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UTA NURS 4431 Exam 3

UTA NURS 4431 Children & Adolescents Exam 3

Congenital Hypothyroidism Congenital hypothyroidism is a condition in which the thyroid gland does not produce sufficient thyroid hormone to meet the body's metabolic needs.
Congenital Hypothyroidism manifestations skin mottling, a large fontanel, a large tongue, hypotonia, slow reflexes, and a distended abdomen. Other signs and symptoms include prolonged jaundice, lethargy, constipation, feeding problems, coldness to touch, umbilical hernia, hoarse cry, and excessi
Congenital Hypothyroidism management lifelong thyroid hormone replacement, usually in the form of levothyroxine.
Levothyroxine thyroid hormone replacement
State-required screening for congenital hypothyroidism Newborn screening (TSH and T4 <48 hrs after birth); low T4 and elevated TSH indicative of congenital hypothyroidism
TSH level indicative of hypothyroidism 100mU/L
Congenital Hypothyroidism teaching levothyroxine medication teaching: leads to intellectual impairment, daily admin (if vomit within 1 hr, readmin), don’t add to full bottle (may not drink entire bottle), monitoring for overdose (rapid HR indicative of hyperthyroidism)
Central diabetes insipidus an inability to concentrate urine due to a deficiency in vasopressin
Nephrogenic diabetes insipidus kidney insensitivity to vasopressin
Vasopressin Antidiuretic hormone (ADH)
Diabetes Insipidus manifestations first sign enuresis (bed wetting); polyuria (increased urination); nocturia; polydipsia (increased thirst); dehydration; hypernatremia; low urine specific gravity (<1.005); elevated serum osmolality (>300); decreased urine osmolality
Electrolyte imbalance seen in diabetes insipidus hypernatremia
Diabetes Insipidus management daily hormone replacement of vasopressin (drug of choice: DDAVP); monitor I&Os for signs of fluid overload; seizure precautions
DDAVP (1-deamino-8-D-arginine vasopressin) drug of choice for Diabetes Insipidus (only therapy for central diabetes insipidus); given IM, IV, or SQ
Diabetes Insipidus teaching admin of DDAVP; manifestations of hypernatremia (untreated) and hyponatremia (overtreatment); to measure urine specific gravity to monitor effectiveness; wear medical alert bracelet; notify school (need to allow free access to water and toilets)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) excessive production or release of ADH, or vasopressin.
SIADH manifestations hyponatremia, decreased urine output, increased urine specific gravity, fluid retention with slightly elevated plasma volume, weight gain, and increased urine osmolality
Electrolyte imbalance seen in SIADH hyponatremia
Hyponatremia manifestations mild: anorexia, nausea, headache, vomiting; moderate: confusion, lethargy, irritability, altered LOC; severe: seizures, coma
SIADH management treatment of underlying cause; fluid restrictions (to correct hyponatremia); IV NaCl (for severe); meds for chronic: lithium and demeclocycline
SIADH teaching high-salt diet, hyponatremia manifestations
Precocious puberty early onset of puberty (before 8 years in girls and before 9 years in boys); the premature appearance of secondary sexual characteristics, accelerated growth rate, and advanced bone maturation
Precocious puberty causes disorder of gonads, adrenal glands, or hypthalmic-pituitary gonadal axis; no causative factor in 80-90% of girls and 50% of boys
Precocious puberty management Treatment of cause, Lupron injections (to slow prepubertal growth), psychologic support
Lupron action slows prepubertal growth to normal rates in patients with precocious puberty
Precocious puberty teaching Lupron admin; expected changes
Growth hormone (GH) deficiency inadequate production or secretion of GH by the hypothalamus, causing poor growth and short stature.
Growth hormone (GH) deficiency causes hypopituitarism, congenital malformations of the pituitary gland, brain tumors (most commonly craniopharyngioma), and cranial irradiation.
Hypopituitarism cause of growth hormone deficiency; children lacking more than one hormone produced by the pituitary gland
Growth hormone (GH) deficiency manifestations height less than 5th percentile, diminished growth rate, immature or cherubic facies, delayed puberty, hypoglycemia, diminished muscle mass with relatively increased body fat (adiposity), and micropenis (associated with hypopituitarism).
Growth hormone (GH) deficiency management replacement therapy: biosynthetic growth hormone and other hormone replacement as needed (thyroid extract, cortisone, testosterone or estrogens/progesterone)
Growth hormone (GH) deficiency teaching adherence to injections improves growth rate; growth monitoring; proper dilution and administration of GH
Diabetes Mellitus inability of body to produce or respond properly to the hormone insulin, resulting in malfunction of carbohydrate, protein, and fat metabolism
Type 1 diabetes juvenile-onset, insulin-dependent, not responsive to oral hypoglycemic medications, abrupt onset, present with DKA, not obese
Type 1 diabetes manifestations polyphagia (hungry), polydypsia (thirsty), polyuria, and unexplained weight loss despite increased food
Lispro/aspart classification rapid-acting insulin
Lispro/aspart onset/peak/duration onset: 5-15 min; peak: 30-90 min; duration: 5 hr
Regular insulin classification short-acting insulin
Regular insulin onset/peak/duration onset: 30-60 min; peak: 2-3 hr; duration: 5-8 hr
Isophane (NPH) classification intermediate-acting insulin
Isophane (NPH) onset/peak/duration onset: 2-4 hr; peak 4-10 hr; duration 10-16 hr
Glargine (Lantus) classification long-acting insulin
Glargine (Lantus) onset/peak/duration onset: 2-4 hr; peak: none; duration: 20-24 hr
Only insulin given IV Regular Insulin; used to treat DKA
Order of mixing insulin clear to cloudy
Type 2 diabetes non-insulin dependent, responsive to oral hypoglycemic medications, adult-onset, insidious onset, not prone to DKA, usually obese
Type 2 diabetes manifestations same as Type 1 without weight loss (polyphagia, polydypsia, polyuria)
Sulfonureas (glyburide or glipizide) action help beta cells of pancreas increase release of insulin
Biguanide (metformin) action “insulin sensitizer” reduces hepatic glucose production
Glitazones (Avandia) action enhances insulin action in skeletal muscle, adipose tissue, and liver; can decrease or eliminate the need for insulin in type 2 diabetics
Alpha-glucosidase inhibitors (acarbose) reduce rate of digestion of complex carbohydrates and subsequent absorption of glucose
Diabetic diet no concentrated sweets, constant carbohydrates, carbohydrate/insulin ratio, exchange diet, calorie restriction
Normal Preprandial (before meal) blood glucose in children 70-110 mg/dL
Preprandial (before meal) blood glucose goal for children with type 1 DM 90-180 mg/dL
Preprandial (before meal) blood glucose goal for infants and toddlers with type 1 DM 100-180 mg/dL
Metabolic Syndrome predicts development of type 2 DM and cardiovascular disease; an individual with at least three of: HTN, low HDL cholesterol, high serum triglycerides, elevated fasting blood glucose, and central obesity with increased waist circumference.
Complications of Diabetes hypoglycemia (< 70 mg/dL), hyperglycemia (> 180 mg/dL)
Hypoglycemia mnemonic “Cool and clammy, need some candy”
Hypoglycemia causes too much insulin, not enough food, exercise
Hypoglycemia management if severe, IM glucagon; fruit juice, carbonated soda, hard candy; follow with protein and complex carbohydrates (Dr. Pepper than Peanut Butter sandwich)
Hyperglycemia mnemonic “Hot and dry, sugar’s high”
Hyperglycemia manifestations extreme thirst, frequent urination, blurred vision, drowsiness, nausea, hunger
Hyperglycemia causes not enough insulin, larger than usual food intake, less exercise than usual, illness, stresses
Hyperglycemia management push sugar-free liquids, insulin, activity
diabetic ketoacidosis (DKA) Metabolic consequence of severe insulin deficiency; marked by hyperglycemia, acidosis, and ketosis.
DKA manifestations polyuria, polydypsia, headache, n/v, lethargy, tachycardia, weight loss, elevated WBC count, low BP, kussmaul respirations
Diabetes Complications microvascular: neuropathy, retinopathy, nephropathy; macrovascular: peripheral vascular disease, atherosclerosis
Type 1 DM sick-day management do not withhold doses, test levels q4hr, test for urine ketones, calorie-free liquids, follow usual meal plan, encourage rest, notify if n/v, fruity breath, kussmaul respirations, decreasing LOC, moderate/high urine ketones, persistent hyperglycemia
Type 1 DM sick-day foods popsicles, sports drinks, soup, fruit juice, regular soft drink, crackers, vanilla wafers, graham crackers, toast, mashed potatoes, gelatin dessert
Most common places for metastasis adrenals, liver, brain, bones, lungs
Cancer cardinal manifestations in children a mass, purpura, pallor, weight loss, whitish eye reflex, vomiting in early morning, recurrent/persistent fever, bone pain, HA, persistent lymphadenopathy, change in balance/gait/personality, fatigue/malaise.
Chemotherapy (antineoplastic agents) action nonselectively kills rapidly dividing cells, including cells of the hematopoietic system, gastrointestinal (GI) tract, and integumentary system
Chemotherapy side effects bone marrow suppression (neutropenia, anemia, thrombocytopenia); GI (n/v, anorexia, mucositis, espophagitis, constipation); hair loss
Nadir the time of the greatest bone marrow suppression when blood counts will be the lowest—generally occurs 7 to 14 days after chemotherapy administration, depending on the specific agent used.
Radiation side effects local erythema, fatigue (most common), anorexia, n/v, altered bone growth (<3yrs)
most common side effect of radiation therapy Fatigue is the most common side effect of radiation therapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers.
benefit of using an implanted port such as a Port-a-Cath Because this device is totally under the skin, there are no activity limitations for the child, except when the port is in use.
Most common form of cancer in children younger than 15 yrs leukemia
Leukemia an abnormal proliferation of immature WBCs (blasts), which compete with normal cells for space and nutrients, causing suppressed RBCs (anemia) and platelets (thrombocytopenia)
Leukemia manifestations fever, pallor, excessive bruising, bone or joint pain (usually leg/knee pain), lymphadenopathy, malaise, hepatosplenomegaly, abnormal WBC counts (either lower or higher than normal for age), and mild to profound anemia and thrombocytopenia
Leukemia manifestations r/t bone marrow involvement petechiae from lowered platelet count, infection from the decreased number of effective leukocytes, and fatigue from the anemia.
Lymphadenopathy Swelling of the lymph nodes detected by palpation.
Hepatosplenomegaly Enlargement of the liver and spleen detected by palpation of the abdomen.
Leukemia management combination chemotherapy
acute lymphocytic (ALL) an abnormality of the lymphocytes
acute nonlymphocytic leukemia (ANLL) a broad term for leukemias not originating from abnormal lymphocytes; includes acute myelocytic leukemia (AML)
Acute myelocytic leukemia (AML) an acute nonlymphocytic leukemia (ANLL) which can be further classified as acute promyelocytic leukemia (APL), acute myelomonocytic leukemia (AMMoL), and acute monocytic leukemia (AMoL).
Differentiating manifestations between ALL and ANLL (AML) ANLL tends to be less common in children, less responsive to therapy, more difficult to treat, and more likely to result in relapse than ALL.
Moderate to severe neutropenia (absolute neutrophil count) moderate: 500-1000; severe: <500
Neutropenic precautions avoid fresh flowers, potted plants, and fresh fruits and vegetables; avoid use of humidifiers; avoid contact with infectious individuals, careful handwashing and protective isolation (if WBC count drops significantly)
Thrombocytopenia (platelet count) <20,000/mm3
Thrombocytopenic precautions bleeding precautions: no razors, urine and stool checks for blood, limit high risk activity (contact sports), soft-bristled toothbrush, stool softeners (not suppositories), no sharp foods (chips)
Most common solid tumor of childhood brain tumor
Most common brain tumor in children cerebellar astrocytoma
Brain tumor manifestations vary with tumor location and the child's age and development. Seizures, morning headaches, vomiting (w/o nausea), behavior changes, eating/sleeping habit changes, lethargy, poor coordination/clumsiness, visual changes
Brain tumor management surgery, chemo, radiation, steroids, antiseizure meds, VP shunt (to relieve hydrocephalus), bone marrow transplant, supportive care, rehab, prophylactic antibiotics, continuous follow-up care
Brain tumor removal postoperative care observe for colorless drainage at the operative site which may be leakage of CSF; Careful assessment of the vital signs and monitoring for signs of increasing intracranial pressure
Hydrocephalus can be caused by brain tumors; an excessive accumulation of CSF in the ventricles of the brain
Hydrocephalus management ventriculoperitoneal (VP) shunt
VP shunt tubing diverts the CSF from the ventricles of the brain into the peritoneal cavity, where it is reabsorbed
VP shunt management monitoring for infection, obstruction, and pain, administering antibiotics and pain medications as ordered, and teaching the family how to change dressings and how to recognize shunt blockages or other problems.
lobe of brain responsible for smell frontal lobe
lobe of brain responsible for thought, reasoning, behavior, memory frontal lobe
lobe of brain responsible for movement frontal lobe
lobe of brain responsible for sensation parietal lobe
lobe of brain responsible for hearing parietal lobe
lobe of brain responsible for sensory prerception and spatial relations parietal lobe
lobe of brain responsible for speech, motion, and sensation left hemisphere of parietal lobe (for right-handed individuals)
lobe of brain responsible for abstract concepts right hemisphere of parietal lobe (or right-handed individuals)
lobe of brain responsible for vision occipital lobe
lobe of brain responsible for behavior, memory, hearing and vision pathways, and emotions temporal lobe
part of brain responsible for balance and coordination cerebellum
Site of sarcoma arises from soft connective tissue (e.g., pia mater)
site of astrocytomas cerebral hemispheres or midline structures
site of optic glioma optic nerve or chaism
site of craniopharyngioma adjacent to structure containing pituitary gland
site of brainstem glioma any portion of brainstem
site of infratentorial ependymoma in lining tissue of fourth ventricle
site of cerebellar astrocytoma cerebellum
site of medulloblastoma cerebellum
site of infratentorial tumors below the roof of the cerebellum
site of supratentorial tumors above the roof of the cerebellum
site of Pinealoma arises from suprasellar germ cells supporting or adjacent to the pineal gland
site of supratentorial ependymoma arises from lining tissue of lateral ventricles
site of meningioma arises from arachnoidal cells in the meninges, primarily dura
Malignant lymphomas neoplasms of lymphoid cells, a component of the immune system.
Non-Hodgkin Lymphoma (NHL) manifestations painless, enlarged lymph nodes in the cervical, axillary or inguinal areas; manifestations specific to area involved (abdominal disease, mediastinal disease, bone marrow disease)
Non-Hodgkin Lymphoma (NHL) manifestations (abdominal disease) abdominal cramping, constipation, pain, anorexia, weight loss, ascites, and obstruction, with vomiting as a late sign
Non-Hodgkin Lymphoma (NHL) manifestations (mediastinal disease) cough, respiratory distress, symptoms of bronchitis, and possibly significant tracheal deviation
Non-Hodgkin Lymphoma (NHL) manifestations (bone marrow disease) general decline in health and bone marrow suppression.
Non-Hodgkin Lymphoma (NHL) management children susceptible to tumor lysis syndrome, stabilize metabolic state with intensive hydration of an IV fluid containing bicarbonate (no potassium), administration of allopurinol or urate oxidase; once stable, chemo
Common electrolyte abnormalities in tumor lysis syndrome hyperkalemia, hyperphosphatemia, and hypocalcemia.
Burkitt lymphoma type of Non-Hodgkin Lymphoma; associated with Epstein-Barr virus
Hodgkin Lymphoma hallmark presence of giant multinucleated cells (Reed-Sternberg cells)
Hodgkin Lymphoma cause unknown, but associated with Herpesvirus 6, cytomegalovirus, and Epstein-Barr virus (EBV)
Hodgkin Lymphoma manifestations Painless, firm, movable adenopathy (lymph node enlargement) in the cervical and supraclavicular regions; fever, drenching night sweats, weight loss, hepatosplenomegaly, and fatigue.
Hodgkin Lymphoma management chemotherapy alone or chemotherapy and low-dose, involved-field radiation therapy. High-dose, extended-field radiation therapy alone may be used if the disease is detected in a single site or in older adolescents who are fully grown.
Most commonly diagnosed malignancy in infants neuroblastoma
Neuroblastoma an embryonal cancer of the sympathetic nervous system with presentation that ranges from very aggressive tumors that are unresponsive to treatment to tumors that spontaneously regress (generally in children younger than age 12 months).
Neuroblastoma causes 20% inherited mutation, followed by second mutation after birth OR two acquired mutations
Most common neuroblastoma abdominal
Neuroblastoma manifestations (abdominal tumor) primary abdominal mass and a protuberant, firm abdomen
Neuroblastoma manifestations (bone marrow tumor) impaired ROM and mobility with pain and limping
Neuroblastoma manifestations (chest tumor) cough and decreased chest expansion with respiratory compromise
Neuroblastoma manifestations (tumor causing superior vena cava compression) facial and periorbital edema
Neuroblastoma manifestations (tumor causing spinal cord compression) inability to walk and impaired bowel/bladder function
Neuroblastoma manifestations (face or head tumor) “raccoon eyes” (tumor infiltration); bruising, drooping eyelids or small pupils with “dancing” eye movements and myoclonic jerks
Neuroblastoma manifestations (tumor causing kidney compression) changes in urination, high BP
Neuroblastoma management radiation, surgery, chemo; good prognosis if diagnosed before 1yr
Most common primary bone malignancy in children osteosarcoma
Osteosarcoma also called osteogenic sarcoma; the most common primary bone malignancy in children; usually occurs in long bones (arms, legs, pelvis)
Osteosarcoma manifestations progressive, insidious, or intermittent pain at the tumor site; a palpable mass; limping, if a weight-bearing limb is affected; progressive, limited range of motion; and eventually pathologic fractures at the tumor site.
Osteosarcoma management surgery (biopsy, resections, bone/skin grafts, limb salvage procedures, reconstructions), amputation, chemotherapy, radiation
Ewing sarcoma second most common bone tumor seen in children occurring most commonly in the diaphysis of the femur, the tibia and humerus
Ewing sarcoma manifestations pain, soft tissue swelling around the affected bone, fever, anorexia, malaise, fatigue, and weight loss; neurologic symptoms (if vertebral) or respiratory symptoms (if rib tumor)
Ewing sarcoma management surgery, chemo, radiation, amputation, resections
Most common soft tissue malignancy in children Rhabdomyosarcoma
Rhabdomyosarcoma a malignancy of muscle or striated tissue that most often occurs periorbitally, in the head and neck in younger children, or in the trunk and extremities in older children.
Rhabdomyosarcoma manifestations (periorbital) visual changes are present; the child may have ptosis (drooping eyelid), exophthalmos/proptosis (bulging eyeballs); possible cranial nerve involvement
Rhabdomyosarcoma manifestations (extremities) limited ROM
Rhabdomyosarcoma manifestations (pelvic) function of organs around the tumor is disrupted
Rhabdomyosarcoma management chemotherapy, surgery, and radiation therapy
Most common type of kidney cancer Wilms tumor
Wilms tumor teaching Do not palpate the abdomen (causes tumor to seed and cancerous cells to spread)
Wilms tumor manifestations asymptomatic, mobile, abdominal mass, hematuria (blood in the urine), anemia, malaise, weight loss, and fever, clothing suddenly tight
Wilms tumor management surgery and chemotherapy alone or in combination with radiation therapy.
Retinoblastoma a rare, malignant tumor of the embryonic neural retina.
Leukocoria seen in retinoblastoma; white reflection in one of the child's eyes instead of the normal red color when the camera flash is reflected off the retina.
Retinoblastoma manifestations Leukocoria and strabismus resulting from vision loss, pain, redness, and inflammation of the eye.
Retinoblastoma management focal therapies alone for small lesions or in combination with multiagent chemotherapy for larger tumors; if doesn’t work, then External-beam radiation therapy; finally if no chance will have useful vision, an enucleation (removal of the eye)
Cancer effects on growth and development and nursing interventions (Infant) fear separation and strangers; provide consistent caretaker and minimize separation from parents and significant others
Cancer effects on growth and development and nursing interventions (Toddler) fear separation and loss of control; keep security objects at hand, minimize separation, and provide play opportunities
Cancer effects on growth and development and nursing interventions (Preschooler) fear bodily injury, loss of control, the unknown, dark, and being left alone; provide simple, concrete explanations and advance preparations using pictures, models, and medical play
Cancer effects on growth and development and nursing interventions (school-aged) fear loss of control, bodily injury, failure to live up to expectations, and death; provide choices, use pictures and models for explanations, reassure they’ve done nothing wrong
Cancer effects on growth and development and nursing interventions (adolescence) fear loss of control, altered body image, separation from peers; allow decision makers in care, give info sensitively, give choices, be honest, stress what they can do and importance of cooperation and compliance
Coombs test identifies neonates with blood group incompatibilities by evaluating for the presence of maternal antibody already bound to fetal erythrocytes
Blood transfusion therapy considerations verify identity and blood group, monitor VS, use appropriate filter and tubing, use blood within 30 mins of arrival, transfuse slowly for first 15-20 min (unless urgent), infuse over 4 hrs max, stop immediately for hemolytic or allergic reactions
Transfusion reactions hemolytic (most severe, but rare); febrile (fever/chills); allergic (urticaria, pruritus, laryngeal edema); air emboli (when transfused under pressure); hypothermia; and electrolyte disturbances (hyperkalemia from massive transfusions or renal problems)
Most sever transfusion reaction hemolytic
Most common type of anemia in children >6 mos iron deficiency anemia
Iron deficiency anemia manifestations pallor, irritability, fatigue (late manifestation in infancy), nail bed deformities, tachycardia, growth retardation, systolic heart murmur, developmental delay, pica
Pica an appetite for nonnutritive substances such as paper, cardboard, ice, or sometimes dirt.
Iron deficiency anemia management oral iron supplements (ferrous sulfate preferred as it is absorbed best), high iron diet, high protein and vitamin C (for new cells), folic acid (convert from ferritin to hemoglobin), fiber and water (for constipation from iron supplements)
Iron deficiency anemia teaching limit to 24 oz of milk/day, administer iron between meals, do not administer iron with milk (or other calcium), expect darker stools, and feed iron-rich foods
iron-rich foods liver, dried beans, Cream of Wheat, iron-fortified cereal, apricots and prunes (and other dried fruits), egg yolks, and dark-green leafy vegetables.
Sickle cell disease (SCD) generic term that refers to a group of genetic disorders characterized by the production of sickle hemoglobin (HbS), chronic hemolytic anemia, and ischemic tissue injury.
Sickle cell disease (SCD) crisis precipitating factors increased blood viscosity (dehydration), hypoxia, high altitudes, hypoventilation, vasoconstriction (when cold), emotional stress
vaso-occlusive crisis blood flow to tissues is obstructed by sickled RBCs, leading to hypoxemia and ischemia
Vaso-Occlusive crisis manifestations painful episode (joint or bone pain lasting a few hrs to days), acute chest syndrome, dactylitis, priapism, CVA
acute chest syndrome can be caused by Vaso-Occlusive sickle cell crisis; chest pain, fever, cough, abdominal pain
dactylitis can be caused by Vaso-Occlusive sickle cell crisis; swelling of hands or feet, pain, warmth in affected area
priapism can be caused by Vaso-Occlusive sickle cell crisis; persistent, painful erection
acute sequestration event blood flow from an organ such as the liver, lungs, or spleen is obstructed by sickled RBCs.
Acute sequestration event manifestation Decreased hemoglobin level, acutely ill-looking child, pallor, irritability, tachycardia, impressively enlarged spleen, hypovolemic shock
aplastic event either an increased destruction or decreased production of RBCs.
Aplastic event manifestations Pallor, lethargy, headache, fainting
Sickle cell anemia management manage symptoms: pain meds, IV fluids, O2, exchange transfusions, spleen removal, antibiotics
Sickle cell anemia teaching encourage fluid intake; expect frequent urination; provide rest periods; avoid cold and extreme heat, infections, and prolonged exposure to sun; monitor temp; administer penicillin; avoid aspirin; avoid travel to locations with decreased atmospheric O2
Hemophilia A deficiency of coagulation factor VIII.
Hemophilia B deficiency of coagulation factor IX, associated with a constellation of symptoms similar to hemophilia A
Hemophilia manifestations hemarthrosis (bleeding in muscles and joints, especially knees), deep tissue and IM hemorrhages, extensive bleeding after procedures (circumcision, tooth extraction), hematuria, ecchymosis, epitaxis (nose bleeds)
Hemophilia management recombinant antihemophilic factor; prevent excessive bleeding (soft bristled tooth brush, no rectal temps, electric razors, etc.)
Bleeding management for hemophiliacs rest, ice, compression, and elevation (RICE); topical coagulants and factor replacement as necessary
hemolytic disease of the newborn (HDN) maternal antibodies cross the placenta into fetal circulation and destroy fetal erythrocytes, resulting in fetal anemia (includes ABO and Rh incompatibilities)
hemolytic disease of the newborn (HDN) manifestations jaundice, anemia, hepatosplenomegaly (liver and spleen enlargement), hydrops fetalis (overwhelming fetal edema and cardiovascular collapse)
hemolytic disease of the newborn (HDN) management ABO incompatibility: aggressive hydration and phototherapy; Rh incompatibility: RhoGAM to suppress maternal immune response
Neonatal hyperbilirubinemia (also referred to as physiologic jaundice) is often a transient, benign disorder occurring during the first week of life.
Neonatal hyperbilirubinemia manifestations jaundice
Jaundice A yellowish brown staining of the skin and the whites of the eyes caused by high bilirubin levels in blood secondary to excessive erythrocyte breakdown, obstruction in or around the liver, or liver disease.
Kernicterus A form of jaundice in the newborn caused by elevated levels of unconjugated bilirubin in the blood secondary to an increase in RBC number and breakdown, and by jaundice-induced lesions in the cerebral gray matter that cause neurologic disorders.
Types of jaundice Hemolytic, Physiologic, and Breast-feeding jaundice
Neonatal hyperbilirubinemia management phototherapy, sun bathing (when only slightly low)
Normal bilirubin levels <12 (placed under bili-lights at 12-16)
first-line, or external, immune defenses intact skin and mucous membranes and processes such as sneezing, coughing, and tearing
antigen A substance that possesses unique configurations enabling the immune system to recognize it as foreign.
nonspecific immune functions Protective barriers, such as chemicals, interferon, inflammation, and phagocytosis, that are activated in the presence of an antigen but are not specific to that antigen.
specific immune functions Humoral (B cell and antibody production) and cell-mediated (T cell) responses that are activated in a highly discriminatory way to antigens that survive in the body.
antibody A protein that the immune system produces to bind to specific antigens and eliminate them from the body.
major organs and tissues of the immune system the bone marrow, thymus, spleen, lymph nodes, and lymphoid tissue
active immunity Protection that forms in response to exposure to natural antigens or vaccines; protection can last months, years, or a lifetime.
passive immunity Protection that occurs when serum containing an antibody is given or transmitted to a person who does not have that antibody.
HIV manifestations respiratory tract, ear, nose, & other infections; poor response to therapy; skin lesions; failure to thrive; chronic diarrhea; thrush; hepatosplenomegaly; anemia, thrombocytopenia, neutropenia; small/absent lymph nodes, tonsils, and adenoids
HIV management Newborns: ZDV IV to mother during labor and PO to newborn within 6-12 hrs of birth; PCP prophylaxis; Infants and children: Highly active antiretroviral therapy (HAART)
Allergy A hypersensitivity reaction in various body systems resulting from the immune system's response to exposure to an irritant (allergen).
Anaphylaxis a severe, immediate hypersensitivity reaction to an excessive release of chemical mediators which affects the entire body.
Anaphylaxis manifestations sneezing; tightness or tingling of the mouth or face, with subsequent swelling of the lips and tongue; Severe flushing, urticaria, and itching of the skin, especially on the head and upper trunk; Rapid development of erythema; A sense of impending doom
Anaphylaxis management epinephrine, diphenhydramine, corticosteroids, ensure airway, administer O2, keep warm and lying flat or with feet elevated, start IV
Evidence-Based Practice (EBP) the thoughtful integration of the best available evidence coupled with clinical expertise.
Length of time implementation of clinical research takes average of 17 yrs
Five Steps to Evidence-Based Practice formulating a well-built question, identifying resources, critical appraisal, applying the evidence, re-evaluation
PICO patient or problem; intervention; comparison intervention; outcomes
Infant nutrition teaching breast milk exclusively for first 6 mos; introduce solid foods at 4-6 mos; introduce new foods at 3-5 day intervals
Infant feeding difficulties regurgitation and “spitting up”; reflux/GERD; Colic (paroxysmal abdominal pain); failure to thrive
Toddler nutrition teaching “physiologic anorexia” (won’t eat) or only will eat specific foods; regular dental exams, plaque removal, fluoride, low-cariogenic diet; only need 4-6 oz of juice; only 16-24 oz of milk/day
Preschooler nutrition teaching require 90 kcal/kg/day, approximately 100 mL/kg/day fluids; childhood obesity concerns; 2 cups of milk/day
School-age nutrition teaching importance of balanced diet to promote growth; quality of diet related to family’s pattern of eating; fast-food concerns
Factors influencing adolescent’s diet busy schedule; body image concerns; skipping breakfast; eating away from home; eating fast food frequently; beginning to buy and prepare food; peer pressure; psychological and emotional problems
Improving absorption of feeds use of pacifier during alternative feeds; quiet, calm environment; consistent feeding
TPN used when GI feeding isn’t possible; administered through central line; IL to help gain weight infused often with TPN
Failure to thrive weight <5th percentile; height WNL
Organic failure to thrive inadequate caloric intake or absorption; increased metabolism; defective utilization
Nonorgantic failure to thrive outside factors such as neglect, abuse, or mixing formula wrong
Calculation for required calories (RDA for weight age (kcal/kg) x ideal weight for height)/ actual weight
Obesity increase in body weight due to accumulation of excessive body fat relative to lean body mass; > 95th percentile (overweight: 84-95th percentile)
Obesity teaching don’t use food as reward; consistent meal and snack times; only healthy food options; avoid unhealthy food; be a role model; encourage fun, physical activities with the family; praise for making appropriate food choices and for increasing activity
Obesity interrelated influences metabolic (polycystic ovary syndrome, Cushing syndrome), hypothyroid, hereditary, social, cultural, psychologic
Effects of childhood obesity increase in type 2 diabetes and insulin resistance; risk of adult obesity; HTN, hyperlipidemia, cardiovascular disease; pulmonary effects; musculoskeletal; psychologic and social complications
Obesity management diet, exercise, behavior modification; pharmacologic agents; bariatric surgery
Erikson’s Stage for Adolescence Identity vs. Role Confusion: Begins to develop a sense of “I”; this process is lifelong; peers become of paramount importance; child gains independence from parents; characterized by faith in self.
Piaget’s Stage for Adolescence Formal operations: New ideas can be created; situations can be analyzed; use of abstract and futuristic thinking; understands logical consequences of behavior.
11-20 year milestones emotional & social turmoil, opposite-sex relationships, adult fine motor control, future oriented, coordinated muscle control
initial indication of puberty in boys testicular enlargement
initial indication of puberty in girls appearance of breast buds (thelarche)
Age puberty begins in boys 9 ½ to 13 ½ yrs
Age thelarche (breast development) occurs 8-11 yrs
Age menarche usually occurs 9-15 yrs; approximately 2 years after the beginning of secondary sexual characteristics
Car safety teaching for adolescents supporting driver education programs for teenagers and the use of seatbelts, and discouraging teens from using a cell phone or texting while driving.
Water safety teaching for adolescents encouraging swimming lessons, water safety classes, and the completion of a course in cardiopulmonary resuscitation.
Suicide teaching for adolescents counsel parents that all adolescent suicidal gestures should be taken very seriously.
Neglect Deliberate failure to provide for a child's physical, educational, or emotional needs
Physical neglect deprivation of food, clothing, shelter, supervision, medical care, and education
Emotional neglect lack of affection, attention, and emotional nurturance
Physical abuse typical perpetrator a direct relative of the child, usually the mother (40%) or father (20%), or both parents (18%)
Sexual abuse typical perpetrator family friend or neighbor (75.9%); males who may have mental health issues, cognitive distortions (rationalizing behavior), social skills and empathy deficits, and decreased coping skills; many were abused during childhood or adolescence
Indicators of physical abuse appearance of bruises, especially bruises in various stages of healing, bite marks, burns in unusual locations (e.g., back, palms of the hands), or signs and symptoms of skeletal injury (e.g., multiple bone fractures).
Indicators of emotional abuse delays in physical and emotional development; behaves in ways that are too adult in relation to the child's age (e.g., being protective of others), or too immature for age; Behavioral extremes (e.g., overly aggressive or overly compliant) are not unusual.
Indicators of sexual abuse difficulty walking/sitting and complain of pain on urination or in the genital area; urinary accidents; sleep disturbances, decreased appetite, sudden refusal to participate in physical activities, aggression; use of sexual language; promiscuity
Shaken baby syndrome manifestations intracranial bleeding, retinal hemorrhages, fractures of ribs and long bones, no signs of external injury
Munchausen syndrome by proxy caregiver fabricates signs and symptoms of illness in child (the proxy) to gain attention from medical staff
Chronic diseases that mimic child abuse mongolian spots (collections of pigment deep in dermis that give appearance of bruising); osteogenesis imperfecta (abnormally fragile bones that fracture easily)
Goals in Terminal Care partner with patient and parent; pain management
autism spectrum disorders Developmental disorders characterized by impairment in communication skills, social interaction, repetitive and stereotyped patterns of behavior; one group of pervasive developmental disorders.
Autism differentiating manifestations (from schizophrenia) onset < 54 mos, no remissions, hallucinations and delusions are rare, absence of thought disorder, no family hx of schizophrenia, self-stimulating behaviors, medications of limited use
Fragile X syndrome (FXS) primarily affects males; most common inherited cause of cognitive impairment, and the most common known genetic cause of autism, although the syndrome may present with or without autism.
Rett Syndrome exclusively linked to females; autism spectrum disorder; mutations on the X chromosome cause stereotyped hand movements, gait disturbances, slowing of normal rate of head growth, seizures, and disorganized breathing patterns.
CHAT screening tool CHecklist for Autism in Toddlers
Autism manifestations disinterested in & stiffins when being held or cuddled, avoids eye contact, poor language development, minimal facial responsiveness, appears not to hear when being spoken to, abnormal activities (head banging), does not engage in social play with others
Autism considerations decrease stimuli, maintain safe environment, maintain routines, encourage activities and specialized educational programs
emotional disorders Disorder of mood (depression) and anxiety disorders
Separation anxiety Distress and apprehension caused by being removed from parents, home, or familiar surroundings.
School refusal Persistent reluctance or refusal to go to school or elsewhere who complain of physical symptoms, cry, bargain, plead, or even exhibit panic symptoms as school time approaches.
Panic disorder anxiety disorder distinguished by rapid onset of physical, cognitive, and emotional symptoms.
Posttraumatic stress disorder a disabling psychosocial disorder that follows a traumatic or overwhelming experience.
Obsessive-compulsive disorder repetitive unwanted thoughts (obsessions) or ritualistic actions (compulsions), or both.
Major depressive disorder (MDD) a debilitating and severe depression, creating significant risk factors.
dysthymic disorder (DD) a chronic lowered level of mood that is persistent; generally able to continue overall functioning, but energy and motivation may be low
Bipolar disorder chronic, fluctuating, and extreme mood disturbances.
Attention deficit-hyperactivity disorder (ADHD) problem with inattentiveness, overactivity, impulsivity, or some combination that is out of normal range for child’s age and development
Female athlete triad eating disorder (anorexia or bulimia), amenorrhea (no period), and osteoporosis (brittle bones)
SCOFF mnemonic Makes self SICK, loss of CONTROL, loss of ONE stones worth of weight, belief that they are FAT; FOOD dominates life
Eating disorder complications osteoporosis, cardiac issues, GI dysfunction, endocrine and electrolyte imbalances (hypokalemia, metabolic alkalosis, infertility), dental erosions, enlarged salivary glands
refeeding syndrome complication of treatment for eating disorders; replenishes electrolytes too quickly and causes cardiac arrhythmias, cardiac arrest, and delirium
anorexia nervosa Intense preoccupation with and unrelenting fear of obesity and a disturbed body image (weight, size, or shape) that is obviously contrary to reality
anorexia nervosa manifestations severe weight loss (at least 15% below expected weight); altered metabolic activity: amenorrhea, bradycardia, decreased BP, hypothermia, cold intolerance, dry skin, brittle hair and nails, appearance of lanugo
anorexia management life-threatening: IV tube feedings, behavior modification, long-term treatment and management
bulimia nervosa recurrent episodes of rapid, compulsive, uncontrolled (binge) eating linked to purging; use of use of strategies to prevent weight gain (self-induced vomiting; use of laxatives, diuretics, or emetics; fasting; vigorous and excessive exercise)
bulimia nervosa manifestations mostly within normal weight percentiles; tooth erosion, esophageal damage, other GI concerns, psychologic issues: self-deprecating thoughts, depressed mood, history of unsuccessful dieting, overweight in childhood, low impulse control
Binge eating disorder mostly overweight; recurrent episodes of rapid, compulsive, uncontrolled (binge) eating NOT linked to purging
Created by: CocoDiva