Chapter 1, Family-centered Nursing Care whatever the individual considers it to by; should remain remain constant in the child's Family: whatever life; nurses should perform comprehensive family assessments to identify strengths and weaknesses of families; consider the child's opinion when giving care Nuclear Family: Two parents and their children (biologic, adoptive, step, foster) Traditional Nuclear Family: married couple and their biologic children (blood) Single-parent family: one parent and one or more children Blended family (reconstituted): (reconstituted): at least one stepparent, step-sibling, or half sibling Extended Family: At least one parent, one or more children, and other individuals either related or not related Gay/Lesbian Family: two members of the same sex that have a common-law tie and may or may not have children Foster Family: a child or children that have been placed in an approved living environment away away from from the family of origin--usually with one or two parents Binuclear Family: parents that have terminated spousal roles but continue their parenting roles Communal Family: individuals that share common ownership of property and goods and exchange services without monetary consideration un questioned rules), Parenting Styles: Dictatorial or authoritarian (control with unquestioned Permissive Permissive or laissez-faire laissez-faire (exert little or no control over the child's behaviors) and Democratic or authoritative (set rules and explain them, negatively reinforce deviation from the rules) Genogram: medical history for parents, siblings, aunts, uncles, and grandparents Chapter 2, Physical Assessment Findings Temperature Expected values: Birth-1 year, 97.7-98.9 F; 1-12 years, 98.1-99.9 F; 12 and older, 97.8-98.0 F Pulse expected values: Birth-1 week, 100-160; 1-3 weeks, 100-220; 3months-2 years, 80-150; 80-15 0; 2-12 years, 70-110, 12 and older, 50-90 Respirations expected values: newborn, 30-60 with short periods of apnea; newborn-1year, 30; 1-2 years, 25-30; 2-6 years, 21-24; 12 and older, 16-18 Expected B/P: infants, 60-80/40-50; 1 year, 94-107/50-60; 3 years, 100-113/59-68; 6 years, 104-117/67-76; 10 years, 110-123/73-82; 16 years, 122-138/79-87 Posterior fontanel: should be flat and closes between 2-3 months; anterior closes between 12-18 months Strabismus: should be further evaluated in children between 4-6 years; use the cover/ uncover test Internal ear: pull pinna down and back to visualize in infants; pull pinna up and back to visualize in children older than 3 1 ; should have 20 deciduous and 32 Teeth: infants should have 6-8 teeth by age 1; permanent teeth stroke the infant's cheek or the edge of the mouth; should turn head Sucking reflex: stroke toward side that is touched; birth-4 months involuntary and for life life voluntary
Palmar grasp: elicited by placing an object in an infant's palm; infant should grasp the object; birth-6 months Plantar grasp: elicited by touching the sole of an infant's foot; the infant's toes curl downward; birth-8 months Moro Reflex: elicited by startling the infant; the arms and legs should symmetrically extend and then abduct while fingers spread to form a c shape; birth-4 months h ead to one side; the infant should Tonic neck reflex: elicited by turning an infant's head extend the arm and leg on that side and flex the arm and leg on the opposite side; birth-4 months stroking the outer edge of the sole of an infant's foot up Babinski reflex: elicited by stroking toward the toes; the toes should fan our; birth-1 year fl at Stepping reflex: elicited by holding an infant upright with his feet touching a flat surface; infant should make stepping movements; birth-4 weeks Cranial nerves: "on old olympus' towering tops a fin and german viewed some hops" olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, spinal accessory, and hypoglossal n ostrils Olfactory: can identify smells through both nostrils Optic: visual acuity is in tact Oculomotor: no nystagmus present Trochlear: able to look down with both eyes Trigeminal: able to clench teeth together Abducens : able to look laterally with eyes Facial: has symmetric facial movements Acoustic: no vertigo present glossopharyngeal: gag reflex intact vagus: has clear speech Spinal accessory : both shoulders have equal strength midlin e Hypoglossal: tongue is midline Romberg test: able to stand with slight swaying while eyes are closed ***left testicle hangs slightly lower than the right; skin on scrotum has a rugated appearance and is loose Chapter 3, Health Promotion of the Infant (birth-1 year) Weight: infants gain about 5-7 oz. per week the first 6 months; infants triple their weight by the end of the first year Height: infants grow about an inch per month for the first 6 months then 1/2 inch the next 6 months month s, 0.2 in. the next Head circumference: circumference: increases 0.6 in. per month the first 6 months, 6 months Teething: should have 6-8 teeth by the end of the first year; for teething pain, use cold teething rings, otc gels, or tylenol; do not use ibuprophen unless over 6 months!!!clean their teeth with cool wet washcloths; do not give bottles if asleep; avoid prolonged exposure to milk or juice because of dental caries
Palmar grasp: elicited by placing an object in an infant's palm; infant should grasp the object; birth-6 months Plantar grasp: elicited by touching the sole of an infant's foot; the infant's toes curl downward; birth-8 months Moro Reflex: elicited by startling the infant; the arms and legs should symmetrically extend and then abduct while fingers spread to form a c shape; birth-4 months h ead to one side; the infant should Tonic neck reflex: elicited by turning an infant's head extend the arm and leg on that side and flex the arm and leg on the opposite side; birth-4 months stroking the outer edge of the sole of an infant's foot up Babinski reflex: elicited by stroking toward the toes; the toes should fan our; birth-1 year fl at Stepping reflex: elicited by holding an infant upright with his feet touching a flat surface; infant should make stepping movements; birth-4 weeks Cranial nerves: "on old olympus' towering tops a fin and german viewed some hops" olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, spinal accessory, and hypoglossal n ostrils Olfactory: can identify smells through both nostrils Optic: visual acuity is in tact Oculomotor: no nystagmus present Trochlear: able to look down with both eyes Trigeminal: able to clench teeth together Abducens : able to look laterally with eyes Facial: has symmetric facial movements Acoustic: no vertigo present glossopharyngeal: gag reflex intact vagus: has clear speech Spinal accessory : both shoulders have equal strength midlin e Hypoglossal: tongue is midline Romberg test: able to stand with slight swaying while eyes are closed ***left testicle hangs slightly lower than the right; skin on scrotum has a rugated appearance and is loose Chapter 3, Health Promotion of the Infant (birth-1 year) Weight: infants gain about 5-7 oz. per week the first 6 months; infants triple their weight by the end of the first year Height: infants grow about an inch per month for the first 6 months then 1/2 inch the next 6 months month s, 0.2 in. the next Head circumference: circumference: increases 0.6 in. per month the first 6 months, 6 months Teething: should have 6-8 teeth by the end of the first year; for teething pain, use cold teething rings, otc gels, or tylenol; do not use ibuprophen unless over 6 months!!!clean their teeth with cool wet washcloths; do not give bottles if asleep; avoid prolonged exposure to milk or juice because of dental caries
Birth: Hep B One month: has a head lag; has a grasp reflex 2 months: lifts head off mattress; holds hands in an open position; DTaP, RV, IPV, Haemophilus influenzae B (Hib), PCV, and Hep B 3 months: raises head and shoulders off mattress; no longer has grasp reflex, keeps hands loosely open 4 months: rolls from back to side; places objects in mouth; DTaP, RV, IPV, Hib, PVC 5 months: rolls from front to back; uses palmar grasp dominantly 6 months: rolls from back to front; holds bottle; DTaP, IPV, PVC, Hep B, RV 7 months: bears full weight on feet; moves objects from hand to hand 8 months: sits unsupported; begins using pincer grasp 9 months: pulls to a standing position; has a crude pincer grasp 10 months: changes from prone to sitting position; grasps rattle by its handle 11 months: walks while holding on to something; places objects into a container p osition without assistance; tries to build a two12 months: sits down from a standing position block tower without success ***Get the yearly flu vaccine between 6-12 months Sensorimotor: Piaget; birth-24 months; three things occur, such as separation (learn to separate themselves from other o ther objects in the environment), object permanence (occurs @ 9 mths), and mental representation (recognition of symbols) Psychosocial development: Erikson; trust versus mistrust; infants trust they will be fed, comforted, stimulated, and caring needs will be met Separation anxiety: develops between 4-8 months; will protest loudly when separated from parents Stranger fear: occurs between 6-8 months; they fear strangers t oys, nesting toys, Appropriate toys for birth-1 year: rattles, mobiles, teething toys, playing pat-a-cake, playing with balls, reading books Breastfeeding: provides completed diet during the first 6 months ***Iron-fortified formula is an acceptable alternative to breast b reast milk; NEVER GIVE COW'S MILK!!! Solids: introduce solids around 4-6 months of age; begin when the infant is interested in solid foods; begin with iron-fortified rice cereal; introduce new foods one at a time, over a 5-7 day period;start veggies and fruits between 6-8 months, followed by meats; delay giving milk, eggs, wheat, citrus fruits, peanuts, pb, and honey until after the first year of life; decrease breast and increase solids d rink from cups with handles; replace replace Weaning: accomplished when infants are able to drink feedings one at a time, with the bedtime feeding being last Car seats: place in a rear facing until the first year of life or 20 pounds remove mobiles at 4-5 months of age; should should sleep on their backs; b acks; slats should Cribs: remove be 6cm apart; do not use pillows or big blankets Chapter 4, Health Promotion of the Toddler, 1-3 years b irth weight Weight: at 30 months, the toddler should weight 4X their birth
Height: Toddlers from about 3 inches per year 15 months: walks without help, creeps up stairs, uses a cup well, builds a tower of two blocks 18 months: assumes a standing position, manages a spoon without rotation, turns pages in a book two or three at a time 2 years: walks up and down stairs, build a tower of six or seven blocks 2.5 years: jumps in place w/ both feet, stands on one foot momentarily, draws circles, has good hand-finger coordination Piaget: sensorimotor stage transitions to the preoperational stage; object permanence is fully developed, they have and demonstrate memories that relate to them; domestic mimicry is evident; do not understand others' viewpoints Language: speak about 400 words with 2-3 word patterns Erikson: autonomy versus shame and doubt; independence is paramount, separation anxiety continues; punishment and obedience orientation begin; see themselves as separate from their parents; increase exploration; have gender identity by 3 years of age Play: solitary play evolves into parallel play, where they may observe other children and may play nearby; plays with toys that can be pushed or pulled, looking at books, playing with blocks, tossing balls, and filling empty containers 12-15 months: IPV, Hib, PCV, MMR 12-23 months: Hep A, given in 2 doses 6 months apart 15-18 months: DTap 12-36 months: yearly flu vaccine Nutrition: picky eaters; should have 24-30 oz. of milk; may switch to 2% at 2 years; juice consumption should be 4-6 oz. per day; 1 tbsp for each year of age; exposure of a new food should be 8-15 times before they accept it; if fam. hx. of allergy, then introduce cows' milk, chocolate, citrus fruits, egg whites, seafood, and nut butters gradually; finger foods are preferred Car seats: rear facing until 20 pounds; front facing until 4 years and/or 40 lb. Chapter 5, Health promotion of the preschooler (3-6 years) Weight: gain about 4.5-6.5 per year Height: grow about 2.5-3 inches per year 3 years: rides a tricycle, jumps off bottom step, stands on one foot for a few seconds 4 years: skips and hops on one foot, throws a ball overhead 5 years: jumps rope, walks backward heel to toe, moves up and down stairs easily Piaget: preoperational phase of cognitive development; have preconceptual thought (2-4, make judgments base on appearance) and intuitive thought (4-7, can classify info and become aware of cause-and-effect) Artificialism: everything is made by humans Animism: inanimate objects are alive Imminent justice: a universal code exists that determines law and order Erikson: initiative versus guilt; may take on new experiences but may feel guilt when they do not accomplish the task
Pretend Play: this is healthy and allows them to determine the difference between real and fantasy Play: playing has shifted to associative play; not highly organized by does exist between children; activities include playing ball, putting puzzles together, riding tricycles, playing pretend, role playing painting, sewing cards and beads, and reading books 4-6 years: DTaP, MMR, varicella, IPV 36-59 months: yearly flu vaccine Nutrition: need 13-19 G protein in addition to adequate calcium, iron, folate, and vitamins A & C Chapter 6, Health Promotion of the school-age child (6-12 years) Weight: gain about 4.4-8.8 lbs. per year; wt. gain typically occurs between 9-12 years of age Height: usually grow 2 inches per year Females: budding breasts, appearance of pubic hair, onset of manarche Males: enlargement of testicles with looseness in the scrotum adn appearance of pubic hair ***Permanent teeth erupt, visual acuity improves to 20/20 Piaget: concrete operations; sees weight and volume as unchanging, understands simple analogies, understands time, able to solve problems and becomes self-motivated Erikson: is in the industry versus inferiority stage; has advancements in learning, motivated by tasks that increase selfworth, fears ridicule by peers and teachers ***peer pressure begins to take effects, they are more modest, and they place emphasis on privacy issues; prefer the company of the same gender and they may rival same-gender parents Play: competitive and cooperative play is dominant--At 6-9 years they play simple board and number games, play hopscotch, jump rope, collect rocks-stamps-cards-coins, ride bicycles, build models, join organized sports for skill building; At 9-12 years they make crafts, build models, collect things, engage in hobbies, solve jigsaw puzzles, play board and card games, and join organized competitive sports ***get yearly flu vaccine and Tdap, HPV and MCV4 vaccines between 11-12 years ***Screen school age children or scoliosis by examining if there is a lateral curvature of the spine Car Safety: they should remain in a booster seat until they are 80 pounds or 4'9" because this is when the adult seat belt will fit properly--keep children less than 13 years of age in the back seat Chapter 7, Health Promotion of the Adolescent (12-20 years) ***The final 20-25% of height if achieved; girls may cease to grow 2-2.5 years after menarch--they will gain 15.5-55 lb. and grow 2-8 in.; boys tend to stop growing between
18-20 years--they will grow 4-12 inches adn gain 15.5-66 lbs. ***Acne will occur Sexual maturation for girls: order for girls is breast buds, growth of pubic hair, and onset of menstruation Sexual maturation for boys: increase in size of testes and scrotum, appearance of pubic hair, rapid growth of genitalia, growth of axillary hair, appearance of downy hair on upper lip, and change in voice Piaget: formal operations; capable of thinking at an adult level, able to think abstractly, capable of evaluating the quality of their own thinking, capable of making decisions, capable of using deductive reasoning Erikson: identity versus role confusion; they develop an identity that is influenced by expectations of their family Vocationally: solidify work habits and plan for future college and careers ***Give any missed immunizations and screen for scoliosis Chapter 8, Safe Administration of Medication ***IM meds are absorbed more slowly in newborns and faster in infants; newborns need reduced dosages because of limited renal excretion abilities; children have a faster metabolism than adults until about age 12; pediatric doses are based on body weight, BSA, and maturation of body organs; newborns are highly sensitive to drugs that affect the CNS 6 Rights: right patient, right medication, right dose, right time, right route, and right documentation ***Always assess for patient allergies!!! ***Consider the oral route the preferred route for children and mL as the preferred measurement ***If using IV, always check the IV site for redness, edema, and patency ***Do not crush enteric coated or time-released tablets; divide tablets only if scored Gastrostomy Tubes: do not mix medications with enteral feedings; use liquid forms; check tube placement; flush tubing with warm water before and after each medication Rectal: used as a substitute for oral meds; cut the suppository lengthwise for partial dosing; insert with the apex entering first, then gently push beyond rectal sphincter and hold the buttocks together until the urge to expel has passed (5-10 minutes) Otic: Remember to pull the auricle down and back when giving otic solutions for children up to 3, and up and back for older than 3; the parent must hold the child; warm otic solutions before instilling Nasal: hyperextend the child's neck for nasal meds to prevent the medication from sliding down into the throat SQ: apply EMLA cream 60 minutes before an injection; change the needle if used to puncture the rubber top of a vial; insert needle at 90 deg. or 45 deg. if minimal sq tissue; use upper arm, abdomen, or anterior thigh Intradermal: insert at a 15 deg. angle, inject a small bubble just beneath the skin; use the surface of the forearm; used for local anesthetics, tb skin test, and allergy testing
IM: apply EMLA 60 minutes prior, change needle if punctured the rubber top of a vial, use the smallest gauge possible, vastus lateralis is the recommended site for infants and children less than 2 years of age; after age 2, the ventral gluteal site can be used Vastus Lateralis: 22-25 g; 0.625-1 inch; 0.5 mL for infants to 2.0 mL for children; supine, side lying, sitting positions; recommended for infants and children less than 2 years of age Ventrogluteal: 22-25 g; 0.625-1 inch; 2.0 mL for children; supine, side lying, and prone positions; can be used for 2 and older, less painful than vastus lateralis, free of any nerves or blood vessels Deltoid: 22-25 g; 0.625-1inch; 0.5 mL for infants to 1.0 mL for children; supine, side lying, and sitting positions; not as painful as vastus lateralis, less local side effects than with vastus lateralis, should not be used in infants/children with underdeveloped muscles, and if muscle size is appropriate it may be used for immunization of toddlers and children IV: use for continuous and intermittent IV medications Chapter 9, Pain Management ***Monitor pain 15min. after IV meds, 30 min. after IM pain meds, 30-60 min. after oral meds ***Monitor children who are on opioid medications very closely for resp. depression CRIES Neonatal postoperative tool: pain rated on a scale of 0-10; behavior indicators are crying changes in v/s, changes in expression, altered sleep patterns; used from 32 wks gestation-20 wks of life FLACC postoperative pain tool: faces, legs, activity, cry, and consolability; used from 2 months-2 years FACES Pain Rating Scale: rating scale that uses drawings of happy and sad faces to depict levels of pain; used for 3 years and older Visual Analog Scale (VAS): pain is rated on a scale of 0-10; child points to the number that best describes the pain he is experiencing; used 7 years and older but may be affective in those as young as 4.5 years Noncommunicating Children's Pain checklist: pain is rated on a scale of 0-18; behavior indicators include vocalization, socialization, facial expressions, activity level, movement of extremities, and physiologic changes; used for children 3-18 years of age (for children with or without cognitive impairments) ***Use caution when giving meds to newborns less than 3 months because of their immature liver function Opioids for children: used for moderate pain and include morphine, oxycodone, and fentanyl EMLA: contains prilocaine and lidocaine in the form of a cream or disk; use for any procedure where the skin will be punctured; place an occlusive dressing over the dressing after application; use 60 minutes prior to a procedure Fentanyl: use for children over 12 years; used to provide continuous pain control; onset of 12-24 hours and a duration of 72 hours; treat resp. depression w/ Narcan
Chapter 10, Hospitalization, Illness, and Play Separation Anxiety: has three behavioral responses; protest (screaming), despair (developmental regression), & detachment (lack of interaction with unfamiliar people) Infant: cannot describe symptoms; lack of understanding; experiences stranger anxiety between 6-18 months; displays physical behaviors as expressions of discomfort due to inability to verbalize; may have sleep deprivation due to noises and procedures Toddler: limited ability to describe symptoms; poor sense of body image and boundaries; limited ability to follow directions; may have separation anxiety; may have an intense reaction to any type of procedure due to the intrusion of boundaries Preschooler: limited understanding of the illness; limited ability to describe symptoms; fears related to magical thinking; ability to understand cause and effect inhibited by concrete thinking; has separation anxiety, my have fears of bodily harm, may believe the illness and/or hospitalization is punishment School-age Child: awareness of body functioning; an describe symptoms, understands cause and effect, fears loss of control, may sense when not being told the truth, and may experience stress from being separated from peers and regular routine Adolescent: understands cause and effect, develops body-image disturbances, experiences feelings of isolation from peers, worries about outcome and impact on school/activities, and may not adhere to treatments/regimen due to peer influence Onlooker play : child observes others at play Solitary play: child plays alone Parallel play: children playing independently but among other children; this is characteristic of toddlers Associative Play: children playing together without organization, which is characteristic of preschoolers Cooperative Play: organized playing in groups, which is characteristic of school-age children Play activities for infants: birth-3 mths., visual and auditory; 3-6 mths., noisemaking objects and soft toys; 6-9 mths., teething toys and social interactions; 9-12 months, large blocks, toys that pop apart, and push/pull toys Play activities for toddlers: cloth books, large crayons and paper, push/pull toys, tricycles, balls, puzzles with large pieces, educational television and videos Play activities for preschoolers: associative, imitative, & imaginative play, drawing, painting, riding a tricycle, swimming, jumping, and running, educational television and videos Play activities for school-age: games that can be played alone or with another person, team sports, musical instruments, arts and crafts, collections Play activities for adolescents: team sports, school activities, reading and listening to music, peer interactions Chapter 11, Death and Dying Palliative care: end of life care; focuses on the process of dying, rather than extending life; pain control, symptom management, and support of the child and family must be given;
top priority; use education, support, and honest communication; provide an environment that is much like home as possible; encourage physical contact Birth-3 years: have little to no concept of death; egocentric thinking, mirror parental emotions; react in response to the changes, may regress 3-6 years: egocentric thinking, magical thinking, interpret separation as punishment, view dying as temporary 6-12 years: start to respond to logical of factual explanations; begin to have an adult concept of death; experience fear of the disease process, the death process, the unknown, and loss of control; fear is often displayed through uncooperative behavior; may be curious about the funeral and what happens to the body afterward 12-20 years: adult-like concept of death; may have difficulty accepting death, rely more on peers rather than the influence of their parents; may be stressed by changes; may experience guilt and shame Chapter 12, Meningitis and Reye Syndrome Meningitis: inflammation of the meninges, which are the membranes that protect the brain and spinal cord; often preceded by viral infections; usually requires supportive care; contagious; risk factors include viral illnesses (measles, mumps, herpes), bacterial meningitis (otitis media, tonsilitis), immunosuppression, injuries, overcrowded living conditions; they may report photophobia, headache, irritability, vomiting, drowsiness; lab tests include blood cultures and sensitivity tests to see what antibiotic to use, CBC, cerebrospinal fluid should be collected...you will see increased CSF pressure, WBC, protein...decreased glucose and CSF that appears cloudy for bacterial and clear for viral; isolate the child ASAP for droplet precautions; initiate IV fluids, minimize exposure to light, keep room cool, and give antibiotics, corticosteroids, anticonvulsants, and analgesics; complications after the sickness include ICP; make sure the child gets the Hib and PVC vaccines!!! Lumbar puncture: empty bladder, place in fetal position, administer sedatives, apply EMLA, label 3 test tubes, monitor the site for hematoma and/or infection, have child remain in bed 4-8 hours in flat position to prevent leakage which causes a spinal headache Meningitis in Newborns: no illness at birth, but progresses within a few days; poor muscle tone, weak cry, and poor feeding, fever or hypothermia, nuchal rigidity is not usually present, bulging fontanels is a late sign Meningitis in 2 months-2 years: seizures with a high-pitched cry, fever and irritability, bulging fontanels, possible nuchal rigidity, poor feeding, vomiting, brudzinski's and kernig's signs do not assist with the diagnosis Meningitis 2 year-adolescence: seizures, nuchal rigidity, positive brudzinski's and kernig's signs, fever and chills, headache, vomiting, photophobia, irritability and restlessness that may progress to drowsiness, delirium, stupor, and coma; petechia or purpuric type rash, involvement of joints, and chronic draining ear
Brudzinski's and Kernig's Signs
Nuchal Rigidity (neck stiffness) Lumbar Puncture Reye Syndrome: A life-threatening disease that leads to multisystem failure; preceded by viral infections; primarily affects the liver and brain causing liver dysfunction and cerebral edema; bleeding and poor blood clotting with lethargy progressing to coma and potential for cerebral herniation; hypoglycemia and shock occur; Using aspirin for treating viral infections can cause the development; there are five stages; the lab tests are Liver enzymes, which will be elevated, serum ammonia level which is elevated, serum electrolytes, low blood glucose, Hgb, Hct, and platelets, and coagulation times may be extended; a liver biopsy will be performed; a lumbar puncture will be performed; maintain hydration, insert a catheter, avoid extreme flexion, extension, or rotation; maintain head in a midline position, keep hob elevated 30 degrees; monitor pain, insert nasogastric tube, assist with intubation and maintain ventilation if required, take seizure precautions, keep family informed, provide private time if death is imminent---medications are osmotic diuretics and insulin Liver biopsy : takes a piece of liver tissue, via a large-bore needle, and sends the tissue to the pathology department; maintain NPO prior to procedure, monitor for hemorrhage after the procedure, assess vitals frequently; limit postprocedure activities
Stage I: lethargy, vomiting, anorexia, early liver dysfunction, brisk pupillary reaction, ability to follow commands Stage II: confusion/disorientation/delirium, combativeness, hyperventilation, hyperactive reflexes, sluggish pupillary response, response to painful stimuli Stage III: coma, seizures, flexion rigidity Stage IV: deeper coma, extension rigidity, fixed large pupils and loss of corneal reflexes, brainstem dysfunction, and minimal liver dysfunction Stage V: hypotonia, seizures, respiratory arrest, and absence of liver function Chapter 13, Seizures Seizures: abrupt, abnormal, excessive, and uncontrolled electrical discharges of neurons within the brain that may cause alterations in level of consciousness and/or changes in motor and sensory abilities and/or behavior; can be abrupt in nature or slow and insidious onset Tonic: stiffening of muscles Clonic: rhythmic jerking of the extremities Tonic-clonic seizure: may begin with an aura; begins with a 10-20 second tonic episode and loss of consciousness; a 1-2 minute clonic episode follows a tonic episode; breathing may stop during the tonic phase and become irregular during the clonic phase; cyanosis may accompany breathing irregularities; biting of the cheek or tongue may occur during the clonic phase; incontinence may accompany the seizure; a period of confusion and sleepiness follows the seizure during the postictal phase Tonic Seizure: only the tonic phase is experienced; usually lasts a few seconds; loss of consciousness does not occur; tonic seizures are much less common than tonic-clonic seizures Clonic Seizures: only the clonic phase is experienced; fatigue does not usually follow the seizure; clonic seizures are much less common than tonic-clonic seizures Absence Seizure: most common in children; loss of consciousness that lasts seconds; blank staring is associated with this type; baseline neurologic function is resumed after the seizure, with no apparent sequela Myoclonic Seizure: consists of brief jerking or stiffening of the extremities; may be symmetric or asymmetric; lasts for seconds Atonic or akinetic seizure: muscle tone is lost for a few seconds; confusion follows; loss of muscle tone frequently results in falling Complex Partial seizure: has associated automatisms(behaviors the child is unaware of, such as picking at clothes or smacking the lips), loss of consciousness that lasts for several minutes, and amnesia may occur immediately prior to and after the seizure Simple partial seizure: consciousness is maintained throughout the event, seizure activity may consist of unusual sensations, a sense of deja vu, autonomic abnormalities (changes in HR and abnormal flushing, unilateral abnormal extremity movements, pain, offensive smell) Unclassified: (idiopathic) do not fit into other categories; account for half of all
seizure activity and occur for no known reason EEG: this test can be performed to identify the origin of the seizure; it records electrical activity; administer sedatives; assist with positioning; abstain from caffeine; wash hair before and after procedure Care during a seizure: protect from injury, position to provide patent airway, suction oral secretions, turn to the side, loosen clothing, DO NOT RESTRAIN, do not attempt to open the jaw or insert an airway during seizure activity; do not use padded tongue blades Care post seizure: maintain the child in a side-lying position; check v/s, assess for injuries, perform neurologic checks, allow the child to rest if necessary, reorient and calm the child, reinstitute seizure precautions, have them describe the period before, during, and after the seizure, determine if the child experienced an aura, try to determine the possible trigger, and document the onset and duration Seizure Medications: Valium, Dilantin, Tegretol, Depakene, and Cerebyx; used for seizure control; monitor therapeutic serum medication levels; should be given the same time every day and be aware of any food/medication interactions Vagus Nerve Stimulation: performed under general anesthesia; device is implanted into the left chest wall and connects to an electrode that is placed at the left vagus nerve; it is programmed to administer intermittent vagal nerve stimulation at a rate specific to the child's needs; the child may initiate vagal nerve stimulation by holding a magnet over the device at the onset of seizure activity to weaken or abort the seizure Status Epilepticus: seizure activity that lasts longer than 30 minutes or continuous seizure activity in which the child does not enter a postictal phase Chapter 14, Head Injury ICP signs: severe headache, deteriorating level of consciousness, restlessness, irritability, agitation, dilated and fixed---constricted and fixed---slow to react or nonreactive pupils, alterations in breathing pattern, intermittent gasping respirations, abnormal posturing, difficulty waking up, bulging fontanels, visual disturbances Decorticate: arms, wrists, and fingers flexed and bent inward onto the chest and the legs extended and adducted Decerebrate: a backward arching of the head and arms with legs rigidly extended and toes pointing downward Flaccidity : no muscle tone ***If a sample of fluid makes a yellow stain surrounded by blood on a paper towel, and tests positive for glucose, it indicates CSF leakage Glasgow Coma Scale: scores of 8 or less are associated with severe head injury and coma; scores between 9-12 indicate moderate head injury; scores of 13 ore greater reflect minor head trauma
Nursing Care: ensure the spine is stabilized, monitor v/s, level of consciousness, pupils, ICP, motor activity, maintain patent airway, provide mechanical ventilation, give oxygen, hyperventilate the child and keep the PaCo2 between 30-35 mm Hg, keep the HOB at 30 degrees, minimize suctioning, avoid coughing, insert a catheter Medications: corticosteroids (Decadron and Solu-Medrol) for acute cerebral edema, Mannitol for acute cerebral edema, Dilantin to prevent seizures, Analgesics (morphine or fentanyl) to control pain ***On the ATI test, our first priority with head injuries is to keep the neck stabilized! Chapter 15, Visual and Hearing Impairments Strabismus: misalignment of the eyes Refractive errors: nearsightedness, farsightedness, astigmatism Amblyopia: decreased acuity in one eye E Snellen: chart used for children that cannot read Snellen: chart used for children that can read ***20/70-20/200 is considered partially sighted for school vision Myopia: nearsighted; sees close objects clearly, but not distant objects; eye rubbing, headaches, dizziness, difficulty reading, poor school performance, clumsiness--corrected by biconcave lenses that help focus light rays on the retina Hyperopia: farsightedness, sees distant objects clearly but not objects that are close, normal vision until age 7, usually able to accommodate--may be corrected using convex lenses that help focus light rays on the retina Astigmatism: uneven vision in which only parts of letters on a page may be seen, headaches and vertigo, the appearance of normal vision because tilting the head enables all letters to be seen--may be corrected with a special lens to correct refractive errors Strabismus: misaligned eyes, frowning or squinting, difficulty seeing print clearly, one eye closed to enable better vision, head tilted to one side, headache, dizziness, diplopia, photophobia, and crossed eyes--may be corrected with eye exercises or patching of the strong eye Conductive Hearing loss: involves interference of sound transmission, which may result from otitis media, external ear infection, foreign bodies or excessive ear wax Sensorimotor hearing loss: involves interference of the transmission along the nerve pathways, which may result from congenital defects or secondary to acquired conditions Central Auditory imperception: involves all other hearing losses Chapter 16, Oxygen and Inhalation Therapy Pulse Oximetry: measures the oxygen saturation of the blood; expected range is 95-100%, and below 86% is life threatening emergency; if less than 90%, it indicates hypoxemia Nebulized Aerosol Therapy: this breaks up medications into minute particles that are dispersed throughout the respiratory tract; these droplets are much finer than those created by inhalers; treatments can cause tachycardia or jitteriness
Metered-dose inhaler or dry powder inhaler: a spacer may be used to keep the medication in the device longer; fungal infections can be an issue with corticosteroid use; make sure all equipment is clean and the child rinses his/her mouth after use Chest Physiotherapy: percussion, vibration, and postural drainage; gravity and positioning loosen respiratory secretions and move them into the central airways where they can be removed by coughing or suctioning; schedule an hour before or 2 hr. after meals; to drain apical sections of the upper lobes, use fowler's...the posterior sections of the upper lobes, use side-lying...right lobe, on the left side with a pillow under the chest wall....left lobe, trendelenburg position; the person claps rhythmically on the chest wall to break up the secretions Hypoxemia: develops when there is an inadequate level of oxygen in the blood; hypovolemia, hypoventilation, and interruption of arterial flow can lead to hypoxemia Early signs of hypoxemia: tachypnea, tachycardia, restlessness, pallor of the skin and mucous membranes, elevated b/p, symptoms of resp. distress; decreased SaOs levels, adventitious cough, visualization of secretions, and absence of spontaneous cough Late signs of hypoxemia: confusion and stupor, cyanosis of the skin and mucous membranes, bradypnea, bradycardia, hypotension, cardiac dysrhythmias Hypercarbia: signs of restlessness, hypertension, and headache ***don't let oxygen blow directly onto the faces of infants Oxygen hood: small plastic hood that fits over the infant's head; use 4-5 L, ensure neck, chin, or shoulders do not rub against the hood Oxygen tent: tent that fits over the crib or bed and can provide oxygen and humidity; use for older than 3 months, set the tent on a high flow rate, then adjust the flow meter; keep the tent around the perimeter of the bed; keep the child warm and dry; monitor the temperature at all times Nasal cannula: safe, easy, well tolerated; can be used by children who are cooperative; may cause skin breakdown and dry mucous membranes; provide humidification Oxygen toxicity: results from high concentrations of oxygen during a long duration of oxygen therapy; signs of toxicity include nonproductive cough, substernal pain, nasal stuffiness, n/v, fatigue, headache, sore throat and hypoventilation ***For endotracheal suctioning, make sure you use sterile water or 0.9% socium chloride, and only suction for 5 seconds at a time ***Be sure to provide tracheostomy care every 8 hours Chapter 17, Acute Infectious Respiratory Illnesses Tonsillitis: the tonsils filter viruses and bacteria which helps protect the resp. tracts and gi tracts; enlarged tonsils can block the nose, throat, and disrupt the eustacian tube causing hearing loss; when they become inflamed and reddened, it is called acute tonsillitis; small patches of yellowish puss may become visible; child will have difficulty swallowing, history of otitis media and hearing difficulties; use Tylenol, Amoxicillin, Tylenol w/ codeine to treat viral tonsillitis symptoms Tonsillectomy : preop--encourage the use of warm salt-water gargles and throat lozenges & encourage fluid intake and monitor hydration; postop--side lying to help w/
drainage, elevate HOB while awake, assess for bleeding, frequent swallowing, clearing of the throat, restlessness, bright red emesis, tachycardia, and/or pallor, assess the airway and v/s, monitor for any difficulty breathing r/t oral secretions/edema/bleeding, provide an ice collar and analgesics, keep throat moist, give pain meds, encourage clear liquids and fluids after the gag reflex returns, give soft diet, discourage coughing/throat clearing/nose blowing, do not put pointed objects in the mouth, & tell parents that there may be blood clots or blood-tinged mucous in the vomit---no swimming for 2 weeks!!! ***Children have short, narrow airways that can become obstructed by mucous; short respiratory tracts allow infections to travel quickly to the lower airways; small surface areas for gas exchange; infectious agents have easy access to the middle ear through the short and open Eustachian tubes Nasopharyngitis: common cold; self-limiting virus; persists for 7-10 days; s/s of nasal inflammation, rhinorrhea, cough, dry throat, sneezing, and nasal qualities hear in voice, fever, decreased appetite, and irritability Pharyngitis: strep throat; caused by GABHS; s/s of inflamed throat with exudate, pain with swallowing, headache, fever, abd. pain, cervical lyphadenopathy, truncal/axillary/ perineal rash Bacterial tracheitis: infection of the lining of the trachea; s/s of thick purulent drainage from the trachea that can obstruct the airway and cause resp. distress Bronchitis: self-limiting and requires symptomatic relief; s/s persistent cough as a result of inflammation Bronchiolitis: mostly caused by RSV; affects the bronchi and bronchioles; s/s include pharyngitis, rhinorrhea, intermittent fever, cough, wheezing, nasal flaring, retractions, cyanosis, increased respiratory rate Allergic rhinitis: caused by seasonal reaction to allergens; s/s watery rhinorrhea, nasal congestion, itchiness of the nose, eyes, and pharynx, itchy watery eyes, nasal quality of the voice, dry/scratchy throat, snoring, poor sleep leading to poor performance in school, and fatigue Pneumonia: s/s high fever, cough that may be unproductive or productive of white sputum, retractions and nasal flaring, rapid/shallow respirations, chest pain, adventitious breath sounds, pale color that progresses to cyanosis, irritability, anxiety, agitation, fatigue, abd. pain, diarrhea, lack of appetite, vomiting, sudden onset usually following a viral infection Bacterial epiglottitis: EMERGENCY!!! caused by haemophilus influenzae; s/s sitting with chin pointing out, mouth opened, and tongue protruding, drooling, anxiety with respiratory distress, absence of spontaneous coughing, dysphonia, dysphagia, inspiratory stridor, sore throat, hight fever, and restlessness Acute laryngitis: self-limiting viral infection; s/s of hoarseness Acute laryngotracheobronchitis: s/s low-grade fever, restlessness, hoarseness, barky cough, inspiratory stridor, and retractions Acute Spasmodic laryngitis: may result from allergens; s/s of barky cough, restlessness, difficulty breathing, hoarseness, and nighttime episodes of laryngeal obstruction
Chapter 18, Asthma Asthma: a chronic inflammatory disorder of the airways that results in intermittent and reversible airflow obstruction of the bronchioles; manifestations are mucosal edema, bronchoconstriction, and excessive secretion production; pulmonary function tests are the most accurate way for diagnosing asthma---during an asthma attack, position the pt. for better breathing (high-fowler's), administer oxygen, get IV access, assess airway patency, listen to lung sounds, monitor s/s Mild-intermittent asthma: symptoms occur less than twice a week Mild Persistent asthma: symptoms occur more than twice a week, but not daily Moderate Persistent asthma: daily symptoms occur in conjunction with exacerbations twice a week Severe persistent asthma: symptoms occur continually, along with frequent exacerbations that limit the child's physical activity and quality of life S/S of asthma: dyspnea, coughing, wheezing, mucous production, use of accessory muscles, poor oxygen saturation, tachycardia and premature ventricular contractions Meds for asthma: bronchodilators (albuterol, atrovent & terbutaline; provide rapid relief, watch for tremors and tachycardia when taking albuterol and observe for dry mouth when on Atrovent; know to give albuterol in an EMERGENCY!!!---Antiinflammatory agents decrease inflammation; includes corticosteroids (flovend & prednisone) and leukotriene modifiers (singulair, Intal, and Xolair); monitor for hyperglycemia, black/tarry stools, fluid retention, cold sores, and make sure they drink plenty of fluids Hypoxemia: decreased PaO2 of less than 80 Hypocarbia: decreased PaO2 of less than 35 early in attack Hypercarbia: increased PaO2 greater than 45 later in attack Forced vital capacity: volume of air exhaled from full inhalation to full exhalation forced expiratory volume: amount of air able to be blown our as quickly as possible during the first second of a forceful exhalation after inhaling fully Peak expiratory flow rate: the maximum airflow exhaled forcefully in one second; measured by the peak expiratory flow meter Chapter 19, Cystic Fibrosis Cystic Fibrosis: dysfunction of the exocrine glands that causes the glands to produce thick, tenacious mucous; organs affected are the lungs, pancreas, small intestine, and liver; the child will have salty sweat; it is from an autosomal recessive trait and both parents must be carriers of the gene; at birth, there will be distention of the abd., vomiting and inability to pass stool; s/s are fatigue, chronic cough, thick/yellow-grey mucous, positvie sputum culture, fever, sob, dyspnea, wheezing, cyanosis, barrel-shaped chest, clubbing, difficulty exhaling air (hyperventilation of lungs), large/loose/fatty/sticky/foul-smelling stools, failure to gain wt., delayed growth patterns, distended abdomen, thin arms/legs, delayed puberty Labs: a sweat chloride test will measure the amount of chloride on the skin; normal amount is less than 40; values greater than 40 are suggestive of cystic fibrosis, and greater
than 60 are indicative of cystic fibrosis Treatments: respiratory treatments include chest physiotherapy, breathing exercises, assistance with coughing, and aerosol therapy; use oxygen; promote nutritional intake and provide pancreatic enzymes at meals and with snacks; make sure each meal is high-caloric and high protein; take vitamins that are water-soluble, such as A, D, E, and K; stool softeners should be used; provide meticulous skin and oral hygiene; give abx. through a port; encourage adequate fluid and salt intake Medications: bronchodilators (albuterol), antibiotics, Pulmozyme (decreases viscocity of mucous), & pancreatic enzymes (pancrease) Chapter 20, Cardiovascular Disorders Congenital Heart Disease: anatomic defects of the heart prevent normal blood flow to the pulmonary and/or systemic system; many children are dx. in the first year; many have an increased incidence of other anatomic defects; risk factors include rubella in early pregnancy, Down syndrome, diabetes, alcohol/drug use---be sure to cluster all care for the child with heart problems, feed every 3 hours, keep hob elevated Medications for heart diseases: Digoxin (do not give if pulse is <90 in infants and <70 in children--if they vomit, do not give it again), Captopril or Vasotec (monitor b/p fefore and after administered and monitor for hyperkalemia), Laxix or Diuril (monitor for hypokalemia and monitor I&O) Ventricular Septal Defect: hole in the septum between the right and left ventricle that results in increased pulmonary blood flow (left to right); loud harsh murmur, heart failure, and failure to thrive Atrial Septal Defect: a hole in the septum between the right and left atria that results in increased pulmonary blood flow (left to right shunt); loud, harsh murmur, mild heart failure, enlarged rt. atrium, and increased oxygen saturation in the right atrium Patent Ductus Arteriosus: the normal fetal circulation conduit between the pulmonary artery and the aorta fails to close and results in increased pulmonary blood flow (left to right shunt); murmur, wide pulse pressure, bounding pulses, asymptomatic Pulmonary stenosis: narrowing of the pulmonary valve or artery that results in obstruction of blood flow from the ventricles; systolic ejection murmur, exercise tolerance, right ventricle enlargement, cyanosis Aortic Stenosis: narrowing at, above, or below the aortic valve; murmur, left ventricle enlargement, chest pain, dizziness, chest pain, and syncope Coarctation of the aorta: narrowing of the lumen of the aorta, that results in obstruction of blood flow from the ventricles; increased b/p and oxygen saturation to upper extremities compared to the lower extremities, nosebleeds, headaches, leg pain, weak lower extremity pulses Transposition of the great Arteries: the aorta is connected to the right ventricle instead of the left, and the pulmonary artery is connected to the left ventricle instead of the right; murmur, severe cyanosis, cardiomegaly, HF Tricuspid Atresia: complete closure of the tricuspid valve that results in mixed blood flow; severe cyanosis, hf, chronic hypoxemia, failure to thrive, growth retardation
Tetralogy of Fallot: four defects that result in mixed blood flow; pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy; murmur, cyanosis, severe dyspnea, clubbing, clot formation, child frequently in squatting position, failure to thrive and growth retardation Manifestations of Heart Failure: tachycardia, murmurs, extra sounds, diaphoresis, decreased urinary output, fatigue, pallor or mottling, cool extremities, weak peripheral pulses, slow capillary refill, cardiomegaly, anorexia, failure to thrive, Manifestations of Pulmonary Congestion: tachypnea, crackles, retractions, nasal flaring, use of accessory muscles, stridor, grunting, recurrent respiratory infections, and exercise intolerance Manifestations of Systemic Venous Congestion: hepatomegaly, enlarged spleen, peripheral edema, ascites, and neck vein distention Manifestations of hypoxemia: cyanosis, poor weight gain, tachypnea, dyspnea, clubbing, and polycythemia Tet/Hypercyanotic spells: acute cyanosis, hyperpnea to detect anemia, polycythemia, and electrolyte imbalances Heart Cath: check for allergies to iodine and shellfish, make sure the child is NPO for 4-6 hours prior, obtain v/s, locate and mark dorsalis pedis and posterior tibial pulses on both extremities; administer presedation; afterwards, assess pulses, v/s, and insertion site, monitor I&O and monitor for hypoglycemia Rheumatic Fever: inflammatory disease that occurs as a reaction to Group A strep infection of the throat; usually occurs within 2-6 weeks following an untreated or partially treated upper resp. infection (GABHS); s/s include hx. of upper resp. infection, fever, fatigue, sore throat, poor appetite, large joints that have painful swelling, pink rash on the trunk, irritability---dx. with a throat culture for GABHS, the major criteria for dx. is carditis, sq nodules, polyarthritis, rash, and chorea...the minor criteria for dx. is fever and arthraligia; medications used are penicillin or erythromycin Chapter 21, Hematologic Disorders Epistaxis: common, may be spontaneous or induced by trauma to the nose, may produce anxiety, rarely and emergency; have the child tilt the head forward, apply pressure to the lower nose, cotton or tissue can be packed into the bleeding side, encourage mouth breathing, apply ice to the bridge of the nose, keep child calm and no rubbing or picking---No need for a humidifier! Iron Deficiency Anemia: most common anemia, prolonged anemia can lead to growth retardation and developmental delays; may have sob, tachycardia, dizziness, pallor, nail bed deformities, fatigue, irritability, abd. pain, low-grade fever, and thinning hair Normal Hgb Values: 2 mths., 9-14; 6-12 years, 11.5-15.5; 12-18 yrs., 13-16 male & 12-16 female Hct Normals: 2 mths., 28-42; 6-12 yrs., 35-45; 12-18 yrs., 37-49 male, 36-46 female Iron Supplements: give 1 hr. before or hr. after giving milk or antacid, diarrhea and constipation are common, admin. on an empty stomach, give vit. c to increase absorption, use a straw, use z-track if giving IM---legumes, fruits, nuts, green leafies, iron-fortified
foods, poultry, and red meats are good sources of iron Sickle Cell Anemia: there is abnormal sickling of RBC's which obstructs blood flow and causes hypoxia; s/s are pain, sob, fatigue, tachycardia, pallor, nail bed deformities, lethargy, impaired healing, n/v, low-grade fever and muscle weakness; sickledex is the screening tool that will detect if the child has sickle cell anemia, but the Hgb electrophoresis is definitive; opioids can be given for pain; there is the vaso-occlusive crisis, which lasts from 4-6 days and has severe pain, swollen joints, anorexia, vomiting and liver failure if chronic; there is the sequestration phase where there is excessive pooling of blood in the liver and spleen; the aplastic phase is extreme anemia with decreased RBC production; hyperhemolytic phase is an increased rate of RBC destruction leading to anemia, jaundice, and reticulocytosis Hemophilia: impaired ability to control bleeding; excessive bruising with minor falls; recessive disorder; prolonged PTT; give factor VIII to prevent and treat hemorrhage by IV infusion---corticosteroids are used to treat hematuria and NSAIDS are used to treat chronic synovitis Chapter 22, Acute infectious Gastrointestinal Disorders Signs of dehydration: dry pale skin, cool lips, dry mucous membranes, decreased skin turgor, diminished urinary output, concentrated urine, thirst, rapid pulse, sunken fontanels, and decreased b/p Isotonic dehydration: water and sodium are lost in equal amounts, hypovolemic shock may occur Hypotonic dehydration: less stuff, more fluid Hypertonic: less fluid, more stuff Mild dehydration: up to 5% loss of wt, v/s in normal limits, slight thirst, urine-specific gravity greater than 1.020, cap. refill greater than 2s Moderate dehydration: up to 10% wt. loss, cap. refill between 2-4s, thirst and irritability, pulse increased, mucous membranes dry, skin turgor decreased, urine-specific gravity greater than 1.020 Severe dehydration: up to 15% wt. loss, cap. refill greater than 4s, tachycardia, extreme thirst, mucous membranes dry, anterior fontanel sunken, oliguria or anuria Pathogens that caused diarrhea: Rotavirus (fecal-oral, dx. w/ enzyme immunoassay stool sample), E.Coli (dx. with sobitol-MacConkey agar stool sample), Salmonella (person to person or undercooked meats, dx. with fram stained stool culture), C.diff (contact with spores, dx. with stool culture), C. botulinum (contaminated foods, dx. with blood in stool/stool culture), staphylococcus (undercooked food, dx. of organism in food, stool, blood), pinworm (fecal-oral beginning when eggs are inhaled or swallowed; dx. with tape test), and giardia lamblia (person to person, dx. with enzyme immunoassay stool sample)---Give Flagyl or tinidazole for c.diff and giardia; give mebendazole, albendazole, and pin-rid for pinworms Chapter 23, Gastrointestinal Structural and Inflammatory Disorders GER: gastric contents reflux back up into the esophagus; may result in failure to thrive,
bleeding, and difficulty swallowing; position the child's head elevated, administer Prilosec or Zantac; surgical manipulation may be needed, which is called Nissen fundoplication Hypertropic pyloric stenosis: thickening of the pyloric sphincter, which creates an obstruction; vomiting occurs 30-60m after a meal, constant hunger, olive-shaped mass in RUQ, failure to gain weight; a surgical incision will be made into the pyloric sphincter Hirschsprung's Disease: lack of ganglionic cells; stool accumulates; a rectal biopsy will be done; s/s of ribbon like stools; surgical removal of the aganglionic section may be done Meckel's diverticulum: complication resulting from failure of the omphalomesenteric duct to fuse during embryonic development; s/s of bloody stools, bright red mucous, abd. pain; do surgery to remove diverticulum Intussusception: telescoping of the intestine over itself; palpable sausage shaped mass in RUQ will be felt; stools are mixed with blood and mucus that looks like red jelly; if the pt. has a brown stool then it has relieved itself; do an air enema or surgical removal of the area Appendicitis: inflammation of the appendix caused by obstruction of feces or lymphoid tissue; RLQ pain at McBurney's point, fever, tachycardia, and vomiting; remove the appendix.....labs will show increased WBC's and increased band counts Cleft Lip: incomplete fusion of the oral cavity; position upright , on back, or onside to maintain integrity of the repair; apply restraints to keep pt. from pulling at repair site, use saline on sterile swab to clean incision site, apply abx. ointment to lip Cleft Palate: incomplete fusion of palatine plates; change positions frequently, may be placed on abdomen, monitor packing, which should be removed in 2-3 days, avoid placing anything in the mouth, do not give anything that will be used to suck Chapter 24, Enuresis and Urinary Tract Infections Enuresis: uncontrolled or unintentional urination after the child has achieved bladder control; child must be at least 5 before he/she can be dx. with enuresis; medications used are antidiuretics (desmopressin acetate), antidepressants (tofranil), anticholinergics (ditropan); bladder stretching exercises can be done UTI: pt. will have dysuria, foul-smelling urine, left flank pain; abx. will be used; most common cause is E. Colli Chapter 25, Structural Disorders of the Genitourinary Tract and Reproductive System ***Any structural defects should be repaired between 6-15 months of age due to the impact of body image Hypospadias: when the location of the urethral meatus is below the glans penis or on the ventral surface of the penis Epispadias: occurs when the location of the urethral meatus is on the dorsal side of the penis Phimosis: the narrowing of the preputial opening of the foreskin that prevents the foreskin from retracting over the glans penis
Cryptochidism: the failure of one or both testicles to descend through the inguinal canal Hydrocele: an abnormal collection of fluid in the scrotum Ambiguous genitalia: congenital malformations that prevent visual identification of a chid's sex Chordee: a fibrous band on the ventral side of the penis resulting in a ventral curvature of the penis Chapter 26, Renal Disorders Acute Glomerulonephritis: an antibody-antigen disease that occurs as a result of certain strains of group A B-hemolytic streptococcal infection; seen in ages 6-7; renal manifestations occur 10-21 days post infection; s/s anorexia, decreased urine output, pallor, reports of discomfort, dyspnea, orthopnea, moist crackles, distended neck veins, facial edema, mild-severe hypertension, pale appearance and lethargy; meds include diuretics and antihypertensives Nephrotic Syndrome: proteins pass into the urine, resulting in decreased serum osmotic pressure; cause is unknown; s/s wt. gain over a short period, poor appetite, anorexia, n/v, diarrhea, irritability, hyperlipidemia, hypoalbuminemia, proteinurea, edema, dark-frothy urine, and decreased urine output; meds include prednisone, lasix (eat foods high in K) and Cytoxan (give if they cannot take prednisone) Chapter 27, Fractures
Types of Fractures
Types of Fractures
Fracture: occurs when the resistance between a bone and an applied stress yields to the applied stress, resulting in a disruption to the integrity of the bone; healing is faster in children due to a thicker periosteum and good blood supply; epiphyseal plate injuries may result in altered bone growth Plastic deformation: the bone is bent no more than 45 degrees Buckle (torus): a bulge or raised area is present at the fracture site Greenstick: a fracture occurs in only one cortex of the bone
Spiral Fracture: occurs from a twisting motion Complete: fragments remain attached Incomplete: Bone fragments are still attached---fracture line can be transverse, oblique, or spiral Simple or closed: the fracture occurs without breaking the skin Open or compound: the fracture occurs with an open wound and bone protruding Complicated Fracture: results in injury to other organs and tissues Crepitus: grating sound created by the rubbing together of bone fragments Deformity: may observe internal rotation of extremity, shortened extremity, and visible bone with open fracture Compartment Syndrome: occurs when pressure within one or more of the muscle compartments of the extremity compromises circulation resulting in an ischemiaedema cycle with compromised neurovascular status Ostemyelitis: infection within the bone secondary to a bacterial infection from an outside source, such as with an open fracture or from a bloodborne bacterial source; s/s will appear ill, will not want to use the extremity, the site will be tender and there will be warmth, erythema, edema and fever ***The first sight of neurovascular function is pain!!! Chapter 28, Musculoskeletal Congenital Disorders Clubfoot: may be due to abnormal embryonic development; complex deformity of the ankle and foot; prenatal ultrasounds can dx.; can be fixed with exercises, serial casting, or surgery Talipes equinovarus: plantar flexion with feet bending inward Talipes Calcaneus: dorsiflexion of feet with toes higher than heels Talipes equinus: plantar flexion of feet with toes lower than heels Talipes varus: inversion of feet Talipes valgus: eversion of feet Developmental dysplasia of the hip: abnormal development of the hop structures; pt. will have asymmetrical gluteal and thigh folds, limited abduction of hips, one knee that appears shorter; the dr. can test with the barlow and ortalani tests by adduction and abduction; older children can be tested with the trendelenburg sigh; x ray can dx. older than 4 mths.; to correct, a pavlik harnis can be used from birth-6 mths. and it keeps the hips in a continually abducted position; a hip spica cast can be used if the infant is older than 6 mths. Scoliosis: complex deformity of the spine that also affects the ribs; there will be asymmetry of the scapula, ribs, flanks, shoulders, and hips; have the child bend over and observe the spine; to fix scoliosis, there is special bracing and surgery; surgery is needed for curves greater than 40 degrees; after surgery the pt. has to be log rolled while turning so the spine does not move; the child will receive blood after the corrective surgery Chapter 29, Chronic Neuromuscular Disorders Cerebral Palsy: nonprogressive impairment of motor function, especially that of
muscle control, coordination and posture; most common permanent disability in children; exact cause is unknown; warning signs are poor head control or absence of smiling in a 3 month old, difficulty with dressing and diaper changes due to stiff arms or legs, the child may push away or arch the back, floppy or limp body parts, inability to sit up without support in an 8 month old, feeding difficulties & painful muscle spasms; pt. will have persistent moro or tonic reflexes, hypertonicity, increased deep tendon reflexes, clonus, poor control of motion/balance/posture; dyskinetic--movements increase with stress but are absent with sleep; athetoid--involuntary jerking movements that appear slow, writhing, and wormlike; dystonic--slow twisting movements occur that affect the trunk and extremities; ataxic--wide-based gait and difficulty with coordination, poor ability to do repetitive movements, difficulty with quick or precise movements; to dx. do an MRI and complete neuro assessment; always have suction equipment handy; meds used include Lioresal (muscle relaxant), valium (muscle relaxant) Spina Bifida: defects in intrauterine closure of the boney spine; meningocele--spinal defect and sac-like protrusion are present but only spinal fluid and meninges are present in the sac; myelomeningocele--the sac includes meninges, spinal fluid, and nerves; high risk of latex allergies; linked to insufficient folic acid during pregnancy; elevated alphafetoprotein may indicate the presence of a neural tube defect; mom should be assessed between 15-20 weeks gestation to see if there are elevated AF proteins; monitor for ICP!!!! Meds used areditropan and detrol (antispasmodics to improve bladder capacity and continence; closure of the sac is done ASAP to prevent injury, a shunt may be placed for ICP Down Syndrome: chromosomal abnormalities; usually have an IQ around 50; have a small head, flattened forehead, low-set ears, upward slant to the eyes, protruding tongue, underdeveloped nasal bone, hypotonia, congenital heart defects; dx. with chromosomal analysis; child will need speech, physical, and occupational therapy Juvenile idiopathic arthritis: group of chronic autoimmune inflammatory diseases affecting joints and other tissues; no definitive dx. is available; peak is between 1-3 yrs.; rarely life-threatening; s/s of joint swelling, stiffness, redness, warmth, mobility limitations, fever, rash, nodules under skin, delayed g&d, enlarged lymph nodes; meds used are NSAIDs (controls pain/inflammation), Rheumatrex (slows joint degenerations), Corticosteroids (provide relief of pain/inflammation), Enbrel; NEVER USE ASPIRIN DUE TO REYE SYNDROME!!! Muscular Dystrophy: inherited disorders w/ progressive degeneration of symmetric skeletal muscle groups; Duchenne muscular dystrophy is the most common form; onset between 3-7 yrs. with life span reaching into early adulthood; family will report delays in walking, changes in gait, and difficulties w/ running, climbing stairs & riding a bike; s/s are muscular weakness in the lower extremities, muscular hypertrophy, mild delay in motor skill development, unsteady gait, mild cognitive delay, cardiovascular complications; dx. with dna analysis; serum creatine kinase will be elevated; meds are prednisone to increase muscle strength RAST: test that detects the presence of a latex allergy; allergy response includes urticaria, wheezing, and possibly anaphylaxis
Chapter 30, Skin infections and infestations Pediculosis: head lice; female lice lay eggs that attach to the hair follicle and hatch in 7-10 days; lice can live up to 1 month on the hose, but only 48 hours off the host; the itching is from the lice saliva and movement; begins with generalized itching, progresses to visible lesions from scratching; apply otc pediculicide shampoo, use a comb to remove nits, do not wash hair for 1-2 days, wash everything and treat in hot water, seal items in sealed bags for 2 weeks and vacuum areas well---pediculosis humanus capitis Scabies: contagious skin infestation from a microscopic mite; appears as a grayishbrown, threadlike burrow with a black dot at the end; accompanied by itching that can leave sores that become infected; apply topical medication from neck to toes, give clean clothes/towels/bedding, leave on skin for 8-12 hours, and bathe to remove medication Lyme disease: Caused by a spirochete, which is contained within the saliva and feces of ticks; has symptoms of viral-like illnesses; has three stages; stage one, rash of red ring 3-31 days after tick bite; stage 2, neurologic, cardiac, and musculoskeletal involvement; stage 3, musculoskeletal pain in joints and supporting structures, as well as neurological problems; give oral abx., use amoxicillin for younger than 8 yrs. and doxycycline for older than 8 yrs., treat for a period of 14-21 days; monitor for 30 days following a tick bite-borrelia burgdorferi Impetigo: red macule that becomes a vesicle and ruptures; thick honey crusted exudate; spreads easily; use aluminum acetate in water and topical antibacterial or oral abx.---staphylococcus Warts: appears as a well-circumscribed grey or brown papule w/ rough papillomatous texture; use destructive therapy; avoid irritation Cold Sores and Fever blisters and genital herpes: group of vesicles on inflamed skin, usually around lips or genitalia; accompanied by burning sensation, driesexfoliates-heals within 8-10 days; use aluminum acetate during weeping stage and topical or oral antiviral medication may be used to lessen the duration and decrease severity Tinea capiis: ringworm, head; circular scaly patches with or without areas of alopecia; progresses to the neck or hairline; administer griseofulvin for 6-8 weeks or oral lamisil for 2-4 wks; use an antifungal like litrimin or manistat 7 use a selenium sulfide shampoo Tinea Corporis: ringworm, body, appears as circular scaly red patches; clear center that spreads peripherally to the edges of the lesion; administer griseofulvin for several months, use topical antifungal medications for 1-2 weeks, even after resolution; apply mycostatin ointment or solution to affected areas---trichophyton tonsurans candidiasis: appears as inflamed areas with white exudate that peel and bleed easily Chapter 31, Dermatitis and Acne Contact Dermatitis: inflammatory reaction of the skin; caused when the skin comes into contact with chemicals or other irritants Diaper dermatitis: caused by detergents, soaps, and/or chemicals; may be the result of Candida Albicans; red/inflamed skin on areas in most contact with urine, feces and/or chemicals; candida makes satellite lesions; apply zinc oxide
Contact dermatitis: the result of urushiol, an oil found in poisonous plants; redness/ swelling/blisters/pruritis; rinse exposed areas, use calamine lotion or ammonium acetate, apply corticosteroid gel Seborrheic dermatitis: cradle cap, unknown etiology; thick/yellowish/scaly adhesions occur on scalp, eyelids, and external ear canals; treat by scrubbing the scalp with shampoo Atopic Dermatitis: type of eczema; pruritus and associated with a history of allergies that are inherited types; new lesions will develop with continued scratching; cannot be cured, but is well controlled; use atarax or benadryl; use topical corticosteroids to reduce or control flare-ups, and nonsteroidal agents during flare-ups; antibiotics are used to treat the secondary infections Acne: acne may be genetic; more common in males; hormonal fluctuations cause flareups in females; one treatment is Retin-A, interrupts abnormal keratinization that causes microcomedones, inform the child that it may irritate the skin, instruct to apply 20-30m after washing the face, use a pea-size amount and apply at night, use sunscreen; Another med is benzoyl peroxide which inhibits the growth of p. acnes, may bleach bed linens and clothes; topical antibacterial agents inhibit growth of p. acnes and there may be an allergic reaction to it, avoid exposure to sun, and use sunscreen; Accutane affects factors involved in the development of acne, side effects include dry skin and mucous membranes, dry eyes, decreased night vision, headaches, photosensitivity, elevated cholesterol and triglycerides, depression, suicidal ideation, and/or violent behaviors, it is contraindicated for women of childbearing age!!! Chapter 32, Burns Thermal: flames, steam, hot liquid Chemical: exposure to a chemical Electrical: when electrical pulses move through the body Radiation: from therapeutic treatment for cancer Burn management: has three phases, which are emergent (occurs first 24-48 hr. after burn occurs), acute (begins when emergent is finished and wound is covered by tissue), rehabilitative (begins when most of the burn is healed and ends when reconstructive or corrective procedures are complete--may be many years) Superficial burn: damage to epidermis, pink-red w/ no blisters, heals in 5-10 days w/ no scarring, ex. sunburn Superficial partial thickness burn: damage to entire epidermis and some parts of the dermis, pink-red color w/ blisters, pain present, heals within 14 days, no scarring, ex. flame or burn scalds Deep Partial thickness burn: damage to the entire epidermis and parts of the dermis, red-white w/ no blisters, pain present, scarring likely, possible grafting, heals in 14-36 days, ex. flame and burn scalds Full thickness burn: damage to entire epidermis, dermis, and possible damage to sq and nerve damage, red-tan-black-brown-white, no blisters, as burn heals the pain returns, heals within weeks-months, scarring present and grafting required, ex. burn scalds, grease,
tar, or electrical burns Deep full thickness: damage to all layers of the skin that extends to muscle, tendons and bones, black in color with no pain; heals within weeks-months; scarring present; ex. flame, electrical, chemical burns Labs: will have elevated Hgb, Hct and K, decreased Na Fluid Replacement: use 0.9% sodium chloride, lactated ringers during early stages; albumin or synthetic plasma expanders during the first 24 hr. Septic Shock: confusion, increased capillary refill time, spiking fever, decreased bowel sounds, decreased urine output Silver Nitrate 0.5%: used on wounds that are exposed to air or with modified or occlusive dressings, may affect joint movement, reduces fluid evaporation, bacteriostatic against pseudomonas and staphylococcus, inexpensive; does not penetrate eschar, stains clothes and linen, discolors the wound, painful on application Silver sulfadiazine 1% (silvadene): used with occlusive dressings, maintains joint mobility, effective against gram-negative and gram-positive bacteria; may cause transient neutropenia, does not penetrate eschar, painful to remove from the wound, decreases granulocyte formation, contraindicated with children who have sulfa allergies Mafenide acetate (sulfamylon): used on wounds that are exposed to air, used as a solution for occlusive dressings to keep the dressing moist, penetrates eschar and goes into underlying tissues, effective w/ electrical and infected wounds, biostatic against grampositive and gram-negative; painful to apply and remove cream, may cause metabolic acidosis or hypercapnia, inhibits wound healing, and may cause hypersensitivity Bacitracin: used on wounds that are exposed to air or with modified dressings, maintains joint mobility, bacteriostatic against gram-positive organisms, painless and easy to apply; limited effectiveness on gram-negative organisms Chapter 33, Diabetes Mellitus Diabetes Mellitus: chronic hyperglycemia due to problems w/ insulin secretion or insulin resistance Hypoglycemia: blood glucose level less than 70; hunger, shakiness, nausea, anxiety, irritability, pale cool skin, diaphoresis, shallow respirations, tachycardia, palpitations, difficulty thinking, change in emotional behavior, slurred speech, headache---if having an episode, treat w/ 15-20g carbs (4 oz. orange juice, 2 oz. grape juice, 8 oz. milk, glucose tablet); after giving the carbs, if blood returns to normal limits, give 7g protein Hyperglycemia: blood glucose levels greater than 250; thirst, frequent urination, hunger, warm/dry/flushed/poor turgor skin; dry mucous membranes, weakness, rapid weak pulse---if hyperglycemic, give insulin Labs: Diagnostic---Fasting glucose >126; symptoms of diabetes + casual plasma glucose concentration >200; 2 hr. glucose >200 w/ an oral glucose tolerance test; HbA1C, show what they have done in a few months Rapid Acting: Humalog, duration of 3-4 hr. Short Acting: Humulin R, duration of 5-7 hr.
Intermediate Acting: Humulin N, duration of 18-24 hr.
Long Acting: Lantus, duration of 10.4-24 hr. Lipohypertrophy: not rotating sites will cause this DKA: life threatening condition characterized by hyperglycemia >300, resulting in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine; onset is rapid and mortality rate is high; s/s n/v, abd. pain, frequent urination, thirsty, hungry, confused, change in mental status, dehydration signs, kussmaul resp. pattern (rapid deep resps.); provide fluids (0.9% sodium chloride), give regular insulin bolus dose followed by continuous IV infusion, monitor K levels, admin. sodium bicarbonate slow IV infusion Chapter 34, Growth Hormone Deficiency Achondroplasia: genetic disorder that causes nonproportional dwarfism; long trunk with shortened upper arms and legs, large head with prominent forehead, flattened bridge of the nose, shortened hands and fingers and decreased muscle tone---not successfully treated w/ GH; pt. will have delayed eruption of permanent teeth, underdeveloped jaws ***GH secretion is stimulated by administering glucose or having the child exercise ***GH deficiency without hormone replacement may result in disruption of vertical growth, delayed epiphyseal closure, retarded bone age, delayed sexual development, and premature aging later in life Chapter 35, Immunizations Active Immunity: long-term and occurs over time as the body produces antibodies in response to an infection or to an immunization and becomes immune as a result Passive Immunity: temporary and occurs after immunization w/ antibodies in the form of immune globulins for individuals who require immediate protection against a disease to which exposure has already occurred, when passed between mother and her fetus, and when transmitted to an infant through breast milk DTap: Diphtheria and tetanus toxoids and acellular pertussis vaccine; Doses @ 2,4,6,15 &18 mths. and again 4-6 yrs.; s/s after vaccine include crying, seizures, fever and irritability; may be an occurrence of encephalopathy, seizures, and uncontrollable crying DTap: tetanus and diphtheria toxoids and pertussis vaccine; one dose 11-12 yrs. Hib: haemophilus influenza type b; doses @ 2,4,6,12,&15 mths.; fever, crying, vomiting
Rotavirus: RotaTeq, three doses beginning at 6 wks w/ doses 4-10 wks apart and should be completed before 32 wks.; Rotarix requires 2 doses beginning @ 6 wks with the next does 4 wks. later, should be completed by 8 mths.; use caution in children who are immunocompromised; may cause diarrhea and vomiting in infants IPV: inactivated polio vaccine; doses @ 2,4,6,&18 mths. and again @4-6 yrs.; Beware if allergic to streptomycin, neomycin, or bacitracin!!! rare paralytic poliomyelitis MMR: measles, mumps, rubella; doses at 12-15 mths. and at 4-6 yrs.; joint pain, risk for anaphylaxis and thrombocytopenia; do not take if allergic to gelatin and neomycin!! Varicella: one does at 12-15 mths. and again at 4-6 yrs.; may cause a rash, do not take if allergic to gelatin and neomycin PCV: pneumococcal conjugate; doses @ 2,4,6,12&15 mths.; may cause mild local reactions Hep A: two doses @ 6 mths. apart after 12 mths. of age Hep B: within 12 hr. after birth with additional doses @ 1-2 & 6-18 mths.; beware if allergic to baker's yeast Seasonal Influenza: annually beginning @ 6 mths. with the inactivated, and 2 yrs. the live attenuated; beware if allergic to eggs!!! May be a risk for GuillainBarré syndrome MCV4: meningococcal vaccine; one dose @ 11-12 yrs.; history of Guillain-Barré syndrome HPV2, HPV4: human papilloma virus; three doses over a 6 month interval for females 11-12 yrs. w/ the 2nd dose 2 months after the 1st dose and the 3rd dose 6 mths. after the 2nd dose; HPV4 can be given to males starting @ 9yrs.; hypersensitivity to yeast; rare risk for Guillain-Barré syndrome ***Give IM in the vastus lateralis or ventrogluteal for infants and young children, and in the deltoid for older children and adolescents ***Instruct parents to avoid aspirin due to Reye syndrome ***Make sure parents pre medicate children before coming in for the vaccine Chapter 36, Communicable Diseases Varicella (chickenpox): direct, droplet, contaminated objects; malaise, fever, lesions beginning as macules and progress to papules before crusting over Rubella: direct contact, droplet; fever, mild rash, malaise--can be a teratogenic effect on the fetus Rubeola: direct contact, droplet; high fever, enlarged lymph nodes, koplik spots on buccal mucosa, red rash beginning in hairline
Pertussis (whooping cough): droplet; nighttime cough, thick mucus plug that dislodges when coughing, eyes bulge and tongue protrudes Erythema infectiosum (fifth disease): respiratory secretions and blood; Mumps: direct contact, droplet; fever, malaise, anorexia for 24 hr., swollen tender painful parotid glands, and earache Epstein Barr virus (mono): direct contact; malaise, fatigue, loss of appetite, fever, sore throat, splenomegaly, elevated WBC, liver enzyme elevation, palatine petechia---a ruptured spleen could happen---participation in contact sports is discouraged ***Health department must be notified if the case is pertussis, mumps or measles Reye Syndrome: follows an episode of viral illness, may be associated with the use of aspirin; nursing care will be provided in the ICU ***Rubeola, pertussis, and chickenpox can all lead to pneumonia Chapter 37, Otitis Media Acute Otitis Media: infection of the structures of the middle ear; usually triggered by a bacterial infection, a viral infection, allergies, or enlarged tonsils; s/s are rubbing/pulling on ear, crying, lethargy, bulging yellow or red tympanic membrane, temp. as high as 104 F, and hearing difficulties; pull pinna down and back with younger than three and up and back if older than 3 yrs. to look at tympanic membrane w/ pneumatic otoscope; meds to give are tylenol, amoxil/ augmentin/zithromax, & benzocaine ear drops for topical relief---long-term complication of numerous ear infections include speech delays Myringotomy: placement of tubes in the eardrum to equalize pressure; do not get water into the chid's ears and eliminate 2nd hand smoke Chapter 38, HIV/AIDS HIV: viral infection in which the virus infects t-lymphocytes causing immune dysfunction; this will lead to organ dysfunction and opportunistic infections; HIV infections that progress to AIDS place children at risk for malignancies; s/s are chills, anorexia, nausea, wt. loss, weakness, fatigue, headache, night sweats Mildly symptomatic children: will have two or more of the following symptoms-- lymphadenopathy, hepatomegaly, splenomegaly, recurrent upper resp. infections/sinusitis/otitis media, dermatitis or parotitis Moderately symptomatic: will have many of the following--anemia, bacterial meningitis/pneumonia/sepsis, oropharyngeal candidiasis, cardiomyopathy, cytomegaloviris infection w/ onset before 1 mth. of age, recurrent or chronic diarrhea, hepatitis, herpes/stomatitis/bronchitis/pneumonitis/esophagitis, herpes zoster, nephropathy, persistent fever, toxoplasmosis, disseminated varicella
Severely Symptomatic: has multiple or recurrent bacterial infections (meningitis, septicemia, pneumonia), esophageal or pulmonary candidiasis (bronchi, trachea, lungs), cytomegalovirus disease, pneumocystis jiroveci, HIV encephalopathy w/ developmental delays, HSV stomatitis/bronchitis/pneumonitis/ esophagitis, kaposi's sarcoma, brain or burkitt's lymphoma, disseminated or extrapulmonary mycobacterium tuberculosis, pneumocystitis jiroveci pneumonia, or wasting syndrome Stage 1: 500 cells; 29% or more Stage 2: 200-499 cells; 14-28% Stage 3: less than 200 cells; less than 14%; many conditions, such as candidiasis, herpes, encephalopathy, kaposi's sarcoma, burkitt's lympoma, mycobacterium turberculosis, pneumocystis jiroveci pneumonia, leukoencephalopathy, salmnella septicemia, and wasting syndrome Medications: HAART therapy will be used; it involves 3-4 HIV meds in combination; the meds include fuseon, retrovir, rescriptor or sustiva, norvir or agenerase or viracept; monitor cbc, wbc, & liver function tests---antibiotics used are TMP-SMZ, (pneumonia) zovirax (herpes), & amphcin (fungal) Chapter 39, Organ Neoplasms Wilm's tumor: malignancy that occurs in the kidneys or abd.; metastasis is rare; treatment may be a combo of surgery, chemo or radiation; a mass or swelling that is firm, non tender, and unilateral; causes urinary symptoms; never palpate!!! Administer Neupogen to stimulate WBC production and Procrit to stimulate RBC formation and Neumega to stimulate platelet formation Neuroblastoma: malignancy that occurs in the adrenal gland, sympathetic chain of the retroperitoneal area, head, neck, pelvis, or chest; treatment will be a combo of surgery, chemo or radiation; asymmetrical, firm, non tender mass that crosses the midline; causes urinary symptoms Chemotherapy medications: Oncovin, Adriamycin, Cytoxan, Dactinomycin and Platinol Chapter 40, Blood Neoplasms Leukemia: malignancies that affect the bone marrow and lymphatic system; causes an increase in the production of immature WBC's; bone marrow infiltration causes crowding of cells that produce RBC's, platelets & mature WBC's; most common type of cancer in childhood; s/s for low-grade fever, pallor, increased bruising, listlessness, enlarged liver/lymph nodes/joints, abd/leg/joint pain, constipation, vomiting, anorexia, and unsteady gait; bone marrow biopsy is the definitive way to dx. leukemia; a cerebrospinal fluid analysis will also be performed; hematopoietic stem cell transplants are done during the first remission and after a second remission,
after the tumor ells are destroyed, the child is given donor bone marrow or other stem cells...implantation may take 2-6 wks...put pt. in private positive-pressure room with HEPA filtration
Chapter 41, Bone and Soft Tissue Cancers Osteosarcoma: usually occurs in the metaphysis of long bones, most often the femur; frequently needs amputation; generally affects males during puberty; alkaline phosphatase will be elevated Ewing's sarcoma: occurs in the shafts of long bones and of trunk bones; treatment includes surgical bx., intensive radiation, chemo, but no amputation; usually affects 4 yrs. and older; Rhabdomyosarcoma: originates in skeletal muscle in any part of the body, but it most commonly occurs in the head and neck, with the orbit of the eye frequently affected; surgical biopsy, radiation, chemo rather than surgery; affects caucasian children more than african american Elavil: can be used for neuropathic pain or phantom pain; monitor for drowsiness, orthostatic hypotension, seizures, mania, anticholinergic effects, and cardiac dysfunction Chapter 42, Pediatric Emergencies ***A toxic dose of Tylenol is 150 mg/kg or higher; antidote is mucomyst given orally---can cause liver failure ***Aspirin poisoning, give activated charcoal, gastric lavage, sodium bicarbonate, oxygen and ventilation, vitamin K, and hemodialysis for severe cases---will have n/ v, ringing in ears and lightheadedness ***Iron poisoning, have pt. vomit or use lavage, do chelation therapy using desferal ***gas, kerosene, lighter fluid, paint thinner, turpentine, do NOT induce vomiting, intubate, treat chemical pneumonia ***household cleaners, batteries, denture cleaners, bleach...maintain airway maintenance, NPO, do not neutralize or induce vomiting, give analgesics for pain ***Lead poisoning...chelation therapy using calcium EDTA---can lead to mental impairment and blindness Chapter 43, Psychosocial Issues of Infants, Children & Adolescents Failure to thrive: inadequate growth resulting from inability to obtain or use calories required for growth; they fall below the 5th percentile; can be organic (physical) or definable psychosocial cause unrelated to disease Good Luck!!! XOXO BECKY
