When does birth weight double?
6 months
When does birth weight triple?
12 months
When does the posterior fontanel close?
By 8 weeks
When does a baby give its 1st social smile?
2 months
When does a baby turn its head toward sounds?
3 months
When does the Moro reflex disappear?
4 months
When does a child achieve steady head control?
4 months
When does a baby turn completely over?
5-6 months
When does a baby transfer objects objects hand to hand?
7 months
When does a baby play peek a boo for 1st time?
After 6 months
When does stranger anxiety develop?
7-9 months
When does a child sit unsupported?
8 months
When does a child crawl?
10 months
When does a child¶s fine pincer grasp appear?
10-12 months
When does a child wave bye bye?
10 months
When does a child walk with assistance?
10-12 months
When does a child say a few words in addition to mama or dada?
12 months
When does birth weight quadruple?
30 months
When do you achieve 50% of adult height?
2 years
What is the appearance of a toddler?
Bowlegged and potbellied
What are the teeth of a toddler (1-3 year old) like?
All 20 primary teeth are present
When does the anterior fontanel close?
12-18 months
When does a child throw a ball overhand for 1st time?
18 months
When can a child kick a ball?
2 yrs
When does a child feed self with cup and spoon?
2 yrs
When can daytime toilet training begin?
2 yrs
When can kids form 2-3 word sentences?
2 yrs
When can kids form 3-4 word sentences? 3 yrs
When can child state full name?
2.5-3 years
When are temper tantrums common?
Toddler (1-3)
What is Erickson¶s Theory of the toddler (1-3)?
Developing a sense of autonomy
What type of toys should you give to babies under 1 year old? What happens to a baby under 1 whose parents are not able to stay with him? What is Erickson¶s Theory of infants under 1?
Mobiles, rattles, squeaking toys, picture books, balls, colored blocks, activity boxes May be inconsolable due t o separation anxiety Developing a sense of trust Board and mallet, push/pull toys, toy phone, stuffed stuffed animals,
What are the toys a ppropriate for the toddler (1-3)?
storybooks with pictures, use of the h ospital playroom playroom bc of mobility (which is important to their development).
How much weight does a preschool child (3-5) gain each year/ inches grown each year?
5 lbs and 2-3 inches/year
When do kids learn to run, skip, jump?
Preschool
How old are you when you start riding tricycle?
3 years old
At what age is standing erect began?
Preschool
When do you establish handedness?
Preschool
At what age do you use scissors?
4 years old
What age ties shoelaces?
5 years old
At what stage do you learn colors and shapes?
Preschool
What is the visual acuity of a preschooler?
20/20
What is the thinking of a preschooler like?
Egocentric and concrete
When does a child learn sexual
Preschool
identity/curiosity/masturbation? When are imaginary friends and fears common?
Preschool
Aggressiveness at ___years old is replaced by in dependence at ___years old. What should you make sure a preschooler knows about their illness? When is fear of mutilation from procedures common? How can you help restore body in tegrity? tegrity?
What are appropriate toys for a preschooler? preschooler? What is Erickson¶s Theory of Preschoolers?
4, 5
They did not cause it, painful procedures are not punishment
Preschool, put on a Bandaid
Coloring books, puzzles, cutting/pasting, dolls, clay, toys that let you work out hospital experiences Developing a sense of initiative
School age (6-12 year olds) have what
weight/height gain per year? What is Erickson¶s Theory of school-agers? When are primary teeth lost an d permanent teeth established? At what age are you able to write script? Egocentric thinking in the school age child is replaced by _________. When are cause and effect effect relations r elationships hips learned? When does socialization with peers become important? When do molars erupt? Whose growth spurt develops 1st? As early as what age?
4-6 lbs and 2 inches per year Developing a sense of industry school age 8 years Social awareness of others School age School age School age (6 year molars)
Girls-10 years old. Boys at 14.
Adult-like thinking begins at what age?
15
When does growth end?
Girl-15, boys-17
What is Erickson¶s theory for adolescents (12 to 19)? After 6 months what is the baby¶s concept of bodily injury? What is the toddler¶s concept of bodily injury? What is the preschooler¶s concept of bodily injury? What is the school age childs concept of bodily injury? What is the adolescent¶s concept concept of bodily injury? When can you start using the numeric pain scale?
Developing sense of identity
They can remember the pain Fear of intrusive procedures Fear of body mutilation
Fear of loss of control over their body
Change in body image
9 and up
How can a non verbal child be assessed for
Using the FLACC pain assessment tool, that looks at the face, leg movement,
pain?
activity, cry, and consolability
What are the best n ondrug measures to reduce pain in infants? What are the best n ondrug measures to reduce pain in toddlers and preschoolers? What are the best n ondrug measures to reduce
Pacifiers, holding, rocking
Distraction Guided imagery
pain in school age and adolescents? At what age can you teach a child how to use PCA?
When is MMR vaccine given? During a measles epidemic when can you give the MMR? What are contraindications contraindications for MMR? How do you administer the MMR vaccine? After the MMR vaccine what is a normal finding? When do you give the DTaP vaccine? How do you give DTaP vaccine? When do you have to stop giving DTaP vaccine? After the injection of DTaP what should the nurse tell the parents to do?
5 years old
12-15 months and then 1 other time between between 4 and 12 years old 6 months and then again at 15 m onths Allergy to neomycin or eggs SQ at 2 difft sites
Light rash 2 weeks later At 2 months, 4 months, and 6 months. THEN get boosters at 15-18 months and again at 4-6 years. IM apart from other vaccines At age 7, bc then you switch to Td vaccine
Give acetaminophen (Tylenol) (Tylenol)
When do you give the IPV vaccine?
At 2 months and 4 months, THEN boosters at 6-18months and again at 4-6 years old
How do you administer IPV?
SQ or IM at separate site from other vaccines
What is the contraindication contraindication for IPV vaccine? How and when do you administer Hib vaccine? When and how do you administer the HepB vaccine? When and how do you give the varicella vaccine? What are normal side effects from DPT and IPV vaccinations? vaccinations? What can decrease soreness after thigh injections? How do you treat fever in a child with a communicable disease? What can you use for itching in
Allergy to neomycin or streptomycin
IM at 2, 4, and 6 months
IM at 0-2 months, 1-4 months, 6-18 months
12-18 months ±should be given with the MMR vaccine OR over 30 days apart
Irritability, Irritability, fever under 102, redness and soreness at injection site for 2-3 days
Warm washcloth on injection sites, bicycling the legs with each diaper change
NON-A SPIRIN PRODUCT Diphenhydramine (benadryl)
communicable diseases? Highly contagious, viral disease that can cause n eurologic problems problems or death,
What is Rubeola (Measles)? How is it transmitted? When is it contagious? What are classic symptoms?
Once scabs have formed on all lesions
contagious?
A viral disease that can kill babies in 1st trimester; spread by droplets and contact, a red
What is German Measles?
maculopapular rash spreads from face to rest of body and fades in 3 days Whooping cough; caused by bacteria prolonged coughing for 4-6 weeks; treated with
What is pertussis?
erythromycin; complications are pneumonia, hemorrhage, and seizures
How do you measure past nutrition in a
Height and head circumference
child? How do you measure current nutrition in
How do you measure the body fat content of a child? What does vitamin B2 (riboflavin) deficiency look like?
How do you treat it? What does vitamin A deficiency (retinol) look like?
How do you treat these kids?
fever and upper respiratory symptoms; symptoms include photophobia, Koplik¶s spots in the mouth, rash starting on face and spreading downward.
When is chicken pox no longer
a child?
transmitted by droplets; contagious mainly during prodromal period when they have
Weight, skinfold thickness, arm circumference
Skinfold thickness
Redness and itchiness of eyes, magenta tongue, delayed delayed wound h ealing
Give these kids green leafy veggies, liver, cow milk, cheddar cheese
Rough dry skin, cornea problems, retarded growth growth
Give them orange foods (sweet potatoes, peaches, apricots)
What are signs of dehydration in an
Poor turgor, depressed fontanels, no tears, dry mucous membranes, weight loss, decreasued
infant/child?
urine output
What are lab signs of metabolic acidosis (caused by dehydration)? When should you add potassium to IV fluids? What is the expected urine output for both infants and children per hour? How many children die from child abuse each year? How should burns in children children be
pH under 7.3, low sodium and potassium, high Hct and BUN
ONLY when the child has adequeate urine output
1-2 mL/kg/hr
3 to 5 thousand Using the Lund-Browder Lund-Browder Chart, which takes into account the changing proportions fo the
assessed?
child's body
How can the nurse BE ST evaluate adequacy of fluid replacement in
Monitor urine output
children? What interventions should be done FIR ST when caring for a child who
Assess repiratory, cardiac, and neuro status
has ingested poison? Cardinal signs: restless, inc respirations, inc pulse, sweating What are the cardinal signs of respiratory distress in children, and other signs of resp. distress in kids?
Other signs: flaring nostrils, retractions, grunting, bad breath sounds, accessory muscle use, head bobbing, low PO2, high PCO2, cyanosis, pallor
Which usually occurs 1st: cardiac failure or respiratoy failure in
Respiratory failure
children? What is epiglottitis caused by? HIB What is the classic position these kids are in?
Upright sitting position with chin out and tongue protruding ("tripod position")
What do you NEVER do in these
NEVER examine the throat of this child!!
patients? What causes bronchiolitis?
R SV
What lung sounds do you hear?
Wheezing and rales
What are their respirations like?
Respirations are shallow and fast
What is given to kids under 2 yrs old born either premature or with lung/heart disease to give passive
Synagis
immunity to R SV? What is a risk of untreated otitis
Conductive hearing loss
media? Pulling at ears, fever, pain, enlarged lymph nodes, discharge from ear IF drum is ruptured, What do you see on a ssessment?
V/D
What can you do to ear for comfort?
Apply warm compress on ear
How can you reduce body temperature in children to avoid
Tepid bath or Tylenol
seizure risk? Tonsillitis can be either bacterial or viral. If related to strep why is
bc the child can develop acute glomerulonephritis or rheumatic heart disease
treatment so important? Prior to tonsillectomy what lab values
PT and PTT, assess for history of bleeding of family hx of bleeding disorders
must be drawn? What are signs of postoperative tonsillectomy bleeding?
Clearing throat, vomiting fresh blood, frequent swallowing swallowing
when is highest risk for hemorrhage?
1st 24 hours and 5-10 days post surgery
These kids should NEVER be given
NO STRAWS!
what? What is the drug of choice for an
Epinephrine bc it is a rrapid apid acting bronchodilator
acute asthma attack? What are the normal PO2 and PCO2
PO2: 83-100
values for kids in an arterial blood gas PCO2: 35-45
draw? What nutritional support should be
pancreatic enzyme replacement, fat soluble vitamins, low carb, high protein, moderate fat
given to a child with CF?
diet
What type of genetic disease is CF?
autosomal recessive
How do you care for a child in a mist tent? An increased respiratory rate in kids puts them at risk for _____________.
Monitor temperature. Keep clothing dry. Keep tent edges tucked in, a ssess respiratory status. dehydration and acid/base imbalance Hole between the aorta and pulmonary artery, artery, which normally n ormally closes within 72 hours
What is a patent ductus arteriosus?
postbirth. If it stays open blood from the aorta returns to the pulmonary artery, resulting in increased blood flow to the lungs and pulmonary hypertension. They can be 1 of three things:
Describe acyanotic defects.
1. L to R shunts 2. Increased pulmonary blood flow
Examples
3. Obstructive defects
VSD, ASD, PDA, A S, and coarctation of the aorta They can be either: 1. R to L shunts Describe cyanotic heart defects. 2. Decreased pulmonary blood flow 3. Mixed blood flow Examples
The 3 T's: Tetralogy of Fallot, TA, TGV Acyanotic What is a ventricular ventricular septal defect? Blood from the L ventricle is shunted to the R ventricle through a hole and recirculated to the lungs, resulting in increased pulmonary blood flow What is an a trial septal defect?
What is a coarctation of the aorta?
What is aortic stenosis? What is a common finding in children with cyanotic heart defects (3 T's)? What is truncus arteriosus?
What is transposition of the great vessels? Is CHF associated more with cyanotic or acyantoic defects? defects?
Oxygenated blood from the L atrium is shunted into the R atrium and lungs through a hole , resulting in increased pulmonary blood flow. It is a narrowing of the aorta which causes HTN in the upper extremities and decreased/absent pulses in the lower lower extremities. A narrowing at or around the aortic valve; Oxygenation to the systemic circulation is poor bc cardiac output is low. polycythemia When the pulmonary artery and aorta do not separate. The blood from th e 2 ventricles mix and causes cyanosis Incompatible with life, a medical emergency where babies recieve prostaglandin E to keep ductus open. acyanotic
MANAGING DIGOXIN: 1. Before giving digoxin what must the
1. Take child's apical pulse. If bradycardic do not administer.
nurse do?
2. 0.8-2.0ng/mL 2. What are therapeutic levels?
3. Throwing or spitting up What is an early sign of digoxin toxicity?
4. Hypokalemia What electrolyte imbalance increases digoxin toxicity?
Rheumatic fever is an _______disease. It is the most common cause of ________ in children. It is associated with an infection of ________. Rheumatic fever is a collagen disease that
Inflammatory Acquired heart disease B-hemolytic strep bacteria Heart, blood vessels, joints, subQ tissue
injures _________. What assessment findings are associated
Chest pain, SOB, tachycardia ALL the time, joint pain, chorea (involuntary
with rheumatic fever?
movements), rash, subQ nodules over bony prominences, fever
Lab values?
Increased Erythrocyte sedimentation rate, increased A SO titer (anistreptolysin O).
What medications are used to treat rheumatic fever? In ____________ (a type of congenital heart defect) the child often experiences "tet spells" (_________), which are relieved by which position? What is the nurse's goal in caring for kids with Down Syndrome? What is cerebral palsy?
Its major risk factor?
What is "scissoring" a characteristic of?
Penicillin, eryhtromycin, and aspirin Tetralogy of Fallot hypoxic episodes squatting or knee chest position help the child reach its OPTIMAL OPTIMAL level of functioning An injury to the motor centers of the brain causes neuromuscular problems of spaasticity or dyskinesia (involuntary movements)
Low birth weight Cerebral Palsy; it occurs when legs are extended and crossed over each other with feet plantar flexed.
If a mother of a Cerebral Palsy child says she is having "difficulty "difficulty with diapering,"
S pasticity
what is the mom describing? What should the nurse do while feeding a cerebral palsy child? What is the most common allergy of kids with spina bifida?
Prevent aspiiration by sitting the child upright and supporting the lower jaw
Latex 1. Prevent infection of the sac
What are 2 n ursing priorities for the infant with myelomeningocele? myelomeningocele?
2. Monitor for h ydrocephalus ydrocephalus (measure head circumference, assess fontanel, and neuro functioning).
What is hydrocephalus and assessment
Accumulation of CSF within the brain and is often associated with spina bifida or
findings?
meningitis
Symptoms: Increased ICP (low pulse, high BP), change in LOC, vomiting, seizures,
bulging fontanels, widening suture lines, sunset eyes What is the surgery like for kids with
A shunt is inserted into the brain ventricle and tubing is then tunneled through skin to
hydrocephalus?
the peritoneum where excess CSF is drained out
Seizures are more common in what age
group?
Under 2 yrs old You get an aura. Then you lose consciousness and the body becomes stiff (tonic). Then
Describe tonic clonic seizures (grand
you stop breathing and become cyonotic before you go into spasms (clonic) and relax.
mal).
Pupils will be dilated and nonreactive to light, incontinent, and then you lay there sleepy and di soriented Usually occur between 4 anbd 12 years old. You lose consciousness for 5-10 seconds
Describe absence seizures (petit mal).
and appear to be daydreaming because posture is kept and you get minor face and hand movements. These kids may be doing poorly in school.
What is the most common cause of increased seizure a ctivity?
Medication noncompliance
What do you see in older children with
ICP, fever, chills, neck stiffness, opisthotonos, photophobia, photophobia, positive Kernig's Sign
bacterial meningitis (normally caused by
(inable to extend leg when knee is bent toward chest), positive Brudzinski's sign (neck
HIB)?
flexion causes flexion movements of lower extremities)
What do you see in infants with bacterial meningitis?
BULGING FONTANEL S, poor feeding, vomiting, irritable, seizures
With meningitis it is important to monitor
Bc with meningtitis there may be inappropriate secretions of ADH, causing fluid
hydration status and IV therapy. Why?
retention (cerebral edema) and dilutional h yponatremia
What antibiotics are usually prescribed for bacterial meningitis?
How do kids usually get Reye's syndrome? What is the most common presenting symptom of brain tumors? How is a child usually positioned after brain tumor surgery? What is the mechanism for inheritance of Duchenne muscular dystrophy? What is "Gower's sign?"
Ampicillin, penicillin, chloramphenicol chloramphenicol
ASA + chicken pox/influenza
Headache upon awakening
flat on his or her side
it is an x-linked x -linked recessive recessive trait affecting a ffecting mostly males An indicator of muscular dystrophy; difficulty moving to standing position-child has to walk up legs using hands to stand up.
What is the first sign of renal failure?
Decreased urine output
What are the symptoms of acute
blood in urine, recent strep infection, infection, HTN, mild edema around eyes, positive ASO
glomerulonephritis?
titer
Dietary interventions?
low sodium diet
what are the symptoms of nephr osis?
severa edema, massive proteinuria, frothy urine, anorexia, negative ASO titer
dietary interventions?
high protein AND low salt
Decribe safe monitoring of prednisone
Give prednisone every other day, signs of ededma/mood ededma/mood changes/GI distress should be
administration and withdrawal?
reported; the drug should always be tap ered.
How can you prevent Urinary Tract
avoid bubble baths, pee a lot, drink lots of fluids (especially acidic ones), wipe from
Infections in kids?
frant to back
what is the vesicoureteral vesicoureteral reflex?
When urine backflows from the bladder up into the ureters. Recurrent UTIs are common.
What do you see in a kid with Wilms
Mass at midline on abdomen, fever, pallor, lethargy, high BP (bc of excess renin
Tumor?
secretion)
What is THE MOST IMPORTANT thing for a nurse to do w/ a child who has
Prevent injury to the capsulated tumor by ma king sure noone palpates the abdomen.
Wilms Tumor? What is hypospadias?
Why is surgical correction usually done before preschool? When is closure of cleft lip normally performed?
After surgery how is child positioned?
When is closure of cleft palate usually performed?
After surgery how is the child positioned? How can you protect the surgical site on a child with cleft li p/palate?
When the urethra opens on the ventral side of the penis behind the glans
To schieve sexual identity, toilet training, and remove the fear of castration anxiety
When the baby weighs 10 pounds and has Hgb of 10g/dL.
on side or upright in car seat (NOT PRONE)
1 year of age to minimize speech impairment
on side or abdomen
Apply elbow restraints, minimize crying, maintain Logan Bow to lip if applied
What is an esophageal atresia with
When the upper esophagus ends in a blind pouch with the lower esophagus connected to
tracheoesophageal fistula?
the trachea. It is a MEDICAL EMERGENCY!!
In tracheoesophageal fistula what do you
The 3 c's (coughing, choking, cyanosis), exxcess salivation, resp. distress, aspiration
see on assessment?
pneumonia
What nursing actions are initiated for a child suspected of having esophageal
NPO immediately and suction secretions
atresia with tracheoesophageal fistula? What are the feeding techniques for a child with cleft li p/palate?
Feed upright with lamb's nipple or prosthesis. Use frequent bubbling. bubbling.
What assessment findings do you see in
Projectile vomiting, constant hunger, weight loss, deh ydration, palpable olive shaped
kids with pyloric stenosis?
mass in RUQ, visible walves of peristalsis
What lab values are seen in kids with
Low sodium, low potassium, metabolic a lkalosis (low chloride, increased ph, increased
pyloric stenosis?
CO2)
What is postoperative nursing care for a child with pyloric stenosis? What assessment findings do you see in a child with intussusception (when 1 part of intestine telescopes into another part of intestine)? Why is a barium enema used to treat intussusception?
What is Hirschsprung's Disease? Disease? What do you see when assessing a Hirschsprung's Disease child?
How do you take their temperature?
IV hydration, small frequent feedings of oral glucose or electrolyte electrolyte solutions, gradually increasing to full strength formula. Position ON RIGHT SIDE in semi fowlers after feedings Intermittent abdominal pain, screaming screaming when legs are pulled toward abdomen, "currant jelly stools" (blood +mucus), sausage shaped mass in RUQ with empty RLQ (Dance sign)
It reduces intestinal telescoping via hydrostatic pressure instead of surgery
Lack of persitalsis in area of colon where ganglion cells are missing. Fecal matter accumulates above this area. Failure to pass meconium in 1st 24 hours, distended abdomen, ribbon like stools
Take axillary temperature.
What are signs of anorectal
Failure to pass meconium in 24 hours, meconium appearing from a fistula or in th e
malformation?
urine, an unusual anal dimple
What are the Hgb norms for: Newborn 14-24 1. Newborn
Infant 10-15
2. Infant
Child 11-16
3. Child What are assessment findings in kids who have iron deficiency anemia?
Pale, fatigue, milk intake over 32oz/day, pica, low Hgb, Low serum iron values
What is the genetic transmission transmission pattern
x-linked recessive transmitted by the mother and expressed by male offspring. These
of hemophelia?
children are missing factors 8 or 9.
What are are assessment assessment findings in a child
Prolonged bleeding(after bleeding(after circumcision circumcision or in general); general); loss of motion motion in in joints, joints, prolonged prolonged
with hemophelia?
PTT
Never give these kids______.
Aspirin Both parent must be heterozygous carriers of the trait. Each child has a 1 in 4 chance of
Describe autosomal r ecessive
having the disease.
transmission and give examples. ex.) sickle cell, CF, PKU The trait is carried on the X chromosome, so it usually affects male offspring. With each pregnancy of a woman who is a carrier there is a 25% chance of having a child Describe X-linked recessive transmission. Give an example.
with the disease. If male there is a 50% chance of getting disease. If female there is a 50% chance of being a carrier.
ex.) hemophelia What is the sequence of events in a vasooclusive crisis of sickle cell anemia? Why is hydration a priority in treating sickle cell disease?
RBCs clump together and block small blood vessels. Cells cannot get through the capillaries, causing pain and ischemia. Lowered O2 affects the Hgb S and causes sickling. Hydration promotes hemodilution and circulation of RBCs t hrough the blood vessels
What should families and clients do to
Keep hydrated, avoid high altitudes, avoid strenuous exercises, avoid unknown sources
prevent sickle cell episodes?
of infection
Do you give supplemental iron to kids
No, bc it is not caused by iron deficiency. You DO give them folic acid, however, to
with sickle cell anemia?
stimulate RBC synthesis.
Nursing interventions and medical treatment for a child with leukemia are
Anemia (decreased RBCs), Infection (neutropenia), and bleeding thrombocytopenia
based on which 3 physiological physiological
(decreased platelets)
problems?
What should you have nearby when administering l-asparaginase to a
Epinephrine and oxygen in case of a naphylaxis
leukemic patient? An infant with ________is often described as a "good, quiet baby" by
Hypothyroidism
the parents. What do you see in children with hypothyroidism? What are the outcomes of un treated congenital h ypothyroidism? ypothyroidism?
sleepy, poor feeders, flat expression, constipations, hypoactive hypoactive
Mental retardation, growth failure
What is phenylketonuria?
An autosomal recessive disorder where the body cannot m etabolize the aa phenylalanine
What is the result of PKU?
The buildup of phe leads to CN S damage (mental retardation) and decreased melanin
On assessment of a child with PKU
Newborn screening using Guthrie test is positive when serum phenylalanine phenylalanine is 4mg/dL or
what do you see?
higher. Vomiting, failure to gain weight, hyperactive, musty urine odor
What are foods high in phenylalanine (which should be avoided if you have PKU)? What 2 formulas are prescribed for kids with PKU? What are the 3 classic signs of diabetes? Diabetes is diagnosed if the fasting blood sugar is greater than_____mg/dl.
high protein foods including meat, dairy, eggs, a spartame. This low protein diet should be done until brain growth is complete (6-8 years old).
Lofenelac and PKU-1
Polydipsia, polyuria (including bedwetting-"enuresis"), bedwetting-"enuresis"), polyphagia
120+
What do you do if a diabetic child is in
Provide care for unconscious child, administer REGULAR insulin IV in Normal Saline,
ketoacidosis?
monitor blood gases, maintain strict I&O
What are the signs and symptoms of
tremors, sweating, headache, hunger, nausea, lethargy, confusion, slurred speech, anxiety,
hypOglycemia?
tingling around mouth, nightmares
What are the signs and symptoms of hypERglycemia? What is the relationship between hypOglycemia and exercise?
polydipsia, polyuria, polyphagia, blurry vision, weight loss, weakness, syncope
During exercise insulin uptake is increased and th e risk for hypOglycemia occurs.
What is a complete fracture?
When bone fragments completely separate
What is an incomplete fracture?
When bone fragments remain attached
Wha is a comminuted fracture?
When bone fragments of the bone shaft break free and lie in surrounding tissue. Rare in children.
What type of fractures have serious consequences in terms of growth of the
Fractures involving the epiphyseal (growth) plate
affected limb? What re the 5 "P's" that may indicate ischemia in the fractured limb? What is a skin traction? What is Buck's Skin Traction? What is Dunlop Skin/Skeletal Traction? What is Russell Skin Traction?
pain, pallor, pulselessness, paresthesia (pins and n eedles), paralysis paralysis Force is applied to the skin. This should NEVER be removed unless specifically prescribed by the MD For the lower extremities; extremities; keeps legs extended with no hip flexion. flexion. When there are 2 lines of pull on the arm 2 lines of pull on lower extremity (1 perpendicular, 1 longitudinal) longitudinal)
What is Bryant's Skin Traction? What is a skeletal Traction?
What is a 90 degree skeletal traction?
Both lower extremities are flexed 90 degrees at hips (rarely used bc extreme elevation of legs causes decreased peripheral circulation) When a pin or wire applies pull directly to the distal bone fragment
90 degree flexion of the hip and knee. The lower leg is in a boot cast. This can also be used on upper extremities.
What is a hip spica? A special type of cast used to immobilize the hip joints and/or the thigh
How do you help with toileting a child
Use Bradford frame under the child. NEVER U SE abduction bar to turn a child.
with a hip spica? What is compartment syndrome? Damage to nerves and vasculature of an extremity due to compression. You see coldness, severe pain, inability to move extremity, poor capillary refill Assessment Assessment findings? What are the signs and symptoms of
Unequal skin fold of buttocks, positive Ortalani Sign (clicking with abduction), limited
congenital hip dysplasia in infants?
abduction of affected hip, unequal leg lengths
What are signs of hip dysplasia in
Limp on affected side, positive Trendelenburg Sign (when standing on one leg the pelvis
older children?
drops on the side opposite to the stance leg. )
How does the nurse conduct scoliosis
Ask child to bend forward from hips with arms hanging free. Examine child for curvature
screening?
of the spine, rib hump, and hip asymmetry Wear it 23 h ours each day. Wear t-shirt under brace. Check skin for irritation. Perform
What instructions should the child
back and abdominal exercises. Modify clothing. Maintain normal activities as able.
with scoliosis receive about the Milwaukee brace?
A brace does not correct the curve of a child with scoliosis. It only stops or slows the progression.
What is the potential outcome for untreated scoliosis? scoliosis? What is postoperative nursing care of a child with scoliosis?
respiratory difficulty
Frequent neuro assessments, log roll for 5 days, keep npo, monitor NG tube/bowel sounds Used postoperatively for scoliosis patients.
Describe log rolling.
Requires 2+ people.
Client is moved on a draw sheet to the side of the bed away from which they are to be turned (rolled toward the L if they are to face the R).
Client is the turned in a simultaneous motion, maintaining the spine in a straight position. Pillows arranged for support and comfort What nursing care is indicated for a child with juvenile rh eumatoid arthritis?
Prescribed exercise to maintain mobility, splinting of a ffected joints, teach medication management and side effects
