Nursing Care of Children ATI

Asthma: Reinforcing Teaching about a Beta2-Adrenergic Agonist

Administer three nebulizer treatments of a beta2-agonist 20 to 30 min apart or continuously. Ipratropium bromide can be added to the nebulizer to increase bronchodilation.

Nutritional Needs of Infants who have Heart Failure

Encourage the child to eat foods high in potassium, such as bran cereals, potatoes, tomatoes, bananas, melons, oranges, and orange juice.

Care of the Child in Traction: Balanced suspension traction

suspends the leg in a flexed position. The hip and hamstring muscles are relaxed.

Care of the Child in Traction: Skeletal traction

uses a continuous pulling force that is applied directly to the skeletal structure and/or specific bone. A pin or rod is inserted through or into the bone. Force is applied using weights attached by rope. Skeletal traction (90°/90° traction) allows the client to change positions without interfering with the pull of the traction and decreases complications associated with immobility and traction.

Care of the Child in Traction: Halo traction

uses a halo-type bar that encircles the head. Screws are inserted into the outer table of the skull. The halo is attached to either bed traction or rods that are secured to a vest worn by the client.

Immunizations: Food Allergy Contraindication

› Allergy to gelatin and neomycin › Allergy to baker's yeast › Hypersensitivity to eggs › Hypersensitivity to yeast

Influenza Immunizations: Contraindications

› Hypersensitivity to eggs › LAIV » Younger than 2 years old » Immunosuppression » Chronic disease

Influenza Immunizations:Adverse Effects

› TIV - mild local reaction, and fever › LAIV - headache, cough, and fever › Rare - risk for Guillain-Barré syndrome

Airflow Disorders: Inhaled Corticosteroid

■ Combination medications ☐ Fluticasone/salmeterol (Advair) ☐ Inhaled corticosteroid/long-acting beta2-agonist) ■ Nursing Considerations ☐ Observe oral mucosa for infection secondary to use of inhaled medication. ☐ Monitor weight, blood pressure, electrolytes, glucose, and growth with oral corticosteroid use

Rheumatoid Arthritis: Appropriate Action for a Child on Long-Term Prednisone Therapy

■ Corticosteroids: Prednisone ☐ Provide symptomatic relief of inflammation and pain. They are reserved for life-threatening complications, severe arthritis, and uveitis. ☐ Nursing Considerations - Administer as eye solution or orally. - Administer at the lowest effective dose for short-term therapy, and then discontinue by tapering the dose. ☐ Client Education - Advise the child and family that weight gain, especially in the face, is a common adverse effect. - Monitor height and weight. - Advise the family that an alteration in growth is a possible long-term complication of corticosteroids. - Advise the child to avoid exposure to potentially infectious agents. - Advise the child and family to practice healthy eating habits.

Asthma: Evaluating Teaching about Inhaler

■ Instruct the child how to use a peak flow meter. ☐ Use same time each day. ☐ Ensure the marker is zeroed. ☐ Stand up straight. ☐ Close lips tightly around the mouthpiece (ensure the tongue is not occluding). ☐ Blow out as hard and as quickly as possible. ☐ Read the number on the meter. ☐ Repeat two more times (wait at least 30 seconds between attempts). ☐ Record highest number. ■ Instruct the child and family how to recognize an asthma exacerbation. ■ Inform the child and family about when to use each of the prescribed medications (rescue vs. maintenance medications). ■ Instruct the child how to properly self-administer medications (nebulizers, inhalers, and spacer). ■ Educate the child and family regarding infection prevention techniques. ☐ Promote good nutrition. ☐ Reinforce importance of good hand hygiene

Physical Assessment Findings: Visual Screening

■ Older children should be tested using a Snellen chart or symbol chart. ◯ Check color vision using the Ishihara color test or the Hardy-Rand-Rittler test. The child should be able to correctly identify shapes, symbols, or numbers. ◯ Peripheral visual fields should be ■ Upward 50° ■ Downward 70° ■ Nasally 60° ■ Temporally 90° ◯ Extraocular movements may not be symmetric in newborns. ■ Corneal light reflex should be symmetric. ■ Cover/uncover test should demonstrate equal movement of the eyes. ■ Six cardinal fields of gaze should demonstrate no nystagmus.

Asthma: Reinforcing Medication Teaching

■ Stress the importance of keeping immunizations, including seasonal influenza and pneumonia vaccines, up to date. ■ Encourage regular exercise as part of asthma therapy. ☐ Promotes ventilation and perfusion ☐ Maintains cardiac health ☐ Enhances skeletal muscle strength ■ Children can require medication before exercise

Health Promotion of School-Age Children (6 to 12 Years): Piaget's Stages of Cognitive Development

● Cognitive Development ◯ Piaget - Concrete operations ■ Transitions from perceptual to conceptual thinking ■ Masters the concept of conservation ■ Learns to tell time ■ Classifies more complex information ■ Able to see the perspective of others ■ Able to solve problems

Health Promotion of Adolescents (12 to 20 Years): Communication Techniques

● Cognitive Development ◯ Piaget - formal operations ■ Able to think through more than two categories of variables concurrently ■ Capable of evaluating the quality of their own thinking ■ Able to maintain attention for longer periods of time ■ Highly imaginative and idealistic ■ Increasingly capable of using formal logic to make decisions ■ Think beyond current circumstances ■ Able to understand how the actions of an individual influence others

Psychosocial Issues of Infants, Children, and Adolescents: Recognizing Manifestations of ADHD

● Diagnostic criteria for diagnosis ◯ Symptoms typically are present between the ages of 4 and 18 years. ◯ Manifestations are present in more than one setting. ◯ Evidence of social or academic impairment. ◯ Six or more findings from a category (inattention or hyperactivity-impulsive).

Physical Assessment Findings: Screening for Visual Acuity

● Eyes ◯ Visual acuity - May be difficult to check in children younger than 3 years of age ■ Check visual acuity in infants by holding an object in front of the eyes and checking to see whether the infant is able to fix on the object and follow it. ■ Use the tumbling E or HOTV test to check visual acuity of children who are unable to read letters and numbers.

Gross to Fine Motor Skills

- 1 month: › Demonstrates head lag › Has a grasp reflex - 2 months: › Lifts head off mattress when prone › Holds hands in an open position - 3 months: › Raises head and shoulders off mattress when prone › Only slight head lag › No longer has a grasp reflex › Keeps hands loosely open - 4 months: › Rolls from back to side › Places objects in mouth - 5 months: › Rolls from front to back › Uses palmar grasp dominantly - 6 months: › Rolls from back to front › Holds bottle - 7 months: › Bears full weight on feet › Moves objects from hand to hand - 8 months: › Sits unsupported › Begins using pincer grasp - 9 months: › Pulls to a standing position › Creeps on hands and knees instead of crawling › Has a crude pincer grasp - 10 months: › Changes from a prone to a sitting position › Grasps rattle by its handle - 11 months: › Walks while holding onto something › Places objects into a container › Neat pincer grasp - 12 months: › Sits down from a standing position without assistance › Tries to build a two-block tower without success

Physical Assessment Findings: Vital Signs to Report to Provider: TEMP

- 3 months: 37.5˚ C (99.5˚ F) › Axillary › Rectal (if exact measurement necessary) - 6 months: 37.5˚ C (99.5˚ F) › Axillary › Rectal (if exact measurement necessary) - 1 year: 37.7˚ C (99.9˚ F) › Axillary › Rectal (if exact measurement necessary) - 3 years: 37.2˚ C (99.0˚ F) › Axillary › Tympanic › Oral (if child cooperative) › Rectal (if exact measurement necessary) - 5 years: 37.0˚ C (98.6˚ F) › Axillary › Tympanic › Oral (if child cooperative) › Rectal (if exact measurement necessary) - 7 years: 36.8˚ C (98.2˚ F) › Oral › Axillary › Tympanic › Oral - 9 years: 36.7˚ C (98.1˚ F) › Oral › Axillary › Tympanic › Oral - 11 years: 36.7˚ C (98.1˚ F) › Oral › Axillary › Tympanic › Oral -13 years: 36.6˚ C (97.9˚ F) › Oral › Axillary › Tympanic › Oral

Health Promotion of Infants (1 Month to 1 Year): Growth and Development of a 6-Month-Old Infant

- 6 months › Rolls from back to front › Holds bottle ◯ Weight, height, and head circumference measurements are used to track the size of infants. ■ Weight - Infants gain approximately 150 to 210 g (about 5 to 7 oz.) per week the first 6 months of life. Birth weight is at least doubled by the age of 6 months, and tripled by the age of 12 months. ■ Height - Infants grow approximately 2.5 cm (1 in) per month the first 6 months of life. Growth occurs in spurts after the age of 6 months, and the birth length increases by 50% by the age of 12 months. ■ Head circumference - The circumference of infants' heads increases approximately 1.5 cm (0.6 in) per month for the first 6 months of life, and then approximately 0.5 cm (0.2 in) between 6 and 12 months of age. ◯ Dentition - Six to eight teeth should erupt in infants' mouths by the end of the first year of age. The first teeth typically erupt between the ages of 6 and 10 months. ■ Teething pain can be eased using cold teething rings and over-the-counter teething gels. Acetaminophen (Tylenol) or ibuprofen (Advil) is appropriate if irritability interferes with sleeping and feeding, but should not be used for more than 3 days. Ibuprofen should be used only in infants older than 6 months.

Cystic Fibrosis: Evaluating Effectiveness of Mucolytics

- Children who have cystic fibrosis have mucus plugs. Administering dornase alfa, which decreases the viscosity of the mucus, should be part of the plan of care.

Health Promotion of Infants (1 Month to 1 Year): Expected Growth and Development

- Expected growth and development ● Physical Development ◯ The infant's posterior fontanel closes by 6 to 8 weeks of age. ◯ The infant's anterior fontanel closes by 12 to 18 months of age. ◯ Weight, height, and head circumference measurements are used to track the size of infants. ■ Weight - Infants gain approximately 150 to 210 g (about 5 to 7 oz.) per week the first 6 months of life. Birth weight is at least doubled by the age of 6 months, and tripled by the age of 12 months. ■ Height - Infants grow approximately 2.5 cm (1 in) per month the first 6 months of life. Growth occurs in spurts after the age of 6 months, and the birth length increases by 50% by the age of 12 months. ■ Head circumference - The circumference of infants' heads increases approximately 1.5 cm (0.6 in) per month for the first 6 months of life, and then approximately 0.5 cm (0.2 in) between 6 and 12 months of age. ◯ Dentition - Six to eight teeth should erupt in infants' mouths by the end of the first year of age. The first teeth typically erupt between the ages of 6 and 10 months. ■ Teething pain can be eased using cold teething rings and over-the-counter teething gels. Acetaminophen (Tylenol) or ibuprofen (Advil) is appropriate if irritability interferes with sleeping and feeding, but should not be used for more than 3 days. Ibuprofen should be used only in infants older than 6 months. ■ Clean infants' teeth using cool, wet washcloths. ■ Bottles should not be given to infants when they are falling asleep because prolonged exposure to milk or juice can cause early childhood caries.

Hematologic Disorders: Iron Deficiency Anemia

- Overview ● Iron deficiency anemia is the most common anemia in the U.S. ● Children ages 12 to 36 months are at risk due to consuming a diet high in cow's milk without adequate intake of foods high in iron. ● Adolescents are at risk due to poor diets, menses, obesity, and rapid growth rates. ● The production of Hgb requires iron. Iron deficiency will result in decreased Hgb levels. ● Iron deficiency anemia usually results from an inadequate dietary supply of iron, and is the most preventable mineral disturbance. - Data Collection ● Risk Factors ◯ Premature birth resulting in decreased iron stores ◯ Excessive intake of cows' milk in toddlers ■ Milk is not a good source of iron. ■ Milk is consumed in place of iron-rich solid foods. ◯ Malabsorption disorders due to prolonged diarrhea ◯ Poor dietary intake of iron ◯ Increased iron requirements (blood loss) ◯ Chronic disorders (folate deficiency, sickle cell anemia, hemophilia)

Hospitalization, Illness, and Play: Preparing a Preschool-Age Child for Venipuncture

- Preschooler: › Explain procedures using simple, clear language. Avoid medical jargon and terms that can be misinterpreted. › Encourage independence by letting the child provide self-care. › Encourage the child to express feelings. › Validate the child's fears and concerns. › Provide toys that allow for emotional expression, such as a pounding board to release feelings of protest. › Provide consistency in assigning caregivers. › Give choices when possible, such as, "Do you want your medicine in a cup or a spoon?" › Allow younger children to handle equipment if it is safe.

Hospitalization, Illness, and Play: Preparing a Preschooler for a Procedure

- Preschooler: › Explain procedures using simple, clear language. Avoid medical jargon and terms that can be misinterpreted. › Encourage independence by letting the child provide self-care. › Encourage the child to express feelings. › Validate the child's fears and concerns. › Provide toys that allow for emotional expression, such as a pounding board to release feelings of protest. › Provide consistency in assigning caregivers. › Give choices when possible, such as, "Do you want your medicine in a cup or a spoon?" › Allow younger children to handle equipment if it is safe.

Health Promotion of Infants (1 Month to 1 Year): Introducing Solid Foods

- ◯ Solids are introduced around 4 to 6 months of age. ■ Indicators for readiness include interest in solid foods, voluntary control of the head and trunk, and disappearance of the extrusion reflex. ■ Iron-fortified cereal is typically introduced first due to its high iron content. ■ New foods should be introduced one at a time, over a 4- to 7-day period, to observe for signs of allergy or intolerance, which can include fussiness, rash, vomiting, diarrhea, and constipation. ■ Vegetables or fruits are started first between 6 and 8 months of age. After both have been introduced, meats can be added. ■ Citrus fruits, meat, and eggs are not started until after 6 months of age. ■ Breast milk/formula should be decreased as intake of solid foods increases, but should remain the primary source of nutrition through the first year. ■ Table foods that are cooked, chopped, and unseasoned are appropriate by 9 months of age. ■ Appropriate finger foods include ripe bananas; toast strips; graham crackers; cheese cubes; noodles; and peeled chunks of apples, pears, or peaches. ◯ Weaning can be accomplished when infants show signs of readiness, and are able to drink from a cup (sometime in the second 6 months). ■ One meal can be replaced with breast milk or formula in a cup with handles. ■ Bedtime feedings are the last to be stopped.

Immunizations: Contraindications to the Trivalent Inactivated Influenza Immunization

-Influenza vaccine; TIV: influenza (inactivated) vaccine; LAIV: influenza (live) vaccine (nasal)

Physical Assessment Findings: Romberg Test

Able to stand with slight swaying while eyes are closed

Psychological Issues of Infants, Children, and Adolescents: Highest Risk of Suicide Completion

Identify actual or potential risk to self (including a suicide plan, the lethality of that plan, and the means to carry out the plan).

Sensory Perceptions: Hearing Aids

Initiate referral for technical aids that can assist with coordination, speaking, mobility, and an increased level of independence. This may be achieved with the use of a voice-activated wheelchair.

Care of the Child in Traction: Skin traction

Skin traction uses a pulling force that is applied by weights (may be used intermittently). Using tape and straps applied to the skin along with boots and/or cuffs, weights are attached by a rope to the extremity (Buck, Russell, Bryant traction).

Care of the Child in Traction: Traction care

Traction, countertraction, and frictional force are used to align, immobilize, and reduce muscle spasms associated with certain fractures. Through the use of a forward-pulling force and a backward force, adding or removing weight controls the degree of force applied to maintain traction and alignment. The type of traction used depends on the fracture, age of the client, and associated injuries.

Reinforcing Teaching about Low-Cholesterol Diet

● High density lipoprotein (HDL) cholesterol - "good" cholesterol, having low level of cholesterol and triglycerides and high level of protein. ◯ Nursing Care/Client Education ■ Assist in screening clients at risk. ■ Instruct the client to keep a diet history for review by the dietitian. ■ Monitor the client for febrile illness 3 weeks prior to screening (illness will alter results). ■ Instruct about a diet to lower cholesterol: low fat, whole grains, fruit and vegetables. ■ Encourage use of olive oil and canola oil. ■ Assist with an exercise program (60 min per day for 5 days per week of aerobic exercise).

Planning Care for an Infant who has Heart Failure

● Nursing Care ◯ General Interventions ■ Remain calm when providing care. ■ Keep the child well-hydrated. ■ Conserve the child's energy by providing frequent rest periods; clustering care; providing small, frequent meals; bathing PRN; and keeping crying to a minimum in cyanotic children. ■ Perform daily weight and I&O to monitor fluid status and nutritional status. ■ Monitor heart rate, blood pressure, serum electrolytes, and renal function for complications. ■ Provide support and resources for parents to promote developmental growth in the child. ■ Monitor family coping and provide support. ■ Administer prescribed medications. ■ Maintain fluid and electrolyte balance. ☐ Administer potassium supplements if prescribed. These might not be indicated if the child is concurrently taking an ACE inhibitor. ☐ Maintain sodium and fluid restrictions if prescribed.

Reinforcing Teaching about Nutrition

● Nutrition ◯ Feeding alternatives ■ Breastfeeding provides a complete diet for infants during the first 6 months. ■ Iron-fortified formula is an acceptable alternative to breast milk. Cow's milk is not recommended. ■ It is recommended to begin vitamin D supplements within the first few days of life. ■ Iron supplements are recommended for infants who are being exclusively breastfed after the age of 4 months. ■ Alternative sources of fluids, such as juice or water, are not needed during the first 4 months of life. ■ After the age of 6 months, 100% fruit juice should be limited to 4 to 6 oz. per day. ◯ Solids are introduced around 4 to 6 months of age. ■ Indicators for readiness include interest in solid foods, voluntary control of the head and trunk, and disappearance of the extrusion reflex. ■ Iron-fortified cereal is typically introduced first due to its high iron content. ■ New foods should be introduced one at a time, over a 4- to 7-day period, to observe for signs of allergy or intolerance, which can include fussiness, rash, vomiting, diarrhea, and constipation. ■ Vegetables or fruits are started first between 6 and 8 months of age. After both have been introduced, meats can be added. ■ Citrus fruits, meat, and eggs are not started until after 6 months of age. ■ Breast milk/formula should be decreased as intake of solid foods increases, but should remain the primary source of nutrition through the first year. ■ Table foods that are cooked, chopped, and unseasoned are appropriate by 9 months of age. ■ Appropriate finger foods include ripe bananas; toast strips; graham crackers; cheese cubes; noodles; and peeled chunks of apples, pears, or peaches. ◯ Weaning can be accomplished when infants show signs of readiness, and are able to drink from a cup (sometime in the second 6 months). ■ One meal can be replaced with breast milk or formula in a cup with handles. ■ Bedtime feedings are the last to be stopped.

Musculoskeletal Congenital Disorders: Findings associated with Scoliosis

● Subjective and Objective Data ◯ Asymmetry in scapula, ribs, flanks, shoulders, and hips ◯ Improperly fitting clothing (one leg shorter than the other)

Physical Assessment Findings: Vital Signs to Report to Provider: Blood pressure

◯ Age, height, and gender all influence blood pressure readings. Readings should be compared with standard measurements (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents). ◯ Infants - 65 to 80 mm Hg systolic and 40 to 50 mm Hg diastolic

Nonopioid Analgesics: Ibuprofen Precautions

◯ Antipyretics - acetaminophen (Tylenol) or ibuprofen (Advil) ■ Antipyretics decrease fever and manage pain. ■ Nursing Considerations - Be aware of allergies. ■ Client Education - Advise parents of the appropriate dosing for acetaminophen and ibuprofen. ◯ Antibiotics - IM penicillin G, erythromycin, azithromycin, cephalosporins, amoxicillin ■ Nursing Considerations - Be aware of allergies. ■ Client Education - Tell parents to administer antibiotics for the full course of treatment.

Acute Otitis Media: Appropriate Instillation of Ear Drops

◯ Benzocaine (Americaine Otic) ■ Ear drops for topical pain relief ■ Client Education ☐ Reinforce teaching to the family on appropriately administering ear drops. ☐ Discourage the use of decongestants or antihistamines.

Reinforcing Teaching about Inflammatory Bowel Disease

◯ Chronic diarrhea is an increase in frequency and change of consistency of stool(s) for more than 14 days. ■ It is caused by chronic conditions such as malabsorption syndrome, food allergies, or inflammatory bowel disease.

Structural Disorders of the Genitourinary Tract and Reproductive System: Collecting Data for Location of Hernia

◯ Inguinal hernia - painless inguinal swelling varying in size ● Inguinal hernia: Protrusion of abdominal organs through the inguinal canal into the scrotum.

Dosage Calculation: Medication for Heart Failure

◯ Metoprolol or carvedilol (Coreg) - beta-blockers, which decrease heart rate and blood pressure, and promote vasodilation ■ Nursing Considerations ☐ Monitor blood pressure and pulse prior to administration. ☐ Monitor for adverse effects such as dizziness, hypotension, and headache

Physical Assessment Findings: Vital Signs to Report to Provider: Pulse rate

◯ Newborn - 80 to 180/min (depending on activity) ◯ 1 week to 3 months - 80 to 220/min (depending on activity) ◯ 3 months to 2 years - 70 to 150/min (depending on activity) ◯ 2 to 10 years - 60 to 110/min (depending on activity) ◯ 10 years and older - 50 to 90/min (depending on activity)

Physical Assessment Findings: Vital Signs to Report to Provider: Respirations

◯ Newborn to 1 year - 30 to 35/min ◯ 1 to 2 years - 25 to 30/min ◯ 2 to 6 years - 21 to 25/min ◯ 6 to 12 years - 19 to 21/min ◯ 12 years and older - 16 to 19/min

Diet Recommendations for a Child who has Celiac Disease

◯ Provide 24 kcal/oz. formula as prescribed. ◯ Provide high-calorie milk supplements for children. ◯ Administer multivitamin supplements including zinc and iron. ◯ Reinforce teaching to parents regarding how to mix formula properly and provide step-by-step written instructions. ◯ Limit juice to 4 oz./day.

Hematologic Disorders: Iron Deficiency Anemia: Nursing Care

◯ Provide iron supplements for preterm and low-birthweight infants by the age of 2 months. ◯ Provide iron supplements to infants who are exclusively breastfed by the age of 4 months. ◯ Recommend iron-fortified formula for infants who are not being breastfed. ◯ Modify the infant's diet to include high iron, vitamin C, and protein content. ◯ Monitor milk intake in toddlers. ■ Limit milk intake to 32 oz. (950 mL) per day. ■ Delay giving milk until after a meal. ■ Do not allow toddlers to carry bottles or cups of milk. ◯ Allow frequent rest periods. ◯ Monitor transfusion of packed RBCs, if required. ● Medications ◯ Iron Supplements

Evaluating Understanding of Diabetes Mellitus Dietary Management

◯ Provide nutritional guidelines. ■ Read labels for nutritional value. ■ Meal planning is based on the requirements of growth and development of the child. ■ Plan meals to achieve appropriate timing of food intake, activity, onset, and peak of insulin. Calories and food composition should be similar each day. ■ Eat at regular intervals and do not skip meals. ■ Count grams of carbohydrates consumed. ■ Recognize that 15 g of carbohydrates are equal to 1 carbohydrate exchange. ■ Avoid high-fat and high-sugar/high-carbohydrate food items. ■ Use artificial sweeteners in moderation ■ Children active with team sports will require a snack 30 min prior to activity. ■ Encourage sugar-free, non-caffeinated liquids to prevent dehydration. ■ Meet carbohydrate needs by eating soft foods if possible. If not, consume liquids that are equal to the usual carbohydrate content.

Diabetes Mellitus: Reinforcing Teaching about Type 1 Diabetes Mellitus

◯ Reinforce teaching on proper foot care. ■ Inspect feet daily. Wash feet daily with mild soap and warm water. ■ Pat feet dry gently, especially between the toes. ■ Use mild foot powder (powder with cornstarch) on sweaty feet. ■ Do not use commercial remedies for the removal of calluses or corns. ■ Perform nail care after a bath/shower if possible. ■ Separate overlapping toes with cotton or lambs' wool. ■ Avoid open-toe, open-heel shoes. Leather shoes are preferred to plastic ones. Wear slippers with soles. Do not go barefoot. Shake out shoes before putting them on. ■ Wear clean, absorbent socks or stockings that are made of cotton or wool and have not been mended. ■ Do not use hot water bottles or heating pads to warm feet. Wear socks for warmth. ■ Avoid prolonged sitting, standing, and crossing of legs. ◯ Reinforce teaching to the caregiver and the child to cleanse cuts with warm water and mild soap, gently dry, and apply a dry dressing. Reinforce teaching to the child and parents to monitor healing and to seek intervention promptly. ◯ Reinforce teaching related to appropriate techniques for SMBG, including obtaining blood samples, recording and responding to results, and correctly handling supplies and equipment ◯ Reinforce teaching to caregiver and the child regarding guidelines to follow when sick. ◯ Reinforce teaching related to signs and symptoms of hypoglycemia (e.g., shakiness, diaphoresis, anxiety, nervousness, chills, headache, confusion, labile, difficulty focusing, hunger, dizziness, pallor, palpations). ◯ Reinforce teaching related to signs and symptoms of hyperglycemia (lethargy, confusion, thirst, nausea, vomiting, abdominal pain, signs of dehydration, rapid respirations, fruity breath).

Hematologic Disorders: Iron Deficiency Anemia: subjective and Objective Data

◯ Shortness of breath ◯ Pallor ◯ Brittle, spoon-shaped fingernails ◯ Fatigue, irritability, and muscle weakness ◯ Systolic heart murmur, enlarged heart, or heart failure ◯ Laboratory Tests ■ CBC - decreased RBC count, Hgb, and Hct ■ RBC indices - decreased, indicating microcytic/hypochromic RBCs ☐ Mean corpuscular volume (MVC) - average size of RBC ☐ Mean corpuscular Hgb (MCH) - average weight of RBC ☐ Mean corpuscular hemoglobin concentration (MCHC) - amount of Hgb relative to size of cell ■ Reticulocyte count - can be decreased (indicates bone marrow production of RBCs) ■ Decreased serum ferritin level (indicator of iron stores)

Health Promotion of Adolescents (12 to 20 Years): Socialization to Meet Developmental Needs

◯ Social Development ■ Peer relationships develop. These relationships act as a support system for adolescents. ■ Best-friend relationships are more stable and longer-lasting than they were in previous years. ■ Parent-child relationships change to allow a greater sense of independence.

Findings for adolescent who has Anorexia Nervosa

◯ Subjective Data ■ History and physical assessment findings may reveal vague reports (anorexia, headache, fatigue).

Pain Management: Guided Imagery following Surgery

☐ Assist the child in an imaginary experience. ☐ Have the child describe the details.

Hematologic Disorders: Iron Deficiency Anemia: Nursing Considerations

☐ Give 1 hr before or 2 hr after milk or antacid to prevent decreased absorption. ☐ Gastrointestinal upset (diarrhea, constipation, nausea) is common at the start of therapy. This will decrease over time. ☐ If tolerated, administer iron supplements on an empty stomach. Give with meals, start with reduced dose, and gradually increase if GI distress occurs. ☐ Give with vitamin C to increase absorption. ☐ Use a straw with liquid preparation to prevent staining of teeth. ☐ Use a Z-track into deep muscle for parenteral injections. Do not massage after injection.

Dehydration: Monitor parenteral fluid therapy as prescribed

☐ Implemented when a child is unable to drink enough oral fluids to correct fluid losses, and those who have severe dehydration or continued vomiting. ☐ Isotonic solution at 20 mL/kg IV bolus with possible repeat for isotonic and hypotonic dehydration. ☐ Hypertonic dehydration - Rapid fluid replacement is contraindicated because of the risk of cerebral edema. ☐ Administer maintenance IV fluids as prescribed. ☐ Avoid potassium replacement until kidney function is verified.

Iron Deficiency Anemia: Dietary sources of iron

☐ Infants - iron-fortified cereals and formula ☐ Older children - dried beans and lentils; peanut butter; green, leafy vegetables; iron-fortified breads and flour; poultry; and red meat

Planning Care for an Infant who has Heart Failure: Decrease workload of the heart

☐ Maintain bed rest. ☐ Position the infant in a car seat or hold at a 45° angle. Keep safety restraints low and loose on the abdomen. ☐ Allow the child to sleep with several pillows and encourage a semi-Fowler's or Fowler's position while awake.

Care of the Child in Traction: Nursing Actions

☐ Maintain body alignment. ☐ Provide pharmacological and nonpharmacological interventions for the management of pain and muscle spasms. ☐ Notify the provider if the client experiences severe pain from muscle spasms that is unrelieved with medications and/or repositioning. ☐ Monitor neurovascular status. ☐ Routinely monitor the client's skin integrity and document findings. ☐ Inspect pin sites for pain, redness, swelling, drainage, or odor. Provide pin care per facility protocol. ☐ Check for changes in elimination, and maintain usual patterns of elimination. ☐ Ensure that all the hardware is tight and that the bed is in the correct position. ☐ Maintain weights so that they hang freely and the ropes are free of knots. Do not lift or remove weights unless prescribed and supervised by the provider. ☐ Ensure that the wrench to release the rods is attached to the vest when using halo traction in the event that CPR is necessary. ☐ Move the client in halo traction as a unit without applying pressure to the rods. This will prevent loosening of the pins and pain. ☐ Consult with the provider for an overbed trapeze to assist the client to move in bed. ☐ Provide range of motion and encourage activity of nonimmobilized extremities to maintain mobility and prevent contractures. ☐ Encourage deep breathing and use of incentive spirometry. ☐ Promote frequent position changing within restrictions of traction. ☐ Remove sheets from the head of the bed to the foot of the bed, and remake the bed in the same manner.

Dehydration: Oral rehydration is attempted first for mild and moderate cases of dehydration.

☐ Mild: 50 mL/kg rehydration fluid every 4 to 6 hr ☐ Moderate: 100 mL/kg rehydration fluid every 4 to 6 hr ☐ Replacement of diarrhea losses with 10 mL/kg each stool

Asthma: Evaluating Understanding of Inhaled Medications

☐ Observe oral mucosa for infection secondary to use of inhaled medication. ☐ Monitor weight, blood pressure, electrolytes, glucose, and growth with oral corticosteroid use

Planning Care for an Infant who has Heart Failure: Provide for adequate nutrition.

☐ Plan to feed the infant using a feeding schedule of every 3 hr. The infant should be rested, which occurs soon after awakening. ☐ Use a soft preemie nipple or a regular nipple with a slit to provide an enlarged opening. ☐ Hold the infant in a semi-upright position. ☐ Allow the infant to rest during feedings, taking approximately 30 min to complete the feeding ☐ Gavage feed the infant if he is unable to consume enough formula or breast milk. ☐ Increase caloric density of formula gradually from 20 to 30 kcal/oz. ☐ Encourage mothers who are breastfeeding to alternate feedings with high-density formula or fortified breast milk.

Planning Care for an Infant who has Heart Failure: Increase tissue oxygenation.

☐ Provide cool, humidified oxygen via an oxygen hood (or tent), mask, or nasal cannula. ☐ Suction the airway as indicated. ☐ Monitor oxygen saturation every 2 to 4 hr.

Hematologic Disorders: Iron Deficiency Anemia: Client education

☐ Reinforce education to the child and family to expect stools to turn a tarry green color if dose is adequate. ☐ Instruct child to brush teeth after oral dose to minimize or prevent staining. ● Care After Discharge ◯ Client Education ■ Advise the family that diarrhea, constipation, or nausea can occur at the start of therapy, but these adverse effects are usually self-limiting. ■ Provide information regarding appropriate iron administration. ■ Increase fiber and fluids if constipation develops. ■ Dietary sources of iron ☐ Infants - iron-fortified cereals and formula ☐ Older children - dried beans and lentils; peanut butter; green, leafy vegetables; iron-fortified breads and flour; poultry; and red meat ■ To prevent overdose, store no more than 1 month's supply in a child-proof bottle, and out of reach of children. ■ Encourage parents to allow the child to rest. ■ Inform parents that the length of treatment will be determined by the child's response to the treatment. If Hgb levels are not increased after 1 month of therapy, further evaluation is warranted. ■ Instruct parents to return for follow-up laboratory tests to determine the effectiveness of treatment. Complications ● Heart failure ◯ Heart failure can develop due to the increased demand on the heart to deliver oxygen to tissues. ◯ Nursing Actions ■ Treat anemia. ■ Monitor cardiac rhythm. ■ Give cardiac medications as prescribed. ◯ Client Education ■ Reinforce education to the child and family on the manifestations of heart failure. ■ Reinforce how to monitor pulse rates. ● Developmental delay ◯ Nursing Actions ■ Check level of functioning. ■ Improve nutritional intake. ■ Assist with referral to appropriate developmental services. ◯ Client Education ■ Provide support to the family

Client Education: Priority Strategy for Teaching Self-Administration of Insulin

☐ Reinforce information regarding self-administration of insulin. - Rotate injection sites (to prevent lipohypertrophy) within one anatomic site (to prevent day-to-day changes in absorption rates). - Inject at a 90° angle (45° angle if thin). Aspiration for blood is not necessary. - When mixing a rapid- or short-acting insulin with a longer-acting insulin, draw up the shorter-acting insulin into the syringe first and then the longer-acting insulin. (This reduces the risk of introducing the longer-acting insulin into the vial of the shorter-acting insulin.)