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RN Program PEDS

Who can give informed consent for a child? parent of the child
How children respond to illness depends on their what? age, cognitive level, and past experiences
what are the three stages of infant separation anxiety? protest-crying, angry. Despair-sad, depressed detachment-ignoring parents
what are some behavioral models for toddlers (1-3 years old)? Parallel play Separation anxiety Interrupted routine and rituals/ Loss of control Fear of injury and pain/ Fear of being hurt
what are specific concerns r/t a toddler? Injury prevention, toilet training, personality and temperament, communication skills
how old are preschoolers? 3-6 years old
what is the mindset of a preschooler r/t hospital and healthcare? Understand illness but not its cause Concept of body limited Fear of mutilation, pain, & bodily injury Separation anxiety Loss of control Fear change
age of school age child 6-12
behaviors of school age child Have a more realistic understanding of the reasons for illness Able to comprehend concepts of time Fear of injury Fear of losing control Fear separation from friends, pets, & family
Interventions with School- Age children School work Encourage communication Allow decision-making Appropriate activities Same sex roommates A place to be with other kids can seperate from parents
behaviors of adolescents Concerned with body image Fear of a loss of independence Fear of losing emotional control More aware of the causes of illness and injury Privacy and modesty Peer group Normal clothes Preparation still important Adol units Visitors “slumber party
what does a case manager do? Coordinates care Prevents gaps & overlaps
how is med administration different from a child to an adult? Sublingual not feasible GI system immature Smaller muscle mass Large BSA Thin epidermis Poor peripheral circulation Immature liver & kidney Immature blood brain barrier Increased metabolism of drugs
what techniques can be used for effective oral intake? Small frequent sips Sippy cups Straws Offer favorites Fruit juices can sting/upset Glass of ice chips/ ½ volume of water
how do you measure the length up to the age of 2 years old lying down
how much of an increase in lenght in the first year 50% increase
normal pulse rates and resp rates on pg 196 of HESI book DANG!
what organism is the primary cause of epiglottitis? H. influenae - mostly type B
what position would you expect to see a child in that has epiglottitis? "tripod postition"- sitting upright with chin our and tongue protruding.
nursing interventions r/t epiglottitis Hib vaccine, maintain upright sitting position, prepare for intubation or tracheostomy, IV antibiotics, ICU/PICU, restrain to prevent extubation, decrease stressors/agitation & crying
True or False: it is ok to examine the throat of a ped with epiglottits. FALSE! DO NOT examine the throat!
what is bronchiolitis and what is it usually caused by? viral infection of the bronchioles that is characterized by think secretions: RSV
describe purpose of bronchodialtors reverse bronchospasms
what kind of things would you look for during an assessment of a pt w/ bronchiolitis? Upper rest symptoms, irritability, paroxysmal coughing, poor eating, nasal congestion, nasal flaring, wheezing, rales, shallow rapid resp.
what does an opening between the atria permit? Atrial septal defect left to right shunting. oxygenated blood from the left atrium is shunted to the right atrium and lungs
how will a "tet spell" be relieved by a child? squatting position or knee to chest
what is the therapuetic level for Digoxin? 0.8 - 2.0
developmental milestones for r/t birth - 1 year birth weight x2 by 6 mos, and x3 by 12 mos, posterior fontanel closes by 8 wks, social smile, head turn to locate sound @ 3 mos, rolls from abdomen to back, peek-a-boo, sits unsupported, crawls, waves bye bye, walks 10-12 mos,"mama/dada".
what is erickson's theory r/t birth - 1 year? trust vs mistrust
what kind of toys would you find for infants? mobiles, rattles, squeaking toys, picture books, balls, colored blocks, activity boxes
when does birth length double? 4 years
when does child sit unsupported? 8 mos
when does child get to 50% of adult height? 2 yrs
when does a child throw a ball overhanded? 18 mos
when does a child speak 2-3 word sentences 2 y/o
when will a child tie their shoes? 5 years
T/F: a girl's growth spurt during adolescence begins earlier than a boy's? TRUE - as early as 10 y/o
when will a child form his/her identity and rebell against family values? adolescence
temper tantrums are common at what age? Toddler
examples of toddler behaviors: 1-3 years old birth weight x3 by 30 mos, 50%of adult height by 2 y/o, growht velocity slows, bowlegged, potbellied, primary teeth(20) present, feeds self w/spoon @2 y/o, toilet trng starts, knows name by 3 y/o, temper tantrums.
what is the erickson theory at the toddler age? autonomy versus doubt and shame
what is the greatest threat to toddler's psychological and emotional integrity? separation from parents
toys for a toddler board and mallet, push-pull toys, toy phones, stuffed animals, storybooks,
what kind of explanation would you give a toddler about procedures? very basic
milestones for preschoole children 3-6 years old 5 lbs of growth, 2 1/2 - 3 inches, stands erect, more slender, run, jump, skip, hop, ride a tricycle, uses scissors, tie shoes, learns colors and shapes, vision is 20/20, egocentric and concrete thinking, 5-8 word sentences, curiosity of sexuality
milestones for preschool children cont'd imaginary playmates and fears are common, aggressiveness @4 y/o replaced by independence @ 5 y/o
erickson's theory r/t preschool children Initiative vs guilt
how would you explain to a preschoold child about their illness? he/she did not cause illness, painful procedures are not punishment, use simple words
what kind of play is useful r/t a preschooler? therapeutic play or medical play that allows child to act out experiences
what kind of toys are good for a preschooler? coloring books, puzzles, cutting and pasting, dolls, building blocks, clay
what task could a 5 y/o diabetic boy be expected to accomplish? let him choose injection site is on example
developmental milestones for a school-aged child 6-12 years each yr child gains 4-6 lbs
developmental milestones for 6-12 year olds 4-6 lbs, 2 inches in height, girls=menarche, loose primary teeth, fine/gross motor skills increase, can dress self, egocentric thinking replaced by social awareness, tell time, understandes cause and effect, molars erupt(6y/o)
erikson's theory for school age children Industry vs inferiority
r/t school, what is important to a school age child? maintaining contact w/ peers and school activities
how do you explain procedures to a school aged child? explanation is important. learn from verbal, pictures, and books, and handling equipment
Are school aged children concerned with modesty? YES. close curtains during procedures
T/F: you would include a school aged child in the planning of care with staff to foster sense of involvement and accomplishment True
Toys for school aged children board games, card games, hobbies: stamp collecting, puzzles, video games
developmental milestones for adolescents 12-19 y/o girl's growth spurt earlier, boys catch up on growth spurt around 14y/o, girls finish growing @15y/o / boys @ 17y/o, secondary sex characteristics develop, family conflicts begin.
erikson's theory r/t adolescents: identity vs role confusion
how does an infant see bodily injury? they remember pain
how does a toddler see bodily injury? they fear intrusive procedures
how does a preschooler see bodily injury fear bodily mutilation
how does a school aged child see bodily injury? fear loss of control of their bodies
how does an adolescent see bodily injury? major concern in change in bodily image.
what are nonverbal signs of pain grimacing, irritability, restlessness, difficulty sleeping or feeding
what are physiologic responses to pain? increased heart rate, RR, diaphoresis, and decreased o2 levels.
what pain scale will you use for children 1-3 mos old? Pain Rating scale
what pain scale would you use for a preschool and older pts? Face Pain Scale, Poker Chip Scale
At what age would you start using the number pain scale? 9 and older
when would you use the FLACC scale? a nonverbal child
nonpharmacologic interventions for infants pacifiers, holding, rocking
nonpharmacologic interventions for toddler and preschoolers Distraction - books, music, TV, bubbles
nonpharmacologic interventions for school aged child and adolescents guided imagery
at what are a children being taught to use a PCA? 5
what are normal side effects after an immunization? irritability, fever <102, redness, soreness at injection site x 2-3 days
how is Rubeola (measles) transferred? droplets from infected person
s/s of measles fever, upper resp symptoms, photophobia, Koplik spots on buccal mucosa, confluent rash begins on face then spreads downward
lesions begin on trunk and spread to other areas of body, progresses through macular, papula, and vesicular, and pustular stages chicken pox
common viral disease that has teratogenic effects of fetus during the 1st trimester of prego,, discrete red maculopapular rash that starts on face and rapidly spreads to entire body Rubella - German measles
what are some complications of Pertussis? pneumonia, hemorrhage, seizures
T/F: it is ok to give milk products while giving Iron medication. FALSE
s/s include fever, headache, malaise, parotid gland swelling and tenderness, manifestations include submaxillary and sublingual infection, orchitis and meningoencephalitis paramyxovirus (mumps)
what are nursing care for children w/ communicable diseases? isolate them, treat fever w/ NON-Aspirin product, report to health dept, no scratching-cut nails, mittens, benadryl, wash hands!
what mineral defiviency occurs most commonly in children, adolescents, and childbearing women? Iron
what measurements reflect past nutrition? height and head circumference
what measurements reflect present nutrition? weight, skinfold thickness, arm circumference
what can be used to determine nutritional status? plasma, blood, urine, tissues from liver, bone, hair, or fingernails
what lab values would you look at to determine nutritional status? Hgb, Hct, albumin, creatinine, nitrogen
signs of dehydration poor skin turgor, absence of tears, dry muscous membranes, weight loss (5%-15%), sunken fontanels, decreased urine/urine specificity
lab signs of acidosis r/t fluid loss < bicarb <7.35, < NA & K, > Hct, > BUN
T/F: give a child with diarrhea Immodium AD. FALSE - NO Imm AD
good food sources of Iron high-protein cereral, rice cereal, liver, beef, pork, eggs
good food source of Vit B2 Liver, cow's milk, cheddar cheese, some green leafy veges(brocc, green beans, spinach,) enriched cereals.
good food source of Vit A liver, sweet pots, carrots, spinach, peaches, apricots
good food sourcs of Vit C strawberries, oranges, tomatoes, broccoli, cabbage, cauliflower, spinach
good food source of Vit B6 meats, liver, cereals, yeast, soybeans, peanuts, tuna, chicken, bananas
signs of deficiency: iron anemia, pale conjunctiva, pale skin color, atrophy of papillae on tongue, brittle nails, thyroid edema
signs of deficiency: Vit B2 redness and fissuring of eyelid corners, burning, itching, tearing eyes, photophobia, magenta-colored tongue, delayed wound healing, seborrheic dermatits
signs of deficiency: Vit A dry, rough skin, dull cornea, bitot spots, night blindness, defective tooth enamel, retarded growth, impaired bone formation,
signs of deficiency: Vit C scurvy, receding gums that are spongy and prone to bleeding, dry rough skin, petechiae, < wound healing, irritablility, prone to infection
signs of deficiency: Vit B6 scaly dermititis, weight loss, anemia, irritability, convulsions, peripheral neuritis
in childhood,a partial thickness burn is considered a major burn if it involves more than ___% of body surface and full thickness is ____% 25, 10
urinary output for infants and children is how much? 1-2 ml/kg/hr
what factors put a child at risk for poisoning? exploratory behavior, curiosity, oral-motor activity
s/s of lead exposure in children anemia, acute crampy abd pain, V, constipation, anorexia, headache, lethargy, impaired growth
early CNS signs of lead exposure hyperactivity, aggression, impulsiveness, decreased interest in play, irritability, short attention span
LATE CNS signs of lead exposure mental retardation, paralysis, blindness, convulsions, come, death
T/F: Lead is absorbed on an empty stomach and hot water can have more lead in it compared to cold water True
normal pulse and RR for newborns 100-60 / 30-60
normal pulse and RR for 1 - 11 mos 100-150 / 25-35
normal pulse and RR for 1-3 years(toddler) 80-130 / 20-30
normal pulse and RR for 6-10 years (school age) 70 - 100 / 18-22
normal pulse and RR for 10-16 years (adolescent) 60-90 / 16-20
T/F: pediatric client will go into resp failure before cardiac failure True
airway becomes edematous, congested w/ mucus, smooth muscles of bronchi & bronchioles constrict, air trapping occurs in the alveoli Asthma
autosomal-recessive disease that causes dysfunction of the exocrine glands, seen with tenacious mucus production that obstructs vital structures cystic fibrosis
what are complications r/t cystic fibrosis? lung insufficiency, pancreatic insufficiency, increased loss of Na & Cl in sweat.
what is a late pre-term infant born between 34-37 weeks of pregnancy
what is Theophylline? bronchodialator, used in asthma to reverse bronchospasm
s/e of Theophylline tachycardia, irritiability, palpations, hypotension, N/V
rapid-acting bronchodilator, drug choice for acute asthma attack Epinephrine HCL
S/E of Epinephrine tachycardia, HTN, Tremors, Nausea
what might you find in a nursing assessment in a child with cystic fibrosis? meconium ileus at birth, recurrent resp infection, pulmonary congestion, steatorrhea(fatty, greasy stools), foul-smelling stool, delayed growth and poor weight gain, skin that tastes salty when kissed. Later: cyanosis, clubbing, CHF
what type of Vitamins would you give a child with cystic fibrosis? A, D, E, K
r/t cystic fibrosis, what type of dietary recommendations would you make? high calorie, high protein, moderate to high fat and moderate to low carbs.
what are some s/s of epiglottitis? high fever, sore throat, dysphagia, drooling, muffled voice, tripod position.
nursing interventions r/t epiglottitis. prevention with Hib vaccine, maintain upright position, prepare for intubation, IV antibiotics, possible restraints, decrease crying/aggravation
viral infection of the bronchioles that is characterized by thick secretions and is usually caused by what? bronchiolitis, RSV
s/s of bronchiolitis paroxysmal coughing, poor eating, nasal congestion, nasal flaring, wheezing, rales, long expirations, >>getting worse=shallow rapid resp.
what type of isolation would you start for a child with RSV? contact isolation
nursing interventions r/t RSV assign nurse with NO other children, observe for hypoxia, bulb syringe to clear airway, mist tent, hydration, admin palivizumab (Synagis)
inflammation of middle ear otits media
s/s of otitis media fever, infant may pull at ear, enlarged lymph nodes, discharge from ear, upper resp symptoms, V,D
nursing interventions r/t otitis media reduce body temp(tepid baths, tylenol), position on affected side, warm compress to ear, no feeding child supine with bottle
what organism leads to tonsilitis Streptococcus
what lab values must be checked prior to a tonsilectomy? PT & PTT
what are signs of post op bleeding? frequent swallowing, vomiting fresh blood, clearing throat
food considerations r/t tonsilectomy NO STRAWS, avoid red foods, encourage soft and oral liquids
what heart d/o are left-to-right shunts or increased pulmonary blood flow, and obstructive defects? ventricular septal defect, atrial septal defect, patent ductus arteriosus, coarctation of aorta, aortic stenosis
which heart defects are right-to-left shunts or decreased pulmonary blood flow, mixed blood flow? cyanotic: Tetralogy of Fallot, truncus arteriosus, transposition of the great vessels
what is ventricular septal defect? there is a hole between the ventricles. Oxygenated blood from Left Ventricle is shunted to right ventricle and recirculated to lungs. (increased pulmonary blood flow)
what is atrial septal defect? hole between the atria. O2 blood from left atrium is shunted to the right atrium and lungs. (increased pulmonary blood flow)
what is the recommended action for an atrial septal defect? recommended closure by school age, can lead to CHF or atrial dysrhythmias later in life.
what is patent ductus arteriosus (PDA)? Abnormal opening between the aorta and the pulmonary artery. usually closes w/in 72 hrs. can cause pulmonary HTN.
medical intervention for PDA? indomethacin (Indocin) or surgical closure
what is coarctation of the aorta? obstruction of blood flow from ventricles - obstructive narrowing of the aorta. most common sites are aortic valve and aorta near ductus arteriosus
common finding for this heart condition is HTN in the upper extremities and decreased or absent pulses in the lower extremities. Coarctation of the Aorta
obstructive narrowing immediately before, at, or after the aortic valve Aortic Stenosis - O2 blood flow from the left ventricle in to systemic circulation is diminished
what is Tetralogy of Fallot? combination of 4 defects: VSD, aorta is over or above the VSD, Pulmonary stenosis, right ventricular hypertrophy.
what is TA? on artery (truncus) rather than two arteries (aorta and pulmonary artery) arise from both ventricles
what is TGA? (transposition of the great vessels) the pulmonary artery and the aorta are reversed on the ventricles: pulm artery leaves from the left ventricle and the aorta exits from the right ventricle.
s/s of tetralogy of fallot cyanosis due to unoxygenated blood is pumped in body, decreased pulmonary circulation occurs r/t PS, child experiences hypoxic spells(child will squat for relief), requires multiple surgeries to correct
manefistations of a child with congenital heart disease murmur, cyanosis, clubbing of digits, poor feeding, poor weight gain, failure to thrive, frequent regurgitation and resp infections, fatigue
what does a nurse assess r/t congenital heart disease heart rate, rhythm, pulses, BP, hx of maternal infection during prego
nutritional needs r/t a pt w/ caridac dysfunction feed small, frequent feedings, high calorie formula, maintain hydration(prevent thrombus)
what two meds would prob be ordered for a cardia dysfunction pt Digoxin and diuretics
what would you teach the parents of a cadiac dysfunction child r/t dental or other other procedures? need for prophylactic antibiotics
what are some risks r/t catheterization for a child arrhythmias, bleeding, perforation, phlebitis, arterial obstruction on the entry site
the basic rundown of an acyanotic defect (VSD, ASD, PDA, AS) has abnormal circulation, however all blood entering the systemic circulation is oxygenated
the basic rundown of cyanotic defects (Tetralogy of Fallot, TGV, TA) has abnormal circulation with UNoxygenated blood entering the blood stream
CHF is more often associated with ____ defects Acyanotic
what are the two main objectives when tx CHF? reduce the workload and increase cardiac output
what are the therapeutic levels for Digoxin 0.8 - 2.0ng/ml
teaching for safe administration of digoxin at home give on regular basis; DO NOT SKIP DOSE or make up for missed dose, give 1 hr before or 2 hrs after meals; DO NOT mix with formula or food, take pulse prior, keep in safe place
s/s of Digoxin toxicity Vomiting(careful because infants only "spit up"), anorexia, D, abd pain, fatigue, muscle weakness, drowsiness. Hypokalemia can increase Dig tox
s/s of CHF tachypnea, tachycardia, difficulty feeding, cyanosis, grunting, wheezing, pulmonary congestion, edema (face, eyes of infants), weight gain, diaphoresis, hepatomegaly
r/t CHF, would you use a car seat or another way to elevate the head of the bed? YES
what kind of diet would a CHF pt be on Low-sodium diet or formula, possible gavage feeding
what is an indication for penicillin G? prophylaxis for recurrence of rheumatic fever
what is rheumatic fever collagen disease that injures the heart, blood vessels, joints, and sub q tissue. usually affects aortic and mitral valves
what would a nurse find in an assessment of a pt with rheumatic fever? chest pain, shortness of breath, tachycardia(even while sleeping), migratory joint pain, chorea(irreg involuntary movements), rash, sub q nodules over body prominences, fever, elevated ESR, elevated ASO (antistreptolysin O) titer
what meds would be given for rheumatic fever? penicillin or erythromycin and aspirin
common characteristics of Down's syndrome flat, broad nasal bridge, inner epicanthal eye folds, upward outward slant of eyes, protruding tongue, short neck, transverse palmar crease(simian), hyperextendible and lax joints(hypotonia)
what are some associated complications r/t Down's syndrome? cadiac defects, resp infections, feeding difficulties, delayed developmental skills, mental retardation, skeletal defects, altered immune function endocrine dysfunctions
what is the nursing goal for a child with Down's syndrome? help the child reach optimal level of functioning
nonprogressive injury to the motor centers of the brain causing neuromuscular problems of spasticity or dyskinesia cerebral palsy
what are some things that cause cerebral palsy? anoxic injury before, during or after birth, maternal infections, kernicterus, low birth weight
what would a nurse notice during an assessment of a child w/ cerebral palsy? neonatal relflexes after 6 mos, delayed milestones, early preference of one hand, poor suck, tongue thrust, spaticity(hard to put a diaper on), scissoring of legs, seizures, involuntary movements
when feeding a child with cerebral palsy, what do you keep in mind? prevent aspiration, position child upright, support lower jaw
defect of vertebrae only. no sac present, usually benign spina bifida occulta
this contains only meninges and spinal fluid and has less neurologic involvement than a myelomeningocele Meningocele
this is more serious because the sac contains spinal fluid, meninges, and nerves myelomeningocele
every child with a hx of spina bifica should be screened for an allergy to what? latex
this has a dimple with or without hair tuft at base of spine spina bifida occulta
what are some associated problems r/t spina bifida? hydrocephalus, neurogenic bladder, poor sphincter tone, congenital dislocated hips, club feet, scoliosis, skin problems
name some preop steps for a child with spina bifida cover sac w/moist sterile dressing, elevate foot of bed, prone position, legs abducted, measure head q8hrs, monitor for s/s infection
what are some of the major teaching that will need to be done with a child w/ spina bifida urinary incontinence, catheterization, developing a bowel program(high fiber, suppositories, reg fluids), ROM exercises
abnormal accumulation of cerebrospinal fluid within the ventricles of the brain; usually caused by an obstruction hydrocephalus
s/s of ICP decreased pulse, increased BP - opposite of shock
what signs of ICP would you expect ini an older child? classic signs: change in LOC, irritability, Vomiting, HA on awakening, motor dysfunction, unequal pupil resonse, seizures, decline in academics, change in personality
Signs of ICP in infants: irritability, lethargy, increase in head circumference, bulging fontanels, widening suture lines, "sunset" eyes, high-pitched cry
what types of procedures would you prepare parents for r/t a child with ICP? elevate head of bed, shunt inserted into ventricle, tubing tunneled through skin to peritoneum where it drains CSF
name signs of shunt malfunction; infant changes in size, signs of bulging, tensness, separation in fontanels and suture lines, irritability, lethargy, seizure activity, altered VS and feeding behavior
signs of shunt malfunction/incresased ICP; older child change in LOC, complaint of headache, spleep patterns, developmental capabilities; watch for infection:meningitis, I&O's
Once a shunt is placed, is it permanent? NO. the child will eventually grow out of it and it will need revision.
what age are seizures more common? under 2 years old
what comlication can lead to a seizure? immaturity of CNS, fever, infection, neoplasms, cerebral anoxia, metabolic d/o
this seizure includes loss of consciousness, generalized stiffness of entire body, spasms followed by relaxation Tonic-clonic(grand mal)
momentary loss of conssciousness, posture is maintained, has minor face, eye, and hand movements Absence (petite mal)
sudden, brief contractures of a muscle or group of muscles, no postictal state. may or may not by symmetrical or include LOC Myoclonic
this seizure usually has an aura tonic-clonic
this seizure may just look like the kid is daydreaming absence
r/t seizure precautions, where is the oral airway kept? taped to the head of the bed
what meds could be ordered for a pt r/t tonic-clonic seizures? phenytoin/dilantin, Tegretol, Luminal/phenobarbital, Cerebyx
what meds could be ordered for a pt r/t absence seizures? Depakene, Zarontin
bacterial inflammatory d/o of the mengines that cover the BRAIN and SPINAL CORD Bacterial meeningitis
where is the usual source of infection r/t bacterial meningitis middle ear or nasopharynx
what lab values would a person w/ bacterial meningitis exhibit? >WBC, protein, >ICP, +culture for meningitis
what is kernig's sign? inability to extend leg when thigh is flexed anteriorly at hip
neck flexion causing adduction and flexion movements of lower extremities Brudzinski sign
condition in which the body is held in an abnormal position. The person is usually rigid and arches the back, with the head thrown backward opisthotonos
+meningitis s/s; older children fever chills, neck stiffness, opisthotonos, photophobia, +Kernig's sign, +Brudinski sign
what is an important sign r/t meningitis r/t an infant bulging fontanel
nursing interventions r/t meningitis antibiotics, isolate for at least 24hrs, VS, quiet/dark invironment, position of comfort; HOB elevated slightly, head circumf, I&O, Hib Vaccine
what other complication can be r/t meningitis? Inappropriate ADH scretions causing fluid retention(cerebral edema) & dilutional hyponatremia
acute, rapidly progressing encephalopathy and hepatic dysfunction Reye Syndrome
complications from Reye Syndrome influenza or chickenpox
Reye Syndrome is associated with use of what OTC med? Apirin
expected lab values r/t Reye syndrome Elevated: AST, ALT, lactate dehydrogenase, serum ammonia. DECREASED PT
nursing interventions r/t Reye Syndrome maintain ventilations, critical care, mannitol, cardiac parameters, I&O's, foley cath, family emotional support
most common childhood brain tumor gilomas
most common s/s for brain tumor HA upon wakening
other s/s for brain tumor vomiting w/ or w/o nausea(usually in the AM), change in behavior, vision problems, tilting head, > sutures, > frontal occipital circmf, tense fontanel
if surgery is decided for a brain tumor r/t a child, what will you teach the parents preop head will be shaved, describe ICU, dressings, IV lines ect...
what positioning could be ordered postop r/t a brain tumor? most are told to lie flat or turn to either side, a large tumor may require NOT to be on operative side
what physical activities can cause >ICP? suctioning, coughing, straining, and turning
inherited disease of the muscles, causing muscle atrophy and weakness muscular dystrophy - most serious=Duchenne
what complications are caused by Duchenne resp and cardiac
typical s/s of Duchenne / MD waddling gait, lordosis, increasing clumsiness, Gowers sign, pseudohypertrophy of muscles, muscle degeneration(thighs, cardiac), >CPK & AST.
what are some later complications r/t Muscular Dystrophy scoliosis, resp difficulty, and cardiac difficulties
gowers sign difficulty rising to standing position, will "walk" up legs using hands
nursing interventions r/t MD provide exercise(passive & active), prevent resp infection, balanced diet/avoid obesity, support grieving process
what parts of the healthcare team could be involved with a MD pt? physical therapy, OT, nurtition, neurologist, orthopedist, geneticist
Immune complex response to a strep infection of the skin or pharynx; the antibody complexes get trapped in the membrane of the glomeruli causing inflammation and decreased glomerular filtration actue glomerulonephritis
s/s of acute glomerulonephritis recent strep infection, mild/moderate edema(face), irritability, lethargy, HTN, dark urine, proteinuria, >BUN & creatinine
what kind of diet would you expect for a pt with acute glomerulonephritis? low-sodium w/ no added salt, low K+
what is the first sign of renal failure? decreased urinary output
s/s of nephrotic syndrome edema that becomes severe and generalized, lethargy, anorexia, pallor, frothy-appearing urine, massive proteinuria,
Acute glomerulonephritis: The basic rundown follows strep infection, edema around eyes, HTN, tea-colored urine, normal serum protein, +ASO titer
nephrotic syndrome: the basic rundown usually idiopathic, severe edema, normal BP, dark frothy yellow urine,
what meds might be prescribed for a pt with nephrotic syndrome? prednisone, cholinergics-Urecholine, Cytoxan, Albumin, diuretic
what bacteria is in a culture of a UTI E. coli
s/s of UTI in an infant vague symptoms, fever, irritable, poor food intake, D,V, jaundice, strong smelling urine
s/s of UTI in older children urinary frequency, hematuria, enuresis, dysuria, fever
this is when urine back flows into ureters from the bladder vesicoureteral reflex - severe cases are associated w/ hydronephrosis
what is the goal of ureteral reimplantation? to stop reflux and prevent kidney damage
malignant renal tumor Wilms Tumor (nephroblastoma)
how are Wilms Tumors usually found? when the parents are giving the child a bath - a mass in the flank area confined to midline
the nurse places a sign on the bed of a child with a Wilms Tumor...what does it say? "no abd palpation"
congenital defect where urethral meatus in males opens on ventral side of penis behind the glans hypospadias
what also may occur along side hypospadias undescended testes, inguinal hernia
in an infant/child what is the best way to get a clean catch urine sample? by using a urine bag that is applied to pt and diaper over it.
when is a cleft palate defect usually corrected? at 1 year of age to minimize speech impairment
how would you feed a newborn with a cleft lip or palate feed in upright position, slowly, and frequent bubbling, soft large nipples(lamb's nipple, prosthetic palate, rubber-tipped Asepto syringe
post op position for cleft lip repair place pt on side or upright in infant seat, NOT PRONE
post op postition for cleft palate repair place pt on side or abdomen
at what type of diet may a child with cleft lip/palate be released to go home from hospital may go home on a soft diet, nothing harder than mashed potatoes
what is a TEF? Esophageal atresia with Tracheoesophageal Fistula
what is the most common type of TEF? upper sophagus ends in a blind pouch, and the lower part of the esophagus is connected to the trachea=EMERGENCY!
what are the three C's of TEF in a newborn? choking, coughing, cyanosis. They will also exhibit excess saliva, resp distress, aspiration pneumonia
preoperative care r/t TEF remove excess secretions, elevate infant to antireflux position of 30 degress, O2, NPO, IV fluids
postop care for an infant r/t TEF surgery; s/s of a stricture of the esophagus poor feeding, dysphagia, drooling, regurgitating undigested food
an infant with this will usually have projectile vomiting that begins 14 days after birth pyloric stenosis
dehydration with decreased Na+ and K+ and a palpable olive-shaped mass in the upper right quadrant, and having visible peristalic waves is probably ___ ____. pyloric stenosis
what position post op would you place a pt r/t pyloric stenosis? on the RIGHT side in semi-Fowler after feeding
why do you want to burp an infant with pyloric stenosis often? avoid stomach becoming distended and putting pressure on surgical sight.
if an infant is screaming with legs drawn up to abdomen, vomiting, and has "currant jelly" stools and a sausage-shaped mass in the upper right quadrant what would you expect? Intussusception - telescoping of one part of intestine into another.
a lack of peristalsis in the area of the colon where the ganglion cells are absent, fecal contents accumulate above the area congenital aganglionic megacolon (Hirschsprung disease)
what is the correction for Hirschsprung disease temporary colostomy, then reananstomosis and closure of colostomy
s/s of Hirschsprung disease suspicion in newborn who fails to pass meconium w/in 24 hrs, distended abd, constipation alterating w/ diarrhea, nutritionally deficient child, ribbonlike stools in older child, enterocolitis
which temp is better r/t a child w/ congenital megacolon? axillary
r/t congenital megacolon, when should you begin toilet training? after age 2
an infant with an unusual-appearing anal dimple and does not pass meconium w/in 24hrs may have a anorectal malformation
what is some postop care r/t anal reconstruction position infant in side-lying prone position with hips elevated-decreases pressure on perineal sutures
postop care for a child with pyloric stenosis IV hydration, small frequent oral feedings of glucose or electrolyte solutions or both w/in 4-6 hours
normal Hgb for a newborn 14-24g/dl
normal Hgb for infant 10-17g/dl
normal Hgb for Child 9.5-15.5g/dl
s/s of an iron deficient baby/child fatigue, overweight "milk baby", more than 32oz of milk/day, pica habit
pt teaching r/t oral iron give on empty stomach, give w/citrus juices, us a dropper or straw, tarry stools occur, can be fatal, DO NOT give w/ dairy products
what are good sources of iron meat, green leafy veges, fish, liver, whole grains, legumes, iron fortified cereals
T/F; hemophilia is inherited bleeding d/o transmitted by X-linked recessive chromosome(by mother) TRUE
A hemophiliac is usually missing factor ___ or factor ____ clotting factors VIII or IV
most frequent site for bleeding of a hemophiliac is _____ which is where hemarthrosis - into joint spaces
what are some classic signs of sickle cell anemia r/t a vaso-occlusive crisis fever, severe abd pain, hand-foor syndrome(painful edematous hands and feet), arthralgia
teach parents to prevent a sickle cell crisis, what do you teach them? no strenuouse excercise, keep away from high altitudes, avoid infections, prophylactic peniciliin, well hydrated, do not with hold fluids at night
T/F: Sickle cell anemia is tx w/ iron supplements False - Folic acid is given to stimulate RBC Synthesis
what are the four phases of tx r/t leukemia induction, sanctuary, consolidation, maintenance
Resp > __ will indicate gavage feeding 60
which chemo meds could be ordered r/t leukemia in the induction phase Vincristine, L-Asparaginase
which phase is Methotrexate used for r/t leukemia sanctuary and maintenance
which phase is Mercaptopurine used for r/t leukemia tx maintenance
s/s for hypothyroidism in a newborn long gestation, large hypoactive infant, delayed meconium passage, poor feeding, prolonged jaundice, hypothermia
s/s for hypothyroidism in early infancy large protruding tongue, coarse hair, lethargy, flat expression, constipation
how do parents usually describe a baby w/ hypothyroidism? a good quiet baby
what are signs of overdose of thyroxine? rapid pulse, irritability, fever, weight loss, diarrhea
foods high in phenylalanine high protein foods, meat, milk, dairy products, eggs
foods low in phenylalanine veges, fruits, juices, cereals, breads, starches
when a child is in ketoacidosis, administer ___ insulin in NS as ordered regular
what are the 5 P's r/t bone fractures and presence of ischemia Pain, Pallor, Pulselessness, Paresthesia, Paralysis
two lines of pull on the arm dunlop traction
lower extremity, legs extended, no hip flexion buck extension tracktion
two lines of pull on the lower extremity, one perpendicular, one longitudinal russell traction
both lower extremities flexed 90 degress bryant traction
s/s of infant hip dislocation +Ortolani sign(clicking w/abduction), unequal folds of skin on buttocks, limited abduction of hip, unequal leg lengths
a child with scoliosis will wear a ____ brace Milwaukee brace
what is a complication r/t rheumatoid arthritis? iridocyclitis - have periodic eye exams
typical size feeding tube r/t gavage feeding 5-8 fr
how do you measure for correct length of feeding tube in an infant bridge of nose to earlobe to a point halfway between xiphoid process and umbilicus
how do you position an infant after gavage feeding to prevent regurgitation and aspiration? on the right side
what are some complications r/t TPN hyperglycemia, electrolyte imbalance, infection, dehydration
if an infant's whole body is yellow, ___ is possibly happening kernicterus
total bili for Term baby >12
total bili for LBW level 10-12 or greater
a child with scoliosis will wear a ____ brace Milwaukee brace
total bili for preterm level >5
what is a complication r/t rheumatoid arthritis? iridocyclitis - have periodic eye exams
typical size feeding tube r/t gavage feeding 5-8 fr
how do you measure for correct length of feeding tube in an infant bridge of nose to earlobe to a point halfway between xiphoid process and umbilicus
how do you position an infant after gavage feeding to prevent regurgitation and aspiration? on the right side
what are some complications r/t TPN hyperglycemia, electrolyte imbalance, infection, dehydration
if an infant's whole body is yellow, ___ is possibly happening kernicterus
total bili for Term baby >12
total bili for LBW level 10-12 or greater
total bili for preterm level >5
how often do you want to turn off the bili lights? q 8 hrs for 5-15 minutes
where is the best place to observe for jaundice in a newborn? Dark skinned newborn? nose, forehead, sternum. conjunctival sac & oral mucosa
Created by: jrstrader