Pediatrics Flashcards
Growth and Development
Growth is an increase in physical size while development is an increase in capability or function.
Development does not always follow growth and chronological age - chronological Age and development are two different things.
Cephalocaudal development
The development that moves from the head downward through the body and towards the feet
Proximodistal development
the Development that moves from the centre of the body outward to the extremities
Infancy is birth to 12 months of age: Trust vs Mistrust (Erikson) : Basic Principles
Basic Principles:
This is a time when the primary source of activity is through the mouth; examples are rooting and sucking reflex, feeding, and pacifier.
Repeated use of reflexes develops experiences
Young infants are totally self-centered; they have little tolerance for delayed gratification
At 4-8 months they can perform a desired activity that will produce a result. Example: secures object by pulling on a string
Late infancy: develops the concept of object permanence understands parents are present even if not in line of vision,
works to get toy that is out of reach
Comprehends simple commands and meaning of words
Can say bye-bye and blow kisses
Begins to explore their surroundings
Infants trust that their needs will be meet (feedings, diaper changes, comfort, stimulation)
The trust developed during infancy is the foundation for all
relationships and for the progression of further development
The single most important element in developing trust is consistency in caregivers. Infants love routines! So do things like having a regular feeding schedule, bathe every night then give a bottle and go to bed.
Infancy is birth to 12 months of age: Trust vs Mistrust (Erikson) : Assessment Guidelines
Important things to focus on when assessing an infant
Head control: should have no head lag by 4 months
Pincer grasp: should have established pincer grasp by 11 months of age. Remember up until 1 month of age, hands are closed, grasping at 2-3 months is a reflex.
By 5 months, infants can voluntarily grasp an object.
Rolling over: should be able to roll over from abdomen to back at 5 months of age. No your baby isn’t advanced if they rolled over at 2 months…..it was an ACCIDENT!!
Weight: gain 5-7oz weekly for first 6 months; at 2 weeks, the infant should have gained back to their birth weight, then weight should double around 5 months of age and triple by age 1
Posterior fontanel closes by 2 months of age anterior fontanel closes by 18 months of age
Verbal skills: should be able to imitate sound around 6 months, by 8 months combines syllables like dada but doesn’t know the meaning, 9 months responds to simple commands, comprehends no-no, 10 months says dada and mama with meaning attached,
12 months says 3-5 words
Infancy is birth to 12 months of age: Trust vs Mistrust (Erikson) : Developmental milestones
Some important developmental milestones to remember:
By 2 months can try to pull up with some head control
By 7 months should bear weight on feet, can sit with support,
transfers object from one hand to the other
By 8 months can move from sitting to kneeling, sits without support
By 9 months can stand holding onto furniture, creeps on hands and knees 9-10 months takes deliberate steps
By 12 months walks with 1 hand held, can sit down from standing position without help
Toddlers are age 12 months to 36 months: Autonomy vs. Shame and Doubt (Erikson) : Basic Principles
The primary source of activity is continued until about 18 months of age
and then the toddler transitions into a focus on elimination needs.
The child learns to control his bowels, but if this process doesn’t happen an “anal” fixation may develop and can lead to obsessive/perfection or
disorganized behaviors.
Cognitive development is characterized by EGOCENTRISM
Curious about their environment
Leaves parents for extended period of time
Searches for objects through hiding places
Imitates words and sounds and adult behavior
Engages in parallel play
LOVES ROUTINE!!!
Uses 2-3 words together
Possessive of their toys; uses the word MINE
Follows direction
Egocentrism is observed in the behaviors and play
The toddler has entered the world of NO NO NO NO NO!
Toddlers are aware of their will and control over others but they
are conflicted with exerting autonomy and relinquishing the much enjoyed independence on others
Holding on and letting go are evident in how the toddler uses his
hands, mouth, eyes: “No don’t touch”, spitting out food, etc.
NEGATIVEISM and RITUALISM are typical
Toddlers learn to behave based on the restrictions that are placed on their actions
If the child’s behaviors is punished they learn it is bad; if it is rewarded, it is positive
By 36 months you may see developmental aspects of a conscience
Toddlers are age 12 months to 36 months: Autonomy vs. Shame and Doubt (Erikson) : Assessment Guidelines
Important things to focus on when assessing the toddler
Steady growth in weight and height
Development of body image; they learn to associate body parts with meanings
Gender identity is developed by age 3
– Developing self-image, avoid using negative terms like skinny legs or chubby legs.
Play is important so provide enough space for play; encourage pretend play
Permit child to help with adult tasks - they want to feel productive
Provide toys or activities that help with expression of feelings: language
skills aren’t developed enough to express all feelings
When assessing the child let them hold and touch equipment-this will greatly reduce their fear.
Toddlers are age 12 months to 36 months: Autonomy vs. Shame and Doubt (Erikson) : Developmental Milestones
Some important developmental milestones to remember:
Gross motor: walks without help, creeps up stairs, kneels without support
Fine motor: builds tower of 2 cubes, holds 2 cubes in one hand, scribbles, uses cup well but struggles with a spoon
Language: says 4-5 words, including name, points and ask for objects, understands simple commands, says 10 or more words, uses 2-3 phrases, TALKS ALL THE TIME
Tolerates separation from parents
TEMPER TANTRUMS are normal
May develop a dependency on security item – like a special blanket or stuffed animal
Preschool is ages 3-5 years: Initiative vs Guilt (Erikson) ; Basic Principles
This is a time when the primary source of activity is related to their sexual identity and relationship with parents.
Becomes rival with same sex parent, develops sexual desires for opposite sex parent. This is sometimes referred to as the Oedipus
Complex for boys and Electra Complex for girls
Develops a fear they will be punished for these feelings by same sex parent and this fear eventually leads the child to learn to identify
with the same sex parent
The preschooler’s thinking transitions from egocentric thought to social
awareness is often referred to as “magical thinking.” They believe their
thoughts are all powerful; for instance, if they wish their sister would die
and something happens and she dies, they think it is their fault
Literal thinkers- if you tell them they were bad for hitting a child, they literally think they are bad, they can’t understand it’s the behavior that was bad not THEM!
Poor body boundaries, they think when they have a cut all their blood is
going to come out. That’s why they always want a million Band-Aids.
Preschool is ages 3-5 years: Initiative vs Guilt (Erikson) : Assessment
Important things to focus on when assessing the preschooler
Usual weight gain is 4-6 pounds per year; good rule of thumb:
4 years, 40 pounds, 40 inches. Average weight of 5 year old is 42.1 pounds.
The preschooler begins to move from parallel play to associative play.
This is group play that is similar but without rigid organization rules.
For example: everyone is sitting around playing with their blocks.
Imaginative and imitative play are also very important as a way for children to express their feelings when they don’t have the vocabulary
yet to describe what they are feeling.
Use drawing and pictures to help child express how they are feeling with procedures and interventions; allow them to help when safe for the child, such as with dressing changes or bandages.
Preschool is ages 3-5 years: Initiative vs Guilt (Erikson) : Developmental Milestones
Some important developmental milestones to remember:
Gross motor: Rides tricycle, jumps off bottom step, Skip and hop on one foot, catch a ball, jumps rope
Fine motor: Builds a tower of 9 blocks, when drawing can copy circles, Use scissors usefully to cut out pictures, ties shoelaces
Vocabulary of 900 - 2100 words as they grow
Uses complete sentences starting with 3-4 words up to 6-8 words
Continues to talk all the time- even if no one is listening!!
Tells exaggerated stories and asks WHY, WHY, WHY?
School Age is 6-12 years: Industry vs Inferiority (Erikson): Basic Principles
The child starts to place importance on privacy.
Plays mostly with same
sex peers. When caring for this age be sure to provide gowns and covers when performing procedures.
Always knock on the door before entering.
Has an increased need to understand the body and functions of the body.
One of the major tasks is mastering conservation. They learn that physical matter doesn’t change when its form is altered. They are no
longer magical thinkers. An example of this being achieved: They understand that if a girl cuts her hair short she doesn’t become a boy, their gender doesn’t change by having a haircut.
Does not reason logically, may use symbols or objects, either words or images. Understands relationship between things and ideas, allow the child to handle equipment-this will help increase
their understanding.
Children become more flexible. They are now able to see and
understand things from anothers point of view, no longer rigid
thinkers. They are no longer so egocentric. This is the beginning of logical thought formation which leads to the development of morality
They use cooperative play. They work hard in school, sports, and in
their family to fill a sense of accomplishment.
They want to be productive and successful!!
The goal of this stage of development is to develop a sense industry. This will help in building self-confidence. They continue to improve their social skills.
Eager to build skills and participate in meaningful and
socially useful work. They must balance this with the knowledge
that although they are improving and successful there is always more to learn.
If the child DOESN’T develop a sense of accomplishment this
may result is a sense of inferiority.
As children move from egocentrism to more logical thinking they are also developing a conscience and moral standards. These standards are
based on the teachings and beliefs of others such as teachers and
parents.
School Age is 6-12 years: Industry vs Inferiority (Erikson): Assessment
Important things to focus on when assessing the school age child:
Height and weight gain slows, appears in bursts, can grow at least 2 inches in height per year
School Age is 6-12 years: Industry vs Inferiority (Erikson): Developmental Milestones
Some important developmental milestones to remember:
Repeats activities in order to master them
Develops concept of numbers, knows when its morning or night, by age 8 gives similarities and differences between two things from memory, can repeat days of the week
Age 6 able to use knife to spread butter, by age 8 helps with routine housework, looks after own meals
Socially at age 6 can share and cooperate, likes to compete in games, enjoy spending time with others of the same age on projects and discussing the activities of the day, develops modesty: these are import ant consideration when they are in an acute care setting.
Adolescents are age 12-18 years: Identity vs. Confusion (Erikson): Basic Principles
Adolescents primary focus is on peers and developing relationships out
side of the family.
Have the ability for mature abstract thoughts and ideas, can think
in hypothetical terms
As the adolescent physically matures and thought and ideas become more complex, a new sense of identity is developed.
This identity consists of a picture of oneself that includes past, present, and future.
Peer groups play a large role in developing a sense a self and self-esteem, with the key to identity achievement being based on interaction with others.
Barriers to developing identity would be lack of role models, inability to identify a meaningful sense of self, and lack of opportunities to explore alternative roles.
Establishes personal ethics on which to base decisions. Increase in reasoning and social cognition
Understands abstract thoughts and understands opinions of others.
Takes into account the opinions of others when making decisions
Adolescents are age 12-18 years: Identity vs. Confusion (Erikson); Assessment
Physical changes related to sex and growth hormone effects; is varied in
rate and timing based on gender and family genetics/influences
Be clear, concise and honest when communicating with the adolescent, particularly with body and sexuality issues.
Nursing considerations: give both written and verbal instructions, give clear and complete information about disease process,
interventions, and hospitalization.
Adolescents are age 12-18 years: Identity vs. Confusion (Erikson): Developmental Milestons
Some important developmental milestones to remember:
GIRLS develop more quickly than BOYS. Adolescents grow
stronger and more muscular.
Increased communication and time with peer group; enjoys
activities like movies, dances, driving, sporting events
Preoccupied with body image, very self-centered;
relationship with peers is the most important relationship
Feelings of “being in love” and dating forms stable
relationships and attachments to others
Emotional and physical separation from parents; becomes more independent
Growth and Development and Toys
In addition to growth and development level, you must also think about the clients disease ( can they tolerate an increased oxygen demand, workload of the heart or stress of physical activity?)
Safety and Toys
Don’t put stuff in croup tent - infection risk. You will have to keep bb in there and play with them - just make sure levels are built up.
When does the anterior fontanel close?
12 - 18 months
When does posterior fontanel close?
2 - 3 months
Why are new foods introduced to babies one at a time?
Allergies and to give them time to get used to the food because that GI is immature
How is the earlobe positioned in a child under 2 to view the auditory canal?
Down and Back
How many cups of milk for the 15 month?
2 -3. you have to balance the diet
Major causes of accidents in children up to 1 year
Falls, poisoning and burns
Between 6 and 12, what major cause of accidents
MVA’s
The Growth rate between 6 and 12 and How many calories a day
DECREASES and 2400
Assessment
Start with observation. Then perform distraction techniques so that we get the most accurate set of vitals. TALK TO parent before child. LEAST INVASIVE FIRST.
Resps, HR, BP, Temp. Always cound HR and RR for a full minute because of irregularities. Record the beahviour if unable to get vitals.
Temperature
Rectal: Recommended for children less than 2. Most reliable route.
Not for the immuno-suppressed or those with no rectum.
Auxillary - all ages, when oral route is not possible
Oral - 5 - 6
Tympanic - all ages
Oxygen saturation
used to obtain a picture of the blood oxygen level through the skin
Check perfusion, skin temp and edema to determine the best location for the sensor probe
Common sites are the fingers and toes
Record what is going on at the time the pulse ox is measured
The pulse wave/intesity display on the oximeter machine should correlate with the childs radial pulse
Communication: Children with Physical or Developmental Disabilities
If unable to communicate may feel helpless, fear or anxiety
Family may become anxious
Non-verbal - use gestures, picture boards and writing tablets
Communication - system of head nods and eye blinks
Respiratory Asessemnt
Observable signs of respiratory dysfunction: Accessory Muscle use Nasal Flaring Circumoral Pallor Sternal Retractions Cap refill more than 3 seconds
Laryngotacheobronchitis (LTB)
The most common type of croup experienced by children admitted to the hospital Primarily affects children under 5 years. Caused by a viral infection
Slight to severe dyspnea
Barking or Brassy Cough
Increased Temp
Treatment:
Manage children at home with mild croup. At home, most episodes can be treated with judicious use of:
Steam and hot showers
Car rides with windows down at night
cool temp therapy assists by constricting edematous blood vessels
If symptoms worsen or there is no improvement, Hospitalization is required. Nebulized epinephrine is often used to constrict the edematous blood vessels - Rapid onset, and improvement is seen in 10 to 15 minutes , Observe for relapse. Corticosteroids to decrease inflammation of the airway.
Don’t confuse Epiglottitis with Croup. Key differences include absence of cough, presence of dysphagia, and the rapid progression to severe respiratory distress
SOUND WORSE THAN THEY LOOK
Epiglottitis
is a serious obstructive inflammatory process that occurs in children 2 to 5 years of age.
absence of cough, presence of dysphagia, and the rapid progression to severe respiratory distress
LOOK WORSE THAN THEY SOUND
Lower Respiratory Tract Disease - RSV
RSV - Respiratory Syncytial Virus - More dangerous for the very young
An Acute viral infection that affects the bronchioles and includes RSV, bronchiolitis and RSV pneumonia
Leading Cause of lower respiratory tract illness in children less than 2 years
Risk Factors Prematurity Congenital disorders Smoke Focus on Prevention; High Risk Children will get palivizumab
Signs/Symptoms: URI Nasal Discharge Mild Fever Dyspnea Non-productive Cough Tachypnea with flaring nares Retraction and possible wheezing It is important to know the onset of signs and symptoms because the disease will become worse on days 2 - 3
Treatment
Mild : Treat symptoms ( Supportive care - antipyretics)
Severe ; Suction, Oxygen: May need mechanical ventilation, IV fluids, Albuterol, Antipyretics
Pneumonia
Disease marked by inflammation of the lungs
Causes
Viral: Common viral causes: RSV, Adenovirus or Parainfluenza
Bacterial: Usually Strep Pneumonia
Children <4 years have the greatest incident rate
Mycotic: Walking pneumonia (adolescents)
Aspiration Pneumonia: Occurs when something other air has gotten into the lungs
S/s The same as generalized respiratory distress: Fine crackles or rhonchi, with a cough that is either productive or non-productive Decreased or absent breath sounds Abdominal distention Back pain Fever, usually quite high Chest pain
Treatment
Depends on the type of pneumonia
ABC’s
Oxygen
Plenty of fluids to keep hydrated and keep secretions moving
Antibiotics for bacterial pneumonia
Supportive care: hydration, antipyretics and nebulizers
Asthma
Inflammation and constriction of the airways, resulting in obstruction. Do an in depth through assessment.
S/s Cough Shortness of Breath Audible Wheezing Prolonged expiratory wheezing Restless and cyanosis
Most important part of prevention is Asthma education and identifying triggers
A fish is a good pet for a person with asthma
Cystic Fibrosis
The two body systems are affected by CF - Resp and GI - Thick secretions, does not absorb fat well.
What type of enzymes can be given to help improve digestion - Pancreatic enzymes. Take within 30 minutes of eating, and the beads should not be crushed or chewed as it can burn oral mucosa.
Diet:
Well balanced, high fat, high calories and high protein
They need water soluable vitamins ( A,D,E,K)
S/s
Steatorrhea - Fatty frothy stools
The sweat chloride test is the diagnostic test cystic fibrosis –> babies taste salty when you kiss them
High risk for hyponatremia
Newborn - Meconium ileus is the first sign of CF
Mucous secretions is thick and sticky.
It is an inherited disease but you must get the gene from both parents
Down Syndrome
Down syndrome children are prone to developing Respiratory , because they have poor immune system.
Heart defects are the most common type of defect associated with Down syndrome
The primary aim in genetic counseling is to inform the parents of their risk
Heart Failure in Peds
In children, HF is usually due to congenital heart defects.
S/s
Increased pulse at rest and with slight exertion
Increased respiratory rate
Scalp sweating
Fatigue
Sudden Weight Gain - more than 1 pound a day
Treatment Ongoing Assessment Listen to the lungs Sit them up Rest Decrease Stimuli Cool humidified oxygen Uninterrupted sleep
Meds
Digoxin
Main signs of toxicity are bradycardia and vomiting
for infants, Hold dose if the pulse is less than 110
For Children, hold the dose if the <70
Infants rarely get more than 1 ml of digoxin per dose
(Normal Level is 0.8 - 2.0) Give one hour before or 2 hours after eating
Don’t mix with food or fluid
If you miss a dose and its 4 hours pass due, hold the dose and give the next dose on time
Don’t give more if the baby vomits
If two doses in a row are missed, call PHP
ALWAYS CHECK DOSE WITH ANOTHER NURSE
ACE inhibitors
Watch for decreased BP ( potential for hyperkalemia)
Kidney problems
A dry cough
Furosemide
Decreases the Volume
Nutrition in the HF Peds Client
Well rested prior to eating
Small frequent feedings
increase Calories (formula has sodium in it)
Good feeding sced for heart baby is every 3 hours
Don’t prolong the infant feedings past 30 mins because they will be exhausted
Use a soft nipple with a larger opening, so baby won’t have to work so hard. Complete lavage feeding for resp distress
Breastfed babies will need additional supplements for calories
Hypercyanotic Spells
known as blue spells
May be seen in infants with Tetralogy of Fallot ( A cogenital Heart Defect)
Treatment: Put infants in knee chest position 100% Oxygen (Blow by oxygen) Morphine for sedation and Cardiac Output Loose clothes Loose diapers Quiet Play No stress Respond to Crying Quickly Infections must be treated quickly because they can't handle fever
Effects of Chronic Hypoxia
50% of brain growth occurs during the first year of life - hypoxia can lead to developmental delays
Polycythemia: Increased Red Blood Cells. The body senses it is hypoxic and makes more red blood cells to carry oxygen but there is no more oxygen to carry. So the blood gets very thick. Keep them hydrated to keep the blood thinned out. With this, there are so many RBC’s that there is no room for platelets/ this becomes a stroke and bleeding risk.
Clubbing (late sign of chronic hypoxia)
Poor growth development
Squatting
Cogenital Heart Defects
A structural or functional defect of the heart or great vessels that is present at birth
In children, cardiac defects are classified by blood flow patterns such as:
Defects with increased pulmonary blood flow
Obstructive defects
Defects with Decreased Pulmonary Blood Flow
Ventricular Septal Defect (VSD)
This is when there is an opening between the left and right ventricle (in
the septum)
This increases the volume on the right side of the heart. The right side
is having to pump harder so this can lead to right sided heart failure.
Many close spontaneously during the first year of life, but if not will have surgical repair.
Signs and Symptoms:
- Signs of heart failure
- Murmur
Coarctation of Aorta
The aorta has a narrowing (pretend there is a tourniquet tied around the aorta). This makes it harder for the LV to pump so the client may wind up with left sided heart failure.
Signs and Symptoms:
Hallmark Sign: There is a BIG difference in the pulses and BP of the
upper and lower extremities. For example, you may have a pediatric
client with an Upper extremity BP = 100/60 and Lower extremity
BP = 70/40
The upper pressures are much greater than the lower pressures.
Treatment:
- Surgery
- Angioplasty in some
Patent Ductus Arteriosus (PDA)
Normal fetal circulation: Blood goes Right Atrium….Right Ventricle….
Pulmonary Artery…doesn’t go to lungs….instead when blood leaves PA
it goes straight over to the aorta via the ductus arteriosis.
Why does the blood do this? Because in utero the baby’s lungs are collapsed, and the
baby gets oxygen through the placenta.
This ductus arteriosis is supposed to close when the baby is born and
takes their first breath. When it closes then blood flows from the
Pulmonary Artery to the lungs etc….just like in the adult. But when it
doesn’t……
This leads to increased workload on the left side of the heart and therefore
left sided heart failure.
Some blood is going like it’s supposed to, but some is going over to the right
side because the left side is pushing it to the right.
Signs and Symptoms:
- May be asymptomatic
- May be in heart failure
- They have a machinery - like murmur
Treatment:
- Indomethacin (Indocin®) (prostaglandin inhibitor) will close PDA
- May need surgery to close the ductus
Transposition of the Great Vessels
Think about the normal blood flow in the heart (remember the square heart in your cardiac lecture?)
In transposition of the great vessels, the pulmonary artery and the aorta have swapped places. The aorta is still going to the right side of the heart and the pulmonary artery is going to the left but they never connect or cross.
So you wind up with 2 separate sets of circulation going in and out of the heart. Yes, some blood is getting out to the systemic circulation, or the client would be dead at birth. Instead, the baby is cyanotic at birth, but
alive. What’s keeping the baby alive?
Usually there is some other defect that is allowing that baby to get
just enough oxygen to stay alive. (often it is a PDA)
Signs and Symptoms: Usually cyanotic at birth
If not picked up on until older……decreased growth, poor feeding
Treatment:
- Surgery
Tetralogy of Fallot
Consists of 4 defects:
a. Ventricular Septal Defect (VSD)
b. Pulmonary Artery Stenosis
c. Overriding Aorta
d. Right Ventricular Hypertrophy
Signs and Symptoms:
Infants may be cyanotic at birth: others may have mild cyanosis that progressively worsens during first year
Murmur
Acute cyanotic or hypoxic spells (blue spells/Tet spells)
*usually seen during crying, after feeding, during bowel movements
*at risk for sudden death, seizures
Older children: Squatting, nail clubbing, poor growth, exercise
intolerance
Treatment:
- Surgery
Cleft Palate/Cleft Lip Clients top concern
Top concern is Nutrition! Use a syringe in the side of the mouth
If both are present, which do you correct first?
The cleft Lip
what do you have to do frequently for these clients?
Burp them because they swallow alot of air, risking abd distention, vomiting or aspiration
Cleft Lip Repair
Position child on their back or side laying position following the repair.
The goal is to protect the suture line. Do NOT place int he prone position.
Post op:
Clean the suture line with saline. Elbow restraints.
Cleft Palate Repair
Done before Speech develops, usually between ages 1 and 2 years
Avoid putting things into their mouth, especially hard things
We don’t want to do anything that will disrupt the suture line. So soft diet until well healed.
Speech defects are common afterwards
GER, GERD
GER is the passage of gastric contents into the esophagus. GERD is chronic form of GER.
With GERD you have tissue damage to respiratory structures which can lead to pneumonia and bronchospasms. So it is worse!
Positioning is controversial.
Use upright position with feeding and at night, Elevated prone otherwise ( 30 degrees) Decreases reflux and improves stomach emptying and decreases the chance of aspiration
Provide small frequent feeding with thickened formula.
Pyloric Stenosis
There is increased resistence on the smaller opening. It results in projectile vomiting after a feeding, patients are always hungry
Olive shaped mass in the epigastric region - it’s the enlarged pylorus
Pyloric ultrasound
Hydration/ I&O/Daily Weights/Monitor urine specific gravity
Intussusception
When the bowel goes backwards on itself; forming an obstruction
Sudden Onset Cramping Intermittent Abd Pain Inconsolability Drawing up of the knees Currant Jelly stools
Monitor the stools closely!
Sometimes a barium or pneumatic enema can be done and the pressure will correct the bowel - others will need surgery. Keep for three days in hospital after resolution because it can come back
Celiac Disease
Celiac Sprue is a genetic malabsorption syndrome where there is a permanent intestinal intolerance to gluten.
Lifelong disorder
No food with gluten ( a veggie protein)
NO BROW: Barley, Rye , Oats and Wheat
YES RCS: Rice, Corn, Soy
Hirschsprung’s Disease
A congenital anomaly also known as aganglionic megacolon that results in mechanical obstruction, due to the lack of nerves in that part of the intestine = no peristalsis. Usually affects the sigmoid Colon.
Presenting symptom is constipation. Abd distention and ribbon like stool that has a foul smell.
Treatment:
Remove part of the bowel that is diseased
May require two surgeries to give the intestines time to heal
UTI
Very common in children and can be potentially serious. usually at 2 to 24 months.
In newborns and children less than 2 years, symptoms will be non-specific - seen as a GI problem
Failure to Thrive
Feeding Problems
Vomiting and Diarrhea
If left untreated, attacks kidneys, tissue and destroyed and then scarring occurs. Then the kidneys could fail.
There is tendency for infections to reoccur
Predisposing Factors Renal Anomalies Constipation Bubble Baths Poor hygiene Pin worms Sexual activity
Signs and Symptoms over 2 Classic symptoms! Frequency Dysuria Fever Flank Pain Hematuria
Requires a properly collected urine specimen
Most accurate method is catheterization
Antibiotic therapy: PO or IV
Sickle Cell Disease
When caring for a client with a hematologic disorder, always include protective isolation as part of their plan of care. High risk of infection - encourage good hand-washing. Always use sterile technique when working with any central lines because these are primary sources of infection.
A hereditary disorder in which the hemoglobin is partly or completely replaced with sickle cell hemoglobin. There is a reduced oxygen carrying capacity.
Sickle Cell Crisis: Decreased Blood flow = Decreased Oxygen = Pain
S/s
Pain in areas of involvement
Anorexia
Exercise intolerance
Treatment Bed Rest HYDRATION Analgesics Antibiotics Blood transfusions Oxygen
Hydrocephalus
A disturbance of the ventricular circulation of the cerebral spinal fluid in the brain. Increased Intracranial Pressure!
S/s
Bulging with palpitation of the anterior fontanel
Dilated scalp veins
Depressed eyes ( due to forehead protruding)
Irritability and changes in the LOC
High pitched cry
Setting sun sign - White around iris of eye
Treatment:
Insertion of a shunt
POst OP:
Measure the frontal occipital circumference
Fontanel and cranial suture line assessment
Monitor the temp
Supine position
Hydrocephalus is often associated with myelomeningocele. When an infant is born with spina bifida. protect the SACK. Do not let it rupture! The baby should be lying prone - cover sack with a moist sterile normal saline dressing so it won’t dry out waiting for surgery
Scoliosis
Lateral curvature and rotation of the spine, seldom appears before 10, can be genetic
Heavy Backpacks, Bags and carrying children on hips can be contributing factors
Observation/Orthosis/Operations (Spinal Fusion with Rods)
Head Lice
Itchy - Spread through personal contact
Pin Worms
Spread Hand to mouth
Collect specimen through tape test
The whole family should be treated
S/s Intense Rectal itching General irritability Restlessness Poor Sleep Bed Wetting Distractibility Short Attn Span
Treatment:
Mebendazole
Good hand hygiene
Keep fingernails SHORT
Chicken Pox
Prevent infection of the lesions
Home remedies include oatmeal baths and baking soda paste
IT IS CONTAGIOUS - in adults it causes shingles
Mononucleosis
Caused by Epstein Bar virus - kissing disease.
Spread through direct intimate contact
Rest/Analgesics and fluid
Spleen will be enlarged so you don’t want them to participate in contact sports.
Tonsillectomy
Positioned on side with elevated HOB or prone after surgery
NO brown or red fluids
Hemorrhage = frequent swallowing
Risk for hemorrhage up to 10 days
Common complaints are sore throat and slight ear pain
Low grade temp
Bad Breath
Otis Media
Middle ear is affected. Eustachian tubes are blocked. Usually follows an upper resp infection.
Tympanic membranes are bulging and bright red
Heat helps the pain
Avoid chewing / Eat soft foods
Lie on the affected side - promotes drainage
May not hear you
Avoid Smoke
May require tympanostomy tubes to keep middle ear drained - its ok if they fall out
Prevention: Have bb sit up for feedings No bottle propping Non-aggressive nose blowing Play blowing games Avoid smoke while tubes are in, wear ear plugs while bathing or swimming
Parenting Styles
Authoritarian: highly controlling, expects to be obeyed, inflexible rules
Authoritative: Sets reasonable limits on behaviour, encourages growing autonomy of child, open communication
Permissive: A few or no restraints, unconditional love, much freedom, little guidance, no limit setting
Indifferent: No limit setting, lacks affection for the child, focused on own life.
Why are peanuts so dangerous when aspirated?
They swell and crumble
Why does a mentally challenged child often deliberately do things to displease?
For Attention.
Why don’t we use ventrogluteal in children that have not been walking for at least a year?
Muscle is not developed.
Post op position of child after perineal surgery?
On their side - Prone is contraindicated. When inserting an NG put them in sniffing position and then head down.
Tracheoesophageal fistula
Tracheoesophageal fistula is an abnormal connection in one or more places between the esophagus (the tube that leads from the throat to the stomach) and the trachea (the tube that leads from the throat to the windpipe and lungs). Normally, the esophagus and the trachea are two separate tubes that are not connected.
Tracheoesophageal fistula is also known as TE fistula or simply TEF.
TE fistula is a birth defect, which is an abnormality that occurs as a fetus is forming in its mother’s uterus.
When a baby with a TE fistula swallows, the liquid can pass through the abnormal connection between the esophagus and the trachea. When this happens, liquid gets into the baby’s lungs. This can cause pneumonia and other problems.
Frothy, white bubbles in the mouth
Coughing or choking when feeding
Vomiting
Blue color of the skin, especially when the baby is feeding
Difficulty breathing
Very round, full abdomen
What is esophageal atresia?
TE fistula often occurs with another birth defect known as esophageal atresia. The esophagus is a tube that leads from the throat to the stomach. With esophageal atresia, the esophagus does not form properly while the fetus is developing before birth, resulting in two segments; one part that connects to the throat, and the other part that connects to the stomach. However, the two segments do not connect to each other.
Since the esophagus is in two segments, liquid that a baby swallows cannot pass normally through the esophagus and reach the stomach. Milk and other fluids cannot be digested if the esophagus does not connect to the stomach.
If a TE fistula is also present, liquid that a baby swallows can pass through the connection between the esophagus and the trachea and go into the lungs. This can cause pneumonia and other problems.
Phenylketonuria
Phenylketonuria (PKU) is one of a few genetic inborn errors of metabolism. 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.
A low-phenylalanine diet is essential in the treatment of PKU (Option 1). Phenylalanine cannot be entirely eliminated from the diet as it is an essential amino acid and necessary for normal development. The diet must meet nutritional needs while maintaining phenylalanine levels within a safe range (2-6 mg/dL [120-360 µmol/L] for clients age <12). There is no known age at which the diet can be discontinued safely, and lifetime dietary restrictions are recommended for optimal health (Option 3).
Management of the client with PKU includes:
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)
Phenylketonuria requires lifetime dietary restrictions. Infants should be given special formulas (eg, Lofenalac). For children and adults, high-phenylalanine foods (eg, meats, eggs, milk) should be restricted and replaced with protein substitutes
Infant botulism
Although more than one of these parent comments are concerning, the most concerning is feeding honey to a child under age 1 year. Honey (especially raw or wild) is not recommended for children under age 1 due to the risk for infant botulism. An infant under age 1 has an immature gut system that can allow Clostridium botulinum spores contaminated in honey to colonize the gastrointestinal tract and release toxin that causes botulism.
Botulinum toxin produces muscle paralysis by inhibiting the release of acetylcholine at the neuromuscular junction. Infants often present with constipation, diminished deep tendon reflexes, and generalized weakness. Additional symptoms are lack of head control, difficulty in feeding, and decreased gag reflex, which can progress to respiratory failure. Isolation of the organism from the child’s stool can take several days; therefore, diagnosis is usually made by history, and treatment with botulism immune globulin is started before laboratory results are known.
