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Pedi Blueprint

Pedi Test 3 Blueprint

Otitis media the eustachian tube is a connection between the nasal passages and the middle ear. The eustachian tube is wider, shorter, and straighter in the infant, allowing organisms from respiratory infections to travel into the middle ear to cause infection.
Common Treatment for Otitis media antibiotics, a 10-day course of amoxicillin. Chronic otitis media kids can be put on prophylactic course of penicillin or solfonamide.
Primary nursing responsibility for otitis media teach family caregivers about prevention and the care of the child
Prevention of Otitis Media 1 Hold infant in upright position or with head slightly elevated while feeding, to prevent formula from draining into the middle ear through the wide eustachian tube. Never prop a bottle.
Prevention of Otitis media 2 Do not give infant a bottle in bed, pretect child from exposure to others with URI, Protect child from passive smoke, Remove sources of allergies, Be aleart to signs of hearing difficulty, Teach about gentle nose blowing.
Watch for signs of ear infection in children: shaking head, rubbing or pulling ears, fever combined with restlessness or screaming and crying.
Care of child with otitis media Have child with URI who shows symptoms of ear discomfort checked by doctor. Complete the entire amoutn of antibiotic prescription. Use heat to provide comfort. Soothe, rock, and comofrt child. Give pain meds (not aspirin). Provide liquid or soft foods.
Signs of hearing impairment inability to locate a sound and turning of the head to one side when listening, failing to comprehend when spoken to, gives inappropriate answers, consistenlty turns up the volume. cannot whisper.
Slight Hearing Loss Unable to hear whispered word or faint speech. No speech impairment present. May not be aware of hearing difficulty. Achieves well in school and home by compensating.
Mild Hearing Loss Beginning speech imparment may be present. Difficulty hearing if not facing speaker, some difficulty with normal conversation.
Moderate hearing loss Speech impairment present; may require speech therapy. Difficulty with normal conversation.
Severe hearing loss Difficulty with any but nearby loud voice. Hears vowels easier than consonants, requires speech therapy for clear speech. May still heart loud sounds.
Profound Hearing Loss Hears almost no sound.
Amblyopia dimness of vision from disuse of the eye, which is also sometimes called lazy eye.
Strabismus the failure of 2 eyes to direct their gaze at the same object simultaneously. This condition is commonly called "squint" or "cross eyes"
Treatment depends on the type of trabismus present, in monocular strabismus, occlusion of the better eye by patching to force the use of the deviating eye should be initiated at an early age.
Reye Syndrome is characterized by acute encephalopathy and fatty degeneration of the liver and other abdominal organs. All-ages. Occurs after a viral illness - particularly URI or Chickenpox.
How to prevent Reye Syndrome Administration of aspirin during the viral illness has been implicated as a contributing factor. So. Don't give kids aspirin.
Reye Syndrome Symptoms Stage 1 Lethargic, follows verbal commands, normal posture, purposeful response to pain
Reye Syndrome Symptoms Stage 2 Combative or stuporous, inappropriate verbalizing, normal posture
Reye Syndrome Symptoms Stage 3 Comatose, decorticate postuirea and response to pain
Reye Syndrome Symptoms Stage 4 Comatose decerebrate posture, and response to pain
Reye Syndrome Symptoms Stage 5 Comatose, flaccid, no pupillary response, no response to pain
Decerebrate Posturing the arms and legs are out straight and rigid, the toes point downward, and the head arches backward (stage 4 Reye Syndrome)
Decorticate Posturing the body is rigid, the arms out straight, the fists are tight, and the legs are straight out (stage 3 Reye Syndrome)
In children between the age of 6 months and 3 years, febrile seizures are the most common. These occur in the form of a generalized seizure early in the course of a fever. Normally associated with High fever, some children appear to have a low seizure thresh hold and convulse when a fever of 100 to 102. Often the symptom of acute infection somewhere int he body.
Nursing Diagnosis during Seizures Risk for apsiration, Risk for inury, Compromised family coping, Deficient family knowledge.
Simple Partial Seizures localized motor activity such as shaking of an arm, leg or ther body part. Loss of consciousness or awareness may not occur.
Complex partial seizures begin in a small part of the brain and change or alter consciousness. They cause memory loss and staring. Nonpurposeful movements such as hand rubbing, lip smacking, arm dropping and swallowing may occur. Child is often unaware of seizure.
Tonic-Clonic Seizure Have four stages: the prodromal period (lasts for hours or days); aura (warning immediately before seizure; tonic clonic movements; and postictal stage. not all occur with every seizure. it may begin with a sudden loss of consciouisness.
Absence seizures rarely last longer than 20 seconds. Child loses awareness and stares straight ahead but does not fall. They can occur frequently, sometimes 50-100 times a day. Child is not aware it is happening.
Atonic or Akinetic Seizures sudden momentary loss of consciousness, muscle tone, and postural control and can cause the child to fall.
Myoclonic seizures characterized by a sudden jerking of a muscle or group of muscles often in the arms or legs without loss of consciousness. occur during the early stages of falling asleep in people who do not have epilepsy.
infantile spansms occur between 3 and 12 months of age. they almost always indicate a cerebral defect and have a poor prognosis despite treatment. Muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. LOC does not always occur.
Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes or a series of seizures in which the child does not return to his or her previous normal loc. immediate treatment decreases likelihood of permanent injury.
Be aware that the drug Phenytoin (Dilantin) can cause hypertrophy of the gums after prolonged use. encourage good oral hygiene and frequent dental checkups.
During the seizure note the following: time the seizure started, what the child was doing, any factor present just before seizure, part of body where it began, movememnt involved, any cyanosis, eye position/movement, Incontinence?, Time seizure ended, Childs activity afterward.
Be sure to ask. The child may be able to describe the aura or sensation that occured just before a seizure
Status epilepticus is an emergency situation and requires immediate treatment. The drugs diazepan, given rectally or IV and lorazepam are used to treat the condition.
Precautions before a seizure swim w companion, Use helmet and padding, supervise with power equipment, Carry or wear med id bracelet, Discuss condition with teachers and school nurse, Know what triggers the seizure.
Precautions During a seizure stay calm. Move objects that would cause injury. Turn on side with head turned to one side. Remove glasses. Protect head. Do not restrain. Do not put anything between teeth. Keep people from crowding. Notify doctor. If status epilepticus, call 911.
Cerebral Palzy is a group of disorders arising from a malfunction of motor centers and neural pathways in the brain. Often accompanied by seizures, mental retardation, sensory defects and behavior disorders.
Spastic Type of Cerebral Palsy is the most common type and is characterized by: A hyperactive stretch reflex in associated muscle groups, increased activity of deep tendon reflex, Clonus (rapid involuntary muscle contraction/relaxiont), Contractures affecting the extensor muscles, especially the heel cord, Scissoring.
Athetoid Type of CP is marked by involuntary, ucoordinated motion with varying degrees of muscle tension. Children with this disorder are constantly in motion. Avg to above avg intelligence and hearing loss is common. Facial grimacing, poor swallowing, and tongue movements.
Ataxic type of CP is essentially a lack of coordination caused by disturbances in the kinesthetic and balance sense. The least common type of CP: gait is awkward and wide-based.
Rigidity type of CP is uncommon and characterized by rigid postures and lack of active movement.
Mixed Type of CP is children with sigsn of more than one type of CP termed mixed type are usually severely disabled. The disorder may have been caused by postnatal injury.
Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord, called the meninges. There are several types of meningitis.
The most common form of meningitis is viral you get when a virus enters the body through the nose or mouth and travels to the brain.
Bacterial meningitis is rare but can be deadly it usually starts with bacteria that cause a cold-like infection. It can block blood vessels in the brain and lead to stroke and brain damage. It can also harm other organs. Pneumococcal infections and meningococcal infections can cause bacterial meningitis.
The onset of meningitis may be either gradual or abrupt after a URI. Children may have a characteristic high pitched cry, fever, and irritability.
More S/S of meningitis Nuchal rigidity stiff neck that may progress to opisthotonos (arching of the back) and delirium. Projectile vomiting, convulsions, coma, purpuric rash.
Conjuctivitis is an acute inflammation of the conjunctiva. In children a virus, bacteria, allergy or foreign body may be the cause. Commonly caused by bacterira
Antibiotic ointment may help prevent conjunctivitis.
Erythromyicin, bacitracin, sulfacetamide, and polymyxin are often used to treat bacterial eye infections
bacterial conjunctivitis is treated with ophthlamic antibacterial agents, eye drops are used during the day and ointments at night. warm moist compresses help remove crusts, seperate washcloths, towels, and disposable tissues.
Treatment for laryngospasms humidified air, sitting with the child in the bathroom with the hot shower running (creating steam) and then running out into cold air.
Tonsillectomy Nursing diagnoses risk for aspiration postop related to impaired swallowing; acute pain; fdeficient fluid volume; deficient knowlddge related to caregivers understanding of postop home care/complications
The major postop goals for tonsillectomy include preventing aspiration, relieving pain, esp while swallowing, and improving fluid intake. The major goal is to increase family knowledge and understanding.
Postop tonsillectomy assessments VS Q10-15 minutes until the child is fully awake and then Q30m-1hour. Observe the pharynx with a flashlight. Bleeding may be present within 24 hours after surgery and the 5th postop day.
Croup is not a disease but a group of disorders typically involving a barking cough, hoarseness, and inspiratory stridor (shrill, harsh respiratory sound). The disorders are named for the respiratory structures involved. Acute laryngotracheobronchitis, for instance affects the larynx, trachea, and major bronchi.
Croup-like disease Spasmodic laryngitis, acute laryngotracheobronchitis, and epiglottitis.
Acute laryngotracheobronchitis s/s child develops hoarseness and a barking cough with a fever that may reach 104-105. As the disease progresses marked laryngeal edema presents and childs breathing becomes difficult, the pulse is rapid and cyanosis may appear. heart failure maybe.
Acute laryngotreacheobronchitis Nursing care Maintain an airway adequate for air exchange. Antimicrobial therapy is ordered. Child in a supersaturated atmosphere (croupette, mist tent). Nebulizers, careful observation.
Epiglottitis s/s epiglottis becomes inflamed and swolen with edema. results in blockage of airway and creates an emergency. Child is very anxious and assums the "tripod" position w mouth open tongue out. High fever, Previous URI, drooling.
Epiglottitis Nursing care endotrach intubation or tracheostomy. Moist air. Pulse oximetry to monitor oxygen requirements. antibioticis. not common.
Spasmodic laryngitis S/S runny nose(coryza), hoarseness, bark-like cough, increasing respiratory difficulty, stridor, anxious restless, and hoarseness. low grade fever and mild uri may be present.
The onset of an asthma attack can be very abrupt or can progress over several days as evidenced by dry hacking, cough, wheezing, and difficulty breathing. Often occur at night and awake the child from sleep. They may be short or may continue for days. Thick, tenacious mucus. coughing . wheezing.
Family teaching tips for respiratory infections. Clear nasal passage with a bulb syringe for the infant. Feed the child slowly. Frequently burp. Offer extra fluids. Leave the child in mist tempt except for feeding and bathing. Sooth and comfort in croupette and mist tent. Follow RI control precautions and hand washing. Discourage infectious people from visiting. Use humidifier. Clean humidifier.
RSV Nursing Diagnoses Activity intolerance (insufficient energy), anxiety (parents usually), hyperthermia (high temp), altered nutrition (insufficient), ineffective airway clearance (inability to clear secretions), ineffective breathing pattern, infection, fluid vol deficit
Rheumatic Fever S/S Onset is slow and subtle, listless, anorectic, pale, lose weight and complain of vague muscle, joint, or abdominal pains. low grade late afternoon fever. Major symptoms: Carditis, polyarthritis, and chorea (emotional instability).
Rheumatic Fever Diagnoses The Jones Criteria: Presence of two major symptoms or one major and one minor.
Kawasaki Signs/Symptoms Elevated temperature, irritability, lethargy, inflammation in the conjunctiva in both eyes, strawberry tongue, dry red cracked lips, edema in hands and feet, red swollen joints, skin on fingers and toes peels, rash on the trunk and extremities, abdom pain
Digoxin Toxicity Above levels of .8 Causes confusion, irregular pulse, loss of appetite, nvd, palpitations, visual changes
VSD ventricular septal defect one or more holes in the wall that seperates the right and left ventricles of the heart. most common congenital heart defect.
VSD S/S SOB, fast breathing, hard breathing, paleness, failure to gain weight, fast heart rate, sweating while feeding, frequent respiratory infections.
ASD Atrial septal defect congenital heart defect in which the wall that seperates the upper heart chambers (atria) does not close completely.
S/S ASD Difficulty breathing (dyspnea), frequent respiratory infections in children, sensation of feeling the heart beat (palpitations), shortness of breath with activity.
PDA patent ductus arteriosus the ductus arteriosus does not close.
S/S PDA fast breathing, poor feeding, rapid pulse, sOB, sweating while feeding, tiring very easily, poor growth
Congenital heart defects are passed genetically from parent to offspring while acquired are acquired after birth.
Defining symptom indicating coarctation of the aorta rib notching
Why is squatting important in tetralogy of fallot? In the past, on experiencing fatigue, breathlessness, and increased cyanosis, the child was described as assuming a squatting posture for relief. Squatting apparently increases the systemic oxygen saturation.
Babies with an inordinate fondness for milk can take in an astonishing amount and with their appetities satisifed, show little interest in solid foods. These babies are prime candidates for iron deficiency anemia. They have pale almost translucent skin and are chubby and susceptible to infection.
Iron deficiency anemia treatments improved nutrition with ferrous sulfate administered between meals with juice. Iron-dextran mixture for IM use id administered should be given in vastus lateralis via Z-Track method.
Common complication of thalassemia iron overload due to frequent transfusions
Hemophilia A treatment Concentrates of clotting factor VIII are slowly administered to replace the missing clotting factor that is missing or low.
Sickle Cell Anemia Prevention of Crises adequate hydration is vital. fluid intake of 1500-2000mL daily is desirable for a child weighing 20kg and should be increased to 3000mL during the crisis. Avoid strenuous activity. Avoid high altitudes. Small blood transfusions help.
With easy bruising, expected lab value low platelet counts
A positive, nonjudgemental attitude when working with family cargivers of children with failure to thrive can have a direct and lasting effect on the familys interaction with their child.
S/S of nonorganic filure to thrive rumination (voluntary regurgitation), perhaps as a means of self-satisfaction, listless, seriously below afverage weight and height, poor muscle tone and loss of subq fat and immobile for long periods of time, unresponsive to cuddling and vocalization
Nursing care of Nonorganic failure to thrive child focus on improving alertness and responsiveness, increasing caoloric and oral fluid intake, maintain normal urinary and bowel elimination and maintain skin integrity. Improve parenting skills and and parental confidence.Feed slowly. Attempt cuddling.
substance abuse is the misuse of an addictive substance that changes the users mental state. The addictive substances commonly abused are tobacco, alcohol, and controlled or illicit drugs.
Warning signs in childrens behavior of suicide previous attempt. thoughts of wishing to kill self. plans. feeling down in dumps. withdrawal. loss of pleasure. change in activity. poor concentration. complaints of headaches. change in eating.
ADHD Characteristics impulsiveness, easy distractability, frequent fidgeting, difficulty sitting still, probleems following through, nattentiveness, frequent losing of things, going from one uncompleted activity to another, frequent excessive talking, dangerous activities
Created by: christinego