NUR 317 Test #2 Peds

What is cystic fibrosis (CF)?

"An inherited autosomal-recessive disorder of the exocrine glands, causing those glands to produce abnormally thick secretions of mucus, elevation of sweat electrolytes, increased organic and enzymatic constituents of saliva, and overactivity of the autonomic nervous system. The glands most affected are those in the pancreas and respiratory system and the sweat glands" (nursingconsult.com). Incidence "1 in every 20 Americans is an unaffected carrier of an abnormal "CF gene." These 12 million people are usually unaware that they are carriers"*. Quick Facts It is one of the most common lethal genetic diseases in the US Incidence of 1:3000 Caucasians , 1:9200 Hispanics,1:17000 African Americans Cause is a defect in on chromosome 7 Although the disease causes abnormalities in the hepatic, gastrointestinal and male reproductive systems, lung disease is the major cause of morbidity and mortality Most individuals with CF develop obstructive lung disease associated with chronic infection that leads to progressive loss of pulmonary function Usually die from a lung infection CF is part of the PA newborn screening panel (PKU)

What is CF prognosis?

A few decades ago, CF was fatal in early childhood Median life expectancy now is 35 years of age Lung transplants may be performed in those with end-stage lung disease Complications increase with age Infants that are diagnosed with CF are strongly recommended to be followed at a CF Foundation- accredited CF care center

NCLEX Questions for GI

A patient diagnosed with ulcerative colitis is admitted to the medical unit. When assessing the patient, which of these findings would be of the most concern? A. Borborygmi B. Oral temperature of 99.0 F (37.2 C) C. Bloody diarrhea D. Rebound tenderness Answer D. Rebound tenderness Bloody diarrhea is a common finding because of bleeding lesions and anal excoriation. A temperature of 99.0 F (37.2 C) is within normal range, and chronic inflammation may keep temperatures within the high normal range or above. Rebound tenderness is a sign of peritonitis that could be the result of rupture of the colon. The healthcare provider is teaching a patient diagnosed with Crohn's disease who is recovering from a bowel resection. Which of the following statements made by the patient indicates the teaching has been effective? A. "Now that the bowel has been removed, the disease is cured." B. "The disease might reappear in another part of the bowel." C. "Now I can discontinue taking my multivitamin supplements." D."I might develop ulcerative colitis because some of my bowel is missing." Answer B. "The disease might reappear in another part of the bowel." - you can fix the portion that is diseased but then it can pop up in one of the sections that was previously healthy. Remember the differences between Crohn's disease and ulcerative colitis. The healthcare provider is caring for a 3-month-old infant diagnosed with infectious gastroenteritis. The infant is lethargic and the mucous membranes are dry. Which additional finding would support a diagnosis of moderate dehydration? A. Increased capillary refill B. Increased thirst C. Anuria D. Sunken fontanelle Answer D. Sunken fontanelle A sunken fontanelle is a sign of increasing dehydration, and is first noticed when dehydration progresses from mild to moderate. Mild dehydration may be evidenced by an increased thirst and decreased urine output. Anuria is a sign of severe dehydration. A child presents to the emergency department with a complaint of watery diarrhea for the past three days. Assessment findings include blood pressure - 100/60, pulse - 110, and dry mucous membranes. The healthcare provider would anticipate intravenous therapy administration with which of the following fluids? A .Isotonic crystalloid B. Hypotonic crystalloid C. Colloid solution D. Hypertonic crystalloid Answer A. An isotonic IV solution will expand the intravascular compartment. The patient is showing signs of volume depletion and dehydration. is corrected by expanding the intravascular compartment. Hypertonic and colloid solutions would pull fluid into the intravascular space, but at the expense of other fluid compartments. When administering intravenous (IV) fluids to a 1-year-old child experiencing severe diarrhea, which of these assessments is the priority for the healthcare provider to monitor? A. Status of the IV site B. Skin integrity C. Cardiopulmonary status D. Urine output Answer C. Cardiopulmonary status The nurse should be concerned about fluid volume overload in this patient, so cardiopulmonary status is the priority assessment. The other assessments will also be part of the patient's ongoing care.

What is vomiting?

A presenting symptom of many pediatric conditions The challenge is to find out the cause! Most common cause is an acute viral gastroenteritis Other causes can be: obstruction, acute or chronic inflammation of the GI tract Metabolic disorders: Sepsis/ drug intoxication Knowing the Difference Vomiting occurs when the flow is forceful — shooting out inches rather than dribbling from the mouth. Spitting up is the easy flow of a baby's stomach contents through his or her mouth, possibly with a burp Ask the parent to describe what they mean by vomiting

What are the GI alternations in Pediatrics?

Abdominal pain Vomiting/spitting up Diarrhea and constipation Nutritional disorders Failure to Thrive (FTT) Hirschsprung disease GER/D Cleft palate Intussusception IBD

What is diarrhea and the types of diarrhea?

Acute diarrhea is leading cause of illness in children <5 years of age Of all deaths in developing countries, 24% are related to diarrhea and dehydration Diarrheal disturbances have several forms Gastroenteritis Enteritis Colitis Enterocolitis Types of Diarrhea Acute Diarrhea Rotavirus is the most common cause of enteric infection. It affects the small intestine causing voluminous watery diarrhea without leukocytes or blood In the U.S. it affects infants between 3 and 15 months of age Transmitted via fecal-oral route and survives for hours on hands and days on environmental surfaces Vaccination is oral at 2, 4 and 6 months of age Goes through for the daycare and hospital quickly Chronic Diarrhea Antibiotic Therapy (affects 60% of all children) Recommendation: Probiotics Extraintestional infections: UTI, URI,OM Malnutrition Diet and Medications; Overfeeding, fruit juices, spices in food, citrus, tomatoes, Munchausen by proxy (laxatives) Allergic Diarrhea: (falls under chronic diarrhea) Cow's milk allergy, lactose intolerance FPIES-Food protein induced enterocolitis syndrome( can be fatal-allergic to milk and soy), Celiac disease, IgE mediated reactions to food (food allergies)

Food allergy

Allergy A specific immune response upon exposure to a given food Intolerance Situation in which a food elicits an adverse reaction without an immunologic mechanism Example: lactose intolerance

What is the prognosis of glomerulonephritis?

Almost all children with a diagnosis of acute post streptococcal glomerulonephritis recover completely Specific immunity is conferred Subsequent recurrences are uncommon Some children have been reported to develop chronic disease

What is chronic nonspecific diarrhea?

Also called "Toddler's diarrhea" Typical healthy child 6-20 months of age with 3 to 6 loose stools per day while awake No blood in stools, WBC, Fat, parasites, bacterial antigens No growth deficiencies Worsens with low-residue, low fat or high carb diets or periods of stress Resolves on its own by age 3 1/2 years of age Other Causes of Chronic Diarrhea Organisms: Salmonella, Shigella, Campylobacter, Giardia, Cryptosporidium, Plesiomonas, Yersinia, Clostridium difficile Pancreatic insufficiency: Cystic Fibrosis Certain malignancies

What is hirschsprung disease?

Also called "congenital aganglionic megacolon" Congenital anomaly Absence of ganglion cells in colon Mechanical obstruction from inadequate motility of intestine Incidence: 1 per 5000 live births; more common in boys (4X) and in children with Down syndrome (10-15% affected)

What is celiac disease?

Also known as "gluten enteropathy" CD is an immune-mediated enteropathy triggered by gluten, a protein found in wheat, rye, barely and (rarely) oats. Disease frequency in Western populations approaches 1 in 100. Associated conditions include: Type1 diabetes(4-10%), Down Syndrome (5-12%), Turner syndrome (4-8%), IgA deficiency (2-8%) and family history (5-10%)

What is Peptic ulcers?

An ulcer is an open, painful wound. Peptic ulcers are ulcers that form in the stomach or the upper part of the small intestine, called the duodenum. An ulcer in the stomach is called a gastric ulcer An ulcer in the duodenum is called a duodenal ulcer. Both a gastric ulcer and a duodenal ulcer happen when H. pylori or a drug weakens the protective mucous coating of the stomach and duodenum, letting acid get through to the sensitive lining beneath. Both the acid and the bacteria can irritate the lining and cause an ulcer.

How to diagnose peptic ulcers?

An upper GI series : X-rays of the esophagus, stomach, and duodenum. Upper Endoscopy: view the lining of the esophagus, stomach, and duodenum to check for possible ulcers, inflammation, or food allergies. It also can be used to perform tissue tests to check for H. pylori.

What are the nursing assessment focus for nephrotic syndrome?

Assess for hypokalemia CV: HR/rhythm ∆; hypotension CNS: hyporeflexia, muscle cramping Assess for hyponatremia CNS/MS: headache, confusion, seizures, muscle weakness, spasms, cramps Cardiac: hypotension GI: abdominal cramping, nausea Assess for hypernatremia CNS: muscle twitching, lethargy, disorientation GI: intense thirst, N/V Other: flushed skin, fever, oliguria Meet nutritional needs/assess nutritional status Assess for Orthopnea Infection Skin breakdown Assess for medication adverse effects Fatigue Altered family coping

What is the pathophysiology of CF?

Autosomal Recessive Gene CFTR Protein (Cystic Fibrosis Transmembrane Regulator) Exocrine gland dysfunction Increased mucus production and viscosity Multisystem involvement Respiratory GI Reproductive Integumentary CFTR Protein is a transporter for chloride and bicarbonate and affects the activity of other plasma membrane channels such as sodium channels A mutated gene governing CFTR proteins results in electrolyte imbalance Decreased pancreatic secretion of bicarbonate and chloride Increased secretion of sodium and chloride in saliva & sweat Their sweaty would taste salty Mechanical Obstruction Viscous secretions block tubules

What are the nursing considerations for asthma?

Beta Adrenergic Agonists Assess HR before and after treatment Corticosteroid inhalers Use a spacer Rinse mouth Leukotriene Modifiers Give 1 hr ac or 2 hr pc Assess for jaundice Precautions with warfarin (Coumadin) use Bronchodilators Contraindicated if rapid HR Know therapeutic range

Risk for growth failure: FTT

Cancer Human immunodeficiency virus (HIV) Sickle cell disease Cystic fibrosis Low birth weight

What is hypertrophic pyloric stenosis?

Cause Unknown Affects males to females 4:1 Positive family history Mean age of diagnosis 43.1 days Link between erythromycin in the neonatal period and a higher incidence of pyloric stenosis in infants younger than 30 days Signs and Symptoms Projectile vomiting beginning at 2 to 4 weeks of age Vomitus may be blood-streaked Infants are usually hungry and nurse avidly Constipation, weight loss, fretfulness, dehydration and finally apathy occur. Upper abdomen may be distended after feeding Constriction of pyloric sphincter with obstruction of gastric outlet Presents birth to 5 months; most common at 3 weeks Forceful vomiting Nursing management Preoperative and postoperative care

What is asthma?

Characterized by chronic inflammation and exacerbated by irritation from an allergen, bacteria, virus, exercise, or stress. Quick Facts Affects over 7.1 million children in the US One out of 10 children has asthma. Of the children affected, 2 out of 3 will have at least one asthma attack during the year. Asthma remains a potentially life threatening disease for children: the rate of death is .3 per 10,000 children Death rate is higher among minority and inner city populations Reasons: poor access to health care, lack of asthma education, delay in use of therapy and environmental factors Up to 80% of children with asthma developed symptoms before their 5th birthday Atopy ("Hyper- allergic") is the strongest identifiable predisposing factor. Sensitization to inhalant allergies increases over time. Principal allergens associated with asthma are: dust mite, animal dander, cockroach, and soil mold. Rarely does food allergies provoke asthma symptoms About 40% of infants and young children who had wheezing with viral infections in the first few years of life will develop asthma Viral infections from: RSV, rhinovirus, parainfluenza and influenza are associated with these wheezing episodes It is still being studied if these viruses definitively contribute to the development of chronic asthma independent of atopy. Severe RSV bronchiolitis in infancy has been linked to asthma and allergy later in childhood Other Triggers Exposure to tobacco smoke, especially from the mother Exercise, cold air, pollutants, strong chemical odors and rapid changes in barometric pressure A recent study suggests that acetaminophen exposure increases the risk of wheezing and asthma Psychological factors may precipitate asthma exacerbations

Quick facts about cleft palate

Cleft lip is more common in males Cleft palate more common in females Cleft lip may be unilateral or bilateral - complete or incomplete It may occur with a cleft of the entire palate or just the anterior or posterior palate Cleft palate can involve only the soft palate or both the hard and soft palates

What is renal failure?

Clinical Findings Oliguria Prerenal causes: In children, dehydration Renal Causes: intrinsic to the kidney and include acute glomerulonephritis, HUS, acute nephritis Postrenal Causes: urologic anatomic abnormalities Acute renal failure (ARF) Inadequate perfusion Kidney disease Urinary tract obstruction Chronic renal failure (CRF) Long-standing kidney disease Congenital anomaly

How to diagnose appendicitis?

Clinical Presentation Pain Clinical signs Psoas Obturator Dunphy's Rebound tenderness Labs CBC (WBC) >10,000 <15000 mm3 and C-reactive protein (CRP) >8 mg/L= 92% predictive value for acute appendicitis

How to manage IBD?

Collaborative Bowel rest Improve nutrition TPN/PPN Surgical resection? Can lead to short bowel syndrome with repeated surgeries Prevent infection Symptom relief Enhance quality of life Medications Azulfidine (sulfasalazine) Antibacterials Flagyl (metronidazole) Cipro (ciprofloxin) Immunosupressants (Imuran) Biologics Remicade, Humira, Cimzia, Tysabri) Steroids Oral vs. IV

What is Gastroesophageal Reflux Disease: GERD?

Common in young infants Recurrent postprandial spitting and vomiting in healthy infants that resolves spontaneously Usually benign Causes: small stomach capacity, frequent large volume feedings, short esophageal length, supine positioning, slow swallowing response to the flow of the feeding

What are the clinical manifestations of CF?

Common presentation is failure to thrive in infants Infants fail to gain weight despite good appetites and have frequent, bulky, foul smelling, oily stools May also present with hypoproteinemia, anemia and deficiencies of fat-soluble vitamins A,D,E and K May have a productive cough, wheezing, recurrent pneumonias, progressive obstructive airway disease, exercise intolerance, dyspnea and hemoptysis (may be blood in the sputum) Respiratory Viscous mucus Cough - paroxysmal-non productive Dyspnea Wheeze Atelectasis Clubbing Barrel shaped chest (1:1 AP) Cyanosis GI Steatorhea (fat in stool, will look yellow - fatty stool) Azotorrhea (grey colored stools) Prolapsed rectum Weight loss Malabsorption of fat soluble vitamins Abdominal distention Meconium Ileus Distal Intestinal Obstructive Syndrome (DIOS) Skin Increased sodium in sweat Reproductive Female Normal fallopian tubes and ovaries Mucus plugs cervix and fallopian tubes Delayed puberty Male Blockage of Vas Deferens 95 % sterility rate

What are symptoms of Crohn's Disease?

Common symptoms can include: frequent diarrhea stomach pain or cramping blood in stool fevers weight loss joint, skin or eye irritations Nutritional complications: malabsorption, anorexia, short stature, secondary lactose intolerance, decreased bone mineralization and specific nutrient deficiencies. Corticosteroid therapy may impact growth and bone mineral density Most patients achieve a reasonable final adult height Intestinal obstruction, fistulae, abdominal abscess, perianal disease, arthritic can occur Crohn colitis carries a risk for adenocarcinoma of the colon

What is ulcerative colitis?

Common symptoms can include: frequent diarrhea stomach pain or cramping blood in stool fevers weight loss joint, skin or eye irritations Nutritional complications: malabsorption, anorexia, short stature, secondary lactose intolerance, decreased bone mineralization and specific nutrient deficiencies. Corticosteroid therapy may impact growth and bone mineral density Most patients achieve a reasonable final adult height Intestinal obstruction, fistulae, abdominal abscess, perianal disease, arthritic can occur Crohn colitis carries a risk for adenocarcinoma of the colon

What are urinary tract infections?

Common: 8% of girls and 2% of boys will have a UTI in childhood Girls older than 6 months have more UTIs than boys but uncircumcised boys younger than 3 months have more UTIs than girls Circumcision reduces the risk of UTIs in boys Most UTIs are ascending infections-which means they are caused by disease agents traveling upward through the urethra to the bladder Most common organisms responsible are E.Coli (85%), Klebsiella, Proteus, Pseudomonas, and other gram-negative bacteria Enterococcus and Coagulase-negative staphylococci less common More the issue is not wiping well - Front to back!

What are Crohn's Disease?

Crohn's disease is swelling and inflammation in the wall of the digestive tract. Both the inner lining (mucosa) and the deeper layers of the wall become inflamed. 30% of children with Crohn's disease have a close family member who also has the disease. We know that it affects boys and girls equally. Crohn's disease most often affects the end of the small intestine but can happen anywhere along the digestive tract from mouth to anus. Crohn's disease can move along the digestive tract and can cause inflammation in one area of the digestive tract, leave the next area disease free and affect another area further down.

What is constipation?

Defined as two or more of the following: Less than 3 bowel movements per week More than 1 episode of encopresis (soiling) per week (60% of children with constipation) Impaction of the rectum with stool You may have skid marks or soiling of the stools because the stool is loose Passage of stool so large it obstructs the toilet Retentive posturing and fecal withholding (2%) Males to females 4:1 Pain with defecation Constipation During Newborn Period First meconium should be passed within 24-36 hours of birth; if not, assess for Intestinal atresia, stenosis Hirschsprung disease, hypothyroidism Meconium plug, meconium ileus (CF) Almost unknown in exclusively breastfed infants. Stool may become infrequent because of minimal residue from digested breast milk May develop in formula-fed infants

Medication Administration

Determination of drug dosage Weight based Body surface area Confirming safe dosage Identification Two identifiers Children may try to trip you up in identification Preparing the parents Preparing the child Calculating Safe Dose Essential to administer safe dose to children The younger the child, the greater the risk for adverse reactions Pedi meds are typically weight based Need to confirm ordered dose is within safe & therapeutic range Dose too low = sub therapeutic Dose too high = risk for adverse/toxic reactions Also critical to educate caregivers How much is a "teaspoon"? However, acetaminophen is both weight based and age based and dosage based Child weighs 20 lbs Order: amoxicillin 60 mg q8H. Child Safe range: 20 - 40 mg q8H Drug available as 125 mg/5 mL Is amount of drug child will receive in 24 hours safe? What about each dose? Order: 60 mg PO q8H = 180 mg/24 H Obtain child's Kg weight: 20 lbs = 9.09 Kg Safe dose range = 20 - 40 mg/kg/day (in divided doses) Calculate low dose: 9.09 X 20 = 181.8 mg/day Calculate high dose: 9.09 X 40 = 363.6 mg/day Is ordered dose safe AND therapeutic? It is not safe and not therapeutic. Consider to be too toxic for the child Oral Intramuscular Selecting the syringe and needle Determining the site Administering medication Subcutaneous and intradermal Intravenous Intraosseous - goes into the bone Intravenous Devices Peripheral intermittent infusion device or "lock" Central venous access devices Short term/nontunneled catheter Long-term tunneled catheter Implanted infusion ports Peripherally inserted central catheters (PICCs) Optic, Otic, and Nasal Administration Eyedrops and ointments; eardrops; nosedrops Techniques May be difficult to obtain cooperation from the child Infection control concerns Nasogastric, Orogastric, or Gastrostomy Administration Advantages Ability to administer medications around the clock without disturbing the child Disadvantages Occlusion, clogging Adequate flushing Rectal Administration of Medications Advantages Alternative route when oral route is difficult or contraindicated Disadvantages May be less reliable Aerosol Therapy Deposits medication directly into the airway Useful in avoiding systemic side effects Nebulized with oxygen Metered-dose inhalers

How to diagnose and treat it?

Diagnosis Anal pruritus "Tape test"- press a piece of tape on the child's anus in the morning prior to bathing then place tape on slide for testing. Sometimes, eggs or adult worms can be seen in feces Treatment All household members should be treated Pyrantel pamoate(Reese's Pinworm medication), Mebendazole (Vermox) and Albendazole(Albenza) are all effective Personal hygiene must be emphasized Nails should be short and clean Children should wear undergarments to bed to keep from itching infected area Launder bed linens frequently

How to diagnose and manage GERD?

Diagnosis Upper GI- to rule out anatomical diseases Esophagoscopy: to rule out esophagitis Managing GER/D Infants Elevate HOB Baby upright 30 minutes after feeding Thicken formula Children/Adolescents Elevate HOB Upright for 2 hours after eating Multiple small meals Medications to Manage GERD Anti-gas medications Simethicone (Mylicon) Antacids Maalox, Mylanta Histamine 2 antagonists (H2 Blockers)(Zantac) Proton pump inhibitors (PPIs)(Prilosec) Treatment Usually resolve spontaneously in 85% of infants by 12 months of age Small feedings at frequent intervals and by thickened feedings with rice cereal Ranitidine (Zantac) or Omeprazole(Prilosec) reduce discomfort not frequency of reflux Hypoallergenic formula can also be tried

What is the pathogenesis of UTI?

Dysfunctional voiding leading to incomplete emptying of the bladder and stasis are the primary cause Any condition that interferes with the complete emptying of the bladder: Constipation Neurogenic bladder Poor perineal hygiene, structural abnormalities, catheterization and sexual activity Structure of the lower urinary tract is believed to account for the increased incidence of infection in females Vesicoureteral reflux, anatomic abnormalities or bladder compression are conducive to infection

Complications of cleft palate

Early feeding difficulties Airway obstruction necessitating a tracheostomy Recurrent serous otitis media (hearing delays) Language delays Hypernasality Dental and orthodontic complications Concerns r/t Cleft Palate Feeding issues Techniques and interventions Special feeding equipment Breast-feeding issues Growth failure Dentition and speech issues

What are the therapeutic management of UTIs?

Eliminate current infection Identify contributing factors to reduce the risk of recurrence Prevent systemic spread of infection Ensure adequate or increased fluid intake Preserve renal function

Alternative Feeding Techniques

Enteral Gavage feedings Nasogastric tubes Not for long term use for feedings Because they will erode even the tiny tube swill erode and cause damage Measure from nose to ear and ear to lower xiphoid process and then pass it Orogastric tubes Gastrostomy feedings Jejunostomy feedings G-J tubes May be continuous or intermittent (bolus) feedings IV Total parenteral nutrition (TPN) Sterile procedure Provides for total nutritional needs Intravenous infusion of highly concentrated nutrient solutions Enteral Feedings Safety always Confirm ordered feeding Confirm dose Assess for tolerance Residual amount? Diarrhea? Constipation? Tube clogged? Tube dislodged? Remember the family!

What is epispadias?

Epispadias is a rare congenital (present at birth) abnormality that involves the opening of the urethra. In boys with epispadias, the urethra opens in top of the penis rather than the tip. The space between this opening and tip of the penis appears like an open book (gutter). The epispadias is classified based on the location of the meatus on the penis. Glanular epispadias: It is found on the head of the penis Penile epispadias: It is found along the shaft of the penis Penopubic epispadias: it is found or near the pubic bone In boys with epispadias, the penis tends to be broad, short, and curved up ("dorsal chordee"). The pelvic bones are widely separated. Since the penis is attached to these bones, it results in a penis that's pulled back toward the body. The position of the meatus can help predict the how well the bladder stores urine. If the meatus is close to the base of the penis (and the abdominal wall), the bladder sphincter is likely affected and it won't hold urine.

What is Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)?

Esophageal atresia: failure of esophagus to develop as a continuous passage TEF: failure of the trachea to separate into a distinct structure May occur separately or in combination Cause unknown Diagnostic evaluation Clinical manifestations

What are the acute episodes of asthma?

Exercise Induced Asthma (EIA) Lot of athletes at school have asthma action plans So the team and the coach know what to do when an athlete suffered an asthma attack They must have a rescue inhaler available in order to participate Asthma Exacerbation Be alert to quieting of breathing Status Asthmaticus Acute, severe, and prolonged asthma attack Caused by critically diminished airway diameter resulting from ongoing bronchospasm, edema, and mucous plugging. Child quickly develops hypoxia, cyanosis, and unconsciousness May be fatal

What are the clinical findings of hirschsprung disease?

Failure of the newborn to pass meconium in first 24 hours of life Followed by vomiting, abdominal distention and reluctance to feed X-ray will show retained stool but digital exam will show an empty anal and rectum

How to do the renal system assessment?

Family history of cystic disease, hereditary nephritis, deafness (Alport syndrome), dialysis or renal transplantation Preceding acute or chronic illnesses Physical examination Observation of symptoms Laboratory, radiologic, or other evaluation methods

What are the signs and symptoms of appendicitis?

Fever Periumbilical abdominal pain which then localizes to the RLQ. Anorexia, vomiting, constipation and diarrhea also occur. Helpful Hint: Vomiting before pain= gastroenteritis Vomiting after pain= appendicitis Soas Sign Pain secondary to psoas muscle stretch or contraction; the muscle borders the peritoneal cavity and friction with inflamed tissues causes pain; positive when pain occurs while patient is lying on left side and right thigh is hyperextended by clinician or when hip is flexed against resistance. Obturator sign Pain secondary to obturator muscle irritation; positive if pain occurs when patient lies supine with hip flexed at 90 degrees; clinician stabilizes ankle with one hand and then with the other hand on the knee moves hip through internal and external rotation. Dunphy's Sign Sharp pain in RLQ with cough; pain caused by peritoneal irritation. Rebound Tenderness Pain is greater when deep palpation is quickly released than during palpation; indicates peritoneal irritation.

What are the complications of renal failure?

Fluid overload: hypertension, CHF, pulmonary edema Electrolyte disturbances (hyperkalemia) Metabolic acidosis Hyperphosphatemia Uremia Dialysis "The process of separating colloid and crystalline substances through a semipermeable membrane" Methods Peritoneal dialysis Hemodialysis Hemofiltration

What is infant: HEENT?

Fontanelles "Soft spots" Anterior closes first because it is much smaller Posterior takes longer Neck appears short Pupils: react to light, + blink and constrict

What is renal transplantation?

From cadaver or living donor Living related donor Usually a parent or sibling 1-year survival rates 2003 to 2006 to 95% and 97.5% Primary goal: long-term survival of grafted tissue Immunosuppressant therapy

What are treatments for peptic ulcers?

Fundoplication: Anti-reflux Surgery when: Unresponsive to medications Persistent vomiting with failure to thrive Esophagitis or esophageal stricture Life threatening apneic spells Chronic pulmonary disease GR Surgical Intervention Nissan Fundoplication

What are the clinical findings of celiac disease?

Gastrointestinal manifestations Celiac crisis: dehydration, hypotension, hypokalemia and explosive diarrhea Non-gastrointestinal manifestations: delayed puberty, short stature, delayed menarche, iron-deficiency anemia and arthritis.

How to treat celiac disease?

Gluten restriction for life. Supplemental calories, vitamins and minerals are indicated in the acute phase Corticosteroids indicated for celiac crisis, malnutrition, diarrhea, anorexia Non-compliance could result in increased risk for fractures, iron deficiency anemia and infertility - teenagers are more likely to be noncompliance

What is H. Pylori?

H. pylori infection is usually contracted in childhood ( through food, water, or close contact with an infected individual) Most people won't have any symptoms until they're older. Although H. pylori infection usually doesn't cause problems in childhood, it can cause gastritis (irritation and inflammation of the stomach lining), peptic ulcer disease, and even stomach cancer later in life.

What are the medications to treat peptic ulcers?

H2 Blockers Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid) PPIs Omeprazole (Prilosec) Esomeprazole (Nexium) Best for erosive GERD Pantoprazole (Protonix) Lansoprazole (Prevacid)

How to diagnose asthma?

History Clinical manifestations Physical exam Lab tests Chest x-ray CBC Peak Expiratory Flow Rate - PEFR Pulmonary Function Tests Pulse Ox Peak Expiratory Flow Rate(PEFR) Tool to evaluate airflow limitation in asthma Take a deep breath and short, quick breath in For kids, pretend they are warriors and blowing darts! Yellow range - may need to change their medications Red range - we ask parents to monitor them and we have them come in Trying to catch the asthma attack before going into an acute attack Personal Best Establish personal best over a 2-3 week period Record PEFR 2x daily Green Zone is 80-100% of personal best Yellow Zone is 50-79% of personal best Red Zone is below 50% of personal best Set the tabs to indicate zones for easy reading

How to diagnose CF?

History & Physical Quantitative Sweat Chloride Test Infant tastes "salty" Chest X-ray Fecal fat test LFTs IRT screening X-Ray Comparison

How to screen for CF?

Immunoreactive Trypsinogen (IRT) Test Newborn screening like PKU Expensive Free in the UK if you live there CFTR gene mutation F508 gene mutation seen in 70% of CF patients Carrier screening F508 gene mutation seen in 70% of Caucasian population and 30% of African American population

What is CF related diabetes (CFRD)?

Incidence is greater in children with CF than the general population Not a true Type 1 or Type 2 Pancreatic fibrosis causes insulin deficiency Beta cell destruction Fewer microvascular complications Insulin is more effective than the oral hypoglycemic drugs.

How to treat constipation?

Increased intake of high-residue foods such as bran, whole wheat , fruits and vegetables Increase in fluid intake Maltsupex (Barley malt extract) or MiraLax are safe stool softeners for children Stimulant laxatives: Senokot syrup, ExLax Encopresis : Disimpaction (saline enemas)

What are the clinical findings and common causes of constipation?

Infants younger than 3 months of age often grunt, strain and turn red in the face while passing stool. This is normal ! Infants/ young children develop the ability to ignore the sensation of rectal fullness resulting in impaction Common Causes of Constipation Functional/ Retentive: Dietary causes Toddlers that hate vegetables Not getting enough fiber Cathartic abuse: Drugs-narcotics, antihistamines, vincristine (chemo agent) Structural defects Anal and rectal stenosis, hemorrhoids Small bowel stricture, intussusception Smooth muscle disease Abnormalities of myenteric ganglion cells Hirschsprung disease Common Causes Spinal cord defects Metabolic and endocrine disorders Hypothyroidism, Hyperparathyroidism Renal tubular acidosis Diabetes insipidus Vitamin D intoxication Skeletal muscle weakness or incoordination Cerebral palsy Muscular dystrophy

What are the infant's temperament?

Infants' behavioral style Strong biologic component May be modified by the environment and family Revised infant temperament questionnaire Difficult Intense Less predictable

What is informed consent?

Informed Consent Requirements for obtaining informed consent The person must be capable of giving consent: age at majority (usually age 18) The person must receive the information needed to make an intelligent decision The person must act voluntarily when exercising freedom of choice Eligibility for giving informed consent Parent or legal guardian status Evidence of consent Mature or emancipated minors Treatment without parental consent Many of the children's treatment centers have a full on legal team for access to legal advice in order to proceed Adolescent's consent and confidentiality Medically emancipated conditions

Maintaining Respiratory Function

Inhalation therapy Oxygen therapy delivery devices "Oxyhood" Nasal cannula O2 masks Ventilators Monitoring O2 therapy Be alert for oxygen toxicity End-tidal CO2 monitoring Interventions Medications Bronchial (postural) drainage Chest physical therapy Procedures for Maintaining Respiratory Function Intubation Mechanical ventilation Tracheostomy Suctioning Routine care Chest tubes

How to prevent UTIs?

Instruct parents to observe child regularly for signs of infection Teach patients that simple hygiene habits should be routine Teach patients & caregivers proper cleansing of genital area Encourage sexually active adolescent girls to urinate as soon as possible after intercourse

What are the four classifications of asthma?

Intermittent Symptoms < 2 days/week and no effect on ADLs Rescue medication - inhaler for symptom control Mild Persistent Symptoms > 2 days/week and mild effect on ADLs Leukotriene modifiers to block inflammatory response-daily med Rescue medication plus inhaled corticosteroid for symptom control Moderate Persistent Symptoms daily with interference with ADLs Daily inhaled medications including a long acting bronchodilator and corticosteroid Exacerbations last days Severe Persistent Continual symptoms limit ADLs Daily high dose corticosteroids(inhaler), oral steroids, long acting bronchodilator Frequent exacerbations

What is Hypospadias?

Is a condition in which the opening of the urethra is on the underside of the penis, instead of at the tip. Hypospadias is common Surgery usually restores the normal appearance of your child's penis. With successful treatment of hypospadias, most males can eventually have normal adult sexual function. In most cases, the opening of the urethra is near the head of the penis. Less often, the opening is at midshaft or at the base of the penis. Rarely, the opening is in or beneath the scrotum. Abnormal spraying during urination Most infants with hypospadias are diagnosed soon after birth while still in the hospital. Abnormal spraying by the male infant - usually diagnose in the hospital

What are the care management of glomerulonephritis?

Manage edema Daily weight measurements Accurate input and output Daily abdominal girth measurements Nutrition Low sodium Fluid restriction Susceptibility to infections

What is chest physiotherapy (CPT)?

Manual Postural drainage Cupped hand Go up one lung and then go down another lung Clopping sound like a horse Vibration Mechanical Oscillating vibrators ThAIRapy Vest Contraindications to CPT After eating Pulmonary hemorrhage PE Increased Intracranial Pressure (ICP) Osteogenesis Imperfecta (OI) (brittle bone disease) Cardiac complications/anomalies Renal failure

Maintaining Fluid Balance

Measurement of intake and output Fluids to be measured Practitioners usually order intake and output measurements Nursing responsibility: to identify when fluids should be measured Diaper weighing technique Care of the child who is on NPO status

How to diagnose of hirschsprung disease?

Most cases diagnosed in the first few months of life Complete and careful history X-ray, barium enema studies Anorectal manometric examination Rectal biopsy to confirm diagnosis

What is hemolytic uremic syndrome (HUS) and the symptomatology?

Most common glomerular vascular cause of acute renal failure in children Usually follows an infection with Shiga-toxin: Shigella or E. Coli Bloody diarrhea is the presenting complaint, then hemolysis and renal failure Hemolytic-uremic syndrome affects males and females equally 10% to 50% HTN as long-term complication Prognosis Recovery rate of 95% Systemic disease that consists of the following symptomatology: Renal failure Hemolytic anemia with fragmented red blood cells and platelets Thrombocytopenia

Peptic Ulcers in children

Most ulcers are caused by an H. pylori infection or the use of common nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen Even moderate use of NSAIDs can cause gastrointestinal problems and bleeding in some children. Acetaminophen does not cause stomach ulcers and is a good alternative to NSAIDs for most childhood conditions.

What is nephrotic syndrome?

Nephrotic syndrome is a kidney disorder that causes the body to excrete too much protein in the urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in the kidneys that filter waste and excess water from the blood. Nephrotic syndrome causes edema, particularly in your feet and ankles, and increases the risk of other health problems. "an abnormal condition of the kidney characterized by marked proteinuria, hypoalbuminemia, and edema" Resolution: 75% in 2 weeks; 95% by 8 weeks

What are the causes for nephrotic syndrome?

Nephrotic syndrome is usually caused by damage to glomeruli of the kidneys. Healthy glomeruli keep blood protein (mainly albumin) — which is needed to maintain the right amount of fluid in the body — from seeping into the urine. When damaged, glomeruli allow too much blood protein to leave the body, leading to nephrotic syndrome. Minimal change disease. The most common cause of nephrotic syndrome in children, this disorder results in abnormal kidney function, but when the kidney tissue is examined under a microscope, it appears normal or nearly normal. Focal segmental glomerulosclerosis(10-15%) Membranous nephropathy-thickening Diabetic kidney disease Systemic lupus erythematosus Amyloidosis. (build up in the blood) Blood clot in a kidney vein Heart failure.

What are the complications of HUS?

Neurologic—mortality rate in children with neurologic symptoms (seizures, coma) is 90% Disseminated intravascular coagulation (DIC) — primarily affects vasculature of kidney, nervous system, and GI tract Renal involvement—anemia, acidosis, hypertension, fluid overload, uremia, death Congestive heart failure Common complication: Renal Failure

Signs and symptoms of UTIs

Newborns and infants have non-specific signs: fever, hypothermia, poor feeding, irritability, vomiting and sepsis Strong, foul smelling urine may be noted Preschool children may have abdominal pain or flank pain, vomiting, fever, urinary frequency, dysuria , urgency and enuresis School age: Cystitis (frequency, dysuria, urgency or Pyelonephritis (fever, vomiting and flank pain)

What are the long term drug therapies for asthma?

Non steroidal antiinflammatory inhaler Cromolyn Sodium (Intal) Leukotriene Modifier/blockers-block inflammatory and bronchospasm effects Oral drug therapy Montelukast (Singulair) for >12 months of age Zafirlukast (Accolate) for >7 years of age Long Acting Beta agonist-antiinflammatory Twice daily dosing NOT for acute symptoms Salmetrol (Serevent) Combination drugs: beta adrenergic agonist + steroid Advair inhaler Monoclonal antibody-blocks the binding of IgE to mast cells-inhibits inflammation Omalizumab (Xolair) 1-2x/month SQ Acute Exacerbation Anticholinergics-bronchodilator action To decrease mucus production Atropine (Atrovent) Methylxanthines-muscle relaxant-given IV Theophylline (rarely used) - therapeutic range 10-20 mcg/ml Aminophylline

Infection Control

Nosocomial infections: 2 million/year CDC as guide for standards Standard precautions unless specific illness Transmission-based precautions Airborne, droplet, and contact precautions

Dehydration

Occurs whenever total output of fluid exceeds intake Ask if the child is taking any fluid at all? Causes Insensible fluid loss Increased renal excretion GI tract dysfunction (vomiting and diarrhea) Ketoacidosis Burns Dehydration: Focus Questions Composition and volume of fluid intake Frequency and amount of vomiting and diarrhea Frequency, amount and color of urine output Pale yellow indicate good hydration Duration of fever Lot of time the tympanic temperature does not read temperature on children under 9 months of age. Recently recorded weight Good idea of hydration status Severely dehydrated child such as an infant that is 10% less of their last weight, it is severely dehydration Measures of Dehydration Capillary fill time (Decreased ECF) Postural blood pressure Heart rate Dryness of lips and mucous membranes Lack of tears Sunken fontanelle in infant Lack of external jugular vein filling when supine Altered mental status Signs of Dehydration Test skin turgor on the baby's abdomen Types of Dehydration Isotonic Water and salt are lost in equal amounts When dehydration does not affect the concentration of sodium in the ECF This is primary form of dehydration in children Hypotonic When dehydration results in a decreased sodium concentration of the extracellular fluids Electrolyte deficit exceeds water deficit Hypertonic When dehydration results in an increased sodium concentration of the extracellular fluid Water loss exceeds water deficit Accurate Measurement of I & O Urine and stools Vomitus Sweating Vital signs Skin turgor and mucous membranes Body weight Fontanel in infants Sensory alterations (older child)

What are the clinical presentations for HUS?

Oliguria, amber urine Renal failure (metabolic disturbance or acidosis; hypocalcemia or hyperkalemia) Edema Hypertension Anemia associated with uremia Anorexia Abdominal pain (caused by splenic enlargement or gastrointestinal [GI] involvement) Mild icterus Pallor Systemic bleeding manifestations—purpura, petechiae Alteration in neurologic status (irritability, lethargy, seizure)

What are the symptoms of glomerulonephritis?

Oliguria, edema, hypertension Hematuria Bleeding in upper urinary tract causes urine to appear smoky (dark) Proteinuria Increased amount of protein reflects increased severity of renal disease

Phimosis vs Paraphimosis

Paraphimosis "Condition characterized by an inability to replace the foreskin in its normal position after it has been retracted behind the glans penis" Narrowed or inflamed foreskin Condition may lead to gangrene. Circumcision may be required. Phimosis "Tightness of the prepuce of the penis that prevents the retraction of the foreskin over the glans" Condition is usually congenital but may be the result of infection. Circumcision is the usual treatment

Home management for asthma

Patient education: caregiver and patient as developmentally appropriate Asthma Action Plan Medication instruction CPT Illness Fluids - keep the secretions thin and hydrate! F/U visits

Signs and Symptoms in Peptic Ulcers

Peptic ulcers are rare in children: Signs of Concern burning pain in the abdomen between the breastbone and the belly button (the most common ulcer symptom) nausea vomiting chest pain (usually dull and achy) loss of appetite frequent burping or hiccupping weight loss feeding difficulties blood in vomit or bowel movements, which may appear dark red or black

Pain Management

Pharmacological management Non-opioids- Tylenol, non-steroidal anti-inflammatory drugs(ibuprofen)-for mild to moderate pain Opioids- for moderate to severe pain Opioids- Tylenol with codeine- very common. Oxycodone is also frequently used Oxycodone Morphine Usually administered q4H, not PRN Meperidine (Demoral) rarely used Morphine is drug of choice- not Demerol- give q 4 hrs- not prn Morphine is gold standard drug for severe pain Can also use Dilaudid or Fentanyl- used in OR for anesthesia, but can be administered IV,IM or SQ for an analgesic PCA - used as early as age 5 Same checks and balances as adults They have the dexterity and control over their pain They can feel pain It is limited of what they can give in an hour Constantly doing assessment to see if need to increase or decrease in an hour EMLA-mixture of Lidocaine and Prilocaine Wong's Nursing care of Infants and Children, Eighth Edition, p. 223-224. EMLA- topically applied-gives dermal analgesic- apply 1 hour prior to procedure- lasts 2 hours Hydromorphone (Dilaudid) and fentanyl for anesthesia Sucrose (Sweet-ease) Effective in reducing pain response in infants less than 6 months of age. Most effective dose: 24% solution given 2 minutes before procedure. The analgesic effect of sucrose in combination of sucking on pacifier appears to enhance the effects. Pain assessment scales FLACC Infants, toddlers, developmentally delayed Faces Infants F-FACE L-LEGS A-ACTIVITY C-CRY C-CONSOLABILITY rated on a 0-2 score for each category low score=low pain total 10 for highest score Older children-developmentally and cognitively appropriate patients Faces Oucher Numeric (0-10) Later school aged or adolescence

How to manage CF?

Prevent or minimize pulmonary complications Ensure adequate nutrition for growth Encourage appropriate physical activity Promote a reasonable quality of life for the child and the family Treatment of CF Pancreatic enzyme supplementation combined with a high calorie, high protein and high fat diet. It is taken immediately prior to each meal. - right before every meal and snacks! Multivitamins that contain vitamins A, D, E and K Caloric supplements Daily salt supplementation to prevent hyponatremia Antibiotic therapy Do prophylactic antibiotic therapy is the reason why people are living into their 30s Chest Physiotherapy (CPT) Forced expiration -"huffing" Bronchodilator drugs Mucolytic drugs (Pulmozyme) Corticosteroids IV Antibiotics Oxygen as needed Lung transplant

What is acute glomerulonephtritis?

Primary event or manifestation of another disorder Acute glomerulonephritis typically occurs after streptococcal infection After infection with certain strains of hemolytic streptococcus Can also occur as immune system alteration or a reaction to drugs Strep Infections

Invasive Procedures

Procedures Related to Elimination Enemas Purpose Techniques (age/weight appropriate) Ostomies Purpose Techniques Skin/stoma care Enlarged colon - and these kids have colostomy Collection of Specimens Fundamental procedure steps Urine Clean catch 24-Hour specimen Bladder catheterization Stool Blood Respiratory secretions

What are the clinical findings and manifestations?

Proteinuria Hypoalbuminemia Hyperlipidemia Edema Massive urinary protein loss Most common ages 2 - 6 y Males > females Edema Facial, periorbital, abdominal, genital Periorbital most severe in AM, upon waking Pallor Fatigue/activity intolerance

How to prepare for procedures?

Psychologic preparation Age-specific guidelines for preparation Developmental and cognitive ability Establish trust Encourage parental presence and support Explain procedures Involve the child Lot of facility have a play therapist to help the child to understand what is going on Provide distraction Use play during procedures Allow expression of feelings Expect success Not really giving false hope to the children. Provide post procedural support Allow expression of feelings

What are the types of UTIs?

Recurrent: repeated episodes Persistent: bacteriuria despite antibiotics Febrile: typically indicates pyelonephritis Cystitis: inflammation of the bladder Pyelonephritis: upper urinary tract and kidneys Urosepsis: bacterial illness; urinary pathogens in blood

What are the medications for IBD?

Reduce inflammation in the inner lining of the intestine (amino salicylates) Suppress the overactive immune system (corticosteroids). Block the immune reaction that worsens inflammation (immunomodulators, such as azathioprine) Block certain substances that fuel the process of inflammation (TNF-alpha blocking agents, such as infliximab or adalimumab) Control bacteria growth (antibiotics)

What is hemodialysis (HD)?

Requires creation of a vascular access and special dialysis equipment Best suited for children who can be brought to facility three times/week for 4-6 hours Achieves rapid correction of fluid and electrolyte abnormalities

What are the rescue drug therapies for asthma?

Rescue medications for quick relief of symptoms Beta Adrenergic Agonists-bronchodilation Albuterol (Proventil) Levalbuterol (Xopenex) Terbutaline Corticosteroids-antiinflammatory Flovent Asmanex Pulmicort Azmacort

What is the patient and family teaching for CF?

Respiratory Pulmonary: postural drainage, CPT Med management Oxygen as ordered Peak Flow Meter, MDI, Spacer, Nebulizer GI Be alert for bowel obstruction Infection control Hand washing Keep away from others with URIs Skin care Immunizations PICC line for antibiotics Nutritional management

What is the management for nephrotic syndrome?

Risk for infection Nutrition: Loss of appetite Salt restriction Small frequent foods Fluid restriction I & O! Activity adjustment Family support and home care

Family Teaching and Home Care

Safety Environmental factors Electrical equipment Furniture Strangulation Toys Choking hazards Preventing falls Falls; risk assessment Once the child is moving, they are at more of the risk of being injury Rule of thumb is something should not be smaller than the inside of the toilet paper tube. If it is smaller and you can fit in the toilet paper tube, it is not safe for the infant!

How to diagnose celiac disease?

Serum antibodies to tissue transglutaminase, endomysium or deamidated gliadin peptides are present Duodenal biopsy shows villous atrophy and increased intraepithelial lymphocytes Improvement on a gluten-free diet

What are the pathologic features of asthma?

Shedding of airway epithelium Edema Mucus plug formation Mast cell activation Collagen deposition beneath the basement membrane Inflammatory cell infiltrate (eosinophils, lymphocytes and neutrophils) Airway inflammation contributes to airway hyperresponsiveness, airflow limitation and disease chronicity - airway narrows Persistent airway inflammation leads to airway wall remodeling and irreversible changes Asthma Attack https://youtu.be/EK8nzKzdnIM

What are the symptoms of nephrotic syndrome?

Signs and symptoms of nephrotic syndrome include: Severe swelling (edema), particularly around the eyes and in ankles and feet Foamy urine, which may be caused by excess protein in your urine Weight gain due to excess fluid retention

What are the surgical corrections for cleft palate?

Stepped surgeries Surgical Lip Closure -after 10 weeks of age Palate closure: 12-18 months of age Bone support of palate: 8 to 10 years of age Maxilla/ mandible repositioning: late adolescence Effects speech development Surgical Correction of Cleft Lip Closure of lip defect precedes correction of the palate Performed when patients are 2-3 months of age Protect suture line with Logan bow or other methods Cleft Palate: Before and After

What are the medications for nephrotic syndrome?

Steroids Continue until proteinuria resolved Prednisone, prednisolone Antihypertensives ACE Diuretics Antibiotics Prevent or treat infections Pain management Anticoagulants Prevent or treat

What is obstructive uropathy?

Structural or functional abnormalities that obstruct normal flow Intrinsic muscle abnormalities, aberrant vessels or fibrous bands Backup of the urine above the obstruction causes hydronephrosis Palpable abdominal mass in the newborn Condition may be acquired, unilateral, bilateral, complete, or incomplete Early diagnosis and surgical correction are essential to minimize damage to the kidney

What are the therapeutic management of nephrotic syndrome?

Supportive care Reducing excretion of urinary protein Reducing fluid retention in the tissues Preventing infection Minimizing complications related to sepsis Manage medication adverse effects

What are the therapeutic management of hirschsprung disease?

Surgery Two stages Temporary ostomy Second stage: "pull-through" procedure (laparoscopic) Complications to be aware: Fecal retention, fecal incontinence, anastomotic stricture Enterocolitis occurs post-op in 15% of patients

How to manage appendicitis?

Surgery! Appendectomy Post-op antibiotics Be alert for perforated appendix

What is intussusception?

Telescoping or invagination of one portion of intestine into another - a bowel within a bowel Occasionally due to intestinal lesions (10%) Most frequent cause of intestinal obstruction in the first 2 years of life More common in boys (3X) than girls In 85% of the cases, the cause is unknown Rotavirus vaccines have been implicated as a potential risk factor but is being studied further Clinical Findings Healthy 3-12 month old infant with recurring abdominal pain with screaming and drawing up of knees Bilious Vomiting and diarrhea occur Bloody (jelly-like) bowel movements follow with mucus within the next 12 hours Child is lethargic between episodes and may be febrile Abdomen is tender and often distended Clinical Findings Sausage shaped mass is palpated usually in the upper mid-abdomen Diagnosis by abdominal ultrasound Barium and air enema reduction is diagnostic and therapeutic Surgery is required inpatients with evidence of bowel perforation Intussusception: Management Spontaneous resolution in 10% of patients Good prognosis with early recognition and intervention Enema Air Barium Surgery

What are the surgical options for UC?

There are two main types of surgery for ulcerative colitis. Both are surgeries to remove the colon. J-pouch surgery (temporary ileostomy) Ileoanal anastomosis Pull-through operation Restorative proctocolectomy (permanent ileostomy) Surgery is not curative for Crohn's. Surgery is curative for UC and recommended for the steroid dependent or resistant patient

Transporting Restraining and Positioning Specimen Collection

Transporting Infants and Children Infants and small children can be carried short distances It is an environment that is familiar with the child Use a suitable conveyance for more extended trips Bassinettes or cribs Strollers or wagons Wheelchair or stretcher Restraining Methods Alternative methods: consider first Diversional activities Parental participation Therapeutic holding Can the parent hold them or distract them while giving them medications? Medical-surgical restraints A necessary part of the procedure Behavioral restraints Used if risk that patient will harm self or others is high Positioning for Procedures Femoral venipuncture Extremity venipuncture or injection Lumbar puncture Bone marrow aspiration or biopsy There will be a treatment room - a room for the child to obtain treatment such as withdrawing blood

how to treat VCR?

Treatment depends on the grade that is diagnosed. In grades I and II, the treatment involves long-term use of a daily dose of antibiotics to prevent the development of infections. The urine is tested regularly to make sure that no infection occurs. The kidneys are evaluated regularly to make sure that they are growing normally and that no new scarring has occurred. Grade III VUR can be treated with antibiotics and careful monitoring. New infections, scarring, or stunting of kidney growth may result in a need for surgery. Grades IV and V are extremely likely to require surgery

How to treat Wilm's Tumor?

Treatment for Wilms' tumor usually involves surgery and chemotherapy.

What are the abnormal labs for nephrotic syndrome?

Urinalysis + proteinuria & hematuria ↑ BUN, creatinine ↓ Albumin ↑ Cholesterol & triglycerides CBC ↑ H&H, platelets + WBC

How to diagnose UTI?

Urine culture and sensitivity (Primary tool) Suprapubic aspiration (for culture) Percutaneous kidney taps Bladder washout procedure Ultrasonography

What is Voiding cystourethrography (VCUG)?

VUR: congenital abnormality present in 1% of the population Intravenous pyelography Treatment Children younger than 3 months should be admitted and treated with IV antibiotics(increased risk for dehydration, toxicity, sepsis) Uncomplicated cystitis: amoxicillin, Bactrim, or first generation cephalosporin Course (po): 7 to 10 days Pyelonephritis: cefixime (Suprax)

NCLEX questions for Pediatric Acute pulmonary disorders

Wheezing: A. Can be cleared with coughing B. Cannot be cleared with coughing C. Can be heard only with a stethoscope D. Produces a sound identical to that of crackles Answer B. Cannot be cleared with coughing Have the child cough and then listen again A new healthcare provider is working on the medical surgical unit of a hospital and notes in a patient's chart a child has cyanosis. When asking the department manager what cyanosis means, the manager's best response would be: A." Cyanosis is the blue coloring of the skin and mucous membranes in the presence of poorly oxygenated blood." B. "Cyanosis means the patient's skin was cold due to his illness." C. "Cyanosis indicates that the patient has pneumonia." D. "Cyanosis is the blue coloring of skin and mucous membranes in the presence of highly oxygenated blood." Answer A. Cyanosis is the blue coloring of the skin and mucous membranes in the presence of poorly oxygenated blood." A pediatric patient has been diagnosed with right lower lobe pneumonia. Upon auscultation of this lung field, the healthcare provider would expect to hear which breath sound? A. Stridor B. Wheezes C. Rhonchi D. Crackles Answer D. Crackles The day-shift nurse is receiving report on her patient assignments for the day. It would be most important for the her to see which child first? A. The patient who is complaining of shortness of breath. B. The patient complaining of pain of "7 " on a "10" point scale. C. The patient with serosanguinous chest tube drainage. D. The patient who with documented bilateral wheezes. Answer A. The patient who is complaining of shortness of breath. A 19-year-old patient has been diagnosed with pneumonia. Upon the healthcare provider's initial assessment, she notes the patient's breathing is rapid and shallow. Place the healthcare provider's next steps in the order in which they should be performed. Listen to the patient's breath sounds. Document the findings. Place a pulse oximeter on the patient. Administer oxygen via nasal cannula. Record the patient's respiratory rate. Answer Use the prioritization method of: 1. airway, 2. breathing, and 3. circulation (ABCs). The healthcare provider should: 1) administer supplemental oxygen 2) place a pulse oximeter on the patient to monitor 3) listen to the lung sounds 4)record the patient's respiratory rate. 5)document all the findings. The healthcare provider on a pediatric unit has received her assignments for the day. Which of the following patients should the healthcare provider assess first? A. The 17-year-old with a left pleural effusion complaining of chest pain 9 on a 10 scale. B. The 11-year-old with pneumonia being discharged today. C. The 6-year-old with bronchitis with an intravenous (IV) antibiotic infusing at 30mL/hour D. The 3-year-old with asthma who has an oxygen saturation of 94% percent on room air. Answer A. The 17-year-old with a left pleural effusion complaining of chest pain 9 on a 10 scale

NCLEX Questions for GU

Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? Jaundice and flank pain Costovertebral angle tenderness and chills Burning sensation on urination Polyuria and nocturia ANSWER B. Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection. You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely? A."I pee a lot." B. "It burns when I pee." C. "I go hours without the urge to pee." D. "My pee smells sweet." ANSWER B. A common symptom of a UTI is dysuria. A patient with a UTI often reports frequent voiding of small amounts and the urgency to void. Urine that smells sweet is often associated with diabetic ketoacidosis. An 18 year old student is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which would most likely be in this student's health history? Renal calculi Renal trauma Recent sore throat Family history of acute glomerulonephritis ANSWER C. The most common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body. Clinical manifestations of acute glomerulonephritis include which of the following? Chills and flank pain Oliguria and generalized edema Hematuria and proteinuria Dysuria and hypotension ANSWER C. Hematuria and proteinuria indicate acute glomerulonephritis. These finding result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis. The most common early sign of kidney disease is: Sodium retention Elevated BUN level Development of metabolic acidosis Inability to dilute or concentrate urine ANSWER B. Increased BUN is usually an early indicator of decreased renal function A teenage patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching? Take cool baths Avoid tampon use Avoid sexual activity Drink 8 to 10 eight-oz. glasses of water daily ANSWER D. Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity. What change indicates recovery in a patient with nephritic syndrome? Disappearance of protein from the urine Decrease in blood pressure to normal Increase in serum lipid levels Gain in body weight ANSWER A. With nephrotic syndrome, the glomerular basement membrane of the kidney becomes more porous, leading to loss of protein in the urine. As the patient recovers, less protein is found in the urine.

What are the possible complications?

perforation (when the ulcer becomes too deep and breaks through the stomach or duodenal wall) bleeding (when acid or the ulcer breaks a blood vessel) obstruction (when the ulcer blocks the path of food from going through the intestines)

Lung Transplant for CF

"26% of all bilateral lung transplants are for CF. For CF LTX recipients ... survival times were 7.5 and 10.4 years, respectively" (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988894/). Both lungs need to be transplanted- bacterial colonization Immunosuppressive drugs lifelong Patients still get infections but manageable mucus production

How to manage tonsillitis?

Medical Treatment Viral Self-limiting Symptomatic treatment Bacterial Antibiotics Surgical Treatment Tonsillectomy Adenoidectomy Tonsillectomy Indications Recurrent, frequent streptococcal infections 7 or more documented infections in a one year period Peritonsillar abscess Massive hypertrophy that causes difficulty eating or breathing Adenoidectomy- hypertrophied adenoids that obstruct breathing especially at night Dysphagia Dental Malocclusion Persistent Streptococcal carrier state Multiple antibiotic allergies Contraindications to Tonsillectomy Palatal abnormalities: such as cleft palate Bleeding Disorder Acute Tonsillitis Tonsillectomy Pre-op Complete history Laboratory values: CBC, PT/PTT Presence of illness (URI) Loose teeth Questions/concerns Usually performed after 3 years of age Post-op Assess for frequent swallowing Inspect secretions/emesis for blood Tonsillectomy Nursing Diagnoses Potential for bleeding related to surgery Alteration in comfort related to surgery Fear and anxiety related to hospitalization and surgery Alteration in fluid balance related to surgery Knowledge deficit related to home care Tonsillectomy: Nursing Care Assessment for excessive bleeding Vital Signs Tachycardia Increased or decreased blood pressure Increased respiratory rate Pallor Frequent clearing of the throat or swallowing Vomiting bright red blood Restlessness Blood on inspection of the throat Pain assessment Analgesic intervention-at least 24 hours post-op Tell the parent that they are going to go home with Tylenol with codeine. Distraction Ice collar Assess level of anxiety Developmental age/Erickson Assess for dehydration Urine output NPO until awake (IV fluids) Ice chips to clears to soft foods No milk products, red or purple food colorings Tonsillectomy: Post -Op Teaching Physical Activity: children should rest but may play inside after one or two days and may be outside after three or four days Diet Hydration will help subside the pain Heal better in moist conditions Helps to clear the passages and help with the healing process Soft foods such as ice cream, sherbet, yogurt, pudding, apple sauce and jello, should also be encouraged. Avoid hot or spicy foods, or foods that are hard and crunchy. Chewing gum speeds comfortable eating by reducing the spasm after surgery and can be started anytime after surgery. Pain Up to 10 days following surgery, pain in the throat is to be expected. This can usually be controlled with Liquid Tylenol (acetaminophen) or Tylenol with Codeine Avoid medication containing aspirin, ibuprofen, or other anti-inflammatory medication, for two weeks. Pain is often worse at night Ear pain, especially with swallowing is also a common occurrence . A stiff neck may occur. Ice Collar An ice collar can also be helpful for post operative sore throat. Make this by placing ice cubes and water in a large Zip-Loc bag and wrapping it in a towel. Gently lay the ice pack on the front of the neck Fever A low-grade fever (less than 101 degrees) following surgery may occur and should be treated with Tylenol (acetaminophen). Bleeding may occur up to 10 days post-op Avoid coughing, gargles, throat clearing, vigorous mouth care Bad breath is common for the first few days post-op

What is the school age child?

"School age" generally defined as ages 6 to 12 years Physiologically begins with shedding of first deciduous teeth; ends at puberty with acquisition of final permanent teeth Gradual growth and development Progress with physical and emotional maturity School Age or Middle Childhood Child is directed away from the family group and is centered around the wider world of peer relationships Social cooperation and early moral development take on more importance This is a critical period in the development of self-concept Start to building an idea of themselves and their self-worth Not the age to start telling girls that they are getting fat

What are the respiratory complications for CF?

Infection Pseudamonas aeruginosa & Burkholderia cepacia most common Chronic colonization Poor survival rates E. coli, H. influenza, MRSA Aspergillus & Candida as most common fungal infections Pneumothorax Epistaxis (nosebleed)

What are the symptoms of ulcerative colitis?

Cramping pain in the belly Ongoing diarrhea, sometimes bloody The symptoms range from mild pain, loose stools or gassy belly to severe, where a child doubles over with pain, loses weight, passes stools more than eight times a day and passes blood. They can vary over time. It's normal for a child to go without symptoms for months or even years and then have symptoms reappear.

What is acute appendicitis?

Inflammation of the appendix Most common indication for emergency abdominal surgery in children Peak age is between 15 and 30 years Incidence of perforation is high in childhood (40%), especially in children younger than 2years of age Pain is usually poorly localized and symptoms nonspecific

What are the gross and fine motor development for toddler?

Locomotion They want to touch everything! Be careful where they want to touch such as electrical cords Refinement of coordination Between ages 2 and 3 years Fine motor development Improved manual dexterity Ages 12 to 15 months Throwing ball By 18 months

What are the treatments for EA and TEF?

NG tube to low suction to drain secretions and prevent aspiration Elevate head of bed to prevent reflux of gastric contents to the lungs IV glucose and fluids Oxygen as needed Treatment is surgery Prognosis: Good in healthy children

Sexual maturation of females using Tanner stages

Thelarche: appearance of breast buds; ages 9-13 years Adrenarche: growth of pubic hair on mons pubis; 2-6 months after thelarche Menarche: initial appearance of menstruation, approximately 2 years after first pubescent changes; average age, 12 years 4 months in North America

What are the complications of viral atypical pneumonia?

Inflammation of the pulmonary parenchyma (alveoli & bronchioles) Can involve a lobe or large segment of the lung Prognosis is good with symptomatic treatment Secondary bacterial infection is a severe complication Children with suspected viral pneumonia should be placed in respiratory isolation

What are the drug therapies for CF?

Nebulized bronchodilators with hypertonic saline Albuterol & Intal Mucolytics Pulmozyme by nebulizer Antibiotics Tobramycin by nebulizer Ticarcillin, Piperacillin, Ceftrazidime IV Kalydeco For G551D mutation only-- 4% of CF patients Helps the defective protein on the cell surface to move Na across the cell membrane

NCLEX questions for Pediatric Chronic Obstructive Pulmonary Diseases

A health care provider is evaluating the management of a child with a history of asthma. Which of the following statements from the child's mother would be most concerning to the health care provider?. A ."My child sometimes has to take breaks during gym class to catch her breath." B. "When my child has an attack, she usually has to use her rescue inhaler 4 times before her breathing improves." C. "My child uses her inhaler about once or twice a week." D. "My child's peak flow reading is usually about 90 percent of her personal best." Answer B. "When my child has an attack, she usually has to use her rescue inhaler 4 times before her breathing improves." - not being managed well A child experiencing an acute asthma exacerbation arrives at the urgent care clinic. Which of these assessment findings require immediate action by the healthcare provider? A. Inaudible breath sounds and an ineffective cough B. Tachycardia and intercostal retractions C. Anxiety and increasing fatigue D. Tachypnea and prolonged expirations Answer A. Inaudible breath sounds and an ineffective cough Inaudible breath sounds and an ineffective cough are an indication that there is little or no air movement in the lungs and the patient is unable to clear secretions, so this finding requires immediate action to prevent respiratory failure. A child is in the emergency department receiving albuterol via nebulizer. which of the following symptoms will the healthcare provider suspect are adverse effects of the albuterol? Select all that apply. A. Chest pain B. Tachycardia C. Hypotension D. Urinary urgency E .Palpitations Answer Chest pain, Tachycardia and Palpatations (a,b, and e) Albuterol is a beta-2 adrenergic receptor agonist. Adrenergic receptors produce sympathetic nervous system response. If high doses are necessary, beta-1 adrenergic receptors may be activated, causing palpitations, tachycardia, and chest pain. A child is brought to the emergency department with wheezing from an acute asthma exacerbation. The healthcare provider gives 6 mL albuterol via nebulization. Which of the following signs indicate the patient is improving on the medication? Check all that apply. A. Arterial pH of 7.35 B. Respiratory rate of 16 per minute C. Pulse rate of 120 per minute D. Pulse oximetry reading 85% percent E .Decreased breath sounds bilaterally Answer A and B. Both the arterial pH and the respiratory rate are within normal limits which indicate improvement in the patient's status Wrong Choices: When a patient with asthma is improving, there will be signs of better air exchange. A pulse rate of 120 per minute is a sign the body is working hard to provide oxygenation to the tissues. A pulse oximeter reading 85% percent is not within normal limits. Decreased breath sounds indicate decreased air exchange and does not indicate improvement.. The foul-smelling, frothy characteristic of the stool in cystic fibrosis results from the presence of large amounts of which of the following: A. sodium and chloride B. Undigested fat C. Semi-digested carbohydrates D. lipase, trypsin and amylase Answer B. Undigested fat The client with cystic fibrosis absorbs fat poorly because of the think secretions blocking the pancreatic duct. The lack of natural pancreatic enzyme leads to poor absorption of predominantly fats in the duodenum. Foul-smelling, frothy stool is termed steatorrhea. A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is performing an assessment. Which later finding of this disease would the nurse not expect to see at this time? A. Positive sweat test B. Bulky greasy stools C. Moist, productive cough D. Meconium ileus Answer C. Moist, productive cough. Noisy respirations and a dry non-productive cough are commonly the first of the respiratory signs to appear in a newly diagnosed client with cystic fibrosis (CF). The other options are the earliest findings. Respiratory failure is the most dangerous consequence of CF.

What are pediatric pulmonary emergencies?

Aspiration/Foreign body Swallowing issues-food or fluids Toys or other objects Pneumothorax Spontaneous Trauma Hemo-pneumothorax Trauma Status Asthmaticus Failure to respond to treatment

How to manage diarrhea?

Assess fluid and electrolyte imbalance Rehydrate! Oral rehydration therapy (ORT) Intravenous rehydration Maintenance of fluid therapy Reintroduction of an adequate diet Preventing Diarrhea Rotavirus vaccine Teach personal hygiene Clean water supply/protect from contamination Teach careful food preparation Encourage handwashing

What is play?

Associative play Group play without rules Rules are very important in the school age child Imitative play Imaginative play Imaginary playmates Dramatic play Mutual play

What are the complications of GERD?

Bile-stained emesis in an infant could indicate bowel obstruction (intussusception) Esophagitis Stricture Anemia Barrett esophagus (lining resembles the intestine)

What is the pathophysiology of RSV?

Bronchiolar mucosa swells; fills with mucus and exudate Next is hyperinflation, obstruction and atelectasis Mimics emphysema- air trapping

What are the conditions that increase the severity of asthma?

Chronic hyperplastic sinusitis GERD (nocturnal asthma) Obesity

How to deal with stress and fear with the school aged child?

Family, interpersonal relationships, poverty, gun violence, academic expectations, pressure to have a boyfriend/girlfriend, sports Signs of Stress Stomach pains or headaches Changes in sleep patterns/ nightmares Bed wetting Changes in eating habits Aggressive or stubborn behavior Withdrawal or reluctance to participate Regression to earlier behaviors- thumb-sucking Trouble concentrating or changes in academic performance

Acute lung conditions and the hospitalized child

IV therapy using D5 ½ NSS (D5.45NS) with Potassium (corticosteroids and B2-agonists can cause potassium loss) NPO Bed rest until stable Nebulizer therapy Moisturized Oxygen Therapy-40% by mask or 4l/m by nc Chest Physiotherapy(CPT) to mobilize secretions out of airway (not recommended for acute exacerbations) Corticosteroids: PO/IV Monitor HR, Pulse ox ( keep above 90%), +ABGs

What are the treatments for asthma?

Identification and Management of Triggers Allergen Control Drug Therapy Rescue Long Term Therapy Acute Exacerbation

What are the clinical findings of EA and TEF?

Incidence is 1 in 3000 births Infants present in the first hours of life with copious secretions, choking, cyanosis and respiratory distress Diagnosis confirmed by X-ray after placement of NG tube

What is inflammatory bowel disease (IBD)?

Is a chronic relapsing inflammatory disease of the bowel Signs: abdominal pain, diarrhea, bloody stools, fever, anorexia, fatigue and weight loss Includes ulcerative colitis (UC) and Crohn's disease

NCLEX questions for growth and development

The nurse is assessing a six-month-old child. Which developmental skills are normal and should be expected? A. Speaks in short sentences. B. Sits alone. C. Can feed self with a spoon. D. Pulling up to a standing position. Answer Answer B. The child develops language skills between the ages of one and three. A six-month-old child is learning to sit alone. The child begins to use a spoon at 12-15 months of age. The baby pulls himself to a standing position about ten months of age. A mother asks the nurse how to handle her 5-year-old child, who recently started wetting the pants after being completely toilet trained. The child just started attending nursery school 2 days a week. Which principle should guide the nurse's response? A. The child forgets previously learned skills B. The child experiences growth while regressing, regrouping, and then progressing C. The parents may refer less mature behaviors D. The child returns to a level of behavior that increases the sense of security. ANSWER Answer D. The stress of starting nursery school may trigger a return to a level of successful behavior from earlier stages of development. A child's skills remain intact, although increased stress may prevent the child from using these skills. Growth occurs when the child does not regress. Parents rarely desire less mature behaviors. A female child, age 6, is brought to the health clinic for a routine checkup. To assess the child's vision, the nurse should ask: A. "Do you have any problems seeing different colors?" B. "Do you have trouble seeing at night?" C. "Do you have problems with glare?" D. "How are you doing in school?" ANSWER Answer D. A child's poor progress in school may indicate a visual disturbance. The other options are more appropriate questions to ask when assessing vision in a geriatric patient. The Nurse should expect a 3-year-old child to be able to perform which action? A. Ride a tricycle B. Tie the shoelaces C. Roller-skates D. Jump rope ANSWER Answer A. At age 3, gross motor development and refinement in eye-hand coordination enable a child to ride a tricycle. The fine motor skills required to tie shoelaces and the gross motor skills requires for roller-skating and jumping rope develop around age 5. Maureen, age 12, is brought to the clinic for evaluation for a suspected eating disorder. To best assess the effects of role and relationship patterns on the child's nutritional intake, the nurse should ask: A. "What activities do you engage in during the day?" B. "Do you have any allergies to foods?" C. "Do you like yourself physically?" D. "What kinds of food do you like to eat?" ANSWER Answer C. Role and relationship patterns focus on body image and the patient's relationship with others, which commonly interrelated with food intake. Questions about activities and food preferences elicit information about health promotion and health protection behaviors. Questions about food allergies elicit information about health and illness patterns. While teaching a 10 year-old child about their impending heart surgery, the nurse should A. Provide a verbal explanation just prior to the surgery B. Provide the child with a booklet to read about the surgery C. Introduce the child to another child who had heart surgery three days ago D. Explain the surgery using a model of the heart ANSWER Answer D. According to Piaget, the school age child is in the concrete operations stage of cognitive development. Using something concrete, like a model will help the child understand the explanation of the heart surgery. The nurse is planning care for an 18 month-old child. Which of the following should be included the in the child's care? A. Hold and cuddle the child often B. Encourage the child to feed himself finger food C. Allow the child to walk independently on the nursing unit D. Engage the child in games with other children ANSWER Answer B. According to Erikson, the toddler is in the stage of autonomy versus shame and doubt. The nurse should encourage increasingly independent activities of daily living. The nurse is observing children playing in the hospital playroom. She would expect to see 4 year-old children playing A. Competitive board games with older children B. With their own toys alongside with other children C. Alone with hand held computer games D. Cooperatively with other preschoolers ANSWER Answer D. Cooperative play is typical of the preschool period. The nurse is assessing a 9-month-old boy for a well-baby check up. Which of the following observations would be of most concern? A. The baby cannot say "mama" when he wants his mother. B. The mother has not given him finger foods. C. The child does not sit unsupported. D. The baby cries whenever the mother goes out. ANSWER C. Over 90% percent of babies can sit unsupported by nine months. Most babies cannot say "mama" in the sense that it refers to their mother at this time. Mary, the mother of an 11-month-old girl is in the clinic for her daughter's immunizations. She expresses concern to the nurse that Shannon cannot yet walk. The nurse correctly replies that, according to the Denver Developmental Screen, the median age for walking is: 12 months. 15 months. 10 months. 14 months. ANSWER A. By 12 months, 50 percent of children can walk well

Upper airway problems

Upper Airway: Laryngitis Common in older children and adolescents Usually viral cause Symptoms Hoarseness URI symptoms Treatment Relieve symptoms Fluids Pain/fever relievers

What is Vesicoureteral Reflux?

Vesicoureteral reflux is a condition in which the child cannot completely empty the bladder. It allows urine to remain in or flow backward (reflux) into the partially empty bladder A condition in which urine flows from the bladder, back up the ureter, and back into the kidneys. VUR may be present in either one or both ureters Concerns Vesicoureteral reflux causes damage to the kidneys in two ways: The kidney is not designed to withstand very much pressure. When VUR is present, back pressure of the urine on the kidney is significant. This can damage the kidney. The kidney is usually sterile. In VUR, bacteria that enter through the urinary tract may be carried back up the ureter with the urine. These bacteria can enter the kidney, causing severe infection

What are the sensory changes in toddler?

Visual acuity of 20/40 is acceptable Hearing, smell, taste, and touch continue developing All senses are used to explore environment

Nutritional Disorders

Vitamin imbalances Mineral imbalances Intolerances Allergies

What is the physical growth in teenagers?

Weight almost doubles during adolescence Height increases by 15%-20% Major organs double in size except for lymphoid tissue which decreases in mass Muscle mass and muscle strength increase for both sexes

What are the clinical manifestations of asthma?

Wheezing is the most characteristic sign of asthma Inspiratory &/or Expiratory Wheezes Sometimes audible without a stethoscope A recurrent cough or shortness of breath Complaints may include: chest congestion, exercise intolerance, dyspnea and recurrent bronchitis or pneumonia Flaring of nostrils, intercostal and suprasternal retractions and use of accessory muscles are signs of severe obstruction Cyanosis of the lips and nailbeds may be seen Tachycardia and pulse paradoxus also occur Agitation and lethargy are signs of impending respiratory failure

What is Wilm's Tumor?

Wilms' tumor is a rare kidney cancer that primarily affects children. Also known as nephroblastoma Wilms' tumor is the most common cancer of the kidneys in children. Wilms' tumor most often affects children ages 3 to 4 and becomes much less common after age 5. Wilms' tumor most often occurs in just one kidney, though it can sometimes be found in both kidneys at the same time. Improvements in the diagnosis and treatment of Wilms' tumor have improved the prognosis for children with this disease. The outlook for most children with Wilms' tumor is very good Wilms' tumor doesn't always cause signs and symptoms. Children with Wilms' tumor may appear healthy, or they may experience: Abdominal swelling An abdominal mass you can feel Abdominal pain Fever Blood in the urine

What are the warning signs for peptic ulcers?

sudden, sharp, lasting belly pain bloody or black bowel movements bloody vomit or vomit that looks like coffee grounds

What is intestinal Parasitic Disease?

tinal Parasitic Disease The most frequent infections in the world Fecal-oral transmission In humans, caused by a variety of organisms Two most common in the United States: Giardiasis Pinworms (enterobiasis) Enterobiasis (Pinworms) Worldwide infection Adult worms are 5-10mm long and live in the colon, in the bladder or the peritoneal cavity of girls Female worms deposit eggs on the perianal area , primarily at night, which causes intense pruritus Scratching contaminates the fingers and allows transmission back to the host or to contacts If one person has it, everyone in the household has to get treated

What is the kohlberg moral development of school aged child?

Stage 3: The interpersonal concordance or "good boy- nice girl" orientation Behavior that meets with approval and pleases or helps others is viewed as good Conformity to the norm is the "natural" behavior and one earns approval by being "nice" Want to be rewarded for good behavior They like to start asking questions to generate discussions Stage 4: The "law and order" orientation Obeying the rules, doing one's duty and showing respect for authority is the correct behavior. The rules or authority can be social or religious depending on which is most valued Want to know the rules Showing respect

What are the signs and symptoms of bronchiolitis?

1 to 2 days of fever Rhinorrhea Cough Wheezing Tachypnea Respiratory distress Breathing pattern is shallow with rapid respirations Nasal flaring, cyanosis, retractions and rales are present

What is the sniffing dog position?

Acute Epiglottitis Diagnosis Do not attempt to look in the patient's throat Portable lateral neck x-ray may be done but airway intervention will take priority "Thumbprint "sign The sign is caused by a thickened free edge of the epiglottis, which causes it to resemble the distal thumb.

What is early adolescence?

Ages 10 to 13 years Period of rapid growth and development of secondary sex characteristics Body image, self concept and self esteem fluctuate dramatically Concerns to teens as they compare themselves to peers: boys with short stature or girls with delayed breast development Curiosity about sexuality but feel more comfortable with members of their own sex "Best Friends" Peer relationships become increasingly important. Friendships are an important link in the progress toward forming an intimate relationship. Teens think concretely and cannot easily conceptualize about the future. Usually have vague and unrealistic professional goals (rock star, NFL, movie star)

What is toddler age?

Ages 12 - 36 m "The terrible twos" Intense period of environmental exploration Temperament issues tantrums/obstinacy/negativism Proportional changes Weight gain slows to 4 to 6 lb/year Birth weight should be quadrupled by age 2½ years Height increases about 3 inches/year Elongation of legs rather than trunk Growth is step-like rather than linear

Safety promotion and injury prevention in adolescence

Motor vehicle-related injuries Other vehicle-related injuries Firearms- availability in the home Sports injuries Injury prevention Anticipatory guidance

What is middle adolescence?

Ages 14 to 16 years Less pubertal development and are now more comfortable with their new bodies Intense emotions and mood swings are typical Need for independence and autonomy can be a period of struggle for teens and parents Move from concrete thinking to formal operations and abstract thinking Develop the belief that the world can be changed by merely thinking about it: "I don't need contraception because I won't get pregnant, it won't happen to me" World is biased against them: 16 year old who believes he is the best driver in the world and the insurance companies are conspiring against them by charging high rates With the onset of abstract thinking, teenagers begin to see themselves as others see them and may become extremely self-centered Because they are establishing their own identities, relationships with peers and others are narcissistic Experimenting with different self-images is common Sexuality becomes more important: dating and experimenting with sex Relationships tend to be more one-sided and narcissistic Peers determine the standards for identification, behavior, activities and clothing and provide emotional support, intimacy, empathy and the sharing of guilt and anxiety

What is the late adolescence?

Ages 17 years and later Teen becomes less self-centered and more caring of others Social relationships shift from peer group to individual Dating becomes more intimate Abstract thinking allows older adolescents to think more realistically about their plans for the future This is a period of idealism: rigid concepts of what is right or wrong

What is spasmodic croup?

Also Called: "midnight croup" or "twilight croup" Usually seen in children ages 1-3 years Paroxysmal attacks of laryngeal obstruction that occurs mainly at night Signs of inflammation are mild or absent Often history of attacks lasting 2-5 days No fever Awaken with barking cough, hoarseness, noisy respirations and dyspnea with excitement Subsides in a few hours Child is well the next day, except for slight hoarseness Some children are predisposed (i.e. allergies)

What is croup syndrome?

Also known as LTB (Laryngotracheobronchitis) or viral croup Usually seen in the fall and early winter months Usually caused by parainfluenza virus serotypes but can also be caused influenza types A and B, adenovirus, RSV, and mycoplasma pneumoniae Inflammation of the entire airway is usually present Edema formation in the subglottic space accounts for the signs of upper airway obstruction Subglottic tracheal narrowing produces the shape of a church steeple within the trachea itself. The presence of the steeple sign supports the diagnosis of croup

What is the management of pneumonia?

Antibiotics, antipyretics, fluids, calories, rest Oxygen as needed Chest tube care as needed (large effusions) Maintain vacuum setting Assess respiratory status frequently Dressing Activity as tolerated CPT, postural drainage, suctioning Reduce anxiety

What are the treatments for bacterial pneumonia?

Antibiotics: Amoxicillin or 2nd generation cephalosporins Children younger than 3 months are usually admitted Children older than 3 months with febrile pneumonias are usually admitted Moderate to severe respiratory distress, apnea, hypoxemia, poor feeding, clinical deterioration require immediate attention Oxygen, humidification, hydration, electrolyte supplementation and nutrition

What are the signs and symptoms of RSV?

Apnea, poor feeding and lethargy are usually the reasons infant presents, especially "preemies" Initially resembles an URI- low grade fever may be present Hyperinflation, crackles , prolonged expiration, wheezing and retractions are present Disease usually lasts 3 to 7 days

What is infant: abdomen?

Assess with flexed knees Protuberant abdomen Umbilical hernia Presents at about 2 weeks, lasts for up to 1 year Can see respiratory movement in abdomen Tympany with percussion Can palpate liver at RUQ It is large 1st stool greenish-black (meconium) and occurs within 24 hours of birth

What is the pubertal growth in males?

Begins 2 years later than girls Boys reach peak height velocity between 13.5 and 14 years of age Pubertal growth lasts longer than 4 years for boys At age 12, boys will have attained 83% to 89% of their height An additional 25-30cm of height is achieved during late puberty Lean body mass increases from 80% to 90% at maturity Muscle mass doubles between 10 and 17 years

What is aggression in a preschool child?

Behavior that attempts to hurt person or destroy property May be influenced by biologic, sociocultural, and familiar variables Factors that increase aggressive behavior: gender, frustration, modeling, and reinforcement

What is infancy?

Birth through 1st birthday Period of rapid growth and development Physical growth (height and weight) Organ system maturation

What are the infant nutrition?

Breast or bottle feed Ideally breast feed for first year Have to be whole milk until 2 years old No child under the age of two is to get skim milk Benefits Food sensitivities, intolerances, or allergies Less likely to overfeed Increased bonding time Cow's milk has less Fe and less vitamins C & E Begin "table" foods 4 - 6 m Whole milk until age 2 y Needed for brain development No juice Water after 6 m

How to manage otitis media?

Careful use of antibiotics Amoxicillin or Augmentin (1st line) Azithromycin Cephalosporins ( Omnicef ,Cefdinir) Single dose IM Ceftriaxone (resistant) Acetaminophen or ibuprofen for pain/fever control Consider age Myringotomy with tubes Criteria for surgery: Effusion > 4 months, bilateral hearing loss > 20 db

What is the pathophysiology of tonsillitis and signs and symptoms?

Causative agent may be viral (90%) or bacterial Inflammation of the palatine tonsils (kissing tonsils) Obstruct the passage of air and food Adenoid enlargement blocks the passage of air from the nose to the throat Mouth breathing Sore throat plus Tonsillar exudate or Positive Group B hemolytic Strep or Fever greater than 100.9F or May have enlarged cervical lymph nodes

What is the growth of the infant?

Cephalo-caudal Infant gains about 5- to 7-oz per week Doubling of birth weight by age 6 months Tripling of birth weight by age 1 year Height increases by 1 inch per month x 6 months Growth in "spurts" rather than gradual pattern Not only communicating with the child but communicating with the parent. They are the child's caregiver and know the child well. We must work with the parent to help the child

How is sexuality is perceived by the preschool child?

Child forms strong attachment to opposite-sex parent while identifying with same-sex parent Modesty becomes a concern Child evinces sex role limitation, "dressing up like Mommy or Daddy" Sexual exploration is more pronounced Questions arise about sexual reproduction Find out what children know and think This information helps ascertain what the child wants to know Use correct anatomic words Be honest Masturbation is common at approximately 4 years of age Private act

What is the treatment of severe croup?

Child with stridor at rest Oxygen should be administered to child with oxygen desaturation Nebulized racemic epinephrine is used because it has a rapid onset of action within 10-30 minutes. Goal is to maintain an airway and decrease the need for intubation Glucocorticoids: Dexamethasone IM or oral or Inhaled budesonide. Some physicians will use prednisolone but Dexamethasone is more effective Old school pediatricians will use prednisolone but it taste horrible for the kids. Dexamethasone works better

What is Piaget's cognitive development for school aged child?

Concrete Operations thought becomes increasingly logical and coherent Children are able to classify, sort, order and organize facts to use in problem solving They do not have the capacity to deal in the abstract: they solve problems in a concrete and systematic way based on what they can perceive Children can consider points of view other than their own

Mortality Data for Adolescence

Cultural and environmental rather than organic factors pose the greatest threats to life. Three leading causes of death include: Unintentional Injury (48.8%) Homicide (16.7%) Suicide (11.1%) Motor vehicle crashes are the leading cause of death among teens in the US Graduated Driver Licensing Programs More Vigorously enforced laws on minimum legal drinking age, blood alcohol concentration (BAC) and safety belt use Demographic and economic changes that impact adolescents: Decrease in two parent households from 79% in 1980 to 66%in 2015 Number of children living below the official poverty threshold increased by 14.7% Consequences for adolescents: Unintended pregnancy Sexually transmitted diseases Substance abuse and tobacco use Dropping out of school Depression Runaways Physical violence Juvenile Delinquency Most of the teaching is focus on the environmental risk factors

What are the indications for problems in adolescence?

Decline in school performance Excessive school absences or cutting class Frequent or persistent psychosomatic complaints Changes in sleeping or eating habits Difficulty concentrating or persistent boredom Signs or symptoms of depression, extreme stress or anxiety Withdrawal from friends or family or change to a new group of friends Severe violent or rebellious behavior or radical personality change Conflict with parents Sexual acting out Conflicts with the law Suicidal thoughts or preoccupation with themes of death They may make comments such as things would be much better if I was not here. Talk to them because study have shown that talking to them will help them talk them out of suicide. They want someone to talk to. Drug or alcohol use Running away from home

What are the psychosocial development of infants?

Developing a sense of trust (Erikson):Trust vs. Mistrust Infants trust that their comfort needs will be met Feeding Stimulation Mistrust Occurs when gratification of needs is delayed Social modifications Grasping Biting

What is the preschool''s development in sense of initiative and spirituality?

Developing sense of initiative Chief psychosocial task of preschool period Feelings of guilt, anxiety, and fear: may result from thoughts that differ from expected behavior Development of superego (conscience) Learning right from wrong/moral development Kids may come to you with a cut that you can't see but they can see it. Best fix is a band-aid. Do not argue with them Spiritual Knowledge of faith and religion is learned from significant others and from religious practices Development of conscience is strongly linked to spiritual development May misinterpret illness as punishment from God They may think they did something wrong

Development of body image in toddler

Development of body image parallels cognitive development Child refers to body parts by name Child recognizes words used to describe appearance Adults should avoid negative labels about physical appearance Child recognizes gender differences by age 2 years Exploration of genitalia is common Genital fondling can occur Teach them to do it in their privacy of their room versus a public place like a grocery store Parental reaction should be accepting Gender roles are understood by toddler Playing "house" Gender identity is formed by age 3 years

What is the RSV infections?

Diagnostics Nasopharyngeal washing 85% accurate Transmission Direct contact of respiratory secretions RSV can survive for hours on countertops, gloves, paper tissues RSV can survive for half an hour on skin Complications RSV commonly infects the middle ear (10%-20%) Bacterial pneumonia complicates in .5%-1% of hospitalized patients Respiratory failure resulting in intubation occurs in 2% of hospitalized infants Nosocomial RSV outbreaks are common

What is epiglottitis?

Dramatic decrease in the incidence of epiglottitis with the introduction of the "Hib" or Haemophilus influenzae vaccine Usually see it in unvaccinated children or in countries with no immunization programs Supra-glottis obstruction Sign and Symptoms Sudden onset of high fever Dysphagia Drooling Muffled voice Inspiratory retractions Cyanosis Soft stridor "Sniffing Dog Position": provides the best airway possible Doing everything they can breathe NO Cough Large, cherry red, edematous epiglottis You never ask them to open their mouth and take a look because you may take away from that tiny opening for airway

What are the nursing considerations for upper airway dysfunction?

Ease respiratory effort Sit up right like high fowler's position Fever management Promote rest and comfort Infection control Promote hydration and nutrition Monitor IV fluids Family support and teaching

How to cope with caregiver concerns related to normal growth and development?

Fear of separation and strangers Alternative child care arrangements Setting limits and discipline Thumb-sucking and use of a pacifier Thumb sucking is only a concern if they are putting pressure on the front teeth Pacifier does not really change dental Teething Happens in middle of infancy Lot of drooling Infant shoes Not walking until the end

what is infant: CV?

Fetal heart starts to beat at 3 weeks gestation Fetal circulation complex Different from post-birth circulation At birth, heart more horizontal in chest Apex higher—at 4th intercostal space—doesn't reach adult location till about age 7 y Infant HR ~ 100 - 140 Assess with pediatric-sized diaphragm and bell Expect sinus arrhythmia When the child exhales, the heart rate goes down When the child inhale, the heart rate goes up PMI at 4th left intercostal, midclavicular Heaves are abnormal Tend to have a rounded abdomen because of all of the organs in a tight space Murmurs during first few days of life common, only considered pathological if persist Ask caregiver if: Any fatigue with feedings Such as not being able to feed 2 oz to their child - why? Need to find out Any color change with feedings Any congenital heart defect? Any nostril flaring with feeding Any respiratory problems? Indicative of respiratory problems Could do some mouth breathing Any developmental delay Are they moving? After the delivery, hospital stay is two days (48 hours)

Sexual maturation using Tanner Stages for Males

First pubescent changes: testicular enlargement, thinning, reddening, and increased looseness of scrotum; ages 9½-14 years Penile enlargement, pubic hair growth, voice changes, facial hair growth Temporary gynecomastia in one third of boys; disappears within 2 years

Confidentiality with teens

Foster a sense of trust and comfort Sometimes the stated chief complaint conceals the teen's real concern By age 11 or 12, patients should be seen alone Sometimes it is necessary to meet with parents first to obtain a history of the concern, but then it is important to meet with the adolescent alone. This conveys that your primary interest is in them but gives you an opportunity to address parental concerns You have to advise patient that you will maintain their confidence and will obtain permission first from them before speaking to parents unless you feel it is life-threatening Speak with the parent to get their side of the story and then speak with the teen second because it make them feel they are the most important person. After the age of 14 years, we don't have to discuss any mental health issues or sexual behavior unless we have permission of the child. However if the 12 years old is sexually active, it put us in an awkward position because we have to tell them that although we are glad they told us but we have to tell their parents and find out who they been sexually active with because it becomes a legal issue. They cannot consent legally to sex

What is the gross and fine motor skills of preschool?

Gross motor Walking, running, climbing, and jumping well established Fine motor Refinement in eye-hand and muscle coordination Skillful manipulation (dressing, drawing)

What are the system maturation of infants?

HR, RR slows Normal HR is 120 to 140 beats/min Normal RR is 30 to 40 sometimes up to 60 Hematopoietic changes Bones are getting longer Head growth Fontanelles close Differentiation of the nervous system Thermoregulation established Increase in auditory acuity and perception Maturation of: GI (digestive processes) In adults, it is acidic In infants, it is neutral Due to eating liquid such as breast milk and formula Eating every two hours and then at 3 to 4 months its every two to four hours. Stomach is so small and used that nutrient and energy quick Immunologic system matures At risk for anything Immunization process starts early First one is the hep B shot at birth and other two shots At two months, it's a booster shot Renal system Stomach is neutral Urine is dilute Vital signs is the same way as adults but different set of values to compare With infant and children that does not understand instruction, take temperature in the axillary (temperature will be cooler)

What are the treatments and managements of bronchiolitis?

Hand washing and reduction of exposure to potential environmental risk factors An RSV vaccine is in development and may be available in the near future Most RSV bronchiolitis children are treated as outpatients Hospitalized children are hypoxic on room air, have a history of apnea, tachypnea with feeding difficulties, respiratory distress with retractions High risk also includes "preemies" and infants under 6 months Therapeutic Management Airway maintenance Mist therapy Oxygen by mask if hypoxic Nasal cannula Croup tent Adequate fluid intake to maintain hydration IV fluids if tachypnea Bronchodilators and corticosteroids are not effective

What is the biologic development of middle childhood?

Height increases by 2 inches/year (birth length triples by the end of this period) Total height gain is 1-2 feet Weight increases by 2-3 kg/year (4 ½- 6 ½ lb.) Weight almost doubles Boys and girls differ little in size Proportional changes Movements more graceful than those of preschoolers Skeletal lengthening and fat diminution (thin, long legs) Increased muscle tissue Decrease in head circumference related to standing height Change in facial proportions (large teeth) The age of "loose teeth" Maturation of Systems Bladder capacity increases (greater in girls than boys) Bed wetting starts to become a concern at this age because it is not more physical but psychological (emotional) Heart is smaller in relation to rest of body (grows slower than the rest of the body) Immune system is increasingly effective Bones continue to ossify Physical maturity is not necessarily correlated with emotional and social maturity ( A 7 year old who looks like 10 still behaves like a 7 year old)

What is otitis media?

Highest incidence between 6 to 20 months Highest incidence during the winter months Smoking, households with many family members and family history of OM increases the risk Formula-fed infants have a higher incidence of OM Terminology Otitis Media (OM)- inflammation of the middle ear Acute Otitis Media (AOM) - rapid onset lasting 3 weeks Otitis Media with Effusion (OME)- fluid in the middle ear Chronic Otitis with Effusion- persists beyond 3 weeks Otorrhea-ear drainage Acute Otitis Media: Diagnosis All of the below must be met to make diagnosis Acute onset of symptoms: fever, pain, decreased sleep and decreased appetite Inflammation Effusion( fluid in the middle ear) Bulging tympanic membrane (TM) Limited or absent mobility of the TM Air- fluid level behind the TM Otorrhea (drainage) Predisposing Factors Eustachian tube dysfunction: Immature anatomy (7Y) Shorter, wider and lies at a more horizontal angle than adults Children with craniofacial disorders Downs syndrome or cleft palate Edema fro URI, Allergic rhinitis, Hypertrophic adenoids Bacterial colonization Nasopharyngeal colonization with Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis increases the risk of AOM. Predisposing Factors Viral Upper Respiratory Infections (URI) Smoke exposure: For infants (12-18 months), exposure to passive cigarette smoke is associated with an 11% per pack increase in otitis media Impaired immune defenses Bottle feeding: Breast feeding provides IgA antibodies that reduce colonization of bacteria and decreases the aspiration of contaminated secretions into the middle ear which occurs with bottle propping Genetic susceptibility: Twin studies- 70% of the risk is genetically determined Otitis Media Diagnostic Evaluation Assessment of the tympanic membrane Mobility :will be absent or resemble a fluid wave OM- intact membrane that is bright red and bulging with obscure landmarks OME- dull grey membrane, obscure landmarks, visible fluid

How to measure the infants?

Important for regular checkups to monitor G & D Begins 24 - 48 hours after birth, then at 2 weeks, then monthly till 6 m Use standardized growth charts Follow growth based on %-tile If there is a child that is at the median at nine months and then go down to the last line at 13 months, it means they are falling off the growth curb. It is concerning.

What is the development of body image in school age child?

In general, children like their physical selves less as they grow older The head is the most important part of the body (hair and eye color) Body image is influenced by significant others Highly influenced by cultural norms and fads of the time Increased awareness of "differences" may influence feelings of inferiority (e.g., hearing or visual defects) Children whose bodies deviate from the norm are often subject to criticism

What is the body image of the preschool child?

Increasing comprehension of "desirable" appearances Aware of racial identity, differences in appearances, and biases Poorly defined body boundaries Children fear that if skin is "broken," all blood and "insides" can leak out They think their body parts are coming out. So give them Band-Aid Intrusive experiences are frightening Needles such as a venipuncture is a big deal so they understand something bad is happening. It is helpful to try to shield them from seeing that

What are the infant reflexes?

Infantile automatisms: reflexes that have predictable timetable of appearance and departure For screening examination, check rooting, grasp, tonic neck, and Moro reflexes Could see it in adults due to head injuries. Like they would demonstrate a primitive reflexes which means relfexes that are seen in infancy Palmar grasp: place baby's head midline to ensure symmetric response; offer finger from baby's ulnar side, away from thumb; note tight grasp of all baby's fingers Present at birth; strongest at 1 to 2 months; disappears at 3 to 4 months Plantar grasp: touch your thumb at ball of baby's foot; note that toes curl down tightly Reflex present at birth; disappears at 8 to 10 months + Babinski: Adult = pathologic Dorsiflexion great toe, rest of toes fan Plantar: Adult Normal: Toes dorsiflex + Babinski: Infant = normal Toe fanning Gone by age 2y Rooting reflex: Brush the infant's cheek near mouth; note whether infant turns head toward that side and opens mouth Appears at birth; disappears at 3 to 4 months Moro Reflex: "Startle" Normal reflex for an infant when he or she is startled or feels like they are falling. Arms fling out sideways with the palms up and the thumbs flexed. Legs may flex Absence of the Moro reflex in newborn infants is abnormal Persists to about age 4-5m If a baby is not wearing a diaper and it is a male baby, do not be in the aim! They can urinate Plantar Reflex + Babinski: Adult = pathologic Dorsiflexion great toe, rest of toes fan + Babinski: Infant = normal Toe fanning Gone by age 2y

What are the anatomical considerations?

Infants enjoy the protective function of maternal antibodies up until 3 months of age when the maternal antibodies disappear and then the infant begins its own antibody production. Deficiencies of the immune system put infants at risk for infections The diameter of the airways is smaller in young children and can narrow considerably from edematous mucous membranes and increased production of secretions. Infants and young children have a greater number of mucous cells than adults The distance between structures in the respiratory tract is shorter and organisms may move more rapidly down the respiratory tract causing more extensive involvement. Infants and young children have less alveoli Greater loss of gas exchanged when lungs are congested. Matures at approximately 8 years of age. Infants' ribs are horizontal so during inspiration the chest diameter decreases Infants are primarily nose breathers (first 4 to 6 weeks of life) and their nasal passages are small so any swelling or increased mucus production can impede breathing Increased risk of obstruction, due to constriction of the airway, especially in the bronchioles (portion that extends from the bronchi to the alveoli).

How to do a pediatric respiratory assessment?

Inspection Respiratory rate and depth Ease of respiration: Use of accessory muscles, nasal flaring or retractions Symmetry of breathing Rhythm of breathing Attentiveness, inconsolability, color and movement Respiratory Distress in Infants https://www.youtube.com/watch?v=42jJ18fkZ0Y Palpation Check position of the trachea Symmetry of chest wall movement Vibration with vocalization to help identify intrathoracic abnormalities Examples: A shift in the trachea can indicate pneumothorax. Tactile fremitus (99): Changes noted with consolidation or air in the pleural space Percussion This component of the exam proves challenging in very young children who usually don't cooperate Therefore, chest X-rays are usually performed Auscultation Assesses the quality of breath sounds Wheezing suggests intrathoracic airway obstruction Unilateral crackles are the usual finding in pneumonia Other abnormal findings: Fine and course crackles Wheezing Rhonchi Stridor Oxygenation Obtain Pulse Oximetry Note if on room air or oxygen Note changes during: feedings sleeping crying

How to determine sexual maturation using the Tanner stages?

Stages of development of secondary sex characteristics and genital development Defined as guide for estimating sexual maturity Occur in an orderly sequence A pictorial chart of sexual development is useful for discussion with counseling teens who lag behind their peers in physical development

What are the cognitive development for toddler?

Invention of new means through mental combinations Final sensorimotor stage: ages 19 to 24 months Imitation of behaviors They like to do what ever the parents do such as helping out with chores. Teaching safety is important Domestic mimicry Concept of time: still embryonic They do not have the abstract ability to process time

What is the treatment for epiglottitis?

It is a medical emergency. ment: Medical Emergency Endotracheal intubation is usually done under general anesthesia to facilitate intubation Cultures of blood and epiglottis are taken Child is started on IV antibiotics to cover H.influenzae and Streptococcus species (usually a cephalosporin) Steroids are not effective Do not give them any of the corticosteroids Extubation is usually done in 24-48 hours after X ray confirmation of reduction in epiglottis IV antibiotics are continued for 2-3 days followed by oral antibiotics for 10 days Child with Epiglottitis https://youtu.be/TxDf3DHGGuE

How is language is developed in preschool child?

Language becomes more sophisticated Language is the major mode of communication and social interaction Vocabulary increases dramatically between ages 2 and 5 years Complexity of language use increases between ages 2 and 5 years Concept of causality begins to develop Concept of time is incompletely understood "Magical thinking" is used frequently

What is bacterial pneumonia?

Lower respiratory tract infections are a major cause of childhood mortality in developing countries In developed countries, the majority of pneumonia is caused by viral agents and bacterial pneumonia is less common. It is difficult to distinguish between viral and bacterial pneumonia since neither the WBCs or chest X-ray are good predictors. The most common cause of bacterial pneumonia in children is Streptococcus pneumoniae Bacterial pneumonia usually follows a viral lower respiratory tract infection Symptoms: High fever, tachypnea and cough Auscultation: Crackles or decreased breath sounds in the area of consolidation Complications: Empyema (pus in the pleural space), distal infections such as: meningitis, otitis media, sinusitis and septicemia At risk patients: Premature BPD (Bronchopulmonary dysplasia) is a chronic lung disorder of infants and children. It is more common in infants with low birth weight and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). Congenital heart disease Prognosis is good Protection from pneumococcal infections is immunization (Prevnar, PCV)

NCLEX Questions for adolescence

Mandy, age 14, is 7 months pregnant. When teaching parenting skills to an adolescent, the nurse knows that which teaching strategy is least effective? A. Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model B. Initiating a teenage parent support group with first - and - second-time mothers C. Using audiovisual aids that show discussions of feelings and skills D. Providing age-appropriate reading materials Answer Answer D. Because adolescents absorb less information through reading, providing age-appropriate reading materials is the least effective way to teach parenting skills to an adolescent. The other options engage more than one of the senses and therefore serve as effective teaching strategies. When evaluating a severely depressed adolescent, the nurse knows that one indicator of a high risk for suicide is: A. Depression B. Excessive sleepiness C. A history of cocaine use D .A preoccupation with death Answer Answer D. An adolescent who demonstrates a preoccupation with death (such as by talking about death frequently) should be considered at high risk for suicide. Although depression, excessive sleepiness, and a history of cocaine use may occur in suicidal adolescents, they also occur in adolescents who are not suicidal While giving nursing care to a hospitalized adolescent, the nurse should be aware that the MAJOR threat felt by the hospitalized adolescent is A. Pain management B. Restricted physical activity C. Altered body image D. Separation from family ANSWER Answer C. The hospitalized adolescent may see each of these as a threat, but the major threat that they feel when hospitalized is the fear of altered body image, because of the emphasis on physical appearance. A 16 year old child is hospitalized, according to Erik Erikson, what is an appropriate intervention? A. tell the friends to visit the child B. encourage parent to help child learn lessons missed C. call the priest to intervene D. tell the child's girlfriend to visit the child. ANSWER Answer A. The child is 16 years old, In the stage of IDENTITY VS. ROLE CONFUSION. The most significant persons in this group are the PEERS. B refers to children in the school age while D refers to the young adulthood stage of INTIMACY VS. ISOLATION. The child is not dying and the situation did not even talk about the child's belief therefore, calling the priest is unnecessary.

What are tonsils?

Masses of lymphoid tissue located in the pharyngeal cavity Filter and protect the respiratory and alimentary tracts from organisms Antibody formation Children have larger tonsils than adults and adolescents

What is the treatment of mild croup?

Mild croup with no stridor at rest is treated with oral hydration. Humidification: Cool mist Exposure to cold air (outside or open freezer door) Warm mist from hot running water in a closed bathroom Mist therapy has been used historically but clinical studies do not demonstrate effectiveness

What to do with injury prevention in school aged child?

Most common cause of severe injury and death in school-age children is motor vehicle crashes: either pedestrian and passenger Bicycle injuries: benefits of bike helmets Appropriate safety equipment for all sports Lot of head injuries

What is bronchiolitis?

Most common serious acute respiratory illness in infants and young children Applies to children younger than 2 years of age 1 % to 3% of children will require hospitalization especially in the winter months RSV is the most common viral cause of acute bronchiolitis

What are the maturation of systems in toddlers?

Most physiologic systems are relatively mature by the end of toddlerhood Upper respiratory infections, otitis media, and tonsillitis are common among toddlers Do not do tonsillectomy as often as in the past. They are dangerous and children can die from it Body temperature is maintained Child is physiologically able to control elimination They may be continence during the day but at night they may be incontinence. It is ok to use pullup at night Defense mechanisms of skin are intact

What is viral atypical pneumonia?

Most pneumonias in children are caused by viruses Symptoms: URI: fever, running nose, nasal congestion and loss of smell, cough and hoarseness Progresses to lower respiratory infection to include signs of respiratory distress Auscultation: Rales and decreased breath sounds (Myalgia, malaise and headache are common symptoms plus the above in older children with pneumonia)

What are the infant neurologic development?

Neurologic system continues to develop during 1st year of life Sensory system Very little sensory testing with infants and toddlers Newborn normally has hypoesthesia (less sensitive to touch) and requires strong stimulus to elicit a response Baby responds to pain by crying and exhibits a general reflex withdrawal of all limbs By age 7 to 9 months, infant can localize stimulus and shows more specific signs of withdrawal

Nutritional and eating disorders

Obesity Defined as increase in body weight caused by accumulation of excessive body fat in relation to lean body mass Obese: generally considered when body mass index (BMI) is in >95th percentile for age, gender, and height Overweight: generally considered when BMI is between the 85th and 95th percentile

What are the infant: motor systems?

Observe spontaneous motor activity for smoothness and symmetry Smoothness of movement suggests proper cerebellar function, as does coordination involved in sucking and swallowing Assess muscle tone by first observing resting posture Bowlegged normal Head control is an important milestone in development Head lag resolves by 3 months Be careful when picking up the baby, their head may lag back Gross Motor Development Head control Rolling over Age 5 months: abdomen to back Age 6 months: back to abdomen Sitting: age 7 months Move from prone to sitting position: age 10 months Locomotion Cephalocaudal direction of development Crawling: ages 6 to 7 months Creeping: age 9 months Walking with assistance: age 11 months Walking alone: age 1 year Fine Motor Development Grasping object: ages 2 to 3 months Transferring object between hands: age 7 months Pincer grasp: age 10 months Removing objects from container: age 11 months Building tower of two blocks: age 1 year Play develops motor skills Denver developmental and it is a standard test in which to measure the person developmental stage

What are quick facts of acute pediatric pulmonary conditions?

Pediatric pulmonary diseases account for almost 50% of deaths in children younger than age 1 year Pediatric pulmonary diseases account for about 20% of all hospitalizations of children younger than age 15 years. Approximately 7% of all children have a chronic disorder of the lower respiratory system

What is the biologic development of preschool?

Physical growth slows and stabilizes Average weight gain remains about 5 lb/year Average height increases 2½-3 inches/year Body systems mature and stabilize; can adjust to moderate stress and change The body can adjust to stress such as emotional and physiologic

What are the complications of bacterial pneumonia?

Pleural effusion - Often accompanies bacterial pneumonia Presentation: fever, tachypnea and cough Also chest pain, decreased breath sounds, dullness to percussion on the affected side and will want to lie on the affected side. Large effusions will have a tracheal deviation to the unaffected lung Check the midline of the trachea because it can indicate a shift to be pleural effusion and will shift to the unaffected side

What is prepubescence (tween)?

Preadolescence is the period of 2 years before age 13 (10 to12) Prepubescence It is the beginning of the development of secondary sex characteristics Looking at the tanner scale and look at their pubic hair and development of the size of the scrotum and the penis typically occurs during preadolescence Age at prepubescence varies from 9 to 12 (girls about 2 years earlier than boys) Puberty begins at approximately age 10 in girls and age 12 in boys

What are the biologic development of teenagers?

Primary sex characteristics External and internal organs necessary for reproduction Secondary sex characteristics Result of hormonal changes: voice change, hair growth, breast enlargement, fat deposits Play no direct role in reproduction Puberty: development of secondary sex characteristics Prepubescence: period of approximately 2 years before onset of puberty; preliminary physical changes occur Postpubescence: period of 1-2 years after puberty; skeletal growth is complete; reproductive functions become well established

What is the pubertal growth in females?

Puberty starts earlier Reach peak height velocity between 11.5 and 12 years Pubertal growth lasts 2-4 years By age 11 years in girls: 83%-89% of ultimate height is attained Additional 18-23cm growth occurs during late puberty Following menarche, height rarely increases more than 5-7.5cm Lean body mass decreases from approximately 80% of body weight in early puberty to 75% at maturity

What is the RSV treatment?

RSV children should be kept in isolation Humidified oxygen based on O2 Saturation Tube feedings if infants are too hypoxic or cannot feed due to respiratory distress A trial of bronchodilators may be given and discontinued if no improvement (Albuterol) Ribavirin Only licensed antiviral therapy used for RSV infection Given by continuous aerosolization Given to severely ill children who are immunocompromised or with severe cardiac disease Pregnant nurses should avoid patients receiving Ribavirin(VSD) Prophylactic: RespiGam or Synagis RSV: Pharmacologic Management Ribavirin Antiviral agent given aerosolized for 12 to 20 hours a day for 3 days Prophylactic RespiGam- IV immunoglobulin for high- risk infants given monthly during RSV season (November- April) Synagis- IM given to high-risk infants monthly during RSV season

What is respiratory syncytial virus (RSV)?

RSV is the most common cause of lower respiratory tract illness in young children. It accounts for: 70% of bronchiolitis cases 40% of pneumonia cases Outbreaks occur annually; 60% of children are infected in the first year of life, 90% by age 2. Ask does your child go to daycare? Usually they catch everything at daycare Usually occurs in cooler months Reinfection is common (despite serum antibodies) but generally only causes upper respiratory infections in normal children

What is the cognitive development of preschool?

Readiness for school Readiness for scholastic learning Introduction of child to school and teachers Developmental screening tool to assess readiness for school Denver developmental is a screening tool Importance of infection control in school setting Language continues to develop Concept of causality begins to develop Concept of time is incompletely understood Not really understand it until they develop a more concrete and abstract thinking "Magical thinking" is used frequently

What are the personal social behaviors of the preschool child?

Ritualism and negativism of toddlerhood diminish Child can dress self Child is willing to please Child has internalized values and standards of family and culture Child may begin to challenge family's code of conduct

What is infant: pulmonary?

Rounded thorax AP equal until about age 6y Normal is 1:2 COPD patient is 1:1 Nose breathing Slight flaring Respiratory rate 30 - 40 Irregular respiratory pattern Bronchovesicular sounds predominate till age 5 - 6 y It is due to the size of the chest Fine crackles in newborn Can hear bowel sounds in thorax

What is play during school aged child?

Rules and rituals Team play Quiet games and activities "Collections" Creative- "The Arts" Ego mastery

How to cope with concerns with the school aged child?

School experience Entrance to school is a sharp break in the structure of the child's world School is second only to the family as socializing agent Values of the society are transmitted in school Peer relationships become increasingly important School experience Seek Approval Teachers Parents "Latchkey children" Kids come home to an empty home and left to care for themselves until the parents come home Limit setting and discipline Guide desired behaviors and eliminate unwanted ones Beyond time out. Best way to get rid of bad behaviors is to eliminate privileges Reasoning, withholding privileges, compensation Dishonest behavior Tend to embellish stories not telling lies like toddlers Reinforce that it is important to be honest

What is Erikson theory of development in school aged child?

Sense of Industry (Erikson) Stage of accomplishment Eagerness to develop skills and participate in meaningful and socially useful work Acquisition of sense of personal and interpersonal competence Growing sense of independence Peer approval: a strong motivator Very important at this age to reward Sense of Inferiority (Erikson) Feelings may derive from self or social environment Feelings may occur if child is unable or unprepared to assume the responsibilities associated with developing a sense of accomplishment All children feel some degree of inferiority regarding skill(s) they cannot master Erickson: Industry vs Inferiority Significant Points: Children should be allowed to engage in tasks and activities and carry them through to completion They need and want real achievement Children have to learn to compete with others and to cooperate and learn the rules Feelings of inadequacy, stress can develop if too much is expected or if they feel they don't measure up or if goals that are set are unrealistic Teachers and peers are important socializing agents You can allow them to fail because that is how they learn When they don't complete the task, take the time to talk to them. You don't want them to feel like a failure and teach them a lesson and you know we will do it better next time This is the age when parents get a little over zealous and start signing their kids up Kids love to take on little tasks Industry Spiritual Development Children think in very concrete terms Children are avid learners with a desire to know their God Children expect punishment for misbehavior Children may view illness or injury as punishment for a real or imagined misdeed Social Development The peer group is extremely important Identification with peers is a strong influence in achieving independence from parents Sex roles are strongly influenced by peer relationships Peer group establishes standards for acceptance and rejection Children will often modify their behavior to be accepted by the group Clubs and peer groups Formation of formalized groups Bullying- Long term affects "Best friends" Relationships with families Parents are primary influence in shaping child's personality, behavior, and value system Increasing independence from parents is primary goal of middle childhood Parents need to be adults, not friends

What is the psychosocial development in teenagers?

Sense of identity (Erikson) Early adolescence: group identity vs. alienation Development of personal identity vs. role diffusion Sex role identity Emotionality Spiritual Development Some adolescents may question values and beliefs of family Adolescents are capable of understanding abstract concepts and of interpreting analogies and symbols Adolescents may fear that others will not understand their feelings Greater levels of spirituality are associated with fewer high-risk behaviors

What is sexual orientation in adolescence?

Sexual orientation develops during early childhood and gender identity is established by age 2 years. Sense of masculinity or femininity usually solidifies by age 5 or 6 years of age Most homosexual adults describe homosexual feelings during late childhood and early adolescence Homosexual experimentation is common during early and middle adolescence

How to relate to teenagers?

Simple- Honest Approach without an authoritarian or excessively professional manner Recognize that outward appearance and chronologic age may not be an accurate reflection of cognitive development Teenagers are consumed with their own emotional needs Counter-transference Over-identification with the parents will be sensed by the teenager as another authority figure who cannot understand the problems of a teen Over-identification with the teen may cause parents to become defensive about their parenting role and to discount the health care provider's experience and ability

What are stress and fears in a preschool child?

Stress Minimum amounts of stress: can be beneficial Parental awareness of signs of stress in child's life Stressors Birth of a sibling Divorce or separation They think "Who is going to take care of me?" Relocation Illness Fears Dark Being left alone Animals (large dogs) Ghosts Sexual matters (castration) Objects or people associated with pain

What is complications of bronchiolitis?

Superinfection with Streptococcus pneumoniae leading to pneumonia Some studies indicate that children are then at risk for chronic airway hyperactivity (Asthma) Bronchiolitis due to RSV can be fatal in children with underlying medical disorders including prematurity, Cystic Fibrosis, congenital heart disease and immunodeficiency They are highly contagious to other children and also at risk for other infections (superinfections)

What is preschool child?

The preschool period: ages 3 to 5 years Preparation for most significant lifestyle change: going to school Cooperative interaction with other children Experience of brief and prolonged separation Use of language for mental symbolization Increased attention span and memory Have memory Remember that grandma is picking me up

What is the developmental passage?

To complete the development from childhood to adulthood includes the following steps: Completing puberty and somatic growth Developing socially, emotionally and cognitively and moving from concrete to abstract thinking Establishing an independent identity and separating from the family Preparing for a career or vocation Generally adolescence begins at 11-12 years and ends between 18 and 21.

What is homosexual identity in adolescence?

Two Stages: Teen feels different and develops feelings for a person of the same sex without clear self-awareness of a gay identity. The coming-out stage in which homosexual identity is defined for the individual and revealed to others The coming out stage may be difficult for the individual and family. Behaviors during this struggle may include both homosexual and heterosexual promiscuity, STD infections, depression, substance abuse, attempted suicide, school avoidance and failure and running away from home

What are the signs and symptoms of croup?

Upper respiratory symptoms followed by a barking cough and stridor Fever is usually absent or low grade Children with mild disease may have stridor when agitated As obstruction worsens, child will experience stridor at rest, accompanied by retractions, air hunger, cyanosis. On examination, the presence of cough and the absence of drooling favor the diagnosis of croup over epiglottitis

How to keep infants safe: vaccines of infancy?

Vaccine schedule per CDC Mostly using the vastus lateralis (side of the thigh) http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html Children are good with diarrhea but infants, it can become lethal http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf