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Family Centered Care an approach to health care that shapes health care policies, progams, facility design, and day to day interactions among patients, families, physicians, and other healthcare professionals- family is constant, address needs of family, involve family
3 phases of separation anxiety protest phase, despair phase, detachment phase
protest phase child cries and is inconsolable in grief for parent. May reject alternate caregivers, desperate clinging, attempts to escape
despair phase sad, lonely, uninterested in food and play ; superficial calm, withdrawn
detachment phase child might have appeared to have adjusted. Increased activity and interest. Transient attachment to nurses, indifferent to parents on return
separation anxiety in toddlers verbally plead for parents to stay, physically attempt to secure or find them, temper tantrums
separation anxiety in preschoolers tolerate separation for brief periods but stress of illness makes them less able to cope
separation anxiety in school age children better able to cope, but stress of illness may increase need for parents. React more to separation from usual activitie and peers (lonely, isolated, bored, depressed)
separation anxiety in adolescents loss of peer group contact is emotional threat
Reactions experienced by all children in hospital Fear, Anger, Guilt, Sadness
How to prevent separation anxiety let family stay, parent participation, bedside reporting, complement/augment parents caregiving functions
how to minimize separation anxiety daily routine, allow child to cry, provide support through physical presence, in detachment, maintain contact with childs family, familiar surroundings, remove frightening stimuli, maintain usual contacts
Erikson- Infants 0-1 trust vs mistrust
Erikson Toddlers 1-3 autonomy vs shame and doubt
Erikson Preschoolers 4-7 initiative vs guilt
Erikson School Age 8-12 industry vs inferiority
Erikson Adolescent 13+ ego identity vs confusion
Restraints any method, physical or mechanical which restricts a person’s movement, physical activity, or normal access to his or her body
medical surgical restraints • used for: risk for interruption of therapy, risk of harm if tubes are dislodged or removed, patient confusion/agitation/unconsciousness
o behavioral restraints risk of patients physically harming themselves or others because of behavioral reasons and when nonphysical interventions fail
- standard precautions: o use barriers (gloves, masks, gowns, etc) to prevent contamination from blood, bodily fluids, secretions, excretions, nonintact skin, mucous membranes
- Transmission Based Precautions used with patients with documented or suspected infection or colonization with highly transmissible pathogens for which additional precautions are needed (airborne, droplet, contact)
preparing child for isolation show mask, gloves, gown, encourage dress up, show face before putting stuff on
Urine Specimens- older children/adolescents bedpan, urinal, or can be trusted to follow directions for colletion in bathroom. Provide paper bag for disguising container, ask about menses
Urine Specimens- toddlers/preschoolers may not be able to void on demand/in unfamiliar places or may be newly potty trained. Give fluids and wait until they are ready to void. Use words like peepee
urine specimens- infants/not potty trained urine collection bag, double diaper
oral meds preferred, ease of administration, measure tsps by 5ml/tsp, crush tablets if not coated, divide only if scored. If not scored, dissolve and take up correct dose
IM meds vastus lateralis; have someone help hold down child, carry extra needles. tell them they are getting medicine under skin, carry out quickly and skillfully
SubQ meds lateral aspect of upper arm, abdomen, center third of anterior thigh
Reasons for getting IV meds poor absorption, need high serum concentration of drug, resistant infections that require parenteral meds over extended period, need continuous pain relief, emergency tx
advantage to NG/OG/gastronomy tube PO meds can be given around the clock without disturbing child
Indications for rectal meds when oral route is difficult or contraindicated- vomiting
Administering Eye drops place child supine or sitting with head extended and ask child to look up, use one hand to pull the lower lid downward, apply solution or ointment to small conjunctival sac
Administering Ear meds pull pinna down and back (<3 yo) or up and backward (>3 yo), administer drops through speculum with child prone or supine and head turned to appropriate side
Administering Nasal Meds • Extend head well over edge of bed or pillow (child should remain in this position for 1 minute) • Insert nasal spray into naris vertically then angle to avoid trauma to septum
Pain Assessment Under 4: flacc scale (facial, legs, activity, cry, comfort), 4-5 and older: FACES, 8 and older: numeric
Shock circulatory failure; tissue perfusion that is inadequate to meet the mtabolic demands of the body, which results in cellular dysfunction and eventual organ failure
3 physiological consequences of shock hypotension, tissue hypoxia, metabolic acidosis
causes of shock inadequate blood volume or inadequate oxygen carryign capacity of blood, inappropriate blood volume distribution, impaired heart contractility, obstructed blood flow
compensatory mechanisms in shock fluid mobilized from extracellular compartments, increased SNS activity(vasoconstriction, increased contractility), release of catecholamines (vasoconstriction/shunting), ADH, corticosteroids, aldosterone, anaerobic metabolism (acidosis), tachypnea
why is skin clammy and cold in shock? catecholamines produce vasoconstriction, reduce blood flow to skin, kidneys, muscles, splanchnic viscera and shunt to heart and brain
patho of metabolic acidosis in shock impaired tissue perfusion/oxygen depletion causes cells to use anaerobic metabolism, which causes build up of lactic acid
why do you breath fast (tachypnea) in shock? lungs try to compensate for metabolic acidosis
3 things to manage shock 1) Ventilation 2) Fluid Administration/Cardiac Support 3) Vasopressor Support
Managing Shock: ventilation oxygen, intubation
Managing Shock: fluid administration/cardiac support Isotonic crystalloids (LR or NS, IV boluses 10-20 ml/kg over 10-15 minutes). Colloids (albumin to incrase CO and volume), blood if blood loss
Managing Shock- vasopressor support exogenous catecholamines (dopamine, epi), calcium chloride, sodium bicarb for metabolic acidosis
hypovolemic shock systemic drop in intravascular blood volume beyond childs physiologic ability to compensate
signs of sever dehydration marked tachycardia, weak distal pulses, narrow pulse pressure, tachypnea, hypotension, decreased LOC
Cardiogenic Shock impaired cardiac muscle functioning that leads to decreased cardiac output (ineffective ventricular filling or insufficient forward flow)
Distributive shock vasogenic shock; results from vascular abnormality that produces maldistribution of blood supply throughout the body (neurogenic, anaphylactic and septic)
neurogenic shock massive vasodilation resulting from loss of sympathetic tone (spinal cord injuries)
anaphylactic shock hypersensitivity reaction that causes massive vasodilation and capillary leak
septic shock decreased cardiac output and derangements in peripheral circulation in response to severe, overwhelming infection
obstructive shock caused by cardiac tamponade, tension pneumothorax, ductal dependent congenital heart lesions, massive pulmonary embolism
ADH secreted in response to increased serum osmolarity and or decreased blood volume- increases water reabsorption by kidneys to increase blood volume and corrct hyperosmolality, decreases urine production
diabetes insipidus - decreased permeability of the renal distal tubules and collecting ducts with resulting decreased water reabsorption (ADH deficit (neurogenic) or vasopressin receptor insensitivity (nephrogenic))
Manifestations of Diabetes insipidus increased urine output, hypernatremia, dehydration, poluria, polydipsia, enuresis, excessive thirst with bedwetting, irritability/crying that is relieved with water
Treatment of DI vasopressin replacement: vasopressin tannate, aqueous lysine vasopressin, desmopressin acetate. Fluid replacement, should wear emergency med alert id band
vasopressin tannate IM/SubQ, 48-72 hour coverage
aqueous lysine vasopressin nasal spray, 8-12 hour coverage
Desmopressin Acetate (DDAVP) intranasal, 6-24 hour coverage, administered 2x daily
Syndrome of Inappropriate ADH (SIADH) - ADH excess: increased permeability of the renal distal tubules and collecting ducts with resulting increased water reabsorption and decreased urine production o Intravascular volume overload o Dilutional hyponatremia
Treatment of SIADH fluid restriction, loop diuretics and NaCl supplementation (for severe hyponatremia)
Diabetic Ketoacidosis most complete state of insulin deficiency
DKA Triad hyperglycemia (>200), ketosis (0.3-7.0), acidosis (ph <7.3)
Manifestations of DKA polyuria, polydipsia, tachycardia, hypotension, poor perfusion (dehydration), lethargy, depressed LOC (shock, cerebral edema), tachypnea (acidosis), acetone/fruity breath (excretion of ketones), abdominal pain (pancreatitis), dry mouth, N/V, weight loss
Nursing Management of DKA 1) ABCs!--> oxygen, volume replacement (slow to prevent cerebral edema), 2) Insulin Replacement IV, 3) Correct Acidosis- sodium bocarb
Monro-Kelley Doctrine because the brain, CSF, and cerebral blood volume are encased in a rigid skull, any increase in volume in any of the 3 must be met with wither a decrease in volume of one of the other components or an increase in the pressure within the brain
Elevated Intracranial Pressure occurs when the volume of brain tissue increases beyond the limit permitted by compression of veins and displacement of CSF
Manifestations of increased ICP headache, N/V, personality changes, irritability, fatigue, double/blurred vision, seizures, pupils sluggish, fixed and dilated, LOC deteriorates from drowsiness to coma
Medical Tx of increased ICP sedation, CSF drainage, osmotic diuretics (mannitol)
nursing interventions- increased ICP position to avoid neck compression, minimize pain/stress, minimize environmental noise
cerebral edema edematous brain is softer than normal and overfills the cranial vault (space occupying)- can cause herniation
brainstem herniation syndrome depressed LOC, decreased pupil reactivity, cranial nerve palsies, characteristic posturing (decerebrate or decorticate), CUSHINGS TRIAD
cushings triad hypertension, bradycardia, irregular respiration (indicative of brainstem herniation)
Intraventricular Catheter/ Extraventricular Drain catheter in lateral ventricle that measures ICP and provides continuous drainage of CSF to reduce pressure
Normal ICP level in infants 2-6 mmHg
normal ICP level in young children 3-7 mmHg
normal ICP level in older children and adults 0-10 mmHg
Central Venous pressure measurement of hydration
CVP indicative of dehydration 0-2
ideal CVP (adequately hydrated) 8-12
CVP indicative of overhydration 12-20
Glascow Coma Scale assesses LOC with eye opening, verbal response (smiling, crying, interaction), and motor response
Unaltered LOC- GCS score 15
GCS score indicative of coma <8
GCS score indicative of deep coma/death 3
Nasal Cannula no minimum flow, max flow 5L, 40% FiO2
Simple Mask min flow 5L, max flow none (consider changing at 8 L), FiO2 35-60%
Venturi Mask min flow dependent, max flow dependent on FiO2, FiO2 settings from 24-55%
Heated High Flow Nasal Cannula used to deliver a heated concentration of gas at a higher flow than normal nasal cannula
Trach Collar min flow 5L, no max flow, FiO2 28-100
Partial Rebreather Mask min flow: 2/3 of bag full on inspiration, min 5 L but normal >10L, FiO2 >60%
Non Rebreather Mask min flow: 2/3 of bag full on inspiration, min 5 L but normal >10L, FiO2 >80%
Normal Value of pH 7.35-7.45
Normal Range of CO2 35-45
Normal Range of HCO3 22-26
normal Range of PaO2 80-100
Normal Range of Base -2 to +2
Drugs used for intubation versed (benzo, sedation/amnesiac/anesthesia), vecuronium (neuromuscular blockade), fentanyl (analgesic)
Cleft Lip embryonic structures around the primitive oral cavity do not fuse completely. Unilateral or bilateral, complete or incomplete
Cleft Palate occurs when primary and secondary palatine plates fail to fuse during embryonic development
Cheiloplasty surgery for cleft lip, done at about 10 weeks of age
Palatoplasty plastic surgery for cleft palate, typically performed at 9-15 months
Long term problems with cleft lip/palate speech impairment,recurrent ear infection, extensive orthodontics, compensatory speech patterns
feeding infant with cleft lip/palate slowly feed in upright position, frequently burp, use special feeding devices, gavage feedings if necessary, psychosocial support to parents
pyloric stenosis thickening of cicular muscle at pylorus that leads to narrowing and elongation of pyloric canal, producing an outlet obstruction and compensatory dilation, hypertrophy, and hyperperistalsis of stomach
manifestations of pyloric stenosis projectile vomiting, dehydration, growth failure, olive shaped mass in epigastrum
tx for pyloric stenosis preop hydration with IV fluids and correction of metabolic alkalosis, decompress stomach with NG tube, pyloromyotomy
hirschsprung disease absence of ganglion cells in affected areas of the intestine resulting in a loss of the rectosphincteric reflex, internal sphincter does not relax causing obstruction
s/s of hirschsprung disease- newborns abdominal distention, bilious vomiting, failure to pass meconium, refusal to feed
s/s of hirschsprung disease- infants abdominal distention, constipation, diarrhea, growth failure, signs of enterocolitis, vomiting
s/s of hirschsprung disease- children abdominal distention, constipation, easily palpable fecal mass, ribbon like foul smelling stools, undernourished anemic appearance, visible peristalsis
treatment for hirschsprung disease bowel resection, renanastamosis, colostomy
ulcerative colitis inflammation limited to colon and rectum, involves continuous segments along length of bowel with varying degrees of ulceration, bleeding, and edema
s/s UC bloody diarrhea/occult fecal blood, abdominal pain, growth failure, anemia, weight loss
crohns disease chronic inflammation to any part of the GI tract from the mouth to anus; ulcerations, fibrosis, adhesions, stiffening of bowel wall, stricture formation, fistulas affecting bowel wall in discontinuous fashion
s/s crohns disease diarrhea, abdominal pain with cramps, fever, weight loss, extraintestinal symptoms
treatments for ulcerative colitis subtotal colectomy and ileostomy, ileoanal pull through, total colectomy
treatment of crohns disease segmental intestinal resections, partial colonic resection
nursing interventions for crohns disease diet teaching (hi cal, hi pro, small frequent meals), coping with stress, adjusting to chronicity, preparing for possibility of surgery, drugs, ileostomy care
intussusception proximal segment of bowel telescopes into a more distal segment, compresses lymphatics and veins. Pressure increases, when pressure equals arterial pressure, arterial pressure, blood flow stops causing ischemia and pouring of mucous into intestine
s/s intussusception crampy, abdominal pain, inconsolable crying, abdominal distention, red currant like stools, sausage shaped mass in RUQ, irritability, lethargy, constipation, etc
treatment for intusussception pneumoenema, ultrasound guided hydrostatic (saline) enema, surgical reduction
UTI presence of a significant amount of microorganism in urinary tract
cystitis bladder infection
pyelonephritis kidney infection
urethritis urethra infection
signs and symptoms of UTI- newborns nonspecific
s/s of UTIp children classic s/s: enuresis/daytime incontinence, fever, foul smelling urine, frequency and urgency, dysuria, hematuria
s/s of UTI- adolescents frequency and painful urination of a small amount of urine that may be grossly bloody, no fever
hypospadias congenital condition in which urethral opening is below glans penis or on the ventral side of the penile shaft
s/s hypospadias urethal opening below glans penis or on ventral side, penis looks abnormal, urine stream appears to be in abnormal direction, chordee
chordee ventral curvature of the penis
surgical repair of hypospadias done at 6-12 months, dont circumsize
acute glomerulonephritis inflammation of glomeruli that hinders the kidney from filtering urine
AGN- cause group A beta strep
s/s AGN antecedent strep infection, cola/tea colored urine, decreased urinary output, hypertension, loss of appetite, periorbital edema
treatment of AGN decreased K+, protein, Na+ diet, fluid restriction, antihypertensives and diuretics
nephrotic syndrome autoimmune process that causes glomerular injury, massive loss of protein in urine (proteinuria), hypoalbuminemia, hyperlipidemia, edema
nephrotic syndrome- patho increased glomerular permeability to protein, loss of albumin in blood decreases oncotic pressure and loss of fluid into interstitial space (edema/ascites), reduced fluid volume stimulates RAA and ADH, tubular reabsorption of sodium and water increases
s/s nephrotic syndrome weight gain, puffiness of face and eyes, swelling of abdomen and lower extremities, labial or scrotal swelling, generalized edema, decreased urine output, pallor, fatigue
treatment of nephrotic syndrome dietary restriction of salt, corticosteroids, immunosuppressants, diuretics
down syndrome genetic disorder, trisomy 21, recognized in prenatal to newborn periods, causes birth defects, intellectual disabilities, distinct facial features
autism spectrum disorders complex neurodevelopmental disorders of unknown etiology with genetic basis. Affects communication skills, social interactions, behavioral patterns
Created by: alexadianna