TEST 1 Flashcards
1
Q
Growth
A
increase in physical size
2
Q
Development
A
process by which infants and children gain various skills and function
3
Q
Maturation
A
Increase in functionality of various body systems or developmental skills
4
Q
Avg newborn weights?
Which gender is typically heavier?
A
3400kg or 7.5lb
boys typically heavier
5
Q
Infant loses 5-10% of body weight over 1st week of life. Then gains about —g/day and regains birth weight by —days?
A
20-30g/day
7-10days of age
6
Q
infants double their birth weight by
triple their birth weight by
A
double - 4-6 months
triple - 1 year
7
Q
Avg newborn length
A
50cm (20in) at birth
8
Q
By 12 months infants length increased by
A
50%
9
Q
Head circumference of full term newborn is ..
Head circumference increases —cm in first year?
A
35 cm (13.5in)
10cm
10
Q
Object permanence
A
between 4-7 months
if object is hidden, infant knows it still exists
**essential for development of self image
11
Q
Gross motor skills
develop in a —-fashion?
A
large muscles (head control, rolling, sitting, walking)
Develop in cephalocaudal fashion (head to tail)
12
Q
Fine motor skills
developed in a —-fashion?
A
Maturation of hand and finger.
Develop proximodistal fashion (center to periphery)
13
Q
What sense is fully developed at birth?
A
Hearing
14
Q
Are newborns nearsighted or far?
How far can they see?
A
Nearsighted
can view 20-38cm (8-15inches)
perfer human face
15
Q
What is binocularity and when does it develop?
When is full color vision, distance and tracking established
A
Ability to fuse two ocular images into one cerbral picture
Develops at 6 weeks, established by 4 months
Full color vision - 7months
16
Q
Warning signs related to sensory development
A
infant does not respond to loud noises, not making sounds or babble by 4 months, doesnt turn to locate sound by 4 months, crosses eyes most of the time by 6 months
17
Q
Warning signs related to language development
(4)
–By 4 mo
–By 6mo
–By 8 mo
–By 12 mo
A
Does not make sounds by 4 mo
Does not laugh or squeal by 6 mo
Does not babble by 8 mo
Does not use single words with meaning by 12 mo
18
Q
When does a babies first real smile appear?
A
2mo
concerned if no smile by 3 mo
19
Q
When do babies mimic parents facial features?
A
3 to 4 months
20
Q
What are warning signs for social/emotional development
(4)
A
Child does not smile at 3 mo
Child refuses to cuddle
Child does not enjoy people
Child shows no interest in peek a boo at 8 mo
21
Q
Temperament
A
Individuals nature, inborn traits that deteremine how they interact wtih world
22
Q
When does stranger anxiety develop
A
8 months
23
Q
What is transcultural nursing
A
nursing care directed by cultural aspects adn respects the individuals differences
24
Q
Anticipatory guidance
A
educating parents and caregivers about what to expect int he next phase of development
purpose is to give parents tools
25
Solitary play
Does not share with others or directly play with others
26
Breast milk includes
LActose, lipids, polyunsaturated fatty acids, amino acids
Contribute to myelination of nervous system
27
Colostrum
First 2-4 days - thin waterly yellowish fluid that is easy to digest, high in protein and low in sugar and fat.
28
Foremilk
Milk that collects in lactiferous sinuses, which are small tubules serving as reserviours for milk located behind mipples
29
Let-down reflex
Responsible for release of milk from reservoirs.
When baby sucks, oxytocin is released and causes sinuses to contract which allows milk to let down into nipples
30
Why is cows milk bad for infants?
Not adequate balance of nutrients
May overload renal system with too much protein, sodium and minerals
31
Why is tounge extrusion reflex important when does it dissapear?
necessary for sucking to be an automatic reaction when nipple placed in mouth
dissapears at 4-6 months
32
What foods to avoid in infancy?
Honey
Eggs and meats
Excessvie fruit juice
Popcorn, hard foods, grapes
Citrus, strawberries, wheat, cows milk, eggs
33
Colic
resolves by
how long does an avg baby cry?
Inconsolable crying that lasts 3 hours or longer per day for more than 3 weeks and no physical cause
usually resolves bt 4 mo
avg baby 2.2 hours a day
34
States of consciousness
(6)
**Deep sleep:** Eyes closed, no movment
**Light sleep:** Eyes closed, Rapid eye movement, irregular movmeents
**Drowiness**: Eyes closed or half
**Quiet alert state:** eyes open, body calm
**Active alert state:** eyes open, body movements
**Crying**: cries or screams, difficult to gain attention
35
As the neuro system matures and myelination of the spinal cord continues, reflexive behavior is replaced with
and primitive reflexes disappear and what reflexes develop?
Purposeful action
Protective
36
Primitve reflexes are
Which ones are present at birth?
Subcortical and involve whole body response
**Moro**, **root**, **suck**, asymmetric tonic neck, **plantar** and **palmar** grasp, step and **babinski**, **startle reflex**
37
Protective reflexes are
when do these reflexes develop?
gross motor and related to maintenance of equilibrium
**-Righting** - occurs when neck muscles strengthen, allowing to maintain normal position in relation to body
and **parachute reactions** tilted and baby extends arms as if to break a fall
develop around 6 months
38
The lack of what immunoglobulin is mucosal lining contributes to frequent infections?
IgA
39
# PROTECTIVE REFLEX
What is neck righting?
When does it start?
Neck keeps head in upright position when body is tilited
starts at 4-6 months and persists
40
# PROTECTIVE REFLEX
What is Parachute (sideways)
Protective extension with arms when tilted to the side in a supported sitting position
6 monhts - persists
41
# PROTECTIVE REFLEX
Parachute (Forward)
Protective extension with arms when held up in the air and moved forward. Infant reaches forward to catch him/herself
6-7months - persists
42
# PROTECTIVE REFLEX
Parachute (backward)
Protective extension with arms when tilited backward
9-10months - persists
43
The presence of natal or neonatal teeth may be assoc with
other birth anomalies
44
Primary teeth began to emerge at what age
What are first teeth to appear
6-8months
Lower central incisors followed by upper central incisors
45
Amylase (digest complex carbs) and lipase (fat digestion) is deficient and do not reach adult levels until
5 months
46
# DEVELOPMENTAL THEORIES FOR NEWBORN AND INFANT
What is Erikson developmental theory
**Trust VS Mistrust (birth - 1yr)
Caregivers respond to infants basic needs. This creates sense of trust
As nervous system matures infants realize they are separate beings. Infants eventually learn even if gratification may be delayed it will eventually be provided
47
# DEVELOPMENTAL THEORIES FOR NEWBORN AND INFANT
What is Piaget developmental theory
4 substages and ages
**ownership develops 18-24 mo (MINE!)**
Sensorimotor (birth - 2years)
Substage 1: use of reflexes (birth - 1 mo)
Substage 2: Primary circular reactions (1-4mo)
Substage 3: Secondary circular reaction (4-8mo)
Substage 4: COordinate of secondary schemes (8-12mo)
48
# DEVELOPMENTAL THEORIES FOR NEWBORN AND INFANT
Piaget theory
Sensorimotor -
Substage 1
Substage 2
Substage 3
Substage 4
**Sensorimotor** - Uses senses and skills to learn about world
**Substage 1 **- Reflexive sucking bring nutrition, begin to gain control over reflexes and recognize objects, odors, sounds
**Substage 2** - Thumn sucking, Imitiation begins, Object permanance begins, infant shows affect
**Substage 3 **- Repeats actions to get results
**Substage 4** - Coordinate previously learned schemes wtih learned behaviors. Shake rattle, crawl. Anticpiate events, assoc symbols with events (waving goodbye when leaving)
49
# DEVELOPMENTAL THEORIES FOR NEWBORN AND INFANT
Freud developmental theory
Oral stage (birth to 1 year)
Pleasure focused on oral activites. Feeding and sucking
50
Nutritional requirments for newborn
Fluid
Calories
Fluid - 140-160ml.kg.day
Calories
Calories - 105-108kcal/kg/day
51
Nutritional requirments for Infant
Fluid
Calories
Fluid - 100ml.kg.day for first 10kg. 50ML.kg.day for next 10kg
Calories - 1-6mo: 108kcal/kg
6-12 mo: 98kcal/kg
52
Infants grow more quickly in length during what time?
1st 6 months than not as quick during month 6-12
53
Head circumference is an important indicator of ?
brain growth
54
Percentiles
Measurements usually in approx the same growth percentiles over time
55
Ready to feed formulas can be stored in fridge for how long?
48 hours
56
What would you assess about an infants diet before taking any action?
feeding pattern, amount, tolerance
57
From birth to 12 months the mucosal lining in upper respiratory tract lacks immunoglobin ?? which places infant at higher risk for?
IgA
Risk for infection
58
What leads to a higher hemoglobin and hematocrit level in newborns?
maternal blood remaining in newborn after cord is cut
also increases with delayed clamping
59
When are maternal iron stores transferred to baby?
if born premature what is infant at risk of?
transferred 36-40th week
risk for iron deficiency anemia //must be supplemented
60
INfants with low iron appear?
Iron supplement cause stool?
pale, weak, fatiqued, eat less, low weight, freq resp and gi infections
iron supplement cause stool black or dark green
61
When does an infant respond to voices with coos?
4-5mo
62
When does an infant like to play patty cake?
6-8 mo
63
GRoss Motor skills appear in a ------fashion?
Cephalocaudal fashion = head to toe
able to life head before roll over and sit
64
Fine motor skills appear in a ----fashion?
proximodistal fashion - center to periphery
1st bats arm then finger pointing
65
When can infants have meat? honey?
No meat until 10-12 mo
No honey until 12
66
How to soothe a crying baby
swaddle, hold, rock, lower lights, talk softly, sing, check diaper, burp, car rides,
baby swings are not primary ways to soothe
67
What does breast feeding decrease incidences of
diarrheal diseases
asthma
otitis media
bacterial meningitis
botulism
UTI
68
Exceptions to breast feeding
Infant with galactosemia, maternal on drugs, untreated TB, HIV in undeveloped countries
69
# TODDLER DEVELOPMENT
What is the avg weight gain per year in toddlers?
lenght/height?
head circumference?
head more proportional by what age?
weight gain 3-5lbs / year
lenght 3in/year (1/2 adult height by 2)
0.5/yr
head more proportional byt 3 years
70
# TODDLER DEVELOPMENT
Normal vision in a toddler?
20/40 to 20/50 in both eyes and continues to improve
70
# TODDLER DEVELOPMENT
Telegraphic speech
nouns and verbs present. but only the words necessary.
Ex. want cookie
71
# TODDLER DEVELOPMENT
How much play does a toddler need? structured and unstructured?
Structured - 30 mins
unstructured - 1-3hrs
72
# TODDLER DEVELOPMENT
How much sleep does a toddler need?
18 mo
24 mo
3 yr
18 mo: 13.5hrs
24 mo: 13 hr
3 yr: 12hrs
73
# TODDLER DEVELOPMENT
Food jag?
only one food for several weeks, then not again for a long time
74
# TODDLER DEVELOPMENT
When can time out be used effectively?
2.5-3years old
75
# TODDLER DEVELOPMENT
Self soothing is a function of
autonomy
76
# TODDLER DEVELOPMENT
Empathy develops at what age
3
77
# TODDLER DEVELOPMENT
Receptive language
ability to understand what is being said
78
# TODDLER DEVELOPMENT
Maternal depression gives babies a risk for poor____development
cognitative
79
Car seat is forward facing in backseat until what weight?
40;bs
80
# TODDLER DEVELOPMENT
Magical thinking
Thoughts are all powerful
81
# TODDLER DEVELOPMENT
Transduction
Extrapolates from one situation to another even if events are unrelated
Ex. a package was delivered when its raining so when it rains again toddler thinks a package will be delivered
82
# TODDLER DEVELOPMENT
Animism
attributes life-like qualities from inanimate objects
83
# TODDLER DEVELOPMENT
What are some social skills developed by a toddler
Cooperation
Sharing
kindness
generousity
affection display
conversation
Expression of feelings
Helping others
Making friends
84
# TODDLER DEVELOPMENT
Overweight for a toddler
Obesity
BMI at or above 85th percentile or below 95Th percentile for age/sex
obesity - BMI greater than 95th percentile
85
IgM levels reach adult level by
IgG levels reach adult by
IgM - 9 mo
IgG - 12mo
86
# SCHOOL-AGED CHILDREN
How does gross motor develop in school age children
Improved coordiantion, ba;ance adn rythym
-Riding bikes, skateboards, scooter, sports
-May be awkward as bodies grow faster than can accomadate
87
# SCHOOL-AGED CHILDREN
How does fine motor develop in school aged children?
Improved hand usage, hand eye coordiantion, can draw with detail, play instrument, help wtoih cooking/chores, build a model
88
# SCHOOL-AGED CHILDREN
What are signs of vision problems in school aged children?
Eye rubbing, squinting, avoiding reading, freq headaches, holding books close, problems with depth perception or hand eye coordination
89
# SCHOOL AGED CHILDREN
**Amblyopia**
Define
Causes
Lazy eye
One eye can focus better than the other
**Causes:** near or far in one eye, astigmatism in one eye, strabismus ( malalignment of eye muscles), cataracts
90
# SCHOOL AGED CHILDREN
ASTIGMATISM
Mismatched curves in the eye involving the cornea or lens causing blurry or distorted vision
91
# SCHOOL AGED CHILDREN
What is the normal vocabulary of a school aged child?
8000-14000 words
Understands metaphors (bad apple, night owl)
Metalinguistic - able to evaluate language (noun, verb)
92
# SCHOOL AGED CHILDREN
Limit screen and video games to how many hours / day
2 hours
93
# SCHOOL AGED CHILDREN
How much sleep in required in school aged children
6-8years
8-10years
10-12years
when do night terrors and sleep walking resolve?
6-8 = 12 hours
8-10 = 10-12 hours
10-12 = 9-10 hours
night terrors resolve by 8-10 years old
94
# ADOLESCENCE
Males and females have what 3 hormones?
Estrogen, progesterone, testosterone
95
# ADOLESCENCE
Phyiscal changes that happen in adolescence
Voice deepens
Limbs elongate disproportionately
GRowth plates at end of long bones begin to close
Apocrine glands secrete in axilla and genital areas
Skin changes (acne)
Increase in body hair
Hips widen in females, shoulders widen in males
96
# ADOLESCENCE
How to encourage communications with teens
Encourage to express fears and emotions
allow to open up
talk face to face, be aware of bdoy language
praise, admit mistakes, state expecations, set fair lmiits, set clear rules
97
# DIVERSE SETTINGS
Reason for majority of hospitalization in children younger than 5?
Respiratory distress
98
# DIVERSE SETTINGS
Reason for majority of hospitalization in older children ?
Respiratory, mental health, injuries, GI
99
# DIVERSE SETTINGS
Reason for majority of hospitalization in adolescents?
Problem related to pregnancy, childbearing, mental health, injury, suicide attempts, drug use/OD
100
# DIVERSE SETTINGS
What are the 3 stages of separation anxiety?
**Protest** - OCCURS WHEN INITIALLY SEPARATED/ CAN LAST HOURS-DAYS - crying, agitation, rejection of others, inconsolable grief
**Despair** - OCCURS WHEN PARENTS DO NOT RETURN W/IN a SHORT TIME- withdrawn, quiet w/o crying, apathy, depression, lack of interest, sadness
**Detachment** - DENIAL/WHEN LONG TERM SEPARATION - uses coping mech, may have developmental delays, may form superficial relationships
101
# DIVERSE SETTINGS
Separation anxiety occurs when what is developed?
Age?
object permenance
4-8 months
102
# DIVERSE SETTINGS
What are the 4 phases of nursing care for hospitalized children?
**Introduction**: establish rapport and trust
**Building a trusting relationship:** use approp language, games, play, explaination, encouragement, down to childs level
**Decision-making phase:** Give some control to child by allowing some decisions, *critical for manifesting trust
***Providing comfort and reassurance** praise, opportunities to cuddle with toy,
103
# DIVERSE SETTINGS
7 rules for child restraints
1. least restrictive
2. fit properly
3. Check (cap refill, pulses, temp) q 15 min then q hourly
4. Must remove q 2hrs for ROM and repositioning
5. Must document q 1 hr and removeal q 2
6. Written order within 1 hour of application
7. Face to face eval by provider within 1 hour of application
104
# DIVERSE SETTINGS
What are the right of medications
Right medication / checking expiration date
Right patient
Right time - give within 20-30 mins of time
Right route of administration
Right dose - check safe range
Right approach
Right documentation
105
# DIVERSE SETTINGS
Why is it important to be careful when giving meds that are excreted through kidneys for children under 2?
Immaturity of these organs
106
# DIVERSE SETTINGS
Factors affecting absorption of medications in child vs adult
ORAL MEDS
Slower GI emptying
Increased intestinal motility
Larger small intestine surface area
higher gastric pH
decreased lipase and amalyase compared to adults
***absorbs within 30-1 hour**
107
# DIVERSE SETTINGS
Factors affecting absorption of medications in child vs adult
IM MEDS
Decreased due to smaller muscle mass, muscle tone
Tissue perfusion and vasomotor instability
***absorbs within 15 mins**
108
# DIVERSE SETTINGS
Factors affecting absorption of medications in child vs adult
SUBQ MEDS
Any decreased perfusion = decreased absorption
***absorbs within10-15 mins**
109
# DIVERSE SETTINGS
Factors affecting absorption of medications in child vs adult
TOPICAL MEDS
Increased due to greater body surface area and greater permeability of infants skin
110
# DIVERSE SETTINGS
How to give PO meds in children under 6
**RISK FOR ASPIRATION**
Ask pharmacist if pill can be crushed/opened
Put in applesauce or juice
Do not put in essential foods / formula
Ask for different form of med
111
# DIVERSE SETTINGS
Guidelines for giving meds via Gastrostomy or Jejunostomy tubes
-Verify placement of tube (check pH of contents)
**if 5. or less = ok to give meds if more than 5.0 dont give med/consult provider**
-Give liquid meds directly via syringe w/ small amount of air
-Mix powder with warm water, crush pills finely
-open capsules and mix with water
-Flush tube with water after given meds
112
# DIVERSE SETTINGS
How to give ophthalmic meds?
Keep eyes closed until ready
open eyes and look up
press down gently on lower lid
place drops in lower sac
apple** punctal occulsion (pressure in lower eye close to nose)**
113
# DIVERSE SETTINGS
How to give optic meds?
If under 3 - pull pinna down and back
if 4 years+ - pull pinna up and back
114
# DIVERSE SETTINGS
How to give Nasal meds?
Child lay down, head hyperextended
after drops, child lay still for 1 min
Infants are nose breathers so 1 nostril at a time
115
# DIVERSE SETTINGS
Where to give IM meds in infants and young children
give in middle 3rd of thigh
VASTUS LATERALIS
116
# DIVERSE SETTINGS
Difference between SUBQ and ID admin and meds
SUBQ - Med into fatty layers / used for insulin, heparin and certain immunizations
ID - Deposits just under epidermis / used for TB screening and allergy screening
117
# DIVERSE SETTINGS
Why are children more susceptible to med errors?
Varying heights
lack of organ immaturity
body surface area
118
# DIVERSE SETTINGS
IV THERAPY
--What size needle?
-Larger the number----size of needle?
For infants, always use what size needle?
- Always use smallest needle for shortest amount of time
- - -Larger the number = smaller the needle
- Infants 24 or 26 guage IV catheter (blood transfusion might need to be bigger)
119
# DIVERSE SETTINGS
Do not start an IV where on a child without an order?
above elbows or knee
Do not start an IV on same extremeity as central line
*Attempt your iV at most distal part and work up
120
# DIVERSE SETTINGS
NUTRITIONAL SUPPORT
ENTERAL
OG/NG/NJ/ND/GT/JT
**For children who can tolerate feeding but cannot eat normally (coma, oral aversion,s evere reflux)**
OG - Orogastric / mouth to stomach
NG - Nasogastric / nasal to stomach
NJ - Nasojejunal / nasal to jejunum
ND - Nasoduodenal / nasal to duodenal
Gt - Gastrostomy / surgical opening
JT - Jejunostomy / surgical opening
121
# DIVERSE SETTINGS
NUTRITIONAL SUPPORT
PARENTERAL
Nutrition given through IV or TPN through central line
For chidlren who cannot tolerate food through GI tract (Nonfunctioning GI, postop, NEC, short gut)
122
# DIVERSE SETTINGS
**Nursing care of a child with enteral tube**
Confirming placement
Signs of misplacement
Placement confirmed
-Check color/pH of aspirate
*-pH 5 or less = OK to feed, 5 or greater hold feeding and notify*
-Check external marking of tube and verify length
**-Always HOB up 30 degrees when feeding**
**Signs of misplacement**
-Unexplained gagging, vomitting, coughing, signs of respiratory distress
123
# DIVERSE SETTINGS
Bolus feed
Continuous feeds
**Bolus** - over 30 min q 3- hours. allows child to be up and not tied down
**Continuous** - Continuous over a feeding pump / tied to pump can interfere with developmental
124
# DIVERSE SETTINGS
Complications with TPN
-Infused through central line which requires heparin for patency. TPN contains heparin and dextrose = can cause hyper/hypoglycemia = **check blood lgucose levels**
-Cannot change rate w/o order
-Strict aseptic techniques
-Closed system. Do not leave ports/caps open. Can cause infection (CLABSI)
-Closely monitor I&O
125
# DIVERSE SETTINGS
TPN - Daily fluid requirements
1st kg = 1000ml
2nd kg = 500ml
remaining kg = 20ml/kg
126
# PAIN MGMT in CHILDREN
When a childs pain is not managed what physical and emotional consequences can develop?
**Physical** - can delay healing/ can lead to increased oxyegen needs and alter blood glucose
**Emotional** - fear, anxiety and increased healing time
127
# PAIN MGMT in CHILDREN
Transduction
**Process of nociceptor activation**
-Nerve fibers extend from spinal cord to peripheral. At end of these fibers are nociceptors.
-Nociceptors become activated when exposed to harmful stimuli (chemical, mechanical, theramal)
128
# PAIN MGMT in CHILDREN
Transmission - define
-Large myelinated A-delta fibers
-Small unmyelinated C-fibers
**Neurotransmitters pass pain to the brain through electrical impulses**
**Large myelinated A-delta fibers** - transmit pain quickly causing reflex response to withdrawl from stimulus (mostly mechanical or thermal)
**Small unmyelinated C-fibers** - transmit pain slowly (chemical)
129
# PAIN MGMT in CHILDREN
Perception
Thalamus quickly sends pain signals to:
**cerebral cortex **(interpreted as sharp, dull, stabbing, burning)
**limbic system** (interpreted emotionally and memory occurs)
**Brain stem** (autonomic nervous system - BP,HR,RR, digestion)
130
# PAIN MGMT in CHILDREN
Modulation - define
Naturally occuring example??
Process by which body alters pain signal as it is transmitted along pain pathway (why individual response to pain is different)
Analgesics and anesthetics interrupt pain perception
Serotonin, endorphines, enkephalins, dynorphins
131
# PAIN MGMT in CHILDREN
A-delta fibers lead to pain feeling like
C fibers lead to pain feeling like
A-delta - sharp, stabbing, local pain
Cfibers - dull, diffuse, burning, aching
132
# PAIN MGMT in CHILDREN
Classifications of pain
Duration
Etiology
Source/location
**Duration** -
Acute- Rapid onset, resolves with healing, protective function
Chronic - Continues past point of healing, no protective function
**Etiology** -
Nociceptive - damage to body tissues, usually external
Neuropathic - nerve pain
**Source/location - **
Somatic - superficial or deep that develops in tissues
Visceral - develops in organs by disease / poorly localized may be referred
133
# PAIN MGMT in CHILDREN
Pain assessment using QUEST
**Question** the child
**Use** a reliable and vali dpain scale
**Evaluate** behavior/physiologic changes to esta baseline and determine effectivness
**Secure** patients involvment
**Take** cause of pain into account
**Take** action
134
# PAIN MGMT in CHILDREN
Reaction to pain
Toddler
preschool
School age
Adolescent
**Toddler** - may react to painless procedures as they do to painful ones
**preschool** - think pain is punishment
**School age** - appear brave to avoid more pain or embarassment
**Adolescent**- moody, fear of losing control
135
# PAIN MGMT in CHILDREN
-What are nonpharmacological pain mgmt -
behavioral -cognitive stratgies
Thought stopping
Imagary
Humor
Relaxation
Distraction
136
# PAIN MGMT in CHILDREN
-What are nonpharmacological pain mgmt -
biophysical stratgie
non-nutritive sucking/sucros
breastfeeding
massage
heat - increases blood flow, decrease nociceptor & swelling
cold - vasoconstrict, decrease edema, histamines and transmission of painful stimuli
137
# PAIN MGMT in CHILDREN
nonopioid analgesics
opioid analgesics
-acetaminophen and NSAIDS (do not use ASPIRIN for REYES SYNDROME)
-Morphine, fetanyl, dilaudid
138
# PAIN MGMT in CHILDREN
Adjuvant
Anesthetics
**Adjuvant**: benzo's, anticonvulsant, antidepressant
**Anesthetics**: Local, EMLA cream (painful procedure), TAC (lacerations required suturing), vapocoolant spray
139
Incubation
Time from entrance of pathogen to first symptom
140
Prodrome
Time from appearance of nonspecific symptoms (fatique, malase) to more specific symptoms
141
Illness
Signs and symptoms of disease are clearly evident
142
Convalescence
Acute symptoms begin to disappear
143
What is the chain of infection
Infectious agent -
Reservoir -
Portal of exit -
Mode of transmission -
Portal of entry -
Susceptible host -
**Infectious agent **- agent capable of causing infection
**Reservoir **- place where pathogen can grow
**Portal of exit** - mucous membranes, skin resp tract, Gi, GU)
**Mode of transmission** - way it travels
**Portal of entry **- mucous membranes, skin resp tract, Gi, GU)
**Susceptible host **- any person who cannot fight
144
Limiting spread of infection
Tier 1
Tier 2
**Teir 1** - Standard precautions (applies to everyone)
all body fluids except sweat / hand hygeine, gloves, ppe
**Tier 2 **- Designed for ppl with known pathogens
Airborne - Measels, rubella, TB / negative pressure, mask, door closed, N95
Droplet - flu. group a strep, mumps, rubella, pertussis, / wear mask w/in 3 ft,
Contact - diptheria, lice, scabies, MRSA / gown, glove, mask
145
CBC elevated WBCs detect= inflammation and infection
Sed-rate indicator of =
CRP indicator of acute =
CBC elevated WBCs detect= inflammation and infection
Sed-rate indicator of chronic inflammation/infection
CRP indicator of acute inflammation/infection; rises with bacterial infection
146
What is considered a fever?
Oral greater than
Temporal/tympanic greater than
Axillary greater than
Oral greater than 37.8C (100F)
Temporal/tympanic greater than 38C (100.4F)
Axillary greater than 37.2F (99F)
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What is a sign of sepsis in a neonate?
hypothermia
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If infant <3 months has fever (>38C rectal),...
Infants >3 months, fever less than 38.9C (102F) ...
if petechiae is present =
If infant <3 months has fever (>38C rectal), possible sepsis, should be seen by HCP
Infants >3 months, fever less than 38.9C (102F) usually does not require treatment by
physician.
f petechiae is present =
Neisseria meningitidis
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CAMRSA=
Scarlet fever=
Diphtheria =
Pertussis (whooping cough) =
Tetanus=
Botulism=
Osteomyelitis=
Septic arthritis=
**CAMRSA**- skin/ tissue infections bump or skin is red, swollen, painful, and warm to the touch.
**Scarlet fever** - group A strep, children 5-15 years old, rash on face and strawberry tongue, usually occurs with strep throat
**Diphtheria** - edematous neck, infected tonsils, pseudomembrane forms
over the pharynx, uvula, tonsils, soft palate
**Pertussis** (whooping cough) - paroxysmal coughing
**Tetanus** - acute, often fatal neuro disease
**Botulism**- ingestion of spores from dust, improperly preserved home-canned foods,feeding raw honey to infant under 1 year old. S/S = poor feeding, listless, weak cry, poor
gag reflex (distinguishing symptom). *Asking about honey takes priority over other information*
**Osteomyelitis**- bacterial infection of the bones
**Septic arthritis **- bacterial infection in the joint space
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Viral exanthems=
Rubella =
Rubeola (measles) =
Varicella (chickenpox) =
Parvovirus B19 (fifth disease) =
Mumps =
**Viral exanthems**= skin rash
**Rubella** = rash begins on face and spreads head-to-toe
**Rubeola (measles)** = Koplik spots
**Varicella (chickenpox**) = clear fluid-filled vesicles that scab and crust, incubation period
of 10-21 days
**Parvovirus B19 (fifth disease) **= begins with slapped cheek flushing
**Mumps** = swelling in the neck bilaterally or unilaterall
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Rabies =
Cat scratch fever =
Lyme disease=
West Nile =
**Rabies** = s/s are confusion, anxiety, and hypersalivation, zoonotic
**Cat scratch fever**= lymph nodes, esp under the arms, become swollen and painful
**Lyme disease** = a ring-like rash at site of tick bite
**West Nile **= vector-borne from mosquito bit
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Pediculosis capitis (head lice) =
Scabies=
Pinworms=
Hookworm=
**Pediculosis capitis (head lice)=** not an indication of poor hygiene/poverty; pediculicide to treat head lice, pubic lice and scabies.
= extreme itching, behind ears/ nape of neck.
**Scabies**= specialized pediculicide cream must be worn for specified timeframe
**Pinworms** = good hand hygiene
**Hookworm** = prevent by having child wear shoes at all time
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Albendazole and pyrantel pamoate drugs to treat=
Erythromycin used to treat
Acyclovir used to treat
Metronidazole used to treat
Permethrin used to treat
Azithromycin used to treat
Albendazole and pyrantel pamoate drugs to treat **helminthic infections**
Erythromycin used to treat **bacterial infections**
Acyclovir used to treat **viral infections**
Metronidazole used to treat **trichomoniasis**
Permethrin used to treat **pediculosis**
Azithromycin used to treat **pertussis** in infants older than 1 month
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