more peds Flashcards
osterogensis imperfecta aka
brittle bone
osterogensis imperfecta
impaired collagen causing bones to be frail and easily fractured
osterogensis imperfecta care
checking bp manually to avoid cuff overtightening
- liftting the infant by slipping a hand under the broadest areas of the body (eg, back, buttocks) so the pressure is distributed
- Repositioning the infant frequently using supportive devices and gel padding to avoid molding of the soft bones of the skull
esophageal atresia and tracheospghgeal fistula manestifatations
- frothy salvia
- choking
- coughing
- drooling
- apnea and cyanosis when feeding
EA/TEF risks
apsirtation
EA/TEF interventions
maintaining NPO status, positioning the client supine, elevating the head at least 30 degrees, and keeping suction equipment by the bed to clear secretions from the mouth.
priority in EA/TEF
maintain clear airway and prevent aspiration
ea/tef contraindiacations
This client will likely require parenteral nutrition prior to surgery. A gastrostomy tube may be placed to allow for release of air and drainage of gastric contents to prevent aspiration; however, feedings or irrigations through the tube are contraindicated until after surgical correction of the TEF.
-NO FEEDINGS OF ANY KIND
pediculosis capitis
head lice
-often seen in school age
pediculosis capitis span
adult louse cannot survive away from the host’s head for >48 hours. However, the nits can live away from the host (eg, on hairbrushes, carpets, hats) for up to 10 days.
SO DONT SHARE
treatment of peduculossis capittis
peduuculicide to the head and removing nits with nit comb or by hand
- use every 2-3 days for 2 weeks
- clean carpets, rugs, fruniture
- wash bedding in hot water and dried on the hottest dryer setting
- non washable items must be sealed in plastic bad for 2 wk
- all hairbrush, combs and ornaments should be soaked in boiling water for 10 mins or lice killing products for one hour
what doesnt transmit lice
household pets, pra; contact
utensils
-IT IS SPREAD DIRECT PERSON TO PERSON OR SHARING COMB PILLOW CLOTHING
juvenile idiopathic arthritis (JIA) minimize the risk
Both aerobic and anaerobic exercise can help minimize this risk, and resistance training can increase muscle strength and endurance.
what kind of excercises for JIA
l, low-impact, weight-bearing, and non-weight-bearing exercises that involve range of motion and stretching
- VOID HIGH IMPACT
- not reading book
hemophilia education
Avoid medications such as ibuprofen and aspirin
- Avoid intramuscular injections; subcutaneous inj are preffered
- Avoid contact sports and safety hazards; noncontact activities (eg, swimming, jogging, tennis) and use of protective equipment (eg, helmets, padding) are encouraged (Option 5).
- -Dental hygiene is necessary to prevent gum bleeding, and soft toothbrushes should be used.
- –MedicAlert bracelets should be worn at all times (Option 3).
what is not assoicated with hemophilia
malnutrtion
dehydration
dont use what in UTI
antibacterial soap bc it destorys natural flora
iron foods
meat
fish
poultry
vit c foods
potatoes
tomatoes
strawberries
what is poor source of iron
milkkkk prpducts
what interers with ironabsotption
calcium
leading cause of iron def in children
overconsumption of milk
vasoocculsive sicle cell crisis
- -high painnnnn
- -iv fluids
- -bed rest to decrease energy expenditure and oxygen demand.
best avcivity for sickle cell
bed rest activity such as movies or book
NOT VIDEO GAMES, PAINTING, CHECKERS
mononucleosis is caused by
Epstein-Barr virus
mono spread by
sharing driks, kissing, direct exposure to salivia
symtoms of mono
fatigue, fever, sore throat, splenomegaly, hepatomegaly (VOID CONTACT SPORTS TO PREVENT INJURY TO SPLEEN OR LIVER), and swollen lymph nodes.
mono treatment
abx not effective bc it is virus
-treatment for mononucleosis is management of symptoms and includes hydration, rest (for fatigue), control of painIibuprhen nor tylenol NOT ASPRIN), and reducing fever as necessary. Sore throat is treated with saline gargles or anesthetic troches.
complications of mono
airway obstruction (eg, stridor, difficult breathing) from swollen lymph nodes around the neck and severe abdominal pain (splenic rupture).
pyrloric stenosis manesitifatations
olive-shaped mass may be palpated in the epigastric area just to the right of the umbilicus. –Emesis is nonbilious (formula in/formula out) and leads to progressive dehydration. –Infants will be hungry constantly despite regular feedings.
what abg is pyloric stenosis
met akalosis
pyrlpic stenosis leads to
dehydration
-IT IS NOT AN INFECTIOUS PROCESS SO WBC SHOULD NOT BE elevated
hypokalmeia
hemoconcentration (eelvated hct, and bun)
v shunt used to treat
hydrocepaylus
cushing triad
brady
slowed resp
widency pulse pressure
cshuntompliations of
blockage (with signs of increased intracranial pressure [ICP]) and infection
braducardia can be sign of
ICP
expected finding in cerebral palsy
spacisity /clonus
musuclar dystropy complation
resp and cardiac
fifth disease “slapped”
viral ilnnes by hpv
mainly in school age
-
fifth disease charactersitic
red rash on the cheeks that gives the appearance of having been slapped. The rash spreads to the extremities and a maculopapular rash develops, which then progresses from the proximal to distal surfaces.
fifth diases recover/ treatment
within 7-10 days.
-malaise and joint pain that are typically well controlled with nonsteroidal anti-inflammatory drugs such as ibuprofen.
fifth disase and inefectious period
- Once these children develop symptoms (eg, rash, joint pains), they are no longer infectious.
- Children with fifth disease are communicable only prior to onset of symptoms (eg, rash, joint pains).
fifth disease spread through
dropplet but isolation is not required
lead positing from
igestion
lead exposure
wall toys glazes (pottery)
-water from lead pipes, or by inhalation of contaminated dust or soil found around older homes.
elevated blood levels impair
neural, blood, and renal development.
blood lead screening test is recommended what age
between ages 1 and 2, or up to age 6 i
what lead level
Clients with elevated BLLs (≥5 mcg/dL [0.24 µmol/L]) require follow-up blood work to ensure that levels decrease
treatement for high lead levle
Chelation therapy
lead teaching
Pediatric and pregnant clients should not live in homes being renovated until the work is complete. —Handwashing, especially before eating, is important to remove lead residue
-Taps should be flushed for several minutes to clear out contaminated water before use.
Hard surfaces should be wet-dusted or mopped at least weekly. NOT VACC
= Hot tap water dissolves lead from older pipes; therefore, cold water should be used
Developmental dysplasia of the hip (DDH)
is instability/ dislocation of the hip joint that may be present at birth- the first few years of life. Nonsurgical treatment methods, such as a harness or cast, are most successful when initiated during the first 6 months of life. surgery is frequently required.
pavlik harness
most ocmmon tool to treat dysplasia
using palik harness how to
slightly flexed and abducted position
- worn for about 3-5 months
caring for pavik harness
Regularly assess skin for redness or breakdown under the straps
- -Dress the child in a shirt and knee socks under the harness to protect the skin (Option 2)
- -Avoid lotions and powders
- -Lightly massage the skin under the straps every day to promote circulation (Option 3)
- -Only apply 1 diaper at a time as wearing ≥2 diapers (previous treatment practice) increases risk of incorrect hip placement
- -Apply diapers underneath the straps
what is contridcated in immunosuppresion
live vacc
FLACC and how to know if child in pain
Facial grimacing
Leg movement, tension, or bending up toward the chest
Activity, including squirming, arching, jerking
Crying or moaning
Difficulty consoling or comforting the child`
Splenic sequestration crisis
occurs when a large number of “sickled” cells get trapped in the spleen, causing splenomegaly.
LIFE THEREANTING AND CAN LEAD TO HYPOVOLVEMIA(HYPOTENSIVE) SHOCK
classic assessment of splenic sqeuestration cirsis
rapdily enlarging sleepn
normal rbc lilves for and sick cell
120 days
-sickle cell reak apart and die within less than 20 days; therefore, the client always has a shortage of red blood cells (anemia). Due to anemia, clients often report feeling fatigued.
complications of sickle
Right arm weakness could indicate new-onset stroke, a common complication of sickle cell disease that needs to be assessed. However, splenic sequestration is immediately life-threatening and a priority.
-) Swelling of hands and feet (dactylitis) is another symptom of this disease due to the sickled red blood cells blocking blood flow to the hands and feet.
Splenic sequestration crisis signs
enlarging spleen and hypotension are the characteristic assessment findings.
duchenne muscular dystrophy
x linked recessive
due to lack of a protein called dystrophin needed for muscle stabilizati
The Gower sign .
involves the use of one’s hands to rise from a squat or from a chair to compensate for proximal muscle weakness
Duchenne muscular dystrophy (DMD) treatment
no cure
- Most children are wheelchair bound by adolescence and die by age 20–30 from respiratory failure.
duchenne muscular eduation
avoid floor clutter (eg, throw rugs) and prevent falls/injury
- gentle recreation-based exercises and swimming to avoid disuse muscle atrophy and social isolation. –Overexertion such as weight lifting is not recommended due to the risk of muscle injury.
- -Diet should be assessed to ensure adequate fluid, whole grains, fruits, and vegetables to maintain bowel function to reduce the risk for constipation from immobility.
what is not related to duchenne muscular
iron def
scarlet feve0 complication of r
group A atrep ( (eg, streptococcal pharyngitis),
signs of scarlet
red rash. The rash begins on the neck and chest and spreads to the extremities, resembles a bad sunburn, blanches with pressure, and has fine bumps like sandpaper. Additional manifestations of streptococcal pharyngitis (eg, exudative pharyngitis, fever, swollen anterior cervical lymph nodes) are typically present.
confiring scarlet fever
- Because the clinical presentation (ie, rash plus sore throat) is characteristic, but not diagnostic, of scarlet fever, the health care provider will prescribe a rapid streptococcal antigen test to confirm symptom etiology
- wabbing the posterior pharynx and tonsils provides test results within minutes. Throat culture may be necessary to verify results.
treatment for scarlet
amoxillin
eye sydnrome signs
cecepthapthy
cerebral edema
-asprin during influenzaor vericella infec
-fatty liver failure
maestificatationsof reyes
ude fever, lethargy, acute encephalopathy, and altered hepatic function.
expected lab finding reyes
Elevated serum ammonia lvl
autism specttrum disorder oftene xhibit
sensory processing problems; they may be hyper- or hypo-sensitive to sounds, lights, movement, touch, taste, and smells.
env for autism spectrum disorder
calming environment with minimal stimulation should be provided; a private room away from the nurses’ station is the best location.
facilitate a calming environment for autism
- Using a quiet or monotone voice when speaking to the child
- Using eye contact and gestures carefully
- Moving slowly
- Limiting visual clutter
- Maintaining minimal lighting
- Providing the child with a single object to focus on
Myelomeningocele area
risk for infection at this area. A priority nursing intervention is to cover the area with a sterile, moist dressing to decrease the risk of infection until surgical repair can occur.
-should be placed PRONE
the amount of iron stored is dependent on the
length of gestation
who at risk for less iron
preterm because less time in utero to accumulate iron
- Preterm infants typically deplete iron stores by age 2-3 months and require additional iron supplementation
iron in a good term baby
sufficient iron stores for the first 4-6 months of life. However, infants receiving exclusively breastmilk require iron supplementation (eg, oral iron drops) around age 4 months until food sources of iron (eg, iron-fortified infant cereal) are adequate around age 6 months.
menegtitis signs in infants and children less than 2
fever, restlessness, and a high-pitched cry.
babinski sign
Babinski reflex can be present up to age 1-2 years and is a normal, expected finding; it does not indicate meningitis.
what prpovides earlier assessment for ICP
Fontanel assessment (bulging tontanel and head circumf) provides an earlier indication of increased ICP.. cushing triad is a late sign (brady, resp dep, widened pulse pressure)
pupil assemnt in mengitis
Because meningitis clients are sensitive to light (photophobia), frequent assessment of pupillary light response will be uncomfortable. Severely increased ICP may alter pupillary response; however, this is a late complication of hydrocephalus. Fontanel assessment provides an earlier indication of a developing problem.
PKU
Individuals with PKU lack the enzyme (phenylalanine hydroxylase) required for converting the amino acid phenylalanine into the amino acid tyrosine. As unconverted phenylalanine accumulates, irreversible neurologic damage can occur.
PKU management
low -phenylalanine diet
- Monitoring serum levels of phenylalanine
Including synthetic proteins and special formulas (eg, Lofenalac, Phenyl-Free) in the diet (Option 4)
Eliminating high-phenylalanine foods (eg, meats, eggs, milk) from the diet (Option 2)
Encouraging the consumption of natural foods low in phenylalanine (most fruits and vegetables)
PKU normal level
2-6
tinea copris aka
ringworm
tinea coporis is a
fungal infection on the superficial keratin layers of the skin, hair, and/or nails.
tinea copris is spread
highly contagious and spreads via contact ((eg, bathroom floors, gymnasium mats, car seats), personal items, or pets. )
managment of tinea copis
hygiene (eg, washing hands after touching infected areas),
- – limited contact with personal items (eg, hair brush),
- – treatment with the prescribed shampoos as well as topical and/or oral medications (eg, terbinafine [Lamisil], miconazole).
tinea copris treatment
Antifungal cream (terbinafine [Lamisil]) is the preferred treatment and is applied to infected areas twice a day. It may take 1-4 weeks to complete treatment depending on infection severity.
who has highet risk of getting autism
genetic
so sibilings
signs on ICP
bulging fontanelles, increasing head circumference, and sunset eyes (or setting-sun sign) (sclera visible above the iris).
plagiocephaly (flat head syndrome)
when infent placed in same position (eg, supine) for an extended period of time and the pliable skull molds to the surface (flattens).
normal amt of diapers in 24 hours
(6-10 diapers/day or approximately 1 diaper every 4 hours)
putting child to sleep with bottle
dental caries - Bottles containing milk or sugary beverages should not be used as bedtime pacifiers.
Developmental dysplasia of the hip (DDH risk factors
breech birth, large infant size, and family history.
reducing risk of breech
Proper swaddling technique - infants should be swaddled with their hips bent up (flexion) and out (abduction), allowing room for hip movement (Option 3)
Choosing infant carriers or car seats with wide bases - infant seats should allow for proper hip positioning in an abducted manner Avoiding any positioning device, seat, or carrier that causes hip extension with the knees straight and together
precautions for mengitis
continued for 24 hours after initiation of antibiotic therapy.
suspected meningits pt should be kept
NPOOOO
- allowing the client to self-position (Options 1 and 4). Due to nuchal rigidity, most clients prefer to lie with the head of the bed slightly raised and without a pillow, or in a side-lying position.
fecal incontience means
repeated passage of stool in inappropriate places by children age ≥4 years.
fecal incontience most of the time is due to
functional constipation
mangemnt of fecal incontinnce/constipation 3 components
Disimpaction followed by prolonged laxative therapy, dietary changes (increased fiber and fluid intake), and behavior modification. Behavioral strategies are used to promote and restore regular toileting habits and to gain the child’s cooperation and participation in the treatment program.
behavioral intevention for fecal incontinence
- regularly schedule toilet sitting times 5-10 X mins after meals for 10-15 mins
- Provide a quiet activity for the child during toilet sitting, which will help pass the time and make the experience more “enjoyable” (
- Initiate a reward system to boost the child’s participation in the treatment program; the reward would be given for effort, NOT FOR SUCESS
–Keep a diary or log of toilet sitting times, stooling, medications, and episodes of soiling to evaluate the success of the treatment
heart value injury
rheumatoid heart disease
intelltual disbaility
fetal etoh , hypothryodism
lead poistioning
cystic fibroris
recurrent pnuemonia
joint destruction and joint bleeding
hemophilia
febrile seziures
gernally benign
Parents should be instructed on appropriate cooling methods (eg, antipyretics, cool compresses), seizure safety precautions, and the avoidance of shivering.
absence seizures last
less than 10 seconds and multiple can occur daily
rotavirus transmission
contagious infection
fecal
transmission can occur through contact with food, toys, diapers, and hands.
children with rotavirus are at risk for
dehydration
rota virus is not treated
with abx bc it is viral
pertussis
contangious
smtoms of pertussis
c violent, spasmodic cough.
-Coughing episodes may continue until a thick mucus plug is expectorated and are sometimes followed by vomiting (posttussive emesis).
-
treatment
- antibiotics and supportive measures. Humidified oxygen and adequate fluids -vaccination -DONT GIVE COUGH SUPP
airborne
measeals
varicella
chicek pox most contgious
1-2 days before the rash and shorly after the rash (until all lesions are crusted over).
water intoxication results in
hyponatremia
formula is too diluted causing hyponatremia or mother gives water
-the babies renal system is imature so it cant filter it the water out
hyponatremia symtoms
irritability, lethargy, and, in severe cases, hypothermia and seizure activity.
only sources of hydration the first 6 months
milk or formula
physiologic anorxia meangement
Set and enforce a schedule for all meals and snacks
Offer the child 2 or 3 choices of food items
Do not force the child to eat
Keep food portions small
Expose the child repeatedly to new foods on several separate occasions
Avoid TV and games during meals or snacks
physicologic anorixia
Physiologic anorexia occurs when the very high metabolic demands of infancy slow down to keep pace with the moderate growth of toddlerhood.
-during this phase toddlers are picky
physilogic anroixia around what age
18 months
acute diahrea and drhydration treamtent
first line is oral rehydration therpy
-continue the childs normal diet
the brat diet
banana rie applysauce and toast is not recommended bc it doesnt have enough protein or energy
use aof anitdiahreal in children
dont use
EEG
Hair should be washed to remove oils and hair care products, and accessories such as ribbons or barrettes should be removed. Hair may need to be washed after the procedure to remove electrode gel.
Avoid caffeine, stimulants, and central nervous system depressants prior to the test.
The test is not painful, and no analgesia is required.
how long are pavlik harness worn for
3-5 months or until hipi joint is stable
ajusting the pavlik harness
parents shouldnt do it
-straps are assessed every 1-2 wk by HCP
