Esophageal Atresia
Rheumatic Fever
Streptococcus pyogenes is responsible for the infectious disease
Cystic fibrosis (respitory)
Symptoms are produced by tick mucus in the airways that block air passage , leading to obstruction to air flow and bacterial colonization and destruction of lung tissue (2) Obstruction of the airways will lead to air trap in the alveoli hence Emphysema(air sac become dilated) develops. (3) Atelectasis (collapse of the lung)occur as the airways become increasingly obstructed (4) Wheezing and dry nonproductive cough (5) Dyspnea; Cyanosis; Clubbing of the fingers and toes-due to chronic hypoxia (6) Repeated episodes of bronchitis and pneumonia
Reye's Syndrome
Syndrome which is an acute encephalopathy (inflammation of the brain). Usually follows a viral illness & linked to intake of aspirin. Use acetaminophen (not aspirin) to reduce fever with child with a communicable disease (virus) to prevent this. Lethargy progressing to coma vomiting hypoglycemia
9-11 mos
TABLE FOOD (1) stand holding onto object like furniture (2) creep and crawl FINE (1) Pincer grasp - using finger not the palm to hold object. For example picking object with thumb and 3 fingers. Can pick small tiny object. Hence can feed self with finger food and can drink from cup.
Sensory Development -0-1year
TRUST VS MISTRUST They can see object best at a distant of 14-15 inches so toy should not be too far from them. (2) They love to look at human face especially when mother carries them in their arm to rock them. Very good to give them unbreakable mirrior to look at the face (3) They are attracted to colorful material object like colorful toy- red, blue and black. (4) 2 things that interest t baby most are colorful contrast object and human face
Reassess the parent's needs and concerns
Ten days after cardiac surgery an 18-month old is recovering well. The child is alert and active and is playing well with the parents. Discharge is planned soon. The nurse notes that the parents are still very reluctant to the child to do anything without help. What the best initial action for the nurse to take?
cyanotic
Tetralogy of Fallot-causes low oxy associated with cynosis prone to CHF
A play telephone
The grandparents of a 2 1/2-year=-old ask what would be an appropriate toy to buy their grandson. Which of the following should the nurse recommend?
hydrocephalus positioning
The infant with hydrocephalus should be positioned sitting up in an infant seat
Frontanels
The infant's posterior fontanel closes by 6 to 8 weeks of age. The infant's anterior fontanel closes by 12 to 18 months of age
Head Circumference
The normal head circumference of a full-term infant is 32 to 38 c,, about 2 cm greater than the chest circumference. In the toddler, both measure are about equal; after the age of 2, the chest circumference exceeds that of the head. Use specific knowledge of growth and development of the infant to systematically eliminate each of the incorrect options. Recall that the measurements "cross over" at about age 2 when the head becomes smaller in circumference than the chest.
transposition of the great vessels
The open ductus arteriosus will allow a small amount of mixing of oxygenated and unoxygenated blood. Stress will increase the cardiac workload and therefore is a priority for the nurse to avoid.
Hydrocephalus positioning after feeding
The side-lying position is the preferred way to place an infant with hydrocephalus after feeding. Because such infants are at risk for vomiting as a result of increased intracranial pressure, placing them on their side allows vomitus to easily escape, decreasing the chance of aspiration.
weight loss by 10%
what are the physical findings of dehydration?
Walks with support
which assessment finding would the nurse consider abnormal for an 18-month-old child?
solid foods
■ Can start at 4 to 6 months. Start with rice cereal (fortifi ed with iron) before other type cereals or food groups
Methylphenidate (Ritalin) or dextroamphetamine (Dexedrine)
■ Psychostimulant, which increases dopamine and norepinephrine levels ■ Nursing Considerations/Client Education ☐ Gradually increase dose to reach therapeutic results. ☐ Give 30 min before meal. ☐ Give last dose of the day prior to 1800 to prevent insomnia. ☐ Monitor for adverse effects.
immunization schedule
● Hepatitis B (HepB) ◯ Birth ◯ 1 to 2 months ◯ 6 to 18 months ● Rotavirus (RV) ◯ 2 months ◯ 4 months ● Diphtheria, tetanus, pertussis (DTaP) ◯ 2 months ◯ 4 months ◯ 6 months ◯ 15 to 18 months ◯ 4 to 6 years ◯ 11 to 12 years ◯ Booster every 10 years ● Haemophilus influenzae type b4 (Hib) ◯ 2 months ◯ 4 months ◯ 12 to 15 months ● Pneumococcal (PCV) ◯ 2 months ◯ 4 months ◯ 6 months ◯ 12 to 15 months ● Inactivated poliovirus (IPV) ◯ 2 months ◯ 4 months ◯ 6 to 18 months ◯ 4 to 6 years ● Measles, mumps, rubella (MMR) ◯ 12 to 15 months ◯ 4 to 6 years ● Varicella (VAR) ◯ 12 to 15 months ◯ 4 to 6 years ● Hepatitis A (HepA) ◯ 12 months to 2 years ◯ 6 to 18 months following ● Meningococcal (MCV4) ◯ 11 to 12 years ● Influenza (TIV) ◯ Yearly ● Human papillomavirus ◯ 11 to 12 years (3 doses)
Sodium salicylate
1. Tinnitus and nausea are signs of toxicity to salicylate drugs.
BUN
10-20 mg/dL
tonsillectomy
After tonsillectomy, the child should be placed ____________position to facilitate drainage
bryant traction
Both lower extremities flexed 90 degree at hips; rarely used because extreme elevation of lower extremities causes decreased peripheral circulation
Potty Training (socialization)
Capable - Child is able to stay dry for 2 hrs, waking up dry from nap, able to sit, squat and walk, able to remove clothes, recognize the urge
cystic fibrosis
Cystic fibrosis results from a buildup of mucus in the lungs or gastrointestinal tract that interferes with breathing or digestion.
maligmant
DANGEROUS spreads
best indication that infant with hydrocephalus is developing increased intracranial pressure?
Decreased pulse and respiratory rates
Pacifier in mouth
Decreases risks for SIDS
Cephalocaudal
Defined as growth and development that proceeds from the head toward the feet
Incranial pressure signs
Difficulty arousing the baby from a nap
elixir
Digoxin- Direct oral elixir toward the side and back of mouth when administering Diretic- Mix the oral elixir in a small amount of juice to disguise the bitter taste and prevent intestinal irritation.
wrist restraints
Limit arm movement. May be used when a person continually tries to pull out tubes used for life-saving treatment. Or when the person scratches at, pulls at, or peels the skin, a wound, or dressing.
cyanotic heart defect home care
Means of promoting mobility while meeting the need for _supplemental oxygen
nephrotic syndrome
Periorbital and/or peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia
Apricots and bananas
The child is being treated with digoxin and hydrochlorothiazide (Hydrodiuril) Not only is potassium needed, but excessive sodium should be avoided because those with severe heart defects are prone to fluid retention
Pink eye
The condition described is probably pink eye, and it is very contagious. Once antibiotic treatment is started, the child should stay out of school for 24-48 hours.
Tay Sachs
There is no cure for Tay-Sachs. The child is missing the enzyme hexosaminidase A, which Is necessary for all tissues. The child will become blind and lose any skills that he may have developed and will eventually die.
Risk for Heart Failure
Bed rest to decrease workload Administer digoxin (monitor pulse; hold <90 in infants <70 in older children watch for digoxin toxcity Diurectics (lasix and Chlorothiazide) monitor I&O, daily weight, watch electrolytes (K+ and Na+) ACE Inhibitors (Capoten and Vasotec) dilates blood vessels monitor BP
Dental Care Nursing Intervention
) Advice mother first visit to dentist is by the age 2 years (2) Child should avoid medications that affect the teeth which include: (3) Medication that stains the teeth such as : tetracycline, iron,dilatin (4) Medication that causes inflammation of the teeth such as Dilantin(phenytoin) that causes gingivitis (5) Monitor for signs of beginning of teething which include: (a) Finger sucking - (b) Bitting object (c) Increase drooling (d) Patient may experience pain- 1. give cool or cold items and acetaminophen (e) Once teeth eruption start - avoid night time bottle or breast feeding or juice or any sugar liquid. Because sugar can cause cavity. Give water only
cardiac conditions
+Feeding and fatigue questions to find out if they lose breath during eating +Prone to upper respiratory infections +Moms labor and delivery +Labor difficulties +Check vitals, physical, History +Diagnostic testing, (sonogram of heart)echo cardiogram, x-ray ,labs,EKG
asthma treatment
- Albuterol (Proventil), Terbutaline (Brethine) - provide rapid e relief of acute asthma attack Assess airway patency (2) Administer humidified oxygen by nasal prongs or facemask (3) Administer quick relief (rescue) medications which include
diphenhydramine
-Anti-histamin causes drowsiness
School Age
-Growth is slow in children 6-10 yrs -2 Inches per year between ages 6 and 12 Weight gain of 4 1/2 to 6 1/2 pounds per year - Vision 20/20 by age 6-7 VSS Pulse 70-110, RR 18-30, BP95-108/56-68 Sleep- 10 to 12 hours a night -deciduous teeth are gradually lost. -Calorie need 2100-2400 kcal/day - Increase protein and calorie needs as child grows
hemophilia
-hemophilia #A clotting factor 8 -hemophilia#b missing clotting factor 9 -An X-linked recessive disorder in which blood fails to clot properly, leading to excessive bleeding if injured. -child get disorder from mom -symptoms is bleeding and bleeding under skin -check urine and stool often to check for black GI -platelet counts are normal -cv's testing -ptt bleeding times will be abnormal( takes a while to clot) -ffp infuse clotting time factor needed -all bleeding precautions (soft toothbrush,no razors, ptt
Normal platelet count for children
150,000-400,000
crib slates
2.36 inch
standing on one foot for several seconds
3 years old expected finding
wbc
4,500-10,000
glucose
70-110 mg/dL
MMR Conraindication
A contraindication to MMR vaccine is a history of allergic reaction to neomycin or gelatin.
Tay-Sachs
A human genetic disease caused by a recessive allele that leads to the accumulation of certain lipids in the brain. Seizures, blindness, and degeneration of motor and mental performance usually become manifest a few months after birth. - Fatal hereditary congenital disease, affects ppl of Ashkenazic (Eastern Europe) Jewish origi
pku phenylketonuria
A human metabolic disease caused by a mutation in a gene coding for a phenylalanine processing enzyme (phenylalanine hydroxylase), which leads to accumulation of phenylalanine and mental retardation if not treated; inherited as an autosomal recessive phenotype. genetic disorder in which the body cannot metabolize their amino acid phenylalanine Avoid meat, milk, dairy, eegs Eat fruits, juices, cereal, bread, starches
Baby Ratttle
A mother brings her 15-month-old son to the clinic. During the exam, the mother makes the following comments. Which comment merits further investigation?
Reschedule
A mother has brought her 4-year-old child for Denver II testing for routine assessment of social and physical abilities. The child refuses to complete the testing. What should the nurse do?
Use of Gestures
A nurse in a well-baby clinic is collecting data about the language and communication developmental milestones of a 7-month-old infant. The nurse understands that which of the following begins to occur in the infant at this developmental age?
History of allergy to neomycin or gelatin.
A pediatric client is scheduled to receive a dose of MMR (measles, mumps, rubella) vaccine. The nurse would question the order to give the dose at this time if which of the following was noted during the short history obtained on intake?
hemolytic crisis
A rapid destruction of red blood cells that occurs faster than the body's ability to create new cells.
atrial septal
ASD; a hole in the atrial septum that causes blood in the RA and LA to mix
atrial septal defect
ASD; a hole in the atrial septum that causes blood in the RA and LA to mix
2years old
AUTONOMY VS SHAME&DOUBT should stand on tippy toes,. draw a line hold a crayon • Sleep- 10-12 hrs a day
cystic fibrosis on integumentary and reproductive
Abnormally high concentrations of sodium and chloride in sweat b. Parents report that the infant tastes "salty" when kissed c. Dehydration and electrolyte imbalances, especially during hyperthermic conditions 4. Reproductive system a. Delayed puberty in females b. Fertility can be inhibited by highly thick cervical secretions, which act as a plug and block sperm entry c. Males are usually sterile, caused by the blockage of the duct in the testes by abnormal secretions or by failure of normal development of duct structures
varicella
Acyclovir a viral condition characterized by a fever and a rash consisting of hundreds of itchy, fluid-filled blisters that burst and form crusts chicken pox
acute otis media
infection of middle ear (still give immunizations)
Primitive reflexes present at birth include
All primitive reflexes disappear between 4- 5months except babinski reflexes that continue till 1 year (4) Primitive reflexes present at birth include: (a) Moro reflex -(infant startled reflex) 1. This occurs from birth until about 4-5 months of age. 2. The reflex is a response to sense of sudden loss of support and the baby feels is falling 3. When the baby is held in the supine position or pull up with his hand and the head is suddenly allowed to fall down, the baby respond by i. Spreading out the arms -abduction ii. Unspreading the arm back- adduction iii. Then crying opening of the palm and extend the arm and legs 4. It is used to assess the neurological status of the baby 5. Absence indicate disorders of motor function 6. Persistence more than 5 month indicate sever neurological deficit (b) Placing reflex- 1. This occurs from birth until about 6 weeks of age 2. When the baby is held upright and the top (dorsum) of the foot is brushed against the edge of a table, the baby will lift the foot and place it on the table. (c) Stepping reflex (dancing reflex) or walking reflexes 1. from birth until about 6 weeks of age. 2. When the baby is held in the upright position and the foot is placed on a firm surface, the baby will attempt to walk by placing one foot in front of the other. (d) Rooting reflex 1. This occurs from birth until about 4 months of age. 2. When the baby is touched near the corner of the mouth, the baby will turn his head towards the stimulus. 3. useful for getting babies to latch onto the breast - the baby will turn to the nipple when mother touches the angle of the baby's mouth with the nipple (e) Sucking reflex 1. This occurs from birth until about 4 months of age. 2. When an object is placed in the mouth, the baby will start sucking. 3. This is one of the baby milestones that is vital for survival. 4. It allows the baby to initiate sucking without training (f) Palmar Grasp reflex - 1. This occurs from birth until about 3 months of age. 2. The baby closes his hand all the time 3. This will prevent the baby from putting anything in the mouth (g) Plantar Grasp reflex 1. occurs from birth until about 10 months of age. 2. When the sole of the foot is stimulated with blunt object there is plantar flexion (the big toe bend downward(plantar flexion ) and other toes curls downward and in ward) same thing as if the baby closes his foot around an object placed against the sole. 3. Abnormal plantar reflex is called babinski reflex- the big toe bend upward( extension or dorsiflexion) and the other toes fan out. This is normal in newborn baby because of immature nervous system. But in adult is a sign of CNS defect especially the pyramidal tract. (h) Atonic neck reflex: 1. occurs from about 2 months until 6 months of age. 2. When the baby is lying on his back and the head is turned to one side, the arm on that side will extend and the other arm will flex - a fencing posture. (i) Parachute (forward) reflex 1. from about 9 months of age and persists. Hanged mobile Rattles - makes sound 2. If the baby is held in a position where he is dropped forward, he will outstretch his hands. 3. This is one of the baby milestones that is protective for falling.
hypertrophy
An increase in size and strength of muscle.
Set of Blocks
An inexperienced mother is playing with her 8-month-old in the playroom. The nurse has shared information with the mother about toys that are developmentally appropriate for the child. The nurse will conclude that the information session has been successful when the mother selects which type of toy?
sinus arrhythmia in 10 yr old
An irregular heart rate that increases with inspiration and decreases with expiration is a sinus arrhythmia, which is common in children. It requires no action on the part of the nurse.
lateral incisors
Anterior teeth characterized by thin, sharp incisal edges that aid in cutting food.
typanostomy tube
Artificial ear tubes inserted to create an airway to ventilate the middle ear -Tube inserted to allow drainage
Malth calculations
AtI pg 391
Immunosuppression
Avoid live vaccines during periods of immunosuppression
streptococcus infection
Bacteria Blood, saliva, mucous, respiratory droplets; practitioner touches instrument that enters mouth of infected. 1-3 days Heart & kidney problems, death
bacterial meningitis
Bacterial inflammatory disorder of the meninges that cover the brain and spinal cord; caused by haemophilus influenza; streptococcus pneumoniae. Or neisseria meningitides; usual source of bacterial invasion is the middle ear or the nasopharynx, fractures of the skull, LP, and shunts; exudates covers the brain and cerebral edema occurs
Height & Weight
Birth height increase by 50% at 1 year Birth height doubles by 4 years Weight Newborn loses 5-10% of birth weight in the first 10 days after birth but regain it back by 2 weeks Birth weight doubles by 6 months Birth weight triples by 1 year by 2 yrs old there height is 50% of adult height
chest bottles
Chest bottles are always positioned below bed level to prevent the reflux of material into the chest cavity.
cystic fibrosis treatment
Chest physiotherapy (a) -involves postural drainage on awakening from bed and in the evening before bed. (more frequently during pulmonary infection) (b) Chest physiotherapy (CPT) should not be performed before or immediately after a meal (3) Bronchodilator medication by aerosol to open the bronchi for easier expectoration (administered before the CPT, when the child has reactive airway disease or is wheezing Prophylactic to prevent infection (b) Aerosolized antibiotics may be prescribed and are administered after CPT is performed, or IV antibiotics may be prescribed and administered at home through a central venous access device (8) Administer oxygen as prescribed during acute episodes; monitor closely for oxygen necrosis The goal of treatment is to replace pancreatic enzymes
rheumatic fever
Child with fever, joint pain, cutaneous nodules 4 weeks after a throat in fection
ASTHMA
Chronic inflammatory diseases of the respiratory tract that result in narrowing and obstruction to airflow b. Is commonly caused by irritation of the airways by physical and chemical irritants called allergy such as foods, pollens, dust mites, cockroaches, smoke animal dander, temperature changes, respiratory infection, activity, and stress c. The airways narrowing is due to three major processes acting on the bronchi: (1) Irritation of the airways leading to constriction of bronchi - (bronchoconstiction) (2) Inflammation of the wall of the airways leading to mucosa edema (3) Excessive secretion of mucus production d. Air is trapped in the lungs, leading to hypoxemia (low oxygen) and accumulation of carbon dioxide. This will result to respiratory acidosis Position patient to expand the lungs- Place client in high fowler's position b. Give Mediation as prescribed to dilate the bronchi c. Administer oxygen d. Give IV fluid e. Maintain calm non-stimulating environment f. Medication given include
cause of the elevated hematocrit?
Chronic oxygen deficiency
Cephalosporin
Class of antibiotics that have 10% cross sensitivity with penicillins
cephalosporin
Class of antibiotics that have 10% cross sensitivity with penicillins
diaper dermititis
Clean with water and mild soap Candida albican..direct contact with certain substances such as soaps,chemical,
Cryptorchidism
Condition in which one or both testes fail to descend through the inguinal canal into the scrotal sac. Cryptorchidism Notify the registered nurse if there is no urinary drainage for 1 hour, because this may indicate kinks in the stent or the catheter.
extraoccular muscles Strabismus
Condition in which the eyes are not aligned because of lack of coordination of the
levalbuterol
Do not take more frequently than recommended. Use in nebulizer. Once foil patch is opened vials inside should be used in 2 weeks. Keep vials in pouch until ready to use. For inhaler shake canister well before use and prime with 4 sprays before the 1st use and if not used for 3 days. Avoid contact with eyes. Causes palpitations
pertusis
Dry Cough
Bacterial Epiglottitis Symptom
Excessive drooling due to painful swallowing
Bladder Exstrophy
Extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall Monitor urinary output (2) Monitor for signs of urinary tract or wound infection (3) Maintain the integrity of the exposed bladder mucosa
elbow restraints
Following the repair of a cleft palate, the nurse places an 18-month-old child in restraints. The caregivers are with the child and will stay in the room at all times. Which of the following types of restraints would the nurse most likely use for this child
tracheostomy care
one finger should fit between ties and neck to ensure tube is secure
FLOW METER (ASTHMA)
Forced vital capacity (FVC) is the volume of air exhaled from full inhalation to full exhalation. (2) Forced expiratory volume (FEV1) is the volume of air able to be blown out as quickly as possible during the first second of a forceful exhalation after inhaling fully. (3) Peak expiratory flow rate (PEFR), measured using a peak expiratory flowmeter (PEFM), is the maximum airflow exhaled forcefully in 1 second. Video- Peak flow meter (4) A decrease in FEV1 or PEFR by 15% to 20% below the expected value iscommon in children with asthma. An increase in these values by 12% following the administration of bronchodilators is diagnostic for asthma
Proximodistal
Growth from the center of the body to the periphery and from general to specific. Ex: Infant can close its hand and grasp before it has finger pinch. Child has gross motor control before fine motor control.
scoliosis testing
Have the child bend over at the waist with arms hanging down, and observe for asymmetry of ribs and flank. ■ Measure truncal rotation with a scoliometer
Coarctation of the Aorta
Have to check all pulses, Narrowing of lumen of aorta
speech therapy if
Hearing loss and/or speech delays
platelets
Help clot blood
low hemoglobin for school age
Hgb 10g/dl
PERTUSSIS
Humidified Oxygen Incubation 5 to 21 days 3. Mode of transmission- direct contact or freshly contaiminated object 4. Prevention- contact precaution and pertusis immunization 5. All acute, infectious respiratory disease usually occurring in infancy 6. Begins with upper respiratory symptoms 7. Paroxysmal stage of the disease is characterized by prolonged coughing and crowing or whooping upon inspiration; lasts from 4 to 6 weeks 8. Treated with erythromycin 9. Complications include pneumonia, hemorrhage, and seizures
sickle cell
Hydration, Oxygenation, Pain management (morphine, ect..), blood transfusions, bone marrow transplant- life threatening, eg. strokes
TET Spells
Hypoxic episodes; relieved by the child squatting or being placed in the knee-chest position Give child morphine,oxy,propranol
moro reflex should be
In End of exam
toddler diet
Increase food variety. 1-4 years is when food preferences form, small portions of different foods
Age Classification
Infancy- from birth to 1 year 2. Toddler-1-3year 3. Preschool- 3-5years 4. School Age-6-12years 5. Adolescence-13-19years 6. Early Adulthood-20-40 years 7. Middle Adulthood-40-65years 8. Late Adulthood- 65years and above
Meningomyelocele positioning
Infants with meningomyelocele should be positioned prone with a pillow under the lower legs. Every effort is made to avoid putting pressure on the sac. Breaking the sac would likely cause the infant to develop meningitis.
Insulin
Insulin lispro (Humalog): Rapid-acting ● Regular Insulin (Humulin R): Short-acting ● NPH insulin (Humulin N): Intermediate-acting ● Insulin glargine (Lantus): Long-acting
neurologic
Intensity of an electric current needed to produce a minimal contraction of a muscle when and electric current of infinate duration is applied
7-8 mos
Introduce juice Gross- months- sit alone without support b. Fine- transfer object from hand to hand
cystic fibrosis on GI
Meconium ileus( obstruction of intestine leading to accumulation of feces) in the neonate ( feces is called meconium in new born) (2) Intestinal obstruction (distal intestinal obstructive syndrome) caused by thick intestinal secretions; signs include pain, abdominal distention, nausea, and vomiting (3) Steatorrhea-greasy, frothy, foul-smelling stools due to abnormal digestion of fat from pancreatic enzymes deficiency (4) Poor absorption of fat will lead to deficiency of the fat-soluble vitamins A, D, E, and K, which causes easy bruising and anemia (5) Malnutrition and failure to thrive due to poor absorption of nutrient from intestine. Diminished absorption of protein, specifically albumin will result in generalized edema (6) Rectal prolapsed can occur as a result of the large, bulky stools, and lack of the supportive fat pads around the rectum
beta thalassemia
Mediterranean descent (Greek islands, Italy), Middle East, India & Pakista - prominent jaw's - ***severe anemia*** - get hemoglobin normal by blood transfusion - may have to get spleen removed because it ends up being problem (do bone marrow before removal, if bone marrow done infection more likely and more suspect able to sepsis )
tetrology
Most common congenital cause of early cyanosis Early Cyanosis due to R-->L shunt, cyanotic spells that are relieved by squatting, boot-shaped heart on CXR pulmonic stenosis, VSD, secondary right ventricular hypertophy and an over-riding aorta. when severe, right to left shunt occurs and progressive polycythemia develop due to poor pulmonary circulation. Includes 4 defects that decrease pulmonary blood flo
kawasaki disease
Multisystem vasculitis - inflammation of blood vessels in the body especially the coronary arteries with antigen-antibody complexes Three Phases of clinical manifestations: Acute Subacute Convalesant
coarctation
Narrowing of the aorta congenital cardiac condition characterized by a narrowing of the aorta
nephrotic syndrome
Nephrotic Syndrome a syndrome characterized by edema and large amounts of protein in the urine and usually increased blood cholesterolFrothy urine Massive proteinuria Edema Anorexia
Spina Bifida?
Neural tube defect that involves incomplete closure of vertebrae and neural tube. incomplete formation of vertebrae at birth. Mother did not have enough folic acid before conception. protect sac from rupturing and drying out moist sterile non-adherent dressing fluids no diaper position on abdomen range of motion early surgical closure of lesion avoid rectal temperature
vaso occlusive crisis
OXYGEN start iv fluids 1st to promote hydration and circulation When cells block capillaries in important organs. what is the most common reason for hospitalization in a sickle cell patient?
seeing child in squatting position
Observe and assist if needed The squatting position will help the child with tetralogy to have better hemodynamics. It increases intraabdominal pressure and increases pulmonary blood flow. Placing child in a lying or standing position will increase his symptoms and be counter productive. It is not necessary to call for help because this is not an emergency situation.
which of the following can be obtained during cardiac catheterization?
Oxygen levels in the chambers of the heart
Pavlik Harness
Pavlik Harness keep femur in acetabulum (4-5mon) wear 24 hrs a day adjust every 2 weeks because of rapid growth
Preschool (3-5 YO)
Physical Development - Growth slows down - Primary teeth are being replaced by permanent teeth; fluoride supplement is essential -VSS: temp 97.5 to 98.6, AP 70-110, BP 95/57 -Sleep disturbance at peek -By 5 has 2100 words -Know name and address -Ask question constantly -Stuttering speech is normal -Cooperative play -same sex small group play
preserve child's tooth by
Place the tooth under the child's tongue
during nosebleed
Position the child's head forward while gently pinching the nostrils, ice on lymph nodes
corticosteroid
Prednisone
hypertrophic pyloric stenosis
Progressive non-bilious projectile vomiting in a previously healthy infantThe vomitus may become blood-tinged if esophageal irritation occurs. A movable, palpable, firm, olive-shaped mass is felt in the right upper quadrant. This mass is most easily palpated when the stomach is empty and the infant is relaxed. Deep gastric peristaltic waves from the left upper quadrant to the right upper quadrant may be visible immediately before vomiting commences. If the condition progresses, the infant may become dehydrated and experience metabolic alkalosis.
serum albumin
Protein in serum (blood)
Adolescence 13-19
RISK TAKERS Growth spurt takes place - In girls, this occurs between 10 and 12 years - in boys it occurs between 12 and 14 years secondary sex characteristics (puberty) - Due to hormonal changes when the hypothalamus begins to produce gonadotropins • Girls- hips widen, breast develop and enlarge, pubic hair and axillary appears, height and weight increases right before puberty • Boys- penis and scrotum enlarge, pubic and axillary appear, voice becomes deeper, puberty in boys officially begins with spermatogenesis and the first nocturnal ejaculation may occur Calorie- boys- 3000Kcal/day; Girls-2400Kcal/day • Calcium, zinc, iron, folic acid, and protein are especially important nutritional needs • Males need more vitamin B complex while females need more iron
juvenile idiopathic arthritis
use splints during day and night
10-12mos
Stand alone with no support (2) Baby start to walk holding onto object like furniture- called cruising (3) Can sit down from upright position Can say three to five words besides "dada" or "mama" b. No true words as yet, but comprehends word such as bye-bye, no-no c. Can respond to the word "NO"
mummy restraints
used for facial suturing
4-6 mos
SOLIDS INTRODUCED (iron fortified cereal) Gross motor (a) Gain head control (b) complete roll over i.e. turn from back lying position to lie on the abdomen or from abdomen to back (c) Can only sit with support
LICE
Scabies: nursing homes, nursing facilities, and day care settings ◯ (Pediculosis capitis)/Head lice: day care and schools; overcrowded conditions; sharing of combs, brushes, or hats ◯(Pediculosis corporis) /Body lice: overcrowded conditions and poor hygiene ◯ Pubic lice: multiple sex partners
10 yr old Normal LABS
Serum BUN 8 mg/dL is within the reference range for a 10-year-old child. Serum creatinine 1.3 mg/dL is out of the reference range for a 10-year-old child. Blood pressure of 100/74 mm Hg is within the reference range for a 10-year-old child. Urine output of 550 mL over 24 hr is within the reference range for a 10-year-old chil
10 yr old RENAL lAbs
Serum protein 5.0 g/dL is out of reference range for a 10-year-old child and should be reported to the Hgb 14.5 g/dL is within reference range for a 10-year-old child. Hct 40% is within reference range for a 10-year-old Platelet 200,000 mm3 is within reference range for a 10-year-old child.
seborrheic dermititis
Shampoo Daily,fine tooth comb seborrheic inflammatory scaling disease of the scalp and face, in newborns this is dermatitis ` known as cradle cap or seborrheic capitis, ottis externa
SIDS
Sleeping on the back decreases the risk of SIDS.
Sphincter
Sphincter controls begin at age 2 years
Streptococcal Prophylaxis
Streptococcal prophylaxis is lifelong if there is actual valve involvement
clubbing fingers
Thickening of the digits-nails are curved and shiny, looks round like sausage due to lack of oxygen
Toddler Problem areas
Thumb sucking • Toilet Training • Ritualistic behavior
signs of toxicity to salicylate drugs.
Tinnitus and nausea
Up only
To examine the tympanic membranes of a 4 year old, the nurse should pull the pinna in which direction?
ventricular shunt
Treatment to relieve some build up in obstruction in the ventricular system of hydrocephalus patients
Hypospadias
Urethral orifice is located below the glans penis along he ventral surface should not be circumsised doctor will create a temporary diversion of urine or urinary stent (used to maintain patency of the urethral opening) so as to allow the repair to heal. Instruct the parents about fluid intake, medication administration, the signs and symptoms of infection, and the need for physician follow-up for dressing removal approximately 4 days after surgery
Epispadias
Urethral orifice is located on the dorsal surface of the penis should not be circumsised doctor will create a temporary diversion of urine or urinary stent (used to maintain patency of the urethral opening) so as to allow the repair to heal. Notify the registered nurse if there is no urinary drainage for 1 hour, because this may indicate kinks in the stent or the catheter. Instruct the parents about fluid intake, medication administration, the signs and symptoms of infection, and the need for physician follow-up for dressing removal approximately 4 days after surgery
Denver II Screening test
Used in kids birth to 6 years old to evaluate social skills, language, fine and gross motor skills
IMMUNIZATION CONTRAIDICTIONS
Varicella- › Pregnancy › Cancers of blood and lymphatic system › Allergy to gelatin neomycin › Corticosteroids › Immunosuppression (with HIV or from medication administration Hep A- Hep B-LAIV » Younger than 2 years old » Immunosuppression » Chronic disease, egg allergy RV- Intussusception › Immunocompromised ipv- Allergy to neomycin (Mycifradin) and/or streptomycin and polymyxin B › Pregnancy Hib(influenza inactivated) HPV 2&4-› Pregnancy › Hypersensitivity to yeast tdap-An occurrence of encephalopathy 7 days after the administration of the vaccine › An occurrence of seizures within 3 days of the immunization › A history of uncontrollable, inconsolable crying after a prior immunization (may have lasted more than 3 hr and occurred within 48 hr of immunization) mmr- Pregnancy › Allergy to gelatin and neomycin › History of thrombocytopenia or thrombocytopenic purpura › Immunosuppression (with HIV infection or from medication administration) › Recent transfusion with blood products or immunoglobulins
acynotic
Ventricular septa defect, Atria septa defect, Patent ductus arterious, coarctation of the aorta- Not associated with cynosis
Neuroblastoma
What disease arises from the adrenal medulla, displaces and crosses the midline, metastasizes early, is the most common solid tumor, and is seen in the 2-to 4-year-old age group? This is a cancer cell that developed from the immature nerve cells (2) Found in several areas of the body such as: (a) Adrenal gland - commonest site because it has tissue similar to the nerve tissue (b) Other areas- lymph nodes, skin and around the eyes b. Symptoms (1) Firm, non-tender, irregular mass in the abdomen that crosses the midline (2) Urinary frequency or retention from compression of the kidney, ureter, or bladder (3) Lymphadenopathy, especially in the cervical and supraclavicular area (4) Bone pain if skeletal involvement occurs Page Updated:09/24/2012 228 (5) Supraorbital ecchymosis, peri-orbital edema, and exophthalmos as a result of invasion of retrobulbar soft tissue (6) Pallor, weakness, irritability, anorexia, weight loss (7) Signs of respiratory impairment (thoracic lesion) (8) Signs of neurological impairment (intracranial lesion) (9) Paralysis from compression of the spinal cord C. P
Hypothroidism
What is Hypothyroidism? deficiency of TSH. Primary cause is disease or loss of thyroid gland, failure of anterior pituitary to stimulate the thyroid gland or failure of hypothalamus to produce thyroid releasing factor. Findings associated with Hypothyroidism? early: fatigue, intolerance to cold, constipation, pale skin, depression, thin and brittle nails late: slow thought process and speech, skin- thick, dry, flaky, thinning of eyebrows, swelling in face, hands and feet, decrease acuity of taste and smell, hoarse, raspy speech What labs would you expect in someone with Hypothyroidism? TSH- increased T3 and T4- decreased CBC- anemia cholesterol and triglycerides- elevated glucose- hypoglycemic Hy How is Hypothyroidism managed? lifelong hormone replacement with levothyroxine bradycardia, hypotension, dysrhythmias, especially during early thyroid therap
RISK OF ABUSE
When Parent has no support system
hydrocephalus
When a 2 week-old infant is seen for irritability, poor appetite, and rapid head growth with an observable distended scalp vein, the nurse recognizes these signs as indicative of which condition? Abnormal accumulation of cerebrospinal fluids in the ventricles of the brain.
Consider this normal
When examining a 1-month-old infant, the nurse finds a head circumference of 32 cm and a chest circumference of 30 cm. The nurse should draw which conclusion about this data?
At the end of the exam,
When examining a 6-week old infant, the nurse should plan on testing for the Moro reflex at what point in the examination?
fluctuation of weight
Which data would be the most useful to the nurse in assessing the child's current congestive heart failure?
Medicines are stored on a high shelf out of the child's reach
Which observation by the nurse indicates that the parents of a toddler need additional teaching regarding household safety?
HODGKIN'S DISEASE
_______ is a form of cancer in the lymphatic system that is characterized by painless swelling of the lymph nodes. A painless swelling in the lymph nodes in the neck, underarm, or groin b. Unexplained recurrent fevers c. Non-productive cough d. Night sweats e. Unexplained weight loss f. Itchy skin g. When symptoms like these occur, they are not sure signs of Hodgkin's disease. In most cases, they are actually caused by other, less serious conditions, such as the flu. When symptoms like these persist, however, it is important to see a doctor so that any illness can be diagnosed and treated
cyanotic heart defect
a hear condition that causes blood to contain less oxygen than required; skin and mucous membrane color usually pale to blue Tetrology of Fallot (4 defects)
hemophilia
a medical condition in which the ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury.
craniotomy
a surgical opening through the skull
endocin
used to close ductus arteriosus
10-12 months
a. Gross (1) Stand alone with no support (2) Baby start to walk holding onto object like furniture- called cruising (3) Can sit down from upright position
0-3 mos
a. Gross Motor - (1) Head lag when pulled from back lying position to sitting position b. Fine motor : (1) Always closing hand-because of grasps reflex 0-3 months Cries , smile and Coos(making sound similar to pigeon or owl bird)and gurgles(making bubbling sound) 6-9 month-Can say "ma-ma" or "da-da" without attaching meaning. They first say da-da before ma-ma because da-da require the use of tongue to pronounce which is more central in the body than lips that is used to pronounce ma-ma
Teeth Growth
a. Teeth emerge by 6 months b. The expected total number of primary teeth a child suppose to have is based on the age using the formula: c. # of teeth= Age of child - 6 d. Examples- what are the number of teeth in the following babies: (1) 12 months old baby: 12-6= 6 teeths (2) 24 months old baby(2years) = 24-6= 18 teeth Page 3 Updated:09/24/2012 (3) The maximum number of primary teeth a child can have is 20 teeths. (4) 30 months old baby(21/2 years) = 30-6= 24 teeths. However a child cannot have more than 20 primary teeths hence by 2 1/2 years a child already have all the primary teeth
Ortolani sign
abducting the thighs and applying gentle pressure forward over the greater trochanter produces a 'clunk"
bacterial meningitis first priority when providing nursing care for this child?
administer antibiotics
proventil
alburterol short acting beta 2 agonist for acute asthma attacks
myelomeningocele treatment
antibiotics, surgery
immuno globulin
antibody activity , immuno means protection
fever from otis media give
antipyretic
muscular dystrophy
any of several hereditary diseases of the muscular system characterized by weakness and wasting of skeletal muscles Delayed Walking Frequent Falls Easily tires when walking Trouble climbing stairs Serum creatine phosphokinase (CK) levels are extremely high in the first 2 years of life before onset
lordalis
arch in back , typical for toddlers also expected to display pot belly
anemia shows jaundice
because bilirubin doesn't circulate, check for yellow eyes, can feel spleen(BIG),Liver(BIG) Hemotoria in urine,continuous erections ,occlusion, complains of joint pain, Spleen easily ruptures, (give Priority fluids, pain management second, give antibiotics, oxy, blood transfusion)
uneresis
bed wetting
glycosylated hemoglobin
blood test that indicates the amount of glucose in the blood over the previous few months; used to indicate how well diabetes mellitus is being controlled
General to specific
body develop from general functions to more specific function examples babies develop gross motor ability such as roll over the whole body, walking, running before progressing to more specific and fine function functions such as writing and handcrafts
cleft palate aspiration prevention
burp often
15 mos
walk alone, can build towers, can drink cup with 2 hands
bacterial pnemonia
caused by -Streptococcus Pneumonia, Hemophilus influenza, Legionnaire's disease is usually an abrupt onset of the illness with shaking chills, fever, and production of a rust-colored sputum Respiratory distress (air hunger, tachypnea, and circumoral cyanosis iii. Antibiotic use is penicillin Maintain patent airways - first priority (1) Suction the infant to maintain a patient airway if the infant is unable to handle secretions (2) Administer chest physiotherapy and postural drainage every 4 hours, as prescribed b. Administer oxygen via: (1) hood, mist tent, or nasal cannula) (2) Place the child in a mist tent, as prescribed; cool humidification moistens the airways and assists in temperature reduction (3) Promote bed rest to conserve energy c. Encourage the child to lie on the affected side (if pneumonia is unilateral) to splint the chest and reduce the discomfort caused by pleural rubbing d. Provide liberal fluid intake (administer cautiously to prevent aspiration); IV fluids may be necessary
Hirschsprung's Disease
caused when parasympathetic innervation that causes normal peristalsis to a portion of colon is absent, results in abd obstruction and distention of bowel, FOWEL, RIBBON LIKE STOOL In child, classically presents with feculant vomiting, abdominal distention, and constipation; often with history of failure to pass meconium during the first 24 hours of life
nephrotic syndrome
characterized by massive proteinuria caused by glomerular damage. corticosteroids are the mainstay HYPERALBUMINURIA
NG tube Priority
check stomach contents
mmr should be avoided if
child has received immunoglobins
nose bleeds
cold compress. pinch nose lean foward
esophageal atresia
congenital absence of part of the esophagus
constipation and UTI
constipation leads to stool mass preventing bladder from emptying completely
RSV
contact precautions....Isolation (contact) Antiviral agent (ribavirin aerosols
pneumonia
contacted through droplet,inhalation,blood stream (Hemophilus influenza)
hypoxemia
decreased level of oxygen in the blood
What is Hypopituitarism What causes it?
diminished/deficient secretions of pituitary hormones primarily GH. Leads to GH deficiency, which inhibits somatic growth in all body cells. cause: tumor, auto-immune, congenital, malnutrition, trauma What findings are associated with Hypopituitarism? absence or regression of secondary sex characteristics ex: slow growth, short stature, normal intelligence, delay puberty hormone replacement therapy (GH)- longterm
first sign of cystic fibrosis and Tx
doesn't pass first meconium because mucus too thick. Treatment is to give pancreatic enzymes for improved GI function
hypoglycemic intervention
encourage patient to drink juice 10-15 grams of simple carbs
glasgow
eyes, verbal, moto
Steatorrhea
fat in the feces; frothy, foul-smelling fecal matter Because of malabsorption of fat there is associated malabsorption of fat soluble vitamins namely-Vitamin-A, D,E,K
fever
forehead, back of neck, groin, armpits (were lymph nodes are)
Careseat
forward facing at 20 lbs and out of car seats at 40 lbs
what to look for8hrs after tonsillectomy
frequent swallowing is a sign of hemmorage
Simple to complex
from simple task like walking to more complex task like playing footballs, solving mathematical equation. From simple concrete thinking to more complex abstract thinking
type 1 diabetes
glycoslayted hemoglobin test to determine gluclose level over last few months
Fine motor
grasping and drawing
Hyperthyroidism
hyper secretion of the thyroid hormone which causes thyroid enlargement, causing increased BMR or hyperactivity of thyroid gland exophthalmos myopathy increased BMR, appetite, nervousness, heart rate gradual weight loss lower tolerance to heat insomnia increased BP decreased TSH increased T3, T4 radioactive iodine uptake elevated presence of thyroid antibodies PTU or methimazole- take with meals, report fever, sore throat, bruising, jaundice propranolol- take with meals, monitor HR and BP saturated solution of potassium iodine (SSKI)- take 1 hour after antithyroid meds
Bucks Traction
immobilizes the joint, prevents hip flexion contractures and relieves muscle spasm and is used for 24-48 hours.
Tuberculosis (TB)
infectious disease caused by myobacterium tuberculosis ;lungs usually are involved but any organ in the body may be affected . Malaise, fever c. Cough productive of sputum which may contain blood d. weight loss, anorexia e. Night sweat and low grade fever in the afternoon f. Specific symptoms related to the site of infection, such as the lungs, brain, or bone, may be present 5. Diagnostic / Lab Test a. WBC - is high showing there is infection but cannot identify what type of infection b. Mantoux test 15 mm or more in children 4 years of age or older who do not have any risk factors. 10 mm or more in children younger than 4 years of age and in those with chronic illness or at high risk for exposure to TB 5 mm or more is considered to be positive for those in the highest risk group, such as children with immunosuppressive conditions or human immunodeficiency virus (HIV) infection A positive reaction does not confirm the presence of active disease. Indicate the child has been previously infected or is having an ongoing infection but yet to be confirmed Negative results may mean that a person has not been exposed to TB, that the person is not infected with tuberculosis, that their immune system has not responded to the antigen in the test
ENURESIS
involuntary discharge of urine bedwetting
acetaminophen poisoning
jaundice
lumbar puncture
keep pt flat for 2-3 hrs afterwards, sterile dressing, frequent neuro assessments to prevent headaches
ataxia
lack of muscle coordination
bilateral myringotomy
making incision into tympanic membrane and inserting tubes to drain fluid from ear
wilm's tumor
malignant tumor of the kidney occurring in childhood, urinary retention is a issue, can spread fast.. Do not palpate belly..can burst mass . radiation depending on stage due to loss of a tumor suppressor gene called WT1 on chromosome 11. Anemia due to hemorrhage within the tumor (6) Elevated blood pressure-hypertension due to excessive secretion of renin. Renin is part of the hormone system naturally secreted in the kidney that is used to prevent hypotension. The system is usually activated when there is a loss of blood volume or a drop in blood pressure (such as in a hemorrhage). I t can spread to the lung Symptoms of Lung involvement include dyspnea, shortness of breath, pain in the chest.
celiac disease
marked by profuse, watery diarrhea and vomiting and can quickly lead to severe dehydration and metabolic acidosis. llergic to glutin. Need vegetable proteins Gluten Sensitivity, watery, pale, foul smelling stool
Hirschsprung's Disease
mechanical obstruction of sigmoid colon (constipation, ribbon-like stools with foul smells, abd. distension) Failure to pass meconium, ribbon like stools, constipation, abd distention, and the possible development if enterocolitis are sx of ? megacolon,high fiber diet, fliiuds, surgery(colostomy)
ddatp /vasopresent
med given to hemopheliac Terminates synthesis because the 3' H cannot act as nucleophile in phosphodiester bond formation.
ffp
med given to hemopheliac fresh frozen plasma C. should be transfused within 24 hours of thawing give before surgery
pinworms
most common type, Identified by itching of the anus, most common in children
Generalized migrating joint tenderness
most indicative of a client with rheumatic fever?
stenosis
narrowing
sign of bacterial meningitis
nuchal rigidty(Neck stiffness) and fever EMERGENCY
Temper tantrums
occur weekly in 50 to 80% of children - peak incidence 18 months - most disappear by age 3
wim's tumor
often in childs kidney before age 5
clostridium difficle stool sample
one of the most common causes of infectious diarrhea; symptoms may include watery diarrhea, nausea, and/or abdominal pain or tenderness; complications may include sepsis, renal failure, toxic colitis, and death; caused primarily by the eradication of native intestinal flora with broad-spectrum antimicrobials and overuse of PPI and H2 blocker therapy
Sibling Rivary
peaks at 1-2 years old
leading cause of death in adolesence
physical injury
myelomeningocele
portion of spinal cord, meninges, spinal fluid, and nerves protrude through neural tube defect
pyloric stenosis
projectile vomitin projecting vomiting,Give IV fluids, NG tube to decompress, monitor hydration, hypokalemia
4 defects (Tetrology of flow)
pulmonic stenosis overriding aorta ventricular septal defect right ventricular hypertrophy
TB patient
put patient in negative pressure room surgical mark if transported
contact dermititis
running cold water,corticosteroid Inflammation of the skin that results from direct contact with certain substances such as soaps, cosmetics, jewelry and weeks like poison ivy,feces
Stranger anxiety
should dissipate by age 2 ½ to 3 years
3yrs old
should draw a circle and a x
shoulder lap seatbelt
should fit across childs abdomen while sitting in booster seat
rheumatic fever
sore throat (usually manifest after a streptococcal infection of the URT
Gross motor
such as walking
Before NG tube feeding
test PH of stomach contents
skeletal tractions
the surgeon inserts pins, wires, or tongs directly through the bone at point distal to the fracture so that the force pull from the weights is exerted directly on the bone
Hypertrophic Pyloric Stenosis(
thickening of the pyloric sphincter, which creates an obstruction, treated with pylorotomy Projectile vomiting, Dry mucus membranes, Constant hunger
croup
this includes laryngitis, tracheitis, epiglottis. These are all airway blocking infections. Usually viral , but can be bacterial. The airway becomes narrowed due to edem barking, harsh cough stridor hoarseness fever purulent drainage dyspnea child will look "sicker" with bacterial How is the Croup managed? viral: cool air mist fluids antipyretics
FLACC
unconsious scale chart- (F) Face; (L) Legs; (A) Activity; (C) Cry; (C) Consolability
crypto
undescended testicles give hcg to help testes come down (
Cryptorchidism
undescended testicles! risk factor for testicular cancer later in life. Teach self exam for boys around age 12--most cases occur in adolescence Some testes may descend spontaneously within 1 year of birth