130483647-HESI-PEDS.pdf

Question Answer Side 3

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Birth weight doubled by _____, tripled by _____.

6 months; 12 months

Birth length increased by 50% at _____. 12 months

Posterior fontanel closes by _____. 8 weeks (2 months)

A child can socially smiles at _____. 2 months

A child should be able to turn head to locate sounds at _____.

3 months

Moro reflex disappears around _____. 4 months

A child should be able to achieve steady head control at _____ of age.

4 months

A child can turn completely over at _____ of age.

5 to 6 months

A child can play peek-a-boo after _____ of age.

6 months

A child should be able to transfers objects hand to hand at _____.

7 months

A child develops stranger anxiety at _____. 7 to 9 months

A child should be able to sit unsupported at _____.

8 months

The infant crawls at _____. 10 months

Fine pincer grasp appears at _____. 10 to 12 months

A child should be able to waves bye-bye at _____.

10 months

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A child should be able to walks with assistance at _____.

10 to 12 months

The infant says a few words in addition to "mama" or "dada" at _____.

12 months

From birth to one year, the baby explores environment by _____ and _____ means.

motor; oral

From birth to one year is what stage of Erikson's theory?

Trust vs Mistrust(Developing a sense of trust)

What are some age-appropriate toys for hospitalized infants?

mobilesrattlessqueaking toyspicture booksballscolored blocksactivity boxes

Birth weight quadruples by _____. 30 months

Achieves 50% of adult height by ___. 2 years

Anterior fontanel closes by _____. 12 - 18 months

A child should be able to throw a ball overhand at _____.

18 months

The nurse tells a mother that her child should be able to kicks a ball at _____.

24 months

A child should be able to feeds self with spoon and cup at _____.

2 years

Day time toilet training can usually be started around _____.

2 years of age

A child should be able to speak two to three word sentences at _____.

2 years (24 months)

A child should be able to speak three to four word sentences at _____ of age.

3 years

A child should be able to states his/her own first and last name by _____.

2.5 to 3 years

Is temper tantrums common among toddlers (1 to 3 years)?

Yes

What is the import developmental task of a toddler according to Erikson's theory?

Developing a sense of autonomy.

What are some age-appropriate toys for the hospitalized toddler?

board and malletpush/pull toystoy telephonestuffed animalsstorybooks with pictures

What can the nurse do to promote the developemental task of a toddler?

Toddlers benefit from being taken to the hospital playroom, as mobility is very important to their development.

What are the average weight and height gain for preschool children (3 to 5 years old)?

Each year gain about 5 lbs and grows 2.5 to 3inches.

A child can use sissors at _____ of age. 4 years

A child should be able to ties shoelaces at _____ of age.

5 years

Visual acuity approaches 20/20 at _____.Preschool age(3 to 5 years)

A preschool child thinking is _____ and _____.

egocentric; concrete

A child should be able to use sentences of 5 to 8 words at _____ of age.

3 to 5 years Preschool

At this stage of developement, a child learns sexual identity (curiosity and masturbationcommon).

3 to 5 yearsPreschool

At this stage of development, imaginary playmates and fears are common.

Preschool(3 to 5 years)

At child at this development stage begins to stands erect with more slender posture.


At this stage of development, a child learns to run, jump, skip, and hop.


A child at this developmental stage learns colors and shapes.


Imaginary playmates and fears are common at this stage of development:


Aggressiveness at _____ is replaced by more_____ at 5 years.

4 years; independence

Preschool child's major developmental taks according to Erikson theory is:

Developing a sense of initiative

At this stage of development, the child appears to be bowlegged and potbellied.

TODDLER (1 TO 3 YEARS)

At this stage of development, all primary teeth (20) are present.

TODDLER (1 TO 3 YEARS)

Nursing implications of hospitalized preschoolers (3-6 years) needs to emphasize understanding of the child's _____.

egocentricity; (Explain that he/she did not cause the illness and that painful procedures are not a punishment for misdeeds.)

_____ or medical play to allow the child to actout their experiences is helpful for _____.

Therapeutic play; Preschoolers

At this stage of development, fear of mutilation from procedures is common.


Toys and play for the hospitalized preschooler include:

coloring bookspuzzlescutting and pastingdollsbuilding blocksclay toys that allow the preschooler to work out hospitalization experiences.

The _____ needs preparation for procedures. He or she needs to understand what is and what is not going to be "fixed." Simple explanations and basic pictures are helpful. Let child handle equipment or models of the equipment.

preschooler(3 to 6 years)

_____ are learning to name body parts and are concerned about their bodies.

Toddlers(1-3 years)

During hospitalization, enforced separation toddler's

from parents is the greatest threat to the _____ psychological and emotional integrity.

(1 to 3 years)

Security objects or favorite toys from home should be provided for _____.

toddlers(1 to 3 years)

Normal gain in weight and height for school-age child (6 to 12 years) are:

Each year gain 4 to 6 pounds and about 2 inches in height.

Loss of primary teeth and eruption of most permanent

school-age child (6 to 12 years)

At this stage of development fine and gross motor skills mature.


During this developmental stage, girls may experience menarche.

school-age (6 to 12 years)

At this stage of development, a child should be able to dresses self-completely.


At this stage of development, egocentric thinking is replaced by social awareness of others.


At this stage of development, a child learns to tell time and understands past, present, and future.


At this stage of development, a child learns cause and effect relationships.


Socialization with peers becomes important at this stage of development:


A child's molars should erupt at _____. 6 years

According to Erikson's theory, developing a sense of industry occurs at this stage:


A child should be able to write script at _____.

8 years

The hospitalized _____ may need moresupport from parents than they wish to admit.

school-age child

Maintaining contact with peers and school activitiesis important during hospitalization for a _____.

school-age child

For school-age child, _____ and _____ are important, and should be respected during hospitalization.

privacy; modesty e.g., close curtainsduring procedures, allow privacy during baths, etc.

Participation in care and planning with staff fosters asense of _____ and _____ for a school-age child (6-12 years).

involvement; accomplishment

Toys for the hospitalized school-age (6 to 12 years) child include:

board gamescard gameshobbies (such as stamp collecting, puzzles, and video games)

School-age children are in Erikson's stage of _____, meaning they like to do and accomplish things. _____ are also becoming important for this age child.

industry; Peers

Girls' growth spurt during adolescent begins _____ than boys (may begin as early as ___ for girls).

earlier; 10

Boys catch up to girls' growth at age _____ and continue to grow.

14

Girls finish growth around _____, boys around _____.

15; 17

Adult-like thinking begins around age _____. They can _____ and use _____ thinking.

15; problem solve; abstract

Secondary sex characteristics begins at this developmental stage:

ADOLESCENCE (12 to 19 YEARS)

At this stage of development, family connflict commonly occurs.

ADOLESCENCE (12 10 19 YEARS)

Hospilalization of adolescents disrupts _____ and _____ activities; they need to maintain contact with both.

school; peer

Illness, treatments, or procedures which alter thebody image can be viewed as devastating bythe _____.

adolescent

For this develpmental stage, teaching about procedures should include time without parents present.

adolescent(12 to 18 years)

For this developmental group, some assessment questions should be asked without parents' presence.

adolescent

When teaching adolescent needs, the focus should be on _____.

here and nowi.e., how will this affect me today?

Infants' concept of bodily injury:

Infants: After 6 months, their cognitive development allows them to remember pain.

Toddlers' concept of bodily injuryToddlers: Fear intrusive procedures.

Preschoolers' concept of bodily injuryPreschoolers: Fear body mutilation.

School ages' concept of bodily injury:School age: Fear loss of control of their body.

Adolescents' concept of bodily injury:Adolescent: Major concern is change in body image.

MMR VACCINE Generally administered at _____ months of age and repeated at _____ years or by _____ years.

12 to 15; 4 to 6; 11 to 12

In times of measles epidemic, it is possible to give measles protection at _____ and repeat the MMR at _____.

6 months; 15 months

Measles vaccine is contraindicated for persons with history of anaphylactic reaction to _____ or _____, those with known altered _____ and _____ women.

neomycin; eggs; immunodeficiency; pregnant

MMR vaccine may be given to those with HIV and breastfeeding women. T or F

True

MMR vaccines are administer _____ at separate sites.

subcutaneously

A child may have a light transient ___ 2 rash

weeks after administration of MMR vaccine.

DTaP Vaccine administration begins at age ____, administer three doses at _____ intervals.

2 months; 2 months

DTaP Vaccine: Booster doses given at _____ to _____; and at _____.

15; 18 months; 4 to 6 years.

DTaP Vaccine: administer _____ (separate site from other vaccine).

intramuscularly

DTaP Vaccine is not given to children past the ______ birthday; they receive _____ which contains full strength protection against tetanus and lesser strength diphtheria protection.

7th; Td

When pertussis vaccine is contraindicated, give _____, until 7th birthday.

DT (full strength diphtheria and tetanus without pertussis vaccine)

Contraindications to pertussis vaccine include:1. _____ within 7 days of previous dose of DTP.2. History of _____. 3. _____ symptoms after receiving the vaccine. 4. _____ allergic reactions to the vaccine.

Encephalopathy; seizures; Neurologic; Systemic

Parents should be instructed to begin _____ administration after the immunization (normal dosage is _____ mg/kg).

acetaminophen (Tylenol); 10 to 15

IPV is recommended for all person under the age of _____.

18

IPV is administer at _____ of age and again at _____ of age. Boosters are given at _____ , and _____.

2 months; 4 months; 6 to 15 months; 4 to 6 years

Administer IPV _____ or _____ at separate site.

subcutaneously; IM

IPV is contraindicated for those with history of anaphylactic reaction to_____ or _____.

neomycin; streptomycin

PRP-OPMs can be given as early as ____ of age.

2 months

DaTP/Hib combinations should not be used as primary immunizations at ages ___, ___, or ___.

2; 4; 6 months

Children at high risk who were not immunized with Hib previously should be immunized after age _____.

5

Hib is administer ______. intramuscularly

_____ offers protection against bacteria that causes serious illness (epiglottitis, bacterial meningitis, septic arthritis) in small children or those with chronic illnesses such as sickle cell anemia.

Hib

_____ offers protection against hepatitis B.Typically, given to all _____ prior to hospital discharge. Vaccinate all children _____ to _____ years of age.

Hepatitis B vaccine; newborns; 0; 18

Hepatitis B vaccine is contraindicated for persons with anaphylactic reaction to _____.

common baker's yeast

Hepatitis B vaccine is administer trough _____ site at _____ , _____, and _____ of age.

IM; 0 to 2 months; 1 to 4 months; 6 to 18 months

_____ offers protection against chickenpox. It is also a school entry requirement in 33 states. And it is safe for children with asymptomatic HIV infection.

VARICELLA vaccine

VARICELLA vaccine is administer at _____ of age (must beat least _____).

12 to 18 months; 12 months

Give _____ and _____ vaccines on same day or >30 days apart (separate site).

MMR; varicella

Irritability, fever (<102 F), redness and soreness at injection site for 2 to 3 days are normal side effects of _____and _____ administration.

DPT; IPV

Following immunization, call health care provider if _____, _____, or _____.

seizures; high fever; high-pitched crying occur

Following immunization, a _____ on the thigh injection site and _____ the legs with each diaper change will decrease soreness.

warm washcloth; "bicycling"

Following immunization, acetaminophen (Tylenol) is administered orally every _____ hours (_____ mg/Kg).

4 to 6; 10 to 15

The common cold is not a contraindication for immunization. T or F

True

A highly contagious, viral disease that can lead to neurologic problems or death.

RUBEOLA (Measles)

RUBEOLA (Measles) is transmitted by _____.

Direct contact with droplets from infected person.

RUBEOLA (Measles) is contagious mainly during the _____ which is characterized by _____ and _____ symptoms.

prodromal period; fever; upper respiratory

Classic symptoms of RUBEOLA (Measles) include:

PhotophobiaKoplik's spots on the buccal mucosa.Confluent rash that begins on the face and spreads downward.

Viral disease characterized by skin lesions.VARICELLA ZOSTER (Chicken Pox)

Chicken Pox lesions begin on the _____ and spread to the _____ and _____.

trunk; face; proximal extremities

Chicken Pox progresses through _____, _____, _____, and _____ stages.

macular; papular; vesicular; pustular

Chicken Pox transmitted by ____, _____, or _____.

direct contact; droplet spread; freshly contaminated objects

Chicken Pox communicability end when _____.

scabs have formed

Common viral disease which has teratogenic effects on fetus durina the first trimester of pregnancy.

RUBELLA (German Measles)

RUBELLA (German Measles) is transmitted by _____ and _____.

droplet; direct contact with infected person

RUBELLA (German Measles) is charcterized by _____ starts on _____ and rapidly spreads to _____.

discrete red maculopapular rash; face; entire body

RUBELLA (German Measles) rash disappears within _____.

3 days

An acute, infectious respiratory disease usually occurring in infancy.

Pertussis(Whooping cough)

Pertussis is caused by a _____. gram-negative bacillus

PERTUSSIS (Whooping Cough) begins with _____.

upper respiratory symptoms

_____ is a paroxysmal state of the disease is characterized by prolonged coughing and crowing or whooping upon inspiration.

PERTUSSIS (Whooping Cough)

PERTUSSIS (Whooping Cough) lasts from _____.

4 to 6 weeks

PERTUSSIS (Whooping Cough) is transmitted by _____, _____, or _____.

direct contact; droplet spread; freshly contaminated objects

PERTUSSIS (Whooping Cough) is treated with _____.

erythromycin

PERTUSSIS (Whooping Cough) complications include _____, _____, and _____.

pneumonia; hemorrhage; seizures

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Differentiate between a right to left and left to

A left to right shunt moves oxygenated blood back through pulmonary circulation. A right to



right shunt in cardiac disease.

left shunt bypasses the lungs and delivers unoxygenated blood to systemic circulation, causing cyanosis.

List the four defects associated with tetralogy of Fallot.

VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy.

List the common signs of cardiac problems in an infant.

Poor feeding, poor weight gain, respiratory distress and infections, edema and cyanosis.

What are two objectives in treating congestive heart failure?

Reduce the workload of the heart and increase cardiac output.

Describe nursing intervention to reduce the workload of the heart.

Give small, frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutral thermal environment. Organize activities to disturb child only as indicated.

What position would best relieve the child experiencing a test spell?

Knee-chest position or squatting.

What are common signs of digoxin toxicity?

Diarrhea, fatigue, weakness, nausea, and vomiting: the nurse should check for bradycardia prior to administration.

List the five risks in cardiac catherization.

Arrhytmia, bleeding, perforation, phlebitis, obstruction of the arterial entry site.

What cardiac complications are associated with rheumatic fever?

Aortic valve stenosis and mitral valve stenosis

What medications are used to treat rheumatic fever?

Penicillin, erthromycin, aspirin

What are the physical features of a child with Down syndrome?

Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes.

Describe scissoring.A common characteristic of spastic cerebral palsy in infants; legs are extended and crossed over each other, feet are plantar-flexed.

What are two nursing priorities for a newborn with myelomeningocele?

Prevention of infection of the sac and monitoring for hydrocephalus (measure head circumference; check fontanel; assess neurologic functioning).

List the signs and symptoms of increased ICP in older children.

Irritability, change in LOC, motor dysfunction, headache, vomiting, unequal pupil response, and seizures.

What teaching should parents of a newly shunted child receive?

Information about signs of infection and increased ICP; understanding that shunt should not be pumped and that child will need revisions with growth; guidance concerning growth and development.

State the three main goals in providing nursing care for a child experiencing a seizure?

Maintain patent airway, protect from injury, and observe carefully.

What are the side effects of Dilantin?

Gingival hyperplasia, dermatitis, ataxia, GI distress

Describe the signs and symptoms of a child with meningitis.

Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig sign, positive Brudzinski sign; infant may not show all classic signs even though very ill.

What antibiotic are usually prescribed for bacterial meningitis?

Ampicillin, penicillin, chloramphenicol

How is a child usually positioned after brain tumor surgery?

Flat or on either side

Desribe the function of an osmotic diuretic.

Osmotic diuretics remove water from CNS to reduce cerebral edema.

What nursing interventions increase intracranial pressure?

Suctioning and positioning, turning

Describe the mechanism of inheritance of Duchenne muscular dystrophy.

X-linked recessive trait

What is gower's sign? Gower's sign is an indicator of muscular dystrophy; to stand, the child has to walk hands

up legs



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List two contraindications to live virus immunization.

immunocompromised child or in a household with an immunocompromised individual.

List three classic sign of measles.

Photophobia, confluent rash that begins on the face and spread downward, and koplik spots on the buccal mucosa.

List the signs and symptoms of iron deficiency.

Anemia: pale conjunctiva; pale skin color; atrophy of papillae on tongue; brittle, ridged, or spoonshaped nails; and thyroid edema.

Identify food sources of Vit A.

Liver, sweet potatoes, carrots, spinach, peaches, and apricots.

What disease occurs with Vit C deficiency.

Scurvy ( sunken eyes, loss of teeth, pale skin)

What measurements reflect present nutritional status?

Weight, skinfold thickness, and arm circumference.

List the signs and symptoms of dehydration in an infant.

Poor skin turgor, absence of tears, dry mucous membranes, weight loss, depressed fontanel, and decreased urinary output.

List the laboratory findings that can be expected that can be expected in a dehydrated child.

loss of bicarbonate/decreased serum ph, loss of Sodium, loss of potassium, elevated hematocrit, and elevated BUN.

How should burns in children be assessed?

By using lund browder chart. This takes into account the changing proportions of the child's body.

How can the nurse best evaluate the adequacy of

By monitoring urine output.



fluid replacement in children?

How should a parent be instructed to child proof a house?

By being taught to lock all cabinets, to safely store all toxic household items in locked cabinets, and to examine the house from the child's point of view.

What interventions should the nurse perform first in caring for a child who has ingested a poison?

Assessment of the child's respiratory, cardiac, and neurologic status.

Describe the purpose of bronchodilators.

To reverse bronchospasm.

What are the physical assessment findings for a child with asthma?

Expiratory wheezing, rales, right cough, and signs of altered blood gases.

What nutritional support should be provided for a child with cystic fibrosis?

Pancreatic enzyme replacement, fat-soluble vitamins, and a moderate to low carbohydrate, high protein, moderate to high fat diet.

Why is genetic counseling important for the family of a child with cystic fibrosis?

Because the disease is autosomal recessive in its genetic pattern.

List seven signs of respiratory distress in a pediatric client.

Restlessness, tachycardia, tachypnea, diaphoresis, flaming nostrils, retractions, and grunting.

Describe the care of a child in midst tent.

Monitor child's temperature; keep tent edges tucked in; keep clothing dry; assess respiratory status; look at child inside tent.

What position does a child with epiglottitis assume?

Upright, sitting, with chin out and toungue protruding (tripod position)

Why are IV fluids important for a child with an increased respiratory rate?

The child is at risk for dehydration and acid base balance.

Children with chronic otitis media are at risk for developing what problem?

Hearing loss/ conductive hearing

What is the most common Hemorrhage; frequent swallowing. vomiting

postoperative complication following a tonsillectomy? Describe the signs and symptoms of this complication.

fresh blood, and clearing throat



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When is iron deficiency most common?

12 -36 months and in females during childbearing years

What is the best indicator of past nutrition?

Height and head circumference

How do you measure nutritional status?

plasma, blood cells, urine, tissues from bone, hair or fingernail, hgb/hct, albumin, Cr, nitrogen

Signs of iron deficiency

anemia, pale conjuctiva, pallor, brittle/ridged nails, thyroid edema

Signs of B2 (riboflavin) deficiency

redness of eyelid corners, burning, itchy, tearing eyes, photophobia

Source of Ironfortified formula, fortified cereal, liver, beef, pork, eggs

Sources of B2 (riboflavin)

leafy green vegetables (broccoli, spinach, green beans), enriched cereal

Signs of Vitamin A (retinol) deficiency

dry, rough skin, night blindness, defective tooth enamel, retarded growth and bone formation, decrease thyroid hormone formation

Sources of Vitamin A (retinol)

liver, carrots, sweet potatoes, spinach, peaches, apricots



Signs of Vitamin C deficiency

scurvy, bleeding receeding gums, dry rough skin, decreased wound healing, increased infection risk, irritability

Sources of Vitamin Cstrawberries, oranges, tomatoes, broccoli, cabbage, cauliflower, spinach

Signs of Vitamin B6 (pyridoxine) deficiency

scaly dermatitis, weight loss, anemia, irritability, convulsions, peripheral neuritis

Sources of B6 (pyridoxine)

meats, cereal, yeast, soybeans, peanuts, tuna, chicken, bananas

Signs of respiratory distress

restlessness, increased resp. rate, increased pulse rate, diaphoresis

Which happens first, respiratory failure or cardiac failure

respiratory failure

Asthmaairway become edematous, becomes congested with mucous, smooth muscles constrict, airtrapping occurs in alveoli

Nursing interventions for acute asthma exacerbations

rapid acting bronchodilators and steroids

Nursing interventions for asthma maintanence at home

identify triggers, reduce allergens, use MDI, monitor through peak flow meter, Asthma Action Plan

What type of disease is Cystic Fibrosis?

autosomal recessive disease that causes dysfunction of exocrine glands

Systemic effects of cystic fibrosis

lung insufficiency (most critical), pancreatic insufficiency, increased loss of sodium and chloride in sweat

Signs and symptoms of Cystic Fibrosis

meconium ileus at birth, recurrent respiratory infections, pulmonary congestion, steatorrhea, foul smelling bulky stools, poor weight gain, salty tasting skin

Cystic Fibrosis nursing interventions

IV abx, pancreatic enzymes given with food/applesauce, fat soluble vitamins, teach postural drainage and percussion

Cystic Fibrosis dietPts will need 1.5x normal caloric intake, high calories, high protein, moderate fat content, moderate carbohydrates

Causes of epiglottitisrapid acute airway obstruction usually caused by H. influenzae type B

Signs and symtoms of epiglottitis

rapid onset, restlessness, high fever, sore throat, dysphagia, drooling, muffled voice, tripod position

What intervention is contraindicated in epiglottitis?

Never put anything in the mouth because of the risk of complete airway obstruction

Nursing interventions in epiglottitis

encourage prevention with HiB vaccine, upright position, NPO, IV abx, prepare for intubation/tracheosomy, prepare for ICU admit

Bronchiolitisviral infection of the bronchioles caused by RSV characterized by thick secretions

Signs and symptoms of bronchiolitis

upper respiratory symptoms, irritability, paroxysmal cough, poor eating, nasal congestion, nasal flaring, prolonged expiration, wheezing and rales

What is given to prevent RSV infections in immunocompromised patients?

Synagis (palivizumab)

Nursing interventions for Bronchiolitis

isolation, assess respiratory status, mist tent, maintain hydration, evaluate respiratory treatment effectiveness

Newborn RR, HRRR: 30-60HR:100-160

Infant RR, HRRR: 25-35HR: 100-150

Toddler RR, HRRR: 20-30HR: 80-130

Preschool RR, HRRR: 20-25HR: 80-120

School Age RR, HRRR: 18-22HR: 70-110

Adolescent RR, HRRR: 16-20HR: 60-90

Why are young children prone to ear infections?

The eustachian tubes are flattened

Otitis Media signs and symptoms

fever, pain, infant may pull at ear, enlarged lymph nodes, drainage from ear (if eardrum is ruptured), vomiting and diarrhea

Nursing interventions for otitis media

Abx as prescribed, Tylenol, reduce body temperature (warm tepid bath), monitor hearing loss

Tonsilitisinflammation of tonsil (viral or bacterial) related to strep

Risks of untreated Tonsilitis

may lead to acute glomerulonephritis or rheumatic heart disease

Signs and symptoms of tonsilitis

sore throat, fever, enlarged tonsils, possible obstructed breathing

Nursing interventions for tonsilitis

throat culture to determine cause, warm salt gargles, ice chips, possible surgery, abx, Tylenol

Post-surgical care of tonsillectomy

Monitor for post-op bleeding (frequent swallowing, vomiting fresh blood, clearing throat), soft foods and fluids, ice collar for comfort

When is highest risk of hemorrhage after tonsillectomy?

first 24 hours, 5-10 days after surgery

Acyanotic heart defects

VSD, ASD, PDA, AS

Cyanotic heart defects tetralogy of Fallot, TA, transposition of great vessels

Increased pulmonary blood flow defects

ASD, VSD, PDA

Obstructive defects coarctation of aorta, AS

Decreased pulmonary blood flow

Tetralogy of Fallot

Mixed blood heart defects

TGV, TA

Atrial Septal Defect (ASD)

Increased pulmonary blood flow. There is a hole between the atria, oxygenated blood from LA is shunted to the RA and lungs.

Treatment and consequences of ASD

Surgical closure before school age recommended. Can l/t CHF and atrial dysrhythmia.

Patent Ductus Arteriosus (PDA)

Increased pulmonary blood flow. Hole between aorta and pulmonary artery, usually closes within 72 hours. Oxygenated blood from the aorta returns to the pulmonary artery.

Treatment and consequences of PDA

Increased blood flow to the lungs l/t pulmonary hypertension. Require Indomethacin or surgical closure.

Coarctation of the Aorta

Obstruction of blood flow from ventricles c/b narrowing of aorta.

Classic signs of coarctation of aorta

Hypertension of upper extremities and decreased or absent pulses in lower extremities, requires surgery.

Aortic Stenosis (AS)Obstruction of blood flow from ventricles immediately before/at/after aortic valve. Oxygenated blood from LV to body is diminished

Three T's of cyanotic heart disease

Tetralogy of Fallot, Truncus Arteriousus, Transposition of the great arteries

What is tetralogy of Fallot?

combination of four defects: VSD, overriding aorta, pulmonary stenosis, right ventricular hypertrophy

Truncus ArteriosusOne artery (truncus) rather than 2 arteries (aorta and pulmonary artery) arises from both ventricles

Transposition of the Great Arteries

Pulmonary artery leaves the left ventricle and the aorta exits from the right ventricle.

Signs and symptoms of Tetralogy of Fallot

Cyanosis because unoxygenated blood is pumped into the systemic circulation, decreased pulmonary circulation. Experiences tet spells or hypoxic episodes and relieved by squatting or put in the knee-chest position.

Truncus ArteriosusPulmonary artery and aorta do not separate. Blood mixes in the R and L ventricles through a large VSD l/t cyanosis and increased pulmonary resistance.

Transposition of the Great Vessels

Mixed blood flow.Pulm circulation arises from L vent and systemic circulation arises from R vent.

Incompatible with life --> medical emergency give prostaglandin to keep ductus open.

Assessment of child with CHD

Check for murmur, cyanosis, clubbing (>age 2), poor feeding, FTT, fatigue, respiratory infections

Feeding a child with CHD

Maintain nutrition status with small frequent meals with high-calorie formula. Maintain hydration to prevent thrombus formation.

Risks of cardiac catheterization

arrhythmias, bleeding, perforation, phlebitis, arterial obstruction at entry site

Basic differences between cyanotic and acyanotic defects.

Cyanotic: abnormal circulation, all blood entering circulation is oxygenatedAcyanotic: abnormal circulation with unoxygenated blood entering the systemic system

Therapeutic digoxin levels

0.8-2ng/ml

Digoxin administration

Check for bradycardia and hold. Do NOT skip doses, not miss with meals

Digoxin toxicityVomiting is early sign, also, anorexia, diarrhea, and abdominal pain, fatigue, muscle weakness

What exacerbates Digoxin toxicity?

Hypokalemia



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When does birth length double

4 years

When does the child sit unsupported

8 months

When does a child achieve 2 years



50% of adult height

When does a child throw a ball overhand

18 months

When does a child speak two to three word sentences

2 years

When does a child use scissors

4 years

When does a child tie his or her shoes

5 years

Which gender's growth spurt occurs first?

Girls: as early as 10 years of age

What kind of behavior is considered common in the toddler?

Temper tantrum

When does a child form his or her identify?

Adolescence

Rebellion against family values is common for which age group?

Adolescence

Concepts of bodily injury: Infants

After 6 months, their coginitive development alows them to remember pain

Concepts of bodily injury: toddlers

They fear intrusive procedures

Concepts of bodily injury: Preschoolers

They fear body mutilation

Concepts of bodily injury: School age children

Fear loss of control of their bodies

Concepts of bodily injury: Adolescents

Major concern is a change in body image

What is a major cause of death in children and adolescents?

Accidents

What kind of children pose a serious threat to

Children with German measles

their unborn siblings?

What kind of hx should be obtained prior to administration of DPAT?

Hx of reactions, sz, nerologic symtptoms after previous vaccine, systematic alergic reactions

What kind of hx should be obtain prior to the administration of MMR?

Hx of anaphylactic reactions to eggs, or neomycin

Pertussus fatalities continue to occurr in which group in the US?

Nonimmunized infants

Which type of administration method invalidates the mantoux test?

subQ rather than ID

Is the common cold a contraindication for immunization?

No

What type of teaching should be provided following immunization?

IrritabilityFever (<102)Redness and soreness at injection site for 2-3 days are normal for DTaP and IPVCall HCP if seizures, high fever, or high pitched crying occursWarm washcloth on thigh injection site and bicycling the legs with each diaper change decreases sorenessTylenol is administered every 4-6 hrs (10-15mg/kg)

Where should milk be stored?

In an opaque container

How do you cook vegetables to preserve potency?

Cook in a small amount of liquid

Is it recomended to induce vomiting in children?

No, it may cause more damage

Should you examine the throat of a child with epiglottitis?

No, there is the risk of completely blocking the airway

Which is the priority of care regarless of age?

Patent airway!

Prior to tonsillectomy, which labs should be known

PT/PTT: in addition to this, its important to know if there is a hx of bleeding, prolonged or excessive, and whether there is a hx of any bleeding disorders in the family

With cyanotic defects, what condition is common

polycythemia

What is the difference between acyanotic and cyanotic?

Acyanotic: abnormal circulation but all blood entering the systemic circulation is oxygenated

Cyanotic: abnormal circulation with unoxygenated blood entering the systemic circulation

Are acyanotic or cyanotic defects more common with CHF children

Acyanotic

To conserve energy in children with heart defects, what may be necessary to conserve energy?

Tube feedings

What are two objectives of tx CHF?

Reduce the workload of the heart and increase CO

What should be consistent when frequently weighing a child?

Weighing the child on the same scale at the same time of day so accurate comparisons can be made

When feeding a child with cerebral palsy, what nursing interventions should be implemented

Preventing aspiration: Position child upright and supporting the lower jaw

What is the nursing goal in caring for a down syndrome child?

Help the child reach his or her optimal level of functioning

What are the s/sx of IICP?Opposite of shock:Decreased pulse, decreased blood pressure

What is essential so changed associated with

Baseline of child's behavior and level of development

IICP can be detected early?

Should a shunt be pumped?

No, the shunt has delicate valves and pumping can change pressures within the ventricles

What is the most common cause of increased seizure activity?

Medication noncomplicance

What should the nurse monitor carefully with meningitis?

Hydration status and IV therapy.

With meningitis, there may be inappropriate ADH secretions causing cerebral edema and dilutional hyponatremia

What is the most common presenting symptom with a brain tumor?

Headache

How should post-op patients with infratentorial tumors be positioned?

Patients should be flat or turned to either side, a large tumor may require a child not be turned to the operative side

What is the first sign of renal failure

Decreased urinary output

When is the correction of hypospadias done?

It is usually done before preschool years to allow for the achievement of sexual identity, to avoid castration anxiety, and to facilitate toilet training

What are typical patient and family reactions to a child with a malformation?

GuiltDisappointmentGriefSense of lossAnger

What is an important nursing diagnosis r/t cleft lip/palate & pyloric stenosis?

Alternation in nutrition: less than body requirements

Cleft lip/palate: r/t decreased ability to suckPyloric Stenosis: r/t frequent vomiting

What are big problems for children with GI problems?

Nutrition needs & electrolyte balance

Younger children are more vulnerable to these problems

Where should you take the temp of a child with megacolon?

Axillary temp

What are the Hgb norms for a:NewbornInfantChild

Newborn: 14-24Infant: 10-15Child: 11-16

What are teaching point of administering iron?

1. Give on an empty stomach2. Give with citrus juice3. Use dropper or straw to avoid discoloring teeth4. Stools will be tarry5. Iron can be fatal in severe doses6. Do not give with dairy products

What supplement is not given to sickle cell anemia?

Supplemental Iron; instead folic acid is given to stimulate RBC synthesis

What needs to be available when administering l-asparaginase?

Epi and O2 to treat anaphylaxis

What is used to reduce the mitosis of lymphocytes?

Prednisone is frequently used in combination with antineoplastic drugs

What is used to prevent renal damage?

Allopurinol - an xanthineoxidase inhibitor

How can you describe an infant with hypothyroidism?

Good, quiet baby

How should insulin be administered when a child is in DKA?

Administer it in normal saline

What type of fractures are related to child abuse?

Spiral fractures

What type of fractures put limb growth at risk?

Fractures involving the epiphyseal plate

What do you want to monitor with pin sites?

s/sx of infection

Does a brace correct or slow the progression of scoliosis?

It slows the progression



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List normal findings in a neurovascular assessment.

Warm extremity, brisk capillary refill, free movement, normal sensation of the afected extremity, and equal pulses.

What is compartment syndrome?

Damage to the nerves and vasculature of an extremity due to pressure.

What are the signs and symptoms of compartment syndrome?

Abnormal neurovascular assessment: cold extremity, severe pain, inability to move the extremity, and poor capillary refill.

Why are fractures of the epiphyseal plates a special concern?

Fractures of the epiphyseal plate (growth plate) may affect the growth of the limb.

How is skeletal traction applied?

Skeletal traction is maintained by pins or wires applied to the distal fragment of the fracture.

What discharge instructions should be included concerning a child with spica cast?

Check child's circulation. Keep cast dry. Do not place anything under cast. Prevent cast soilage during toileting or diapering. Do not turn child using an abductor bar.

What are signs and symptoms of congenital dislocated hip in infants?

Unequal skin folds of the buttocks, Ortalini sign, limited abduction of the affected hip, and unequal leg lengths.

How would the nurse conduct a scoliosis screening?

Ask the child to bend forward from the hips with arms hanging free. Examine the child for a curve in the spine, rib hump, and hip asymetry.

What instructions should a child with scoliosis

The child should be instructed to wear the brace 23 hours per day; wear a T-shirt under brace;



recieve about the Milwaukee brace?

check skin for irritation; perform back and abdominal exercises; modify clothing. The child should be encouraged to maintain normal activities as able.

What care is indicated for a child with juvenille rhuematoid arthritis?

Prescribed exercise to maintain mobility; splinting of affected joints; and teaching about medication management and side affects of drugs.

HESI HINTSGrowth and Development MilestonesWhen does birth length double?

Answer: By 4 years

When does the child sit unsupported?

Answer: 8 months

When does a child achieve 50% of adult height?

Answer: 2 years

When does a child throw a ball overhand?

Answer: 18 months

When does a child speak 2-3 word sentences?

Answer: 2 years

When does a child use scissors?

Answer: 4 years

When does a child tie his/her shoes?

Answer: 5 yearsBe aware that a girl’s growth spurt during adolescence begins earlier than boys (asearly as 10 years old).Temper tantrums are common in the toddler, i.e., considered “normal,” or averagebehavior.Be aware that adolescences is a time when the child forms his/her identity and thatrebellion against family values is common for this age group.

Normal growth and development knowledge is used to evaluate interventions and

therapy.

For example, “What behavior would indicate that thyroid hormone therapy for a 4-month-old is effective?” You must know what milestones are accomplished by a 4-

month-old.One correct answer would be “has steady control” which is an expected milestonefor a 4-month-old and indicates that replacement therapy is adequate for growth.

Use facts and principles related to growth and development in planning teaching

interventions.

For example: “What task could a 5-year-old diabetic boy be expected to accomplishby himself?”One correct answer would be to pick the injection sites. This is possible for apreschooler to do and gives the child some sense of control.

School-age children are in Erikson’s stage of industry, meaning they like to do and

accomplish things. Peers are also becoming important for this age child.

Age groups concepts of bodily injury:

Infants: After 6 months, their cognitive development allows them to remember pain.Toddlers: Fear intrusive procedures.Preschoolers: Fear body mutilation.School age: Fear loss of control of their body.Adolescent: Major concern is change in body image.

Pertinent history should be obtained prior to administering certain immunizationsbecause reactions to previous immunizations or current health conditions maycontraindicate current immunizations:

DPT: History of seizures, neurological symptoms after previous vaccine, or

systematic allergic reactions.

MMR: History of anaphylactic reaction to eggs or neomycin.Pertussis fatalities continue to occur in unimmunized infants in the U.S.Subcutaneous injection, rather than intradermal, invalidates the Mantoux test.The common cold is not contraindication for immunization.Following immunization, what teaching should the nurse provide to the parents?Irritability, fever (<102 degrees F), redness and soreness at injection site for 2-3

days are normal side effects of DPT and IPV administration.Call health care provider if seizures, high fever, or high -pitched crying occur.A warm washcloth on the thigh injection site and “bicycling” the legs w/each diaperchange will decrease soreness.Acetaminophen (Tylenol) is administered orally every 4-6 hours (10-15 mg/Kg).

Children w/German measles pose a serious threat to their unborn siblings. Thenurse should counsel all expectant mothers, especially those w/young children, tobe aware of the serious consequences of exposure to German measles duringpregnancy.

Common childhood problems are encountered by nurses caring for children in the community or hospital settings. The child’s age directly influences the severity and management of these problems.

Nutritional Assessment:Teach proper cooking and storage to preserve potency, i.e., cook vegetables insmall amount of liquid.

Store milk in opaque container.

Add potassium to IV fluids ONLY w/adequate urine output.Urinary output for infants and children be 1-2 ml/kg/hour.Use of syrup of ipecac is no longer recommended by the American Academy of

Pediatrics. Teach parents that it is NOT recommended to induce vomiting in any way

as it may cause more damage.Child needs 150% of the usual calorie intake for normal growth and development.Do not examine the throat of a child w/epiglottitis due to the risk of completely

obstructing the airway, i.e., do not put a tongue blade or any object in the throat.

In planning and providing nursing care, a patent airways is always a priority of care,

regardless of age!

Respiratory disorders are the primary reason most children and their families seekmedical care. Therefore, these disorders are frequently tested on the NCLEX-RN.Knowing the normal parameters for respiratory distress in children is essential!

The nurses should be sure a PT and PTT have been determined prior to atonsillectomy. More importantly, the nurse should ask if there has been a history ofbleeding, prolonged/excessive, or if there is a history of any bleeding disorders inthe family.

When calculating a pediatric dosage, the nurse must often change the child’s weight from pounds to kilograms. HINT: Weight expressed in kilograms should always be a smaller number than weight expressed in pounds.

Polycythemia is common in children w/cyanotic defects.

For normal cardiac rates in children, see Respiratory in this chapter. The heart rate

of a child will increase w/crying or fever.

Infants may require tube feeding to conserve energy.

Basic difference between cyanotic and acyanotic defects:Acyanotic: Has abnormal circulation, however, all blood entering the systemiccirculation is oxygenated.Cyanotic: Has abnormal circulation w/unoxygenated blood entering systemic

circulation.

CHF: Congestive heart failure is more often associated w/acyanotic defects.

CHF is a common complication of congenital heart disease. It reflects the increasedworkload of the heart resulting from shunts or obstructions. The two objectives intreating CHF are to reduce the workload of the heart and increase cardiac output.

When frequent weighings are required, weigh client on the same scale at same time

of day so that accurate comparisons can be made.

The nursing goal in caring for children w/Down syndrome is to help the child reach

his/her OPTIMAL level of functioning.

Feed infants or child w/cerebral palsy using nursing interventions aimed at

preventing aspiration. Position child upright and support the lower jaw.

The signs of increased ICP are the opposite of those of shock.Shock: Increased pulse, Decreased blood pressure.Increased ICP: Decreased pulse, Increased blood pressure.

Baseline data on the child’s USUAL behavior and level of development is essential

so changes associated w/increased ICP can be detected EARLY.

Do not pump shunt unless specifically prescribed. The shunt is made up of delicate

valves, and pumping changes pressures within the ventricles.Medication noncompliance is the most common cause of increased seizure activity.Do NOT use tongue blade, padded or not, during a seizure. It can cause traumatic

damage to mouth/oral cavity.

Monitor hydration status and IV therapy carefully. With meningitis, there may beinappropriate ADH secretions causing fluid retention (cerebral edema) and dilutionalhyponatremia.

Headache upon awakening is the most common presenting symptoms of brain

tumors.

Most postoperative clients w/infractentorial tumors are prescribed to lie flat and turnto either side. A large tumor may require that the child NOT be turned to theoperative side.

Suctioning, coughing, straining, and/or turning causes increased ICP.

Decreased urinary output is FIRST sign of renal failure.

Surgical correction for hypostasis is usually done before preschool years due to

achieving sexual identity, castration anxiety, and toilet training.

Typical parent/family reactions to a child w/an obvious malformation such as cleft

lip/palate are guilt, disappointment, grief, sense of loss, and anger.

Children w/cleft lip/palate and those w/pyloric stenosis both have a nursingdiagnosis “alteration in nutrition; less than body requirements.”Cleft lip/palate is related to decreased ability to suck.Pyloric stenosis is related to frequent vomiting.

Nutritional needs and fluid and electrolyte balance are key problems for childrenw/GI disorders. The younger the child, the more vulnerable they are to fluid andelectrolyte imbalances and greater is the need for caloric intake required for growth.

Take axillary temperature on children w/congenital mega colon.

REMEMBER the Hgb norms.Newborn: 14 to 24 g/dlInfant: 10 to 15 g/dlChild: 11 to 16 g/dl

TEACH FAMILY ABOUT ADMINISTRATION OF ORAL IRON:Give on empty stomach (as tolerated for better absorption).Give w/citrus juices (vitamin C) for increased absorption.Use dropper or straw to avoid discoloring teeth.Stools will become tarry.Iron can be fatal in severe overdose; keep away from children. Don not give w/dairyproducts.

Inherited bleeding disorders (hemophilia and sickle cell anemia) are often used totest knowledge of genetic transmission patterns. Remember:Autosomal recessive: Both parents must be heterozygous, or carriers of therecessive trait, for the disease to be expressed in their offspring. With eachpregnancy, there is a 1:4 chance of the infant having the disease. However, allchildren of such parents CAN get the disease - NOT 25% of them. This is thetransmission for sickle cell anemia, cystic fibrosis, and phenylketonuria (PKU).X-linked recessive trait: The trait is carried on the X chromosome, therefore, usuallyaffects male offspring, e.g., hemophilia. With each pregnancy of a woman who is acarrier there is a 25% chance of having a child w/hemophilia. If the child is male, hehas a 50% chance of having hemophilia. If the child is female, she has a 50%chance of being a carrier.

Hydration is very important in treatment of sickle cell disease because it promotes

hem dilution and circulation of red cells through the blood vessels.

Important terms:

Heterozygous gene (HgbAS) sickle cell trait.Homozygous gene (HbSS) sickle cell disease.Abnormal hemoglobin (HGBS) disease and trait.

Supplemental iron is not given to clients w/sickle cell anemia. The anemia is not

caused by iron deficiency. Folic acid is given orally to stimulate RBC synthesis.

Have epinephrine and oxygen readily available to treat anaphylaxis when

administering I-asparaginase.

Prednisone is frequently used in combination w/antineoplastic drugs to reduce themitosis of lymphocytes. Allopurinol, a xanthine-oxidase inhibitor, is alsoadministered to prevent renal damage from uric acid build up during cellular lysis.

An infant w/hypothyroidism is often described as a “good, quiet baby” by the

parents.

Early detection of hypothyroidism and phenylketonuria is essential in preventingmental retardation in infants. Knowledge of normal growth and development isimportant, since a lack of attainment can be used to detect the existence of thesemetabolic/endocrine disorders and attainment can be used for evaluating thetreatment’s effect.

NutraSweet (aspartame) contains phenylalanine and should not therefore, be given

to a child w/phenylketonuria.

Diabetes mellitus (DM) in children was typically diagnosed as insulin dependantdiabetes (Type 1) until recently. A marked increase in type 2 DM has occurredrecently in the U.S., particularly among Native-American, African-American, andHispanic children and adolescents. Adolescence frequently causes difficultyw/management since growth is rapid and the need to be like peers makescompliance difficult. Remember to consider the child’s age, cognitive level ofdevelopment, and psychosocial development when answering NCLEX-RN questions.

When child is in ketoacidosis, administer regular insulin IV as prescribed in normal

saline.

There has been an increase in the number of children diagnosed with Type 2diabetes. The increasing rate of obesity in children is thought to be a contributingfactor. Other contributing factors include lack of physical activity and a familyhistory of Type 2 diabetes.

Fractures in older children are common as they fall during play and are involved inmotor vehicle accidents.Spiral fractures (caused by twisting) and fractures in infants may be related to childabuse.

Fractures involving the epiphyseal plate (growth plate) can have seriousconsequences in terms of growth of the affected limb.

Skin traction for fracture reduction should NOT be removed unless prescribed by

healthcare provider.

Pin sites can be sources of infection. Monitor for signs of infection. Cleanse and

dress pin sites as prescribed.

Skeletal disorders affect the infant’s or child’s physical mobility, and typical NCLEX- RN questions focus on appropriate toys or activities for the child who is on bedrest and/or immobilized.

Children do not like injections and will deny pain to avoid “shots.”

A brace does not correct the curve of a child w/scoliosis, it only stops or slows the

progression.

Corticosteroids are used short term in low doses during exacerbations. Long-term

use is avoided due to side effects and their adverse effect on growth.



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CV Changes at Birth* Ductus arteriosis ____* Pulmonary vascular bed ____* Pulmonary vascular resistance ____* Systemic vascular resistance ____* Foramen ovale __ d/t ___

*Ductus arteriosis CONSTRICTS*Pulmonary vascular bed OPENS*Pulmonary vascular resistance DECREASES*Systemic vascular resistance INCREASES*Foramen ovale CLOSES d/tBLOOD FLOW FROM LEFT TO RIGHT

ACYANOTICcongenital heart diseasesthat cause ↑ Pulmonaryblood flow:_____

* A/V septal defects* Patent ductus arteriosus* Atrioventricular canal



__________

ACYANOTICcongenital heart diseasesthat cause obstructed blood flow from ventricles:____________

* Coarctation of aorta* Aortic stenosis* Pulmonic stenosis

CYANOTICcongenital heart diseasesthat cause ↓ Pulmonaryblood flow:________

* Tetralogy of Fallot* Tricuspid atresia

CYANOTICcongenital heart diseasesthat cause mixed blood flow:________________

* Transposition of great arteries* Total anomalous pulmonary venous return* Truncus arteriosus* Hypoplastic L heart syndrome

NCLEXAfter a pediatric client has a cardiaccath, which intervention would thenurse consider to be of highest priority during the immediate post procedure period?

1. Encourage intake of small amounts of fluid.2. Teach the parents signs of CHF.3. Monitor the site for signs of infection.4. Apply direct pressure to entry site of 15 minutes.

4. Apply direct pressure to entry site of 15 minutes.

NCLEXWhich of the following home care instructions in included for a child postcatheterization?1. Encourage fluids and regular diet.

1. Encourage fluids and regular diet.

2. Encourage physical activities.3. The child can routinely bathe after returninghome.4. The child may return to school the next day.

Patent Ductus Arteriosus* Diagnosis- Continuous ____ below left ____- Dx with ____, cardiac ___* Treatment- ____ for preterm only- ____

Patent Ductus Arteriosus* Diagnosis- Continuous MURMUR below left CLAVICLE- Dx with X-RAY, cardiac ECHO* Treatment- INDOMETHACIN for preterm only- SURGERY

Transposition of the Great Arteries* Pathophysiology- ____ bloodenters ____ and ____- ____ circulation* Clinical manifestations- Initially appears ____- ____ develops withina few hours of life

Transposition of the Great Arteries* Pathophysiology- UNOXYGENATED bloodenters RA and RV- PARALLEL circulation* Clinical manifestations- Initially appears NORMAL- CYANOSIS develops withina few hours of life

NCLEXWhich of the following statements is

correct for a child with tetralogy of Fallot?1. The condition is commonly referred to as “blue tets.”2. They experience hypercyanotic, or “tet” spells.3. They experience frequent respiratory infections.4. They experience decreased or absent pulses in the lower extremities.

2. They experience hypercyanotic, or “tet” spells.

NCLEXAdministration of which of the following drugs

4. Prostaglandin E1

would be the most important in treatingtransposition of the great arteries?1. Digoxin2. Diuretics3. Antibiotics4. Prostaglandin E1

NCLEXWhich of the following cardiovascular disordersis considered acyanotic?1. Patent ductus arteriosus2. Tetralogy of Fallot3. Tricuspid atresia4. Truncus arteriosus

1. Patent ductus arteriosus

Psychosocial Factors* ____* ____* ____* ____

* Separation* Bonding* Feeding* Care

NCLEXA 2-year-old child has a known cardiac defect and is in congestive heart failure. Which assessment finding indicates to the nurse a toxic dose of digoxin?1. Tachycardia and dysrhythmia2. Headache and diarrhea3. Bradycardia, nausea, and vomiting4. Tinnitus and nuchal rigidity

3. Bradycardia, nausea, and vomiting

Kawasaki Disease* Pathophysiology- ____itis- ____itis - ____ on echocardiogram

Kawasaki Disease* Pathophysiology- VASCULitis (BV inflamm)- PANCARDitis (inflamm of ALL structures of heart)- ECTASIA (dilation of tubular vessel) on echocardiogram

NCLEXWhen assessing a child with suspectedKawasaki disease, which of the

2. “Strawberry” tongue

1st sign - HIGH (not low) fever

followingsymptoms is common?1. Low-grade fever2. “Strawberry” tongue3. Pink moist mucous membranes4. Bilateral conjunctival infection with yellowexudate

NCLEXA nurse is giving discharge instructions to the parents of a child with Kawasaki disease. Which of the following statements shows anunderstanding of the treatment plan?1. “A regular diet can be resumed at home.”2. “Black, tarry stools are considered normal.”3. “My child should use a soft-bristled toothbrush.”4. “My child can return to playing football next week."

3. “My child should use a soft-bristled toothbrush.”

NCLEXWhich of the following statements best defines the term cardiogenic shock?1. Decreased cardiac output2. A reduction in circulating blood volume3. Overwhelming sepsis and circulating bacterial toxins4. Inflow or outflow obstruction of the mainbloodstream.

1. Decreased cardiac outputCAUSES2. A reduction in circulating blood volumeRESULTING IN GLOBAL HYPOPERFUSION

NCLEXWhich of the following signs is considereda late sign of shock in children?1. Tachycardia2. Hypotension3. Delayed capillary refill4. Pale, cool, mottled skin

2. Hypotension

NCLEX 3. Low-grade fever

A child with suspected bacterial endocarditis arrives at theemergency department. Which of thefollowing findings is expected duringassessment?1. Weight gain2. Bradycardia3. Low-grade fever4. Increased hemoglobin level

NCLEXA nurse is teaching wound care to parents after cardiac surgery. Which of the following statements is most appropriate?1. Lotions and powders are acceptable.2. Your child can take a complete bath tomorrow.3. Tingling, itching, and numbness are normal sensations at the wound site.4. If the sterile adhesive strips over the incision fall off, call the physician.

4. If the sterile adhesive strips over the incisionfall off, call the physician.

NCLEXA child with an atrial septal repair is enteringpostoperative day 3. Which of the followinginterventions would be most appropriate?1. Give the child nothing by mouth.2. Maintain strict bed rest.3. Take vital signs every 8 hours.4. Administer an analgesic as needed.

4. Administer an analgesic as needed.

NCLEXA chld with a cyanotic heart defect is being discharged home to await surgical repair. In the discharge teaching, the nurseinstructs the parents:1. To prevent the child from crying

2. To observe the child for signs of increased intracranial pressure.

at all.2. To observe the child for signs of increased intracranial pressure.3. In cardiopulmonary resuscitation.4. To identify growth and development milestones.

Monro - Kellie Hypothesis

• Once sutures have fused, the skull isa rigid compartment filled tocapacity with non-compressible contents:– brain ____%– blood ____%– CSF ____%• If one component increases in volume, another component must ____or ICP will ____.

Monro - Kellie Hypothesis

– brain 80%– blood 10%– CSF 10%

• If one component increases in volume, another component must DECREASE or ICP willINCREASE.

Normal ICP

Adult ___-___ mm Hg Child ___-___ mm Hg

(Accept values < ___ mm Hg)

Normal ICP

Adult 3 - 15 mm Hg Child 0 - 10 mm Hg

(Accept values < 20 mm Hg)

Cerebral Perfusion Pressure

- blood pressure gradient across the brain

CPP = ____–____

Keep above ____

CPP = MAP – ICP

Keep above 60

Causes of Increased ICP

• ____ lesions (__,__,__)• ____ injury (__,__)• ____ problems (__natremia,__failure,__failure,__acidosis)• Subarachnoid/intracerebral ____

Increased ICP

• MASS lesions (TUMORS, ABSCESSES, HEMATOMAS)• ISCHEMIC injury (STROKE, HYPOXIA)• METABOLIC problems(HYPOnatremia, LIVER failure, RENAL failure,

• ____ Malfunction

Diabetic Ketoacidosis)• Subarachnoid/intracerebralHEMORRHAGE• SHUNT Malfunction

S/S of Increased ICP

• ____ dysfunction• ____ weakness• ____ deficits• ____ nerve palsies• ____ pain• Deterioration in level of ____• ____

• PUPILLARY dysfunction• MOTOR weakness• SENSORY deficits• CRANIAL nerve palsies• HEADACHE pain• Deterioration in level of CONSCIOUSNESS• SEIZURE

LATE S/S of Increased ICP

• Severe deterioration of ___• ____• ____edema• ____ing• Change in ____ signs• Impaired brain stem ____

• Severe deterioration of LOC• VOMITING• PAPILLedema• POSTURing• Change in VITAL signs• Impaired brain stem REFLEXES

S/S of Increased ICP in an INFANT

• ____ feeding• ____ity• ____-pitched cry• ____, ____ fontanel• ____ing• ____ scalp veins• ____ head circumference

S/S of Increased ICP in an INFANT

• POOR feeding• IRRITABILity• HIGH-pitched cry• TENSE, BULGING fontanel• VOMITing• DISTENDED scalp veins• INCREASED head circ

TX for Elevated ICP (slide#1)

• 1st: ___'s!– Stabilize ____- ____-____ CO2– ____active drugs– ____ drugs (Osmotic/Loop)– ____osmolar therapy with ____% saline– Positioning: ____, HOB ___, ____/____ alignment


• 1st: ABC’s!– Stabilize AIRWAY- LOW-NORMAL CO2– VASOactive drugs– DIURETICS (Osmotic/Loop)– HYPERosmolar therapy with 3% saline– Positioning: SUPINE, HOB UP, HEAD/NECK alignment


• ____tion• Maintain ____ temp• ____• ____ Drainage• ____ control• ____ regimen• Avoid clustering ____• Avoid ____ exercises• Provide a ____ environment


• SEDAtion• Maintain NORMAL temp• SURGERY• CSF Drainage• SEIZURE control• BOWEL regimen• Avoid clustering ACTIVITIES• Avoid ISOMETRIC exercises• Provide a CALM environment

Syndrome of InappropriateADH Secretion

- ____ H2O reabsorption– ____ serum osmolality– ____ serum Na (<110mEq/L)– ____ urine osmolality

– Irritability, anorexia, nausea, cramps, lethargy, stupor, convulsions

- INC. H2O reabsorption– DEC. serum osmolality– DEC. serum Na (<110mEq/L)– DEC. urine osmolality

– Irritability, anorexia, nausea, cramps, lethargy, stupor, convulsions

SIADH Tx/NSG interventions

• ____ fluids• ____tonic saline• Monitor ____• Accurate __&__• Urine ____• Daily ____• ____ checks• ____ precautions

SIADH Tx/NSG interventions

• RESTRICT fluids• HYPERtonic saline• Monitor ELECTROLYTES• Accurate I&O• Urine SPECIFIC GRAVITY• Daily WEIGHT• NEURO checks• SEIZURE precautions

S/S Diabetes Insipidus

• Insufficient ___ Hormone• ____ diuresis• ____ osmolality • ____ urine specific gravity• ____ thirst• ____hydration

S/S Diabetes Insipidus

• Insufficient ADH• UNCONTROLLED diuresis• DEC. osmolality • DEC. urine specific gravity• INSATIABLE thirst• DEhydration

DI Tx/NSG Interventions

• Fluid ____• Strict __&__

DI Tx/NSG Interventions

• Fluid REPLACEMENT• Strict I&O

• Daily ____• Urine ____• Monitor ____• Med: ____

• Daily WEIGHT• Urine SPECIFIC GRAVITY• Monitor ELECTROLYTES• Med: DDAVP (Desmopressin)

Nursing Dx for pts withNeural Tube defects

• Potential for ____• Potential for ____• Potential for ____• Potential for ___ skin ___• Altered ____• Alteration in ___ processes

Nursing Dx for pts withNeural Tube defects

• Potential for infection• Potential for trauma• Potential for injury• Potential for impairedskin integrity• Altered body image• Alteration in familyprocesses

50-70% of Spina Bifida pts have an allergy to _____

50-70% of SB pts have an allergy to LATEX

Treat ALL SB pts as if they have this allergy

Found in: catheters, gloves, tubing, tape, tourniquets, glue, toys, handles, tires, balloons, elastic

Most common causative organisms of MENINGITIS (80%)

• ____• ____• ____

• Haemophilus influenza b(Hib)

• Strep pneumoniae (pneumococcal)

• Neisseria menigitidis (meningococcal)

MENINGITIS Tx/NSG Intervent.

• Meds: ____• ____ precautions• ____tion• Fluid ____ (how much?)• Monitor for increased ___• ____ measures• ____ tests

MENINGITIS Tx/NSG Intervent.

• Meds: ABX• Isolation precautions• Ventilation• Fluid restriction (how much? 1/2 to 2/3)• Monitor for increased ICP• Comfort measures• Hearing tests

MENINGITIS residual effects

• ____ness, ____ness• ____• Subdural ____,____cephalus• ____• ____ palsy• ____ (Meningococcal)

MENINGITIS residual effects

• Deafness, blindness• Paralysis• Subdural effusions, hydrocephalus• Seizures• CP• Amputation (Meningococcal)

Etiology of Seizures

• ____pathic• ____ Process• ____ Imbalance• ____ (temp)• ____ Injury or ____ Tumor• ____ Intoxication• ____therapeutic Drug Levels

Etiology of Seizures

• Idiopathic• Infectious Process• Metabolic Imbalance• Fever• Brain Injury or Brain Tumor• Drug Intoxication• Subtherapeutic Drug Levels

Seizure Types• Partial– ____– ____• Generalized– ___-___– A____– A____– A____

Seizure Types• Partial– Simple– Complex• Generalized– Tonic-Clonic– Absence– Atonic– Akinetic

Status Epilepticus- MED EMERG

• Continuous ____ activity• Loss of ____

Status Epilepticus- MED EMERG

• Continuous SEIZURE activity• Loss of CONSCIOUSNESS

Causes of Cerebral Palsy

• ____ birth• Perinatal ____• ____• Intrauterine ____• Congenital ____ Anomalies• ____ Disorders

Causes of Cerebral Palsy

• PREMATURE birth• Perinatal ASPHYXIA• INFECTION• Intrauterine ISCHEMIA• Congenital BRAIN Anomalies• METABOLIC Disorders

Med/Nsg Interventions for CP

• ____ training

Med/Nsg Interventions for CP

• ADL training

• ____ assistance• ____ aids• ____ Therapy• ____• ____

• Mobility assistance• Communication aids• Physical Therapy• Medication• Surgery

Hypopituitarism: GHDClinical manifestations

* ____ stature* ____ or ____rate of growth* Higher ____-to-____ratio* ____ bone age

Hypopituitarism: GHDClinical manifestations

* Short stature* Deteriorating or absentrate of growth* Higher weight-to-heightratio* Delayed bone age

Congenital Hypothyroidism

* Clinical manifestations- Large ____ fontanel- Umbilical ____- ____ (bowels)- Prolonged ____

* Treatment: Early Txprevents ____

Congenital Hypothyroidism

* Clinical manifestations- Large posterior fontanel- Umbilical hernia- Constipation- Prolonged jaundice

* Treatment: Early Txprevents Cretinism

Definitions:

Virilization = Development of male secondary sexual characteristics

Adrenarche = the increase in activity of the adrenal glands just before puberty

Pseudohermaphroditism = an individual having internal reproductive organs of one sex and external sexual characteristics resembling those of the other sex or being ambiguous in nature

NORMAL HGB VALUES

Infant: __-__ g/dl

6-12 yr: __-__ g/dl

12-18 yr: __-__ g/dl

NORMAL HGB VALUES

Infant: 9 – 14 g/dl

6-12 yr: 11.5 – 15.5 g/dl

12-18 yr: 12 – 16 g/dl

Anemia (Hgb levels)

– Mild: __ g/dl

Anemia (Hgb levels)

– Mild: 11 g/dl

– Moderate: __–__ g/dl– Severe: < __ g/dl

– Moderate: 3 – 7 g/dl– Severe: < 3 g/dl

SICKLE CELL complication

STROKE (or high-risk for it)Tx: * ____ transfusion q ____ wks* Desferoxamine (____ therapy) binds ____, allowsexcretion to occur (b/c RBC destruction from SCD -> ____ overload -> ____deposited in tissues unless excreted - __ infusion __ nts/week

SICKLE CELL complication

STROKE (or high-risk for it)Tx: * Blood transfusion q 3-4 wks* Desferoxamine (Chelation therapy) binds iron, allowsexcretion to occur (b/c RBC destruction from SCD -> iron overload -> iron deposited in tissues unless excreted - SC infusion 5 nts/week

Beta-thalassemiaMedical/Nursing Management

• Medical Tx:– Chronic ____– Sometimes ____ectomy– ____ transplant• Nursing Issues:– Blood Transfusions– ____ therapy– Risk of infection, post- splenectomy– Patient/Family Education

Beta-thalassemiaMedical/Nursing Management

• Medical Tx:– Chronic transfusions– Sometimes splenectomy– Bone marrow transplant• Nursing Issues:– Blood Transfusions– Chelation therapy– Risk of infection, post- splenectomy– Patient/Family Education

Aplastic Anemia

• Pancytopenia– Neutrophils < ____– Platelets < ____– Hemoglobin (RBCS) ____– Reticulocytes < ____%• Etiology– Primary (congenital): ____– Secondary (acquired): ____ (viral, toxic,pharmacologic)

Aplastic Anemia

• Pancytopenia– Neutrophils < 500– Platelets < 20,000– Hemoglobin (RBCS) DEC.– Reticulocytes < 1%• Etiology– Primary (congenital): Fanconi’s anemia– Secondary (acquired): Injury (viral, toxic,pharmacologic)

Coagulation Disorders Coagulation Disorders

• ____ A (factor VIII)– aka classic hemophilia• ____ B (factor IX)– aka Christmas Disease• ____ C (factor XI)• ____ disease(vWF)

• Hemophilia A (factor VIII)– aka classic hemophilia• Hemophilia B (factor IX)– aka Christmas Disease• Hemophilia C (factor XI)• Von Willebrand’s disease(vWF)

Hemophilia A & BLab Findings

• Platelets: ____• Bleeding time: ____ (clot formation)• PT (or INR): ____ (extrinsic pathway)• PTT: ____ (intrinsic pathway)

Hemophilia A & BLab Findings

• Platelets: normal• Bleeding time: normal (clot formation)• PT (or INR): normal (extrinsic pathway)• PTT: prolonged (intrinsic pathway)

Hemophilia A & BMedical/Nursing Management

• Monitor for ____ episodes/complications• “First aid” for bleeding:– ____– Administer ____-containing product• ____ infusions– ____-derived or recombinant– DDAVP (Mild Hemophilia A)

Hemophilia A & BMedical/Nursing Management

• Monitor for bleeding episodes/complications• “First aid” for bleeding:– RICE– Administer factor-containing product• Factor infusions– Plasma-derived or recombinant– DDAVP (Mild Hemophilia A)

HemophiliaPatient/Family Education

• Emergency treatment of bleeding• IV ____ administration• Anticipatory guidance:– ____ precautions– Physical activity– Monitoring for complications

HemophiliaPatient/Family Education

• Emergency treatment of bleeding• IV factor administration• Anticipatory guidance:– Safety precautions– Physical activity– Monitoring for complications

von Willebrand’s Disease von Willebrand’s Disease

• vWf “transports” Factor ____• Types: decreased, abnormal or near absence of vWF• Results in : mucosal bleeding, epistaxis, easy bruising, menorrhagia• Treat with ____, andvWF replacement

• vWf “transports” Factor VIII• Types: decreased, abnormal or near absence of vWF• Results in : mucosal bleeding, epistaxis, easy bruising, menorrhagia• Treat with DDAVP, andvWF replacement

Differences in Adult and Child Cancer

– Origin– Cause– Prevention and screening– Metastasis at diagnosis– Response to treatment– Cure rate

Find answers in book

Childhood CancerTreatment Modalities

• ____ (biopsy, resect, debulk)• ____ (rapidly dividing cells)• ____ therapy (shrink, residual)• ____ transplant• ____ response modifiers

Childhood CancerTreatment Modalities

• Surgery (biopsy, resect, debulk)• Chemotherapy (rapidly dividing cells)• Radiation therapy (shrink, residual)• Bone marrow transplant• Biologic response modifiers

LYMPHOMA

• From lymphoid and hematopoietic systems

HODGKINs Disease– Older children/adolescents– Focal, painless enlarged ____ tissue

Dx: Node biopsy and stagingTx: Chemotherapy & radiation

LYMPHOMA


HODGKINs Disease– Older children/adolescents– Focal, painless enlarged lymph tissue

Dx: Node biopsy and stagingTx: Chemotherapy & radiation

Atrial Septal Defect* Pathophysiology

Atrial Septal Defect* Pathophysiology

- Blood flow ____ to ____- ____ congestion* Clinical manifestations- Symptomatic? ____- ____ ____ failure* Treatment- ____ for ___ ___ failure- ____ repair

- Blood flow LEFT to RIGHT- PULMONARY congestion* Clinical manifestations- Symptomatic? SOMETIMES ASYMPTOMATIC- CONGESTIVE HEART failure* Treatment- DIURETICS for CHF- SURGICAL repair

Ventricular Septal Defect* Pathophysiology- Blood flow ____ to ____- Heart ____- ____ congestion* Clinical manifestations- Symptoms? ____- ____ ____ failure* Treatment- May ____ by age ___

Ventricular Septal Defect* Pathophysiology- Blood flow LEFT to RIGHT- Heart ENLARGEMENT- PULMONARY congestion* Clinical manifestations- Symptomatic? SOMETIMES ASYMPTOMATIC- CONGESTIVE HEART failure* Treatment- May CLOSE by age TWO

Patent Ductus Arteriosus* Pathophysiology - ____ to ____ shunt- Fibers don’t respond to ____ ____ at birth* Clinical manifestations- Symptomatic? ____ - Sounds? ____- ____ pulses, ____ pulse pressure- ____ ____ failure

Patent Ductus Arteriosus* Pathophysiology - LEFT to RIGHT shunt- Fibers don’t respond to INCREASED O2 at birth* Clinical manifestations- Symptomatic? SOMETIMES ASYMPTOMATIC - Sounds? MURMUR- BOUNDING pulses, WIDERpulse pressure- CONGESTIVE HEART failure

FACTORS KNOWN TO ELEVATE INTRACRANIAL PRESSURE

Elevate ICP• Hypercapnia• Hypoxemia• Respiratory Procedures• Vasodilating Drugs• Positioning• Valsalva Maneuver• Coughing• Emotional Upset• REM sleep• Arousal from sleep• Hyperthermia

• Seizures• Clustering of Activities

SICKLE CELL Life-threatening complications

• ____ Sequestration:– Trapping of blood in ____, can result in shock/rupture• Infection/____:– Fever, S&S infection– Leading cause of death in SCD pts < __ (#) yrs• Hemolytic/Aplastic:– ____ failure


• Splenic Sequestration:– Trapping of blood in spleen, can result in shock/rupture• Infection/Sepsis:– Fever, S&S infection– Leading cause of death in SCD pts < 5 yrs• Hemolytic/Aplastic:– Bone marrow failure

SCDMedical/Nursing Management

• ____ transfusion• PT teaching: Living with chronic illness• Pain Management- Opioids: ATC, PCA, __->__ transition (avoid ____)- NSAIDS (motrin)• Adequate ____• Adequate ____• Support coping• Observe for complications

SCDMedical/Nursing Management

• Blood transfusion• PT teaching: Living with chronic illness• Pain Management- Opioids: ATC, PCA, IV -> oral transition (avoid meperidine)- NSAIDS (motrin)• Adequate oxygenation• Adequate hydration• Support coping• Observe for complications

Acute Lymphocytic Leukemia

• Proliferation of abnormal lymphoblasts, causes pancytopenia

• Presenting symptoms:____, ____ pain, ____ (color), ____ing

• TX: 3 Treatment phases (chemo)– Induction (4 weeks)– Consolidation (6 months)– Maintenance (2 - 3years)• For relapse, further ____

Acute Lymphocytic Leukemia

• Presenting symptoms:Fever, bone pain, pallor, bruising

• 3 Treatment phases (chemo)– Induction (4 weeks)– Consolidation (6 months)– Maintenance (2 - 3years)• For relapse, further chemo and bone marrow transplant

and ____ transplant

Acute Myelogenous Leukemia

• ____ proliferation of ____ cells in ____

• Presenting symptoms:____-like, ____ing, or as in ALL

• TX:– Induction phase– Intensive ____

• Increased incidence of ____

Acute Myelogenous Leukemia

• Malignant proliferation ofmyeloid cells n bone marrow

• Presenting symptoms:Flu-like, bleeding, or as in ALL

• TX:– Induction phase– Intensive chemotherapy

• Increased incidence of DIC

S/S of Hydrocephalus

• Assess: ____ circ, ____fontanel, ____ sutures• Same S/S as ICP– ____ache, ____ing, ____edema, ____ (musc), ____ity, ____argy, ____-pitched “neuro” cry, ____sion, ____s, ____ nervedysfunction• ____ ventricles on CT/MRI

Hydrocephalus• Assess: HEAD circ, BULGINGfontanel, SEPARATED sutures• Same S/S as ICP– HEADache, VOMITing,PAPILLedema, ATAXIA (musc), IRRITABILity, LETHargy, HIGH-pitched “neuro” cry, CONFUsion, SEIZUREs, CRANIAL nervedysfunction• ENLARGED ventricles on CT/MRI

Status EpilepticusNursing Tx/Interventions

1. ____2. ____3. ____

ALSO:• ____ diet• ____

Status EpilepticusNursing Tx/Interventions

1. Stabilize airway!2. Safety precautions3. Medications– Ativan or Valium– Dilantin (Phenytoin);Fosphenytoin– Tegretol– Depakote– Phenobarbital

ALSO:• Ketogenic diet

• Education

NSG Management of GHD

> Assessment> Nursing diagnoses- ____ growth/developmtr/t inadeq ____ secretion- Disturbed ____ image r/t ____ stature- Deficient ____ r/t tx> Outcome identification> Planning/implementation- ____ injections of ____> Evaluation> ____ teaching re: ____

NSG Management of GHD

> Assessment> Nursing diagnoses- Delayed growth/developmtr/t inadeq GH secretion- Disturbed body image r/t short stature- Deficient knowledge r/t tx> Outcome identification> Planning/implementation- SQ injections of GH> Evaluation> Pt/Family teaching re:tx

Acquired HypothyroidismClinical manifestations

* ____ rate of growth* Weight ____* ____ (bowels)* ____ skin* ____ or ____ hair* ____ (energy)* ____ intolerance* ____ of face, eyes, hands* ____ deep tendon reflexes* ____ puberty

Tx = Med: ____

Acquired HypothyroidismClinical manifestations

* Decreased rate of growth* Weight gain* Constipation* Dry skin* Thinning or coarse hair* Fatigue* Cold intolerance* Edema of face, eyes, hands* Delayed deep tendon reflexes* Delayed puberty

Tx = Med: Levothyroxine

HyperthyroidismClinical manifestations

* ____ rate of growth* Weight ____ despite ____ appetite* ____, ____ skin* ____cardia* ____ changes* Heat ____* Emotional ____* _____somnia, ____ tremors

HyperthyroidismClinical manifestations

* Increased rate of growth* Weight loss despite excellent appetite* Warm, moist skin* Tachycardia* Ophthalmic changes* Heat intolerance* Emotional lability* Insomnia, fine tremors

Tx: * ____ medication* ____ therapy* Subtotal ____ectomy

Tx: * Antithyroid medication* Radioactive iodine therapy* Subtotal thyroidectomy

Congen. Adrenal HyperplasiaClinical manifestations

* Male fetus: ____

* Female fetus: virilized _____• Enlarged ____• Fusion of ____• ____ appearance to labia• ____ism (genitals)

* Children (often toddlers) present with: adrenarche, ____ growth velocity, ____ bone age, acne, ____ism (hair)

Congen. Adrenal HyperplasiaClinical manifestations

* Male fetus: no phys changes

* Female fetus: virilized external genitalia• Enlarged clitoris• Fusion of labial folds• Rugae appearance to labia• Pseudohermaphroditism

* Children (often toddlers) present with: adrenarche, accelerated growth velocity, advanced bone age, acne, hirsutism

HEMATOLOGY• Red Blood Cells– Life span: ____ days, removed by ____– Types of hgb: ____ and ____– Hgb molecule has __(#) heme, __(#) globin chains• White Blood Cells– Early inflammatory response: neutrophils– Immunity: lymphocytes– Inflammatory/phagocytic: monocytes, macrophages• Platelets– Life span: ____ days– ____ # in inflamm. states

HEMATOLOGY• Red Blood Cells– Life span: 120 days, removed by SPLEEN– Types of hgb: A (adult)and F (fetal)– Hgb molecule has 4 heme, 4 globin chains• White Blood Cells– Early inflammatory response: neutrophils– Immunity: lymphocytes– Inflammatory/phagocytic: monocytes, macrophages• Platelets– Life span: 10 days– INC. # in inflamm. states

SICKLE-CELL pathophysiology

• RBC sickling caused by: ___emia(O2), ___osis(pH), ____hydration, stress,

SICKLE-CELL pathophysiology

• RBC sickling caused by: hypoxemia, acidosis, dehydration, stress,

infection, ____ extremes• Sickled RBC destruction -> ____• Accumulated RBCs in spleen-> ____ damage & fibrosis• Sickled RBCs obstruct capillaries/____, impair____ -> pain, ____ dysfunction

infection, temp extremes• Sickled RBC destruction -> anemia• Accumulated RBCs in spleen-> spleen damage & fibrosis• Sickled RBCs obstruct capillaries/vessels, impaircirculation -> pain, organ dysfunction

Hemophilia (A & B)• Clinical Manifestations:– Hemat____, Hem____, Hemat____, Epistaxis (nose ____),Intracranial ____, Other ____ (neck, abdomen, mouth)

• Dx– History, Thromboplastin Generation test• Severity (based on % of factor)– Mild: __-__% of normal– Moderate: __-__%– Severe: < __%

Hemophilia (A & B)• Clinical Manifestations:– Hematomas, Hemarthroses, Hematuria, Epistaxis, Intracranial bleed, Other bleeding (neck, abdomen, mouth)• Dx– History, Thromboplastin Generation test• Severity (based on % of factor)– Mild: 5-35% of normal– Moderate: 1-5%– Severe: < 1%

TYPES of Cerebral Palsy

* ____- tense, contracted muscles (most common)* ____- poor sense of balance, falls/stumbles* ____- constant, uncontrolled motion of limbs, head, and eyes* ____- tight muscles that resist effort to make them move* ____- uncontrollable shaking, interfering with coordination

TYPES of Cerebral Palsy

* SPASTIC- tense, contracted muscles (most common)* ATAXIC- poor sense of balance, falls/stumbles* ATHETOID- constant, uncontrolled motion of limbs, head, and eyes* RIGIDITY- tight muscles that resist effort to make them move* TREMOR- uncontrollable shaking, interfering with coordination


•____-occlusive episode:


•Vaso-occlusive episode:

-PAIN due to ____(acute, chronic)–____ *S/S= severe ____ache, ____ signs*Evaluate c transcranial ____*Tx: ____ transfusion q 3-4 wksTx: ____ therapy: Desferoxamine SC infusion __ nts/week–Acute ____ Syndrome*S/S= pneumonia-like picture, ____emia, pain*Tx= Transfusion or ____ transfusion, ____ support

-Pain due to ischemia(acute, chronic)–Stroke *S/S= severe headache, neuro signs*Evaluate c transcranial doppler*Tx: blood transfusion q 3-4 wksTx: Chelation therapy: Desferoxamine SC infusion 5 nts/week–Acute Chest Syndrome*S/S= pneumonia-like picture, hypoxemia, pain*Tx= Transfusion or exchange transfusion, Respiratory support

Beta-thalassemia

• Mediterranean, MiddleEast, Africa, SouthChina, Southeast Asia• Synthesis beta ____ chain impaired• RBCs w/ less ____• ____ in marrow destroyed• Increased erythropoietin, but ineffective ____ production• Bone marrow ____ (abnormal multiplication of cells)• Sequelae (a secondarycondition resulting from a disease):– Severe ____– ____ growth/development– Without treatment: ____ by 5 – 6 years

Beta-thalassemia

• Mediterranean, MiddleEast, Africa, SouthChina, Southeast Asia• Synthesis beta Hgb chain impaired• RBCs w/ less Hgb• RBCs in marrow destroyed• Increased erythropoietin, but ineffective RBC production• Bone marrow hyperplasia• Sequelae:– Severe anemia– Impaired growth/development– Without treatment: death by 5 – 6 years

Aplastic Anemia

• Dx'd with: ____ aspirate, ____studies

Aplastic Anemia

• Dx's with: bone marrow aspirate, chromosomestudies

• Tx: • ____ therapy may induceremission (ATG, cyclosporin, steroids)• Only cure is ____

• Nursing Management:– Potential for infection– Potential for injury– Inadequate tissue perfusion

Tx: • Immunosuppressive therapy may induceremission (ATG, cyclosporin, steroids)• Only cure is bone marrow transplant• Nursing Management:– Potential for infection– Potential for injury– Inadequate tissue perfusion

14 yo with sickle cell disease, admitted from ER for fever and pain. 3 day hx increasing chest pain, fever to 38.5. Wt = 45 kgAdmit VS: T= 38.4ax, HR= 140, RR= 32, BP= 142/88, 02 sat 90% on room air. Rates pain as 9/10 on 0-10 scale. Points to upper right chest as pain location, also back and abdomen.Has an implanted port in rt chest, accessed in ER, now with D5%/0.45NS at 25 ml/hr.CBC, retic count, and blood cultures drawn, chest xray done.* What are your nursing priorities?* What else do you need to assess?* What other information would be useful in planning care?

* What are your initial nursing actions?* When will you reassess?* What kinds of medical orders do you expect?* Which, if any, of these results is concerning? And, why?•CXR results show a right upper lobe opacity. ? Infiltrate.•CBC results: H/H = 7.0 / 20 (norm =13-16/37-49)•Retic count = 1.5 (norm = 0.5-1.5)•WBC = 15,000 (norm = 4.5 –11.0)•segs:80%, bands:10% (norm segs = 54 - 62, bands = 3 - 5)

Lymphoma


NON-HODGKINs Lymphoma– Peak 7-11 yearsS/S: Depend on location (mediastinal mass,pleural effusion, lymphadenopathy)– Pain, edema, generalized– Often advanced at dx• With mediastinal mass,

Lymphoma


NON-HODGKINs Lymphoma– Peak 7-11 yearsS/S: Depend on location (mediastinal mass,pleural effusion, lymphadenopathy)– Pain, edema, generalized– Often advanced at dx• With mediastinal mass,

risk of ____ distress and superior vena cava syndrome• Treatment with multi-agent ____• High risk of ____ lysis syndrome

risk of respiratory distress and superior vena cava syndrome• Treatment with multi-agent chemotherapy• High risk of tumor lysis syndrome

Wilms Tumor

• Arises in ____, primordial cells• S/S: ____ swelling, pain, ____uria, ____ BP, malaise• Dx: CT/MRI• Surgery to remove ____ or ____, ____therapy• Pre-op: monitoring, no ____ palpation(fragile outer capsule of tumor)• Postop:– Care as for major abd surgery, large abd incision– Fluids, BP, pain

Wilms Tumor

• Arises in kidney, primordial cells• S/S: abdominal swelling, pain, hematuria, INC. BP, malaise• Dx: CT/MRI• Surgery to remove tumor/kidney, chemo• Pre-op: monitoring, no abdominal palpation(fragile outer capsule of tumor)• Postop:– Care as for major abd surgery, large abd incision– Fluids, BP, pain

Neuroblastoma

• From neural crest cells:– brain, adrenal medulla, pelvis, mediastinum,sympathetic ganglia• S/S: caused by ____ on adjacent structures, ____• Dx: scans, lab tests (depending on location), biopsy• Staging: based on age, markers present, histology, extent of spread (62% have ____)• Treatment: surgical removal, intensive ____,radiation (stage III), BMT

Neuroblastoma

• From neural crest cells:– brain, adrenal medulla, pelvis, mediastinum,sympathetic ganglia• S/S: caused by compression on adjacent structures, metastases• Dx: scans, lab tests (depending on location), biopsy• Staging: based on age, markers present, histology, extent of spread (62% have mets)• Treatment: surgical removal, intensive chemo,radiation (stage III), BMT

CHF* Treatment:- ____- Meds: ____- Positive ____- ____ support* Nursing management- 1st: ____~ ____ assessment~ ____ support, ____ c child- Nursing diagnoses~ ____ Cardiac output~ Fluid volume ____~ Imbalanced nutrition:____ than body reqs- ____ identification and planning- Evaluation and family ____

CHF* Treatment:- SURGERY- Meds: DIURETICS- Positive INOTROPES (↑CO)- NUTRITIONAL support* Nursing management- 1st: ASSESSMENT~ PHYSICAL assessment~ FAMILY support, INTERACTION c child- Nursing diagnoses~ DECREASED cardiac output~ Fluid volume EXCESS~ Imbalanced nutrition:LESS than body reqs- OUTCOME identification and planning- Evaluation and family TEACHING



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What is the leading cause of death in infants?

Birth DefectsCongenital Anomalies

What level of preventative care is a child wearing a helmet?

Secondary

How does Erikson describe school age children?

6-12 yearsinitiave vs guiltlearn to carry out taskswant to be good at things

How do children intrepret blood being taken from them?

Make a hole in them and their insides will come out.



Fine and gross motor skills for a 5 monthj old?

Can grasp large objects but not small onesRoll from belly to back

What is a big danger with small children and foods?

Choking

How do you give ear drops to a small child?

Pull ear down and back

How do you give vitamin K? IM

Rational for potty training at 2 years?Their bodies are not ready until they are two.

What age and weight can a car seat be turned forward facing?

Age one year20 pounds

At what age are testicular tumors more likely?

Adolescents

What accounts for 75% of all cases of spina bifida?

Myelomeningocele

What is myelomeningocele?Back bone and spinal canal do not close before birth.

Symptom of hip dysplasiaHips POP when ortiloni maneuver is preformed.

What usually occurs with hip dysplasia? neural tube disorders.

Symptoms of hydrocephalous

Big head with rapid increase in diameterVomitsleepyirritabilityseizuresdownward deviation of eyes (sunsetting)

Symptoms of Rubella

Appear 2-3 weeks after infectionSlightly raised temperatureswollen glandsrash of pink spots that start on faceconjunctivitis

Symptoms of Roseola

Persistant high temperaturehigher than 102 for 3-4 days in an otherwise well childlowered fever with onset of rashappears on trunk and spreads

Impetigo

Begins in broken skinUsually with staphred macules-vesiclesmost common in nose and mouthwash with topical ointment 3x day

How do you treat cellulitis? oral or parenteral antibiotics

What causes ringworm? Fungus

How to manage head lice?

clean environmentwash in HOT watertx entire family with NIX or Kwell

Lyme Disease

caused by Deer Tick biteCaused by spirochetestage 1 rash stage 2 most serious, involves neuroTX oral doxycycline, less than 8 is amoxicillin or penicillin

Papulefirm PALPABLE elevation of skin less than 1 cm

vesicleelevated lesion less than 1 cm filled with fluid

anorexia nervosaeating disorder characterised by low body weight and body image distortion

What causes a wart? Virus usually HPV

S/S of scabies?Intense puritis especially at nightFine grayish threadlike lines

What causes 5th disease? human parvovirus B 19

Side effects of wearing a cast?muscle lossatrophyincreased sensitivity

What do you do with evulsed tooth if you do not want to put it back into your mouth until you can see a dentist?

put in cold milk or cold water

Hepatitis vaccine1st injection2nd one month later3rd is 6 months from 1st

What injections will a 5 year old have?DTaPIPVMMR

Most common form of childhood cancer? Leukemia

How is leukemia diagnosed?Bone marrow AspirationBiopsyLumbar Puncture

Wilm's Tumor

most common malignant tumor of kidneysswelling or mass in abdomenfirm. nontender massincreased abdominal girth

Symptoms of brain tumor?

HA with projectile vomitingcauses obstruction in CSF circulationCauses increased ICP

What should you watch for in a child using diuretics?

Dehydrationclotting problems because of hypokalemia

S/S of necrosis

maybe no s/s of painloss of movementstiffnessloss of ROMavascular is arthritis

pyelonephrosis disease of pelvic kidney

Why should you treat strep?It could lead to Rhumatic fever if untreated.

Isotonic Dehydrationloss of water and electrolytes in equal proportions

How much fluid loss is there with mild dehydration?

Loss of less than 50ml/kg of fluid

What causes diarrhea most often in children?

Rotavirus

Complications of 3rd degree burns in children

Respiratory compromisehypovolemic shocklocal infectionssepsislittle or no pain because of nerve damage

What is the leading cause of death in adolescents?

Accidentsnext is homocide

assess skin turgor?check for tentingcolor, dry, moist?

epiglottis

one of the biggest emergenciesTrachea swells shut needs trach or will die

Complications of bulemia

malnutritiondehydrationelectrolyte imbalancetooth erosiondamage to voicepotential for gastric rupture

Stenosis

abnormal narrowing in blood vessel or other tubal organMay be called strictureNoise over turbulent flow, bruitultrasound or MRI to Diagnose

Intussusception current jelly stools

How do you treat celiac disease? Avoid Wheat.

First signs of puberty in females? Breast Buds

First signs of puberty in males? enlarged testicles

Hep B

2 months4 months6-18 months11-16 years

DTaP

2 months4 months6 months12-18 months4-6 years

Hib

2 months4 months6 months12-15 months

Prevnar

2 months4 months6 months15 months

IPV

6 months9 months18 months4-6 years

MMR12-18 months4-6 years

Varicella 12-18 months

Communicability of 5th disease (Erythema Infectiosum)Incubation oftransmission

Before onset of s/s- 1 week after rash4-14 daysunknown blood/resp

communicibality of roseola

incubationtransmission

during high temp until after rash5-15 daysunknown

Chicken pox incubation 14-21 days

Rubella communicability

incubation

7 days before and 5 days after rash appears14-21 days

transmissionresp direct and indirectprevent with MMR

measles

Koplik's spots (bluish spots in mouth and oral mucosaVitamin A decreases mortality and morbidity

communicabilityDisease is transmittable to others

Incubation Periodtime between invasion of organism and outbreak of infection

prodromal periodtime between beginning and non specific s/s

illness stage appearance of disease

convalescentTime between time when s/s begin to disappear and complete return to wellness.

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