Kaplan Pediatric Final

Rheumatic fever

*Inflammatory disease; Occurs after group A beta-hemolytic streptococcal infection; *Often pharyngitis before* -"Have you had a sore throat"?* -S/S: Fever. Carditis (narrow mitral valve causing murmur) . Polyarthritis (joint disease that involves at least five joints). Erythema marginatum (skin rash that spreads on the trunk and limbs; red outline with pink/pale center). Subcutaneous nodules. Chorea (jerky involuntary movements like tics) -*Elevated ASO, ESR-inflammation & C-reactive protein* -Treatment: penicillin. -Nursing considerations: Instruct family about antibiotics. Provide emotional support.

toddler nutrition

-15-18 months: May begin to drink whole cow's milk. Will eat 3 meals and 2 snacks per day. Limit milk and dairy products to 16 ounces per day. Eats with fingers and a spoon or a fork.Should drink out of cup. ---Avoid foods the child can choke on: Raw carrots. Peanuts.Whole grapes.Popcorn. ---Avoid large amounts of sweets. -2-3 years: Can have 2% milk. Diet should resemble that of the rest of the family, with 3 meals a day plus 2 snacks. Limit milk and dairy products to 16-24 ounces per day. Offer variety of good food to encourage good eating habits.

Respiratory Infections in Children

-Acute in young children usually caused by viruses -Common cold (acute nasopharyngitis) is most common -Young children ages 6 months to 3 years have generalized symptoms: Fever, Listlessness-low energy, Irritability, Anorexia, Vomiting, Diarrhea -Nursing care: Warm or cool mist to decrease respiratory discomfort, Rest, Careful handwashing to prevent spread, Administer antipyretic-fever (Acetaminophen/Ibuprofen), Frequently offer small amounts of favorite fluids to prevent dehydration, Aspirate nose in young infants to remove secretions -*Children under 12/18 years of age should not use aspirin as an antipyretic because of the danger of contracting Rye's syndrome, which can be life-threatening* & Cough suppressants should not be used *Respiratory Syncytial Virus (RSV)*: -Most important pathogen in infancy and early childhood; *Common cause of bronchiolitis/pneumonia in infants, otitis media in older children* Begins as a mild upper respiratory tract infection; Eventually affects the bronchioles or lower airways -S/S: Rhinorrhea, Low-grade fever, Retractions, Grunting, Rales, Rhonchi, Expiratory wheezing, rapid RR, Apneic episodes, Lethargy, Poor feeding, LOC, Dehydration because of poor feeding, Tachycardia, Cyanosis not relieved by oxygen in severe cases, Hypoxemia/Hypercapnia -Treatment: Increase humidity, Encourage fluids, Rest, Ribavirin; bronchodilators, epinephrine, and steroids; Mechanical ventilation if apnea -Nursing care: Suspected RSV - droplet, contact, standard precautions required; Diagnosis of RSV - contact and standard precautions required. Place in private room or with others with RSV. Ensure nurse caring for child not caring for high-risk children. *Pregnant staff should not care for child receiving ribavirin*!!!!

chemotherapy

-Adverse effects: Bone marrow suppression. Nausea and vomiting. Altered immunologic response. Impaired oral mucous membrane. Stomatitis (examine mouth). Fatigue. Sterility in boys -Nursing considerations: Monitor: Bleeding, Appetite, Nutrition, Intake and output, Avoid injections and rectal temperatures & Put pressure on venipuncture sites, Prophylactic antiemetics; Provide small, frequent meals; Prevent infection, Monitor and provide oral hygiene, Administer antifungals and anesthetics as ordered. -Client education: S/S infection & prevent infection, Avoid hot and spicy foods, preserve rest and conserve energy

Congenital heart defects

-At risk = maternal: rubella infection, alcoholism, age over 40; parent/sibling history -Chest X-ray for size of heart, echo with contrast, cardiac cath: fluoroscopy -All extremity BP (even for infant; Coarctation of the aorta), listen for murmur, pulses, cyanosis, Transposition of the Great Vessels will get bluer with oxygen, Acyanotic with HF = adventitious heart sounds -Post-op = elevate HOB to reduce respiratory effort; use pillow or stuffed animal to splint when coughing -"my 5 year old child cannot ride a bike" for ventricular dystrophy

Infant Nutrition

-Breast milk or formula provides all nutrition to approximately 6 months (Solid foods introduced) ---Introduce only one food at a time, offer new food at 2-week intervals. ---First food usually iron-fortified cereal. ---Next, strained fruits, strained vegetables. ---Then meat, eggs, citrus fruits. -By 12 months, should tolerate well-cooked table foods. -Avoid foods that cause choking:Hot dogs. Nuts. Grapes .Raw carrots. Popcorn. -Breast-fed infants may need supplements of iron and vitamin D. -Home-prepared formula (based on evaporate milk) fed infants may need supplements of iron and vitamin C. -both may need a fluoride supplement

Newborn assessment

-Breathing: diaphragmatic and abdominal. May be short, periods of apnea. -First stools: Meconium:Black and tarry.Passed within 12 to 24 hours; Transitional stools: Thin, green-brown. Part meconium. Day 2 or 3; Formed: 1 to 2 pale yellow to light brown stools per day with formula feeding.Loose golden yellow stools with sour milk odor with every breastfeeding. -Fontanels: should be soft and flat to touch ---Anterior fontanel: Diamond-shaped 2.5 to 4.0 centimeters.Easily felt, usually open and flat..May have slight pulse.Closes by 18 months of age. ---Posterior fontanel: Triangular 0.5 to 1.0 centimeters. Not easily palpated. Closes between 8 and 12 weeks of life. -Head circumference: Measure at greatest circumference - above the eyebrow and ears and around the back of the head at the occiput -Reflexes: Moro: startle = body stiffens, thumb and index finger in a "C" formation (3 to 4 months); Rooting and sucking: by 4 to 7 months; Stepping: when toes touching a surface; Tonic neck: arm and leg outstretched to side that head is turned (3-4 months); Palmar (3 months); Plantar (8 months); Tongue Extrusion: Disappears at 4 months allowing for spoon feeding

Hypospadias

-Congenital malformation. -Urethral opening is a groove on the ventral surface of the penis; chordee (downward curve) -Treatment: surgery Postoperative: Teach about postoperative care: Anticholinergics to prevent bladder spasms.Antibiotics to prevent infection. Catheter care. Increased fluids.Pain medications. Dressing changes. Reassure parents child will recover and function normally -Complications: Undescended testes, Urethral fistula is possible post-surgical, If untreated - defective urinary function & infertility

Seperation anxiety

-Distress, apprehension conveyed mainly by infants and toddlers, but could also be anyone. -Expressed when leaving:P arent(s). Familiar surroundings. Favorite toy. -Begins between 4 to 8 months. -Disappears by 15 months. Phases: -Protest: Cries or screams for parents.Inconsolable by other person. -Despair: Crying ends. Less active. Disinterested in food or play. Clutches "security" object if available. -Denial: Appears adjusted. Evidences interest in environment. Ignores parent's return. Resigned. Not content.

Croup Syndromes

-General term for respiratory system complex affecting children; --Causes: commonly caused by viral infection (parainfluenza & RSV); 6 month-3 years most common Names given according to main anatomic areas affected: 1. Acute epiglottitis: Acute spasmodic laryngitis, Acute laryngotracheobronchitis (LTB), Acute tracheitis (LTB is the most common) -S/S: *Cough described as barking or seal-like* in sound, Hoarseness, Dyspnea, Inspiratory stridor, Retractions, Restlessness/slow feeding, Irritability, Low-grade fever, tachycardia-->bradycardia May develop: Hypoxia, Cyanosis, Respiratory acidosis, Respiratory failure. -Nursing interventions: Vigilant observation of respiratory status (with particular focus on recognizing signs of impending respiratory failure so emergency measures can be taken immediately if needed), *Keep tracheostomy set at bedside*, bed-rest, Use oxygen hood over cribs with *cool humidified oxygen* (everything done in mist tent, mom goes in), Regular oxygen only if hypoxia/low sat, *Keep calm environment*, *Administer IV fluids* and meds (antipyretics-fever, avoid cough suppressant; steroid if worsens; antibiotics if bacterial), Position infant in infant seat or propped with pillows (high-Fowler position), Cough/deep breathe, Recommend care at home that includes supervised *steamy shower, sudden exposure to cold air, sleep with cool, humidified air* (stand in front of freezer; outside cold air) 2. Epiglottitis: -Childhood bacterial or viral inflammation of epiglottis leading to swelling above the epiglottis causing airway obstruction; Emergency because blocks airway -*Causes: Haemophilus influenza Type B (Hib)*. Streptococcus. Staphylococcus.. *Theses mean closing airway*: -S/S: Sudden development of sore throat, Dysphagia, High fever, *Agitation, Drooling, absent cough*, Frightened, Muffled voice, Dyspnea, Substernal retractions, Stridor, Cyanosis, sitting in tripod position - upright, leaning forward with mouth open, Severe respiratory distress, Respiratory arrest -Treatment: Airway management - intubation or tracheostomy and ventilator-aided respirations, Moist air--Oxygen, Cultures of blood and throat, Antibiotic specific to organism, Bronchodilators and corticosteroids -Nursing considerations: Tracheostomy tray in room if the child is not intubated or has a tracheostomy, Close observation, Assess airway -Client/parent education :Immunization of siblings with Hib vaccine, Prophylactic antibiotics prescribed for siblings

Head Injury: infant

-Head is larger and heavier than other body parts and most likely to be injured; Incomplete motor development contributes to falls (risk for ICP) ---Most common head injury is concussion; also Contusion, Laceration, Skull fractures -AIRWAY PRIORITY -Not all closed head injuries initially present symptoms: observe child for at least 6 hours for vomiting or change in LOC (awake every 1 to 2 hours; Do not administer analgesics or sedative) -Check papillary reaction to light every 4 hours for 48 hours, Assess LOC with Glasgow Coma Scale, Keep HOB elevated 30 degrees, Maintain seizure precautions, Meds to decrease gastric irritation, monitor for hypothermia -Notify Doc if vomits more than three times, has papillary changes, or change in LOC -Possible burr holes in the cranium to reduce the pressure For lacerations: Apply ice pack and pressure until bleeding is controlled, Clean an open wound and use sterile dressing, Assess need for stitches.HEAD LAG COMPLETE BEFORE 4 MONTHS 12 month fell from high chair-- most important to assess for head injury

Hemophilia

-Hereditary bleeding disorder (X-linked-females carriers & males get); Caused by deficiency of a clotting factor. --Hemophilia A - deficiency of factor VIII, most common. -S/S: Prolonged internal or external bleeding. Easy bruising. *Joint pain/swelling with bleeding* MOST IMPORTANT TO ACCESS. Pallor, Blood in the urine or stool, Infants may have unexplained irritability -Severe = spontaneous bleeding & severe bleeding after procedure/injury -Problems: blood loss, damage to organs (ex =brain bleed), joint damage, infection -Diagnostics = bleeding time/prothrombin time within normal limits (effect different part), aPTT is prolonged, decreased factors (VIII or IX) -Nursing interventions: *Assess ability to perform ROM*, Assess for internal bleeding. Recognize and control all bleeding. Administer analgesics for joint pain. Avoid intramuscular (IM) injections--5-15 min pressure & Rectal temperatures. Administer factor replacement therapy as ordered. During bleeding episodes: Maintain bed rest. Joint elevation and immobilization. Ice or cold packs. active ROM after bleeding episodes. Decrease risk of injury. Teach to avoid contact sports (Engage in activities such as swimming or golf). No Aspirin or NSAIDs-ibuprofen (acetaminophen, opiates common), Medic Alert bracelet *important to inform parents about factor replacement*

Oxygen tents

-Important not to open tent any more than necessary. -Ensure tent tucked in tightly. -Check temperature inside tent. -Change child's clothing and bedding as needed. -*Do not offer stuffed toys* that will absorb moisture; *no blankets* -Vinyl or plastic toys allowed; no battery-operated -No candles, cigarettes in the area. -Sign posted on door to room. -Grounded electrical outlets. -Avoid use of electric razors, hairdryers, electric blankets, electric heaters - may cause spark. -Avoid use of flammable or oil-based products. -*If oxygen tank used: secure in upright position* -*Allow parent to play games with child in tent*

Increased ICP

-Indications in infants: Tense, *bulging fontanelle*. Separated cranial sutures.Irritability.High-pitched cry. Poor feeding. -Indications in children: Headache. Nausea. Forceful vomiting. Irritability and restlessness. Drowsiness, lethargy. *diplopia (blurred vision)* ---*Late signs: Bradycardia. Decreased response to commands. Alterations in pupil size and reactivity. Decorticate posturing & Decerebrate posturing (midbrain/brainstem; arms extended; more serious)*. -Treatment: ---Medications:Osmotic diuretics (furosemide) Steroids. Antihypertensives. Anticonvulsants. Hyperventilation. ----Surgery for decompression or shunt. -Nursing care: Maintain airway by suctioning. Elevate head of bed 30 degrees. Keep head in midline position. Administer fluids as prescribed.

Fluid and Electrolytes

-Infants dehydration S/S: Tachycardia.Dry skin and mucous membranes.Sunken fontanel.Loss of skin elasticity. --Nursing care: -Introduce clear fluids (or Pedialyte) slowly; 1 tsp every 15 minutes for 2 hours; then 1 oz. every 2 hours for the next 12 to 18 hours; Then progress to breast milk or formula; For prolonged vomiting or severe diarrhea, IV therapy is needed. -lost < 5% of body weight, they need 50 mL/kg -lost 10% of body weight, they need 100 mL/kg -lost 12-15% of body weight, they need 125 mL/kg ----Fluid will be given rapidly for 3 to 6 hours, then slowed to a maintenance rate -Child: Vomiting and/or diarrhea most common causes of dehydration; Fever may be a cause ---Treatment: treat underlying cause ---Nursing care: Promote hydration by offering glucose-electrolyte solutions if child is alert. Antiemetics.

Osteomyelitis

-Infection of the bone caused by Staphylococcus aureus; Carried by blood from primary site of infection: Upper respiratory infections. Otitis media. Tonsillitis. Wound. -S/S: *Severe pain. Fever. Irritability. Swelling/Tenderness*. *May not want to move extremity. May hold extremity in a position of semi-flexion*. -Treatment: Bed rest. Analgesics. Antibiotics. *Support affected extremity with pillows. Splints to maintain proper body alignment.* Encourage fluid intake. Monitor intake and output. High-protein diet with sufficient carbohydrates, vitamins, and minerals

Hodgkin's lymphoma

-Lymph node biopsy & Reed Sternberg cells present -Cause unknown; related to Epstein-Barr virus or HIV -S/S: large painless lymph nodes, night sweats, fever, unexplained weight loss ---enlarged liver & spleen may come later in disease

retino blastoma

-Malignant glioma of retina, usually unilateral; Occurs in young children. -S/S: *Cat's-eye reflex - whitish "glow" in pupil*, Strabismus, Red, painful eye; Orbital cellulitis ---As condition worsens: Reddened eye, Fixed pupil, Blindness. -Treatment: Depends on staging; Assess is vision can be maintained (I, very likely to V, very unlikely) Laser therapy plus chemotherapy most often used if diagnosed early; When detected later: stem cell transplantation, Chemotherapy, Radiation. -Nursing considerations: Instruct parents how to care for surgical site & how to care for the prosthesis

Cancer: Neuroblastoma

-Malignant hemorrhagic tumor. -Primarily in infants and children. Located in mediastinal and retroperitoneal area (lung to abdomen) Composed of neuroblast cells that create sympathetic system and adrenal medulla

Car seat safety

-Rear facing = Place infant and toddler in back seat in rear facing seats (birth-2 years OR 20 LBS) -Forward facing = 20-50 lbs (2-4 years) -Booster = *at least 40 pounds or more* belt-positioning booster seat (4-8 years) -adult seat belt when 4 feet 9 inches in height (8 to 12 years old)

Cyanotic Defects

-S/S for all cyanotic: Cyanosis-blue (mucus membrane; no matter what oxygen you give). hypercyanotic spell. *Polycythemia*. Embolism. Heart murmur. CNS depression due to hypoxia (reflex; eating) acidosis. *Poor weight gain. Poor feeding habits (hypoxia causes tachypnea)* *Clubbing of fingers* (prolonged hypoxia). Risk for seizures/death. Delayed physical growth and development. Child squats or assumes knee-chest position. Delayed bonding Frequent respiratory infections. -Treatment: surgery, oxygen (will remain cyanotic until repaired; look at O2 or ABG to determine amount), rest/quiet environment (respond to infant before cry), small frequent feedings (every 2 hrs & large hole nipple), hypercyanotic spell: knee-chest & 100% oxygen & keep calm, model bonding behavior; medication: digoxin/ diuretics/ACE/iron/potassium, Diet low in sodium and high in potassium Decreased pulmonary flow: 1. *Tetralogy of Fallot*: Four defects: 1. Pulmonary artery stenosis. 2. Right *ventricular hypertrophy* due to increased pressure in right ventricle 3. Ventricular septal defect (blood goes through hole bc of #1) 4. Overriding aorta (sits over ventricle hole-- bring deoxygenated blood to body) ---Most common; blood flows from RA to RV, Pulmonary stenosis makes blood flow through ventricular hole, majority of blood-unoxygenated- goes to body through overriding aorta 2. Tricuspid Atresia OR mixed blood flow: 1. Transposition of the Great Vessels: Pulmonary artery arises from left ventricle & Aorta arises from right ventricle (opposite) 2. Truncus arteriosus: Normal in utero; Single vessel removing blood from both ventricles. Treatment: surgery to create two vessels. 3. Hypoplastic left heart

Child abuse

-S/S: Inconsistency of type or location of injury with the history of the incident; Bruises, burns, fractures, especially chip/spiral; severe CNS or abdominal injuries; Sexual abuse indicators: (Lacerations, bruises, bleeding, irritations of the genitals, anus, throat, or mouth. Torn or bloody underwear.STDs, Recurrent UTIs, increase in sexually related behaviors, increased anxiety and fears, clinging, Weight changes, regression, anger, emotional neglect, failure to thrive) -Nursing care: Provide for physical needs first, Ensure mandatory reporting to supervisor or appropriate agency; Engage in nonjudgmental treatment of parents, encourage expression of feelings, Teach growth and development concepts: Safety, Discipline, Age-appropriate activities, Nutrition, Provide emotional support for the child, Engage child in play therapy: Dolls, Drawings, Making up stories; Do not promise secrecy, Do not use leading statements, Reassure child that telling was the right thing to do, Initiate protective placement and/or appropriate referrals for long-term follow-up, Documentation - reflect only what nurse saw or was told, not nurse's interpretation or opinion -Child neglect is a form of abuse

Acyanotic Defects

-S/S: tachycardia, weak peripheral pulses, pale; *tachypnea, dyspnea, grunting, cough; HF-pulmonary*, frequent breaks while eating, impaired bonding -Treatment: surgery, medication: digoxin/diuretics/ACE; quiet environment & rest, frequent feeding breaks, model bonding behavior Increased pulmonary flow 1. Ventricular septal defect (VSD): Hole between ventricles; most common; Many VSDs close spontaneously during the first year of life. -Blood flows from the higher pressured left side to the lower pressured right side causing an increased blood volume in the right ventricle and lungs: RA to RV, out pulmonary artery to lungs, in pulmonary veins to LA, Then to LV (pressure in LV causes blood to go through hole & back to RV; very little oxygenated blood through aorta -Complications: overload & hypertrophy of RV, decreased CO, HF-pulmonary 2. *Atrial septal defect* (ASD): Hole in atria which allows blood to flow from left atrium into right atrium. --*antibiotic prophylaxis to prevent infective endocarditis; surgery* 3. Patent ductus arteriosus: bridge between aorta and pulmonary artery normal in utero, but if does not close then too much blood in lungs *given indomethacin to close duct also NSAIDs: Ibuprofen* Obstruction of blood flow from LV: 1. Coarctation of the aorta: Localized malformation resulting in narrowing of the aorta. Causes increased pressure proximal to the defect and decreased pressure distal to the obstruction ---Treatment: Resection. Grafting. Balloon angioplasty 2. Pulmonic stenosis: Narrowing of pulmonary artery entrance. The greater the narrowing, the greater the symptoms ---Treatment: Balloon angioplasty. Rarely - surgery. 3. Aortic stenosis

Vital signs

-Temperature: same as adult (oral temp older than 4 years; rectal last option) Newborn: -Normal respiratory rate 30 to 50 breaths per minute -Normal pulse rate 120 to 140 beats per minute, may go to 230 while crying -Normal blood pressure 60 to 80/40 to 50 mm Hg Infant: -Normal respiratory rate 20 to 30 breaths per minute -Normal pulse rate 80 to 140 beats per minute, may go to 200 while crying -The average blood pressure is 95/58 mm Hg Age 1 to 4 years: -Normal respiratory rate: 20 to 40 breaths per minute. -Normal pulse rate: 80 to 140 beats per minute. -Normal blood pressure: 90 to 99/60 to 65 mm Hg. Age 5 to 12 years: -Normal respiratory rate: 15 to 25 breaths per minute. -Normal pulse rate: 70 to 115 beats per minute. -Normal blood pressure: 100 to 110/56 to 60 mm Hg

information technology (IT)

-Use of telecommunication electronic devices. -Store, share, retrieve, and transmit information in client's personal health record

Gastroesophageal Reflux (GER)

-will resolve with maturation of the esophageal sphincter -Found in: Premature infants. Infants with bronchopulmonary dysplasia. Children with:Neurologic disorders.Scoliosis.Asthma.Cystic fibrosis. -S/S: Passive regurgitation.Emesis.Poor weight gain.Irritability, Apnea -*Nursing considerations:Place infants in prone position. Older children should stand or sit upright when awake. Offer more frequent feedings. (importance of feeding infants in an upright position and keeping them upright for 1 hrs after) Enlarge nipple to accommodate thickened formula (*mixing rice cereal* with formula or breast milk---1 tablespoon of cereal per ounce of milk)Avoid strenuous play after eating. Do not eat before bedtime; If surgery, assess NG tube & abdomen distention* -Complications: Dehydration, Alkalosis, aspiration, esophagus damage

Growth and development: Infant

0-1 year -Erikson: trust vs mistrust (feeding consistently) -2-month-old milestones: Posterior fontanel closure, Lifts head off bed when prone, Visually searches to locate sounds, cries for reason, recognize mom's voice, sleep 14 hrs, can turn side-back (Falls, Suffocation, Drowning, Supine position for sleeping = SIDS) -3-month-old milestones: Localization of sound by turning head, Vocalization, Raises head and shoulders from prone position (supine position for sleeping) HEAD LAG COMPLETE BEFORE 4 MONTHS -4-month-old milestones: Begins drooling, Rolls from back to side, Tonic neck reflex absent, Able to appose thumb, Shows pleasure in social contact, Balances head when sitting, Sits if assisted, Begins eye-hand coordination, Inspects hands, Pulls clothes and blanket over head, Grasps object with both hands, Puts everything into mouth, Laughs, Shows excitement, Enjoys attention, Vocalization of consonants (rattles, cradle gym; Introduce only one food at a time for each two week period - first is rice cereal, banana) -5-month-old milestones: Doubled birth weight, Rests weight on forearms when prone, Straightens head or back when propped or held in sitting position, Sustains a portion of own weight when in standing position, Moro reflex is fading, Grasps objects with a whole hand; can hold bottle, Has some simple vowel sounds, Displeased when an object is taken away -6-month-old milestones: 3-5 oz weight gain per week, Teething, Rolls from back to abdomen, Manipulates small objects, Holds arms out to be picked up, sleep 15 hrs- 9 hrs night with several naps, social smile (Weekly introduction of pureed solid food; Aspiration.Poisoning.Suffocation.Falls.Burns) -8-month-old milestones: Continues to increase in height/length by ½ inch per month.Head circumference increases about 0.2 inches monthly, Milestones: Parachute reflex, Sits unsupported, Crawls, Throws objects, Stands holding furniture, stranger anxiety peaks, Plays peek-a-boo, Vocalizes to toys, babbles. Uses "mama" and "dada" - may be out of reference, Turns head to own name, Object permanence appears, Looks for dropped toys (Protect from stairs, Small parts.Plastic bags.Balloons.Avoid baby walkers with wheels, Post Poison Control numbers near phone.Protect from direct sunlight - use sunscreen.Avoid insect repellents with DEET.Nutrition: avoid foods prone to choking: Small candy.Hot dogs.Popcorn.Peanuts.Habits: establish consistent bedtime routine) -9-month-old milestones: Creeps from prone position, Sits steadily, Can lean forward but not sideways, Regains balance, Stands holding onto table, May pull up to standing position, Likes toys that go inside each other - pots, pans, Very aware of the changes in voice tone of others, Crude pincer grasp present by 9 months -10 month: Able to pick up raisins and other finger foods; saying "mama" & "dada" with meaning -11-month-old milestones: Walks holding furniture, Sequential play, Imitates definite speech sounds, Holds cup alone (Limit setting for beginning tantrums) -12-month-old milestones: Tripled birth weight, 50% birth length increase, Cruises well, Says 3 to 5 words, Comprehends meaning of several words, Has 6-8 teeth, Eats some table foods, Disappearance of Babinski reflex. PMI = left midclavicular, 4th intercostal space

Growth and development: adolescence

12-20 -Erikson: identify vs role confusion (plans future; peer influence; crushed by peers = no identity) -Develop ability to deal with logic, metaphors, and rational thought; Can make conclusions and reflect on ideas. -masturbation, sex, peer pressure, media -Weight = F 15-55; M 15-66 -Length = F 5-20 cm; M 10-30 cm -Puberty timing = F 6-14 years; M 10-16 years (growth spurt ends 18 F & 21 M) -Male changes: Increase in genital size (10.5-16; testes begin 9.5-12 & end 13-17).Breast swelling.Appearance of pubic (13-17), facial, axillary, and chest hair.Deepening of the voice.Production of functional sperm, and nocturnal emissions. ---2,600 cal/day -Female changes:Increase in pelvic diameter.Breast development (begin 7-13; end 12-18). Altered nature of vaginal secretions.Appearance of axillary and pubic hair (10-14) .Menarche: first menstrual period (10.5-15.5) ---2,000 cal/day; INCREASED NEED FOR ALL NUTRIENTS

Growth and development: toddler

1-3 -Erikson: autonomy vs shame & doubt (toilet training; wants control; need to show support or else defiance/negative) -Weight = 4-6 lbs/year; Length = 7.5 cm (3 in)/year -Anterior fontanel closes 12-18 months -Brain 75% adult; 20 teeth by 2.5; appetite less; sphincter control for potty training -Pot belly, Normal bowlegged toddling gait -20-40 vision -@ 13 months says da, ya, na -At 15 months: Weight about 24 pounds and height about 31 inches, Walks alone (13 months) and crawls up stairs, Still loses balance easily, Likes to throw things; especially down;Holds spoon and cup, but difficulty feeding self, Places objects in holes appropriately, builds two blocks.Looks at books with big pictures.Beginning to say words.Shakes head "no" in response to most questions.Imitates parents with tasks.Kisses and hugs.Has temper tantrums. -At 17 months:Average weight 24 lb (11 kg), with average weight gain of 4 to 6 lb/year; average height gain of 3 inches/year (7.5 cm).Clumsy when runs and falls often.Climbs stairs.Sucks thumb or fingers.6 to 10-word vocabulary.Parallel play.Pulls and pushes toys. -At 24 months:Begins to jump.Builds 5-6 block tower.300-word vocabulary.Obeys easy commands; should be able to sit still for 5-10 minutes, early efforts at jumping -At 36 months:Copies a circle and straight line.Holds cup by handle.Balances on one foot.Pedals tricycle.Uses question words (why, how, etc.).Can only think of one idea at a time, jumps with two feet, stand on one foot, alternating feet up/down stairs -Toilet training:Children attain sphincter control at approximately 18-24 months.Girls attain toilet training tasks earlier than boys.Dry diaper at the end of a nap indicates child's ability to stay dry.

Meningococcal

11 years or older (>6) IM

HPV

11-12 years, 1-2 months after 1st dose, 6 month after first dose IM any location

pneumococcal

2, 4, 6, 12-15 months -vastus lateralis -chest pain

Streptococcal A

2-3 days = contact Beginning: fever, sore throat Then: severe sore throat, white tonsils -Antibiotics, fluid, Tylenol -complications = Rheumatoid fever, glomerulonephritis

Growth and development: preschool

3-6 -Erikson: initiative vs guilt (family; learns limits; allow creativity & independence or are fearful and lack confidence) -20/20 vision (amblyopia); asks "why", conflict with same sex parent, conscience -General learning: Runs well.Jumps rope.Dresses without help.Imitates adult patterns and roles. -Safety: Use bicycle helmet.Car seat or safety restraints in car.Teach to look both ways before crossing street. -3-year-old:Copies a circle.Builds bridge with 3 cubes.Less negative than toddler.Fewer tantrums.Learns from experience.Rides tricycle.Walks backward and downstairs without assistance.Undresses without help. 900-word vocabulary.May invent imaginary friend. -4-year-old:Climbs and jumps well.Laces shoes.Brushes teeth.Has 1,500-word vocabulary.Skips and hops on one foot. Throws overhead, draws 6 body parts & square -5-year-old: Average weight 41 1/4 lb, with average weight gain of 5 lb/year.Average height of 43 1/4 inches (110 cm), with average height gain of 2 1/2 to 3 inches/year.Handedness established.Runs well.Jumps rope. Dresses without help. 2,100-word vocabulary.Tolerates increasing periods of separation from parents.Beginning of cooperative play. Gender-specific behavior. Skips on alternate feet. Ties shoes, draws body with face & triangle

Growth and development: school-age

6-12 -Erikson: industry vs inferiority (school/sports; allow chances; no encouragement = self-doubt) -Some problems are expected as part of normal growth and development: Examples: dishonest behaviors—such as lying, cheating, and stealing—in children who were previously well-behaved. Interventions: role modeling and honesty by parents, admonition with reasonable punishment, such as returning stolen objects. -Some problems indicate serious psychiatric disturbance: *Fear of using school bathrooms is the leading cause of new-onset constipation in school-aged children*. Encourage child to establish a regular toilet time after a meal when child is not hurried, encourage diet high in fiber (whole-grain breads, bran, raw vegetables, raw fruit, beans, popcorn). -Age 6 years: Self-centered.Show-off.Rude.Extremely sensitive to criticism.Begins losing baby teeth. Appearance of first permanent teeth. 2100 words, 3 commands, print writes, follow line with scissors -Age 7 years: Average weight 46 lb with average weight gain of 4.5 to 6.5 lb/year. Average height 45 inches (114 cm), with average height gain of 2 inches/year (5 cm/year).Temporal perception improving.Increased self-reliance for basic activities.Participates in team games/sports/organizations.Develops concept of time.Likes playing with same sex. -Age 8 years:Actively seeks out friends.Eye development generally complete.Movements more graceful.Writing replaces printing, swings bat/tumbles, pattern with scissors, complex sentences -Age 9 years:Skillful manual work possible.Conflicts between adult authorities and peer group.Better behaved.Conflict between needs for independence and dependence. -Age 10 to 12 years:Remainder of teeth (except wisdom) erupt.Uses telephone.Capable of helping, increasingly responsible.More selective when choosing friends.Develops beginning interest in opposite sex.Loves conversation. Raises pets. Adult vocab. 5 commands.

Influenza (not nasal)

>6 months; yearly (under 6 years old may need 2 doses 28 days apart; not good antibody response when young & bottle fed vs breast) -vastus lateralis

Developmental Dysplasia of the Hip (DDH)

Abnormal hip development; Acetabulum partially or totally unable to hold head of femur. -S/S: *Uneven gluteal folds and thigh creases - deeper on affected side*!!!. Limited abduction of hip with pain. Ortolani's sign: Seen in infants less than 24 months old (Place newborn on back, legs flexed. Click sound heard when affected hip moved to abduction, Shortened limb on affected side in older infant and child, Delayed walking, With older child: Limp. Lordosis Waddling gait) -Interventions: Newborn to 6 months: Reduce by manipulation--Splint; Pavlik harness worn full time for 3 to 6 months until hip stable; 6 to 18 months of age: Gradual reduction by traction & Cast for immobilization; Older child: Preliminary traction .Open reduction. Hip spica cast.

Hirschsprung Disease

An extremely dilated colon (megacolon) -Caused by failure of development of the myenteric plexus (no nerves in rectal area) -S/S: *Chronic constipation, Abdominal distension, Ribbon-like stools* -Treatment: Surgery, First, colostomy after removal of affected section, Then reanastomosis. ---Preoperatively: Enemas. Low-fiber, high-calorie, and high-protein diet. TPN if needed. Measure abdominal girth at level of umbilicus ---Postoperatively: Reassure parents that colostomy is temporary. Provide stoma care.

Eating disorders

Anorexia nervosa: More common in females 8 to 18 years. -S/S: Dramatic weight loss, Anemia, Amenorrhea, Hypothermia, hypotension, bradycardia, Gastric complications, Denial/fear of sexuality, Repression/Regression, Strained family relationships, perfectionism, Depression, dysrhythmias -Nursing responsibilities: Monitor: Weight/Intake, Encourage responsibility for self, Explore sexual issues Bulimia nervosa: Binge eating behaviors frequently followed by self induced vomiting, laxative, or diuretic use; May have history of anorexia -S/S: Depression, Anxiety, Impulsivity, Weight - normal to slightly above or below normal, Dental caries and erosion, Gastric dilation, Calluses or scars on hands from inducing vomiting, dysrhythmias -Nursing interventions: Monitor electrolytes, especially potassium and sodium, Monitor cardiac status, Use: Milieu management/Cognitive behavioral therapy. Teach stress management skills; sit with client during meals (limited to 30 min) and 1 hr after

phenylketonuria

Autosomal recessive = cannot metabolize the essential amino acid phenylalanine --> high levels of phenyl ketone in the brain causes mental retardation -Guthrie test: screening test for PKU -*Restrict protein*: Meat, Milk, Eggs, Beans, Bread, Check all artificial sweeteners - many contain phenylalanine

Cystic fibrosis

Autosomal recessive = dysfunction of exocrine glands causing obstructions because of flow of thick mucus (sweat glands, respiratory, pancreas) ---secretions containing chloride become thick and tenacious and clog airways -95% white children, both parents carriers -Complications = Respiratory failure, Sepsis, Right-sided heart failure, Malabsorption/Malnutrition, Diabetes mellitus (pancreas clogged), portal hypertension (ascites, encephalopathy--liver failure/coma/confusion), newborn-bowel obstruction S/S: -Salty skin, Steatorrhea - fatty, foul smelling stools (fat malabsorption--Nutrition deficiencies), Chronic cough, Thick tenacious mucus, Frequent respiratory infections, Hypoxia, Delayed growth and development, hyper-inflamed alveoli -Voracious appetite early in disease and loss of appetite later (bc respiratory) Interventions: -*High protein, high calories, tolerated fat (unless steatorrhea is uncontrolled)* Sample foods - fruit, vegetables, cereals, lean meats -Lots of water, *Pancreatic enzyme* replacement is required- no crush/chew; with meals, Water-miscible forms of fat-soluble vitamins are given -Aerosol therapy with bronchodilators and mucolytics THEN Postural drainage, chest physiotherapy & breathing exercises (do not wait until they get sicker to start antibiotics for infection); Pancrease with meals (not given if allergic to pork) -Check stools for steatorrhea; assess airways/breathing -*Diagnostics = sweat chloride >60*!!!!, *72hr stool collection & diet* -Cross-infection with other CF patients

Hepatitis B

Birth, 4 weeks, 8 weeks -IM deltoid for young child; thigh baby

Asthma

Bronchial constriction, inflammation & increased mucus; obstructive airflow (reversible & intermittent & reactive) -at risk: hypersensitivity reaction (allergies), intrinsic factors (meds like aspirin, NSAIDs, beta blockers; extreme temps, viral infections-upper), exercise & cold air = bronchospasm, GERD (aspiration) -problems during attack: bronchospasm, airway swelling, thick sputum, acidosis (possible res failure; accessory muscles, air trapping); repeated attacks = permanent bronchial wall changes (thick) -S/S during acute: wheezing during expiration (increased length; lack of wheezing not good sign), non-productive cough, sit up or lean forward (tripod), increased RR, tachycardia -Triggers: external vs intrinsic (when; keep track), baseline status (peak expiratory flow) -Short acting bronchodilators: albuterol (tremors/heart palpations, tachy, angina, headache, Increased glucose) -Anticholinergics: ipratropium (urinary retention, blurry vision, dry mouth, constipation) -Inhaled corticosteroids (Contacts should not be worn during treatment.); epinephrine if acute episode; admin *humid warm oxygen* -Leukotriene-Receptor Blockers (Montelukast): dilate airways, decrease mucus & inflammation; Not a rescue medication

hip spica cast

Cast that immobilizes hips and knees. -Nursing care: Instruct family to immediately report swelling or discoloration of the extremities. Remove toys and hazardous rugs from path. Keep family pets at a safe distance. Encourage child to engage in quiet activities. Encourage the use of muscles. Move the joints above and below the cast on the affected extremity. *Place in prone position to eat*- not supine

Central Precocious Puberty

Children develop sexually at a young age: --Girls before the age of 8. Boys before the age of 9. -Treatment: monthly injection of luteinizing hormone-releasing hormone (Synthetic GnRH); progestin, *Children function at their chronological ages: age appropriate clothes* -Risk: Brain injury, Brain infection such as meningitis, Radiation or chemotherapy for cancer treatment

Diarrhea

Children: Rotavirus most common cause of diarrhea. -S/S: Abrupt onset, Fever, Nausea/vomiting -Nursing care: Assess for: Decreased urinary output, Decreased weight, Dry mucous membranes, Poor skin turgor. Administer oral rehydration therapy, Instruct parents to assess number of wet diapers and voiding, Instruct parents about *handwashing* to prevent spread of infection, Meticulous *skin care*, If fluids tolerated for 24 hours, start BRAT diet: Bananas. Rice. Applesauce. Toast.

hydrocephalus

Congenital or acquired; Increased ICP; Subsequent increase in ventricular size/pressure (brain ventricles). Can be communicating (impaired absorption or increased production) or non-communicating (obstruction or blockage) -At risk: premature with brain bleed, maternal infection, spina bifida, meningitis, head trauma (shaken baby), neoplasm -S/S: Front-occipital circumference increases at abnormally fast rate, Split sutures, Widened, distended, tense fontanelles; Prominent forehead, Dilated scalp veins, Irritability, Vomiting, Unusual somnolence, Convulsions, High-pitched cry, poor reflexes, bradycardia, bradypnea, apnea -Treatment: place a shunt (ventricularperitneal--can expand but higher chance of infection or VA--smaller and has to be changed more often) -Nursing care prior to surgery: Assess for increasing ventricular size & Increased ICP ---Nursing care postoperatively: Position on the unoperated side, Keep flat to prevent complication of too rapid reduction of intracranial fluid, Assess for increased ICP & Signs/symptoms of infection--shunt, quiet environment, no IV in head,

Acute Myelocytic Leukemia

overproduction of immature WBCs -infection risk (report fever), bruising easily -weight pads when menstruating -packed RBC for anemia

inflammatory bowel disease (IBD)

Crohn disease & Ulcerative colitis. -S/S: Abdominal pain. Diarrhea (less severe with chrons) Fluid imbalance.Weight loss, Nutritional deficit Anemia.Dehydration. WBC elevated -Nursing considerations: High-protein, high-calorie, low-fat, low-fiber diet. May require PN to rest bowel. Administer:Analgesics.Anticholinergics.Sulfonamides (gentamicin). Corticosteroids. Antidiarrheals Maintain fluid/electrolyte balance, Promote rest ---Maintain bowel rest (NPO) during exacerbations ---Do not consume: Cocoa.Chocolate.Citrus juices.Cold or carbonated drinks.Nuts.Seeds.Popcorn.Alcohol. -Crohn Disease: ---Anywhere; Pain extends through all layers of bowel wall; Restricts absorption of nutrients, cobblestones, thick walls, bloody stool not common ---Symptoms: lower right quadrant pain not relieved by defecation. anorectal fissure or fistula. Ulcerative Colitis: eroded areas of mucous membrane and tissues; lower GI ---Symptoms: Rectal bleeding. Blood, pus, mucus in stool. Abdominal pain occurs pre-defecation.May have 20 to 30 diarrhea stools daily, ulcers, pseudopolyps

Turner's syndrome

Monosomy X -Occurs only in females; One X chromosome is missing from all cells. -Underdeveloped female sex characteristics -Indications: At birth: *Low posterior hairline.Widely spaced nipples.Edema of the hands and feet. shield shaped chest* Childhood: Webbed neck.Short stature. Puberty - diagnosed because of three outstanding features: Short stature.Sexual infantilism.Amenorrhea.. -Most women with Turner syndrome lead productive lives

osteogenic sarcoma (osteosarcoma)

Most common bone cancer in children; Most commonly occurs in the long bones. -S/S: localized pain at the affected site that is relieved in the flexed position; Fever, Tiredness, swelling over the tumor site -Treatment: surgery; Amputation of limb if disease affects surrounding blood vessels and nerves -Instruct family how to care for amputation and prosthesis

Glomerulonephritis

Damage to glomeruli -Cause: (IMPETIGO OR STREP) Occurs 10 days after skin or throat infection -S/S: Fever, Chills, *Hematuria*, Proteinuria, Weakness, Pallor, Dyspnea, Lung rales, Weight gain, Fluid overload, Generalized and/or facial and periorbital edema, Moderate-to-severe hypertension, Oliguria with fixed specific gravity ---Excess fluid volume, Fatigue, Potential for infection, Potential for skin breakdown, potential for inability to care for self -Complications: Hypertensive encephalopathy, Acute cardiac decompensation, Acute kidney injury (nephrotic syndrome) -Administer: Antibiotics. Corticosteroids. Antihypertensives.Restrict sodium intake. Restrict water & high-potassium if oliguric, Assess vital signs frequently, Measure daily weight, Monitor intake and output, Assess for cerebral complications, Ensure bed rest (Schedule activities), assist with ADLs

Medications: Cardiac Glycoside

Digoxin: also called Lanoxin -Action: Decreases heart rate.Increases force of contraction. -Adverse effects: *Bradycardia*. Anorexia. Nausea and vomiting. Fatigue. Dysrhythmias. Diaphoresis. -Nursing considerations: Know baseline vital signs. *Check for signs of toxicity especially if taking furosemide (hypokalemia): Anorexia. Nausea. Vomiting. Diarrhea. Confusion. Visual disturbances* extreme bradycardia -Take apical pulse for 1 full minute, hypokalemia increases likelihood of digoxin toxicity, Avoid antacids and laxatives -*Infants and Children: Margin of safety for digoxin blood levels is narrow. *Therapeutic serum level 0.8-2* Hold dose if apical rate is less than 90 to 110 beats/min in infants and younger children. Hold for older children if heart rate is less than 70 beats/min* -high potassium foods = Bananas, Prunes, Apricots, Potatoes, Cauliflower, Spinach.

DTaP

Diphtheria, tetanus, pertussis 3-dose series at age 2, 4, and 6 months, followed by boosters at age 15-18 months and 4-6 years -Adverse effects: Extremely high temperature. Redness at injection site. Fever may occur within 24 to 48 hours. -IM anterior or lateral thigh -Pertussis (whooping cough) 5-21; usually 10 days = droplet/contact ---Beginning (or prodromal): upper res infection ---Then: severe cough "whoop sound" at night 4-6 weeks -high pitched cry ---hospitalize--respiratory distress, humidification

AKI: Nephrotic Syndrome

Glomerular permeability to proteins; Massive protein loss in urine (more common in younger children) ----Minimal-change nephrotic syndrome (MCNS) most common type of nephrotic syndrome in children. -S/S: *Periorbital or ankle edema, anasarca (body edema)*, *weight gain*, decreased urinary output, Pallor, fatigue, Hyperalbuminuria, hypoalbuminemia, Ascites: Respiratory difficulty, Abdominal pain, Anorexia, Diarrhea, Irritability, Lethargy; Hypovolemia, Hyperlipidemia, HTN (late sign), HF or Pulmonary congestion -Treatment: Restrict salt in diet, Corticosteroid therapy/Immunosuppressant therapy, diuretics -Nursing considerations: Monitor intake and output, daily weights, Test urine for albumin, Measure abdominal girth, Protect from upper respiratory infection (Lung sounds), Effectiveness of diuretics, Skin for breakdown

Adolescent nutrition

Growth spurt increases nutritional needs: -Girls need increased iron because of menarche. -Folic acid important in females. -Calcium needs elevated when milk intake is decreased (Maximum bone mass is now) -Many want to eat increased amounts of: Calories.Sugar.Fat.Cholesterol.Sodium. -Eating disorders occur frequently -Daily intake: 6 ounces of whole grains. 2½ cups colorful vegetables. 2 cups fruit. 3 cups milk.Meats/proteins 5½ ounces. Carbohydrates if regular to moderate exercise.

Hib vaccine

Haemophilus influenzae type B 2, 4, 12 month -vastus lateralis

Sickle cell anemia & crisis

Hereditary (*autosomal recessive*), severe, chronic condition; Abnormal hemoglobin/fragility of erythrocytes-->Anemia -S/S: Systemic. Chronic anemia - hemoglobin, 6 to 9, Delayed growth, Pain focused on joints. Pallor. Swelling of hands and feet. Jaundice. Impaired kidney function-Dark urine. Priapism (prolonged erection). Cardiac murmurs. tachycardia, Altered pulmonary function. Increased susceptibility to infection. Fatigue. impaired wound healing--ulcers -Interventions: Rest. Oxygen. IV fluids. Electrolytes. Sedation. Analgesia. Possible transfusion. -Nursing care: CONTROL PAIN; *Warm compress not cold*!!!!, Promote rest. Administer analgesia as prescribed. Teach use of patient-controlled analgesia (PCA) pump as indicated. Administer oxygen. Maintain I and O. *Ensure adequate fluid intake*. Monitor for infection. Encourage activity as tolerated when not in crisis. -Vaso-occlusive crisis: Painful due to hypoxia and necrosis of tissues or organ (block blood flow to an organ or body part) -S/S: SOB, Res failure, HF, bone pain, swollen/painful hands/feet, Stroke. *Seizures (LOC)*. Blindness, Hematuria. Enuresis, Priapism (prolonged erection), decreased liver function, difficult arousing, pale lips/nail beds ---high altitude.Sudden change temperature. Illness. Dehydration. Stress. Pregnancy. met/res acidosis -Nursing considerations: Manage pain. Prevent infection. -Client education: Take medication as ordered. Discuss pregnancy with health care provider. Seek medical assistance for leg/ankle wounds that do not heal -*Treatment for infants and children: Routine immunizations, Daily antibiotics from 2 months to 5 years of age to prevent life-threatening infections, Hydroxyurea--prevents formation of sickle cells, Iron/Folic acid supplements, Protein supplements if there is a lag in weight gain, Pain management*

Osteogenesis Imperfecta

Heterogeneous group-inherited syndrome; Most common osteoporosis syndrome in children; May be born with fractures. -S/S: Multiple bone fractures. Short stature. Bluish tint to sclera. Hearing loss. Curvature of spine -Nursing considerations: Support child when: *Turning.Positioning.Moving.Holding* Offer parents guidance about: Child's limitations. Activities to promote optimum development without causing harm to child

Myringotomy

Incision in tympanic membrane to insert tympanostomy tubes due to recurrent and chronic otitis media (relieves pressure) -Nursing considerations: *No diving, jumping, or submerging in water without earplugs*; Keep bath water and shampoo out of ear, Wear earplugs when swimming in lake water, Inform parents that tubes will eventually fall out, notify practitioner when this occurs -Post surgery: Should keep mouth open when sneezing or coughing, Avoid upper respiratory infections, Keep ear dry for 6 weeks (Place sterile cotton loosely in external ear; replace when damp)

Craniotomy

Incision through the cranium; relieves pressure -Nursing responsibilities: 1. Assess client every 15 minutes times 4 or until stable; 2. then every 30 minutes times 2 3. then every 1 hour times 4 5. then every 4 hours Observe temperature because hyperthermia may occur, place cooling blanket under client before returning to the unit from the operating room; Assess for increased ICP (sluggish, dilated or unequal pupils) maintain ICP less than 15, frequent neurologic checks; After infratentorial surgery (back of head), client usually positioned flat or on either side.After supratentorial surgery (top of head), head usually elevated, health care provider orders position. First oral fluid is water, discontinue if client vomits. -Endocrine complications: (SIADH) & Diabetes insipidus, Bacterial meningitis, increased ICP, Bleeding, Seizures. Brain herniation, Death.

Headaches in children

Indications that require an immediate follow-up:!!!! -Increased frequency and severity of headache. -*Headaches that awaken child at night*. -Early morning headaches. -Headaches that worsen when child gets out of bed in morning. -Changes in behavior or personality. -Treat as with an adult.

Spinal Muscular Atrophy- Type 1 (Werdnig-Hoffman Disease)

Infantile spinal muscular atrophy; Autosomal-recessive trait; Causes *progressive weakness and wasting of skeletal muscles*. --Begins in utero or during first 2 months after birth. -S/S: Inactivity. Infant lies in frog-leg position with legs externally rotated, abducted, and flexed at knees. Weakness. Weak cry and cough. Does not sit alone, roll over, or walk. -Nursing considerations: Change position frequently. Maintain body in appropriate alignment. Frequent suctioning. Feed slowly to prevent aspiration

Dental health

Infants: Don't allow to go to sleep with a bottle, Avoid fruit juices until 6 months, Wipe teeth and gums with damp cloth daily, First dental health visit by 12 months, Begin to use soft tooth brush as more teeth erupt (The first deciduous teeth usually erupt between 6 and 8 months), Add fluoride at 6 months if water is not fluorinated, Avoid sugary foods. ---6 months-2 years: May use rice-size smear of toothpaste -start to decrease teeth brushing supervision @ school-aged

Meningitis

Infection or inflammation of meninges -Cause: Bacteria (can be fatal). Virus (no treatment). Fungus. ----increased ICP to fight At risk: poor dental care, upper res or ear infections, basilar skull fracture -S/S: Headache. Fever. Photophobia. Changes in LOC. Motor seizures, hearing loss, hydrocephalus, Signs of meningeal irritation: Nuchal rigidity. Kernig's sign--pain when knee extended. Brudzinski's sign--neck foward knee flexes (REPORT SIGNS TO DR--spinal cord tension), Opisthotonus position (arched back) -S/S in infants: Refuse feedings. Vomiting. Diarrhea. Bulging fontanelles.Vacant stare. High pitched cry. -Nursing interventions: Administer antibiotics or antifungals as ordered. Observe for increased ICP Maintain seizure precautions. *Decreased stimuli*-low lights & noise, Maintain adequate fluids and electrolyte balance. -CT before lumbar to see if increased ICP -Lumbar puncture (Bacteria = WBC & protein high, glucose low) -----supine after to avoid headache DROPLET PRECATIONS

Tonsilitis

Inflammation of lymphatic tissue of pharynx. -Treatment: Antibiotics for 10 days. Liquid to soft diet. Cool vaporizer. Surgery. -Tonsillectomy: Removal of frequently inflamed tonsils. ---Postoperative nursing care: Position on side. Discourage coughing. Apply ice collar. Administer analgesics. Suction set at bedside. Offer clear liquid diet. *Check throat for bleeding. Observe for frequent swallowing - may indicate bleeding*; When gag reflex returns - offer cool fluids and ice chips ---Client education - avoid: Irritating or highly seasoned food. Gargling. Vigorous tooth-brushing

Tetanus

Last Td was 6 years ago? -first determine how many vaccines they have received & wound is cleaned -If they had all 3 Td doses and it has been 5-10 years, they will receive Td or Tdap -If less than 3, will receive both Td & immune globulin (TIG) -Unsure? give immune globulin (TIG) -wound-dirt = TIG

Scoliosis

Lateral deviation of one or more vertebrae -S/S: Poor posture, Uneven hips or scapulae, Kyphosis hump on back, Uneven waistline, *Visualization of deformity when bend forward at waist 90 degrees*!!! -Treatment and Nursing care: Functional type: Isometric exercises (Sit-ups, Pelvic tilt, Push-up with pelvic tilt, Swimming), Electrostimulation, Milwaukee brace (4-6 year program; Wear for 23½ hours daily with ½ hour for personal hygiene; Wear protective shirt under brace; Skin care to pressure areas), May require surgery for implantation of Harrington rods for stabilization

heart failure

Left-sided failure S/S: Dyspnea. Orthopnea. Cough. Crackles. *Tachycardia*. Fatigue. Anxiety. Restlessness. Confusion. Right-sided failure S/S: Jugular vein distention (JVD). Dependent edema, (especially lower extremities and progressing up the body eventually up to the abdomen) Hepatomegaly. Right upper quadrant tenderness. Ascites, anorexia, nausea, weight gain, weakness, respiratory distress, abdominal pain. Altered liver (hepatic) function. GI distress -Treatment:Oxygen. Digoxin. Diuretics. Vasodilators. Potassium supplements. Low-sodium diet. Bed rest. -Nursing responsibilities: Promote physical and emotional rest. High Fowler position. I/Os. Skin care

Inhalers

Metered dose inhaler -Enables smaller doses, rapid absorption and onset of action -Give bronchodilators first. -Procedure: Remove the cap. Shake vigorously 5 or 6 times immediately before use. Breathe out all the way. Put the spacer in the mouth (Put inhaler 1 to 2 inches in front of the mouth if no spacer). Depress the inhaler while inhaling deeply and slowly 3 to 5 seconds. Hold the breath for several seconds. Exhale slowly through pursed lips. If repeating, wait 2 to 5 minutes. Rinse mouth with water after steroid inhalation to prevent oral candidiasis. Dry powder inhaler: -Easier to use than metered-dose inhalers. -Does not require propellant. -Delivers more medication than MDIs. -Procedure: Do not shake inhaler prior to administration. Load medication as directed. Exhale before inhalation of medication. Position mouthpiece between lips. Inhale deeply through mouth. Hold breath for 5 to 10 seconds. Wait for prescribed time before next inhalation. Inform client that a gagging sensation may occur

Wilms tumor

Nephroblastoma; Most common kidney tumor of childhood (most common 3-4; rare after 5; can affect 1 or both kidneys) -S/S: Firm, nontender mass confined to one side of abdomen, Pallor, Anorexia, Constipation, Hematuria, Lethargy, Weight loss, Fever, SOB, HTN *Considered a "silent" tumor; most diagnosed when already metastasized* -Prognosis: poor because many children are diagnosed after metastasis has occurred. -Treatment: Surgery. Chemotherapy. -Preoperative nursing care: *Do not palpate abdomen*, IMPORTANT TO MONITOR BP -Postoperative nursing care: Monitor: Bowel, Distention, Vomiting; Monitor BP, Instruct to avoid contact sports, Instruct on how to prevent UTIs

SIDS (sudden infant death syndrome)

Occurs during first year of life, peaks at 2 to 4 mo.; Occurs between midnight and 9 AM; Increased incidence in winter. -Risk factors: Infants with life-threatening events, Siblings of infants with SIDS, Preterm infants, especially with low birth weight. African American infants. Multiple births. Infants of addicted mothers. Infants who sleep on abdomen. -*Place all healthy infants in supine position* -Home apnea monitor.

Immunization

Passive =. IgG (giving antibodies) Active = natural or acquired (infection or vaccines) -Live vaccines = polio, mumps, MMR, small pox, varicella (chicken pox), nasal flu (> 2 years) -Contraindications = severe febrile illness, altered immune system, previous allergic reaction, recently acquired passive immunity (IgG or transfusion) -no IM in gluteal muscle until walking (use 25 to 30 gauge needle for IM) -Inactive side effects: low grade fever, fretfulness, erythema-swelling, local tenderness -Live side effects: mild reaction 30-60 days later, rubella bothers older (pre-treat with tylenol) -Allergic reaction to inactive ingredients = flu has egg, neomycin in MMR, varicella, polio -Adverse reactions = febrile seizures, allergic reaction

Duchenne Muscular Dystrophy (MD)

Progressive muscular weakness with atrophy of voluntary muscles (*3-5*-pre-school year male) -Mild to moderate mental impairment is common -Etiology is genetic; X-linked recessive disorder carried by mother affecting male -S/S: Muscular weakness, Poor coordination, Unsteady gait--gower's sign, Scoliosis or lordosis, Progressive loss of joint mobility, Contractures, immobility causes osteoporosis, learning difficulties, Progresses to cardiac (HF) and respiratory (assess hypoxia/breathing; increased infections) -Treatment: Intensive physical therapy. Active and passive stretching. Range of motion. -Nursing considerations:Promote safety, Discuss balance between activity and rest for child, Prevent contractures. -Prednisone may increase muscle strength -Follow-up with cardiologist and pulmonologist

Renal: Vesicoureteral Reflux

Retrograde reflux of urine from bladder into ureters.; Causes residual urine in the bladder (bacteria to kidneys --> causing pyelonephritis) -Causes: Primary - congenital anomaly. Secondary - blockage in bladder. -S/S: Recurrent urinary tract infection -Treatment: *Continuous low-dose antibiotics*!!!. Frequent urine cultures. -Nursing considerations: Age-appropriate preparation for tests.Encourage child and/or parents to comply with medication regimen.Encourage siblings to be screened, double voiding, *Antibiotics until most grades of vesicoureteral reflux resolve with maturity OR surgery (consider catheter)*

intussusception

Slipping of one part of the intestine into another part just below it; Most often occurs in young children. -not hereditary -S/S: Pain. Palpable sausage-shaped abdominal mass. *Currant-jelly stools*. Diarrhea. Anorexia. Weight loss. -Treatment: Hydrostatic reduction by: Barium enema/Water-soluble contrast or Air pressure, Surgery

Death and Grief

Stage 1: Denial Stage 2: Anger Stage 3: Bargaining or yearning Stage 4: Depression or disorganization Stage 5: Acceptance or reorganization (relinquishing old attachments, readjusting, and reinvesting in a life without) -Grief is not a "go through one step and on to the next" ---No time line for this process, everyone is different

Pyloric stenosis

Thickening of pylorus muscle--> obstruction; Seen soon after birth 3-5 weeks (first 2 months) -Risk factors = cause unknown; Males, Caucasian, Family history, Early exposure to antibiotics, Mother who smoked during pregnancy, first born -S/S: *Projectile vomiting (non gastric)*!!!!!!!!!!!!!!!!!!! within 30 min after eating....Always hungry. Weight loss. Diminished stools (constipation), Hyperactive bowel sounds, Palpable olive-shaped mass by umbilicus. Peristaltic waves, weight loss, risk for aspiration ---Signs of dehydration: Irritable or lethargic, Poor skin turgor, Dry mucous membranes, Sunken fontanel and eyes, Decreased tears/urine output -Treatment: pyloromyotomy. ---Preoperative nursing care: Correct fluid and electrolyte abnormalities - alkalosis, hypokalemia. Gastric decompression if feeding not tolerated--NG, NPO ---Postoperative nursing care: Check incision site. Provide parenteral fluids at ordered rate. Monitor warmth. Small, frequent feedings of glucose water or electrolyte solution for 4 to 6 hours. If clear fluids retained then start formula 24 hours postoperative.

Down Syndrome

Trisomy 21; 47 chromosomes -Risk: maternal age over 35, genetic -Complications: decreased muscle tone (injury; obese), congenital heart defects (ventricular septal defect), leukemia, sleep apnea, intestinal obstruction, Shortened lifespan, frequent ear infections, hearing loss, vision problems, anemia, thyroid disease, hip dysplasia -S/S: Separated sagittal suture, Eyes slanted upward and outward, Small nose with low nasal bridge, flat forehead/face, epicanthal fold, protruding tongue, low set ears, small head, hearing loss, shot stature, hypotonia or "floppy baby", increased flexibility, mental retardation, Single palmer crease, Short fingers/neck (fat pads), White spots in the iris of the eye, space in between toes -Diagnostics: During first or second trimester of pregnancy = Ultrasound. Alpha-fetoprotein blood test. Chorionic villus sampling. Amniocentesis.

Impetigo

bacterial skin infection characterized by isolated pustules that become crusted and rupture -caused by strep ---> Glomerulonephritis

Strabismus

crossed eyes; unable to focus on same object -Risk Factors: Low birth weight, Neurotrauma, Cerebral palsy, Down syndrome, Hydrocephalus, severe hyperopia -S/S: Squints eyelids to see, Tilts head to one side, Headache, Dizziness, Cross-eyed, Inaccurate judgment in picking up objects, *Closing one eye when looking around the room*, Nystagmus-repetitive eye move -Treatment: Patch stronger eye to increase visual stimulation of weaker eye; Surgery -Nursing considerations: *Explain importance of complying with patching stronger eye*; Encourage children to sit close to board or teacher; Allow extra time to read and complete assignments

IPV

inactivated polio vaccine 2, 4, 6-18, 4-6 years -leg or arm

Varicella

live (immunocompromised, pregnant; ask mom titers) 12 months, 4-6 years -injection subQ -Adverse effects: injection site soreness and fever. -Nursing considerations: Children with rash may transmit disease. Varicella (chicken pox) 13-17 days = AIRBORNE/droplet Beginning: low fever, malaise, anorexia Acute: rash (macule-->papule-->vesicle), high fever -isolate until vesicles crusted, Tylenol, lotions or oatmeal baths

MMR

measles, mumps, rubella -live (immunocompromised, pregnant; ask mom titers) 12 months, 4-6 years -*subQ* vastus lateralis; booster arm -playing catch up? 1&2 4 weeks apart -adverse: arthritis, rash, fever -measles 10-20 days = AIRBORNE -rubella = beginning: respiratory symptoms, koplick's spots (2 days before rash) DROPLET ---Then: maculopapular rash turns brown ---isolate for 5 days/bed rest, hydrate, dim lights (if photophobia) -mumps = AIRBORNE

otitis media

middle ear infection; *Often preceded by upper respiratory infection*; common in children (short tubes) -Two main types: Acute otitis media & Otitis media with effusion. -Risk: upper res infection, supine when feeding, allergic reaction, high altitudes/travel -Complications: can spread and cause meningitis/mastoiditis (pain behind ear), hearing loss, cyst in ear -S/S: Fever, Chills, enlarged lymph nodes, Headache, Sense of fullness in ear (drainage if ruptured), Ear noises, Deafness; Head rolling, Crying, Irritability/Sleeping & feeding problems in younger, Reddened tympanic membrane, Nausea, Vomiting; Sharp pain in middle ear causes child to rub, pull, or tug at ear (younger children) -Surgical interventions: Ventilatory tubes. Myringotomy. -Nursing interventions: Report persistent symptoms, Meds: Antibiotics.Antihistamines.Nasal decongestants. Analgesics/antipyretics; Heat/cold therapy, Maintain bed rest if temperature elevated, *Position on side of affected ear to promote drainage*, Instruct to bottle or breastfeed with infant in upright position, do not prop bottle while feeding--milk pooling in mouth -ruptured membrane = no swimming

Cerebral palsy

permanent & non progressive neuro-muscular disorder -Commonly not intellectually impaired, but motor -Cause unknown; in utero: Genetic factors.Maternal infections, labor and delivery - lack of oxygen, Postnatal factors: Infections. Stroke. Trauma, low birth weight, shaken baby -May be: Spastic. Hypotonic. Dystonic. Combination of all. -S/S: *poor head control after 3 months*!!!, early hand dominance, stiff or rigid arms or legs, pushing away or arching the back, limp body posture, cannot sit up by 8 months, Muscle spasticity and/or rigidity, persistent reflexes, hyperreflexia, ankle clonus, swallowing and/or sucking problems, Speech impairments, Urinary incontinence, Visual/hearing impairments, Seizures. -Important to maximize the child's functioning (all of the therapies; promote independence); normal bowel/bladder, no aspiration, good communication, home safety, pain meds & botulism injections (botox; S/E = muscle weakness--eye/resp/bladder), surgery for spasticity or contractures if not respond to other treatment -Complications: Muscle contractures, Breathing complications, Nutritional deficits due to problems swallowing, Impaired eye muscles, Osteoarthritis, Depression related to social isolation

Blood pressure

usually above 3 years Size of cuff: 1/2-2/3 area of extremity