peds #4

*1.* cognitive impairment levels

(1) *mild* educable IQ of 50 or 55 to approximately 70 (2) *moderate* trainable IQ of 35 or 40 to 50 or 55 (3) *severe* IQ of 20 or 25 to 35 or 40 (4) *profound* IQ below 25 FON 1067

Atomoxetine

*Strattera* presynaptic norepinephrine transport inhibitor -recently became available for use in children *side effects* -dose related (adjust in individual basis) FON 1076

*43.* suspect sexual abuse, what s/s do you typically see

*behavioral* -provider will sometimes not nonspecific symptoms such as sleep disturbances or abdominal pain -promiscuous behavior -unwillingness to change for gym -withdrawal, fantasy, or infantile behavior -age-inappropriate sexual knowledge -poor peer relationships -delinquency -prostitution -forcing sexual acts on other children -fear of being touched -suicide attempts -low self-esteem -excessive or public masturbation -declining school performance *physical* -difficulty in walking or sitting -torn, stained, or bloody underclothing -pain or pruritus in genital area -ecchymosis or bleeding in external genitalia, vaginal, or anal areas -ecchymosis to the hard or soft palate -sexually transmitted diseases in preteens -adolescent pregnancy -enuresis or encopresis -vaginal or penile discharge -foreign bodies in vagina or rectum -presence of semen -recurrent UTIs FON 1073

*7.* maltreatment

*child abuse* is the non accidental physical injury or the non accidental act of omission of care by a parent or person responsible for a child; includes neglect, physical, sexual or emotional maltreatment NCLEX 361 broad term used to describe physical and emotional neglect and physical, emotional, and sexual abuse of children FON 1072

*6.* abandonment

*child neglect* *physical* failure of a parent or caretaker to supply a child with adequate food, clothing, shelter, education, or health care despite being financially able to do so or offered financial or other means to do so -*behavioral indicators* -begging or stealing food -extended stays at school -fatigue or listlessness at school -delinquency -alcohol and/or drug abuse -*physical indicators* -FTT: abnormal retardation of growth and development of the infant resulting from conditions that interfere with normal metabolism, appetite, and activity -lag in growth and development -consistent hunger -poor personal hygiene -inappropriate dress for season -unattended medical needs -abandonment *emotional* failure by a parent or caretaker to meet a child's needs for emotional nurturance, affection, and attention -*behavioral indicators* -stranger anxiety -emotional withdrawal -inappropriate fearfulness -delinquency -lag in emotional and intellectual development -language difficulties -suicide attempts -*physical indicators* -FTT -feeding difficulties -enuresis or encopresis -sleep disturbances FON 1072 *neglect* can be in the form of physical or emotional neglect and involves the deprivation of basic needs, supervision medical care, or education; and failure to meet the child's needs for attention and affection -inadequate weight gain -poor hygiene -consistent hunger -inconsistent school attendance -constant fatigue -reports of lack of child supervision -delinquency NCLEX 361

*2.* cognitive impairment criteria

*cognitive impairment* -refers to significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period -fall into four general categories -each corresponding to a range of the *intelligence quotient (IQ)* and index of relative intelligence determined through the subject's answers to arbitrarily chosen questions FON 1067 *diagnostic tests* neurologic examination CT scan serum metabolic screening developmental screening tests (Denver II) standardized intellectual tests (Stanford-Binet Intelligence Scale; Wechsler Intelligence Scale for Children, Revised) chromosomal analysis and genetic screening FON 1068 *description* child manifests subaverage intellectual functioning along with deficits in adaptive skills *data collection* 1. deficits in cognitive skills and level of adaptive functioning 2. delays in fine and gross motor skills 3. speech delays 4. decreased spontaneous activity 5. nonresponsiveness 6. irritability 7. poor eye contact during feeding NCLEX 365

*24.* most common developmental disability in children

*cognitive impairment* FON 1067

*25.* child with special needs, which characteristics are typical for them

*data collection* 1. deficits in cognitive skills and level of adaptive functioning 2. delays in fine and gross motor skills 3. speech delays 4. decreased spontaneous activity 5. nonresponsiveness 6. irritability 7. poor eye contact during feeding NCLEX 365 -vary according to the child's age and degree of impairment -children typically fail to achieve developmental milestones at appropriate ages -generally, they tend to manifest delays in motor, social, cognitive, or language skills, or some combination FON 1068

suicide

*deliberate act of self-injury with the intent that the injury result in death" -3rd leading cause of death among 10 to 19 year olds in the U.S. FON 1077

*17.* tricyclic antidepressants

*description* 1. block the reuptake of norepinephrine (and serotonin) at the presynaptic neuron; used to treat depression 2. may reduce seizure threshold 3. may reduce effectiveness of antihypertensive agents 4. concurrent use with alcohol or antihistamines can cause CNS depression 5. concurrent use with MAOIs can cause hypertensive crisis 6. cardiac toxicity can occur and all clients should undergo ECG evaluation before treatment and periodically thereafter 7. overdose is life threatening, necessitating immediate treatment 8. the tricyclic antidepressant clomipramine (Anafranil) may be used to treat obsessive-compulsive disorder *side effects* 1. anticholinergic effects: dry mouth, difficulty voiding, dilated pupils and blurred vision, decreased GI motility, constipation 2. photosensitivity 3. CV disturbances such as tachycardia, dysrhythmias 4. orthostatic hypotension 5. sedation 6. weight gain 7. anxiety, restlessness, irritability 8. decreased or increased libido with ejaculatory and erection disturbances *interventions* 1. monitor the suicidal client, especially during improved mood and increased energy levels 2. the clint is instructed to change positions slowly to avoid a hypotensive effect 3. monitor pattern of daily bowel activity 4. monitor for urinary retention 5. for the client on long-term therapy, monitor liver and renal function test results 6. administer with food or milk if GI distress occurs 7. administer the entire daily oral dose at one time, preferably at bedtime 8. the client is instructed to avoid alcohol and nonprescription medications to prevent adverse medication interactions 9. the client is instructed to avoid driving and other activities requiring alertness until the response is known; sedation is expected in early therapy and may subside with time 10. when the medication is discontinued by the health care provide, it should be tapered gradually 11. the potential for mediation interactions with OTC cold medication exists 12. the client is cautioned about photosensitivity and to take measure to prevent exposure to sunlight 13. oral hygiene and the use of hard candies and mouth rinses to relieve dry mouth is encouraged 14. psychotherapy is encouraged *the client is informed that antidepressant medication may take several weeks to produce the desired effect; the client response may not occur until 2 to 4 weeks after the first dose)* NCLEX 952

mental retardation

*description* 1. in mental retardation, the child manifests subaverage intellectual functioning along with deficits in adaptive skills 2. down syndrome is a congenital condition that results in moderate to severe retardation and has been linked to an extra group G chromosome (chromosome 21/trisomy 21) *data collection* 1. deficits in cognitive skills and level of adaptive functioning 2. delays in fine and gross motor skills 3. speech delays 4. decreased spontaneous activity 5. nonresponsiveness 6. irritability 7. poor eye contact during feeding NCLEX 365 -most common developmental disability -subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period *causes* -varied and include biochemical, infectious genetic, endocrine, and idiopathic factors -chromosomal abnormalities (down syndrome) -perinatal infections (cytomegalovirus, rubella, syphilis, toxoplasmosis) -perinatal anoxia -maternal drug or alcohol abuse -metabolic disorders (PKU) -lead poisoning -hypothyroidism -prematurity *s/s* -fail to achieve developmental milestones at appropriate ages -delays in motor, social, cognitive, or language skills *diagnostics* -neurologic examination -CT scan -serum metabolic screening -developmental screening tests -standardized intellectual tests -chromosomal analysis -genetic screening *interventions* -promoting optimal development -providing family with support, education, and referrals -support at the time of initial diagnosis and encouragement to verbalize their fears and concerns -encourage parents to enroll the child in an early intervention program that will facilitate the child's self-care abilities and assist the family with future needs -when teaching, break up each task into small, specific steps, because the child will not always be able to understand the task as a whole -encourage parents to keep their focus on the normal needs of all children (love, social interaction, and play) regardless of cognitive ability *family teaching* -essential to provide parents with information on normal developmental milestones, stimulation techniques, safety, normal speech development, sexual development, and role of positive self-esteem in motivating children to accomplish goals within their limitations *prognosis* -chronic condition FON 1067

*29.* down's syndrome, which diagnostic test is done to confirm it

*diagnostic tests* -adjunct to the characteristic manifestations indicating the diagnosis -performance of a chromosomal analysis helps confirm the chromosomal abnormality FON 1070

*26.* what disease is most common chromosomal abnormality

*down syndrome* it is the most common chromosomal abnormality, affecting 1 in 600 to 800 live births FON 1068

*4.* down syndrome

*e&p* majority of cases (95%) are attributable to an extra chromosome on the twenty-first pair *trisomy 21* *clinical manifestations* -*characteristic facial appearance* (small, square head; upward slant to the eyes; flat nasal bridge; protruding tongue; mottled skin; and hypotonia) -*some degree of intellectual impairment*, ranging from low normal intelligence to severe cognitive impairment -*individual abilities vary, but typically* --strengths in visual processing over auditory --weaknesses in grammar and language --delays in motor development *medical management* -routine medical care -corrective surgery will be indicated in some cases for congenital heart defects -standard to conduct auditory and vision screening to assess for any sensory impairments -treatment of otitis media is necessary to prevent auditory loss, which has potent to influence cognitive function -most experts also recommend thyroid function tests -if growth is delayed, it is important to carefully monitor and document nutrition, height, and weight -in an attempt to increase height, health care providers give growth hormones in some cases -plastic surgery to ameliorate the abnormal physical characteristics is another possibility FON 1069

*8.* torment

*emotional abuse* the intentional attempt by a parent or caretaker to impair or destroy the mental or emotional state of a child -*behavioral indicators* -stranger anxiety -emotional withdrawal -inappropriate fearfulness -delinquency -lag in emotional and intellectual development -language difficulties -suicide attempts -*physical indicators* -FTT -feeding difficulties -enuresis or encopresis -sleep disturbances FON 1072 *emotional abuse* -speech disorders -habit disorders such as sucking, biting, and rocking -psychoneurotic reactions -learning disorders -suicide attempts NCLEX 361

*16.* adolescent that is depressed, feel they might be suicidal, what questions should a nurse ask

*if you have any concerns, be direct by asking about thoughts of death or suicide* -when the thoughts occurred -how long these thoughts lasted -whether the patient has a plan FON 1078

depression

*mood disturbance with overall feelings of sadness, despair, worthlessness, or hopelessness* -36% of girls and 22% of boys in ninth through twelfth grades reported feeling "sad or hopeless almost every day for greater than or equal to 2 weeks in a row" in the previous 12 months -20% of these students reported seriously considering suicide during the past 12 months -around 9% of U.S high school students reported actually having attempted suicide during the previous 12 months, with girls (12%) being more likely than boys (5%) to have attempted suicide FON 1076

*28.* newborn, how would nurse be able to tell down's syndrome looking at them, right away

*most frequently* -small, rounded skull with a flat occiput -upward-slanting eyes with epicanthal folds -broad, flat nose -protruding tongue -short, thick neck -hypotonic extremities -mottled skin -low-set ears -simian crease on the palmar side of the hand FON 1069

*30.* primary nursing goal for down's syndrome

*nursing interventions* -primary nursing goals include supporting the family at the time of diagnosis and referring the child and family to agencies that provide support and services FON 1070 *interventions* 1. medical strategies are focused at correcting structural deformities and treating associated behaviors 2. implement community and educational services with the use of a multidisciplinary approach 3. promote care skills as much as possible 4. assist with communication and socialization skills 5. facilitate appropriate playtime 6. initiate safety precautions, as necessary 7. assist the family with decisions regarding care 8. provide information regarding support services and community agencies NCLEX 365 -provide parents with information on normal developmental milestones -encourage stimulating play -provide nutritionally dense foods -encourage physical activity and exercise -praise child for accomplishments -provide consistency in matters relating to discipline -screen children for atlantoaxial instability with a neurologic examination and radiography after their second birthday, before they engage in physically energetic exercise or sports or rehabilitative procedures FON 1068

*41.* which kinds of children are typically abused

*parental* -culture -socialization history and history of abuse -parent's age and developmental level -attitudes towards child and child rearing -knowledge of normal child behavior and development -psychological state *child* -temperament -age -exceptional physical needs -disabilities -health or behavior problems *situational* -sources of stress and support within the family's environment -marital problems -financial difficulties -drug and/or alcohol abuse -lack of social support or the inability of the parent or caretaker to ask for support -poor social network -poor relationships with extended families FON 1072

*40.* down's syndrome, discharge instructions given

*patient and family teaching* the family will need education regarding their child's condition FON 1070 -provide parents with information on normal developmental milestones FON 1068 -encourage parents to enroll the child in an early intervention program that will facilitate the child's self-care abilities and assist the family with future needs -encourage parents to keep their focus on the normal needs of all children (love, social interaction, and play) regardless of cognitive ability *family teaching* -essential to provide parents with information on normal developmental milestones, stimulation techniques, safety, normal speech development, sexual development, and role of positive self-esteem in motivating children to accomplish goals within their limitations FON 1067

*27.* different types of child abuse

*physical* intentional infliction of physical injury upon a child, usually by a child's caregiver *emotional* intentional attempt by a parents or caretaker to impair or destroy the mental or emotional state of a child *sexual* commission of a sexual offense by a person responsible for the child's care, such as a print, relative, acquaintance of the family, or babysitter, against a child who is dependent or developmentally immature, for the purpose of the perpetrator's own sexual stimulation or gratification FON 1072

*37.* down's syndrome, what other kinds of congenital defects are common

*prone to* -upper respiratory infection -frequent otitis media -congenital heart defects (chief cause of death, particularly during the first year of life) *associated health problems* -increased incidence of leukemia -dysfunction of the immune system -thyroid dysfunction, especially congenital hypothyroidism -atlantoaxial instability FON 1070

*14.* Ritalin

*psychostimulant* *mehtylphenidate* *CNS stimulants* -increases levels of dopamine and norepinephrine, which stimulate the inhibitory system of the CNS -80% of children significantly improve while on one of these medications *positive effects* -increased attention span -normalization of activity level -reduced impulsiveness *side effects* -insomnia -decrease in appetite -abdominal pain -dazed or withdrawn behavior -worsening of behaviors as medication wears off -development of tics FON 1076 1. children with ADHD may require medication to reduce hyperactive behavior and lengthen attention span 2. medications that are most effective in controlling this disorder are CNS stimulants 3. CNS stimulants, which increase agitation and activity in adults, have a calming effect on children with ADHD and increase alertness and sensitivity to stimuli 4. *side effects* -tachycardia -anorexia and weight loss -elevated blood pressure -dizziness -agitation 5. *interventions* -monitor for CNS side effects -obtain a baseline ECG -monitor the blood pressure -the child and parents are instructed that OTC medications need to be avoided -the child and parents are instructed that the last dose of the day should be taken at least 6 hours before bedtime (14 hours for extended-released forms) to prevent insomnia -monitor height and weight (particularly in children) -reinforce that several weeks of therapy may be necessary before the therapeutic effect is noted -the client and parents are instructed that a drug-free period may be prescribed to allow growth of the chid if the medication has caused growth retardation NCLEX 960

*38.* RAP s/s

*recurrent/psychogenic abdominal pain* -afebrile -occasional vomiting and constipation -nonspecific -c/o episodic periumbilical or epigastric pain that is unrelated to eating, defecation, or exercise FON 1079

*20.* primary characteristics of autism

*social* 1. abnormal lack of comfort-seeking behaviors 2. abnormal or lack of social play 3. impairment in peer relationships 4. lack of awareness of the existence of feelings of others 5. abnormal or lack of imitation of others *communication* 1. lack of, impaired, or abnormal speech such as producing a monotone voice or echolalia 2. abnormal nonverbal communication (does not use gestures to communicate) 3. lack of imaginative play *behavior* 1. persistent preoccupation or attachment to objects; range of interests restricted 2. self-injurious behaviors 3. must maintain routine; any environmental change produces marked distress 4. produces repetitive body movements suck as rocking or head banging NCLEX 359 -peculiar and often seemingly bizarre characteristics, primarily in social interactions, communication, and behavior -inability to maintain eye contact with another person *hallmark* -limited functional play -sometimes interact with toys in an unusual manner -bizarre, repetitive, rapid motor activities such as flexing and extending the hand or gibers or performing distorted body movements -some have significant GI symptoms; constipation is common -deficits in social development *primary feature* -lack socialization skills; sometimes manifested by their inability to share enjoyment, achievements, or areas of interest with other persons -savants -speech and language delays are common FON 1071

*13a.* what would the parents be going through

-a critical role for the nurse is parent counseling -*it is most important to allay any inappropriate feelings of guilt or responsibility the parents might have*

*31.* ADHD, what kind of behaviors would you expect them to demonstrate

-decreased attention span -impulsivity -failure to follow instructions -hyperactivity -poor self-regulation -noncompliance -aggression -fidgeting -immaturity during play -failure to follow rules of play games -lack of turn-taking during play -easy distraction by extraneous stimuli *associated problems* -poor school performance -learning disabilities -antisocial behaviors such as lying, cheating, stealing -excessive anxiety -sleep disturbances -poor peer relationships -limited fine motor skills -additional psychiatric diagnoses FON 1075 1. fidgets with hands or feet or squirms in a seat 2. easily distracted by external or internal stimuli 3. difficulty with following through on instructions 4. poor attention span 5. sifts from one uncompleted activity to another 6. talks excessively 7. interrupts or intrudes on others 8. engages in physically dangerous activities without considering the possible consequences NCLEX 359

*45.* ADHD, teach parents, what kinds of things do you need to focus on

-educate the parents on discipline -teach them how to set limits that are appropriate and provide rewards -encourage parents to establish a strict daily routine -counsel the parents regarding the dangers of controversial therapies (megavitamin and herbal therapies) -stress the importance of accident prevention and safety -explain to them the need for increased supervision while fostering additional responsibilities and independence -assist in the development of the educational plan where appropriate -if the child is on medication, explain the reasons and minimal risks of such therapy with the child's teacher and school officials as needed -parents also need to be informed of the importance of routine follow-up of children on medication -make sure to check children for medication side effects every 6 months, and to assess ongoing need for medication therapy every year or more often FON 1076

*5.* what is missing in child diagnosed with down syndrome

-intellectual impairment -decreased muscle tone -weaknesses in grammer and language -delays in motor development FON 1069

*21.* down's syndrome, average life span (age they live to)

-life expectancy has improved in recent years but remains lower than that for the general population -more than 80% survive to age *55* years and beyond -associated with earlier aging -as prognosis continues to improve, important to provide for this long-term health care, and social and leisure needs FON 1070

*11.* when nurses are legally bound to report child abuse

-mandatory reporting of child maltreatment when a health professional has reason to suspect that child abuse or neglect has occurred or is occurring -it is not necessary for the professional to be certain or prove that a child has been maltreated; it is enough for the reporter to distrust or doubt the caretaker's explanation of what has been observed in the child -all health care providers are obliged to be alert to, assess, and report any abusive situations to proper authorities FON 1072

*10.* cognitive impairment what diagnostics

-neurologic examination -CT scan -serum metabolic screening -developmental screening tests (Denver II) -standardized intellectual tests (Stanford-Binet Intelligence Scale; Wechsler Intelligence Scale for Children, Revised) -chromosomal analysis -genetic screening FON 1068

*15.* causes of childhood depression

-not been established *possible risk factors* -genetic or environmental -3 to 6 times greater rate of depression in a child of a parent suffering from a major affective disorder *cognitive theories* -feelings of hopelessness and helplessness secondary to an actual or perceived loss *psychosocial theories* -disturbance in family dynamics or in the parent-child relationship -family move -death of a loved one -divorce -abuse or maltreatment FON 1076

*12.* child demonstrating school avoidance, interventions

-primary role is to assist in convincing parents that their child is healthy -explain the diagnosis of school avoidance to them -assist in returning the child to regular school attendance -educate that school avoidance occurs in "normal" children and that it is stress related and not a psychiatric disorder -once convinced that their child is healthy, it is necessary that the child immediately return to school -important to bring any somatic complaints to the attention of the primary care provider and if the condition is minor or without an organic cause, to then send the child to school -reassure the child that attendance at school is nonnegotiable -provide support and reassurance to the child who is anxious about peer or academic issues FON 1074

*34.* which babies are at risk for down's syndrome

-risk increases with maternal age, especially as women pass 35 years of age -peak incidence (1 in 110) occurring in offspring of women older than 40 years FON 1069

*38.* RAP how often child needs to be seen

-sometimes need to be seen as often as once every 2 weeks to a month for pain evaluation and reassurance FON 1080

*17a.* what they need to be cautioned about the first week or two with tricyclic antidepressants

-the client is instructed to avoid driving and other activities requiring alertness until the response is known; sedation is expected in early therapy and may subside with time NCLEX 953 -parents need to be aware of suicidal tendencies during the first and second weeks of therapy -"black box" warning on all antidepressants to alert health care providers on an increased risk of suicidal thoughts or ideation in pediatric patients FON 1077

*32.* child taking antidepressants, what signs do you need to watch first few weeks of treatment

-the client is instructed to avoid driving and other activities requiring alertness until the response is known; sedation is expected in early therapy and may subside with time NCLEX 953 -parents need to be aware of suicidal tendencies during the first and second weeks of therapy -"black box" warning on all antidepressants to alert health care providers on an increased risk of suicidal thoughts or ideation in pediatric patients FON 1077

*18.* RAP (recurrent abdominal pain) what are the characteristics

-usually multifactorial, organic, dysfunctional, or psychogenic in origin -most common in school-age and adolescent children -warrants consideration in children with episodes of RAP occurring monthly for a least 3 consecutive months once other causes have been ruled out -often related to emotion factors; poor self-esteem, depression, school phobia, maternal depression, marital problems and divorce FON 1079

tricyclic OD

1. check airway and maintain patent airway 2. administer oxygen 3. check VS 4. obtain and ECG (check for dysrhythmias) 5. prepare for gastric lavage with activated charcoal (prevent further medication absorption) 6. prepare for the administration of physostigmine (a cholinesterase inhibitor given to counteract antichloinergic effects) and antidysrhythmic medications (as needed) 7. document the event, actions taken, and the client's response NCLEX 953

*33.* autistic in hospital, what therapeutic nursing interventions would be appropriate

1. determine the child's routines, habits, and preferences, and maintain consistency as much as possible 2. determine the specific ways in which the child communicates and use these methods 3. avoid placing demands on the child 4. evaluate the child for safety 5. implement safety precautions, as necessary, for self-injurious behaviors such as head banging 6. initiate referrals to special programs, as required 7. provide support to the parents *ensuring a safe environment for a child with autism is a priority* NCLEX 360 -when these children are in the hospital, the *parents are essential to planning care and ideally will stay with the child as much as possible* -each one will require *individual assessment and treatment* -*decrease stimulation* by using a private room, avoid extraneous auditory and visual distractions, and encourage parents to bring in possessions the child is attached to usually helps lessen the disruptiveness of hospitalization -*minimum holding and eye contact* will sometimes by necessary to prevent behavioral outbursts because physical contact often upsets these chidden -*take care when performing procedures on administering medicine* to, or feeding these children, because they are either fussy eaters who at times willfully starve themselves or gag to avoid eating, or are indiscriminate gorgers, swallowing any available edible or inedible items, such as a thermometer; eating habits of autistic children tend to be particularly problematic for families and often involve food refusal, mouthing objects, eating non edibles, and smelling and throwing food -*need to be introduced slowly to new situations* -*keep visits with staff caregivers short whenever possible* -because these children have difficulty organizing their behavior and redirecting their energy, they *need to be told directly what to do* -*keep communication at the child's developmental level brief, and concrete* FON 1071

*13.* ADHD interventions for parents

1. provide parents with information about the disorder and treatment plan; encourage support groups for the parents 2. treatment included behavioral therapy, medication, maintaining a consistent environment, and appropriate classroom placement 3. behavioral therapy focuses on preventing undesirable behavior 4. maintain a consistent home and classroom environment, and provide environmental and physical safety measures 5. promote self-esteem 6. stimulant medications may be prescribed; possible side effects include appetite suppression and weight loss, nervousness, tics, insomnia, and increased blood pressure 7. instruct the child and parents regarding, medication administration and the need for regular follow-up NCLEX 359

CNS stimulants

Amphetamine Atomoxetine (Strattera) Dexmethylphenidate (Focalin) Dextroamphetamine (Dexedrine) Dextroamphetamine and amphetamine (Adderall XR) Methamphetamine (Desoxyn) Methylphenidate (Ritalin, Concerta, Metadate CD, Methylin) NCLEX 960

tricyclics

amitriptyline hydrochloride clomipramine (anafranil) desipramine hydrochloride (norpramin) dosepin hydrochloride (sinequan) imipramine hydrochloride (tofranil) nortriptyline hydrochloride (aventyl, pamelor) protriptyline hydrochloride (vivactil) timipramine maleate (surmontil) NCLEX 953

*22.* what they call autistic child if they excel in certain areas

despite their relatively moderate to severe disability, some children with autism excel in particular areas, such as art, music, memory, mathematics, or perceptual skills, such as puzzle building; they are known as *savants* FON 1071

*9.* types of child abuse

includes neglect, physical sexual, or emotional maltreatment *neglect* -inadequate weight gain -poor hygiene -consistent hunger -inconsistent school attendance -constant fatigue -reports of lack of child supervision -delinquency *physical* -unexplained bruises, burns, or fractures -bald spots on the scalp -apprehensive child -extreme aggressiveness or withdrawal -fear of parents -lack of crying (older infant, toddler, or young preschool child) when approached by a stranger *emotional* -speech disorders -habit disorders such as sucking, biting, and rocking -psychoneurotic reactions -learning disorders -suicide attempts *sexual* -difficulty walking or sitting -torn, stained, or bloody underclothing -pain, swelling, or itching of the genitals -bruises, bleeding, or lacerations in the genital or anal area -unwillingness to change clothes or unwillingness to participate in gym activities -poor peer relations *shaken baby syndrome* -external signs of trauma are usually absent -ophthalmoscopic exam reveals retinal hemorrhages -full bulging fontanels and head circumference greater than expected NCLEX 361

down syndrome safety alert

provide radiologic evaluation for *atlantoaxial instability* in children participating in sports that potentially involve stress on the head and neck, such as gymnastics, diving, butterfly stroke in swimming, high jump, and soccer -do not allow children with down syndrome and atlantoaxial instability to be involved in activities that put stress on the head and neck -surgical intervention will be required in some cases -symptoms of the disorder include back pain, weakness, and torticollis -affected children are at risk for spinal cord compression, which places the child at risk of losing established motor skills and bladder or bowel control report immediately any child with the following signs of spinal cord compression -persistent neck pain -loss of established motor skills and bladder or bowel control -changes in sensation *monitor airway clearance* measures to decrease respiratory infections include clearing the nose with a bulb type of syringe rinsing the mouth with water after feedings, increased fluid intake and using a cool-mist vaporizer to keep the mucous membranes moist and the secretions liquefied -other helpful measures include changing the child's position frequently, performing postural drainage with percussion if necessary, practicing good hand hygiene, and properly disposing of soiled articles such as tissues monitor for adequate nutritional and fluid intake -the protruding tongue also interferes with feeding, especially of solid foods -parents need to know that the tongue thrust is not an indication or refusal to feed, but a physiologic response -advise parents to use a small but long straight-handled spoon to push the food toward the back and side of the mouth -if the child thrusts the food out, the parent feeds it in again -decreased muscle tone affects gastric motility, predisposing the child to constipation -dietary measures such as increased fiber and fluid intake promote evacuation -it is important to supervise dietary intake -it will sometimes be necessary to scrutinize the child's eating habits to prevent obesity FON 1069

*3.* cognitive impairment nurses focus in regards to family of child

providing the family with: -*support* at time of initial diagnosis and encouragement to verbalize their fears and concerns -*education* when teaching, break up each task into small, specific steps, because the child will not always be able to understand the task as a whole -*referrals* encourage parents to enroll the child in an early intervention program that will facilitate the child's self-care abilities and assist the family with future needs *encourage parents to keep their focus on the normal needs of all children* love, social interaction, and play-regardless of cognitive ability *teaching* essential to provide parents with information on normal developmental milestones, stimulation techniques safety, normal speech development, sexual development, and the role of positive self-esteem in motivating children to accomplish goals within their limitations FON 1068

*42.* physical indications of child that might be abused

see 6-9 see 43

*39.* learning disabilities, how do they impair a child

speech behavior motor coordination -failure to master basic, grade-appropriate academic skills in one or more subject areas -progressive decline in school performance -delayed acquisition of language milestones -deficient social skills -avoidance behavior when confronted with challenging tasks -low frustration tolerance -disorganization -somnolence FON 1075

*23.* child maltreatment, most important nursing intervention

the most important role for any health care provider, especially nurses, is the identification of a child who is being maltreated -thorough h&p -take cure to investigate further from the presence of a behavioral or physical indicator -carefully document any manifestations (use direct quotes, report only objective findings) -pay special attention to injuries that are unexplained or inconsistent with the parents or caretaker's explanation -question parent and child separately -use of drawings, play, diagrams, and anatomically correct dolls sometimes help a child to express what has happened FON 1072

psychostimulants

three of the most widely used medications for ADHD -methylphenidate (Ritalin) -dextroamphetamine sulfate (Dexedrine) -pemoline (Cylert) FON 1076

ADHD second-line medications

tricyclic antidepressnat atypical antidepressant bupropion (Wellbutrin) alpha-2 agonists (clonidine [Catapres]) FON 1076