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Unit IV


Period of approximately 2 years that begins at the end of middle childhood and ends with the thirteenth birthday. Preadolescence
Signals the beginning of the development of secondary sex characteristics. Prepubescence
There is a difference of approximately ___ years between girls and boys in the age of onset of pubescence. 2
Generally, puberty begins at ___ years in girls and ___ years in boys; normal for either sex after the age of ____ years. 10;12;8
Eriksons stage of development for school age children. Industry vs Inferiority (6-12y/o)
Piaget stage of cognitive development for school age children. Concrete Operational (7-12y/o)
When children are able to use though processes to experience events and actions. Concrete Operations
Making judgements based on what they can reason. Conceptual Thinking
During school age ____ of mass is usually accomplished first, weight some time later, and volume last. Conservation
What are 3 cognitive advancements of school age years. Conservation, Classification, & Ability to read.
______ ______ is an important factor in gaining independence from parents. Peer Group
The school age period is the time when children have “____ ____” with whom they share secrets, private jokes, and adventures. Best Friend
Refers to a conscious awareness of self perception, such as ones physical characteristics, abilities, values, self-ideals and expectancy. Self Concept
Is a discipline technique that is effective for middle school age children. Reasoning
These children fear death and are fascinated by all aspects of death and dying. School Age
The first permanent teeth erupt by this age. 6y/o
The principal oral problem in children and adolescents. Dental Caries(Cavities)
The initial indication of puberty is the appearance of breast buds. Thelarche (8-13y/o)
Growth of pubic hair on the mons pubis. Adrenarche
The initial appearance of menstruation; which occurs about 2 years after the appearance of the first pubescent changes. Menarche(10.5-15y/o)
What are the 1st pubescent changes in boys. Testicular elargement, thinning, reddening and ↑looseness of scrotum.
Common during mid-puberty, occurring in up to 1/3 of boys; disappears w/in 2 years. Gynecomastia
Erikson stage of development for adolescents. Identity vs Role Conflict
Piaget stage of development for adolescents. Formal Operational
Adolescence is considered as beginning with the gradual appearance of 2° sex characteristics at about _____ or _____ y/o and ending with cessation of body growth at _____ to ____ y/o. 11,12 & 18-20
Includes abstract thought, thinking beyond the present, logical reasoning, and a sense of idealism. Adolescence (Cognitive Devel.)
Is closely related to body changes with social interactions. Body image
Adolescents _______ fluctuate. Emotions
What are 3 supplements adolescents may lack due to poor food choices. Calcium, Zinc, Iron
The primary cause of death from injury in the adolescent years. Motor Vehicle Injuries
Prepare mothers to expect more demands by _____ years. 8
Prepare father to expect ↑ admiration at ____ years; encourage father-child activities. 10
Teach bicycle safety to this age group. School Age (Helmet)

During school age primary teeth are lost and replaced by _____ teeth. Permanent
School age; growth is ____ than previous years, there is a steady gain in height and weight with maturation of body systems. Slower
Prime elements of play during the school years. Rules; Rituals; Cooperative Play; Teams
Parental concerns during middle childhood include _____, ____, _____ and social achievement. Lying; cheating; stealing
Gametes, both ova and spermatozoa are haploid cells, with _____ chromosomes each. 23
An unequal addition of one (or few) chromosomes. Aneuploidy (-somy)
The only monosomy that is compatible with life. Turners Syndrome
Are the external and internal organs that carry out the reproductive functions(i.e. Ovaries, uterus, breasts, penis). Primary Sex Characteristics
Changes that occur throughout the body as a result of hormonal changes(i.e. Voice alterations, facial and pubertal hair, fat deposits). Secondary Sex Characteristics
The stages of development of secondary sex characteristics and genital development; a guide for estimating sexual maturity. Tanner Stages (1-5 least to most)
The leading causes of death in children ages 5-9 y/o. Accidents, Neoplasms, Homicide, heart disease
Personify death as the devil, a monster or bogeyman; ↑ fears; fear of the unknown; interested in post death services; “What happens to the body?”. School Age(Death)
Have the most difficulty in coping with death; feel alone; worry about physical changes; may criticize funeral rights. Adolescents (Death)
The family should be allowed to remain with the body and hold or rock the child if they desire. After child’s death
School age children view death as _______ but not necessarily inevitable and may fear mutilation. Irreversible
Children beyond ______ to ______ years of age realize that death is irreversible, universal, and inevitable but may resist the thought of their own death. 12-15
Only s small percentage of children have a ______ factor. Rheumatoid
A chronic autoimmune inflammatory disease causing inflammation of joints and other tissue with unknown cause; <16y/o(Peak1-3);↑♀; may be triggered by virus. JIA
Chronic inflammation of the synovium with joint effusion and erosion, destruction and fibrosis of the articular cartilage. JIA (Patho)
Children with arthritis in _____ or fewer joints had the greatest likelihood for sustained remission. Four
Can cause permanent vision loss if undiagnosed and not aggressively treated. Acute Uveitis (JIA)
≦4 joints usually small joints. Pauciarticular
≧5 joints usually larger joints knee/elbow. Polyarticular
Is arthritis in one or more joints associated with at least 2weeks of quotidian fever, rash, lymphadenopathy, hepatosplenomegaly, and serositis. Systemic Arthritis
Onset <16y/o, arthritis in one or more joints for 6weeks or longer, and exclusion of other causes. JIA (Diagnosis)
______ is frequently present during exacerbations of systemic JIA. Leukocytosis
The ____ may or may not be elevated. ESR
Are common in JIA but are not specific for arthritis; however, they help identify children who are at greatest risk for uveitis. Antinuclear Antibodies (ANA)
Control pain, preserve ROM, ↓inflammation, and promote normal growth. JIA (Goal)
First line drug therapy for JIA. NSAID’s(Naproxen, ibuprofen, tolmetin, indomethacin, celecoxib, meloxican)
Is the second-line med used in children who have failed with NSAID’s alone. Methotrexate (Teratogenic)
Potent immunosuppressives used for life-threatening complications; incapacitating arthritis, and uveitis. Corticosteroids
A tumor necrosis factor-a (TNF-a) receptor blocker and an effective drug for children with JIA unresponsive to Methotrexate. Entanercept (Biological Agent)
Is excellent therapy because it allows freedom of movement with support and minimal gravitational pull. Exercise in Pool
Is the presence of a new pulmonary infiltrate and may be associated with chest pain, fever, cough, tachypnea, wheezing, and hypoxia. Acute Chest Syndrome (ACS)
Is a sudden and severe complication, often with no related illness. CVA; stroke
Because levels of HbS are low at birth, Hgb ______ or toher tests that measure Hgb concentrations are indicated. Electrophoresis
Frequently used because it can be performed on blood from finger-stick and yields accurate results in 3min. Sickle-Turbidity Test (Sickledex)
(“Finger printing of the protein”) an accurate, rapid , and specific test for detecting the homo and hetero forms of the disease as well as the percentages of the various types of Hgb. Hemoglobin Electrophoresis
Hand-foot Syndrome. Dactylitis
Administration of _______ and _______ vaccines is recommended for SCA pts, because of their susceptibility to infection as a result of functional asplenia. Pneumococcal; Meningococcal (Yearly Flu Vacc)
O₂ therapy is of little therapeutic value unless the patient has _____. Hypoxia
A successful, rapid method of ↓ the number of circulating sickle cells and therefore slowing down the vicious cycle of hypoxia, thrombosis, tissue ischemia, and injury. Exchange Transfusion(Used to prevent ACS & CVA)
Test identifies the child with SCD who is at ↑risk for developing CVA by monitoring intracranial vascular flow. Transcranial Doppler (TCD) [2-16y/o yearly]
Multiple blood transfusions ↑risk of this. Hemosiderosis, Rxn’s, Hyperviscosity
For recurrent life-threatening splenic sequestration. Splenectomy
Are recommended for Tx of splenic sequestration and stroke. Packed RBC transfusions
Mild to mod pain VOC. Ibuprofen, Ketorolac, or Tylenol
Severe pain r/t VOC. Morphine or Dilaudid
Physical and sexual maturation are ______ in adolescents with SCA. Delayed(Problem for adolescents)
Approved med that ↑ the production of HbF, ↓ endothelial adhesion of sickle cell, ↑ sickle cell hydration, ↑NO₂(Vasodilator) and ↓leukocytosis, ↓retic count. Hydroxyurea
Offers a curative approach for some children with SCD with event free survival of 95%. HSCT
Prevents sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle. Adequate Hydration
Three manifestations of SCD that may appear in the first 2 years. Dactylitis, Severe Anemia, Leukocytosis
Practitioners may recommend night-time _______ to help minimize pain and reduce flexion deformity. Splinting
Places additional stress on affected joints (JIA), need to avoid. Excessive Weight Gain(Obesity)
______ has been shown to be beneficial to children with arthritis. Heat(morning bath)
One of a group of diseases collectively termed hemoglobinopahties in which normal adult Hgb A is partly or completely replaced by abnormal sickle Hgb; 1:4 change; Autosomal Recessive trait. Sickle Cell Anemia (SCA)
SCA is believed by some to be the result of selective protection afforded trait carriers against one type of _______. Malaria
How do you know ADHD med is working. Kid has a GF
The clinical features of SCA are primarily the result. Obstruction, Vascular inflammation, ↑RBC destruction.
Is characterized by ischemia causing mild to severe pain that may last from minutes to days. Vasoocclusive Crisis(VSO)
A pooling of a large amount of blood usually in the spleen and infrequently in the liver that causes a ↓ blood volume and ultimately shock. Sequestration Crisis
Diminished RBC production usually caused by viral infection that may result in profound anemia. Aplastic Crisis
An accelerated rate of RBC destruction characterized by anemia, jaundice, and reticulocytosis. Hyperhemolytic Crisis
Initial enlargement of scrotum and testes; reddening and textural changes of scrotal skin; sparse growth of long, straight, downy and slightly pigmented hair at base of penis. Stage 2(pubertal)
Breast bud stage-small area of elevation around papilla; enlargement of areolar diameter. Stage 2(pubertal)
Projection of areola and papilla to form a secondary mound (May not occur in all girls). Stage 4
In about ___ cases of hemophilia, the inheritance pattern is demonstrated as X-linked recessive. 80%
The most common type of Hemophilia 80%. Factor VIII deficiency(Hemophilia A or Classic)
Unlike hemophilia, ___ affects both males and females. vWD
The most frequent type of internal bleeding in hemophiliac pts. Hemarthrosis
Swelling, warmth, redness, pain and loss of movement. Signs of Hemarthrosis
______ _______ can have fatal consequences and is one of the major causes of death in Hemophilia. Intracranial Hemorrhage
The primary therapy for hemophilia. Replace Missing Factors
Increases plasma factor VIII activity and is the treatment of choice in mild hemophilia and certain types of vWD if the child shows an appropriate response. DDAVP
These are given for hematuria, acute hemarthrosis, & chronic synovitis. Corticosteroids
PO administration; prevents clot destruction; limited to mouth trauma sxg with a dose of factor concentrate given first. E-aminocaproic Acid (Amicar)
______  activity w/in reasonable limits strengthens muscles around joints and may decrease the number of spontaneous bleeding episodes. Physical
The child can learn to self administer AHF by this age. 8-12y/o
This has proven effective in hemophilia pts in preventing bleeding complications by administrating periodic factor replacement. Primary prophylaxis
Involves the infusion of factor VIII concentrate on a regular basis after the child experiences his or her first joint bleed. Secondary Prophylaxis
THis alternative may be a cost-effective alternative to primary prophylaxis, but prophylaxis decreases the development of joint disease. On-Demand Factor Replacement
Can think in terms if future. Adolescent (think)
Teens need peer groups for sense of ______• Belonging
___% of teenager deaths are involving vehicles 40
Side effects include Nervousness, decrease appetite, insomnia, HTN Ritalin
Track down all sexual partners and treat w/ Abx Gonorrhea (chlamydia)
Asthma in infants is commonly _____. Viral
Long term steroid use can lead to ____ growth. Slowed
Swollen hands and feet, joint pain; needs hydration and analgesics. SCD Crisis
Hemophilia A or Classic hemophilia. Factor VIII deficiency
Hemophilia B or Christmas disease. Factor IX deficiency
Is a chronic inflammatory disorder of the airways characterized by recurring symptoms, airway obstruction, and bronchial hyperresponsiveness. Asthma
Continual symptoms throughout the day. Severe Persistent Asthma
Daily symptoms. Moderate Persistent Asthma
Symptoms >2 times/wk but <1 time/day. Mild Persistent Asthma
Symptoms ≤2 days/wk. Intermittent Asthma
Studies of children with asthma indicate that _____ influence both the persistence and severity of the disease. Allergies
Is the strongest identifiable predisposing factor for developing asthma. IgE response(Atopy)
A key component of asthma therapy. Anti-inflammatory agents (Corticosteroids)
What are the 3 classic manifestations of asthma. dyspnea, wheezing and coughing.
Chronic cough in the absence of infection or diffuse wheezing during the expiratory phase of respirations is sufficient to establish a diagnosis. Diagnosing Asthma
Provide an objective method of evaluating the presence and degree of lung disease , as well as the response to therapy. Pulmonary Function Tests
_______ can generally be performed reliably on children by the age of 5 or 6 years old. Spirometry
Signals all clear; asthma is under reasonably good control; no symptoms present. Green (80-100%PB)
Signals caution; asthma is not well controlled an acute exacerbation may be present; maintenance therapy may need to be increased. Yellow(50-79%PB)
Signals medical alert; severe airway narrowing may be occurring; short-acting bronchodilator should be administered. Red(<50%PB)
Measures the maximum flow of air that can be forcefully exhaled in 1sec. Peak Expiratory Flow Rate
Test for allergen-specific sIgE may be used to identify environmental allergens which trigger asthma. Skin Prick Testing (SPT)
An MDI should always be attached to a _____ when an inhaled corticosteroid is administered to prevent yeast infections in the mouth. Spacer
Are used as first-line therapy in children older than 5y/o with Asthma. Corticosteroids (
Budesonide and Fluticasone. Inhaled Corticosteroids
Short Acting; primarily Albuterol, Levabuterol[Xopenex], & Terbutaline are used for Tx of acute exacerbations & prevention of exercise-induced bronchospasms. B-Adrenergic Agonists
A long acting B-agonist(bronchodilator); prevents symptoms specially at night and exercise induced bronchospasms. Salmeterol (Serevent)
Relieve symptoms and prevent asthma attacks; used primarily in the ED when the child is not responding to maximal therapy. Theophylline
A medication used in maintenance therapy for asthma; inhibits the acute airway narrowing after exposure to exercise, cold air, and sulfur dioxide. Cromolyn Sodium
Zafilukast(Accolate) & Montelukast Sodium (Singulair) block inflammatory and bronchospasm effects. Leukotriene Modifiers
(atropine and ipratropium[Atrovent]) may be used for relief of acute brochospams. Anticholinergics
When used in combination with albuterol, has been shown to be effective during acute severe asthma. Ipratropium
Fairly new asthma drug; blocks binding of IgE to mast cells; eventually inhibits inflammation. Omalizumab (Xolair)
Prophylactic treatment with _____ or _____ before exercise usually permits full participation in strenuous exertion. B-adrenergic; Cromolyn sodium(Maintenance Therapy)
Successful treatment is continued for a minimum of 3years and then stopped. Hyposensitization
A medical emergency that can result in respiratory failure & death if untreated; sweats profusely, tripod position, agitation to quietness; little relief with breathing treatments.. Status Asthmaticus
A potent muscle relaxant that acts to decrease inflammation and improves pulmonary function and peak flow rate. Magnesium Sulfate
Administered to decrease airway resistance & thereby decrease the WOB; delivered via non-rebreather mask; used in acute exacerbations as an adjunct to B-agonist and IV corticosteroid therapy. Heliox
Risk factors that may predic the persistence of symptoms into childhood (from infancy). Atopy, Male, Environmental tobacco, Maternal Hx of Asthma
Excessive cold, wind, extremes of weather, smoke (open fire/tobacco), sprays, scents, and other irritants. Possible Allergens
Approximately 2-6% of children with asthma are sensitive to _____. Aspirin
The most accurate way to determine how many doses remain in a n MDI. Count & record each actuation as it is used.
Breath in n out; Hold 1-1.5 inch form mouth (or airtight seal w/ spacer); End of expiration Press and inhale 3-5sec. and Hold for 5-10sec.(x6 times w/ Aerochamber); remove and breath out slowly through nose; wait 1min between puffs. Use of MDI
The family should obtain a ____ and learn to use this device to monitor the child's asthma if the child is 5 years of age & older. PEFM
A home asthma action plan may reduce the risk of asthma death by ___%. 70%
These vaccines are recommended for all children with Asthma. Influenza & Pneumococcal
Refers to a group of bleeding disorders in which there is a deficiency of one of the factors (proteins) necessary for coagulation of the blood. Hemophilia
Is a pathologic process involving the scap, skull, meninges or brain as a result of trauma. Head Injury
The number one health risk for children & leading cause of death in children older than 1y/o Unintentional Injuries
Bruising at the point of impact. Coup
Brain collides with the unyielding surfaces, far removed from the point of impact. Countercoup
Most common head injury; alteration in neurologic or cognitive function w/ or w/o loss of consciousness; occurs immediately after head injury. Concussion (Resolve in 7-10days)
What are the hallmarks of a concussion. Confusion & Amnesia
Are used to describe visible bruising & tearing of cerebral tissue. Contusion & Laceration
Single fracture line that starts at the point of maximum impact but does not cross suture lines. Linear Fx
Consist of multiple associated linear Fx. Comminuted Fx
Hemorrhage, infection, edema, & herniation through the brainstem. Complications of Trauma to the Head
Should be suspected in children with increasing drowsiness and fever who also have a basilar skull Fx. Posttraumatic Meningitis
Bleeding between the dura and the skull to form a hematoma; generally arterial; Rapid. Epidural Hemorrhage
Momentary unconsciousness followed by a normal period and the lethargy or coma (less evident in children). Signs of Epidural Hemorrhage
Bleeding between the dura and the arachnoid membrane; usually as a result of rupture of cortical veins that bridge the subdural space. Subdural Hemorrhage
Some degree of cerebral edema is expected ___ to ___ hours after craniocerebral trauma. 24-72
Is a common sequela to brain injury w or w/o loss of consciousness. Postconcussion Syndrome
The most important nursing observation is assessment of the child's. LOC
Seizures are common in children with head trauma; Lethargic with sluggish pupils. Postictal (Postseizure)
Complex neurodevelopmental disorders of unknown etiology composed of qualitative alterations in social interaction & verbal impairment w/ repetitive, restricted & stereotype behavioral patterns. Autism Spectrum Disorders (ASD's)
ASD is manifested during early childhood, primarily from __ to __ months of age. 18-36
Although etiology is unknown theories of links between hereditary, genetic, and medical problems (i.e. viral infections) have been postalized; Fragile X Chromosome; Increased risk w/ families of affected child. Etiology for ASD
Hallmark characteristic of ADS person. Inability to maintain eye contact.
Lack of emotional reciprocity, Failure to develop peer relationships; lack of development of spoken language; inability to sustain conversations;repetitive motor mannerisms; preoccupation w/ parts of objects. Diagnostic Criteria for ASD
In ASD more Boys are affected than girls although girls are affected more ______. Severely
This children excel in particular ares, such as art, music, memory, math, or perceptual skills like puzzle building. Savants
Providing a _____ _____ for the child to follow is a key in the management of ASD. Structured Routine
Because physical contact often upsets children with ASD, these measures may be necessary to avoid behavioral outbursts. Minimal holding & eye contact
Because children with ASD have difficulty organizing their behavior and redirecting their energy. They need to be told Directly what to do.
Instruct family on pain meds and maintaining blood level. JIA
Delayed language, delay or absent imaginative play, impaired social interaction. ASD Diagnostic Criteria**
______ is a common symptom and can be associated with acquired megarectum in children with ASD. Constipation
Caused by excessive and disorderly neuronal discharges in the brain; symptom of an underlying disease process. Seizures
A condition characterized by two or more unprovoked seizures and can be caused by a variety of pathologic processes in the brain. Epilepsy
Are associated with an acute insult such as head trauma or meningitis. Acute Symptomatic Seizures
Are those w/o an immediate cause but w/ and identifiable prior brain injury (i.e. head trauma) Remote Symptomatic Seizures
Are those occurring with no clear cause. Cryptogenic Seizures
Seizures that are genetic in origin. Idiopathic Seizures
Hallmark early systemic clinical changes during generalized seizure. Tachycardia, HTN, Hyperglycemia, and Hypoxemia
Prolonged seizures can lead to these  s/s Lactic acidosis, rhabdomyolysis, hyperkalemia, hyperthermia, and hypoglycemia.
Have a local onset and involve a relatively small location of the brain; discharges remaining unilateral; localized motor symptoms. Partial Seizures
Involve both hemispheres of the brain and are w/o local onset. Generalized Seizures
Observed in children 3y/o-adolescents; Altered Behavior; Aura; drowsiness or sleep usually following seizure; Confusion & Amnesia; Stares into space; Automatism. Complex Partial Seizure
Most common & most dramatic of all seizures; Occur w/o warning; Includes Tonic/Clonic phases; Postictal state Generalized Seizure (Grand Mal)
Eyes roll; Falls to floor; Stiffens; LOC; arms flexed; piercing cry; Apneic; Increase salivation & loss of swallow reflex; lasts 10-20sec. Tonic Phase
Violent jerking movements as the trunk & extremities undergo rhythmic contraction and relaxation; foam at the mouth; incontinent of urine and feces; lasts 30sec but varies. Clonic Phase
Series of seizures at interbals too brief to allow th child to regain consciousness between the time one event ends and the next begins; lasts ≥30min. Status Epilepticus
May remain semiconscious and difficult to arouse; remains confused for several hours; poor coordination; may vomit & c/o severe HA; no recollection of event. Postictal state
Onset 4-12y/o, more common in Females; cease at puberty; Brief LOC; No alteration in muscle tone; May go unrecognized; abrupt onset (+20/day); may be mistaken for daydreaming; last 5-10 sec.; Does NOT Fall or incontinent; Amnesia+ Absence Seizures (Petit Mal or Lapses)
Onset 2-5y/o; sudden momentary loss of muscle tone & postural control; Falls to the floor violently;LOC only momentarily; May cause facial trauma. Atoni & Akinetic Seizures (Drop Attack)
Is ontained for most children with seizures and is the most useful tool for evaluating a seizure disorder; provides information on the seizure type and focus. EEG
Management of epilepsy has these four treatment options. Drugs, Ketogenic diet, VNS, epilepsy surgery
______ drugs serve to raise the threshold of excitability and prevent seizures from occuring. Antiepileptic (70-80% effective)
If complete seizure control is maintained on an anticonvulsant drug for ___ yrs, it is safe to D/C the drug for patients w/ no risk factors. 2
High fat, Low Carb, & adequte Protein diet; Causes induced Ketosis=using Fat as primary source for energy; Requires vitamin supps.; diarrhea, hypoglycemia, dehydration, acidosis, lethargy are long term side affects. Ketogenic Diet
Uses an implantable device that reduces seizures in individuals who have not had effective control with drug therapy. Vagus Nerve Stimulation
Defined as the persistence of seizures despite adequate trials of three antiepilecptic medications, alone or in combination. Refractory Seizures
These two drugs are quick, effective, and safe treatmetns for home or prehospital treatment of status epilepticus. Buccal Midazolam & Rectal diazepam
For in hospital management of status epilepticus; these are the first line drug of choices. IV diazepam or lorazepam (ATIVAN)**
Note the ______ of the seizure with start and stop times. Duration
If the nurse is able to reach the child in time, a child who is stading or seated (including a wheelchair) . Is eased to the floor immediately (turn to side)
Children taking phenobarbital or phenytoin should receive these supplemental vitamins. Vit D & Folic Acid
The most common factors that may trigger seizures in children. Emotional stress, sleep deprivation, fatigue, fever,  illness; flickering lights, menstrual cycle & Alcohol
A febrile seizure lasting more than 5min. Call 911 (Do Not place child in car w/ active seizure)
Main sign of a generalized seizure. LOC
The most common skin problem treated by physicians during patients' adolescence; caused by testosterone, a hormone present in boys and girls that increases during puberty. Acne Vulgaris
Is the only drug that effectively interrupts the abnormal follicular keratinization that produces microcomedones, the invisible precursors of the visible comedones. Tretinoin (Retin-A)
Start with pea-sized dot of med; wait 20-30min after washing face; Avoid sun; apply at Night; use sunscreen(SPF 15or >) Application of Retin-A
Anti-bacterial agent that inhibits growth of P. acnes organisms; First line agent. Benzoyl Peroxide
When inflammatory lesions accompany the comedones; these agents are used to prevent new lesions & to treat preexisting acne. Topical Antibacterial Agents
Are used when moderate to severe acne does not respond to topical treatments. Systemic Abx Therapy
Young women with mild to moderate acne mayy respond well to topical treatment and the addition of an _______ pill. Oral Contraceptive
A potent and effective oral agent that is reserved for severe cystic acne that has not responded to other treatments; affects factor involved in the development of acne; 20wk course; Teratogenic. Isotretinoin, 13-cis-retinoic acid (Accutane)
Causes dry mm; nasal irritation, dry eyes, decreased night vision, photosensitivity, arthralgia, HA mood changes, violent behaviors, Depression, & Suicidal Ideation. Side effects of Accutane
Is due to the loss of fluid from the vascular compartment into the area of injury; Fluid shifts from intravascular spaces into extravascular spaces. Burn Shock
Infusion of Ringer's Lactate. >2 years of age
Infusion of D5LR. <2 years of age
The fluid formula for the first 24 hours post burn 3-4mL IV fluid/Kg/TBSA + Maintenance Fluid
Maintenance fluid requirements. 100, 50, 20
Give 1/2 during first __ hrs. 8
Give 2nd half during subsequent ___hrs. 16
Urine output for children <30kg. 1ml/kg/hr
Urine output for children >30kg 30-50mL/hr
The extent of a burn is expressed as a percentage of the ____. TBSA
Usually minor; Sunburn; involves epidermal layer only; NO blistering; heals in 5-10 days. Superficial (First-degree)
Involve the epidermis & varying degrees of the dermal layer; painful, red, Blistering; sweat glands and hair follicles remain intact; heals in 14-21days. Partial-thickness (second degree)
Dry, leathery; involve the entire epidermis & dermis & extend into Sub-Q tissue; nerve endings, sweat glands; and hair follicles are destroyed.. Full-thickness (third-degree)
Are full-thickness burns that involve underlying structures such as muscle, fascia, and bone. Fourth-degree burns
Evidence of direct thermal injury to the upper airway includes. Burns to face/lips; Nasal hairs; laryngeal edema
Can cause restriction of chest excursion as a result of edema & inelastic eschar formation. Encircling burns (Thorax)
Maximum edema formation in small burn wounds occurs __ to __ hours after injury. 8;12
There is a systemic response involving an increase in cap. permeability, allowing plasma proteins, fluids and electrolytes to be lost. ≥30% TBSA
Results from pulmonary capillary damage and leakage of fluid into the interstitial spaces of the lung. Acute Respiratory Distress Syndrome (ARDS)
First step in emergency treatment of any burn. Stop the Burning process
Two Early signs of wound sepsis. Decreased LOC & Lethargy
Require continuous flushing with large amounts of water before transport to a medical facility. Chemical Burns
The burn wound should be covered with a clean ___ cloth to prevent contamination. Dry
_______ 0f the chest relieves this constriction and improves ventilation. Escharotomy
A high protein, high calorie diet is encouraged. Nutrition for Burn Patient
To facilitate growth and proliferation of epithelial cells; and increase wound healing. Vitamin A, C, and Zinc
Is the drug of choice for severe burn injuries. Morphine Sulfate (Versed & Fentanyl also used in conjunction)
The use of these short-acting anesthetic agents has proven beneficial in eliminating procedural pain. propofol(Diprivan) & Nitrous Oxide
______ and ______ are also needed for itching that occurs after whilpool and debridement. Hydroxyzine; diphenhydramine
Is used to cleanse the wound and involves soaking i a tub or showering at least once a day for no more than 20min. Hydrotherapy
Skin is obtained from human cadavers that are screened for communicable diseases; body rejects in 3-4wks. Allograft (homograft)
Used from a variety of species most notably pigs; needs replacement every 1 to 3 days. Xenograft
Are available for the management of partial-thickness burn wounds; readily available; indefinite shelf life; and relatively inexpensive. Synthetic Skin Coverings
May be sheet graft or mesh graft; permanent coverage of deep partial and full thickness burns; use a Dermatome. Split-thickness skin grafts
A sheet of skin removed from the donor site is placed intact over the recipient site and sutured in place(Good cosmetic outcome). Sheet Graft
A sheet of skin is removed from the donor site and passed through a mesher, which produces a larger surface area of material (Less desirable cosmetic). Mesh Graft
A product that allows the dermis to regenerate, has produced significant improvement in burn wound healing and decreased scar formation. Integra
The single most important element of infection control of burn patients. Frequent hand & forearm washing
Causes Urethritis (Dysuria w/ profuse yellow discharge, frequency, urgency, nocturia) or pharyngitis. Gonorrhea Male
Meatal erythema, tenderness, itching, dysuria, urethral discharge; or no symptoms and in females: mucopurulent cervical exudate with erythema, edema, congestion; or no symptoms. Chlamydia
Chancre, a hard, painless, red, sharply defined lesion with indurated base, raised border; secondary stage: systemic influenza-like symptoms; give Penicillin-G. Syphilis
For a patient positive for STI. Tx all sexual partners
Ensure vaccination for ____, ____, and ______. Hep A, B; HPV
This disease is of major concern to nurses because of its devastating effects on the reproductive system. Pelvic Inflammatory Disease
A group of permanent disorders of the development of movemen and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Cerebral Palsy (Definition)
It has been estimated that as many as ___ of CP cases are attributed to unidentified prenatal factor. 80%
Is also associated with a later diagnosis of CP. Perinatal Ischemic Stroke
Additional factors that contribute to these disease: B. Meningitis, multiple births, viral encephalitis, MVA, and child abuse. Factors for CP
Appears to play the most significant role in the pathologic state of brain damage, which is often secondary to other causative mechanisms. Anoxia
Persistent primitive reflexes, positive Babinski reflex, anle clonus, exaggerated stretch reflexes, development of contractures; 80% of cases most Common type. Spastic CP
All extremities affected; lower more than upper (30-40% of spastic CP). Diplegia
All four extremities involved; legs and trunk, mouth, pharynx, and toungue (10-15% Spastic CP) Tetraplegia
Three limbs involved. Triplegia
Only one limb involved. Monoplegia
Motor dysfunction on one side of the body; upper extremity more affected than lower (2-30% of spastic CP). Hemiplegia
Involves Athetoid, Dystonic; involvement of the pharyngeal, laryngeal, and oral muscles causing drooling and dysarthria (imperfect speech articulation). Dyskinetic (Nonspastic, Extrapyramidal)
Chorea; slow, wormlike, writhing movements that usually involve the extremities, trunk, neck, facial muscles, and tongue. Athetoid
Slow, twisting movements of the trunk or extremities; abnormal posture. Dystonic
Wide-based gait; rapid, repetitive movements performed poorly; disintegration of movements of the upper extremities when the child reaches for objects. Ataxic
Combination of spastic CP and dyskinetic CP. Mixed CP
More often diagnosis cannot be confirmed until the age of ___ years because motor tone abnormalities may be indicative of another neuromuscular illness. 2 y/o (CP Dxg)
Delay in all motor accomplishments; rigid and unbending at the hip and knee joints when pulled to sitting position; elbows flexed; hands fisted; Persistence of primitive infantile reflexes; seizures. Dxg CP signs
Persistent primitive reflexes such Moro, atonic neck; Poor head control; stiff; scissoring legs; clenched fists; Floppy or limp posture; cant sit w/o support by 8mo; after 6mo tongue pushing; failure to smile by 3mo; lack of interest. Early Signs of CP
Are worn by many children with CP and are used to help prevent or reduce deformity, increase the energy efficiency of gait, and control alignment. Ankle-foot orthoses (AFO's, braces)
Procedure involves selectively cutting dorsal column sensory rootlets that have an abnormal response to electrical stimulation. Dorsal Rhizotomy
Drug used to reduce spasticity in targeted muscles (commonly quadriceps, gastrocnemius, or medial hamstrings). Botulinum Toxin A (Botox)
This therapy is best suited for children with severe spasticity that interferes with ADL's and ambulation. Intrathecal baclofen
Head cooling or whole-body cooling within 6 hours of birth improved survival without CP by approximately 40%. Therapeutic Hypothermia (offers Neuroprotection)
Middle finger of the nonfeeding hand is placed posterior to the bony portion of the chin, the index finger is placed on the chin below the lower lip & the thumb is placed obliquely across the cheek to provide lateral jaw stabilization. Manual Jaw control Side
The middle finger of the nonfeeding hand is placed posterior to the body portion of the chin, the thumb is placed below the bottom lip, & the index finger is placed parallel to the child's mandible. Manual Jaw control Anteriorly
A complex spinal deformity; involving curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis; common during growth spurt in early adolescence; ill-fitting clothes. Idiopathic Scoliosis
Observation is performed behind an undressed (in undergarments), standing child, noting shoulder height, scapular or flank shape, and hip height and alignment; w/ hanging arms. Screening for Scoliosis
What is the definitive diagnosis for scoliosis patients. Standing Radiograph (Cobb technique)
Radiograph curves of at least ___ degrees for diagnosing scoliosis. 10
Require observation; exercise; exam every 3-6mo. Curve <20 degrees
Require orthosis with Milwaukee, Boston; or Halo brace; also electrical stimulation. Curve 20 to 40 degrees
Require Sxg or if unacceptable cosmetic appearance; or failure of brace Tx. Curve > 40 degrees
______ is the standard treatment for moderate curvatures in growing children. Bracing
______ are of benefit when used in conjunction with bracing to maintain and strengthen spinal and abdominal muscles during treatment. Exercise
Patients are monitored in an acute care setting and ____ ____ when changing position to prevent damage to the fusion and instrumentation. Log-rolled
May occur several days after surgery; this involves duodenal compression by the aorta and superior mesenteric artery. Superior Mesenteric Artery Syndrome
Is diminished or deficient secretion of pituitary hormones. Hypopituitarism
Refers to a method of assessing skeletal maturity by comparing the appearance of representative epiphyseal centers obtained on x-ray exam w/ age-appropriate published standards. Bone Age (X-ray Hand-wrist)
Children w/ poor linear growth, delayed bone age, and abnormal GH stimulation tests. Growth Hormone Deficient
Optimum dosing is often achieved when GH is administered at ______. Bedtime
Over-secretion of GH occurs after epiphyseal closure, growth is in the transverse direction. Acromegaly
Manifestations of sexual development before age 9y/o in boys or age 8 in girls. Precocious Puberty
More common in Girls; pubertal development is activated by the hypothalamic gonadotropin-releasing hormone. Central Precocious Puberty (CPP)
May be caused by congenital anomalies; Infections; Radiotherapy; Trauma; Neoplasms. Etiology of Precocious Puberty
If needed, precocious puberty of central origin is managed with monthly injections. Leuteinizing hormone-releasing hormone (Lupron Depot)
Refers to developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. ADHD
The symptoms must have been present in children 4 to 18 y/o and must be present in more than one major setting. Dxg ADHD
Learning disabilities and ADHD affect every aspect of the child's life but are most obvious in the ______. Classroom
Affect the child's written and adaptive skills, social status, and self esteem. Characteristics of ADHD
The most frequently used Stimulants for ADHD. Ritalin and Dexedrine
Children who receive stimulants should be monitored carefully for the development of ___. Tics
Focuses on the prevention of undesired behavior. Behavioral Therapy (Used w/ Meds)
The use of pharmacotherapy and behavioral intervention as well as close follow-up and feedback. Multimodal Treatment
_______ and _______ is especially important in children with ADHD. Consistency; Structure
Appetite suppression,HA, irritability, abdominal pain, N/V, Slowed growth, and sleep disturbances. Side effects of Stimulants
Psycho-stimulants should be administered ____ in the day. Early
PPrecocious puberty (central), needs monthly injections. LH (9 for girls, 11 for boys)
Characterized by destruction of pancreatic B cells, which produce insulin; this usually l/t absolute insulin deficiency; can be autoimmune or idiopathic. Type 1 DM
Is a chronic disorder of metabolism characterized by a partial or complete deficiency of the hormone insulin. Diabetes Mellitus (Definition)
Usually arises because of insulin resistance in which the body fails to use insulin properly combined with relative insulin deficiency. Type 2 DM
Influenza, gastroenteritis, and appendicitis are conditions that may _____ signs of DM. Mask
3 "P's", weight loss, Enuresis irritability, short attention span, dry skin, Blurred vision, poor wound healing, fatigue, flushed skin, HA, hyperglycemia. Signs of Type 1 DM
School-age children are able to administer their own ______. Insulin
Adrenergic; sweating and trembling. Early Hypoglycemia
Illness, emotional upset, stress, physical response to immunizations; steroids; menses. Factors for Hyperglycemia
Give 3-6oz of OJ, followed by starch protein snack. Tx for mild Hypoglycemia
The focus of type __ DM is insulin replacement, diet and exercise. 1
***Vaccines; no _______ between receiving vaccines and risk for autism. Correlation
These two STI are Tx at the same time. Gonorrhea & Chlamydia
This STI can cause blindness in newborns. Gonorrhea
Curling ulcer in GI tract, wound sepsis, CO2 inhalation, B. Pneumonia. Complications of burns.
Burn patients may benefit from this vaccine to prevent anaerobic organisms from growing underneath the wound. Tetanus vaccine
Asthma is considered ___ in children under 2y/o RAD
***Tx with anti-TNF same pain but had lower disease activity, w some having no pain at all. May be causal relationship with cognition affects perception of pain. Study for JIA
Must wait __ hours to take long term asthma med after quick relief has been administered. 4
Emergency medication for status asthmaticus. Epinephrine
Lowers estrogen level; slows prepubertal growth to a normal rate; stop when normal. Lupron
***Liquid hydroxyurea for pain; function of kidneys and spleen did not improve but significant decrease in pain with this drug. Study on SCA
Monitor ______ count regularly to evaluate bone marrow function is patients with SCA. Reticulocyte
Normal boy, Normal girl, Girl w Trait, Boy w disease. Genetic outcome for Hemophilia (1:4)
Dxg on basis of Hx, PTT, low levels of Factor VIII or IX; can be Dxg i through amniocentesis; Elective abortion an option. Dxg Hemophilia
Must be given through a warming coil or a warming machine; avoids central hypothermia. Blood Transfusion
If a reaction to blood or blood products occurs. STOP; take V/S, maintain patent IV, Notify MD
Tx for a concussion. Brain Rest
Traumatic Fx separation of cranial sutures. Diastatic Fx
What other drugs may be given to children with ADHD besides stimulants. Beta Blockers
***Cairo study; exercise on trunk muscles significant improvement in posture; Forward head movement. Study on Scoliosis
Preterm _____ of ELBW & VLBW is single most important determinant of CP. Birth
Created by: BOjangles1006