Final Exam Flashcards
Fluid-filled lesion greater than 1 cm in diameter
Bulla
Inflammation of skin and subcutaneous tissue
Cellulitis
Highly vascular, inner supportive layer of skin
Dermis
Also known as atopic dermatitis; chronic superficial inflammatory skin disorder characterized by dry scaly patches and pruritus
Eczema
Tough, outer layer of skin
Epidermis
Diffuse skin redness
Erythema
Highly ocntagious superficial skin infection caused by group A beta-hemolytic streptococcus or Staphylococcus aureus
Impetigo
Large, dry thinckeded lesions
Lichenification
Discolored spot on skin that is neigher raised nor depressed
Macule
Raised lesion
Papule
Head lice
Pediculosis capitis
Itchiness
Pruritus
Small, blisterlike elevation that contains pus
Pustule
Skin infestation caused by scabies mite
Scabies
Small, blisterlike elevation that contains serous fluid
Vesicle
Accessory structures of skin include
Hair, nails, Glands
Provide sebum into hair follicle
Sebaceous Gland
Provides thermoregulation through sweating
Sweat Gland
First line of defense against infectious organisms
Skin
Newborns are covered with this. Shed in first month of life
Lanugo
Newborns have thin ______ and little _______
skin, subcutaneous fat
Sweat glands are not fully developed until
Middle childhood
dark-colored areas may be present on sacrum or buttocks of Native American, Asian, African-American, or Latino infants
Mongolian spots (dermae melanocytosis)
Non-invasive procedure in which a skin sample is obtained with a sterile applicator; used to identify viral, bacterial, or fungal causes of skin lesions
Skin cultures
Non-invasive procedure in which epithelial cells are scraped off and examined microscopically to identify viral, bacterial, fungal, or parasitic causes of skin lesions
Skin scrapings
Invasive procedure in which a skin sample is removed for histological analysis
Skin biopsy
Requires informed consent.
May need to apply pressure to site until bleeding stops; sutures may be required.
Used to identify tumors or persistent dermatitis
Skin biopsy
Frequently related to food allergies when seen in infants
Eczema
Often related to allergies to dust mites when seen in older children
Eczema
Intensified by dry skin, detergents, constricting clothing, or perfumed soaps and lotions
Eczema
Red papules (raised lesions) usually appear first on cheeks and then spread to forehead, scalp, and down extensor surfaces of arms and legs
Eczema
Characterized in adolescents by lichenification on flexor folds, face, neck, back, upper arms, and dorsal aspects of hands, feet, fingers, and toes
Eczema
Teach to pat, not rub, skin dry after bathing when dealing with
Eczema
Used to control itching
Antihistamines
Topical steroids are applied to lesions to reduce inflammation during flare-ups of
Eczema
Begins with a single erythematous macule (nonraised discolored spot) 2 to 4 mm in diameter that rapidly progresses to a vesicle (small, blisterlike elevation that contains serous fluid) or pustule (small, blisterlike elevation that contains pus)
Nonbullous impetigo
Soak crusts of these bullae in warm water
Impetigo
Apply topical antibiotic ointment such as Neosporin, Polysporin, Bacitracin, or mupirocin (Bactroban) three or four times daily for five to seven days or as ordered for
Impetigo
Systemic antibiotic may be ordered, such as dicloxacillin (Dynapen), cephalexin (Keflex), cefaclor (Duricef), or erythromycin, if no response to topical antibiotics in 72 hours for
Impetigo
Infection is communicable for 48 hours after antibiotic treatment is begun with
Impetigo
Incubation period for nits (eggs) is 8 to 10 days for
Head lice (Pediculosis capitus)
Can survive up to 48 hours away from human host
Lice
Nits can survive for 8 to 10 days away from human host
Lice nits (eggs)
Apply about two ounces of pediculicidal agent onto wet hair and add additional water to make a lather, and allow lather to remain on hair for 10 minutes, then rinse hair thoroughly, for
Head lice
Wash clothing in hot water, and dry for at least 20 minutes for
Head lice
A second treatment may be needed 7 to 10 days after the first treatment for
Head lice
Itching begins about one month after infestation from
Scabies
Characterized by intense pruritus, especially at night and nap times.
Lesions appear as linear, grayish burrows 1 to 10 cm long ending in a pinpoint vesicle, papule, or nodule
Scabies
Apply lotion to cool, dry skin over entire body from chin down, and leave on for 8 to 12 hours before washing off. May apply to face of child older than 2 months if lesions are present, for ________
Scabies
All family members and close contacts (playmates and caregivers) should be treated, when dealing with
Scabies
Items that connot be washed should be sealed in plastic bags for four days before use, when dealing with
Scabies
Crotamiton (Eurax) and permethrin 5% cream (Elimite) are used for
Scabies
lindane (Kwell) should not be used on ______ or _______ because of risk of neurotoxicity and seizures
infants, young children
Most common site is legs, but any area can be affected
Cellulitis
History of trauma, impetigo, recent otitis media, or sinusitis may result in
Cellulitis
Usually results from a recent sinus infection
Periorbital Cellulitis
Facial cellulitis in young children usually results from recent episode of
Otitis media
Clients with this often appear ill and are often febrile
Cellulitis
Warmth and tenderness are present over affected site of
Cellulitis
Regional lymph nodes are often enlarged with
Cellulitis
White blood count will be elevated with
Cellulitis
Apply warm compress to affected area of
Cellulitis
Broad spectrum parenteral antibiotics are administered for this until infection subsides, then switch to oral; frequently prescribed antibiotics are nafcillin (Nafcil), dicloxacillin (Dynapen), or ceftriaxone (Rocephin)
Cellulitis
Oral antibiotics for this are usually prescribed for 10 days; frequently prescribed antibiotics are amoxicillin/clavulanate (Augmentin) or oxacillin (Bactocill)
Cellulitis
Marked improvement should be seen with treatment in 48 hours when dealing with
Cellulitis
Causes of burns
Thermal, chemical, electrical, or radioactive
Second-leading cause of injury or death in clients under age 14
Burns
Exposure of skin to flames, scalds, or contact with a hot object
Thermal burns
Exposure of skin or mucous membranes to chemical or caustic agents
Chemical burns
Exposure to electrical current in wires or appliances
Electrical burns
Exposure of skin to sunlight or radioactive substances
Radioactive burns
Substantial edema and capillary damage occur at site of injury in this type of burn
Partial-thickness (Second-degree) burns
A systemic response occurs of increased capillary permeability, which causes loss of fluid, electrolytes, and plasma proteins
Full-thickness (Third-degree) burns
This chart identifies extent of burn in a child
Lund and Browder
Partial- and full-thickness burns to less than 10% of total body surface area (TBSA) with no other significant injuries; client is more than 5 years old; and no burns on hands, feet, genitalia, face, nor any circumferential burns
Minor burns
Full-thickness burns of more than 10% of TBSA; burns of hands, feet, genitalia, face, or any circumferential burns; respiratory tract involvement; fractures or other soft tissue injuries; or deep chemical or electrical burns
Major burns
Damaged epithelium peels off in 5 to 10 days without scarring
Superficial burns (e.g., sunburn)
Crusts form in three to five days, and healing takes place from beneath.
May be grafted to speed healing if large area
Partial-thickness burns
Healing is slow with thin epithelial covering in about a month; scarring is usual.
Requires grafting unless very small injury
Full-thickness burns
Burns covering more than _______% TBSA usually require fluid replacement
10%
Assess renal function and urine output when dealing with
Burns
Morphine via IV route is usually prescribed for
Major burns
Administer analgesic about ____ minutes before wound care for ______
30, burns
Fluid of choice for burns
Lactated Ringers
Based on formula that considers body weight, body surface area, and maintenance needs
Fluid replacement for burns
Unless immunization status is known, administer tetanus toxoid for
Burns
Use mafenide (Sulfamylon), silver sulfadiazine (Silvadene), or bacitracin as topical antimicrobials for
Major burns
Infants and young children with ______ may need to be restrained
Burns
Give high-calorie, high-protein, high-carbohydrate diet to promote wound healing from
Burns
Debride wound every ___ to ____ hours as prescribed
8, 12
Must be washed off and reapplied every 8 to 12 hours
Sulfadiazine (Silvadene)
H2-receptor antagonists such as ranitidine (Zantac) or famotidine (Pepcid) are given to prevent stress ulcers in
Major burns
Connective tissue that composes most of skeleton of an embryo and changes to bone through process of ossification
Cartilage
Congenital malposition of foot involving bone and soft tissue
Clubfoot
Congenital condition leading to improper formation and function of hip socket
Developmental dysplasia of the hip (DDH)
Long central shaft in long bones that constitutes major portion of bone
Diaphysis
Rounded end portion of long bones that consist of layers of cartilage, subcondral bone, and spongelike cancellous bone
Epiphysis
Situated between diaphysis and epiphysis and plays major role in longitudinal growth in children
Epiphyseal plate
discontinuity in bone caused by force to the bone
Fracture
Condition in which there is avascular necrosis of femoral epephysis in school-age children
Legg-Calve-Perthes disease
Columns of spongy tissue that unite diaphysis with epiphyseal plate
Metaphysis
Inherited condition where there is progressive weakness and wasting of symmetrical groups of skeletal muscle, with increasing disability and deformity
Muscular Dystrophy
Process of gradual conversion of cartilage to bony structures, which begins in embryo and continues until 18 to 21 years of age
Ossification
Immature bone cells that replace cartilage cells as bones grow
Osteoblasts
Inherited disorder characterized by connective tissue and bone defects leading to bones that are fractured by the slightest trauma
Osteogenesis imperfecta (OI)
Infection of bone that may be caused by any microorganism, but usually caused by bacteria
Osteomyelitis
Thin, tough membrane covering central shafts of all bones, containing blood vessels that nourish the bone
Periosteum
Enlargement of muscles as a result of infiltration by fatty tissue that occurs in Duchenne’s muscular dystrophy
Pseudohypertrophy
Lateral curvature of spine, which may be idiopathic or caused by neuromuscular disease
Scoliosis
A condition where proximal femoral head displaces posteriorly and inferiorly in relation to neck of hte femur during rapid adolescent growth spurt
Slipped Capitol Femoral Epiphysis
Involves pulling on a body part in one direction against a counter-pull exerted in opposite direction; used to reduce dislocations and immobilize fractures
Traction
Stronger than bone until puberty; as a child grows, muscles increase in length and circumference
Tendons and ligaments
During childhood and adolescence it is essential to provide sufficient _______ to promote adequate bone density and prevent osteoporosis later in life
Calcium intake
Foot is twisted and fixed in an abnormal position; may be one or a combination of four deformities
Clubfoot
Foot is lower than heel
Plantar flexion
Heel is lower than foot
Dorsiflexion
Foot turns in
Varus Deviation
Foot turns out
Valgus deviation
Nursing care for client after casting and after surgical repair of clubfoot
- Neurovascular checks, at least every 2 hours.
- Observe for any swelling around cast edges.
- Elevate ankle and foot on pillows.
- Monitor drainage on cast.
- Pain management.
- Appropriate distraction
Assessment findings for ________ include affected leg shorter than the other, telescoping or piston mobility of affected leg, hx of delay in walking, limp and toe walking, trendelenburg sign, waddling gait with bilateral dislocation, lordosis with bilateral dislocation
Developmental dysplasia of hip (DDH)
when child bears weight on affected side, pelvis tilts downward on normal side instead of upward as it would with normal stability
Trendelenburg Sign
For infants less than 3 months, the most common treatment of this process is a Pavlik harness, usually worn for three to six months
Developmental dysplasia of hip (DDH)
an adjustable chest halter that abducts legs; soft plastic stirrups hold hips flexed, abducted and externally rotated; may or may not be removed for bathing
Pavlik harness
For infants older than 3 months of age, skin traction followed by spica cast application may be required to treat
Developmental dysplasia of hip (DDH)
Characteriazed by occurrence of pathologic fractures resulting from connective tissue and bone defects
Osteogenesis Imperfecta (OI)
Results from a biochemical defect in collagen production
Osteogenesis Imperfecta (OI)
Major clinical manifestations of this disease include multiple and frequent fractures, some of which may be present at birth
Osteogenesis Imperfecta (OI)
Calcitonin, which aids bone healing, may be used for
Osteogenesis Imperfecta (OI)
Medications that increase bone mass
Biphosphonates
A self-limiting disorder in which there is aseptic necrosis of femoral head
Legg-Calve-Perthes disease
Affects clients between ages of 2 and 12 years, but is most comon in those 5 to 7 years of age
Legg-Calve-Perthes disease
Aseptic necrosis of femoral capitol epiphysis with degenerative changes producing flattening of femoral head
Stage I: avascular stage of Legg-Calve-Perthes disease
old bone absorption and revascularization occurs during this time
Stage II: Fragmentation or revascularization stage of Legg-Calve-Perthes disease
New bone formation occurs during this time
Stage III: reparative stage of Legg-Calve-Perthes disease
Gradual reformation of femoral head occurs during this time
Stage IV: regeneration stage of Legg-Calve-Perthes disease
Undiagnosed or late-diagnoses of this disease can lead to osteoarthritis and hip dysfunction in later life
Legg-Calve-Perthes disease
Initial treatment of this disease includes rest to reduce inflammation and restore motion
Legg-Calve-Perthes disease
Postoperative care following surgical treatment for Legg-Calve-Perthes disease includes
- Frequent neurovascular checks
- Pain management
- Activity based on surgeon’s orders
A condition in which upper femoral epiphysis gradually slips from its functional position
Slipped capitol femoral epiphysis
Onset of symptoms may be gradual, with persistent hip pain that is aching or mild, and can be referred to thigh and/or knee, along with limp and decreased ROM and internal rotationof hip; client may hold leg in an externally rotated position to relieve stress and pain in hip joint. An acute slip presents with sudden, severe pain and cannot bear weight
Slipped capitol femoral epiphysis
Client should be placed on strict bedrest until surgery; adolescent may use crutches, as long as affected leg is non-weight bearing, but should not sit in a wheelchair, as this may increase the slippage when treating
Slipped capitol femoral epiphysis
Lateral curvature of the spine; may be functional, which occurs as a compensatory mechanism in clients who have unequal leg lengths or poor posture
Scoliosis
A permanent curvature of spine accompanied by damage to vertebrae
Structural scoliosis
Occurs most often during rapid growth spurt in adolescence, 11 to 14 years for females, 13 to 16 years for males
Structural scoliosis
A parent that notices a skirt hangs unevenly, or that a bra is adjusted unevenly from one side to the other, may lead to a finding of
Structural scoliosis
Exam for this process reveals unequal shoulder heights, waist angles, scapula prominences, rib prominences, and chest asymmetry
Scoliosis
Screening for this by school nurse begins in fifth grade as mandated by law in many states
Scoliosis
Postoperative care for ________ includes ROM excersies, log rolling every two hours, encouraging coughing, deep breathing, and use of incentive spirometry, NPO, nasogastric tube, strict intake and output, frequent VS and neurological checks, monitoring hematocrit, blood transfusions, pain management, antibiotic administration, antiembolism stockings or sequential compression boots, and gradual resumption of activity as ordered
Scoliosis
Teaching for Milwaukee or other brace when used for scoliosis:
- Brace worn for 23 hours a day
- Brace off to shower, bathe, or swim
- T-shirt should be worn under brace next to skin for protection
- Pelvic tilt and lateral strenghening exercises are done several times a day while in brace to correct thoracic lordosis
- Consistent use of brace will provide maximum benefit
- Slight muscle aches may be noticed when first wearing brace
- Encourage adolescent to be as active as possible while in brace
Group of disorders characterized by progressive degeneration of skeletal muscles (muscles that are under voluntary control)
Muscular Dystrophy
All muscular dystrophies are ________disorders
Inherited
The most common type of musclular dystrophy is _______, and is a sex-linked recessive trait, therefore only occurs in males
Duchenne’s (pseudohypertrophic muscular dystrophy
Symptoms of this generally become obvious and acute at 3 years of age
Muscular dystrophy
Symptoms of this usually begin with waddling gait, lordosis, difficulty climbing stairs, running or pedaling a bike
Muscular dystrophy
Clients have difficulty walking on an even surface and rise from floor only by rolling onto their stomachs, then pushing themselves to their knees, and walk their hands up their legs to stand. This is known as
Gower’s sign
Muscles feel unusually woody on palpation and look enlarged
Pseudohypertrophy
A diet low in calories and high in protein, as well as a high fiber, and high fluid diet is encouraged with
Muscular Dystrophy
An infection of bone
Osteomyelitis
Can occur at any age, but is most common between 1 and 12 years
Osteomyelitis
This process usually begins with acute symptoms, systemic malaise, fever, irritability, rapid pulse, and possibly dehydration
Osteomyelitis
Symptoms of this process include pain, tenderness, swelling, and redness in area of infection; there is also decreased mobility of affected extremity
Osteomyelitis
Blood studies for this process reveal an increased white blood cell count, C-reactive protein, and erythrocyte sedimentation rate (ESR); blood cultures will be positive
Osteomyelitis
Surgery may be needed for this for incision and drainage; if surgical drainage is carried out, polyethylene tubes are placed in wound- one tuve instills antibiotic solution directly into wound, while other provides drainage
Osteomyelitis
IV antibiotics for three to six weeks, initiated in hospital, and then continued at home; length of IV therapy is determined by duration of symptoms, initial response to treatment, and sensitivity of organism; oral antibiotics for two weeks following IV antibiotics; both used for __________
Osteomyelitis
Providing good food sources of calcium and protein for bone healing is important for
Osteomyelitis
Growth plate or epiphyseal plate is a common place of this injury, and can lead to improper growth if not treated correctly
Fractures
Used to describe fractures of growth plate and is based on angle of fracture in relation to epiphysis
Salter-Harris classification system
___________ of a child’s bone is thicker and stronger and aids in rapid healing
Periosteum
Adolescents who limit their intake of calories and calcium and who are involved in sports such as distance running or gymnastics are at risk for __________
Stress fractures
May present with chronic pain that changes in intensity
Stress fracture
Growth plate undisturbed, growth disturbances rare, common fracture
Type 1 fracture
Growth disturbances rare, most comon fracture
Type II fracture
Serious threat to growth and joint, less common fracture
Type III fracture
Serious threat to growth (fracture)
Type IV fracture
Rare fracture, crush injury causes cell death in growth plate, resulting in arrested growth and limited bone length. If bone plate is partially destroyed, angular deformities may result
Type V fracture
Break across entire section of a bone at a right angle to the bone shaft resulting in two or more fragments
Complete (transverse) fracture
Associated with high impact forces; bone breaks into three or more segments
Comminuted fracture
Broken bone does not protrude through the skin
Closed fracture
Associated with twisting force; fracture coils around the bone
Spiral fracture
Broken bone protrudes through the skin leaving a path to the fracture site; high risk of infection exists
Open fracture
Caused by compression force; often seen in young children
Greenstick fracture
The five “Ps” in affected extremity
- Pain and joint tenderness
- Pulselessness distal to fracture site
- Pallor
- Paresthesia distal to fracture site
- Paralysis or movement distal to fracture site
Things to assess for when in a cast
Neuro status of involved extremity and compare with unaffected side; assess temp, pallor, pain, tingling sensation, edema, pulse, and cap refill every 15 minutes for the first hour, then hourly for 24 hours, then every 2 to 4 hours
Used for clients under 3 years of age and weighing less than 35 pounds, who have a fractured femur or congenital hip dysplasia; both legs are placed in skin traction, hips are flexed at a 90 degree angle, with knees extended, and both buttocks are slightly elevated above mattress
Bryant’s traction
Used for knee immobilization or for short-term immobilization of a fracture; this running skin traction keeps legs in extended position without hip flexion
Buck’s traction
Used for fractures of femur and lower leg; skin traction is placed on lower leg while knee is suspended in a padded sling; hips and knees are slightly flexed; skin care and monitoring of skin resting in the sling is indicated
Russell’s traction
Inspect pin insertion sites at least every _____ hours for redness, swelling, irritation, or drainage
Eight
Used for fractures of humerus; flexed arm is suspended horizontally; this may be applied as skin or skeletal traction
Dunlop’s traction
Used when minimal traction is needed; traction is applied to skin with adhesive ematerials or straps; foam boots and skin serve as the counter-pull
Skin traction
Used when a greater strength of traction or a longer period of traction is needed; pull is directly applied to bone by pins or wires surgically placed through distal end of bone
Skeletal traction
Skeletal traction used for fractures of femur or tibia; hip and knee are positioned at 90 degree angles, and lower part of extremity is put into a sling or boot cast; ensure skin care to area in boot cast or sling
90-90 traction
Attached to extremity by percutaneous transfixing of pins or wires to bone; these can be used for simple fractures or for complicated fractures or deformities
External fixators
claim more lives during adolescence than all other causes of death combined
Injuries
is considered part of normal growth and development for the adolescent
Risk-taking behavior
This stage of development is generally a period of wellness
Adolescence
Establishment of autonomy (Erikson) Sexual identity A vocational/educational identity Identity and self-perception Early and middle adolescents are egocentric.
Developmental tasks of the adolescent
characterizes the last stage of cognitive development. (Piaget)
Formal operations, or abstract thinking
Cognitive thinking during adolescence moves from concrete to
abstract reasoning
predict stages of sexual maturation
Sexual maturity ratings (SMRs; Tanner stages)
Girls achieve reproductive maturity ____ years after menarche.
2-5
Type of inheritance when one parent has an illness, and the other parent does not. 50% chance of child having the disease.
Autosomal Dominant Inheritance (Ex. Neurofibromytosis, and some blood groups)
Type of inheritance when both parents are carriers of a disease. Child will have 25% chance of having the disease, 50% chance of being a carrier, and 25% chance of being normal
Autosomal Recessive Inheritance (Ex. Sickle Cell, cystic fibrosis)
Type of inheritance when mother is a carrier and father does not have the disease. Female child has 50% chance of being a carrier, and 50% chance of being normal. Male child has 50% chance of having the disease, and 50% chance of being normal.
X-Linked Recessive Inheritance (Ex. Hemophilia)
At what age a child is functioning
Mental Age
Nursing responsibilities for a child with a developmental disability
Facilitating initial grief, assistance with coping, identifying resources to meet lifelong needs.
A legal term that encompasses both intellectual disability and disability that occurs as a result of a developmental disorder
Developmental Disability
Disorder of intellectual impairment
Down Syndrome
Disorders of known genetic cause
Fragile X and Rett Syndrome
Behavioral Characteristics of ____________
Disruptive behaviors, such as temper tantrums
Self-injurious behaviors
Extreme agitation
Autistic-like behaviors (e.g., gaze avoidance, hand flapping,
echolalia, abnormal speech patterns)
Hyperkinetic behaviors, including restlessness, agitation, and
attention deficits
Hand biting
Sensory motor integration deficits (i.e., poor coordination,
tactile defensiveness)
Fragile X Syndrome
almost exclusively linked to female gender.
characterized by an initial period of normal development, with symptoms emerging between the ages of 6 and 18 months.
Social and intellectual development stops, and seizures and physical disabilities emerge.
Rett Syndrome
Disorders related to environmental alterations
Fetal Alcohol Syndrome (FAS), Nonorganic failure to thrive
Disorders with little understood genetic influence
Autism Spectrum Disorders
Trisomy 21-
3 chromosomes on DNA strand 21.
Occurs in 1.7 of 1000 live births with life expectancy of 55
Down Syndrome
Family hx, maternal age >35 (25% of children born with Down Syndrome), paternal age >55, are all risk factors for a child to have
Down Syndrome
Congenital heart defects (VSD most common), thyroid dysfunction, leukemia, imperforate anus, Hirschsprung’s disease, infertility, are all co-morbidities of
Down Syndrome
The presence of more than one type of cell in a person, usually described as a percentage. Same features and health problems as a baby with trisomy 21. May have fewer characteristics, but will vary greatly. Percentages are not accurate predictor of outcome.
Mosaic Down Syndrome
Clinical presentation/characteristics of this include, flat facial profile, short neck, abnormally shaped ears, depressed nasal bridge, protruding tongue, Simian crease-single deep transverse crease on the palm, Almond shaped eyes (upward slant), white spots on the iris of the eye (Brushfield Spots), protruding abdomen, stubby fingers, mental retardation, muscular low tone (hypotonia)
Down Syndrome
A malformation of the upper part of the spine located under the base of the skull in some individuals- may cause spinal cord compression. May require surgical stabilization.
IMPORTANT BECAUSE IT CAN AFFECT OVERALL FUNCTIONING OF CHILD
Atlantoaxial Instability
Care of child with this disease includes correction of heart defect, feeding issues, ancillary support services (PT, OT, speech), promote parental attachment/bonding, promote independence, genetic counseling for parents
Down Syndrome
It is important to maintain a routine for a child with _________
Autism
Characteristics of this syndrome include: Three facial abnormalities Smooth philtrum (lip) Thin vermillion border Small palpebral fissures Growth deficit Less than or equal to 10th percentile for height, weight, or both Central nervous system abnormalities Head circumference less than or equal to 10th percentile Brain abnormalities Motor deficits or seizures Intellectual/functional deficits
Fetal Alcohol Syndrome (FAS)
Bacterial infection of the bone
Osteomyelitis
Nursing care for osteomyelitis
Assessment and documentation of the child’s status
Pain management
Administration of antibiotics without iatrogenic injury
Symptoms of this include bone pain, edema, joint pain, and fever
Osteomyelitis
May be idiopathic or nosocomial
Due to trauma or pins
Osteomyelitis
Most common spinal deformity
Most common in preadolescent growth spurt & usually idiopathic
Scoliosis
Treatment for this disease includes:
40: spinal fusion with rod placement
Scoliosis
Clinical manifestations of this disease include:
Visible curve of spine
Rib hump when child is bending forward
Asymmetric rib cage
Uneven shoulder or pelvic heights
Prominence of the scapula or hip
Difference in space between arms and trunk when child is
standing
Apparent leg-length discrepancy
Scoliosis
Types of Muscular Dystrophy
Duchenne- most common, onset 1-4 yr, rapid progression, X
–linked recessive
Myotonic-onset in severe neonatal form, autosomal dominant
Becker-onset-5-10 yrs, slow progressive, x-linked recessive,
mobile to late teens
Congenital-onset birth, slow but variable, autosomal
recessive
Fascioscapulohumeral-onset first decade, may span many
decades, autosomal dominant or recessive
Emeray-Dreifus-scapuloperoneal or scapulohumeral- onset
middle childhood to early teens slow progress-x-linked
recessive
Younger than 16 years
Joint swelling in at least one joint for at least 6 weeks that is
not the result of trauma, infection, or malignancy (Dannecker
& Quartier 2009)
Juvenile Idiopathic Arthritis
Etiology is unknown, multifactorial, genetic predisposition,
immune response with environmental triggers ( infections or
trauma)
Joints may be stiff , swollen, warn to the touch and
erythematous with limited range of motion. Stiffness is worse
in the morning or after prolonged rest periods
Juvenile Idiopathic Arthritis
Treatment for Juvenile Idiopathic Arthritis
Medication Physical therapy Occupational therapy Family education Home care Activity should be encouraged as tolerated
Nursing outcomes for juvenile idiopathic arthritis
Keeping the child free from injury
Controlling pain
Enhancing physical mobility
Promoting age-appropriate developmental behaviors
Brittle-Bone Disease, Collagen Defect
Thin Soft Skin, Increased Flexibility, Short Stature, Weak
Muscles, Hearing Loss
Parents may be blamed for the child’s injuries until the
diagnosis is established
Osteogenesis Imperfecta
Autosomal dominant or recessive inherited disorder with
fragility of connective tissues resulting in bone defects
Symptoms: sclera normal or blue, teeth brittle or normal, poor
growth, short stature, frequent fractures, thin skin,
hyperextensibility of ligaments, easy bruising, Conductive
hearing loss by age 20 to 30 years
Diagnosis: hx, PE, xrays
Osteogenesis Imperfecta
Treatment for osteogenesis imperfecta
supportive, lightweight braces/splints, PT, surgical
rods if indicated
Nursing considerations for osteogenesis imperfecta
Prevention of fractures
Identification of mobility issues that affect the child’s
functioning
Gentle turning, passive range of motion exercises
Daily skin care
Proper nutrition to support growth and development, with
emphasis on foods high in calcium
Family education- Teach parents safe/gentle handling, injury
prevention
IO Foundation
Girls experience budding of the breasts followed by
the appearance of pubic hair
Approximately 1 year after breast development
height increases rapidly until it reaches its peak
Growth in height in girls typically ceases
2 to 2½ years after menarche
Boys first experience testicular enlargement, followed in approximately 1 year by
penile enlargement
Pubic hair usually ________ the growth of the penis
precedes
The growth spurt in boys occurs later than it does in girls, beginning between ages ______ and ____ years and ending between ___ and ___ years
10½, 16, 13½, 17½
. Growth continues at a much slower pace for several years after the spurt but usually ceases between
18 and 20 years of age
Menarche usually occurs between ages
9 and 15
Most young women achieve reproductive maturity ___to ___ years after the start of menstruation
2 to 5
a biologic process that brings about PHV, or the “growth spurt,” the changes in body composition, and the development of primary and secondary sexual characteristics in both sexes
Puberty
The beginning Tanner stages frequently occur in the _______ child
school-age
Tanner stages 3 to 5 occur in
Adolescence
In boys, puberty is considered delayed if testicular enlargement or pubic hair development has not occurred by age
14
Absence of breast budding or pubic hair development in girls by _____ years is reason for referral
13
Sexual maturation in girls begins with the appearance of
breast buds (thelarche)
Thelarche occurs at approximately age ___ to ___ and is followed by __________
8 to 11
The growth of pubic hair
The first sign of pubertal changes in boys is
testicular enlargement in response to testosterone secretion
The skin has five major functions:
(1) to protect the deeper tissues from injury, drying, and invasion by foreign matter; (2) to regulate temperature; (3) to aid in excretion of water; (4) to aid in production of vitamin D; and (5) to initiate the sensations of touch, pain, heat, and cold.
a chronic inflammatory skin condition seen frequently in infants. It is referred to as “cradle cap” when located on the scalp. It often begins in the first 2 to 3 weeks of life and usually disappears by age 12 months
Seborrheic dermatitis
a skin inflammation that results from direct skin-to-irritant contact
Contact dermatitis
Herpes labialis, commonly referred to as a “fever blister,” is one of the most common manifestations of
HSV 1
Chronic, inflammatory rash caused by rapid proliferation of keratinocytes. Hereditary predisposition; onset in first 2 decades of life.
Psoriasis
develops from release into the blood of products found in normal muscle; the release can be occasioned by electrical injury
Myoglobinuria
follows electrical injury because of the associated cellular destruction and hypovolemic shock. Ringer’s lactate solution, the fluid used for fluid resuscitation, contains sufficient bicarbonate to manage the acidosis that accompanies burn shock but not enough to correct that associated with shock after electrical injury (i.e., pathophysiologic hypovolemic shock, not a “shock” from the electrical current).
Metabolic acidosis
Nursing care of the adolescent with acne includes
teaching about regular, gentle cleansing of the skin, applying topical medications, and encouraging a healthy lifestyle with adequate rest, exercise, and a balanced diet.
In comparison with adults, children who sustain burn injuries are at increased risk for
fluid and heat loss, hypertrophic scarring, cardiovascular problems, infection, and protein and calorie deficiency.
A minor burn wound should be
cleaned with mild soap and water, débrided of loose debris and tissue, and covered with an antimicrobial ointment and a sterile dressing.
occur as a result of trauma to a joint in which ligaments are stretched or are partially or completely torn
Sprains
also known as pulls, tears, or ruptures, result from an excessive stretch of muscle
Strains
pain, swelling, localized tenderness, limited range of motion, poor weight bearing, and a pop or snapping sound (sprain)
Manifestations of soft tissue injuries
The primary goal in managing a soft tissue injury is to
control swelling and prevent further injury.
the natural curvature of the thoracic spine in the sagittal plane
Kyphosis
the most common cause of hyperkyphosis in adolescents
Scheuermann’s disease
Bilateral knee pain that occurs with running, jumping, or climbing stairs; associated with growth and more common in boys; pain and swelling at the tibial tubercle from inflammation at the tendon insertion site
Osgood-Schlatter Disease
Softened, loose, or separated cartilage and bone along the femoral articular surface; knee pain, parapatellar ache that worsens with sports or vigorous activity
Osteochondritis Dessecans of the Knee
Tall, lanky, abnormally long arms with reduced extension of the elbows
Marfan
Age-normal skills across all domains
Normal Intelligence (IQ 85 to 115)
Early milestones achieved, including language and social skills
Likely to be noticed when school performance is monitored
Vocational skills adequate for competitive employment, can live independently as adults
Borderline Intellectual Disability (IQ 71 to 84)
Slight delay in achieving developmental milestones but can communicate well and demonstrate some social skills
May require special education services with an emphasis on vocational and self-maintenance skills
Able to form and maintain adult relationships and can care for themselves
Mild Intellectual Disability (IQ 50-55 to ~70)
Noticeable delay in motor and speech development by preschool age
Can communicate, although have less than adequate social skills
Usually can achieve cognitively at an elementary school level
Can live best as an adult in a supportive and supervised setting, such as a group home
Can perform unskilled work in a supervised setting, such as a sheltered workshop
Moderate Intellectual Disability (IQ 35-40 to 50-55)
Early and marked delay in all motor skills
Limited expressive speech and self-help skills
Constant supervision required, with group home living possible as an adult
Severe Intellectual Disability (IQ 20-25 to 35-40)
May be able to walk
May have primitive speech
Usually requires complete provision of activities of daily living
Profound Intellectual Disability (IQ <20 to 25)
Spans ages 11 to 21 years
Adolescence
Tissue that joins fx bone ends or repairs damaged bone; begins as cartilaginous tissue and becomes hardened through osteoblastic activity
Callus
