Peds Exam 3 study guide
Tetralogy of Fallot (Decreased Pulm Blood Flow) A.Is a congenital heart defect composed of four heart defects: 1. Pulmonary stenosis (narrowing of pulmonary valve, creating and obstruction) 2.VSD 3.Overriding aorta(Enlargement of the aortic valve) 4.Right ventricular hypertrophy B. What are the signs and symptoms the Nurse should be aware of and should assess?
1. Pulmonary stenosis (narrowing of pulmonary valve, creating and obstruction) -Pulm stenosis - flow from r ventrical is slowed as a result decreased blood flow to lungs for oxygenation and ultimately a decrease in the amount of oxygenated blood. -Pulm stenosis increases pressure in right ventricle -Poorly oxygenated blood in the r ventricle shunt thru VSD to left ventricle REPAIR- surgical B. -During periods of stress the infant may become cynotic as the condition gradually grows more severe and as the child gets older - Asses hx of color changes associated with feeding, activity or crying. -Determine if infant is demonstrating hyper cyanotic spells: note: Hypercyanosis develops suddenly and is manifested as increased cyanosis, hypoxemia, dyspnea and agitation. -If the infants oxygen demand is greater than supply ...the infant will become unreposive. -As the infant gets older: he may use specific postures such as: A. BENDING at the KNEES or ASSUMING the FETAL POSTION to relive a hyper cyanotic spell. -The walking infant or toddler may squat periodically note: These positions improve pulmonary blood flow by increasing systemic vascular resistance -If the child has a hyper cyanotic during the assessment 1. Count the childs respiratory rate and observe the work of breathing, retractions, SOB, or noisy breathing. 2. Doc O2 sat 3. Ausculate chest 4. Auscultae heart
Tricuspid Atresia p.669 (Decreased Pulmonary blood Flow) a. Valve between right atrium and ventricle does not develop As a result: -Blood cant get to RV - deoxygenated blood goes through ASD -Mixing deoxygenated and oxygenated blood in the Left Atrium -Minimum oxygenation occurs -Treatment- Surgery - several over 5 years Flip for S/Sx
A. S/SX: -Apical pulse overactivity -Weak or poor sucking -Tachypnea -Coolness and clamminess -Crackles and Wheezes Atruamatic Care: -When a child is diagnosed with congenial heart disease, involve the child life specialist early in the course of treatment
Duchenne Muscular Dystrophy p.835 -refers to a group of inherited conditions that results in progressive muscle weakness and wasting -General term for a group of inherited types of neuromuscular disorders that affect voluntary muscles. -Symptoms not always evident at birth; may manifest later in childhood. -May limit life span due to compromised ability to adequately support ventilation. -Spinal muscular atrophy is a rare similar type or neuromuscular disease that affects the motor neurons in the spinal cord, rather than the muscle fibers themselves. Symptoms are similar to those of muscular dystrophy. Flip for More: Nursing Signs/Sx
A. Duchenne Muscular Dystrophy: Inherited - x linked -Progressive muscle weakness: Generalized weakness, muscle wasting; Limb and trunk first -No cure -Corticosteriods slow progress (Prednisone) : boys treated with this showed improved strength and function Nursing interventions Gower sign Promote mobility Life expectancy - early adulthood B.Nursing Assessment (S/sx_ -Observe childs ability to rise from floor -Hallmark is presence of GOWERS SIGN: child cannot raise from the floor in standard fashion because of increasing weakness (Child must roll onto his hands and knees, then hems bear weight by using his hands to support some of his weight while raising his posterior... The boy uses his hands to "walk" up his legs to assume an upright position) -Observe gait -observe effectiveness of cough -Tachycardia as muscle heart weakens -perfome a EMG to demonstrate the problems that lies in the muscles - Serum Creatine Kinase levels may be elevated C.Nursing management Goals with Child with Muscular Dystrophy: 1.Promoting mobility -Administering medications: corticosterioids and calcium supplements as ordered -Performing passive stretching and strengthening exercises/encourage at least minimal weigh bearing in a standing position to promote improved circulation , healthier bones and a straight spine. -Use orthotic supports such as hand braces or ankle to prevent contractors of joints -Schedule activities during part of day when child has most energy 2.Managing elimination 3.Maintaining cardiopulmonary function - Position child for maximum chest expansion -Teaching deep breathing exercises -Performing chest physical therapy -Preventing complications and maximizing quality of life -Developing a diversional schedule -Providing emotional support
All types of Cerebral palsy p.841 Cerebal palsy 1.A term used to describe a range of nonspecific symptoms. 2.Most common motor disorder in childhood; lifelong impairment. 3.Incidence is higher in premature and low birth-weight infants. 4.Signs and symptoms A.Motor impairments including abnormal motor patterns including spasticity, muscle weakness, and ataxia; abnormal brain function is not progressive. 5.Complications B.Mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus. Flip for nurse managent
A. Management of Cerebral palsy involves multiplinary disciplines: PT, OT, speech Types spastic, athetoid (dyskinetic), ataxic, mixed A. Spastic: Hypertonincity and Permanaent contractions. different types based on which limbs are affected 1. Hemipegia: both extremities on one side 2. Quadriplega: all four extremities 3. Diplegia or Paraplegia: Lower extremities s/sx: -POOR CONTOL of posture, balance and movement -EXAGGERATIONN of deep tendon reflects -Hyper tonicity of affected extremities -Continuation of primitive reflexes Failure to progress to protective reflexes -Most common B. Athetoid or Dyskinetic -Abnormal INVOLUNTARY MOVEMENTS s/sx: infant is limp and flacid uncontrolled, slow, worm like writhing or twisting movements Affects all four extremities and possible movement of face movements increase during periods of stress -Dysarthia and drooling may be present Meds to tx spasticity:Baclofen, Dantolene Sodium Diazepam. Intrathecal administration of baclofen has been shown to DECREASE tone but it must be infused continuosly. C. Ataxic: affects BALANCE and DEPTH PERCEPTION s/sx POOR CORDINATION , Unsteady gait WiDE BASEd GAIT Teaching Guidelines of Baclofen pump, -Check incisions daily for redness, drainage or swelling -Notify Physcian or NP if the child has a temp greater than 101.5 F or if the child has persistent incision pain -Avoid tub baths for 2 weeks -Do not allow the child to sleep on Stomach for 4 weeks after pump insertion -Disocurage twisting at the waist , reaching high over head, stretching or bending forward or backward for 4 weeks -When the incisions have healed , normal activity may be resumed -Wear loose clothing to prevent irritation -Carry implanted device identification and emergency cards at times Promoting nurtirion -Soft of purred makes swallowing easier -Proper positing
5 P's - "Take Note!" p 857 Flip for five Ps Take note: Fractures in the newborn (with the exception of birth trauma) or infant should raise a high index of suspicion for abuse as fractures are very unusual in children who cannot yet walk
Asses the injured, splinted or casted extremity frequently for the "5 Ps" which may indicate compartment syndrome: -Pain -Pulselessness -Pallor -Paresthesia -Paraylysis Report these immediately Nursing Management: -this is for nursing management immediately after the injury/Sprain/Fracture -Immobilize the limb above and below the site -Use cold therapy to reduce swelling first 48hrs -Perform frequent Neurovascular checks Assess pain and administer pain medications PRN. -Adminster tetanus vaccine in the child with an open fracture if he or she has not received a tetanus booster within past 5 years -Unless bed rest is prescribed, children with upper extremities and walking leg cast can resume INCREASED LEVELS of activity as the pain subsides -Crutches can go to school -Spica casts will be at home for several weeks -Provide distraction and ways to keep up with school work -Teach families to care for the cast: (22.1 -Discourage risky behaviors
Performing Ortolani/Barlow Maneuver Chpt 22 Ortolani Maneuver: 1. Place the Newborn in the SUPINE position and FLEX the hips and knees to 90 degrees at the hip 2. Grasp the inner aspect of the thighs and abduct the hips (usually to approximately 180 degrees while applying upward pressure 3. Listen for any sounds. Their should no "Cluunk heard or felt when legs are abductd - A clunk indicated DDH flip for Barlow Maneuver
Barlow Maneuver: 1. using the same position -Adduct (bringing them together ) the thighs while applying outward and downward pressure to the thighs 2. Feel for the femoral head slipping out of the acetabulum, also look and feel for clunk
Dyslexia : -Children with DYSLEXIA have difficulty with reading, writing, and spelling. Flip for Dysgraphia
DYSGRAPHIA -Children with DYSGRAPHIA have difficulty producing the written word (COMPOSITION,SPELLING,WRITING).
Dyspraxia -Children with DYSPRAXIA have problems with MANUAL DEXTERITY and COORDINATION. Flip for Dyscalculia:
Dyscalculia: -Children with DYSCALCULIA have problems with MATH and COMPUTATION
Patent ductus arteriosis (PDA) p. 673 (increased pulm blood flow) 1.Failure of ductus arteriosis to close 2.Connection between aorta and pulm artery 3.2nd most common Most common 10% CHD- more common in premature infants and high altitude births 4.Blood flows from aorta to pulm artery via PDA instead of entering systemic circulation- increased workload on left heart 5.Treatment- observation or surgery
Nursing Assessment: -PDA depends on the size of the Ductus arteriosus - Diastolic Bp is usually low due to shunting -MACHINE-LIKE MURMUR
Congenital clubfoot p.828 Club foot consists of: 1. Talipes Varus (INVERSION of heel) 2. Talipes Equinus ( PLANTAR FLEXION of the foot; the heel is RAISED and would not strike the ground in a standing position 3. Cavus (PLANTARFLEXION of the forefoot on the HINDFOOT) 4. Forefoot adduction: with supination (the forefoot is INVERTED and turned SLIGHTLY UPWARD S/s: the foot resembles the " HEAD of a GOLF CLUB" -Males more effected Club foot may be classified into four categories: 1. Postural club foot : Often RESOLVES with a short series of manipulative casting 2. Neurogenic club foot: occurs in Infants with Myelomeningocele 3. Syndromic club foot: When associated with other syndromes are RESISTANT to tx 4. Idiopathic club foot: happens in Normal healthy Infants. note: Approach to tx is similiar regardless of the classification. Goal: Achievement of functional foot -weekly manipulation with serial cast changes is performed Flip for Nursing Assessment/Management
Nurse Assessment: -Family hx -Perform AROM, noting inability to move foot into normal positioning -Xrays to determine bony abnormality Nurse management: -Performe neurovascular assessent and Cast care for infants requiring casting Tx families cast care
Osteogenesis imperfecta p.829 -genetic bone disorder that results in LOW BONE MASS, INCREASED FAGILITY and CONNECTIVE TISSUE PROBLEMS: hypermobility resulting in instability of the joints. - ass these contribute to FRACTURE OCCURENCE Dentinogenesis imperfect may occur: Tooth enamal wearing easily, brittle teeth, discovered teeth types ranges from mild to severe -Subtypes A or B depend on the presence of Dentinogenisis Take note: Blue/Gray Sclera is NOT a diagnostic of Osteogenesis imperfecta Goal: DECREASE INCIDENCE OF FRACTURES and MAINTIAN MOBILITY Admin of BISPHOSPHONATE : for Moderate to Severe flip for Nursing Management:
Nurse Managenement: Handle the child carefully and teach the family to avoid trauma - Never push or pull or arm or leg -do not bend an arm or leg into an awkward position -Lif a baby by placing one hand under the legs and buttocks and one hand under the shoulders head n neck -do not lift baby's legs by the ankles to change the diaper do not lift a baby of small child from under the armpits -Provide supported positioning -If fracture is suspected handle the LIMB minimally TX: reinforce physical and occupational therapists for promotion of fine motor skills and independence in activities of daily living -adapted physical education is important to promote mobility and maintain bone and muscle mass. (walking and swimming and water therapy) Take note: USE caution when inserting an IV line or taking a blood pressure measurement, as pressure on the arm or leg can lead to bruising and fractures.
Soft tissue injuries p. 858 -where injuries occurs to muscles tendons or ligaments Where they stretch excessively and may tear Therapeutic management of sprains includes RICE Rest Ice Compression Elevation Flip for Nursing Assessment/ Nurse Management.
Nursing Asessment: dertermine mechanism of injury Assess affected body part for edema , bruising, note limp or inabiliy to bear weigh -DO NOT ATTEMPT to Perform PAssive Range of MOTion on the affected body part -Assess Neurovascular status distal to the injury (usually normal) Nursing Management: Instruct the child and family to -Rest: limit activity -Ice: apply cold packs for 20 to 30 mins, remove for 1 hour and then repeat for the first 24 to 48 hours -Compression : apply an Ace Wrap or other elastic bandage or race; check skin for alterations when rewrapping -Elevation: elevate the injured exterminative above the level of th heart -Tx that to avoid sprains appropriate warmups and stretching is goos Take note: -If childs fingers or toes become increasingly swollen or discolor, remove the ace wrap immediately.
Legg-Calve-Perthes Disease p. 848 - is a SELF LIMITING condition that involves AVASCULAR NECROSIS of the FEMORAL HEAD -Affectts children between 4-8 yrs of age -Affects MALES more often -Etiology is unknown: But interruption of the blood supply to the femoral head results in bone death, and the spherical shape of the femoral head may be lost. - Swelling may occur Problem with this disease: As the new blood vessels to develop, DURING this period of revascularizaton, (takes 18-24 months) , the bone is SOFT and more LIKELY TO FRACTURE. Therapeutic management: -Goal: Maintaon normal femoral head shape and to restore appropriate motion. Flip for Nursing Aessement and Nursing Management:
Nursing Assessment: -short stature, delayed bone maturation, r/t trauma or family history - painless limp, can be intermittment -Mild hip pain Observe child walking and note TRENDELENBURG GAIT. -Perform ROM, noting INTERNAL ROTATION of the hip and limited abduction -Muscle Spasm may result with hip extension and rotation Nursing management: -Adminster Anti-inflammatory medications -If activities are restricted, exercise the unaffected body parts -Assist families with use of brace -tx that the brace may be wiped with a damp cloth if it becomes dirty -Advoidance of high impact sports -Swimming and bicycle riding help to maintain ROM with little risk.
Depression (mood disorder) p. 1108 Chapter 28 -Girls are twice as likely to be affected as boys note: Depression may cause significant alterations in school performance and social relationships. -Children and adolescents experiencing depressive episodes may harm themselves purposefully (without the intent to kill themselves) -they may hit, cut, or burn themselves -THESE CHILDREN ARE AT RISK FOR SUICIDE Patho: -Norepinephrine and dopamine play a role in mods , when an alteration in the neurotransmission of norepinephrine and dopamine occur, the symptoms of depression (APATHY,LOSS OF INTEREST and PLEASURE) result. Flip for Nursing Assessment and Nursing Management
Nursing Assessment Risk Factors for Suicide -Previous suicide attempt -Change in school performance, sleep, or appetite -Loss of interest in formerly favorite school or other activities -Feelings of hopelessness or depression -Statements about thoughts of suicide Nursing management: -These children usually benefit from psychotherapy -Child may be on mood stabilizers/antidepressants Take note: Closely observe children taking antidepressants for the development of pre-suicidal behavior Nurse management focuses on education and support and prevention of depression and suicide. -Teach families that mood disorders are biologic conditions, not personality flaws . -Teach families how to administer antidepressant medication and to monitor for adverse effects. -Encourage and praise the child's and family's efforts at following through with cognitive and behavioral therapies. -Support the family throughout the process, as sometimes treatment may be lengthy . -Refer the family to local support resources.
Scoliosis p.849 -is a lateal curvature of the spine that exceeds 10 degrees -Can be idiopathic,Neuromuscular or Congenital A. Idiopathic: unknown cause, but genetic factors, growth abnormalities and bone, muscle disc or CNS B. Nueromuscular: associated with neurologic or muscular disease such as cerable palsy C. Congenital: Results from Anomalous vertebral development therapeutic Management: -Tx is preventing progression of the curve and decreasing impact on pulmonary and cardiac function -Spine radiographs are used to monitor curve progression -curves 25-40: bracing may be sufficient to decrease progression of the curve. -Greater than 45: surgical correction Box 22.2 : Types of braces used to treat scoliosis a.Underarm: for low thoracic and thoracolumbar curves;less conspicuous, no visible neckpiece b. Milwaukee: for THORACIC or MAJOR DOUBLE CURVES; traditional , standard and has a visible neckpiece with chin rest C. Nighttime bending (Charleston): Creastes a curve so severe that walking is not possible, so can be worn only at night. Flip for Nursing Assessement/ Nursing managemet
Nursing Assessment: -Determine why -Child usually does not report back pain, mild discomfort -Observe the child at rest, sitting and standing for evidence of poor posture -Inspect the childs back in a standing position -note: asymmetries such as shoulder elevation, prominence of one scapula, uneven curve at waistline , or rib hump on one side -Measure shoulder levels from the floor to the acromioclavicular joints -note difference in high and low shoulder -With child binding forward arms hanging Test: Full-spine radiograhs Nursing management: 1.Encouraging compliance with bracing: bracing is intended to prevent progression but does not correct curve (many adolescents are non-compliant) - The brace must be worn 23 hours per day to prevent curve progression -Adolescent or child may be concerned with body image -Inspect Skin for evidence of rubbing by the brace that may impair skin integrity: tx families appropriate skin care and recommend they check the brace daily for fit and breakage -Encourage the teen to shower during 1 hour per day that the brace is off and to ensure that the skin is clean and dry before putting the brace back on. -Wear a cotton T shirt under neath -Excercises to strengthen back muscles and prevuing muscle atrophy from pooled bracing 2. Pomoting Positive Body image: -Encourage teen to express his or her feelings -Give the teen ways to explain scoliosis and its tx to his or her peers -Wear stylish baggy clothes may help the teen to conceal the brace if desired. 3. Providing PREoperative Care: -If curve progresses despite bracing causing pulmonary or cardicac compromise surgery is needed. -In preoperative: teach Turning, coughing and deep breathing -Explain the tubes and lines that will be present after surgery -Review positioning guidelines: BACK FLEXION OR EXTENSION WILL NOT BE ALLOWED -Introduce child to patient controlled analgesia pump and explain pain scales -High risk for blood loos (A lot): so arrange for a preoperative autologous blood donation 3. Providing POSTOPERATIVE CARE: -Goal is to avoid complications -Perfrom neurovascular checks with each set of vital signs -When turning child use the LOG ROLL technique to avoid flexion of the back -Provide pain management and medicate for pain before repositioning and ambulating -Administer prophylactic intravenous antibiotics -Assess for drainage from the operative site -Maintain foley patency -Strict InOs -Ambulation once ordered should be done slowly to avoid orthostatic hypotension -Assist the family with arrangements to continue the teens school work while hospitalized or arrange for home tutoring.
Polydactyly p. 828 Presence of extra digits on the hand or foot -Usually at the border therapeutic management: -surgical removal Flip for: Nuring assessment/Nursing management
Nursing Assessment: -Inspect hands and feet for the presence of extra digits -Assess wether soft or hard(with or without bone) Nursing management: -after surgery provide routine pre and postoperative care
Syndactyly p.828 (Chp22) -Webbing of the fingers and toes This can be inherited or associated with other genetic syndromes Therapeutic management: - surgical removal
Nursing Assessment: -Inspect hands and feet for the presence of extra digits -Assess wether soft or hard(with or without bone) Nursing management: -after surgery provide routine pre and postoperative care
Anorexia nervosa Chapter 28 -Characterized by dramatic weight loss as a result of decreased food intake and sharply increased physical exercise (bulimia-normal food cycle, followed by binge eating and then purging) Concept Mastery alert: -An adolescent with anorexia nervosa would most likely experience amenorrhea, hypothermia, low blood pressure and bradycardia. The nurse also NOTE soft hair on the individuals back and arms Flip for nursing Assessment:
Nursing Assessment: -anorexic is usually severely underweight, with a body mass index of less than 17 -Cachectic appearance, dry sallow skin, thinning scalp hair, soft sparse body hair and nail pitting Nurse management: Anorexia need to be hospitalized -Refeading syndrome may occur as a result -SLOW REFEEDING is essential to avoid complications -Give phosphorus as ordered -Assess vitals frequently for orthostatic hypotension -Aim for wight gain goal of 0.5 to albs per week. -Tx child and family to keep a daily journal of intake, binging (excessive consumption) and Purging (Forced vomiing -Tx a suitable structured routine for the child that includes meals , snack and physical activity -Educate child about consequences -Provide emotional support and positive reinforcement to the child and family
Atrial Septal Defect (ASD)p.670 (Increased pulmonary blood flow) A. Hole between atrium (that divides the right atrium from the left atrium) 3 types: 1. Ostium Primum (ASD1): the opening is at the lower portion of the septum 2. Ostrium secundum (ASD2): the opening is near the center -Small- spontaneous closure- if not closed by 3 yo surgery -Blood flows from left to right atrium- increased blood flow to the lungs Flip for nursing assessment:
Nursing Assessment: - most children with ASD is Asymptomatic but: this causes increased blood flow leading to HF, SOB, Easy fatigability or poor growth. S/Sx noted upon assessment: -poor feeding as infant -Decreased ability to keep up with peers or hx of dificulty growing -Obsereve for hyperdynamic precordium -Auscultate the heart noting a fixed split second heart sound and a systolic ejection murmur (listen in pulmonic valve area) -Right Ventricular Heave
Torticollis p.834 -a painless muscular condition presenting in infants or children with certain syndromes. -can results from utero positing or difficult birth. -Preferential turning of the head to one side while in the supine position after birth -Results from tightness of the sternocleidomastoid muscle , resulting in the infants head being tilted to one side. Management: -Passive stretching exercises Flip for Nursing Assessment/Management
Nursing Assessment: -Head tilt to one side and limited neck movement of the neck while performing passive range of motion -Palpate the neck noting a mass in the sternocleidomastoid muscle on the affected side Nursing Mangement: Tx the parents gentle neck-stretching exercises to be performed several times a day -While immobilizing the shoulder on the affected side, gently sustain a side to side stretch toward the unaffected side, holding the stretch for 10 to 30 seconds. -Repeat 10 to 15 times per session -Perform an ear to shoulder strech in a similiar fasion -To prevent the development of torticollis in the unaffected infant, prevent positional plagiocephaly. -Prevent flatness of one side of the head by varying the infants head position and do not always turn the infants head to one side supine
Kawasaki Disease: - is an acute systemic vasculitis occurring mostly in children -Occurs most frequent in Asian or Pacific descent -Infectious organism unidentified -Self limiting- CV effects 25%- CA aneurysm MI or death Treatment- reduce inflammation in CA - high dose aspirin, IVIG S/Sx: Fever Note high fever for 5 days that is unresponsive to antibiotics. Chills Headache Malaise Extreme irritability Vomiting Diarrhea Abdominal and joint pain Strawberry tongue -Erythema of hands and feet during acute stage then desquamation in the 2nd weekx
Nursing Assessment: Assessing any of the s/sx - Assess for significant Bilateral Conjunctivitis WITHOUT EXUDATE -Assess for dry, fissured lips -Assess for Pharyngeal and oral mucosa erythema 1. Monitor Cardiac status: Admin IV fluids, monitor I/Os, assess frequently for signs of developing heart failure -assess quality and strength of pulses -cardiac monitoring 2. Promoting comfort: -Acetaminopen for fever management apply cool cloths as tolerated -Keep environment quiet -Appy petrolatum jelly to lips -Ice chips and popsicles 3. Providing child and Family education Tx parents to monitor childs temp after discharge -Tx irritability may last for two months -Tx to avoid NSAIDS while aspirin is going on -For children with contd. arthritis: tea that ROM exercises with a morning bath may help decrease stiffness - teach patients to avoid measles and varicella vaccination for 11 months after hugh dose IVIG admin -tx about cpr
Autism spectrum disorder Chapter 28 spectrum ranges from mild to Severe -Behaviors develop in infancy -Dev delays or behaviors noted at 12- 36 months when regression may occur -Why? Genetic, brain abnormalities, alt chemistry -Impaired social interaction -Relationships -Intellectual disability -Goal - reach optimal function How to screen for Autism: 1.Checklist for Autism in Toddlers (CHAT) 2.Modified Checklist for Autism in Toddlers (M-CHAT) 3.Social Communication Questionnaire (SCQ) 4.Pervasive Developmental Disorders Screening Test-II (PDDST-II) Flip for Warning Signs of Autism: -Not babbling by 12 months -Not pointing or using gestures by 12 months -No single words by 16 months -No two-word utterances by 24 months -Losing language or social skills at any age (Smith, Segal, & Hutman, 2010) flip for Nursing Interventions for Famiies with Autism:
Nursing Interventions for Families of Children With Autism 1.Provide emotional support. 2.Provide professional guidance and education about the disorder. 3.Assess the fit between the child's developmental needs and the treatment plan. 4.Help parents overcome barriers to obtain appropriate education, developmental, and behavioral treatment programs. 5.Stress the importance of rigid, unchanging routines. 6.Assess the parents' need for respite care and make referrals. 7.Provide positive feedback to parents for their perseverance in working with their child.
Cervical spine injury in children p.852 - Spinalcord injury is damage to the spinal cord that results in loss of function. seein in more 16-30 years of aged to increased incidence of accidents - This is a MEDICAL EMERGENCY and immediate attention is needed Nursing Assessment: -Inability to move or feel extremities -Numbness -tingling -weakness Flip for Nursing Management
Nursing Management: -Any child who requires hospitalization due to trauma should be considered at risk for a spinal cord injury. -Immobilization of the spin is essential -focus is optimizing mobility, promoting bladder and bowel management, promoting adequate nutritional status, preventing complications associated with extreme immobility such as contractures and muscle atrophy, managing pain and providing support and education to the child and family -Interdiscipliany team is essential -Prevention of spinal cord injuries is an important nursing consideration -Educate the public on SAFETY!!!
Enuresis p. 776 -Is continued incontinence of urine past the age of toilet Primary Enuresis: Emuresis in the child who has never achieved voluntary bladder control Secondary Enuresis: Urinary inconinecne in the child who previously demonstrated bladder control over a period of at least 3-6 months Diurnal Enuresis: Daytime loss of urinary control Nocturnal Enuresis: Nighttime bed wetting Flip for nursing management:
Nursing Management: For child with DIURINAL enuresis: Encourage hm or her to increase the amount of fluid consumed during the day in order to increase the frequency of the urge to void. -Set a fixed schedule for child to void throughout day (These practices will usually be sufficient to retrain the childs voiding patterns Nocturnal enuresis: without a physiologic cause needs Educate the child and family about Nocturnal Enuresis: -Tx family that the child is not lazy nor does he or she wet the bed intentionally. -Encourage to read books dry all night etc -Limit bladder irritants such as chocolate and caffeine. -Tx parents to limit fluid intake after dinner and ensure that the child voids just before going to bed -Waking the child to void at 11pm may also be helpful -Use bed pass and make the bed with two sheets to decrease the work at night -When sleeping at home child should wear his or her usual underwear or pajamas Provide support and encouragement: -It is important to let child he is not alone. Decrease nighttime voiding -Using an Enuresis alarm system - most of these devices work by sounding an alarm when the first few drops of urine appear; the child then awakens and stops urine flow -Overtime the child becomes conditioned to either awaken when bladder is full or stop the urine flow when sleeping .
Myelomeningocele p.821 is a type of spina bifida cystica -Usually obvious and visible at birth: a SAC COVERES the deformity of meningocele. -These babies are at increased risk for: Meningitis , hypoxia and hemmorrhage. - In myelomenigocle, the spinal cord often ends at the point of the defect resulting in absent motor and sensory function beyond that point. Tx is SURGERY!!! Nursing Assessment: -Visible external sac protruding from the spinal area -Assess for movement of extremities and ANAL REFLEX, which will help determine the level of neurologic involvement s/x: -Flaccid paralysis, absence of DTRS, lack of response to touch and pain stimuli, skeletal abnormalities such as club feet constant dribbling of urine and a relaxed anal sphincter may be found - in OLDER INFANT check Functional status Flip for Nursing Management
Nursing Management: preventing trauma and preventing infection before surgical repair 1. Preventing Infection: -Goal is to prevent rupture of CSF from the SAC. -keeping sac from drying out is important as is preventing trauma or pressure on the same -USE STERILE_SALINE SOAKED GAUZE to keep sac moist . Immediately report any seepage of CLEAR FLUID from lesion: this indicates an opening in the sac and is a portal of entry for microorganisms - positon infant in PRONE Position or SUPPORTED on the SIDE to avoid pressure -Place infant in warmer: pay close attention as this may cause drying an cracking of skin -Keep lesion free of feces and Urine to help avoid infection -Positon so that the urine and feces flow away from the sac (e.g Prone position or a Place a FOLDED towel under the abdomen) - placing a piece of plastic wrap below the meningocele is another way of preventing feces from coming in contact with lesions AFTER surgery: Place in Prone or Side lying position to allow incision to heal 2.Promoting Urinary elimination: -Children with meningocele often have bladder incontinences -it is the most common cause of a Neurogenic Bladder: Refers to the failure of the bladder to either store urine or empty itself of urine : constant dribbling , urinary stasis , places the child at risk for UTI Goal: promote optimal urinary continence and prevent renal complications Interventions are CLEAN INTERMITTent Catherization -meds such as OXYBUTYNIN CHLORIDE (DITOPAN) to improve bladder capacity 3.Promoting Bowel Elimination: -Bowel training with use of timed enemas or suppositories along with DIET modifications can allow for defecation at predetermined times ONCE or TWICE a DAY Take note: USE LATEX FREE Caths for children with this condition because these children exhibit a high incidence of latex allergy. 4.Promoting Adequate nutrition: - at risk based on restrictions on positioning of the infant before and after -Assist family in assuming normal feeding position -Infants head can be turned to the side or the Infant can be placed in the SIDE LYING POSITION to facilitate feeding. -Encourage the parents to interact as much as possible 5. Preventing Latex Allergic Reaction -A latex free environment should be created for all procedures perfumed on children with myelomeningocele to prevent latex allergy . 6. Maintain skin integrity: -Prone position puts mad pressure on knees -Ensure that infant is kept as clean and dry as possible -Placing pad beneath the diaper area and changing it frequently is import -Special attention to the infants legs needs to occurs when positioning them, since paralysis may be present -Use a folded diaper between the legs can help reduce pressure and fiction from the legs rubbing together 7. Educating an dispiriting the child and family - teaching in regards to positioning , preventing infection , feeding m promoting urinary elimation through clean cath and preventing latex allergy and identifying complications of Increased ICP
Hemolytic uremic syndrome p. A. It is defined by 3 features- hemolytic anemia- thrombocytopenia- acute renal failure B. diarrhea turns bloody, C. Causes include idiopathic, inherited, drug related, malignancies, transplant, malignant hypertension Microthrombic and ischemic changes in organs- sm clots occlude glomerulus - renal failure (Focus is on typical HUS, the type preceded by a diarrheal illness, watery diarrhea progresses to hemorrhagic colitis then to the triad of HUS) E coli most common cause- via feces Theraputic management is towwards: MAintaing Fluid balance, correcting hypertension, acidosis and , electrolytes abnormalities , rbc Flip for nursing assessment/Management
Nursing assessment: -watery diarrhea -cramping -Assess for ingesting of ground beef (normally the cause ) -Visists to a water park or petting zoo -Oliguria (decreased urine output) -Anuria (absent urine ouput) -Elevated BP and tnderness in abdomen -Neuro involvement: irritability, altered LOC Seizures , posturing or coma Nurse management: -institute and maintain contact precautions to prevent spread of E.Coli Maintaining fluid balance -Maintain strick I n O -Monitor labs -Assess bp -Encourage adequate nutritional intakes -Monitor for bleeding as well as fatigue and pallor -Blood is given if severe thrombocytopnia Preventing: -Tx proper handwashig -Encourage use of swim diapers -Tx parents to thorughly cook all meats to a core temperature of 155 F or until the meat is gray or brown through out -Wash all fruits and vegetables thoroughly -Drink water and -Avoid unpasteurized dairy products and fruit juices
UTI p. 774 infection of urnary tract Most common cause is by E.Coli tx: oral or IV antibiotics 7 to 14 day course Nursing Assessment: Fever, n&V, just not eating right, urinary frequency or urgency , burning or stinging with urination, foul smelling during, blood, cloudiness, dark color sediments, mucous. - observe for Jaundice or increased respiratory rate Labs: Urinalysis, urine cultue Flip for nursing management:
Nursing management: -Children who can tolerate oral antibiotic -Child who is vomiting : IV antibiotics -Children younger than 3 months and those with dehydration, a toxic appearance or sepsis should be admitted admin of IV anti boys -urge parent to complete the entire course , even when child is feeling better Administer antipyretics such as Acetaminophen or ibuprofen to reduce fever -A heating pad or warm compress may help relive abdomen or flank pain -If child is afraid to urinate due to burning or stinging, encourage voiding in a warm sitz bath or tub bath. Preventing UTI Teaching" Drink enough fluid -Drink cranberry juice to acidify the urine -Avoid colas and caffeine , which irritate the bladder -Urinate frequently do not "Hold urine" -Avoid bubble baths -Wipe from Front to back after voiding -Wear cotton underwear -Avoid tight jeans or pants -Wash perineal area daily with soap and water -While menstruating, change pads frequently to discourage bacterial growth. -Void immediately after sexual inter course
Acute renal failure p. 781 -Condition in which the kidneys cannot concentrate urine, conserve electrolytes, or excrete waste products -May be acute or chronic -When acute renal failure continues to progress, it becomes chronic (also known as end-stage renal disease [ESRD]). -Dialysis and kidney transplantation are treatment modalities used for ESRD. Fluid overload may lead to hypertension, pulmonary edema, and congestive heart failure Take note : medications such as Cephalosporins may cause a transient increase in BUN and CREATININE -True NEphortic drugs are:Vancomycin and NSAIDS , Sulfonamides and AMinogylcosides Take note: Monitor the infant or child with renal failure carefully for signs or congestive heart failure such as edema accompanied by bounding pulse, presence of an S3 heart sound, adventitious lung sounds and shortness of breath.
Nursing management: Managing hypertension: give fast acting NIFEDIPINE (PRocardia ) - when used stay with the child and frequently monitor BP Restorng Fluid and Electrolyte Balance: -monitor vitals -Assess urine specific gravity -Monitor signs of hyperkalemia(Weak, irregular pulse, muscle weakness, abdominal cramping and hypocalcemia (muscle twitching or tetany ) -ADMIN POLYSTYRENE SULFONATE to decrease Potassium levels Educate the family on the need for fluid restricts Meds used to tx ESRD Vitamin D or calcium: correction of hypocalcemia Ferrous sulfate (Iron) tx of anemia Bicitra or Sodium Bicarbonate tablest : correction of Acidosis Multivitamin : augument nutritional status Erythropoeitin injections : stimulate red blood cell growth Growth hormone injections: stimulate growth in stature
Hypospadias p. 769 (BELOW ) -is a Urethral defect in which the opening is on the VENTRAL SURFACE of the penis rather than at the end of the penis. Tx: goal is to provide for an appropriately placed meatus that allows normal voiding and ejaculation because if not it can lead to infertility by surgery Nursing Assessemnt: -history of unusual urine stream. Assess for placement of the urethral meatus, -Inspect for Chordee, a fibrous band causing the penis to curve downward. -Palpate the presence or absence of testicles in sac, because cryptorchidism (Undescended testicles) often occurs with hypospadias Flip for nurisg management:
Nursing management: Newborn cannot get cirumscion until after surgical repair 1. Providing Postoperative Care: -Assess urinary drainage from urethral stent Ensure that the urinary drainage tube remains carefully taped with the penis in an upright position to prevent stress -Assess for pain -Administer analgesics or antispasmodics (Oral Oxybutynin or B&O suppository) as needed for bladder spasms. - Doubling Diaper to protect the urethra and stent or catheter after technique : 1. cut hole or cross-shaped slit in front 2. unfold diapers and place the smaller diaper (with hole inside larger one 3. Place child 4. Carefully bring the penis and catheter through the hole in the smaller diaper and close the diaper 5. Close the larger diaper 2. Educate the family tx the parents how to care for the catheter and drainage system. - have parents demonstrate there ability to to irrigate the catheter should a mucous plug occur -Tx that TUB baths are NOT ALLOWED until dressing is removed - Roughhousing, ride on toys or any activity involving straddling is not allowed for 2-3 weeks
ADHD: p. 1104 Chp 28 -MOST COMMON NEURODEVELOPMENT DISORDER of childhood Three Subtypes of ADHD -Hyperactive-impulsive -Inattentive -Combined -50% comorbidity Nursing Assessment: History - problems or behavioral issues in school, exposures, head trauma, family history Behaviors- box 28.3 pg 1105 (6 behaviors must be present) -failure to pay close attention -Careless mistakes on school work -Difficulty paying attention to tasks or play -Dosent listen -Dosent Follow through -Dosent complete tasks -Dosent understand instructions -Poorly organized -Avoids, dislikes or fails to engage in activities requiring mental effort -Loses things needed for task completion -Easily distracted -Forgetful -Fidgety or squirmy -Often out of seat -Activity inappropriate to the situation -Cannot engage incite play -allways on the go -Talks excessively -Blurts out Answers -Has difficulty waiting on his or her turn -Often interrupts or intrudes on others
Nursing mangement: -Provide support -Work with family to develop goals -Assit family to advocate for their childs needs through public school system tx: that their child is entitled to a developmentally appropriate education via and IEP as necessary -Schedule systematic communication -Use behavioral techniques such as time-out, positive reinforcement, reward or privilege withdrawal or a token system. -Explain that stimulant medications should be taken in th eMORNING to decrease effect of insomnia -Some children may experience decreased appetite so giving the medication with or after the meal may be beneficial -If child may feel different from peers when he or she has to visit the school nurse for a lunchtime dose of ADHD medication this may lead to non compliance ...Encourage the family to explore with physician or NP extended release or once daily ADHD.
Heart Failure: A.refers to a set of clinical signs and symptoms that reflect the hearts inability to pump effectively to provide adequate blood, oxygen and nutrients to the body organs an tissues. Flip for Pathophysiology: S/sx: Failure to gain weight or rapid weight gain Failure to thrive -Dizziness, irritability Exercise intolerance SOB Sucking and then tiring quickly SYncope Decreased number of wet diapers Nurse; Be alert for statements such as the baby drinks a small amount of breast milk (Or formula) and stops but then wants to eat again very soon afterwards
Pathophysiology: 1. s/s because heart cannot pump effectively 2. Preload, afterload and contractility affected- reduced CO-renin angiotensin aldosterone system activated (compensating)-fluid and Na retention, improved contractility and vasoconstriction-then increased afterload worsens systolic function-CO limited 3. Compensatory mechanisms wear out over time Nursing Interventions: A.Promoting Oxygenation: -Position the infant or child in a semi-upright position to decrease work of breathing and lessen pulmonary congestion Take note: in a child with a large left to right shunt, oxygen will decrease pulmonary vascular resistance while increasing the systemic vascular resistance, which leads to increased left-to right shunting. Monitor the child carefully and use oxygen as prescribed. B. Supporting Cardiac Function: Administer DIGITALIS and ACE inhibitors and Durectics as prescribed. During digitalization -Monitor the electrocardiogram for a PROLONGED PR Interval and Decreased ventricular rate. -Adminster every 12 hours -Monitor child for signs of digoxin toxicity -Measure BP before and After admin of ACE if BP falls more than 15 HOLD DOSE CALL DOC. -Weigh child to determine fluid loss -Carefully monitor potassium levels admin if prescribed Levels: 3.5-5 C. Adequate Nutrition: -Offer small frequent feedings if child can tolerate D. Promote rest: Minimize metabolic needs to decrease cardiac demand Ensure adeqqate time for sleep and attempt to limit disturbing interventions -Provided age appropriate activities that can be performed quietly or in the bed, such as books, coloring or drawing and video or board games.
Developmental disorder Chapter 28: p. 1100 A. Learning Disabilities: -The essential characteristic of learning disability is INNATE COGNITIVE DIFFICULTY resulting in LOWER ACADEMIC Achievement than would be expected for a childs intellectual potential (Dyslexia, Dyscalculia, Dyspraxia,Dysgraphia) B. Intellectual disability - refers to a Functional state in which specific limitation in INTELLECTUAL STATUS and ADAPTIVE BEHAVIOR (functioning in daily life) Criteria for Diagnosis of Intellectual Disability p. 1102 1.Deviations in IQ of two or more standard deviations (IQ of less than 70 to 75) 2.Coexisting deficits in at least two adaptive skills: communication, community use, functional academics, health and safety, home living, leisure, self-care, self-direction, social skills, and work 3.Disability occurring before the age of 18 years Goal: to achieve optimal level of functioning Nursing Assessment: -For know intelectuall disorder: Flip for Primary goals of Intellectual disability
Primary goal is to: -Provide appropriate educational experiences that allow the children to achieve a level of functioning and self-suffiecieny needed for existence in the home, community, work and leisure settings Take note: Due to the extent of cognition required to understand and produce speech, the most sensitive early indicator of intellectual disability is delayed language development. Categories of Intellectual Disability A.Mild: IQ 50 to 70 B.Moderate: IQ 35 to 50 C.Severe: IQ 20 to 35 D.Profound: IQ less than 20 (Council for Exceptional Children, 2011) Nursing management: -when children with intellectual disability are admitted to the hospital, it is important for the nurse to continue the childs usual home routine
Ventricular Septal Defect (VSD) p. 671 ( Increased pulmonary flow) - Hole between ventricles -30% of CHD's -Small VSD's asymptomatic -Left to right shunt- increased blood -into pulm circulation... Wich leads to pulmonary hypertension -Heart failure can occur -Risk for aortic valve regurgitation and infective endocarditis tx: Surgical repair
S/Sx from Nursing Assessment: Same as all others -hx of tiring easilywith exertion -color change -SOB and edema Labs: MRI or Echocardiogram
General Guidelines for behavior management: -
Set limits -Hold child responsible -Do not argue, bargin or negotiate about the limits -Provide consistent caregivers -Use low pitched voice and remain calm Redirect child's attention when needed Ignore inappropriate behaviors Praise efforts of self control Use restraints only when necessary
Cognitive delays Chapter 28: p. 1100 Take note: Observe a childs play or drawings if the manner or theme of play or nature of the drawings leads you to suspect cognitive or psychological issues , - Refer child for further mental health evaluation. Take note: Sensory processing disorder may be mistaken for a learning disability, but it is not and should be treated differently Flip
Take note: IF a child cannot speak in sentence by 30 months of age, does not have understandable speech 50% of the time by age 3 years, cannot sit still for a short story by 3-5 years of age, or cannot tie shoes, cut, button, or hop by 5 to 6 years of age, REFERE TO BE EVALUATED FOR A LEARNING DISABILITY. Box 28-1: Sensory Processing Disorder -A nurologic disorder in which the child cannot organize sensory input used in daily living -Hyposensitiviy or hypersensitivity to sensory input -Results in overreaction to different textures, decreasing the childs ability to participate in the world -Preterm and low-birthweight infants are at increased risk compared with typical infants
Clean intermittent catheterization p.824 1. Performing Clean Intermittent Catherization: Child with MYELOMENINGOCELE, Clean intermittent catheterrization may be started at that time note: Children with Myelomeningocele often have bladder incontinence. -In other children with Spinabifuda or Who suffer spinal cord injury: Can be done at a later age. Tx parents technique of clean intermittent cauterization Flip for Teaching Guidelines:
Teaching Guide lines -wash hands or waterless antibacterial cleanser -Have supplies within reach and place child on his back, on toilet or in wheel chair -Clean genitalia with a wash cloth or disposable wipe (on girls separate labia and wipe FRONT TO BACK, on boys clean TIP of the penis; if circumsicised pull back fore skin -Apply generous amount of water based lubricant to catheter -Perform catheterization: -Insert catheter only as fas as needed to obtain urine flow (2-3in for females/4-6 in for males) -holds catheter there until urine flow stops -move catheter slightly, press on lower abdomen, or have children lean forward to tense abdominals to ensure no more urine is in the bladder. -Wash Reusable catheter -When dry store in zip top plastic bag -STERILIZE DAILY ;soak the catheter in a 1:1 vinegar and water solution for about 30 mins, rinse well and place catheter in boiling water for 10 mins -Allow to dry well before storing -Replace catheter if it becomes cloudy, stuff, rough cracked or damaged -Teach child if they are developmentally ready.
Cast Care p. 815 Perform frequent neurovascular checks of the casted extremity to identify signs of compromise: Increased pain, Increased edema, Pale or blue color, skin coolness, numbness or tingling, prolonged capillary refill, decreases pulse strength -Notify physcian or NP of changes n neuromuscular status or oder or drainage from cast Fiber glass cast usually have a soft Fabric edge Plaster casts require special tx of the cast edge to PREVENT SKIN Rubbing: this is done by PETALING: cut round-edge strips of moleskin or another soft material with an adhesive backing and apply them to the edge of the cast If cast is lined with GORE TEX DO NOT PETAL IT! -position the child with the casted extremity elevated on pillows -Ice may be apples during first 24 hours to 48 hours -Teaching child how to use crutches. Flip for Teaching guidelines for Home cast Care: (22.1)
Teaching guidelines for Home cast Care: (22.1) -First 48, elevate above level of heart and apply COLD therapy for 20-30 mins then off 1-2 hours and repeat. -Take prescribed meds -Assess for swelling, and have the child wiggle the fingers or toes hourly -For itching inside the cast: 1. NEVER INSERT ANYTHING into the cast for the purposes of scratching 2. blow cool air in from a hair dyer/ tap highly on cast 3. Do not use lotions or powders 4. DO not pull padding out from the inside of the cast -Protect from wetness: 1. Apply plastic bag around cast and tape securely before bathing or showering 2. Cover it when child eats or drinks 3. If it becomes soiled wipe it clean with a slightly damp clean cloth 4. If the cast gets wet, dry it with a bow dyer on cold setting. Use vacuum cleaner with a hose attatchment to pull air through - IF child has large cast: change position every 2 hours during the day and while sleeping -Check skin for irrigation Call doc if : -extremity is cool to touch, pale, blue, very swollen -child cannot move fingers or toes -Severe pain occurs when the child attempts to move the fingers or toes -Persisiteant numbness or tingling occurs -Drainage or a foul smell comes from under the cast -Severe itching occurs inside of cast -The child runs fever greater than 101.5 Skin edges are red and swollen or exhibiting breakdown - child complains of rubbing or burning under cast -Cast gets wet and does not dry or is cracked, splinted or softened
Types of therapy: 1.Behavioral therapy: uses stimulus and response conditioning to manage or alter behavior 2.Play therapy: Designed to change emotional status. Encourages the child to act out feelings of sadness, feat, hostility or anger 3.Cognitive therapy: Teaches children to change reactions so that autonomic negative thoughts patterns 4. Family therapy: Exploration of the Childs emotional issue and its effect on family members 5. Group Therapy: may be considered in a school, hospital , treatment facility or neighborhood center. Feelings are expressed and participate gain hope, feel a part of something and benefit from role modeling. Take advantage of peer relationships as developmental focus in preterm and in teen groups Flip for practice question
The nurse caring for a child with autism coaches the child to change reactions by replacing automatic negative thought patterns with alternative ones. What treatment is the nurse employing? a. behavioral therapy b. play therapy c. milieu therapy d. cognitive therapy Answer: d. cognitive therapy. Cognitive therapy involves coaching the child to change reactions by replacing automatic negative thought patterns with alternative ones. Rationale: Behavioral therapy uses stimulus and response conditioning to manage or alter behavior. Play therapy encourages the child to act out feelings of sadness, fear, hostility, or anger. Milieu therapy is a specially structured setting designed to promote the child's adaptive and social skills.
Developmental dysplagia of the hipp (DDH) p. 831 -refers to developing hip that include disolocation, subluxation and displace of the hip joint. -the femoral head has an abnormal relationship to the acetabulum. 1.Frank dislocation: no contact between the femoral head and acetabulum. 2.Subluxation: is a partial dislocation, the acetabulum is not fully seated within the hip joint. 3.Dysplasia: refers to an acetabulum that is shallow or sloping Factors: More common in Females -Mechanical factors: breech positon or oligohydraminos -Genetic Factors -Increased for Native Americans and Eastern Europe descent Low rates for African Americans GoaL: is to maintain the hip joint in reduction so that the femoral head and tabular can develop properly. Flip for Therapeutic management/Nursing Assessment
Tx: Infants younger than 6 months: Pavlik harness: reduces and stabilizes the hip by preventing hip extension and adduction and maintaining hip in flexion -must be used on a full time basis -4 months to 2 years of age often require closed reduction Nursing Asessment: S/Sx: -Unequal Knee hight -Unequal folds of skin -Limited hip abduction: should occur to 75 degrees and adduction to 30 degrees -Trendelenburg gait: the childs trunk in shifted over the affected hip during ambulation -Perform Barlow and Ortolan tests, feeling for or noting a "Clunk" as the femoral head dislocates (Positive Barlow) or reduces (Positive Ortolani) note: force is not necessary when performing theBarlow and Ortolans Maneuvers Take not: A higher pitched "click" may occur with flexion or extension of the hip. When assessing don't be confused the benign , adventitial sound with a true"CLUNK" Nursing Management: -making earlier recognition of hip dysplasia with earlier harness use so Assessment is critical note: THE PHYSCIAN OR NURSE PRACTIONER MAKES ALL APPROPRIATE ADJUSTMENTS TO THE HARNESS WHEN APPLIED Nurse: Tx parenst the use of the harness and assessment of the babys skin -that it usually continues for 3 months -Breastfeeding can continue throughout the harness tx period Teaching for Care of Child in Pavlik (22.5) -Do not adjust straps without checking with physcian or NP first -Until your physician or NP instructs you to take the harness off for a period of time each day, it must be used continuously -Change your baby's diaper while he or she is in the harness -place your baby to sleep on his or her back -Check skin folds, especially behind the knees and diaper area, for redness , irritation or breakdown. Keep these areas clean and dry. -Once the baby is permitted to be out of the harness for a short period, yu may bathe your baby while the harness is off -Long knee socks and an undershirt are recommended to prevent rubbing of the skin against the brace -note the location of the markings on the straps for appropriate placement of the harness. -Wash the harness with mild detergent by hand and air dry. If using dryer , use only the air fluffing setting Call doc if : -Babys feet are swollen or bluish -The harness appears to small -Skin is raw or rash develops -Your baby is unable to actively kick his or her legs
Glomerulonephritis: Immune procees injure the glomeruli. Immune mechanisms cause inflammation, which results in altered glomerular structure and function. -often occurs following a infection -More in males Nursing Assessment s/s - mild edema- -cardiopulmanry congestion (increased work of breathing or cough), -lung sounds: Crackles -listen for, gallop, -Proteinuria -Hematuria -urine spilling yes -urine color is Tea colored,coa covered dirty green maybe -Elevated ESR, BUN, Creat, - LAbs specific to streptococcus are: elevated antistreptolysin (ASO) and DNAase B antigen titer Tx is aimed at maintaining fluid volume and managing hypertension Flip for nurse management
p. 780 Adminster antihypertensive LABETALOL or NIFEDIPINE -Monitor Bps frequently -Maintain sodium and Fluid restrictions -Weigh child on same scale/SAME EVERYTING -Assess neurologic evaluation : hypertension may cause encephalopathy and seizures -Tx family to monitor urine output and take bp measurements and retrict diet as prescribed -No strenuous activity until proteinuria and hematuria are resolved Take note: AVOID USE OF NSAIDS in children with questionabale renal function, this may further decrease the glomerular filtration rate.
