Test 3 Flashcards
Respiratory in infant
Airway is Narrow and more easily occluded
Obligatory nose breather
What is an infant’s cough typical characteristics
Unproductive- produce little mucus
What vs to assess in anemia
How to asess
Increase respiratory due to compensation
Count for full min
A child respiratory rate and depth in anemia can be impacted by what
Crying Physical activity Anxiety Anemia Acid base disturbances Fever CNS Aspirin toxicity
ARDs
Acute respiratory distress syndrome
Diagnosed how?
Treatment?
Bad
X-ray
Tx underlying cause
Respiratory disorders of lower airway
Nasopharyngytis
Pharyngitis
Tonsillitis
Mucus in lungs , reproductive system, gi system , heart , diagnosed by sweat test
Cystic fibrosis
What is rhinosinutis
Cold
Headache - worse when leaving forward
Closes down airway fast
Have intubation equipment available
Epiglottis
Four Ds of epiglottis
Dysphonia- horse voice
Drooling
Dysphasia
Distress
Can be fatal !!
Most common hernias in infants
S/s
When they resolve? How
Umbilical hernias ?
A symptomatic
Resolve by 3-5?yrs outpatient surgery
80% of all childhood hernias
Bulging esp when crying
How to repair?
Inguinal hernias
Surgery to repair
Hurt uncomfortable !!!
Rsv prevention
Hand hygiene!!
What are some Influences on Growth and Development
Nature
◦Describes the traits inherent in the infant
Nurture
◦Refers to the influence of external events
Principles of Childhood Growth and Development
Growth
◦Continuous adjustment in the size of the child, internally and externally
Development
◦Ongoing process of adapting throughout the lifespan
Cephalocaudal
◦Development is a progression from head to tail—top to bottom
Proximodistal
◦Development progresses from near to far and midline to periphery
Gross motor and fine motor skills
◦Gross motor skills, such as running, jumping, or riding a bike, provide the foundation for fine motor development, such as eating, coloring, or buttoning a shirt
Touchpoints
◦Periods during the first 3 years of life during which children’s spurts in development result in pronounced disruption in the family system
◦Brazelton also tracked the variations in these touchpoints and offered anticipatory guidance for parents and professionals who are moving with the child through the stages of development.
A theoretical approach explains, describes, and predicts the various aspects of growth and development
A developmental domain refers to a way of understanding the total child in relation to the mind, body, and spirit
Each child develops at his or her own pace, and the stages are not rigid
There is developmental variability within each child
Nonstage theories are less concerned with specific ages or timeframes but are focused on the process or trajectory of developing maturity
Jean Piaget: four stages
Cognitive theory
How an individual thinks and how thinking influences worldview
◦Sensorimotor (birth to age 2): cognition is through the senses
◦Preoperational (ages 2 to 7): development of motor skills
◦Concrete operational (ages 7 to 11): organize thought in a logical order
◦Formal operational (ages 11 to 15): abstract reasoning to handle difficult concepts
Learning theories
Behavioral: passive learner
◦J. B. Watson….Sought to understand observable behavior
◦B. F. Skinner…..Growth and development are a process of responding to stimuli within the environment
Social learning: emphasizes interplay within the environment
◦Albert Bandura….Learning occurs through observation and modeling
◦Lev Vygotsky….Culture has an impact on development
◦Urie Bronfenbrenner …..The social environment has an effect on development
Intelligent theories
Intelligence is the ability to learn or understand or to deal with new or trying situations by using reason
Howard Gardner: eight forms of intelligence ◦Bodily kinesthetic: movement ◦Interpersonal: relate to others ◦Intrapersonal: self-reflection ◦Linguistic: auditory ◦Logical-mathematical: “figure things out” ◦Musical: song or musical instrument ◦Naturalistic: natural animal world ◦Spatial: visual
Language development of infants
Infant
◦vocalize by babbling, cooing, and laughing
◦Responds to voices
Language development of one year old
◦Able to say 1 or more words
◦Understands simple instructions
◦Able to respond to their name
Language by age 2
◦Vocab of 50 words
◦Combine 2 simple words
◦Follow one step instructions
◦50% comprehension by others
Language by age 3
◦Combine 3 or more words in sentence
◦75% comprehension by others
Sigmund Freud (psychosexual) ◦Id (instinct), ego (identity and individual function), superego (regulates behavior) ◦
ORAL (Birth to 1 year) ◦Anal (1-3 years) ◦Phallic (3-6 years) ◦Latency (6-12 years) ◦Genital (12-18 years)
Psychosocial Development theory Erik Erikson (stages)
◦Trust vs. mistrust: birth–1 year (trust is learned)
◦Autonomy vs. shame and doubt: 1–3 years (balance independence and self-sufficiency)
◦Initiative vs. guilt: 3–6 years (resourcefulness to achieve and learn new things)
◦Industry vs. inferiority: 6–12 years (sense of confidence through mastery of tasks)
◦Identity vs. role confusion: 12–18 years (forging ahead and acquiring a clear sense of self )
Moral Development Theories:
Perception About Right and Wrong
Jean Piaget: progression of moral thinking in children based on the ability to reason and understand the environment
◦Two stages:
< 11 years old: experience right and wrong as concrete (good or bad)
•> 11 years old: rules are important but are not always absolute or “carved in stone “
Perception of right and wrong
Lawrence Kohlberg
◦Three levels:
- Preconventional : thinking is concrete and egocentric
- Conventional: incorporation of social and interpersonal relationships
- Postconventional: social contract and individual rights and universal principles
Moral Development Theories:
Perception About Right and Wrong (cont’d)
Carol Gilligan
◦Two tracts:
Male: autonomy and justice
•Female: caring and relationship
Newborn and Infant
Birth to 12 Months
Cognitive development Language development Biological development Psychosocial development Moral Development Physical development Discipline Anticipatory guidance
Toddler (1 to 3 Years)
Language development Physical development Cognitive development Language development Psychosocial development Moral Development Discipline Anticipatory guidance
Early Childhood (Preschooler: 3 to 6 Years
Physical development Cognitive development Language development Psychosocial development Moral Development Discipline Anticipatory guidance
School-Age Child (6 to 12 Years)
Physical development Cognitive development Language development Psychosocial development Moral Development Discipline Anticipatory guidance
Adolescence (12 to 19 Years)
Physical development Cognitive development Language development Psychosocial development Moral Development Discipline Anticipatory guidance
Gathering the Child’s Health History
Establish a relationship with the patient and family
•Culturally competent care
•Health Insurance Portability and Accountability Act (HIPAA)
•Asking questions
•OLD CAT
•SODA
Comprehensive Health History of child
Family medical and social history •Past medical history •Immunizations •Developmental milestones •Denver II screening test
Patterns of daily activities
•Sleep
•Nutrition
•Play, activities, and schoolwork
Review of Systems in peds
General •Skin •Head, eyes, ears, nose, and throat •Neck •Chest •Cardiovascular •Gastrointestinal •Genitourinary •Musculoskeletal •Neurological •Endocrine
Health Assessment
•Anthropometric measurements
- Length
- Weight
- Body mass index
- Head circumference
- Skinfold thickness
Vitals in peds
Temperature
•Pulse
•Respirations
•Blood pressure
Physical Assessment
And fontanels?
General assess?
Ear assess?
Eye assessment?
Triangle back of head
Diamond - front of head
General impression
•Skin assessment
•Head assessment
•Neck assessment
Eye assessment
•Visual acuity
•Ocular alignment
•Color blindness
- Ear assessment
- Hearing screening
- Rinne test
- Screening techniques for children
•Nose/sinus assessment
Throat/mouth assessment
- Chest assessment
- Retractions
- Lung assessment
- Breath sounds
- Important respiratory signals
- Cardiac assessment
- Abdominal assessment
Genitourinary and perineal assessment
- Female genitalia
- Male genitalia
- Anal examination
- Musculoskeletal assessment
- Neurological assessment
- Cultural assessment
The Child in Pain
•Pain assessment and management
Appropriate pain scale •Mild, moderate, severe •Acute, chronic •Myths about pain management •Pain management strategies
Wonkers face scale , Flacc for nonverbal
Understanding the child with a disability:
Emotional concerns •Disruption of normal routines •“Bad news” •Financial implications •Developmental concerns •Constant support needed •Regression or “maturity beyond years”
Physical concerns
•Fluid and electrolyte changes
•Procedures that are worrisome or painful
•Lifetime of corrective procedures
•Several different medical specialists may be involved
- Pharmacotherapeutic regimens
- Family must learn to care for the physical needs of the child
Caregiver fatigue
•Disability takes it toll on entire family
•Respite care agencies provide short-term relief
•Multiple visits to clinics, hospitals, or rehabilitation centers
•Extra requirements to accomplish normal daily activities
•Trouble sleeping
- Resiliency
- Nurses can help parents and children develop resiliency and positive self-esteem by fostering a mix of love and nurturing in the face of overwhelming stressors
Several options for the delivery of nursing care in the hospital setting:
Hospital •Children’s hospital •Day hospital •24-hour observation unit •Ambulatory surgery center •Fast-track care •Emergency department •Critical care unit
Reasons for Accessing Medical Care
Epistaxis (nosebleed) •Poisoning due to ingestion of medicine •Common toxic ingestions •Acetaminophen (Tylenol) •Lead poisoning
Ways to Decrease the Stress of Hospitalization
Theuraputic Play
Guided imagery
Role modeling
Parents With a Hospitalized Child
Parents with a hospitalized child often need to debrief and tell their story about the events that led to their child’s hospitalization
•Seeking parental advice about the best way to approach their child, acknowledging parental need for involvement, and anticipating stressful events are integral to appropriately caring for the child in a family-centered manner
•The communication between the pediatric nurse and family members must be genuine, and the plan of care must include resources available in the hospital as well as the community
Holistic Nursing Care for the Child
Bathing
Feeding
Rest
Safety
Medication administration
Infection control
Emotional support
Bathing
•Assess home practices and preferences
•Bathe an infant using a portable tub
•A sponge bath is given to a child who is feeling ill or has tubes, drains, or dressings
•Give a bed bath if a tub bath is contraindicated
•Water temperature should not exceed 100°F (37.8°C)
•Never leave a child alone
•Shampooing is based on family preferences
•Observe parent–child interaction during bath
•Assess language and social skills
•Assess skin and muscle tone
•Bathing is a way for the child to become acquainted with the nurse
Feeding
•Formula-fed infants require no more than 24 to 32 ounces of iron-fortified formula a day
•Assess food preferences for the older child
•Children are prescribed a diet “as tolerated”
•Foods also important for their fluid content
•Encourage parents to bring food from home
•Average daily caloric requirements for children
•0–1 mo: 100–110 kcal/kg/day
•2–4 mo: 90–100 kcal/kg/day
•5–60 mo: 70–90 kcal/kg/day
•> 5 years: 1,500 kcal for first 20 kg + 25 kcal for each additional kg/day
Rest •Assess normal sleep patterns •Allow child and family to “sleep in” •Provide uninterrupted nap time •Safety measures •Keep toxic materials out of reach •Verify child’s identify by checking name band •Know whereabouts of child on the unit •Provide safe environment •Transport child safely
Safety measures (cont’d)
•Restraint devices on highchairs, strollers, and beds are kept in locked and lowest position
•Crib and bed side rails are elevated
•Bubble tops may be needed
•Medication administration
•Consider developmental level of child
•Administering medications to infant may require additional assistance
Medication administration (cont’d)
•Infant needs immediate cuddling and comfort after medication administration
•Toddler may consider medications to be punishment
•To increase compliance of toddler, it may be necessary for nurse to allow parent to administer the oral medications
•Oral medications in cup or syringe can be self-administered by the preschooler under direct and close supervision
•The school-age child is far more cooperative
Medication administration (cont’d)
◦Nurse must be patient and allow time for more complex questions from adolescent
◦ Education of child and parent about medications being administered is important
◦Always use “6 rights” of medication administration (right patient, right medication, right dose, right route, right time, and right documentation
Infection control measures
◦Use good hand hygiene
◦Isolation precautions include standard precautions and transmission-based precautions
◦Use diversionary activities for child in isolation
◦Place isolation guidelines on door with step-by-step instructions
•Fever-reducing measures
◦Antipyretics
◦Environmental measures
Emotional and spiritual support •Be “in the moment” •Convey a caring attitude •Listen •Clarify misconceptions •Help family develop coping strategies
Preparing Children for Procedures
Explaining procedures •Preparing an infant, toddler, preschooler, school-age child, and adolescent for procedure •Distraction •Environment •Preparing the parent •Use developmentally appropriate words
- Provides patient with necessary knowledge to make decision regarding health care
- Implies that person understands benefits and risks of treatment or refusal of treatment
- Legal age is required
- Required before diagnostic procedures, medical treatments or surgical procedures, immunizations, or any treatment with inherent risks
Informed consent
•Dehydration •Fluid maintenance or replacement •Before diagnostic testing •Blood product placement •Medication administration •Preoperatively •Types •Peripheral line •Normal saline locks Types (cont’d) •Central venous access devices •Peripherally inserted central catheter line (PICC) •Vascular access port (Infus-A-Port)
•Monitor for signs and symptoms of infection: change in temperature, erythema, edema, pain at IV site, tenderness on palpation
Intravenous lines
Measuring intake and output
•
Vomiting, diarrhea, fever, NG suctioning, draining wounds, burns, presurgical patients and children with cardiac, renal or respiratory illness
Calculation of daily maintenance fluid requirements
Weight Fluid Requirement
0–10 kg 100 mL/kg of body weight
11–20 kg 1,000 mL + 50 mL/kg for each kg > 10
> 20 kg 1,500 mL + 20 ml/kg for each kg > 20
• Output is 1 to 2 mL/kg per hour
X-ray exams
•
Diagnostic purposes
•Checking tube placement
Specimen collection
•
Urine sample collection •Stool sample collection •Blood sample collection •Throat culture collection •Cerebrospinal fluid collection
Enteral tube feedings
Ostomies
Orogastric feeding tubes
•Nasogastric feeding tubes
•Gastrostomy feeding tubes
Restraining the child
May be necessary to ensure safety during procedure or to prevent injury to operative site
•Inform parents and child why restraint is necessary
•Extremity is checked every 15 minutes for first hour after initial application
•Child must be checked and skin condition documented every 1–2 hours
•Physical restraint
•Elbow restraint
•Papoose restraint
•Pharmacological restraint
•Chloral hydrate (Aquachloral)
There are many places in the community where children and their families can access health care:
Primary health-care provider’s office or clinic •Community centers •Preventative medicine center •Home health care •Medical home •Mobile health care unit •Rehabilitation service •School setting State health program •Department of Health and Human Services •Specialty camps •Churches, synagogues, mosques
Care in the school setting
Provides case management services •Collaborates with other professionals •Instills self-management skills •Works with children who do not have access to primary care, are uninsured, or are homeless •Advocates for children •Encourages parents to immunize •Keeps track of immunizations
- Prevents illness
- Helps children with special needs
- Assists in early identification
- Promotes optimal health and learning
- Helps children maintain good health practices, along with academic success
- Facilitates normal development
- Promotes health and safety
- Intervenes with actual and potential health problems
Benefits of a medical home
Child regularly sees same primary care physician and staff
•Coordination of care for the child
•Open exchange of information in honest and respectful manner
•Support for finding resources and information related to all stages of growth and development and medical conditions
•Family is connected to information and family support organizations
•Medical home partnership promotes health and quality of life as child grows and develops
In a community, there can be one general care clinic or many types of specialty clinics:
- Allergy and asthma clinic
- Audiological clinic
- Cardiology clinic
- Diabetes clinic
- Eating disorders clinic
- Endocrinology clinic
- Gastroenterology—nutrition clinic
- Genetics clinic
Immunology clinic •Infectious disease clinic •Neurology clinic •Oncology clinic •Ophthalmology clinic •Orthopedics clinic •Pulmonary/cystic fibrosis clinic •Rheumatology clinic •Urology clinic
Health screenings
Community settings often provide primary care along with health screening and surveillance
- Health screening is a way to test or examine children for presence of disease, illness, chronic condition, developmental delays, or mental health issues
- Health surveillance is the continuous observation related to tracking health conditions and risk behaviors
- Children are screened for iron-deficient anemia, cholesterol, tuberculosis
The nurse has a key role in health screening and surveillance:
Pay attention to voiced parental concerns
•Ask questions about child’s growth and development
•Observe child’s mental, physical, and spiritual state (not just diagnosed condition)
•Note any risk factors that may be present
•Document specific observations and findings
•Provide community resources and make appropriate referrals
•Track disease incidence and demographics of illnesses
•Implement policies that may prevent further spread of diseases
•Initiate follow-up care for any concerns and conditions
Infants airway info
●Airway of the newborn is narrow
●Obligatory nose breathers; they do not use their mouth for breathing.
●Nonproductive cough
●little respiratory mucus
●susceptible to respiratory infections.
●Tonsils are absent at birth and grow more rapidly in the child than any other tissue. By age 7, the tonsils present at adult size.
Child airway info
Epiglottis of children age 8 and younger is longer and flaccid (floppy), making it more susceptible to swelling that can lead to airway occlusion.
●The thyroid, cricoid, and tracheal cartilages are immature and are easily collapsible with flexion of the neck.
●Fewer functional muscles in the neck, and the increased amount of soft tissue makes the younger child more susceptible to infection and edema.
●The trachea in children is shorter and narrower in diameter than in adults, approximately 4 mm in diameter, while an adult’s trachea is from 18 to 20 mm in diameter.
●Born with 20-50 million alveoli, reaching approximately 300 million by 8 years of age
When assessing the respiratory rate of the pediatric patient, the nurse counts for?
●Rate and depth of respirations can be impacted by:
a full minute.
Crying ●Physical activity ●Anxiety ●Anemia ●Acid-base disturbances ●Fever ●Central nervous system disturbances ●Salicylate ingestion.
Normal resp rate in
preterm?
Newborn?
1 year?
3 year?
6?
10?
14?
18?
preterm? 40-70
Newborn? 30-50
1 year? 20-40
3 year? 20-30
6? 16-22
10? 16-20
14? 14-20
18? 16-20
●Congenital malformation of the nose
●Signs and symptoms
●Difficulty breathing, and therefore eating
●Cyanosis may be evident
●May choke or regurgitate formula/breast milk
●Diagnosis
●Identified by inability to pass firm catheter through each nostril 3 to 4 cm into nasopharynx
●Confirmed by CT scan with intranasal contrast that shows narrowing of posterior side of the nose
Choanal Atresia - bone blocks nasal passage
Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)
ESOPHAGEL ATRESIA
•Congenital discontinuity of esophageal lumen
- Tracheoesophageal FISTULA
- Abnormal community between trachea and esophagus
Common, and very contagious droplet transmission, virus that infects the respiratory tract of most children before their second birthday
•Peaks in the winter months
- Signs & Symptoms
- Fever, Nasal, Wheezing, Congestion, Cough
- 1-2 weeks (No treatment)
- Diagnosis
- enzyme linked immunosorbent assay (ELISA)
- Prevention
- Proper hand washing
- Respiratory Hygiene
RSV Respiratory Syncytial Virus (RSV)
Repair: 2 months/6-12 months
●Feeding:
●Lip: Breastfeeding
●Palate: Special nipple (Haberman)
●Postop: No sucking. Address pain and anxiety
Cleft palate and lip
Return of gastric contents from the stomach through the lower esophageal sphincter into the esophagus.
●Signs and Symptom:
●Irritability and fussiness, dysphagia or refusal to feed, choking, chronic cough, wheezing, apnea, weight loss, bloody vomit or hematemesis.
●Diagnosing GERD
●Through hx and physical examination, barium swallow test, 24 hour intraesophageal pH monitoring study is essential in diagnosing GERD
●Prevention:
●Instructing patients on proper formula preparation, feeding, and positioning the infant during and after feeding.
●Nursing Care:
●Thorough assessment of growth measurements and development patterns. Baseline respiratory status
●Medical Care:
●Pharmacological therapy: Prilosec, Nexium, Protonix. Surgical treatment
Gerd
? or aganglionic megacolon is lack of nerve endings in a small segment of the large bowel. Stool cannot pass this point, so constipation occurs.
●Signs and Symptoms:
●Failure to thrive, poor feeding, chronic constipation, failure to pass meconium within the first 48 hours of life.
●Vomiting, diarrhea, flatus, abdominal obstruction, and explosive bowel movements
●Nursing Care:
●Pre-op assessment of fluid and electrolyte status, placed on NPO status and NG tube is inserted.
●Enema for constipation: isotonic to prevent fluid from shifting from the bowel into interstitial tissue by osmosis, causing water intoxication
●Treatment:
●Surgical resection of the affected bowel with, or without colonoscopy
Hirschsprung disease
Complication during embryonic development of midgut
Signs and Symptoms: abdominal pain, painless rectal bleeding, dark stools, severe anemia, Current “jelly” stool
Diagnosis: based on history, physical exam, radiography, specifically a nuclear medicine scan
Intervention: Surgery, monitoring for shock, blood loss, and providing rest. Pre-op antibiotics and fluid replacement- prevent hypovolemic shock from hemorrhage
Meckel’s Diverticulum
Anpendictis pre and post op
●Pre-op care:
●IV fluids and antibiotics
●NG for rupture
●Post-op care: ●Airway ●Vitals ●Pain management ●Surgical Site assessment ●Bowel activity ●NPO ●NG post rupture
is defined as protrusion of bowel through inguinal canal and is usually evident by a protrusion in the inguinal area and a bulging of the scrotal sac
- Signs and Symptoms: bulge on either side of public bone, buring, gurgling, aching, pain, discomfort, heavy and dragging gestation in groin, weakness or pressure in groin
- Diagnosis: identified by swelling in the inguinal area that extends towards into the scrotum
- Nursing Care: surgical repair- education for parents, and pre/post op care, discharge instructions
- Discharge Instructions: Include informing the parents of wound care and keeping the surgical site clean and dry. Resume normal activities after 4-6 weeks
INGUINAL HERNIA
is the protrusion of the intestines through the abdominal fascia, which is often identifiable during crying, defection or coughing.
- Signs and Symptoms: The majority of umbilical hernias are asymptomatic, umbilical hernias are more prominent with infant is crying
- Diagnosis: identified as a soft midline swelling in the umbilical area, which can be reduced with pressure
- Nursing Care: Most resolve by 3 to 5 years- outpatient surgery
- Discharge instructions: parents instructed to avoid strenuous activities, resume normal diet
Umbilical hernia
Immunizations of childhood
When when and what ages they get them
Hepatitis A and B ●Diphtheria ●Tetanus ●Pertussis ●Measles (rubeola) ●Mumps ●Rubella (German measles) ●Haemophilus influenzae type B ● Pneumococcus ● Polio ● Gardasil or Cervarix (optional) ● Meningitis (usually required before college or dormitory housing) ● Influenza (optional)
Nursing interventions and vaccines
Organizing and carrying out the vaccination program
●Develop and distribute accurate and timely information about vaccines
●Educate parents about possible adverse effects, what to watch for and how to treat it.
Cardiovascular assessment in children
Systemic
●Assess respiratory effort – could be a secondary condition
●Assessment of liver – hepatomegaly could indicate of poor right sided heart function
●Urine output – indicator of cardiac output
●Normal: void several times a day & urine should be light in color
●Edema – retained or excess fluid
●Late sign of heart disease
●Neuro – if child is lethargic or non interactive
●Could be experiencing poor tissue perfusion
Heart defects that increase pulmonary blood flow
Ventricular Septal Defect
●Murmur @ Left Sternal Boarder
●Cardiac Cath to close
●Diuretics
●Atrial Septal Defect ●Loud, harsh murmur ●Diuretics ●Cardiac Cath to close ●Low Dose aspirin following procedure
●Patent Ductus Arteriosus
●Machine murmur
●Wide pulse pressure
●Bounding pulses
Heart disorder that decrease pulmonary blood flow
Tricuspid Atresia
●Cyanosis
●Clubbing
●Three stages of repair (shunt, Glenn, Fontan)
●Tetralogy of Fallot
●Pulmonary Stenosis, VSD, Overriding Aorta, Right Ventricular Hypertrophy
●Stents, complete repair by 1
●Diagnostic or interventional procedure where one or more small catheters are passed through a large vein or artery into the heart.
●Used to treat…
●Septal defects, narrowed valves or vessels, stent placement, closure of collateral or abnormal vessels, placement of artificial values, and myocardial biopsy.
●*Preprocedural assessment…
●No upper respiratory tract infection or fever
●Assess for baseline vital signs
●Laboratory values should be collected
●Families should have a large amount of support from health care personnel
Cardiac Catheterization
slowly developing
Signs and Symptoms: Low-grade fever, malaise, loss of appetite, muscle aches, night sweats
Diagnosis: medical history and a physical exam, recent fever, chills, or flu-like symptoms lasting more than 2 weeks, Blood Cultures
commonly seen in patients with an unrepaired congenital heart defect or valve disease
Cause of infection: invasive procedure
Nursing Care: support good oral hygiene and taking preventive antibiotics
BACTERIAL ENDOCARDITIS
heart muscle to become enlarged, inflamed, thick or rigid = HEART FAILURE
●Signs and symptoms: Weakness, excessive tiredness , shortness of breath, exercise intolerance, heart palpitations, chest pain, poor feeding, slow weight gain, syncope (fainting), light-headedness.
●Diagnosis: complete physical examination; ECG, Cardiac Cath
●Nursing Care:
●Monitor the patient’s cardiovascular status and vital signs to be alert to any evidence of decompensation
●Assess Oxygenation, Apply O2 as needed
●Encourage rest and minimize stress
●Monitor for s/s of heart failure
●Educate patient on low-sodium diet (DASH diet), avoiding processed or canned foods
Cardiomyopathy
●Mucocutaneous Lymph Node Syndrome
●Cause: Unknown
●Diagnosis: ECG
●Treatment:
●Gamma Globin (antibodies)
●Aspirin (platelets)
Kawasaki disease
Occurs when the heart is unable to pump blood as well as it should.
●Signs and symptoms: Poor feeding; poor growth, irritability, shortness of breath or excessive sweating; in advanced stages, an enlarged liver or edema develops
●Babies and toddlers exhibit: Puffy eyelids, swelling of hands and feet, bulging fontanelle
● Diagnosis: weight gain, or changes in breath sounds; blood pressure and pulses may be diminished
●Nursing Care
●Implement Oxygen therapy as needed
●Provide good skin care
●Monitor blood pressure
●Restrict sodium intake
●Administer diuretics as prescribed
●Monitor edema
●Medication: Digoxin
●Give as prescribed
●Check pulse rate daily (infant 90, Child 70
CHF
Endrocrine system in child
Controls what
Regulates ?
●Endocrine system is composed of multiple organs throughout the body.
●The hypothalamus, pituitary gland, thyroid, parathyroids, adrenal glands, pineal body, and reproductive glands (ovaries and testes)
●The endocrine system controls a child’s growth and development.
●Hormones regulate a child’s response to stress and physical trauma.
somatrotropin, naturally occurring ●Essential for growth, development, cellular metabolism ●Hypopituitarism, diminished GH ●Other hormones: ●Adrenocorticotropic Hormone ●Thyroid Simulating Hormone ●Gonadotropins ●Symptoms: ●Short Stature, but proportional height/weight ●Delayed epiphyseal closure ●Delayed dentition ●Delayed sexual development
Human growth hormone (GH),
MOST common in adolescents, rare in children under five.
●Nursing care
●Goal is to restore thyroid gland functioning in which production of thyroid hormone is at normal levels
●Recognize signs and symptoms of both hyperthyroidism and hypothyroidism
●Monitor for and report any sudden onset of restlessness, fever, diaphoresis, and tachycardia in case of thyroid storm
Graves’ disease
Result of extended exposure to increased levels of cortisone. In young children, often caused by an adrenal tumor or prolonged steroid therapy
●Nursing care
●Steroid therapies may need reduction to lowest possible level needed for underlying condition
●Cortisol production inhibitors
●If surgery not possible, radiation therapy is used
●If surgical intervention is needed
●Fluid hydration
●Pain control
● Medication regimens; cortisol replacement if needed
Cushing s disease
ARDs
S/s
Causes
ABGs
Tachycardia Dyspnea Retractions Hypoxia Decrease pulmonary compliance
Decrease Po2
Increase dyspnea
Racing heart and sob
Causes- trauma Pulmonary infection Aspiration Bypass Shock Fat emboli sepsis
A nurse is caring for a 6 w/o who has a pyloric stenosis. Which of the following clinical manifestations should the nurse expect?
Projectile vomiting
A nurse is caring for a child who has a suspected diagnosis of cystic fibrosis. Which of the following diagnostic tests will confirm the diagnosis?
sweat chloride test 85meq
Air raid
Airway inflammation or obstruction
Increased pulse
Restlessness
Retractions
Anxiety
Inspiratory stridor
Drooling
Tx?
Epiglottis
Don’t examine throat Decrease anxiety Position for comfort Teach tube Cool mist - warm would catch infection
Oxygen
Nonoral fluids
IV fluids
LTB croup
Slow onset
Barking cough
3 m to 3 years
URIs
Restless
Retractions
Hypoxic
Fever
Night is worse
Stridor on inspiration
Crowing sounds
Cystic fibrosis tx
?
A nurse is caring for a child who has bronchiolitis. Which of the following are appropriate actions for the nurse to take? (Select all that apply)
C. Administer humidified oxygen
D. Suction the nasopharynx as needed
A nurse is planning care for a child who has asthma. Which of the following interventions should the nurse include in the plan of care. (Select All that Apply)
A. Perform chest percussion B. Place the child in an upright position C. Administer oxygen saturation D. Administer bronchodilators E. Administer dornase alfa daily. B. C. D.
A: NOT correct. Why? the nurse should use chest percussions to promote movement of mucus plugs for a child who has cystic fibrosis
B. Correct: child who is experiencing asthma exacerbation has decreased oxygenation so you put them upright to promote ventilation
C. Correct: child who is experiencing asthma exacerbation has decreased oxygenation. So you much monitor oxygen saturation
D. Correct: Correct: child who is experiencing asthma exacerbation experience bronchoconstriction. so give them a bronchodilator to promote ventilation
E. NO: you should administer donate alfa for a child who has cystic fibrosis to have the removal of respiratory secretions
Gastrointestinal conditions
Left lip and palate, gastrointestinal reflux disease, hypertonic pyloric stenosis s, Hirschsprung’s disease, Appendicitis, incussusception , meckels diverticulum , hernias , dehydration
Pattern of normal feeding a new onset bilious vomiting
Projectile vomiting
Valve between the stomach and duodenum results and the inability of food to pass through the valve
Diagnosis how?
Nursing care
Tx?
Diagnosed by palpating in pyloric mass
Careful history and assessment of the child monitor for alkalosis
Surgery correct the disorder my enlarging the size of the valve
Occurs when one portion of the intestines telescopes into another portion
Abd acute pain
Colicky, fever, dehydration, abd distention, lethargy
Diagnoses:
Sausage shaped mass in upper right abdomen
Intussuception
Sudden pain relief in appendicitis’s May indicate what?
Point?
Rupture
Mcbutrneys point
Rebound pain RLQ
Increase WBCs
Mild, moderate, severe dehydration?
Mild - vs are WNL 3-5% wt loss
Moderate - vs changes tachycardia, hypotension , decreased years
Severe - tenting , indented fontanels, eyes sunken , no tears , over 10% wt loss
Nursing role in vaccinations
Ensure up to date immunizations for all children based on heath status
Vaccination Produced when the disease causing microbes killed but is still capable of inducing the human body to produce antibodies
In activated vaccines
Vaccine is made by using a disease causing organisms that is not killed but is growing under special conditions designed to degrees viruses
Live vaccines (mmr, varicella)
Used in an in activated form and has been treated with either heart or a chemical to weekend it’s toxic effects
Toxoid vaccines
Use only a portion of virus or bacteria them to to produce the desired immuno logical response
Submit vaccines
Pertusis
Uses genetic engineer in to insert the jeans for production of the antigens desired to low virus vector
Recombinant vaccine (hbv)
Lesions appear in waves so different stages are present at any one time
Crusts are infectious but do not exists for 6 weeks
Smallpox appears all at once
precautions? Vaccine
Varicella
Chickenpox
Direct contact , droplet , items
Hepatomegaly could indicate what
Poor Rt sided heart failure
Indicator of cardiac output
Urine output
Should be light in color several times a day
Edema is late sign of what
Heart disease
When to do neuro exam
If child is lethargic or non interactive
Could be poor tissue perfusion
Most common dysrhythmia
Child may report racing or pounding heart lightheaded
Manage with beta blockers
STV
Growing problem problem is US
Management of HTN
Underlying issues fix
Ace inhibitors , arbs , beta blockers , diuretics, Valium channel blockers , vasodilaters
Rheumatic Fever
Involuntary movements of limbs and face that affect speech
Cartitis - inflammation of heart
Abd pain
Swelling joints and pain
Red skin lesions
Fever and sore throat
Red lips
Strawberry tounge
Fever greater than 102.2
Pallor
Red soles and palms
2-12 weeks
And pain
Rash over trunk and perineal area
Irritability
Lethargic
Conjunctivitis
Kawasaki disease
Intolerance to heat
Fine straight hair
Bulging eyes
Facial flushing
Enlarged thyroid
Increased bp
Edema
Breast enlargement
Wt loss
Finger clubbing
Menstural changes
Hyperthyroidism
When born with inadequate thyroid hormone
Severe mental and physical disorders may occur if not tx immediately
Congenital hypothyroidism
Moon face
Chubby
Osteoporosis
Purple strae
Thin skin
Edema
Infection increase
Cushings
Too much ADH hormone (water retained) leads to hypocalcemia which leads to HF, brain injury or hypothalamus damage
Diagnosis by checking K or NA levels
To: vasopressin
S/s: seizures , memory issues , cramps , depression , vomiting
Syndrome of inappropriate antidiuretic hormone secretion
Diabetes insipidus
??
Diabetes mellitus
?
Three ps
Insulin pumps
Given for steady release through tour day
Parent education with insulin
1-4 injections per day
