HESI PEDS

Question

Answer

Loading... Birth weight doubled by _____, tripled by  _____.

6 months; 12 months

Bir Birth lengt ength h inc incre reas ased ed by 50% 50% at at ____ _____. _.

12 mont months hs

Posterior fontanel closes by _____.

8 weeks (2 months)

A child can socially smiles at _____.

2 months

A child should be able to turn head to locate 3 months sounds at _____. Moro reflex disappears around _____.

4 months

A child should be able to achieve steady head 4 months control at _____ of age. A child can turn completely over at _____ of  5 to 6 months age. A child can play peek-a-boo after _____ of  6 months age. A child should be able to transfers objects hand to hand at _____.

7 months

A child child develo develops ps str strange angerr anxiet anxiety y at _____ _____..

7 to 9 month monthss

A child should be able to sit unsupported at  _____.

8 months

The infant crawls at _____.

10 months

Fine pincer grasp appears at _____.

10 to 12 months

A child should be able to waves bye-bye at  _____.

10 months

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A child should be able to walks with assistance at _____.

10 to 12 months

The infant says a few words in addition to "mama" or "dada" at _____.

12 months

From birth to one year, the baby explores environment by _____ and _____ means.

motor; oral

From birth to one year is what stage of  Erikson's theory?

Trust vs Mistrust (Developing a sense of trust)

What are some age-appropriate toys for  hospitalized infants?

mobiles rattles squeaking toys  picture books  balls colored blocks activity boxes

Birth weight quadruples by _____.

30 months

Achieves 50% of adult height by ___.

2 years

Anterior fontanel closes by _____.

12 - 18 months

A child should be able to throw a ball overhand at _____.

18 months

The nurse tells a mother that her child should 24 months  be able to kicks a ball at _____. A child should be able to feeds self with spoon and cup at _____.

2 years

Day time toilet training can usually be started 2 years of age around _____. A child should be able to speak two to three 2 years (24 months) word sentences at _____. A child should be able to speak three to four  3 years word sentences at _____ of age. A child should be able to states his/her own first and last name by _____.

2.5 to 3 years

Is temper tantrums common among toddlers Yes (1 to 3 years)?

A child should be able to walks with assistance at _____.

10 to 12 months

The infant says a few words in addition to "mama" or "dada" at _____.

12 months

From birth to one year, the baby explores environment by _____ and _____ means.

motor; oral

From birth to one year is what stage of  Erikson's theory?

Trust vs Mistrust (Developing a sense of trust)

What are some age-appropriate toys for  hospitalized infants?

mobiles rattles squeaking toys  picture books  balls colored blocks activity boxes

Birth weight quadruples by _____.

30 months

Achieves 50% of adult height by ___.

2 years

Anterior fontanel closes by _____.

12 - 18 months

A child should be able to throw a ball overhand at _____.

18 months

The nurse tells a mother that her child should 24 months  be able to kicks a ball at _____. A child should be able to feeds self with spoon and cup at _____.

2 years

Day time toilet training can usually be started 2 years of age around _____. A child should be able to speak two to three 2 years (24 months) word sentences at _____. A child should be able to speak three to four  3 years word sentences at _____ of age. A child should be able to states his/her own first and last name by _____.

2.5 to 3 years

Is temper tantrums common among toddlers Yes (1 to 3 years)?

What is the import developmental task of a toddler according to Erikson's theory?

Developing a sense of  autonomy.

 board and mallet  push/pull toys What are some age-appropriate toys for the toy telephone hospitalized toddler? stuffed animals storybooks with pictures

What can the nurse do to promote the developemental task of a toddler?

Toddlers benefit from being taken to the hospital  playroom, as mobility is very important to their  development.

Each year gain about 5 lbs What are the average weight and height gain and grows 2.5 to 3 for preschool children (3 to 5 years old)? inches. A child can use sissors at _____ of age.

4 years ars

A child should be able to ties shoelaces at  _____ of age.

5 years

Visual acuity approaches 20/20 at _____.

Preschool age (3 to 5 years)

A preschool child thinking is _____ and  _____.

egocentric; concrete

A child should be able to use sentences of 5 3 to 5 years to 8 words at _____ of age. Preschool At this stage of developement, a child learns 3 to 5 years sexual identity (curiosity and masturbation Preschool common). At this stage of development, imaginary  playmates and fears are common.

Preschool (3 to 5 years)

At child at this development stage begins to Preschool stands erect with more slender posture. (3 to 5 years) At this stage of development, a child learns to Preschool run, jump, skip, and hop. (3 to 5 years) A child at this developmental stage learns colors and shapes.

Preschool (3 to 5 years)

Imaginary playmates and fears are common Preschool at this stage of development: (3 to 5 years) Aggressiveness at _____ is replaced by more 4 years; independence  _____ at 5 years. Preschool child's major developmental taks according to Erikson theory is:

Developing a sense of  initiative

At this stage of development, the child appears to be bowlegged and potbellied.

TODDLER (1 TO 3 YEARS)

At this stage of development, all primary teeth (20) are present.

TODDLER  (1 TO 3 YEARS)

egocentricity;  Nursing implications of hospitalized (Explain that he/she did not  preschoolers (3-6 years) needs to emphasize cause the illness and that understanding of the child's _____.  painful procedures are not a  punishment for misdeeds.)  _____ or medical play to allow the child to act out their experiences is helpful for _____.

Therapeutic play; Preschoolers

At this stage of development, fear of  mutilation from procedures is common.

Preschool (3 to 5 years)

Toys and play for the hospitalized  preschooler include:

coloring books  puzzles cutting and pasting dolls  building blocks clay toys that allow the  preschooler to work out hospitalization experiences.

The _____ needs preparation for procedures. He or she needs to understand what is and what is not going to be "fixed." Simple  preschooler  explanations and basic pictures are helpful. (3 to 6 years) Let child handle equipment or models of the equipment.  _____ are learning to name body parts and are concerned about their bodies.

Toddlers (1-3 years)

During hospitalization, enforced separation

toddler's

from parents is the greatest threat to the (1 to 3 years)  _____ psychological and emotional integrity. Security objects or favorite toys from home should be provided for _____.

toddlers (1 to 3 years)

 Normal gain in weight and height for school- Each year gain 4 to 6 pounds age child (6 to 12 years) are: and about 2 inches in height. Loss of primary teeth and eruption of most  permanent

school-age child (6 to 12 years)

At this stage of development fine and gross motor skills mature.

school-age child (6 to 12 years)

During this developmental stage, girls may experience menarche.

school-age (6 to 12 years)

At this stage of development, a child should school-age child  be able to dresses self-completely. (6 to 12 years) At this stage of development, egocentric thinking is replaced by social awareness of  others.

school-age child (6 to 12 years)

At this stage of development, a child learns to school-age child tell time and understands past, present, and (6 to 12 years) future. At this stage of development, a child learns cause and effect relationships.

school-age child (6 to 12 years)

Socialization with peers becomes important at this stage of development:

school-age child (6 to 12 years)

A child's molars should erupt at _____.

6 years

According to Erikson's theory, developing a school-age child sense of industry occurs at this stage: (6 to 12 years) A child should be able to write script at  _____.

8 years

The hospitalized _____ may need more school-age child support from parents than they wish to admit. Maintaining contact with peers and school activities is important during hospitalization for a  _____.

school-age child

For school-age child, _____ and _____ are important, and should be respected during hospitalization.

 privacy; modesty e.g., close curtains during procedures, allow  privacy during baths, etc.

Participation in care and planning with staff  fosters a involvement; sense of _____ and _____ for a school-age accomplishment child (6-12 years).  board games card games Toys for the hospitalized school-age (6 to 12 hobbies (such as stamp years) child include: collecting, puzzles, and video games) School-age children are in Erikson's stage of   _____, meaning they like to do and industry; Peers accomplish things. _____ are also becoming important for this age child. Girls' growth spurt during adolescent begins  _____ than boys (may begin as early as ___  earlier; 10 for girls). Boys catch up to girls' growth at age _____  14 and continue to grow. Girls finish growth around _____, boys around _____.

15; 17

Adult-like thinking begins around age _____. 15; problem solve; abstract They can _____ and use _____ thinking. Secondary sex characteristics begins at this developmental stage:

ADOLESCENCE (12 to 19 YEARS)

At this stage of development, family connflict commonly occurs.

ADOLESCENCE (12 10 19 YEARS)

Hospilalization of adolescents disrupts _____  and _____ activities; they need to maintain school; peer  contact with both. Illness, treatments, or procedures which alter  the adolescent  body image can be viewed as devastating by the _____.

For this develpmental stage, teaching about  procedures should include time without  parents present.

adolescent (12 to 18 years)

For this developmental group, some assessment questions should be asked without parents' presence.

adolescent

When teaching adolescent needs, the focus should be on _____.

here and now i.e., how will this affect me today?

Infants' concept of bodily injury:

Infants: After 6 months, their  cognitive development allows them to remember   pain.

Toddlers' concept of bodily injury

Toddlers: Fear intrusive  procedures.

Preschoolers' concept of bodily injury

Preschoolers: Fear body mutilation.

School ages' concept of bodily injury:

School age: Fear loss of  control of their body.

Adolescents' concept of bodily injury:

Adolescent: Major concern is change in body image.

MMR VACCINE Generally administered at  _____ months of age and repeated at _____  12 to 15; 4 to 6; 11 to 12 years or by _____ years. In times of measles epidemic, it is possible to give measles protection at _____ and repeat 6 months; 15 months the MMR at _____. Measles vaccine is contraindicated for   persons with history of anaphylactic reaction neomycin; eggs; to _____ or _____, those with known altered immunodeficiency; pregnant  _____ and _____ women. MMR vaccine may be given to those with HIV and breastfeeding women. T or F

True

MMR vaccines are administer _____ at separate sites.

subcutaneously

A child may have a light transient ___ 2

rash

weeks after administration of MMR vaccine. DTaP Vaccine administration begins at age  ____, administer three doses at _____  intervals.

2 months; 2 months

DTaP Vaccine: Booster doses given at _____  15; 18 months; 4 to 6 years. to _____; and at _____. DTaP Vaccine: administer _____ (separate site from other vaccine).

intramuscularly

DTaP Vaccine is not given to children past the ______ birthday; they receive _____  which contains full strength protection 7th; Td against tetanus and lesser strength diphtheria  protection. When pertussis vaccine is contraindicated, give _____, until 7th birthday.

DT (full strength diphtheria and tetanus without pertussis vaccine)

Contraindications to pertussis vaccine include: 1. _____ within 7 days of previous dose of  DTP. Encephalopathy; seizures; 2. History of _____.  Neurologic; Systemic 3. _____ symptoms after receiving the vaccine. 4. _____ allergic reactions to the vaccine. Parents should be instructed to begin _____  acetaminophen (Tylenol); 10 administration after the immunization to 15 (normal dosage is _____ mg/kg). IPV is recommended for all person under the 18 age of _____. IPV is administer at _____ of age and again 2 months; 4 months; 6 to 15 at _____ of age. Boosters are given at _____ , months; 4 to 6 years and _____. Administer IPV _____ or _____ at separate site.

subcutaneously; IM

IPV is contraindicated for those with history of anaphylactic reaction to neomycin; streptomycin  _____ or _____.

PRP-OPMs can be given as early as ____ of  2 months age. DaTP/Hib combinations should not be used as primary immunizations at ages ___, ___, or ___.

2; 4; 6 months

Children at high risk who were not immunized with Hib previously should be immunized after age _____.

5

Hib is administer ______.

intramuscularly

 _____ offers protection against bacteria that causes serious illness (epiglottitis, bacterial meningitis, septic arthritis) in small children Hib or those with chronic illnesses such as sickle cell anemia.  _____ offers protection against hepatitis B. Typically, given to all _____ prior to hospital Hepatitis B vaccine; discharge. newborns; 0; 18 Vaccinate all children _____ to _____ years of age. Hepatitis B vaccine is contraindicated for  common baker's yeast  persons with anaphylactic reaction to _____. Hepatitis B vaccine is administer trough  _____ site at _____ , _____, and _____ of  age.

IM; 0 to 2 months; 1 to 4 months; 6 to 18 months

 _____ offers protection against chickenpox. It is also a school entry requirement in 33 states. VARICELLA vaccine And it is safe for children with asymptomatic HIV infection. VARICELLA vaccine is administer at _____  12 to 18 months; 12 months of age (must beat least _____). Give _____ and _____ vaccines on same day MMR; varicella or >30 days apart (separate site). Irritability, Irritability, fever (<102 F), redness and soreness at injection site for 2 to 3 days are normal side effects of _____  and _____ administration.

DPT; IPV

Following immunization, call health care  provider if _____, _____, or _____.

seizures; high fever; high pitched crying occur 

Following immunization, a _____ on the thigh injection site and _____ the legs with each diaper change will decrease soreness.

warm washcloth; "bicycling"

Following immunization, acetaminophen (Tylenol) is administered orally every _____  4 to 6; 10 to 15 hours (_____ mg/Kg). The common cold is not a contraindication for immunization. T or F

True

A highly contagious, viral disease that can lead to neurologic problems or death.

RUBEOLA (Measles)

RUBEOLA (Measles) is transmitted by  _____.

Direct contact with droplets from infected person.

RUBEOLA (Measles) is contagious mainly  prodromal period; fever; during the _____ which is characterized by upper respiratory  _____ and _____ symptoms.

Classic symptoms of RUBEOLA (Measles) include:

Photophobia Koplik's spots on the buccal mucosa. Confluent rash that begins on the face and spreads downward.

Viral disease characterized by skin lesions.

VARICELLA ZOSTER  (Chicken Pox)

Chicken Pox lesions begin on the _____ and trunk; face; proximal spread to the _____ and _____. extremities Chicken Pox progresses through _____,  _____, _____, and _____ stages.

macular; papular; vesicular;  pustular 

Chicken Pox transmitted by ____, _____, or  direct contact; droplet spread;  _____. freshly contaminated objects Chicken Pox communicability end when  _____.

scabs have formed

Common viral disease which has teratogenic RUBELLA (German effects on fetus durina the first trimester of  Measles)  pregnancy.

RUBELLA (German Measles) is transmitted droplet; direct contact with  by _____ and _____. infected person RUBELLA (German Measles) is charcterized discrete red maculopapular   by _____ starts on _____ and rapidly spreads rash; face; entire body to _____. RUBELLA (German Measles) rash disappears within _____.

3 days

An acute, infectious respiratory disease usually occurring in infancy.

Pertussis (Whooping cough)

Pertussis is caused by a _____.

gram-negative bacillus

PERTUSSIS (Whooping Cough) begins with upper respiratory symptoms  _____.  _____ is a paroxysmal state of the disease is PERTUSSIS (Whooping characterized by prolonged coughing and Cough) crowing or whooping upon inspiration. PERTUSSIS (Whooping Cough) lasts from  _____.

4 to 6 weeks

PERTUSSIS (Whooping Cough) is transmitted by _____, _____, or _____.

direct contact; droplet spread; freshly contaminated objects

PERTUSSIS (Whooping Cough) is treated with _____.

erythromycin

PERTUSSIS (Whooping Cough) complications include _____, _____, and  _____.

 pneumonia; hemorrhage; seizures

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Question

Answer

Loading... Differentiate between a A left to right shunt moves oxygenated blood right to left and left to  back through pulmonary circulation. A right to

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right shunt in cardiac disease.

left shunt bypasses the lungs and delivers unoxygenated blood to systemic circulation, causing cyanosis.

List the four defects VSD, overriding aorta, pulmonary stenosis, and associated with tetralogy right ventricular hypertrophy. of Fallot. List the common signs of  Poor feeding, poor weight gain, respiratory cardiac problems in an distress and infections, edema and cyanosis. infant. What are two objectives Reduce the workload of the heart and increase in treating congestive cardiac output. heart failure? Give small, frequent feedings or gavage feedings. Describe nursing Plan frequent rest periods. Maintain a neutral intervention to reduce the thermal environment. Organize activities to workload of the heart. disturb child only as indicated. What position would best relieve the child Knee-chest position or squatting. experiencing a test spell? Diarrhea, fatigue, weakness, nausea, and What are common signs vomiting: the nurse should check for bradycardia of digoxin toxicity?  prior to administration. List the five risks in cardiac catherization.

Arrhytmia, bleeding, perforation, phlebitis, obstruction of the arterial entry site.

What cardiac complications are associated with rheumatic fever?

Aortic valve stenosis and mitral valve stenosis

What medications are used to treat rheumatic fever?

Penicillin, erthromycin, aspirin

What are the physical features of a child with Down syndrome?

Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes.

Describe scissoring.

A common characteristic of spastic cerebral  palsy in infants; legs are extended and crossed over each other, feet are plantar-flexed.

What are two nursing Prevention of infection of the sac and monitoring  priorities for a newborn for hydrocephalus (measure head circumference; with myelomeningocele? check fontanel; assess neurologic functioning). List the signs and symptoms of increased ICP in older children.

Irritability, change in LOC, motor dysfunction, headache, vomiting, unequal pupil response, and seizures.

What teaching should  parents of a newly shunted child receive?

Information about signs of infection and increased ICP; understanding that shunt should not be pumped and that child will need revisions with growth; guidance concerning growth and development.

State the three main goals in providing nursing care Maintain patent airway, protect from injury, and for a child experiencing a observe carefully. seizure? What are the side effects Gingival hyperplasia, dermatitis, ataxia, GI of Dilantin? distress Fever, irritability, vomiting, neck stiffness, Describe the signs and opisthotonos, positive Kernig sign, positive symptoms of a child with Brudzinski sign; infant may not show all classic meningitis. signs even though very ill. What antibiotic are usually prescribed for   bacterial meningitis?

Ampicillin, penicillin, chloramphenicol

How is a child usually  positioned after brain tumor surgery?

Flat or on either side

Desribe the function of  Osmotic diuretics remove water from CNS to an osmotic diuretic. reduce cerebral edema. What nursing interventions increase intracranial pressure?

Suctioning and positioning, turning

Describe the mechanism of inheritance of  X-linked recessive trait Duchenne muscular  dystrophy. What is gower's sign?

Gower's sign is an indicator of muscular  dystrophy; to stand, the child has to walk hands

up legs

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Question

Answer

Loading... List two contraindications to immunocompromised child or in a household live virus immunization. with an immunocompromised individual. List three classic sign of  measles.

Photophobia, confluent rash that begins on the face and spread downward, and koplik  spots on the buccal mucosa.

Anemia: pale conjunctiva; pale skin color; List the signs and symptoms atrophy of papillae on tongue; brittle, ridged, of iron deficiency. or spoonshaped nails; and thyroid edema. Identify food sources of Vit Liver, sweet potatoes, carrots, spinach, A.  peaches, and apricots. What disease occurs with Vit Scurvy ( sunken eyes, loss of teeth, pale skin) C deficiency. What measurements reflect Weight, skinfold thickness, and arm  present nutritional status? circumference. Poor skin turgor, absence of tears, dry List the signs and symptoms mucous membranes, weight loss, depressed of dehydration in an infant. fontanel, and decreased urinary output. List the laboratory findings loss of bicarbonate/decreased serum ph, loss that can be expected that can of Sodium, loss of potassium, elevated  be expected in a dehydrated hematocrit, and elevated BUN. child. How should burns in children be assessed? How can the nurse best evaluate the adequacy of 

By using lund browder chart. This takes into account the changing proportions of the child's body. By monitoring urine output.

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fluid replacement in children? How should a parent be instructed to child proof a house?

By being taught to lock all cabinets, to safely store all toxic household items in locked cabinets, and to examine the house from the child's point of view.

What interventions should the nurse perform first in caring for a child who has ingested a poison?

Assessment of the child's respiratory, cardiac, and neurologic status.

Describe the purpose of   bronchodilators.

To reverse bronchospasm.

What are the physical assessment findings for a child with asthma?

Expiratory wheezing, rales, right cough, and signs of altered blood gases.

What nutritional support should be provided for a child with cystic fibrosis?

Pancreatic enzyme replacement, fat-soluble vitamins, and a moderate to low carbohydrate, high protein, moderate to high fat diet.

Why is genetic counseling Because the disease is autosomal recessive in important for the family of a its genetic pattern. child with cystic fibrosis? List seven signs of  respiratory distress in a  pediatric client.

Restlessness, tachycardia, tachypnea, diaphoresis, flaming nostrils, retractions, and grunting.

Monitor child's temperature; keep tent edges Describe the care of a child tucked in; keep clothing dry; assess in midst tent. respiratory status; look at child inside tent. What position does a child with epiglottitis assume?

Upright, sitting, with chin out and toungue  protruding (tripod position)

Why are IV fluids important The child is at risk for dehydration and acid for a child with an increased  base balance. respiratory rate? Children with chronic otitis media are at risk for  Hearing loss/ conductive hearing developing what problem? What is the most common

Hemorrhage; frequent swallowing. vomiting

 postoperative complication following a tonsillectomy? Describe the signs and symptoms of this complication.

fresh blood, and clearing throat

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Question

Answer

Loading... When is iron deficiency most common?

12 -36 months and in females during childbearing years

What is the best indicator of past nutrition?

Height and head circumference

How do you measure  plasma, blood cells, urine, tissues from bone, hair or  nutritional status? fingernail, hgb/hct, albumin, Cr, nitrogen Signs of iron deficiency

anemia, pale conjuctiva, pallor, brittle/ridged nails, thyroid edema

Signs of B2 (riboflavin) deficiency

redness of eyelid corners, burning, itchy, tearing eyes, photophobia

Source of Iron

fortified formula, fortified cereal, liver, beef, pork, eggs

Sources of B2 (riboflavin)

leafy green vegetables (broccoli, spinach, green  beans), enriched cereal

Signs of Vitamin A (retinol) deficiency

dry, rough skin, night blindness, defective tooth enamel, retarded growth and bone formation, decrease thyroid hormone formation

Sources of Vitamin A liver, carrots, sweet potatoes, spinach, peaches, (retinol) apricots

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Signs of Vitamin C deficiency

scurvy, bleeding receeding gums, dry rough skin, decreased wound healing, increased infection risk, irritability

Sources of Vitamin C

strawberries, oranges, tomatoes, broccoli, cabbage, cauliflower, spinach

Signs of Vitamin B6 scaly dermatitis, weight loss, anemia, irritability, (pyridoxine) convulsions, peripheral neuritis deficiency Sources of B6 (pyridoxine)

meats, cereal, yeast, soybeans, peanuts, tuna, chicken, bananas

Signs of respiratory distress

restlessness, increased resp. rate, increased pulse rate, diaphoresis

Which happens first, respiratory failure or  respiratory failure cardiac failure Asthma

airway become edematous, becomes congested with mucous, smooth muscles constrict, airtrapping occurs in alveoli

 Nursing interventions for acute asthma rapid acting bronchodilators and steroids exacerbations  Nursing interventions identify triggers, reduce allergens, use MDI, monitor  for asthma through peak flow meter, Asthma Action Plan maintanence at home What type of disease autosomal recessive disease that causes dysfunction is Cystic Fibrosis? of exocrine glands Systemic effects of  cystic fibrosis

lung insufficiency (most critical), pancreatic insufficiency, increased loss of sodium and chloride in sweat

meconium ileus at birth, recurrent respiratory Signs and symptoms infections, pulmonary congestion, steatorrhea, foul of Cystic Fibrosis smelling bulky stools, poor weight gain, salty tasting skin IV abx, pancreatic enzymes given with Cystic Fibrosis food/applesauce, fat soluble vitamins, teach postural nursing interventions drainage and percussion

Cystic Fibrosis diet

Pts will need 1.5x normal caloric intake, high calories, high protein, moderate fat content, moderate carbohydrates

Causes of epiglottitis

rapid acute airway obstruction usually caused by H. influenzae type B

Signs and symtoms of rapid onset, restlessness, high fever, sore throat, epiglottitis dysphagia, drooling, muffled voice, tripod position What intervention is  Never put anything in the mouth because of the risk  contraindicated in of complete airway obstruction epiglottitis? encourage prevention with HiB vaccine, upright  Nursing interventions  position, NPO, IV abx, prepare for  in epiglottitis intubation/tracheosomy, prepare for ICU admit Bronchiolitis

viral infection of the bronchioles caused by RSV characterized by thick secretions

upper respiratory symptoms, irritability, paroxysmal Signs and symptoms cough, poor eating, nasal congestion, nasal flaring, of bronchiolitis  prolonged expiration, wheezing and rales What is given to  prevent RSV infections in Synagis (palivizumab) immunocompromised  patients? isolation, assess respiratory status, mist tent,  Nursing interventions maintain hydration, evaluate respiratory treatment for Bronchiolitis effectiveness  Newborn RR, HR 

RR: 30-60 HR:100-160

Infant RR, HR 

RR: 25-35 HR: 100-150

Toddler RR, HR 

RR: 20-30 HR: 80-130

Preschool RR, HR 

RR: 20-25 HR: 80-120

School Age RR, HR 

RR: 18-22 HR: 70-110

Adolescent RR, HR 

RR: 16-20 HR: 60-90

Why are young children prone to ear  The eustachian tubes are flattened infections? Otitis Media signs and symptoms

fever, pain, infant may pull at ear, enlarged lymph nodes, drainage from ear (if eardrum is ruptured), vomiting and diarrhea

 Nursing interventions Abx as prescribed, Tylenol, reduce body for otitis media temperature (warm tepid bath), monitor hearing loss Tonsilitis

inflammation of tonsil (viral or bacterial) related to strep

Risks of untreated Tonsilitis

may lead to acute glomerulonephritis or rheumatic heart disease

Signs and symptoms sore throat, fever, enlarged tonsils, possible of tonsilitis obstructed breathing  Nursing interventions throat culture to determine cause, warm salt gargles, for tonsilitis ice chips, possible surgery, abx, Tylenol Monitor for post-op bleeding (frequent swallowing, Post-surgical care of  vomiting fresh blood, clearing throat), soft foods tonsillectomy and fluids, ice collar for comfort When is highest risk  of hemorrhage after  first 24 hours, 5-10 days after surgery tonsillectomy? Acyanotic heart defects

VSD, ASD, PDA, AS

Cyanotic heart defects tetralogy of Fallot, TA, transposition of great vessels Increased pulmonary ASD, VSD, PDA  blood flow defects Obstructive defects

coarctation of aorta, AS

Decreased pulmonary Tetralogy of Fallot  blood flow Mixed blood heart defects

TGV, TA

Increased pulmonary blood flow. There is a hole Atrial Septal Defect  between the atria, oxygenated blood from LA is (ASD) shunted to the RA and lungs. Treatment and Surgical closure before school age recommended. consequences of ASD Can l/t CHF and atrial dysrhythmia. Patent Ductus Arteriosus (PDA)

Increased pulmonary blood flow. Hole between aorta and pulmonary artery, usually closes within 72 hours. Oxygenated blood from the aorta returns to the pulmonary artery.

Increased blood flow to the lungs l/t pulmonary Treatment and hypertension. Require Indomethacin or surgical consequences of PDA closure. Coarctation of the Aorta

Obstruction of blood flow from ventricles c/b narrowing of aorta.

Classic signs of  coarctation of aorta

Hypertension of upper extremities and decreased or  absent pulses in lower extremities, requires surgery.

Obstruction of blood flow from ventricles Aortic Stenosis (AS) immediately before/at/after aortic valve. Oxygenated blood from LV to body is diminished Three T's of cyanotic Tetralogy of Fallot, Truncus Arteriousus, heart disease Transposition of the great arteries What is tetralogy of  combination of four defects: VSD, overriding aorta, Fallot?  pulmonary stenosis, right ventricular hypertrophy Truncus Arteriosus

One artery (truncus) rather than 2 arteries (aorta and  pulmonary artery) arises from both ventricles

Transposition of the Great Arteries

Pulmonary artery leaves the left ventricle and the aorta exits from the right ventricle.

Cyanosis because unoxygenated blood is pumped into the systemic circulation, decreased pulmonary Signs and symptoms circulation. Experiences tet spells or hypoxic of Tetralogy of Fallot episodes and relieved by squatting or put in the knee-chest position. Truncus Arteriosus

Pulmonary artery and aorta do not separate. Blood mixes in the R and L ventricles through a large VSD l/t cyanosis and increased pulmonary resistance.

Transposition of the Great Vessels

Mixed blood flow.Pulm circulation arises from L vent and systemic circulation arises from R vent.

Incompatible with life --> medical emergency give  prostaglandin to keep ductus open. Assessment of child Check for murmur, cyanosis, clubbing (>age 2), with CHD  poor feeding, FTT, fatigue, respiratory infections Maintain nutrition status with small frequent meals Feeding a child with with high-calorie formula. Maintain hydration to CHD  prevent thrombus formation. Risks of cardiac catheterization

arrhythmias, bleeding, perforation, phlebitis, arterial obstruction at entry site

Cyanotic: abnormal circulation, all blood entering Basic differences circulation is oxygenated  between cyanotic and Acyanotic: abnormal circulation with unoxygenated acyanotic defects.  blood entering the systemic system Therapeutic digoxin levels

0.8-2ng/ml

Digoxin administration

Check for bradycardia and hold. Do NOT skip doses, not miss with meals

Digoxin toxicity

Vomiting is early sign, also, anorexia, diarrhea, and abdominal pain, fatigue, muscle weakness

What exacerbates Digoxin toxicity?

Hypokalemia

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Loading... When does birth length double

4 years

When does the child sit unsupported

8 months

When does a child achieve 2 years

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50% of adult height When does a child throw a 18 months  ball overhand When does a child speak  two to three word 2 years sentences When does a child use scissors

4 years

When does a child tie his 5 years or her shoes Which gender's growth spurt occurs first?

Girls: as early as 10 years of age

What kind of behavior is considered common in the Temper tantrum toddler? When does a child form his or her identify?

Adolescence

Rebellion against family values is common for  which age group?

Adolescence

Concepts of bodily injury: After 6 months, their coginitive development Infants alows them to remember pain Concepts of bodily injury: They fear intrusive procedures toddlers Concepts of bodily injury: They fear body mutilation Preschoolers Concepts of bodily injury: Fear loss of control of their bodies School age children Concepts of bodily injury: Major concern is a change in body image Adolescents What is a major cause of  death in children and Accidents adolescents? What kind of children  pose a serious threat to

Children with German measles

their unborn siblings? What kind of hx should be Hx of reactions, sz, nerologic symtptoms after  obtained prior to  previous vaccine, systematic alergic reactions administration of DPAT? What kind of hx should be Hx of anaphylactic reactions to eggs, or  obtain prior to the neomycin administration of MMR? Pertussus fatalities continue to occurr in which group in the US?

 Nonimmunized infants

Which type of  administration method invalidates the mantoux test?

subQ rather than ID

Is the common cold a contraindication for  immunization?

 No

Irritability Fever (<102) Redness and soreness at injection site for 2-3 days are normal for DTaP and IPV What type of teaching Call HCP if seizures, high fever, or high pitched should be provided crying occurs following immunization? Warm washcloth on thigh injection site and  bicycling the legs with each diaper change decreases soreness Tylenol is administered every 4-6 hrs (1015mg/kg) Where should milk be stored?

In an opaque container 

How do you cook  vegetables to preserve  potency?

Cook in a small amount of liquid

Is it recomended to induce  No, it may cause more damage vomiting in children? Should you examine the  No, there is the risk of completely blocking the throat of a child with airway epiglottitis?

Which is the priority of  care regarless of age?

Patent airway!

Prior to tonsillectomy, which labs should be known

PT/PTT: in addition to this, its important to know if there is a hx of bleeding, prolonged or  excessive, and whether there is a hx of any  bleeding disorders in the family

With cyanotic defects,  polycythemia what condition is common

What is the difference  between acyanotic and cyanotic?

Acyanotic: abnormal circulation but all blood entering the systemic circulation is oxygenated Cyanotic: abnormal circulation with unoxygenated blood entering the systemic circulation

Are acyanotic or cyanotic defects more common Acyanotic with CHF children To conserve energy in children with heart defects, what may be necessary to conserve energy?

Tube feedings

What are two objectives of tx CHF?

Reduce the workload of the heart and increase CO

What should be consistent Weighing the child on the same scale at the when frequently weighing same time of day so accurate comparisons can a child?  be made When feeding a child with Preventing aspiration: cerebral palsy, what Position child upright and supporting the lower  nursing interventions  jaw should be implemented What is the nursing goal in caring for a down syndrome child?

Help the child reach his or her optimal level of  functioning

What are the s/sx of IICP?

Opposite of shock: Decreased pulse, decreased blood pressure

What is essential so changed associated with

Baseline of child's behavior and level of  development

IICP can be detected early? Should a shunt be  pumped?

 No, the shunt has delicate valves and pumping can change pressures within the ventricles

What is the most common cause of increased seizure Medication noncomplicance activity? Hydration status and IV therapy. What should the nurse monitor carefully with meningitis?

With meningitis, there may be inappropriate ADH secretions causing cerebral edema and dilutional hyponatremia

What is the most common  presenting symptom with Headache a brain tumor? How should post-op Patients should be flat or turned to either side, a  patients with infratentorial large tumor may require a child not be turned to tumors be positioned? the operative side What is the first sign of  renal failure

Decreased urinary output

It is usually done before preschool years to When is the correction of  allow for the achievement of sexual identity, to hypospadias done? avoid castration anxiety, and to facilitate toilet training What are typical patient and family reactions to a child with a malformation?

Guilt Disappointment Grief  Sense of loss Anger 

Alternation in nutrition: less than body What is an important requirements nursing diagnosis r/t cleft lip/palate & pyloric Cleft lip/palate: r/t decreased ability to suck  stenosis? Pyloric Stenosis: r/t frequent vomiting  Nutrition needs & electrolyte balance What are big problems for  children with GI Younger children are more vulnerable to these  problems?  problems

Where should you take the temp of a child with Axillary temp megacolon? What are the Hgb norms for a:  Newborn: 14-24  Newborn Infant: 10-15 Infant Child: 11-16 Child 1. Give on an empty stomach 2. Give with citrus juice 3. Use dropper or straw to avoid discoloring What are teaching point of  teeth administering iron? 4. Stools will be tarry 5. Iron can be fatal in severe doses 6. Do not give with dairy products What supplement is not given to sickle cell anemia?

Supplemental Iron; instead folic acid is given to stimulate RBC synthesis

What needs to be available when administering lasparaginase?

Epi and O2 to treat anaphylaxis

What is used to reduce the Prednisone is frequently used in combination mitosis of lymphocytes? with antineoplastic drugs What is used to prevent renal damage?

Allopurinol - an xanthineoxidase inhibitor 

How can you describe an infant with Good, quiet baby hypothyroidism? How should insulin be administered when a child Administer it in normal saline is in DKA? What type of fractures are Spiral fractures related to child abuse? What type of fractures put Fractures involving the epiphyseal plate limb growth at risk? What do you want to monitor with pin sites?

s/sx of infection

Does a brace correct or  slow the progression of  scoliosis?

It slows the progression

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Loading... List normal findings in a Warm extremity, brisk capillary refill, free neurovascular  movement, normal sensation of the afected assessment. extremity, and equal pulses. What is compartment syndrome?

Damage to the nerves and vasculature of an extremity due to pressure.

What are the signs and Abnormal neurovascular assessment: cold symptoms of  extremity, severe pain, inability to move the compartment syndrome? extremity, and poor capillary refill. Why are fractures of the Fractures of the epiphyseal plate (growth plate) epiphyseal plates a may affect the growth of the limb. special concern? How is skeletal traction Skeletal traction is maintained by pins or wires applied? applied to the distal fragment of the fracture. What discharge instructions should be included concerning a child with spica cast?

Check child's circulation. Keep cast dry. Do not  place anything under cast. Prevent cast soilage during toileting or diapering. Do not turn child using an abductor bar.

What are signs and Unequal skin folds of the buttocks, Ortalini sign, symptoms of congenital limited abduction of the affected hip, and unequal dislocated hip in infants? leg lengths. How would the nurse conduct a scoliosis screening?

Ask the child to bend forward from the hips with arms hanging free. Examine the child for a curve in the spine, rib hump, and hip asymetry.

What instructions should The child should be instructed to wear the brace a child with scoliosis 23 hours per day; wear a T-shirt under brace;

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recieve about the Milwaukee brace?

check skin for irritation; perform back and abdominal exercises; modify clothing. The child should be encouraged to maintain normal activities as able.

What care is indicated Prescribed exercise to maintain mobility; for a child with juvenille splinting of affected joints; and teaching about rhuematoid arthritis? medication management and side affects of drugs. HESI HINTS Growth and Development Milestones When does birth length double? Answer: By 4 years When does the child sit unsupported? Answer: 8 months When does a child achieve 50% of adult height? Answer: 2 years When does a child throw a ball overhand? Answer: 18 months When does a child speak 2-3 word sentences? Answer: 2 years When does a child use scissors? Answer: 4 years When does a child tie his/her shoes? Answer: 5 years Be aware that a girl’s growth spurt during adolescence begins earlier than boys (as early as 10 years old). Temper tantrums are common in the toddler, i.e., considered “normal,” or average  behavior. Be aware that adolescences is a time when the child forms his/her identity and that rebellion against family values is common for this age group .  Normal growth and development knowledge is used to evaluate interventions and therapy. For example, “What behavior would indicate that thyroid hormone therapy for a 4month-old is effective?” You must know what milestones are accomplished by a 4-

month-old. One correct answer would be “has steady control” which is an expected milestone for a 4-month-old and indicates that replacement therapy is adequate for growth. Use facts and principles related to growth and development in planning teaching interventions. For example: “What task could a 5-year-old diabetic boy be expected to accomplish  by himself?” One correct answer would be to pick the injection sites. This is possible for a  preschooler to do and gives the child some sense of control. School-age children are in Erikson’s stage of industry, meaning they like to do and accomplish things. Peers are also becoming important for this age child. Age groups concepts of bodily injury: Infants: After 6 months, their cognitive development allows them to remember pain. Toddlers: Fear intrusive procedures. Preschoolers: Fear body mutilation. School age: Fear loss of control of their bod y. Adolescent: Major concern is change in body image. Pertinent history should be obtained prior to administering certain immunizations  because reactions to previous immunizations or current health conditions may contraindicate current immunizations: DPT: History of seizures, neurological symptoms after previous vaccine, or  systematic allergic reactions. MMR: History of anaphylactic reaction to eggs or neomycin. Pertussis fatalities continue to occur in unimmunized infants in the U.S. Subcutaneous injection, rather than intradermal, invalidates the Mantoux test. The common cold is not contraindication for immunization. Following immunization, what teaching should the nu rse provide to the parents? Irritability, fever (<102 degrees F), redness and soreness at injection site for 2-3 days are normal side effects of DPT and IPV administration. Call health care provider if seizures, high fever, or high -pitched crying occur. A warm washcloth on the thigh injection site and “bicycling” the legs w/each d iaper  change will decrease soreness. Acetaminophen (Tylenol) is administered orally every 4-6 hours (10-15 mg/Kg). Children w/German measles pose a serious threat to their unborn siblings. The nurse should counsel all expectant mothers, especially those w/young children, to  be aware of the serious consequences of exposure to German measles during  pregnancy.

Common childhood problems are encountered by nurses caring for children in the community or hospital settings. The child’s age directly influences the severity and management of these problems.  Nutritional Assessment: Teach proper cooking and storage to preserve potency, i.e., cook vegetables in small amount of liquid. Store milk in opaque container. Add potassium to IV fluids ONLY w/adequate urine output. Urinary output for infants and children be 1-2 ml/kg/hour. Use of syrup of ipecac is no longer recommended by the American Academy of  Pediatrics. Teach parents that it is NOT recommended to induce vomiting in any way as it may cause more damage. Child needs 150% of the usual calorie intake for normal growth and development. Do not examine the throat of a child w/epiglottitis due to the risk of c ompletely obstructing the airway, i.e., do not put a tongue blade or any object in the throat. In planning and providing nursing care, a patent airways is always a priority of care, regardless of age! Respiratory disorders are the primary reason most children and their families seek  medical care. Therefore, these disorders are frequently tested on the NCLEX-RN. Knowing the normal parameters for respiratory distress in children is essential! The nurses should be sure a PT and PTT have been determined prior to a tonsillectomy. More importantly, the nurse should ask if there has been a history of   bleeding, prolonged/excessive, or if there is a history of any bleeding disorders in the family. When calculating a pediatric dosage, the nurse must often change the child’s weight from  pounds to kilograms. HINT: Weight expressed in kilograms should always be a smaller  number than weight expressed in pounds. Polycythemia is common in children w/cyanotic defects. For normal cardiac rates in children, see Respiratory in this chap ter. The heart rate of a child will increase w/crying or fever. Infants may require tube feeding to conserve energy. Basic difference between cyanotic and acyanotic defects: Acyanotic: Has abnormal circulation, however, all blood entering the systemic circulation is oxygenated. Cyanotic: Has abnormal circulation w/unoxygenated blood entering systemic

circulation. CHF: Congestive heart failure is more often associated w/acyanotic defects. CHF is a common complication of congenital heart disease. It reflects the increased workload of the heart resulting from shunts or ob structions. The two objectives in treating CHF are to reduce the workload of the heart and increase cardiac output. When frequent weighings are required, weigh client on the same scale at same time of day so that accurate comparisons can be made. The nursing goal in caring for children w/Down syndrome is to help the child reach his/her OPTIMAL level of functioning. Feed infants or child w/cerebral palsy using nursing interventions aimed at  preventing aspiration. Position child upright and support the lower jaw. The signs of increased ICP are the opposite of those of shock. Shock: Increased pulse, Decreased blood pressure. Increased ICP: Decreased pulse, Increased blood pressure. Baseline data on the child’s USUAL behavior and level of development is essential so changes associated w/increased ICP can be detected EARLY. Do not pump shunt unless specifically prescribed. The shunt is made up of delicate valves, and pumping changes pressures within the ventricles. Medication noncompliance is the most common cause of increased seizure activity. Do NOT use tongue blade, padded or not, during a seizure. It can cause traumatic damage to mouth/oral cavity. Monitor hydration status and IV therapy carefully. With meningitis, there may be inappropriate ADH secretions causing fluid retention (cerebral edema) and dilutional hyponatremia. Headache upon awakening is the most common presenting symptoms of brain tumors. Most postoperative clients w/infractentorial tumors are prescribed to lie flat and turn to either side. A large tumor may require that the child NOT be turned to the operative side. Suctioning, coughing, straining, and/or turning causes increased ICP. Decreased urinary output is FIRST sign of renal failure.

Surgical correction for hypostasis is usually done before preschool years due to achieving sexual identity, castration anxiety, and toilet training. Typical parent/family reactions to a child w/an obvious malformation such as cleft lip/palate are guilt, disappointment, grief, sense of loss, and anger. Children w/cleft lip/palate and those w/pyloric stenosis both have a nursing diagnosis “alteration in nutrition; less than body requirements.” Cleft lip/palate is related to decreased ability to suck. Pyloric stenosis is related to frequent vomiting.  Nutritional needs and fluid and electrolyte balance are key problems for children w/GI disorders. The younger the child, the more vulnerable they are to fluid and electrolyte imbalances and greater is the need for caloric intake required for growth. Take axillary temperature on children w/congenital mega colon. REMEMBER the Hgb norms.  Newborn: 14 to 24 g/dl Infant: 10 to 15 g/dl Child: 11 to 16 g/dl TEACH FAMILY ABOUT ADMINISTRATION OF ORAL IRON: Give on empty stomach (as tolerated for better absorption). Give w/citrus juices (vitamin C) for increased absorption. Use dropper or straw to avoid discoloring teeth. Stools will become tarry. Iron can be fatal in severe overdose; keep away from children. Don not give w/dairy  products. Inherited bleeding disorders (hemophilia and sickle cell anemia) are often used to test knowledge of genetic transmission patterns. Remember: Autosomal recessive: Both parents must be heterozygous, or ca rriers of the recessive trait, for the disease to be expressed in their offspring. With each  pregnancy, there is a 1:4 chance of the infant having the disease. However, all children of such parents CAN get the disease - NOT 25% of them. This is the transmission for sickle cell anemia, cystic fibrosis, and phenylketonuria (PKU). X-linked recessive trait: The trait is carried on the X chromosome, therefore, usually affects male offspring, e.g., hemophilia. With each pregnancy of a woman who is a carrier there is a 25% chance of having a child w/hemophilia. If the child is male, he has a 50% chance of having hemophilia. If the child is female, she has a 50% chance of being a carrier. Hydration is very important in treatment of sickle cell disease because it promotes hem dilution and circulation of red cells through the blood vessels. Important terms:

Heterozygous gene (HgbAS) sickle cell trait. Homozygous gene (HbSS) sickle cell disease. Abnormal hemoglobin (HGBS) disease and trait. Supplemental iron is not given to clients w/sickle cell anemia. The anemia is not caused by iron deficiency. Folic acid is given orally to stimulate RBC synthesis. Have epinephrine and oxygen readily available to treat anaphylaxis when administering I-asparaginase. Prednisone is frequently used in combination w/antineoplastic drugs to reduce the mitosis of lymphocytes. Allopurinol, a xanthine-oxidase inhibitor, is also administered to prevent renal damage from uric acid build up during cellular lysis. An infant w/hypothyroidism is often described as a “good, q uiet baby” by the  parents. Early detection of hypothyroidism and phenylketonuria is essential in preventing mental retardation in infants. Knowledge of normal growth and development is important, since a lack of attainment can be used to detect the existence of these metabolic/endocrine disorders and attainment can be used for evaluating the treatment’s effect.  NutraSweet (aspartame) contains phenylalanine and should not therefore, be given to a child w/phenylketonuria. Diabetes mellitus (DM) in children was typically diagnosed as insulin dependant diabetes (Type 1) until recently. A marked increase in type 2 DM has occurred recently in the U.S., particularly among Native-American, African-American, and Hispanic children and adolescents. Adolescence frequently causes difficulty w/management since growth is rapid and the need to be like peers makes compliance difficult. Remember to consider the child’s age, cognitive level of  development, and psychosocial development when answering NCLEX-RN questions. When child is in ketoacidosis, administer regular insulin IV as prescribed in normal saline. There has been an increase in the number of children diagnosed with Type 2 diabetes. The increasing rate of obesity in children is thought to be a contributing factor. Other contributing factors include lack of physical activity and a family history of Type 2 diabetes. Fractures in older children are common as they fall during play and are involved in motor vehicle accidents. Spiral fractures (caused by twisting) and fractures in infants may be related to child abuse.

Fractures involving the epiphyseal plate (growth plate) can have serious consequences in terms of growth of the affected limb. Skin traction for fracture reduction should NOT be removed unless prescribed by healthcare provider. Pin sites can be sources of infection. Monitor for signs of infection. Cleanse and dress pin sites as prescribed. Skeletal disorders affect the infant’s or child’s physical mobility, and typical NCLEXRN questions focus on appropriate toys or activities for the child who is on bedrest and/or  immobilized. Children do not like injections and will deny pain to avoid “shots.” A brace does not correct the curve of a child w/scoliosis, it only stops or slows the  progression. Corticosteroids are used short term in low doses during exacerbations. Long-term use is avoided due to side effects and their adverse effect on growth. << first < prev1next >last >>

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Loading... *Ductus arteriosis CONSTRICTS CV Changes at Birth *Pulmonary vascular bed OPENS * Ductus arteriosis ____  *Pulmonary vascular resistance * Pulmonary vascular bed ____  DECREASES * Pulmonary vascular resistance *Systemic vascular resistance  ____  INCREASES * Systemic vascular resistance ____  *Foramen ovale CLOSES d/t * Foramen ovale __ d/t ___  BLOOD FLOW FROM LEFT TO RIGHT ACYANOTIC congenital heart diseases that cause ↑ Pulmonary  blood flow:  _____ 

* A/V septal defects * Patent ductus arteriosus * Atrioventricular canal

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 _____   _____  ACYANOTIC congenital heart diseases that cause obstructed blood flow from ventricles:  ____   ____   ____ 

* Coarctation of aorta * Aortic stenosis * Pulmonic stenosis

CYANOTIC congenital heart diseases that cause ↓ Pulmonary  blood flow:  ____   ____ 

* Tetralogy of Fallot * Tricuspid atresia

CYANOTIC congenital heart diseases that cause mixed blood flow:  ____   ____   ____   ____ 

* Transposition of great arteries * Total anomalous pulmonary venous return * Truncus arteriosus * Hypoplastic L heart syndrome

 NCLEX After a pediatric client has a cardiac cath, which intervention would the nurse consider to be of highest  priority during the immediate  post procedure period? 4. Apply direct pressure to 1. Encourage intake of small entry site of 15 minutes. amounts of fluid. 2. Teach the parents signs of CHF. 3. Monitor the site for signs of  infection. 4. Apply direct pressure to entry site of 15 minutes.  NCLEX 1. Encourage fluids and regular diet. Which of the following home care instructions in included for a child  postcatheterization? 1. Encourage fluids and regular diet.

2. Encourage physical activities. 3. The child can routinely bathe after  returning home. 4. The child may return to school the next day. Patent Ductus Arteriosus * Diagnosis - Continuous ____ below left ____  - Dx with ____, cardiac ___  * Treatment - ____ for preterm only - ____ 

Patent Ductus Arteriosus * Diagnosis - Continuous MURMUR below left CLAVICLE - Dx with X-RAY, cardiac ECHO * Treatment - INDOMETHACIN for preterm only - SURGERY

Transposition of the Great Arteries * Pathophysiology - ____ blood enters ____ and ____  - ____ circulation * Clinical manifestations - Initially appears ____  - ____ develops within a few hours of life

Transposition of the Great Arteries * Pathophysiology - UNOXYGENATED blood enters RA and RV - PARALLEL circulation * Clinical manifestations - Initially appears NORMAL - CYANOSIS develops within a few hours of life

 NCLEX Which of the following statements is correct for a child with tetralogy of  Fallot? 1. The condition is commonly referred 2. They experience hypercyanotic, or  to as “blue tets.” “tet” spells. 2. They experience hypercyanotic, or  “tet” spells. 3. They experience frequent respiratory infections. 4. They experience decreased or  absent pulses in the lower  extremities.  NCLEX Administration of which of the following drugs

4. Prostaglandin E1

would be the most important in treating transposition of the great arteries? 1. Digoxin 2. Diuretics 3. Antibiotics 4. Prostaglandin E1  NCLEX Which of the following cardiovascular disorders is considered acyanotic? 1. Patent ductus arteriosus 2. Tetralogy of Fallot 3. Tricuspid atresia 4. Truncus arteriosus

1. Patent ductus arteriosus

Psychosocial Factors * ____  * ____  * ____  * ____ 

* Separation * Bonding * Feeding * Care

 NCLEX A 2-year-old child has a known cardiac defect and is in congestive heart failure. Which assessment finding indicates to the nurse a toxic 3. Bradycardia, nausea, and vomiting dose of digoxin? 1. Tachycardia and dysrhythmia 2. Headache and diarrhea 3. Bradycardia, nausea, and vomiting 4. Tinnitus and nuchal rigidity

Kawasaki Disease * Pathophysiology - ____itis - ____itis - ____ on echocardiogram

 NCLEX When assessing a child with suspected Kawasaki disease, which of the

Kawasaki Disease * Pathophysiology - VASCULitis (BV inflamm) - PANCARDitis (inflamm of  ALL structures of heart) - ECTASIA (dilation of  tubular vessel) on echocardiogram 2. “Strawberry” tongue 1st sign - HIGH (not low) fever 

following symptoms is common? 1. Low-grade fever  2. “Strawberry” tongue 3. Pink moist mucous membranes 4. Bilateral conjunctival infection with yellow exudate  NCLEX A nurse is giving discharge instructions to the parents of a child with Kawasaki disease. Which of the following statements shows an understanding of the treatment plan? 1. “A regular diet can be resumed at 3. “My child should use a soft-bristled home.” toothbrush.” 2. “Black, tarry stools are considered normal.” 3. “My child should use a soft bristled toothbrush.” 4. “My child can return to playing football next week."  NCLEX Which of the following statements  best defines the term cardiogenic shock? 1. Decreased cardiac output 2. A reduction in circulating blood volume 3. Overwhelming sepsis and circulating bacterial toxins 4. Inflow or outflow obstruction of  the main  bloodstream.

1. Decreased cardiac output CAUSES 2. A reduction in circulating blood volume RESULTING IN GLOBAL HYPOPERFUSION

 NCLEX Which of the following signs is considered a late sign of shock in children? 1. Tachycardia 2. Hypotension 3. Delayed capillary refill 4. Pale, cool, mottled skin

2. Hypotension

NCLEX

3. Low-grade fever  

A child with suspected bacterial endocarditis arrives at the emergency department. Which of the following findings is expected during assessment? 1. Weight gain 2. Bradycardia 3. Low-grade fever  4. Increased hemoglobin level  NCLEX A nurse is teaching wound care to  parents after cardiac surgery. Which of the following statements is most appropriate? 1. Lotions and powders are acceptable. 4. If the sterile adhesive strips over  2. Your child can take a complete the incision  bath tomorrow. fall off, call the physician. 3. Tingling, itching, and numbness are normal sensations at the wound site. 4. If the sterile adhesive strips over  the incision fall off, call the  physician.  NCLEX A child with an atrial septal repair is entering  postoperative day 3. Which of the following interventions would be most 4. Administer an analgesic as needed. appropriate? 1. Give the child nothing by mouth. 2. Maintain strict bed rest. 3. Take vital signs every 8 hours. 4. Administer an analgesic as needed.  NCLEX 2. To observe the child for signs of  A chld with a cyanotic heart defect is increased intracranial pressure.  being discharged home to await surgical repair. In the discharge teaching, the nurse instructs the parents: 1. To prevent the child from crying

at all. 2. To observe the child for signs of  increased intracranial pressure. 3. In cardiopulmonary resuscitation. 4. To identify growth and development milestones. Monro - Kellie Hypothesis • Once sutures have fused, the skull is a rigid compartment filled to capacity with non-compressible contents:  – brain ____%  – blood ____%  – CSF ____% • If one component increases in volume, another component must  ____  or ICP will ____.

Monro - Kellie Hypothesis  – brain 80%  – blood 10%  – CSF 10% • If one component increases in volume, another component must DECREASE or ICP will INCREASE.

 Normal ICP

 Normal ICP

Adult ___-___ mm Hg Child ___-___ mm Hg

Adult 3 - 15 mm Hg Child 0 - 10 mm Hg

(Accept values < ___ mm Hg)

(Accept values < 20 mm Hg)

Cerebral Perfusion Pressure - blood pressure gradient across the brain CPP = ____–____ 

CPP = MAP – ICP Keep above 60

Keep above ____  Causes of Increased ICP

Increased ICP

• ____ lesions (__,__,__) • ____ injury (__,__) • ____ problems (__natremia,__failure,  __failure,__acidosis) • Subarachnoid/intracerebral  ____ 

• MASS lesions (TUMORS, ABSCESSES, HEMATOMAS) • ISCHEMIC injury (STROKE, HYPOXIA) • METABOLIC problems (HYPOnatremia, LIVER  failure, RENAL failure,

• ____ Malfunction

Diabetic Ketoacidosis) • Subarachnoid/intracerebral HEMORRHAGE • SHUNT Malfunction

S/S of Increased ICP • ____ dysfunction • ____ weakness • ____ deficits • ____ nerve palsies • ____ pain • Deterioration in level of ____  • ____  LATE S/S of Increased ICP • Severe deterioration of ___  • ____  • ____edema • ____ing • Change in ____ signs • Impaired brain stem ____ 

• PUPILLARY dysfunction • MOTOR weakness • SENSORY deficits • CRANIAL nerve palsies • HEADACHE pain • Deterioration in level of CONSCIOUSNESS • SEIZURE

• Severe deterioration of LOC • VOMITING • PAPILLedema • POSTURing • Change in VITAL signs • Impaired brain stem REFLEXES

S/S of Increased ICP in an INFANT

S/S of Increased ICP in an INFANT

• ____ feeding • ____ity • ____-pitched cry • ____, ____ fontanel • ____ing • ____ scalp veins • ____ head circumference

• POOR feeding • IRRITABILity • HIGH-pitched cry • TENSE, BULGING fontanel • VOMITing • DISTENDED scalp veins • INCREASED head circ

TX for Elevated ICP (slide#1)

TX for Elevated ICP (slide#1)

• 1st: ___'s!  – Stabilize ____  - ____-____ CO2  – ____active drugs  – ____ drugs (Osmotic/Loop)  – ____osmolar therapy with ____% saline  – Positioning: ____, HOB  ___, ____/____ alignment

• 1st: ABC’s!  – Stabilize AIRWAY - LOW-NORMAL CO2  – VASOactive drugs  – DIURETICS (Osmotic/Loop)  – HYPERosmolar therapy with 3% saline  – Positioning: SUPINE, HOB UP, HEAD/NECK alignment

TX for Elevated ICP (slide#2)

TX for Elevated ICP (slide#2)

• ____tion • Maintain ____ temp • ____  • ____ Drainage • ____ control • ____ regimen • Avoid clustering ____  • Avoid ____ exercises • Provide a ____ environment

• SEDAtion • Maintain NORMAL temp • SURGERY • CSF Drainage • SEIZURE control • BOWEL regimen • Avoid clustering ACTIVITIES • Avoid ISOMETRIC exercises • Provide a CALM environment

Syndrome of Inappropriate ADH Secretion - ____ H2O reabsorption  – ____ serum osmolality  – ____ serum Na (<110mEq/L)  – ____ urine osmolality

- INC. H2O reabsorption  – DEC. serum osmolality  – DEC. serum Na (<110mEq/L)  – DEC. urine osmolality  – Irritability, anorexia, nausea, cramps, lethargy, stupor, convulsions

 – Irritability, anorexia, nausea, cramps, lethargy, stupor, convulsions SIADH Tx/NSG interventions

SIADH Tx/NSG interventions

• ____ fluids • ____tonic saline • Monitor ____  • Accurate __&__  • Urine ____  • Daily ____  • ____ checks • ____ precautions

• RESTRICT fluids • HYPERtonic saline • Monitor ELECTROLYTES • Accurate I&O • Urine SPECIFIC GRAVITY • Daily WEIGHT • NEURO checks • SEIZURE precautions

S/S Diabetes Insipidus

S/S Diabetes Insipidus

• Insufficient ___ Hormone • ____ diuresis • ____ osmolality • ____ urine specific gravity • ____ thirst • ____hydration

• Insufficient ADH • UNCONTROLLED diuresis • DEC. osmolality • DEC. urine specific gravity • INSATIABLE thirst • DEhydration

DI Tx/NSG Interventions

DI Tx/NSG Interventions

• Fluid ____  • Strict __&__ 

• Fluid REPLACEMENT • Strict I&O

• Daily ____  • Urine ____  • Monitor ____  • Med: ____   Nursing Dx for pts with  Neural Tube defects • Potential for ____  • Potential for ____  • Potential for ____  • Potential for ___ skin ___  • Altered ____  • Alteration in ___ processes

• Daily WEIGHT • Urine SPECIFIC GRAVITY • Monitor ELECTROLYTES • Med: DDAVP (Desmopressin)  Nursing Dx for pts with  Neural Tube defects • Potential for infection • Potential for trauma • Potential for injury • Potential for impaired skin integrity • Altered body image • Alteration in family  processes 50-70% of SB pts have an allergy to LATEX

Treat ALL SB pts as if they have this 50-70% of Spina Bifida pts have an allergy allergy to _____  Found in: catheters, gloves, tubing, tape, tourniquets, glue, toys, handles, tires, balloons, elastic Most common causative organisms of MENINGITIS (80%) • ____  • ____  • ____  MENINGITIS Tx/NSG Intervent. • Meds: ____  • ____ precautions • ____tion • Fluid ____ (how much?) • Monitor for increased ___  • ____ measures • ____ tests

• Haemophilus influenza b (Hib) • Strep pneumoniae (pneumococcal) • Neisseria menigitidis (meningococcal) MENINGITIS Tx/NSG Intervent. • Meds: ABX • Isolation precautions • Ventilation • Fluid restriction (how much? 1/2 to 2/3) • Monitor for increased ICP • Comfort measures • Hearing tests

MENINGITIS residual effects

MENINGITIS residual effects

• ____ness, ____ness • ____  • Subdural ____,  ____cephalus • ____  • ____ palsy • ____ (Meningococcal)

• Deafness, blindness • Paralysis • Subdural effusions, hydrocephalus • Seizures • CP • Amputation (Meningococcal)

Etiology of Seizures

Etiology of Seizures

• ____pathic • ____ Process • ____ Imbalance • ____ (temp) • ____ Injury or ____ Tumor  • ____ Intoxication • ____therapeutic Drug Levels

• Idiopathic • Infectious Process • Metabolic Imbalance • Fever  • Brain Injury or Brain Tumor  • Drug Intoxication • Subtherapeutic Drug Levels

Seizure Types • Partial  – ____   – ____  • Generalized  – ___-___   – A____   – A____   – A____ 

Seizure Types • Partial  – Simple  – Complex • Generalized  – Tonic-Clonic  – Absence  – Atonic  – Akinetic

Status Epilepticus- MED EMERG

Status Epilepticus- MED EMERG

• Continuous ____ activity • Loss of ____ 

• Continuous SEIZURE activity • Loss of CONSCIOUSNESS

Causes of Cerebral Palsy

Causes of Cerebral Palsy

• ____ birth • Perinatal ____  • ____  • Intrauterine ____  • Congenital ____ Anomalies • ____ Disorders

• PREMATURE birth • Perinatal ASPHYXIA • INFECTION • Intrauterine ISCHEMIA • Congenital BRAIN Anomalies • METABOLIC Disorders

Med/Nsg Interventions for CP

Med/Nsg Interventions for CP

• ____ training

• ADL training

• ____ assistance • ____ aids • ____ Therapy • ____  • ____ 

• Mobility assistance • Communication aids • Physical Therapy • Medication • Surgery

Hypopituitarism: GHD Clinical manifestations

Hypopituitarism: GHD Clinical manifestations

* ____ stature * ____ or ____  rate of growth * Higher ____-to-____  ratio * ____ bone age

* Short stature * Deteriorating or absent rate of growth * Higher weight-to-height ratio * Delayed bone age

Congenital Hypothyroidism

Congenital Hypothyroidism

* Clinical manifestations - Large ____ fontanel - Umbilical ____  - ____ (bowels) - Prolonged ____ 

* Clinical manifestations - Large posterior fontanel - Umbilical hernia - Constipation - Prolonged jaundice

* Treatment: Early Tx  prevents ____ 

* Treatment: Early Tx  prevents Cretinism

Definitions: Pseudohermaphroditism = an Virilization = Development of male individual having internal secondary sexual characteristics reproductive organs of one sex and external sexual characteristics Adrenarche = the increase in activity resembling those of the other sex or  of the adrenal glands just before  being ambiguous in nature  puberty  NORMAL HGB VALUES

 NORMAL HGB VALUES

Infant: __-__ g/dl

Infant: 9 – 14 g/dl

6-12 yr: __-__ g/dl

6-12 yr: 11.5 – 15.5 g/dl

12-18 yr: __-__ g/dl

12-18 yr: 12 – 16 g/dl

Anemia (Hgb levels)

Anemia (Hgb levels)

 – Mild: __ g/dl

 – Mild: 11 g/dl

 – Moderate: __–__ g/dl  – Severe: < __ g/dl

 – Moderate: 3 – 7 g/dl  – Severe: < 3 g/dl

SICKLE CELL complication

SICKLE CELL complication

STROKE (or high-risk for it) Tx: * ____ transfusion q ____ wks * Desferoxamine (____  therapy) binds ____, allows excretion to occur (b/c RBC destruction from SCD -> ____ overload -> ____  deposited in tissues unless excreted - __ infusion __ nts/week 

STROKE (or high-risk for it) Tx: * Blood transfusion q 3-4 wks * Desferoxamine (Chelation therapy) binds iron, allows excretion to occur (b/c RBC destruction from SCD -> iron overload -> iron deposited in tissues unless excreted - SC infusion 5 nts/week 

Beta-thalassemia Medical/Nursing Management

Beta-thalassemia Medical/Nursing Management

• Medical Tx:  – Chronic ____   – Sometimes ____ectomy  – ____ transplant • Nursing Issues:  – Blood Transfusions  – ____ therapy  – Risk of infection, postsplenectomy  – Patient/Family Education

• Medical Tx:  – Chronic transfusions  – Sometimes splenectomy  – Bone marrow transplant • Nursing Issues:  – Blood Transfusions  – Chelation therapy  – Risk of infection, postsplenectomy  – Patient/Family Education

Aplastic Anemia

Aplastic Anemia

• Pancytopenia  – Neutrophils < ____   – Platelets < ____   – Hemoglobin (RBCS) ____   – Reticulocytes < ____% • Etiology  – Primary (congenital):  ____   – Secondary (acquired):  ____ (viral, toxic,  pharmacologic)

• Pancytopenia  – Neutrophils < 500  – Platelets < 20,000  – Hemoglobin (RBCS) DEC.  – Reticulocytes < 1% • Etiology  – Primary (congenital): Fanconi’s anemia  – Secondary (acquired): Injury (viral, toxic,  pharmacologic)

Coagulation Disorders

Coagulation Disorders

• ____ A (factor VIII)  – aka classic hemophilia • ____ B (factor IX)  – aka Christmas Disease • ____ C (factor XI) • ____ disease (vWF)

• Hemophilia A (factor VIII)  – aka classic hemophilia • Hemophilia B (factor IX)  – aka Christmas Disease • Hemophilia C (factor XI) • Von Willebrand’s disease (vWF)

Hemophilia A & B Lab Findings

Hemophilia A & B Lab Findings

• Platelets: ____  • Bleeding time: ____  (clot formation) • PT (or INR): ____  (extrinsic pathway) • PTT: ____  (intrinsic pathway)

• Platelets: normal • Bleeding time: normal (clot formation) • PT (or INR): normal (extrinsic pathway) • PTT: prolonged (intrinsic pathway)

Hemophilia A & B Medical/Nursing Management

Hemophilia A & B Medical/Nursing Management

• Monitor for ____  episodes/complications • “First aid” for bleeding:  – ____   – Administer ____containing product • ____ infusions  – ____-derived or  recombinant  – DDAVP (Mild Hemophilia A)

• Monitor for bleeding episodes/complications • “First aid” for bleeding:  – RICE  – Administer factorcontaining product • Factor infusions  – Plasma-derived or  recombinant  – DDAVP (Mild Hemophilia A)

Hemophilia Patient/Family Education

Hemophilia Patient/Family Education

• Emergency treatment of   bleeding • IV ____ administration • Anticipatory guidance:  – ____ precautions  – Physical activity  – Monitoring for  complications

• Emergency treatment of   bleeding • IV factor administration • Anticipatory guidance:  – Safety precautions  – Physical activity  – Monitoring for  complications

von Willebrand’s Disease

von Willebrand’s Disease

• vWf “transports” Factor ____  • Types: decreased, abnormal or near absence of vWF • Results in : mucosal  bleeding, epistaxis, easy  bruising, menorrhagia • Treat with ____, and vWF replacement

• vWf “transports” Factor VIII • Types: decreased, abnormal or near absence of vWF • Results in : mucosal  bleeding, epistaxis, easy  bruising, menorrhagia • Treat with DDAVP, and vWF replacement

Differences in Adult and Child Cancer   – Origin  – Cause  – Prevention and screening  – Metastasis at diagnosis  – Response to treatment  – Cure rate

Find answers in book 

Childhood Cancer  Treatment Modalities

Childhood Cancer  Treatment Modalities

• ____  (biopsy, resect, debulk) • ____  (rapidly dividing cells) • ____ therapy (shrink, residual) • ____ transplant • ____ response modifiers

• Surgery (biopsy, resect, debulk) • Chemotherapy (rapidly dividing cells) • Radiation therapy (shrink, residual) • Bone marrow transplant • Biologic response modifiers

LYMPHOMA

LYMPHOMA

• From lymphoid and hematopoietic systems

• From lymphoid and hematopoietic systems

HODGKINs Disease  – Older children/adolescents  – Focal, painless enlarged  ____ tissue

HODGKINs Disease  – Older children/adolescents  – Focal, painless enlarged lymph tissue

Dx: Node biopsy and staging Tx: Chemotherapy & radiation

Dx: Node biopsy and staging Tx: Chemotherapy & radiation

Atrial Septal Defect * Pathophysiology

Atrial Septal Defect * Pathophysiology

- Blood flow ____ to ____  - ____ congestion * Clinical manifestations - Symptomatic? ____  - ____ ____ failure * Treatment - ____ for ___ ___ failure - ____ repair 

- Blood flow LEFT to RIGHT - PULMONARY congestion * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - CONGESTIVE HEART failure * Treatment - DIURETICS for CHF - SURGICAL repair 

Ventricular Septal Defect * Pathophysiology - Blood flow ____ to ____  - Heart ____  - ____ congestion * Clinical manifestations - Symptoms? ____  - ____ ____ failure * Treatment - May ____ by age ___ 

Ventricular Septal Defect * Pathophysiology - Blood flow LEFT to RIGHT - Heart ENLARGEMENT - PULMONARY congestion * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - CONGESTIVE HEART failure * Treatment - May CLOSE by age TWO

Patent Ductus Arteriosus * Pathophysiology - ____ to ____ shunt - Fibers don’t respond to  ____ ____ at birth * Clinical manifestations - Symptomatic? ____  - Sounds? ____  - ____ pulses, ____ pulse  pressure - ____ ____ failure

Patent Ductus Arteriosus * Pathophysiology - LEFT to RIGHT shunt - Fibers don’t respond to INCREASED O2 at birth * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - Sounds? MURMUR  - BOUNDING pulses, WIDER   pulse pressure - CONGESTIVE HEART failure

FACTORS KNOWN TO ELEVATE INTRACRANIAL PRESSURE

Elevate ICP • Hypercapnia • Hypoxemia • Respiratory Procedures • Vasodilating Drugs • Positioning • Valsalva Maneuver  • Coughing • Emotional Upset • REM sleep • Arousal from sleep • Hyperthermia

• Seizures • Clustering of Activities SICKLE CELL Life-threatening complications

SICKLE CELL Life-threatening complications

• ____ Sequestration:  – Trapping of blood in  ____, can result in shock/rupture • Infection/____:  – Fever, S&S infection  – Leading cause of death in SCD pts < __ (#) yrs • Hemolytic/Aplastic:  – ____ failure

• Splenic Sequestration:  – Trapping of blood in spleen, can result in shock/rupture • Infection/Sepsis:  – Fever, S&S infection  – Leading cause of death in SCD pts < 5 yrs • Hemolytic/Aplastic:  – Bone marrow failure

SCD Medical/Nursing Management

SCD Medical/Nursing Management

• ____ transfusion • PT teaching: Living with chronic illness • Pain Management - Opioids: ATC, PCA,  __->__ transition (avoid ____) - NSAIDS (motrin) • Adequate ____  • Adequate ____  • Support coping • Observe for complications

• Blood transfusion • PT teaching: Living with chronic illness • Pain Management - Opioids: ATC, PCA, IV -> oral transition (avoid meperidine) - NSAIDS (motrin) • Adequate oxygenation • Adequate hydration • Support coping • Observe for complications

Acute Lymphocytic Leukemia

Acute Lymphocytic Leukemia

• Proliferation of abnormal lymphoblasts, causes pancytopenia

• Presenting symptoms: Fever, bone pain,  pallor, bruising

• Presenting symptoms:  ____, ____ pain,  ____ (color), ____ing • TX: 3 Treatment phases (chemo)  – Induction (4 weeks)  – Consolidation (6 months)  – Maintenance (2 - 3years) • For relapse, further ____ 

• 3 Treatment phases (chemo)  – Induction (4 weeks)  – Consolidation (6 months)  – Maintenance (2 - 3years) • For relapse, further chemo and bone marrow transplant

and ____ transplant Acute Myelogenous Leukemia

Acute Myelogenous Leukemia

• ____ proliferation of   ____ cells in ____ 

• Malignant proliferation of  myeloid cells n bone marrow

• Presenting symptoms:  ____-like, ____ing, or as in ALL

• Presenting symptoms: Flu-like, bleeding, or as in ALL

• TX:  – Induction phase  – Intensive ____ 

• TX:  – Induction phase  – Intensive chemotherapy

• Increased incidence of ____ 

• Increased incidence of DIC

S/S of Hydrocephalus • Assess: ____ circ, ____  fontanel, ____ sutures • Same S/S as ICP  – ____ache, ____ing,  ____edema, ____  (musc), ____ity,  ____argy, ____-pitched “neuro” cry, ____sion,  ____s, ____ nerve dysfunction • ____ ventricles on CT/MRI

Hydrocephalus • Assess: HEAD circ, BULGING fontanel, SEPARATED sutures • Same S/S as ICP  – HEADache, VOMITing, PAPILLedema, ATAXIA (musc), IRRITABILity, LETHargy, HIGH-pitched “neuro” cry, CONFUsion, SEIZUREs, CRANIAL nerve dysfunction • ENLARGED ventricles on CT/MRI

Status Epilepticus  Nursing Tx/Interventions

Status Epilepticus  Nursing Tx/Interventions

1. ____  2. ____  3. ____ 

1. Stabilize airway! 2. Safety precautions 3. Medications  – Ativan or Valium  – Dilantin (Phenytoin); Fosphenytoin  – Tegretol  – Depakote  – Phenobarbital

ALSO: • ____ diet • ____ 

ALSO: • Ketogenic diet

• Education  NSG Management of GHD

 NSG Management of GHD

> Assessment > Nursing diagnoses - ____ growth/developmt r/t inadeq ____ secretion - Disturbed ____ image r/t ____ stature - Deficient ____  r/t tx > Outcome identification > Planning/implementation - ____ injections of ____  > Evaluation > ____ teaching re: ____ 

> Assessment > Nursing diagnoses - Delayed growth/developmt r/t inadeq GH secretion - Disturbed body image r/t short stature - Deficient knowledge r/t tx > Outcome identification > Planning/implementation - SQ injections of GH > Evaluation > Pt/Family teaching re:tx

Acquired Hypothyroidism Clinical manifestations

Acquired Hypothyroidism Clinical manifestations

* ____ rate of growth * Weight ____  * ____ (bowels) * ____ skin * ____ or ____ hair  * ____ (energy) * ____ intolerance * ____ of face, eyes, hands * ____ deep tendon reflexes * ____ puberty

* Decreased rate of growth * Weight gain * Constipation * Dry skin * Thinning or coarse hair  * Fatigue * Cold intolerance * Edema of face, eyes, hands * Delayed deep tendon reflexes * Delayed puberty

Tx = Med: ____ 

Tx = Med: Levothyroxine

Hyperthyroidism Clinical manifestations

Hyperthyroidism Clinical manifestations

* ____ rate of growth * Weight ____ despite  ____ appetite * ____, ____ skin * ____cardia * ____ changes * Heat ____  * Emotional ____  * _____somnia, ____ tremors

* Increased rate of growth * Weight loss despite excellent appetite * Warm, moist skin * Tachycardia * Ophthalmic changes * Heat intolerance * Emotional lability * Insomnia, fine tremors

Tx: * ____ medication * ____ therapy * Subtotal ____ectomy

Tx: * Antithyroid medication * Radioactive iodine therapy * Subtotal thyroidectomy

Congen. Adrenal Hyperplasia Clinical manifestations

Congen. Adrenal Hyperplasia Clinical manifestations

* Male fetus: ____ 

* Male fetus: no phys changes

* Female fetus: virilized  _____  • Enlarged ____  • Fusion of ____  • ____ appearance to labia • ____ism (genitals)

* Female fetus: virilized external genitalia • Enlarged clitoris • Fusion of labial folds • Rugae appearance to labia • Pseudohermaphroditism

* Children (often toddlers)  present with: adrenarche, ____ growth velocity, ____ bone age, acne, ____ism (hair)

* Children (often toddlers)  present with: adrenarche, accelerated growth velocity, advanced  bone age, acne, hirsutism

HEMATOLOGY • Red Blood Cells  – Life span: ____ days, removed by ____   – Types of hgb: ____ and  ____   – Hgb molecule has __(#) heme, __(#) globin chains • White Blood Cells  – Early inflammatory response: neutrophils  – Immunity: lymphocytes  – Inflammatory/phagocytic: monocytes, macrophages • Platelets  – Life span: ____ days  – ____ # in inflamm. states

HEMATOLOGY • Red Blood Cells  – Life span: 120 days, removed by SPLEEN  – Types of hgb: A (adult) and F (fetal)  – Hgb molecule has 4 heme, 4 globin chains • White Blood Cells  – Early inflammatory response: neutrophils  – Immunity: lymphocytes  – Inflammatory/phagocytic: monocytes, macrophages • Platelets  – Life span: 10 days  – INC. # in inflamm. states

SICKLE-CELL pathophysiology

SICKLE-CELL pathophysiology

• RBC sickling caused by:  ___emia(O2), ___osis(pH),  ____hydration, stress,

• RBC sickling caused by: hypoxemia, acidosis, dehydration, stress,

infection, ____ extremes • Sickled RBC destruction ->  ____  • Accumulated RBCs in spleen -> ____ damage & fibrosis • Sickled RBCs obstruct capillaries/____, impair   ____ -> pain, ____  dysfunction Hemophilia (A & B) • Clinical Manifestations:  – Hemat____, Hem____, Hemat____, Epistaxis (nose ____),Intracranial  ____, Other ____  (neck, abdomen, mouth) • Dx  – History, Thromboplastin Generation test • Severity (based on % of  factor)  – Mild: __-__% of normal  – Moderate: __-__%  – Severe: < __%

infection, temp extremes • Sickled RBC destruction -> anemia • Accumulated RBCs in spleen -> spleen damage & fibrosis • Sickled RBCs obstruct capillaries/vessels, impair  circulation -> pain, organ dysfunction Hemophilia (A & B) • Clinical Manifestations:  – Hematomas, Hemarthroses, Hematuria, Epistaxis, Intracranial bleed, Other bleeding (neck, abdomen, mouth) • Dx  – History, Thromboplastin Generation test • Severity (based on % of  factor)  – Mild: 5-35% of normal  – Moderate: 1-5%  – Severe: < 1%

TYPES of Cerebral Palsy

TYPES of Cerebral Palsy

* ____- tense, contracted muscles (most common) * ____- poor sense of   balance, falls/stumbles * ____- constant, uncontrolled motion of  limbs, head, and eyes * ____- tight muscles that resist effort to make them move * ____- uncontrollable shaking, interfering with coordination

* SPASTIC- tense, contracted muscles (most common) * ATAXIC- poor sense of   balance, falls/stumbles * ATHETOID- constant, uncontrolled motion of  limbs, head, and eyes * RIGIDITY- tight muscles that resist effort to make them move * TREMOR- uncontrollable shaking, interfering with coordination

SICKLE CELL Life-threatening complications

SICKLE CELL Life-threatening complications

•____-occlusive episode:

•Vaso-occlusive episode:

-PAIN due to ____  (acute, chronic)  –____  *S/S= severe ____ache,  ____ signs *Evaluate c transcranial  ____  *Tx: ____ transfusion q 3-4 wks Tx: ____ therapy: Desferoxamine SC infusion __ nts/week   –Acute ____ Syndrome *S/S= pneumonia-like  picture, ____emia, pain *Tx= Transfusion or   ____ transfusion,  ____ support

-Pain due to ischemia (acute, chronic)  –Stroke *S/S= severe headache, neuro signs *Evaluate c transcranial doppler  *Tx: blood transfusion q 3-4 wks Tx: Chelation therapy: Desferoxamine SC infusion 5 nts/week   –Acute Chest Syndrome *S/S= pneumonia-like  picture, hypoxemia, pain *Tx= Transfusion or  exchange transfusion, Respiratory support

Beta-thalassemia Beta-thalassemia • Mediterranean, Middle East, Africa, South • Mediterranean, Middle China, Southeast Asia East, Africa, South • Synthesis beta ____ chain impaired China, Southeast Asia • RBCs w/ less ____  • Synthesis beta Hgb chain impaired • ____ in marrow destroyed • RBCs w/ less Hgb • Increased erythropoietin, • RBCs in marrow destroyed  but ineffective ____  • Increased erythropoietin,  production  but ineffective RBC • Bone marrow ____ (abnormal  production multiplication of cells) • Bone marrow hyperplasia • Sequelae (a secondary • Sequelae: condition resulting from a  – Severe anemia disease):  – Impaired growth/  – Severe ____  development  – ____ growth/  – Without treatment: death development  by 5 – 6 years  – Without treatment: ____   by 5 – 6 years Aplastic Anemia

Aplastic Anemia

• Dx'd with: ____  aspirate, ____  studies

• Dx's with: bone marrow aspirate, chromosome studies

• Tx: • ____  therapy may induce remission (ATG, cyclosporin, steroids) • Only cure is ____  • Nursing Management:  – Potential for infection  – Potential for injury  – Inadequate tissue  perfusion

Tx: • Immunosuppressive therapy may induce remission (ATG, cyclosporin, steroids) • Only cure is bone marrow transplant • Nursing Management:  – Potential for infection  – Potential for injury  – Inadequate tissue  perfusion

14 yo with sickle cell disease, * What are your initial nursing admitted from ER for fever and pain. actions? 3 day hx increasing chest pain, fever  * When will you reassess? to 38.5. Wt = 45 kg * What kinds of medical orders do Admit VS: T= 38.4ax, HR= 140, you expect? RR= 32, BP= 142/88, 02 sat 90% on * Which, if any, of these results is room air. Rates pain as 9/10 on 0-10 concerning? And, why? scale. Points to upper right chest as •CXR results show a right  pain location, also back and upper lobe opacity. ? abdomen. Infiltrate. Has an implanted port in rt chest, •CBC results: H/H = 7.0 / accessed in ER, now with 20 (norm =13-16/37-49) D5%/0.45NS at 25 ml/hr. •Retic count = 1.5 (norm = CBC, retic count, and blood cultures 0.5-1.5) drawn, chest xray done. •WBC = 15,000 (norm = 4.5 –  * What are your nursing priorities? 11.0) * What else do you need to assess? •segs:80%, bands:10% (norm * What other information would be segs = 54 - 62, bands = useful in planning care? 3 - 5) Lymphoma

Lymphoma

• From lymphoid and hematopoietic systems

• From lymphoid and hematopoietic systems

 NON-HODGKINs Lymphoma  – Peak 7-11 years S/S: Depend on location (mediastinal mass,  pleural effusion, lymphadenopathy)  – Pain, edema, generalized  – Often advanced at dx • With mediastinal mass,

 NON-HODGKINs Lymphoma  – Peak 7-11 years S/S: Depend on location (mediastinal mass,  pleural effusion, lymphadenopathy)  – Pain, edema, generalized  – Often advanced at dx • With mediastinal mass,

risk of ____  distress and superior vena cava syndrome • Treatment with multi-agent  ____  • High risk of ____ lysis syndrome

risk of respiratory distress and superior vena cava syndrome • Treatment with multi-agent chemotherapy • High risk of tumor lysis syndrome

Wilms Tumor 

Wilms Tumor 

• Arises in ____,  primordial cells • S/S: ____ swelling,  pain, ____uria, ____ BP, malaise • Dx: CT/MRI • Surgery to remove  ____ or ____, ____therapy • Pre-op: monitoring, no  ____ palpation (fragile outer capsule of  tumor) • Postop:  – Care as for major abd surgery, large abd incision  – Fluids, BP, pain

• Arises in kidney,  primordial cells • S/S: abdominal swelling,  pain, hematuria, INC. BP, malaise • Dx: CT/MRI • Surgery to remove tumor/kidney, chemo • Pre-op: monitoring, no abdominal palpation (fragile outer capsule of  tumor) • Postop:  – Care as for major abd surgery, large abd incision  – Fluids, BP, pain

 Neuroblastoma

 Neuroblastoma

• From neural crest cells:  – brain, adrenal medulla,  pelvis, mediastinum, sympathetic ganglia • S/S: caused by ____  on adjacent structures,  ____  • Dx: scans, lab tests (depending on location),  biopsy • Staging: based on age, markers present, histology, extent of  spread (62% have ____) • Treatment: surgical removal, intensive ____, radiation (stage III), BMT

• From neural crest cells:  – brain, adrenal medulla,  pelvis, mediastinum, sympathetic ganglia • S/S: caused by compression on adjacent structures, metastases • Dx: scans, lab tests (depending on location),  biopsy • Staging: based on age, markers present, histology, extent of  spread (62% have mets) • Treatment: surgical removal, intensive chemo, radiation (stage III), BMT

CHF * Treatment: - ____  - Meds: ____  - Positive ____  - ____ support * Nursing management - 1st: ____  ~ ____ assessment ~ ____ support,  ____ c child - Nursing diagnoses ~ ____ Cardiac output ~ Fluid volume ____  ~ Imbalanced nutrition:  ____ than body reqs - ____ identification and planning - Evaluation and family  ____ 

CHF * Treatment: - SURGERY - Meds: DIURETICS - Positive INOTROPES (↑CO) - NUTRITIONAL support * Nursing management - 1st: ASSESSMENT ~ PHYSICAL assessment ~ FAMILY support, INTERACTION c child - Nursing diagnoses ~ DECREASED cardiac output ~ Fluid volume EXCESS ~ Imbalanced nutrition: LESS than body reqs - OUTCOME identification and planning - Evaluation and family TEACHING

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Question

Answer

Loading... What is the leading cause of death in infants?

Birth Defects Congenital Anomalies

What level of preventative care is a child wearing a helmet?

Secondary

How does Erikson describe school age children?

6-12 years initiave vs guilt learn to carry out tasks want to be good at things

How do children intrepret blood being taken from them?

Make a hole in them and their  insides will come out.

Sid e3

Fine and gross motor skills for a 5 monthj old?

Can grasp large objects but not small ones Roll from belly to back 

What is a big danger with small children and foods?

Choking

How do you give ear drops to a small child?

Pull ear down and back 

How do you give vitamin K?

IM

Rational for potty training at 2 years?

Their bodies are not ready until they are two.

What age and weight can a car seat be turned forward facing?

Age one year  20 pounds

At what age are testicular tumors more likely?

Adolescents

What accounts for 75% of all cases of spina Myelomeningocele  bifida? What is myelomeningocele?

Back bone and spinal canal do not close before birth.

Symptom of hip dysplasia

Hips POP when ortiloni maneuver is preformed.

What usually occurs with hip dysplasia?

neural tube disorders.

Symptoms of hydrocephalous

Big head with rapid increase in diameter  Vomit sleepy irritability seizures downward deviation of eyes (sunsetting)

Symptoms of Rubella

Appear 2-3 weeks after  infection Slightly raised temperature swollen glands rash of pink spots that start on face conjunctivitis

Symptoms of Roseola

Persistant high temperature higher than 102 for 3-4 days in an otherwise well child lowered fever with onset of  rash appears on trunk and spreads

Impetigo

Begins in broken skin Usually with staph red macules-vesicles most common in nose and mouth wash with topical ointment 3x day

How do you treat cellulitis?

oral or parenteral antibiotics

What causes ringworm?

Fungus

How to manage head lice?

clean environment wash in HOT water  tx entire family with NIX or  Kwell

Lyme Disease

caused by Deer Tick bite Caused by spirochete stage 1 rash stage 2 most serious, involves neuro TX oral doxycycline, less than 8 is amoxicillin or penicillin

Papule

firm PALPABLE elevation of  skin less than 1 cm

vesicle

elevated lesion less than 1 cm filled with fluid

anorexia nervosa

eating disorder characterised  by low body weight and body image distortion

What causes a wart?

Virus usually HPV

S/S of scabies?

Intense puritis especially at night Fine grayish threadlike lines

What causes 5th disease?

human parvovirus B 19

Side effects of wearing a cast?

muscle loss atrophy increased sensitivity

What do you do with evulsed tooth if you do not want to put it back into your mouth  put in cold milk or cold water  until you can see a dentist? Hepatitis vaccine

1st injection 2nd one month later  3rd is 6 months from 1st

What injections will a 5 year old have?

DTaP IPV MMR 

Most common form of childhood cancer?

Leukemia

How is leukemia diagnosed?

Bone marrow Aspiration Biopsy Lumbar Puncture

Wilm's Tumor 

most common malignant tumor of kidneys swelling or mass in abdomen firm. nontender mass increased abdominal girth

Symptoms of brain tumor?

HA with projectile vomiting causes obstruction in CSF circulation Causes increased ICP

Dehydration What should you watch for in a child using clotting problems because of  diuretics? hypokalemia

S/S of necrosis

pyelonephrosis Why should you treat strep?

maybe no s/s of pain loss of movement stiffness loss of ROM avascular is arthritis disease of pelvic kidney It could lead to Rhumatic fever if untreated.

Isotonic Dehydration

loss of water and electrolytes in equal proportions

How much fluid loss is there with mild dehydration?

Loss of less than 50ml/kg of  fluid

What causes diarrhea most often in children?

Rotavirus

Complications of 3rd degree burns in children

Respiratory compromise hypovolemic shock  local infections sepsis little or no pain because of  nerve damage

What is the leading cause of death in adolescents?

Accidents next is homocide

assess skin turgor?

check for tenting color, dry, moist?

epiglottis

one of the biggest emergencies Trachea swells shut needs trach or will die

Complications of bulemia

malnutrition dehydration electrolyte imbalance tooth erosion damage to voice  potential for gastric rupture

Stenosis

abnormal narrowing in blood vessel or other tubal organ May be called stricture  Noise over turbulent flow,  bruit ultrasound or MRI to Diagnose

Intussusception

current jelly stools

How do you treat celiac disease?

Avoid Wheat.

First signs of puberty in females?

Breast Buds

First signs of puberty in males?

enlarged testicles

Hep B

2 months 4 months 6-18 months 11-16 years

DTaP

2 months 4 months 6 months 12-18 months 4-6 years

Hib

2 months 4 months 6 months 12-15 months

Prevnar 

2 months 4 months 6 months 15 months

IPV

6 months 9 months 18 months 4-6 years

MMR 

12-18 months 4-6 years

Varicella

12-18 months

Communicability of 5th disease (Erythema Infectiosum) Incubation of  transmission

Before onset of s/s- 1 week  after rash 4-14 days unknown blood/resp

communicibality of roseola incubation transmission

during high temp until after  rash 5-15 days unknown

Chicken pox incubation

14-21 days

Rubella communicability

7 days before and 5 days after  rash appears 14-21 days

incubation