic not metabolized by the liver

What are the pain responses typical for an older infant?

Localized body response with deliberate withdrawal of stimulated area, loud crying, facial pain expression or anger, physical resistance, especially pushing painful stimulus away after it is applied

What are some possible sibling reactions to a childs hospitalization

Loneliness, fear, worry, anger, resentment, jealousy, guilt

Treatment for Osteomyelitis

Long term IV antibiotics (4-6 weeks), immobilize with no weight bearing(to prevent fracture and spreading of infection)

This is a congenital deformity of the foot, in which the toes adduct and the forefoot.. can be usually treated by gentle manipulation and passive stretching which the parents are taught to do at home.

Metatarsus adductus

Nursing care management for Acute Renal Failure

Meticulous I and O, Monitoring of balance and vital signs, always be alert for complications and signs of complications, often child will be on ICU, may need to be ingenuitive to restrict fluid intake in thirsty children, be alert for changes in behavior, be supportive, empathetic and provide comfort and stability for the pt and family with the numerous frequent and painful treatments and tests that might be required.

When is neuroblastoma diagnosed as stage IV?

Mets to lymph nodes

This is a small head caused by failure of brain to develop, there is no treatment for this, the child will be mentally retarded may be picked up on ultra sound

Microcephaly

List the types of cranial deformities

Microcephaly, craniosynostosis, hyrocephalus,

This period of development is critical for development of self concept, and usually at the later stages is found to have the child directing away from family relationships to peer (group) focused relationships. Social cooperation and early moral development take place.

Middle childhood (6-12 years)

Why might some children have dosages close to adult dosages?

Overall children 1+ tend to metabolize drugs faster than adults, sometimes the dose can seem a little high but the mg/kg it is accurate, but the mg/kg might be higher because they metabolize it faster.

Possible causes of night terrors

Overtired, overanxious, stress (child won't remember it in AM)

What are the age ranges for drug therapies dose recommendations in pediatric nursing?

Premature infants - less than 36 wks gestation, full term infants 36-40 weeks gestation, neonates - first 4 postnatal weeks, Infants - weeks 5-52 postnatal, Children-1-12 years, adolescents - 12-16 yrs.

What are the developmental age periods?

Prenatal(Conception-birth), Infancy(birth-12months), Early Childhood(1-6 years), Middle Childhood(6-11 or 12 years), and Later childhood(11 or 12 - 19 years)

This type of bone cancer involves the soft tissue, most often found in head/neck or orbital areas (may see eye droop), only have signs if very large or pushes against organs and has a high potential for mets. Usually treated by removal and chemo/radiation

Rhabdomyosarcoma

This is an autoimmune inflammatory disorder often acquired after a strep infection. It can affect the heart, joints, connective tissues, and the CNS.

Rheumatic Fever

If a child is positive for Group A Strep, what other disease are they at risk for?

Rheumatic Fever, and acute glomerulonephritis

Medication used to treat flu symptoms in children and adults for type A virus only (do not use in children under 1year old) Must be started within 48 hours of onset symptoms. This is an ORAL medication (7 days)

Rimantadine (there has been widespread resistance shown for this medication, so it is not being used as much now)

Nursing diagnoses for the child with leukemia

Risk for Infection Acute Pain r/t diagnosis, Tx, tests Altered Nutrition: <body requirements r/t N/V, anorexia Fear/Anxiety Risk for Injury r/t bleeding, chemo Tx Body Image Disturbance r/t hair loss, moon face Interrupted Family Processes r/t child with life-threatening disease Impaired Mucous Membrane Impaired Skin Integrity r/t chemo, radiation

What are some nursing diagnoses for the unconscious child

Risk for suffocation, risk for injury (seizures), Risk for aspiration, interrupted family process, self care deficit, Risk for impaired skin integrity, risk for ineffective airway clearance, risk for imbalance nutrition

What are the quality patient outcomes for bronchiolitis

Room air o2 sats >90% at all times, respiratory rate <60 breaths/min, adequate oral fluid intake

Infectious diarrhea causes

Rotavirus(SMELLS), noro virus, e.coli, shigella, salmonella, yersinia, campylobacte, cholerae, c-diff, staph

Which vaccinations are given at 2, 4 and 6 months of age?

Rotavirus, DTaP, HIB, PCV(pneum)

What are some primary prevention measures for cognitive impairment

Rubella immunizations, genetic counseling (for downs or fragileX), use of folic acid supplements during Pg to prevent neural tube defects, education regarding dangers of ETOH use during pregnancy and lead in childhood, reduction of head injuries

Therapeutic management of nephritis?

Salt restriction in diet to reduce edema effects, fluid restrictions (only short term and only if massive edema) also potassium limits in diet, antihypertensives and antibiotics are used to treat as well as diuretics as needed. watch for s/s of renal failure

In this age for separation anxiety the child might tolerate the separation but miss routines at home and may feel lonely, bored, isolated or depressed.

School age children

This is a complex spinal deformity with lateral curvature of spine, rotation causing rib asymmetry, thoracic hypokyphosis (backpacks can cause this lasting spine problems if not used properly, put heavy stuff in back, have bold shoulder straps, or use wheeled ones)

Scoliosis

This disease is x recessive or autosomal recessive and is the absence of both humoral and cell mediated immunity, literally born without an immune system.

Severe combined immunodeficiency disease

What is the most common cause in children of acute renal failure?

Severe dehydration or other causes of poor perfusion that may respond to restored fluid volume.

What occurs in all children who have been without purposeful movement and normal brain stem function after a near drowning/submersion injury?

Severe neurological defects or death

How is scoliosis screened for?

Shirt off, bend slowly at waist, look at spine, scapula and shoulders. (Look at legs, may have one pant leg longer than the other) Xray confirms (most common in girls 10-13)

What are some contributing factors to developing UTIs?

Shortened urethra, Uncircumcised, urinary stasis or reflux, altered urine and bladder chemistry, indwelling intermittent catheterization, tight clothing, bubble baths

What solution should be used to rehydrate children with diarrhea associated dehydration?

Should be 75-90 mEq/L of sodium, give 40-50ml/kg of rehydration solution over 4 hours. Replacement and maintenance solution should consist of 40-60mEq/L of Sodium. Reevaluate need for further rehydration - do not exceed 150ml/kg/day volume. (THIS IS ORAL)

What would be the best way to explain a procedure for the Urinary tract system to a 3-4 year old?

Show them using a doll

Which childhood disease often results in opioid pain therapy early in life?

Sickle Cell disease

With which problems would open surgery of the urinary tract be recommended to a pt?

Significant anatomic abnormality at uterovesical junction, severe VUR (reflux), noncompliance with med therapy, intolerance to abx, VUR (reflux) after puberty in women, and chronic recurrent UTIs

List the types of partial seizures

Simple partial, Complex partial

What is the treatment for dislocations?

Simple- reduce asap, with conscious sedation and possible local. (Ketamine, versed, diprivan, fentanyl)

What happens to fontanels with dehydration?

Sink in

What positions would be best for performing a physical assessment on a toddler?

Sitting or standing on or by parent. Prone or supine in parents lap

What are the steps for physical assessment of cerebral function

Size and shape of head, spontaneous activity, postural reflex activity, sensory responses, symmetry in movement of extremities, high pitched, piercing cry, abnormal eye movements, problems coordinating suck/swallow, lip smacking

This bone disease is characterized by persistent, intermittent bone pain, joint swelling and stiffness fever and weight loss, usually does not occur in USA.

Skeletal TB (treat with TB drugs)

List some gross motor, fine motor, sensory and social milestones of a 4 year old preschooler

Skips/hops on one foot, catches ball reliably, uses scissors following the line, can lace shoes without a bow, vocab 1500+words, peak of questioning, exaggerates, sings, names one or more colors, can do analogies(if ice is cold, fire is hot), independent, selfish, inpatient, agressive physically and verbally, pride, mood swings, fears, imaginary playmates, associative play, intuitive thought phase - causality, judge everything according to one dimension, more social awareness, may count but poor math concepts, obeys parents because of limits set - not because of knowing right from wrong, rebels if expectations too high, takes aggression out on parents/sibs, may "run away" from home, ID strongly with parent of OPPOSITE sex,

Which flu vaccine should not be used in children who are immunocompromised?

The live virus (nasal spray)

Parasympathetic nervous system controls what?

Stimulates flow of saliva, slows heartbeat, constricts bronchi, stimulates peristalsis and secretion, stimulates release of bile, contracts bladder

This is cross eyed

Strabismus

This is a microscopic tear to the tendon can occur suddenly or over time (Stress)

Strain

Nursing care for the pt with genitourinary nephrotic syndrome? (nephrosis)

Strict I and O, daily weights, daily abdominal girth measurements (ascities), promote rest, good skin care to protect from infection, teach diet (low salt) - early detection of relapse-meds(steroid side effects), normal course of treatment

This type of osteomyelitis is often viral and usually found within an abscess , and has a longer course.

Subacute (often in proximal or distal tibia)

This is bleeding between the dura and the cerebellum (under the dura) usually result of veins 10 times more frequent than other types of brain hemorrhages, usually peak at age 6 months, often result of trauma, falls, assaults, SHAKING VIOLENTLY

Subdural hemorrhage

This type of hip dysplasia results in a flat socket from head of femur still being in contact but with ligaments stretched holding it into socket. Pressure on the roof inhibits ossification.

Subluxation

Early signs/symptoms of increased ICP in infants

Tense/bulging fontanel, irritable, high pitched cry, distended scalp veins, changes in feeding, sun setting sign (eyes) - eye pushed down

What is the most rapidly developing part of a childs body physically?

The Legs

This scale is most widely used in children 8 and older for assessment of pain

The Numerical Rating scale (1-10, 10 being the worst)

What structures in the brain make up its overall volume?

The brain itself, the CSF and the blood.

Poststreptococcal Glomerulonephritis pathophysiology

The glomeruli become edematous and infiltrated with lumpy bumpy leukocytes which occlude the capillaries, the resulting decrease in plasma filtration results in excess accumulation of fluid interstitially leading to circulatory congestion and edema.

What is important to remember about seizure control medications

They are usually titered... blood levels are usually drawn to check for therapeutic dosage levels and to monitor for toxicity. If they reach therapeutic level and seizures still occur- they may add another, or try something different.

What if a child is at high risk for RSV(Bronchiolitis?) (high risk=preemies, preemies in daycare/older sibs under 5, children with weakened immune systems or heart issues)

They can receive the Synagis immunization every month during the peak seasons, November-March for prophylaxis

How do seizure medications work?

They can suppress the discharge of neurons from within the seizure focus, They can suppress propagation of seizure activity from one focus to other areas of the brain by suppressing calcium influx, suppressing GABBA,

How do preschoolers feel in control? What happens if they feel loss of this control?

They experience loss of control caused by physical restriction, altered routines, and enforced dependancy. They feel all powerful and this can also make them feel out of control as well. The sense of control and power is a critical influence on their perception of and reaction to separation, pain, illness and hospitalization. They have egocentric and magical thinking, so it limits their ability to fully understand events that are not in their own perspectives. They have preoperational thinking understanding explanations only in terms of real events so if purely verbal instructions are given they are often inadequate becuase they can not synthesize beyond what their senses tell them. They may interpret messages according to past experiences. They use transductive reasoning not understanding cause/effect relationships. For example - preschoolers may perceive that nurses inflict pain, preschoolers will think then that EVERY nurse or EVERY person wearing a similar uniform will also inflict pain.

Three major quality outcomes for urinary tract infections

Treatment based on culture and sensitivity (right meds!), renal function is maintained, and appropriate diagnosis of renal abnormalities

Which conditions are considered "Medically emancipated" from having to obtain parental consent for treatment for adolescents?

Treatment for STI's, mental health services, alcohol and drug dependancy, pregnancy, and contraceptive advice.

What are some tertiary prevention strategies for cognitive impairment?

Treatment to minimize long term consequences, and early rehab and treatment of coexisting problems that might occur

True or False,in all dimensions of growth and development there is a definite, predictable sequence of events. (sequential trends)

True (crawl before creep, creep before stand, stand before walk - example - another example - Child babbles, forms words, then forms full sentences)

This stage of Eriksons Psychosocial development indicates that the child must have loving care by a mothering person. If the child lacks this care, or if basic needs are not adequately or inadequately met mistrust is acquired and carries on throughout the childs life.

Trust vs Mistrust (birth-1yr)

Eriksons stages of psychosocial development

Trust vs Mistrust (birth-1yr), Autonomy vs Shame and doubt (1-3yrs), Initiative vs Guilt(3-6yrs), Industry vs Inferiority(6-12yrs), and Identity vs Role Confusion(12-18yrs)

When does the infant start rolling over (gross motor)

Tummy to back -5 months, back to tummy - 6 months

What is classified as epilepsy?

Two or more unprovoked seizures (idiopathic)

Treatment for hemophilia

Tx by replacing missing factor via transfusion Factor VIII 3-4 X week Von Willebrand's Tx at home Factor replacement comes from multiple donors DDAVP -Desmopressin - a synthetic form of vaso-pressin that increases plasma factor VIII and vWF levels and holds the pee in (:D) ADH hormone; the treatment of choice in mild hemophilia

What is some of the basic treatments for rheumatic fever?

Tx with aspirin during course of condition r/t anti inflammatory effects and prevention of heart problems (ASA OK to use r/t RF sequella is not viral) Since RF can reoccur - prophylactic antibiotics ordered throughout childhood IM q mo or oral daily for 5 years or until 21 years old If heart disease, need lifelong prophylaxis

The quality of this type of research is evidence for at least one of the critical outcomes from unsystematic clinical observations or very indirect evidence

Very Low Quality

Points to remember about child cerebral structure and function.

Very rapid head growth/ (at 6 brain is size of adults), Infants skull is soft, not rigid, with fontanels present anterior (front) closing at 9-18 months, and posterior (back) closing at 2 months.

Two types of pneumonia

Viral and bacterial

This type of pneumonia is more common, often with URI, usually mild but can lead to bacterial, treat symptoms

Viral pneumonia

Two most common reasons for dehydration in children

Vomiting and diarrhea

Symptoms of Hemolytic Uremic Syndrome

Vomiting, irritability, lethargy, marked pallor, bruising, petechiae, jaundice, bloody diarrhea, oliguria or anuria, at worst if CNS is involved - Seizures, stupor, coma, heart failure signs

This hemophilia is actually two missing factors

Von willdebrands (VwF and Factor VIII)

Treatment for roseola (exanthum subitum)

Watch temp, seizure precautions, no real treatment, listed as nonspecific.

What is best indicator of dehydration in a child/infant?

Weight - 5% loss = mild, 10% loss=moderate, >10% loss=severe

Side effects of steroids

Weight gain, rounded face, behavior changes, increased appetite. Long term use - hirsutism, growth retardation, cataracts, hypertension, GI bleed, bone demineralization, infection, hyperglycemia

Signs of dehydration in children?

Weight loss, behavior changes, fontanels sunken, increased RR, Decreased UO, Decreased turgor, decreased tears, sunken eyes,

Which childhood communicable diseases are bacterial?

Whooping Cough, Diptheria, scarlett fever and bacterial conjunctivitis

List some "other" infections of the respiratory tract

Whooping cough (pertussis), Tuberculosis, Foreign body aspiration / aspiration pneumonia, pulmonary edema, ARDS, ALI, Smoke inhalation injury and environmental smoke exposure

What would pupils look like after a seizure?

Widely dilated but reactive (Only one side may be involved)

This is an encapsulated tumor of the kidney that is the most common malignant renal /intraabdominal tumor of childhood, peak age 3 years old

Wilm's Tumor

Clinical manifestations of hirschsprung disease in infants

growth failure, constipation, abdominal distension, diarrhea and vomiting episodes, signs of enterocolitis - explosive diarrhea (watery), fever, appears significantly ill

Early signs/symptoms of increased ICP in children

h/a, n/v, diplopia, seizures, irritability, restlessness, indifference, decline in school performance, memory loss, diminished physical activity, inability to follow simple commands, lethargy, drowsiness

Child specific signs of chronic renal failure

headaches, muscle cramps, nausea

Name 7 factors that can have an influence on development

heredity, neuroendocrine, nutrition (HUGE FACTOR), interpersional relationships, socioeconomic level, disease, environmental hazards

Examples of alternative medical systems for pain

homeopathy, naturopathy, ayurvedic, traditional chinese medicine(acupunture) (native american spiritual medicine women/men) - my own 2 cents :D

medications used to treat sickle cell anemia

hydroxyurea, preventative antibiotics, folic acid(helps RBC production)

This is hernial protrusion of a saclike cyst of meninges filled with spinal fluid

meningocele

Examples of mind-body techniques for pain

mental healing, expressive treatments, spiritual healing/cleansing, hypnosis, relaxation

This is hernial protrusion of saclike cyst containing meninges, spinal fluid and a portion of the spinal cord with nerves.

myelomeningocele

What are the healing times for broken bones in children according to age range of neonates/young kids/older kids/teens

neonates 2-3 weeks, young kids 4 weeks, older kids 6-8 weeks, teens 8-12 weeks

This is one type of tumor that might spontaneously regress

neuroblastoma

This type of tumor often presents with back and abdominal pain

neuroblastomas

This is impaired absorption of CSF within the subarachnoid space

non obstructive/communicating hydrocephalus

This is prevention of flow of CSF through the ventricular system

obstructive/non-communicating hydrocephalus (often caused by developmental abnormalities -(aqueduct stenosis arnold-chiari malformation)

Would they try IV therapy or oral fluid rehydration first in an infant/young child who has been vomiting and showing signs of dehydration?

oral fluids first, (less invasive). If still vomit after attempt to give oral fluids to rehydrate, then last resort IV.

List some seizure medications

phenobarbital, tegretol, dilantin, cerebyx, depakote, depakene, zarontin, lamictal, felbatol, keppra, trileptal, neurontin, topamax, sabril

This is the deliberate infliction of physical injury on a child

physical abuse

Treatments for cystic fibrosis

prevent or minimize pulmonary injury/complications, ensure adequate nutrition for growth, encourage appropriate physical activity, promote reasonable quality of life for the child and family.

This type of ureteral reflux is a congenitally abnormal insertion of ureters

primary reflux

General manifestations of aplastic crisis in sickle cell anemia

profound anemia if increased erythropoiesis is compromised, not making enough RBCs

Goal for working with failure to thrive children

provide them with sufficient nutrients for growth to reverse the malnutrition

Why is it believed that breastfed babies have less occurence of otitis media?

r/t IgA, decreased exposure to pathogens and foreign proteins and more upright feeding position.

What is global organization (toddlers 1-3)

reasoning that changing one part of the whole changes the entire whole (example - child refuses to sleep in a room because bed location has changed)

What is the goal for treating hydrocephalus?

reduce hydrocephalus, treat complications, encourage growth and development, post op- check neuro status, watch for s/s infection, watch for shunt malfunctions (blockage, misplacement) Most often child will resume normal intelligence. 1/3 will be normal 2/3 will have some problems.

Examples of energy based treatments for pain

reiki, bioelectric, magnet treatments, pulsed fields, alternating and direct currents

When is a bone marrow transplant considered for leukemia?

reserved for ALL kids with relapse (done in 2nd remission phase) since good outcome with chemo or AML kids in 1st remission if donor is available.

What is the purpose of traction?

to help overcome muscle spasm, keep in alignment and immoblize until healing begins (Callus forms)

This is the way a person deals with life

Temperament

TWo types of hydrocephalus

Nonobstructive or communicating; obstructive or non-communicating

This is failure to thrive caused by psych/soc issues (caregiver neglect etc)

Nonorganic Failure to Thrive

What is early stage tx of neuroblastoma?

Complete removal of the tumor possible resection if large, with possible radiation if some is left, (the younger the child at diagnosis, the better the chance for survival)

What is The best mode of communication with an infant?

Nonverbal

Infants breathe through their _______.

Nose

What is the biggest factor in extending life expectancy with the child diagnosed with cystic fibrosis?

Compliance right from the start and ongoing.

In this type of fracture, the bone fragments cause damage to other organs

Complicated

This is one of the most crucial times in the development process of a human being

Conception -birth (also contains the Germinal, Embryonic and Fetal stages)

What is a "Strong" recommendation for research?

Desirable effects clearly outweigh undesirable effects or vice versa

What is "weak" recommendation for research?

Desirable effects closely balanced with undesirable effects.

This is a qualitative change

Development

What is the favorable outcome if the child successfully develops through the Identity vs Role Confusion(12-18 yrs) Stage?

Devotion and fidelity to others and values.

This is an amphetamine used to treat ADHD

Dexedrine (dextroamphetamine)

The only two treatments available for the pt with End stage renal disease

Dialysis and transplant.

What nursing care is done for pts with high cholesterol?

Dietary teaching / meds if needed

80% of all UTIs are caused by this organism

E. Coli (mostly gram negative organisms)

What is used to determine brain death?

EEG

What are some special diagnostic procedures for assess cerebral function

EEG, Lumbar puncture, CT and MRI, PET scans

Four types of hemophilia

Factor VIII (A), Factor IX(B), Factor XI(C), Von Willebrands

This is an arthritis that requires very long treatment and they may aspirate fluid/pus from hip area, often caused by S. areus

Septic Arthritis

If one child in the family is being abused are they all?

Not usually, often it is one child singled out (may be adhd, difficult child that just doesn't mesh with the parent)

In general, treatment for acute renal failure

Treat underlying cause, manage complications, provide supportive therapy

Which site is most commonly used when vaccinating infants?

Vastus lateralis

Four emergency treatments for shock

Ventilation, fluid administration, cardiovascular support, general support

Normal platelet counts

150-400 x 10^3

How many hours a day do newborns sleep?

16-18

At what age do children run?

18 months

When can the deltoid muscle be used for vaccinations? (age)

18 months or older

Largest dose of digoxin an infant might receive?

1mL (50mcg or 0.05mg)

Predominant symptoms of fifths disease?

(caused by HPV) Slapped face red cheeks, rash after a day on face, symmetrical rash, after rash subsides skin still looks irritated can lead to aplastic anemic crisis which includes fever, myalgia, lethargy, n/v, and abdominal pain. If mother is infected during pg, fetal death can occur.

What does the CNS consist of?

2 cerebral hemispheres, brainstem, cerebellum, spinal cord

What is the amount of TV exposure recommendation for children ?

2 hours a day, no more than 10 hours / week.

Predominant symptoms of Roseola (Exanthum Subitum)

(caused by Herpes virus) High fever, rash develops fever breaks, discrete rose-pink macules on trunk then speads to face neck, non itching. Isolation not necessary

Which heart defects cause decreased pulmonary blood flow (right to left shunting)?

(cyanotic) teratology of fallot

What is the treatment for hip dysplasia for the infant 0-6 months?

(if 0-6 months) Keep hip abducted (pavlick harness, brace), keep hip in contact with acetabular roof

At what age do children move up and down stairs

2 years

How long must a child be seizure free before seizure medications might be backed off on?

2 years

A diagnosis of cognitive impairment/mental retardation is based on what criteria?

(not IQ) - Subaverage intellectual functioning, deficits in adaptive skills, and onset before age 18 years old

What is the average yearly weight gain of preschoolers and school aged children?

2-3 kg (4.5-6.5 lbs)

When can an infant reflex grasp (fine motor)?

2-3 months

Age range for epiglottitis

2-5 year olds

Predominant age for Minimal change nephrotic syndrome (aka... idiopathic nephrosis, childhood nephrosis) is?

2-7 years of age.

Normal Uric Acid levels in a child?

2.0-5.5

What is the median age of occurance for neuroblastomas?

23 months

When are affected persons with influenza the most infectious?

24 hours before and after the onset of symptoms

When is the peak time that cerebral edema may occur after at trauma?

24-72 hours after.

When can can infant open hands (fine motor)

3 months

Median survival age for Cystic fibrosis?

37.5 years

When does the infant gain head control (gross motor)

4 months

Normal BUN levels for Newborns

4-18

What age should infants start cereal?

4-6 months

When does the infant do the locomotion(Push back with arms) (gross motor)

4-6 months

Normal BUN levels for infants and children

5-18

What is the average weekly weight gain for a child 1-6 months old?

5-7 oz (140-200g)

How much time do newborns spend in REM Sleep

50%

List some creative techniques for communicating with children

"I" messages (Avoid YOU), third person (Sometimes when a person is sick, he feels angry, do you ever feel that way?), facilitative response(feedback response after they share with you for understanding So what you are saying is you feel_________ because________), Storytelling (have them tell the story), Bibliotherapy, dreams, "What if ?'s", Three wishes, word association game, sentence completion, pros and cons, nonverbals, drawing, magic (Simple tricks), play

Which heart defects cause left to right shunting? (increased pulmonary blood flow/congestion)

(acyanotic) Patent Ductus Arteriosus, Atrial Septal defect, Ventricular Septal Defect, atrioventricular canal defect

Normal urine osmolality levels

50-1400 depending on fluid intake. after 12 hr fluid restriction >850, 24 hr urine screen = 300-900

When does the infants manipulate skill increase?(fine motor)

6 months

How many symptoms of ADHD must be present to be diagnosed with ADHD?

6 out of 9

How long is the steroid treatment for nephrosis?

6 weeks usually.

Normal urine protein levels 1-7 year old

6.1-7.9

Normal urine protein levels 8-12 year old

6.4-8.1

Normal urine protein levels 13-19 year olds

6.6-8.2

Five stages of spiritual development (FOWLER)

0 - undifferentiated(infants), 1-intuitive-projective(toddlers), 2-mythical-literal(school age), 3-synthetic-convention(approaching adolescence), 4-individuating-relexive(adolescence - skepticsm, owning own belief)

When can the infant transfer objects hand to hand and hold and object in each hand and bang? (fine motor)

7 months

When does the infant start to sit (gross motor)

7 months

Normal Creatinine levels in an infant?

0.2-0.4

Normal Creatinine levels in a child?

0.3-0.7

Normal Creatinine levels in an adolescent?

0.5-1.0

When is chickenpox contagious

1 day before lesions erupt, to 6 days after first crop of vesicles crusts have formed.

When measuring I and O how much is 1g of weight in the diaper?

1 mL of fluid

What are some of the criteria for Anti-D Antibody therapy to be administered in a pt with ITP (immune thrombocytopenia)

1-19 years old and Rh+, normal WBC for age, and platelets of 20,000, no active mucosal bleeds, no history of reaction to plasma products, no known IgA deficiency, no autoimmune hemolytic anemia, non suspicion of lupus or other collagen vascular disorder, no splenectomy, no concurrent infection present

When is the greatest risk for infection after shunt placement for hydrocephalus?

1-2 months after placement - treated with massive antibiotics if persistent - removal must happen, and external drainage might be used until CSF is sterile again.

When are children screened for lead levels?

1-2 years old

Influenza incubation period

1-3 days

What are the patterns in order of physical development of neuromuscular functions?

1. Cephalocaudal, Proximodistal, Differentiation

What is the overall aim of therapy for treating sickle cell pts?

1. Prevent sickling, treat emergencies of crisis.

What are important points to assess if a child has a suspected communicable disease or infection?

1. Recent exposures? 2. Prodromal symptoms(sx that occur between early manifestations and it's clinical syndrome) or evidence of constitutional (Certain) symptoms 3. immunization history 4. history of having the disease

The child is most susceptible to overwhelming infection during three phases of leukemia. What are they?

1. at time of diagnosis and relapse when leukemic process has replaced normal leukocytes, 2. during immunosuppressive therapy, and 3. after prolonged antibiotic therapy, which predisposes the child to the growth of resistant organisms. (May use Neupogen-GCSF to reduce incidence of infection in children getting treatment for cancer)

What are the stages of the sensorimotor(birth-24 months) phase of cognitive development?

1. reflexes(birth-1month) example-grasping, sucking 2. primary circular reactions (1-4 months) still somewhat reflex based. example - sucking thumb-by chance the thumb came to mouth and the infant sucked the thumb -because this created a pleasurable response the infant will attempt it again but may not succeed. 3. Secondary circular reactions (4-8months) example- A child is moving about in a playpen and happens to hit the mobile overhead. The mobile spins and catches the baby's attention. Once the mobile stops spinning, if the child enjoyed the experience, the child will move his arms and legs again to try and hit to mobile. The child wants to repeat the behavior.4. Coordination of secondary circular reactions (8-12 months) example - A child wants the a rattle but a blanket is in the way. The child will move the blanket to get the rattle.

Two steps to treating Hirschsprung disease

1. temporary ostomy to allow bowel rest 2. corrective surgery to reconnect (most kids need surgery intervention - high success rate)

Incubation period for rabies

10 days to 8 months (!)

When can the infant pick up finger foods?(fine motor)

10 months

When does the infant start to maneuver from prone position (gross motor)

10 months

Television/video viewing by infants/toddlers shown to increase risk of ADD by _______% for each _____ hour(s) of viewing/day before 2 years!

10%, 1 hour

At what age do children learn to ascribe meaning to words?

10-11 months

How much should school aged children at 5 yo sleep?

11 hours

When is an infants pincer grasp replaced with neat pincer? (Fine motor)

11 months

How much do preschool age children sleep

12 hrs/night rarely nap

At what age do children walk?

12-13 months

This is classic hemophilia, 75% of all cases x linked recessive (mom carries to sons) (x linked recessive = 50% chance daughter carrier, 50% chance son diseased)

Factor VIII (Hemophilia type A)

When is BMR highest? As an adult or as a newborn?

A newborn has the highest BMR.

What would be the best way to explain a procedure for the urinary tract system to an older child?

A simple drawing of the system involved with explanation.

Assessment of child with head injury

ABC, evaluate for shock, assess of papillary symmetry and response to light (pupils), observation for seizures, LOC

This disorder is developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. Can cause difficulties in school, distractibility, impulsivity, aggression, maladaptive coping but usually 1/3 of kids outgrow it.

ADHD

What prenatal tests are done to detect neural tube defects

AFP blood test 16-18 weeks (increased with spina bifida 80% of the time), Ultrasound to diagnose may choose c-section

This is the most common type of leukemia with the best prognosis

ALL (Acute Lymphoid Leukemia)

Which leukemia AML or ALL requires inpatient hospital treatment?

AML (it is more severe than ALL) AML=Acute myelogenous Leukemia with only 30-40% cure rate. (ALL- 75% cure rate)

What test is most used to detect recent strep infection? (nephritis)

ASO tests(antistrep O titer)

Causes of Scoliosis

Abnormal formation of vertebrae (congenital deformity), Trauma/fracture or radiation, muscle weakness(CP, MD, Polio), unequal leg lengths, some may be idiopathic

What is hyperpnea?

Abnormal increase in depth and rate of the respiratory movements.

What are three clinical observations that are predictive of croup - acute epiglottitis?

Absence of spontaneous cough, presence of drooling, and agitation.

This type of hip dysplasia, is the most mild form and is not dislocated.

Acetabular (preluxation)

Three types of hip dysplasia

Acetabular, subluxation, dislocation

Most common accidental drug poisoning in children?

Acetaminophen

What is the normal chemotherapy treatment for Wilms Tumor after surgical removal (even if only Stage I!)

Actinomycin D (dactinomycin), Vincristine, Adriamycin (6-15 months)

Your pt has recently undergone surgery and is experiencing diminished urinary output and lethargy should be evaluated for what?

Acute Renal Failure

Infants and young children react more severely to ____ ____________ ________ infections than older children.

Acute Respiratory tract infections

This croup is a viral with allergic component, occurs suddenly at night, in 1-3 year olds, associated with URI, croupy cough, stridor, hoarseness, dyspnea, restlessness, symptoms awaken the child at night but disappear during the day. Treatment is cool mist, reassurance has tendency to recur. (Classic night time croup)

Acute Spasmodic Laryngitis

List some of the more common croup syndromes

Acute epiglottitis, acute laryngotracheobronchitis, acute laryngitis, bacterial tracheitis

This croup is a viral disease that affects children 5 and under slow progression, URI present, brassy dry barky cough (barking/seal like cough), hoarseness, dyspnea, low fever, nontoxic appearance, restless, irritable

Acute laryngotracheobronchitis (LTB)

This type of osteomyelitis is caused by blood borne bacterium (abscessed teeth, URI, otitis media, lesions, tonsilitis, pyelonephritis, infected burns, etc)

Acute osteomyelitis

Four classifications of osteomyelitis

Acute, exogenous, subacute, chronic

Three phases of Kawasakis

Acute, subacute, convalescent

When enlargement of these occurs, the space behind the posterior nares becomes blocked, making it difficult or impossible for air to pass from the nose to the throat = child breathes through the mouth

Adenoids

What should the nurse *plan* for when treating the child with a respiratory infection?

Adequate oxygenation Effective clearance of secretions Optimum comfort Effective respirations Adequate fluid and nutrient intake Child will maintain optimal body temperature

When renal function is suddenly restored in Acute failure, what must the nurse watch for?

Adequate replacement of fluid, potassium, and sodium because some patients pass enormous amounts of electrolyte rich urine once kidney function is restored.

What is the convalescent phase of kawasakis?

All signs and symptoms gone but lab values off ( day 26- 6-8 weeks after onset) (increased platelets, sed rate)

What can trigger relapses of Nephrosis (Genitourinary Nephrotic syndrome)?

Allergies, viral or bacterial infection, stress

What are some things that may cause a school aged child to feel loss of control?

Altered family roles, physcial disability, fear of death, abandonment, permanent injury, loss of peer acceptance, lack of productivity, inability to cope with stress according to cultural expectations (Boys are tough!) In hospital - enforced bedrest, use of bedpan, inability to choose food from menu, lack of privacy, help with a bed bath or transport by wheelchair or stretcher. They need freedom of choice. (Increase sense of control = feeling us usefulness with helping make decisions) To combat this provide them with choices, keep them from getting bored, promote adjustments to physical restrictions.

What are some reasons an infant might be born with a skeletal limb missing/deficient?

Amniotic band syndrome, heredity, or environmental factors (teratogens)

List the ADHD medication classes overall

Amphetamines, Stimulants, Atomoxetine, try cyclic antidepressants, bupropion(Wellbutrin)

What member of the healthcare team is often the first to become aware of the need for a genetic evaluation by identifying an inhereted disorder in a family history, or by noting physical, cognitive, or behavioral abnormalities?

An RN, when performing a nursing assessment.

Three main consequences of leukemia

Anemia (from decreased RBCs), infection (neutropenia), and bleeding (decreased platelet production) Can weaken bone itself leading to tendency to fracture. If CNS is involved can lead to increased ICP

What is the triad diagnostic evaluation for Hemolytic Uremic Syndrome? (Diagnose early, treat aggressively!)

Anemia, thrombocytopenia and renal failure (Evidenced by proteinuria, hematuria, urinary casts, BUM and creatinine are elevated and low Hgb and Hct are noted and high reticulocyte counts.

This is what occurs if the fetus with exencephaly (Brain on outside) survives, the brain degenerates to a spongiform mass with no bony covering, is incompatible with life.

Anencephaly

Signs of Uremic syndrome?

Anorexia, N/V, bruises, bloody stools with diarrhea, stomatitis, bleeding from lips/mouth, itching, uremic frost (crystals on skin), deep respirations, hypertension, CHF, pulmonary edema, confusion that progresses, dulled senses, tremors, muscle twitching, seizures, coma

What are some treatments for pharyngitis?

Antibiotics (oral Penicillin) only if streptococcal sore throat (bacterial) infection is present (oral erythromycin is indicated for children allergic to penicillin) Warm salt water gargle Acetaminophen/Ibuprofen to decrease throat pain Cool liquids or ice chips may be preferable to solids Educate family on importance of correct medication administration and completing the course of antibiotics Children should not return to school/daycare until on antibx for 24

Treatment for bacterial tracheitis

Antibiotics, fluids, antipyretics, monitor for impending respiratory failure in not intubated, may lead to intubation need and mech vent.

These meds are last resort for use in children with ADHD

Antidepressants

Why does Rheumatic fever attack the heart?

Antigenic makers for strep toxin closely resemble markers for heart values causing antibodies made against strep to also attack heart valves.

Treatment for fifths disease?

Antipyretics analgesics, anti-inflammatory drugs, may need transfusion if anemia is present. DOES NOT REQUIRE ISOLATION unless HPV is suspected (then droplet)

This is removal of blood to separate components refeeding some and using others

Apheresis

What VS should be assessed before digoxin is given?

Apical pulse for 1 full minute, hold if <90-110 in infants, <70 in young kids, and <60 in older kids

This is anemia when the bone marrow is suppressed, leading to a lack of production of WBCs, RBCs and platelets

Aplastic Anemia (Congenital or acquired)

Early signs of shock

Apprehension, irritability, normal BP, narrowing pulse pressures, thirst, pallor, diminished Urinary output, unexplained mild tachycardia, decreased perfusion of hands/feet

When should a child missing a limb at birth be fitted with prosthetic devices?

As soon as possible so they have it during growth and become accustomed to it during all stages (crawling, walking etc)

What is negativism

As toddlers attempt to express their will, they may act this way, in response to answers they do not like . "No", or "me do it", often with rapid mood swings (terrible twos?) in a quest for autonomy

Causes of accidents/injury in children

Aspiration/choking, biking, bodily damage (Might be where sports came in?), burns, drowning, falls, fire arms, motor vehicles, poisoning, street accidents and suicide.

Things to *assess* in the child with a suspected Respiratory infection

Assess resp. effort (rate, accessory muscle use, retractions, nasal flaring) Assess oxygenation (pulse oximetry, color,cap refill) Assess body temperature Assess child's activity level Assess child's level of comfort

This is the most common chronic disease of childhood? It is a reversible airway disease characterized by bronchoconstriction of smooth muscles, inflammation and edema of bronchial mucosa, increased mucus secretions, spasm of smooth muscle of bronchi and bronchioles decreasing caliber of the bronchioles.

Asthma

What is a tell - tale sign of hip dysplasia in an infant?

Asymetrical gluteal tight folds, apparent uneven length of femur

What is thalassemia minor

Asymptomatic silent trait carrier (no problems)

When does neural (brain,spinal cord, head dimensions) growth seem to complete? (age)

At about 5-6 years old.

How long must signs be present for diagnosis of ADHD?

At least 6 months

(CP)This is wide based gait, rapid repetitive movements performed poorly, sometimes associated with severe neonatal hypoglycemia

Ataxic

This is actually one of the first non stimulant ADHD med approved for adult use (1 of 2)

Atomoxetine (Strattera) (the other approved for adults is adderall XR) Takes 3 weeks for max response

This is the provision of therapeutic care that eliminates or minimizes the psychologic and physical distress experienced by children and their families

Atraumatic Care

What is animism (toddlers 1-3)

Attributing lifelike qualities to inanimate objects (example-child scolds stairs for making them fall down)

Name the autism spectrum disorders

Austism , aspergers, and pervasive developmental disorder NOS

This system controls vital functions such as breathing, heartbeat, etc.

Autonomic nervous system (sympathetic/parasympathetic)

Four things the nurse should consider to maintain ethical decision making with care.

Autonomy (self governance -give kids choices), Nonmaleficence (minimize harm), Beneficence (Promote well being), Justice (fairness)

This stage of development according to Erikson, is when the child is centered on an increased ability to control their own bodies, themselves and their environment, They want to do things for themselves using their newly acquired walking, climbing and selecting/decision making. If the child does not do this successfully, negative feelings arise, especially if they are made to feel small or self conscious when their choices are wrong or they are put down or not allowed to be independent when possible.

Autonomy vs Shame and Doubt (1-3 yrs)

How much do toddlers sleep

Ave 12 hrs/night with 1 nap until 2nd or 3rd year.

What is the treatment for Pulmonary Artery Hypertension?

Avoid exercise/activity Meds may help (vasodilators) Lung transplantation Give Viagra!

This is an excess in the blood of urea, creatinine and other nitrogenous end products of protein and amino acids metabolism.

Azotemia

This is the accumulation of nitrogenous waste within the blood.

Azotemia

Why is it uncommon for hospitalized children to reach the PERMANENT stage of detachment?

Because the temporary separations imposed by hospitalization do not cause such prolonged parental absences. Also, children are overall remarkably adaptable and premanent ill effects are rare.

Why do infants feel secure when swaddled

Because their flexor muscles are dominant (think startle with arms flailing)

What specific labs are done during renal shutdown that serve to guide therapy for treatment?

BUN, Creatinine, pH, Sodium, Potassium and Calcium (especially hyperkalemia, hypertension, anemia)

What medications might be used in the pt with CP?

Baclofen PO or intrathecally for spasms (muscle relaxers), Tegretol for seizure activity if present or depakote. May also use robinul for secretion (drooling) issues.

Is epiglottitis viral or bacterial

Bacterial

Most common type of meningitis

Bacterial

This is an infection of the valves or the inner lining of the heart, often a sequella of bacteremia in a child with congenital heart abnormalities. Organisms that enter the blood stream through invasive procedures (dental work etc) can occur with these.

Bacterial (infective) endocarditis

Differences in CSF testing results for viral vs bacterial meningitis

Bacterial - CSF is cloudy, positive for culture, decreased glucose, increased protein and elevated WBC counts. Viral- clear, negative culture, normal glucose, normal or very slight increase protein, slight elevation of WBCs

This pneumonia is often more serious, can present with fever, requires antibiotics , includes cough, rhonchi or crackles, retractions and nasal flaring

Bacterial pneumonia

This croup is bacterial, usually S. Areus - moderately progressive in children under 3 years old, high fever present, thick purulent secretions are common and can lead to airway obstruction, no drooling, Doesn't respond to humidity or Epi, if not treated can lead to ARDS, respiratory failure, upper airway obstruction and multiple organ dysfunction. Has features of croup and epiglottitis

Bacterial tracheitis

Three types of meningitis

Bacterial, Viral, and TB

Different Classifications of UTIs

Bacteriuria, asymptomatic bacteriuria, symptomatic bacteriuria, recurrent UTI, persistent UTI, febrile UTI, cystitis, urethritis, pyelonephritis, urosepsis

Important reminders about bedtimes for children

Be consistent, reading can be calming, teach independence, encourage security item, keep positive and calm, nothing scary at bedtime, try not to make it a punishment, discourage co-sleeping (SIDS) - hard habit to break

Foods high in fiber

Beans, wheat flour whole grain, lentils, peas, lima beans, dates, beets mixed frozen veggies.

Why isn't the distal 1/3 of the urethra included in UTI definition?

Because it normally contains and increased level of bacteria anyway without presence of true infection.

How is digoxin used in children almost exclusively?

Because of its rapid onset, the child is monitored by ECG during the initial phases of dosing digoxin (called digitalizing the dosage) to observe for desired effects (prolonged PR interval and reduced ventricular rate) and to detect negative effects such as dysrhythmias.

Why does hypothermia occur so quickly in children/infants?

Because of their large surface area relative to body mass.

Why are there two stages of the infancy period?

Because the first month of life is crucial with major physical adjustments to extrauterine existence and the psychological adjustment of the parent.

Explain the pathophysiology or MCNS (Minimal change nephrotic syndrome)

Because the glomerular membrane allows the proteins and albumin to spill out of the urine, this reduces the serum albumin level, decreasing the colloidal osmotic pressure in the capillaries, as a result the vascular hydrostatic pressure exceeds the pull of the colloidal osmotic pressure and fluid begins to accumulate in the insterstitial spaces (edema) and body cavities, particularly fluid builds up in the abdominal cavity (ascities). This shift of fluid from plasma to interstitial spaces reduces vascular volume (hypovolemia), stimulates ADH and aldosterone hormones and tubular absorption of sodium and water is increased in an attempt to increase the intravascular volume (edema). Blood flow to the kidneys is also decreased because of the hypovolemia occurring which activates the renin-angiotensin system vasoconstricting and again leading to more edema. There is also an increase in fats (hyperlipidemia)

During this phase of treatment for leukemia, Chemo is injected directly into Spinal column.

CNS Prophlyaxis stage

Tests that may be done with a child that has a head injury

CT(all children with head injuries who have any alteration of consciousness, h/a,vomiting, skull fracture, seizure or other medical condition should have one), MRI (provides details of soft tissues)

Treatment for Whooping cough - pertussis

Can be vaccinated against - older adults and children 10-64 years old to protect newborns! Otherwise treatment includes adequate hydration and antipyretic administration. If symptoms are severe or apnea is present - hospitalization may be required.

Treatment for mumps

Can be vaccinated against! Isolation droplet and contact precautions encourage rest, give analgesics for pain, encourage fluids, apply hot/cold, IV fluid if needed for child who refuses to eat or drink may be needed.

What happens in the sickle cell pts if they become hypoxic?

Can lead to acidosis which promotes sickling

This type of pulmonary edema is caused by an increase in pulmonary capillary pressure because of an increase in pulmonary venous pressure, can be caused by excessive fluid overload, left ventricular heart failure, heart valve disorders, sepsis, etc.

Cardiogenic Pulmonary edema

Two main types of pulmonary edema

Cardiogenic and noncardiogenic

This leads to the inability of the heart to contract, and requires heart transplant. Muscle of heart fails to contract. Can be idiopathic or secondary in nature.

Cardiomyopathy

Teaching for the pt with seizure disorders

Care during a seizure for caregivers, importance of drug therapy, medic-alert bracelet, support explain to peers, safety

What is the most important responsibility of an RN when assessing a childs Urinary and Renal function status?

Careful Intake and Output measurements and blood pressures.

Nursing care of the pt with Nephritis?

Careful assessment of VS, volume and character of urine noted, daily weights, restrict fluid/sodium intake if needed. If the child has excessive edema, hypertension and gross hematuria seizure precautions should be taken, Give antibiotics and antihypertensives as needed. watch for s/s of renal failure.

What are some nursing considerations for the pt experiencing immobilization?

Careful skin care, Encourage fluids, provide diversional activities, ROM for unaffected limbs, small frequent meals, mobilize as soon as possible, Provide a high protein and high fiber diet, prevent pressure areas, Use anti-embolism stockings, encourage frequent position changes, monitor hydration blood pressure and urinary output, elevate extremities without flexing knee, watch for edema, monitor for signs of pulmonary embolism, C&DB, Monitor bowel sounds

This is an opacity of the crystalline lens

Cataracts

95% of children with adrenal or sympathetic tumors excrete this in their urine

Cathecholamines

What does lead poisoning do to a child?

Causes anemia, renal problems and neurological problems. At low doses can cause distractibility, impulsivity, hyperactivity, hearing impairment, and high doses can cause encephalopathy, mental retardation, paralysis, blindness, convulsions, coma or death even. If a child has high levels that cause anemia - they pull even MORE lead from environment.

In this pattern of neuromuscular function development, the head end of the person develops first and is large and complex, and the lower end is small and simple. (Infants have structural control of their heads before they have control of their trunks and extremities, hold backs erect before they stand, use eyes before hands, and gain control of their hands before they have control of their feet

Cephalocaudal

This is a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain (also the most common permanent physical disability of childhood - not progressive)

Cerebral Palsy (CP)

What is the favorable ego outcome if the child successfully develops through the Industry vs Inferiority(6-12yrs) stage?

Competence

What do children assess as far as self esteem goes?

Competence, sense of control, moral worth, or worthiness of love and acceptance

What is the most common type of fracture in kids?

Complete

Nursing care interventions after cardiac cath procedures

Check extremity distal to cath site Check temperature and color of affected extremity (coolness or blanching may indicate arterial obstruction) Keep extremity straight as ordered Check pressure dressing for bleeding If bleeding occurs, direct continuous pressure is applied 2.5cm above the percutaneous skin site to localize pressure over the vessel puncture S&S of hemorrhage include: HR, BP Monitor I&O, HR, temp Monitor B/P - hypotension may indicate hemorrhage

What is a hint when a UTI might be suspected of a child wearing diapers?

Check the diaper every 1/2 hour, it can increase opportunity for observing the stream for such findings as straining, fretting before voiding begins, discomfort signs during urination, or dripping of small amounts of urine at a time frequently.

This is the mainstay for tx of neuroblastoma that is advanced stage

Chemotherapy

What is one way to maintain airway patency in the child with cystic fibrosis with excessive mucous secretions?

Chest Physiotherapy (CPT) = vest that vibrates chest similar to "tapping on back" to loosen secretion.

This is failure of a parent or caregiver to provide for basic needs and adequate care of a child

Child neglect

List some planning strategies used with children that have cognitive impairments

Child will be educated using effective teaching strategies, childs optimal development will be promoted, child will learn self care skills, family will plan for future care, child will be cared for appropriately during hospitalization.

Planning for the child that is unconscious

Child will maintain respiratory integrity (first priority) , Will not experience increased ICP, Keep head of bed elevated, meet childs basic needs also - airway, hydration, nutrition, and elimination, turn q 2, support family and educate them

What age is recommended for the FACES pain scale?

Children as young as 3 years and up. Ensure you do not use affect words such as happy/sad, it could result in mood scores over pain scores. It provides facial expressions, numbers and words. Can be used despite culture (Widespread culture pain assessment use).

Examples of manipulative treatments (for pain)

Chiropractic, osteopathy, massage

This occurs when the diseased kidneys can no longer maintain the normal chemical structure of the body fluids under normal conditions.

Chronic Renal Failure (GFR < 50%, they retain waste products(BUN, creatinine), water and sodium, hyperkalemia, met. acidosis (treated with sodium bicarb), calcium and phosphorus disturbances, anemia and growth disturbances(treated with growth hormones) (freq infections also such as pneumonia, UTI) Anemia r/t decrease erythropoietin, hypertension treated with decreased sodium diet fluid restrictions and if needed, meds (may need to check BPs manually)

This type of osteomyelitis is slow but steady progression of bone deterioration, dead bone, bone loss, drainage of the sinus tracts

Chronic osteomyelitis

Mnemonic for caring for the pt with fractures is CLIENTS what does it mean?

Circulation, lungs, integumentary, elimination, nutrition, traction, social/psychological

What are signs in children 2 and older that they might have a UTI.

Classic symptoms - Fever incontinence, increasing frequency, dysuria, urgency, strong smelling urine, abdominal or flank pain

What is the most useful clinical estimation of GFR (without actually testing for it specifically?)

Clearance of creatinine. (Urine test over 12 -24 hours)

Results of positive CSF test for bacterial meningitis will show what?

Cloudy, increased protein, decreased glucose (think..hungry bacteria ate the sugar), increased cell count, positive cultures.

This is a skeletal congenital deformity of the foot in which the foot is twisted out of normal position, and can not be manipulated into a normal position. Affects boys twice as much as girls

Club Foot

What would a good family and health history tell you about the cerebral function in a child?

Clues regarding genetic disorders with neuro manifestations, and may provide clues as to cause of dysfunction if present

This is the process by which developing individuals become acquainted with the world and the objects it contains.

Cognition

This is any type of mental difficulty or deficiency, usually intelligence quotient of <70-75 or below and includes functional impairment of at least 2 of these - communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work

Cognitive Impairment (mental retardation)

In this type of fracture, small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue (rare in kids)

Comminuted

This applies to infections characterized by hoarseness, barky cough, inspiratory stridor, varying degrees of respiratory distress, it is common in younger children because the smaller diameter of the airway leads to a greater narrowing with the same degree of inflammation

Croup

How do infants attempt to maintain control of their enivronment while hospitalized? What happens to the infant if they feel out of control?

Cry, smiles. Routines need to be established to meet the infants needs for control. inconsistency and deviations from the sense of control for the infant may lead to mistrust and decreased sense of control.

This is an autosomal recessive disease, affects exocrine glands involving primarily the lungs, pancreas and sweat glands. Secretions from mucous glands are thick, sweat and saliva have characteristic high levels of sodium chloride (salt)

Cystic Fibrosis

This type of spina bifida is visible with saclike protrusion

Cystica

What are some complications that may occur r/t bacterial meningitis?

DI-increased highly diluted urine, If urine specific gravity decreases - give DDAVP (vasopressin) , SIADH - decreased urinary ouput, blood sodium lost in urine, increase in urine specific gravity(restrict fluids), may have seizures, may have vision/hearing issues, may have cognitive delays

What is the number one consideration when caring for a child with an intact Wilm's Tumor?

DO NOT PALPATE THE ABDOMEN (Could disperse cancerous cells throughout body)

Damage to this part of the urinary system can alter the ability to concentrate urine, increasing urine flow and leading to metabolic acidosis from decreased excretion of acid.

Damage to the distal nephrons

Signs observed by parents of athletes after a hit that may indicate head trauma

Dazed, stunned in appearance, confused about assignment, forgets play, unsure of game score or opponent, moves clumsily, answers questions slowly, loses consciousness, shows personality changes and behavior changes, can't recall events prior to hit, can't recall events after hit.

This is seen with severe dysfunction of cerebral cortex (above the brain stem)

Decorticate posturing (flexion)

What are some non medication ways to lower cardiac workload?

Decrease activity, Maintain steady body temp, Feeds-NG if too fatigued to eat, higher calorie formula, minimize stress, Soft nipple on bottle to make feeds easier, consider gavage feeding

Do dogs in the house increase or decrease the risk of otitis media?

Decrease.

Later signs of chronic renal failure

Decreased appetite, less interest in activities, increased or decreased output with compensatory intake of fluid, more pallor, sallow muddy appearance of skin

What is hypopnea?

Decreased rate and depth of breathing (Shallow)

This type of respiration may be the result of metabolic acidosis

Deep and rapid respiration's

Which pain medication is contraindicated in the pt with sickle cell disease?

Demerol. (build up in system from repeated dosage causes anxiety , tremors, myoclonus and seizures.

Diagnostic findings and preceeding factors in the pt with DIC

Depressed platelet counts, fragmented RBCs and depleted fibrinogen (any child acutely ill is at risk for this - it occurs secondary to a complication to a number of diseases, such as hypoxia, acidosis, shock and endothelial damage from a number of diseases - systemic diseases, congenital heart disease, necrotizing enterocolitis, gram negative bacterial sepsis, ricketts and some severe viral infections.)

What is the name of the drug used in chelation therapy for thalassemia

Desferal (deferoxamine)

This pattern of neuromuscular function development is simple operations first then more complex activities and functions. The earliest of these is seen in utero when embryonic cells who are individualized with different functions separately join together to begin forming one complex multifunction organism together at conception. Also indicates postnatally that gross motor functions develop before fine motors

Differentiation

What is orthopnea?

Difficulty breathing when lying down. Need to sit up to breath normally

What is done to improve cardiac function in a child with heart failure?

Digoxin(improves contractility), and ACE inhibitors (reduce afterload making it easier to pump)

Sympathetic nervous system controls what?

Dilates pupil, inhibits flow of saliva, accelerates HB, dilates bronchi, inhibits peristalsis and secretion, conversion of glycogen to glucose, secretion of adrenaline/noradrenaline, inhibits bladder contraction.

What are the quickest methods to measure for UTI?

Dipstick test for leukocyte esterase or nitrite are the quickest, most inexpensive methods

What are the favorable outcomes if the child successfully develops through the initiative vs guilt (3-6yrs) stage?

Direction and Purpose

This type of hip dysplasia is when the femoral head loses contact with the acetabulum, and is displaced posteriorly and superiorly (back and up) over the rim, ligament is elongated

Dislocation

This is the process of separating opposing bone to encourage regeneration of new bone in the created space (think growth- dwarves) Usually with external fixation.

Distraction

Name some nonpharmacological methods to manage pain in children

Distraction, relaxation, guided imagery, positive self talk, thought stopping, cutaneous stimulations, behavior contracting, swaddling, nonnutritive sucking, kangaroo care

What are some considerations when giving medications to infants/neonates?

Distribution in infants may be greater due to poor protein binding, And drugs with central nervous side effects may have worse effects due to the immature functioning of the infants blood brain barrier. Infants, especially neonates have a decreased ability to metabolize drugs, especially in the liver, if the drug is metabolized in the liver - it will affect dosing, same goes for kidneys - less blood flow less filtration rates in neonates and infants = dosages affected for this reason.

What is important for the nurse to educate parents of sickle cell anemic pts with regards to CVA (Stroke) symptoms

Do not assume they know everything about the disease, assess current knowledge, teach s/s of stroke

How can you estimate how tall a child might be as an adult?

Double their height at age 2.

This is the most common chromosomal abnormality, etiology is unknown, more likely with older mothers (even dads) but majority is from younger moms

Down Syndrome

What is the Max drainage for chest tubes post op?

Drainage greater than 3ml/kg/hr for more than 3 consecutive hours or 5-10ml/kg in any 1 hour is excessive and may indicate hemorrhage. Notify surgeon immediately tamponade can develop quickly and is life threatening

When does the primary socialization sensitive period occur?

During the first year when the infant makes the initial social attachments and establishes basic trust in the world.

When do babies usually begin to sleep through the night?

During the later part of the first year.

(CP)This is abnormal involuntary movement (chorea) usually involving extremities, trunk, neck, facial muscles, tongue, pharyngeal, laryngeal and oral muscle involvement, may have drooling or poor speech articulation(dysarthria), signs disappear in sleep. Associated with birth anoxia

Dyskinetic (extrapyramidal, athetoid, dystonic) - abnormal involuntary movement that goes away during sleep Athetoid-chorea(writhing, wormlike, movements Dystonia-slow twisting movements of trunk/extremities, abnormal posture may drool

Early signs suggestive of cognitive impairment

Dysmorphic features (body structure), irritability or unresponsiveness to contact, abnormal eye contact during feeding, gross motor delay, decreased alertness to voice or movement, language difficulties or delay, feeding difficulties

What is labored breathing also known as?

Dyspnea

Manifestations of asthma

Dyspnea, wheezing, coughing, itchy, irritable, uncomfortable, restless, headache, feeling tired, tightness in chest, infants may have retractions

Signs of digoxin toxicity in children?

Dysrhythmias, bradycardia, N/V (spitting up), anorexia

This period of development consists of intense activity and discovery of the things in the world. Often language will develop and motor development advances steadily. They learn role standards, gain self control and develop increasing awareness of self dependence and self concept

Early Childhood (1-6 years)

Treatment for sickle cell anemia

Early detection/screening, minimize crises (nutrition, avoid infection, hand washing, prophylactic meds), minimize deoxygenation, promote hydration, promote supportive therapies (control pain, heat, rest, O2, monitor fluids/electrolytes), encourage screening, educate and support family, possible stem cell transplants

Treatment for myelomeningocele

Early surgical closure, (even fetal surgery in early stages @21 weeks) in first 24 hours ideally to decrease risk of infection if leaking sac present. Orthopedic care best early, may be able to walk with braces if lesion low enough, but may have some paralysis. genitourinary care to ID bladder dysfunction and treat quickly . Bowel/bladder training helpful depending on level of defect but 90% have neurogenic bladder dysfunction(urinary reflux, kidney infection)

What should the nurse *implement* to care for the child with a respiratory infection

Ease respiratory efforts - HOB ↑, warm or cool mist in room, suction Promote rest - often children will comply if are allowed to lie on couch to watch movies, play video games Promote comfort - humidify air, Tylenol, nasal aspirator, bulb syringe, nose drops Prevent spread of infection - wash hands, do not share cups/utensils, keep child home from school/daycare Reduce temperature - Acetaminophen, Ibuprofen, cool liquids to reduce temp and prevent dehydration Promote hydration - offer small amounts of favorite liquids at frequent intervals, oral rehydration solutions (Pedialyte, Infalyte) should be considered for infants and sports drinks such as Gatorade should be considered for older children. Avoid fluids with caffeine Provide nutrition - most children respond well to foods like gelatin, popsicles and soup (urging solid foods to kids that are sick may precipitate N/V) Family support and home care - family needs support and encouragement, practical suggestions concerning comfort measures and administration of medications

Three basic categories of temperament

Easy children, difficult children, the slow to warm up children

What are toddlers main areas in their lives they need to be consistent to feel "in control"

Eating, sleeping, bathing, toileting and play. Threats to these can cause regression - not a good thing because it can relinquesh previously acquired achievements.

Two things that are critical in health promotion?

Education and Anticipatory guidance

Name some characteristics of preoperational thought often exhibited by toddlers (1-3)

Egocentrism, transductive reasoning, global organization, centration, animism, irreversibility, magical thinking, inability to conserve.

Nursing considerations for the pt with a cast

Elevate above heart, check for the six P's, if edges are rough petal for comfort, may need to be windowed to view certain part, or bivaled for swelling, watch for signs of compartment syndrome

What should the nurse do if compartment syndrome is suspected?

Elevate extremity and call the doctor asap

What are the objects of treatment for children with the UTI?

Eliminate the infection, Identify any contributing factors to reduce risk of recurrence, prevent systemic spread of the infection (urosepsis), preserve renal function

This is an inflammatory process of the CNS that produces altered function of various portions of the brain that may be infected. Usually caused by direct infection by a virus (CNS), can occur also after an infection from a virus. Onset can be sudden or gradual and symptoms may mimic meningitis

Encephalitis

This is herniation of brain and meninges through a defect in the skull producing a fluid filled sac outside of the skull

Encephalocele

Non pharmacological interventions and teaching for the pt with UTI?

Encourage fluids, instruct on antibiotics(take all), teach prevention

This is a subcategory of neglect in which inadequate growth from inability to obtain and/or use calories required for growth (child below 5%)

Failure to Thrive

What is the end result of a positive Trust vs Mistrust(birth-1yr) stage of development in a child?

Faith and Optimism

In general what is the process for speech development?

Nouns first, then verbs, combination words, adjectives and adverbs then later pronouns last (you, me, he, she)

What are some activities that promote anticipatory guidance that nurses can teach to parents when working with their infants to promote mastery motivation?

Encourage unobtrusive assistance during play, share pleasure with infant in accomplishments (Clap, praise), don't give immediate assistance during tasks, don't interrupt infant during tasks, let infant initiate activities, limit controlling feedback during play, provide audio and visually responsive toys, provide early kinesthetic stimulation (picking up, rocking)

What is one of the biggest causes of toddler negativism with regard to loss of control?

Enforced dependancy (causing prolonged loss in autonomity) Can result in passive withdrawal from relationships and regression in all areas of development.

General manifestations of hyperhemolytic crisis in sickle cell anemia

Enough RBCs being produced but they are being broken down faster than can be made.

The most common type of virus that causes nonspecific (aseptic) non-bacterial meningitis?

Enterovirus (Also HIV, Herpes, cytomegalovirus, adenovirus)

This is when blood accumulates between the dura and the skull to form hematoma (above the dura). bleeding usually arterial with compression occuring rapidly, uncommon in children younger than 4. Pushes brain contents downward as brain expands

Epidural hemorrhage

Signs/symptoms of hemophilia

Epistaxis Heavy periods in women Bleeding gums Prolonged bleeding after circumcision in boys Concerned about hemarthrosis (bleeding into joints can result in degeneration of joint, deformity)

Treatments for Diphtheria

Equine antitoxin, complete bedrest, Can be prevented with vaccination!

Which labs can be drawn to check for signs of inflammation?

Erythrocyte sedimentation rate (ESR)

Therapeutic management for the pt with CP

Establish locomotion, communication and self help skills, gain optimal appearance and integration of motor functions, correct associated defects as possible, provide educational opportunities for child, promote socialization with other affected and unaffected children

This type of bone cancer is inside of the marrow tissue, it often requires chemo and radiation and usually between 4 and 25 years old. And is the 2nd most common bone cancer in children

Ewings Sarcoma

What are some things to be aware of with the skin when assessing neuro function?

Examine for signs of injury (needle marks, petechiae, bites and ticks) Evidence of toxic substances may have traces left on hands, mouth, clothes

This is when the brain is totally exposed or extruded through an associated skull defect (fetus usually aborted)

Exencephaly

This type of osteomyelitis is caused by direct inoculation of the bone with bacteria, through a puncture wound, open fracture, surgical contamination, or adjacent tissue infection

Exogenous

This is a posturing sign of dysfunction at level of midbrain (IN the brain) clenched jaw, more serious - if greater than 1 week with symptoms - not good prognosis

Extension, decerebrate posturing

Behavioral signs of CP

Extreme irritability or crying, failure to smile by 3 months, feeding difficulties (gagging, choking, after 6 mos of age persistent tongue thrusting) Mentally - may be of normal intelligence but have trouble expressing r/t speech difficulties

What is the FLACC pain scale?

Facial expression, Leg movement, Activity, Cry, Consolability. It measures pain by quantifying pain behaviors with scores ranging from 0 to 10.

This is hemophilia aka christmas disease accounts for 15% and is also x linked recessive (mom carries to sons) (x linked recessive = 50% chance daughter carrier, 50% chance son diseased)

Factor IX (Hemophilia type B)

What foods help decrease chances of constipation or lessen constipation symptoms for infants and children?

For infants, Increase cereals with Oats/ Barley. (NOT RICE), Increase fruits and veggies. For children increase fiber and fluids

This stage of cognitive development is when the child becomes adaptable/flexible. they can think in abstract terms and use abstract symbols (algebra), can draw logical solutions from a set of observations. They can make and test hypothesis and can consider philosophical matters, they may confuse ideal with practical but deal with contraindications in the world well.

Formal Operations (11-15yrs)

This is a condition in which there is a fragile chromosome, it is dominant x linked meaning there is a 50-50 chance of the child having it, leads to violent outbursts and behavioral problems with low attention span and hyperactivity

Fragile X

What is the most likely cause of seizures in older kids?

From Epilepsy

What is the most likely cause of seizures in younger kids?

From acquired causes (not epilepsy disorder)

List the levels of consciousness in order

Fully conscious, confusion, disorientation, lethargy, obtunation, stupor, coma, persistent vegetative state.

List some gross motor, fine motor, sensory and social milestones of a 24 month old toddler

Gains 1.5-2.7kg/year, 10-12.5 cm / year in height, may be ready to potty train (daytime), up and down stairs alone, runs well, pick up objects without falling, kicks ball forward without falling, can insert block into oblong spaces, well developed geometric discrimination, vocab 300+words, word phrases 2-3, understands commands, uses pronouns (I, we, you, us), gives name, verbalizes ADL needs(food, drink toilet), talks nonstop/incessantly, remembers sequences of actions/gestures, parallel play, good attention span, tantrums increase, pull people to show them something, increased independence from parent, dresses self in simple clothing, visual recognition and verbal recognition of self (me big girl),

Nursing considerations for observing seizures?

General description of events before, during and after, time of onset, possible triggers, noted behaviors, positioning, movements noted, body parts involved, types of movement, face color, perspiration, mouth, any assymetry, eyes, pupils, respiratory effort, apnea if present, watch after, observe if postictal period present need to supervise

What are the pain responses typical for a young infant

Generalized body response of rigidity or thrashing, possible with local reflex withdrawing from painful area, loud crying, facial pain expression, no association demonstrated between approaching stimulus and subsequent pain (No crying before painful stimulus introduced- injections, etc)

What are some nursing considerations to take when an infant is in a pavlick harness or braces for hip dysplasia?

Gentle massage once a day to stimulate circulation, Always put on and undershirt and knee socks to prevent rubbing on skin, Check skin frequently for red areas 2-3 times a day under straps and clothing.

What is the number one nursing consideration for the pt who has experienced a near drowning (submersion injury)

Get Oxygen to the cells. Decrease the hypoxia

Who gets more UTI's boys or girls?

Girls

Who is affected more by lupus girls, or boys?

Girls 5:1, usually diagnosed in teen years 10-19 y/o

Who is more advanced in physiologic growth at all ages? boys or girls?

Girls.

Ways to help with the mucosal ulceration that may occur from leukemia treatment

Give glutamine - promotes cell recovery Use mouth rinses to kill germs and promote healing BMX - Benadryl, Maalox and Xylocaine Bland diet Superb mouth care For yeast/thrush give Nystatin, Flagyl

two types of lymphomas

Hodgkins and nonhodgkins

Treatment for bronchitis

Humidify air, cough suppressant but that might prevent clearing of secretions, analgesics

This is a major consequence of chronic renal failure in children, especially in preadolescents.

Growth failure

Clinical manifestations of Failure to Thrive

Growth failure (wt less than 5% only, or ht/wt less than 5%-this is known longer term issue), developmental delays, apathy, poor hygiene, withdrawn behavior, feeding/eating disorders, vomiting, anorexia, pica, rumination (chewing for a long period of time), no fear of strangers, avoid eye contact, wide eyed gaze with continual scan of environment, stiff and unyielding or flaccid and unresponsive, minimal smiles

General manifestations of Sickle cell anemia

Growth retardation, chronic anemia, delayed sexual maturation, susceptible to sepsis,

What are some acquired neuromuscular disorders?

Guillian-Barre (infections), tetanus, botulism, spinal cord injuries

What are some causes of Secondary Nephrosis?

HIV, Cancer, diabetes, Lupus, vasculitis (caused by damage from secondary disease process)

Common causes of aplastic anemia

HPV, some autoimmune disorder, drugs (chemo, anticonvulsants, antibiotics), industrial/household cleaners (MANY MEDICATIONS CAUSE MYLEOSUPPRESSION)

What is thalassemia Trait?

Have some mild microcytic anemia

Ways to assess for hydrocephalus symptoms in a child

Head circumference (if increases, increased ICP suspected), Fontanel tension, Ventricular size by ultrasound

Symptoms that the athlete may report having that may indicate head trauma

Headache, Nausea, balance/dizzy, double or fuzzy vision, sensitive to light/noise, feels sluggish, feels groggy or foggy, concentration or memory problems, confusion

Treatment for LTB (Laryngotracheobronchitis)

Humidity, steroids, epi nebs,

This is usually caused by an increased blood volume pressure in the heart and is a result of the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the bodys metabolic demands.

Heart Failure

How does heat application help with vaso-occlusive crisis in sickle cell pts?

Helps relax blood vessels

What is the most consistent treatment for Hemolytic Uremic Syndrome?

Hemodialysis, or peritoneal dialysis. (given to those who have been low urine output or no urine output for 24 hours or with seizures and hypertension), may need blood transfusions r/t severe anemia from cell damage moving through clotted vessels.

Possible complications to watch for with blood transfusions.

Hemolytic Reaction Sudden severe HA, fever, chills Febrile Reaction increase in temp by 1 degree Celsius Allergic Reaction Urticaria, pruritus, flushing, wheezing, laryngeal edema Circulatory Overload Dyspnea, cyanosis, HTN, cough, rales Air Emboli Sudden difficulty breathing, sharp chest pain, apprehension Hypothermia Chills, low temp, irregular HR, possible cardiac arrest Electrolyte Disturbances Hyperkalemia Nausea, diarrhea, muscle weakness, bradycardia

This renal disease is possibly related to bacterial toxins, chemicals or viruses such as uncooked ground beef, unpasteurized milk or apple juice, alfalfa sprouts, lettuce and salami. Drinking or swimming in sewage contaminated waters

Hemolytic Uremic Syndrome

Signs of hemolytic reaction to blood transfusion

Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock.

A 3 year old male presents to the ER with widespread pallor and seems weak and lethargic. PE shows notable hepatosplenomegaly and petechiae. His mother said he had a stomach virus a week ago and was throwing up and having diarrhea, while maintaining a fever. The diagnosis at that time was related to eating an undercooked hamburger. What do you suspect?

Hemolytic uremic syndrome

This is an uncommon acute renal disease that affects primarily infants and small children between the ages of 6 months - 5 years. It is also one of the most frequent causes of acute renal failure in children.

Hemolytic uremic syndrome

This hemophilia is autosomal recessive in males and females and is usually less severe

Hemophilia C Factor XI

The undersurface of the skull has grooves with arteries, if the skull is fractured there what can occur?

Hemorrhages - watch infants for hypovolemic hypotension who have skull fractures.

Which immunization is given at birth?

Hep B

List the immunizations recommended for children/adolescents in the US overall

Hep B, rotavirus, DTP, HIB, Pneumococcal, polio, Flu, MMR, Varicella, Hep A, Meningococcal, HPV

This virus might be a cause of encephalitis, and they may use Acyclovir to treat it with supportive care

Herpes simplex

The quality of this type of research is exceptionally strong evidence from unbiased observational studies

High Quality

How is Kawasakis managed?

High doses of IVIG given very helpful if in 1st 10 days(no live vaccines for a year after), Aspirin- prevents aneurysm and clotting (in first phase, 80-100 dose, in second phase - 3-5 dose) NO STEROIDS

What is the acute phase of kawasakis

High fever not responsive to attempts to reduce, 10 days redness of hands/feet - edema

Why are children often at higher risk for fractures of the bone?

High mobility, limited coordination, more easily injured/bones break more easily

What are the four quality "grades" that can be given about research studies in nursing?

High, Moderate, low and very low quality

What carrying position decreases risk of dysplasia in an infant by parents?

Hip carrying by parents. (helps with hip placement)

List overall the congenital defects of the hip/bones

Hip dysplasia, club foot, metatarsus adductus, skeletal limb deficiency (missing/defective), osteogenesis

This is a congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine. Accounts for 1/4 of all neonatal intestinal obstructions. More common in males, may be genetic. Absences of ganglion cells in affected areas of intestine resulting in loss of enteric nervous stimulation. Perstalsis is lacking, colon is distended, the *internal sphincter does not relax*

Hirschsprung Disease

This lymphoma only affects lymph tissues

Hodgkins (90% survival rate if caught early)

Symptoms of hydrocephalus

Large head or increasing ICP, enlarged head, bulging fontanels, irritable, high-pitched cry, difficulty feeding, setting sun sign (sclera visible above iris, vomiting, headaches, irritability, confusion

This period of development in the later stages shows the child focusing on individual identity rather than group. Sometimes there is emotional turmoil, and biological and personality maturation.

Later Childhood (11-19 years)

This is a group of disorders with difficulties in the acquisition and use of listening, speaking, reading and writing, reasoning or math skills, may also be compounded by self esteem issues that can impact behavior

Learning disabilities

In an infant which hip is more likely to be affected by dysplasia

Left hip, (intrauterine position, left hip pushed against moms organs and spine)

This is idiopathic avascular necrosis of the femoral head, affects children 2-12 yo, often boys between 4 and 8, symptoms of pain in hip/inner thigh develops limp, xray confirms and may do surgery (Loss of blood flow to the femoral head resulting in necrosis) Can mean rest and non weight bearing for 2-4 years! Or surgery and then return to normal activity in 3-4 months.

Legg-Calve Perthes Disease

List overall the acquired defects of the musculoskeletal system

Legg-Calve Perthes disease, Slipped femoral capital epiphysis, scoliosis, Kyphosis, lordosis

What are the best predictors of a good outcome if a child has a near drowning / submersion injury

Length of submersion in non-icy water for less than 5 minutes and the presence of sinus rhythm, reactive pupils, and neuro response at the scene

Most common cancer of childhood, and is the cancer of blood forming tissues

Leukemia

What is the whitish glow in the retina called of a child with retinoblastoma?

Leukokoria

What does the nursing assessment include for the unconscious child

Level of consciousness, Pupillary reaction, and vital signs

This is usually the standard stable measurement of growth

Linear growth - Height. (it is often more stable than weight, which is often more variable based on outside factors)

What are some nursing interventions to focus on while caring for the family of hospitalized children?

Listen to parents verbal and nonverbals, providing clergy support if needed, accepting cultural, socioeconomic and ethnic values, giving information to families and siblings, and preparing for discharge and home care.

This is abnormal increase in curvature of the lumbar/cervical spine causes pain

Lordosis

Early signs of chronic renal failure

Loss of normal energy, increased fatigue on exertion, pallor - subtle, elevated BP

The quality of this type of research is evidence for at least one critical outcome from observational studies, from randomized clinical trials (RCTs) with serious flaws or from indirect evidence

Low Quality

Signs/symptoms of down syndrome

Low intelligence or severely retarded, some might be r/t heredity disposition, may lag behind 2-3 years in social development, Heart defects common (up to 50%), respiratory infections prevalent, hypothyroidism, leukemia, eye and ear problems, altered immune function, more susceptible to cancer, reduced height more than weight, tend to be overweight, may have delayed or incomplete sexual development, boys may be infertile, girls may be fertile but if they conceive the child may have congenital abnormalities

What is contraindicated if the pt has increased ICP?

Lumbar Puncture

How is bacterial meningitis diagnosed?

Lumbar puncture, also possible blood, urine, stool, nasal cultures may be done

This is a chronic multisystem autoimmune disease of the connective tissues and blood vessels (can lead to inflammation of any body tissue and can cause life threatening complications) even leading to psychosis, kidney issues, etc

Lupus

This is a group of neoplastic diseases that arise from the lymphoid and hemopoietic systems

Lymphomas

What shots require a minimum age of 12 months?

MMR, Varicella, Hep A,

What is the key to preventing UTI?

Maintain adequate blood supply to the bladder wall by avoidance of over-distention and high bladder pressure.

What is a cause of hydrocephalus?

Malformation, infection, trauma/bleeding, tumors; CSF accumulation in the ventricular system causing enlarged ventricles putting pressure on brain (Enlarging head or increasing ICP)

Wilm's Tumor signs and symptoms.

Mass is palpable in the abdomen. Child may experience abdominal pain, fever, anorexia, nausea, vomiting, and hematuria, hypertension

What would the labs (urinalysis and blood serum) look like in a pt with MCNS? (childhood nephrosis)

Massive proteinuria (higher than 2+ on dipstick), presence of hyaline cysts, oval fat bodies, and few RBCs may be seen in the urinalysis. For serum - total serum protein is low, with serum albumin significantly low/reduced, and plasma lipids elevated. Hemoglobin and Hematocrit are usually normal or elevated r/t hemoconcentration, and the platelets might be elevated. Serum sodium concentration might be low.

Symptoms of Genitourinary nephrotic syndrome (Nephrosis)

Massive proteinuria, decreased serum albumin, edema, increased serum lipids, decreased immunity, puffiness of face (Facial edema) - especially around eyes mostly in the morning and subsides during the day, abdominal swelling, pleural effusion, labial or scrotal swelling, edema of intestinal mucosa leading to diarrhea, anorexia, poor absorption, ankle or leg swelling, irritability, easy to fatigue, lethargic, BP normal or slightly low, urine has decreased volume and may be frothy, hepatomegaly may be present, paleness

Causes of neural tube defects

Maternal dietary deficiency of folic acid(Good sources include spinach, beans(lentils), elevated temp of mother in 1st trimester of pg

Signs of flu

May be subclinical, mild, moderate or severe Dry throat and nasal mucosa Dry cough and tendency toward hoarseness Flushed face, photophobia Myalgia, hyperesthesia Sometimes exhaustion and lack of energy accompany a sudden onset of fever and chills

What should be done if the child has high dose lead levels?

May need Chelation with either penicillamine, or succimer. Succimer has nasty side effects and liver function must be assessed. Penicilliamine requires low pediatric doses and monitoring of blood counts and renal function is necessary during treatment.

Symptoms of meningitis in neonates?

May not have high fever, may have rash/petechial, poor feeding/sucking, vomiting, diarrhea, poor tone, lack of movement, irritable, tense/bulging fontanel, seizures

What are the pain responses typical for a school aged child?

May see same as for young child (Upset by intrusive stimulus even if it is not painful, can even have reaction to holding/restraining them and not pain itself. Loud crying, verbal expressions, thrashing of arms and legs, attempt to push away stimulus before applied, lack of cooperation, requests to stop procedure, cling to parents or others, requests emotional support, Restless irritable with continuing pain) and may stall, may have muscle rigidity with clenched fists, white knuckles, gritted teeth, contracted limbs, body stiffness, closed eyes, wrinkles forehead, may be able to explain benefits/dangers to them of the procedures.

Treatment for seizures

Medication, possible surgery (if lesions/tumors), vagus nerve stimulation, ketogenic diet

Name the stimulants used to treat ADHD

Mehtylphenidate (ritalin-short acting, Concerta-long acting), Dexmethylphenidate(focalin), Amphetamine mixtures - Adderall (short acting).

This is neural irritability, with abrupt onset of fever, without actual infection of the coverings in the brain/spinal chord, accompanied by headache, pain and stiffness in the back and neck, and usually subsides as temp decreases.

Meningismus

two types of Spina bifida Cystica

Meningocele, Myelomeningocele

General manifestations of Acute chest syndrome in sickle cell anemia

Mimic pneumonia, It is the presence of a new chest infiltrate and is associated with chest pain, cough, tachypnea, wheezing, hypoxia

This type of nephrosis accounts for 80% of occurrences, for some reason (thought autoimmune) the glomerular basement membrane which is usually impermeable to albumin and other proteins (mostly albumin), becomes permeable to them allowing them to be lost in the urine.

Minimal Change Nephrotic Syndrome. (MCNS) (Nephrosis)

Four kinds of thalassemia

Minor, trait, intermdeia, major (cooley)

(CP) This is a combination of spasticity and athetosis, may be labeled this when no particular pattern of motor movement is dominant

Mixed type/dystonic

The quality of this type of research is unusually strong evidence from unbiased observational studies and the evidence from RCTs(randomized clinical trials) with important limitations such as inconsistent results, methodologic flaws, indirect evidence, or imprecise results)

Moderate Quality

What are some evaluations made when caring for the unconscious child?

Monitor VS and behavior, observe responses to actions therapies procedures, monitor ICP, observe color, position motor activity, measure fluid and nutritional I and O, monitor RR an status, renal fx GI sx, skin, observe family behaviors and assess understanding and feelings/ concerns.

What should be done if the child has low dose lead levels?

Monitor, recheck, discover where it is coming from and remove the source, make sure they have adequate iron, vit C, and Calcium in their diet and decreased fat consumption.

Ways to reduce respiratory distress in children with Heart Failure

More upright position, knee-chest squatting position (for cyanotic heart disease)

Most common illness in children

Most episodes of acute illness in young kids involve the respiratory system due to exposure to infection and decreased immunity. (takes time to Build up those immune systems)

What is the difference in absorption rates of subcutaneous or transdermal type of drugs in infants / neonates and older children/ adults?

Much faster absorption in the infant/neonate (Think - very thin skin=very quick absorption)

What systems are affected by immobilization?

Muscular, Skeletal, Metabolism, cardiovascular, respiratory, GI, Urinary, Integumentary, psychological.

This type of cystica spina bifida involves weakness/paralysis below the level of the defect site, the higher the level of defect - the more concerning. Bowel/bladder function affected, often 85% have hydrocephalus,

Myelomeningocele

This type of seizure can be sudden brief contractures of a muscle or group of muscles and can occur single episode or repetitively, there is not postictal state, and the pt may or may not lose consciousness

Myoclonic...

This is a lazy eye

Myopia

This is near sightedness

Myopia (can't see things far away)

If infectious diarrhea is suspected should the child be given anti-diarrheals?

NO, let the diarrhea flush out the system

This is the basic common cold - it is not preventable due to how widespread it is in the population, and usually viral in nature. Can consist of Rhinovirus, RSV, Adenovirus, Influenza virus, Parainfluenza virus

Nasopharyngitis

Ideas to help with N/V caused by leukemia treatments

Need antiemetics ideally PRIOR to chemo and continue ATC throughout, then use PRN Zofran used a lot Hydrate Use relaxation Teach to eat lighter meals during chemo Do NOT offer favorite foods - might end up vomiting it and then hating it

Treatment for severe combined immunodeficiency disease

Need stem cell transplant, and maybe IVIG until able to get transplant

What might happen if the pt is on medications to treat what the drs believe to be MCNS (nephrosis, Minimal change nephrotic syndrome) for weeks and there is no improvement?

Need to re-evaluate for other types of nephrosis (congenital, secondary) biopsy would need to be done.

Two stages of the infancy period

Neonatal (birth-27 or 28 days), and infancy (1-12 months or so)

These disorders (which include leukemia) are the leading cause of death from disease in children past infancy.

Neoplastic disorders

This is an immune complex disease that occurs after group A strep infections usually 10-21 days after. It is a reaction to the infection. Signs include tea colored urine, increased BP, facial edema, pallor, irritability, lethargy, headaches, abdominal discomfort, dysuria, may have vomiting.

Nephritis (genitourinary poststreptococcal glomerulonephritis)

This is an autoimmune (attacks itself) process leading to structural alteration of glomerular membrane that results in increased permeability to plasma proteins particularly - albumin. (leads to edema/hypertension)

Nephrotic Syndrome (Nephrosis)

Post op assessment for Spinal surgery (Fusion) to correct scoliosis

Neuro assessment important (prevent nerve damage), pain control is #1, Very painful surgery, Keep flat and log roll initially, keep brace on for day or so.

This is the most common malignant extra cranial (not brain) tumors in children. Highly malignant, often diagnosed after mets, because the symptoms of a the localized tumor are minimal and do not show up until after mets, most children who have this are found to have it before 10 years of age. They are usually a firm, solid non tender mass

Neuroblastomas

Surgical management for children with GER (gastroesophageal reflux)

Nissen fundoplication (if fail to thrive etc)

Is when the child begins to speak a sign of intelligence?

No

Is the detachment stage of separation anxiety considered a sign of contentment in the child suffering from it?

No, It is a result of resignation, the child detaches in an effort to escape emotional pain and copes by forming shallow attachments to others, becoming increasingly self centered and attaching primary importance to material objects.

Should children be encouraged to drink large amounts of fluid before a urinalysis?

No, a recent high fluid intake may indicate a false low organism count.

Is informed consent needed for life threatening emergencies?

No, in emergencies including danger ot life or possibility of permanent injury appropriate care should not be withheld or delayed because of problems obtaining consent to treat. (document any efforts to obtain consent however)

Does a positive TB skin test confirm active disease?

No, just exposure.

This lymphoma originates in lymph tissues but diffuses throughout other areas

Non-Hodgkins lymphomas (remission 2-4 years, relapse is rare)

This type of meningitis is usually seen during the months of july-sept, often self limiting and benign, with lower fevers.

NonSpecific (Aseptic) non-bacterial meningitis

This type of pulmonary edema is caused by increased capillary permeability in the lungs, caused by ARDS, ALI, high altitudes too fast, neurogenic (after seizures etc), opiate overdose

Noncardiogenic Pulmonary edema

This is the number 1 influence on growth of a child

Nutrition, sleep is #2.

What are some *Evaluations* that the nurse should use when caring for the child with a respiratory infection?

Observe respiratory effort and chest movement (are they still retracting?) Observe behavior and activity Observe other family members and contacts for evidence of infection Take VS Observe hydration status Assess for complications (dehydration, wt loss, spread of infection) Observe family's behavior, and interview members about feelings and concerns

What complications does cystic fibrosis lead to in the lungs?

Obstruction by thick mucus leads to atelectasis (fluid) and hyperinflation

This type of spina bifida (myelodysplasia) is not visible, the kids usually have no problems and it is usually lumbosacral with not much done about it for tx. It may include a skin depression at the site, with a dimple or tuft of hair

Occulta Spina bifida(myelodysplasia)

Two types of spina bifida (myelodysplasia)

Occulta, and Cystica (broad term for any malformation of the spinal chord and canal)

Ideas to help with altered nutrition /anorexia from leukemia treatments

Offer higher calorie supplements Boost Instant Breakfast Enteral feedings Put powdered milk in recipes to calories Offer small, frequent meals Monitor I&O Chemo alters taste

Signs of iron deficiency anemia

Often not noticed until severe Milk babies pale, weak overweight r/t excessive milk ingestion milk is a POOR source of iron and is given almost to exclusion of solid food 50% of iron-deficient infants fed cow's milk have fecal loss of blood Tachycardia (trying to compensate for less cells circulating 02), SOB, weakness, pallor, fatigue Exercise intolerance In severe cases CHF may develop Cognitive and Motor function is impaired - low scores in school

What are some indicators with respirations with altered cerebral function

Often slow, deep, irregular

Symptoms of nasopharyngitis (Cold) in the older child

Older Child Dryness and irritation of nose and throat Sneezing, chilling Muscle aches Cough (sometimes)

What is the principle feature of Acute Renal Failure?

Oliguria/Anuria associated with azotemia, metabolic acidosis, and electrolyte disturbances.

What is the treatment for UTIs?

Oral Antibiotics for 10-14 days including penicillin, sulfonamide (trimethoprim and sulfisoxazole combos), cephalosporins, tetracycline, nitrofurantoin, - if abnormal defects of the urinary tract are present, surgery may be required

Development has a fixed ____________, but does not progress at the same _______ or ________.

Order, Rate or Pace. (each child grows at his or her own pace but the sequence/order is the same)

This is failure to thrive caused by a physical problem such as heart defect or reflux, malabsorption etc

Organic Failure to Thrive

What are the signs an advanced practitioner can check for that might indicate hip dysplasia?

Ortolanis sign (click on abduction), Barlows sign (hip dislocates and reinserts)

This is a heterogenous inherited syndrome characterized by excessive fractures and bone deformities. (Unbreakable- the Movie!!!) Bones are extremely brittle with varying degrees of fragility)Goal is to prevent contractures, muscle weakness, and maintain alignment

Osteogenesis

This type of bone tumor produces needle like new bone growth at right angles to the shaft, (Sunburst) arises from the ostoid tissue. It looks like an attachment outside of the bone and is the most common bone cancer in children. Usually affects children over age 10, over 1/2 occur in femur and requires surgery, usually amputation and then chemo

Osteogenic Sarcoma

Three most common bone and soft tissue tumors in children

Osteogenic sarcoma, Ewing Sarcoma, and Rhabdomyosarcoma

This is an infection of the bone

Osteomyelitis

This is inflammation of the middle ear, very common, often bacterial but may be r/t allergies, most of the time breastfed infants have less occurrence, often associated with RSV or cold.

Otitis Media (ear infection)

What is the goal for keeping Hgb at for Thalassemia?

Over 9.5

Which lab value indicates that it is taking longer to clot the blood than usual if you are bleeding?

PTT (prothrombin time)

How are bradydysrhythmias treated?

Pacemakers

Factors that reduce the risk for SIDS

Pacifier use while sleeping, breastfeeding (esp 1st 4 months), immunizations up to date, avoid overheating, fan in room, bassinet at bedside rather than cosleeping, encourage "tummy time"

This is the most prevalent symptom in the child with cancer

Pain

What is the most common reason for ED visits or physician office visits for the pt with Sickle Cell disease?

Pain

This is the number one symptom of a bone tumor

Pain (diagnosed with CT or MRI)

What are the six P's to assess if there is a fracture?

Pain/point of tenderness, pallor, pulselessness, paresthesias, puffiness/edema, paralysis

Signs and symptoms with sickle cell crisis

Pale, (low O2), fatigue, jaundice, irritable, poor healing, spleen enlarged, poor liver function enzymes, kidney issues, bone changesSOB Jaundice Pallor Fatigue Poor healing Splenomegaly increase liver function Anorexia

These are late signs of compartment syndrome

Pallor, paralysis, and pulselessness

Factors that increase the risk for child abuse in a family

Parent abused as a child, termperament, position in family, physical needs, premature infants, social issues, environmental stress, poverty, poor housing, alcoholism and drugs.

This measures the maximum amount of air that can be forcefully exhaled in 1 second, measured in liters per minute.

Peak expiratory flow rate (PEFM)

What medications are used for Strep sore throat infections?

Penicillins for 10 days Orally. (Penicillin can prevent Rheumatic Fever from developing but can not prevent acute glomerulonephritis sequelae) could also use erythromycin if penicillin is contraindicated. (Penicillin should NEVER BE GIVEN IV. May be IM but NO IV)

Possible causes of ADHD

Perinatal complications, exposure to toxins/chemicals/meds during pregnancy, head trauma, infections, hereditary predisposition, biochemical, psychosocial, diet, not enough out doors times/exercise

Ways of preventing UTI's

Perineal hygiene (front to back for girls), avoid tight clothing, empty bladder completely , acidify urine with grape or cranberry juice avoid soaps or perfumed toilet papers, prevent constipation

This is an acute respiratory tract infection caused by bordetella, it is highly contagious and very threatening to younger infants. Parents can contract it with little symptoms but it can be deathly to infants. Apnea is a common presenting symptom. It can result in encephalopathy, seizures and pneumonia. Single attack gives lifetime immunity.

Pertussis (whooping cough)

Manifestations of DIC (Disseminated Intravascular Coagulation)

Petechiae Purpura Bleeding from openings in skin IV site Surgical site Bleeding from umbilicus, trachea (newborn) Evidence of GI bleeding Hypotension Organ disfunction from infarction and ischemia

This is a painful inflamed throat, usually viral (cold that settles in throat) but should have culture done to r/o strep

Pharyngitis

What therapies might be used in the pt with CP

Physical therapy, Occupational therapy for special equipment that might be needed (to correct posturement etc), speech therapy(75% have speech probs), special education (picture boards, button boards), surgery, medication therapy, service coordination

Types of neglect

Physical, emotional

According to this psychologist, intelligence enables individuals to make adaptations to the environment that increase the probability of survival, and through their behavior, individuals establish and maintain equilibrium with the environment.

Piaget

This person developed the best known theory regarding cognition and childrens thinking

Piaget

What would pupils look like with poisoning or brainstem damage?

Pinpoint

What are some ways prevention of poison absorption is done if the child ingests poison?

Place in side lying position, induce vomiting if indicated, give activated charcoal if indicated, give antidote if indicated, perform gastric lavage (pump the stomach), May need whole bowel irrigation.

What are signs for diagnosis of hemophilia?

Platelet count normal, but anemic = leads to believe missing clotting factor r/t bleeding into joints and MM, not always obvious Prolonged coagulation time: PTT increased.

This is the "work" of children

Play

What are some prophylactic measurements taken after / before splenectomy in children?

Pnuemococcal and meningococcal vaccines given, and after the child will receive penicillin, the length of therapy for the penicillin in in general minimum of 3 years.

Which test is most accurate for HIV in an infant with a mother that is HIV positive

Polymerase chain reaction can detect HIV in almost all infant 1-6 months of age if they have it. They can not use typical ELISA - it will still detect levels from mothers antibodies in the babies system

General manifestations of sequestration crisis in sickle cell anemia

Pooling of large amounts of blood leads to serious crisis (50% death rate in children), hepatomegaly, splenomegaly, leads to circulatory collapse

Symptoms/presentation of brain tumors

Poor coordination that worsens, decreased school performance, increased intra cranial pressure, ataxia, muscle weakness, eye problems, head tilt, headache especially on awakening, vomiting

Physical signs of CP

Poor head control after 3 months of age, stiff or rigid arms/legs, pushing away/arching back, floppy/limp body posture, poor head control(lag) and clenched fists after 3 months of age, can't sit up without support by 8 months, uses only one side of the body or only arms to crawl, clenched fists after 3 months alone

More common types of families that neglect children

Poorly educated, dysfunctional families with poor support systems (but abuse is found in ALL socioeconomic levels)

What is a concern with children who are blind?

Possibly concerns with parent/infant attachment

Post op tonsillectomy treatment

Post-op no gargling, nose blowing or coughing Most need pain medication for 24 Until fully awake, children are placed on side or abdomen to facilitate drainage of secretions Watch for postop hemorrhage: Observe throat directly w/light (if necessary, carefully use tongue depressor Tachycardia Pallor Frequent clearing of the throat or swallowing Decreasing blood pressure = late sign of shock

These are behavioral disturbances that occur as the result of head trauma

Post-traumatic Syndromes (Sleep probs, phobias, emotional lability, altered school performance, aggression/withdrawal)

This level of moral development coincides with the formal operations cognitive level theory (11-15yrs) acceptable behavior is termed by what society believes (Rights and standards), The most advanced level of moral development is one in which self chosen ethical principles guide decisions of conscience, with respect of dignity of persons as individuals. (few people actually reach that advanced stage)

Postconventional (Autonomous or principled) level of moral development. (Kohlberg)

Causes of Failure to Thrive

Poverty, health beliefs, inadequate nutritional knowledge, family stress, feeding resistance, insufficient breast milk

This level of moral development coincides with the pre operational level(Piaget 2-7yrs) and concludes good/bad - right/wrong. (Physical or pleasurable consequences to their actions.)

Preconventional level of moral development.(Kohlberg)

What positions would be best for performing a physical assessment on a school aged child?

Prefer sitting, cooperative in most positions, younger child prefers parents present, older children might prefer privacy

What positions would be best for performing a physical assessment on an adolescent?

Prefer sitting, cooperative in most positions. Offer option of parents presence or not.

What positions would be best for performing a physical assessment on a preschool child?

Prefer standing or sitting, usually cooperative prone or supine, prefer parents closeness

This cognitive development stage is mostly predominated by egocentrism - (inability to put oneself in the place of another, unable to see things from anothers perspective), They can not reason beyond what is observed and can not "generalize". They do increase in language development including using symbols to represent objects in their environment. Intuition reasoning (the stars have to go to bed because they do), and transductive reasoning (if two events occur together they cause each other or knowledge of one characteristic is transferred to another (all women with big bellies have babies)

Preoperational (2-7yrs)

Nursing care interventions before cardiac cath procedures

Prep child; describe sensations (helps with decreased anxiety) NPO as ordered Infants with polycythemia (an increaseG in proportion of blood volume that is occupied by RBC which is measured by hematocrit) may need IV fluids to prevent dehydration and hypoglycemia Complete assessment including ht and wt Assess allergies (some dyes are iodine based) Assess and mark where pedal pulses are located PRIOR to surgery Baseline O2 sats documented prior to surgery

Two stages of later childhood

Prepubertal (10-13 years), Adolescence (13-18 years)

This age group can tolerate brief periods of separation from their parents and are more inclined to develop subsititue trust in other significant adults. But with the ADDED stress of illness, they may regress to previous behaviors of separation anxiety but with more subtility. (breaking toys or hitting)

Preschool age

What does it mean "do no harm"?

Prevent or minimize separation from family, promote sense of self control, prevent or minimize bodily injury and pain.

What do ACE inhibitors (pril) do for Heart failure?

Prevent vasoconstriction, increases vasodilation - decreasing pulmonary and systemic vascular resistance leading to decreased BP and afterload

The primary goal of treating VUR? (Reflux of urine)

Preventing bacteria from reaching the kidneys with very low dose antibiotics taken daily with urine cultures q 2-3 months and every time the child is febrile. (they usually outgrow this condition)

What is nursing care of the child in the hospital mostly aimed at?

Preventing or minimizing seperation, decreasing loss of control for the child, minimizing fear of bodily injury, using play or expressive activities to lessen stress, and maximizing the potential benefits to hospitalization (fostering parent-child relations, provide educational opportunities, promote self mastery, encourage socialization)

What complications does Cystic Fibrosis lead to in the pancreas?

Prevents pancreatic enzymes from reaching duodenum impairing digestion and absorption of nutrients

This type of pneumonia is caused by M. Pneumoniae and is common in kids 5-12 years old usually lasts 1-2 weeks.

Primary Atypical

This type of seizure affects both hemispheres of the brain

Primary Generalized seizures

List the types of seizures

Primary generalized, Partial

What are the medical management interventions for cystic fibrosis pts

Promote absorption, maintain airway patency, prevent lung infection, assist child/family in adapting to a chronic disorder.

What are nursing considerations when working with the child with Chronic kidney failure?

Promote maximum renal function, maintain body fluid and electrolyte imbalances, treat systemic complications, promote as active and normal of a life as possible for as long as possible. (Usually on dialysis waiting for transplant), diet regulation to reduce amount of waste.

Management of the pt during a seizure

Protect from injury - nothing in mouth, keep airway open (side lying - suction if needed)

What is the aim of therapy and follow up of the client with a UTI overall?

Protect kidney scarring, most infections recur after 1-2 months of discontinuing treatment however and recurrent infections of the bladder predisposes the pt to transient vesicoureteral reflux (VUR)

During this pattern of neuromuscular function development, the midline develops before the periphery, one illustration of this is in utero when the limb buds develop before the hands and fingers to follow, postnatally control of the shoulders by the infant precedes the mastery of the arms, the arms mastery before the hands, and the hands mastery before the fingers. This is also when a child develops preference for right hand over left or vise versa around 5 years old

Proximodistal

This is increased pressure in the lungs vasculature. It does not have a cure. It is poorly understood

Pulmonary Artery hypertension

Stressors of hospitalization in children

Separation, separation anxiety, loss of control, bodily injury, pain

List some gross motor, fine motor, sensory and social milestones of a 5 year old preschooler

Pulse/resprs decrease, left or right handedness is established, skips hops on alternate feet, throws and catches well, skates, jumps rope, jumps from 12 inches and lands on toes, balances on alternate feet with eyes closed, ties laces, scissors, copies more complex shapes when drawing, vocab 2100+words, names coins, knows names of days weeks months, knows what things are made of, can follow three commands in a row, less rebellious than 4 yo, eager to get down to business, names four or more colors, has fewer fears, eager to do things right and follow rules, cares for self totally, occasionally needing supervision for dress/hygiene, still some unrefined hand/eye coordination, may cheat during play to avoid losing, questions and compares parents to others, may notice prejudice, tolerates others views that are different than theirs, gets along well with parents, seek out parent more often for reassurance/security, strongly identifies with parent of same sex(especially boys)

What does the presence of a fever usually indicate if the pt has a UTI?

Pyelonephritis (inflammation of the upper urinary tract and kidneys)

What is iron needed for

RBC production

Box 22-1 in the text book... Play activities for specific procedures..

READ IT!

What is treatment for small bleeds with hemophilia to help stop the bleeding.

RICE Rest, Ice, Compression, Elevation

What is the overall management for Sprains/strains

RICES and ICES (rest/immobilization/ice/compression dressing/Elevate above heart)

Most predominant virus that causes Bronchiolitis

RSV Respiratory Syncytial viral infection

This is an acute infection of the nervous system often caused by an unprovoked attack by an animal can lead to death if untreated

Rabies

Symptoms of Acute Epiglottitis

Rapidly progressive, dysphagia, stridor - worsens when supine, drooling, high fever, toxic appearance, rapid pulse and respirations, bright large cherry red edematous epiglottis is present on careful throat inspection, voice is thick and muffled, may have a frog like croaking sound on inspiration.

What are signs in toddlers younger than 2 years old that they might have a UTI?

Rash, Poor intake, wt loss

Symptoms of lupus

Rash, photosensitivity, oral ulcers, arthritis, renal problems, seizures, hematologic problems, immunologic problems

What are the main assessment points for checking respiratory status

Rate, depth, ease, labored breathing present?, rhythm (rate+depth)

What is transductive reasoning (toddlers 1-3)

Reasoning from the particular to the particular (example - child refuses to eat a food because something previously eaten did not taste good)

What are the therapeutic management objectives for treating Genitourinary nephrotic syndrome?(Nephrosis)

Reduce excretion of urinary protein, reduce fluid retention in the tissues, prevent infection, minimize complications r/t therapies

How is phosphorus intake monitored in the pt with Chronic Kidney Failure?

Reduction of protein and milk intake to prevent or correct the calcium-phosphorus balance. Phosphorus levels can also be reduced by oral administration of calcium carbonate (they combine with phosphorus to decrease GI absorption, thereby decreasing serum levels of phosphate)

What are the goals of treatment for fracture?

Regain alignment and length of the bony fragments (may need ORIF), Retain alignment and length (immoblize), restore function to injured parts, Prevent further injury

What is one hypothesis about the cause of SIDS

Related to a brainstem abnormality in the neurologic regulation of cardiorespiratory control.

Treatment for Otitis media?

Relieve pain, antibiotics, facilitate drainage, prevent recurrence, educate family , provide support

What are the goals for managing Juvenile Rheumatoid Arthritis?

Relieve pain, encourage compliance with meds, encourage heat/exercise, support family/child, Meds -NSAIDS/Methotrexate/Corticosteroids, Biologic agents - Etanercept Adalimumab, Abatacept, PT/OT, Promote ADLs

What is a reminder about oral hygiene after having a strep infection or pharyngitis?

Remind the child to discard their toothbrushes and replace them with new ones after they have been taking the antibiotics for 24 hours.

This is the inability of the kidneys to excrete waste material, concentrate urine, and conserve electrolytes. Can be acute or chronic in nature.

Renal Failure

Main objectives to treating a sickle cell crisis

Rest to promote oxygenation and minimize energy expendature, hydration through oral/iv, electrolyte replacement (hypoxia leads to further sickling from acidosis, analgesia for pain from vasoocclusions, blood replacement to treat anemia and reduce viscosity of sickled blood, and antibiotics to treat any possible infection present.

What is seizure activity caused by (what is happening in the brain)?

Result of cortical neuronal discharge May arise from central areas in the brain that affect consciousness, may be restricted to one area of the cerebral cortex, may begin in a localized area of the cortex and spread. Caused by spontaneous electric discharge initiated by a group of hyperexcitable cells called epileptogenic focus

In this most common intraocular malignancy of childhood, there is a cats eye type reflex when shining a light into the babies eye, often due to rare genetic mutation and can lead to blindness, there is however a 90% cure rate

Retinoblastoma

This is an acute noninflammatory encephalopathy and hepatopathy without explanation. Also Fever, impaired consciousness, and usually sequella to a viral infection and diagnosed by liver biopsy. Vomiting, and various degrees of neurologic impairment followed by coma, seizures and possible zero liver function/death

Reye Syndrome (stay away from ASA - (even look for it in hidden ingredients of other meds like pepto bismol etc) if the child has a fever) ASA doesn't cause it but increases the risk for it

This type of ureteral reflux is the result of an acquired condition/ another disease

Secondary reflux (ex: lupus)

How is nasopharyngitis spread?

Secretions, best means to avoid catching cold - wash hands, avoid touch eyes, noses, and mouths, avoid contact with those people affected. (haha)

What are the favorable outcomes if the child successfully develops through autonomy vs shame and doubt stage (1-3yrs)

Self Control and Willpower

These are notion, beliefs, convictions, that consititute a persons self knowledge and influence their relationships with others, it is how an individual describes themselves. May be influenced for girls by how their fathers treat their mothers, be careful not to go overboard with making the child feel they are best at everything

Self concept/Perception

These are times during growth and development in which positive or negative influences may have a greater impact.

Sensitive periods (such as the 1st trimester of conception has huge impact on fetal growth)

Through this type of play/development children explore the nature of physical world. Infants gain impressions of themselves and their world through tactile, auditory, visual and kinesthetic stimulation. This is the predominant form of play in infancy

Sensorimotor Development -

List the functions of play

Sensorimotor development, intellectual development, socialization, creativity, self awareness, therapeutic value, and moral value

During this stage of cognitive development the child begins to distinguish cause/effect, trial/error, they progress from reflex activity through simple repetitive behaviors and imitation. They are highly curious, experiment, and begin to differentiate themselves from their environment, they become aware later in this stage that objects have permanence (the object exists even though it is not longer visible) and begin to use language and thought.

Sensorimotor stage- Piaget (birth-2yrs)

What are the four stages of cognitive development? (piaget)

Sensorimotor(birth-2yrs), Preoperational(2-7yrs), Concrete operations(7-11yrs), Formal Operations(11-15yrs)

This is the greatest stress imposed by hopitalization during early childhood.

Separation anxiety

Side effects of ADHD meds

Sleeplessness, Growth retardation, anorexia

This is spontaneous displacement of the proximal femoral epiphysis in a posterior/inferior direction. Often happens around puberty in boys that are overweight, usually requires surgery. (The head(ball) of the thigh bone slips off the neck of the thigh bone) (Think scoop of ice cream falling off the cone) Causes pain/stiffness at hip joint

Slipped Femoral Capital Ephiphysis

This type of respiration may be the result of narcotics

Slow shallow breathing

Conservative management of the child with GER (Gastroesophageal reflux)

Small frequent thickened feeds, frequent burping, prone position, antacids or H2 blockers, PPIs,

Increased risk factors for SIDS

Smoking (prenatal, and second hand after birth), males greater risk than females, preemies, apnea, disruption in serotonin receptors, drug use by mom during pregnancy, cosleeping, soft bedding, increased risk in winter, lower socioeconomic status, 2 weeks - 6 months old, low birth weight babies, low apgar scores, recent viral illness, siblings of two or more SIDS victims, Native Americans, African Americans

Treatments for chickenpox

Standard, airborne, contact precautions until all lesions crusted. Keep child home away from susceptible individuals, administer skin care give bath and change clothes/linens daily, calamine lotion for pruritis, keep childs nails short mittens even if needed, keep child cool, teach child to put pressure on itchy areas not scratch. NO ASPIRIN. Antiviral agents (acyclovir) Benadryl for itching. Can be prevented with vaccination

What is the initial therapy for treating Genitourinary nephrotic syndrome (Nephrosis)

Steroids (to reverse protein loss), if that doesn't work - immunosuppressant therapy (Cytoxan). Salt restriction in diet to reduce edema effects, fluid restrictions (only short term and only if massive edema)

Name some anti-inflammatory drugs for asthma

Steroids = inhaled or oral, Intal and nedocromil (Inhaled), leukotriene modifiers (Singulair), IgE antagonists.

This shunt is usually put in the older child with no cardiopulmonary disease

Ventriculoatrial shunt (to heart)

Examples of Inductive Reasoning (Found in Concrete operations stage of cognitive development - Piaget) (7-11yrs)

Some examples of inductive reasoning include: •Jill and Bob are friends. Jill likes to dance, cook and write. Bob likes to dance and cook. Therefore it can be assumed he also likes to write. •Jennifer leaves for school at 7:00 a.m. and is on time. Jennifer assumes, then, that she will always be on time if she leaves at 7:00 a.m. •Robert is a teacher. All teachers are nice. Therefore, it can be assumed that Robert is nice. •All cats that you have observed purr. Therefore, every cat must purr. •All students that have been taught by Mrs. Smith are right handed. So, Mrs. Smith assumes that all students are right handed. •All observed basketball players are tall, so all basketball players must be tall. •All observed women in one area wear high heels, so all women must wear high heels. •Suzy is a doctor. Doctors are smart. Suzy is assumed to be smart. •John is a financial analyst. Individuals with professions in finance are very serious people. John is a very serious person. •Jerry is a bartender. Bartenders are friendly. Jerry is assumed to be friendly. •All observed brown dogs are small dogs. Therefore, all small dogs are brown. •All observed children like to play with Legos. All children, therefore, enjoy playing with Legos. •The water at the beach has always been about 75 degrees in July. It is July. The water will be about 75 degrees. •All observed police officers are under 50 years old. John is a police officer. John is under 50 years old. •Mary and Sue are friends. Mary enjoys fishing, running and rock climbing. Sue likes fishing and rock climbing. Sue must also like running. •Barry is a baseball player. All baseball players can make it to first base in at least 4 seconds. Barry can make it to first base in at least 4 seconds. •Ray is a football player. All football players weigh more than 170 pounds. Ray weighs more than 170 pounds. •All observed lacrosse players are tall and thin. George plays lacrosse. It is assumed that George is tall and thin. •All little dogs are "yappy." Bill has a small dog. His dog barks frequently at a high pitched level. •All observed cats in the area are brown. Tiny is a cat. Tiny is brown. •All observed houses on the South Street are falling apart. Sherry lives on South Street. Her house is falling apart. •Jenny is a dancer. Dancers are thin and tall. Jenny is thin and tall. •Bob is a sumo wrestler. Sumo wrestlers weigh a lot. Bob weighs a lot.

What are some symptoms of a lower tract UTI in older children and adolescents?

Some hematuria, with frequency and urgency. (Rarely fever for Lower UTI)

(CP)This is hypertonicity of muscles poor posture control, poor balance and coordination of movement/motion, impairment of fine and gross motor skills, scissoring of legs, and often found in those who were preemies. leads to contractures, positive babinski reflex present,

Spastic (pyramidal)

Classifications of CP

Spastic(Pyramidal), dyskinetic(nonspastic,extrapyramidal), ataxic, mixed type dystonic

This is a fissure in the spinal column that leaves the meninges and spinal cord exposed

Spina bifida (Rachischisis)

These are progressive type neuromuscular disorders

Spinal muscular Atrophy type 1 and 3 (Werdnig-Hoffmans)(Kugelberg-Welanders), Muscular Dystrophies (Duchene, faciocapulohumeral, limb girdle)

This fracture can sometimes be suspected of abuse

Spiral fracture

What is thalassemia intermedia

Splenomegaly with moderate to severe anemia

This is trauma to a joint that involves torn or stretched ligaments, occurs very quickly and may accompany a pop, snap or tearing sound.

Sprain

What are the stages of Wilm's Tumor?

Stage I - Tumor limited to kidney and completely resected. Stage II- Tumor extends beyond kidney but is completely resected. Stage III-Residual nonhematogenous tumor is confined to abdomen. Stage IV-Hematogenous metastases;deposits are beyond stage III, namely to lung, liver, bone and brain. Stage V-Bilateral renal involvement is present at diagnosis.

During this stage of separation anxiety, the young child may become less active, less crying, withdraws from others, depression, sadness, lack of interest in environment, non communicating, regression, physical condition may even deteriorate from not eating/drinking/moving.

Stage of Despair

During the stage of separation anxiety, the child cries, kicks, screams, calls out for the missing parent, searches for the parent with eyes, clings to parent if present and impending separation, avoids and rejects stranger contact, verbally attacks others, physcial attack possible of strangers, may attempt to escape to find parent, may attempt to physically force parent to stay, can persist up to phsycial exhaustion.

Stage of Protest

During this stage of separation anxiety in a young child the child begins to show signs of adjustment but with resignation, may even reject parents when they do finally come, they will interact with strangers or unfamiliar caregivers. This is usually a superficial adjustment to the loss. (usually uncommon to reach this stage)

Stage of detachment

What are the three stages of separation anxiety in young children?

Stage of protest, stage of despair, and stage of detachment

Nursing considerations for caring for a child with neuro dysfunction

Suction, may end up with trach, monitor ICP (may need mannitol) - check pupils, perform coma scale monitor, HOB at 30 degrees, keep head midline, suction and percussion are poorly tolerated if ICP is increased so only use if the pt is coughing or choking or needs suction, carefully watch fluids and I and O's, watch for s/s of SIADH(no pee, swell) or DI (pee lots), May need NG tube for longer term or G tube, watch for signs of dehydration (mucous membranes, skin), give meds as ordered, keep temp regulated, catheter may be inserted, diapers may be used, stool softeners prn, mouth care at least 2x a day, lip care, eye moisture, position to prevent aspiration, ROM, Footboards/boots to prevent foot drop, low stimulation, soothing music, reorient and talk to them like they can hear you, support the family.

What is the treatment for bronchiolitis?

Suctioning is #1 treatment, keep POX levels >90% at all times hopefully on room air, ensure adequate fluid intake, (NO antibiotics) (Steroids/antihistamines are not proven to be effective, chest percussion is not proven to be effective) IV fluids might be needed if fluid by mouth is contraindicated r/t poor fluid intake/dehydration. Watch for respiratory failure signs! There are no medications appropriate for the infant that can ease the stuffy symptoms, suctioning is #1.

Should infants be put to sleep prone or supine?

Supine (ON their backs!)

What is the nursing care for the pt with hemolytic uremic syndrome?

Supportive care for renal failure and dialysis teaching. administer blood products as needed. Support for the family of this previously healthy child for a very big impact on hospitalization and aggressive treatment needed. Recovery rate is 95%, but residual renal impairment is from 10-50%.

What is the treatment for scoliosis?

Surgery usually required if >40 degree curve(spinal fusion with poss hardware). If less curve <40 degrees, may have brace on 23 hrs/ day to correct. If only mild curve 10-20 degrees, may observe and do mild exercises to adjust as long as it doesn't progress.

How is cystic fibrosis diagnosed?

Sweat Chloride test

Signs of HIV in a child

Symptoms of human immunodeficiency virus include poor weight gain, inter- mittent diarrhea, frequent respiratory infections, and inability to tolerate feedings.

Predominant symptoms of diphtheria (prodromal and constitutional)

Symptoms vary according to anatomic location of membrane affected. Nose- resembles cold. Tonsils/pharyngeal - malaise, anorexia, sore throat, low grade fever, pulse increased, smooth white/grey colored membrane lymphadenitis (bulls neck) pronounced, toxemia, sepsis/shock, death within 6-10 days. Layrngeal-fever, hoarseness, cough, potential airway obstruction, apprehension, dyspnea, cyanosis

All children with this disease should be tested for HIV because there is such an correlation.

TB

Medication used to treat flu symptoms also for types A and B and is ORAL medication and must be taken within 48 hours of symptoms and for children older than 1.

Tamiflu

Nursing considerations for administering iron supplements and for iron deficient children

Teach to take with Vit C. Teach compliance to keep taking it, teach stool colors will change, teach to beware of overdose, IM Z track change needle (can stain skin), warn that liquid Iron can stain teeth (straws)

Treatment for Fragile X

Tegretol or Prozac(violent outbursts), and CNS stimulants (Clonidine)-for improving attention span and decreasing hyperactivity, and early speech and language therapy to prevent IQ decline

What makes infants and young children more susceptible to catching respiratory infections?

The structures of respiratory tract have a narrower lumen making kids more susceptible to obstruction/distress caused by inflammation

What is affected by a UTI in the body?

The urethra and bladder (Lower urinary tract) and the ureters, renal pelvis, renal parenchyma and calyces (Upper Urinary Tract)

What are the reactions to a childs stress levels regarding hospitalization influenced by?

Their developmental age, previous experience with hospitalization or illness, separation, coping skills, seriousness of diagnosis, support system available

Describe the clinical course of reversible acute renal failure?

There is usually a period of severe oliguria, or low output phase, followed by an abrupt onset of diuresis, or high output phase, and then a gradual return to normal urine volumes.

This is one of the most important adaptation responses of an infant to the external environment outside of the womb.

Thermoregulation

What are some ways to prepare the toddler (1-3yrs) for procedures based on their developmental stage?

They are developing autonomy and sensorimotor to preoperational thought, so use the same approaches as for the infant (notecard #153), consider the following - egocentric thought (explain everything, its okay to cry, use one person to speak during procedure), negative behaviors(resistance is possible, expect it, be firm, ignore tantrums, restrain prn), animism (keep scary objects out of view), limited language skills(one direction at a time), limited concept of time, striving for independence (allow choices, allow them to participate in care if possible)

What are some ways to prepare the school aged (6-12 yrs) child for procedures based on their developmental stage?

They are developing industry and concrete thought, they have increased language skills and an increase interest in learning, they have an improved concept of time and increased sense of control, they are striving for industry (Allow responsibility for simple tasks, include them in decision making and activie participation (remove dressings, handling equipment, opening packages)) they are developing relationships with peers (consider preparing two or more children for the same procedure or encourage one to help the other, provide privacy from peers during the procedure to maintain self esteem)

What are some ways to prepare the preschool aged child (3-6 yrs) for procedures based on their developmental stage?

They are developing initiative and preoperative thoughts, so consider that they are egocentric (explain everything, demonstrate use of equipment, allow them to play with equipment, encourage playing of procedure with a doll, use neutral words), they have increased language skills but do not overestimate what they understand. They have limited concept of time and frustration tolerance, illness might be viewed as punishment (guilt), animism (keep scary objects out of view), fears bodily harm intrusion or castration (emphasize no other body part involved other than where surgery taking place (show on doll)) They are striving for initiative so involve them when possible, give choices, and praise them for cooperation never shame them.

What are some ways to prepare the infant aged(birth-1yrs) child for procedures based on their developmental stage?

They are developing trust and sensorimotor thought, consider these things... Attachment to parent, stranger anxiety, sensorimotor phase of learning (soothe - talk soft, stroke skin, give paci), increasing muscle control with age (may resist), memory for past experiences (may associate objects/things from previous experience - keep scary things out of view), imitation gestures(model desired behavior, open mouth, close eyes, etc)

What is the best mode of communication with a child in early childhood?

They are egocentric and very literal concrete thinkers. (Say things like Poop or Pee, speak their language, DO NOT use off handed comments "put you to sleep" "put a little stick in your arm")

Why are kids bones more susceptible to breaking?

They are more porous

This shunt allows for growth

Ventriculoperitoneal shunt (to abdomen)

How do preschoolers strive to maintain control of their environment? What can occur with restriction of this?

They have egocentric and magical thinking, they feel all powerful and have transductive reasoning and preoperational thinking(purely verbal instructions are often inadequate for them because they are unable to synthesize beyond what their senses tell them - they understand only in terms of real events). They will lack understanding of cause and effect relationships, for example if the preschooler percieves that nurses inflict pain, preschoolers will think that EVERY nurse or everyone wearing a similar uniform will also inflict pain.

What is important to remember about cystic fibrosis pts caloric needs?

They need 150% rec. daily intake.

How to toddlers strive to maintain control of their environment? What can occur with restriction of this?

They strive for autonomy, (seen in motor skills, play interpersonal relationships, ADL's, communication). Any restriction or limitation of movement can cause forceful resistance and noncompliance (Even something as little as making a toddler lie down) A loss of control can also occur in toddlers resulting from changes in daily routine and rituals. They need consistency and familiarity of these to provide stability and control.

What are some things that can result in loss of control feelings in an adolescent?

They struggle for independence, self assertion, liberation and personal identity. Anything that interferes with that poses a threat and results in loss of control. Illness and hospitalization constitutes a major situational crisis for them.(can lead to anger) Watch to not be condescending, they infer tone easily- carefully assess their intellectual abilities and previous knowledge as a nurse to avoid the adolescent from feeling threatened.

What is important to remember about communicating with school aged children?

They want answers and explanations.

What is ritualism?

This is the need to maintain sameness and reliability providing comfort (Toddlers)

What is the key to preventing rheumatic fever?

Thoroughly treating strep infection with antibiotics (full course)

Why are children with GER (Gastroesophageal reflux) given thickened feeds?

To help weigh the food down in stomach.

Two stages of early childhood

Toddler (1-3 years), Preschool(3-6years)

When does the child develop gender identity development?

Toddler age (1-3)

During this stage of a grand mal seizure the arms are curled inward and back is arched

Tonic

list the types of primary generalized seizures

Tonic-clonic(Grand mal), Absence(petit mal), atonic(drop), myoclonic

This inflammation usually occurs with pharyngitis and can be viral or bacterial in nature.

Tonsillitis

These are masses of lymphoid tissue located in the pharyngeal cavity. They filter and protect the respiratory and alimentary tracts from invasion by pathogenic organisms and play a role in antibody formation. Can swell to the point of causing breathing difficulty and swallowing difficulty and might require surgical removal

Tonsils

What increases the risk of hip dysplasia for infants?

Too tight swaddled with legs straightened, larger babies.

Which tests would confirm anatomic abnormalities of the Urinary tract (upper or lower) which could cause UTIs or be the result of damage to the kidneys from recurrent infections.

Ultrasonography, voiding cystourethrogram, Intravenous pyelogram, Dimercaptosucinic acid scan. (VCUG, IVP, DSMA)

What would be done to confirm diagnosis of hip dysplasia in an infant under 4 months of age?

Ultrasound (Over 4 months - Xray)

Which age/*** is the highest incidence of UTI's overall

Uncircumcised male infants younger than 3 months of age. (if a young male infant has a fever - circumcision status should always be checked)

Ways to promote positive self esteem in your children

Unconditional love, comment on behaviors not the childs, give choices, realistc goals, polite/respect, appreciate their help, problem solve, rationale (why), value who he/she is not looks

This is depressed cerebral function - inability to respond to sensory stimuli and have subjective experiences

Unconsciousness

If there are normally bacteria in the Urinary Tract, why does one not develop a symptomatic infection all of the time?

Under normal conditions the act of completely and repeatedly emptying the bladder flushes away any organisms before they have an opportunity to multiply and invade surrounding tissues.

Quality pt outcomes for pt with acute renal failure

Underlying cause treated and identified, water balance maintained, hypertension controlled, electrolyte balance maintained, diet maintains calories while minimizing tissue catabolism, metabolic acidosis, hyperkalemia and uremia (usually amino acids IV route chosen)

Pathophysiology of leukemia

Unrestricted proliferation of immature WBCs in the blood forming tissues of the body, leading to bone marrow suppression. the most severely affected organs are the most highly vascular - The liver and spleen.

What are the pain responses typical for a young child (toddler)?

Upset by intrusive stimulus even if it is not painful, can even have reaction to holding/restraining them and not pain itself. Loud crying, verbal expressions, thrashing of arms and legs, attempt to push away stimulus before applied, lack of cooperation, requests to stop procedure, cling to parents or others, requests emotional support, Restless irritable with continuing pain

This is retention of nitrogenous waste products which produces toxic symptoms.

Uremia

Which is worse, Azotemia or Uremia?

Uremia. Azotemia is not life threatening, and uremia is a serious condition that often involves other body systems

This in an infection of the lower or upper urinary tract, specifically it is an increase number of microorganisms anywhere within the urinary tract except the distal 1/3 of the urethra.

Urinary Tract Infection

When should once daily dose antibiotics be given for UTI

Usually at bedtime, this allows the drug to remain in the bladder overnight.

What is important to remember about Diuretic use with ACE inhibitors? (PRIL)

Usually do not need to add potassium supplements because ACE's also block the action of aldosterone. (could cause hyperkalemia) (Watch electrolytes and renal function)

What is average I and O balance of a child?

Usually pretty even, 1ml/Kg/hr

What treatments are done for brain tumors usually with children?

Usually shrink tumor first then do surgery while maintaining function. Chemo has emerged in the past decade to delay radiation in children younger than 3 years old. (NO radiation under 3)

What is the treatment for hydrocephalus?

Usually surgically treated with removal of obstruction or shunting.

What tests does the child with reflux usually undergo, and what if they do not want to take oral antibiotics every day - what then?

VCUGs are done yearly on these children to check reflux status. If they do not want to undergo antibiotic treatment they can have a subtrigonal injection (STING) - a bulking agent is injected into ureters to slow the reflux action or make it more difficult. (Deflux - dextranomer -hyaluronic acid polymer)

This is the abnormal retrograde flow of bladder urine into the ureters. (Two types, primary and secondary) this is more commonly associated with recurring kidney infections (pyleonephritis) rather than bladder infections (cystitis) and renal scarring in children.

VUR (vesicoureteral reflux) (ureteral reflux) (can cause kidney infections with severe symptoms such as high fever, vomiting and chills)

What happens to the toddler without establish ritualism?

With out comfortable rituals, they have little oportunity to exert autonomy, consequently dependency and regression can occur.

How is lupus treated?

With supportive care and medications (steroids, antimalaria, NSAIDS, Immunosuppressants, Antihypertensives, ASA, Antibiotics), Nutrition, rest, exercise, avoid sunlight exposure,

How might brain tumors be diagnosed

X-rays, MRI, CT, LP, Maybe EEG, Nursing assessment very important r/t varied symptoms

Can children understand what they hear sooner than they can speak?

Yes, they show comprehension far sooner than expression (sign language for example)

What age is most at risk of renal injury associated with UTI?

Young children, especially 2 and under. (even more so with congenital renal malformations and reflux)

Clinical manifestations of nasopharyngitis (cold) in the younger child

Younger Child Fever Irritability, restlessness Poor Feeding and decreased fluid intake Sneezing Nasal mucus causing mouth breathing Vomiting or Diarrhea

Medication used to treat flu symptoms in patients 7 years and older and for prophylaxis of flu in children 5 years and older. must be started within 48 hours of onset symptoms, it is an INHALED medication for types A and B flu virus (5 days)

Zanamivir

Which antiviral for the flu should not be given to pts with COPD or asthma?

Zanamivir because it can cause bronchospasm and a decline in lung function.

This might be protective of nasopharyngitis (colds) or lessen the severity.

Zinc (do not use spray kind, could result in loss of smell/taste)

Drugs used for N/V from chemo

Zofran (Before you start treatment and then around clock after)

Signs of MI in child

abdominal pain, vomiting, restlessness, pallor, crying

List some gross motor, fine motor, sensory and social milestones of a 18 month old toddler

anterior fontanel closes, can control sphincters, stands from sitting, walks up steps with one hand held, pull/push toys, jumps with two feet, seats self in chair, throws ball overhand without fall, tower build of three cubes, release and reaches well, makes strokes to imitate others while drawing, manages spoon well, says 10+words, points to words given (shoe, ball, cat), forms some word combinations, gestures, expresses emotions, tantrums, imitator, takes off articles of clothing, ownership (MINE!), may have security blanket (transitional objects dependancy)

How is dehydration managed overall?

assess for cause, oral replacemnet if possible, then Parenteral fluid if severely dehydrated, vomiting or can't drink

Signs and symptoms of rheumatic fever

chorea, carditis, polyarthritis, erythema(rash), subq nodules, arthralgia, fever, elevated reaction markers in blood (C-reactin, sed rate)

During this stage of a grand mal seizure the arms are straightened out and knees possibly bent back not arches

clonic

List some of the adverse respiratory sounds you might hear in an infant/child with a respiratory infection

cough, hoarseness, grunting, stridor, wheezing, crackles, or diminished/absent sounds in lungs

List some gross motor, fine motor, sensory and social milestones of a 30 month old toddler

day/night bowel and bladder control, jumps with both feet, jumps from chair/step, stands on one foot, takes steps on tip toe, builds 8 cube tower, adds chimeny blocks to train of blocks, good hand/finger coordination, holds crayon with fingers rather than fist, imitates while drawing - vertical and horizontal strokes, makes two or more strokes for cross, draws circles, gives first/last name, refers to self with pronoun (me, I), uses plurals, names a color, seperates more easily from parent, helps put things away, carries breakable objects, pushes with good steering, begins to notice gender differences and knows own gender, may attend to toilet need with exception of needing help wiping, emotions expand to include pride, shame, guilt and embarrassment.

List the sources and risk factors for osteomyelitis

direct contamination to the bone, indirect seeding from other infections, predisposing factors- poor physical condition, poor nutrition, poor hygiene

What are some possible parental reactions of parents to a childs hospitalization?

disbelief, anger, guilt, fear, anxiety, frustration, depression

clinical manifestations of thalassemia

early - pallor, unexplained fever, poor feeding , enlarged spleen or liver, as it progresses = hypoxia signs headace, bone pain, fatigue, listlessness, anorexia, Other features - small stature, delayed sexual maturation, bronzed freckled skin with no chelation therapy if getting transfusions, may have in older children - enlarged head bones in skull - flat bridge of nose, osteoporosis

Suggestions for implementing care for children with cognitive impairment

educate child and family, teach child self care skills, promote childs optimum development, play/exercise, communication, discipline, socialization, sexuality, help families adjust to future care, care for the child during hospitalization

Clinical manifestations of Hirschsprung disease in newborns

failure to pass meconium within 24-48 hrs after birth, refusal to feed, bilious vomiting, abdominal distension.

Predominant symptoms of mumps

fever headache, anorexia for 24 hours - followed by earache aggravated by chewing. by the third day parotid glands enlarge and reach huge size and other exocrine glands may be swollen.

What is the subacute phase of kawasakis

fever resolves but still other symptoms (fever, peeling skin, lesions on lips,) 10-25 day, desquamination of hands/feet near nails

Symptoms of TB

fever, malaise, anorexia, cough(May or may not be present), aching pain/tightness in chest, then later- increasing rr, poor expansion of lung on affected side, diminished breath sounds and crackles, dullness to percussion, persistent fever, generalizedsx- pallor, weakness, anemia, wt. loss

What is centration (toddlers 1-3)

focusing on one aspect rather than considering all of the other possible alternatives (example - child refuses to eat a food because of its color even though the taste and smell are acceptable)

What are some genetic factors that influence development

genes, congenital anomalies, disorders of intrauterine development, genetic disorders.

This is an increase in intraocular pressure

glaucoma

What is the prognosis for those with juvenile rheumatoid arthritis?

good, 70% enter long remissions with out major residual deformity or impaired function

What are some reasons for recurrent chronic seizures in children

idiopathic epilepsy, or epilepsy secondary to; trauma, hemorrhage, anoxia, infections, toxins, degenerative phenomena, congenital defects, parasitic brain disease, hypoglycemia injury, sensory stimulus epilepsy, stimulating states - epilepsy including narcolepsy, catalepsy, psychogenic, tetany from hypocalcemia, alkalosis; Hypoglycemic states including hyperinsulinism, hypopituitarism, adrenocortical insufficiency, hepatic disorders; uremia, allergy, cardiovascular dysfunction or syncopal episodes, migraines

Treatment for aplastic anemia

immunosuppressive therapy, or bone marrow transplant

Majority of sites neuroblastomas develop (aka "Silent tumors")

in abdomen along the adrenal gland, Head, neck, chest, pelvis

Signs and symptoms of compartment syndrome

increase pain distal to the injury not relieved by pain meds, decreased sensation in toes/fingers, loss of movement of toes/fingers, decreased distal pulses, cyanosis, increased cap refill

This seizure type is often seen as less severe from the outside, but have far reaching implications on growth and development, the child MIGHT outgrow them but may have severe delays

infantile spasms

Pathophysiology of Hemolytic Uremic Syndrome

injury to the endothelial lining of the small glomerular arterioles, which then become swollen and occluded with deposits of platelets and fibrin clots, RBCs are damaged as they attempt to move through partially occluded vessels, the damaged cells are then removed by the spleen, causing hemolytic anemia, and the platelet aggregation within the damaged blood vessels produces the thrombocytopenia.

Manifestations of osteomyelitis

irritable/restless, increased temp, localized tenderness, increased warmth and swelling over involved bone, guarding of extremity during movement especially

How does ITP usually resolve?

it is generally self limiting, without major complications. Overall quality outcomes - serious bleeding prevented, activities that increase the risk for serious bleeding avoided, and treatment administered without serious side effects.

What is some important teaching for the parents of fragile X children?

it is hereditary, so they much teach their children of the risks that they have a 50% chance of having a child with the syndrome.

Joints most often affected by hemophilia?

knees, ankles, elbows, wrists

Where are common sites of mets for neuroblastomas?

lymph nodes, bone marrow, skeletal system, skin, or liver (Very important to do skeletal survey to check for mets/tumors)

List some gross motor, fine motor, sensory and social milestones of a 3 year old preschooler

rides tricycle, stands on one foot, goes up steps using alternative feet, dances, broad jumps, builds tower of 9-10 cubes, builds bridge with three cubes, vocab 900+ words, complete sentences, can prepare simple meals such as cold milk and cereal, dresses self almost completely (buttons may need help), pulls on shoes, increased attention span, feeds self completely, can set table, asks many questions, is in preconceptual phase = egocentric in thought/behavior, may begin to understand time, improved concept of self space, may just start to view concepts from another perspective, wants to attempt to please, less jealous of siblings, aware of family relationships/functions, boys id more with dad, increased ability for separation.

What is thalassemia major

severe anemia

What factors affect the formation of a childs self esteem?

temperament/personality, abilities and opportunities available to accomplish age appropriate tasks, how significant others interact with the child, social roles assume and expectations of these roles.

List some gross motor, fine motor, sensory and social milestones of a 15 month old toddler

walks without help, creeps up steps, kneels, loses balance with sudden stops or corners, cant throw ball without falling, falls often, casts objects to floor, builds two cube tower, holds two cubes in one hand, releases small object into narrow necked bottle, scribbles, uses cup well but rotates spoon before it reaches mouth, can put round objects into round holes etc, intense interest in pictures, less fear of strangers, begins to imitate parents, may discard bottle, kisses hugs parents

Steps to follow in general if pt comes in with suspected poisoning?

we ASSESS (ABC's), stop exposure to the toxin, identify toxin if possible, remove internal poisons/ prevent absorption/ use antidotes

When does compartment syndrome usually develop?

within 48 hours of injury

Are small tremors common in the first few months? Yes or no

yes