Test 2 (Mod 3 and 4) Flashcards
Four Heart Valves are
Tricuspid, Pulmonic, Mitral, Aortic
Tricuspid Valve links
Right atrium to right ventricle
Pulmonic Valve links
Right ventricle to pulmonary artery
Mitral Valve links
Left atrium to left ventricle
Aortic Valve links
Left ventricle to aorta
Umbilical Vein carries oxygenated blood from
Placenta to infant
In fetal circulation, blood bypasses the liver through the
Ductus Venosus
In fetal circulation, oxygenated blood flows from right to left atria through the
Foramen Ovale
Closes after birth with change in pressure in cardiac chambers
Foramen Ovale
Causes fetal circulation blood to bypass the lungs, which are nonfunctional at this time
Foramen Ovale
A fistula between aorta and pulmonary artery that allows for mixing of blood
Ductus Arteriosus
Closes after birth, sometimes with first few breaths but may take up to three days
Ductus Arteriosus
Bound to hemoglobin on red blood cells
Oxygen
Facilitate Oxygen
Hematocrit and hemoglobin
Heart rate is sensitive to
Oxygen level
Cardiac output is dependent on ________ until child is 5 years old
Heart rate
A child has an increased risk of heart failure because of
Immature heart that is sensitive to volume or pressure overload, and muscle fibers that are less developed
Reveals size and contour of heart
X-ray
Visualizes characteristics of pulmonary vascular markings
X-ray
Identifies heart structure
Ultrasound (Echocardiography)
Identifies pattern of movement, hemodynamics
Ultrasound (Echocardiography)
Records quality of major electrical activity of heart
Electrocardiogram (ECG)
Identifies dysrhythmias
Electrocardiogram (ECG)
Encourage increased fluid intake to maintain hydration to offset diuretic effect of contrast dye after
Cardiac Catheterization
Heart conditions that do not cause deoxygenation or low oxygen levels; skin and mucous membrane color is usually normal pink
Acyanotic heart defects
Atrial Septal Defect is a defect between
Atria
Septal wall defect allowing blood to flow from left atrium to right atrium, called left to right shunt
Atrial Septal Defect
Often asymptomatic if small defect, dyspnea, fatigue, poor growth, soft systolic murmur, and CHF are all assessment findings of
Atrial Septal Defect
Defect between Ventricles
Ventricular Septal Defect (VSD)
Septal wall incomplete allowing blood to flow from left ventricle to right ventricle (left to right shunt)
Ventricular Septal Defect
Tachypnea, dyspnea, poor growth, reduced fluid intake, palpable thrill, systolic murmur at lower sternal border, large septal defects detected on ECG and radiology, and signs of CHF are all assessment findings of
Ventricular Septal Defect
Teach the need for antibiotic prophylaxis to prevent subacute bacterial endocarditis with
Ventricular Septal Defect
Narrowing of descending aorta and restriction of blood flow leaving the heart are signs of
Coarctation of Aorta
Narrowing or constriction of descending aorta, often near ductus arteriosus. Progressive disorder that leads to CHF.
Coarctation of Aorta
Assessment of ________ may be asymptomatic, have blood pressure difference of 20mm between upper and lower extremities, with upper extremity pressure higher, have brachial and radial pulses full, and femoral pulses weak, have headache, vertigo, and epistaxis, have exercise intolerance, left ventricular hypertrophy, and dyspnea, and can have CVA secondary to hypertension in upper circulation
Coarctation of Aorta
Therapeutic Management for Coarctation of Aorta
- Balloon cardiac catheterization with insertion of endovascular stents. 2. Surgical resection and patch of coarctation. 3. Possible prophylaxis for endocarditis when undergoing surgical or dental procedures. 4. Prior to correction, monitor BP in upper and lower extremities. 5. Rebound hypertension occurs in immediate postoperative period.
Heart conditions that cause blood to contain less oxygen than required; skin and mucous membrane color is usually pale to blue
Cyanotic heart defects
Four defects that combine to allow blood flow to bypass lungs and enter left side of heart, called a right to left shunt
Tetralogy of Fallot
This heart defect leads to unoxygenated blood to enter the body circulation accounting for cyanosis
Tetralogy of Fallot
Four defects: pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and overriding aorta, all make up _________
Tetralogy of Fallot
Deficient oxygen in the tissues leads to
acidosis
Hypercyanosis (TET) spells are
transient periods when there is an increase in right to left shunting of blood
TET spells are characterized by:
Hypoxia, pallor, and tachypnea, which may be precipitated by crying, defecation, and feeding; older children will assume squatting position to decrease blood return from the lower extremities.
Treatment for TET spell
place child in knee-chest position, administer morphine or propranolol and O2
Signs of Tetralogy of Fallot
Clubbing of digits, polycythemia, poor growth, exercise intolerance, systolic murmur in pulmonic area, right ventricular hypertrophy, and TET spells
Prostaglandin E1 is given in order to maintain open ductus arteriosus in treatment of
Tetralogy of Fallot
Aorta arises from right ventricle, and pulmonary artery arises from left ventricle
Transposition of the great vessels
Anomolies exist that increase mixing of blood between two separate circulations; these anomalies promote oxygenation. Right to left shunting occurs.
Transposition of the great vessels
Progressive cyanosis to hypoxia to acidosis. Signs and symptoms of CHF. Tachypnea. Poor feeding. Failure to grow. Echocardiogram identifies misplacement of arteries.
Assessment findings for Transposition of the great vessels
Abnormally small left ventricle noted at birth
Hypoplastic left heart syndrome
Inability of heart to supply oxygen needs of body is a description of
Hypoplastic Left Heart Syndrome
Absent or stenotic mitral and aortic valves, abnormally small left ventricle and aortic arch, major resistance to aortic flow, hypertrophy of right ventricle, with a poor prognosis, all describe
Hypoplastic Left Heart Syndrome
Tachypnea, chest retractions, dyspnea, cyanosis, decreases pulses, poor peripheral perfusion, increases right ventricular implies, echocardiogram indicating small and weak left ventricle, and CHF, are all signs of
Hypoplastic Left Heart Syndrome
Prostaglandin E1 given to prevent closure of patent ductus arteriosus, palliative surgery, transplant, are all interventions for
Hypoplastic left heart syndrome
Survival rate currently at or above 50% for
Hypoplastic Left Heart Syndrome
Systemic inflammatory disease that involves heart and joints; CNS and connective tissue involvement may also occur
Rheumatic Fever
Occurs secondary to infection by group A beta-hemolytic streptococcus; most common in children age 5 years to adolescence
Rheumatic Fever
Follows one to three weeks after a group A beta-hemolytic streptococcal infection
Rheumatic Fever
Must have presence of two major or one major and two minor criteria to diagnose __________using Jones Criteria
Rheumatic Fever
A new murmur, pericardial fruition rub, changes on the ECG; tachycardia may be noted by nurse as a pulse greater than 100 while sleeping, are all symptoms of
Carditis
Involves involuntary movement of limbs; emotional lability and slurred speech may occur; this symptom tends to have a latent period of two months or more from strep infection
Chorea (CNS symptom of Rheumatic Fever)
An erythematous, macular rash that occurs primarily on trunk and proximal limbs; frequently associated with carditis
Erythema Marginatum
non-tender nodules that develop on skin over flexor surfaces of joints and vertebrae
Subcutaneous Nodules
Planning and Interventions for Rheumatic Fever
- Bedrest until ESR returns to normal 2. Use ASA and prednisone as ordered anti-inflammatory agents to reduce inflammation; aspirin will also promote comfort from painful joints. 3. Give PCN as ordered in either an oral daily dose or monthly long-acting injection after recovery from rheumatic heart disease to reduce risk of recurrence of strep infection; erythromycin given if allergic to PCN. 4. Design nursing activities to promote rest and to encourage diversional activities which do not stress heart; maintain bed rest with bathroom privileges.
A multisystem disorder involving vasculitis, also called mucocutaneous lymph node syndrome. Leading cause of acquired heart disease in children
Kawasaki’s Disease
Inflammation of tunica intima or inner lining of arteries and veins
Vasculitis
Acute, systems inflammatory illness involving arteries, unknown cause but generally affects young children; most frequently affected are boys under 5 years of age
Kawasaki’s Disease
Three phases of Kawasaki’s Disease
Acute, subacute, and convalescent
Characterized by fever, conjunctival hyperemia, swollen hands and feet, rash, and enlarged cervical lymph nodes
Acute phase of Kawasaki’s disease
characterized by cracking lips, desquamation of skin on tips of fingers and toes, cardiac disease, and thrombocytosis
Subacute phase of Kawasaki’s disease
Has lingering signs of inflammation
Convalescent phase of Kawasaki’s disease
Fever lasting longer than five days that is unresponsive to antipyretics, conjunctivitis, crusted and fissured lips, swelling of hands and feet, erythema, lymphadenopathy, are all signs of
Stage one Kawasaki’s. (one to two weeks)
Fever diminishes, irritability, anorexia, desquamation of hands and feet, arthritis and arthralgia, cardiovascular manifestations
Subacute stage of Kawasaki’s (two to four weeks)
Drop in ESR and diminishing signs of illness
Convalescent stage of Kawasaki’s (six to eight weeks)
A condition that causes swollen glands and can be caused by infection or cancer
Lymphadenopathy
Treatment for Kawasaki’s Disease
Administer 80 to 100 mg/kg/day ASA as anti platelet agent. Wean child over time to decrease risk of bleeding. Administer gamma globulin (IVIG) once as ordered to reduce risk of coronary artery lesions and aneurysms; may be repeated if fever does not decrease
Nursing management of Kawasaki’s Disease
Promote comfort, small frequent feedings, passive range of motion to extremities, cool baths, gentle oral care, encourage fluids, monitor for complications such as aneurysms, side effects of aspirin therapy: bleeding, GI upset, side effects of IVIG therapy: elevated blood pressure, facial flushing, tightness in chest, monitor temperature, and monitor eyes for conjunctivitis.
noted when clients head is flexed while in the supine position, resulting in involuntary flexion of knees or hips; a positive result is a common sign in meningitis.
Brudzinski’s Sign
level of consciousness in which client cannot be aroused even with painful stimuli
Coma
a late sign of increased intracranial pressure characterized by widening pulse pressure (rising systolic blood pressure with a stable diastolic pressure), bradycardia, and irregular respirations
Cushing’s Triad
bleeding between the dura and the cranium
Epidural Hematoma
force exerted by brain tissue, cerebrospinal fluid, and blood within cranial vault; normal is 4 to 12 mm Hg and is dependent on age in childhood
Intracranial Pressure (ICP)
demonstrated when client’s leg is raised with knee flexed and any resistance or pain is felt; it is a common finding that indicates meningeal irritation in meningitis
Kernig’s Sign
a measure of degree of responsiveness of mind to sensory stimuli; lower levels indicate decreased neurologic functioning; levels can be categorized (in order of decreasing level of function) as confusion, delirium, obtunded, stupor, and coma
Level of Consciousness (LOC)
fibrous membrane that covers brain and lines vertebral canal; consists of three layers: dura, arachnoid, and pia matter
Meninges
a sheath made of a fatty substance that covers axon process of neuron or nerve fibers and increases speed and accuracy of nerve impulses; accounts for gradual development of fine and gross motor skills during early childhood
Myelin
refers to a lack of innervation to an organ
Neurogenic
stiffness of neck or resistance to neck flexion, often seen in infections of central nervous system
Nuchal Rigidity
Client positions self with hyperextension of head and neck; this is seen in meningitis and felt to relieve some discomfort from meningeal irritation
Opisthotonus
Sensitivity to light, seen in some clients with migraine headaches or viral infections such as measles, meningitis, and encephalitis
Photophobia
difference in systolic and diastolic blood pressure
Pulse Pressure
bleeding between dura and cerebrum
Subdural Hematoma
tenseness of muscles, uncoordinated, stiff movements; can be seen as scissoring or crossing of legs; exaggerated reflex reactions
Spasticity
term frequently used to describe characteristics of certain seizures, involving continuous muscle contractions, and alternating contraction and relaxation of muscles
Tonic Clonic
Brain and spinal cord develop during
First trimester
Not mature at birth, but as numbers of glial cells and dendrites increase, refinement continues until about 4 years of age
Nervous system
Posturing seen with severe dysfunction of cerebral cortex; it includes adduction of arms at shoulders, arms flexed at chest, wrists flexed, hands fisted, and lower extremities flexed
Decorticate Posturing
Posturing seen with dysfunction at level of midbrain; it includes rigid extension and pronation of arms and legs
Decerebrate Posturing
Corneal, pupillary, muscle-stretch, superficial, and plantar reflexes are all absent in
Deep Coma
A nonprogressive motor disorder of central nervous system (CNS) resulting in alteration in movement and posture
Cerebral Palsy (CP)
Classified as spastic, athetoid, or mixed
Cerebral Palsy
Causes of ________ may include trauma, hemorrhage, anoxia, or infection before, during, or after birth
Cerebral Palsy
One-third of children with this disease will also have some degree of mental retardation, while the other two thirds do not
Cerebral Palsy
Many clients with this disease may require increased caloric intake because of spasticity or increased motor functioning
Cerebral Palsy
Use of adaptive feeding devices and positioning during feedings to decrease risk of aspiration, and the use of a gastrostomy tube may be needed for
Cerebral Palsy
Develop during the first trimester of fetal development; defects can occur at any place along spinal canal
Neural tube defects
Unknown etiology, but may be associated with maternal dietary folic acid deficiency; incidence has decreased with emphasis on folic acid supplementation during pregnancy; the degree of disability is determined by location of defect and amount of spinal nerves encased in sac; the higher the defect, the greater the neurologic dysfunction
Neural Tube Defects
Neural Tube Defects are also known as
Spina Bifida, or Myelodysplasia
Posterior vertebral arches fail to fuse, but there is not herniation of spinal cord or meninges; no loss of function
Spina bifida occulta
Posterior vertebral arches fail to fuse, and there is a saclike protrusion at some point along posterior vertebrae; sac contains meninges and CSF but not spinal cord
Meningocele
Posterior vertebral arches fail to fuse; saclike herniation contains meninges, CSF, as well as a portion of spinal cord or nerve roots; sometimes leakage of CSF occurs
Myelomeningocele
brain and meninges herniate through defect in skull into a sac
Encephalocele
Elevated levels of alpha-fetoprotein (AFP) in maternal serum and fluid obtained by amniocentesis, as well as ultrasound, all lead to
prenatal diagnosis of open spinal defects
Frequent, clean straight catheterization is the preferred method of management for
Neurogenic bladder
High fiber diet, adequate fluid intake, and pattern of evacuation of bowels, some cases of laxative and enema use, are all means of managing
Neurogenic bowel
A condition characterized by imbalance between CSF production and absorption resulting in enlarged ventricles and an increase in ICP; if untreated, this condition can cause permanent brain damage
Hydrocephalus
Congenital causes of this disease include Arnold Chiari malformation associated with myelomeningocele, and can be acquired from meningitis, trauma, or intraventricular hemorrhage in premature infants. Etiology is idiopathic (cause unknown) in up to 50% of cases
Hydrocephalus
Increased head circumference, split cranial sutures, high-pitched cry, bulging fontanel, irritability when awake and seizures, are all assessment findings of
Hydrocephalus
Toddlers and older children suffering from _______, may also present with setting-sun eyes, seizures, irritability, papilledema, decreased LOC, and changes in vital signs (increased BP and widening pulse pressure).
Hydrocephalus
All children with this disease can present with vomiting, lethargy, and Cheyne-Stokes respiratory pattern
Hydrocephalus
Surgical insertion of a tube or “shunt” into ventricles with other end in either the peritoneum or atrium; the most common version is ventriculoperitoneal; preoperatively position client flat and on unoperative side; if held it is important not to allow head to be elevated.
Treatment for Hydrocephalus
Alterations in firing of neurons in brain (cortical neuronal discharge); the result of this discharge depends on where in brain discharge begins and how it spreads
Seizures
Seizure that begins locally in one hemisphere of the brain
Partial Seizure
Seizure that begins in both hemispheres of the brain
Generalized Seizures
Tegretol is commonly used in children for
Seizures
Premature closure of cranial sutures in young children; there is some relationship between this and several inherited syndromes
Craniosynostosis
Premature closure of skull may lead to
increased ICP with subsequent brain damage
Fluid restriction may be prescribed in postop period; head of bed may be ordered to elevation at 30-degree angle to assist in decreasing facial swelling with this disease
Craniosynostosis
Inflammation of meninges; is most common infection of CNS; two primary classifications include viral or aseptic and bacterial
Meningitis
Clinical manifestations of this process in infants and toddlers are irritability, vomiting, and change in appetite
Viral Meningitis
Clinical manifestations for an older child with this process are usually preceded by a nonspecific febrile illness; client presents with headache, malaise, muscle aches, n/v, photophobia, and nuchal/spinal rigidity
Viral Meningitis
Clinical manifestations of this process in infants and toddlers include poor feeding/suck, vomiting, high-pitched cry, bulging fontanel, fever or hypothermia depending on maturity of infant’s neurological system, and poor muscle tone and nuchal rigidity
Bacterial Meningitis
Stiffness of the neck
Nuchal Rigidity
Hyperextension of head and neck
Opisthotonus
Positive Kernig or Brudzinski’s sign indicates
Meningeal irritation
ND for Meningitis
Risk for ineffective breathing pattern, pain, risk for injury, risk for ineffective thermoregulation
Treatment for Meningitis
Elevate head of bed 15 to 30 degrees, avoiding neck extention or flexion, and maintaining head in neutral position. Monitor for cerebral edema. restrict oral fluids and monitor IV fluids to prevent fluid overload
Syndrome of inappropriate antidiuretic hormone
SIADH
Normal CSF Values
ICP- 50-100 Appearance- Clear Leucocytes- 0-8 Protein- 14-45 Glucose- 35-75
CSF with Viral Meningitis
ICP- Normal or slightly elevated Appearance- Clear Leukocytes- Slightly elevated Protein- Slightly elevated Glucose- Normal or decreased
CSF with Bacterial Meningitis
ICP- Elevated Appearance- Cloudy Leukocytes- Elevated Protein- Elevated Glucose- Decreased
Clients with this type of meningitis will need to have transmission-based droplet precautions instituted until at least 24 hours of antibiotic therapy have been completed
Bacterial Meningitis
Complications of Meningitis
Seizures, hearing loss, visual alterations
This is treated with IV antibiotics sensitive to causative organism; treatment usually continues for 7 to 14 days; preventative care includes Hib vaccine
Bacterial Meningitis
Those in close contact with a child who has bacterial meningitis may receive
Rifampin (Rifadin) or ciprofloxacin (Cipro) prophylactically
Inflammation of brain
Encephalitis
Classic symptoms of this include an acute febrile illness with neurologic signs
Encephalitis
Usually caused by a viral organism; herpes simplex type 1 is most common cause during neonatal period; enteroviruses are frequently identified as causative agents; nonviral agents include bacteria, parasites, fungi, and rickettsiae
Encephalitis
Fever, h/a, n/v, and signs of an upper respiratory infection are all assessment findings of
Encephalitis
Neurologic symptoms of this process include those of nuchal rigidity, photophobia, and positive Kernig’s and Brudzinski’s signs
Encephalitis
Treatment for Encephalitis
seizure precautions, if bacterial use antibiotics, acyclovir or other antiviral agents used for herpes virus infection
An acutre metabolic encephalopathy of childhood; fatty degeneration of liver leads to liver dysfunction
Reye Syndrome
This process is characterized by five stages: 1. Vomiting and lethargy 2. Combativeness and confusion 3. Coma, decorticate posturing 4. Decerebrate posturing 5. Seizures, loss of deep tendon reflexes, respiratory arrest
Reye Syndrome
Ususally develops after a mild viral illness such as chickenpox
Reye Syndrome
Linked to the use of ASA in children
Reye Syndrome
Hypoglycemia is one of the earliest signs of this syndrome
Reye Syndrome
Child presents with an abrupt change in LOC; hx reveals client recovering from viral disease with sudden onset of vomiting and mental confusion
Reye Syndrome
Liver enzymes and ammonia levels are elevated; blood glucose levels are below normal and prothrombin time is prolonged; bilirubin levels remain normal; liver biopsy shows small fat deposits
Reye Syndrome
Tx for Reye Syndrome
ICU, monitor cerebral edema, fluid restrictions usually instituted; frequent vials and neurological assessments. Monitor lab values for elevated ammonia, acidosis, or hypoglycemia; I&O
Toddler ages
12-36 months
Toddler motor development
Slower physical growth. Reduced demand for calories. Learning to walk. Increased motor skills and lack of experience place the toddler at risk for injury. Child-proofing the home is essential.
Preschooler ages
3-5 years
Preschool motor development
Coordination and muscle strength increase rapidly. Increases in brain size and nerve myelinization. Perfects fine and gross motor skills. Engages in activities such as running cutting with scissors and drawing. By ages 4 or 5, the child is independent and can dress, eat, and go to the bathroom.
Cognitive and Sensory Development for Toddler
Consumed with curiosity. Boundless energy. Tremendous cognitive growth. Piaget’s sensorimotor period. Thinking is immature and limited in its logic. Behavior is characterized by negativsm, ritualism, and egocentrism.
Cognitive and Sensory Development for Preschooler
A critical period for the development of socialization. Children need opportunities to play with others. Learn communication skills. Play is often dramatic, imitative, and creative. Thinking is magical and egocentric. Overwhelmed by guilt if a loved one is injured or ill.
Psychosocial Development for Toddler
Characterized by the struggle for autonomy. Develops a sense of self separate from the parent Autonomy vs shame and doubt Erikson Stage Spend most of their time at play- it is the childs work.
Psychosocial Development for Preschooler
Developmental task is to gain a sense of initiative (Erikson). Busy learning how to do new things. Takes great pride in accomplishments. Encourage the preschooler’s imagination and creativity. Praise appropriate behavior.
Psychosexual Development for Preschooler
Gender identity and body image are developing. Sexual curiosity, anatomic exploration, and masturbation are common. Encourage parents to answer questions simply and honestly. Children should not be shamed or punished for self-comforting behaviors.
Discipline for Toddler
Firm, consistent discipline helps toddlers learn self-control.
Discipline for Preschooler
Need consistent discipline. Appropriate limits setting teaches self-confidence, self-control, and normal values. Techniques include time-out, time-in, restricted choices, and diversion.
Discipline for a Toddler
Must be consistent, immediate, age appropriate, and related to the incident. Clearly explain limits and give enough time for toddlers to respond to instructions. Avoid arguments and extensive explanations. Avoid withdrawing love as punishment. Separate the toddler from the behavior. Praise the toddler for good behavior.
This many teeth by age 3
20 deciduous teeth
Removes own clothes. Is willing to let go of toy. Is able to sit, squat, and walk well. Has been walking for 1 year.
Physical signs of readiness for toilet training
Notices wet diaper. Indicates need for diaper change. Communicates need to go to the bathroom and can get there by self. Wants to stay dry.
Psychological signs of readiness for toilet training
Children under the age of _____ should not ride in the font seat of a car that is equipped with an air bag
13 years
Requirements to start and stop using a booster seat
More than 40 pounds to start, until they reach 4 foot 9 inches in height, and they are 8-12 years old
Modes of Transmission of Pathogens
Direct contact with another infected person. Contact with animal or insect carriers. Ingestion of contaminated food or water. Contact with a contaminated object.
Active immunity occurs either _________ or _________
Naturally, through vaccine administration.
Forms of Vaccines
Live or attenuated. Killed or inactivated toxins. Human immune globulin. Animal serum or antitoxins.
A severe, potentially fatal hypersensitivity reaction; histamine is released and leads to respiratory and vascular changes
Anaphylaxis
A substance that possesses a unique configuration enabling immune system to recognize it as foreign; any substance that causes production of antibodies; are usually large molecular-weight proteins
Antigen
Attachment of an antibody to an antigen that forms the basis for B-cell-mediated immunity
Antigen-antibody reaction
A protein produced by immune system that binds to specific antigens and eliminates them from the body
Antibody
A disease process where body identifies itself or a component of itself as foreign and attacks itself
Autoimmune Disease
A blood test that indicates percentages of different types of white cells present in blood and is sometimes useful in identifying cause of an illness
Differential Blood Count
Time between exposure to an antigen (bacterial or viral organism) and formation of first general symptoms of disease
Incubation period
Resistance of body to effects of harmful organism or its toxin
Immunity
Process of introducing an antigen into body, allowing immunity against a disease to develop naturally
Immunization
Period of time when an illness is directly or indirectly transmittable from one person to another
Period of Communicability
Period of time between initial symptoms and presence of full-blown disease
Prodromal Period
A generalized infection spread throughout the body through blood stream
Sepsis
An acronym for a complex of communicable diseases often present at birth
TORCH, which can cause teratogenic effects to unborn fetus
TORCH stands for
T=toxoplasmosis O=other (such as syphilis, hepatitis) R=rubella C=cytomegalovirus H=herpes simplex
Functional at birth. First line of defense. Reacts similarly to all invaders. Phagocytosis of foreign material by WBCs. Includes the inflammatory response.
Nonspecific Immunity (resistance of body to harmful organism)
Most common type of WBC involved in acute inflammatory process
Polymorphonuclear leukocytes, or granulocytes
Include B cells (B lymphocytes), T cells (T lymphocytes), and NK (Natural Killer cells)
Lymphocytes responsible for specific immune response
A nonspecific response to any tissue injury aimed at maintaining homeostasis; chemicals are released from injured cells, which cause blood vessels to dilate, bringing large numbers of neutrophils and macrophages to area for phagocytosis of injured cells and foreign material, allowing healing to occur.
Inflammatory Response
Second line of defense. Not functional at birth, must be learned by body. Not fully functional until a child is 6 years old.
Specific Immune Response
Depends upon antibody-producing abilities of B cells
Humoral Immunity
In response to antigens B cells convert into plasma cells and secrete specific antibodies (immune system proteins) to assist body in eliminating foreign proteins.
Humoral Immunity
Antibacterial and antiviral antibody found in large quantities in all body fluids; can cross placenta; from mom, provides passive immunity for first 6 months of infant’s life.
IgG antibody
Found in saliva, tears, bronchial secretions, mucous secretions of small intestine, vagina, and in breast milk; not present at birth and reaches normal levels at 6 to 7 years of age
IgA antibody
Body’s primary antibody response to an antigen; levels are low at birth and reach adult levels by 1 year of age.
IgM antibody
Role is unknown but seems to be related to B cell differentiation
IgD antibody
Normally found in very small amounts and is associated with allergic reactions; elevated levels are found in individuals with an allergy and clients infected with intestinal parasites; not present at birth
IgE antibody
Produced in thymus and function to protect individual from intracellular organisms, viruses, and slow-growing bacteria
T cells
Responsible for rejection of foreign grafts
T cells
Kill virus infected cells and depend upon IgG being bound to cell
Killer T cells
Help regulate actions of B cells
Helper T cells
Enzyme that responds to antigen-antibody reactions causing inflammation and destruction of foreign cells
Complement
Plays a role in autoimmune diseases (body attacks itself)
Complement
Levels of proteins lower in newborns than older children and adults
Complement
Usually performed under local anesthesia. Postprocedure complications include bleeding and infection. Done to provide information about hematologic and immunologic disorders
Bone Marrow Aspiration (from iliac crest)
As one white blood cell type increases the others decrease when dealing with
White blood cell differentials (differential blood found)
Rise in response to inflammation, acute bacterial infections, and a few malignancies
Neutrophils
Elevations are associated with allergies and parasitic infections as well as skin diseases such as eczema and psoriasis. Decreased in children receiving corticosteroids
Eosinophils
Counts may rise in response to chronic infection and stress, and in leukemia; contribute to inflammatory process and allergic reactions because they store histamine. Decreased in allergy acute infection, collagen and chronic diseases
Basophils
Active in chronic infection, increased in tuberculosis, protozoan infection and monocytic leukemia
Monocytes
Increased in several infections, decreased in children with immune deficiency
Lymphocytes
Looks for allergen-specific IgE antibodies in a blood sample; it is no more sensitive than other methods but does not involve risk of anaphylaxis or other allergic reactions
Radioallergosorbent testing (RAST)
Can be acquired either from exposure to disease or by immunization
Immunity
Involves body’s formation of antibodies in response to exposure to an antigen
Active Immunity
Temporary immunity achieved by administration of antibodies produces by another individual; when antibodies pass from mother to the fetus; it is acquired
Passive Immunity
Contain antigens to specific diseases; they cause body to respond with development of antibodies and active immunity
Vaccines
This type of vaccine should be avoided in immunocompromised or pregnant client
Live vaccines
The most severe of several different congenital disorders of immune system yielding susceptibility to infections, other forms can include B cell and T cell deficiencies.
Severe Combined Immunodeficiency Disease (SCID)
Occurs as a result of X-linked recessive or autosomal recessive inheritance, as well as because of a spontaneous mutation
SCID
Characterized by absence of both humoral and cellular immunity. Maternal antibodies may protect for a short period of time, but chronic infections become apparent around 3 months of age. Death usually occurs within first 2 years of life
SCID
Assessment of this reveals initial infection often persistent thrush (oral candidiasis), followed by chronic infections. May be caused by cytomegalovirus, and Pneumocystis carinii. Failure to thrive also accompanies dx. Leukocyte counts are usually reduced
SCID (Severe combined immunodeficiency disease)
Treatment for SCID
Protect form infection. Hand hygienic. Prevent contact with infected individuals. No live plants or fresh flowers due to mold and bacteria. Bone marrow transplant offers best hope for survival.
Med therapy for SCID
Intravenous immune globulin (IVIG). Immunizations 14 days prior to or 3 months after IVIG administration. Antibiotics as needed
Hypersensitivity to a foreign protein
Allergy
Antigen-antibody reaction causes release of histamine and other chemicals into body; chemicals are responsible for symptoms. Broad group of disorders; symptoms very dependent on body cell that has been sensitized.
Allergies
First exposure to antigen causes production of
IgE antibodies
Subsequent exposure to an antigen causes an antigen-antibody reaction with cell damage causing
release of histamine and other chemicals
Elevated eosinophil counts will be seen in
Allergies
Large number of allergens can be tested quickly in about 30 minutes, if allergic a reddened wheal will form in 15 to 30 minutes. Anaphylaxis is rare but potential problem
Allergy Skin testing
Med therapy for allergies
Antihistamines given prior or early in reactive phase; compete with histamine on receptor sites, therefore will be ineffective if given late in reaction. Bronchodilators may be given for lower respiratory symptoms. Corticosteroids may be administered systemically or topically, depending upon symptoms. Epinephrine is administered for anaphylaxis (Epi-Pen Jr for up to 65 pounds, Epi-Pen Adult for over 65 pounds)
An acronym for a group of infections, which when acquired in utero, cause teratogenesis (fetal harm)
TORCH
Red Measles
Rubeola
Is a virus. Transmitted by direct or indirect contact with droplets. Incubation 10-20 days. Communicability is several days before rash appearance to 5 days after rash appearance. Immunity from vaccination or disease
Rubeola
Prodromal stage shows fever and lethargy, cough, and coryza; photophobia; koplik spots on buccal mucosa. Acute stage show red flat rash lasting about a week, which begins behind ears, spreads to face, trunk, and extremities
Rubeola
Management of this disease includes managing temperature, keeping room dim, and a vaporizer that may improve respiratory secretions
Rubeola
Pneumonia, otitis media, encephalitis
Complications of Rubeola
German or 3 day measles. Caused by virus. Transmitted by droplets. Incubation is 2-3 weeks. Communicability is 1 week before to 5 days after onset of rash. Immunity from vaccination or disease.
Rubella
Prodromal stage reveals low-grade temperature, h/a, sore throat and cough. Acute stage reveals flat red rash beginning on face and spreads to rest of body. Rash lasts 3 days
Rubella
Management of this disease includes non aspirin antipyretics; encourage fluid; recommend to avoid contact with all pregnant women; non immune females should be immunized before reaching childbearing age
Rubella
Mumps. It is a virus. Transmitted by droplet or direct contact. Incubation is 2 to 3 weeks. Communicability 1 week before parotid swelling until 1 week after swelling begins. Immunity from vaccination or disease
Parotitis
Prodromal stage reveals fever, h/a, earache that worsens with chewing. Acute stage reveals swelling of parotid glands
Parotitis
Treatment of this includes non aspirin antipyretics; fluids and soft liquids are easier to swallow; avoiding sour foods
Complications of this disease include orchitis (testicular swelling); encephalitis, and deafness.
Chickenpox. It is a virus. Transmitted by direct contact and airborne. Incubation is 2-3 weeks. Communicability is day(s) before rash to 1 week after first lesions crust over. Immunity from vaccination or disease
Varicella
Prodromal stage reveals mild fever and malaise for 24 hours. Acute stage reveals rash that progresses from macule to vesicle to crusts; eruption lasts up to 5 days and lesions of all types will be present at one time.
Varicella
Treatment of this disease includes Acyclovir or IVIG to high risk child. Nonaspirin antipyretics, calamine lotion topically, oral antihistamines, oatmeal and Aveeno baths, keep nails short, and discourage scratching.
Varicella
Complication of this disease include encephalitis, Reye syndrome
Varicella
Associative Play
play together engaging in similar type of activity without organization or goals. Rely on own wants/desires to dictate activities. May borrow toys or follow activities but no leader or rules. Characteristic of preschoolers.
Autonomy vs. Shame and Doubt
1 to 3 years. Increased ability to control self and environment. Practices and attains new physical skills, and develops autonomy. Symbolizes independence by controlling body secretions, saying “no” when asked to do something, and directing motor activity. Develops self-confidence and willpower, and develops shame if criticized or unsuccessful.
Child should be able to differentiate colors by age
5 years
Child should have ______ teeth by late ________
32, adolescence
Children who are immunologically compromised…
Should not receive live bacterial or viral vaccines
Concept of death for 2-7 year olds
Death as a reversible and temporary separation
Concept of death for 7-12 year olds
Death as sad and irreversible but not necessarily inevitable
Concrete Stage of Piaget
Thoughts become increasingly logical and coherent. Able to shift attention from one perceptual attribute to another (decent ration). Concrete thinkers: view things as “black or white, right or wrong, no in between or gray areas.” Able to classify and sort facts, do problem solving. Acquires conservation skills.
Cooperative Play
organized group play with rules, goals, and a plan. There is a leader responsible for division of labor and direction of activities. Characteristic of children and adolescents.
Deciduous teeth erupt by
about six months of age
Deciduous teeth by age 2 1/2 to 3 years
20
Fine motor development for toddler (1-3 years)
Uses cup well by 15 months Builds a tower of two cubes or blocks by 15 mo. Holds crayon with fingers by 24-30 months Good hand-finger coordination by 30 months Copies a circle by 3 years
Formal Operations Stage of Piaget
Able to logically manipulate abstract and unobservable concepts. Adaptable and flexible. Able to deal with contradictions. Uses scientific approach to problem solve. Able to conceive the distant future.
Gross motor development for toddler (1-3 years)
Walks without help by 15 months Jumps in place by 18 months Goes up stairs (with 2 feet on each step) by 24 mo. Runs fairly well (wide stance) by 24 months
Growth during school age years (6 to 12 years)
Weight steady slow. 5 lbs per year Height increases 1 to 2 inches per year
Growth during Preschool years (3 to 6 years)
Weight is slow and steady (4 to 5 lbs per year) Height increases 2 to 3 inches per year
Height at 2 years
50% of future adult height
Industry vs. Inferiority
6 to 12 years. Middle years of childhood. Development of new interests and involvement in activities. Learns to follow rules. Acquires reading, writing, math, and social skills If successful, develops confidence and enjoys learning about new things. When compared to others, may feel inadequate, inferior, if too much is expected.
Infant and Toddler Responses to Pain
Infants will have increases in BP and HR, and decrease in arterial O2 saturation. Harsh, tense, or loud crying. Facial grimacing, flinching, thrashing of extremities. Toddlers will verbally indicate discomfort. Generalized restlessness, uncooperative, clings to family member.
Initiative vs. Guilt
3 to 6 years. Explores the physical world with all senses, initiates new activities, and considers new ideas. Demonstrates initiative by being able to formulate and carry out a plan of action. Develops a conscience. If successful, develops direction and purpose. If criticized, leads to feelings of guilt and a lack of purpose.
Intellectual development
learn colors, shapes, sizes, textures, and significance of objects. Association of words with objects, abstract meaning and spatial relationships (up down over) play helps them understand the world and distinguish between fantasy and reality
Lose first deciduous teeth at age
Six. By age 12 has all permanent teeth, except final molars
Most important consideration for the successful assessment of a child
Developmental Level
Motor development of preschooler (3 to 6 years)
Skips and hops on one foot by 4 years Rides tricycle by 3 years Throws and catches ball well by 5 years Balances on alternate feet by 5 years Knows 2100 words by 5 years Increased strength and refinement of fine and gross motor abilities
Nursing Interventions for Preschooler Fears
Encourage parents to participate in child care. Allow child to express feeling. Give simple explanations. Avoid Med Terms. Provide therapeutic play. Allow child to manipulate and play with equipment. Maintain trusting relationship with parents and child. Allow time for questions. Praise child, focus on desired behavior, and give rewards.
Onlooker
play children watch older children but do not attempt to interact
Pain assessment in preschoolers
Cry and struggle. May deny pain.
Pain assessment in school age children
Stiff body posture. Withdrawn.
Pain assessment in toddlers
Generalized restlessness. Guarding of the painful site. Excessive crying.
Parallel play
play that is not influenced by other children playing in the same area. Play beside and not with each other with similar toys. Characteristic of toddlers.
Physical Assessment Approach for Preschoolers
Allow to handle equipment. Head to toe if cooperative. Same as toddler if uncooperative.
Physical Assessment Approach for Toddlers
Minimal contact initially. Allow to inspect equipment. Assess heart and lungs while quiet, then head to toe. Eyes, ears, and mouth last.
Physical Assessment Approach for School Age
Respect Privacy. Explain procedures. Head to toe. Genitalia last.
Preferred site for IM vaccines to infants and children
Anterolateral thigh, or the deltoid in older children
Preoperational Stage of Piaget
Forms symbolic thought. Exibits Egocentrism- unable to put oneself in the place of another. Unable to understand conservation. Increasing ability to use language. Play becomes more socialized. Can concentrate on only one characteristic of an object at a time (cent ration).
Preschool Nutritional Requirements
90 kcal/kg/day 13 grams/day Protein
Preschool Play
Enjoys imitative and dramatic play Imitates same-sex role in play Provide toys to develop motor and coordination skills (tricycle, clay, paints, swings, sliding board) Parental supervision of tele vision Enjoys sing along songs with rhythm
Preschoolers Fears to Illness and Hospitalization
Major fears are mutilation and intrusive procedures. Perceives illness as punishment. Some separation anxiety will still exist.
Preschoolers Response to Pain
Major fear of needles, will deny pain to avoid injection. Restlessness, irritability, cries, kicks with experiences of pain. Able to describe the location and intensity of pain.
Regression in Infant or Toddler
use of behavior that is more appropriate to an earlier stage of development, often used to cope with stress or anxiety. HELP PARENTS understand changes in behavior, and avoid punishment
Ritualism
A toddlers need to maintain sameness and reliability; provides sense of comfort
School Age Play (cooperative)
Comprehends rules and rituals of games Enjoys team play Enjoys athletic activities Provide construction toys, puzzles, erector sets, Legos.
School Age Safety (6 to 12 years)
Teach sex education Injury prevention- bike safety, firearms, smoking, hobbies
School age vision
20/20 by age 6 to 7 years Myopia may appear by age 8
Secondary sex characteristics begin at:
10 years in girls 12 years in boys
Self-awareness
active exploration of their body, separation from mother and developing self identity, test own ability, try roles, learn behavior with others.
Sense pleasure play
non-social interactive stimulating experience, reacting to environment- light, color, taste, odors, textures. Pleasurable experiences are derived through touch, body motion and use of senses and abilities.
Sensorimotor Development
all ages but major type of infancy, for muscle development and energy release. Exploration through senses and development of movement of body.
Sensorimotor Stage of Piaget
An infant learns about world through senses and motor activity. Progresses from reflex activity through simple repetitive behaviors to imitative behaviors. Develops a sense of “cause and effect.” Curiosity, experimentation, and exploration result in the learning process. Object permanence is fully developed
Sensory Development for toddler (1-3 years)
Binocular vision well developed by 15 months Knows one name by 12 months; refers to self Follows simple directions by 2 years Identifies geometric forms by 18 months Uses short sentences by 18 months to 2 years Remembers and repeats 3 numbers by 3 years Able to speak 300 words by 2 years
Should have _____ deciduous teeth by age 2 1/2
20
Skill play
using new discovered skills of grasp and manipulation children practice over and over for proficiency but may lead to frustration along the way until they succeed.
Social affective play
interacting with people as a reaction to attention and provoking interaction through smiling cooing etc.
Solitary play
independent play, no effort is made to interact with other children
Stages of Erickson’s Theory of Psychosocial Development
- Trust vs. Mistrust (birth to 1 year) 2. Autonomy vs. Shame (1 to 3 years) 3. Initiative vs. Guilt (3 to 6 years) 4. Industry vs. Inferiority (6 to 12 years) 5. Identity vs. Role Confusion (12 to 18 years)
Stages of Grief
“DABDA” Denial Anger Bargaining Depression Acceptance
Stages of Piaget’s Theory of Cognitive Development
- Sensorimotor (birth to 2 years) 2. Preoperational (2 to 7 years) 3. Concrete Operational (7 to 11 years) 4. Formal Operations (11 years to death)
Stages of Separation Anxiety
- Protest- child appears sad, agitated, angry, inconsolable, watches desperately for parents to return. 2. Despair- child appears sad, hopeless, withdrawn; acts ambivalent when parents return. 3. Detachment- child appears happy, interested in environment, becomes attached to staff members; may ignore parents
Teeth begin to fall out around
age six
To medicate a preschooler
Offer choices
To medicate a school age child
provide choices, explanations, distraction, and support
To medicate a toddler
use play, minimize restraint, and give praise and stickers as rewards
Toddler Nutritional Requirements
102 kcal/kg/day 11 grams/day Protein
Toddler Play
Begins as imaginative and make-believe play; may imitate adult in play Provide blocks, wheel toys, push toys, puzzles, crayons to develop motor and coordination abilities Toddlers enjoy repetitive stories and short songs with rhythm
Trust vs. Mistrust
Birth to 1 year. Establish trust in people providing care. Mistrust develops if basic needs are inconsistently or inadequately met.
Visual Acuity at 4-6 years
20/30 to 20/20
Visual Acuity at 7 years
20/20
Weight Gain for toddler (1-3 years)
4 times birth rate by 2 1/2 years
Rocky Mountain Spotted Fever
Rickettsial
Prevention is most important with imiting exposure and contact with sources of diesase.
Early detection of tick through assessment after possible contact and tick removal.
Assessment and treatment if reaction is detected.
Treatment with appropriate course as soon as possible with antibiotic treatment
Lyme Disease
Causes a widespread spectrum of illnesses in children.
Symptoms range from mild to severe.
Can be spread by unprotected sexual activity, sharing needles, an infected mother to her baby, breastfeeding, and open wounds if there is blood to blood contact.
HIV
Treatment of this disease includes a modified immunization program, antiretroviral therapy, pneumocystis carinii pneumonia (PCP) prophylaxis, and aggressive use of antibiotics
HIV
A child taking these meds will have both immunosuppressive and antiinflammatory properties. During cessation of therapy, gradually taper the dose to allow for a gradual return or adrenal function
Corticosteroids
Immediate (anaphylactic) hypersensitivity.
Examples include allergic rhinitis, acute anaphylaxis, haves, eczema, asthma
Type I allergic reaction
Cytotoxic hypersensitivity.
Examples include transfusion reaction after receiving incompatible blood
Type II allergic reaction
Arthus hypersensitivity (immune complex).
Examples include serum sickness, glomerulonephritis
Type III allergic reaction
Delayed cell-mediated hypersensitivity.
Exampes include contact dermatitis (poison ivy)
Type IV allergic reaction
Sneezing, tightness, tingling of mouth or face, with subsequent swelling of lips and tongue, severe flushing, urticaria and itching, sepecially on head and upper trunk, rapid development of erythema, sense of impending doom are all signs of
Impending Anaphylaxis
The infant kidney is ______; however, it is proportionately ________ than the adults.
Small.
Larger.
Kidneys reach near adult function at what age
6-12 months of age
Manifestations of this can vary widely in relation to age, gender, underlying anatomic or neurologic abnormalities, frequency of recurrence, and vesicoureteral reflu (VUR)
UTI
Personal hygience, increased fluid intake, regular emptying of the bladder, and wearing cotton underwear, are all ways to prevent
UTI’s
Complete or almost complete cessation of urine produciton by kidneys
Anuria
Retention of excess nitrogenous wastes in blood
Azotemia
Ventral curvature of penis caused by a fibrous band of tissue
Chordee
Operation to remove part or all of prepuce (foreskin) of penis
Circumcision
Substance produced daily in body; found in blood, muscle, and urine; measurement of its excretion is used to evaluate kidney function
Creatinine
Failure of one or both testes to descend
Cryptorchidism
Inflammation or urinary bladder
cystitis
A malformation in which urethra opens on dorsum of penis; frequently associated with extrophy of bladder
Epispadias
Congenital eversion of a hollow organ; a congenital gap in anterior wall of bladder and abdominal wall in front of it, with posterior wall of bladder being exposes
Extrophy
Inflammation of glomerulus of nephron
Glomerulonephritis
A tuft formed of capillary loops at beginning of each nephric tubule in kidney; this tuft with its capsule (Bowman’s capsule) constitutes the corpusculum renis
Glomerulus
Filtering of blood to remove toxins (nitrogenous wastes)
Hemodialysis
A malformation in which urethra opens on ventral aspect of penis; frequently associated with congenital chordee
Hypospadias
Act of urinating
Micturition
A long, convoluted tubular structure in kidney, consisting of renal corpuscle, proximal convoluted tubule, nephronic loop, and distal convoluted tubule
Nephron
A urine output of less than 0.5-1.0 mL/kg/hour
Oliguria
Filtering blood to remove toxins via a catheter inserted into peritoneal cavity
Peritoneal Dialysis
Free fold of skin that covers glans penis
Prepuce
Inflammation of renal parenchyma, calyces, and pelvis, particularly due to local bacterial infection
Pyelonephritis
Excess of urea and other nitrogenous waste products in blood
Uremia
Inflammation of a ureter
Ureteritis
Inflammation of the urethra
Urethritis
Forms and excretes urine.
Regulates fluid and electrolyte balance within body
Regulates acid-base balance within body
Regulates blood pressure.
Stimulates production of erythropoietin, which promotes production of red blood cells (RBCs) in bone marrow
Regulates calcium metabolism in body
Functions of the Renal System
Innervation of stretch receptors in bladder wall does not occur before the age of
2 years old
Congenital defect in which urinary meatus is not at end of penis but is located on lower or underside of shaft
Hypospadias
Congenital defect in which urinary meatus is not at end of penis but on upper side of penile shaft; less common than hypospadias
Epispadias
Care and treatment for Hypo or Epispadias
Surgical correction before 18 months of age.
Post op care includes urethral stent in place and wrapped with pressure dressing.
Arm and leg restraints may be needed to prevent accidental removal of the stent.
Encourage increased fluid intake to maintain urine output and stent patency.
Call provider if no urine output for one hour; there could be kinks in the system or occlusion by sediment.
Med therapy includes antibiotics until stent falls out, Tylenol for pain, and anticholinergics such as oxybutynin (Ditropan) for bladder spasms.
Postsurgical instructions for Hypo or Epispadias
Double diapering to protect stent.
Limit activity for two weeks.
Med administration.
Monitor for signs of infection.
Call provider if urine leaks from anywhere but penis.
Urine will be blood-tinged for several days- this is normal.
Lower portion of abdominal wall and anterior bladder wall are missing, resulting in bladder being open and exposed on abdomen
Exstrophy of Bladder
Treatment of Exstrophy of Bladder
Bladder closure is corrected during first 48 to 72 hours of life.
Preoperative covering of bladder with sterile plastic wrap and maintaining skin integrity of surrounding area using skin sealant to protect it from excoriating effects of urine.
Post op care may include Bryant’s traction to facilitate healing, avoiding abduction of legs, changing dressings as ordered, monitoring urine output, bladder spasms, and urine or blood draining from meatus.
A failure of one or both testes to descend from inguinal canal into scrotum. More frequently seen in premature infants, exposes testes to heat of body, leading to low sperm counts at sexual maturity, and leads to a greater risk of torsion and trauma, and higher incidence of cancer, and inguinal hernias
Cryptorchidism
Treatment for Cryptorchidism
If testes do not descend by first year of life, hCG hormone is given to induce descent. If this does not work, then an orchiopexy is performed before age 2.
A prosthesis may be placed in scrotum if testes are damaged or absent.
Use ice post op, analgesics for pain, and monitor for infection.
A disease process that affects primarily the glomerulus of kidney
Acute Glomerulonephritis
Elevated BUN, indicating impaired renal function; elevated erythrocyte sedimentation rate (ESR) indicates inflammation in body; elevated anti-streptolysin O (ASO) titer indicates a previous streptococcal infection; renal ultrasound shows enlarged kidneys, while urine exams demonstrate gross hematuria, proteinuria, and red blood cell casts; serum samples may also display azotemia
Acute Glomerulonephritis
Treatement for Acute Glomerulonephritis
Bedrest during acute period.
Monitor fluid and electrolyte imbalances; I&O, dialy weight, fluid restriction if ordered, sodium, potassium, and possible protein intake will be limited; monitor dietary intake to optimize calories consumed.
Med therapy for Acute Glomerulonephritis
Antihypertensives, such as hydralazine (Apresoline)
Diuretics, such as furosemide (Lasix)
Features of Acute Glomerulonephritis
Caused by immune reaction to group A beta-hemolytic streptococcal infection.
Onset is abrupt.
Hematuria is grossly bloody
Proteinuria is 3+ or 4+, not massive.
Edema is mild.
Hypertension is marked.
Hyperlipidemia is rare or mild.
Peak age frequency is 5-10 years of age.
Interventions include limited activity, anti-hypertensives as needed, symptomatic therapy if CHF occurs.
Diet is normal for age; no added salt if child is hypertensive.
Prevention through treatment of group A beta-hemolytic streptococcal infections
Course is acute 2-3 weeks
Features of Nephrotic Syndrome
Cause is idiopathic; possible a hypersensitivity reaction.
Onset is insidious.
Hematuria is rare.
Proteinuria is massive.
Edema is massive.
Hypertension is mild.
Hyperlipidemia is marked.
Peak age frequency is 2-3 years of age.
Interventions include bedrest during edema stage; corticosteroid administration.
Diet is nutritious for age; no added salt; small, frequent meals may be desirable.
Prevention is not known.
Course is chronic- may have relapses.
Clinical state characterized by edema, massive proteinuria, and hyperlipidemia
Nephrotic Syndrome
Sudden onset of diminished renal function.
Occurs suddenly and is often reversible; generally follows ischemic or toxic trauma to the kidney.
Acute Renal Failure (ARF)
Assessment findings for ARF
Hyperkalemia, hyponatremia, hypocalcemia, BUN and serum creatinine are elevated.
Pt will appear pale and lethargic with edema; hypertension occurs secondarily to fluid volume overload.
Treatment of ARF
Restrict sodium, potassium, and phosphorus as needed.
Parenteral or enteral nutrition may be needed initially.
Dialysis may be required to correct electrolyte and fluid balances while eliminating wastes.
Monitor I&O and weigh daily.
Monitor BP.
Med tx for ARF
Antibiotic therapy.
Avoid nephrotoxic drugs (such as aminoglycosides, cephalosporins, sulfonamides, tetracycline, contrast dye with iodine, indomethacin, ASA, and heavy metals)
An irreversible loss of kidney function over months to years.
Families that are affected require multidisciplinary care.
Kidney transplantation
Chronic Renal Failure
Manifestations of this disease include poor weight gain, failure to thrive, tachycardia, cardiomegaly, galloping rhythm, poor perfusion, liver and spleen enlargement, and weight gain
Heart failure
Feeding Children with CHF
feed in relaxed environment; frequent small feedings may be less tiring.
Hold infant in upright position for less stomach compression and improve respiratory effort.
If child is unable to consume appropriate amount during 30 minute feeding every three hours, then and NG feeding tube needs to be considered.
Monitor for increased tachypnea, diaphoresis, or feeding intolerance (vomiting).
Concentrating formula to 30kcal/oz may increase caloric intake without increasing infants work
Manifestations of this disease include migratory polyarthritis, carditis, chorea, erythema marginatum, subcutaneous nodules, and erythema marginatum
Rheumatic Fever
When infusing IV antihypertensive Meds
Infuse very slowly.
Maintain an arterial line for monitoring.
Observe for hypotension.
The ability of RBCs to carry oxygen is dependent upon sufficient circulating
Iron
A group of congenital disorders:
Sickled hemoglobin
Chronic hemolytic anemia
Ischemic tissue injury
Found in 8% of persons of African descent
Also prevalent in persons of Mediterranean, Middle Eastern, Indian, Caribbean and Central and South American Decent
Sickle Cell Disease (SCD)
Autosomal Recessive Condition
Treatment of Pain related to Sickle Cell Disease
Opioids (Morphine)
Nonsteroidal Antiinflammatories
Frontal bossing (prominent and protruding forehead), maxillary prominence, wide-set eyes with a flattened nose, hepatosplenomegaly, greenish-yellow skin tone, one inherited gene=mild anemia (minor), two inherited genes=severe anemia (major), are all characteristics of
Child with Beta-thalassemia (autosomal recessive)
Treatment for Beta-thalassemia
Erythrocyte transfusion
Chelation therapy
Splenectomy
Bone marrow transplantation is the only available cure for thalassemia at this time
A lifelong hereditary blood disorder usually seen in males, but if gene is passed by both parents to a femal, she could be affected
Hemophilia (X linked autosomal recessive)
Treatment of a bleed in hemophilia
Factor prophylaxis
RICE (Rest, ice, compression, and elevation)
Bruising and Petechiae may be seen with
Hemophilia
Von Willebrand’s disease
Immune thrombocytopenic purpura (ITP)
Disseminated intravascular coagulation (DIC)
Aplastic Anemia
Hours of sleep for 6-7 year olds
12 hours.
Nap or quiet time may still be needed
Sleep for 12 year olds
9-10 hours
Therapy for childhood cancers.
Allogenic bone marrow (matched donor)
Autologous peripheral stem cells (child’s own)
Umbilical cord blood stem cells
Bone Marrow Transplantation (BMT) / HSCT
GVHD
Graft versus host disease.
Monitor for this post bone marrow transplant
May cause bone marrow suppression, alopecia, malaise/fatigue, n/v, anorexia, stomatitis
Chemotherapy
May cause skin reactions, fatigue, bone marrow suppression, n/v, anorexia, mucositis
Radiation
The most common childhood cancer
Leukemia
Manifestations of this include fever, pallor, excessive bruising, bone or joint pain, lymphadenopathy, hepatosplenomegaly, and abnormal WBC counts
Leukemia
Treatment for Leukemia
Once medically stable, most chemo is given outpatient
85% can achieve remission with a 5 year disease free survival rate
Second most common childhood cancer
Brain Tumors
Manifestations of this include H/A, morning vomiting, seizures, focal symptoms, and neurologic deficits
Brain Tumors
Surgical removal of tumor
At risk for increased ICP
Edema
Hydrocephalus
Hemorrhage
Nursing care includes
Frequent vitals, mental staus, and neurologic status checks
Child with Type I DM needs to add an extra 15 to 30 grams of carbohydrate snack for each
45-60 minutes of exercise
This will present with severe hyperglycemia, ketones in the blood, metabolic acidosis
Diabetic Ketoacidosis
Management of this requires intensive care to lower glucose, reverse acidosis, and correct fluid and electrolyte imbalance
Diabetic Ketoacidosis
Signs of this include personality changes, slurred speech, decreased level of consciousness, trembling, sweating, tachycardia, pallor, and clammy skin
Hypoglycemia
Signs of this include increased urine output, thirst and hunger, fatigue, blurred vision, h/a, emotional lability
Hyperglycemia
Congenital neural tube defects classified by incomplete closure of the vertebrae
Spina Bifida
No herniation of the spinal cord or meninges; vertebral arches between L5 and S1 fail to fuse; may be noted as a dimple at the level of L5-S1
Occulta Spina Bifida
Posterior vertebral arches fail to fuse; saclike protrusion containing meninges and CSF at some point along the posterior vertebrae
Cystica Spina Bifida
Posterior vertebral arches fail to fuse; saclike herniation contains meninges, CSF, and a portion of spinal cord or nerve roots
Meningocele Spina Bifida
Seizure lasting more than 30 minues is considered
Status Epilepticus
Drugs used to decrease ICP in cerebral edeam
Mannitol and furosemide
