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Loading... Birth weight doubled by _____, tripled by _____. Birth length increased by 50% at _____. Posterior fontanel closes by _____. A child can socially smiles at _____. 6 months; 12 months 12 months 8 weeks (2 months) 2 months

A child should be able to turn head to locate 3 months sounds at _____. Moro reflex disappears around _____. 4 months

A child should be able to achieve steady head 4 months control at _____ of age. A child can turn completely over at _____ of 5 to 6 months age. A child can play peek-a-boo after _____ of age. A child should be able to transfers objects hand to hand at _____. A child develops stranger anxiety at _____. A child should be able to sit unsupported at _____. The infant crawls at _____. Fine pincer grasp appears at _____. A child should be able to waves bye-bye at _____. 6 months 7 months 7 to 9 months 8 months 10 months 10 to 12 months 10 months

A child should be able to walks with assistance at _____. The infant says a few words in addition to "mama" or "dada" at _____. From birth to one year, the baby explores environment by _____ and _____ means. From birth to one year is what stage of Erikson's theory?

10 to 12 months 12 months motor; oral Trust vs Mistrust (Developing a sense of trust) mobiles rattles squeaking toys picture books balls colored blocks activity boxes 30 months 2 years 12 - 18 months 18 months

What are some age-appropriate toys for hospitalized infants?

Birth weight quadruples by _____. Achieves 50% of adult height by ___. Anterior fontanel closes by _____. A child should be able to throw a ball overhand at _____.

The nurse tells a mother that her child should 24 months be able to kicks a ball at _____. A child should be able to feeds self with spoon and cup at _____. 2 years

Day time toilet training can usually be started 2 years of age around _____. A child should be able to speak two to three 2 years (24 months) word sentences at _____. A child should be able to speak three to four 3 years word sentences at _____ of age. A child should be able to states his/her own first and last name by _____. 2.5 to 3 years

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

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

Developing a sense of autonomy. board and mallet push/pull toys toy telephone stuffed animals storybooks with pictures Toddlers benefit from being taken to the hospital playroom, as mobility is very important to their development.

What are some age-appropriate toys for the hospitalized toddler?

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

Each year gain about 5 lbs What are the average weight and height gain and grows 2.5 to 3 for preschool children (3 to 5 years old)? inches. A child can use sissors at _____ of age. A child should be able to ties shoelaces at _____ of age. Visual acuity approaches 20/20 at _____. A preschool child thinking is _____ and _____. 4 years 5 years Preschool age (3 to 5 years) egocentric; concrete

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

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

Imaginary playmates and fears are common Preschool at this stage of development: (3 to 5 years) Aggressiveness at _____ is replaced by more 4 years; independence _____ at 5 years. Preschool child's major developmental taks according to Erikson theory is: At this stage of development, the child appears to be bowlegged and potbellied. At this stage of development, all primary teeth (20) are present. Developing a sense of initiative TODDLER (1 TO 3 YEARS) TODDLER (1 TO 3 YEARS)

egocentricity; Nursing implications of hospitalized (Explain that he/she did not preschoolers (3-6 years) needs to emphasize cause the illness and that understanding of the child's _____. painful procedures are not a punishment for misdeeds.) _____ or medical play to allow the child to act out their experiences is helpful for _____. At this stage of development, fear of mutilation from procedures is common. Therapeutic play; Preschoolers Preschool (3 to 5 years) coloring books puzzles cutting and pasting dolls building blocks clay toys that allow the preschooler to work out hospitalization experiences.

Toys and play for the hospitalized preschooler include:

The _____ needs preparation for procedures. He or she needs to understand what is and what is not going to be "fixed." Simple preschooler explanations and basic pictures are helpful. (3 to 6 years) Let child handle equipment or models of the equipment. _____ are learning to name body parts and are concerned about their bodies. During hospitalization, enforced separation Toddlers (1-3 years) toddler's

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

Normal gain in weight and height for school- Each year gain 4 to 6 pounds age child (6 to 12 years) are: and about 2 inches in height. Loss of primary teeth and eruption of most permanent At this stage of development fine and gross motor skills mature. During this developmental stage, girls may experience menarche. school-age child (6 to 12 years) school-age child (6 to 12 years) school-age (6 to 12 years)

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

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

Socialization with peers becomes important school-age child at this stage of development: (6 to 12 years) A child's molars should erupt at _____. 6 years

According to Erikson's theory, developing a school-age child sense of industry occurs at this stage: (6 to 12 years) A child should be able to write script at _____. 8 years

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

school-age child

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

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

Participation in care and planning with staff fosters a involvement; sense of _____ and _____ for a school-age accomplishment child (6-12 years). board games card games Toys for the hospitalized school-age (6 to 12 hobbies (such as stamp years) child include: collecting, puzzles, and video games) School-age children are in Erikson's stage of _____, meaning they like to do and industry; Peers accomplish things. _____ are also becoming important for this age child. Girls' growth spurt during adolescent begins _____ than boys (may begin as early as ___ earlier; 10 for girls). Boys catch up to girls' growth at age _____ and continue to grow. Girls finish growth around _____, boys around _____. 14 15; 17

Adult-like thinking begins around age _____. 15; problem solve; abstract They can _____ and use _____ thinking. Secondary sex characteristics begins at this developmental stage: At this stage of development, family connflict commonly occurs. ADOLESCENCE (12 to 19 YEARS) ADOLESCENCE (12 10 19 YEARS)

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

For this develpmental stage, teaching about procedures should include time without parents present. For this developmental group, some assessment questions should be asked without parents' presence. When teaching adolescent needs, the focus should be on _____.

adolescent (12 to 18 years)

adolescent here and now i.e., how will this affect me today? Infants: After 6 months, their cognitive development allows them to remember pain. Toddlers: Fear intrusive procedures. Preschoolers: Fear body mutilation. School age: Fear loss of control of their body. Adolescent: Major concern is change in body image.

Infants' concept of bodily injury:

Toddlers' concept of bodily injury Preschoolers' concept of bodily injury School ages' concept of bodily injury: Adolescents' concept of bodily injury:

MMR VACCINE Generally administered at _____ months of age and repeated at _____ 12 to 15; 4 to 6; 11 to 12 years or by _____ years. In times of measles epidemic, it is possible to give measles protection at _____ and repeat 6 months; 15 months the MMR at _____. Measles vaccine is contraindicated for persons with history of anaphylactic reaction neomycin; eggs; to _____ or _____, those with known altered immunodeficiency; pregnant _____ and _____ women. MMR vaccine may be given to those with HIV and breastfeeding women. T or F MMR vaccines are administer _____ at separate sites. A child may have a light transient ___ 2 True subcutaneously rash

weeks after administration of MMR vaccine. DTaP Vaccine administration begins at age ____, administer three doses at _____ intervals. 2 months; 2 months

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

DTaP Vaccine is not given to children past the ______ birthday; they receive _____ which contains full strength protection 7th; Td against tetanus and lesser strength diphtheria protection. When pertussis vaccine is contraindicated, give _____, until 7th birthday. Contraindications to pertussis vaccine include: 1. _____ within 7 days of previous dose of DTP. 2. History of _____. 3. _____ symptoms after receiving the vaccine. 4. _____ allergic reactions to the vaccine. DT (full strength diphtheria and tetanus without pertussis vaccine)

Encephalopathy; seizures; Neurologic; Systemic

Parents should be instructed to begin _____ acetaminophen (Tylenol); 10 administration after the immunization to 15 (normal dosage is _____ mg/kg). IPV is recommended for all person under the 18 age of _____. IPV is administer at _____ of age and again 2 months; 4 months; 6 to 15 at _____ of age. Boosters are given at _____ , months; 4 to 6 years and _____. Administer IPV _____ or _____ at separate site. subcutaneously; IM

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

PRP-OPMs can be given as early as ____ of 2 months age. DaTP/Hib combinations should not be used as primary immunizations at ages ___, ___, 2; 4; 6 months or ___. Children at high risk who were not immunized with Hib previously should be immunized after age _____. Hib is administer ______. 5 intramuscularly

_____ offers protection against bacteria that causes serious illness (epiglottitis, bacterial meningitis, septic arthritis) in small children Hib or those with chronic illnesses such as sickle cell anemia. _____ offers protection against hepatitis B. Typically, given to all _____ prior to hospital Hepatitis B vaccine; discharge. newborns; 0; 18 Vaccinate all children _____ to _____ years of age. Hepatitis B vaccine is contraindicated for common baker's yeast persons with anaphylactic reaction to _____. Hepatitis B vaccine is administer trough _____ site at _____ , _____, and _____ of age. IM; 0 to 2 months; 1 to 4 months; 6 to 18 months

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

DPT; IPV

Following immunization, call health care provider if _____, _____, or _____. Following immunization, a _____ on the thigh injection site and _____ the legs with each diaper change will decrease soreness.

seizures; high fever; highpitched crying occur warm washcloth; "bicycling"

Following immunization, acetaminophen (Tylenol) is administered orally every _____ 4 to 6; 10 to 15 hours (_____ mg/Kg). The common cold is not a contraindication for immunization. T or F A highly contagious, viral disease that can lead to neurologic problems or death. RUBEOLA (Measles) is transmitted by _____. RUBEOLA (Measles) is contagious mainly during the _____ which is characterized by _____ and _____ symptoms. True RUBEOLA (Measles) Direct contact with droplets from infected person. prodromal period; fever; upper respiratory

Photophobia Koplik's spots on the buccal Classic symptoms of RUBEOLA (Measles) mucosa. include: Confluent rash that begins on the face and spreads downward. Viral disease characterized by skin lesions. VARICELLA ZOSTER (Chicken Pox)

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

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

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

RUBELLA (German Measles) is transmitted droplet; direct contact with by _____ and _____. infected person RUBELLA (German Measles) is charcterized discrete red maculopapular by _____ starts on _____ and rapidly spreads rash; face; entire body to _____. RUBELLA (German Measles) rash disappears within _____. An acute, infectious respiratory disease usually occurring in infancy. Pertussis is caused by a _____. 3 days Pertussis (Whooping cough) gram-negative bacillus

PERTUSSIS (Whooping Cough) begins with upper respiratory symptoms _____. _____ is a paroxysmal state of the disease is PERTUSSIS (Whooping characterized by prolonged coughing and Cough) crowing or whooping upon inspiration. PERTUSSIS (Whooping Cough) lasts from _____. PERTUSSIS (Whooping Cough) is transmitted by _____, _____, or _____. PERTUSSIS (Whooping Cough) is treated with _____. PERTUSSIS (Whooping Cough) complications include _____, _____, and _____. 4 to 6 weeks direct contact; droplet spread; freshly contaminated objects erythromycin pneumonia; hemorrhage; seizures

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

right shunt in cardiac disease.

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

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

Aortic valve stenosis and mitral valve stenosis

Penicillin, erthromycin, aspirin

Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes. A common characteristic of spastic cerebral palsy in infants; legs are extended and crossed over each other, feet are plantar-flexed.

What are two nursing Prevention of infection of the sac and monitoring priorities for a newborn for hydrocephalus (measure head circumference; with myelomeningocele? check fontanel; assess neurologic functioning). List the signs and symptoms of increased ICP in older children. What teaching should parents of a newly shunted child receive? Irritability, change in LOC, motor dysfunction, headache, vomiting, unequal pupil response, and seizures. Information about signs of infection and increased ICP; understanding that shunt should not be pumped and that child will need revisions with growth; guidance concerning growth and development.

State the three main goals in providing nursing care Maintain patent airway, protect from injury, and for a child experiencing a observe carefully. seizure? What are the side effects Gingival hyperplasia, dermatitis, ataxia, GI of Dilantin? distress Fever, irritability, vomiting, neck stiffness, Describe the signs and opisthotonos, positive Kernig sign, positive symptoms of a child with Brudzinski sign; infant may not show all classic meningitis. signs even though very ill. What antibiotic are usually prescribed for bacterial meningitis? How is a child usually positioned after brain tumor surgery? Desribe the function of an osmotic diuretic. What nursing interventions increase intracranial pressure? Ampicillin, penicillin, chloramphenicol

Flat or on either side Osmotic diuretics remove water from CNS to reduce cerebral edema. Suctioning and positioning, turning

Describe the mechanism of inheritance of X-linked recessive trait Duchenne muscular dystrophy. What is gower's sign? Gower's sign is an indicator of muscular dystrophy; to stand, the child has to walk hands

up legs

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Loading... List two contraindications to immunocompromised child or in a household live virus immunization. with an immunocompromised individual. List three classic sign of measles. Photophobia, confluent rash that begins on the face and spread downward, and koplik spots on the buccal mucosa.

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

fluid replacement in children? How should a parent be instructed to child proof a house? What interventions should the nurse perform first in caring for a child who has ingested a poison? Describe the purpose of bronchodilators. What are the physical assessment findings for a child with asthma? What nutritional support should be provided for a child with cystic fibrosis? By being taught to lock all cabinets, to safely store all toxic household items in locked cabinets, and to examine the house from the child's point of view. Assessment of the child's respiratory, cardiac, and neurologic status.

To reverse bronchospasm. Expiratory wheezing, rales, right cough, and signs of altered blood gases. Pancreatic enzyme replacement, fat-soluble vitamins, and a moderate to low carbohydrate, high protein, moderate to high fat diet.

Why is genetic counseling Because the disease is autosomal recessive in important for the family of a its genetic pattern. child with cystic fibrosis? List seven signs of respiratory distress in a pediatric client. Restlessness, tachycardia, tachypnea, diaphoresis, flaming nostrils, retractions, and grunting.

Monitor child's temperature; keep tent edges Describe the care of a child tucked in; keep clothing dry; assess in midst tent. respiratory status; look at child inside tent. What position does a child with epiglottitis assume? Upright, sitting, with chin out and toungue protruding (tripod position)

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

postoperative complication following a tonsillectomy? Describe the signs and fresh blood, and clearing throat symptoms of this complication.

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Loading... When is iron deficiency most common? What is the best indicator of past nutrition? 12 -36 months and in females during childbearing years

Height and head circumference

How do you measure plasma, blood cells, urine, tissues from bone, hair or nutritional status? fingernail, hgb/hct, albumin, Cr, nitrogen Signs of iron deficiency Signs of B2 (riboflavin) deficiency Source of Iron Sources of B2 (riboflavin) Signs of Vitamin A (retinol) deficiency anemia, pale conjuctiva, pallor, brittle/ridged nails, thyroid edema redness of eyelid corners, burning, itchy, tearing eyes, photophobia fortified formula, fortified cereal, liver, beef, pork, eggs leafy green vegetables (broccoli, spinach, green beans), enriched cereal dry, rough skin, night blindness, defective tooth enamel, retarded growth and bone formation, decrease thyroid hormone formation

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

Signs of Vitamin C deficiency Sources of Vitamin C

scurvy, bleeding receeding gums, dry rough skin, decreased wound healing, increased infection risk, irritability strawberries, oranges, tomatoes, broccoli, cabbage, cauliflower, spinach

Signs of Vitamin B6 scaly dermatitis, weight loss, anemia, irritability, (pyridoxine) convulsions, peripheral neuritis deficiency Sources of B6 (pyridoxine) Signs of respiratory distress meats, cereal, yeast, soybeans, peanuts, tuna, chicken, bananas restlessness, increased resp. rate, increased pulse rate, diaphoresis

Which happens first, respiratory failure or respiratory failure cardiac failure Asthma airway become edematous, becomes congested with mucous, smooth muscles constrict, airtrapping occurs in alveoli

Nursing interventions for acute asthma rapid acting bronchodilators and steroids exacerbations Nursing interventions identify triggers, reduce allergens, use MDI, monitor for asthma through peak flow meter, Asthma Action Plan maintanence at home What type of disease autosomal recessive disease that causes dysfunction is Cystic Fibrosis? of exocrine glands Systemic effects of cystic fibrosis lung insufficiency (most critical), pancreatic insufficiency, increased loss of sodium and chloride in sweat

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

Cystic Fibrosis diet

Pts will need 1.5x normal caloric intake, high calories, high protein, moderate fat content, moderate carbohydrates rapid acute airway obstruction usually caused by H. influenzae type B

Causes of epiglottitis

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

upper respiratory symptoms, irritability, paroxysmal Signs and symptoms cough, poor eating, nasal congestion, nasal flaring, of bronchiolitis prolonged expiration, wheezing and rales What is given to prevent RSV infections in Synagis (palivizumab) immunocompromised patients? isolation, assess respiratory status, mist tent, Nursing interventions maintain hydration, evaluate respiratory treatment for Bronchiolitis effectiveness Newborn RR, HR Infant RR, HR Toddler RR, HR Preschool RR, HR School Age RR, HR RR: 30-60 HR:100-160 RR: 25-35 HR: 100-150 RR: 20-30 HR: 80-130 RR: 20-25 HR: 80-120 RR: 18-22 HR: 70-110

Adolescent RR, HR

RR: 16-20 HR: 60-90

Why are young children prone to ear The eustachian tubes are flattened infections? Otitis Media signs and symptoms fever, pain, infant may pull at ear, enlarged lymph nodes, drainage from ear (if eardrum is ruptured), vomiting and diarrhea

Nursing interventions Abx as prescribed, Tylenol, reduce body for otitis media temperature (warm tepid bath), monitor hearing loss Tonsilitis Risks of untreated Tonsilitis inflammation of tonsil (viral or bacterial) related to strep may lead to acute glomerulonephritis or rheumatic heart disease

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

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

Decreased pulmonary Tetralogy of Fallot blood flow Mixed blood heart defects TGV, TA

Atrial Septal Defect (ASD)

Increased pulmonary blood flow. There is a hole between the atria, oxygenated blood from LA is shunted to the RA and lungs.

Treatment and Surgical closure before school age recommended. consequences of ASD Can l/t CHF and atrial dysrhythmia. Patent Ductus Arteriosus (PDA) Increased pulmonary blood flow. Hole between aorta and pulmonary artery, usually closes within 72 hours. Oxygenated blood from the aorta returns to the pulmonary artery.

Increased blood flow to the lungs l/t pulmonary Treatment and hypertension. Require Indomethacin or surgical consequences of PDA closure. Coarctation of the Aorta Classic signs of coarctation of aorta Obstruction of blood flow from ventricles c/b narrowing of aorta. Hypertension of upper extremities and decreased or absent pulses in lower extremities, requires surgery.

Obstruction of blood flow from ventricles Aortic Stenosis (AS) immediately before/at/after aortic valve. Oxygenated blood from LV to body is diminished Three T's of cyanotic Tetralogy of Fallot, Truncus Arteriousus, heart disease Transposition of the great arteries What is tetralogy of Fallot? Truncus Arteriosus Transposition of the Great Arteries combination of four defects: VSD, overriding aorta, pulmonary stenosis, right ventricular hypertrophy One artery (truncus) rather than 2 arteries (aorta and pulmonary artery) arises from both ventricles Pulmonary artery leaves the left ventricle and the aorta exits from the right ventricle.

Cyanosis because unoxygenated blood is pumped into the systemic circulation, decreased pulmonary Signs and symptoms circulation. Experiences tet spells or hypoxic of Tetralogy of Fallot episodes and relieved by squatting or put in the knee-chest position. Truncus Arteriosus Transposition of the Great Vessels Pulmonary artery and aorta do not separate. Blood mixes in the R and L ventricles through a large VSD l/t cyanosis and increased pulmonary resistance. Mixed blood flow.Pulm circulation arises from L vent and systemic circulation arises from R vent.

Incompatible with life --> medical emergency give prostaglandin to keep ductus open. Assessment of child with CHD Check for murmur, cyanosis, clubbing (>age 2), poor feeding, FTT, fatigue, respiratory infections

Maintain nutrition status with small frequent meals Feeding a child with with high-calorie formula. Maintain hydration to CHD prevent thrombus formation. Risks of cardiac catheterization arrhythmias, bleeding, perforation, phlebitis, arterial obstruction at entry site

Cyanotic: abnormal circulation, all blood entering Basic differences circulation is oxygenated between cyanotic and Acyanotic: abnormal circulation with unoxygenated acyanotic defects. blood entering the systemic system Therapeutic digoxin levels Digoxin administration Digoxin toxicity What exacerbates Digoxin toxicity? 0.8-2ng/ml Check for bradycardia and hold. Do NOT skip doses, not miss with meals Vomiting is early sign, also, anorexia, diarrhea, and abdominal pain, fatigue, muscle weakness Hypokalemia

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Loading... When does birth length double When does the child sit unsupported 4 years 8 months

When does a child achieve 2 years

50% of adult height When does a child throw a 18 months ball overhand When does a child speak two to three word 2 years sentences When does a child use scissors 4 years

When does a child tie his 5 years or her shoes Which gender's growth spurt occurs first? Girls: as early as 10 years of age

What kind of behavior is considered common in the Temper tantrum toddler? When does a child form his or her identify? Rebellion against family values is common for which age group? Adolescence

Adolescence

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

their unborn siblings? What kind of hx should be Hx of reactions, sz, nerologic symtptoms after obtained prior to previous vaccine, systematic alergic reactions administration of DPAT? What kind of hx should be Hx of anaphylactic reactions to eggs, or obtain prior to the neomycin administration of MMR? Pertussus fatalities continue to occurr in which group in the US? Which type of administration method invalidates the mantoux test? Is the common cold a contraindication for immunization? Nonimmunized infants

subQ rather than ID

No

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

Cook in a small amount of liquid

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

Which is the priority of care regarless of age? Prior to tonsillectomy, which labs should be known

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

With cyanotic defects, polycythemia what condition is common Acyanotic: abnormal circulation but all blood entering the systemic circulation is oxygenated Cyanotic: abnormal circulation with unoxygenated blood entering the systemic circulation

What is the difference between acyanotic and cyanotic?

Are acyanotic or cyanotic defects more common Acyanotic with CHF children To conserve energy in children with heart defects, what may be necessary to conserve energy? What are two objectives of tx CHF?

Tube feedings

Reduce the workload of the heart and increase CO

What should be consistent Weighing the child on the same scale at the when frequently weighing same time of day so accurate comparisons can a child? be made When feeding a child with Preventing aspiration: cerebral palsy, what Position child upright and supporting the lower nursing interventions jaw should be implemented What is the nursing goal in caring for a down syndrome child? What are the s/sx of IICP? What is essential so changed associated with Help the child reach his or her optimal level of functioning Opposite of shock: Decreased pulse, decreased blood pressure Baseline of child's behavior and level of development

IICP can be detected early? Should a shunt be pumped? No, the shunt has delicate valves and pumping can change pressures within the ventricles

What is the most common cause of increased seizure Medication noncomplicance activity? Hydration status and IV therapy. What should the nurse monitor carefully with meningitis? With meningitis, there may be inappropriate ADH secretions causing cerebral edema and dilutional hyponatremia

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

It is usually done before preschool years to When is the correction of allow for the achievement of sexual identity, to hypospadias done? avoid castration anxiety, and to facilitate toilet training Guilt What are typical patient Disappointment and family reactions to a Grief child with a Sense of loss malformation? Anger Alternation in nutrition: less than body What is an important requirements nursing diagnosis r/t cleft lip/palate & pyloric Cleft lip/palate: r/t decreased ability to suck stenosis? Pyloric Stenosis: r/t frequent vomiting Nutrition needs & electrolyte balance What are big problems for children with GI Younger children are more vulnerable to these problems? problems

Where should you take the temp of a child with Axillary temp megacolon? What are the Hgb norms for a: Newborn Infant Child Newborn: 14-24 Infant: 10-15 Child: 11-16

1. Give on an empty stomach 2. Give with citrus juice 3. Use dropper or straw to avoid discoloring What are teaching point of teeth administering iron? 4. Stools will be tarry 5. Iron can be fatal in severe doses 6. Do not give with dairy products What supplement is not given to sickle cell anemia? What needs to be available when administering lasparaginase? Supplemental Iron; instead folic acid is given to stimulate RBC synthesis

Epi and O2 to treat anaphylaxis

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

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

Does a brace correct or slow the progression of scoliosis?

It slows the progression

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

What are the signs and Abnormal neurovascular assessment: cold symptoms of extremity, severe pain, inability to move the compartment syndrome? extremity, and poor capillary refill. Why are fractures of the Fractures of the epiphyseal plate (growth plate) epiphyseal plates a may affect the growth of the limb. special concern? How is skeletal traction Skeletal traction is maintained by pins or wires applied? applied to the distal fragment of the fracture. What discharge instructions should be included concerning a child with spica cast? Check child's circulation. Keep cast dry. Do not place anything under cast. Prevent cast soilage during toileting or diapering. Do not turn child using an abductor bar.

What are signs and Unequal skin folds of the buttocks, Ortalini sign, symptoms of congenital limited abduction of the affected hip, and unequal dislocated hip in infants? leg lengths. How would the nurse conduct a scoliosis screening? Ask the child to bend forward from the hips with arms hanging free. Examine the child for a curve in the spine, rib hump, and hip asymetry.

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

recieve about the Milwaukee brace?

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

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

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

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

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

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

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

Fractures involving the epiphyseal plate (growth plate) can have serious consequences in terms of growth of the affected limb. Skin traction for fracture reduction should NOT be removed unless prescribed by healthcare provider. Pin sites can be sources of infection. Monitor for signs of infection. Cleanse and dress pin sites as prescribed. Skeletal disorders affect the infants or childs physical mobility, and typical NCLEXRN questions focus on appropriate toys or activities for the child who is on bedrest and/or immobilized. Children do not like injections and will deny pain to avoid shots. A brace does not correct the curve of a child w/scoliosis, it only stops or slows the progression. Corticosteroids are used short term in low doses during exacerbations. Long-term use is avoided due to side effects and their adverse effect on growth. << first < prev1next >last >> Si de 3

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

_____ _____ ACYANOTIC congenital heart diseases that cause obstructed blood flow from ventricles: ____ ____ ____ CYANOTIC congenital heart diseases that cause Pulmonary blood flow: ____ ____ CYANOTIC congenital heart diseases that cause mixed blood flow: ____ ____ ____ ____ NCLEX After a pediatric client has a cardiac cath, which intervention would the nurse consider to be of highest priority during the immediate post procedure period? 4. Apply direct pressure to 1. Encourage intake of small entry site of 15 minutes. amounts of fluid. 2. Teach the parents signs of CHF. 3. Monitor the site for signs of infection. 4. Apply direct pressure to entry site of 15 minutes. NCLEX 1. Encourage fluids and regular diet. Which of the following home care instructions in included for a child postcatheterization? 1. Encourage fluids and regular diet.

* Coarctation of aorta * Aortic stenosis * Pulmonic stenosis

* Tetralogy of Fallot * Tricuspid atresia

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

2. Encourage physical activities. 3. The child can routinely bathe after returning home. 4. The child may return to school the next day. Patent Ductus Arteriosus * Diagnosis - Continuous ____ below left ____ - Dx with ____, cardiac ___ * Treatment - ____ for preterm only - ____ Transposition of the Great Arteries * Pathophysiology - ____ blood enters ____ and ____ - ____ circulation * Clinical manifestations - Initially appears ____ - ____ develops within a few hours of life NCLEX Which of the following statements is correct for a child with tetralogy of Fallot? 1. The condition is commonly referred 2. They experience hypercyanotic, or to as blue tets. tet spells. 2. They experience hypercyanotic, or tet spells. 3. They experience frequent respiratory infections. 4. They experience decreased or absent pulses in the lower extremities. NCLEX Administration of which of the following drugs 4. Prostaglandin E1 Patent Ductus Arteriosus * Diagnosis - Continuous MURMUR below left CLAVICLE - Dx with X-RAY, cardiac ECHO * Treatment - INDOMETHACIN for preterm only - SURGERY Transposition of the Great Arteries * Pathophysiology - UNOXYGENATED blood enters RA and RV - PARALLEL circulation * Clinical manifestations - Initially appears NORMAL - CYANOSIS develops within a few hours of life

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

1. Patent ductus arteriosus

* Separation * Bonding * Feeding * Care

NCLEX A 2-year-old child has a known cardiac defect and is in congestive heart failure. Which assessment finding indicates to the nurse a toxic 3. Bradycardia, nausea, and vomiting dose of digoxin? 1. Tachycardia and dysrhythmia 2. Headache and diarrhea 3. Bradycardia, nausea, and vomiting 4. Tinnitus and nuchal rigidity Kawasaki Disease * Pathophysiology - VASCULitis (BV inflamm) - PANCARDitis (inflamm of ALL structures of heart) - ECTASIA (dilation of tubular vessel) on echocardiogram 2. Strawberry tongue 1st sign - HIGH (not low) fever

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

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

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

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

2. Hypotension

3. Low-grade fever

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

at all. 2. To observe the child for signs of increased intracranial pressure. 3. In cardiopulmonary resuscitation. 4. To identify growth and development milestones. Monro - Kellie Hypothesis Once sutures have fused, the skull is a rigid compartment filled to capacity with non-compressible contents: brain ____% blood ____% CSF ____% If one component increases in volume, another component must ____ or ICP will ____. Normal ICP Adult ___-___ mm Hg Child ___-___ mm Hg (Accept values < ___ mm Hg) Cerebral Perfusion Pressure - blood pressure gradient across the brain CPP = ________ Keep above ____ Causes of Increased ICP ____ lesions (__,__,__) ____ injury (__,__) ____ problems (__natremia,__failure, __failure,__acidosis) Subarachnoid/intracerebral ____ Increased ICP MASS lesions (TUMORS, ABSCESSES, HEMATOMAS) ISCHEMIC injury (STROKE, HYPOXIA) METABOLIC problems (HYPOnatremia, LIVER failure, RENAL failure, CPP = MAP ICP Keep above 60 Monro - Kellie Hypothesis brain 80% blood 10% CSF 10% If one component increases in volume, another component must DECREASE or ICP will INCREASE.

Normal ICP Adult 3 - 15 mm Hg Child 0 - 10 mm Hg (Accept values < 20 mm Hg)

 ____ Malfunction

Diabetic Ketoacidosis) Subarachnoid/intracerebral HEMORRHAGE SHUNT Malfunction PUPILLARY dysfunction MOTOR weakness SENSORY deficits CRANIAL nerve palsies HEADACHE pain Deterioration in level of CONSCIOUSNESS SEIZURE

S/S of Increased ICP ____ dysfunction ____ weakness ____ deficits ____ nerve palsies ____ pain Deterioration in level of ____ ____ LATE S/S of Increased ICP Severe deterioration of ___ ____ ____edema ____ing Change in ____ signs Impaired brain stem ____ S/S of Increased ICP in an INFANT ____ feeding ____ity ____-pitched cry ____, ____ fontanel ____ing ____ scalp veins ____ head circumference TX for Elevated ICP (slide#1) 1st: ___'s! Stabilize ____ - ____-____ CO2 ____active drugs ____ drugs (Osmotic/Loop) ____osmolar therapy with ____% saline Positioning: ____, HOB ___, ____/____ alignment

Severe deterioration of LOC VOMITING PAPILLedema POSTURing Change in VITAL signs Impaired brain stem REFLEXES S/S of Increased ICP in an INFANT POOR feeding IRRITABILity HIGH-pitched cry TENSE, BULGING fontanel VOMITing DISTENDED scalp veins INCREASED head circ TX for Elevated ICP (slide#1) 1st: ABCs! Stabilize AIRWAY - LOW-NORMAL CO2 VASOactive drugs DIURETICS (Osmotic/Loop) HYPERosmolar therapy with 3% saline Positioning: SUPINE, HOB UP, HEAD/NECK alignment

TX for Elevated ICP (slide#2) ____tion Maintain ____ temp ____ ____ Drainage ____ control ____ regimen Avoid clustering ____ Avoid ____ exercises Provide a ____ environment Syndrome of Inappropriate ADH Secretion - ____ H2O reabsorption ____ serum osmolality ____ serum Na (<110mEq/L) ____ urine osmolality Irritability, anorexia, nausea, cramps, lethargy, stupor, convulsions SIADH Tx/NSG interventions ____ fluids ____tonic saline Monitor ____ Accurate __&__ Urine ____ Daily ____ ____ checks ____ precautions S/S Diabetes Insipidus Insufficient ___ Hormone ____ diuresis ____ osmolality ____ urine specific gravity ____ thirst ____hydration DI Tx/NSG Interventions Fluid ____ Strict __&__

TX for Elevated ICP (slide#2) SEDAtion Maintain NORMAL temp SURGERY CSF Drainage SEIZURE control BOWEL regimen Avoid clustering ACTIVITIES Avoid ISOMETRIC exercises Provide a CALM environment

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

SIADH Tx/NSG interventions RESTRICT fluids HYPERtonic saline Monitor ELECTROLYTES Accurate I&O Urine SPECIFIC GRAVITY Daily WEIGHT NEURO checks SEIZURE precautions S/S Diabetes Insipidus Insufficient ADH UNCONTROLLED diuresis DEC. osmolality DEC. urine specific gravity INSATIABLE thirst DEhydration DI Tx/NSG Interventions Fluid REPLACEMENT Strict I&O

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

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

Treat ALL SB pts as if they have this 50-70% of Spina Bifida pts have an allergy allergy to _____ Found in: catheters, gloves, tubing, tape, tourniquets, glue, toys, handles, tires, balloons, elastic Most common causative organisms of MENINGITIS (80%) ____ ____ ____ MENINGITIS Tx/NSG Intervent. Meds: ____ ____ precautions ____tion Fluid ____ (how much?) Monitor for increased ___ ____ measures ____ tests Haemophilus influenza b (Hib) Strep pneumoniae (pneumococcal) Neisseria menigitidis (meningococcal) MENINGITIS Tx/NSG Intervent. Meds: ABX Isolation precautions Ventilation Fluid restriction (how much? 1/2 to 2/3) Monitor for increased ICP Comfort measures Hearing tests

MENINGITIS residual effects ____ness, ____ness ____ Subdural ____, ____cephalus ____ ____ palsy ____ (Meningococcal) Etiology of Seizures ____pathic ____ Process ____ Imbalance ____ (temp) ____ Injury or ____ Tumor ____ Intoxication ____therapeutic Drug Levels Seizure Types Partial ____ ____ Generalized ___-___ A____ A____ A____ Status Epilepticus- MED EMERG Continuous ____ activity Loss of ____ Causes of Cerebral Palsy ____ birth Perinatal ____ ____ Intrauterine ____ Congenital ____ Anomalies ____ Disorders Med/Nsg Interventions for CP ____ training

MENINGITIS residual effects Deafness, blindness Paralysis Subdural effusions, hydrocephalus Seizures CP Amputation (Meningococcal) Etiology of Seizures Idiopathic Infectious Process Metabolic Imbalance Fever Brain Injury or Brain Tumor Drug Intoxication Subtherapeutic Drug Levels Seizure Types Partial Simple Complex Generalized Tonic-Clonic Absence Atonic Akinetic Status Epilepticus- MED EMERG Continuous SEIZURE activity Loss of CONSCIOUSNESS Causes of Cerebral Palsy PREMATURE birth Perinatal ASPHYXIA INFECTION Intrauterine ISCHEMIA Congenital BRAIN Anomalies METABOLIC Disorders Med/Nsg Interventions for CP ADL training

 ____ assistance ____ aids ____ Therapy ____ ____ Hypopituitarism: GHD Clinical manifestations * ____ stature * ____ or ____ rate of growth * Higher ____-to-____ ratio * ____ bone age Congenital Hypothyroidism * Clinical manifestations - Large ____ fontanel - Umbilical ____ - ____ (bowels) - Prolonged ____ * Treatment: Early Tx prevents ____ Definitions:

Mobility assistance Communication aids Physical Therapy Medication Surgery Hypopituitarism: GHD Clinical manifestations * Short stature * Deteriorating or absent rate of growth * Higher weight-to-height ratio * Delayed bone age Congenital Hypothyroidism * Clinical manifestations - Large posterior fontanel - Umbilical hernia - Constipation - Prolonged jaundice * Treatment: Early Tx prevents Cretinism

Pseudohermaphroditism = an Virilization = Development of male individual having internal secondary sexual characteristics reproductive organs of one sex and external sexual characteristics Adrenarche = the increase in activity resembling those of the other sex or of the adrenal glands just before being ambiguous in nature puberty NORMAL HGB VALUES Infant: __-__ g/dl 6-12 yr: __-__ g/dl 12-18 yr: __-__ g/dl Anemia (Hgb levels) Mild: __ g/dl NORMAL HGB VALUES Infant: 9 14 g/dl 6-12 yr: 11.5 15.5 g/dl 12-18 yr: 12 16 g/dl Anemia (Hgb levels) Mild: 11 g/dl

 Moderate: ____ g/dl Severe: < __ g/dl SICKLE CELL complication STROKE (or high-risk for it) Tx: * ____ transfusion q ____ wks * Desferoxamine (____ therapy) binds ____, allows excretion to occur (b/c RBC destruction from SCD -> ____ overload -> ____ deposited in tissues unless excreted - __ infusion __ nts/week Beta-thalassemia Medical/Nursing Management Medical Tx: Chronic ____ Sometimes ____ectomy ____ transplant Nursing Issues: Blood Transfusions ____ therapy Risk of infection, postsplenectomy Patient/Family Education Aplastic Anemia Pancytopenia Neutrophils < ____ Platelets < ____ Hemoglobin (RBCS) ____ Reticulocytes < ____% Etiology Primary (congenital): ____ Secondary (acquired): ____ (viral, toxic, pharmacologic) Coagulation Disorders

Moderate: 3 7 g/dl Severe: < 3 g/dl SICKLE CELL complication STROKE (or high-risk for it) Tx: * Blood transfusion q 3-4 wks * Desferoxamine (Chelation therapy) binds iron, allows excretion to occur (b/c RBC destruction from SCD -> iron overload -> iron deposited in tissues unless excreted - SC infusion 5 nts/week Beta-thalassemia Medical/Nursing Management Medical Tx: Chronic transfusions Sometimes splenectomy Bone marrow transplant Nursing Issues: Blood Transfusions Chelation therapy Risk of infection, postsplenectomy Patient/Family Education Aplastic Anemia Pancytopenia Neutrophils < 500 Platelets < 20,000 Hemoglobin (RBCS) DEC. Reticulocytes < 1% Etiology Primary (congenital): Fanconis anemia Secondary (acquired): Injury (viral, toxic, pharmacologic) Coagulation Disorders

 ____ A (factor VIII) aka classic hemophilia ____ B (factor IX) aka Christmas Disease ____ C (factor XI) ____ disease (vWF) Hemophilia A & B Lab Findings Platelets: ____ Bleeding time: ____ (clot formation) PT (or INR): ____ (extrinsic pathway) PTT: ____ (intrinsic pathway) Hemophilia A & B Medical/Nursing Management Monitor for ____ episodes/complications First aid for bleeding: ____ Administer ____containing product ____ infusions ____-derived or recombinant DDAVP (Mild Hemophilia A) Hemophilia Patient/Family Education Emergency treatment of bleeding IV ____ administration Anticipatory guidance: ____ precautions Physical activity Monitoring for complications von Willebrands Disease

Hemophilia A (factor VIII) aka classic hemophilia Hemophilia B (factor IX) aka Christmas Disease Hemophilia C (factor XI) Von Willebrands disease (vWF) Hemophilia A & B Lab Findings Platelets: normal Bleeding time: normal (clot formation) PT (or INR): normal (extrinsic pathway) PTT: prolonged (intrinsic pathway) Hemophilia A & B Medical/Nursing Management Monitor for bleeding episodes/complications First aid for bleeding: RICE Administer factorcontaining product Factor infusions Plasma-derived or recombinant DDAVP (Mild Hemophilia A) Hemophilia Patient/Family Education Emergency treatment of bleeding IV factor administration Anticipatory guidance: Safety precautions Physical activity Monitoring for complications von Willebrands Disease

 vWf transports Factor ____ Types: decreased, abnormal or near absence of vWF Results in : mucosal bleeding, epistaxis, easy bruising, menorrhagia Treat with ____, and vWF replacement Differences in Adult and Child Cancer Origin Cause Prevention and screening Metastasis at diagnosis Response to treatment Cure rate Childhood Cancer Treatment Modalities ____ (biopsy, resect, debulk) ____ (rapidly dividing cells) ____ therapy (shrink, residual) ____ transplant ____ response modifiers LYMPHOMA From lymphoid and hematopoietic systems HODGKINs Disease Older children/adolescents Focal, painless enlarged ____ tissue Dx: Node biopsy and staging Tx: Chemotherapy & radiation Atrial Septal Defect * Pathophysiology

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

Find answers in book

Childhood Cancer Treatment Modalities Surgery (biopsy, resect, debulk) Chemotherapy (rapidly dividing cells) Radiation therapy (shrink, residual) Bone marrow transplant Biologic response modifiers LYMPHOMA From lymphoid and hematopoietic systems HODGKINs Disease Older children/adolescents Focal, painless enlarged lymph tissue Dx: Node biopsy and staging Tx: Chemotherapy & radiation Atrial Septal Defect * Pathophysiology

- Blood flow ____ to ____ - ____ congestion * Clinical manifestations - Symptomatic? ____ - ____ ____ failure * Treatment - ____ for ___ ___ failure - ____ repair Ventricular Septal Defect * Pathophysiology - Blood flow ____ to ____ - Heart ____ - ____ congestion * Clinical manifestations - Symptoms? ____ - ____ ____ failure * Treatment - May ____ by age ___ Patent Ductus Arteriosus * Pathophysiology - ____ to ____ shunt - Fibers dont respond to ____ ____ at birth * Clinical manifestations - Symptomatic? ____ - Sounds? ____ - ____ pulses, ____ pulse pressure - ____ ____ failure FACTORS KNOWN TO ELEVATE INTRACRANIAL PRESSURE

- Blood flow LEFT to RIGHT - PULMONARY congestion * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - CONGESTIVE HEART failure * Treatment - DIURETICS for CHF - SURGICAL repair Ventricular Septal Defect * Pathophysiology - Blood flow LEFT to RIGHT - Heart ENLARGEMENT - PULMONARY congestion * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - CONGESTIVE HEART failure * Treatment - May CLOSE by age TWO Patent Ductus Arteriosus * Pathophysiology - LEFT to RIGHT shunt - Fibers dont respond to INCREASED O2 at birth * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - Sounds? MURMUR - BOUNDING pulses, WIDER pulse pressure - CONGESTIVE HEART failure Elevate ICP Hypercapnia Hypoxemia Respiratory Procedures Vasodilating Drugs Positioning Valsalva Maneuver Coughing Emotional Upset REM sleep Arousal from sleep Hyperthermia

 Seizures Clustering of Activities SICKLE CELL Life-threatening complications ____ Sequestration: Trapping of blood in ____, can result in shock/rupture Infection/____: Fever, S&S infection Leading cause of death in SCD pts < __ (#) yrs Hemolytic/Aplastic: ____ failure SCD Medical/Nursing Management ____ transfusion PT teaching: Living with chronic illness Pain Management - Opioids: ATC, PCA, __->__ transition (avoid ____) - NSAIDS (motrin) Adequate ____ Adequate ____ Support coping Observe for complications Acute Lymphocytic Leukemia Proliferation of abnormal lymphoblasts, causes pancytopenia Presenting symptoms: ____, ____ pain, ____ (color), ____ing TX: 3 Treatment phases (chemo) Induction (4 weeks) Consolidation (6 months) Maintenance (2 - 3years) For relapse, further ____ SICKLE CELL Life-threatening complications Splenic Sequestration: Trapping of blood in spleen, can result in shock/rupture Infection/Sepsis: Fever, S&S infection Leading cause of death in SCD pts < 5 yrs Hemolytic/Aplastic: Bone marrow failure SCD Medical/Nursing Management Blood transfusion PT teaching: Living with chronic illness Pain Management - Opioids: ATC, PCA, IV -> oral transition (avoid meperidine) - NSAIDS (motrin) Adequate oxygenation Adequate hydration Support coping Observe for complications Acute Lymphocytic Leukemia Presenting symptoms: Fever, bone pain, pallor, bruising 3 Treatment phases (chemo) Induction (4 weeks) Consolidation (6 months) Maintenance (2 - 3years) For relapse, further chemo and bone marrow transplant

and ____ transplant Acute Myelogenous Leukemia ____ proliferation of ____ cells in ____ Presenting symptoms: ____-like, ____ing, or as in ALL TX: Induction phase Intensive ____ Increased incidence of ____ S/S of Hydrocephalus Assess: ____ circ, ____ fontanel, ____ sutures Same S/S as ICP ____ache, ____ing, ____edema, ____ (musc), ____ity, ____argy, ____-pitched neuro cry, ____sion, ____s, ____ nerve dysfunction ____ ventricles on CT/MRI Status Epilepticus Nursing Tx/Interventions 1. ____ 2. ____ 3. ____ ALSO: ____ diet ____ Acute Myelogenous Leukemia Malignant proliferation of myeloid cells n bone marrow Presenting symptoms: Flu-like, bleeding, or as in ALL TX: Induction phase Intensive chemotherapy Increased incidence of DIC Hydrocephalus Assess: HEAD circ, BULGING fontanel, SEPARATED sutures Same S/S as ICP HEADache, VOMITing, PAPILLedema, ATAXIA (musc), IRRITABILity, LETHargy, HIGH-pitched neuro cry, CONFUsion, SEIZUREs, CRANIAL nerve dysfunction ENLARGED ventricles on CT/MRI Status Epilepticus Nursing Tx/Interventions 1. Stabilize airway! 2. Safety precautions 3. Medications Ativan or Valium Dilantin (Phenytoin); Fosphenytoin Tegretol Depakote Phenobarbital ALSO: Ketogenic diet

 Education NSG Management of GHD > Assessment > Nursing diagnoses - ____ growth/developmt r/t inadeq ____ secretion - Disturbed ____ image r/t ____ stature - Deficient ____ r/t tx > Outcome identification > Planning/implementation - ____ injections of ____ > Evaluation > ____ teaching re: ____ Acquired Hypothyroidism Clinical manifestations * ____ rate of growth * Weight ____ * ____ (bowels) * ____ skin * ____ or ____ hair * ____ (energy) * ____ intolerance * ____ of face, eyes, hands * ____ deep tendon reflexes * ____ puberty Tx = Med: ____ Hyperthyroidism Clinical manifestations * ____ rate of growth * Weight ____ despite ____ appetite * ____, ____ skin * ____cardia * ____ changes * Heat ____ * Emotional ____ * _____somnia, ____ tremors NSG Management of GHD > Assessment > Nursing diagnoses - Delayed growth/developmt r/t inadeq GH secretion - Disturbed body image r/t short stature - Deficient knowledge r/t tx > Outcome identification > Planning/implementation - SQ injections of GH > Evaluation > Pt/Family teaching re:tx Acquired Hypothyroidism Clinical manifestations * Decreased rate of growth * Weight gain * Constipation * Dry skin * Thinning or coarse hair * Fatigue * Cold intolerance * Edema of face, eyes, hands * Delayed deep tendon reflexes * Delayed puberty Tx = Med: Levothyroxine Hyperthyroidism Clinical manifestations * Increased rate of growth * Weight loss despite excellent appetite * Warm, moist skin * Tachycardia * Ophthalmic changes * Heat intolerance * Emotional lability * Insomnia, fine tremors

Tx: * ____ medication * ____ therapy * Subtotal ____ectomy Congen. Adrenal Hyperplasia Clinical manifestations * Male fetus: ____ * Female fetus: virilized _____ Enlarged ____ Fusion of ____ ____ appearance to labia ____ism (genitals) * Children (often toddlers) present with: adrenarche, ____ growth velocity, ____ bone age, acne, ____ism (hair) HEMATOLOGY Red Blood Cells Life span: ____ days, removed by ____ Types of hgb: ____ and ____ Hgb molecule has __(#) heme, __(#) globin chains White Blood Cells Early inflammatory response: neutrophils Immunity: lymphocytes Inflammatory/phagocytic: monocytes, macrophages Platelets Life span: ____ days ____ # in inflamm. states SICKLE-CELL pathophysiology RBC sickling caused by: ___emia(O2), ___osis(pH), ____hydration, stress,

Tx: * Antithyroid medication * Radioactive iodine therapy * Subtotal thyroidectomy Congen. Adrenal Hyperplasia Clinical manifestations * Male fetus: no phys changes * Female fetus: virilized external genitalia Enlarged clitoris Fusion of labial folds Rugae appearance to labia Pseudohermaphroditism * Children (often toddlers) present with: adrenarche, accelerated growth velocity, advanced bone age, acne, hirsutism HEMATOLOGY Red Blood Cells Life span: 120 days, removed by SPLEEN Types of hgb: A (adult) and F (fetal) Hgb molecule has 4 heme, 4 globin chains White Blood Cells Early inflammatory response: neutrophils Immunity: lymphocytes Inflammatory/phagocytic: monocytes, macrophages Platelets Life span: 10 days INC. # in inflamm. states SICKLE-CELL pathophysiology RBC sickling caused by: hypoxemia, acidosis, dehydration, stress,

infection, ____ extremes Sickled RBC destruction -> ____ Accumulated RBCs in spleen -> ____ damage & fibrosis Sickled RBCs obstruct capillaries/____, impair ____ -> pain, ____ dysfunction Hemophilia (A & B) Clinical Manifestations: Hemat____, Hem____, Hemat____, Epistaxis (nose ____),Intracranial ____, Other ____ (neck, abdomen, mouth) Dx History, Thromboplastin Generation test Severity (based on % of factor) Mild: __-__% of normal Moderate: __-__% Severe: < __% TYPES of Cerebral Palsy * ____- tense, contracted muscles (most common) * ____- poor sense of balance, falls/stumbles * ____- constant, uncontrolled motion of limbs, head, and eyes * ____- tight muscles that resist effort to make them move * ____- uncontrollable shaking, interfering with coordination SICKLE CELL Life-threatening complications ____-occlusive episode:

infection, temp extremes Sickled RBC destruction -> anemia Accumulated RBCs in spleen -> spleen damage & fibrosis Sickled RBCs obstruct capillaries/vessels, impair circulation -> pain, organ dysfunction Hemophilia (A & B) Clinical Manifestations: Hematomas, Hemarthroses, Hematuria, Epistaxis, Intracranial bleed, Other bleeding (neck, abdomen, mouth) Dx History, Thromboplastin Generation test Severity (based on % of factor) Mild: 5-35% of normal Moderate: 1-5% Severe: < 1% TYPES of Cerebral Palsy * SPASTIC- tense, contracted muscles (most common) * ATAXIC- poor sense of balance, falls/stumbles * ATHETOID- constant, uncontrolled motion of limbs, head, and eyes * RIGIDITY- tight muscles that resist effort to make them move * TREMOR- uncontrollable shaking, interfering with coordination SICKLE CELL Life-threatening complications Vaso-occlusive episode:

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

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

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

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

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

14 yo with sickle cell disease, * What are your initial nursing admitted from ER for fever and pain. actions? 3 day hx increasing chest pain, fever * When will you reassess? to 38.5. Wt = 45 kg * What kinds of medical orders do Admit VS: T= 38.4ax, HR= 140, you expect? RR= 32, BP= 142/88, 02 sat 90% on * Which, if any, of these results is room air. Rates pain as 9/10 on 0-10 concerning? And, why? scale. Points to upper right chest as CXR results show a right pain location, also back and upper lobe opacity. ? abdomen. Infiltrate. Has an implanted port in rt chest, CBC results: H/H = 7.0 / accessed in ER, now with 20 (norm =13-16/37-49) D5%/0.45NS at 25 ml/hr. Retic count = 1.5 (norm = CBC, retic count, and blood cultures 0.5-1.5) drawn, chest xray done. WBC = 15,000 (norm = 4.5 * What are your nursing priorities? 11.0) * What else do you need to assess? segs:80%, bands:10% (norm * What other information would be segs = 54 - 62, bands = useful in planning care? 3 - 5) Lymphoma From lymphoid and hematopoietic systems NON-HODGKINs Lymphoma Peak 7-11 years S/S: Depend on location (mediastinal mass, pleural effusion, lymphadenopathy) Pain, edema, generalized Often advanced at dx With mediastinal mass, Lymphoma From lymphoid and hematopoietic systems NON-HODGKINs Lymphoma Peak 7-11 years S/S: Depend on location (mediastinal mass, pleural effusion, lymphadenopathy) Pain, edema, generalized Often advanced at dx With mediastinal mass,

risk of ____ distress and superior vena cava syndrome Treatment with multi-agent ____ High risk of ____ lysis syndrome Wilms Tumor Arises in ____, primordial cells S/S: ____ swelling, pain, ____uria, ____ BP, malaise Dx: CT/MRI Surgery to remove ____ or ____, ____therapy Pre-op: monitoring, no ____ palpation (fragile outer capsule of tumor) Postop: Care as for major abd surgery, large abd incision Fluids, BP, pain Neuroblastoma From neural crest cells: brain, adrenal medulla, pelvis, mediastinum, sympathetic ganglia S/S: caused by ____ on adjacent structures, ____ Dx: scans, lab tests (depending on location), biopsy Staging: based on age, markers present, histology, extent of spread (62% have ____) Treatment: surgical removal, intensive ____, radiation (stage III), BMT

risk of respiratory distress and superior vena cava syndrome Treatment with multi-agent chemotherapy High risk of tumor lysis syndrome Wilms Tumor Arises in kidney, primordial cells S/S: abdominal swelling, pain, hematuria, INC. BP, malaise Dx: CT/MRI Surgery to remove tumor/kidney, chemo Pre-op: monitoring, no abdominal palpation (fragile outer capsule of tumor) Postop: Care as for major abd surgery, large abd incision Fluids, BP, pain Neuroblastoma From neural crest cells: brain, adrenal medulla, pelvis, mediastinum, sympathetic ganglia S/S: caused by compression on adjacent structures, metastases Dx: scans, lab tests (depending on location), biopsy Staging: based on age, markers present, histology, extent of spread (62% have mets) Treatment: surgical removal, intensive chemo, radiation (stage III), BMT

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

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

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Loading... What is the leading cause of death in infants? What level of preventative care is a child wearing a helmet? How does Erikson describe school age children? How do children intrepret blood being taken from them? Birth Defects Congenital Anomalies Secondary 6-12 years initiave vs guilt learn to carry out tasks want to be good at things Make a hole in them and their insides will come out.

Can grasp large objects but Fine and gross motor skills for a 5 monthj not small ones old? Roll from belly to back What is a big danger with small children and foods? How do you give ear drops to a small child? How do you give vitamin K? Rational for potty training at 2 years? What age and weight can a car seat be turned forward facing? At what age are testicular tumors more likely? Choking Pull ear down and back IM Their bodies are not ready until they are two. Age one year 20 pounds Adolescents

What accounts for 75% of all cases of spina Myelomeningocele bifida? What is myelomeningocele? Symptom of hip dysplasia What usually occurs with hip dysplasia? Back bone and spinal canal do not close before birth. Hips POP when ortiloni maneuver is preformed. neural tube disorders. Big head with rapid increase in diameter Vomit sleepy irritability seizures downward deviation of eyes (sunsetting) Appear 2-3 weeks after infection Slightly raised temperature swollen glands rash of pink spots that start on face conjunctivitis

Symptoms of hydrocephalous

Symptoms of Rubella

Symptoms of Roseola

Persistant high temperature higher than 102 for 3-4 days in an otherwise well child lowered fever with onset of rash appears on trunk and spreads Begins in broken skin Usually with staph red macules-vesicles most common in nose and mouth wash with topical ointment 3x day oral or parenteral antibiotics Fungus clean environment wash in HOT water tx entire family with NIX or Kwell caused by Deer Tick bite Caused by spirochete stage 1 rash stage 2 most serious, involves neuro TX oral doxycycline, less than 8 is amoxicillin or penicillin firm PALPABLE elevation of skin less than 1 cm elevated lesion less than 1 cm filled with fluid eating disorder characterised by low body weight and body image distortion Virus usually HPV Intense puritis especially at night Fine grayish threadlike lines human parvovirus B 19

Impetigo

How do you treat cellulitis? What causes ringworm?

How to manage head lice?

Lyme Disease

Papule vesicle

anorexia nervosa What causes a wart? S/S of scabies? What causes 5th disease?

Side effects of wearing a cast?

muscle loss atrophy increased sensitivity

What do you do with evulsed tooth if you do not want to put it back into your mouth put in cold milk or cold water until you can see a dentist? Hepatitis vaccine 1st injection 2nd one month later 3rd is 6 months from 1st DTaP IPV MMR Leukemia Bone marrow Aspiration Biopsy Lumbar Puncture most common malignant tumor of kidneys swelling or mass in abdomen firm. nontender mass increased abdominal girth HA with projectile vomiting causes obstruction in CSF circulation Causes increased ICP

What injections will a 5 year old have? Most common form of childhood cancer? How is leukemia diagnosed?

Wilm's Tumor

Symptoms of brain tumor?

Dehydration What should you watch for in a child using clotting problems because of diuretics? hypokalemia maybe no s/s of pain loss of movement stiffness loss of ROM avascular is arthritis disease of pelvic kidney It could lead to Rhumatic fever if untreated.

S/S of necrosis

pyelonephrosis Why should you treat strep?

Isotonic Dehydration How much fluid loss is there with mild dehydration? What causes diarrhea most often in children?

loss of water and electrolytes in equal proportions Loss of less than 50ml/kg of fluid Rotavirus Respiratory compromise hypovolemic shock local infections sepsis little or no pain because of nerve damage Accidents next is homocide check for tenting color, dry, moist? one of the biggest emergencies Trachea swells shut needs trach or will die malnutrition dehydration electrolyte imbalance tooth erosion damage to voice potential for gastric rupture abnormal narrowing in blood vessel or other tubal organ May be called stricture Noise over turbulent flow, bruit ultrasound or MRI to Diagnose current jelly stools Avoid Wheat. Breast Buds

Complications of 3rd degree burns in children

What is the leading cause of death in adolescents? assess skin turgor?

epiglottis

Complications of bulemia

Stenosis

Intussusception How do you treat celiac disease? First signs of puberty in females?

First signs of puberty in males?

enlarged testicles 2 months 4 months 6-18 months 11-16 years 2 months 4 months 6 months 12-18 months 4-6 years 2 months 4 months 6 months 12-15 months 2 months 4 months 6 months 15 months 6 months 9 months 18 months 4-6 years 12-18 months 4-6 years 12-18 months Before onset of s/s- 1 week after rash 4-14 days unknown blood/resp during high temp until after rash 5-15 days unknown 14-21 days 7 days before and 5 days after rash appears 14-21 days

Hep B

DTaP

Hib

Prevnar

IPV

MMR Varicella Communicability of 5th disease (Erythema Infectiosum) Incubation of transmission communicibality of roseola incubation transmission Chicken pox incubation Rubella communicability incubation

transmission

resp direct and indirect prevent with MMR Koplik's spots (bluish spots in mouth and oral mucosa Vitamin A decreases mortality and morbidity Disease is transmittable to others time between invasion of organism and outbreak of infection time between beginning and non specific s/s appearance of disease Time between time when s/s begin to disappear and complete return to wellness.

measles

communicability

Incubation Period

prodromal period illness stage convalescent