Peds Exam 2

Electromyography (EMG)

recording the strength of muscle contraction as a result of electrical stimulation. Recording electrodes placed in the skeletal muscle and electrical activity is recorded. It is used for diagnosing muscular disorders. Short needles are inserted into muscle.

RSV/ Preventing RSV

respiratory syncytial virus. Common and very contagious virus. Causes bronchiolitis in high-risk infants. High risk infants include: premature delivery, less than two years with heart or lung disease, Immunocompromised, less than 8 to 10 weeks old. Teach strict adherence to handwashing policies in the day care centers and when exposed to individuals with cold symptoms for all age groups. Administer paliviumab (Synergis) A monoclonal antibody Immuno prophylaxis (not a vaccine) to prevent severe RSV disease in those who are most susceptible. Give intramuscularly once a month throughout RSV season to children younger than two years of age with qualifying factors. Qualifying factors are: premature infants born less than 35 weeks. Children with bronchopulmonary dysplasia or chronic lung disease of prematurity and children less than two years old. Also Children with history of CHD less than two years old. It's administered every 28 to 30 days during RSV Season to maintain serum antibody levels. First dose before the start of RSV season. If infant or child develops RSV during doses, dosing should continue.

Nephrotic syndrome parent teaching

Teach parents about long-term administration effects of medications. Teach them that they cannot run out of medicines, because they cannot be stopped abruptly. Ensure every other day dosing, at the same time each day; do not alter timing or dosage. Teach parents how to mask the taste of medicine. Demonstrate the urine dipstick technique for detecting protein and encourage the family to keep a chart of dipstick results. Child may return to school but should avoid contact with sick playmates.

erythrocyte sedimentation rate (ESR)

measures time it takes for erythrocytes to settle to the bottom of a test tube. ESR indicates inflammation, indicating an injury or infection. Normal ESR levels: newborns 0-2 mm/hr. Children 0-10 mm/hr

Simple Mask

provides 35 to 60% oxygen with a flow rate of 6 to 10 L per minute. Oxygen delivery percentages affected by respiratory rate, inspiratory flow, and adequacy of mask fit. Must maintain oxygen flow rate of at least 6 L a minute to maintain inspired oxygen concentration and prevent re-breathing of carbon dioxide. Mask should fit snugly to be effective but should not be tight enough to irritate the face.

Tanner stages for males

1 - young child/prepubescent 2 - sparse hair growth, enlarged balls 3 - coarser and more hair, longer penis, enlarged balls 4 - more hair (not on thighs), inc breadth and length of glans, scrotal skin darkened 5 - adult but not on abdomen

Asthma treatment

1. Avoid asthma triggers 2. Stepwise approach to management 3. Periodic assessment of asthma control. 4. Reduce/control inflammatory episodes inhaled corticosteroids. They may get a low-dose of corticosteroid every day so that when a trigger does happen some of the inflammation will be reduced. Inhaled corticosteroids takes about two weeks until therapeutic affect. Dosing is daily or every other day. 5. Short acting bronchodilators (albuterol) 6. Long-acting bronchodilators 7. Exercise induced asthma. Children should warm up before, and take a bronchodilator prior. 8. Leukotriene inhibitors Cough suppressants are contraindicated because they can mask cough. For mild persistent (3 to 6 episodes every week; 3 to 4 times a month): Use inhaled corticosteroid for better asthma control, fewer symptoms and flareups, reduce need for hospitalization. See number four above. For moderate persistent (Daily symptoms; nighttime symptoms five or more times a month): Use long acting bronchodilators at HS with inhaled steroid. Advair given at night. For severe persistent (Continuous with frequent nighttime episodes): Will be put on high-dose oral corticosteroid, inhaled corticosteroid, And a long acting bronchodilator at HS (bedtime).

Breast/pubic hair development. Tanner stages

1. Pre-pubertal/no pubic hair 2. No breast development/straight pubic hair 3. Breast budding/pubic hair darker, increasing quantity, triangular pattern 4. Breast with projection of areola/hair thicker and curly. 5. Breast adult configurations/hair extends to medial aspect of thigh

Isotretinoin (Accutane)

Reduces sebaceous gland size, decreases seven production and regulates cell proliferation and differentiation. Indicated for cystic acne or severe acne that is resistant to three months of treatment with oral antibiotics. Ensure that the adolescent girl is not pregnant and does not become pregnant. Labs will have to be routinely monitored. Monitor CBC, lipid profile, liver function tests, and B human chorionic gonadotropin monthly. Monitor for suicide risk.

Intussusception

A proximal segment of bowel telescopes into a more distal segment, causing Edema, vascular compromise, and ultimately partial or total bowel obstruction. Most cases occur in toddlers 1 to 2 years old. It is an abdominal emergency. Blacks flow of fluids and food through bowel; causing swelling and bleeding of bowel and cut off blood supply which can lead to gangrene. A lead point i.e. pathologic point, may cause the telescoping. Examples of lead points are diverticulum, duplication cysts, polyps, hemangiomas, tumors, or the appendix. Typically symptoms flare and then regress. Between episodes children may have no symptoms.

Behavioral cognitive strategies for pain control

Relaxation, thoughts stopping, positive self talk, imagery, distraction: counting, listening to music or singing, playing games, blowing bubbles or pinwheel, listening to favorite stories.

School age children

6-12 years old. Slow, steady growth. Refined and subtle changes. Brain is 95% of adult size by age 12 In their nervous system is almost completely matured that allows for coordinated body movements. Sexual organs are growing but remain dormant. All permanent teeth are in by age 12. Can hold pencil and print words at six years. Able to write in script and in sentences by 12 years. It's during this time the children move toward abstract thinking and seek approval of peers.

Asthma

A chronic inflammatory airway disorder characterized by airway hyperresponsiveness, Edema, mucus production. It is the most common chronic illness of childhood. Severity ranges from symptoms associated only with vigorous activity, to daily symptoms that interfere with quality of life. Prevention of inflammation is the core of asthma management. Asthma results from a complex variety of responses in relation to a trigger. Current research recognize the concept of airway remodeling as a significant long-term complication. Overtime, with repeat asthma exacerbations, irreversible structural airway changes occur in pulmonary function decreases with this remodeling. Current goals of medical therapy are avoidance of asthma triggers and reduction or control of inflammatory episodes. A stepwise approach to medication management involves increasing medications as the child condition worsens, then backing off treatment as he or she improves. Children may avoid exercise induced bronchospasm by using a longer warm-up. Prior to vigorous exercise and if necessary inhaling a SABA just prior. Long term prevention usually involves inhaled steroids. Leukotriene modifiers may be used as an alternative but are not preferred. Common signs and symptoms reported might include cough, particularly at night, hacking cough that is initially non-productive but becoming productive with frothy sputum. Difficulty breathing, shortness of breath, chest tightness or pain, dyspnea with exercise, wheezing Risk factors: history of allergic rhinitis or atopic dermatitis, Family history of atopy. Recurrent episodes diagnosed as wheezing, bronchiolitis, or bronchitis. Known allergies. Seasonal response to pollen. Tobacco smoke exposure, poverty.

Diagnostics for cerebral palsy

A complete history, physical examination, Neuro assessment will be done. EEG: usually abnormal but the pattern is highly variable. Cranial radiographs or ultrasound: may show cerebral asymmetry MRI or CT: may show area of damage or abnormal development but may be normal Screening for metabolic defects and genetic testing may be performed to help determine the cause of palsy

vesicoureteral reflux (VUR)

A condition in which the urine from the bladder flows back up the ureters. This reflects of urine occurs during bladder contraction with avoiding. Reflux may occur in one or both ureters. If reflux occurs when the urine is infected, the kidney is exposed to bacteria and pyelonephritis may result. The increased pressure placed upon the kidneys with reflux can cause renal scarring and lead to hypertension later in life or renal failure if severe. Primary VUR results from congenital abnormality, secondary VUR is related to other structural or functional problems such as neurogenic bladder, bladder dysfunction or obstruction. The UR is graded according to its severity from grade I to grade V. Grade 1 and two cases usually resolves spontaneously but three through five usually need surgery. The goal of therapeutic management is preventing pyelonephritis and renal scarring. Management continues to include antibiotic prophylaxis. Hygiene practices are used to assist with prevention of UTI. Serial urine cultures are used to determine recurrence of UTI. Bi annual, annual or biennial radionucleotide VCUG's are performed to determine the status of VUR. Grade 34 and five cases usually warrant surgical intervention. The ureters are resected from the bladder and re-implanted elsewhere in the bladder wall to regain functionality. Nursing assessment: signs and symptoms may include fever, dysuria, frequency or urgency, nocturia, hematuria, or back, abdomen, or flank pain. Monitor the blood pressure for elevation. Palpate the abdomen for presence of a mess because Hydronephrosis may be present. Teach the child to empty the bladder completely and teach appropriate perennial hygiene as well as toileting hygiene to prevent UTI.

Metabolic and genetic testing

A diagnostic that's going to be done anytime there's a neuromuscular disorder. Test for presence of gene for disease or for carrier status. The entire family should be tested even those unaffected.

Hirschsprung disease

A disorder of motility of the intestinal tract resulting in obstruction. It is caused by absence of parasympathetic ganglion cells in portion of large intestine that causes inability of movement of fecal material through the affected colon section. This result in chronic constipation, ribbon like stools (remember this), dilation of bowel proximal to obstruction, abdominal distention. It affects males more than females and has a familial tendency, may be caused by abnormal gene on chromosome 10. Risk factors: down syndrome or other chromosomal abnormality

Serum Creatinine

A more direct measurement of renal function, only minimally affected by liver function. Generally, doubling of the creatinine level is suggestive of a 50% reduction in GFR. In normal breakdown of muscle tissue, creatinine filters through kidneys and is excreted in urine. This tests kidney function and ability to filter blood.

nephrotic syndrome

A result of increased glomerular basement membrane permeability which allows abnormal loss of protein in the urine. Has to do with autoimmune process and T lymphocyte dysfunction. Can be congenital, idiopathic, or secondary. Idiopathic is the most common and is also called minimal change nephrotic syndrome (MCNS). Increase glomerular permeability results in passage of larger plasma proteins through the membrane. This results in excess loss of protein, namely albumin, in the urine. And decreased protein and albumin in the bloodstream. Hypoalbuminemia results in a change in osmotic pressure and fluid shifts from the bloodstream to the interstitial tissue causing edema. Children with nephrotic syndrome are at an increased risk for clotting and thromboembolism because of the decreased intravascular volume. They are also at increased risk of infection And hyperlipidemia (Liver keeps producing more and more cholesterol to make up for the protein loss) Signs and symptoms: nausea or vomiting (it may be related ascites), recent weight gain, periorbital Edema upon waking, progressing to generalized edema Throughout the day. Weakness or fatigue, irritability or fussiness. Inspect the skin for a stretched tight appearance, pallor, or skin breakdown related to significant Edema. Note increased respiratory rate or increase work of breathing. Heart sounds may be muffled due to fluid overload.

Arterial blood gases

ABG. Invasive method of measuring arterial PH, partial pressure of oxygen and carbon dioxide, and base access in blood. Usually reserved for severe illness, the intubated child, or suspected carbon dioxide retention. Hold pressure for several minutes after a peripheral arterial stick to avoid bleeding. Radial arterial sticks are common and can be very painful. Note if the child is crying excessively during the blood draw, as this affects the carbon dioxide level.

School aged health issues

Accidents. Communicable diseases: lice, scabies, impedigo, URI's ADHD/learning disorders: developmentally inappropriate degree of inattention, impulsiveness, and hyperactivity. Education for all handicapped children's Act Learning disorders: difficulty listening, speaking, reading, writing, reasoning, math skills or social skills. Enuresis: at age 5, still having involuntary urination usually at night, self-limiting and will out grow it. Obesity: sudden weight gain is the most prevalent in this age group. Research has found that infants can be predisposed to obesity due to higher glucose intake and increase insulin resistance in utero based off what the mother eats.

Piagets adolescent

According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one. It is the formal operational period. During this period, the adolescent develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. The adolescents thinking becomes logical, organized, and consistent. They are able to think about a problem from all points of view. In the early stages of formal operational reasoning, the adolescent thinking is egocentric, thinking they are the center of everyone's attention. The adolescent is very idealistic, constantly challenging the way things are and wondering why things cannot change.

cysticfibrosis/pancreas

Acinar cells of pancreas produce lipase, trypsin, and amylase. These flow into the duodenum to digest fat, protein and cholesterol. With cystic fibrosis enzyme secretions are so thick they plug the ducts which result in back pressure in acinar cells causing atrophy and inability to produce enzymes. The islets of Langerhans and insulin production is not influenced until late. Since the enzymes cannot be made useful, then they must be made available with supplementation.

Acne

Acne is a common childhood disorder that affects the pilosebaceous unit. It affects males and females as well as all ethnic groups. Acne neonatorum: Occurs as a response to the presence of maternal androgens or to transient androgen production in the newborn. May be present immediately after birth but often occurs between two and four weeks of age. Usually no treatment is necessary but in severe cases there is a risk of scarring so topical preparation may be prescribed. Assessment: document absence of fever. Management: instruct parents to avoid picking or squeezing the pimple. Wash affected areas daily with clear water avoid using fragrance soap or lotions. Acne vulgaris: effects adolescence beginning as early as 7 to 10 years and between the ages of 12 and 16 years. Indigenous androgens play a role in its development. Risk factors include adolescence, being male, oily complexion, Cushing's syndrome. Management: focuses on decreasing seven production, normalizing skin shedding, and illuminating information. Teach adolescent to cleanse skin gently twice a day. Medication therapy may include a combination of benzoyl peroxide, salicylic acid, Retinoids, and topical or oral anabiotic's. Isotretinoin may be used in severe cases. And girls, oral contraceptives can help lessen acne by decreasing the effects of androgens on sebaceous glands. Nursing assessment/tx : determine medication used, certain medication May hasten the onset in particular use of corticosteroids, androgens, lithium, phenytoin, and isoniazid. And girls, note the worsening of acne 2 to 7 days before the start of menstrual Period. Avoid oil base cosmetics and hair products because they can block pores. Look for cosmetic products labeled as non-comedogenic. Mild cleansing with soap and water twice daily is appropriate. Avoid excessive scrubbing and harsh chemical or alcohol-based cleansers. Avoid squeezing lesions, using non-comedogenic sunscreen with SPF of 30 or higher is recommended. Teach adolescence that prescribed topical medication must be used daily and that it may take 4 to 6 weeks to see results. Avoid use of over-the-counter preparation's because they are irritating and aggravate the Drying effect of prescription acne treatments. Instruct boys to shave gently and avoid using dull razors. Of course assess for depression because adolescents can be very fatalistic in their thinking. Adolescent girls taking isotretinoin who are sexually active must be on a pregnancy prevention program because the drug causes defects in fetal development. If they are sexually active they must be on a contraceptive (Remember this)

Promoting mobility for muscle dystrophy

Administer corticosteroids and calcium supplements as ordered. There is no cure however the use of corticosteroids may slow the progression of the disease. It is thought that prednisone helps by protecting muscle fibers from damage. Corticosteroids have many side effects including weight gain and osteoporosis. Calcium supplements and vitamin D are prescribed to prevent osteoporosis.

Adolescent (11-20 years)

Adolescence is a time of physical growth for both boys and girls were they experience a growth spurt. They also experience puberty, a time when a person first becomes capable of sexual reproduction. There are also secondary sex changes such as body hair and breast growth. Other physiological changes are blood pressure increases, pulse decreases, Vital organs reach adult size. Menarche by age 14 years and girls. Secondary sex characteristics and boys my age 17 to 19 years.

Communication, adolescent

Always respect their privacy. Ensure confidentiality. Use appropriate medical terminology, defining terms as needed. Use creativity. Prepare the teen up to one week prior to a procedure. Listen. Validate their feelings. Show trust. Give praise. Set aside appropriate amount of time to discuss subject matter without interruptions. Talk face-to-face. Be aware of body language. Ask him or her to be patient as he tell your thoughts. Don't pretend to know all the answers. Admit you make mistakes. Set rules and limits fairly.

Folliculitis

An infection of the hair follicle most often results from occlusion of the hair follicle. May occur as a result of poor hygiene, prolonged contact with contaminated water, maceration, a moist environment, or use of occlusive emollient products. Findings: red, raised hair follicles Folliculitis may be prevented with diligent hygiene and avoidance of occlusive emollients. Treat with aggressive hygiene: warm compresses after washing with soap and water several times a day. Topical mupirocin is indicated, occasionally oral antibiotics are required.

cystic fibrosis

And autosomal recessive disorder. A deletion occurring on the long arm of chromosome seven at the cystic fibrosis transmembrane conductance regulator (CFTR) Is the responsible gene mutation. This mutation causes alterations in epithelial ion transport on mucosal surfaces resulting in generalized dysfunction of the exocrine glands. The epithelial cells fail to conduct chloride, and water transport abnormalities occur. This results in thickened secretions in the sweat glands, gastrointestinal tract, pancreas, respiratory tract and other exocrine tissues. This increased viscosity makes them difficult to clear and clogs ducts. The sweat glands produce a larger amount of chloride, leading to a salty taste of the skin and alterations and electrolyte balance and dehydration. The pancreas, bile ducks, intestinal glands, gallbladder, and some maxillary glands become obstructed by mucus. Pancreatic enzyme activity is lost and malabsorption of fats and proteins and carbohydrates occurs resulting in poor growth in large malordorous stools. Abnormally thick mucus plugs the small airways and bronchiolitis and further plugging of the airways occur. Secondary infection ensues. This can lead to chronic infection, tissue damage, and respiratory failure. Reproductive ducts can be clogged and mucous thickened causes infertility in adults with CF.

Retinoids

Anticomedogenic activity in moderate to severe acne vulgaris. Adverse effects: dryness, burning, photosensitivity. Instruct child to use SPF 15 or higher sunscreen.

Maintaining cardiopulmonary function For Muscle dystrophy

Assess respiratory rate, depth of respirations, and work of breathing. Auscultate the lungs to determine whether aeration is sufficient and to assess clarity of breath sounds. Position child for maximum chest expansion usually in the upright position. Teach the child and family deep breathing exercises to strengthen or maintain respiratory muscles and encourage coughing to clear the airways. Perform chest physical therapy or assist with chest percussion. Use of ventilator may become necessary in the teen years. Monitor the results of pulmonary function testing. Monitor cardiac status closely to identify heart failure early. Assessed for Edema, weight gain, or crackles. Maximize quality of life by working with family and child to develop a schedule for the virginal activities to provide appropriate developmental stimulation, but avoid overexertion of frustration.

Diagnostic tests for myelomeningocele

Blood tests can detect alpha feta proteins (AFP). Hey myelomeningocele can be detected prenatal around 16 to 18 weeks gestation but in ultrasound. Analysis of amniotic fluid can also detect AFP increases. Other common laboratory and diagnostic studies Include MRI, CT, ultrasound, myelography.

Suicide

Boys are more successful at their suicide attempts and females, but females are more likely to make an attempt. Most people are not comfortable discussing the topic of suicide and therefore not comfortable communicating about the topic openly. It is important that healthcare providers address this important health problem and work to prevent it. Risk factors for suicide in adolescents: Depression or other mental illness, mental health changes, family history, history of previous attempt, poor school performance, family disorganization, substance abuse, LGBTQ, giving away valued possessions, being a loner/having no close friends, changes in behavior, incarceration

Integumentary: diagnostic and lab values

CBC with differential: Evaluates H&H, WBC, platelets. Indicated for infection or inflammatory process. May be affected by myelosuppressive drugs (corticosteroids). Eosinophils Will be elevated in a child with atopic dermatitis. Erythrocyte sedimentation rate (ESR): Non-specific test used to detect the presence of infection or inflammation. Send sample to lab immediately, if allowed to stay in longer than three hours may result in falsely low result. Cultures KOH (potassium hydroxide) prep: This reveals branching fungus when it's looked at under a microscope. It's used with skin scrapings on a microscope slide. Play skin scrapings on a slide and add KOH 20% drop. Immunoglobulin E (IgE): Used to indicate atopic dermatitis. Linked to allergic reaction. Will be increased if child is on a Corticosteroid.

Diagnostics for neuroblastoma

CT/MRI to determine site of tumor and evidence of metastasis Chest x-ray and skeletal survey to identify metastasis Bone marrow aspiration and biopsy to determine metastasis to bone marrow 24 hour urine collection for Homovanillic acid (HVA) and vanillymandelic acid (VMA) levels will be elevated.

Diarrhea

Can be acute or chronic. Most common causes viruses. Other causes are milk intolerance, Hirschsprung disease, toddler diarrhea (Caused by too much liquid and not enough carbs and bulk), Celiac disease, constipation with encopresis, IBD. Assessment: No child's general appearance in color. Note decrease tear production, sunken orbits, or dry mucous membranes. Inspect the anal area for presence of redness or rash related to increased stool volumes and increased frequency. No tenderness to palpation in the lower quadrant, the rebound tenderness should not be present. Obtain history of symptoms: how long, number stools, consistency, size, other symptoms, blood or mucus. Labs/diagnostics: stool culture, over and parasites, KUB (Fecal impaction) Nursing care: restore fluid and electrolytes, avoid glucose, avoid milk products, encourage complex carbs, add fat to carbs Because flat slows the passage of stool through the colon.

school aged safety concerns

Car/Seatbelt: school-age children should always sit in the rear seat. The front seat is dangerous because the passenger side airbags in most new model cars. Seat belt or age and weight appropriate booster seat should be used at all times. The lap belt should lie low and flat on the hips and shoulder belt should lie on the shoulder, not the neck or face. Seatbelts should be fastened before car is started. Children under 13 years must sit in the back seat. Childproof locks should be used in the backseat. Rules of conduct for car rides should be established. Bike safety: Child should know to wear a properly fitted, consumer product safety commission, or Snell approved helmet every time he or she rides a bike. Proper fitting helmet should sit level, not tilt, and firmly and comfortably on the head. Have strong wide Y shaped straps and when you open your mouth should pull down a bit; not move with sudden pulling or twisting, never be worn over anything else such as a hat or scarf etc. Bikes should be well-maintained and properly sized. Fire safety: Working smoke detectors and fire extinguishers. Change the batteries at least twice a year. Have a escape plan. Practice it routinely. No smoking in home especially in bed. Teach what to do in case of a fire, call 911. Use stove and other cooking facilities under supervision of adult. Fireplaces should have protective greetings teach children to avoid touching wires. Firearm safety: Teach child never to touch guns. Tell an adult. If there are guns in household, need to secure them in a safe place, use gun safety locks, store bullets in a separate place. Never point a gun at a person. Drugs: just say no. Teach child the hazards of excepting illegal drugs, alcohol, or dangerous drugs. Store potential dangerous materials and safe place

Type 1 diabetes

Caused by a deficiency of insulin secretion due to pancreatic cell damage. It is an auto immune disorder that occurs to genetically susceptible individuals. The deficiency of insulin leads to an inability of cells to take up glucose. The end result is hyperglycemia and the bodies inability to use its main source of fuel efficiently. The kidneys try to lower blood glucose resulting in glycosuria and polyuria, and protein and fat are broken down for energy resulting in a buildup of keytones and acidosis. DKA can develop resulting in anorexia, nausea and vomiting, lethargy, stupor, altered level of consciousness, confusion, decreased skin turgor, abdominal pain, Kussmaul respirations and air hunger, fruity smelling breath, tachycardia and if untreated coma and death. Prolonged exposure to high blood glucose levels resulting damage to blood vessels and nerves. It can cause retinopathy, neuropathy, vascular complications, PVD, cardiovascular disease.

Cellulitis

Cellulitis is a localized infection and inflammation of the skin and subcutaneous tissues and is usually preceded by skin trauma of some sort. Periorbital cellulitis is a bacterial infection of the eyelids and tissue surrounding the eye. Bacteria may gain entry to the skin via an abrasion, laceration, and said bye, foreign body, or in pet or lesion. Findings: localized reaction: erythema, pain, Adema, warmth at site of skin disruption In Periorbital cellulitis note marked eyelid Edema as well as a purpleish or red color of the eyelid. And restricted movement of the eye area. Notify physician or nurse practitioner immediately if any of these signs of progression to orbital cellulitis occur: conjunctiva redness, change in vision, pain with eye-movement, eye muscle weakness or paralysis, proptosis. Treatment for Periorbital cellulitis, apply warm soaks to the eye area for 20 minutes every 2 to 4 hours (remember that). Administer intravenous antibiotics as prescribed. Instruct parents to call the physician or nurse practitioner to have the child evaluate it again if child is not improving. In all skin bacterial infections teach the family to keep the child's fingernails cut short and clean the nails with a nail brush at math time.. When I skin disruption such as cut, scrape, or insect bite occurs teach the family to clean the area well to prevent development of cellulitis.

cerebral palsy

Cerebral palsy is a term used to describe a range of non-specific clinical symptoms characterized by abnormal motor pattern and posture. It's caused by non-progressive abnormal brain function. Many times no specific causes can be identified. It is a lifelong condition and very common cause of disability. There's a wide range of symptoms that may be from very mild, to causing severe motor and neurological impairment. Primary signs include motor impairment such a specificity, muscle weakness, and ataxia (Lack of coordination of muscle movements during voluntary movements). Complications include mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus. Pathophysiology: cerebral palsy is caused by abnormal development of, or damage to, the motor areas of the brain, resulting in a neurological lesion. The brain injury does not progress however clinical manifestations change as the child grows. Cerebral palsy is classified by the type of movement disturbance it causes: Spastic: hypertonicity and permanent extremity contractures, one of the most common forms. Dyskinetic: abnormal involuntary movements Ataxic: affects balance and depth perception Mixed: combination of the above. Most common spastic and dyskinetic

Cystic fibrosis treatment

Chest physiotherapy: usually done 2-3 times daily. May be preceded by an inhalation treatment and should not be performed after eating. Percussion is provided via a cupped hand or an infant percussion device. Appropriate percussion yields a hollow, not clapping sound. There are 10 different positions that correspond with different segments of the lung lobes to clear them (pg. 599) Exercise: exercise loosens mucus and optimizes cardiovascular strength. Medication: bronchodilators, corticosteroids, antibiotics Diet: High protein high calorie healthy diet. They must take pancreatic enzymes for digestion, Usually around 20 to 40 capsules a day. They should also take vitamin supplements (ADEK) In treatment if they get intestinal obstruction.

croup

Children between three months and three years of age are the most frequently affected with croup rarely affecting children over six. Also referred to as laryngotracheobronchitis because inflammation and Edema of the larynx, trachea, and bronchi occur as a result of viral infection. Inflammation and Edema obstruct the airway resulting in symptoms. Children have smaller airways so are more prone to narrowing of the trachea. Mucus production also occurs further contributing to obstruction of airway. Narrowing of subglottic area of the trachea result in audible respiratory stridor. Edema of the larynx causes hoarseness. Inflammation in the larynx and trachea causes the characteristic barking cough of croup. Nursing assessment: history may reveal a cough that developed during the night and that sounds like barking, or a seal. Inspect for the presence of mild URI (upper respiratory) symptoms. Temperature may be normal or elevated mildly. Listen for inspiratory stridor and observe for suprasternal retractions. The child with fever, a toxic appearance, and increasing respiratory distress despite appropriate croup treatment may have bacterial tracheitis, notify physician of these findings. Treatment: Steam. Tell the parent to try steaming up a Bathroom and taking the child in there to breathe in the steam. If that doesn't work bundle them up and take them out into the cold. Breathing cold air also helps. Give them plenty of fluids, of course no smoking around them, and do not give them cough medicine because they do not work with croup. If a medication is given it is usually a corticosteroid. Croup is usually diagnosed based on history and clinical presentation.

applying a urine bag

Cleanse the peroneal area well and pet dry. If a culture is to be obtained, cleanse the genital area with Betadine or per protocol. Apply benzoin around the scrotum or valvular area to aid with your own bag and he Asian and allow it to dry. Apply the urine bag. For boys, ensure that the penis is fully inside the bag; a portion of the scrotum may or may not be inside the bag depending on squirrel size. For girls, apply the narrow portion of the bag on the peroneal space between the anal and vulvar Areas first for best adhesion and then spread the remaining adhesive section. Took the bag down words inside the diaper to discourage leaking. Check the bag frequently for urine. Atraumatic care: when examining the genital area or performing urinary catheterization of the young female, allow the girl to sit with her mother on the examination table to decrease anxiety encourage the mother to console and hug the girl while the invasive examination or procedures being performed.

Cocaine

Cocaine is a powerful stimulant. Manifestations: weight loss, euphoria, elation, agitation, increased motor activity, pressured speech, dilated peoples, tachycardia, hypertension, anorexia (not hungry), insomnia. It also increases social abilities.

Sweat chloride test

Collection of sweat on filter paper after stimulation of skin with pilocarpine. Measures concentration of chloride in the sweat. It is indicated for cystic fibrosis. May be difficult to obtain sweat in a young infant. In cystic fibrosis the sodium may be 2 to 5 times above normal. It is the gold standard diagnostic for cystic fibrosis.

Piaget's School Aged Stage

Concrete operational stage (7-11 yrs) In concrete operations the child is able to assimilate and coordinate information about his or her world from different dimensions. The child is able to see things from another persons point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action. School age child can perform mental operations. Organize facts to solve problems. Think logically. Develop concepts of mass, volume, weights and measurements. Deals best with actual objects and people. They also have concrete thinking meaning that they Take the meanings of things more literally. Language skills and vocabulary expands. Culturally specific words are used. They also develop metalinguistic awareness , And ability to think about language and comment on its properties. This enables them to enjoy jokes and riddles and plays on words and sounds, And allows them to experiment with profanity and dirty jokes if exposed. School age children can store information in there long term memory and retrieve it

Delayed puberty

Condition of delayed secondary sexual development. For girls, if breasts have not developed in pubic hair has not appeared by age 14, or menarche has not occurred by age 17. For boys if no testicular enlargement, scrotal changes, or pubic hair has not appeared by age 15 followed by testicular enlargement. Most common cause is hereditary pattern of growth and development known as constitutional delay or "late bloomer" Therapeutic management: administering testosterone for males or Australian all conjugated estrogen for girls in low dosages (if not underlying situation to address Such as tumor, infection, trauma etc.) Usually only necessary for a short time.

Constipation and encopresis

Constipation is defined as a failure to achieve complete evaluation of the lower colon. As stool passes through the colon, water is Reabsorbed into the colon, resulting in a form stool by the time it reaches the rectum. At this point the anal sphincter relaxes to allow passage of the stool from the anus. In constipation however, this relaxation does not occur. Most causes are functional in nature, meaning that the child intentionally withholds a bowel movement from fear of pain from a past painful stool. Organic causes are rare but can be from spina bifida, or sacral agenesis. Encopresis is a term used to describe soiling of underwear Beyond 4 to 5 years old. Encopresis is often seen as a result of chronic constipation and withholding of stool. As stool is withheld in the rectum, the rectal muscle can stretch over time, and the stretching of the rectum causes fecal impactions. Children who have a stretched rectal vault may experience liquid stool leaking around a fecal mass. This is often an embarrassing issue that occurs with school age children.

benzoyl peroxide

Decreases colonization of P. Acnes and mild acne vulgaris. Available in combination with topical antibiotics apply sparingly. Shake before application. Avoid contact with eyes and mucous membranes.

Creatinine clearance rate

Defines kidneys ability to handle creatinine an estimate GFR. A 24 hour urine collection is evaluated for the presence of creatinine, then compared with the serum creatinine to determine creatinine clearance. Used to diagnose impaired renal function

Nursing assessment: enuresis

Determine the age of toilet training and when or if the child achieved successful daytime and nighttime dryness. Inquire about urine holding behaviors such as squatting, dancing, or staring, as well as rushing to the bathroom (diurnal enuresis). Inquire about the amount and type of fluid the child typically consumes before bedtime (nocturnal enuresis). Assess the child's cognitive status: developmentally delayed children take significantly longer. Assess for short stature or elevated blood pressure, as this may occur when renal abnormalities are present.

Hygiene

Do not share hats, combs, brushes.

Neuromuscular anatomy and physiology

Early in gestation around 3 to 4 weeks the neural tube of the embryo begins to differentiate into the brain and spinal cord. If the fetus suffers infection, trauma, malnutrition, or teratogen exposure during this critical period of growth and differentiation, the brain or spinal cord development may be altered. This could result in delayed motor skill attainment or cerebral palsy. The structures of the nervous system are complete at birth but Myelinization is incomplete. Myelinization continues to progress in his complete by two years of age. It proceeds in a head to toe fashion. As myelinization proceed, the speed and accuracy of nerve impulses increase and primitive reflexes are replaced with a voluntary movement. At birth, the muscles tendons, ligaments, and cartridge are all present and functional. The infant is able to move but lacks purposeful control. Full range of motion is present at birth as well as deep tendon reflexes. Sluggish deep tendon reflexes indicate an abnormality.

Nursing management for reye syndrome

Early recognition and treatment are the most important aspects of managing this illness. Maintaining cerebral perfusion and managing and preventing increased ICP, providing safety measures due to changes in LOC and risk procedures, and monitoring fluid status to prevent dehydration and overhydration. Positioning indicated will likely be a low Fowlers position of about 10 or 15°. Do not do a high Fowlers because it can increase ICP. These patients are at higher risk for seizures and brain hemorrhage. Education is an important aspect of preventing this disease. Salicylates are found in many products including many over-the-counter products like Alka-Seltzer and Pepto-Bismol. Recovery is dependent on the severity of swelling of the brain. Some children will make a full recovery while others may suffer long-term neurological damage.

Atopic Dermatitis (Eczema)

Eczema is one of the disorders of the Atopy family along with asthma and allergic rhinitis. Onset of symptoms is usually before two years of age. It is often associated with food allergies as well. The chronic itching causes a great deal of psychological distress. Difficulty sleeping may occur. The child is Irritable and has difficulty concentrating. The parent stress may increase the child's anxiety leading to increase in itching and scratching. The child may outgrow a topic dermatitis. Pathophysiology: it has a relapsing and remitting nature. The skin reaction occurs in response to specific allergens usually food, Especially eggs, wheat, milk, and peanuts. Or environmental triggers like dust and mold, other factors such as ambient temperatures, perspiring, scratching, skin irritants and stress contribute to flareups. Scratching causes the rash to appear. Findings: if lesions are present they may be dry, weepy, or vesicles. And children younger than two, the rest is most likely on the face, scout, wrists, and extensor surfaces of the arms or legs. And older children may occur anywhere on the skin but has found more calmly on the flexor areas. Erythema and warmth may indicate secondary bacterial infection. Document areas of hyper pigmentation or hypo pigmentation which may have resulted from a prior exacerbation. Lab and diagnostic tests: IGE levels may be elevated. Skin prick allergy test may determine the food allergen. Nursing management: management focuses on promoting skin hydration, maintaining skin integrity, and preventing infection. First and foremost, avoid hot water and any skin or hair product containing perfumes, dies, or fragrance. Bathe the child twice a day in warm water. Use mild soap like dove or tone or caress. Slightly pat the child dry after the bath but do not rub the skin. Leave the child moist. Apply prescribed topical appointments or creams such as corticosteroids or immune modulator's. Apply fragrance free moisturizer over the prescribed topical Medication and all over the child's body. Avoid clothing made of synthetic fibers or wool. Cut the child's finger nails short and keep them clean. Avoid tight clothing and heat. Use 100% cotton bed sheets and pajamas.. It's extremely important to prevent the child from scratching. Antihistamines given at bedtime they sedate the child enough to allow them to sleep. Keep a scratching diary. A handheld clicker may raise awareness. Use of diversion, imagination, play. Pressing the skin or clenching the fist may replace scratching.

Nursing assessment for Reye syndrome

Elicit a description of the present illness in chief complaint. Common signs and symptoms reported during the health history might include: severe and continual vomiting, changes in mental status (from brain swelling), lethargy, hyperreflexia, Irritability, confusion, elevated liver enzymes. Explore the child's current and past medical history for risk factors such as: a prodromal viral illness, like chickenpox, croup, flu, Or an upper respiratory infection. Ingestion of salicylate containing products within three weeks of the start of the viral illness. Elevated liver function tests and elevated serum ammonia levels can confirm diagnosis.

Enuresis

Enuresis is continued incontinence of urine past the age of toilet training. Nocturnal enuresis generally subsides by six years of age. Enuresis can be secondary to physical disorders like diabetes, sickle cell anemia, ectopic ureter, or urethral obstruction. Nocturnal enuresis can be related to high fluid intake in the evening, obstructive sleep apnea, sexual abuse, family history, or inappropriate family expectations. Primary enuresis: enuresis in a child who has never achieved voluntary bladder control Secondary enuresis: Urinary incontinence in the childhood previously demonstrated bladder control over a period of at least 3 to 6 consecutive months Diurnal enuresis: Daytime loss of urinary control Nocturnal enuresis: Nighttime bedwetting

Nursing management for neuroblastoma

Nursing care depends on site of tumor removal which is most often the abdomen. Provide routine care after abdominal surgery. Also provide routine care for effects of chemotherapy and radiation. Provide emotional support and possible referrals to help children and families cope with a potentially poor prognosis. Address pain. Stick to pain relief regimen and if it is PRN assess pain every hour. For promoting nutrition, allow them to eat whatever they want.

Pharmacological therapies

Expectorants: liquify secretions Cough suppressant's "dextromethorphan" when indicated? Antihistamines: drying effect Antibiotics Racemic epinephrine inhaled: temporary relief of chest tightness and wheezing. Anticholinergics: relax and dilate bronchioles; reduce mucus production; Ipatropium, adjunct a beta 2 agonist.

school age pain

Finding alternatives for pain management: new pain management protocols being developed and used. Non-opioid meds: acetaminophen, celecoxib and gabapentin. started 48 hours before surgery. Continued use of non-opioid meds the morning of surgery and for only five days afterward. Use of opioids only as secondary meds in support of the other three pain relievers. Raising awareness of opioid issue. Potential of children and teens becoming part Of the opioid problem from meds prescribed for post surgical pain. Proper disposal of unused opioids. Providing info and education non-appropriate pain med dosages for pediatric patients.

Nursing management/teaching: enuresis

For the child with diurnal enuresis, encourage him or her to increase the amount of fluid consume during the day in order to increase the frequency. Set a fixed schedule for the child to attempt to avoid throughout the day. These practices will usually be sufficient to reaching the child. The child over six years old with nocturnal enuresis without a physiologic cause may require a varied approach. Teach the family that the child is not lazy nor do they wet the bed intentionally. Encourage the child and family to read books that encourage techniques that stop bedwetting. Encourage parents to limit intake of bladder irritants such as chocolate and caffeine. Ensure the child boys just before going to bed. Use bed pads. Parents can also set up a reward system for dry nights and include the child in bed linen changes when he or she does with the bed, but should do so not in a punitive way. It is important to always avoid punishment for bedwetting. Many families also find great success with the use of enuresis alarm (In lecture she said they don't work well)

Assessment of the child with a G.I. disorder

Gather a past history, if the child has familial G.I. symptoms or disorder such as irritable bowel syndrome, inflammatory bowel disease or food allergies. Perform physical examination and go from least invasive parts of the most invasive. Inspect and observed the child color, hydration status, abdominal size and shape, and mental status. Observe the child skin, eyes, and lip color as pallor may be a sign of anemia or dehydration. Note presence of jaundice, inspect the abdomen for distended veins indicating Abdominal or vascular obstruction or distention. Watch for areas of ecchymosis which may be a sign of abuse. Carefully assess the child hydration status as it may indicate how severe the current G.I. illness is. Decreased turgor and skin turgor tinting indicate dehydration. The absence of tears during crying may indicate dehydration. the number of wet diapers and amount of urine output the child has had in the past 24 hours. Perform weight comparisons.

Nursing assessment for muscle dystrophy

Gather health history and physical examination. Boys with Duchenne muscular dystrophy learn to walk but over time become unable to do so. Inquire about functional status and need for assistive or adaptive equipment such as braces or wheelchairs. Note a history of cough or frequent respiratory infections which occur as the respiratory muscles weaken. Ask about psychosocial issues such as low self-esteem or depression or alterations and socialization that might be present. Observe the child's ability to rise from the floor. A hallmark finding of Duchenne muscular dystrophy is the presence of Gowers sign. The child cannot rise from the floor in standard fashion Because of increasing weakness. Observe the child gait, determine effectiveness of cough. Auscultate heart and lungs, no tachycardia which develops as heart muscle weekends. Note adequacy of breath sounds which may diminish with decreasing respiratory function. And palpate the muscles to see if there is muscle atrophy. Labs and diagnostics: Electromyography (EMG) Demonstrates that the problem lies in the muscles, not in the nerves. Serum creatinine kinase levels are elevated early in the disorder one significant muscle wasting his activity occurring. Muscle biopsy provides definitive diagnosis demonstrating the absence of dystrophin.

Nursing assessment: cerebral palsy

Gather information about gestational and perinatal events. Physical examination: Observe general appearance. Pay close attention to the neurologic assessment and motor assessment. Assess for delayed development, size for age, and sensory alterations such as strabismus, vision problems, and speech disorders. Abnormal postures may be present. While lying supine, the infant may demonstrate scissor crossing of the legs with plantar flexion. In the prone position the infant may raise his or her head higher than normal due to arching of the back. The infant may also abnormally flex the arms and legs under the truck. Primitive reflexes may persist beyond the point at which they disappear and a healthy infant. Watch the infant or child play, crawl, walk, or climb to determine motor function and capability. They may scoot on their back instead of crawl or walk. It says active and passive range of motion. Pay particular attention to muscle tone, hypertonicity is most often seen.

Growth hormone deficiency

Growth hormone deficiency, also known as hypopituitaryism or dwarfism, is characterized by poor growth and short stature. It is generally a result of the failure of the anterior pituitary or hypothalamus stimulation on the pituitary to produce sufficient GH. Primary causes of GH deficiency Include injury to or destruction of the anterior pituitary gland or hypothalamus. Causes include tumor, infection, infarction, CNS irradiation, abnormal formation of these organs in utero, or damage or trauma during birth or after. They can also be part of genetic syndrome, such as prater Willi syndrome or turner syndrome or the result of genetic mutation or deletion. In some cases the cost may be idiopathic.

Growth hormone deficiency assessment

Health history may reveal a familial pattern or short stature or a prenatal history of maternal disorders such as malnutrition. It says the child's feelings about being short. Physical examination: height will be at or below the 3rd percentile. Child may have higher weight to height ratio. Other findings may include prominent subcutaneous deposits of abdominal fat; a child like face with a large prominent for head; a high-pitched voice; delayed sexual maturation; delayed dentention; delayed skeletal maturation; and decreased muscle mass. Labs: Labs will rule out chronic illnesses such as renal failure or liver and thyroid dysfunction. Lab tests include: -bone age -CT or MRI To rule out tumors or structural abnormalities. -Pituitary function testing confirms the diagnosis. This test consists of providing a GH stimulant such as glucagon, clonidine, insulin, arginine, or L dopa to stimulate the pituitary to release a burst of GH. Peak GH levels below 7 to 10 ng/mL In at least two tests confirms the diagnosis.

Precocious puberty assessment

Health history may reveal complaints of headache, nausea, vomiting, and visual disturbances due to circulating hormones. Child may show emotional liability, aggressive behavior, and mood swings. Child may have a history of risk factors such as exposure to exogenous hormones, History of CNS trauma or infection, or a family history of early puberty. Physical examination may reveal acne and an adult like body odor. Child will present with an accelerated rate of growth. The child does not typically display sexual behavior. Females may present with menstration.

Ericksons adolescent

Identity vs role confusion. As the adolescent is trying out many different roles in regard to his or her relationships with peers, family, community, and society, he or she is developing his or her own individual sense of self. If the adolescent is not successful in forming his or her own sense of self, he or she develops a sense of role confusion or diffusion. Erikson believed that during the stage the adolescent revisits each of the previous stages of development. Revisiting sense of trust, autonomy, avoiding behaviors that would shame ridicule him or her in front of peers, the sense of initiative is revisited as they develop vision for what they may become, and since of industries again encountered as adolescent makes his or her choice to participate in different activities at school, community, church, workforce. They have increasing reliance on peers, ambivalent feelings toward their family, anxiety over and/or preoccupation with sex and sexuality.

Impetigo

Impetigo is a readily recognizable skin rash. Nonbullous impetigo Generally follows some type of skin trauma or may arise as a secondary bacterial infection of another skin disorder such as a topic dermatitis. Bullous Impetigo demonstrates a sporadic occurrence pattern and develops on intact skin. Note history of skin disruption such as cut, scrape, or insect or spider bite. Note body piercing in the adolescent. Measure child's temperature because fever can occur with bullous impetigo. Findings: (non bullous) papules progressing to vesicles, then painless pustules with a narrowing erythematous border. Honey colored exudate when the vesicles rupture. (Bullous): Read macules and bullous eruption's on an erythematous base. Size may be from a few millimeters to several centimeters. Treatment: administer antibiotics topically or systemically as prescribed. Soak lesions with cool compress or burrow solution to remove crust before applying topical anabiotic's. The impetigo is considered a contagious disorder among vulnerable populations, removal from school or day care is not necessary unless the condition is widespread or actively weeping.

Precocious puberty

In precocious puberty the child develop sexual characteristics before the usual age of puberty onset. Normal puberty typically occurs around 10 to 12 years for girls and 11 to 14 for boys. In precocious puberty, secondary sexual characteristics develop in girls before the age of 8 and then for boys, younger than 9. Disorder is more common in females and the majority of the time the cause is unknown in females, while in males a structural CNS abnormality is often present. Other causes include hypothalamic tumor, brain injury or radiation, history of infectious Encephalitis, meningitis, congenital adrenal hyperplasia, and tumors of the ovary, adrenal gland, pituitary gland, or testes.

Idiopathic causes of growth hormone deficiency

In some cases the cars maybe idiopathic such as nutritional deprivation or psychosocial issues, and reversible. Psychosocial dwarfism results from emotional deprivation causes suppression of production of the pituitary hormones, resulting in decreased GH. The child is withdrawn, has a bizarre eating and drinking habits such as drinking from the toilet, and has primitive speech. The treatment involves removing the child from the dysfunctional environment and providing normal dietary intake. With normalized eating and behavioral habits, pituitary secretion is restored.

cystic fibrosis presentation

Inability to digest fat, protein, and some sugars. Stools are large, bulky, and greasy (steatorrhea). Foul smelling stools. Protuberant abdomen. Only 50% of food is digested which causes malnutrition. Malnutrition leads to emaciated extremities and loose, flabby folds of skin on buttocks. 4 symptoms: Malnutrition, protuberant abdomen, steatorrhea, fat soluble vitamin deficiency (ADEK). Newborn: Thick meconium if pancreatic enzymes lacking, obstruct the intestine, abdominal distention with no passage of stool. Observe for stool passage within 24 hours of birth. Rectal prolapse

Bacterial skin infections

Include bullous and non-bullous impetigo, Folliculitis, Cellulitis, and staphylococcyl scalded skin syndrome.

BUN

Indirect measurement of renal function and GFR in the presence of adequate liver function. Used to monitor progression of kidney failure. Liver breaks down proteins then urea nitrogen is released in the bloodstream and filters through kidneys. With healthy kidneys it filters out into the urine, with unhealthy kidneys it does not, and raises the BUN level in the blood. It is indicated for nephrotic syndrome, hemolytic uremic syndrome, renal failure, acute glomerulonephritis. BUN may be elevated with high protein diet or dehydration, maybe decreased with over hydration or malnutrition

Erickson's School Age Stage

Industry versus inferiority Focus is on achievements. They like to finish projects and receive recognition. The child is very interested in learning how things are made and work. If the expectations of adults are set too high, the child will develop a sense of inferiority and incompetence that can affect all aspects of life. In the hospital it's important to give a child praise and recognition and they can even help with tasks pertaining to their own care like making the bed.

Nursing management for Hirschsprung's disease

Nursing management includes providing postop care, ostomy care, and providing child and family education. Observe for the possible complication of enterocolitis. Perform proper ostomy care to avoid skin breakdown. Accurately measure stool output to assess the child fluid volume status. Observe for signs and symptoms of enterocolitis: fever, abdominal distention, chronic diarrhea or explosive stools, rectal bleeding, or straining. If any of the above symptoms are noted, immediately notify the physician or nurse practitioner, maintain bowel rest, and administer IV fluids and antibiotics to prevent the development of shock and possibly death. Educate parents on proper stoma care as well as medication management to avoid dehydration. Most children with Hirschsprung disease will be prescribe medication to slow stool output.

Epiglottitis

Inflammation and swelling of the epiglottis. Most often caused by HIB virus. Has become a rare occurrence since the extensive use of the HIB vaccine. Respiratory arrest in death may occur if the airway becomes completely occluded. S/S: Epiglottitis is characterized by dysphasia, drooling, anxiety, irritability, and significant respiratory distress. Prepare for the event of sudden airway occlusion. Nursing assessment: note sudden onset of symptoms in high fever. The child has an overall toxic appearance. He or she may refuse to speak or may speak only with a very soft voice. The child may refuse to lie down and may assume the characteristic position of sitting forward with neck extended. Drawling may be present. Note anxiety or frightened appearance. No child color. Cough is usually absent. A lateral neck radiograph may be performed to determine if epiglottitis is present. This is done cautiously so as not to induce Airway obstruction. Do not under any circumstance attempt to visualize the throat, because it can trigger reflex laryngospasm. Nursing management: do not leave the child unattended. Keep the child and parents as calm as possible. Allow the child to assume a position of comfort. Do not place the child in supine position. Provide 100% oxygen in the least invasive manner that is acceptable to the child. If the child experiences complete airway occlusion, and emergency tracheostomy may be necessary. Ensure that emergency equipment is available.

Bronchiolitis

Inflammation of the fine bronchioles and small bronchi. Nearly always caused by a virus. RSV accounts for the majority of cases of bronchiolitis followed by adenovirus para influencer virus. The peak incidence of bronchiolitis is the winter and spring. It is transmitted by close contact with nursing staff, families, and other children. Virtually all children will contract RSV infection within the first few years of life. It occurs most often in infants and toddlers, but frequency and severity of RSV decrease with age. RSV causes necrosis of respiratory epithelium of the small airways, plugging of the lumens with mucus and exudate. This allows adequate inspiration but prevents for exploration leading to hyper inflation and atelectasis. This can cause arterial hypoxemia and carbon dioxide retention. The lumen of the bronchi can also narrow from swelling. S/S and findings: Onset of illness with a clear runny nose, pharyngitis, low-grade fever, development of cough 1 to 3 days into the illness followed by a wheeze shortly there after, poor feeding. Leukocytosis, elevated ESR (Sedimentation rate, has to do with inflammation) Treatment: focuses on supportive treatment, supplemental oxygen, nasopharyngeal suctioning, oral or intravenous hydration, and inhaled bronchodilator therapy with racemic epi or albuterol/levalbuterol. In Lecture was stated these meds generally do not help, but that oxygenation, hydration, and time are what is truly needed. The infant with tachypnea and significant retractions, poor oral intake or lethargy can deteriorate quickly. Nursing management: RSV infection is usually self limited. Children with less severe disease might require only antipyretics, adequate hydration, and close observation. They can be managed at home. Teach parents or caregivers to watch for signs of worsening and to seek care quickly should child condition deteriorate. There also may be feeding issues because of risk of aspiration.

Tonsillitis

Inflammation of the tonsils. Often occurs with pharyngitis thus may also be viral or bacterial. Viral infections require only symptomatic treatment. Treatment for bacterial tonsillitis is the same as for bacterial pharyngitis. Occasionally surgical intervention is warranted (Tonsillectomy) For the child with recurrent streptococcal tonsillitis (7 or more in a year) or massive tonsillar hypertrophy. Nursing assessment: note whether fever is present currently or by history. May also note drooling, ill appearing, puss, throat pain. Inquire about the history of recurrent pharyngitis or tonsillitis. Note if the child's voice sounds muffled or horse. Inspect the pharynx for redness and enlargement of the tonsils. The child may experience difficulty breathing and swallowing. Rapid test or culture may be positive for streptococcus A. Nursing management: until fully awake place the child on a sidelying or prone position to facilitate safe drainage of secretions. Once alert, the child may prefer to sit up or have head of the bed elevated. Suctioning if necessary should be done carefully to avoid trauma to the surgical site. Alert parents to the possibility of the presence of blood. Monitor for hemorrhage. Hemorrhage can occur as late as 10 days post surgery. Mucus tinged with blood may be expected, fresh blood indicates bleeding. Watch for continuous swallowing of small amounts of blood, clearing of the throat, Emesis of bright red blood, other indications of bleeding such as tachycardia, pallor, restlessness. Maintain fluid volume encourage children to take any fluids they desire except citrus juice and brown or red fluids. Citrus may irritate the throat and brown or red fluids can be confused with blood if vomiting occurs. Relieving pain: educate families that for the first 24 hours the throat will be very sore. Celine gargle can be used. Saline gargle can be used.cProvide adequate pain relief, may be done with or without narcotics. Pain relief is done not only for pain but also so that adequate fluid intake can be achieved. Apply ice collar if prescribed.

Topical Immunomodulators

Inhibit T lymphocytes action at the skin level use for moderate to severe a topic dermatitis or in conditions resistant to topical steroids. He's only in children older than two years old. Avoid sunlight exposure. May cause burning, itching, and flu like symptoms.

Physical examination for myelomeningocele

Initial assessment after delivery reveals a visible external sac protruding from the spinal area. Observe general appearance of Baby and assess whether sac covering is intact. Assess neurologic status and look for associated anomalies. Assess for movement of extremities and anal reflex, which will help determine the level of neurologic involvement. Flaccid paralysis, absence of deep tendon reflexes, lack of response to touch and pain stimuli, skeletal abnormalities such as clubbed feet, constant dribbling of urine, and a relaxed anal sphincter may be found.

Differences in GU system in infants/children versus adults

Kidneys sit slightly lower than the ribs than they do in adults. Children do not have as much perinephric fat to pad the kidneys, in the kidney is large in relation to the size of the abdomen until the child reaches adolescence which also makes them less protected from injury. The urethra is naturally shorter in all ages of women compared with men placing them at increased risk for entrance of bacteria into the bladder. This risk is compounded by the physical Proximity of the urethral opening for the rectum. Glomerular filtration rate is slower in the infant and young toddler compared with the adult. The kidney is less able to concentrate urine and reabsorb amino acids, placing the infant and young toddler at increased risk for dehydration during times when fluid loss or decrease fluid intake occurs. The renal system usually reaches functional maturity at around two years old. The expected urine output in the infant and child is 0.5 to 2 mL per kilogram per hour, with the average one year old voiding about 400 to 500 mL per day.

Sexual development

Later in the school aged age group it may be time for "the talk" about sexual development. Possibly around age 9 or 10. Talk to parents of younger school aged. To child if an older end of age group. Talk about changes their body will go through. Growth spurt, breast development, testes and penis growth, body hair. Breast development in male is normal. It is important that children hear this from parents and not from peers.

Tv/ phone screens

Limit screen time to one hour a day. Encourage physical activity instead. Monitor what they are watching on TV computer and phone. Adults should model limiting screen time by limiting their own screen time. Establish a consistent time limit for any media use and develop a family media plan. establish media free time such as meal time. Monitor television programs and Internet activity. Prohibit television or video games with violence. Do not put television, video games, or Internet connected devices in Children's bedrooms. Place computers in an open area that allows easy monitoring by an adult. Watch television and play games with the child. Encourage sports and reading. Teach your child Internet safety such as never giving personal information or passwords. Television watching, Internet activity or games should not be used as a reward.

Leukotrienes

Look at trains or chemical mediators that cause inflammatory response and prolonged airway constriction. So there are available leukotriene inhibitors: Singulair (Montelukast). Chewable or oral granules, contains phenylalanine. Daily dosing in the evening. Not a rescue medicine. May take several weeks for noted improvement.

Therapeutic management for Hirschsprung disease

Surgical resection of the aganglionic bowel and reanastenosis of the remaining intestine are necessary to promote proper bowel function. There are several types of surgical procedures to correct this, usually performed in stages. The surgical resection requires the child to have an ostomy to divert the stool through a stoma on the abdomen. This allows the area of the resected bowel and anastomosis to heal before it is used. The ostomy is closed at a later date.

Diagnostics: lumbar puncture

Lumbar puncture is used to withdraw cerebrospinal fluid from the subarachnoid space for analysis. It's indicated to diagnose hemorrhage, infection, or obstruction. Can obtain measurement of spinal fluid pressure. Important thing to remember about it is the nurse is to assist with proper positioning. Help child maintain position and remain still. Proper positioning is the newborn is positioned upright with head flexed forward. Child or older infant is positioned on the side with head flexed forward and knees flexed to the abdomen. Maintain asepsis. Monitor respiratory status, changes in consciousness, heart rate, pain level. Encourage fluids after procedure if not contraindicated. Keep child flat for One hour if ordered. Apply EMLA cream to puncture site 30 to 60 minutes before procedure if ordered. Headache is a common side effect of lumbar puncture.

Nephrotic syndrome management

Management usually involves the use of corticosteroids. Intervenous albumin may be used in the severely edematous child. Diuretics are also required in the edematic phase. Long-term therapy is usually required to induce remission. Children who have steroid responsive MCNS generally have a favorable prognosis. Immunosuppressive therapy may be necessary. Cortical steroids include methylprednisolone, prednisolone, prednisone. PO corticosteroids have a very bad taste and applesauce may not be strong enough to mask it, chocolate syrup would be a better choice. The corticosteroids are used to knock the immune system down so that the body is not fighting against itself Nursing care: Rest/cluster care, want to conserve their energy. Strict I&O's. Monitor urine protein. Daily weights. Assess and monitor Edema and abdominal girth. Encourage nutrition and may need to be sodium restricted when edematous. Assess for skin breakdown. Monitor and prevent infection.

pulmonary function tests (PFTs)

Measures respiratory flow and lung volumes. Indicated for asthma, cystic fibrosis, chronic lung disease. Usually performed by a respiratory therapist train to do the full spectrum of tests. Spirometry can be obtained by the trained nurse in the outpatient setting.

Immunizations (11-12 years)

Meningococcal Cause: Neisseria meningitis and blood infections. All 11 to 12-year-olds received this, booster at 16. Tdap Human papilloma virus (Gardasil)

Nursing management for cerebral palsy

Mobility is critical to the development of the child. Treatment modalities to promote mobility include physiotherapy, pharmacologic management, and surgery. Surgery is not done often but they are usually orthopedic or Nuro surgical such as tendon lengthening procedures, correction of hip and adductor muscle spasticity or fusion of unstable joints. Of course if casts are used then cast care will be a priority. Pain management. These children may have difficulty eating and swallowing due to poor motor control. Nurse must be aware of special diets such a softer puréed food. Proper positioning during feeding is essential to facilitate swallowing and reduce risk of aspiration. Speech or occupational therapist can assist in working on strengthening swallowing muscles in case is a very severe swelling problems or malnutrition a feeding tube such as a gastrostomy tube may be placed. Always keep suction supplies on hand in case of aspiration The nurse wants to provide support and education with family centered care. If the child has special devices it's important to not only teach the client but also the parents on their use. It's also important to teach about respite care so that the parents or caregivers can take a couple days to rest

muscular dystrophy

Muscular dystrophy is inherited condition that results in progressive muscle weakness and wasting. The primary muscles affected are skeletal muscles although involuntary muscles can be affected later on. The genetic mutation in muscular dystrophy results in absence or decrease of a specific muscle protein that prevents normal function of the muscle. The gene is X linked recessive, meaning that mainly boys are affected, And will receive the gene from their mother. Duchenne Muscular dystrophy is the most common type, there are eight other types. The hips, thighs, pelvis, and shoulders are affected initially as the disease progresses. Eventually all voluntary muscles as well as cardiac and respiratory muscles are affected. Boys with Duchenne muscular dystrophy are often late in learning to walk, it can be cloaked as clumsiness when learning to walk. They may also present with enlarged calves. They also have difficulty climbing stairs and running and cannot get up from the floor in the usual fashion. School-age child may walk on toes or balls of feet with a rolling or waddling gait. During school age years it becomes difficult for the child to raise his arms. And at about 7 to 12 years old they will lose their ability to ambulate. In teen years they may require assistance for their entire trunk.

Precocious puberty therapeutic management

Must first determine cause. For example if etiology is tumor of the CNS, the child undergo surgery, radiation, or chemo. The treatment for central precocious puberty involves administering a GnRH Analog. This is available as a subcutaneous injection given daily, and intranasal compound given two or three times each day, a Depot injection given every 3 to 4 weeks, a Depot injection given quarterly, or a subcutaneous implant yearly. Goal is to stop or even reverse sexual development. Stop rapid growth and bone maturation. Lower the higher levels of sex hormones with meds. Results should be within one year, a decrease or stopping further development of breast size, and for boys penis and testes to shrink back to expected size for age.

Pharmacological therapies

NSAIDs: inhibit prostaglandin synthesis, having a direct effect on pain perception DMARDs: disease modifying antirheumatic drugs Benzodiazepines: anticonvulsants, relieves muscle spasms, decrease spasticity in children with motor neuron lesions Baclofen: skeletal muscle relaxant, treat painful spasms and decrease spasticity in children with motor neuron lesion Corticosteroids: anti-inflammatory and immunosuppressive action. For Muscular dystrophy. Botulinum toxin A: Blocks neuromuscular conduction, relieves spasticity in cerebral palsy

Adolescent nutrition

Need to increase zinc, calcium, and iron. Iron for expanding blood volumes, calcium and vitamin D for rapid skeletal growth, and zinc for sexual maturation and final body growth. Foods high in iron: beef,chicken, seafood, liver tofu, nuts and seeds, lentils, eggs, dark leafy vegetables, fortified cereal Foods high in calcium: fortified cereal, cheese, yogurt, almond milk, white beans, and broccoli. Foods high in protein: Meat, fish, poultry, beans and dairy products Assess how often the adolescent eats fast food and other junk per week. Educate about alternatives and educate client about Myplate.

Neuroblastoma

Neuroblastoma is a tumor that arises from embryonic neural crest cells. It is the most common extracranial solid tumor and children. It most frequently occurs in the abdomen, mainly in the adrenal gland, but it may occur anywhere along the paravertebral sympathetic chain in the chest or retroperitoneum. By the time of diagnosis which is past infancy or early toddler hood, the neuroblastoma has usually already metastasized. Staging of the tumor at diagnosis determines the course of treatment and prognosis. Stages are I through IVS. Metastasis to the bone is a worst prognostic factor than metastasis to skin, liver, or bone marrow. Complications may include nerve compression, resulting in neurologic deficits. The neuroblastoma must be removed surgically. Radiation and chemo therapy or administer to all children with neuroblastoma except those with stage one disease in whom the tumor is completely resected.

Anatomy and physiology of children respiratory system

Newborns are obligatory nose breathers. Newborn only breathe through mouth while crying. Large tongue in infant relative to oropharynx. Airway lumen smaller in infants and children. Highly compliant airway leads to susceptible airway collapse. Children have significantly fewer alveoli than a full grown adult increasing chance of hypoxia and CO2 retention. Bifurcation of trachea is at third thoracic vertebrae in children versus the sixth in adults.

Asthma continued

Observe the child's general appearance and color. If asthma worse and cyanosis may result. Assess work of breathing which is variable ranges from mild retractions to significant accessory muscle use and eventually head bobbing if not treated effectively. Note lethargy, irritability, or the appearance of anxiety or fearfulness. Wheezing Is the hallmark of airway obstruction. A quiet chest upon auscultation in an asthmatic child can be an ominous sign. Percussion may yield hyperresonance. Asthma pathophysiology: when the process begins, mast cells, T lymphocytes, macrophages, and epithelial cells are involved in the release of inflammatory mediators. EosinoPhils and neutrophils migrate to the airway, causing injury. Chemical mediators such as leukotrienes*, bradykinin, histamine, and platelet activating factor also contribute to the inflammatory response. The presence of leukotriene contributes to prolonged airway constriction. Autonomic neural control of airway tone is affected, airway mucus secretion is increased, mucociliary function changes, and airway smooth muscle responsiveness increases. As a result, acute bronchoconstriction, airway Edema, and mucus plugging occur. * Remember leukotrienes Because it will come in to play when talking about medications.

Constipation Medications

Over the counter fiber supplements, over the counter stool softeners (glycerin suppositories), laxatives (MiraLAX, does titrated to obtain a soft formed stool every day).

The Hospitalized School-Age Child

Parents are important. Maintain contact with peers and school activities. Provide privacy and modesty. Involve them in their own care (sense of accomplishment) They experience loss of freedom so allow some measure of control when possible Encourage child to do what they can for themselves such as make their own bed, encourage interactions with other children and play games.

Promoting healthy eating habits

Parents should provide children with a variety of food. Myplate illustrates the five food groups and encourages children to make half of their plate fruits and vegetables, to make half of their grains whole grains, and to choose lean proteins and calcium rich foods. School age children need to limit intake of fat and processed sugars. Provide the child with food and if they do not eat it, that means they are probably not hungry, put the food away and wait a little while bring it back out and they will eat it.

Nursing assessment for neuroblastoma

Presenting signs and symptoms depend on location of the primary tumor and extent of metastasis. Often parents are the first to notice a swollen or asymmetric abdomen. Elicit the health history, documenting bowel or bladder dysfunction, especially watery diarrhea, neurologic symptoms (brain metastasis) Bone pain, anorexia (decreased thoracic cavity space), vomiting, or weight loss. Upon physical exam note neck or facial swelling, bruising above the eyes, or Edema around the eyes (skull mets). Inspect the skin for pallor or bruising (marrow mets). Document cough or difficulty breathing. Auscultate the lungs for wheezing. Palpate for lymphadenopathy, especially cervical. Palpate the abdomen, noting a firm, nontender mass. Palpate for a note hepatomegaly or splenomegaly if present. If there is an abdominal mass, palpate very gently because there's a type of tumor that if palpated to harshly can cause fatal hemorrhage.

Nursing management for myelomeningocele

Preventing trauma to the meningeal sac and preventing infection before surgical repair of the defect is goal. The potential for rupture is central nursing concern in the newborn. The goal is to prevent rupture or leakage of CSF from the sack. Keeping the sack from drying out is important. Use sterile saline soaked non adhesive gauze or antibiotic soaked gauze to keep the sac moist. Immediately report any seepage of clear fluid from the lesion. Position the infant in prone position or supported on the side to avoid pressure on the sac. To keep infant warm, placed the infant in a warmer or isolette to avoid the use of blankets which could exert too much pressure on the sac. Pay special attention while the infant is in A warmer as that can cause the sac to dry out. Keep the lesion free from feces or urine to help avoid infection. Position the infant so that urine and feces flow away from the sac (Either prone, or place to fold a towel under the abdomen). Placing a plastic wrap below the meningocele is another way of preventing feces from coming into contact with the lesion. Bowel training with the use of timed enemas or suppositories along with diet modifications can allow for defecation at predetermined times once or twice a day. Assist the family in assuming as normal a feeding position as possible. Risk of rupture may be too hard to warrant holding. Therefore the infants head can be turned to the side or infant can be placed in the sideline position to facilitate feeding. Encourage interaction during feeding to promote intake Due to repeated exposures these children are at a higher risk of developing latex allergy. Latex free environment should be created for all procedures performed on children with myelomeningocele to prevent latex allergy. Maintaining skin integrity is also a part of management. The prone position puts constant pressure on the knees and elbows, and it may be difficult to keep the infant clean of urine and feces. Diapering may be contraindicated preoperatively therefore, ensure the infants kept it clean and dry as possible. Placing a pad beneath the diaper area and changing it frequently is important. Perform meticulous skin care. Place the Internet a special care mattress in place synthetic sheepskin under the infant to help reduce friction. Special attention to the infants legs needs to occur in positioning them since Paralysis may be present. Using a folded diaper between the legs can help reduce pressure and friction from the legs rubbing together.

Firearm Safety

Provide education about gun safety. Guns in the home must be kept in a locked in a safe location with ammunition kept separately. Parents must teach adolescence about the dangers of playing with firearms.

Electroencephalogram (EEG)

Records changes in electrical potential (measures electrical activity of the brain). Electrodes are placed at various points to assess electrical function in a particular area. Impulses are recorded by electromagnetic pin or digitally. Requires patient to remain quiet and still during procedure and may require sedation, But should be avoided if possible because sedatives can alter the EEG reading. Minimize external stimuli during procedure. It is used to diagnose seizures and brain death,Evaluate brain tumors, subdural hematomas, intracranial hemorrhages. Inform technician of what anticonvulsants the child is taking. Morning anticonvulsants may need to be held.

Type 1 diabetes nutritional guidelines

Provide sufficient calories and good nutrition for normal growth and development. Diet low in saturated fats and concentrated carbs. Learn to identify carbs, proteins, and fat foods. Make adjustments during periods of rapid growth in for issues such as travel, school parties, and holidays. Provide three meals a day and mid afternoon and bedtime snacks. Be consistent in intake to prevent complications and maintain near normal blood glucose levels. Encourage child to exercise routinely to help the body use insulin efficiently, to reduce the insulin requirement. Encourage child to participate in age-appropriate sports. When exercising, monitor insulin dose and nutritional and fluid intake. Observe for hypoglycemic reactions. Add an extra snack with 15 to 30 g of carbs for each 45 to 60 minutes of exercise. Avoid exercising excessively with insulin is peaking.

Venturi mask

Provides 24 to 50% oxygen by using a special gauge at the base of the mask that allows and mixing of room here with oxygen flow. Set oxygen flow rate according to percentage of oxygen desired as indicated on the gauge.

Oxygen hood

Provides high concentration up to 80 to 90% for infants only. Allows easy access to chest and lower body. Liter flow must be said at 10 to 15 L per minute. Good method for infant but needs to be removed for feeding. Can and should be humidified.

oxygen tent

Provides high humidity environment with up to 50% oxygen concentration. Oxygen level drops when tent is opened. Must change linen frequently as it becomes damp from the humidity. Secure edges of tent with blankets or by tucking edges under mattress. Young children may be fearful and resistant. Mist may interfere with visualization of child inside tent.

Nasal cannula

Provides low oxygen concentration of 22 to 44%. Must be used with humidification to prevent drying and irritation of airways. Can provide very small amounts of oxygen as low as 25 mL a minute. Maximum recommended liter flow in children is 4 L per minute. Children can eat or talk while on oxygen. Inspired oxygen concentration affected by mouth breathing. Requires patent nasal passages.

Therapeutic management of ADHD

Psychostimulants, non-stimulant norepinephrine reuptake inhibitor's, or a agonist antihypertensive agents. They are not cures but help to increase child's ability to pay attention and decreased level of impulse behavior. Nursing management: provide emotional support, allowing enough time for the family to air their concerns. Work with a child and family to develop goals such as completion of homework, improve communication, or increasing independence in self-care. Assist the family to advocate for their child's needs through the public school system. Teach families and school personnel to use behavioral techniques such as time out, positive reinforcement, reward or privilege withdrawal, or a token system.

puberty

Puberty in girls: breast changes, rapid increase in height and weight, pubic hair growth, axillary hair appears, ministration, abrupt decel of linear growth. Puberty and boys: testes and large, pubic hair grows, axillary hair, facial hair, and body hair. Rapid increase in height. Change and larynx invoice. Nocturnal emissions. Abrupt decel of linear growth. Puberty is when a boy or a girl becomes sexually mature. For girls it's usually takes place between ages 10 and 14. For boys between ages 12 and 16. In girls the first sign of fever he's usually breast development, then hair grows in the pubic area and axillae, then ministration happens last. And boys puberty usually begins with testicular and penis growth, then hair grows in the pubic area in axillae, muscles grow, the voice deepens, and facial hair develops as puberty continues.

Precocious puberty labs and diagnostics

Radiologic examinations and pelvic ultrasound identify advanced bound age, increased uterus size, and development of ovaries consistent with a diagnosis of precocious puberty. Lab studies include screening radioimmunoassays forLH, FSH, estradiol, or testosterone. The child's response to connect a trap and releasing hormone stimulation confirms the diagnosis of central precocious puberty versus gonadotropin independent purity. This test involves administering synthetic GnRH intravenously and drawing serial blood levels, about every two hours

Staphylococcal scalded skin syndrome

Results from infection with S. aureus that produces a toxin, which then causes exfoliation. It has an abrupt onset and resulting diffuse erythema (Reddening of the skin). It is common in infancy and rare beyond five years of age. Of particular concern is community acquired bacterial skin infections caused by methicillin-resistant S. aureus. MRSA Most commonly occurs as a scan or soft tissue infection, such as cellulitis or an abscess. Risk factors are turf burns, towel sharing, participation in team sports, or attendance at day care or outdoor camps. If child presents with a skin infection that is not responding as expected to therapy, it is important to culture for MRSA. Findings: flattish Bullae that rupture within hours. Red, weeping surface is left, mostly commonly on face, groin, neck, and axillary region. The skin will peel like a sunburn. Treatment: first golden skin syndrome, reduce the risk of scarring by minimal handling, avoiding corticosteroids, and applying soothing appointments as the skin heals.

Reye syndrome

Reye syndrome is an extremely rare disease that primarily affects children younger than 15 years of age who are recovering from a viral illness. The cause is unknown. Reye syndrome is a reaction that is triggered by the use of salicylates or salicylate containing products to treat a viral infection. This reaction causes brain swelling, liver failure, and death and hours if treatment is not initiated.

Nonrebreathing mask

Simple face mask with valves at the exhalation port and an oxygen reservoir bag with a valve to prevent exhaled air from entering the reservoir. Provides 95% oxygen concentration. Must set liter flow rate at 10 to 12 L per minute to prevent rebreathing of carbon dioxide. The reservoir bag does not completely empty when the child inspires if the flow rate is set properly.

Long term effects of marijuana use

Sinusitis, bronchitis, emphysema, lung cancer, low sperm count in males.

Nursing assessment for intussusception

Sudden onset of intermittent crampy abdominal pain. Severe pain, (children usually draw up their knees and scream) Vomiting. Diarrhea. Currant jelly stools (remember this), gross blood, or Hemoccult positive stools. Lethargy Determine risk factors such as cystic fibrosis or celiac disease. Determine severity of pain, length of time the symptoms have been present, presence of vomiting, and stool patterns in color. Palpate the abdomen for presence of a sausage shaped mass in the upper mid abdomen which is a hallmark sign. A barium enema is sometimes successful at reducing a large percentage of Intussusception cases. Otherwise surgery is required. Immediately report the presence of bilious vomiting, which occurs only in an obstructive situation. Nursing management: administer IV fluids and anabiotic's before the diagnostic laboratory and radiograph studies are performed.

Pyloric stenosis

The circular muscle of the pylorus becomes hypertrophied, causing sickness in the lumen outside of the pyloric can now creating a gastric outlet obstruction to the duodenum. This causes non-bilious vomiting that presents between weeks three and six of life. The vomiting becomes more frequent and forceful as time goes on and is often projectile. Pyloric stenosis require surgical intervention. The pyloromyotomy is performed to cut the muscle of the pylorus and relieve the gastric outlet obstruction.

Type 2 diabetes

The consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue with different degrees of B cell impairment. The pancreas usually produces insulin with the body is resistant to the insulin or there is an in adequate insulin secretion response. Eventually, insulin production decreases with a result similar to type one diabetes. It has a gradual insidious onset. Causes can be genetics, obesity, physical inactivity, high triglycerides over 250 mg/dL, hypertension, excess fat around the abdomen. Labs: eight hour fasting blood glucose greater than or equal to 126 mg/dL. Random blood glucose greater than or equal to 200 mg/dL with signs and symptoms. A1c greater than 4 to 5.9%, children acceptable range is 6.5 to 8 with a target goal of less than seven. Signs and symptoms: polyuria, polydipsia, fatigue, blurry vision, acanthosis nigricans. Treatment: oral antidiabetic agents or insulin if not controlled with nutrition and exercise.

Growth hormone deficiency nursing management

The goal of growth promotion is for the child to demonstrate an improved growth rate, as evidenced by at least 3 to 5 inches of linear growth in the first year of treatment without complications. They will be referred to endocrinologist, height should be monitored every 3 to 6 months. Height should be plotted on a growth chart. Treatment stops when epiphyseal growth plate fuse. Treatment: Somatropin (Growth hormone) It is supplied in a powder or multidose pen. Must do teaching on giving the right dose and how to prepare the powder. Show them how to give a subcutaneous injection and then have them return a demonstration. Be sure to rotate injection sites. Report side effects: Headache, rapid weight gain, increased thirst/urination, painful hip and knee joints. Stress the need for compliance of injections and follow up appointments. Talk about financial costs

meningocele

The less serious form of spina bifida cystica, occurs when the meninges herniate through a defect in the vertebrae. The spinal cord is usually normal and there are typically minor or no associated neurological deficits. It's really just a sack of CSF. Initial assessment will Reveal a visible external sac protruding from the spinal area. Most often seen in the lumbar region but can be anywhere along the spinal canal. Most are covered with skin and pose no threat to the child. However, assessment to ensure that the sack covering is intact remains important. Assess neurologic status carefully. Diagnostic procedures (should surgery be needed) will be CT, MRI, and ultrasound. Surgical correction may be delayed if the skin covering the sac is intact, and the child has normal neurologic functioning. Report any evidence of leaking CSF to ensure prompt intervention to prevent infection. Nursing management will be supportive. Provide pre-and post operative care similar to the child with myelomeningocele to prevent rupture of the sac, to prevent infection, and to provide adequate nutrition and hydration. Monitor for symptoms of constipation or bladder dysfunction that may result due to the size of the lesion (The meningocele may be in the area of nerves that control those functions). Resulting hydrocephalus has been associated with some cases of meningocele, therefore, monitor head circumference and watch for signs and symptoms of ICP.

Trikafta (elexacaftor/tezacaftor/ivacaftor)

The long-awaited cystic fibrosis drug. It has one copy of it 508DEL mutation. It is for patient's age 12 years and older. Together, the three components help F508DEL-CFTR Proteins function better. It has taken once at nighttime and once in the daytime. Causes fewer pulmonary exacerbations, decreases sweat chloride, improvement in CF respiratory symptoms, increase in BMI

Precocious puberty: pathophysiology

The most common form is central precocious puberty. Develops as a result of premature activation of the hypothalamic pituitary gonadal axis that results in the production of gonadotropin releasing hormone (GnRH), Which stimulates the pituitary to produce luteinizing hormone and follicle stimulating hormone. These hormones stimulate the gonads to secrete the sex hormones estrogen or testosterone. The child develops sexual characteristics, shows increased growth and skeletal maturation, and has reproductive capability. If left untreated the child may become fertile. In addition, the hormones stimulate rapid growth. Therefore the child may appear taller than peers but will reach skeletal maturity and closure of the epiphyseal plates early which results in overall short stature.

myelomeningocele

The most severe form of neuro tube defect. Clinically the term "spina bifida" is often used to refer to Myelomeningocele. It is visually obvious at birth, and the newborn is at increased risk for meningitis, hypoxia, and hemorrhage. In myelomeningocele the spinal cord often ends at the point of the defect, resulting in absent motor and sensory function beyond that point. Therefore, long-term complications of paralysis, orthopedic deformities, and bladder and bowel incontinence are often seen in children with myelomeningocele. The presence of neurogenic bladder and frequent catheterizations put the child at an increased risk for urinary tract infections, pyelonephritis, and Hydronephrosis which can result in long-term renal damage. It also may be accompanied with hydrocephalus. This is due to improper development and the downward displacement of the brain into the cervical spine, CSF flow is blocked, resulting in hydrocephalus. Learning problems and seizures are common in these children.

Urinary tract infections

The urinary tract from the kidneys to the urethral meatus is normally sterile and resistant bacterial colonization despite frequent contamination of the distal urethra. The major defense against UTI is complete emptying of the bladder during urination. Other mechanisms that maintain stability include urine acidity, and the vesicoureteral valve, and various immunologic and mucosal barriers. However UTI occurs most often because bacteria asending to the bladder via the urethra In spite of these defenses. One explanation is in females they have a shorter urethra. UTI presents differently in infants than it does in children. Infants may exhibit fever, irritability, vomiting, failure to thrive, or jaundice. Children may also experience fever and vomiting, but also may have dysuria, frequency, hesitancy, urgency, and or pain. UTI is diagnosed with urinalysis and culture. > 100,000 colony count of bacteria per mL is diagnostic for UTI.

Urinalysis

Urinalysis evaluates color, pH, specific gravity, the odor of urine. Also assesses for presence of protein, glucose, keytones, blood, leukocyte esterase, red and white blood cells, bacteria, crystals, and casts. Reveals preliminary information about the urinary tract. Useful in children with fever, dysuria, flank pain, urgency, or hematuria. Protein urea may be noted in renal disorders. Nursing implications: be aware of the many drugs affecting urine color and notify laboratory if child is taking one. Notify laboratory a female is menstruating. Refrigerate specimen if not processed promptly. While proteinuria may occur with various renal disorder's, it may also occur as either transcend or orthostatic proteinurea, both of which are benign.

Constipation/encopresis: Therapeutic management

Therapeutic management: Once any organic process is ruled out as a cause, constipation may be initially managed with dietary manipulation such as increasing fiber and fluids. However behavior modification is necessary for most children, and children need to relearn how to allow evacuation. Children with severe constipation and withholding behaviors may require laxative therapy. Other management is to encourage physical activity, potty training 30 minutes after breakfast and after dinner, They should sit on toilet for 5 to 15 minutes with their feet on a stool as necessary. And reward with stickers to encourage compliance. Parents should award the star for compliance with time sitting on the toilet and should not reserve rewards for successful bowel movements only. Assessment: Assess abdominal size and shape, palpate for masses, listen to bowel sounds, they will be hypoactive if theres an obstruction. If no bowel sounds are heard after five minutes then bowel sounds are absent

Fungal infections (tinea)

Tinea is a fungal disease of the skin occurring on any part of the body. All fungal skin infections may occur around, but tinea versicolor is more common in warm weather. Therapeutic management of fungal infections involves appropriate hygiene (the big thing) and administration of antifungal agent. Elicit health history noting exposure to another person with a fungal infection or exposure to a pet. Note onset of rash and whether or not it is itchy. Determine a child has recently visited the barber (tinea capitis) Or has been in contact with damp areas such as locker rooms and swimming pools. Nursing management: Tinea corporis is contagious, but the child may return to daycare or school once treatment has begun. Keep child from scratching Council the child with tinea capitis that hair will regrow in 3 to 12 months (fungus has to be eliminated before hair can re-grow). Wash sheets and clothes in hot water to decrease risk of spread to other family members. Instruct the child with tinea pedis to keep the feet clean and dried. Rinse feed with water or a water/vinegar mixture and dry well. Cancel child or adolescent with tinea Cruris to wear cotton underwear and loose clothing.

High flow devices

To qualify as a high-flow device, a system should provide at least 60 L/min total flow. Flow rate will be 15 L per minute or wide open. This flow criterion is based on the fact that the average adult peak inspiratory flow during tidal ventilation is approximately three times the minute volume. Because 20 L/min is close to the upper limit of sustainable minute volume for an ill person, a flow of 3 × 20, or 60 L/min, should suffice in most situations. In a few rare circumstances, flow must reach or exceed 100 L/min.

Controlling exposure to allergens

Tobacco: avoid all exposure to tobacco smoke. No parental smoking inside the home or car. Dust mite: use pillow and mattress covers. Wash bed linens once a week and 130° water. Use blinds rather than curtains in the bedroom. Remove stuffed animals from bedroom or minimize number and Wash weekly. Reduce indoor humidity to less than 50%. Remove carpet from bedroom. Clean solid surface floors with wet mop each week. Pet dander: remove pets from home permanently. If unable to remove them, keep them out of the bedroom and off carpet and upholstered furniture. Cockroaches: keep kitchen very clean. Avoid leaving food or drinks out. Use pesticides if necessary but ensure that the asthmatic child is not inside the home when pesticides sprayed. Indoor molds: repair water leaks. Use dehumidifier to keep basement job. Reduce indoor humidity to less than 50%.

Collecting urine specimens in children

Urine specimens may be collected using a variety of different methods in infants and children. Suprapubic aspiration is a useful method for obtaining a sterile urine specimen from the neonate or young infant. A sterile needle is inserted into the bladder through the interior wall of the abdomen the urine is then aspirated. The physician or nurse practitioner generally performs this method. Infants and toddlers who are not toilet trained may require a urine bag for urine collection. A sterile urine bag is required for a urine culture, a clean bag for routine urinalysis. A 24 hour urine collection bag is also available. Sterile urinary catheterization is performed like that in adults.

school age communication

Use diagrams, pictures, books, videos. Allow child to honestly express feelings. Use third-party stories to elicit desired information. Allow child to ask questions related to care. Give child adequate time for all questions to be answered. Prepare child a few days in advance for a procedure so they can prepare mentally.

Nursing assessment for pyloric stenosis

Usually occurs in firstborn males. Cause unknown. Assess for forceful non-bilious vomiting, unrelated to feeding position. Assess for Hunger soon after vomiting episode. Weight loss due to vomiting. Progressive dehydration with subsequent lethargy, possible positive family history. Palpate for a hard movable olive like object in the right upper quadrant (Hypertrophied pylorus), If an easily palpable masses felt, no further testing is necessary, and a surgical consult is called. May also see abdominal wavelike movement from left to right. If no masses identified, a pyloric ultrasound may be ordered to identify a thickened hypo a quick ring in the region of the pylorus. Assess lab values to determine if the infant has metabolic alkalosis resulting from dehydration.

Medication for cerebral palsy

Various pharmacologic options are available to manage spasticity. Oral medication is used to treat spasticity include baclofen, dantrolene sodium, and diazepam. Children with this kinetic cerebral palsy may be given anticholinergics to help decrease abnormal movements. Anticholinergic agents such as scopolamine or glycopyrrolate decrease saliva and are used to help control drooling.

Medications for enuresis

When behavioral and meditation or therapies are unsuccessful, particularly in the older child, medication may be prescribed. Teach the child and parents about the use of medication such as oxybutynin, imipramine, and desmopressin. DDAVP Is a synthetic Antidiuretic hormone (ADH) that is a nasal spray (remember this med) It promotes the reabsorption of water into the renal tubule. It's typically use for special occasions like if they're going to a sleepover.

Nursing assessment for Hirschsprung disease

When eliciting the history of the present illness, keep in mind that newborn stool patterns are a key element and recognizing this diagnosis. Assess whether the newborn past and meconium still within the first 24 to 48 hours of life. Determine if the newborn required rectal stimulation to pass their first meconium stool or passed a meconium plug. Assess for history of down syndrome or other chromosomal abnormality or family history. Inspect the abdomen for distention. Palpate the abdomen for presence of stool masses. Perform a rectal examination for rectal tone, And presence of store in the rectum. Often with Hirschsprung's disease, no stool is present in the rectum. However at the end of the rectal examination, when the finger is being withdrawn, a child may have a forceful expulsion of fecal material. Barium enema may reveal intestinal narrowing. Rectal suction biopsy will demonstrate an absence of ganglion cells and provides the definitive diagnosis.

Wilms tumor

Wilms tumor is a common solid tumor that affects the kidney. Peaks at ages 2 and 5. Affects one kidney only. Ideology is unknown but it may be genetic. Has a rapid growth, metastasizes to peroneal tissues, liver, diaphragm, lungs, abdominal muscles and lymph nodes. Has a 90% survival rate. Abdominal mass is usually noted by parents. Usually associated with abdominal pain, constipation, vomiting, anorexia, weight loss, difficulty breathing. Assessment: Assess blood pressure, hypertension occurs in 25%. Inspect for abdominal symmetry or mess. Auscultation lungs. Palpate for lymphadenopathy. Avoid palpating abdomen after initial assessment, preoperatively. Tumor is highly vascular and soft and excessive handling may result in tumor seeding and metastasis Treatment: Removal of tumor and infected kidney, and radiation or chemo. To avoid injuring the remaining kidney, children with a single kidney should not play contact sports.

C-reactive protein (CRP)

a blood test to measure the amount of C-reactive protein in the blood, which, when elevated, indicates inflammation in the body. It is sometimes used in assessing the risk of cardiovascular disease. Normal CRP lab value is < 10 mg/L

attention-deficit/hyperactivity disorder (ADHD)

a neurodevelopmental disorder involving a persistent pattern of inattention and/or hyperactivity Symptoms begin Before age 7 years And persist at least six months Four major behaviors: inattention, impulsiveness, hyperactivity, distractibility Diagnosing ADHD: Fidgets or squirms excessively, leaves seat when inappropriate, runs about and climbs extensively when inappropriate, has difficulty playing quietly, often "on the go" talks excessively, blurts out answers before question is finished, cannot wait their turn, interrupt or intrude on others, Failure to pay close attention, careless mistakes on schoolwork, doesn't listen, doesn't follow through. More information on page 1017. The child with ADHD has a disruption in learning ability, socialization, and compliance. Many also have a comorbidity that accompanies the disorder such as oppositional defiant disorder, conduct disorder, or an anxiety disorder, depression among others. They may have depression and may have poor metacognitive abilities such as organization, time management, and the ability to break a project down into a series of smaller tasks.

spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord, so it can be confusing and a cause of concern for parents. Children with spina bifida occulta need no immediate medical intervention. Nursing care will focus on educating the family. Inform parents of its presence and what the diagnosis means. Many times parents will confuse this diagnosis with spina bifida cystica, how much more serious defect. Occasionally children with spina bifida occulta eventually need surgical intervention due to degenerative changes or involvement of the spine and nerve roots resulting in complications. Spina bifida occulta may present with a small patch of hair where it is located on lumbosacral area. There will also be a dimple there and possibly even an area of discoloration.

assent

to express agreement. The age of ascent is usually between the age of 7 and 14, it depends on the child's development level, maturity, and psychological state. It is recommended that children and adolescents be involved in the discussion about their healthcare and kept in formed in age-appropriate manner. As the child gets older, assent or dissent should be given more serious consideration.When obtaining ascent, the first step is to help child understand his her health condition, depending on developmental level. Next inform the child of the treatment plan and discuss what he or she should expect. Lastly, ascertain the child's willingness to participate in the treatment or research.