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NU 374 > Ch. 3, 19, 20, 5, 8, 11, 17 (Abnormal G&D) > Flashcards

Ch. 3, 19, 20, 5, 8, 11, 17 (Abnormal G&D) Flashcards

Growth & Development Pt. 2

1
Q

congenital anomalies are

A

birth defects
- occur in 2-4% of all live-born children and are often classified as either deformations, disruptions, dysplasias, or malformations
- some are preventable, some are not

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2
Q

deformations

A

caused by extrinsic mechanical forces on normally developing tissue
- ie. uterine restraint causes club foot

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3
Q

disruptions

A

result from the breakdown of previously normal tissue
- ie. congenital amputations caused by amniotic bands

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4
Q

dysplasias

A

result from abnormal organization of cells into a particular tissue type
- ie. congenital anomalies of the teeth, hair, nails, or sweat glands may be manifestations of one of the more than 100 different ectodermal dysplasia syndromes

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5
Q

malformations

A

abnormal formations of organs or body parts resulting from an abnormal developmental process
- most occur before 12 weeks gestation
- ie. cleft lip (5 weeks gestation)

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6
Q

cleft lip is an example of

A

malformation

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7
Q

club foot is an example of

A

deformation

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8
Q

congenital amputation is an example of

A

disruption (think something is missing)

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9
Q

absent sweat glands is an example of

A

dysplasia

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10
Q

when can genetic screening occur?

A
  • prenatal
  • pre-conception (before pregnant): screening of selected populations for heterozogyous carriers
  • post-conception (after pregnant)
  • family medical history: screening of relatives of known carrier or affected individuals within a family, for purpose of reproductive decision making
  • newborn
  • any time a family asks
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11
Q

pediatric indications for genetic consultation

A
  • family hx (of something metabolic, drug use)
  • abnormal newborn screen (PKU)
  • abnormal genetic test result
  • progressive neurologic condition
  • major congenital anomaly
  • pattern of major or minor anomalies
  • congenital or early-onset hearing/vision loss
  • CI or autism
  • abnormal sexual maturation or delayed puberty
  • abnormally tall/short
  • excessive bleeding or clotting
  • parental requests
  • if baby dies (SIDS), get testing done to determine reason for death
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12
Q

nurse’s role in caring for children and families with hereditary disorders

A
  • apply/integrate genetic knowledge into nursing assessment
  • ID and refer clients who may benefit from genetic information or services
  • ID genetics resources and services to meet clients’ needs
  • providing care and support before, during, and after providing genetic information and services
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13
Q

assessment clues of genetic disorders

A
  • major or minor birth defects and dysmorphic features (think Downs)
  • growth abnormalities (not growing/delayed)
  • skeletal abnormalities (club foot)
  • visual or hearing problems
  • metabolic disorders (PKU test)
  • sexual development abnormalities (ambiguous genitalia)
  • skin disorders
  • recurrent infection or immunodeficiency
  • development and speech delays or loss of milestones
  • cognitive delays
  • behavioral disorders
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14
Q

major or minor birth defects and dysmorphic features may indicate

A

genetic disorder

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15
Q

visual or hearing problems may indicate

A

genetic disorder

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16
Q

metabolic disorders may indicate

A

genetic disorder

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17
Q

sexual developmental abnormalities may indicate

A

genetic disorder

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18
Q

skin disorders may indicate

A

genetic disorder

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19
Q

recurrent infection or immunodeficiency may indicate

A

genetic disorder

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20
Q

developmental or speech delays or loss of milestones may indicate

A

genetic disorder

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21
Q

cognitive delays may indicate

A

genetic disorder

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22
Q

behavioral disorders may indicate

A

genetic disorder

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23
Q

skeletal abnormalities may indicate

A

genetic disorder

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24
Q

growth abnormalities may indicate

A

genetic disorder

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25
Q

adaptive tasks for parents with a chronically ill child begins with

A

acceptance of child’s diagnoses

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26
Q

adaptive tasks for parents with a chronically ill child ends with

A

establishment of a support program

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27
Q

adaptive tasks for parents with a chronically ill child

A
  • accept diagnosis
  • establish support system
  • family-centered care- make the family involved every step of the way through the child’s care
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28
Q

times of anticipated stress begins with

A
  • time of child’s diagnosis (extent of it, what it means for the child’s future)
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29
Q

time periods of anticipated stress in parents

A
  • dx and development of milestones (ability to meet or being delayed in meeting milestones)
  • start of school (social acceptance by peers, how will the child in a wheelchair get to school)
  • adolescence (child may not be allowed to be independent because of their disease impeding their level of functioning, puberty, social acceptance)
  • parental realization (that child will not be able to live up the potential the parent originally thought due to disease; and future placement decisions)
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30
Q

times of anticipated stress ends with

A

death of child

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31
Q

ways to promote sibling relationships/help siblings cope

A
  • get siblings involved (but don’t give them too many responsibilities- that will make them resentful)
  • don’t expect the siblings to be involved
  • making time for the children without illness
  • recognizing when the child needs a break
  • allow siblings to have battles and let them work it out on their own
  • allow healthy sibling to learn how similar and different they are
  • get resources involved: support groups, books
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32
Q

involving siblings with the care of their sibling with chronic illness

A
  • get siblings involved (but don’t give them too many responsibilities- that will make them resentful)
  • don’t expect the siblings to be involved
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33
Q

normalization

A

efforts of family members make to create a normal family life, their perceptions of the consequences of these efforts, and the meanings they attribute to their management efforts
- attempt to make life as normal as possible
- culture norm: ie. of town
- social norm: what society, other kids norm

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34
Q

age appropriateness

A

having the disabled child spend time with the age group that they are in
- when a disabled child is surrounded by their age group, they do better in life

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35
Q

what is the difference between normalization and age appropriateness?

A

normalization: family makes life as normal as possible for disabled child
age-appropriateness: theory of keeping the disabled child engaged with other children their age

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36
Q

approach behaviors

A

result in movement toward adjustment and resolution of the crisis
- accepting dx
- giving care
- utilizing resources: communicating with HC team about what they can do

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37
Q

avoidance behaviors

A

result in movement away from adjustment and represent maladaptation to the crisis
- denying its happening
- unrealistic expectations
- upset or abrupt or doesn’t want to talk to the HC team

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38
Q

coping behaviors

A

behaviors that are aimed at reducing the tension caused by a crisis (ie ill dx of child)
- include avoidance and approach behaviors

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39
Q

family centered care

A

philosophy that considers the family as the constant in the child’s life
- nurses must have effective communication and trust with parents to meet the needs of the parents and child

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40
Q

is it realistic to expect a chronically ill child to participate in their own care?

A

yes- we allow them to do as much as they can
- promotes sense of self-worth
- promotes independence

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41
Q

examples of dysmorphic syndromes

A
  • down syndrome
  • fragile x syndrome
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42
Q

early signs of cognitive impairment

A
  • gross motor delay
  • fine motor delay
  • behavior difficulties
  • language difficulties or delay
  • major organ system dysfunction (ie feeding or breathing difficulties)
  • irritability or non-responsiveness to their environment
  • dysmorphic syndromes
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43
Q

global developmental delay

A

term used to describe a child who has delays in two or more areas of development and functioning
- motor
- language
- social-emotional
- self-care
- behavior

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44
Q

developmental delay

A
  • descriptive term
  • not a dx
  • rarely an accurate designation beyond 3 years old
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45
Q

demonstration vs explanation for a child with CI

A

demonstration
- showing will usually be more effective than explanation
- normally visual learners

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46
Q

nursing care for a child with CI

A
  • demonstration
  • one-step directions (no medical jargon)
  • positive reinforcement
  • repetition (demonstration)
  • non-verbal communication (sign language)
  • set limits (discipline)
  • social behaviors (hello, good-bye, please, thank you)
  • mainstreaming peers (think age-appropriateness)
  • sexuality (adolescence)
  • promote interactive play vs self-stimulatory
  • independence w/ ADLs (as much as they can do)
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47
Q

non-verbal communication skills to use with a child with CI

A
  • sign language
  • picture board
  • computer technology
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48
Q

social behaviors to use with a child with CI

A
  • say hi, bye
  • thank you
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49
Q

explaining sexuality to an adolescent with CI

A
  • simple explanations (ie menstruation)
  • self-care/hygiene
  • physical development changes
  • conception
  • supervision
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50
Q

clinical manifestations of down’s syndrome

A
  • simian palm crease (1 big crease across their hand)
  • almond-shaped eyes that turn up
  • space between big toe and second digit
  • hypotonic: low tone, very floppy, wet noodle
  • hyperreflexive joints
  • dots on eyes
  • flat nasal bone (resp. issues)
  • flat face
  • protrude their tongue (drooling)
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51
Q

can down’s syndrome be prevented?

A

**no it cannot be prevented- it is genetic

older mother is at a higher risk
- under 35 years: 1/350
- over 40 years: 1/100
family history more at risk (genetic condition)

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52
Q

how would a nurse care for a child and family with down’s syndrome?

A
  • ongoing emotional support
  • let the parent grieve after the initial dx
  • give resources
  • assisting with physical problems
  • supporting prenatal and genetic counseling
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53
Q

what physical problems of a pedi with down’s syndrome do nurses help with?

A
  • feedings: suction mouth after feeding
  • respiratory health: aspiration, suctioned nose for secretions, saline in nose
  • decreased tone: positioning while eating
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54
Q

autism

A

a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave

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55
Q

how can you decrease stimulation in a child’s hospital room?

A
  • close the door/ wear earphones
  • close the blinds
  • dim the lights
  • shut the tv off/turn volume down
  • private room
  • limit people going in and out of the room
56
Q

atraumatic care to an autistic child and their family

A
  • ask the parent: likes/dislikes, what i can/can’t do
  • getting family involved in care (medication, sitting on parent lap)
57
Q

children with communication or CI are at a higher risk for inadequate treatment of ____

A

pain
- hard to measure pain because they can’t really “tell” you

58
Q

non-pharmacologic pain interventions: infants

A
  • hold
  • rock
  • feed sugar water
  • feed them breastmilk/formula
  • sing/play music
  • kangaroo care (skin-to-skin)
59
Q

non-pharmacologic pain interventions: young children

A
  • distraction (call child life: blow bubbles, video games)
60
Q

non-pharmacologic pain interventions: teenagers

A

diversion
- play music
- watch a tv show
- guided imagery (ie. think of a peaceful place/vacation you went on; can begin at school-age)

61
Q

pain management without drugs with pedi patients

A
  • describe sensation they will experience
    • use pinching, pulling, pushing, heat
  • avoid over-explanation/lies
  • stay with child
  • praise, positive reinforcement
  • bubbles, imagery, movies, music, thought stopping, etc.
  • consult child life specialist (if avail)
62
Q

medication administration: which preparations are preferred?

A
  • liquid/suspension
    (*only use oral syringes)
63
Q

what is the key to pediatric medication administration?

A

positioning- therapeutic hold PRN

64
Q

pedi medication administration tips

A

*only use oral syringes
- no nostril pinching unless by child
- put in the cheek
- not in their bottle- may not finish
- flavoring if possible
- suppository (rectal route) as an alternative
- IVP (IV push) can be used in children

65
Q

if a child is in pain and requires pharmacologic treatment, use the correct _____ for oral ingestion.

A
  • syringe
66
Q

what should you not mix oral medication with for pediatric patients?

A

favorite drink or any beverage

67
Q

if the child has a CI and needs oral medication, the nurse should

A

empower the parent to help
- increases medication compliance in child
- gives nurse an opportunity to evaluate parent technique

68
Q

what does a child’s pain rating need to be in order to receive drug treatment?

A

moderate rating

69
Q

can PCA (patient controlled analgesic) pumps be used in pediatrics?

A

(patient controlled analgesic)
yes as long as child is …
- child has to be old enough to understand number sense and cause and effect
- 7-8 year old

70
Q

how do you manage opioid induced respiratory depression in children?

A
  • evaluate sedation level
  • full set of VS
  • taper off
  • O2
  • support respirations
  • monitor
  • naloxone
71
Q

how can you prevent opioid induced respiratory depression in children?

A
  • monitor VS
  • taper off
  • O2 should be in the room
  • hooked up to a monitor
72
Q

acute failure to thrive

A
  • weight <5th percentile *if child started at 50%, then 25%, then 5%; height WNL
73
Q

pearl

A

a consistent nurse is important in developing a trust with infants who have failed to thrive

74
Q

acute failure to thrive is also called

A

growth failure

75
Q

acute failure to thrive is classified (diagnosed) according to ____

A

pathophysiology
- inadequate caloric intake
- inadequate absorption (ie CF, celiac disease, lactose intolerant)
- defective utilization- genetic/metabolic (ie trisomy 21)
- metabolic: hyperthyroidism

76
Q

why does inadequate caloric intake occur in patients with FTT?

A
  • dilution
  • breastfeeding- but baby is not latching properly
  • family can’t afford formula
77
Q

clinical manifestations of acute FTT

A
  • gaze, don’t blink
  • sucking on fingers
  • small
  • thin
  • head looks big in relation to body
  • frontal bossing: protrusion of forehead
  • cognition and developmental delays
  • no stranger anxiety (should kick in at 9 months, but doesn’t)
  • irritable, not smiley
  • stiff or hypotonic
78
Q

management of FTT is focused on ____

A

reversing the cause(s)

79
Q

who is involved in the interdisciplinary approach to FTT of a pediatric?

A
  • nutritionist
  • lactation consultant
  • nurse
  • physician
  • parent
80
Q

what are the goals of treatment for FTT?

A
  • determine cause
  • increase the calories
  • educate parents about FTT
81
Q

cleft lip and palate can be detected when?

A

in utero (at 16 weeks) or at birth

82
Q

what is cleft lip/palate a result of?

A
  • environmental and genetic factors
  • not taking Folic Acid
  • certain medication (anti-seizure, __)
  • drug and alcohol use
83
Q

environmental factors of cleft lip/palate

A
  • maternal alcohol ingestion, smoking, teratogens
  • not taking FA
  • certain medication (anti-seizure,
84
Q

genetic factors of cleft lip/palate

A
  • familial occurence
85
Q

how can cleft lip/palate be treated?

A

surgical correction during infancy

86
Q

how can cleft lip/palate be prevented?

A

yes it can be prevented
- mom takes FA
- avoids teratogens during pregnancy

87
Q

nursing goals for a patient with cleft lip/palate

A
  • parental acceptance
  • feeding and growing
  • pre/post-op care and education
  • long-term family guidance
88
Q

incidence/inheritance: cleft lip

A
  • 1:600
  • multifactorial causes
  • M>F
89
Q

incidence/inheritance: cleft palate

A
  • 1:2500
  • associated with syndromes
  • genetic and environmental causes
  • F>M
90
Q

anatomy: cleft lip

A
  • unilateral or bilateral
  • may involve external nose, nasal cartilage, septum, maxillary alveolar ridges, and dentition
91
Q

anatomy: cleft palate

A
  • soft and/or hard palate
  • midline of posterior plate
  • may involve nostril and absence of septum
92
Q

management: cleft lip

A
  • surgical repair early infancy (2-3 months)
93
Q

management: cleft palate

A
  • surgical repair late infancy (6-12 months)
  • if it involves lip, repairs may extend into early toddlerhood
94
Q

short-term problems (pre-op): cleft lip

A
  • feeding
  • weight gain
95
Q

short-term problems (pre-op): cleft palate

A
  • feeding efficiency
  • growth failure (FTT)
96
Q

special post-op care: cleft lip

A
  • suture line care and protection
  • positioning: elbow restraints, on back
  • special feeding techniques (slow/flow; syringe)
97
Q

special post-op care: cleft palate

A
  • feeding cup
  • syringe feeds
  • special needs feeder
  • pigeon nipple
  • avoid utensils/straws (no sucking)
  • squeeze bottle for feeding
  • can go on stomach when supervised
98
Q

long-term concerns: cleft lip

A
  • social acceptance
  • dental and/or orthodontic
99
Q

long-term concerns: cleft palate

A
  • speech
  • OM
  • middle ear effusion (ear infections)
  • hearing loss
  • URI’s
  • dental and/or orthodontic
  • feeding
  • social acceptance
100
Q

infants at risk for SIDS:

A
  • low birth weight
  • low APGAR scores
  • recent viral illness
  • male
  • native american or african american ethnicity
  • maternal ETOH and smoking
  • co-sleeping
  • prone and side lying positioning
  • bedding (soft, bumpers, toys, blankets)
  • sibling of two or more victims of SIDS
  • hx of central hypoventilation
101
Q

what ethnicities are at a higher risk for SIDS?

A
  • african american
  • native american
102
Q

are males or females at a higher risk for SIDS?

A

males

103
Q

are males or females are a higher risk for cleft lip? cleft palate?

A

CL: M>F
CP: F>M

104
Q

if an infants has one or more severe BRUE requiring CPR or vigorous stimulation, the infant is at a high risk for ____

A

SIDS

105
Q

preterm infants experiencing apnea at time of discharge from the hospital are at risk for ___

A

SIDS

106
Q

anticipatory guidance to parents to prevent SIDS

A
  • appropriate bedding surfaces
  • association of SIDS and maternal smoking
  • dangers of co-sleeping

modeling behaviors
- placing infant supine to sleep

107
Q

BRUE stands for

A

brief resolving unexplained events

108
Q

BRUE definition

A
  • unexplained respiratory pause lasting 20 seconds or more
    OR
  • unexplained respiratory pause lasting less than 20 seconds accompanied by pallor, cyanosis, bradycardia, or hypotension (term infant)
109
Q

causes of BRUE

A
  • 50% are unidentified
  • premature
  • LBW
  • upper respiratory illness
  • reflux- spit up/vomit
  • seizure
  • cardiac defect
110
Q

BRUE was formerly called

A

ALTE
- apparent life-threatening event

111
Q

ALTE

A
  • may be present with or without accompanying apnea
112
Q

if the etiology of ALTE is unknown…

A

at home monitoring

113
Q

ALTE management is

A

dependent on cause

114
Q

testicular torsion

A

partial or complete venous occlusion with rotation of testicle
- very sudden
- not associated with a fever

115
Q

testicular torsion prevalence/occurence

A

1:4000 males

116
Q

peak onset of testicular torsion?

A

age 13

117
Q

testicular torsion treatment

A

surgical emergency to prevent necrosis

118
Q

s/sx of testicular torsion

A
  • severe/acute pain
  • red, swollen, hot scrotum
  • no fever
  • absent cremasteric reflex
  • nausea
  • vomiting
  • abdominal pain
119
Q

what can the nurse do if testicular torsion is suspected?

A

refer for immediate medical evaluation
- have 6 hours to remedy this: untwist testes/epididymis manually

120
Q

nursing considerations for testicular torsion

A

this is an emergency- 6 hours to remedy this or will need surgery to prevent loss of testicle
- if testicle is lost, fertility is reduced by 50%

121
Q

teach parents of children with communication or CI to look for: (to assess pain)

A
  • pain with ADLs
  • inactivity or a reduction in activity
  • irritability/ personality/ emotional change
  • uncooperativeness
  • change in sleep pattern
  • change in muscle tone (ex. rigidity)
  • vocal sounds (ex. moaning, crying)
122
Q

syndrome

A

a recognized pattern of anomalies resulting from a single specific cause

123
Q

association

A

a nonrandom pattern of malformations for which a cause has not been determined

124
Q

sequence

A

when a single anomaly leads to a cascade of additional anomalies, the pattern of defects is referred to as a sequence

125
Q

abnormalities in autosomes usually account for syndromes of ___ deficiency

A

cognitive deficiencies

126
Q

gene transfer

A

an experimental technique used to introduce a normally functioning gene into the cells of a patient with a genetic disorder

127
Q

causes of congenital anomalies

A
  • family history
  • teratogens during pregnancy
  • alcohol
128
Q

ambiguous genitalia: definition

A

when the genitalia is swollen to the point that you don’t know what sex the baby is
- have to send them for genetic testing to determine the sex

129
Q

labs to be done with CP/CL

A
  • PT/PTT
  • Urinalysis (UA)
  • CBC
  • CMP/Electrolytes
130
Q

cheiloplasty

A

lip repair of CL

131
Q

palatoplasty

A

palate repair of CP

132
Q

if CL is repaired with sutures: keep site

A
  • antibiotic ointment for 3 days
  • vasaline
133
Q

if CL is repaired with glue: keep site

A

stay dry
- when feeding, if milk gets near site, dab dry

134
Q

pain control post-op CL repair

A

24-48hr ATC
- Tylenol 10-15mg/kg q4-6hr

135
Q

why do we wait to repair CP after CL?

A

wait because they want palate to expand and lip to heal

NU 374 (18 decks)

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