Pediatrics- Final Exam Review

Atonic Seizures

"drop attack" suddent memory loss Happens in pts 2-5 years of age Tx w/ medications Will have face plant

Gi Dysfunctions

#1 S&S is FTT (inability to grow r/t malabsorption or NOT taking in food, 2 standard deviations BELOW normal growth curve), spitting up, regurgitation, N/V/D, constipation, abdominal pain/distention, and GI bleed

ARF/AKI Treatment

- Ensure diet HIGH in carbs & fat, LOW in protein/K/Na+ -LIMIT fluid intake to 1/3 of the maintenance (calculate pt's maintenance intake & divided that by 3!) -Get a CBC, Kidney Function, and serology -Restrict fluids and give diuretics! -**DO NOT Give NSAIDs if have renal insufficiency!**

Normal Red Blood Cells count

4.5-5.5 million/mm3

Normal Blood Glucose Levels for a newborn?

45-60 mg/dL

Toddler (12-36 months)- Growth

5 lbs per year and 3 inches per year! Anterior Fontanel closes at 12-18 months of age (the soft spot) Achieves 50% of adult height by 2 years of age!

What constitutes cure of cancer?

5 years since diagnosis and NO diagnoses signs So need to be 5 years cancer free since dz and NO signs of dz

Normal Blood Glucose Levels for child??

80-120 mg/dL

Trachea Suctioning

<5 seconds in infant <10 seconds for child or adult -Rest for 30-60 seconds after EACH suction to get O2 back up. -Only suction 3 runs in one period -suction tube SHOULD be 1/2 in diameter

For every degree GREATER than 99 F......

ADD 7 mL/kg/24 hours OR 7 mL/kg/day

Decerebrate posturing

AKA EXTENSION POSTURING -CELEBRATE the DECEREBRATE- looks like a dancer move! -arms EXTEND at side and WRISTS FLEXED IN -rigid extension and pronation of the arms and legs, flexed wrists and fingers, clenched jaw, extended neck, and possibly an arched back. -Unilateral extension posturing is caused by tentorial herniation -a sign of dysfunction AT the level of the midbrain or lesions to the brainstem

Anticonvulsant Drugs

AKA antiepileptics MOA= block the initiation of electrical discharge or prevent spread of abnormal electrical discharge to adjacent brain areas. Need to take meds the SAME TIME AS DONE AT HOME, do NOT discontinue (can worsen SEs) Initial drug therapy is based off of type of seizure DO NOT TAKE for Febrile Seizures

Abdominal Wall Defects

AKA= Omphalacele Abdominal contents herniate OUT THROUGH THE UMBILICUS (belly button!) INTACT PERITONEAL SAC!

Increased Pulmonary Blood Flow Defects

ASD, VSD, PDA left to right shunting An abnormal connection of 2 sides of the heart usually by the hole Flow sends more blood to the lungs than needed causes decrease in systemic blood flow, increased blood volume on right side of heart Too much fluid in lungs ACYANOTIC

Gun Safety and School Aged Kids

AVOID having firearms in the house LOCK ammunition and firearms in separate cabinets and out of reach of kids Talk about firearms- waht to do if you find a gun at school or at a friend's house Educate the parents to teach kids about firearm safety and if around guns how to be around them safely, and if they found a gun at school or a friend's house to NOT TOUCH GUN & TELL A TRUSTED ADULT (like the teacher, principle, friend's parent, or their parents)

Leading Causes of Death in 5-14 year olds

Accidents (unintentional injuries) Cancer Intentional self-harm (suicide!)

Combination Drugs

Acetaminophen with codeine Hydrocodone with acetaminophen (Lortab/Hycet) Be very aware of acetaminophen amount in the child's dose

Acid-Base Balance

Acidic <7.35 Respiratory Acidosis= ventilation prob, hypoventilation Metabolic Acidosis= diarrhea, kidney failure, DKA Basic >7.45 Respiratory Alkalosis= test taking/nervousness/overly anxiety, any rapid RR, Hyperventilation Metabolic Alkalosis= vomiting PO2 80-100 and 50-80 in neonates Potassium= b/c cell membrane permeability is affected by pH. High (Hyperkalemia)=acidic Low/Hypokalemia= alkalosis

Glomerular Diseases- Two types

Acute Glomerulonephritis (AGN) & Nephrotic Syndrome

Postconventional

Adolescents -principal moral reasoning, absolutes and rules are questioned, fair treatment of individuals and justice are main priority

Clubfoot

Affects lower leg and ankle Can be one or both feet Consists of 1 or combo of 4 deformities -plantar flexion (points down!) -dorsiflexion (upward) -varus deviation (foot turns in!) - valgus deviation (foot turns out!) VARUS= In, Valgus=OUT Need manipulation ASAP to correct after birth, casting soon after and in Dennis Brown Splint initially, if NO change in 3-6 months then need surgery.

Transmission of Infectious Diseases can be through what?

Airborne- Ex. Measles, TB, Varicella (chicken pox) Droplet- ex. Influenza Fecal-Oral route- Ex. Hand-Foot- and Mouth Disease; not properly washing hands after using restroom and putting in mouth! ewww Contact- Ex. Gastroenteritis, C. Diff, RSV Vectors- Ex. mosquitoes carrying disease like malaria, bats, birds, chickens, Tick (Lyme Disease or Rocky Mountain Spotted Fever) Direct inoculation- ex. Tetanus, Hep B (from needle sticks from dirty needle or not getting immunized or vaccinated!)

Treatment of Acne

Antibacterial soap! NO picking & squeezing Medications- Tretinoin (Retin-A), Tetracycline, Isotretinoin (Accutane) Tretinoin= causes photosensitivity, GI upset Tetracycline= causes photosensitivity, discoloration of teeth Isotretinoin= Is Teratogenic; causes dry skin/dry eyes/dry mucous membranes, photosensitivity, mood changes/depression/suicidal ideation (SI)

Isotonic Cystaloids ( NS, LR)......

Are the BEST for children! NOTE= only add dextrose to these fluids to stabilize blood glucose if not eating, & only add K+ if the kidneys are working (check this by seeing an appropriate UOP)

Nursing Interventions for Cognitive Impairment

Assess developmental age Keep routine from home and communicate w/ them properly

Nursing Interventions for JIA

Assess for S&S of impaired mobility Administer NSAIDs 30 min PRIOR to getting up in morning Use MOIST HEAT by shower or bath in the AM -Ensure that the child's body is in PROPER ALIGNMENT -Make sure child has a FLAT OR NO PILLOW -Perform schedules active and passive ROM at least q4H -Encourage active play (sports, swimming, bike riding, walking) -Allow adequate rest periods -Allow child to do as much self-care themselves as much as they can Assess if meds are working by: -Improved grip strength -Increased joint mobility -Reduced joint tenderness -relief of pain -Decreased swelling and stiffness

Headaches (HAs)

Assess to find out type Types: Acute Acute and recurrent (migraine) Chronic Progressive Chronic Nonprogressive (Tension) DO a HA diary to assess for which type HA in the morning= think tumors! HA later in the day= think eye strain & see eye dr!!

Preschooler Toys

At age 4- climbs and jumps and skips At age 5- uses scissors, skips on alternate feet, ties shoes, beginning of cooperative play Imitative of adult patterns and roles, offer the playground and housekeeping toys and coloring books Preschooler toys if hospitalized= coloring books, puzzles, cutting and pasting, dolls, building blocks, clay, pretend medical toys

Lorazepam

Ativan Longer duration than Diazepam and causes LESS respiratory depression in children over 2 years Emergency treatment for seizures Ask what has already been given by family and paramedics b/c more than 2 doses of benzos can cause repsiratory depressoin

What types of foods should you avoid with Latex Sensitivity?

Bananas, avocado, kiwi, and chestnuts

Nursing Management of Childhood Infectious Illnesses

Bed rest, quiet activities Fluid intake VERY IMPORTANT Tepid sponge baths help baths with baking soda or oatmeal help (like helps itching with Chicken Pox) Treat fever w/ acetaminophen or ibuprofen NEVER give ANY form of ASA/aspirin NO topical steroids if young child scratches- cotton socks over hands! Report occurrence to the health department if necessary!

Toys/Games for School Aged Kids

Board games Cards/card games Hobbies puzzles video games cooperative play Sports

Toddler -Gross Motor Skills

By 15 months- can walk, removing clothes, bends over and can get back up. By 18 months- can run clumsily but falls often, WALKS UPSTAIRS WITH HAND HELD, jumps in place with both feet; have parents proof house for FALLS! By 24 months- throws ball overhand, kicks ball, GOES UP AND DOWN STAIRS WITH 2 FEET ON EACH STEP By 30 months- jumps from chair, steps, anything, balances on 1 foot By 36 months (3 years old)- can ride a tricycle, gender identification occurs at this time

Communication with a Toddler

By 15-18 months they put words together and understand 50 words and can understand simple directions. By 2 years old, they use 2-3 word phrases with 50-100 word vocabulary (have out 50 words that have meaning to them and to us!) By 3 years old, they use 3-4 word sentences and have a 300-500 word vocabulary. If not talking by age 3, be concerned and do a hearing test! Might have about 900 meaningful words drastic increase at age 3 First and last name can be stated at 2.5-3 years of age. They Use holographic speech and tell a sentence using simple words, they may say "Me go" or "Me do" for a sentence. Ask parents what words they use for urination, etc. (like go pee or go poop, etc.) Tell them exactly what you are going to do. -If not able to meet these milestones by age 3 might need to have an evaluation to rule out things like hearing and developmental delay and cognitive issues or autism spectrum if not able to speak to use like they should (ex. Like when my nephew JB had to get evaluated around this age and they found out he had developmental delays)

How do you know if a baby is eating enough??

By the # of wet/dirty diapers! 1 wet/dirty diaper of life per day until days 5-6 of life. Then 5-6 wet/dirty diapers per day until 14 days old! Then 6-10 wet/dirty diapers per day after first 14 days of life! Stools/Poopy Diapers= if bottle fed should have 1 stool every 2-3 days, and if breast fed should have 2-3 stools per day. Breastfed stool= more liquidy, not as formed Bottle fed= more formed looking Will have a lot more frequent stools in breastfed babies!

With Neuro Issues in babies, THINK- Is ICP actually increased or is crying causing it?

CALM them if they are crying with high ICP to make sure

Isolation precautions are NOT done on hospital basis, but are based on what?

CDC Guidelines!

Foods BAD for Diarrhea (DON'T GIVE)

Caffiene, soda, BRAT diet foods (bananas, rice, applesauce, toast- NO PROTEIN!), only clear liquids, high carb liquids, fruit juice, gelatin, broths

Types of Infant Growth

Cephalocaudal and Proximodistal

With administering morphine in patients, what are we going to be observing and assessing and worrying about?

Check RR- worry about respiratory depression Dysphoria, confusion, hallucinations and urinary retention

Education/Communication Considerations with Cognitive Impairment Children/Pts- What to Educate pts and families

Children with intellectual disability have deficit in ability to discriminate between 2 or more stimuli Use colors to emphasize visual cues Singing or rhymes to stress auditory cues Eliminate extraneous stimuli- sometimes stimuli impairs cognition or distracts them and causes issues that could worsen their adaptation to skill or treatment with these pts Need to be patient with these patients Will have early intervention programs in schools to help, IEP plans to help these kiddos to allow them to have that time to promote better cognition, but also still allow them that independence and promote their self-esteem and learning abilities or growth needs

Patient Teaching- Atopic Dermatitis (AD)

Chronic lichenification results from persistent scratching! Triggers= overheating, soaps, wool Nursing considerations & Teaching: -Scratching leads to more lesions so pruritus NEEDS to be controlled -Antihistamines can be helpful -Keep fingernails and toenails short -Cotton socks & gloves

Obstructive Defects

Coarctation of the Aorta (COA) Aortic Stenosis Pulmonic Stenosis

Cognitive Development in School Aged Children

Concrete Operations- think literally -reversibility, conservation, classification & logic, and humor

Types of Hearing Loss

Conductive- interfere w/ transmission of sound to or by the middle ear, loudness of sound (conductive=something CAUSES it) Sensory- inner ear, cochlea, sounds are distorted, discrimination of sound is hampered Neural- auditory nerve prob. Sensorineural- conductive and sensorineural

Managing Common Side-Effects of Opioids

Constipation- encourage fluids, might give stool softeners, encourage fiber Sedation - from opioids, might have to reduce dose of opioids Nausea/Vomiting- usually give Zofran to help with this Pruritus- narcotics might cause itching as well, so might give diphenhydramine (Benadryl) to treat that -Respiratory depression -Dysphoria, confusion, hallucinations -Urinary retention -Opioids will cause constipation, be on top of treating constipation for these patients on opioids Have also have sedating effects r/t to taking opioids so might need to decrease dose or try other means of medications, might have to give stool softeners and increase fluids to teat constipation Have Nalaxone/Narcan for opioid overdose/toxicity Urinary retention might need to give meds for that such as Oxybutynin to help the bladder relax so they are able to pull fluid out and pee

Post-Op After Brain Tumor Removal

Correct position is CRITICAL r/t especially 24-48 hours DO NOT put on post-op side 2 nurses should turn Put sign at HOB for positioning instructions NEVER put in Trendelenburg -For infratentorial = put FLAT on non-operative side -For supratentorial = elevate head above heart to help with cerebrospinal fluid (CSF) drainage Question- terminally ill patient has something happen to them, don't ask them what do they want, ask- the answer will be do you HAVE A DETAILED PLAN OF CARE?!!

Pituitary Disorders

DI and SIADH

Differences Between DI & SIADH

DI= HIGH AND DRY!! -Dehydration -Hypernatremia (High Na+ = >145) -Increased urination (polyuria, HIGH UOP!) -Increased thirst (polydipsia!) -Urine specific gravity <1.005 SIADH= LOW & WET!!! -Fluid retention (FVO!) Hyponatremia (Too Low Na+ <135) -Decreased urination (Low UOP! ) -Hypertension -Wt. gain -Urine specific gravity >1.030

Pertussis vaccination recommendations

DTaP vaccine in early childhood (given at 2,4, & months, & then at 12-15 months, & then again at 4-6 years old!) Tdap vaccine (given starting at > 7 years old!) -Give to All pregnant women with each pregnancy between 27-36 weeks -Postpartum women after delivery before discharge NO tdap vaccine ever received or if vaccine status unknown -Adults- the current recommended tetanus toxoid (Td) injection every 10 years; those without the Tdap vaccine in adolescence need one Tdap vaccine to replace 10 year booster dose.

NOT using muscles does what?

Decreases muscles by 3% a day Leads to tissue breakdown and atrophy -Need to do ROM exercises asap ( within 3-7 days) or will be at risk for contractures, venous stasis, constipation ( DO a bowel regimen or MACE is common tx for constipation), decreased UOP (which causes more UTIs), edema, and skin breakdown

Infants 7-9 months of Age

Develop object permanence (know something is still there even if they don't see it, ex. toy fell on the floor they know its there. If mom was in room with them then left to another room they know she is still there) Stronger attachment, develops attachment to objects (such as special teddy bear or blanket)

Diagnosis/Diagnostics of Austism Spectrum Disorder (ASD)

Diagnosed by age 2 Screening tools are a modified checklist for autims in toddlers (MCAT)= diagnostic test for autism Need to treat early!!

Nonbacterial (Asceptic/Viral) Meningitis

Diagnosis is based off of S&S and CSF Tx w/ rest and hydration, antipyretics, and NSAIDs

Hematologic Disorders are what?

Disorders of the blood

Treatment of ADHD

Drug of choice, 1st drug you give= stimulant meds! First you try environmental and behavioral management. Behavioral therapy is first line treatment especially if young= teach more sleep, stay hydrated, get exercise, provide soothing music and mediation Want to TREAT EARLY!

How do you diagnose type of Seizure?

EEG sleep study video of seizure

Diagnostic Tests for Cardiac

EKG, chest x-ray (heart size), echocardiogram, cardiac cath

CKD S&S

Edema HTN hyperkalemia (K+ HIGH!) metabolic acidosis (b/c cannot regulate base) bone demineralization impaired growth bone deformities (cannot absorb Ca+) renal osteodystrophy (renal rickets) anemia infections delayed sexual maturation

Learning body parts as a toddler, what should we tell parents to do?

Educate that parents SHOULD teach them the correct anatomical names. Toddlers are very concerned about their body and want boo-boos hidden, so as a nurse remember cover boo-boos w/ band-aids and get no-no bands for covering IVs (try to keep IV out of site and out of mind) - realizing male vs. female

Partial Seizures

Electrical discharge in limited area Awareness, memory and consciousness may be affected! Simple Partial= ALL of these (awareness, memory, consciousness) are preserved Complex Partial= problems w/ 1 or more of these

Intracranial and Cerebral Infections

Examples- Meningitis types Meninges protect the brain and spinal cord and can become infected by surgeries, sinus and ear infections, etc.

Post Immunizations- NEED TO KNOW INFO to Tell Patients and Families

Expect irritability, fever (<102 F), redness, and soreness at the injection site for 2-3 days, especially w/ DTaP and IPV -Call HCP if seizures, high fever, or high-pitched crying occurs A warm washcloth on the thigh injection site and "bicycling" the legs w/ each diaper change decreases soreness Acetaminophen can be administered orally q6h as needed for pain or fever (dose: 10-15 mg/kg!)

About 30% of a TODDLER's body fluid is what?

Extracellular Fluid (ECF)

About 50% of NEWBORN's body fluid is what?

Extracellular Fluid (ECF)= outside of the cell

Hepatitis A

FECAL-ORAL TRANSMISSION incubation period about 4 weeks! Transmission of virus occurs for 2-3 weeks BEFORE onset of jaundice Tx/Prevent with Hep A vaccine (given in 2 doses; 1st dose= at 12 months on 1st birthday, second dose= at 24 months on 2nd birthday!)

Fetal RBCs

Fetal Hgb EASIER O2 binding than adult (Fetal RBCs better b/c easier to bind to O2 than adult RBCs) After birth production of adult RBC begins Completely replaced by 3 months. Breakdown of fetal RBC into UNCONJUGATED BILIRUBIN, iron and protein. Then unconjugated bilirubin binds to albumin to make conjugated, and conjugated bilirubin is water soluble and can be excreted easily. Unconjugated is FAT SOLUBLE and cannot be excreted in this form. Conjugated Bilirubin= WATER SOLUBLE Unconjugated Bilirubin= FAT SOLUBLE

Fever does what to water loss?

Fever INCREASES insensible water loss by 12% for each degree AFTER 99 F

Treatment for Sickle Cell Crisis and Sickle Cell Disease (SCD)

Fluids O2 pain meds RBC transfusion exchanges transfusion (erythrocytapheresis) Hydroxyurea meds (decreases the risk for silent stroke and extends time in between crisis IV fluids 2x maintenance levels and electrolytes Monitor I&O Give blood Warm compress on joints (NOT ICE/COLD) ABX (if infection caused it) Keep WARM High protein and high calorie diet O2 is NOT needed unless hypoxic of O2 sats less than 94% Prolonged administration of O2 can depress bone marrow activity and worsening the sickle cell anemia HYDRATE and GIve Fluids 2x maintenance rate

Corticosteroids

Fluticasone and Budesonide anti-inflammatory, inhaled corticosteroids help heal lungs and decrease severity (decrease swelling, decrease spasms, decrease mucus). All ages for persistent asthma, can be used in combo with albuterol if over 12 yrs. Side Effects are: cough, dysphonia, and oral thrush. Check growth q3-6 months due to growth suppression, immunocompromise, and can increase blood glucose so check blood glucose levels too esp. if diabetic

Gender Identification

Formed by age 3 They identify with the same sex parent but will attach to the opposite sex parent (by age 3!) Attachment is different at this age b/c they start identifying with the parent of the same sex but are CURIOUS about the opposite sex parent trying to figure them out, etc.

Levels of Consciousness (LOC)

Full LOC- awake, alert & oriented Confused- don't think clearly or rapidly Disoriented- can't recognize person or place Lethargic- awaken easily but limited response Obtunded- sleeps when aroused Stupor- need considerable stimulation to arouse Coma- NO response/complete loss of consciousness

Family Education on Vaccines

Give Vaccine Information sheets and answer any questions and ask if they understand, etc.

Asthma Action Plan

Green- 80-100%, no S&S or cough, slept w/ no S&S Yellow- 50-80%, have S&S, need albuterol, if doesn't bring to green then may need STEROID (oral steroid for 4 days), signs of cold, coughing or wheezing, tight chest, trouble breathing at night Red- >50% seek medical attention. No meds help, have S&S at rest, breathing hard and fast, nasal flaring, using accessory muscles, cyanosis

Tonsillitis/Pharyngitis

Group A beta hemolytic strep spread by direct contact saliva or nasal secretions S&S= fever, no cough, pharyngotonsilar exudate, anterior cervical adenopathy (swollen adenoids)

Montelukast Side Effects

HA, can increase SGoT/SGPT so use cautiously in liver patient, canno t use in patient with PKU

How do you prevent diarrhea?

HANDWASHING- wash hands! Drink clean water Prepare food properly Diarrhea is usually spread by oral-fecal route

Hyperglycemia S&S

HIGH BS hot and dry= SUGAR HIGH! nausea, thirsty, confused, dehydrated polyuria, polydipsia, lethargic (LATE SIGNS!) **HALLMARK S&S of DM= polydipisa, polyphagia, polyuria- THREE Ps!***

Classification of Congenital Heart Disease (CHD)

Hemodynamic Characteristics Increased Pulmonary Blood Flow Decreased Pulmonary Blood Flow Obstruction of Blood Flow out of Heart Mixed Blood Flow

Other Viral Hepatitis

Hep C- blood borne can be chronic as well, does NOT have a vaccine, can also be caught by sharing dirty needles by doing certain drugs, seen in older/adolescent peds population, so talk w/ them about it Hep D- (can NOT occur w/out having Hep B virus!), not real common problem in USA Hep E- rare in the USA, transmitted fecal-oral route and in contaminated water, can get from traveling outside the USA and drinking their water (remember no fresh fruits, always use bottled water and drinks when traveling), bad diarrhea, usually get over it but just ruins travel Hep G- similar to Hep C, blood borne

Adolescent

Identity vs. Role Confusion Hospitalization disrupts school and peer activities and they NEED BOTH! Alteration of body image Teach about procedures without parents there When parents are there direct questions at adolescent They use abstract thinking Need feeling of normalcy risk taking and rebelling is normal Encourage socialization with peers Repsonsibility and management of diagnosis Promote good appearance and clothes and activities for age (prom, school, graduate, driver's license, etc.) Goal is to achieve being normal, obtain highest level of health, family remain intact ****QUESTION ABOUT DIABETIC CHILD BEING TAUGHT HOW TO GIVE INJECTION, ANSWER IS GET A PEER ROLE MODEL!!!****

When should you hold an infant's feeding???

If respiratory rate is OVER 60!

Dermatological Infections & Alterations in Children

Impetigo Cellulitis Candida Albicans Lice Scabies Atopic Dermatitis (Eczema) Acne

Urinary Tract Infections (UTIs) in children- Causes/Etiology

In Infants= major cause is E. Coli Toddlers= E. Coli and Klebsiella Preschooler= E. Coli, Klebsiella, Pseudomonas School- Aged= Klebsiella, pseudomonas, Proteus Mirabillis Adolescents= E. Coli, Klebsiella, Pseudomonas, Staphylococcus, saprophyticus, and Group B/D strep (AGN)

School-Age

Industry vs. Inferiority develop sense of accomplishment and form peer relationships use concrete operations Chronic illness can affect development by decreased socialization and alter mental wellbeing and missing school Toys are BOARD GAMES, VIDEO GAMES, and HOBBIES

Fears by Age Group

Infancy= separation from mom,dad & fear of strangers Toddlers- Loss of control and separation Preschoolers= loss of control, body invasion, and being abandoned School Aged= loss of control, body invasion, not being enough, and death Adolescents= loss of control, altered body image, and separation/not being accepted from peers

Concepts of Bodily Injury by Age

Infants- AFTER 6 months old can remember pain Toddlers- fear intrusive behaviors. Preschoolers- fear intrusive behaviors also, but also disrupting skin and body mutation School Aged group- fears loss of control over their body Adolescent group- concern is body image

Preschool

Initiative vs. Guilt They should develop initiative and purpose and develop peer relationships and master self-care skills, use preoperational though, they feel guild thinking they caused illness or that they are being punished, nurse should explain they did NOT cause or are being punished, explain procedures in simple terms to them and allow them to ask questions. Fix boo-boos with a band-aid and cover IV with no-no board. Encourage mastery of self-help skills, socialization through play dates and daycare, provide associative play and emphasize abilities. Therpeautic play provides emotional outlet, can reduce fear and help with pre-op teaching, use pretent medical equipment.

Types of Dehydration

Isotonic Hypotonic Hypertonic -is r/t the plasma Na+ concentration

Articular Dysfunction problems

Juvenile Idiopathic Arthritis (JIA)

ICF

K+ 3.5-5.0 Mag 1.5-2.5

Top Predictors of Respiratory Failure

LOC decreased Cannot speak absent breath sounds central/core cyanosis (like around the mouth,etc.)

Age Appropriate Toys for 6-9 Months of Age

Large toys w/ bright colors and movable parts and noise makers Ex. pots & pans, nesting containers

Neurological Emergency in Increased ICP

Late problems Impending death Asymmetrical pupils = one dilated and one unreactive pupil Widening PP (Pulse Pressure) Deep, periodic or gasping respirations Slowing pulse Brainstem involvement

Live Vaccines

MMR Varicella Rotavirus POSTPONE live vaccines for minimum of 3 months after being given immunoglobulins or in some cases, blood transfusions

Immunizations- How do we give them? What route?

MMR- subcut Varicella- subcut DTaP- IM Hep B- IM in the vastus lateralis in infants & deltoid in children and adults Pneumococcal Conjugate (PCV)- IM Rotavirus- oral/PO HPV- IM

C. Diff infection

MUST use Handwashing, NO alochol based gels! Tx of C. Diff= Metronidazole (Flagyl) and put on Contact Precautions!

Fears with Hospitalization in Adolscents

Major fears are loss of control, altered body image, separation from peer group, encourage schoolwork, alteration in body image can be devastating, talk with and help them cope, get child life specialist and social work involved, teach without parents, direct questions towards patient not parent, risk taking is normal at this age, give as many CHOICES as possible, give information as importance "matter of fact", encourage stylish clothes and appropriate activities for age (ex. get their drivers license, final decision of choices depends on age, competency, and state.

Therapeutic Management of CKD

Manage Diet Manage HTN prevent/manage/tx infection prevent/manage/tx seizures

Jehovah's Witnesses

NO BLOOD TRANSFUSIONS!!

ECF

Na+ 135-145 & Chloride 96-106

Treatment of DMD

No cure Corticosteroids to protect muscles and help with heart failure -Treat frequent respiratory infections -Keep active as much as possible -ROM -bracing -encourage ADLs -Surgery to release contractures PRN -genetic counseling for the parents/family -promote independence GOAL= to keep function in muscles as long as possible!!

Cause for Concern at 12 months/1 year of Age

Not crawling Not pulling to stand Says NO single consonant (da-da or ma-ma) Does NOT use gestures Does NOT respond to games like peek-a-boo Worried if cannot walk by 15 months!

Most common S&S of ARF/AKI is what?

OLIGURIA (UOP is BELOW NORMAL/LOW!)

Care of Children with Congestive Heart Disease (CHD)

Nursing Assessment: 1. Manifestations of CHD a. Murmur (present or absent; thrill or rub) b. Cyanosis, clubbing of digits (usually after age 2) c. Poor feeding, poor weight gain, failure to thrive d. Frequent regurgitation e. Frequent respiratory infections f. Activity intolerance, fatigue 2. The following are assessed: a. Heart rate and rhythm and heart sounds b. Pulses (quality and symmetry) c. Blood pressure (upper and lower extremities) d. History of maternal infection during pregnancy Nursing Diagnosis: Decreased cardiac output Activity intolerance Delayed growth and development Nursing Interventions: 1. Provide care for the child with cardiovascular dysfunction a. Maintain nutritional status; feed small, frequent feedings; provide high calorie formula i. Infants may require tube feeding to conserve energy. Infants being tube fed need to continue to satisfy sucking needs by a pacifier. b. Maintain hydration (polycythemia increases risk for thrombus formation). c. Maintain neutral thermal environment d. Plan frequent rest periods e. Organize activities so as to disturb child only as indicated f. Administer digoxin and diuretics as prescribed g. Monitor for signs of deteriorating condition or congestive heart failure h. Teach family the need for prophylactic antibiotics prior to any dental or invasive procedures due to risk for endocarditis 2. Assist with diagnostic tests, and support family during diagnosis a. ECG b. Echocardiography 3. Prepare family and child for cardiac catheterization (conducted when surgery is probable or as an intervention for certain procedures). a. Risks of catheterization are similar to those for a child undergoing cardiac surgery: i. Arrhythmias ii. Bleeding iii. Perforation iv. Phlebitis v. Arterial obstruction at the entry site b. Child requires reassurance and close monitoring post-catheterization: i. Vital signs ii. Pulses iii. Incision site iv. Cardiac rhythm c. Prepare family and child for surgical intervention is necessary d. Prepare child as appropriate for age: i. Show to ICU ii. Explain chest tubes, IV lines, monitors, dressings, and ventilator iii. Show family and child waiting area for families iv. Use a doll or a drawing for explanations v. Provide emotional support

What should the nurse observe for during peritoneal dialysis?

Observe for changes in the color of the dialysate draining from the child. IF the color is cloudy, brown, or pink, notify PCP immediately!!!

Epidural Pain Control

Opioid = Fentanyl or Hydromorphone or Preservative-free morphine Local anesthetic= (bupivacaine or ropivacaine) Clonidine= Administered via single or intermittent bolus, continuous infusion, or patient-controlled epidural analgesia (PCEA) Monitor neurovascular checks, pain assessment, VS regularly- every unit will have a different protocol With eipidural will have an opioid and local anesthetic (numbing agent to block pain there) and clonidine to slow everything down and make comfortable PCA= demand only and continuous -demand only- might be a bolus dose, can hit button and get extra bolus of medication -Continuous- gives a continuous constant amount, don't' hit button to get bolus

Lice

Pediculosis infestation! MUST get rid of the eggs Tx= Permethrin 1% OTC Take care of clothing linens, etc. (Make sure washed properly or stored properly in clear sealable bags if something that can't be washed, etc.)

Kohlberg's Moral Development Stages

Preconventional Conventional Postconventional

Warning Signs of Suicide (p.751 Box 18-12)- KNOW!!

Preoccupation w/ themes of death-focuses on morbid thoughts -Wants to give away cherished possessions -Talks of own death, desire to die -Loss of energy, loss of interest, listlessness -Exhaustion without obvious cause -Changes in sleep patterns-too much or too little -Increased irritability, argumentativeness, or stubborness -Physical complaints- recurrent stomach aches, HAs) -Repeated visits to physician, NP, or ED for treatment of injuries -Reckless behavior -Antisocial behavior- engages in drinking, uses drugs, fights, commits acts of vandalism, runs away from home, becomes sexually promiscuous -Sudden change in school performance- lowered grades, cutting classes, dropping out of activities -Resists or refuses to go to school -Remains distant, sad, remote--flat affect, frozen facial expression -Describes self as worthless -Sudden cheerfulness after deep depression -Social withdrawal from friends, activities, interests that were previously enjoyed - Impaired concentration -Dramatic change in appetite

Goal of Nursing Care in Patients with Intellectual Disability/Cognitive Impairments

Promote their optimum social, physical, cognitive and adaptive development, ADLs, independence, and involve them with peers

Haemophilus Influenzae type b (Hib) Vaccine

Protects against epiglottitis, bacterial meningitis, sepsis, bacterial pneumonia, septic arthritis Vaccines= minimum age is 6 weeks old Routine vaccination= depends on brand! -4-dose series at 2,4,6, and 12-15 months -3-dose series at 2,4, and 12-15 months

Toddlers Respiratory

RR of more than 40 breaths/min is too high intervene to slow the breaths down Need to hold feeds if RR is over 40 breaths/min

Seizure Precautions

Reduce stimuli Pad side rails Have Suction and O2 ready/nearby/at bedside put them on monitor Seizure not at the hospital = Call 911 if seizure is longer than 5 minutes!!!

Sleep Requirements for School Aged Children

Reduces from 12 hours a day at nighttime at 6 years old to 9-10 hours a day at nighttime for a 12 year old.

Egocentrical Thought of Preschool and Toddlerhood is replaced by what in School Aged Children?

Replaced by social awareness of others socialization with peers is important School aged is a period of calm, "latent" school is considered a job an they think about actions BEFORE doing them Industry vs. Inferiority (sense of accomplishment and socially aware)

GOOD foods for Diarrhea (GIVE THESE)

Rice, wheat, potatoes, cereal, yogurt, cooked veggies, lean meat

Tick Borne Illnesses

Rocky Mountain Spotted Fever- Rickettsiae Lyme Disease

Infant Reflexes

Rooting Sucking Ciliary Doll's eyes Moro Grasp reflexes: Plamar Plantar Step/Walking Babinski Truncal incurvation (Galant) MOST reflexes should disappear in 3-4 months of age, if they come back after you MUST think about or consider developmental delays/

Treatment for Hypoglycemia in PEDS

Rule of 15: 15 grams quick acting glucose every 15 minutes until reached goal, then 15 gram complex carb snack or meal. Never "cover" rescue carbs. (recheck blood glucose q 15 min until goal) 15 grams of simple carbs includes 1 tbsp table sugar 8 oz milk Insta-glucose Cake icing -Use glucagon IM in unconscious patient -Put child on side when using glucagon b/c can cauase PROJECTILE VOMITING! = use the Rule of 15 to tx HYPOglycemics So treat with 15 grams of cabs/quick acting glucose and wait 15 minutes, after those 15 minutes then recheck BG, and then give 15 grm complex carb snack or meal; in pediatric patients do NOT use candy 15 grams of simple carbs= 1 tbsp table sugar, 8 oz milk (can be both a simple and complex carb- lactase helps), insta-glucose, cake iceing, and use of glucagon in UNCONSCIOUS PATIENT (given IM injection, watch/be concerned for risk of emesis if given glucagon, so make sure patient is on side so don't aspirate, can take 12-15 minutes to take effect) -If have to administer rescue carbs, NEVER COVER for those by giving insulin b/c will just put them right back where they began, etc. -Simple carbs are used for RESCUE ONLY Long acting carbs are given once stable

Types of Traction

Russel and Buck's Traction= Skin Traction Skeletal Traction

Hypotension in 1-10 years of age.......

SBP <70 + (age in years x 2) Example= 2 year old would have SBP of what? <70 mmHG +( 2 x 2) = 70 + 4= 74 so <74 would be considered hypotension for a 2 year old! -Hypotension for a 10 year old would be what? 70 + (10x2)= 70 +20= 90 so anything <90 SBP would be hypotension for 10 year old!

Conventional

School Aged -Rules become less absolute and are a mutual agreement, cooperation, and respect, maintains social order and follows rules. -Able to think more logically. -The younger school-aged children may know the rules but not the reason behind them As they grow they understand and do not judge an act by only the consequence. SATA question abotu 8-9 year olds--- 8-9 year olds like a reward system, they respect parents, and they don't play with the opposite sex

Acquired Orthopedic Conditions

Scoliosis Osteomyelitis

Infant in Trust Vs. Mistrust stage should have what??

Should have consistent, reliable care Start attachment at birth! When in the hospital, try NOT to separate, decrease anxiety and promote family to stay, let them have attachment object, etc. Communication by touch and soft baby voice NO INVASIVE PROCEDURES IN CRIBS b/c that is their SAFE PLACE ***p.865 Box 22-2- Stages of Separation-REVIEW OVER***

Why should we keep infants warm?

So water is not lost! With infants they have larger quantities of water are LOST through the skin, increased metabolic rate, IMMATURE KIDNEY FUNCTIONING, faster RR, and a longer GI tract.

Lyme Disease

Stage 1- Bull's eye, edematous, fever, HA Stage 2- early disseminated disease- occurs in 3-10 weeks; they have a fever, HA, malaise, fatigue, stiff neck, lymphadenopathy Stage 3- neuro,cardiac, musculoskeletal involved -Occurs In 2-12 months; they have LYME ARTHRITIS (painful, swollen joints, mainly in knees!)

Other Complications from Sickle Cell Disease

Stroke Acute Chest Syndrome (chest pain, fever, cough, dyspnea, overwhelming infection)

10-12 Months Physical

TRIPLE BIRTH WEIGHT by 1 year! Head and chest circumference are equal Length increases 50% from birth Babinski reflex disappears See Lordosis when walking (evident during walking-lower back sticking belly out, waddling!) waddling and leaning back Uncoordinated walking Get off bottle to decrease dental carries, pad corners of furniture, pincer grasp (2 fingers) at 11-12 months PINCER GRASP BECOMES NEAT can feed self with spoon and wave bye-bye.

Respiratory Distress Cardinal Signs

Tachypnea (increased RR) Restlessness (earliest sign!) Tachycardia (increased HR) Diaphoresis (intense sweating) Other signs include= grunting, nasal flaring, retracting, confusion, anxiety, irritability, wheezing. Catch these S&S early b/c can lead to respiratory failure

Family Digoxin Teaching

Teach to admin regularly (never skip or double for missed doses), 1 hour BEFORE or 2 hours AFTER meals, do NOT mix w/ formula or food, take child's pulse PRIOR, keep locked away, know S&S of toxicity, take on empty stomach, check competency, must have 2 people check at home, DON"T MIX W/ FOOD!

Normal Neonate Vital Signs

Temp 97.3-98.6 axillary HR 120-160 Resp Rate 30-60

If caring for a pt that comes in with bacterial meningitis and was NOT put on droplet precautions prior to starting meds, what will the RN need?

The RN will/may need ABX b/c they might contact bacterial meningitis form the pt.

Assessment of Pain

The most critical aspect of pain assessment is that it is done on a regular basis using a standard format." Wells, Pasero, McCaffery (2008) When assessing pain it is physiological and psychological Sometimes children see pain as a punishment and don't understand the illness is NOT their fault and they think they have caused it or the pain is because they have done something,etc. So need to educate these children that the pain or illness isn't their fault or something they have done, and make sure you help and treat the pain as soon as possible Pain considered the 6th vital sign = pain is something you constantly evaluate or reevaluate when seeing a patient, etc. -Assess for physical & behavioral changes -Determine type, location, intensity, location, and duration Pain thresholds vary depending on age, sex, how they were raised (like some cultures are very stoic and patients may not tell us they are in pain when they really are in pain) so be mindful different things may cause pain to be a lower level than you think or higher level than you think, etc. With children, might need to distract them and see if that helps with their pain Young children/Infants,etc. might look at pain as far as = If right arm is hurting, might be using left arm; might be mean, grumpy or irritable if can't tell you they are in pain, might have diaphoresis (get real sweaty), tired, fatigued, look at VS to tell if in pain like with BP or HR go up, behavioral changes once pain hits (might be a nice little kid one minute, then hateful and in pain the next) Pediatric Pain Assessment Scales Infants/Toddlers Ages: 4 years-8 years Older children/adolescents Look at different pediatric pain scales for different areas and different age ranges we are in

Oxybutynin

- Med that helps w/ bladder spasms! Do NOT GIVE with antihistamines b/c it increases effects -it can increase effects of Digoxin if given together Side Effects= constipation, dry mouth, drowsiness, decreased sweating (can't see, can't pee, can't sit, can't sh*t, LOL!)- anticholinergics dry things up! You'll wan to treat constipation if have this with this medication!

Industry vs. Inferiority

- School Aged (6-12 years old) - During this time the child develops a stage of ACCOMPLISHMENT and a SENSE OF PERSONAL COMPETENCE. They are EAGER TO BUILD SKILLS and do work. -Failure to develop this accomplishment results in INFERIORITY, PEER APPROVAL is an important factor....if the child has limitations it can put the mat a disadvantage. Developing a sense of industry is key for a stable identity later in life.

6 Months of Age- Physical

- Teeth eruption=Have first tooth in around 6 months of age -Start solid foods around 6 months of age -Tylenol is OKAY but NO IBUPROFEN before 6 months of age -they DOUBLE THEIR BIRTH WEIGHT BY 6 MONTHS! -After 6 months, weight fain is 1 lb/month and length is 1/2 inch per month -Stranger Danger/Stranger Anxiety is expected/normal! -They crawl a lot and parents need baby gates! -# of teeth child should have = age of child in months - 6 So for example: a 10 month old child should have how many teeth? 10 months-6= 4 teeth! -Parents need to lower the crib mattress so they cannot climb out. -Teach parents to use shoes and socks w/ grippers because still not able to be steady on feet yet.

Piaget's Cognitive Development Stages

- deals with brain development and learning Sensorimotor Peroperational Concrete Operational Formal Operational **NOTE for exam= question about a child collecting rocks, what stage might that child be in? - deals with cognitive development stages**

Nephrotic Syndrome

- idiopathic/dont know what causes it -**can be caused by a hypersensitivity reaction** Common in 2-3 year olds (toddler stage) -Minimal Change Nephrotic Syndrome (MCNS) is the most common form of this! -CHRONIC and can relapse -Insidious onset

Nursing Care of SB patient BEFORE Surgery

- maintain integrity of sac/protrusion -Put a MOIST, STERILE 4x4 guaze/dressing on the protrustion -Keep infant PRONE (on belly) and turn head to ONE SIDE for feeding -AVOID contamination of sac from urine and feces -Can put a plastic MUD FLAP on back to prevent contamination - NO DIAPERS typically, change pads under infant FREQUENTLY put on pressure reducing mattress -CAN HOLD IF PRONE (with pillow on the lap) -Check Head Circumference for baseline

What is the TREATMENT for Nephrotic Syndrome?

- put on STRICT BEDREST(turn and reposition q2h!) -give diuretics and corticosteroids -LOW Na+ diet -Provide smaller more frequent meals -Check for signs of infection!!

Late Signs of Hydrocephalus in CHILD

-***Seizures*** -Increased BP -Decreased HR -Altered Respiratory pattern -Blindness (from herniation of optic disc) -***DECEREBRATE POSTURING!!!***

Health Promotion of The Preschooler (3-6 years old)

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Hematological Disorders in PEDS patients

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NEUROLOGICAL ALTERATIONS IN PEDS

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PEDS Gastrointestinal

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Cognitive,Sensory, and Communication Impairments-PEDS

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ENDOCRINE ALTERATIONS IN CHILDREN

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Fluid and Electrolytes

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Health Promotion of the Adolescent (12-18 years old)

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PEDS Cardiac

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Nursing Care for Epidural Pain Control

-Careful monitoring for respiratory depression -Record entry mark at beginning and end of shift -Skin care around catheter Insertion site (monitor for any type of leaking) -Assessment of pain -Treat itching with diphenhydramine or naloxone infusion

S&S of AGN

-DARK BROWN urine (coca-cola or tea colored!) HEMATURIA (blood in urine) -PERIORBITAL EDEMA (swelling around the face/eyes, seen more in the morning/AM) -PERIPHERAL EDEMA (in extremities, mostly lower) -HTN (can get DANGEROUSLY HIGH!!) -UOP is very decreased/low -shorter sickness than w/ nephrotic syndrome and they can recover and go home -Can go into HTN crisis b/c FVO

Malabsorption Disorders

-FTT -chronic diarrhea (lasting longer than 14 days!) -Abdominal distention

Facilitating Lip-Reading

-Get their attention before speaking -Touch lightly -Stand close -Face them at 45 degrees -Stand still at eye level -Use facial expressions -Eye contact important -Speak slow, clear and short -Incorporate family and media to help!

Normal Social/Emotional Development in Preschoolers Ages 3-6

-Have imaginary playmates- normal for Ages 3-6 -Play is important (play is the work of childhood!) -Aggressiveness at age 4 years is replaced w/ independence at age 5 -Have concrete thinking and don't understand but think in LITERAL TERMS (ex. the term "put to sleep" they may think means they won't ever wake up or won't ever go home, so try not to use those types of terms with patients, just use the normal jargon to explain)

Nursing Interventions for CP

-Increase calories d/t spasticity or increased motor function -Prevent aspiration- PUT FOOD IN BACK OF MOUTH! -Hold upright and hold head when feeding -Support lower jaw - Take Seizure precautions - Provide safe environment -Communication board

Trust vs. Mistrust

-Infancy (0-12 months) -infants trust that they will be fed, comforted, and cared for (have their needs met), and when not done the outcome is mistrust. CONSISTENCY of care is essential. Trust is needed to be met so that ALL other developments can occur

Developmental Dysplasia of Hip- Treatment & Nursing Care

-MUST wear Pavlik Harness at ALL times -teach skin care (can remove Pavlik Harness for bath) -ALWAYS wear onsie under pavlik harness -check area understraps for redness -always diaper UNDER the Pavlik Harness -Need followup and frequent adjustments to allow for growing -Patient may need spica cast if pavlik harness is not working.

4-6 months Sensory

-Make noises -say DA-DA first then MA-MA= monosyllabic babbling! -Polysyllabic babbling- says stuff like DA-DA and MA-MA but keep repeating it -Begins consonant sounds first then vowels -Responds to rhythms -tracks objects with eyes 180 degrees Want attention -Saying things but doesn't mean anything to anyone else -Make sure have an equal Red Eye Reflex, b/c if unequal may have a rare cancer called retinoblastoma.

The immobilized Child

-May need restraints to be immobilized b/c hard to immbolize a child -Immobilization inhibits growth & development, decreases muscle mass, strength, social problems, loss of joint immobility

Newest Guidelines for Pain Management

-Multimodal - using a variety of analgesic medications with nonpharmacological therapies -Using NSAIDs and/or acetaminophen around the clock as part of the multimodal analgesia for postoperative pain in adults and children -Switch to oral opioids after immediate post-op period in those who tolerate Multimodal pain management Orthopedic Patients- use prison protocol, try to use as many meds that are nonsedating and nonnarcotic as much as possible like acetaminophen and ibuprofen and gabapentin in ortho patients and then maybe an opioids if that is what helps them Switch to oral opioids in immediate post-op and in those who tolerate Try to stagger meds and do them around the clock, and then also do things nonpharmacologically like distraction or comfort measures, etc.

Cerebral Palsy (CP)

-NON-PROGRESSIVE motor disorder of the CNS resulting in alteration in movement and posture -alteration in VOLUNTARY muscular control r/t cerebral insult (ex. stroke in utero, etc.) Different types include= -Spastic= have eventual contractures, more common, scissoring of legs -Dyskinetic= non-spastic type -Ataxic= non-spastic type, can walk but has a WIDE GAIT

Isotonic dehydration

-Na+ is NORMAL (135-145) -Most common type of dehydration in PEDS -Is from vomiting and diarrhea -Major loss is from ECF -Danger/At Risk of SHOCK Tx: replace fluids OVER 24 HOURS

Infective Endocarditis (IE)

-This is of concern in children who have had cardiac surgery. These individuals develop an infection that sits on a prosthetic valve or mitral valve replacement. Bacteria colonizes in these areas. If the infection occurs, the progress of surgery is lost. Most commonly, this can occur through bacteria from the teeth. -Prophylactic antibiotics before dental work for highest-risk CHD patients; do not want to over use antibiotics! Also, give prophylaxis before soft tissue infections. -Meticulous dental hygiene very important in this population!

12 Month Check Up Visit

-lead screening at infancy,1 year, and 2 years old =Hct screening to check for iron deficiency anemia

Late Signs of Increased ICP in Infants & Children

-posturing -bradycardia (Low HR) -Increased BP -Alterations in pupil size and reactivity -Cheyne-Stokes Respirations (near death, deep & rapid initially resp then space apart w/ apnea- periods of deep &rapid resp. interchanged w/ periods of apnea!) -Decreased LOC (Level of Consciousness) -Coma (GCS 1-8)

Spiritual and Moral Development in Adolescents

-principled moral reasoning- a change in the concrete rules (right and wrong) to QUESTIONING ABSOLUTE RULES, occurs between puberty and adulthood -They understand orientation to justice more -POST-CONVENTIONAL (Kohlberg's Moral Stages)

Increased viscosity of mucous gland secretions results in what?

-results in mechanical obstruction, causes bronchopneumonia, thick mucoprotein -accumulates dilates, precipitates coagulates to form concentrations in glands and ducts "breeding ground" for bacteria!

Vision Screening for Preschoolers

-screen begins at 3 yeras old - Use Tumbling E or Lea symbol chart -ambylopia (lazy eye!) needs to be detected and treated by age 4 or serious complications! Check for strabismus This age group have binocular vision= where both eyes have to work together to see If have to get closer to board in like classroom setting then might have vision or even hearing problems, etc.

Safety for Preschoolers

-teach fire hazards and to stop,drop, and roll (this age can understand fire safety stuff now!) -Teach/enforce wear helmets w/ sports and teach how to put helmets on, etc. -Watch this age group around water still, safety important with possible drowning if don't know how to swim or still learning,etc. still Car Seats= these kids still need booster seat and to sit in the back seat, by certain weight they can transition to booster once they hit that weight requirement

Early Signs of Increased ICP in Infants

-tense, bulging fontanels -separated sutures -distended scalp veins -drowsiness -poor feeding -high-pitched cry -setting sun look

Western Biomedical View

-view of most in America -Reliance on doctors and pills -Faith in machines and equipment, lots of equipment -Preoccupation w/ time -Self-sufficiency -Individuality

Sensory Development of School Aged Children

-vision matures fully (eyes fully developed) by 7 years old -growth spurt in eyes causes myopia (nearsightedness) -These kids need yearly eye checks/visual screenings-- using the Snellen Chart!

Irreversible Shock S&S

-worry about CARDIAC ARREST - S&S = hypotension, COMA, anuria (NO UOP)

Toxic Epidermal Necrolysis

-worse than SJS -burns cover 30% of BSA affect -F&E imbalance -Have to go to/in burn unit -BURNING RASH present then flu S&S and then the rash worsens!

Sensorimotor

0-2 years old -Begins to interact with the environment, goes from reflex behavior to imitative activity. They learn separation (separate themselves from objects in the environment), object permanence (realizing that objects that leave the visual field exists at 9-10 months, ex. like realize mom was there but left in another room and is not totally gone, etc.), and last they achieve mental representation (which means they can think of an object or situation with experiencing it, symbol of understanding time and space). They learn causal relationships (connections between 2 events- ex. flipping light switch and it turns on lights, etc) but cannot transfer this understanding to new situations. Also learning spatial relationships and recognize different shapes and their relationship to one another, imitation such as domestic mimicry is shown.

Normal Reticulocytes

0.5-1.5% -They are BABY RBCs that carry O2 -High if acute and chronic hemolytic anemia and low if bone marrow failure/suppressed -Anemia from Vit B12, folate, or iron deficiencies

Communication with School Aged Kids

These kids are interested in/like to know how things work- demonstrations or visuals They like to draw- so use drawing as valuable form of communication! -Conversation - these kids like to talk about school so talk about school with them and they use an expanding vocabulary Engage these kids in thinks they enjoy or like to do in order to communicate with them and know the things you need to know about and ask and understand for their particular hospital visit reason, etc.

Anticipatory Teaching w/ School Aged Children and Families

These kids are resistant to hygiene so encourage parents that they need to reinforce hygiene habits, etc. Parents need to try and promote good hygiene as soon as possible with their children! They are resistant to baths, showers, brushing teeth etc then they will go from wanting to shower all the time when a little older -AKA the "Stinky period of childhood"

Health Promotion for School Aged Children

These kids need a health care visit about every 2 years now! Perform scoliosis screening at Dr's office, These kids have an increased appetite so ask about what they have had to eat and find out nutrition habits, etc. Check weight with this age group and ask what they had to eat for breakfast or lunch, etc. Will help as caregivers as far as finding out if they are getting an adequate nutrition.

Children under 10 years of age have what?

They have SOFTER BONES!

Media Use with School Aged Kids

Things like broadcast TV, social media, internet, video games, etc. difficult to limit But try to limit screen time SET LIMITS! Make designated unplugged time (like during meal times & at night for sleep!)

If K+ is INCREASED then what should we think about?

Think PROBLEM WITH THE CELL MEMBRANE & Think WATER AND REPLACE IT!

Internal Mechanisms

Thirst first, and kids will ignore this Hypothalamus tells ADH to be released which holds on to more urine, then Blood Volume is decreased and this stimulates the kidneys into RAAS when renin is release this causes vasoconstriction and angiotensin to release Aldosterone and that holds on to Na+ And increased Na+ leads to dehydration.

If identify type of hearing loss and treat before 6 months, what does this do?

This helps the child have typical communication by age 3 years old regardless of degree of hearing loss

Truncal Incurvation (Galant) reflex

This reflex is stimulated by suspending the infant ventrally, supporting the anterior chest wall in the palm of the hand. Pressure is applied along the spine in the thoracic area with thumb or cotton swab. The infant reflexes the trunk and swings the pelvis toward the stimulus.

Parasites

Tick born illnesses & worms

S&S of Hypocalcemia (Ca+ Low)

Tingling of fingertips, nose, ears Tetany Convulsions Laryngospasms Hypotension Cardiac Arrest

Preconventional

Toddler/Preschooler -punishment/obedience; they do NOT have any concern for right or wrong, they just think the action is good or bad according to if they get punished, regardless of the meaning. -By 36 months they have developed a conscience (conscience developed by 3 years of age!)

Mumps

Transmitted through SALIVARY SECRETIONS Use CONTACT AND DROPLET PRECAUTIONS Infectious BEFORE swelling Aseptic meningitis S&S= CNS signs of nuchal rigidity, lethargy, vomiting, orchitis

Down Syndrome

Trisomy 21 Most common genetic cause of cognitive impairment Mild to moderate impairment Male and Females affected equally in 1:8,000 births Have multiple congenital anomalies and a higher risk of Alzheimer's Need genetic testing and to see various other specialists

Erickson's Psychosocial Stages

Trust vs. Mistrust Autonomy vs. Shame & Doubt Initiative vs. Guilt Industry vs. Inferiority Identity vs. Role Confusion

Inflammatory Bowel Disease (IBD)

Two types: Crohn's Disease and Ulcerative Colitis (UC) S&S= abdominal pain, bloating, diarrhea, inflamamtion, QOL is an issue

Preschoolers Ages 3-5 need how much sleep??

10-13 hours of sleep per day which includes naps Sleep problems are common b/c active imaginations Extensive TV time is associated w/ sleep issues Can have Nightmares and Night Terrors

Normal Hemoglobin (Hgb)

11.5-15.5 g/dL

Toddlers at 12 months of age-3 years old need how much sleep?

12 months/1 year- 2 year olds need 11-14 hrs of sleep per day including naps 3-5 year olds need 11-13 hours per day including naps

Formal Operational

12 years and up+- begins at 11-14 years typically Can transcend the concrete situation and think about the future. Begin forming ABSTRACT THINKING AND POSSIBILITIES, such as sequence of future events. They are ABLE TO REASON & UNDERSTAND THINGS

Measles, Mumps, and Rubella (MMR) vaccine

1st dose MMR is given at 12-15 months, 2nd dose given at 4-6 years old!

Supplementing Iron AKA Ferrous Sulfate

2 divided doses daily on an empty stomach Is strong and bitter Given with citrus and Vit. C to absorb better (ex. orange juice) Stains teeth so use straw or syringe Can cause tarry green/black stool or constipation DO NOT take iron w/ tea (it has tannin) and will NOT be absorbed. Reticulocytes will be increased about a week after iron supplementation has been started

Atopic Dermatitis (Eczema)

Usually begins in infancy has a hereditary tendency- atopy! Asthma, allergic rhinitis in 80% of children with AD High levels of histamine trigger an inflammatory response! Chronic skin inflammation---erythema, edema, intense pruritus (itching) Dry skin, itchy----does better in humid environments!- wet

Preoperational

2-7 years old -Begins to represent the world symbolically. They think egocentrically (inability to see from another person's perspective), they speak egocentric or socialized. Mental symbolization is associated with prelogical reasoning (remembering that needles hurt or that people in scrubs hurt them), as a preschooler the egocentric though goes into social awareness and ability to consider another person's viewpoints. They do NOT understand time and still use MAGICAL THINKING (thinking whatever they think happens will happen, etc.)

Meningitis

3 types: bacterial, asceptic (viral), tuberculosis meningitis For bacterial type= isolate w/ droplet precautions for 24 hours until been on ABX for a full 24 hours Viral types= isolate w/ droplet precautions Tuberculin type= put on Airborne precautions & test family to ensure they don't have it as well

Mild Dehydration

3-5% Signs and Symptoms= thirsty, normal pulse, normal RR, irritable & fussy, Alert, UOP mildly decreased, cap refill > 2 seconds, mucous membranes normal to sticky, tears present, anterior fontanel is normal Tx= managed at home with oral rehydration solution (ORS) such as pedialyte with 50mL/kg over 4-6 hours and 10 mL/kg for each time had diarrhea/emesis (vomiting). Give small frequent sips, ORS popsicles, feed/breastfeed if they will eat

Normal Hematocrit (Hct)

35-45% Hct= the % of RBC to whole blood

Normal WBCs/leukocytes

4,500-17,00 check level by CBC w/ diff Granulocytes= neutrophils (acute bacterial infections!), basophils, and eosinophils (allergic reaction). Agranulocytes= monocyte and lymphocyte (viral infection) % of bands vs. segs Accelerated production of immature granulocytes leads to increased bands in the peripheral circulation causing SHIFT TO THE LEFT indicating bacterial infection. Agranulocyte means nothing is in the middle of the cell they go to an infection and start attack

Examples of Anticonvulsants (ACs)

Valprex Sodium Clorazepam Gabapentin (Neurontin) Lamotrigine Phenobarbital Phenytoin Topramate Valproic Acid

Vitamins that are most likely NOT consumed enough during the school-aged years are what???

Vitamins A, C, and B6 and B12 Ensure parents give them multivitamins, very important for this age group to take multivitamins at this age b/c they may not be getting all the nutrients they need with their meals, etc.

Vit D Toxicity S&S

Weakness, fatigue, lassitude N/V/D HA

How do you know if the seatbelt fits on a child?

When the lower lap belt is across the thighs, NOT the abdomen AND when the top belt fits across the chest NOT the neck!

Health Promotion of the Newborn & Infant

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Health Promotion of School Aged Child (6-12 years old)

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Respiratory Alterations in Children

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Urinary Tract Infections (UTIs) in children

a clinical condition that may involve the urethra and bladder (lower urinary tract), and the ureters, renal pelvis, calyces, and renal parenchyma (upper urinary tract).

Seizures

abnormal firing or electrical discharge in the brain d/t things like meningitis, infections, or genetic component, etc.

Acute Epiglottitis

bacterial sudden onset of sore throat in ages 2-8 year olds S&S= drooling (increased secretions), dysphonia, dysphagia, tripod position, retractions, flaring, inspiratory stridor, mild hypoxia, distress (NOT hoarse) and NO cough, is a MEDICAL EMERGENCY, occurs within hours Diagnosis with hypo

Motor Development of Newborns & Infants is......

based on infant reflexes

Salmeterol

beta 2 agonist long acting for acute and chronic wheezing, bronchospasm Adverse Effects- nervousness, tachycardia, jitteriness, DO NOT USE SPACER WITH THIS. Used no more than every 12 hours, not for children under 12 yo, NOT for acute S&S

Active Immunity

body reacts to antigens long-term immunity vaccinations

4-6 Months Age Appropriate Toys

bright colored & soft toys Toys small enough to grasp Anything that makes noise

Lower Respiratory Tract

bronchi, bronchioles, alveoli, lungs

2 Months of age GROSS MOTOR

by 2 months of age raises head and chest when lying on stomach and supports upper body with arms, called heads up 45 degrees, uses tummy time to teach and promote this

Moro, Rooting, and Tonic (Fencing) Reflex should be gone by when?

by 4 months of age!!!

Congenital Musculoskeletal Conditions in PEDS

clubfoot Developmental Dysplasia of the Hip Osteogenesis Imperfecta (OI)

Tension HAs

common TX= acetaminophen or ibuprofen- can have daily! If they take them on a set schedule then don't take them they can get a rebound HA that is WORSE!

Latex Sensitivity w/ SB

common in children with spina bifida (SB) d/t latex exposure early on in life and also b/c more prone to CKF want to avoid latex exposure like on latex gloves or items and foods that can also create that latex sensitivity

Increased RBCs could be d/t what?

congenital heart defects chronic hypoxia higher altitudes

Ductus Venosus

connects umbilical artery & inferior vena cava

Encoperesis

constipated and impacted and creates incontinence and leakage around stool soilage on the pants Educate the family/parents!

Premature Infants Respiratory Distress Syndrome

decreased surfactant from functional thorax being immature mostly in preterm infants

Suctioning

deep suction= throat short suction= nasal or oral

Autusm Spectrum Disorder (ASD)

developmental disorder of brain function characterized by deficits in intelligence and behavior More common w/ males 1:68 males Has abnormalities in behavior Interferes w/ ability to have social interactions and impairs verbal communication They have repetitive behaviors Don't like to have any eye contact Don't like cuddling with mom & dad

Diplopia

double vision

Beta Blockers

end in -OLOL slow AV conduction so the heart can fill better, decreased O2 requirements, for hypertension and arrhythmias Adverse Drug Reactions- hypoglycemia in children and masks S&S, sleep disturbances, drowsiness, fatigue, bradycardia, and hypotension Assess apical pulse and BP BEFORE GIVING Take at night and check blood sugar (BS)

Meds for CHF

enhance myocardial function

Hyperopia

farsightedness- see far not near!

S&S of Reye's Syndrome

fever impaired LOC disordered hepatic function metabolic encephalopathy cerebral edema fatty changes to liver (liver enzymes will show this) prolonged bleeding times

Otitis Media w/ Effusion (OME)

fluid in the ear WITHOUT signs of infection, observe only, NO ABX unless it lasts longer than 3 months

Russel Traction

for lower extremities w/ 2 lines pull (perpendicular/longitudinal), days-weeks bone realigned & muscle relax

Upper Airway Obstruction

foreign body swelling (croup, tonsils, epiglottitis), congenital narrowing, S&S of tachypnea, increased inspiratory effort, hoarse voice or cry, seal-life cough, STRIDOR

Atopy

genetic predisposition for IgE mediated response, strongest predisposing factor for getting asthma, may or may not have other allergies, atopy puts at risk for asthma, familial basis

Nursing Interventions for Increased ICP

gentle ROM exercises slowly Later being gastric feedings NG May be at risk for aspiration Elevate HOB if allowed

Treatment of DI

give vasopressin (ADH)= when subcut it MUST be mixerd with oil and brown particles in suspension and last 48-72 hours. If given intranasally in aqueous form lasts 8-12 hours and done at night with moistened cotton pledget with spray and insert into nostril. Can also give Desmopressin acetate (DDAVP)= synthetic ADH that promotes reabsorption of water in renal tubules, contraindicated if nephrogenic DI, give intranasal and duration is 6-24 hours, given 2x a day! DO NOT give an OTC cough/hay fever meds b/c they can decrease the drug response of the vasopressin or desmopressin (ADH)- so NO OTC cough or hat fever meds with vasopressin or desmopressin!

Benzodiazepines- Diazepam

given as buccal, rectal, or IV Is the 1st line tx of seizures incompatible w/ MANy diluents Give slowly and directly into the vein w/out dilution as closely as possible to the vein, can dilute w/ NS, D5W, or LR in 1:20 for 6-8hours (1:15 dilution results in immediate precipitation) Given close to vein, IV slow push! no dilution!

Centration

hard for toddlers to see the big picture and to finish, so focused and can't understand that one piece of the puzzle is part of what makes the picture, etc. Focus on one aspect, cannot see the big picture, cannot do puzzle b/c cannot imagine, focus on dominate features not fine

Cystitis

inflammation of the bladder, bladder is inflamed!

Indomethacin (Indocin)

inhibits prostaglandin synthesis, that helped keep open in utero will be inhibited to help close, closes PDA, surgical alternative Adverse Effects/Reactions- decreased renal blood flow, make sure UOP is adequate, and tell doctor, may need to decrease dose or increase fluids. Nursing Considerations= monitor murmur, BP, UOP, NA, glucose, platelet, electrolytes, and S&S of infection. Can mask S&S of infection, pay close attention to temperatures may cause necrotic entercolitis (NEC)

Type 2 DM

insulin resistance and may be overweight and high BMI Tx= weight loss and exercise and oral meds (MED triad!) such as glyburide and Glucophage/metformin to decrease glycogenesis of the liver and increase insulin sensitivity

S&S of Hypernatremia (Na+ High!)

intense thirst N/V Dry, sticky mucous membranes Flushed skin Hyperirritability Disorientation, seizures Nuchal Rigidity (neck stiffness)

Buck's Traction

keeps legs in extension

Pyelonephritis

kidney infection An acute, febrile UTI UPPER UTI TREATED PROMPTLY w/ ABX vesicoureteral REFLUX causes this! Is an infection of the structures of the kidneys

Death in School Aged Kids

may still associate misdeeds w/ death By age 7 yo they should have adult view of death being inevitable and irreversible (on Kaplan said 9 years old!) Become preoccupied about what happens after death Fear of influences by others, mostly parents Nursing Interventions = promote industry and self-esteem by them understanding what is happening, and let them control and participate, know about drugs, talk about feeligns, provide agression outlet by play

Treatment for Croup and LTB

mild -use outpatient hospital care moderate- get hospitalized for respiratory support and IV fluids, may need nebulized racemic epinephrine (breathing treatment with epinephrine) helps bronchodilate and relax smooth muscle- have to stay in ER for at least 4 hours till better, works within 30 min for up to 2 hours, monitor for 3 hours after for side effects, humidified, and short corticosteroids course (dexamethasone) even if mild S&S this will decrease severity if caught within the first 24 hours. cough and decongestants are contraindicated (b/c can lead to pneumonia), increase fluids, do NOT use heat humidifiers, cool humidifiers is okay/good

Triggers for Asthma

most only know 50% of triggers that include allergens, cold weather changes, infections, exercise, fatigue, emotional distress, environmental changes (ex. such as changing schools, starting new school, etc.)

Rapproachment

moves away and comes back for reassurance

Myopia

nearsightedness

Tiotropium

new med for pediatric patients long acting cholinergic antagonist, anticholinergic will decrease albuterol needs and improve night S&S Used for uncontrolled asthma

Upper Respiratory Tract

oropharynx, pharynx, larynx, trachea

Pierre Robin Sequence (PRS)

palate issues and the lower jaw is smaller or set back from the upper causes tongue to be displaced back and causes airway obstruction need surgery to repair and monitor their breathing Smaller jaw= micrognathia Set back jaw= retrognathia

Night terror

partial arousal from deep sleep in non-REM sleep in the first few hours of sleeping screaming and NOT aware of other person in room, NO intervention needed, normal

Immune Alteration Deficiencies in Children- Human Immunodeficiency Virus (HIV)

pediatric HIV/AIDs occurs mostly d/t perinatal transmission Rising HIV rate in adolescents d/t unprotected sex and drug use Clinical presentation of HIV in children----

Chronic supprative Otitis Media

perforation of the tympanic membrane 6-12 weeks or longer, give topical ABX drop (not oral!), drain and clean

Apnea of Prematurity

periods of apnea, periodic breather, lapse of breathing for 20 seconds, less than seconds is okay/normal as long as VS are not affected, if decreased O2 and decreased HR then apnea should NOT last more than 10 seconds is the recommendation Decreased O2, Decreased HR= apnea NOT good

acrocyanosis

peripheral cyanosis or bluish color on extremities -Considered normal for first 12 hours of life abnormal after 12 hours

2 month old Doctor visit

physical- should be smiling spontaneously, social smile, follows past midline w/ eyes, loves looking at faces and imitating them Strabismus= normal in the young infant but should NOT be present (should be gone) BY 3 MONTHS! Will turn head to sounds (mainly the parent's voice), and makes noises and coos (NOT babbling yet), could be deaf if does coo but does not turn head to sounds. First sign of being deaf is NOT babbling!

Assessment of Cardiac

pre and postnatal, color (blue, cyanotic), auscultate (murmur, gallops), pulse (equal bilaterally and in upper/lower), need initial BP in all 4 extremities, distended liver (CHF). Newborns, murmur can be heard also on their back and will get more faint as closing

Cystic Fibrosis (CF) Respiratory Manifestations/S&S

present in almost all patients but onset and extent are variable stagnation of mucus and bacterial colonization result in destruction of lung tissue, tenacious secretions are difficult to expectorate, obstruct bronchi and bronchioles

SIDS

prevent by laying the baby flat on back in crib with nothing else in crib with them

Erythropoietin

produces in the kidneys in response to tissue hypoxia -NEED iron to make RBCs! RBC is made when hypoxia

Death in Infants and Toddlers

proverbal and lack understanding outside their egocentricity Nursing Interventions= physical comfort, consistent routines and care takers, familiar objects (like special blanket)

S&S of Otitis Media

pulling/holding at ear (not always a positive sign), rolling head, pain, fever, enlarge post auricular cervical lymph glands

Ventriculoperitoneal shunt (VP Shunt or VPS)

put in for hydrocephalus after spina bifida or if had hydrocephalus from other reason -implant a catheter in the ventricle and the tubing goes all the way to the peritoneal cavity and it drains the CSF fluid into the peritoneal cavity to be absorbed there. -May be bulges on scalp where it was placed. This is permanent, and they may coil it so it can grow with them -Can have an occlusion or malfunction and may need a revision to fix

Nursing Interventions w/ Reye's Syndrome

put pt in a quiet, dark environment b/c of hepatic encephalopathy (makes you go crazy, stimulation makes it worse, toxins in brain) Discontinue ASA use Monitor for fever

Age Appropriate Toys for 2-4 months of Age

rattles, cradle gyms

Status Asthmaticus

respiratory distress continues despite vigorous therapeutic measures, medical emergency, humidified O2, aerosolized short acting beta 2 agonist, IV access, emergency treatment w/ epinephrine 0.01 mL/kg subcut maximum dose 0.3 mL unconscious patient give SABA, oral steroids, O2 and epi if unconscious. This causes an airway obstruction. These patients are at risk for asphyxia (lack of O2/suffocation) and cardiac arrest.

Foramen Ovale

should close when the baby takes first breath Is the flap that connects RA to LA allowing blood to shunt

MACE

similar to the Chair Tube but creates a stoma through the abdominal wall

4-6 Months Social/Emotional

smiles and laughs smiles at self in mirror comforting habits such as thumb sucking begins Demands attention by being fussy Have an increased interest & parent attachment Reciprocal cycle establishes trust and confidence in parents

Ciliary Reflex

stroking the eyelashes results in closure of one or both eyes (blinking!)

Rooting Reflex

stroking the infant's cheek or corner of the mouth will cause the infant to turn the head toward the side stroked and open the mouth. This reflex is less prominent AFTER 1 month of age.

Acute Otitis Media (AOM)

sudden, inflamed inner ear, rapid onset, pain, fever

Insensible Water Loss

sweat, respiratory secretions, droplets, coughs

Hypotensive Shock S&S

tachypnea moderate metabolic acidosis OLIGURIA COOL, PALE EXTREMITIES DECREASED LOC pronounced tachycardia poor capillary refil Developing hypotension Lethargic

Indicators of Cardiac Dysfunction

tachypnea, tachycardia (NOT bradycardia), FTT, poor weight gain, activity intolerance, developmental delay (especially gross motor), family hx of cardiac disease, NOT feeding well, increased respiratory infections and difficulty. They have decreased energy so they do NOT meet milestones and cannot keep up with their peers -If Sleeping HR increased above 160 = REPORT IT!!

Hypocalcemia S&S

tingling of fingertips, nose, ears Tetany Convulsions Laryngospasm Hypotension (decreased BP) Cardiac Arrest Trousseau &Chvostek's Signs

Irreversibility

toddlers have issues with this, can't see a process in reverse order, can't follow form end back to beginning, can't understand if you can take apart parts of a sandwich and put them back together again, etc. cannot see process in reverse, cannot recreate in mind if seen it done

Diabetes Insipidus (DI)

too little of ADH and NO reabsorbing they void a LOT (high UOP!) and are thirsty Dx when hypernatremic over 150, decreased SG <1.005, and normal BG levels Tx= replace ADH, they are at risk for HYPOVOLEMIC DEHYDRATION/SHOCK so do strict I&O and weigh daily, monitor for water intoxication if given too much meds and show S&S of SIADH

Passive Immunity

transfers from one person to another short-term immunity placental transfer( mother--> baby!) immunoglobulins ( Hep B infected pt given HBIG Hep B immunoglobulin short term)

Concussion

trauma-induced alteration in mental status that may or may not be w/ Loss of Consciousness S&S/Features- confusion, loss of memory, reduced speed in info. processing Teach them to NOT continue sport

Goal of Treatment for Meningococcemia

treat infection Keep organs viable Keep BP stable

Chait Tube/MACE

tube placed to provide irrigation can put down enema or laxative and have child sit on the toilet for 30 minutes to help them go and irrigate that bowel out to help with constipation issues that occur in SB -used for bowel irrigation, able to use an enema via the MACE, so whatever was prescribed to them will do a flush through the chait tube/MACE, might be set up to do once a day or every other day, sit them on commode for 30 minutes and promote bowel function and just helps set up that bowel regimen to help them go and reduce constipation

Complications of Peritoneal Dialysis

tunneling infections occlusion peritonitis leaks ventral hernia Maybe cannot void according to where the port is

Cause of Autsim

unknown Trying to find out Might be from infection in utero, genetics, low Vitamin D during pregnancy/in utero, low iron, overacitve inflammatory process

Compartment Syndrome

unrelieved pain even AFTER medications and elevation, decreased sensation, pale skin, weakness, swollen, shiny skin, can be BEFORE OR AFTER surgery. Can use a bivalve to help w/ swelling. Tx= call doc if have signs of it, then will do a fasciotomy and if don't do fasciotomy might do a bivalve to reduce swelling These patients will go to the ED and will need to call HCP if suspect this!

Inspiratory Breath Sounds indicate what?

upper airway problem (ex. croup syndromes)

Communication with Preschoolers

use simple sentences be careful with what words you use! Use play in explaining- ex. might be beneficial if in hospital might want to do medical play with this age group to help them understand their thought processes, what is happening to them or how surgery will go, etc. -This age group are starting to speak in full sentences

FLACC Pain Scale

used for children of any age who can't tell us if in pain or not able to understand or convey their pain level, etc. Used for any age like a nonverbal patient with CP that can't tell us numbers or understand how to rate a number pain rating, etc. Might have to be used across the gamut in peds patients Preverbal and Nonverbal Look at Face, Legs, Activity, Cry and Consolability (FLACC) Will practice pain assessment and record that in our careplan/paperwork for peds clinical-----won't chart this in VUNET but will use this to practice assessment on peds floor

Hemodialysis

used for patients w/ Acute Kidney Injury (AKI) Blood is circulated outside the body through artificial membranes that permit a similar passage of water and solutes

Hemofiltration

used in critically ill patients and with fluid volume overload (FVO) with no urine output Blood filtrate is circulated outside the body by hydrostatic pressure exerted across a semipermeable membrane with simultaneous infusion of a replacement solution

3-6 year old Fine Motor Skills

uses scissors at 4 years old Ties shoelaces at 5 years old! washes hands still in fantasy play scribbles and draws (important for learning to read and write!)

Constipation

usually happens w/ school-aged kids poblems at school won't use bathroom at school is #1 reason of constipation in children! Tx= give fluids, fiber (offer popcorn!), and exercise, reestablish normal bowel movements, do bowel regimen (sit on toilet x mins for x times a day!), avoid caffeine, Meds=give stool softeners, polyethylene glycol daily! Might use a Chait Tube or MACE

Prostaglandin

vasodilation of smooth muscle in the ductus arteriosus, to open or maintain the patency of DA, expected result to improve perfusion and oxygenation Adverse Reactions/Effects- respiratory depression, apnea, hypotension, bradycardia/tachycardia, jittery, diarrhea, inhibits platelet aggregation, monitor for bleeding. Nursing Considerations= support ventilation, infuse at separate IV site

Parent Self-Help Groups

veteran parents share experiences, they have practtical knowledge parent to parent

Auscultation of Breath Sounds

w/out stethoscope you may hear grunting, stridor, wheezing, barking cough (croup) WITH stethoscope= inspiratory and expiratory, fluid, crackles, diminished. Know when the last time breathing treatment was and assess BEFORE & AFTER

S&S of Hyponatremia (Na+ low!)

weakness HA, dizziness Nausea Abdominal Craps Confusion, apathy, progressing to lethargy Irritability weak pulse Decreased BP

Expiratory Breath Sounds indicate what?

wheezes lower airway obstruction/problem (asthma, bronchiolitis

Tune Up For CF

when PFT are decreased they need to go in for a tune up and get ABX usually stay about 2 weeks. Will get breathing treatment 3-4x/day

Jaundice

when is it normal? 2-3 days old is normal initially If it is early such as within 24 hours this is abnormal!- BAD!! -Can cause kernicutus= where bilirubin is attacked to the fatty parts of the brain.

Generalized Seizures

widespread discharge in BOTH sides of the brain----> suddent generalized movements or LOSS OF CONSCIOUSNESS Tonic (stiffening) Clonic (brief jerking), atonic (loss of muscle tone)

Types of Play

***Refer to Types of Play in Children Handout*** Parallel Play= toddlers play alongside another toddler but not playing together, play beside them Symbolic Play= playing and connected to imagination.....example= assign role to teddy bear or stick is a person domestic mimicry= see mom and dad do household chores and will imitate them

Down Syndrome Congenital Anomalies

***p.834 Box 21-5- REVIEW OVER!!*** Heart, septal defects (ASD & VSD defects) , common or aniofacial features (large), renal agenesis, Hirschsprung Disease, duodenal atresia, TEF, decreased immune system, sensory deficits (decreased feelings in hands/feet), hyper reflexes, hyperextensible, spasticity, increased weight/decreased height, hypotonic, muscles weak (like a rag doll!), atlantoaxial inability (bone at atlas at notch not fused right!), neck pain, decreased mobility, flat broad nasal bridge and inner epicanthal eye folds, upward outward slant of eyes; transverse palmar crease (simian crease), protruding tongue, short neck

Acne

More than 50% of adolescents are affected! Causes/Etiology: familial aspect hormonal influence Other influences can affect Psychosocial ramifications w/ acne= self-esteem issues!!

Patient Controlled Analgesia (PCA)

Morphine is gold standard drug of choice for PCA Dosage: 1 mg/ml typical for PCA usage

Controlled Analgesia (PCA) Drug of Choice for PEDS is what?

Morphine! Can use/take a PCA at 5 years of age or older (when they understand when and how to use the PCA pump button, etc.)

Worms

Most common is the pinworms Pinworms= will have anal itching at night, do the scotch tape test!! Tapeworms- will have weight loss! Roundworms- abdominal pain & distention Hookworms- anemia and malnutrition

Types of Spina Bifida (SB)

Occulta Cystica- Two types: Meningocele and Myelomeningocele

FACES Pain Scale

FACES Wong Baker FACES scale Used by the child to be able to tell you what their pain level is depending on their cognition and ability, kid needs to be at a level that they understand how to use this scale Might be pointing at a number 2 FACE but acting like a number 10 FACE 4 year olds= start using FACES pain scale with these kids

Signs of VP Shunt Malfunctioning???

FEVER, vomiting, personality changes, irritable, not eating well Tell parents to take their child to the ER if showing these signs and symptoms

If a patient has been at 50th % AND had 2 standard deviations, what should be considered???

Failure to Thrive (FTT)

Culturally Competent Nursing Care

-Be open minded and respectful and think "is what they are doing harming the patient?" -Use open ended cultural questions such as from pg. 40 Box 2-8 -NOT EVERYONE uses the western biomedical view of nursing care Asian, Chinese,Southeast Asia (Cambodians, Vietnamese, Laotian, etc.), Hispanic, Mexican-American, Muslim, and Amish, etc.

Neurological Assessment Considerations in Children

-Know their baseline -Ask family what normal development level they are at -Ask/Obtain cognitive baseline ( especially for those kids that have cognitive impairment or disabilities) -Get Preop and Post-Op Baseline to note any changes!

Diagnosis of Nephrotic Syndrome

-Lab results show 2-4+ protein in urine -Microscopic hematuria (little blood in urine, not like AGN has lots of blood in urine) - ELEVATED LIPIDS -ELEVATE H&H and PLATELETS ( makes them at risk for thrombosis/blood clot- increased clotting risk!!)

Tuberculin Meningitis

-S&S of fever, change in Level of Consciousness (LOC), and CNS involvement, seizures and neuro deficits, meningeal signs -Treatment is similar to bacterial meningitis NEED TO BE ON AIRBORNE PRECAUTIONS & family needs to be checked out for it

Doll's Eyes Reflex

IF the infant is placed in a supine position and the head is turned form side to side, the eyes should move to the opposite side.

Scarlet Fever

INFECTED by NASOPHARYNGEAL SECRETIONS- Place patient on DROPLET PRECAUTIONS Caused by GROUP A BETA-HEMOLYTIC STREP (GBHS) S&S= Strawberry red tongue Tx= Penicillin VK for full 10-14 days Can return to school AFTER 24 hours of ABX therapy and clinically improving Rash more intense in folds of joints strawberry tongue

Scabies

INTENSE itching especially at night Papules, vesciles, nodules at wrists, finger webs, elbows, umbilicus, axillae, groin, buttocks Tx= Permethrin 5%

Interventions for Cellulitis

IV ABX Elevation Warm, moist soaks q4h! Acetaminophen

Nursing Interventions of Meningococcemia

IV fluids Broad spectrum ABX (antibacterial, antifungal, and antiviral!) Notify of infection control Need O2/supplemental oxygen & blood

Treatment of DKA

IV fluids NS or 1/2 NS replaced evenly over 26-48 hours SLOWLY -IV insulin 0.1 U/kg/hr, as soon as voiding and insulin is given -Add K+ and when BG is at 250-300 add dextrose to solution D51/2NS

Treatment for Tetrology of Fallot

If Prostaglandins are NOT effective, then need Blalock Tausig shunt, surgery to help as palliative measure to get them through until old enough to do a primary repair surgery, helps with S&S shunts blood to take O2 send to lungs then brain (like DA), but they still need primary repair (cardio pulmonary bypass at around 12 months)

Infants Respiratory

If breathing OVER 60 BREATHS/MIN= hold feeds b/c they can aspirate, too high apnea of 20 seconds or longer is BAD check is chest rise normal? Abdominal distention can cause it to be unequal and harder to breathe

Brain Tumors

Most common solid tumor in children Most in peds are infratentorial (posterior third of brain, cerebellum/brainstem) 40% are supratentorial (the anterior 2/3 in the brain in the cerebrum) S&S= based off location infratentorial S&S: HA (especially after awakening) vomiting (not r/t feeding!) signs of increased ICP S&S of Supratentorial: seizures personality/behavior changes visual disturbances changes in school performance

Other Problems Seen in Spina Bifida (SB)

-clubfoot -dislocated hip -scoliosis -precocious puberty (d/t leuprolide acetate- puberty sped up a little bit b/c of this!) -cognitive impairment (sometimes, depending) -Learned Helplessness (d/t famlies doing everything for them, want to promote independence and make chidlren do things independently!)

Motor Activity of School Aged Children

-constantly active (gross motor skills!) -precise hand and eye coordination -Can play musical instruments now (fine motor skills!) -IgG and IgA are at adult levels

Side Effects of Ketogenic Diet

-constipation -weight loss -lethargy (especially at first) -kidney stones -poor bone mineral density -Diet is deficient in vitamins and minerals so MUST supplement!

Diarrhea

3 or more loose stools that take the shape of their container Sensible loss Can be caused by parasitic, viral, bacteria= all causes are called gastroenteritis

Moderate Dehydration

6-10% S&S= moderate thirst, slight increase in pulse, slight tachypnea (RR increased), lethargic but arousable, sunken fontanels, sunken eyes, Decreased UOP & concentrated urine Spec Grav 1.020-1.030, cap refill 2-4 seconds, dry mucous membranes, tears are decreased, anterior fontanel normal to sunken Tx= MAY be managed at home according to how they will drink, at this stage give ORS 100 mL/kg over 4-6 hours, feed/breastfeed if will tolerate, IV if needed is bolus 20 mL/kg over 20 minutes and assess after if need more, DON'T ADD K+ unless UOP is adequate, D5 1/2 NS at two times the hourly maintenance

Concrete Operational

7-12 years old -This means that children are able to use their thoughts to experience events and actions, and learn rules such as conservation (that physical matter does NOT appear and disappear with magic, etc.), they start UNDERSTANDING RELATIONSHIPS BETWEEN THINGS & IDEAS, and are able to MAKE JUDGEMENT BASED ON WHAT THEY THINK (conceptual thinking), they also learn to read, which is a valuable tool for independence

Mexican-Americans

A curandero/curandera Herbs/Teas Religious Artifacts Fate of the will of God

Sickle Cell Crisis

More cells sickle during crisis and clump easier! Clumping causes crisis and have a lot of pain. Pain is Nursing Interevention #1 to tx, Hemoglobin Electrophoresis verifies diagnosis by differentiating trait from actual diagnosis, this means sending off the blood. So if + screen then must get a Hgb Electrophoresis Nursing Diagnosis= Altered Tissue Perfusion r/t tissue hypoxia

Osteogenesis Imperfecta (OI)

AKA Brittle Bone Disease Multiple Fractures may be in different healing stages S&S= -bones fragile -blue sclera (sometimes)-was on exam HINT HINT! -discolored teeth -conductions heading losso by age 20-30 -translucent skin -easily bruised -short stature -spinal deformities

Chronic Kidney Disease/CKD/CRF

AKA CRF (Chronic Renal Failure) When the kidneys cannot maintain normal chemical structure of body fluids. Patients with this will have: uremia (high waste in the blood) Elevated BUN and creatinine levels Water and Sodium retention Is irreversible and progresses to ESRD and will need transplant

Decorticate Posturing

AKA FLEXION POSTURING -TO THE CORE = DeCORticate -looks like a cheerleader pose/move -rigid flexion with arms held tightly to the body -flexed elbows, wrists, and fingers and plantar flexed feet; legs are extended and internally rotated and possibly fine tremors or intense stiffness -Occurs with severe dysfunction of the cerebral cortex or with lesions to corticospinal tracts ABOVE the brainstem

Dialysis

AKA renal replacement therapy The process of separating colloids and crystalline substances in solution by the difference in their rate of diffusion through a semipermeable membrane Three types: hemodialysis, peritoneal dialysis, and heomfiltration

Emesis

AKA vomiting that precedes/BEFORE abdominal pain Give 5mL of ORS q5min AND ondansetron (Zofran) for upset stomach, popsicles for ORS If have emesis= 5-10 mL q5min if NO emesis= 2-5 mL q5min

Candidiasis Albicans

AKA- Thrush Oral= white, curd-like plaques on the tongue or gums that are difficult to remove Perineal candida= small, red papules with satellite lesions on perineum, thighs, and abdomen TX= Nystatin

Types of Immunity

Active and Passive

O2 Safety

avoid material that generate static electricity (NO wool or NO synthetic fabrics), USE cotton and avoid volatile flammable materials (NO oils, grease, alcohol, ether, acetones) near O2, be cautious of lip balms, ONLY use NON-PETROLEUM. Make sure electrical devices are in working order and prevent short circuits, smoke OUTSIDE and away from O2.

Bone Marrow Aspiration

can be done w/ conscious or unconscious sedation Relax Opioids EMLA can be painful aspirate from iliac crest of pelvis! NI= main thing is how they need to lay AFTER getting bone marrow aspiration is to lay them ON that side they got aspirated on and check site for bleeding, etc.

Tonsillectomy/Adenoidectomy

can be for obstructive sleep apnea, NO CODIENE, give acetaminophen, ibuprofen, at risk for bleeding even after 7-10 days, at risk for dehydration, strict I&O, no straws, crunchy/salty foods, no red foods (may assume blood), throat moist?, excessive swallowing means bleeding! Strep= sore throat, keep throat moist dehydration= at risk for bleeding!

Skin Breakdown issues in SB

can cause pressure ulcers when having to lay prone/on belly and when can't move much Prevent pressure ulcers Turn and reposition q2h Keep dry as much as possible

Lower Airway Obstruction

caused by asthma, bronchiolitis, S&S heard on expiration, wheezing, tachypnea, retractions, nasal flaring, cough, prolonged expiratory phase and effort

Impetigo

caused by staph aureus or GROUP A BETA-HEMOLYTIC STREP (GBHS) Transmitted by CONTACT- Highly contagious Exudate of honey-colored crusts Wash lesions 3 times a day W/ SOAP AND WATER Topical and oral ABXs KEEP NAILS SHORT Complication of impetigo caused by GBHS is acute glomerulonephritis!

Congestive Heart Failure (CHF)

causes depend on age <2 mo CHF r/t structural disease (PDA etc.) >2 mo CHF r/t HTN, renal failure, drug use, etc. CHF leads to chronic arrhythmia, left sided obstruction, myocardial dysfunction S&S of CHF= increased HR at rest, gallops, tired/fatigue, trouble feeding, decreased UOP, weakness, restlessness, cool extremities, decreased BP, developmental delays, poor weight gain, EARLIEST SIGN IS TACHYCARDIA In infants earliest sign is sleeping HR OVER 160!! <2 mo = structural >2 mo= HTN, renal failure

Skeletal Traction

cervical screws surgically implanted in the skull need pin care they stay months in the hospital DO NOT RELEASE WEIGHTS Dr. will do this sometimes and may give RN orders to release them THey have a Halo Vest or Brace to manually manipilate to align the spine with weights then will go back to get surgery for rod impant. Used for severe scoliosis Pin care for pins going into skin= -use NS (NO betadine or peroxide!) to clean w/ cotton swab -RN/Family can transition from bed to wheelchair ( a chair that holds weights) after taught and Dr. allows so they can go outside the room -pin care is q4h initially Nurse not allowed to mess with weights, only doctor can tell what weights to use, etc. Role of nurse is to provide good pin and skin care during this type of traction! Clean pins going into the skin with NS (nothing else!!)

Treatment of Seizures

change medications Diet (ketogenic diet!) Control and reduce frequency & severity Observe and document seizures!

Digoxin Toxicity

dyspnea, dizziness, HA, agitation, N/V, color vision disturbed (see yellow-green), blurred vision/halos, DIARRHEA, bradycardia, PVCs Decreased K+= Increased Digoxin (Digoxin Tox) Vomiting= hold med and draw digoxin levels

Nursing Considerations for Seizures

ease child to the floor Maintain privacy Protect from injury (SAFETY!) Place on side after seizure (b/c increased salivation and decreased swallow reflex after) Allow rest Educate regarding antiepileptic med administration and SEs

Nursing Interventions for PE

elevate HOB FIRST immediately and administer O2 Notify HCP STAT these patients will have SOB despite interventions rapid onset!! Need to report any bluish discoloration!

Diagnostic Criteria for FAS

growth deficiency (at or below 10th percentile and head circumference) All 3 facial features present Structural, neuro, or functional impairment Learning problems Decreased memory Decreased neuronal and white matter in brain Small Head Higher rates of mental health issues

Cephalocaudal

growth from HEAD-TO-TOE

Proximodistal

growth from THE CENTER OUTWARD

Croup

happens mainly in autum/winter months Happens in 6 months-3 years old S&S= barking cough, hoarseness, inspiratory stridor, respiratory distress, S&S tachypnea, distress Different forms of croup/croup syndromes= acute spasmodic croup from allergies, laryngotracheitis/LTB, epiglottitis, bacterial tracheitis- UPPER AIRWAY ISSUE

Organic Failure to Thrive (OFTT)

has a medical reason, ex. cystic fibrosis Reason for it, so maybe patient has CF or something is causing it like maybe mom didn't know how to mix formula, etc. Patient is losing a lot of weight and maybe mom only doing 1 scoop to an ounce of water instead of 2 scoops CAN BE REVERSIBLE and treated CF patients may always be underweight and getting them to eat can be difficult but you can work on it and increase their appetite at least some, etc.

School aged/Older kids Respiratory

have an increase in beta strep infection and mycoplasma bacteria

Toddler-preschool ages Respiratory

have increased viral infections (from starting daycare, etc.)

1-3 month old infants

have rapid weight gain of 1.5 lbs/month for the first 6 months of life, and a height gain of 1 inch/month for the first 6 months. Posterior fontanel (the base of the skull) closes by 2 months, should have concern if it is closing too fast Immunizations= get the D TAP at 2,4, and 6 months of age! Birth-4 months of age= head development (head is larger than chest) 4-7 months of age= hand development!

+ Kernig's Sign

have the child lying supoine and flex their hip 90 degrees, they won't be able to extend leg fully w/out bad pain.

+ Brudzinski's Sign

have them lie supine and lift neck up, the legs should also come up and will also have neck rigidity (nuchal rigidity) when bending neck and have pain

Head Injury

head trauma Minimal= GCS of 15 - NO loss of consciousness Mild = GCS of 14, brief loss of consciousness<5 min Moderate = GCS 9-13, loss of consciousness >5 min Severe= GCS 5-8 Critical= GCS 3-4

Sensorineural Hearing Loss Treatment

hearing aids may NOT be helpful and may cause pain! Can't treat this type of hearing loss medically Speech therapy IS HELPFUL NO hearing aids! YES NEED SPEECH THERAPY!

Traction

helps decrease pain preoperatively Does NOT reduce the fracture

Gastroschisis

herniation LATERAL TO THE UMBILICUS RING (usually the right!) NO PERITONEAL SAC The organs are exposed! NI= Gauze soaked in saline and wrap or saran wrap the organs

Asians

hierarchy of care, see nurses as above others, children and elderly are HIGHLY VALUED It's IMPOLITE TO SAY NO Prolonged eye contact is NOT POLITE Touching is limited Chi

Precipitating Factors for Sickle Cell Crisis (SCC)

hpoxia increased blood viscosity dehydration fever infections high altitudes hypoventilations cold vasoconstriction emotional or physical stress

BMI

if ABOVE 85% = considered OVERWEIGHT or OBESE, and counsel family about it >95%= Obese Overweight= 85-95% Healthy/Normal= 25-75% Below 5%= Underweight DO NOT DO BMIs until 2 years of age!!

What is a child who was once toilet trained previously and comes into the hospital and starts wetting the bed again, etc.?? What do you say to the parents??

if kids have already begun potty training and come into the hospital for whatever reason and they regress and are wetting the bed again, etc. then that means they are having a stressor on them while in hospital,so if parent is concerned about that their toddler was potty training and doing great then regressed back, explain it is normal for this to happen when undergoing a stressful event like being in hospital Other stressful events that might cause kid to regress are things like a big change in their life such as divorce, or death of an important family member or stressful family events

Magical Thought

if they wish something to happen it can and will happen, believe their thoughts are all powerful Ex. kid wishes parent was sick and they got sick so they think they made it happen by wishing it., need to help kids know things like that aren't their fault or didn't happen b/c they wished it,etc.

Chinese

illness is b/c an imbalance of yin and yang, herbs, tai chi, acupuncture, moxibustion by cupping (putting in the good and taking out the bad)

Animism

inanimate objects ar egiven life to these kids (ex. might think their teddy bear is alive and want to have their BP taken first or might scold stairs for making them fall down the steps, etc (ex. "Big Bird did it Mommy"-Morgan Elizabeth Cook at 2 years old lol)

Delayed Babbling is considered what?

is the 1st sign of deafness/hearing loss. Normally babbling after 5 months old should imitate parents, deaf infants will still coo and laugh at 3-4 months but babbling is delayed and noticed at 6 months old and NOT babbling by 10 months old is BAD! Worry at by 11 months old if NOT babbling da-da & ba-ba, etc.

Asthma and Nursing

know baseline respiratory, pre and post assessment with meds, pulse and quality, lung sounds, cyanosis

Decreased Cardiac Output if in Shock- what will that look like??

lethargic>coma, poor perfusion, mottled skin, extremities cool, weak thready pulses, poor capillary refill, acidosis, HIGH LACTATE (lactic acid), little/small UOP

Vagus Nerve Stimulation (for Seizure tx)

like a pacemaker surgically inserted, implantable device that prevents seizures by sending electrical activity to the brain Activated by a magnet that family member places on the generator Used when diet and meds DO NOT work for partial-complex and generalized siezures. Other surgical therapy used after all else fails= focal resections, corpus callostomy, lobectomy

Ulcerative Colitis (UC)

limited to the colon and rectum, mucosa and submucosa RECTAL BLEEDING is common SEVERE diarrhea Mild growth impairment Rare abdominal pain During flare ups, use antidiarrheal med and REHYDRATE Meds used = corticosteroid Surgery depends on the severity and will have a colostomy or ileostomy

When giving insulin IV, what should we do?

line and tubing MUST be primed and sit for 30 minutes BEFORE giving so insulin can bind to sites in tubing and the patient will get ALL insulin If the line and tubing are NOT primed the pt. will get LESS insulin PRIME YOUR TUBING AND LINE!!

Antihistamines

loratadine and cetirizine competes with histamine on H1 receptor sites, fexofenadine and agonizes histamine effects, side effects are dry mouth, HA, drowsiness, children may have paradoxical reactions such as restlessness, insomnia, and nervousness

Lactulose Intolerance

milk intolerance Have deficiency in lactase enzyme. Most formula is cow's milk based! Manage/Tx by: reduce dairy consumption, use probiotics, eat HARD cheese, cottage cheese and yogurt Change formula to a soy based one. Can be genetically inherited. Don't want to cut out ALL calcium b/c growing bones and bodies!

With SCD/SCA/SCC teach family to do what?

minimize deoxygenation promote hydration minimize crisis give immunizations (pneumococcal, meningococcal, HIB, and Hep B vaccines)

Rotavirus

most common cause of diarrhea in children less than 5 years of age! FECAL-ORAL ROUTE transmission Prevention= oral drops at 2,4,6 months

Peritoneal Dialysis

most common for children, easier to do at home, normally the color of solution should be straw colored or clear If urine is pink , brown or cloudy=TELL DR. ASAP!! The abdominal cavity acts as a semipermeable membrane through which water and solute of small molecular size move by osmosis and diffusion according to their respective concentrations on either side of the membrane

Absolute Neutrophil Count (ANC)

reflects the body's ability to handle bacterial infections should be checked daily until increased WBCs. If ANC is less than 500 then severe infection risk is present. Calculate by how? ANC= % of neutrophils (segs) and bands x true WBC

Feeding Intolerance

reflux, colic, diarrhea Spit up AFTER feeds, amount?? Manage/Tx w/ frequent small feeds and change formula. Usually not a complain with breastfed babies, but if it is then help change mom's diet intake.

Posterior Pituitary Hormones

releases ADH aka vasopressin and oxytocin!

Anterior Pituitary Hormones

releases TSH, GH, and ACTH, prolactin, LH, and FSH (LH and FSH from ovaries and tests) , and melanocyte stimulating hormone

Low/Decreased RBCs could be from what?

renal/kidney disease hematologic conditions w/ RBC destruction Iron Deficiency Anemias Vitamin B12 deficiency blood loss Bone marrow depression

Neutropenic Precautions

revere isolation (protect them form our germs!) good handwashing NO rectal temps NO live plants NO tampons NO humidifiers NO live vaccines Will be on contact MAYBE droplet precautions NO raw fruits or veggies

3-6 year old Gross Motor Skills

runs well, hops on 1 foot (will hop on 2 feet at 18 months then progresses to hopping on 1 foot around 3 years old) can ride a tricycle at 3 years old! walks up and down stairs well TIES SHOES BY 5 YEARS OLD!

Strep Throat

same as pharyngitis and treat with penicillin/amoxicillin 10 days OR erythromycin/cephalexin 10 days if allergic to PCN. Will have sore throat with strep and need ABX

10-12 Months Sensory/Language

says dada and mama w/meaning Specifically use dada and mama now Can call them and they will respond to simple verbal requests Knows own name, uses simple gestures Shakes head for "no" SAYS SIMPLE WORDS TO COMMUNICATE Has a 5 word vocabulary

Nightmares

scary dream followed by FULL AWAKENING In REM sleep second half of night, crying and aware of other person in room, will need to counsel if recurrent

Pectoris excavatum

seen in teenagers, have increased issues with the chest caving in

Proton Pump Inhibitors (PPIs)

ompeprazole, lansoprazole, blocks the pump that produces gastric acids. Indications for use= erosive esophagitis, GERD, H. Pylori. Adverse Effects/SEs= Ha, dizziness, nausea, abdominal pain, diarrhea, flatulence (gas), and an increase in oral anticoagulants with omeprazole. PPI, give at least 30 minutes prior to breakfast to be most effective

Discipline and Toddlers

Parents should... set limits toddlers respond to consistency and understand the word "no" so toddlers will respond best with consistency and guidelines Practice/Give positive reinforcement If toddler has temper tantrums= ISOLATE & IGNORE safely Inconsistent parenting increases temper in toddlers! They get frustrated if they cannot convey their thoughts.

Treatment of CF

Percussion with vest helps break secretions and mobilize (chest/vest physiotherapy), depends on patient participation and ability to clear secretions can also use postural drainage. Acapella is a positive expiratory pressure device that helps keep airways open. Meds: Mucolytic agents= pulmonzyme- given via a nebulizer; hydrolyzes DNA in sputum; give BEFORE chest physiotherapy and bronchodilator before ABX= vancomycin, tobramycin, cefepime, piperacillin/tazobactam extended infusion Diet= supplement ADEK fat soluble vitamins, HIGH PROTEIN, HIGH CALORIE, UNRESTRICTED FATS CF patients have the energy intake of 100-200% of a healthy person, they crave salt Pancreatic Enzymes- cannot absorb vitamins and nutrients, this is why we give enzyme before snacks and meal (30 min. before!). If they are NOT taking pancreatic enzymes then you will see azotorrhea (increased protein in stool- smells very stinky/foul) and steatorrhea (increased fat in stool, greasy stools) New CF Meds= ivafactor/lumafactor but used in a specific population of Cf pt, according to where the mutation on the chromosome is at.

Local Anesthetics: Lidocaine-Side effects:

Stinging and burning on injection Buffered lidocaine Warming lidocaine to body temperature

Hirschsprung Disease (toxic Mega colon!)

absence of neurons in the colon distended sigmoid and CANNOT PASS STOOL Ribbon-like stools if they do pass any stool Chronic constipation and pain w/ stool CANNOT pass meconium w/in first 48 hours of life! Emesis initially, notice within the first 6 weeks of life Do a suction rectal biopsy to dx! Tx= must treat w/ surgery! Take out aganglionic portion where neurons are NOt working and reconnect with colostomy after can reverse colostomy (take down) the colostomy only done to allow rectum to rest and heal; manage pain and NG tube to suction to take out and allow bowels to rest

Migraine HAs

acute recurrent caused from post-concussion syndrome Can have NSAIDs at higher dose (naproxen sodium) Tx= Beta Blockers (BB) daily prophylaxis, anticonvulsants (ACs) mild (Mag, B2, riboflavin) Can take Triptans in adolscents. Teach to get enough sleep and avoid triggers and decrease stress

Crohn's Disease

affects ENTIRE GI from the MOUTH TO ANUS AND ALL LAYERS Fistulas Anal lesions Severe anorexia Significant growth impairment Frequent abdominal pain Meds depend on where it is in the GI tract Surgery can cause regression Surgery is NOT as a relief like in UC Need HIGH PROTEIN diet NO RECTAL BLEEDING!

Quick Relief/Rescue Meds (SABA)

albuterol, ipratropium (anticholinergic), Magnesium (used in ICU for status asthmaticus)

Cardiac Catheterization

allows/is able to see what is going on and locate dysfunction, usually go thru right femoral or brachial vein. They are AT RISK FOR HEMORRHAGE AND ARRHYTHMIA, put on monitor, check for bleeding at site and check vital signs (for first 2 hours will be Q15min). Preop RN should mark all pulses to make easier to find, check all pulses bilaterally. When checking for bleeding under patient and around site, position extremity in flat straight position, DR will give time frame to lay flat supine usually 6 hours. More moving increases bleeding, change bandage q2days! Emergency Management of Bleeding= APPLY pressure 1 inch above the insertion site and call for help, get the cardiologist to come and assess. Discharge usually the day after, can change the pressure dressing. they should AVOID EXERCISE but can return to school. Dr will decide the length to time for no exercise, usually until the postop follow up appointment.

Cromolyn

anti-asthmatic, antiallergenic, mast cell stabilizer, few side effects, not used in children under 5 years of age. NOT for acute symptoms Prevents inflammatory response ONLY FOR 5 YO and UP!

Low H&H is due to what?

aplastic anemia renal/kidney disease iron deficiency bone marrow suppression Sickle Cell Disease (SCD) Overhydration hemorrhage (bleeding out!)

Plantar grasp reflex

applying fingertip pressure to the ball of the foot will cause the infant to curl toes and attempt to grasp the finger.

True Dawn Phenomenon

around 3am the body NORMALLY does a surge of glucose and the body handles it unless the person has DM! So in DM they get HIGH BS/BG levels and NEED to get breakfast ASAP in the morning as this will TURN OFF the adrenal reaction which causes the high BG levels Normal person will have insulin kick in to bring down that high BG that happens normally, but with diabetics they don't have that so the reason we HAVE TO GIVE THEM THEIR BREAKFAST IMMEDIATELY UPON WAKING!!

Communication with Adolescents

assess for abuse, suicide ideation & plans, alcohol, etc. Ensure confidentiality and privacy BUT there are limits (as nurse, you MUST tell if something life theatening to self or others= must tell Doctor!) IF they tell about abuse, self-harm it CANNOT STAY BETWEEN US Interview alone FIRST and then with parents. More casual conversation, open ended questions if educating use audiovisual, NEVER TALK DOWN to them, know they are able to comprehend adult topics and their affect is here and now "how will this affect me today?"

Vomiting

assess- when does it occur and what does it look like? Green bilious, projectile, any fever, abdominal pain -LEADS TO METABOLIC ALKALOSIS (ahk, ahk AHKalosis, I'm vomiting! lol)

Peak Flow Meter

assesses the severity of asthma how well the air is moving in the lungs, if decreased then that means decrease in airway space (narrowing), PFM can tell something is wrong even before S&S . Done in the morning, standing, huff and cough 2-3x to clear airway and set meter gauge on zero before beginning the test.

Glascow Coma Scale

assessment to rate LOC different according to if they can communicate and age. Check when pre and post operative from surgery, in the ER/ED, and if any change in LOC, Checks eyes (4), verbal (5), and motor (6). **REVIEW CHART** Best score = 15 Coma = <8 Complete Loss of Consciousness = 3 or less

Folic Acid Recommendation for Women of Childbearing Age or Women who Plan to Get Pregnant

at least 400 mcg or 0.4 mg DAILY!

Treatment of Epiglottitis

at risk for RESPIRATORY OBSTRUCTION Tx= NO tongue blades, do NOT try to assess epiglottitis, STAY CALM, keep patient calm, comfort pt, have emergency intubation equipment handy and ready, give Hib vaccine to prevent!, get cultures AFTER intubation, IV ABX 2-3 days, then PO ABX for 10 days

Type 1 DM

autoimmune destruction of beta cells and cannot make insulin

Toddler

autonomy vs. shame and doubt develop autonomy master locomotor and language skills Encourage independence in dressing and feeding Use security objects from home Provide gross motor activities Give choices (videos, books) Toys are PUSH/PULL, STUFFED ANIMALS, STORY BOOKS w/ pictures, take to the playroom. Teach parents to explain when they will be back and child will have negativism and ritualism, also expect regression, provide sensory play (water and fingerpainting)

Sickle Cell Anemia (SCA)

autosomal recessive condition Normal Hgb is replaced with sickle shaped Hgb Cells clump together and stop circulation in small vessels, the cells have ea life span on 10-20 days while normal RBCs is 120 days Sickle cells help prevent malaria Newborns are screend for this when born 255 change to get = MUST HAVE 2 carriers!!

Goals of Asthma

avoid exacerbations, avoid allergens/triggers, relieve episode promptly, relieve bronchospasm, monitor with peak flow meter (PFM), exercise when asthma is controlled. Make sure they know what meds are to be taken and when.

Reye's Syndrome

the reason we are cautious w/ Aspirin (salicylates) in Pediatrics/children- especially during viral illness like varicella or influenza -Causes Acute metabolic encephalopathy and hepatic problems ***NO ASA in viral illnesses (NO NO NO AT ALL) in ALL kids! Do Liver biopsy if suspect this in any patient!**

Sensible Water Loss

urine, stool, emesis

Which SCC is most common and non-life threatening??

Vasooclusive Crisis

Types of Sickle Cell Crises

Vasooclusive- stasis of blood causes ischemia and infarction;seriousness depends on site of occlusive crisis. Classic signs= Fever,Severe abdominal pain, Hand-foot syndrome (infants) - painful edematous hands and feet,Arthralgia, & Leg ulcers - mostly in adolescents Sequestration- life threatening, blood pools in the spleen, usually younger children, signs are profound anemia, hypovolemia, and shock, may need spleen removed before age 5 Aplastic- anemia r/t increased destruction of fragile RBCs, NOT RBCs carrying O2, signs are profound anemia and pallor Hyperhemolytic- accelerated rate of RBC destruction. Signs are anemia, jaundice, reticulocytes, decreased RBCs

Types of O2

Venturi Mask- 1 piece dial for % O2 Simple Face Mask- if won't keep on NC, flow rate of at least 5-10 L/min (if not high enough CO2 rebreathing will occur) Low Flow Nasal Canula- infants 0.1-2 L/min, children 0.5-4 L/min, adolscents 1-6 L/min High flow nasal canula increases positive pressure Nonrebreather- 2 way valve for higher O2 concentration, don't want for long term, flow rate must be enough to inflate bag 1/3 to 1/2 full during inspiration- acute hypoxia Humidify O2 so you don't dry out and cause nose to bleed. Use pinwheel and bubbles to help encourage deep breaths, works like incentive spirometer- use this if have asthma, it increases extend expiratory time/effetiveness Speaking Valve- Pasy Muir Valve, directs airflow through vocal chords. What are its benefits??- only for deflated cuffs, taste &smell better, better ability to swallow, better hid at, improves gas exchange Heat Moisture Exchange- put over the trach, artificial nose, thins secretions, humidifies, prevents small particles from getting in cover trach with a thin cloth to protect from cold air

What is a common cause of renal scarring in children?

Vesicoureteral Reflux associated with UTI

At 2 1/2 years and older what hearing screen do you use?

2 1/2 year olds= Use Conditioned Play Audiometry (make a game out of the test) audiometry at 4-5 years old and raise hand when they hear sound

Types of Cardiac Defects

Congenital- a defect that baby is born with, anatomical resulting in abnormal function Acquired- autoimmune, infection, environmental, and familial tendencies can cause this

Meningocele

Moderate form/type of SB posterior vertebral arches fail to fuse Sac protrusion w/ meninges and CSF along posterior vertebrae CAN MOVE LEGS MENINGO= affects just hte meninges and CSF

Transmucosal and Transdermal Analgesia

Oral transmucosal fentanyl Fentanyl transdermal patch Anesthetic creams (EMLA, LMX) Refrigerant sprays Pain patches- monitor when need to be changed and that they are still on there, where they are placed etc. Creams (EMLA, LMX)- might do that if accessing portacath or IV draw , takes about 45 minutes Refrigerant sprays- Freeze spray, might be used before IV sticks or pokes, etc. faster than cream

Priority of Care BEFORE SB patient goes to surgery??

PREVENT TRAUMA to SAC & NO URINE/FECES contaminate sac

Pain in Children

Pain is whatever the experiencing person says it is, existing whenever the person says it does." McCaffery & Pasero (1999) Pain is whatever the patient says it is -McCaffery- nurse that focused on pain and this goes all the way back to 1968 Chronic pain especially needs to be focused on, sometimes ignored by nurses and not treated accordingly so need to be mindful of pain and treating it Pain is a symptom that that child says it is, be mindful of parents if saying their child is having pain especially regarding their age level, etc. Different modes used to monitor pain level we can use

Retinoblastoma

congenital malignant tumpr in retina Has CAT'S EYE REFLEX most common sign strabismus 2nd most common red, painful eye w/ glaucoma, blindness (is a LATE SIGN), red reflex should happen But you can see while leukoria in one eye, especially in pictures! Remove eye (enucleation) if needed Can use radiation if early. If bilateral attempt to preserve vision in least affected eye -See Cat's Eye Reflex/leukoria AND strabismus, will take pictures and see flash- white in the eyes (CAT'S EYE REFLEX)

Transesophageal Fistula (TEF)

connections that are there that normally DO NOT occur Connections of the esophagus and trachea Reflex of gastric juices/acid in trachea They have excessive secretions that may look like frothy saliva Other signs= cyanosis, choking, abdominal secretions THEY NEED A G-TUBE and SURGERY to repair DO NOT FEED PO (by mouth!) if this is suspected! Make sure= AIRWAY IS PATENT & SUCTION IS AT BEDSIDE!!

PICA

consumption of non-nutritive sybstances (dirt, starch, lead based paints, paper, etc.) Happens in severe anemia and they crave it. Fix by supplementing iron

Status Epilepticus

continuous seizure occuring longer than 30 minutes OR series of seizures with NO intermittent regained LOC!

Goals for treating JIA

control pain preserve joint ROM and function There is NO CURE Decrease inflammation and promote normal growth and development - Eye exam called Slip lamp is used to check vision regularly and detect uvulitis/uveitis

Long Term/Preventative Meds

corticosteroids, Cromolyn, albuterol, salmeterol, leukotriene modifiers (such as montelukast)

Eye trauma

cover the eye that had the trauma with fox field and patch the good eye Need to see eye doctor! Do NOT remove object if object is in eye Get to the ED/ER ASAP!!

Strabismus

crossed eyes, Use cover/uncover test Risk factor for ambylopia (lazy eye) Close one eye when looking around the room. Lack of coordination of hte extraoccular muscles LACK OF BINOCULARITY after 4 months is normal and shold be treated to prevent ambylopia Unqueal red reflex Preferred eye (the one they lean on is the one that is NOT crossed)

Diuretics

decrease preload, enhances excretion of Na+, K+, and Cl (Chloride) by direct action at the ascending limb in the LOH. Furosemide most common in peds, excretes Na+, Cl and K. Monitor electrolytes, teach diet high in K+ Adverse Drug Reactions= nausea, GI upset, diarrhea, constipation, electrolyte disturbances, ototoxicity can occur (esp if renal patient!), monitor output and watch for ringing in the ears, avoid exposure to sun and tanning beds. Monitor for S&S of hypokalemia!!

Conductive Hearing Loss defects Treatment

decreased transmission of sounds Meds if r/t otitis media ear tubes placed bone anchored hearing aids can be placed NO speech therapy needed but DO need hearing aids NO SPEECH THERAPY YES need Hearing Aids!

Fetal Development

deficits in utero - neural tubal defects (NTDs) usually occur in the first few weeks of pregnancy, that is why a woman of child bearing age should take folic acid

Diabetes Insipidus w/ Increased ICP

dehydration increased urine (increased UOP) Increased thirst Urine Specific Gravity (SG) <1.005 High Na+

Neural Tubal Defects (NTDs)

develop into spinal cord and brain, are defects that come from embryonic neural tube and consistent the largest group of congenital anomalies with multifactorial inheritance. Failure of neural tube closure produces defects of varying degrees. They may involve the entire length of the neural tube or may be restricted to small area -Before birth, structures in the embryo -affects the brain and spinal cord during the first few weeks of life (in embryo during pregnancy) Reasons this occurs= woman doesn't know she is pregnant and not taking in enough folic acid

Hydrocephalus

develops d/t increased ICP because the imbalance between CSF absorption and production, causes enlarged ventricles -Ventricles are NOT filtering CSF effectively -Tx= typically VP shunt to drain that CSF -can still get it when child has a malfunctioning VP shunt

epilepsy

2 or more unprovoked seizures NOT r/t a fever

Infant

trust vs. mistrust established by trust and learning the environment by sensorimotor exploration, same caregiver, parents in room, keep home schedule. Toys are MOBILES, RATTLES, SQUEAKY TOYS

Moro Reflex

- AKA the "Startle!" reflex This reflex is elicited by placing the infant in a semi-upright position, allowing the head to momentarily fall backward, with immediate resupport by the examiner's hand. The infant symmetrically extends and abducts the harms and opens the hands, then adducts and partially flexes the arms as if in an embrace. The fingers extend except for the index finger and thumb, which are often semiflexed forming a characteristic "C" position. Following the return of the arms toward the body, the infant may relax or cry. -feel like falling, look like hugging a tree

Nursing Interventions for Child w/ Vision Issues

- Ensure safety -Ensure that everyone that goes in that room should introduce self -orient the patient -promote independence as much as possible -Keep consistency w/ home life and use same RN -Talk to child about what is going on

Health Promotion of the Toddler (12-36 months)

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Musculoskeletal/Neuromuscular Conditions in PEDS

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Pediatric Immunology & Infectious Diseases

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RENAL ALTERATIONS IN CHILDREN

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The Child with Cancer- PEDS CANCER

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The Terminally Ill Child

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Pain Management in Pediatric Patient

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Sulfamethoxazole/Trimethoprim (Bactrim)

-1st line treatment/med for UTI -Given BEFORE SLEEP/going to bed (so it can sit longer in the bladder) -Give with 8oz of water and increase water intake during medication regimen -It can cause photosensitivity so AVOID THE SUN! Serious SEs of Drug: -bruising -bleeding -aplastic anemia -jaundice -hepatic necrosis -mouth sores -joint aches -rashes -itching -sore throat -CAN cause Steven Johnson's Syndrome with scalded skin (IF you see FEVER, RASH, BLISTERING, SORE THROAT, HA these will lead to Steven's Johnson Syndrome so TELL DOCTOR AND STOP MED! Tell doc about rash no matter how mild it is!!)

Pediatric Med Adminsitration

-5 Rights of Medication Administration: right patient, right drug, right route, right dosage, right time, right documentation (6th right) -Hospital policies & procedures -High Alert Medications -RN Double Checks: -Heparin is a double check, -K+ is a double check -TPN and lipids is a double check -Double check= 2 nurses, the RN giving it and another RN and checking against the MAR etc. So if giving TPN and Lipids and an ABX like Vancomycin, is it compatible??

Juvenile Idiopathic Arthritis (JIA)

-AKA/used to be called Juvenile Rheumatoid Arthritis (JRA) -chronic inflammation of the synovium with joint effusion and destruction -most common chronic joint disease -Unknown cause -Adhesions between joint surfaces and ankyloses of joints. -Stiffness and swelling and loss of motion in affected joints, tender and warm but NO ERYTHEMA -No test to diagnose! -Increases & Worsens with stress

Osteomyelitis

-Acquired musculoskeletal issue -Bacteria in bone and bone marrow -Usually caused by Staph infection **BONE INFECTION** S&S in older child: - increased WBCs and ESR -fever -irritability -warmth -tenderness (localized over site of infection!) -erythema -limited ROM -lethargy -favoring affected extremity -holds extremity in semi-flexion and resists movement -Diagnostics= GET a CT/MRI if see S&S to see how deep the infection is, can be similar to malignancy so want to rule out leukemia or juvenile arthritis TX= -bedrest if severe -may need immobilization or surgery with splint or bivalve cast -will need HIGH DOSE ABX IV then oral abx -Will need surgery if abscess or ABX failure occurs.

Kawasaki's Disease

-Acute systemic autoimmune vasculitis of unknown cause that has three phases (distinctive to Pediatrics!) -Affects the vessels and can cause a coronary artery aneurysm. -Leading cause of acquired heart disease in children in the U.S. • Clinical manifestations: - Cervical lymphadenopathy - Red, cracked lips - Strawberry tongue - Erythematous palms - Reddened, dry eyes - Hands and feet edematous - Palms and soles erythematous Treatment: High dose IVIG and high dose aspirin Nursing Interventions: • Management of risk for fluid imbalance • Assess for signs of heart failure - Decreased UOP - Gallop rhythm - Tachycardia - Respiratory distress • Provide quiet, restful environment • Mouth care - lubricating ointment for lips • ROM in bath for arthritic pain • Acetaminophen for fever • Clear liquids/soft foods • Cool cloths • Gentle lotions • Monitor for allergic reaction during IVIG infusion • Cardiac monitoring during IVIG administration and any evidence of cardiac involvement • Provide support and respite for parents - very irritable child for a very long time

Identity vs. Role Confusion

-Adolescent (12-18 years old) -find out who they are!

What Are Nursing Interventions for the Unconscious Child w/ Increased ICP???

-Assess/Monitor ABCs (airway, breathing, circulation) -proper positioning -Avoid ANYTHINg that increases ICP (ex. cough, Valsalva maneuver, caffeine, pain, crying, suctioning, any stimulation, changing positions too much)

Dental health promotion in School Aged Kids

-At age 6 years old= loss of primary teeth and ERUPTION OF PERMANENT TEETH -Will replace about 4 teeth per year till 12 years old -Teach fluoride toothpaste and flossing -Teach about use of mouth guards with sports -Teach tobacco use at any age is BAD for teeth and health! (dangers of smokeless tobacco- may have provider step in with parents and kid to ask about if they are using tobacco, etc.) ***SO...you start getting primary teeth at 6 months old up to age 3 when all 20 primary teeth are in, then you lose primary teeth at 6 years old and permanent teeth will come 4 teeth per year up til age 12!***

7-9 months Sensory/Language

-Babbles contently to self upon waking -Responds to simple commands -Understands NO NO -Depth perception is developing -Identifies causal relationships -Can play peek-a-boo- associated w/ object permanence -Developing object permanence (mom walks out of room and infant looks for mom) -Motor activity is necessary for cognitive development

Atopic Dermatitis Nursing Interventions/Tx

Tepid bath with NO soap or mild soap, immediately followed with emollient (Aquaphor, Cetaphil, Eucerin), soft cotton PJs Room humidifiers MAY be helpful Avoid exposure to latex products and foods!

Hispanics

-Believes in family before anything else -Children are cherished -Have a flexible view of time (like maybe 11 am appointment they might get there at 11:30am) -Stoical (stick to their beliefs and very insistent on what they DON'T want) -Value touch & embracing w/ respect -Address the male of the family -Eldest family member consents -Make sure they understand you by having them "teach back" or demonstrate back to you

Nursing Interventions for Meningitis

-Check ABCs -Get IV access and bloodwork -Lumbar Puncture (LP) to get CSF -Stat start ABX (PCN and cephalosporins) -Monitor for increased ICP -Check temperature -If unstable or have increased ICP, then delay LP -DO NOT DELAY ABX regimen -Sterilization 2 hours AFTER ABX -Perform Neuro Cheks q4h -Monitor STRICT I&Os -Monitor electrolytes -Comfort measures -Compilations -Hearing Screen after discharge (6 months after diagnosis resolves) -Ensure decreased stimulation -NO pillows- b/c of comfort measures

Morning Hyperglycemia

-Check BG levels at 10pm, 2am, and 6am -will see this in pediatric patients even before breakfast Reason they check BG so frequently and intently at the beginning of a peds patient beginning insulin therapy for newly diagnosis of Type 1 DM, Will check around 10pmish at night time, if don't check then will check around 2am in the morning Different effects we see in hyperglycemia Do a lot of accuchecks initially with these children initially and while they get home to ensure no effects and get good control of diabetic state and BG

Neuro Assessment w/ Head Injury & Increased ICP

-Check VS, HR, BP, temp (hypothalamus damage) -Increased BP & Slow HR= called Cushing's Response and is rare in children, if it occurs that means brainstem herniation -Pupils (dilation occurs on the same side as pressure) -Papilledema (vision change r/t increased ICP; swelling on the optic nerve) -Pre-retinal hemorrhages = common w/ subdural hematoma and in non-accidental trauma (shaken baby syndrome)

Neurovascular Checks

-Check pulse distal to injury, color, temp, movement, sensation, swelling, and for pain. -Check 6 Ps (Pain, Paresthesia, Paresis, Pallor, Poikilothermia, & Pulselessness) -Check ALL immobilization casting to get a baseline- check baseline before casting! -cap refill should be pink & brisk to return <3 sec -Done q1-2h at hospital and q4h at home! **REPORT ANY BLUISH DISCOLORATION!!** **NV Checks are q1-2h in hospital & q4h at home!**

Problems seen in Spina Bifida (SB)

-Chiari Type 2 Malformation (abnormalities in the hindbrain) Brainstem and 4th ventricle protrudce through the foramen ovale at the back of hte brain and you will see S&S of HYDROCEPHALUS -Hydrocephalus -Neurogenic Bladder (hostile bladder! no bladder function!) -Ineffective bowel function -Loss of motor/sensory below lesion -Skin Breakdown

Congestive Heart Failure (CHF)

-Condition in which the heart is unable to pump effectively the volume of blood that is presented to it. -CHF is a common complication of congenital heart disease. It reflects the increased workload of the heart caused by shunts or obstructions. The two objectives in treating CHF are to reduce the workload of the heart and increase the cardiac output. Nursing Assessment 1. Tachypnea, shortness of breath 2. Tachycardia 3. Difficulty feeding 4. Cyanosis 5. Grunting, wheezing, pulmonary congestion 6. Edema (face, eyes of infants) , weight gain 7. Diaphoresis (especially head) 8. Hepatomegaly Nursing Diagnosis: Decreased cardiac output Impaired gas exchange Nursing Interventions: 1. Monitor vital signs frequently, and report signs of increasing distress 2. Assess respiratory functioning frequently 3. Elevate head of bed, or use infant seat 4. Administer oxygen therapy as prescribed 5. Administer digoxin and diuretics as prescribed 6. Weigh frequently (may be every shift for infants) a. When frequent weights are required, weigh client on the same scale at the same time of day so that accurate comparisons can be made 7. Maintain strict input and output, weighing all diapers 8. Report any unusual weight gains 9. Provide low sodium diet for formula gavage/bolus feed infants if unable to get adequate nutrition by mouth 10. Continue care for infant or child with a congenital defect as indicated

Middle Adolescent (15=17 years old)

-Conformity -Most ( About 46.7 %) have sexual intercourse/experience -peer orientation of upmost importance- acceptance by peers is their total focus -Abstract thinking (idealistic, political and social concerns) Teach safe sex, etc. important at this age, and try to promote parents discuss/talk with/educate their adolescent about safe sex practices and what they expect, etc. is important at this age too

Ineffective Bowel Function in SB

-Constipation big issue in SB! -Want to prevent constipation! -Want To establish a bowel management/regimen -Chait Tubes or MACE helps with management of bowel function!

Tetrology of Fallot

-Cyanotic, or Decreased Blood Flow, Right- to- left shunt -Tetralogy of Fallot consists of four defects: -Pulmonary stenosis that obstructs right ventricular outflow: 1.VSD 2. Overriding aorta 3. Right ventricular hypertrophy. The severity of the pulmonary stenosis is related to the degree of right ventricular hypertrophy and the extent of shunting 4. Cyanosis occurs because unoxygenated blood is pumped into the systemic circulation -Infant with cyanotic heart defect by require prostaglandin administration prior to surgery to keep the PDA open. -Decreased pulmonary circulation occurs because of the pulmonic stenosis -The child experiences hypoxic episodes or "tet" spells. They are relieved by the child squatting or the infant being placed in the knee-chest position -Tetralogy of Fallot requires staged surgery for correction. decreased pulmonary blood flow Have 4 defects = VSD, pulmonic stenosis (trouble getting blood flow to lungs due to pulmonic valve stenosis), overriding aorta (R & L constantly mixing blood), RVH (thick heart muscle due to overworking to push past stenosis and build muscle). They are blue at birth and O2 does NOT help, blood is NOT fully oxygenated. Hopefully diagnose in utero so we have everything (PGE) prepared after birth. It is the most common cyanotic lesion, hallmark sign is a BOOT SHAPED HEART w/ xray (AFTER vessels have hypertrophy, initially x-ray will be normal), may need PGE to keep PDA open, clubbing (long term), cyanotic tet spells (acute episodes of cyanosis and hypoxia, increases risks), squatting during spells ( KNEES TO CHEST- to increase pressure in lower body, learn on their own to adapt) They are at risk for emboli, siezures, LOC change, sudden death, S&S depend on severity They are chronically hypoxic which leads to increased erythropoietin (due to kidney thinks there isn't enough due to low O2), increased RBC production, increased Hgb & Hct (H/H) leading to increased clotting and polycythemia (keep hydrated!)

Decreased Metabolism causes what?

-Decreased demand for O2/CO2 exchange causes the respirations to get slower and more shallow. -Reduced energy leads to anorexia

Acute Renal Failure (ARF)

AKA Aute Renal/Kidney Injry (AKI) -Kidneys cannot regulate the volume and composition of urine, usually r/t dehydration -Abrupt and rapid decline in kidney function! -Can get WATER INTOXICATION & HYPONATREMIA (low Na+)

Lyme Disease Treatment

-Doxycycline for children 8 years or older -Amoxicillin for those under 8 years old -IF Allergy to PCN will have to give them erythromycin or cefuroxime!

S&S of Nephrotic Syndrome

-EDEMA = generalized & severe (look like michelin man!) -MASSIVE PROTEINURIA (too much protein in urine!) -HYPERLIPIDEMIA -Edema is extreme (all over!) -Weight gain WITH abdominal swelling -golden, yellow foamy/frothy urine -Decreased appetite -Nausea and anorexia - low serum albumin (HYPOALBUMINEMIA) -Immunoglobulins are LOST leading to altered immunity (risk for infections!)

Treatment of Autism Spectrum Disorder (ASD)

-Early intervention is key! -Can use therapy and meds sometimes are used -Ventalfaxine----> Med for Autism used -Keeping Routine is recommended/used -Communicate in short commands -Identify emotional disturbances -Use FLACC pain scale w/ these kids -Encourage parents to stay -Ask parents how you should communicate w/ these kids! -These kids may use a board,speak, or are even nonverbal -Can use a weighted vest/blanket to help with any sensory issues and feedback and to help refocus

Decreased Pulmonary Blood Flow Defects

Tetrology of Fallot Triscupid Atresia Transposition of the Great Vessels Right to Left Shunting Blood is shunting away from the lungs Look blues blue and CYANOTIC

How Do we PREVENT UTIs?

-Females old enough should wipe front-to-back -Wear cotton panties/underwear -AVOID holding in pee -Empty bladder completely! -Treat any constipation as prescribed/indicated -HIGH FIBER DIET (give em popcorn if need be!) -NO bubble baths (harbors bacteria b/c more alkaline solution!) -Change diapers frequently ( don't want them to sit in pee or poop, can cause infection!) -***Drink 100 mL/kg of clear liquids or give 100 mL/kg*** -NO Caffeine or carbonated beverages -Adolescents/sexually active need to URINATE AFTER SEX/INTERCOURSE -Observe for parasites (pinworms) if bottom is itchy b/c can transmit to the front, etc.

Dental Considerations for Preschoolers

-First dental exam is at age 3 years old -Brush teeth 2 x per day -See dentist every 6 months -Need to use fluoride supplements after 3 years of age and able to spit out (don't start fluoride any sooner than that!)

UTI S&S in older Children

-Frequency -Strong smelling urine -HEMATURIA (blood in urine) -ENURESIS (bed-wetting!) -DYSURIA (pain w/ urination) -fever -abdominal pain in <4 year old -Flank pain in >4 year old -Specific Gravity, color/clarity, and pH of urine effected!

Physical Development of School Aged Child (6-12 yo)

-Gains 5.5 lb per year -Grows 2 inches per year -Growth spurt is at 10-12 years old for girls (puberty onset) and 12-14 for boys -They sleep 9-12 hours at night -Enlarged tonsils/adenoids normal for this age

Non-pharmacologic Pain Management in Neonates

-Give 24% sucrose water (sugar water on paci!) -Swaddling in the neonate -Keeping the parents close by, involved

Early Signs of Increased ICP in Child

-HA -N/V -seizures -blurred/double vision -lethargy -increased sleepiness

Anticipatory Teaching for Toddlers & Families

-Have consistent, regular meal times with utensils that fit for them and with the whole family -Use soft toothbrush and non-fluoride toothpaste -Make sure they sleep at least 11-14 hours per day including for 1-2 year olds and 11-13 hours per day including naps for 3-5 year olds -Limit TV time and electronics to less than 1 hour per day -Have a bedtime routine (consistency!)

Well-Child Doc Visit for Preschoolers

-Hgb and Hct between 3 and 5 years old -Lead screen if at risk or not done at 1 and 2 year old visits. -Normal Hgb 11.5-14.5 g/dL -Vision screening more detailed at 3-5 years old then done regularly -Hearing screening at age 4 and -UA if bedwetting issues

Foods NOT to Feed a Baby BEFORE 1 year of Age

-Honey (b/c concern for botulism) -Hot dogs, grapes, hard candies, raw carrots, popcorn (choking,aspirating risk/hazard!) -Nuts and Peanut Butter (concern for allergies) -Cow's Milk (cannot digest before 1 year of age and can cause blood in stool if give it too early!)

Nursing Interventions for Increased ICP

-IV fluids and TPN (total parenteral nutrition) -STRICT I&O monitoring -Monitor for DI and SIADH -Monitor for Cerebral Edema

Late Adolecence (Ages 18-21 years old)

-Idealistic -Emancipation from parents completely at this age (by age 18-21 years old) -This age they are TRANSITIONING TO ADULTHOOD! -On their own and trying to be independent -Help these kids transition to adulthood and college by making sure they are getting right vaccines for college and jobs and educate them still about safe sex practices still at this age

What makes a toddler ready for toilet training??

-If fall asleep and wake up dry= good sign they are probably ready to start potty training -If able to say they are wet then that is also a good sign to start transitioning from diapers to potty train! -if can hold it or recant the urge -if can communicate to parents they need to go potty. -Can follow directions -can sit, walk, squat -ability to stay dry for 2 hours -wake up dry from naps -decreased wet diapets -voluntary control (which starts 22-30 months of age) -time **** -can remove own clothing -willing to let go of a toy when asked -been walking for 1 year -Knows when they have to go to the bathroom -notices when their diaper is wet -family not under major stressors -wants to please parents by staying dry -communicated when they need to go

Immunizations in HIV

-Immunize w/ non-live vaccines! -Pneumococcal and influenza vaccines -Assess CD4 counts BEFORE giving MMR and varicella!

Normal Physical Characteristics/Development of Newborns

-Incomplete brain, incomplete myelination, rapid growth the first 2 years of life -Neonate usually LOSES 10% of birth weight by 2-4 days old, then start gaining it back -Colostrum (first milk mom creates after birth before regular breast milk develops) helps with giving immunoglobulins

Colic

-Inconsolable crying lasting 3 hours or longer per day where there is NO cause. -Nothing will console or stop the crying, baby is very fussy -Puts stress on parents -Babies with colic= at risk for Shaken Baby Syndrome -Usually resolves by 3 months of age -Teach parents= change the formula type (formula modification), burp more often (frequent burping), hold them (need warmth to abdomen), and cuddling and closeness, teach no massaging by can put the baby's abdomen up on shoulder for pressure to help relieve their discomfort, etc. ***SATA question on EXAM- HINT HINT***

Atrial Septal Defect (ASD)

-Increased pulmonary blood flow defect (Acyanotic) -There is a hole between the atria -Oxygenated blood from the left atrium is shunted to the right atrium and lungs(Left to right shunt) -Most defects do not compromise children seriously -Surgical closure is recommended before school age. It can lead to significant problems, such as congestive heart failure or atrial dysrhythmias later in life if not corrected hole between the atriums, initially the foramen ovale, small should monitor, may or may not hear a murmur, 2x more common in females, monitor, make sure the child is growing and playing approximately, usually asymptomatic and grow out of If have S&S then may need repair. THe chronic excess blood flow to lungs leads to pulmonary vascular obstructive disease, atrial dysrhythmias form atrial enlargement, surgical or nonsurgical cardiac cath is done to prevent pulmonary vascular obstructive disease From Foramen Ovale not closing!

Ventricular Septal Defect (VSD)

-Increased pulmonary blood flow defect (Acyanotic) -There is a hole between the ventricles -Oxygenated blood from the left ventricle is shunted to the right ventricle and recirculated to the lungs (Left to right shunt) -Small defects may close spontaneously -Large defects may require surgical closures hole between the ventricles, LOUD MURMUR, should close on its own, chronic VSD leads to increased pulmonary vascular resistance (causes pulmonary HTN) , fine as long as no S&S, need repair if so. Surgical or non-surgical cardiac cath most common

Patent Ductus Arteriosus (PDA)

-Increased pulmonary blood flow defect (Acyanotic) -There is an abnormal opening between the aorta and the pulmonary artery. -It usually closes within 72 hours after birth -If it remains patent, oxygenated blood from the aorta returns to the pulmonary artery. -Increased blood flow to the lungs causes pulmonary hypertension -It may require medical intervention with indomethacin (Indocin) administration or surgical closure common in premies, closes with O2 and falling prostaglandin levels, Indomethacin, can have cardiac cath for embolization, will close soon after birth, if not need meds!

Fears During Hospitalization for School Aged Kids

-Loss of control -Body injury -Failure to live up to expectations (like with missing school & getting school work done or missing extracurriculars, etc.) -Death Nursing Considerations/Interventions for these Fears: -Give choices, provide concrete explanations (don't sugar coat), contact with peers, emphasize normal things child can do, have schoolwork brought to hospital so they can keep up -By age 9-10 they have a concept of death and understand it is unavoidable and inevitable so allow them to talk about it if want to, and don't sugar coat anything about their diagnosis, etc.

Diagnostics for Meningitis

-Lumbar Puncture (LP) is gold standard/definitive -Also get blood -Nose and throat culture -CSF will be cloudy -Increased WBCs count -Increased Proteins -Decreased glucose -Blood Culture can be positive when CSF was negative!

Muslims

-Men are considered the breadwinner and protectors (Man is the head of the family!) -Women are responsible for the children -Women want a female HCP -Physician is NOT/rarely questioned -They do NOT eat pork (no pork in diet!) -Family usually stays w/ ill member -Food is usually brought from home -NO direct eye contact ( it is disrespectful!) -Knock and wait (b/c women wear veils and scarves to cover up head so give them time to put their scarf over head, etc.) -Be courteous to work medication times or care times around their prayer times as much as possible!

Nursing Interventions for Fractures

-Monitor circulation -Examine for bruising, lacerations, and swelling - Do Neurovascular Checks q1-2h = Check 6 Ps! -Make sure open wounds are cleaned and covered BEFORE casting( b/c increase in infection risk!)

Neuroblastoma

-Most common malignant extracranial solid tumor in children -Most commonly in in the adrenal gland or retroperitoneal sympathetic chain Can be in head, neck, chest, and pelvis, abdominal mass that CROSSES midline, can compress the kidney, ureter, bladder, causing urinary retention or frequency S&S= -abdominal pain -hard to diagnose and treat -metastasis may have alrady occured -decreased survival compaired to Wilms Tumor -worse and crosses the midline compared to Wilms -younger age at diagnosis means better prognosis

Treatment of JIA

-NSAIDs such as naproxen and ibuprofen -NO aspirin -Meloxicam -DMARDS (Disease Modifying Rheumatic Drugs)= (ex. include- methotrexate, sulfasalzine, hydroxychloroquine)- these prevent progression and decrease joint destruction and decrease loss of function! Methotrexate= most common DMARDs -Corticosteroids -Biological Agents- helps increase quality of life, decrease progression of joint erosion; use after if DMARDS are unsuccessful, but avoid if can b/c they are IMMUNOMODULATORS

Coarctation of the Aorta (COA)

-Obstructive Blood Flow defect -There is an obstructive narrowing of the aorta -The most common sites are the aortic valve and the aorta near the ductus arteriosus -A common finding is hypertension in the upper extremities and decreased or absent pulses in the lower extremities -It may require surgical correction need to do BP in all 4 extremities, upper extremities BP and pulses WILL be stronger/higher than the lower extremities BP Treatment= remove the constricting part of aorta -Will have a decreased BP/pulse in lower extremities!

Spinal Muscular Atrophy Type 1 (Werdnig Hoffman)

-PROGRESSIVE muscle weakness and wasting of skeletal muscles and LMN (lower motor neurons) -AKA "Floppy Infant Syndrome" -Is Autosomal Recessive and there is NO CURE -Pts have head lag and congenital HYPOTONIA -Usually is diagnosed AT BIRTH -Death usually around 2 YEARS OLD d/t respiratory failure -Child is intellectually normal and realizes what is happening

Amish

-Prefer to give birth and die at home -Disability is feared more than death -Modesty highly valued -Reluctant to discuss personal issues -Conservative & modest -Children are taught to be stoic (taught to mind adults and listen and behave well!) -NO PHOTOS -NO Heart transplants -They pay out of pocket for medical expenses -NO Modern Equipment -Very community-based and helping -If sending medical equipment/meds/materials home, think about if it can be used WITHOUT electricity, b/c they don't use electricity

Initiative vs. Guilt

-Preschool (3-6 years old) -In a stage of energetic learning and have a sense of accomplishment with their tasks, also a feeling of guilt and anxiety when not behaving. The superego or conscience and learning RIGHT FROM WRONG is developing and they SEE SOMETHING IS ACCEPTABLE OR NOT. It is common to wish that a parent was dead during this transition. -Feeling secure and leading others OR sense of guilt and remain a follower

Systemic Hypertension

-Primary: no known cause -Secondary: identifiable cause -Pediatrics: hypertension generally secondary to structural abnormality or underlying pathologic condition: -Renal disease (most common) -Cardiovascular disease -Endocrine or neurologic disorders -BP should be measured annually in children and adolescents > or = to 3 years of age.

Promoting Self-Esteem in School Aged Children

-Promote by giving chores to help with responsibility -Help with industry development, emphasize strengths, do NOT do homework for them but only help and support them= Emphasize the child's strengths (things they do well, like if excel in sports encourage that, if read well encourage them to read more, etc.) -Allow children to make mistakes -BE CONSISTENT!- consistency still important! continue to have consistency like with meal times and family meals and constant sleep schedules/times, keep schedules as consistent as possible

Physical Development of the Adolscent

-Rapid growth Peak Height Velocity (PHV)- girls at 12 years old, and boys at 14 years old -Sleep time reduces from 12 hours at 6 years to 9-10 hours at 12 years old! Boys (read pg. 656)- occurs at age 14, first you see testicular enlargement and then scrotal change, this is the ONSET of puberty, see increase in muscle mass, GYNECOMASTIA= may occur then decrease after 1 year, steroids or endocrine issues or increased testosterone makes that worse Girls (read pg. 654)- occurs at age 12- growth in height stops 2-2.5 years AFTER onset of menarche/first period, girls sexual maturation occurs about 2 years earlier than boys, have an increase in fat deposits, breast buds are the first visible sign of puberty

Side-Effects of PCA Use

-Respiratory depression - Check Respiratory rate q 2 hours with PCA use -Oxygen saturation monitoring -Naloxone order in med profile (Naloxone has a short half-life) Itching - Tx w/Diphenhydramine and/or Naloxone infusion Constipation -Treat with= Stool softeners, increased fiber, increased fluids, laxatives

Late Signs of Hydrocephalus in Infant

-SETTING SUN sign (eyes appear fixated downward w/ upward gaze, see sclera above the iris) -Muscular issues in eyes -Frontal bone enlargement (Bossing) -Vomiting -Difficulty swallowing or feeding -Increased BP -Decreased HR -ALTERED RESPIRATORY PATTERN -Shrill, High-Pitched, ear piercing cry = Neuro Cry -Sluggish/Unequal Pupillary Responses TEACH parents to be aware of head size changing & report to doctor immediately

7-9 Months Nutrition

-SLOWLY introduce foods-soft mashed table foods -NO egg whites until 1 year d/t allergies -Peanuts= can expose to a type of peanut product if low risk to help prevent peanut allergies from developing.

Early Signs of Hydrocephalus in CHILD

-Strabismus/Diplopia -HA in the morning/AM that's relieved by vomiting or sitting up -N/V (projectile vomiting!) -Restlessness -Behavioral/personality changes -Ataxia -Sluggish/Unequal Pupillary Responses -Confusion -Changes in school work/abilities (decreased ability to concentrate, do schoolwork, etc.) -Lethargy -Vision changes are common -Feel better AFTER vomiting -Parents say they are "not being his/herself"

Pre- Op for Fixing Scoliosis- Posterior Spinal Fusion: Nursing Interventions

-Teach pt to turn, cough, and deep breathe (TCDB) -Teach/ Have pt. properly utilize the IS and -Teach how to check for and manage pain adequately -consider ROM -Ensure and teach pt how to do log-roll that will initially be done AFTER surgery is through.

VP Shunt Placement Post-Op Care

-There will be a bandage on scalp and abdomen -Position them FLAT on non-operative side -Assess for signs of increased ICP -Assess surgical site for any leakage and test clear drainage for glucose to see if it is CSF (CSF will be clear and have glucose positive!) -Assess for abdominal distention (in case too much drainage or it not being absorbed, if draining too much might need to go back in to fix, tell Dr. if pt has abdominal distention b/c could be sign need to fix shunt) -Check for S&S of infection and give ABX -Reposition q2h, keep flat on side off BOTH incisions

Osteogenesis Imperfecta Nursing Interventions

-These pts need to have gentle handling, daily skin care, and proper nutrition for growth, especially high Ca+. -Need to get a manual BP (if needed) -some pts do NOT have BP checked according to parent or Dr. and put sign at bedside if NOT checking BP - The Pts Will have a higher baseline temp and more sensitive to warm temperatures -Do NOT grab ankles when changing diaper ONLY pic up hips These pts need a diet HIGH IN Ca+, so INCREASE Ca+ foods= ex. cheese, milk, yogurt, kale, brocolli

Psychosocial Development in Preschoolers

-They develop ability to be able to separate from parent for a while -more independent and social and willing to please than toddlers - still based off of punishment and reward (Kohlberg's stages)

Moral Development in School Aged Children

-This age develops morals and plays by the rules -May cheat in game or on school work, etc. but DO NOT UNDERSTAND WHY THEY SHOULDN'T CHEAT, consequences -Views are black and white (concrete thinking) -CONVENTIONAL (Kohlberg's Moral Stages) - know right from wrong

Autonomy vs. Shame & Doubt

-Toddlers (12-36 months) -Toddlers acquire a sense of autonomy while overcoming doubt, they understand their behavior is its own and has predictable, reliable effect on others, NEGATIVISM & RITUALISM is their way of learning this transition. They explore to develop NEGATIVISM= toddlers often act with giving a negative response to requests like when child tells their parents "no" or "me do" all the time; tell parents this is normal for this age group. Toddlers express emotions strongly and are often in rapid mood swings. One minute can be engrossed in an activity and the next can be violently angry because they can't open a door or manipulate a toy. RITUALISM= the need to maintain sameness and reliability; provides a sense of comfort for toddlers; keep consistent schedule and routine for children like when in hospital, keep their same schedules as much as possible like they would at home, kids need

Physical Dependence on Meds

-Tolerance vs. Addiction -Ceiling Effect Tolerance= opioid dose needs to be increased to achieve same affect that it once was at lower dose Addiction- persistent need or pattern where need that med no matter what, may be causing adverse consequences or effects, might have loss control of use of the med/drug and have a preoccupation with having that medication/drug Ceiling effect= dose beyond which there is no additional effect, no additional affect of increasing affect, higher doses don't give additional pain relief but will have more side effects if just keep increasing that dose Keep dose as low as possible to treat and keep SEs at a minimum The optimum dosage of an analgesic is the one that controls pain without causing undesirable side effects.

What is the TREATMENT for AGN?

-Treat recurrent strep - increase fluids -reduce urea - get daily weights -give diuretics and antihypertensive medications -monitor BP -limit foods high in Na+/sodium -keep meal schedule like at home & assess likes and dislikes - provide bed rest during acute stage initially & then LIMITED ACTIVITY as the condition improves

Nursing Interventions for Spinal Muscular Atrophy Type 1 (Werdnig Hoffman)

-Treatment similar to immobilized patient -Need a brace -Prevent contractures! -Improve their quality of life!

Spica Cast

-Used for Femur or hip dysplasia -can come all the way to the nipple line, including both legs (May not go to ankle on both legs) -Pts are completely immobile w/ this cast -Has a bar in between the legs to separate and keep the legs apart. Teach the family NOT TO USE THE BAR AS A HANDLE and DO NOT PICK THEM UP WITH IT (pick pt up with the hips!) -These pts are a 2- person job (to change diapers or do anything with them!) , they have these casts d/t congenital or pelvic injury and SPECIAL CAR SEAT IS NEEDED. If not in a car seat they need a harness. -Teach how to diaper the patient with these on and USE NORMAL SIZE DIAPER AND A BIGGER DIAPER OVER to not get the cast dirty. -Need special car restraint! -TURN Q2H (NOT q8h)

Language for Preschoolers

-Uses 2-4 word sentences ( **age + 1 = # of Words in the sentence they should be using! so for example A 5 year old will use 6 words in a sentence b/c 5 + 1= 6**) -Vocabulary increases from 300 at 2 years old to 2100 words at 5 years old -At 4 years old they should COUNT and NAME COLORS -Most critical speech period is 2 and 4 years old!! -DEVELOPMENTAL STUTTERING= when a child stutters or stammers when thinking of a word, they know what they are thinking of but just can't say it

Exploring a Family's Culture, Illness, and Care- Open Ended Questions to Ask Family and patient (Box 2-8, p.40)

-What do you think caused your child's health problem? -Why do you think it started when it did? -How severe if your child's sickness? Will it have a short or long course? -How do you think your child's sickness affects your family? -What are the chief problems your child's sickness has caused? -What kind of treatment do you think your child should receive? -What are the most important results you hope to receive from your child's treatment? -What do you fear most about your child's sickness?

NI for Both Omphalacele & Gastroschisis

-Worry about Thermoregulation -KEEP WARM -Fluid management -Cover area and KEEP MOIST Both at risk for infection -Parenteral Nutrition -Surgery causes SBS (short bowel syndrome!)

Duchenne Muscular Dystrophy (DMD)

-X-linked inheritance pattern -Males affected, females are carriers -Most severe and most common -PROGRESSIVE muscle weakness and wasting -Have contractures -Causes respiratory & cardiac complications -Death is common by 25 YEARS OLD (d/t respiratory failure) -Diagnosed by appearance, labs, and MUSCLE BIOPSY

Pyloric Stenosis

-a functional gastric outlet obstruction -intestinal obstruction at the base of the stomach where pylorus will NOT allow food into intestines and it stays in the stomach and causes nonbilious (meaning problem is before the common bile duct) PROJECTILE VOMITING AND HUNGRY AFTER FEEDS, irritable, weight loss, 1-2 cm olive shaped mass that can be palpated, can see peristalsis wave in RUQ -Dx w/ ultrasound -Hypertrophy of the pylorus muscle -Causes DEHYDRATION so check electrolytes May need to correct BEFORE surgery Tx= surgery called PYLOROMYOTOMY where they make a small cut in the pylorus to relax and allow food passage, usually laparoscopic but may have to open up. NPO and reflux precautions 6 HOURS AFTER surgery to let stomach muscle rest, then give ORS 1 oz at a time then 2 hours later progress to formula/breastmilk. Teach family that may have emesis initially d/t pylorus still be inflamed if lasts longer than 7 days then TELL DOCTOR

Central Cyanosis

-blue in core, more issues, more than likely to need oxygen therapy and need to go to NICU for more supportive care -Cyanosis around the mouth or lips -Worse than peripheral/acrocyanosis

Steven Johnson's Syndrome (SJS)

-burns cover 10% of BSA affected -more common in males -hypersensitivity reaction on skin and mucus membranes -have flu-like S&S and then inflammation -Lesions ALL OVER the body and can extend into the lungs -Painful Treat w/ IV fluids and TPN

Bone Demineralization (Osteopenia)

-causes weakened bones and increases Ca+ level in the blood (causes HYPERcalcemia)- tx w/ fluids! -At risk for kidney stones and low Ca+ in bones

Anticonvulsant (AC) Drug Reactions/SEs

-caution if taken w/ anticoagulants, ASA, sulfonamides, cimetidine, or antipsychotics -Absorption is DECREASED if taken w/ milk, Ca+, antiacids, or antineoplastic medications (DON'T take with milk, Ca+, antiacids, or antineoplastic/cancer drugs) -Monitor renal and liver function/labs -monitor levels of drug's therapeutic dose -Can cause Steven Johnson's Syndrome or Toxic Epidermal Necrolysis (TEN)- (rash, skin peeling, sores around mucus membranes) -REPORT RASH

Post-Op for Fixing Scoliosis- Posterior Spinal Fusion

-check VS -Neurovascular checks -Check ROM -Logroll q2h -TCDB -Monitor bowel sounds -monitor I&Os -Monitor and manage any pain -Ensure ABX is taken and taken correctly as needed -SCDs first 24 hours & bedrest -Foley cath 1st day until able to get OOB -Day 2 will dangle and maybe up to chair then advance to OOB 2x per day in discharge 4-5 days AFTER surgery -Involve parents, usually adolescent age and education and purpose

Nursing Interventions (NI) for Seizures

-check for apnea -lay on ground and place on the side and do NOT restrain -Put oral airway & suction at bedside -Teach family do note what happens before, during, and after seizure -Note if the mouth has deviation to one side or the other teeth clenth, tongue bitten, frothing at the mouth, and flecks of blood or bleeding in mouth -prevent triggers -Give adequate Vit D and folic acid to prevent

7-9 Months Motor

-creeping and crawling creeping= not as mobile or get as far crawling=more distance made, more mobile -fine motor skills-rakes objects then progresses to -crude pincer grasp -feeds self cheerios -transfers objects from hand to hand -goes from tripod position to sitting alone by 8 months -can stand while holding on to something -starting to stand by pulling self u or holding self up on table or side of couch, etc.

Attention Deficit Hyperactivity Disorder (ADHD)

-developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity -Affects memory, concentration, mood swings, fatigue, diagnosis is based off multidisciplinary evaluation -Increases in self-injury and addictive behaviors in this disorder! -Affects different parts of the brain -Environmental changes -Changes in the brain lobes= frontal (motor, problem solving, memory, and judgement. Partial and cerebellum- tactile,sensory, and voluntary movements)

Gastroesophageal Reflux Disease (GERD)

-does have FTT! -At risk for aspiration pneumonia -Vomit w/ feeds -Decreased weight -Treat same as GER and medications then surgery if meds do NOT resolve/fix issue!

Voiding Cystourethrography (VCUG)

-done to check for vesicoureteral reflux -Will have contrast dye inject into the bladder through a catheter (check for allergy to dye/contrast/shellfish/iodine) - PREPARE CHILD FOR CATHETERIZATION! = will need to talk to kid about it and what to expect (will wait to do this procedure in an infant if only have had 1 UTI) - USE LIDOCAINE JELLY during this procedure -Siblings will need same screening before the age of 2 years old!

Functions of the Kidneys

-eliminate waste -produce erythropoietin (RBCs) -produce renin -stimulate aldosterone -regulate fluid and electrolytes and acid-base balance! -Metabolize Vitamin D and convert it to ACTIVE form allowing Ca+ to be absorbed

S&S of DMD

-evidence of muscle weakness BETWEEN 3-7 YEARS OLD! -May have delay in walking, trouble running, riding bike, and climbing stairs -Have a WADDLING GAIT - falls common - "GOWER'S SIGN" (uses hands to walk UP legs in order to stand up) -Lordosis of back -pseudo hypertrophy of muscles (especially calves d/t fat deposits -May have mental deficiencies

Cystic Fibrosis (CF)

-exocrine gland dysfunction that produces multisystem (respiratory, GI, hepatobiliary, reproductive, pancreas) involvement - autosomal recessive due to chromosomal mutation, most lethal genetic illness in Caucasian children, approximately 3% of Caucasian population are carriers. Increase secretions, thicker secretions. -Causes obstructive pulmonary disease, intestinal malabsorption, pancreas insufficiency. They NEED extra salt and fluids especially during hot weather.

Fetal Alcohol Syndrome (FAS)

-exposed to alcohol in utero S&S= small upper lip, small eye opening, and smooth philithrum, short palpebral fissures **REVIEW OVER Box 9-13, p.401 S&S of FAS***

S&S of DKA

-hypertonic dehydration -severe HA -N/V -abdominal pain -frequent urination and then NO URINE -Ketonuria -Confused -Kussmaul's respirations (Deep breathing blowing off acid!) -Ketones in urine and by the lungs causing fruity/acetone breath -BG levels can be in the 600s! -breath smells like "juicy fruit gum" fruity/sweet smell! Late S&S= lethargic, irritable, seizures, coma

Tx/Nursing Care and Interventions for Scoliosis

-initially wear brace to help improve BEFORE surgery -the brace is called a throcolumbosacralorthosis (TLSO!) that covers the area trying to treat. -Need to wear the brace if prescribed -Pts have concern with body image and need support from the RN and their parents -If don't wear brace, it makes treatment time longer -If NO change in curvature of spine then they WILL need surgery- a posterior spinal fusion (helps straighten out the spine with rod).

Diaphragmatic Hernia

-intestines where a lung should be inflated -In the diaphragm -NEED SURGERY to correct and PUT INTESTINES BACK INTO THE ABDOMINAL CAVITY so lungs can inflate and they can breathe better -WORRY ABOUT RESPIRATORY -BOWEL SOUNDS IN LUNG AREA! -Will need TPN nutrition

External Fixation

-keeps bones in alignment, NOT weighted or in traction, can change alignment -DO pin care -Use for damaged skin if don't want to cast extremity!

Acute Glomerulonephritis (AGN)

-kidney condition that follows after 1 week to 10 days AFTER a streptococcal infection (AKA Step Throat) -***Immune reaction to group A beta-hemolytic strep** -Common in 5-10 year olds (school-aged kids!) -ABRUPT ONSET -Lasts about 2-3 weeks

Syndrome of Inappropriate AntiDiuretic Hormone (SIADH)

-kidneys absorb TOO MUCH WATER -Oversecretion of ADH from PP -Assess for S&S of FVO and electrolyte imbalances (HYPONATREMIA!- too much Na+) -Restrict fluids, b/c water intoxication! S&S of HYPOnatremia= N/V, abdominal cramps, HA, weight gain, weakness, also may have cerebral edema, FVO signs like crackles in lungs, decreased urination, SG >1.030, and HTN. Late signs= lethargic, confusion, irritability, seizures

Safety and Adolescents

-leading cause of death in ages 15-19 is accidents (unintentional injuries) such as MVA is most common -Suicide -Homicide

Diabetic Ketoacidosis (DKA)

-life threatening insulin deficiency -osmotic diuresis d/t the EXCESSIVELY HIGH GLUCOSE LEVELS causing water and sodium depletion -They have a TRIAD of metabolic acidosis, hyperglycemia, and hyperketonemia Ketones= fat broken down

Complications from Meningitis

-meningococcal sepsis (AKA meningococcemia) -Waterhouse Friderichsen (WF Syndrome) Syndrome (AKA being septic) -SIADH -Cerebral Edema -Subdural Effusions -Hydrocephalus -Seizures -Brain damage -Hearing Loss -Learning Disability -Paresis -Shock -respiratory distress

Methotrexate

-most common rx/DMARDS for JIA -helps prevent against uveitis (inflammation of the iris and ciliary body and can cause permanent vision loss if not aggressively treated) Adverse Drug Reactions= -liver disease -bone marrow suppresssion -decreases immune system -GI disturbances -teratogenic -have possible carcinogens (carcinogenic) Nursing considerations= -MONITOR Liver enzymes, CBC w/ diff, & platelets - ensure pt takes folic acid daily to reduce occurrence of oral ulcers -take at bed time to reduce nausea. -DO NOT take if have infection -NO LIVE vaccines while on this med

Scoliosis

-most common spinal deformity -Cause of it is unknown/idiopathic -Can catch/dx at the well-child checkups -No longer checked/tested for in schools -Is Congenital or Acquired -Ask pt to bend and touch toes and you will see uneven shoulders & hips = how screening is done - It Worsens after preadolescent growth spurt initially wear brace to help improve BEFORE surgery

Poison Prevention w/ Infants

-most victims are under 5 years of age -Keep everything up and locked away -NEVER store nonedible things in edible containers Things that can cause poisoning: adult meds, alcohol, plants, ashtrays CALL POISON CONTROL if poisoning occurs at 1-800-222-1222

If hemorrhagic shock....

-need to control external bleeding -give 20 mL/kg NS or LR 2-3x as needed -Transfuse PRBC if losing blood -1st give blood!

Nursing Interventions for Casts and Traction

-neurovascular checks q1-2 hours AFTER application. -Assess pulses distally -Check cap refil -Check 6 P's of pain (pain, pallor, paresthesia, paralysis, pulse, poikilothermia) -Turn q2h -Prevent Skin Breakdown -watch for signs of infection -Hydration -ROM encouraged -Allow therapeutic play -Allow School-Age and Adolescent to keep up with schoolwork and friends -Monitor for Constipation (b/c immobilization from casting and traction)

Obesity issues with School Aged Children

-obesity is caused by genetic, cultural, environmental, and socioeconomic issues, having unstructured and fast food meals a lot, a lack of exercise, and parents using food as a reward for good behavior. Focus in the USA right now is to prevent obesity in children early on by doing these things: -Try to take focus off of using food as a reward, maybe do something differently for reward such as like an outing for good behavior or a fun activity they want to do like swimming or go to see a ball game or hiking (something active) -Try to encourage exercise, and remember that play is a form of exercise---encourage kids to get outside and play like back in the day when we were kids

Assessment of CP child

-observed neonatal reflexes -delay in development -apparent early preference for one hand (before age of 1 year old) -hemiplegia -poor sucking (suspect CP if have this early on!) -tongue thrust -leads to FTT -stiff muscle tone (common sign!) -hypertonic -scissoring of legs (especially if spastic)- extended & crossed legs, feet plantar flexed -involuntary movements -seizures

Acute Appendicitis

-obstruction of appendix in cecum caused by infection or diet -Common in school age children -Treat pain and manage fluids! S&S= -RLQ pain -abdominal pain/tenderness -rebound tenderness -increased WBCs -decreased bowel sounds perforated or ruptured appendix= SURGICAL EMERGENCY!! TAKE TO the OR STAT! Give ABX before surgery! Non-perforated appendix= will have surgery also before perforation happens Ruptured Appendix S&S= -relief of pain after feeling seriously ill -rigid guarding of abdomen -fever -tachycardia -abdominal distention -rapid, shallow breathing NG Tube w/ suction for abdominal distention and flush with sterile water and REPLACE FLUIDS that comes out! Excess output could mean NG migrated into the KUB (kidneys, ureters, bladder). INCREASED distention= NO output, NG tube displaced, CHECK NG PLACEMENT!

Gastroesophageal Reflux (GER)

-painless emesis -immature esophageal sphincter -NO FTT -Not much spit up and doesn't bother them -Correct w/ small, frequent feeds -Elevate head AFTER feeds by holding them up for 30 min. -Burp between each ounce -May thicken feeds with a thickener -If older than 6 months try rice cereal -Usually resolves within 6mo-1yr of age after sphincter matures!

Classification of Seizures

-partial (simple or complex) -Generalized -Atonic/Akinetic -Absence -Unclassified

Daily Fluid Intake Requirements for Maintenance (24 Hour Intake)

1-10 kg = 100 mL/kg/hr 11-20 kg = 50 mL/kg/hr + 1000 mL (for first 10 kg) above 20 kg= 20 mL/kg/hr + 1500 mL(for first 20 kg)

Hourly Fluid Intake Requirements

1-10 kg = 4 mL/kg/hr 11-20 kg = 2 mL/kg/hr + 40 mL (for first 10 kg) above 20 kg=1 mL/kg/hr + 60 mL (for the first 20 kg)

Three Stages of Shock

1.Compensated 2. Hypotensive 3. Irreversible Is determined by degree of tachycardia and ability to perfuse extremities, LOC, and BP (late sign!)

Severe Dehydration

10% S&S= intense thirst, tachycardic w/ weak and thready pulse, rapid & deep respiratory rate (Hyperpnea), not arousable, gray, clammy, marked sunken fontanels & eyes, NO UOP and if any with a spec grav of >1.030, cap refill >4 seconds, skin turgor with tenting and skin is cool and mottled, parched mucous membranes, absent tears, anterior fontanel sunken Tx= MUST Admit to hospital, THINK they are in shock, IV, give NS or LR 20 mL/kg over 20 min. bolus and REASSESS if need more, do this bolus then do a maintenance

Lab Values to Know (Normal Levels)

135-145 mEq/L- Na+ 3.5-5.0 mEq/L- K+ 1.5-2.5 mEq/L -Mag. 8.6-10.2 mg/dL - Ca+ Blood Gases: pH 7.35-7.45 pCO2 35-45 pO2 80-100 (50-80 for neonates!) HCO3- 22-26 Base Excess +3 to -3

Infants 4-12 months of age need how much sleep??

14-16 hours of sleep a day including naps

Addiction Problems in Adolscents

15-16 years old is use alcohol will have cognitive impairments, long term negative effects, marijuana leads to lower IQ and synthetics lead to kidney failure, teach social consequences, start teaching about this in elementary school

Normal Platelets

150,000-400,000 -They signal clotting to stop bleeding -Made in response to blood loss -High if myeloproliferative disease -Acute blood loss and low if leukemia -Idiopathic thrombocytopenia purpura (ITP) -Splenomegaly/splenic sequestration

Pulmonary Embolism (PE)

AFTER trauma or immobilization, DVT can cause SUDDEN CHEST PAIN & DYSPNEA (SOB)

Tonic Neck reflex

AKA "Fencing" reflex When the infant is place in a supine position, the head is turned to one side and the arm and leg on that side extend, while opposite arm and leg are flexed. If the head is turned the other direction, the positioning of the extremities is reversed. This is sometimes called the fencing reflex. Keeps the baby from rolling off the bed Disappears @ 2-4 months of age, b/c will start to roll over

Types of Pain

Acute Pain- pain lasting less than 2 weeks, might be postop pain, accident they've been in (like fallen off bike and broken arm- might have significant pain first few days) Chronic Pain - lasts at least 3 months, extended period of pain, can be a constant type of pain or transient (comes and goes), Recurrent Pain- something that occurs within a 3 months time period, appears and then reoccurs, like migraines area reuccrent pain; some days are good days then some days it comes back up like migraines or sickle cell anemia pain

Principles of Management of Pain

Acute, continuous pain is best managed with fixed-dose scheduling or around-the-clock medications PRN orders for breakthrough or activity pain -Talk to parents and families about plans and keep them aware of the fact that you will stay on top of a child's pain level and treat that as often as needed and around the clock, etc. -Stay on top of pain management for these patients -Make certain when they call for pain meds that you don't delay that, etc. -Educated patients to let you know if they are in pain, and educate them on if they feel a certain way or if having pain, etc. and what you will give them and what you will -Ice cream, chocolate sauce, flavoring to help get meds in can help that process -Begin with a low dose of opioid and titrate to comfort -Assess for effect of opioid based on peak times Think about peak times with oral meds, etc. Nonopioids oral meds= peak comes about 2 hours after, will assess about an hour after giving an oral med- will take about 45 mins- 1 hour to work Opioids oral meds- take effect a little quicker than nonopoinds but will reassess still about 1 hour after giving IV meds= take affects as soon as 15 minutes (like morphine) so will need to reassess in about 5-10 minutes, maybe for IV meds - ASSESS IV MEDS in 30 minutes not an hour -Children older than 6 months metabolize drugs more rapidly than adults, so that younger children may require higher doses of opioids to achieve the same analgesic effect. -Titrate for effect -Be mindful and check the dose in case it is too high, so really check these because it is important

Beta 2 Adrenergic Agonist (beta 2 blocker)

Albuterol- short acting (SABA) bronchodilator-rescue PRN, to relax muscles, short acting, albuterol with a spacer, 2 puffs for S&S, allows smooth muscles to relax, inhaled has a more rapid onset than oral, SEs mostly in oral, irritability, tremor, nervousness, and insomnia. If used too much then the medication will NOT work as well especially in an emergency this is called tachyphylaxis. Overuse leads to loss of bronchodilation effects, severe paradoxical bronchoconstriction, teach pt. this and to wait 2 minutes between each puff.

Nursing Care of SB patient AFTER Surgery

Assess for Signs of Increased ICP and infection -Monitor Head Circumference Daily (needs to be at same as baseline prior to surgery, and needs to be at same time) -KEep prone or sidelying position -Can be upright if no pressure on surgical site -gentle ROM exercise shold be done -Check for S&S of hydrocephalus (bulging fontanels!) -Change dressing if Dr. orders or if it gets soiled

Types of Play in Preschoolers

Associative Play= group play without group goals- predominant in the preschool period (ex. might play make-believe with a group of kids all playing together but no goal in mind) Cooperative Play- organized play with group goals Dramatic Play- child acts out roles or experiences (ex. cooperative play but with specific roles for each child such as "you make the tea & sweep the floor", telling the other kids what they will pretend to do/play...ex. like growing up when we were playing school with my cousins when we were younger and we deemed cousin Jeff "The Kisser" and Jennifer the "chalkboard eraser" LOL!! haha Therapeutic Play- good type of play to help kids cope before going into a procedure or surgery, helps them act out how things will go in the medical sense; provides an emotional outlet and provides pre-operative teaching and helps reduce fears--- example, allow the patient to check their teddy bear's heart with the stethoscope or put the mask on special baby doll, etc.

Assessing Respiratory in PEDs

BEFORE touching, assess their work of breathing (WOB) such as grunting, nasal flaring, retracting Infant has IRREGULAR BREATHING and are nose breathers. Assess rate and if chest movements are equal. Posture/activity level, SENSORIUM (delay in senses reacting to voices, pain, level of comfort, and color of milimeters

Somogyi Effect -rebound hyperglycemia

BG levels are stable UNTIL 3am and then they are hypoglycemic and the body releases glucose and they get REBOUND HYPERGLYCEMIA by the morning Tx= DECREASE their insulin at night fo the decreased BG levels does not occur insulin is given at bedtime and if we check this patient in rebound their BG will be normal around 12am/midnight, but when we see when we check BG after given insulin at 2-3am they will have HYPOGLYCEMIA, body will release glucose from the liver and then will have a REBOUND HYPERGLYCEMIA So, gave insulin at midnight, normal glucose at midnight, then around 2-3am will have HYPOglycemia, body will kick in and release glucose to cause REBOUND HYPERGLYCEMIA in the morning Will need to REDUCE NIGHT-TIME INSULIN to fix that problem!

Hepatitis B

BLOOD-BORNE! Can lead to chronic hepatitis, cirrhosis of liver, and/or hepatocellular carcinoma Hep B Vaccine to prevent/tx HBIG is given for infants born to Hep B positive mothers! Acute Hep B S&S= will have a LOW GRADE FEVER and jaundice and have a liver and spleen enlargement known as hepatosplenomegaly

Diagnostics/Labs for ARF/AKI are what?

BUN, Creatinine and K+ will be HIGH/ELEVATED! Na+ will be DECREASED

Cellultis

Bacterial infection of subcut tissues and dermis Common areas infected= lower extremities, periorbital, buccal areas RED, hot swollen, painful,red streaking, lymph node enlargement, fever, malaise, HA

Classifications of UTIs or Inflammation

Bacteriuria= presence of bacteria in the urine Asymptomatic Bacteriuria= significant bacteriuria with no evidence of clinical infection (usually define as >100,000 colony-forming units/mm3) Symptomatic bacteriuria= bacteriuria accompanied by physical signs of urinary infection (dysuria, suprapubic discomfort, hematuria, fever) Recurrent UTI= repeated episode of bacteriuria or symptomatic UTI Persistent UTI= persistence of bacteriuria despite ABX treatment Febrile UTI= bacteriuria accompanied by fever and other physical signs of UTI; presence of fever typically implies pyelonephritis Cystitis= inflammation of the bladder Urethritis= inflammation of the urethra Pyelonephritis= inflammation of the upper urinary tract and kidneys Urosepsis= Febrile UTI coexisting with systemic signs of bacterial illness; blood culture reveals presence of urinary pathogen

Hypoglycemia in PEDS

Below 80 for young children= Hypoglycemic Below 70 for school aged and adolescents= hypoglycemic Normal for newborns to have a BG lower than 60 S&S= Nervousness, pallor dizziness, headache, drowsiness, irritability, palpitations, sweating

4-6 Months Nutrition

Between 4-6 months the INFANT WILL BEGIN IRON FORTIFIED CEREAL= RICE CEREAL which is recommended first with millk Fetal Iron stores are depleted by 4 months (if a term infant), preterm infant iron stores are depleted at 2 months of age They NEED iron supplement after 4 months of age Milk alternative like rice milk are LOW in protein, calcium and Vitamin D so need Parent should continue breastfeeding OR start on an iron fortified formula. Ideally want to have mother continue breastfeed until about 12 months of age so will try and keep them breastfeeding or on an iron fortified formula

Hospitalization Major Fears for Preschoolers

Bodily injury being abandoned Fear anything invading the body (ex. mickey button, IVs, foley caths) Loss of control Nursing Interventions to Help= use home rituals, have parents close & involved, encourage at least 1 parent to stay at hospital with child if able to, tell child they did NOT cause their illness, accept regression and explain to parents

Non-pharmacologic Interventions for Pain

Breathing techniques Distraction Guided imagery Relaxation Music Massage Heat/cold therapy Hypnosis

High H&H is due to what?

Congenital Heart Disease (CHD) CHronic hypoxia High altitudes fluid loss dehydration PCV (packed cell volume) increased= Hct increased!

Acute Diarrhea

Caused by Rotavirus most commonly Gave give a vaccine in drop form. Bacteria like salmonella, shigella, C. Diff are also causes. Giardia is common in daycares Management= rehydrate and heal the bowels/intestines, don't always have to be NPO, breastfeed infants (or lactose free formula) and normal REGULAR DIET for others, continue replacing stool loss with 10 mL/kg (4-8 oz) of ORS for every diarrhea stool. NEVER give antidiarrheal. Normal diet is BEST, give milk to kids if they can tolerate. Supplement breastfed infants w/ ORS.

S&S of Meningitis

Children- sudden onset of fever, vomiting, severe HA, irritability Infants= fever OR hypothermia, poor feeding, bulging anterior fontanel, high pitched neuro cry Children will also have a +Kernig's Sign and also see a +Brudzinski's Sign

Urinalysis/UA Culture- for Diagnosing UTIs

Clean Catch! Done first thing in the morning and female faces back of toilet, take to lab ASAP and do NOT refrigerate for more than 24 hours If older they can wipe and void and then catch midstream. AVOID In and Out Cath for an infant unless need a sterile urine sample, and try to get cotton balls in diaper instead if they don't need a culture- In and Out cath is done for infant but needs to be sterile!!! STERILE SAMPLE=need in and out cath instead of clean catch!! IF 2nd UTI then get UA/culture and send for a voiding cystourethrography (VCUG) especially if an infant, b/c this is to make sure NOTHING ELSE like vesicoureteral reflux is present or anything else wrong. NEED CULTURE---> GET IN AND OUT CATH

Codeine and cultural differences

Codeine gets its analgesic properties with its conversion to morphine by the liver. However about 10% of Caucasians and varying percentages of other ethnic groups are unable to convert codeine to morphine because they lack the CYP2D6 enzyme. Don't usually give codeine in hospital setting to pediatric patient b/c of metabolism of meds breaks down differently (acts like morphine if broken down too quickly) Can have severe responses or toxic levels of morphine the way it breaks codeine down, etc. Did at one point give codeine but don't' do this routinely anymore We do use hydrocodone and acetaminophen quite frequently (already made up together) and can give oxycodone and acetaminophen together (not already made together) -Ultrametabolizers of codeine have a genetic variation in CYP2D6 causing abnormally high levels of morphine after taking codeine. -Risk of toxic levels of morphine -Higher genetic difference in certain ethnic groups: Ethiopian (29%), Greek (6%); 3.4% -- 6.5% African American

Isolation Precautions w/ Infectious Diseases

Contact- for things like MRSA, C. Diff, skin infections and wound infections, respiratory infections,etc; MUST wear gown and gloves Droplet- for things like Flu, Mumps/meningitis,pneumonia Parvovirus, spesis/scarlet fever/strep pharyngitis, adenovirus (THINK mnemonic SPIDERMAN); must wear gown, gloves and surgical mask Airborne- for things like Measles, TB, and varicella (mnemonic- THINK On Air On MTV!), must wear gown and gloves and a special HEPA Filter/N95 mask for TB, and must be in a negative air-pressure room, must have private room

Teach about Iron Deficiency/ NI

Decrease milk intake less than 32 oz/day Eat more meat green leafy veggies fish liver whole grains legumes If infant = needs iron-fortified cereal and formula IRON RICH FOODS!

Severity of Asthma is determined by what?

Determined by Meds and how often they are needed Mild= 2x/week + 1-2x/minth @ night Moderate= daily S&S w/ 3-4x/month @ night Severe= affects Quality of Life, severe at night attacks every night, CANNOT control, educate about how to help control it better If using a SABA more than 2x/week then need MORE meds to control it -Teach patients/family to Give meds several weeks to take effects before results Need spacer to use Albuterol

How do they DIAGNOSE JIA?

Diagnosis= -onset is before age 16 years old -flares at 1-3 years old and again at 8-10 years old -Arthritis in 1 or more joints for 6 weeks with no other cause -negative test for rheumatoid factor - leukocytosis -presence of antinuclear antibodies ( not specific to JIA but may mean a great risk of uveitis)

What diet does a patient w/ CKD need?

Diet low in phosphorus ( NO dairy, bran cereals, whole grains, peanut butter) Diet Low in K+ Diet Low in Na+ (no canned foods, no highly processed foods-needs fresh foods)

Sports Related Injuries

Do NOT work through injuries ( ex. fx, concussions) Use RICE mnemonic to treat soft tissue injuries, prevention NSAIDS (sometimes, may delay healing) exercise AFTER injury Do NOT ice before activity (may number and cause further injury), and do NOT heat after activity. Elevate ABOVE the heart vs. below it

APGAR Scoring System

Done at birth, infant is evaluated on HR, Resp effort, muscle tone, reflex irritability, and color A- Appearance- color- blue/pale=0, blue extremities,core pink= 1, all pink=2 P- Pulse- absent=0, below 100=1, above 100=2 G- Grimace- reflex irritability- none=0, grimace=1, cry/sneeze=2 A- Activity/muscle tone- limp=0, some flexion of extremities= 1, well flexed=2 R- Respiratory effort- absent=0, irregular/slow/weak cry=1, good strong cry=2 APGAR is done at first 1 min then at 5 minutes after birth! -Score of 8= BEST SCORE! -Score of 7 or above= baby okay, good to go to regular newborn nursery, etc. Score BELOW 7= may need supportive care, and need to go to NICU

Newborn Screening SABR (screening Audio Brainstem Response)

Done if in NICU more than 5 days Pass/Fail Only Doesn't rule out change of hearing loss Put electrodes on head and checks brain activity to sound

Precautoins

Droplet/Contact= RSV neg. bronchiolitis, CROUP, any unknown infection Droplet- influenza, pertussis, pharyngitis Contact- RSV positive bronchiolitis, CF CF will be on droplet and contact if they have a virus!

Therapeutic Mangement of Seizures

Drug Therapy, need to know therapeutic levels! Ketogenic diet Vagus Nerve Stimulation- magnet that is activated! Sx last resort

Nutrition and Feeding Schedule

Exclusive breastfeeding is recommended and encouraged until about 6 months of age to 1 year after food is introduced Breast milk is ideal so try to encourage that if can and it is recommended until 6 month of age if possible and ideally until 1 year of age Newborn has a deficiency of pancreatic lipase for fat absorption which makes cow's milk indigestible... so DON"T GIVE NEWBORNS COW'S MILK!! NO NO NO!!- can't have cow's milk to 1 yr old! Breast Milk contains enzymes lipase that enables the high fat content breast milk to be easily digested. The increased fat helps grow the myelin sheath, also has immunoglobulins, probiotics, and iron. Breast milk has a DECREASED of VITAMIN D so MAY NEED TO SUPPLEMENT SO INFANT DOES NOT GET RICKETS! Need supplement if not receiving 1000 mL of D-fortified formula/day or exclusively breastfeeding. Promote breastfeeding by.... SKIN TO SKIN, correct (en-face) position, feed on demand, and lactation rooms

Periods of Reactivity in Newborns/Infants

First period of reactivity= MOST AWAKE the first 30-60 minutes, BREASTFEED DURING THIS TIME b/c alert and interested in environment 1-4 hours after delivery they are very sleepy and calm and all systems slow down and temperature decreases Second reactivity period= occurs when the infant awakens from deep sleep, lasts about 2-5 hours and is alert and responsive; FEED DURING THIS TIME!

Foods Low in K+

Foods prepared with white flour (ex. pasta, bread), white rice. Non-dairy creamers, fruit punch, drink mixes (ex. Kool-Aid), tea (< 2 cups or 16 oz per day), coffee (<1 cup or 8 oz per day) Angel or yellow cake, pies w/out chocolate or high-potassium fruits, cookies w/out nuts or chocolate Fruits= apples (1 whole!), apple juice, applesauce, canned apricots, blackberries, blueberries, cherries, cranberries, fruit cocktail (drained!), grapes, grape juice, grapefruit (1/2 of 1), mandarin oranges, peaches (1/2 fresh or 1/2 cup canned), pears (1 small fresh or 1/2 cup canned), pineapple and juice, plums (1 whole), raspberries, strawberries, tangerine (1 whole), watermelon (1 cup) Vegetables= alfalfa sprouts, asparagus ( 6 spears), green or wax beans, cabbage (cooked), carrots (cooked), cauliflower, celery (1 stalk), corn (1/2 fresh ear or 1/2 cup), cucumber, eggplant, kale, lettuce, mushrooms (fresh), okra, onions, parsley, green peas, green peppers, radish, rhubarb, water chestnuts (canned, drained), watercress, spinach (raw, 1 cup), squash (yellow), zucchini Proteins= chicken, turkey (3 oz), tuna, eggs, baloney, shrimp, sunflower or pumpkin seeds (1 oz), raw walnuts, almonds, cashews, or peanuts (all 1 oz), flax seeds (2 tablespoons ground), unsalted peanut butter (1 tablespoon) Dairy Products= cheddar or swiss cheese (1 oz), cottage cheese (1/2 cup)

Renal Development in Infancy

Glomerular filtration and absorption is LOW in infancy until age 2 Newborns CANNOT concentrate urine or reabsorb Na+ and water Urine is DILUTE Kidneys are IMMATURE IF urine is dark & concentrated this is NOT NORMAL!

Goal of care of child with CP is what?

Goal is to decrease spastic muscles! GIVE Baclofen orally and if it works then can surgically implant a baclofen pump. Pump puts them at risk for infection though d/t the pump malfunction, etc. TEST then can put in pump! Baclofen= med that DECREASES SPASTICITY!

Key Milestones at 6 months of Age

Good head support No head lag Rolling in both directions Bears weight on their legs Sitting w/ support (tripod position) Reaches for objects

Southeast Asia (Cambodians, Vietnamese, Laotians)

HEAD IS SACRED & NOT TO BE TOUCHED Direct gaze between people of different status is avoided, will agree whether or not they understand They believe suffering and illness are unavoidable, feet are dirty Coining- practice that may produce welt-like lesions on the child's back when the edge of a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of disease

Human Papilloma Vaccine

HPV vaccine recommended for males and females around 11-12 years of age! Series of 3 shots over 6 months Protects against genital warts and as a result prevent cervical, anal, and oropharyngeal cancer (72% of oropharyngeal cancers positive for HPV) Most oncogenic strains of genital warts are acquired shortly after sexual debut

Normal Vital Signs for Preschooler

HR= 80-110 RR= 22-34 SBP= 82-110 DBP= 50-78 BP= 82-110/50-78

Normal Toddler Vital Signs

HR= 90-140 bpm RR = 24-50 breaths/min SBP= 80-112 DBP= 50-80 BP= 80-112/50-80 mmHg

Other S&S of ARF/AKI

HTN anemia seizures HYPERvolemia (too much fluid volume!) Cardiac Failure w/ pulmonary edema Water intoxication signs

Prevention of AOM

Hib vaccine, flu vaccine (6 months and greater) pneumococcal conjugate vaccine (PVC 13- prevenar 13) Avoid second hand smoke

Step/Walking grasp reflex

Holding the infant upright so that the soles of the feet touch a flat surface will cause the infant to make alternate stepping movements. This reflex becomes more active 72 hours AFTER birth. -walking when foot on ground

Hearing Impairment

Human ear can detect 500=6,000 Hz (frequency or pitch) and amplitude or loudness is dB 20 db is a whisper and 100 dB is lawn mower Profound hearing loss is at 91 or greater dB. Hearing loss as low as 16. genetics r/t 50% of hearing loss! 4 month of doesn't turn head to voice= concern for hearing loss, get hearing screening!

Types of Shock

Hypovolemic Cardiogenic Distributive Obstructive

Babinski reflex

If the infant's foot is stroked on the outside (little toe) edge, the toes fan up and outward. Should go away after 9 months of age or whenever ready to walk- if it comes back then it could mean neurological deficits/issues! -Foot/toes fan when stroke side of foot

Parenting of Preschoolers

Ignore the bad behavior and reward the good Enforce time outs (1 min for how many years old they are, so if 5 years old should have 5 min of timeout) Set LIMITS

Cultural Barriers to Pain Treatment

Inadequate assessment of pain Concern about side effects and dependence Reluctance to report pain Reluctance to take pain medications Lack of adherence to treatment plan

What is the EARLIEST SIGN of Dehydration?

Increased HR followed by increased capillary refill, abnormal skin turgor (increased turgor time) decreased skin elasticity, abnormal respiratory pattern

Death in Adolescent

Mature understanding of death But they think they are invincible and it will NOT happen to them They question waht will come and search for spiritual meaning Least likely of any age groups to accept their own death Nursing Interventions= honesty, privacy, maximum self-control and independence

Infants Vision

Infant's ability to fixate is greatest at the 1st hour of life! -Postpone erythromycin ointment IMMEDIATELY after birth, but it MUST be given within first 2 hours of life by law (done to prevent neonatal opthalmic issues such as Chlamydia and gonoccoal conjuctivitis) -Infants are very nearsighted and see 8 inches at best or from baby to breasts, they only see light and dark. Encourage bonding with mom and put infant on mom's chest and hold in the "en-face" position (can see mom, cheek to nipple) Promote development of trust- "trust vs. mistrust" starts early on so hold them, touch important!

Normal Urine Output for Pediatric Patients Per Hour

Infants & Toddlers = 2-3 mL/kg/hr Preschool & young school age children= 1-2 mL/kg/hr School-Age Children & Adolescents= 0.5-1 mL/kg/hr

Concepts of Bodily Injury by Age

Infants= after 6 months can remember pain Toddlers= fear INTRUSIVE procedures Preschoolers= fear BODY MUTILATION School Aged= fear LOSS OF CONTROl Adolescents= concerned about change in BODY IMAGE!

Rheumatic Fever (RF)

Inflammatory disease A. Rheumatic fever is the most common cause of acquired heart disease in children. It usually affects the aortic and mitral valves of the heart. B. Rheumatic fever is associated with group a beta-hemolytic streptococcal infection(untreated strep) C. Rheumatic fever is a collagen disease that injures the heart, blood vessels, joints, and subcutaneous tissue D. Self-limiting disease process that affects joints, skin, brain, serous surfaces, and heart Nursing Assessment: 1. Chest pain, shortness of breath (carditis-inflammation of the heart) 2. Tachycardia, even during sleep 3. Migratory large-joint pain 4. Chorea (irregular involuntary movement) 5. Rash (erythema marginatum) 6. Subcutaneous nodules over bony prominences 7. Fever 8. Lab findings: -Elevated erythrocyte sedimentation rate - Elevated ASO (antistreptolysin O) titer Nursing Diagnoses: Decreased cardiac output Risk for injury related to........ Nursing Interventions: 1. Monitor vital signs 2. Assess for increasing signs of cardiac distress 3. Encourage bed rest 4. Assist with ambulation 5. Reassure child and family that chorea is temporary 6. Administer prescribed medications -Penicillin or erythromycin -Aspirin (ASA) for anti-inflammatory and anticoagulant actions

Hypernatremia S&S

Intense thirst Nausea & Vomiting Dry, Sticky membranes Flushed skin Oliguria- Decreased UOP Hyperirritability Disorientation, Seizures Nuchal Rigidity

Toddlers and Hospitalization

Interferes with the development of control and autonomy, they FEAR LOSS OF CONTROL AND STRANGERS so always explain what you are doing and if the parent leaves let them know, minimize separation form parents, give brief explanations, ASK ABOUT HOME RITUALS, teach parents to explain in ways they understand (ex. they will be back after their nap). Promote sensory play (finger painting, etc.), take trips to the playroom and expect regression (ex. may wet underwear or pullup

Total Body Water

Intracellular Fluid (ICF)= fluid in the cells & Extracellular Fluid (ECF) = fluid outside the cells ECF includes= intravascular, interstitial, transcellular, CSF, blood and plasma. MORE problems w/ ECF

Bronchopulmonary Dysplasia (BPD)

Is a chronic lung disease causes of BPD include= mechanical ventilation Tx= need O2 extended pds.

Removing a Cast

Is scary for a child They feel that it is part of their body and may not want to remove it! NEED to talk to and explain to child that this is NOT part of their body and that it is okay and explain how you will remove the cast in terms they can understand and that you aren't going to hurt them, etc.

Wilms Tumor (Nephroblastoma)

Kidney tumor malignant renal and intraabdominal tumor 3x more common in AA children peak at age 3 years and more common in males Does NOT cause pain and DOES NOT CROSS MIDLINE, painless, swelling of abdomen, one side of the abdomen or hte other NEVER PALPATE ABDOMEN (rupture or metastasize) Possible HTN (b/c have excess renin!) Polycythemia (excess erythropoietin) Nursing Interventions= Monitor BP, will have surgery (a nephrectomy) followed by radiation/chemotherapy

Hypoglycemia S&S

LOW BS cold and clammy= NEED/GIVE EM CANDY!! -palpitations, nervous, jittery, lethargic (LATE), weak, shaky, irritable. -sweating/diaphoresis, cold and clammy, nervous & shaky, palpitations, might also be hungry and have HAs (like when you get hangry get shaky, HA, famished!) Young child will have BS LESS than 80 mg/dL and can be HYPOGLYCEMIC, while a school-aged/older child will have a BS less than 70 mg/dL

Amyblopia

Laxy eye Treat before 4 years old or can lose sigh in lazy eye Treat by patching the good eye or can use Atropine drops that blurs vision (must use this if pt refuses to use patch) Can treat w/ patch or Amldopia by 4 yrs old patch or atropine in good eye!

Lead Poisoning in Infants

Lead Blood Levels- blood test done if infant is at risk at ANY TIME Universal Lead Serum Test (serum testing) is done at 1 and 2 years old. The concern for elevated blood lead levels (BLL) is 5 mcg/dL. Teach family: about soil contamination, pain from older homes, using cold water only for making formulas for bottles and for cooking b/c the warm water can dissolve lead. wash toys and pacifiers frequently, do NOT VACUUM HARDWOOD FLOORS b/c can spread dust if in home built BEFORE 1960, wash and dry hands frequently (especially before eating!) New immigrants have higher instances of lead poisoning (make-up, home remedies, digestive aids, etc.)

Prevention of Sex Abuse in Preschoolers

Make sure parents teach kids where they are allowed to be touched Teaching children normal healthy boundaries of their bodies Teach kids safe and healthy boundaries with other people Teach them to tell someone if someone is trying to touch them in a way they do NOT feel comfortable with like if at daycare or an outing or out and about , etc.

18 months -3 year olds......

Make their own will Erickson- Autonomy vs. Shame & Doubt- promote INDEPENDENCE, give them developmentally appropriate tasks (stir the bowl, put away something, etc.) Piaget- know something will happen, aware, ex. electrical outlet shocks them so they avoid that outlet, and are egocentric Kohlberg- cause & effect relationships w/ events Moral= precoventional or premoral phase- whether an action is good or bad is based off of reward or punishment Good action= get rewarded Bad action= get punished

Leukemia

Malignant disease of bone marrow Acute lymphoid leukemia (ALL) most common Caucasian/White males 2-6 y.o. most common S&S: pallor fatigue petechiae bleeding fever 25% have bone pain CBC may be normal genetic testing such as the Philadelphia chromosome can show increase risk for leukemia Bone marrow aspiration to confirm diagnosis Nonproductive WBC can be normal count Usually treat w/ systemic chemo or radiation

Cardiogenic Shock

May occur after some type of cardiac surgery. -If due to bradycardia or supraventricular tachycardia (SVT), we will correct the rhythm. -If related to congestive heart disease, we will treat with a bolus. This bolus is only 5-10ml/kg because the "pump" is not working well. Always listen to lungs to check for fluid overload! -Acute kidney injury is also pertinent to cardiogenic shock. There is no blood flow to the kidneys! The kidneys will not work without blood flow resulting in decreased to no output. In turn, cerebral edema & generalized edema occurs, toxins accumulate, and electrolytes have nowhere to go. -These patients can only have 1/3 of their maintenance fluids. Must monitor fluids closely! Once resuscitated, they usually recover very well! Low Cardiac Output Signs/Symptoms: • Poor neurological status • Acidosis • High lactate • Poor perfusion • Mottled skin • Weak/thready pulses • Hands and feet cool to touch • Poor urine output

Bowel Movements- Types of Stools

Meconium- 1st infant stool, is dark green and stick, usually passes within the first 24 hours of life, BUT IF NOT then think do they have an anus, a meconium plug (ex. CF, hypothyroidism, and heart defect pts will have this issue!) Acholic- pale due to NO bile salts, clay colored stools, happens w/ biliary atresia Azotorrhea- protein in stool Steatorrhea- fatty stool Ribbon like stools- think Heart Defect pts Currant jelly looking stools= think Intussception!

Meds for ADHD

Methylphenidate = a CNS stimulant given as a first line med. MOA= like amphetamine, it inhibits the reuptake of dopamine and norepinephrine SEs= HA, insomnia anorexia, increased HR, can worsen or cause TIC disorder. Teach give med with or after meals, helps complete tasks. May need a drug holiday during the summer months when out of school to decrease SEs Atomoxetine = a NONstimulant that is used 2nd line and inhibits reuptake of norepi SEs= dyspnea, vomiting, fatigue, decreased appetite, dizziness, adolescent cannot drive until effects are known, change positions slowly, can increase suicidal ideation/can cause suicide or suicdial thoughts, can have cardiac SEs so get baseline ECG before giving medication! Clonidine and Guaifenesin have lots of misuse and depends on the child Also can give tricyclic antidepressants- they have increased adverse reactions and need an ECG

Degrees of Dehydration

Mild Moderate Severe

Age Appropriate Toys for Birth-2 months of Age

Mobiles Dark and light, black and white w/ movement

Hyperkalemia S&S

Muscle weakness Flaccid paralysis Hyperreflexia Bradycardia ventricular fibrillation & cardiac arrest Twitching Oliguria- decreased UOP Apnea- respiratory arrest

Side-effects of NSAIDS

N&V- w/ ibuprofen or naproxen Dyspepsia Epigastric pain Dizziness Diarrhea Constipation Gastric ulceration Bleeding nephritis To reduce GI effects - take with food Take in afternoon or evening No alcohol No smoking -Can take ibuprofen with food to help with GI upset/effects

Anoriexa in cancer

N/V or mouth ulcers can lead to weight loss give small frequent appealing meals (like ice-cream!) high calories and protein Allow food choices Be careful of food aversions, N/V and eating only favorite foods they may not want their favorites anymore, so DON"T allow their most favorite foods - question on exam, pick most nutritious and high-calorie foods

Pain Scales in Children

NIPS= for neonatal and infant; used in NICU setting CRIES = used in postoperative setting for infants FLACC= for preverbal/nonverbal patients or patients of any age FACES= child looks at faces to describe their pain (4-8 years old) Numeric Pain Rating Scale= rate pain on 0-10 scale, for odler patients 8 years and older

Febrile Seizures

NO Anticonvulsants (ACs) drugs for this type R/T the onset of a temperature NOT about how high the temp is but mor about how FAST it got to that set point Occurs mostly in males and in ages 6 months-5 years of age! Treat the cause of the fever! Antipyretics DO NOT prevent it

Esophageal Atresia (EA)

NO PASSAGE OF STOOL esophagus ends and does NOT go into the stomach!

3 months causes for concern

NO response to loud noises palmar grasp should be GONE- if not then issues! Heads up and legs should NOT be rigid and stiff Does NOT follow speaker with eyes Does NOT coo Constant fisted hand (a reflex that should have gone away!) Stiff legs Does NOT lift head when on stomach Crosses eyes most of the time

Acute Bilirubin Encephalopathy

NOT normal causes kernictus, CNS effects, athetoid cerebral palsy, developmental delay, hearing deficit, oculomotor disturbances, dental dysplasia

Hypertonic Dehydration

Na+ is GREATER THAN 150 Most dangerous type of dehydration Can result in PERMANENT BRAIN DAMAGE Fluid shifts from ICF to ECF CNS Signs of Damage are: Altered LOC, inability to concentrate, lethargic, hyperreflexia, hyperirritability, seizures, takes water OUT of the brain cells. Caused by OVER CONCENTRATED FORMULA, high protein, NG Tube feeds that put TOO MUCH SOLUTE on kidney Patients are EXTREMELY THIRSTY and can have DKA Tx: require a SPECIAL FLUID THERAPY, no bolus, GIVE OVER 48 HOURS, if given too quickly can cause cerebral edema (the dehydrated brain cells will fill too quick with fluid)

Hypotonic Dehydration

Na+ is LESS THAN 130 Na+ is going INTO THE ECF Water is going INTO the ICF Loss of Na+ is GREATER than the loss of water Worry about CEREBRAL EDEMA - replace w/ electrolytes -Causes are inappropriate IV therapy, SIADH, unreplaced gastric suctioning, GI infection/bug with PLAIN WATER as replacement Tx: replace fluids & electrolytes OVER 24 HOURS

Narcotic wasting

Narcotic counts before/after removal Narcotic wasting Witness must be another licensed nurse ******Important to waste narcotics with another licensed nurse! ****** Waste right then and there when you pull the meds, and do it in the presence of the other licensed nurse. HAVE TO WASTE IN THE SINK!! Ex. Pull out morphine in med dispenser and patient only gets 0.3 out of supplied 1 mL vial, so need to get rid of 0.7 mL and waste 0.7 mL and then you draw up the whole 1 mL and then get rid of 0.7 mL and give the 0.3 left to the patient that is needed. And you document how much you wasted nad how much you gave, etc.

How do we give insulin in pediatric patients?

Need to check 2x with another RN Goal is to imitate the pancreas for the child DO NOT give insulin until child actually EATS

Parents of Adolescents

Need to discipline and encourage good decisions and teach consequences, save battles for the most important issues (like things that are going to hurt them or get them in the most trouble, etc.)

Cast Care

Neurovascular assessment q1-2h(Check 6 Ps!) Elevate extremity DO NOT get wet or take in the mud COVER in shower and rain DO NOT put anything in cast ( NO hangers, etc.) COVER when eating USE fan or hair dryer on COOL SETTING if itchy

Post-Op Care for Clubfoot

Neurovascular checks q2h check swelling around cast Elevate ankle and foot on pillows Apply ice monitor drainage Monitor for pain Monitor for infection

Intact Skin- What is the difference between nonspecific and specific immune responses?

Nonspecific= interferon, PHAGOCYTOSIS, enzymes, phagocytic cells (neutrophils & monocytes) Specific (Humoral)= B cells (antibody production) & cell-mediated T- cells

Adequate Glucose Control in PEDS

Normal Hgb A1c levels are 4-6% BUT , 6.5-8% is acceptable in children since they can tolerate higher since hypoglycemia can damage the brain cells. IN children an increased BG level puts them at risk for atherosclerosis! -Look at HgbA1C just as you would with adults -Levels are different in peds -Concern in adults with over 7%ish, but might accept up to 8% in pediatric patients! -6.5-8% acceptable in peds -Normal is 4-6% in everyone, but reason we have a higher number for peds if because the hypoglycemia cause such damage to brain cells in peds patients if gotten too low And puts these children at greater risk MONITOR FOR HYPERGLYCEMIA IN PEDS PATIENTS b/c it puts them at greater risk of atherosclerosis if continue to have such high BG

Spina Bifida (SB)

One of the most common NTDs during pregnancy Is treatable, but also preventable if the woman is taking in enough folic acid Treated in utero or AFTER birth- depends on the severity or prenatal situation, etc.

Rapid Acting Onset Insulin (Lispro, Aspart)

Onset - 15 min Peaks - 30 - 90 min Lasts - 5 hours

Short Acting (Regular) Insulin

Onset - 30 minutes Peaks - 2 - 4 hours Lasts - 4 - 8 hours

Intermediate Acting (NPH, Lente) Insulin

Onset- 2-6 hours Peaks- 4-14 hours Lasts- 14-20 hours

Long Acting (Ultralente) Insulin

Onset- 6-14 hours NO PEAK Lasts- 20-24 hours

What is the preferred form of dialysis in infants, children, and parents who wish to remain independent, families who live a long distance from the medical center, and children who prefer fewer dietary restrictions and gentler forms of dilaysis?

Peritoneal Dialysis!

Pre-Immunizations- NEED TO KNOW INFO FOR FAMILIES & PATIENTS

Pertinent History questions prior to administering some immunizations: -DTaP= hx of reactions, seizures, neurologic symptoms, other previous vaccines, or systematic allergic reactions -MMR= hx of anaphylactic reaction to eggs or neomycin -IPV= hx of anaphylactic reaction to neomycin or streptomycin -Hep B= hx of anaphylactic reaction to common backer's yeast -Influenza= hx of reaction to eggs, previous reaction to vaccine, or hx of Guillain-Barre Syndrome

Ketogenic Diet to help with Seizures

REVIEW OVER PPT & NOTES OVER THIS!!** -HIGH FAT, restricted carbs, adequate protein diet! -Change formula for infants, see effects in 2-3 months, forces body into using glucose as primary energy source, puts body into state of ketosis -Is used with Anticonvulsants (ACs) Check ketosis in urine/blood Change meds if they have carbs NO LIQUID MEDS (high carbs) mix meds w/ water stay on diet 2-3 years then wean off

Bronchiolitis

RSV is most common cause spread by close contact Diagnosed w/ culture of secretions Tx= rest, hydrate, and humidify (NO bronchodilators or corticosteroids!) HYDRATE Can prevent with palivizumab vaccine, VERY EXPENSIVE, pts must meet parameters to recieve it- only given if high risk (ex. premie around RSV seasons) #1 cause of <1 yr old in hospital!

Difference between raking objects and pincher grasps?

Raking means just scooting, pincher grasp they are actually starting to use their fingers more to pick items up.

Histamine 2 Blockers

Ranitidine, famotidine, and Cimetidine Milder than PPIs Inhibits histamine of H2 receptors and reduces gastric acid secretion Indications for use: heartburn, esophagitis, GERD, ulcers. SEs/Adverse Effects= Ha, Constipation, diarrhea. Given after GI surgery to coat stomach and cause renal/hepatotoxicity, confusion, nausea, depression, and blurred vision. NI= don't give within 1 hour of antacids (tums or Ca+ supplement), give without regard to meals but best given BEFORE meals or at bedtime, may cause dizzinesss, drowsiness. Interferes w/ allergen extracts, if getting allergy tested then cannot be on this medication!

Insulin Specifics for PEDS

Rapid Acting Insulin and will have Long Acting are the main types of insulin in pediatric patients- will be treated with long acting if first/newly diagnosed and then will need rapid acting to maintain carbs/glucose levels, etc. Regular and Intermediate insulins will maybe be given together (Mixed)- know how to prepare mixed insulins (Not Ready to be an RN) Lispro (Rapid Acting) & Ultralente (Long Acting)- used more in peds b/c it helps the children imitate the pancreas, don't give together but give rapid during meals and long-acting at night! Children MUST EAT BEFORE YOU GIVE THEM THEIR INSULIN Will do a LOT of carb counting with pediatrics - carb counting is where a patient or family will order what the patient is supposed to have and will set up a dietary carb count set up for each meal (like can have 20 carbs at breakfast, 15 at lunch, etc.) will get an itemized receipt with how much each food is given and how many carbs they eat so they can check how many carbs they ate and check blood sugar and determine how much insulin they can be given once they have ate, etc. Need to double check insulin with another RN Goal is for that rapid acting will take place as they are digesting that food so it will bring that blood sugar where it needs to be is reason they give the iinsulin AFTER eating b/c of the carb counting rules Usually give long-acting insulin at night, might have some patients give long-acting in the morning b/c of being a newer diabetic, etc. but usually done at night Ask (especially or new Type 1 Diabetics) for these patients to keep a food diary/diabetic diary to see how they look if they are in DKA or hyperglycemia or hypoglycemia episode, etc. Know PEAKS and ONSETS and how long they last!

Toddler- Fine Motor Skills

Scribbles (can scribble w/ pen or crayon now!) Can use toothbrush and spoon messily Washes hands at 2 years old (able to wash and dry hands now!) Toddler WANTS to be an adult, they say NO to EVERYTHING......ask them to help you and they will say YES Encourage toddler to do as much as they can for themselves

Critical Tasks of Toddlerhood

Recognition of self as a separate person w/ own will. Control of impulses and acquisition of socially acceptable ways to communicate wants and needs Control of elimination Toleration of separation from parent Need to ensure/promote that as a nurse for this group so want to encourage it and promote it- these tasks are critical to make sure they develop Need to help them learn how to develop autonomy with impulses and deal with tantrums, etc.

Diet for Preschoolers

Recommended to switch from whole milk to 2% milk by this stage Drink 2-3 oz of milk per day and 4-6 oz of juice 5-2-1-0 RULES of Diet and Activity: -5 services of fruits and veggies, -2 hours or less of TV -1 hour of physical activity per day -0 sugary drinks,

Vesicoureteral Reflux

Refers to the abnormal retrograde/back flow of bladder urine into the ureters. During voiding, urine is swept up to the ureters and then flows back into the empty bladder, where it acts as a reservoid for bacterial growth until the next void. -most likely associated w/ kidney infections rather than simple bladder infections -Children are VERY symptomatic with high fevers, vomiting, chills This causes UTIs/pyelonephritis Graded by severity 1-5, 5 is gross dilation Need to get a Voiding cystourethrography (VCUG) if suspect or have this! These pts will need prophylactic ABX - ****These pt's siblings will need to be screened BEFORE the age of 2 years old b/c more than likely will have it too (genetic component-siblings might also have it or have some damage if don't know they have it, etc.)****

Mastoiditis

S&S are like AOM ( sudden, inflammation, rapid onset, pain and fever)

UTI S&S in Infant

S&S are vague fever irritable poor feeding diarrhea vomiting jaundice strong smelling urine lethargic

Rubella (German Measles)

S&S: congenital rubella maculopapular rash rubella syndrome= microcephally, PDA, cataracts Transmitted through AIRBORNE & DROPLET infectious BEFORE rash and for 2 weeks afterwards. Infant w/ congenital rubella can be infectious for months Maculopapular rash-starts on the face and rapidly spreads throughout the body! Severe complications in the fetus

Rubeola (Red Measles)

S&S: maculopapular rash koplik's spots on mucosa Transmission through DIRECT CONTACT WITH DROPLETS USE AIRBORNE PRECAUTIONS! Maculopapular rash- rash begins on face and spreads downward Infectious BEFORE the rash Koplik's spots in prodromal phase, photophobia Tx w/ Vitamin A Supplementation

Hypotension in Infants or less than 1 year of age....

SBP <70 mmHg

Myelomeningocele

SEVERE form/type of SB posterior vertebral arches fail to fuse AND the sac herniation contains meninges, CSF, and spinal cord/nerves MAY have lower limb paralysis and decreased sensation NO MOVEMENT BELOW PROTRUSION! MYELO= effects menginges, CSF, AND also spinal cord/nerves

How do prevent SIDS (Sudden Infant Death Syndrome ) in children??

SIDS occurs in the first year of life peaking at about ages 2-4 months old, happens between midnight and 9am, and there is an increased incidence in the winter months Teach parents= need a firm mattress for baby, NO TOYS IN CRIB w/ baby, NO BUMPER, NO smoking or drugs or alcohol around baby, no use of pacifier while sleeping, teach to sleep in same room as parent for first 6 months of life up to a year old BUT NEVER IN SAME BED AS PARENTS b/c could smother them, also teach them that breastfeeding does help give a protective factor against SIDS Teach ABCs of SIDS= ALONE, on my BACK, in a CRIB Make sure they are laying flat on back in crib with nothing else in the crib w/ them that could smother them ***Will be a SATA on the exam! HINT HINT!!***

Anaphylaxis-allergy in cancer treatment

STOP transfusion keep IV patent with NS after to keep vein open (KVO) May need O2 and epinephrine Monitor close for 1 hour after infusion (rash, urticarial, hypotension, wheezing, N/V)

Car Seats in Infants

Should continued to be rear facing until the child is at the maximum height and weight requirements. Continue rear facing car seat until child outgrows rear facing car seat by reaching the top height or weight limit allowed by your car seat's manufacturer.

Types of Fractures

Simple-closed-NO break in skin Compound- opened- see a break in skin, give ABX asap if have an open fx!!! Greenstick- usually less than 10, incomplete fx, one side is broke and one side bent, usually cast 4-8 weeks. Comminuted Impacted Plastic Deformation- bone bends and bows but does NOT break Buckle Fx- common, raised/bulges at fx site! Complete Fx- bones break into 2

4-6 months of Age MOTOR

Sits with support Discovers hands, begins reaching and grabbing Brings hands to midline! Begins playing with rattles, squeaky toys, etc. Likes noises Moro, Tonic Neck, and Rooting reflexes are gone/ Tonic Neck reflex disappears and infant turns over abdomen to back at 5 months and back to abdomen by 6 months. Head lag- when picked up by the arms the head lags, should disppear at 4 months, head needs ot be able to be held up to eat. Drool a lot, TONGUE THRUST DIMINISHING (which means they are ready to eat solid foods like rice cereal) Teething Fussy Diarrhea Puts weight on feet when held upright FINE MOTOR at 4-6 months RAKES OBJECTS (NOT PINCHER GRASP YET!)

Safety Promotion and Injury Prevention w/ Toddlers

Teach parents to note different formulations of Acetaminophen, b/c Acetaminophen is the most common accidental poisoning by ingestion in toddlers! Well child visits= will check lead levels (if high see developmental delays, vision changes), will checkHgb and Hct (checks for iron deficiency anemia), vision screen (cover and uncover test) and check for a shift of fixation and check for strabismus Preventing drownings= don't leave child alone or unattended in any type of water (baths, swimming pools, etc.) even if child is able to swim, etc. Preventing Burns- kids might try to take pot handles down off the stove when you are cooking so they can get burned that way, so be mindful and prevent by turning pot handles around where they can't reach and might Careful with Falls- shoes and grippy socks important

What should parents do for toddler temper tantrums??

Temper Tantrums occur b/c of the limited language of toddlerhood leads to frustration. Parents should anticipate this as normal Educate parents that inconsistent parental practices INCREASE the frequency of tantrums Parents should isolate their child in a safe place and ignore the tantrum. Parents should use time outs! Time outs should be = 1 min per each year of age, but don't want to have time out in an area with lots of stimulation or that will cause the toddler to hurt themselves, just put them at a wall or corner to be the MOST effective. BE CONSISTENT

Adolescents (ages 12-18)

They are developing a sense of identity, developing independence from their family, and establishing relationships with peers, FORMAL OPERATIONAL thinking (abstract thinking/thoughts about things like beauty and the future) Identity vs. Role Confusion- Erickson's Stage ADOLESCENT= ABSTRACT THINKING

Internal Control Mechanisms Influencing Fluid Balance (Box 24-1 p. 947)

Thirst- the impetus to ingest water is stimulated by increased solute concentration (osmolality) of ECF and/or diminished intravascular volume Antidiuretic Hormone (ADH)- ADH is released form the posterior pituitary gland in response to increased osmolality and decreased volume of intravascular fluid; it promotes water retention in the renal system by increasing the permeability of renal tubules to water Aldosterone- Aldosterone is secreted by the adrenal cortex; it enhances sodium reabsorption in renal tubules, thus promoting osmotic reabsorption of water Renin-Angiotensin System (RAS)- diminished blood flow to the kidneys stimulates renin secretion, which reacts with plasma globulin to generate angiotensin, a powerful vasoconstrictor. Angiotensin also stimulates the release of Aldosterone.

Sexual Education for Preschoolers

This age group have sexual curiosity Masturbation is normal w/ this age group THey are very interested in anatomical differences (male vs female) For Parents or Nurses- find out what they know & think and use anatomical terms for part of body

Total UOP for 24 Hours

Total Output for 24 hours (in mL) / weight of pt in kg/ 24 hour = mL/kg/hr

Sucking Reflex

Touching the infant's mouth will cause the infant to respond by opening the mouth and making sucking movements' Moving the finger along cheek and the infant starts to suck.

Sensory Development in Neonatals/Infants

Tracts that develop myelin first are the sensory and cerebellar tracts Touch is especially important and so is most acute sense in the neonate Senses help with creating trust for newborn They develop trust vs. mistrust during that first period of life! ALL newborns senses are very acute, except for sight! Normally that first hour after birth they will be the most awake and alert, so most able to go to the breast and feed easily, so very critical to try and check scoring and get them to feed/breastfeed as soon as possible At least 2-4 hours after that they will wake up again and want to feed. Try to manage care and schedule around feeding and awake times with these newborns patients. First hour of life, infant is awake and vigorous, limit care and encourage bonding w/ parent, also greatest time to fixate and lights low and postpone erythromycin after born BUT give within 2 hours (By law!)

Pertussis

Transmitted by DIRECT CONTACT & DROPLET! CONTACT ISOLATION & DROPLET PRECAUTIONS Highly contagious! AKA "Whooping Cough" Have a VIOLENT PAROXYSMAL COUGH! Nursing Interventions: - NO cough medications!- NO NO NO! -Hydration is key to tx- make sure hydrated and rested! - Do NOT get child upset, worked up, or stressed! -Position infant on side to decrease chance of - aspiration w/ vomiting -Provide humidified oxygen -Suction as needed (prn) -Observe for signs of respiratory distress

Diphtheria

Transmitted by DIRECT CONTACT- Use contact & droplet precautions!! Laryngeotracheitis w/ upper airway obstruction Tx= IV Antitoxin! Prevention= Immunization!! Symptoms can mimic other childhood diseases b/c will have sore throat and sometimes not have any other symptoms besides a sore throat so might get diagnosed with strep throat when really have this disease. Remember kids w/ childhood cancers will lose immunity to diphtheria & Tetanus vaccine so will need to reimmunize if this is the case.

Varicella (Chicken Pox)

Transmitted by DIRECT CONTACT/AIRBORNE PLACE IN NEGATIVE PRESSURE ROOM! Contagious BEFORE onset of rash and until lesions crust over!! macular rash---> red, papular rash---> vesicles/pustules---->dry and crusted over! Tx/Prevent= VZIG- varicella zoster immune globulin Vaccine= 1st at 12-15 months and 2nd at 4-6 years old!

Tetanus

Transmitted by DIRECT INNOCULATION- soil, dust, intestinal tracts of humans and animals Prolonged contractions of skeletal muscles, "lockjaw", opisthotonos Tx= tetanus immunoglobulin (TIG) and tetanus toxoid Prevention= Tetanus toxoid

Polio

Transmitted by FECES AND OROPHARYNGEAL SECRETIONS- Use CONTACT PRECAUTIONS! "Infantile paralysis" Destroys motor neurons paralysis infectious 7-10 days prior to symptoms developing

Hearing Screen 6month-2 1/2 years old

Use visual reinforcement audometry (behavioral techniques!) and conditioned orienting (COR- activities in response to sound!)

Communication with Infants

Use... Touch Soft voice Be responsive to crying and needs Take turns in baby conversation Develops from babbling and cooking to single word production

Casts are used to do what?

Used to immobilize a joint or bone Left on for/Takes at least 4-8 weeks to heal

Prevent Meningitis with what?

VACCINATIONS HIB (H. Influenza Type B) and Pneumococcal at 2,4,& 6 months of age and booster at 12-15 months of age Also Meningococcal conjugate at 11-12 yera olf w/ booster at 16 years old!

Intussusception

VERy painful setion fo intestine telescopes and goes back into self! Common in pts 5 months - 3 years old! S&S= vomiting, abdominal pain, passage of blood, RED CURRANT LIKE JELLY STOOLS w/ blood and mucus mixed in, lethargy, will palpate an abdominal mass in RUQ (sausage like mass!), bowel obstruction causes ileum. Tx= first try to treat w/ nonsurgical methods w/ air enema in rectum and push intestines BACK OUT, then inject barium enema (monitor stool after, will turn chalky white), if nonsurgical methods do NOT work then need surgery if any bowel necrosis then must take it out.

Hyponatremia S&S

Weakness HA, Dizziness- feel "hungover" Abdominal cramps Confusion, apathy progressing to lethargy Irritability Weak pulse Decreased BP

S&S of Vitamin D Deficiency

Weakness fatigue lassitude N/V Diarrhea HA

S&S of Hypercalcemia (High Ca+)

Weakness, fatigue N/V anorexia Constipation Dry mouth/thirst Muscle Hypotonicity Bradycardia (low HR)

Hypercalcemia S&S

Weakness, fatigue Nause & Vomiting , anorexia Constipation Dry Mouth/thirst Muscle Hypotonicity Bradycardia

10-12 Months Nutrition

Wean from bottle to cup Use whole milk after 12 months Eats 3 meals with snacks Need toothbrush & non-fluoride toothpaste until they are able to spit or age 3 Prevent bottle mouth (dental caries in primary teeth from sleeping with bottle) Think about risk for obesity and don't allow them to go to bed with bottle to prevent dental caries/ sugar sitting on the teeth form having bottle with things in it like milk and juice so wean them off bottle and go to regular sippy cup Encourage parents to give healthy snack options

Prior to the administration of ANY medication, you as the nurse need to know:

What data would cause the nurse to hold or otherwise manage the administration of this medicine? BP, HR, TEMP, VS, any pain, allergies, when last given, how it is given, any N/V if relief of it if med given to relieve that, etc. Before this drug is given, the nurse should do what? What indicates a therapeutic or non-therapeutic response to this drug?

Hemophillia

X-linked RECESSIVE trait Mother is the carrier Expressed almost all in carrier as female and affected in males TWO TYPES= Hemophillia A and B Hemophillia A is worse Joint Destruction form hemoarthrosis, bleeding into the joints (ELEVATE- RICE methods!), caused by falling or even bumping happens within a few hours will start swelling. -Give DDAVP for mild hemophilia and von willebrand disease for prophylaxis -Give Factor VIII concentrate (recombinant form) for moderate or severe hemophilia- give Factor VIII as IV form! Teach family to= recognize bleeding (esp. into joints early), teach administration of factor VIII, dental hygiene w/ soft toothbrush, protective care (soft toys, padded rails, knee bads for crawling, need med alert bracelet, RICE for minor bleeds and if joint is bleeding elevate and immobilize, after acute bleeding tx w/ active ROM, NO Warm compresses- want cold compresses! School aged and adolescents should do safe sports such as golf, swimming, walking, jogging, fishing, or bowling is okay to do.

HIV

Zidovudine (ZDV)- oral antepartum, IV during labor, oral for infant for 6 weeks Reduction in transmission rate to 2% Western blot or ELISA will ALWAYS be positive in newborn! PCR is the definitive test! Prophylactic trimethoprim-sulfamethoxazole (Bactrim) -Children taking HIV meds may need chocolate syrup

Hypovolemic Shock

a decrease in circulating blood volume (BV) Is r/t to blood loss, plasma loss, or burns ECF loss (risk for diarrhea or dehydration), MVA/trauma/post-op DECREASE BV

Development and Hospitalization

a response to hospitalization is influenced by AGE, DEVELOPMENTAL STAGE Goal is to minimize hospitals' effect on child's growth and development =As the Nurse your responsibility is to: LISTEN to the family, include the child, and teach them ***Review the Providing Developmentally Appropriate & Safe Care in Hospital handout/sheet***

Biliary Atresia

bile duct obstruction in bile flow -cholestasis Causes itching/pruritus -xanthomas (painful itchy, fatty deposits around joints, lipid deposits form cholestasis!) LOW ADEK vitamins, iron, zinc, selenium (supplement these vitamins d/t absorptive issue!) Usually seen in the first few weeks of life S&S = -jaundice -dark urine -acholic stool (pale stool d/t NO bile salts!) -Monitor for= weight gain! Get a Kasai procedure done = hepatic protoenterostomy (connects small intestine to the liver to treat that, allows the bile to drain, palliative measure until can get liver transplant!)

Waterhouse-Friedrichsen Syndrome

bleeding into the adrenals causes them to fall PURPURA rash is KEY

Leukotriene Modifiers "lukast"

block inflammatorhy and bronchospasm effects of leukotrienes, alternative or in addition to corticosteroids Side Effects = flu/cold like S&S, thirst, ear/leg pain, itchy/urticaria. Give Zafirlukast if 7 yo and up, and Montelukast for 1 yo and up!

Right Sided HF

blood backs up to the body (spleen enlarged/splenomegaly, liver/hepatomegaly, ascites, edema, JVD, peritoneal edema, venous congestion , weight gain

Left Sided HF

blood backs up to the lungs (wet sounding, crackles, resp. distress, actvity intolerance, cyanosis, retractions)

Age Appropriate Toys for 9-12 months of Age

books w/ large pictures push-pull toys teddy bears balls Anything bright and moves that they can look at

Early Adolescent (11-14 years old)

changes in puberty decline in self-esteem imaginary audience and personal fable preoccupied w/ rapid body changes Start to really see changes in themselves, and they get fixated on what is happening to their body and in their body, etc. Might have a decline in self-esteem if expectations not met with how their body is changing or doing, etc. so might cause a little depression or anxiety as well with this stage Might try to equal their peers and match them to keep up with their peers or friends Being accepted by their peers/friends is VERY important to them at this period/stage in life.

Treatment of Status Epilepticus

check ABCs provide O2/supp. oxygen Get IV access (for antiepileptic agents: diazepam or lorzepam; diastat (valium in gel-rectal); fosphenytoin w/ phenobarbital) **DO NOT MIX Diazepam Provide safety,Assess, and Document! Ask what meds were given if comgin from outside the hospital, etc (like if coming from home or ambulance)

Sick Day Rules/Sick Day Management with DM

check BG and ketones q3h & give JUICE/SODA if not eating, insulin will need to be INCREASED when sick when sick the body will have an increased need for insulin/ BG will be high and will have a stronger stress response to raise the BS levels, when BS levels are raised it will block insulin effects, So if have an increased BG still need to continue SCHEDULED insulin in a sick day regimen, even if don't eat much, need to increase accuchecks/glucose checks in these patients and might have to do that every 3 hours to make sure they are staying stable, check for ketones in the urine b/c the body will break down fats and as a result will create ketones which comes out through the urine and through respirations out from the lungs (secretions, etc.) so if in DKA with this might have a very fruity smell in their mouth (like juicy fruit bubble gum!) IN sick patients only time it is okay to give them to give them small amounts of grape juice or soda (like coca-cola) if not able to eat just to help them get those carbs they need to keep BG stable and in check.

1 -2 week Visit Followup After Birth

check weight to make sure they are gaining weight back as expected, ask about feeding and peeing and pooping, ask parents questions about how things are going in the home, ask about postpartum depression (check mom for signs of that), check for shaken baby syndrome, assess attachment and bonding with mom and/or parents, teach/discuss to NEVER leave infant alone with a pet or sibling, teach proper way to warm formula (warm it in a cup of warm water, NEVER microwave!), and teach parents milestones to expect from their baby at this first visit b/c very important to their development!

Risk Factors of Otitis Media

children at risk due to shorter/horizontal eustachian tubes, immature immune systems, less than 2 years old, atopy, bottle propping or bottle feeding when supine, chronic sinusitus, cleft palate , child care attendance, down syndrome, passive smoke

Asthma

chronic inflammatory narrowing of the airways, limits airflow, has response with certain stimuli and swells/closes airway, bronchial hyper responsiveness, episodic dyspnea, wheeze, cough. If attack the increased mucous secretions, thicker mucous, muscles tighten around airway causing it to swell. Wheezing= give bronchodilator

Nausea and Vomiting in cancer

common SE with chemotherapy anticipate and treat before get it! give ondanestron/antiemetics before chemo- tx 30 minutes before then around the clock,okay to tx around the clock, key is to anticpate the need for it! Check I&O and monitor eating (SATA question!!)

Water Intoxication S&S

elevated UOP, HA, vomiting, seizures, irritability, sleepiness, edema, Appear well hydrated but actually in fluid volume overload (FVO). Decreased H&H b/c of dilution Caused by: IV therapy, tap water enema, incorrectly mixed formula, excess water ingestion, too rapid dialysis treatment, too rapid of glucose levels going up in DKA MAKE SURE YOU ARE GIVING THE CORRECT IV SOLUTION!!

Cleft Lip/Palate

failure of bone/tissue in upper jaw to form correctly at midline Multiple types Hereditary or occurred spontaneously during pregnancy (2-3 months gestation!) Increased risk of getting in native americans More common in male babies! Can be partial or complete and unilateral or bilateral, & lip or palate Will have multiple surgeries Cleft Lip= at 3 months of age Cleft Palate= at 9-12 months of age repaired 7-8 years old= they will have a bone graft and orthodontic/dental repairs often! Causes an increase in Otitis Media (OM) incidences Also at risk for URI and aspiration! Monitor for respiratory distress! Cleft palate babies= swallow more so burp 2-3 x every feeding and set them up as upright as posible Larger holes in the nipples of bottle increase milk intake! Pre-op= -monitor respiratory status q4h, -suction w/ a bulb syringe, -keep upright for feedings, -feed them slow, burp often -use special nipples on bottle if needed -keep upright held like a football position for 30 minutes AFTER feeding -wean them off bottle to a sippy cup ASAP! -They can use breast or bottle w/ a cleft lip, but cleft palate they MUST USE SPECIAL nipple/bottle with the one way valve! ENSURE THE BOTTLE NIPPLE IS IN BACK OF MOUTH! Post-Op= -Assess respiratory status q4h -Ensure patent airway! (ABCs!) - Avoid suctioning in mouth - Use NO-NO elbow restraints for a week -Remove elbow restraint q2h one at a time for ROM and check circulation! These are used so they CANNOT TOUCH/MESS UP SUTURES -Position them on their side or back -Prevent crying -Post op syringe with rubber tip catheter -NO SPOONS OR STRAWS -NO PACIFIERS -Perform suture line care per doctor's orders -NOTHING IN MOUTH that can harm suture!

Developmental Dysplasia of the Hip

femoral and acetabulum NOT aligned. Ortaloni test= that HCP does, can hear and feel hips clicking, you are feeling the femoral head slip out of the acetabulum with click or clunk DURING ABDUCTION. Barlow test= you can feel dislocation, ability to dislocate the femoral head and then it slips back into place, RN does this one, not really supposed to do it bit done on accident a lot These two (Ortaloni and Barlow tests) screen for it until infant can walk. Initially these kids will be in a pavlik harness to maintain flexion abduction and external rotation to hips to help realign. Infants signs= positive Ortaloni and Barlow test, unequal folds on buttocks and thighs, limited abduction of affected hip, unequal leg lengths. Older Child signs= lip on affected side, leg discrepancy such as Galeazzi sign seen in walking pt when flexing knees lying and touch ankles ot butt you can feel click. Trendelenburg sign= is when the child stands and bears weight on the affected hip the pelvis tilts down on the normal side instead of upward with normal stability ( means the Trendelenburg sign is positive) MUST wear Pavlik Harness at ALL times, teach skin care (can remove Pavlik Harness for bath), ALWAYS wear onsie under pavlik harness, check area understraps for redness, always diaper UNDER the Pavlik Harness, need followup and frequent adjustments to allow for growing, can't grow and develop (pull/crawl). Patient may need spica cast if pavlik harness is not working.

Dental in 6 months of Age

first tooth eruption at 6 months of age Clean tooth with plain water and a washcloth Routine fluoride supplements are NOT recommended before 6 months of age If city water there is NO need to supplement, if well water then the infant NEEDS supplement after 6 months of age

SIADH w/ Increased ICP

fluid retention (FVO) decreased UOP HTN Weight Gain Specific Gravity (SG) >1.030 dilute urine LOW Na+

Fundoplication (Nissen)

for GERD treatment when meds don't work. Helps reduce GERD/reflux, top of stomach is wrapped 360 degrees around the esophagus and helps tighten that area. May have a g-tube and this at the same time!

Chait Tube

for constant/chronic constipation commonly used for paraplegic, CP, spina bifida, and immobile pts It is like a trap door outlet to irrigate the bowels Do enema w/ NS and flush thru surgical opening while they are on the toilet, use NS & NOT water!

Fetal Circulation

forms of bypasses, lungs not used in utero they are filled with fluid and bypasses, fetus gets oxygenated blood by the placenta Ascending aorta sends blood to HEAD & Descending aorta to lower BODY circulation Pulmonary veins take oxygenated blood into the left atrium, mitral to the left ventricle, then to the body via the aorta

Open Reduction Internal Fixation (ORIF)

fracture and surgically go in with rod and screws, usually to stabilize long bones. Move all other limbs Care for incision site!!

Preschooler Physical Development

gains 5 lbs per year and 2-3 inches per year Average weight of 3 year old is 32 lbs. Have all primary 20 teeth by age 3, and may have achieved nighttime bowel and bladder control by now.

Pharyngitis

gargle with warm saline 3x/day, ice/popsicle, acetaminophen/ibuprofen q4-6 hours

Terminal Illness in Children

goal is to involve everyone earlier implementation of DNR less use of aggressive therapy provide palliative care Include family in decision making process

FAS Functional Deficits

inappropriate behavior At risk for substance abuse later on in life poor personal boundaries Small corpus callosum and cerebellum Poor anger management Intrusive behaviors Too Friendly w/ strangers NO BOUNDARIES ADHD Vision and hearing issues NI= need routine, structured and consistent care FAS is Dx at 1 year of age typically Don't have LARGE EARS OR TONGUES!!! They get in trouble a lot and do things to get attention! Is a learning disability

Myringotomy

incision to allow drainage, relieves pressure, if draining put cotton ball in ear and moisture barrier on skin, do hearing and speech BEFORE post-op follow up to check lingering effects ABX ear drops AFTER

Teaching Plan for Asthma

increase fluids, don't abruptly discontinue meds, good oral hygiene, house at 50-60% humidity, NO carpet, if have carpet vacuum daily

Treatment for UTIs

increase fluids, maintain IV, and monitor/check for fever! Meds= will give sulfamethoxazole/trimethoprim (Bactrim) with 8oz of water

Maternal Antibodies

infants have this till they develop their own immunity, maternal respiratory antibodies until 3 months, that is why at 3-6 months they have increased infections breastfeeding= gives immunity

Nutrition for 6 months of Age

introduce one food at a time start with vegetables first Rule is 1 single food/ingredient for 3 days to make sure no allergy exists and can tolerate that food NO solids before 4-6 months of age If developmental delays then way longer to introduce solid foods.

Negativism

is expected by toddler Is an attempt for the toddler to who their will Says "No" to everything and wants to do everything alone ex. "me do" When taking their BP, don't ask if you can take it, just explain what you are doing and work your way into it before doing so, and allow them to put the BP cuff on you or put it on themselves before taking their BP, etc. if they are able)

Death in Precshoolers

magical thinking leads to a sense of omnipotence, guilt, and punishment They think death is temporary 3-5 year olds may think death is like SLEEP AND REVERSIBLE Greatest fear over death is separation from parents Regression in development and behavior Nursing Interventions= minimize parent separation, clarify misconceptions (guilt, punishment), use accurate simple language, and play

Treatment of Shock includes.....

maintain airway O2 non-rebreather mask fluid resuscitation (bolus 20 mL/kg with isotonic crystalloids) Position child flat w/ legs above the level of heart Keep warm Treat pain (will be in ICU) Trendelenberg= head down, feet up, heels of- helps w/ INCREASING BP Reverse Trendelenberg= head up, feet/heels down- helps DECREASE BP

Short Bowel Syndrome (SBS)

malabsorptive issue usually born w/ an anomaly and surgery caused it Results form a decreased mucosal surface area AFTER small bowel resection Lose small intestines after surgery! They have chronic diarrhea and CANNOT absorb nutrients Common if pt has Gastroschisis, Omphalacele, Intestinal atresia (can cause small bowel obstruction when they need a resection!) , or if taken out if necrosis Is common in PREEMIES and those who have had Necrotizing Entercolitis (NEC) Can be on TPN/lipids or G-tube placed for extended periods of time

Symptoms of Cancer

many S&S are common w/ other disease S&S Bone pain may be a key S&S Pallor tired weak lethargic (d/t anemia) petechiae bleeding bruising (d/t thrombocytopenia) infection fever (d/t neutropenia) bone/joint pain (d/t leukemic infiltration of bone marrow) enlarged lymph nodes (hepatosplenomegaly) HA/vomiting (CNS involvement) anorexia weight loss bone marrow aspiration shows 80-90% immature blast cells Get a CBC w/ diff If have leukemia may have normal CBC, don't only depend on CBC to diagnose, need ot check bone marrow aspiration Tx= depends on cancer type!

Compensated Shock S&S

mild tachycardia APPREHENSION decreased UOP thirsty BP is NORMAL IRRITABLE Pallor Narrowing Pulse Pressure (PP)

SB Occulta

mildest form/type Usually found incidentally NO herniation NO S&S Vertebral arches between L5 and S1 fail to fuse MAY be noted with dimple in region or hair tuft Can see w/ imaging! Can be repaired in utero or at birth DOESN'T AFFECT the baby/child "Least bad" type of SB child typically doesn't even know they have it

Iron Deficiency Anemia

most common in 6-24 months old (during growth spurt) -toddlers and females most commonly effected. -Also common in female adolescents. -Maternal iron stores last full-term infant 4-6 months old and preterm only 2-3 months old. Need supplementation AFTER running out, iron fortified formula S&S: pallor pale (espec. mucous membranes) TIRED prone to infections Increased HR (sometimes murmur) Overweight "milk baby" (d/t lots of whole milk but no food)- this baby will be pale, chubby, petite Low Iron intake Milk intake greater than 32oz/day is too much D/T whole milk not having enough iron

Laryngotracheobronchitis (LTB)

most common of the croup syndromes viral onset is abrupt and WORSE AT NIGHT sound worse than they look Usually in children under 3 Common causes= RSV, parainfluenza, virus, mycoplasma pneumonia, influenza A & B LTB- sound bad, abrupt, bad @ night

Meningococcemia

most dramatic and serious complication of meningitis -sepsis Need emergency treatment! Waterhouse-Friderichsen Syndrome septic shock Disseminated Intravascular Coagulation (DIC) Bilateral adrenal hemorrhage PURPURA Decreased BP

OME

most resolved in 2 months, can cause temporary hearing/language deficit if has longer than 3 months, ABX do NOT work. NO ABX Give tympanostomy tubes if deficit for 3 months

S&S of Hyperkalemia

muscle weakness flaccid paralysis Hyperreflexia Bradycardia (Low HR) Ventricular Fibrillation (V.Fib) and cardiac arrest Twitching Oliguria Apnea- resp. arrest!

Hypokalemia S&S

muscle weakness muscle cramping/stiffness Hyporeflexia/paralysis Hypotension Cardiac arrhythmias, gallop rhythm tachycardia or bradycardia Ileus/abdominal distension Irritability and fatigue Apathy

S&S of Hypokalemia

muscle weakness muscle cramping/stiffness Hyporeflexia/paralysis Hypotension Cardiac arrythmias, gallop rhythm Tachycardia OR Bradycardia (high or low HR) Ileus/Abdominal distention Irritability and fatigue Apathy

Car Seat Safety w/ School Aged Kids

must be in a BOOSTER seat until reach 4 ft 9 inches AND 8-12 years old! AND MUST BE in BACK SEAT

Nursing Interventions (NI) for Croup

neb. epi, dexamethasone, cool humidifier, hydrate

S&S of Autusm Spectrum Disorder (ASD)

ned for routine they are resistent to change they have a lack of responsiveness to other people NO fear of danger do NOT develop relationships They play alone Use of objects is bizarre (ex. they will spin tires on toys) -No eye contact -don't like cuddling

Neurogenic Bladder in SB

need frequent clean, straight catheterization Teach family how to do it. Maybe can diaper according to location or severity. Anticholinergic agents need to be given ( Ex. oxybutynin) As the child gets older they can get a Vesicostomy (a temporary fix) or Mitrofanoff (more permanent fix) that are placed in the RLQ to help with independence and so they can do if they are at school or away from home, etc.

Ritualism

needs consistency, be consistent and comfort them, use cluster care and try to mimic home schedule as much as possible They need that reliability and sense of comfort like sense of their family and familiarity Hospitalizations are out of their daily routine and they might not understand it, etc. Will still see some separation anxiety (can actually increase in toddlerhood) so it's even harder to not be around parent-figures/familiar people if in hospital, etc.

Water

newborns are about 75% total body water (TBW) until about 6 months AND it gradually decreases. Adolescents are about 43% TBW

Nonorganic Failure to Thrive

no reason known to have decreased weight and growth, could be abuse or neglect No reason known, do all the tests and everything comes back normal, so don't know why Concern maybe child neglect and not getting fed the way they should be, etc. Nurse might notice something is off like how the child interacts w/ their parent or how the parent talks to the child, etc.

Toddler Toys

noise making push-pull toys riding toys work benches hammers musical toys blocks puzzles finger paints dolls crayons clay toy phones storybooks w/ pictures toddlers enjoy tactile toys so they can do something w/ it or manipulate toys, etc. TACTILE TOYS

Fractures

non-accidental trauma (NAT) or AKA abuse- THINK this is a spiral fracture caused by twisting! Multiple fractures= can indicate osteogenesis imperfecta (OI) where they have brittle bones (AKA brittle bone disease!) Fractures in Infants Fractures at Various Healing Stages

Autism in Infancy

normal development until about 6 months of age 6-12 months of age they fall behind in some areas. By age 3 years old there are considerable developmental delays in language and social skills

Insulin Waning

not enough insulin given at night, so GIVE MORE INSULIN insulin is being given at bedtime for these patients and as the night goes on what happens is the BG will RISE/GET HIGH and if it rises at the early morning state they didn't have enough insulin at night to control it throughout the night so HAVE TO INCREASE NIGHTTIME DOSE! Insulin given at bedtime and as the night continues pt will have hyperglycemia so we know we didn't' give enough insulin at nighttime dose so will need an INCREASE IN NIGHT-TIME DOSE by increasing that rapid-acting

Posturing

noticed when painful stimuli is done based on how they look Two Types: -decerebrate = extension dysfunction; midbrain and brainstem effected; extended arms and flexed wrists -decorticate = flexion dysfunction in cerebral cortex or tracts ABOVE it

Absence Seizures

often looks like ADHD or daydreaming Pt does NOT remember, can last for 30 seconds Most pts will outgrow these types of seizures Can have up to 20 a day! Thumb against thigh lip movements brief loss of consciousness!

Intellectual Disability

onset before 18 years old intelligent quotient (IQ) functional capacity of 70-75 or below Problems w/ learning, adaptive behaviors, social and practical skills Is the most common developmental disability There is an increased risk for Alzheimer's Disease in Intellectual disablity/cognitive impairment Educable/mild- IQ 50-75- achieved mental age of 8-12 year old Trainable/moderate- IQ 36-49 and mental age of 3-7 year old Severe= IQ 20-35 and age of a toddler Profound= IQ less than 20 and shows basic emotional responses and needs complete care

Digoxin

oral positive inotropic, improves contractility, increase strength of contraction and slows so it can fill Adverse Reactions= bradycardia, AV/SA node block, ventricular arrhythmia Nursing Interventions= evaluate apical HR for a full 1 minute (RIGHT before administration), HR MUST BE AT LEAST OR ABOVE 90 bpm in infant/child, and at least 70 bpm in the older child (school age/adolescent), HR to low, hold and ask doctor

LEAD

patient with anemia will absorb lead faster and easier Ca+ helps prevent the absorption of lead Adequate Ca+ prevents lead poisoning , also more lead absorbed in an empty stomach More lead in hot water d/t it dissolving Use only COLD WATER for drinking, cooking, nad making infant formula! Increased Lead= Decreased Iron/Fe Increased lead absorbed on an empty stomach Chronic lead poisoning----> neuro S&S!! Abdominal pai----> Acute Lead Poisoning

Early Signs of Hydrocephalus in Infant (SATA question)

rapid head growth full, bulging fontanels irritability poor feeding distended prominent scalp veins widely separated head sutures Lethargy

Neuromuscular Disorders

reappearance (or sometimes never losing) PRIMITIVE REFLEXES (ex. moro, grasp, rooting, etc.) after 5 months of age is associated with neurological disease Examples= Cerebral Palsy (CP), Spinal Muscular Atrophy Type 1 (Werdring Hoffman), and Duchenne Muscular Dystrophy

Nursing Interventions w/ Hearing Impairment/Loss

reassess that instructions are understood Use visual and tactile medai Can communicate using picture board if needed

Tympanostomy Tubes

recommended after recurrent AOM (3 episodes in 6 months or 4 episodes in 1 year with 1 in the last 6 months). Keep bath water and shampoo out of ears, ear plugs, stay out of the sun

Ace Inhibitors (ACE Is)

reduce afterload on the heart Captopril most common in peds patients helps with cardiac output (CO Obtain BP RIGHT BEFORE dose and monitor after If BP falls, place patient in supine with legs elevated Give 1 hour BEFORE meals, monitor for proteinuria (frothy urine) and anorexia (causes altered taste perceptions) Teach family that skipping causes severe rebound hypertension, teratogenic effects (don't use if an adolescent female that can become pregnant, unless no other choice and then must have to put them on birth control) End in -PRIL

ANC reflects what?

reflects the ability to handle bacterial infection BELOW 500= BAD!!

Celiac Disease

sensitivity to wheat, rye, barley, oats= AKA gluten -An immune-mediated IgA deficiency. -Causes growth retardation & celiac crisis (profuse watery diarrhea and vomiting in VERY young children) -chronic diarrhea until dx w/ abdominal distention -weight loss -fatty stool (steatorrhea) -Dx by stool culture and biopsy of jejunum looking for villous atrophy -seen in 2-6 month old infants AFTER solids are introduced. CAN EAT= corn, corn on the cob, popcorn, corn chips, rice, millet, potato flour, soy - Will be on a Temporary lactose free diet - Need high protein/calorie diet -AVOID high fiber until bowel inflammation has subsided -supplement w/ fat solubile vitamins and folic acid and iron risk of developing lymphoma

hospitalization in infants- Major fears are....

separation and strangers Nursing INterventions are: -Provide consistent caretaker -Attachment object ( allow them to have that special teddy bear or blanket with them at all times) -Minimize separation from parents and significant others as much as possible

Ductus Arteriosus

shold close within 1 hour of birth connects pulmonary artery and aorta; O2 closes

Respiratory System Normals in PEDs- Kids Have....

shorter eustachian tubes smaller airways -shorter distance btwn everything so easier for bacteria to grow!

Apnea

should be no longer than 20 seconds less than 20 seconds is normal if longer, then could mean respiratory distress/issues

Otitis Externa

swimmer's ear

Mouth Ulcers in cancer

soft bland food is recommended anesthetic mouth washes acid will burn mouth (tomatoes, etc.)- NO acidic foods! TEACH to brush teeth Rinsing is NOT adequate Clean mouth to decrease bacteria If plateletes are above 40,000 they can brush and floss 4x a day! (CANNOT brush or floss if below 40,000 platelets!) If less than 40,000 platelets, they need to wipe with moist gauze, use a very soft toothbrush. Stomatitis is common 5-10 days after chemo Use baking soda or saline rinse or magic mouthwash (Benadryl, Maalox, and numbing agent) Swish and swallow! YOU DO SWALLOW the swish-and-swallow nystatin!

Cardinal Signs of Impending Respiratory Failure

somnolence (extremely drowsy!) & cyanosis Other signs include: bradycardia, stupor/coma, O2 desats, dyspnea (SOB)

Meter Dosed Inhaler (MDI)

spacer helps prevent thrush, uncoordinated use, helps meds get into the lung instead of the throat

Treatment of AOM

spontaneous resolution within 80% of children watchful waiting 48-72 hours while providing pain control Give amoxicillin 80-90 mg/kg/day divided into BID for 10 days second line calvulanate and third line cefliaxone steroids, decongestants, or antihistamine should NOT be used in AOM, tonsillectomy does NOT reduce the incidence of otitis For pain, give acetaminophen, ibuprofen, benzocaine drops, local heat over ear while laying on affected side

Palmar grasp reflex

stroking the infant's palm with a finger will cause the infant to grasp the finger. The infant will tighten the grasp when his/her arm is drawn upwards. When the palmar grasp is tested in both hands, the term infant can be briefly listed -clutches object in palm

Gold Standard to Diagnose CF

sweat chloride/sweat electrolytes test Most reliable test is the sweat chloride test; normal sweat chloride is <40 mEq/L and anything more than 60 is diagnostic of CF skin tastes like salt!

Post-Concussion Syndrome

symptoms develop within days of injury S&S= may start days later but stay and don't go away. Resolve in 3 months up to 1 year, HA, dizziness, fatigue, irritability, insomnia, loss of concentration, memory impairment. Teach to contact HCP if S&S of increased ICP occur (ex. if vomiting, vision changes, Loss of Consciousness occurs) May have a hard time going to school and only be able to go half of a day

Visual Acuity Testing in Children

testing BEGINS at 3 years old See vision issues BEFORE kindergarten Can use tumbling E charr or Lea Symbol chart Ten Feet Refer for discrepancy of two line even within passing range PReschool passing is <20/40 and school-aged <20/30 1st comprehensive eye exam is at 3 years old!

Denver Developmental Test (Denver I & II)

tests milestones, shows what milestones MUST be met at certain ages and stages -done with any child infant to 5 years old

Alopecia in cancer

they can choose head coverings protect their heads from sunburn hair should grow back after 3-6 months after treatment has ended.

Nutrition

toddlers have the highest number of taste buds, only need 1 Tbsp of solid food per year of age per serving Should have 24-30 oz of WHOLE MILK per day and 4-6 oz of 100% juice. Toddlers have eating/food jag Eating/Food jag= fixated on and only eat 1 thing or a few things over and over again- ex. like only eat chicken nuggets so want chicken nuggets at every meal, normal for this to happen, talk to parents about it as something to expect, toddlers can develop physiologic anemia from this.

Pain in cancer

treat w/ multimodal approach acetaminophen may mask fever in neutropenia NSAIDs are contraindicated if thrombocytopenia neuropathic pain treat w/ tricyclic antidepressants (TCAs), anticonvulsants, and ketamine, may use gabapentin- tx pain around the clock! Prison Protocol- give acetaminophen and naracotics (multimodal) to tx pain even before get it!

Phototherapy (for jaundice tx)

used when cannot excrete bilirubin alone expose much skin as possible Turn off lights q3-4hours and take off eye patches (make sure they aren't too tight and not covering nose) Rinse eyes w/ saline also When eyes rest let them see parents Cluster care to increase phototherapy time Monitor for temperature instability, I&O, record photometer measurement (how long were they under the light?and check bilirubin levels * This tx converts unconjugated bilirubin to conjugated bilirubin!*

Egocentrism

view everything in relation to themselves and not able to think about anyone else's thoughts or views; nothing else matters to them but self at this point. everything in reference to them, cannot see others' views

Diet for Adolescents

weight and fat distribution is normal but may lead to body image issue and eating disorders TEACH about normal body changes Vegetarian Diet= benefits is that it is low fa and high fiber and it reduces DM risk and obesity and CV disease; disadvantages are that if i is vegan- low in Vit D, B12, calcium, omega 3, iron, and zinc. Vegetarian- low in B12

Foods High in K+ (and not good for CKD)

whole-grain breads, wheat bran, granola, and granola bars Sports drinks (Gatorade, etc.), instant breakfast mix, soy milk Peanut Butter (2 tablespoons), nuts or seeds (1 oz), fig cookies, chocolate (1.5 to 2 oz), molasses (1 tablespoon) Fruit= apricots, avocado (1/4 whole), bananas (1/2 whole), coconut, melon (cantaloupe and honeydew), kiwi, mango, nectarines, oranges, orange juice, papaya, pears (fresh), plantains, pomegranate (and juice), dried fruits (apricots (5 halves), dates (5), figs, prunes, raisins), prune juice, yams Vegetables= bamboo shoots, baked or refried beans, beets, broccoli (cooked), brussel sprouts, cabbage (raw), carrots (raw), chard, greens (except kale!), kohlrabi, olives, mushrooms (canned), potatoes (white and sweet), parsnips, pickles, pumpkin, rutabaga, sauerkraut, spinach (cooked), squash (acorn, butternut, hubbard), tomato, tomato sauce, tomato juice, and vegetable juice cocktail (ex. V8!) Dairy Products= milk and milk products, buttermilk, yogurt Proteins= (3 oz serving) clams, sardines, scallops, lobster, whitefish, salmon (and most other fish), ground beef, sirloin steak (and most other beef products), pinto beans, kidney beans, black beans, navy beans (and most other peas and beans, serving size is 1/2 cup) Soups= salt-free soups and low-sodium bouillon cubes, unsalted broth Condiments= imitation bacon bits, lite salt or salt substitutes (avoid those completely!!!)