Spec Pedia Flashcards
Growth and development
Growth is Development is Cephalocaudal development Proximodistal development ☆Development does not always follow
Growth is increase in physical size
Development is increase in capability and function
Cephalocaudal development is from head down to feet
Proximodistal is the development from center to outward to extremities
Development does not always follow growth and chronological age
Play is
When choosing toys you must also
When a baby is born they have a
Play is work for children. This where they learn coping skills, new things and socialize
Also think about the clients disease, what toy is appropriate for the client
Involuntary grasping reflex
Nclex tip for picking answer in growth and development
Pick the nerdiest answer
Anterior fontanel Posterior fontanel IM in ventrogluteal? Foods introduced one at a time? Peanuts are dangerous Ear canal, pull? Most common reason for failed toilet training? Best friend stage occurs at? Cups of milk per day on 15 month old? Leading causes of death to infants up to 1 year?
Closes 12 to 18 mos
Closes 2 to 3 mos
Ventrogluteal muscle is not used for IM meds not until the child is walking for at least a year otherwise it is undeveloped
Foods are introduced one at a time or one per week due to Allergies and immature GI
Peanuts can cause aspiration when it is wet it easily crumbles and swell
Pull down and back
Not ready yet. Boys take longer because they need to decide whether to stand or sit
Ages 9 to 10
2 to 3 cups per day
Suffocation,drowning and motor vehicle related
Car seat safety guide
Dont: Front seat and Paddings Infants <20 lbs Aged 12 to 23 months can Car seats at least 30 lbs Booster seats are used Hyperthermia in car
Dont place infants in the front seat in the passengers side and Dont place padding under or behind a car seat it could cause ejection
Infants less than 20 lbs should be placed at the back seat facing backwards this helps protects the heavy head and weak neck
Age 12 to 23 months can face forward in a car seat
Car seats should be used regardless of age until the child weighs at 30 lbs
Booster seats are used ages 4 to 8 years old and are less than 4’9” tall and weigh between 35 to 80 lbs
Hyperthermia develops in an infant rapidly at temps >80°f when they are left inside a car
Cause of severe accidents in 6 to 12 years old?
Growth rate in 6 to 12 years old?
Calories per day in school age child?
Teach Stranger
How much earlier girls experience adolescence than boys?
MVA like bicycle,atv or skates.. Decreases 2,400 calories per day Stranger safety 1 to 2yrs earlier
Vital Signs
Observe Distraction techniques Parents Order in getting the vital signs Infants and toddler,HR and RR full minute,why?
Always observe FIRST
Distraction techniques is used to get the most accurate V/S
You should talk to parents to establish trust
Less invasive first and again always begin with observation:
RR➡️HR➡️BP➡️Temp
RR and HR must be taken in one full minute in infants and toddler because their nervous system is still immature.
Temperature routes
Rectal -contraindicated in Axillary Oral Tympanic
Rectal is the most accurate route. Done in all ages except Infants due to risk of anal perforation and not used on child who has diarrhea,receiving chemotherapy,immunosuppresed and rectal lesions
Axillaey is Done in all ages when ORAL is not possible
Oral temp Start at age 5 to 6yrs because they are cooperative
Tympanic is used in all ages but is less sensitive in ages < 3 yrs
Newborns
Primary communication
Express themselves by
Nursing strategy
Infants
Primary communication
Begin verbal with
Nursing strategies:speak
Birth to 1 month
Non-verbal
Crying
Encourage parent to touch because touch has a positive effect
1 month to 12 months
Still non-verbal
Repeating consonants
Speak in gentle toned voice, cuddle, rub to calm and encourage presence of parents
Toddlers and Preschoolers Verbal skills Telegraphic speech "Why" Memory and attention Cognitive development "EMAO" Nonverbal communication are
Ages 1 to 5 years
Verbal skills are evolving
Ages 3 to 4 yrs old forms 3 to 4 word sentences called telegraphic speech
Preschoolers ask alot of why questions
Limited memory and attention span
Egocentric, Magical Thinking, Animism(objects are alive), Object permanence
Express themselves non verbally through dramatic play and drawing
School age children
Cognitive development: Logic Cause and effect Point of view Body functions
Verbal communication:
Vocabulary
Misinterpretation
Balanced Language
Nonverbal communication:
Nonverbal messages
Expression of
Ages 6 to 12 years old
Able to use logic
Begin to understand the cause and effect
Begin to understand others point of view
Develop understanding of body functions
Big vocabulary
Misinterpretation of phrases is still common
Receptive and expressing language is balanced
Can interpret nonverbal messages
Thoughts and feelings
Adolescents
Abstract thinking
Rapport
Independence and privacy
Nursing strategies
Ages 13 to 18 yrs old
They can do abstract thinking without full adult comprehension
To build rapport, trust and understanding is needed
Strive for independence and they need privacy
Straightforward approach, talk in private area. Conduct some part of interviews without parents for them to tell you the truth
Children with Physical and/or Developmental Disabilities
Unable to communicate
Family also
Nursing strategies
If unable to communicate, may feel helplessness, anxiety or fear
Family may also experience fear and anxiety
Nursing strategy is to use Nonverbal communications like:
Gestures, picture boards, tablet writing, head nods and eye blinking
What are observable signs of Respiratory distress in children?
ANGS
Causes
Illness and Lungs ability IN and OUT
Examples
Depends on Degree
Accessory muscle use
Nasal Flaring
Grunting with respirations
Sternal retractions
Any illness that affects the lungs ability to get oxygen IN and carbon dioxide OUT
Examples are pneumonia, atelectasis, pneumothorax, and pleural effusion
Amount of respiratory distress depends on the degree of disease
What is Laryngotracheobronchitis?
BED
They sound like
Causes:
PA RSV
Treatment:
Mild At home
Steam
Cool therapy
If symptoms worsens:
Give epi and corti
Rapid and return
Commonly known as CROUP
A viral infection that results in Barking or Brassy Cough, Elevated Temperature and Dyspnea that is severe. “Croup Up in “BED”.
Barking Seal
Causes: Parainfluenza, Adenovirus, RSV
Children with mild croup are treated at home
Steam from hot showers dilates the vessels
Cool temperature therapy constricts the blood vessels in trachea that are swollen. This decreases workload of breathing
Nebulized epinephrine or corticosteroids may be prescribed by PHC or administered at the ED
Watch out for nebulized epinephrine because it has a rapid onset of 10 to 15 mins and return of symptoms may happen when it wears off
What is Epiglottitis?
Primary cause and primary prevention
S/S “MR DAD”
Medical Respiratory Droo Absence Dys
They look worse than they sound
Never try to visualize
It is the infection of the epiglottis. Which causes psrtial or full obstruction of the airway
Cause is H-Flu and prevention is Hib Vaccine
Medical Emergency (considered as)
Respiratory distress (progresses rapidly to)
Drooling because increase saliva
Absence of cough
Difficulty in swallowing due to inflammation
It means that the less noise they make the worse the airway obstruction
Never try to look at the throat or tongue because airway obstruction can occur at anytime UNLESS it needs to be done ot must be at The E.D. with medical equipments
What is RSV? R2V? B?
In infants?
Causes
Focus on premature infants?
S/S “Reverse FWRD N (forward, Neutral)
Starts with URI
Must know the onset of S/S
Hint: S/S can range from mild to severe from…
Treatment:
Mild
Severe
Respirator Syncytial Virus. Acute viral infection that affects the bronchioles. It is the leading cause of Lower respiratory illness in children less than 2 yrs old.
In infants this can be life threatening
Premature
Congenital disorders such as congenital heart defects
The focus is on PREVENTION. Which includes avoiding the Sick and RSV vaccine ( Synagis, RespiGAM)
Fever, Flaring nares with Tachypnea Dyspnea Wheezing Nonproductive Paroxysmal cough Runny Nose
Because it has a rapid progression of just 2 to 3 days to Respiratory Distress
A simple cough and runny nose to increased mucus to severe respiratory distress
Mild: supportive care(antipyretics) Severe: Intubate and ventilation Oxygen IV fluids Supportive care
What is pneumonia?
S/S (PNEU) The same as generalized respirstory distress Productive or non productive Decrease or absent Pain Fever
Treatment:
Depends on type of pneumonia
Supportive
Meds
Childhood vaccines
It is an inflammation of the lungs caused by bacterial, viral, fungal or any foreign substance that is aspirated
Pain, Non productive,fEver,lUngs sounds
Fine crackles or rhonchi with productive or non productive cough
Decreased or absent of affected lung sounds
Chest and or abdominal Pain
Fever which is very HIGH
Supportive care, like oxygen, hydration,nebulizers and antipyretics
Antibiotic for bacterial while supportive for viral
Help prevent the most common type of bacterial pneumonia so parents must be encouraged
What is cleft palate/ cleft Lip?
Develops during
Treatment: surgery
Pre op:
Elongated nipple or medicine dropper
Burp frequently, abdominal distention
If baby have both cleft lip and palate? Repair which one first?
Post op: Goal Position Avoid putting hard Diet
When is best time to repair cleft palate?
Clue: PLATE 🍽
It is an orodacial defect that affects the oropharynx and increases risk for malnutrition and aspiration
Develops during fetal development
Medicine dropper or elongated nipple is used to feed the baby on the SIDE of the mouth to prevent aspiration
The baby must be burped frequently to remove excess air because they usually swallow alot of air and it could lead to abdominal distention increasing the risk ofvomiting and aspiration
Cleft Lip. Because it promotes feeding and parental bonding. And also the palate is still pure cartilage and cartilage does not do well in surgery
Goal is to protect SUTURE
Supine or side lying. Never prone position
Avoid putting hard foods or utensils in childs mouth
Diet is soft foods until well healed
Before speech develops and usually it is between 1 and 2 years.
What is GERD?
Risk to have pneumonia. Why?
Reflux precautions
Gastroesoohageal refulx.It is the reflux of gastric contents to the esophagus.
Because gastric contents could go into the lungs . Remember any foreign aspirated foreign substance in lungs could lead to pneumonia.
Sitting upright for 30 minutes
Burping baby frequently
Small frequent feedings
Thickened formula
What is Pyloric stenosis?
S/S
Enlarged pylorus,abdomen
Projectile
Diagnosis
Treatment: I&O Weight USG Hydrate Surgery
It is a disorder that causes projectile vomiting during or after feeding. This baby is hungry and cant wait to eat again
S/S
Upon assessment, you may feel an OLIVE shaped mass in the epigastric region near umbilicus
Projectile vomiting because there is a small opening in the pylorus thus pressure will build up
Diagnosis is done by Abdominal Ultrasound
Intake and output is monitored Daily weights Urine specific gravity must be checked Hydration and electrolyte replacement Surgery is done to open the pylorus
What is Intussusception?
(Into Zoom)
S/S Onset Pain Incinsolability Drawing up of Classic symptom is
Treatment:
Enema
Surgery
Closely monitor for
A poece of bowel will telescopes into itself causing obstruction
Onset is SUDDEN
Episodes of pain, may be cramping pain and abdominal pain
Incomsolable due to the pain
Drawing up of knees
Currant Jelly stools is the classic symptom, it is maroon colored which is blood
Air contrast, barium or ultrasound guided saline enema can be done. The pressure of these enema will push out the telescoped area
After surgery, they still keep them at the hosp for several days because of the possibility of recurrence
STOOLS to watch out for perforation
What is Hirschsprungs Disease?
Usually
Patho
S/S
ARC
Treatment
It is a congenital defect or anomaly aka AGANGLIONIC MEGA COLON that results in mechanical obstruction
Usually affects the Sigmoid Colon.
There is a part of the intestine that has no nerves, no movement, which will cause the obstruction.
Abdominal distention
Ribbon like stools that have a foul smell
Constipation which is the presenting symptom. Why? Because it is Aganglionic which means no Nerves; No peristalsis.
Surgery: removal of the portion of bowel that is diseased
What is Head Lice?
Main symptom?
Spread to other parts of body? How?
Treatment
Parasite in the scalp
Scalp itching
Yes. Direct contact.
Antiparasitic medications. Like PERMETHRIN (NIX) , PYRETHRIN (RID)
Pin worms
“Worms”
S/S
How are they spread?
Whole family should be..
Diagnosis
Wetting of the bed pOor Sleep Rectal Itching which is INTENSE Mebendazole is the DOC (1 Dose) Short fingernails is recommended
Hand to mouth
Treated because eggs might be everywhere
Tape test. Taping the rectum before bowel to see if there are eggs because the worm goes out yo lay eggs then goes back in.
What is Infectious Mononucleosis?
Caused by EB
S/S:
KISSS
Spread by?
Avoid what sport?
Aka the Kissing Disease.
Eipstein Barr Virus
(K) Ontact sport is limited FatIgue Swollen lymph nodes Spleen enlargement Sore throat
Direct intimate Contact
Example is getting a direct drink on the fountain
Contact sport because spleen is enlarge
What is tonsillectomy and adenoidectomy?
Post op position, and Goal of positioning?
What indicates hemorrhaging is occuring
How many days client is at risk for hemorrhage ( how many letters in hemorrhage)?
Common complaints Post op?
Low grade temp is?
Bad breath
It is a surgical procedure for children that have recurring upper respi infections or obstructive sleep issues
Goal of positioning is to prevent Aspiration. So client must be in side lying position with HOB elevated or Prone position
Frequent swallowing
Up to 10 days. Because scabs on surgical sites will begin to slough off at 7 to 10 days. Avoid chips or Rough foods
Sore throat and Slight ear pain
Is normal
Bad breath may be caused by foreign substance that caused infection in the nose example ate imsertion of toys and may also be caused by old blood in throat
What is Otitis Media?
Treatment: Give Teach parent, child cant Diet is Avoid Tympanostomy tube
Prevention:
During feeding..
Play Blowing games
Avoid smoke
Infection in middle ear usually preceded by a respi infection. There is Bulging, Bright red tympanic membrane.
Treatment:
Give antibiotics
Child cant hear properly
Diet is soft foods because child must AVOID chewing
Tympanostomy Tube or Pressure Equalizing tube which drains the middle ear and is just temporsry and could fall off anytime, usually after 1 year, and that is okay. Also avoid any water getting inside the ear, use EARPLUGS
Prevention:
During feeding must sit the baby upright and Avoid bottle propping
Blowing games helps keep it clear
Avoid smoke of anykind
What is Cystic Fibrosis?
Treatment:
Pancreatic enzymes
What is the major concern?
Vitamins
S/S
Steatorrhea
What is the earliest sign in newborn?
Diagnosis
It is a genetic disease that BOTH parents have a gene of and passed to the baby. It involves exocrine glands and GI problems also Respiratory system.
Pancreatic enzymes is given to help improve digestion. Given 30 mins before EVERY MEAL and EVERY SNACK. Do not crush or chew on these meds.
Nutrition. Because it involves absorption Problems. Must have a diet of High Fat and High calorie with well balanced meal.
Water miscible ADEK vitamins is given because they cannot properly absorb fat.
Steatorrhea. ( fatty and frothy stools) because they have a poor intestinal absorption Meconium ileus(bowel obstruction). Because they have a thick and sticky secretions everywhere
Sweat chloride test. The baby tastes salty. Baby will become hyponatremic
What is down syndrome?
What type of infection is most common?
What is the most common physical defect?
Primary aim?
Increased risk in?
It is the most common birth defect in US. Aka Trisomy 21
Respiratory infection because they have a poor immune system.
Congenital heart defects
Advanced maternal age
Genetic counseling to inform parents of the risks
What is celiac disease?
Cant have BROW
Can have RCS
Intolerabke to gluten. So must have a gluten free diet. Vegetable protein
Barley,Rye,Oats,Wheat
Rice,Corn,Soy
What is Sickle Cell Anemia?
“AABOHH the APE has a SSICCLE crisis”
S/S: (also fatigue)
Treatment:
Sickle cell crisis
Hereditary form of anemia with sickle shaped RBC
Anorexia (loss of appetite)
Pain in the area involve
Exercise intolerance
Analgesic
Antibiotic if theres any infection
Bed rest
Blood transfusion
Oxygen
Hydration to promote circulation and breakup sickle cells clumped together
Hydroxyurea which is a chemotherapy drug to help reduce painful episodes
"Decreased blood flow➡️low oxygen➡️pain" Significant blood loss Stress Illness Climbing to high altitude Cold Low fluid intake leads to dehydration( must hydrate) Elevated temperature
What is DMD?
“XL35 GoToW”
Specific to
Onset?
Diagnosis
S/S (development is rapid) Spine is Gait is Frequent Classic DMD sign
Treatment: PT Contractures Steroids Support groups
Duchenne’s muscular dystrophy. The most common childhood severe muscular dystrophy.
X linked trait excessive Lordosis Occurs at 3 to 5 yrs old Gowers sign is thr inability to rise from floor and stairs Toe walking Waddling gait
Specfic to MALE children because it is Xlinked recessive trait.
3 to 5 years old
Genetic testing
Spine is curved inward. LORDOSIS
Waddling gait and toe walkig
Frequent falls due to muscle weakness
Gowers sign, hard time rising from floor and climbing stairs
Physical therapy to help in muscle function
Contractures are prevented
Steroids is given to help improve muscle strength and respiratory function
Support groups and palliative care
What are TET spells?
Treatment:
Knee-chest position
Oxygen
Morphine
Monitor
Prevention:
Play
Stress
Crying must be
Tetralogy of Fallot. Where there is Hypercyanotic spells due to less blood going to the lungs which means less blood is being deoxygenated.
Knee chest position promotes blood going to the lungs. There is decreased venous return from lower extremeties and increase in systemic resistance which diverts the blood to the pulmonary artery for oxygenation
Oxygen at 100%
Morphine for sedation
Monitor cardiac output
Play must be quiet
Stress is minimized
Crying must be responded to quickly because infants bear down and increases resistance to lungs
What is UTI?
S/S under 2 years old
S/S greater than 2 years old
Causes:
Treatment Cotton Drinks Wiping Meds
Urinary tract infection. Most common with potential serious infection that usually occurs 2 to 6 yrs old. Usually on females because their urethra is 3/4 inches prematurely and 1 1/2 inches long in maturity
Signs and symptoms under 2 yrs old are non specific. May even seem to be a GI problem.
So it includes, Feeding problems, Vomiting and Diarrhea,failure to thrive
Classic signs and symptoms of UTI: Flank pain Frequency urinating Dysuria Fever Hematuria Foul smelling urine
Renal anomalies Constipation Pin worms Bubble baths Poor hygiene
Antibiotics Wiping front to back Limit carbonated drinks because this decreases acidity in the urine Cotton underwear No bubble baths
What is Hydrocephalus?
S/S Bulging Scalp veins Sunken Setting sun sign High-pitched Irritability
Diagnosis
Surgical treatment: Vp shunt Post op care: Measure Assess for Position Temp
Myelomeningocele(type of spina bifida)
Must protect
Position
Cover with
There is ventricular circulation disturbance which leads to build up of pressure of CSF and causes increased ICP
Bulging fontanels with head enlargement
Scalp veins are dilated
Sunken eyes due to forehead bulging
Setting sun sign is where you can see the white sclera above iris
High pitched cry is seen with baby of increased ICP
Irritability and change in LOC
Measuring the head circumference until 3 years old
Ventriculoperitoneal shunt:
Measure the head circumference pre and post op care
Assess for bulging fontanels and suture lines
Position supine
Check temperature for infection
It is often associated with hydrocephalus.
Must protect the sac and not let it rupture
Prone position
Cover sac with sterile moist dressing so it wont dry out while waiting for surgery
What is scoliosis?
Contributing factors:
HBC
Treatment:
3 O’s
Lateral curvature and rotation of the spine. Can be idiopathic or congenital.
Heavy backpacks
Bags
Carrying children on hips
Observation
Orthosis(supports and braces)
Operation which is usually spinal fusion with rods
What is chicken pox?
Virus to cause this
Primary focus
Home remedies for itching
Is it contagious?
Childhood communicable disease that is rare. The same virus that cause shingles as a person gets older.
Varicella Zoster. Same virus that causes shingles in adults
Prevent infection
Oatmeal bath and baking soda paste. Helps dry them up
Very contagious