Child health final exam

GU quiz(:

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Psychosocial problems in children and families ((:

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The child with a genitourinary alteration (:

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The child with an intellectual disability or developmental disability (:

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a child with a chronic condition or terminal illness(:

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a child with metabolic/endocrine alteration(:

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metabolic/endocrine alteration quiz(:

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pop quiz(:

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the child with a musculoskeletal alteration(:

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the child with cancer(:

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the child with diabetes(:

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neuromuscular assessment

**CSM (circulation, sensation, and motion) -Assess at least every 1 hour during the first 24 hours -Strength of the pulse distal to the site -Capillary refill time -Temperature -Sensation; presence of paresthesia -Motion - active ROM, passive ROM

complementary therapy

- not harmful and used with conventional standard or normal treatment

skeletal traction

- pin put in bone and weights and pulleys pull bones back into place Skeletal traction is used to reduce and immobilize fractures and allows greater pull than would be possible with skin traction.

rhabdomyosarcoma

- rare, malignant tumor in striated muscle tissue in children less than 5 years of age. Symptoms depends on location (can be all over the body) treatment is surgery, chemo and radiation

type 1 DM lab tests

-8 hour fasting blood glucose > or equal to 126 mg/dL -Random blood glucose 200 mg/dL -Oral glucose tolerance test > or equal to 200 mg/dL in the 2-hour sample -Hemoglobin A1C target 6.5% to 8% for children with diabetes; total target goal <7% -Self-monitored blood glucose

chronic illness defined

-A condition that is long term, persisting for more than 3 months -Does not spontaneously resolve -Is without a complete cure -Has residual characteristics -Limits activities of daily living

Developmental dysplasia of the hip (DDH)

-Abnormal development of the hip structures -Clinical manifestations -Dislocation of the hip -Assessment finding: walking on the toe of one leg (cause leg is shorter than the other)

Inadequate motor and cognitive skills

-Accidental trauma --Falls, sports, motor vehicle crashes -Non-accidental trauma -Child abuse -Pathologic conditions

Stem cell transplantation

-Allogeneic transplant: blood-forming stem cells are donated by another person -Autologous transplant: blood-forming stem cells come from the patient -High-dose chemotherapy and possible full body radiation prior to stem cell transplant -Donor stem cells given via IV infusion -Protective isolation after transplant -Increased risk for infection and bleeding until transfused stem cells grow -All organ systems must be monitored for graft versus host disease (GVHD) -MINIMIZE INFECTION

care after death

-Allow family to stay with the child as long as they desire -Allow the family to rock the child -Offer to allow family to assist with preparation of the body -Assist with preparation involving the death ritual -Remain with the family and offer support -Allow family to share stories and memories about the child -Allow all family members to communicate feelings

diabetes insipidus (DI)

-An inability to concentrate urine accompanied by hypernatremia and dehydration -Deficiency of antidiuretic hormone (ADH) and makes body unable to conserve water so put out a lot of free water lost -DI is high and dry (increased sodium, decreased fluids (dehydrated))

ADHD

-Associated with significant problems in 3 areas: --Attention and concentration --Impulse control --Hyperactivity -Male to female ratio is 2:1

Juvenile idiopathic arthritis

-Autoimmune inflammatory disease with no known cause -Formerly known as juvenile rheumatoid arthritis -Chronic inflammation of the synovium of the joints leads to wearing down and damage to the articular cartilage

insulin preferred sites

-Back of upper arms (2nd fastest absorption) -Top and outer portion of thighs (slowest absorption) -Abdomen (most rapid absorption) -hips (3rd fastest absorption)

DI risk factors

-Central deficiency that stems from the brain where posterior pituitary does not release enough antidiuretic hormone -Head trauma -Cranial radiation -Tumors of the head -Infections (meningitis)

cerebral palsy

-Chronic neuromuscular disorder -Manifests differently in each child -Impaired motor function, muscle control, coordination, posture -Visual, hearing, speech impairments, seizures, cognitive disability -Spastic cerebral palsy - spastic muscles -Dyskinetic cerebral palsy - involuntary jerking movements, twisting of the extremities -Ataxic cerebral palsy - wide based gait

physical assessment findings of acute glomerulonephritis

-Cloudy, tea-colored urine -Decreased urine output -Irritability -Periorbital edema -Facial edema that spreads to the abdomen and extremities as the day progresses -Hypertension -Lethargy -Anorexia

compartment syndrome

-Compartment syndrome is the compression of nerves, blood vessels, and muscle inside a confined space which results in ischemia (lowered blood flow to that area) fascia does not give so muscle starts to die -True surgical emergency that needs to be treated promptly. If not treated quickly, can lead to paralysis, nerve damage, loss of limb or loss of life -Neurovascular damage can occur in a short period of time!!

clubfoot

-Congenital dysplasia of all tissue (bone, muscle, ligaments, nerves, blood vessels) below the knee -Deformity below the knee - genetic predisposition -One or both feet may be affected

SIADH clinical manifestations

-Decreased urine output -Weight gain -Signs and symptoms of hyponatremia

Physical assessment findings of fracture

-Deformity -No pulse = neurovascular problem (worst case scenario) -Bruising (later) -Swelling -Redness immobile / barely move -Crepitus - bone end grating on bone end

DM Considerations - adolescent

-Developmental milestones may interfere with diabetes management -May miss injections, omit blood tests, eat irregularly, and have dietary indiscretions -Diabetes management shifts to the adolescent -May not be concerned about potential future complications -Focus on issues of current significance - personal appearance, weight, athletic ability, muscle mass

DM Considerations - school age

-Diabetes care is incorporated into the school day -Diabetes plan should be communicated to the school -Planning ahead for field trips, school parties, athletic events -Prevention of hypoglycemia during athletic events

nursing considerations for muscular dystrophy

-Encourage genetic counseling -assess/monitor: --Ability to perform ADLs --Respiratory function --Cardiac function --Coping and support system -Maintain optimal physical function -Maintain respiratory function

Juvenile idiopathic arthritis nursing considerations

-Encourage physical activity -Full ROM exercises -Apply heat or warm, moist packs to joints prior to exercise -Warm baths -Encourage self-care

DM exercise

-Enhances the action of insulin -Exercise lowers glucose levels - avoid exercise while insulin is peaking -Add an extra 15 to 30 grams carbohydrate snack for each 45-60 minutes of exercise -Promotes a greater sense of well being -Improves cardiovascular and physical fitness -Lowers lipids -Age appropriate sports are encouraged

cerebral palsy physical assessment findings

-Failure to meet developmental milestones -Persistent infantile reflexes gagging/choking with feeding -Poor suck reflex -Tongue thrust -Poor head control -Rigid posture -Abnormal posturing -Hyperreflexia -Seizures -Vision, speech, hearing impairments -Impaired social relationships

Goals of diabetes management

-Glycemic control -Reasonable weight for height -Age appropriate lifestyle -Prevention of acute and long-term complications

Epiphyseal growth plate injuries

-Growth plate injury: A fracture between the shaft of the bone and epiphyseal plate -The region of least resistance to stress in a growing bone is the areas between the metaphysis and cartilaginous epiphyseal plate -Fracture to the growth plate may result in growth disturbance -Five types of fractures in the epiphyseal growth plate

manifestations of growth hormone deficiency

-Height below the 5th percentile for age and sex -Delayed epiphyseal closure -Hypoglycemia *main manifestation -Delayed puberty -Delayed sexual development -Delayed dentition and underdeveloped jaw -Increased body fat

medications for nephrotic syndrome

-High dose Corticosteroids (until 1+ protein in the urine) -Diuretics (for edema) -Albumin (put protein back into blood vessels so they can pull fluid back into blood vessels instead of interstitial space.) -Cyclophosphamide (if become resistant to steroids or steroid dependent)

DM nursing care and education

-I/O -Weight -Skin integrity -Wound care --Clean with warm water and soap --Watch for signs of infection --Pat dry and apply a bandage -diet/exercise patterns -Nail care -Yearly eye exams -Nutrition -Managing diabetes during times of illness -Avoid wearing sandals, walking barefoot, wearing shoes without socks -Regular dental and health care visits

family dynamics--a situational crisis for the family

-Illness trajectory -Normalization - family regroups, everyone has their role as far as what they're gonna do to care for this child. Every family is different -Family resiliency -Maintaining social integration -Equitable allocation of resources - how to allocate time, energy, money, etc. -Need a balance

Syndrome of inappropriate antidiuretic hormone (SIADH)

-Inability to excrete free water due to excessive antidiuretic hormone (ADH) or vasopressin -Low and wet. Unable to excrete free water, excessive ADH, low sodium, weight gain

diabetes mellitus

-Increased prevalence of type 1 and type 2 diabetes worldwide -Type 2 diabetes is increasing in the pediatric population -Both are chronic diseases requiring lifelong management and care

DI manifestations

-Increased urination and nocturne -Increased thirst (polydipsia) -Dehydration -Hypernatremia -Urine specific gravity less than 1.005 -Elevated serum osmolality (greater than 300 mOsm/kg) -Decreased urine osmolality

cerebral palsy nursing considerations

-Individualize care -Monitor developmental milestones hearing/speech, vision evaluations -Promote independence -Adaptive devices airway/suction -Nutrition -Skin care

insulin therapy

-Insulin requirements are based on age, weight, and pubertal status -Diluted insulin for infants and toddlers -Short acting, intermediate acting, and long acting insulins are used -Insulin administration is individualized - peak action of insulin is timed to correspond to meal and snack times -Insulin pump -Oral hypoglycemic agents are not effective in treatment of type 1 diabetes mellitus

Juvenile idiopathic arthritis physical assessment findings

-Joint swelling, stiffness, redness, and warmth - worse in the AM or after inactivity -Limited mobility -Rash -Fever -Limp in the morning

diabetic ketoacidosis (severe hyperglycemia)

-Ketones in the blood (and urine) -Metabolic acidosis -Management requires intensive care to lower glucose, reverse acidosis, and correct fluid and electrolyte imbalance

clinical manifestations of autism

-Lack of awareness of feelings of others -Lack of abnormal social play -Impaired peer relationships -Impaired verbal communication -Abnormal nonverbal communication -Absence of imaginative play -Impaired interactive speech -Abnormal body movements -Preoccupation or attachment to certain objects -Distress over changes in the environment *PRIORITY: MAINTAIN NORMAL ENVIRONMENT" -Insistence on a routine -Marked restriction in range of interests

scoliosis

-Lateral curvature of the spine and spinal rotation that causes rib asymmetry -Congenital deformity -Screening during preadolescence -manifestations: --Asymmetry of scapula, ribs, flanks, shoulders, and hips --Improperly fitting clothing

hip spica cast

-Less mobile -If older child -Full cast from torso to toes -Hips flexed, abducted, and externally rotated in a cast after surgical repair -Nursing care: --Cast care --Neurovascular tests --Sponge baths --Provide waterproof barrier around genital area to prevent soiling

SIADH labs

-Low serum sodium (less than 125 mEq/L) -High urine specific gravity (lot of solute in urine) -Decreased serum osmolality (everything is diluted) -Increased urine osmolality

DM nutrition

-Meals and snacks are balanced with insulin action -Both the timing of the meal or snack and the amount of food are important in avoiding hyperglycemia or hypoglycemia -Adherence to a daily schedule that maintains a consistent food intake combined with consistent insulin injections aid in achieving metabolic control

nursing considerations for acute glomerulonephritis

-Monitor I/O -Daily weights -Neuro checks -Nutrition: --Sodium and fluid restriction --Restrict potassium-rich foods if oliguric --Small, frequent meals -Skin assessment and interventions to prevent breakdown

pavlik harness

-More mobile -Holds legs up and out -Hips flexed, abducted, and externally rotated -Nursing care: --Adjust straps every 1-2 weeks --Skin care of utmost importance --Frequent skin checks --Clothing on between harness and skin to decrease risk of skin breakdown --Diaper goes under the straps, not over the straps --Wear knee socks

muscular dystrophy

-Most common - duchenne muscular dystrophy -Progressive muscle atrophy and weakness -Walking ability is lost by ages 9-12 years -Frequent falls -Mild cognitive delays -Respiratory and cardiac difficulties as the disease progresses *medication: prednisone

type 1 DM

-Most common childhood endocrine disorder -An inflammatory process in the insulin-secreting islet cells of the pancreas resulting from an autoimmune process that causes their eventual destruction -Genetic predisposition and environmental triggers may initiate the autoimmune destructive process -Glucose = primary source of energy -Any extra glucose is stored as glycogen in the fatty tissue

caring for a dying child

-Nursing professionalism and boundaries -Communication -Family dynamics, beliefs, and practices -Pain control -Hospice care -The dying process and the time of death -Most important thing - pain management -Kids may be more mature and wiser beyond their years -Tell them it's okay for them to pass on, everyone left will be okay and he/she will always be remembered -Nurse gets very involved with family so be in touch with your own feelings

The five Ps of ischemia for compartment symdrome

-Pain - unrelieved with elevation or pain meds -Pallor - extremity gets pale -Pulselessness - late finding -Paresthesia - numbness and tingling - early finding -Paralysis - late finding, occurs when there is nerve damage

DM Considerations - infants and toddler

-Parents or caregivers are solely responsible for management -Severe hypoglycemia occurs most often in this age group -Achieving consistency in dietary intake is a challenge -Allow the toddler to participate in making food choices -Hypoglycemia is difficult to recognize in an infant -Toddlers may exhibit temper tantrum - like behavior with hypoglycemia

manifestations of type 1 DM

-Polyuria (includes enuresis in a toilet-trained child) -Polydipsia -Polyphagia -Weight loss -Fatigue -Blurred vision

Infection prevention

-Private room -Restrict visitors with active illness -Strict hand hygiene -Assess for infection -Administer antibiotics as prescribed -Adequate protein and caloric intake -Monitor absolute neutrophil count (REAL number of cells that are neutrophil) -Avoid live virus vaccines -Ensure that siblings are up-to-date on immunizations

treatment of fracture -reduction methods

-Repositioning of the bone fragments into normal alignment -Closed or open reduction (ORIF) ---Closed: general sedation, move fragments to align bones ---Open: go in and open the skin to align bones with screws

type 2 DM

-Rise in incidence of overweight and obese children -Not caused by an autoimmune response -Majority of children between the 85th and 95th percentile for BMI -Genetics, family history, race, and ethnicity contribute -Children with intrauterine growth retardation and females are at increased risk -Decreased physical activity in children

Physical manifestations of death

-Sensation of heat when the body feels cool -Decreased sensation and movement of the lower extremities -Loss of senses - hearing is the last to be lost -Confusion; loss of consciousness -Decreased appetite and thirst -Swallowing difficulties -Loss of bowel and bladder control -Bradycardia; hypotension -Cheyne-Stokes respirations - periods of apnea followed by deep rapid respirations

storage of insulin

-Store insulin in a cool, dry place; do not freeze or expose to heat or agitation -Check the expiration date on the vial before using -Once opened, date the vial; discharge as recommended -When mixing two different types of insulin, inject the appropriate amount of air into both vials, and then withdraw the short acting (clear) insulin first -Lantus insulin should not be mixed with other insulins

Management and prevention of urinary tract infections

-Take complete course of antibiotics -Wipe from front to back -Avoid "holding of urine" -Plenty of fluids -Cotton underwear -Avoid bubble baths -Good hygiene for sexually active adolescent girls

Pediatric differences in the endocrine system

-The endocrine system is less developed at birth than any other body system -Hormonal control of many body functions is lacking until 12−18 months of age -Infants may manifest imbalances in concentration of fluids, electrolytes, amino acids, glucose, and trace substances

leukemia

-The most common cancer of childhood -Acute lymphoid leukemia (ALL) -Acute myelogenous leukemia (AML) -Abnormal proliferation of immature WBCs which compete with normal cells for space and nutrients -Bone marrow production of other cells is suppressed (bone marrow failure) -Proliferation of immature white blood cells (malignant, blast cells) causes decreased erythrocytes (causing anemia → weakness and pallor), decreased lymphocytes (causing immunosuppression → infection → fever), decreased platelets (causing bleeding and decreased clotting causing thrombocytopenia → petechiae, bruising, purpura) -Could infiltrate CNS and testicles (most common sites), or also lymph nodes, liver and spleen with enlargement and/or be painful

wilm's tumor

-The most common renal tumor in children -Avoid palpating the tumor mass during assessment because of the risk of rupturing the protective capsule -Excessive manipulation can cause seeding of the tumor and spread of cancerous cells -Treatment: surgical removal soon after diagnosis then chemotherapy +/- radiation

Pediatric differences in the musculoskeletal system

-The periosteum of the child's bone is much stronger than that of adults. -Growth of the long bones occurs at the epiphyses → injury to the epiphyses can cause growth disturbances. -Fractures in children less than one year old are unusual due to the large amount of force necessary to break an infant's bone. Abuse or an underlying disease is often the cause of fractures in infants. -Fractured bones produce callus and heal quickly in children. -Muscle tissue is almost completely developed at birth. Growth occurs due to increased size of muscle tissue vs increased number of muscle fibers. -Soft tissue is resilient in children → dislocations and sprains are less common than in adults

Intellectual and developmental disorders

-These children may have limitations in both intellectual and adaptive functioning --Social interaction --Use of language for self-expression --Self-care abilities -Lifelong challenges that require assistance from health care and educational professionals

labs for acute glomerulonephritis

-Throat culture -UA (protein, casts (bad sign), platelets, rbc) -Renal function (elevated BUN and creatinine) -Antistreptolysin O (ASO) titer (positive - test shows streptococcal pneumonia)

SIADH treatment

-Treat underlying cause -Fluid restriction

blood glucose monitoring

-Typically performed before meals and bedtime -More frequent monitoring: --Prolonged exercise --During illness --Nighttime hypoglycemia is suspected --Record blood glucose readings in a diary - most machines store readings -A 3 to 4 day pattern of elevated blood glucose readings requires an adjustment of insulin dosage

DM Considerations - preschooler

-Understand simple explanations - help to calm fears that diabetes occurred because they were "bad" -Play therapy and medical dolls are helpful to allay fears and teach about diabetes -More predictable appetite than toddlers -May be able to identify symptoms of hypoglycemia -Increased risk for hypoglycemia with high energy activities

urinary tract infection risk factors

-Urinary tract obstructions -Voiding dysfunction (urinary stasis) -Anatomic differences (females) (shorter urethras) -Individual susceptibility to infection -Vesicoureteral reflux (VUR) -Urinary retention while toilet-training -Sexual activity during adolescence (females

halo traction

-external fixation device -For cervical spine fractures -Holds neck in place -Need good pin care -Wrench at bedside at all time in case it needs to come out quick

growth hormone deficiency

-inadequate production or secretion of growth hormone resulting in poor growth and short stature -Etiology - stimulated anterior pituitary secretes growth hormone is defective

Acute glomerulonephritis

-inflammatory injury in the glomerulus as a result of a strep infection (such as streptococcal infection) --Damages glomerular capillaries, cannot filter efficiently and causes kidney problems --Don't get rid of fluids so they puff up and get an acute kidney injury

Acute poststreptococcal glomerulonephritis:

-most common type in children -Most common in children 5-8 year olds -Symptoms occur weeks after infection

treatment of DDH

-pavlik harness -hip spica cast

treatment of hypoglycemia when conscious with a gag reflex

10-15 g of carbohydrates orally 4 oz juice 8 oz milk 3-4 glucose tablets 4 oz regular soft drink Monitor glucose frequently

cancer is the ____ leading cause of death in children

2nd

insulin injection

45-90 degree angle Rotate injection site to prevent fatty lumps

children manifestations of UTI

Abdominal or suprapubic pain Voiding frequency Voiding urgency Dysuria New or increased incidence of enuresis Fever

cancer

Abnormal cell growth Cause unknown Difference in kids: symptoms resemble those of other illnesses so difficult to diagnose

goals for the child for chronic care

Achieve and maintain normalization Obtain the highest level of health and function possible

leukemia labs

Anemia Thrombocytopenia (low platelets) Neutropenia (low neutrophils) Leukemic blasts (immature WBCs)

mild (early) signs of hyponatremia

Anorexia Headache Nausea Vomiting

treatment of osteomyelitis

Antibiotics Elevate extremity Provide adequate nutrition Immobilize extremity Wound care

nursing care for osteomyelitis

Assessment Pain control Administration of antibiotics - monitor renal and hepatic function Skin culture, blood culture, culture of the bone

A potential complication of bone marrow suppression is _____. A. depression B. infection C. constipation D. sleep disturbances

B. infection

What best describes acute glomerulonephritis? A. occurs after a urinary tract infection B. occurs after a streptococcal infection C. associated with renal vascular disorders D. associated with structural anomalies of genitourinary tract

B. occurs after a streptococcal infection

A 6-year old believes death is ___. A. a loss of a caregiver B. reversible and temporary C. sad and irreversible D. inevitable but a distant event

B. reversible and temporary

Kristin, age 10, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, what should the nurse consider? A.Healing is usually delayed in this type of fracture. B.Bone growth can be affected by this type of fracture. C.This is an unusual fracture site in young children. D.This type of fracture is inconsistent with a fall.

B.Bone growth can be affected by this type of fracture.

medications for spasms of cerebral palsy

Baclofen Diazepam Botulinum toxin A to reduce spasticity

osteomyelitis

Bacterial infection of the bone

diagnostic procedures for leukemia

Bone marrow biopsy Lumbar puncture

chemotherapy side effects

Bone marrow suppression Malaise, fatigue Mucosal ulceration (stomatitis) Skin breakdown Neuropathy Nausea and vomiting Loss of appetite Bruising and bleeding Alopecia

non-operative treatment modalities of clubfoot

Casting stretching/manipulation Denis Browne bar - keeps feet turned in place and holds it there Achilles tenotomy (release the achilles)

casts

Casts - more permanent stabilization

leukemia treatment

Chemotherapy Radiation Steroids Stem cell transplant

Therapeutic management of cancer

Chemotherapy Surgery Radiation therapy Stem cell transplant Steroid therapy Biologic agents Complementary and alternative therapies

cancer Symptoms vary according to:

Child's age Type of tumor Location of the tumor Extent of the disease

failure to thrive

Children whose weight or rate of weight gain is below that of comparably aged children •Organic/medical causes: •Chromosomal abnormalities •Heart or lung defects •CNS damage •Exposure to toxins Nonorganic causes •Child temperament •Parental expectations •Maternal emotional state •Socioeconomic factors

complications of nephrotic syndrome

Circulatory insufficiency Thromboembolism infection/sepsis

caring for siblings

Concerns and needs of the sibling can be more difficult to address -These vary according to age and developmental level -Siblings often have feelings of guilt -Provide education regarding treatment of the ill child -Siblings may regress developmentally -Relationships with other family members may be altered

moderate signs of hyponatremia

Confusion Irritability Lethargy Altered level of consciousness

DI treatment

DDAVP - synthetic vasopressin Dosage based on child's age, size, urine output, and urine specific gravity

The child's concept of death 2-7 (early childhood)

Death as a reversible and temporary separation

The child's concept of death 12+ years (adolescent)

Death as inevitable and irreversible but often a distant event. Consider themselves invulnerable. See it only happening to others. May isolate the child

The child's concept of death 0-2 years (infancy to toddlerhood)

Death as loss of the caretaker

The child's concept of death 7-12 years (middle childhood)

Death as sad and irreversible but not necessarily inevitable. Fear. ask a lot of questions. Afraid of never seeing family or pets again

How can you tell if the kiddo is getting better from acute glomerulonephritis ? (indicators)

Decreased BP Increased urine output Less irritable, more normal Clear urine Eating, no longer anorexic Decreased weight (fluid off)

diagnosis of cancer

Difficult to diagnose because symptoms tend to be similar to other illnesses

Primary nephrotic syndrome (also called minimal change nephrotic syndrome (MCNS):

Disorder within the glomerulus of the kidney Most common type in children

Medications (main treatment for acute strep glomerulonephritis):

Diuretics (decreases BP which is a result of fluid volume overload, and get fluid off) Antihypertensives (if diuretics not doing the job)

Child has primary nephrotic syndrome. What lab finding should the nurse expect?

Elevate hemoglobin and hematocrit, elevated lipid levels, increased risk of infection, increased risk of thromboembolism

stages of grief

Elisabeth Kubler-Ross 1. Denial, disbelief, shock 2. Anger (internal or external) 3. Bargaining (with themselves, something spiritual) 4. Depression 5. Acceptance

intermediate acting insulin

Ex: NPH insulin Onset: 1-2 hr Peak: 6-14 hr Duration: 16-24 hr

long term insulin

Ex: insulin glargine Onset: 70 min Peak: none Duration 24 hr

rapid acting insulin

Ex: insulin lispro Onset: 15-30 min Peak: 30 min - 2.5 hr Duration: 3-6 hr

short acting insulin

Ex: regular insulin Onset: 30 min - 1 hr Peak: 1-5 hr Duration: 6-10 hr

Hypoglycemia information

Excess of carbohydrate intake with inadequate insulin Increased urine output Thirst and hunger Fatigue Blurred vision Headache Emotional lability

nursing considerations for clubfoot

Family education Reduction of discomfort and pain Patient advocacy

signs and symptoms of leukemia

Fever Pallor Excessive bruising Bone or joint pain (usually in leg or knee pain) Lymphadenopathy Malaise Hepatosplenomegaly - enlarged liver and spleen

treatment of hypoglycemia when unconscious without gag reflex

Glucagon subcutaneous or IM or: Dextrose IV Protect the airway Notify provider Monitor glucose frequently Hypoglycemia protocols

physical assessment finding for nephrotic syndrome

Gradual Edema - periorbital, face, abdomen (ascites), lower extremities Frothy urine (due to increased protein in urine) Decreased urine output (because fluid is third spaced) Anorexia Fatigue Increased weight Ascites - free fluid floating in abdominal cavity Irritability Lethargy Respiratory infection Normal/low blood pressure

endocrine conditions

Growth hormone deficiency Diabetes insipidus Syndrome of inappropriate antidiuretic hormone (SIADH)

cerebral palsy risk factors

Head trauma Brain anoxia Maternal infection Premature birth Multiple births High bilirubin

common features of acute glomerulonephritis

Hematuria Proteinuria Hypertension Edema Renal insufficiency

trauma

Increased mobility puts young children at risk

S/S of osteomyelitis

Irritability Fever Tachycardia Edema Constant pain that worsens with movement Tenderness, swelling and warmth

overt signs of cancer

Mass Purpura (purple spots) Pallor Weight loss Whitish reflex in the eyes Vomiting in the early morning Recurrent and/or persistent fever Bone pain Headache Persistent lymphadenopathy Change in balance, gait, or personality Fatigue, malaise

nursing considerations for nephrotic syndrome

Monitor I/O Daily weights Monitor edema and abdominal girth daily Measures to prevent infection No salt diet Skin assessment and interventions to prevent skin breakdown

Growth hormone deficiency nursing consideration

Monitor the effectiveness of GH replacement Provide support - psychosocial impact of short stature

Juvenile idiopathic arthritis medications

NSAIDs Methotrexate Corticosteroids Etanercept

infant manifestation of UTI

Nonspecific Fever or hypothermia Irritability Dysuria as evidenced by crying when voiding Change in urine odor or color Poor weight gain Feeding difficulties

Acquired nephrotic syndrome

Occurs as the result of a systemic disease ie: hepatitis, SLE, heavy metal poisoning, cancer

8 year old child got ulcers from radiation for leukemia. What is the appropriate action by the nurse?

Offer foods that are soft and bland

treatment for fractures -retention

Once aligned the fracture site must be protected Application of splint, cast, traction, or external fixator

Caring for parents

Parents must move from fear to acknowledgment of the child's impending death -Grief education and support -Cultural and religious beliefs -Referrals (schooling, social work) -The nurse as liaison

A child has acute post streptococcal glomerulonephritis. what should the nurse expect?

Periorbital edema

Hypoglycemia clinical manifestations

Personality changes Slurred speech Headache Dizziness Decreased level of consciousness Shakiness Diaphoresis Tachycardia Pallor and clammy skin "Cold and clammy, give me candy"

goals for the family for chronic care

Remain intact Achieve and maintain normalization Maximize function throughout the illness

autism medications

SSRIs- decrease aggression Antipsychotics and melatonin - help with sleep

UTI manifestations in children with pyelonephritis

Same as in children above plus... High fever, chills Back pain Costovertebral angle tenderness Nausea and vomiting Appears very ill

severe signs of hyponatremia

Seizures Coma

radiation side effects

Skin reactions Bruising Fatigue Bone marrow suppression Nausea and vomiting Anorexia Mucositis

Assisting the Child--resources they may need

Speech therapy Physical therapy nutritional/diet therapy Special education Palliative care team

scoliosis treatment

Spinal fusion with rod placement for curvatures greater than 45 degrees -Major surgery! -Blood transfusions during surgery -Pain control

death and dying

The child's concept of death and dying -Age and developmental level -Cognition -Life experiences -Chronic sorrow ---Ill children and siblings fluctuate in their understanding of death and dying

labs for nephrotic syndrome

UA/24 hour urine -Proteinuria Chemistry -Hypoalbuminemia (low serum protein and albumin) -Hyperlipidemia -Hemoconcentration - elevated hgb, hct, and platelets (due to decreased circulation) -Possible hyponatremia -GFR - normal or high

synthetic cast

Water resistant (but will get stinky) , lightweight, take 5-10 min to dry, ice and elevate above the heart

nephrotic syndrome

a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema -major thing is loss of protein -loss of protein --> hyperlipidemia -increased risk for infection (may be put on antibiotics to prevent infection) -fluid is thirdspaced = less circulating fluid = dehydration = packed rbc together = increased risk of DVT/thrombosis -more in toddler and preschool age children

A nurse is caring for a 5-year-old child who weighs 40 lbs. Considering the urine output is normal, how much urine output would you expect the child to have in 8 hours? Select one: a. 160mls b. 100mls c. 50mls d. 800mls

a. 160mls

A nurse is caring for a 3-year-old child with osteomyelitis of the foot. Which of the following is a nursing consideration when caring for a child with osteomyelitis? (Select all that apply) a. Administer IV antibiotics as prescribed. b. Encourage a diet high in protein and calories to promote healing. c. Discuss with importance of adherence of the medication regimen with the parents. d. Provide developmental appropriate activities for the child. e. Encourage the use of R-I-C-E (rest, ice, compression, and elevation) for treatment of pain.

a. Administer IV antibiotics as prescribed. b. Encourage a diet high in protein and calories to promote healing. c. Discuss with importance of adherence of the medication regimen with the parents. d. Provide developmental appropriate activities for the child. NO ICE

Which should a nurse identify as common chronic illnesses of childhood? (Select all that apply) Select one or more: a. Autism b. Respiratory syncytial virus (RSV) c. Cerebral palsy d. Sickle cell disease e. Human immunodeficiency virus infection (HIV)

a. Autism c. Cerebral palsy d. Sickle cell disease e. Human immunodeficiency virus infection (HIV)

A nurse is caring for a 10-year-old child with muscular dystrophy. Which of the following is an expected finding? a. Difficulty climbing stairs. b. Joint swelling. c. Rigid posture. d. Visual impairment.

a. Difficulty climbing stairs.

Which of these findings are signs of compartment syndrome? Select all that apply. a. Diminished dorsalis pedis pulse b. Macular rash c. Paresthesia d. Capillary refill less than 2 seconds e. Increased pain

a. Diminished dorsalis pedis pulse c. Paresthesia e. Increased pain

A nurse is providing education to the parents of a 2-year-old child with nephrotic syndrome who is being treated with prednisone. Which of the following should be included in the education? (Select all that apply) Select one or more: a. Discuss the importance of performing frequent hand hygiene. b. Avoid large crowds. c. Adverse effects include increased risk of infection and hypoglycemia. d. The child may experience an increased appetite and weight gain. e. Administer prednisone with food.

a. Discuss the importance of performing frequent hand hygiene. b. Avoid large crowds. d. The child may experience an increased appetite and weight gain. e. Administer prednisone with food.

A nurse is caring for an 18-month-old child with acute renal failure secondary to dehydration from viral gastroenteritis. Which of the following is a priority nursing intervention when caring for this child? Select one: a. Provide IV fluid hydration as prescribed. b. Limit activity. c. Maintain neutral temperature. d. Assess skin turgor.

a. Provide IV fluid hydration as prescribed.

A nurse is caring for a 4-year-old girl with suspected sexual abuse. Which finding noted by the nurse on a physical assessment is most suggestive of sexual abuse? Select one: a. Swelling of the genitalia and pain with urination. b. Smooth philtrum and thin upper lip. c. Speech and delayed physical development delays. d. History of drowsiness, constipation, and constricted pupils.

a. Swelling of the genitalia and pain with urination.

The nurse is caring for a 3-year-old child who has characteristics of autism. Which observed behaviors are associated with autism? (Select all that apply) Select one or more: a. The child clicks a pen repetitiously. b. The child has a flat affect. c. The child demonstrates imitation and gesturing skills. d. The mother reports the child has no interest in playing with other children. e. The child makes good eye contact.

a. The child clicks a pen repetitiously. b. The child has a flat affect. d. The mother reports the child has no interest in playing with other children.

pediatric fractures...

are seldom complete breaks. Rather, children's bones tend to bend or buckle because of increased flexibility. This flexibility is due to a thicker periosteum and increased amounts of immature bone

A nurse is caring for a 16-year old adolescent with depression and is concerned that she may be suicidal. Which of the following questions is the most appropriate for the nurse to ask? Select one: a. "Do you belong to a church that can provide support to you?" b. "Have you tried to hurt yourself in the past?" c. "Have you been seeing a counselor?" d. "Do you have a boyfriend?"

b. "Have you tried to hurt yourself in the past?"

A nurse is caring for a 13-year-old adolescent with scoliosis. Which of the following is a manifestation of scoliosis? (Select all that apply) a. An exaggerated concave curvature of the lumbar spine. b. Asymmetrical rib cage. c. Uneven shoulder or pelvic height. d. A rib hump that is visible when the child is bending forward. e. Asymmetric shoulder height.

b. Asymmetrical rib cage. c. Uneven shoulder or pelvic height. d. A rib hump that is visible when the child is bending forward. e. Asymmetric shoulder height.

A nurse is caring for a newborn who is noted to have a depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are suggestive of which of the following? Select one: a. Microcephaly b. Down Syndrome c. Cerebral palsy d. Fragile X syndrome

b. Down Syndrome

A nurse is caring for a 3-month-old with developmental dysplasia of the hip. Which method of treatment should the nurse anticipate? a. Hip spica cast b. Pavlik harness c. Sugar tong splint d. Thoracolumbosacral orthosis (TLSO)

b. Pavlik harness

A nurse is caring for a 2-year-old child with glomerulonephritis. Which combination of signs and symptoms is commonly associated with glomerulonephritis? Select one: a. Proteinuria, hypotension, hematuria, and lethargy. b. Proteinuria, hypertension, cloudy tea-colored urine, and lethargy. c. Proteinuria, edema, normal blood pressure, lethargy. d. Proteinuria, decreased urinary output, hypotension, and lethargy.

b. Proteinuria, hypertension, cloudy tea-colored urine, and lethargy.

A nurse is caring for a 5-year-old with a terminal illness. Which of the following corresponds to a 5-year-old child's understanding of death? Select one: a. Loss of a caretaker. b. Reversible and temporary. c. Permanent. d. Inevitable.

b. Reversible and temporary.

A nurse is providing education to the parents of adolescents regarding eating disorders. Which of the following should the nurse include? Select one: a. Adolescents with bulemia have a disturbed body image and intense fear of obesity. b. Ritualistic behaviors surrounding food are common in adolescents with anorexia nervosa. c. Anorexia nervosa and bulemia only affects girls. d. Adolescents with anorexia nervosa are at risk for hyperglycemia.

b. Ritualistic behaviors surrounding food are common in adolescents with anorexia nervosa.

A nurse is caring for a 6-year-old child with autism who is hospitalized with an asthma exacerbation. Which of the following should be considered when developing the plan of care? Select one: a. The parents' expectations should be met. b. The child's home routine should be maintained. c. The child is supported through the autistic crisis. d. Parents are encouraged to let the nursing staff care for the child as much as possible.

b. The child's home routine should be maintained.

A nurse is caring for a 2-year-old female with a urinary tract infection. Which of the following predisposes this child to developing a urinary tract infection? Select one: a. Young girls have a longer urethra. b. Urinary retention during toilet training. c. Poor nutritional status. d. Wiping from front to back after going to the bathroom.

b. Urinary retention during toilet training.

open fracture

bone has access to outside of the skin. More prone to infections

comminuted fracture

bone is splintered into pieces. This is a rare occurrence in children

greenstick fracture

break occurs through the periosteum on one side of the bone while only bowing or buckling on the other side. Seen most frequently in forearm. Occurs from a twisting motion

transverse fracture

break or fracture line occurs at right angles to the long axis of the bone

A nurse is caring for a 6-year-old child with growth hormone deficiency. A prescription is written for a dose of 0.025mg/kg of somatotropin subcutaneously 3 times weekly. The child weighs 59.4 pounds. What is the dose of medication that will be administered? Select one: a. 0.5mg b. 1mg c. 0.675mg d. 1.5mg

c. 0.675mg

Recognizing Madison's developmental and cognitive stage (16 years old), which of the following statements best supports your approach to discharge teaching? a. Adolescents are capable of thinking in concrete terms only. b. Adolescents are preoccupied with the immediate situation rather than future events. c. Adolescents can anticipate future implications of current decisions. d. Family acceptance is more important than peer acceptance.

c. Adolescents can anticipate future implications of current decisions.

A nurse is providing education to the parents of a 2-year-old child with diabetes insipidus (DI). What information should the nurse emphasize with the family? Select one: a. Measurement of urine glucose levels at home will be important to monitor the effectiveness of treatment. b. Children should wear medical alert bracelet if they are over 5 years old. c. Diabetes insipidus is different from diabetes mellitus. d. Treatment of DI involves maintaining fluid balance and administering dexamethasone.

c. Diabetes insipidus is different from diabetes mellitus.

A nurse is caring for a 4-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH) who is experiencing lethargy and an altered level of consciousness. Which of the following is the most likely cause of these symptoms? Select one: a. Hypernatremia b. Decreased urine specific gravity c. Hyponatremia d. Decreased urine osmolality

c. Hyponatremia

A nurse is caring for a 4-year-old child with a terminal illness who is experiencing confusion, hypotension, and Cheyne-Stokes respirations. The nurse is aware that these are signs of: Select one: a. Clinical improvement. b. Congestive heart failure. c. Imminent death. d. Pulmonary embolism.

c. Imminent death.

A nurse is caring for a 14-year-old with anorexia nervosa. Which of the following assessment findings should the nurse expect? Select one: a. Hair loss, ulcers in the mouth, nausea and vomiting b. Abdominal pain, diarrhea, and brittle hair c. Lanugo on the face, muscle weakness, and dry skin d. Fatigue, lymphadenopathy, and muscle weakness

c. Lanugo on the face, muscle weakness, and dry skin

A nurse is caring for 7-month-old infant with failure to thrive. Which of the following should the nurse include in the plan of care? Select one: a. Assign a variety of nurses to care for the child. b. Use of 32 calorie/ounce concentrated formula to promote weight gain. c. Observation of parent-child interactions. d. Limit fluid intake.

c. Observation of parent-child interactions.

A nurse is caring for a 3-year-old child with nephrotic syndrome.Which of the following is an expected finding when a child has nephrotic syndrome? Select one: a. Hyperalbuminemia b. Leukocytosis c. Proteinuria d. Positive streptolysin O (ASO) titer

c. Proteinuria

A nurse is caring for a 15-year old adolescent with a chronic medical condition that requires frequent hospitalizations. How does chronic illness and frequent hospitalizations affect the psychosocial development of this adolescent? Select one: a. They can lead to feelings of inadequacy. b. They can interfere with parental attachment. c. They can interfere with the development of identity.

c. They can interfere with the development of identity.

Lymphomas

cancer of lymph nodes/lymphatic system, third most common cancer in children, treatment is chemo, radiation and stem cell transplant

Neuroblastoma

cancer that starts early in the nerve cell in the sympathetic nervous system, most in adrenal gland on kidney in children less than 10. Treatment is removal of tumor, chemo and radiation

A nurse is providing education to the parents of a 3-year-old child with growth hormone deficiency. Which metabolic alteration is related to growth hormone deficiency and should be discussed with the parent? Select one: a. Hypocalcemia b. Diabetes insipidus c. Hyperglycemia d. Hypoglycemia

d. Hypoglycemia

oblique fracture

diagonal or slanting break that occurs between the horizontal and perpendicular planes of the bone

splints

do before casts, fracture will swell and if you put a cast on right away it will cause compartment syndrome. Splints are for stabilization

skin traction

gradually pulls bones together - tape on skin and use weights and pulleys to pull bones together

osteosarcoma

malignant tumor of bone. Peak incidence at age 15. Treatment is surgery to remove tumor (possible amputation), chemo, and radiation

closed fracture

no access to the outside of skin

complication of skeletal traction

osteomyelitis because skeletal traction is invasive Pin care with soap and water May cause bone infection

What's the difference between a hematopoietic stem cell transplant and a bone marrow transplant?

same thing!

plaster cast

tell patient it will warm up as it hardens because of chemical reaction so do not put directly on skin, takes 10-24 hours to dry so don't knock it around, do not get cast wet, let dry naturally Do not stick anything in there to itch!!!! Can cause a scratch or puncture and cause infection and no way to assess it

alternative therapy

therapy designed to replace conventional therapy

most common area for compartment syndrome

tibial fractures and forearm fractures

causes of compartment syndrome

tight dressing/cast, hemorrhage, burns, surgery, massive IV infiltration

spiral fracture

twisted or circular break that affects the length rather than the width. Seen frequently in child abuse

ewing sarcoma

type of bone cancer or in soft tissue surrounding bone. Treatment is surgery, maybe amputation, chemo, and radiation

referring syndrome

¢A fluid, electrolyte, mineral, and metabolic disturbance that results from introducing nutrition too rapidly to someone who has been starving ¢Greatest risk - weight <70% of expected body weight, particularly during first week of treatment ¢Sudden availability of carbohydrates stimulates insulin secretion and increases need for thiamine and minerals involved in carbohydrate metabolism ¢Hypophosphatemia, hypokalemia, and hypomagnesemia - cells rapidly remove these minerals from the bloodstream ¢Edema and fluid retention can cause heart failure ¢Thiamine deficiency causes acidosis, hyperventilation, and neurologic impairments

munchausen syndrome by proxy

¢A psychiatric disorder where a caretaker falsifies illness in the child to gain attention

Abusive head trauma (AHT)

¢Also known as shaken baby syndrome or shaken infant ¢Caused by vigorous shaking of the baby while being held ¢Results in intracranial and retinal bleeding

ADHD treatment

¢Behavioral interventions ¢Medications: ¢Ritalin,Concerta, Ritalin LA ¢Dexedrine ¢Adderall, Adderall XR ¢Most common medication side effects: ¢Weight loss ¢Difficulty sleeping ¢Decreased appetite ¢Tics ¢Cardiovascular events

ADHD impulsivity

¢Blurting out responses ¢Difficulty waiting turns ¢Interrupting frequently ¢Striking out, biting, shouting

Physical exam findings for maltreatment:

¢Bruises in various stages of healing ¢Bite marks ¢Burns in unusual locations ¢Fractures in various stages of healing

ADHD inattention

¢Carelessness ¢Inattention to details ¢Does not listen ¢Poor follow-through with instructions ¢Difficulty organizing activities ¢Avoidance of tasks that require mental effort ¢Losing objects ¢Easily distracted

child maltreatment

¢Deliberate failure to provide for a child's needs ¢Physical ¢-Inadequate weight gain for age ¢-Failure to thrive ¢-Poor growth pattern ¢-Inappropriate dress for the weather ¢-Inadequate hygiene ¢-Lacking routine healthcare ie: immunizations, glasses ¢Emotional ¢-Delays in physical and emotional development ¢Sexual abuse ¢-Difficulty in sitting and walking, bladder infections, sexually-transmitted diseases

anorexia nervosa

¢Deliberate refusal to maintain adequate body weight ¢Compulsive pursuit of thinness ¢Distorted body image results in extreme need to control food intake ¢Self-worth is based on size and shape ¢Intense preoccupation with and unrelenting fear of obesity ¢See themselves as fat in the mirror and are repulsed

ADHD nursing considerations

¢Educate family about the disorder and assist with management strategies ¢Calm, firm, respectful approach with the child ¢Obtain child's attention before giving instructions ¢Short, clear explanations ¢Set clear limits on unacceptable behaviors ¢Physical activity to expend energy ¢Focus on the child's strengths ¢Assist family with behavior strategies ¢Assist family with modification of the environment ¢Assist with appropriate classroom placement

child maltreatment

¢Emotional abuse ¢Neglect ¢Physical abuse ¢--Increases during times of hardship or emotional stress ¢Sexual exploitation or molestation ¢All suspected child abuse must be reported to the appropriate authorities

ADHD hyperactivity

¢Fidgeting ¢Failing to remain seated ¢Runs or climbs excessively in inappropriate settings ¢Excessive talking ¢Difficulty engaging in quiet play

Questions to assess potential for suicide

¢Have you ever thought of trying to hurt yourself? How might you do this? ¢Have you ever thought of killing yourself? How might you do this? ¢Have you known anyone who has committed suicide? When did this occur? What was this like for you? ¢Do you have access to firearms or knives? ¢Do you ever do things to deliberately place yourself in danger? ¢Have you ever told anyone you want to kill yourself? ¢Have you ever been hospitalized for suicidal behavior? ¢Can you describe how you feel right now?

Indications of physical maltreatment:

¢History inconsistent with physical exam findings ¢Activity reportedly leading to the trauma is inconsistent with the age and condition of the child ¢Delay in seeking treatment for the trauma ¢History of past emergency department visits

Characteristics of abusive families

¢Isolated from community ¢Intense competition for emotional resources ¢Lack of a support system ¢Exhibit low levels of trust ¢Resolve conflict through aggression ¢Assume fixed and traditional roles ¢Establish rigid rules

suicide risk factors

¢Previous suicide attempts ¢Psychosocial hospitalization ¢Suicide of friend or family member ¢Death of a parent prior to 13 years of age ¢Preoccupation with death ¢Self-abusing behaviors ¢Overwhelming sense of guilt or shame ¢Social isolation ¢Handguns in the home ¢Homosexuality

eating disorders nursing consideration

¢Recognition of children with eating disorders ¢Monitor electrolytes ¢Monitor caloric intake ¢Individualized therapy - individual, group, and family therapy sessions ¢Observing after meals to prevent episodes of purging

bulemia

¢Recurrent episodes of rapid, convulsive binge eating and purging ¢A sense of lack of control over eating behavior ¢Use of strategies to prevent weight gain (self-induced vomiting, laxatives, diuretics, fasting, vigorous and excessive exercise) ¢At risk for tooth erosion due to effects of acidic stomach contents on the teeth ¢Most are within normal weight percentiles

suicide nursing considerations

¢Safe environment is priority ¢Non-judgmental ¢Empathy ¢Clear, direct, and supportive demeanor ¢Remove potentially harmful objects ¢Promote adherence to treatment plan - cognitive behavioral therapy (CBT), medication

anorexia manifestations

¢Weight - 15% below expected weight ¢Emotional symptoms - low self-esteem, denial of condition, body image disturbance ¢Skin, hair, nails - lanugo on the face and trunk, dull brittle hair, dry skin, brittle nails ¢CV - arrhythmias, bradycardia, hypotension, orthostatic hypotension ¢GI - delayed gastric emptying, decreased GI motility, severe constipation ¢Endocrine/metabolic - cold sensitivity, fatigue, hypercholesterolemia, hypoglycemia, amenorrhea or menstrual irregularities ¢Musculoskeletal - osteopenia, osteoporosis, muscle weakness and wasting ¢Nutrient deficiencies - protein-calorie malnutrition, various micronutrient deficiencies

manifestations of bulemia

¢Weight - normal or slightly above normal ¢Emotional symptoms - mood swings, feelings of isolation, depression, low self-esteem ¢Skin, hair, nails - typically normal ¢CV - arrhythmias, palpitations ¢GI - bloating, constipation, flatulence, gastric dilation with risk of rupture ¢Endocrine/metabolic - menstrual irregularities, electrolyte abnormalities ¢Musculoskeletal - dental erosion, muscle weakness ¢Growth - usually not affected ¢Nutrient deficiencies - variable Yellow areas on tongue- side of these upper teeth is all acid erosion of the tooth enamel

down syndrome

•A collection of associated symptoms and disorders that tend to occur together •Trisomy 21 •Moderate to severe intellectual impairment •Distinct facial features •Heart defects •Risk factors include increased maternal age and genetic predisposition

Growth hormone deficiency education

•Administration of GH replacement at home •Importance of compliance with injections •Therapy continued until growth plates close or the child reaches an acceptable or predicted height - typically ~16 for boys and ~14 for girls •May need replacement into adulthood, in some situations

fetal alcohol spectrum disorder nursing considerations

•Assist family with dealing with feeding difficulties, irritability •Monitor height & weight •Monitor intake & output •Family support

autism nursing considerations

•Assist with screening tools •Assist with behavior modification •Decrease environmental stimulation •Introduce the child to new situations slowly •Age-appropriate play •Age-appropriate communication •Support family •Encourage support groups

behavior indications of failure to thrive

•Avoidance of eye contact •Avoidance of physical touch •Intense watchfulness •Sleep disturbances •Lack of age-appropriate stranger anxiety •Inappropriate lack of preference for one's own parents •Apathy •Extreme irritability vs extreme compliance •Repetitive self-stimulating behaviors - rocking head banging, intense sucking

autism diagnostic evaluation

•Behavioral manifestations •Developmental screening - Ages & Stages Questionnaires, Checklist for Autism in Toddlers, Pervasive Developmental Disorders Screening Test

Autism spectrum disorders

•Complex neurodevelopmental disorders with spectrum of behaviors affecting an individual's ability to communicate and interact with others in a social setting •Unknown cause •Symptoms typically noticeable by 3 years of age •Asperger Syndrome vs Autism

Americans with disabilities act

•Developmental disability has become an umbrella term to encompass children with -•Intellectual disability -•Sensory deficits -•Orthopedic problems -•Cerebral palsy -•Autism spectrum disorders

autism management

•Environment that facilitates interaction and normal behaviors •Special programs for children with autism

fetal alcohol spectrum disorder

•FASD is the most severe form experienced by the infant exposed to alcohol in utero •Persistent symmetric growth retardation •Malformations of the face and skull •Skeletal and cardiac malformations •CNS deficits •Intellectual and developmental disabilities

failure to thrive nursing cnsiderations

•Facilitate child's physical and developmental status •Role model for positive parenting Thorough psychosocial history •-Family income •-Family organization •-Social isolation •-Stress factors •-Support systems •-Maternal depression •-Family violence •-Drug/alcohol use •-Food security •-Facilities for preparing and storing food

management of intellectual disability

•General strategies •--Increase the time spent in a regular school setting •--Multidisciplinary efforts •--Strong advocacy on the part of parents •--Comorbidities •Safety challenges •--Environmental challenges -----PRIMARY CONCERN IS PATIENT SAFETY! Most important to maintain a safe environment •--Parental oversight

Causes of intellectual disability

•Genetic •Alterations occurring during pregnancy •Neonatal alterations •Acquired childhood conditions or diseases •Environmental problems •Unknown causes

Pediatric differences in the GU system

•Kidneys operate at a functional level appropriate for body size; however, function is reduced when the infant is under stress •Kidneys reach near adult function at 6 to 12 months of age •Infants cannot concentrate urine as efficiently as older children or adults •Shorter urethras predispose children to UTIs •Achieve complete bladder control by 4 to 5 years of age •Unlike adults, children with acute renal failure regain normal function

diagnostic evaluation of Growth hormone deficiency

•Measurement of growth over 6-12 months •Labs: CBC, electrolytes, thyroid function, insulin-like growth factor (IGF-1), IGF binding protein 3 (IGFBP-3) •Bone age radiographs •Growth hormone stimulation test to confirm diagnosis

manifestations of fetal alcohol spectrum disorder

•Microcephaly •Small eyes with epicanthal folds •Thin upper lip •Small palpebral fissures (eye openings) •Flat midface •Short nose •Hypotonia •Irritability, tremulousness •Feeding difficulties •Prenatal and postnatal growth restriction •Developmental delays •Neurologic abnormalities •Diminished fine motor skills

Excretion of medication

•Most medications are excreted through the kidneys •Due to renal immaturity in infants and young children, adequate quantities of a given medication are not filtered medication can circulate longer and reach toxic levels in the blood •Dehydration can decrease a child's ability to excrete medications

failure to thrive management

•Multivitamin and mineral supplements •Caloric enrichment of food •24cal/oz infant formula •Parenting classes •Family therapy

Growth hormone deficiency medication

•Replacement therapy - Somatropin (growth hormone) •Subcutaneous injection

down syndrome manifestation

•Small, round head •Flattened forehead •Upward, outward slant to eyes •Small nose with depressed nasal bridge •Epicanthal folds •Protruding tongue •Small, low-set ears •Transverse palmar crease •Inward curve to 5thfinger •Large space between big and 2ndtoes with plantar creases •Hyperflexibility, muscle weakness, hypotonia

failure to thrive manifestatiosn

•Weight below the 5thpercentile •Sudden or rapid deceleration in the growth curve •Delay in reaching developmental milestones •Decreased muscle mass •Muscle hypotonia •Abdominal distention •Generalized weakness •Cachexia

Review the Genitourinary System Structure

◦Bean-shaped kidneys are located one on each side of the spinal column ◦Ureters extend down from the kidney and enter the bladder wall ◦The nephron is the kidney's functional unit

Review the Genitourinary System Function

◦Maintain fluid and electrolyte balance