Unit One Flashcards by Bethany Koehle

A paternalistic approach with a narrower perspective; care team is viewed as having the expertise.

Health care team puts together a plan of care in which they (the healthcare team) deem to be in the patients and families best interest. The patient/family is minimally involved in the assessment and planning but then expected to follow through with recommendations

Family Focused Care

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A collaborative approach with a broader perspective.

Family is involved in all phases of assessment and planning; the team and the family each bring a different but essential and respected expertise to the table.

Family Centered Care

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Erikson’s Stage
Trust v. Mistrust
“Can I trust the world?”

Infancy (birth to 18 months)

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Erikson’s Stage
Autonomy v. Shame & Doubt
“Is it OK to be me?”

Early Childhood (18 months - 3 years)

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Erikson’s Stage
Initiative v. Guilt
“Is it OK for me to move, act, and do?”

Preschool ( 3 - 5 years)

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Erikson’s Stage
Industry v. Inferiority
“Can I make it in the world?”

School Age (5 - 12 years)

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Erikson’s Stage
Identity v. Role Confusion
“Who am I and who can I be?”

Adolescence (12 - 18 years)

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Which age group has a calorie requirement of 125-155/kcal/kg/day?

Preemies

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Which age group has a calorie requirement of 105 kcal/kg/day?

Infants

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Which age group has a calorie requirement of 90-100 kcal/kg/day?

Toddlers

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Which age group has a calorie requirement of 80-90 kcal/kg/day?

Preschoolers/School age

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Which age group has a calorie requirement of 2100-2700 cal/day (females) and 2700-2800 cal/day (male)

Adolescents

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Reflex - when infant’s cheek is stroked, the infant turns to the side, searching with mouth

Appears at birth and disappears at 3 months

Rooting reflex

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Reflexive sucking when nipple or finger is placed in infant’s mouth

Appears at birth and disappears at 2-5 months

Sucking reflex

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Reflex - with sudden extension of the head, the arms abduct and move upward and the hand form a “C”

Appears at birth and disappears at 4 months

Moro reflex

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Reflex - infant reflexively grasps when palm is touched

Appears at birth and disappears at 4-6 months

Grasping reflex

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Reflex - stroking along the lateral aspect of the sole and across the plantar surface results in fanning and hyperextension of the toes

Appears at birth and disappears at 12 months

Babinski reflex

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Infants ________ their weight by 4 months of age & _________ their birth weight by 1 year

Double; Triple

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Age Group Growth Needs:
-Gain 15-30g a day
-No juice or water - Pedialyte can be given
-Good at self-regulation
-Sleep 15-20 hr in 2-3 hr increments

Newborns - 6 months

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Age Group Growth Needs:
-Decrease growth velocity to 2oz/week
-Need protein, fruit, & veggies
-Teething begins now (7mo) and usually ends by age 3
-Sleep 9-14 hr with 2-2.5 hr naps; naps may decrease

6 months - 12 months

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Age Group Growth Needs:
-Eat approximately 7 times a day - “grazers”
-Transition to milk

Toddlers

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Age Group Growth Needs:
-Structure meal times & snacks
-Limit juice to 4-6oz per day
-Normal to play with food as they learn about texture and tastes

Preschoolers

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Age Group Growth Needs:
-Decreased caloric requirements
-Advise 2-3 glasses of low fat/skim milk per day
-Encourage physical activity (60 min/day) & limit TV (no more than 2hr/day)
-Don’t use food as a reward
-18% are obese & 18% are underweight

School age

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What temperature is considered a fever in pediatrics?

100.4 F or 38. 0 C

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Which form of temperature taking is most accurate for children under 2?

Rectal

Which medication should not be given to children under the age of 6 months due to an increased risk of renal damage?

Ibuprofen

Hep B vaccine is given individually at which age?

At birth

These vaccines are given at which age? Hep B, DTap (Diphtheria/Tetanus/Pertussis), HIB (Haemophilus influenzae type B), Polio, PCV (pneumococcal conjugate), RV (rotavirus)

2 months

These vaccines are given at which age? DTap (Diphtheria/Tetanus/Pertussis), HIB (Haemophilus influenzae type B), Polio, PCV (pneumococcal conjugate), RV (rotavirus)

4 months

These vaccines are given at which age? Hep B, DTap (Diphtheria/Tetanus/Pertussis), HIB (Haemophilus influenzae type B), Polio, PCV (pneumococcal conjugate), RV (rotavirus), flu shot

6 months

These vaccines are given at which age? DTap, HIB, PCV, MMR (measles, mumps, rubella), varicella, Hep A, flu shot

12-18 months

These vaccines are given at which age? DTap, Polio, MMR, Varicella

4-6 years

When are the side effects of live vaccines usually seen?

2 to 4 weeks after administration

Where are vaccinations administered for infants and young toddlers?

Vastus lateralis

Where are vaccinations administered for children 18 months and older?

Deltoid

Childhood Infections: -Highly contagious -Affects kids 2-6 years -Most common in summer -Common sites: mouth/face/hands -Yellow honey crusted -Common bacteria: Staphylococcus aureus; Streptococcus pyogenes

Impetigo

Childhood Infections: -Caused by Parovirus B19 -Common in kids 5-15 years -Contracted when Parovirus B19 spreads through respiratory secretions -Treatment: comfort measures (fluids/rest/Tylenol/ibuprofen) -Presentations: red rash on the face; after a few days the rash spreads to the trunk, arms and legs; has a lacy appearance -S/S: low grade fever, cold like symptoms, muscle aches

Erythema Infection (Fifth disease)

Childhood Infections: -Caused by Epstein-Barr virus (EBV) -Clinical presentation: fever, sore throat, extreme malaise, enlarged lymph nodes (neck), splenomegaly -Incubation period is 4-6 weeks --> symptoms may not be seen until after 4-6 weeks -Primarily affects adolescents -Treatment: rest/fluids/Tylenol/ibuprofen

Mononucleosis (Mono)

Childhood Infections: -Clinical presentations: Appears 10 to 21 days after exposure to the virus and usually lasts about 5 to 10 days. -Prodromal: fever & malaise -Rash: appears first on trunk & face; spreads to rest of the body; causes extreme itching -Diagnosed by rash -Complications: bacterial infections of skin; shingles in adulthood

Varicella-Zoster

Childhood Infections: -Viral -Transmission: contact & droplet -Clinical Manifestations: Initial --> fever, sore throat, poor intake 1-2 days --> painful ulcers in mouth 1-2 days later --> rash on palms of hand and soles of feet -Treatment: comfort care; usually treated outpatient

Hand Foot & Mouth Disease

Childhood Infections: -Bacterial (contagious, sticky pus) -Viral (contagious, watery discharge, burning, red) -Treatment: eye drops

Conjunctivitis (Pink eye)

Childhood Infections: -Spreads easily & quickly -Nits (eggs) -Causes itching -Treatment: lice shampoo; wash all linens

Pediculosis Capitis (head lice)

Childhood Infections: -Diaper rash area becomes irritated from chemicals & enzymes in urine and feces -Erythema w/possible small vesicles -Yeast --> beefy red w/papules and/or pustules -Treatment: cream, powders, frequent diaper changes

Dermatitis (Diaper Rash)

Childhood Infections: -Greasy and scaly on scalp and in body folds -Caused by a yeast organism -Loosen the scales with a small, soft-bristled brush or fine-toothed comb before rinsing off the shampoo

Seborrheic Dermatitis (cradle cap)

Baby acne is known as...

Acne neonatorum

Teenage acne is known as...

Acne vulgaris

Developmental Milestone: -Gross motor: head lag (poor head control) -Fine motor: reflexes -Language: responds to touch and voices; sensory motor communication -Social/Cognitive: find safety with caregiver and looks at faces

1 month

Developmental Milestone: -Gross motor: kicks legs as response; raises head when prone -Fine motor: grasp reflex diminishes -Language: responds to sounds and begins making sounds -Social/Cognitive: smiles and coos when seeing familiar faces

2-3 months *remember: 2 legs kick at 2 months*

Developmental Milestone: -Gross motor: no head lag; ___ month rolls from front to back -Fine motor: grasps objects; other reflexes begin to diminish such as Moro reflexes -Language: mimic sounds heard; change cry tone for different needs -Social/Cognitive: soothe by caregiver voices; copies expression; cries when they don't get their way

4 - 5 months * 5 month rolls from front to back *

Developmental Milestone: -Gross motor: birth weight doubles; roll from back to front; can sit up unsupported; can pull self up -Fine motor: can hold a bottle with both hands -Language: babble words; responds to their name -Social/Cognitive: identifies faces; separation anxiety starts

6 - 9 months

Developmental Milestone: -Gross motor: can go from prone to sitting position -Fine motor: pincer grasp; transfer objects from hand to hand -Language: able to make more sounds; mimics gestures; understand yes or no -Social/Cognitive: vocalization and speech improve

10 - 12 months

Developmental Milestone: -Gross motor: birth weight triples; sit down from standing; crawl up stairs -Fine motor: fully develops the 2-finger pincer grasp; try to build a block tower; attempt to turn book page -Language: 3-5 words; begin non-verbal communication -Social/Cognitive: stranger danger begins; can follow simple directions; object permanence begins

12 months

Developmental Milestone: -Gross motor: walk up and down stairs while holding a hand; throw balls; jump with both feet -Fine motor: turn 2 pages in a book (uncoordinated); holds cup and spoon -Language: can say 10 words -Social/Cognitive: think angry babies; everything is theirs (in their mind); parallel play

18 months

Developmental Milestone: -Gross motor: walk with help; run and kick a ball; walk up stairs independently -Fine motor: build tower of 7 blocks; open doors -Language: say their first and last name; 300+ words; 2-3 word sentences -Social/Cognitive: imitates adult behavior

2 years

Developmental Milestone: -Gross motor: use tricycle; walk upstairs w/alternate feet -Fine motor: spoon feeds self; undress themselves -Language: 3-4 word sentences; asks "why"; knows age -Social/Cognitive: associative play; have imaginary play

3 years

Developmental Milestone: -Gross motor: skip/hop on 1 foot; climb and jump -Fine motor: can pour drink and make food; draw 4-sided shapes -Language: able to tell stories; can memorize the alphabet and numbers -Social/Cognitive: likes to play dress up and more involve imaginary play; plays well with others

4 years

At what age does the anterior fontanelle close? Posterior fontanelle?

Anterior: 18 months Posterior: 2 months

How many inches in length does an infant grow for the first 6 months?

1/2 to 1 inch every month for the first 6 months

When and where do an infant's first teeth come in?

They come in in their lower central incisor around 10 months of age

At what age should the child begin to gain about 4-6 pounds per year and should be about 4x their birth weight?

2 years old

At what age should the child begin to increase their height by 2-3 inches per year and should be about half of their adult height? *The average height by this age is 33-34 inches

2 years old

When should head-chest circumference be equal in a child?

12-24 months

Which age group practices ritualism (wants things done the same way every time), rivalry (especially with siblings), and regression (revert back to infant skills)

Toddlers

Which age group practices negativism (doing the opposite of what is being asked)?

Toddlers

Which age group gains 5lb/year (average 42lbs), and grows 3in/year (average 44 in)

Preschoolers

Developmental Theory: Age group: 2-7 years Still egocentric like toddlers Literal thinkers Animistic

Piaget Preoperational

Which age group starts to develop a fear of things? (Afraid of hospitalization, fear that hospitalization is due to punishment, fear of mutilation of their body)

Preschoolers

At what age does associative play occur?

3 years old

At what age does cooperative play occur?

4-5 years old

What is the first sign of puberty changes in a female?

Breast bud development

When does the respiratory system develop in a fetus?

Development of the respiratory system is complete just prior to birth

Which organ takes care of oxygenating the fetus in utero?

The placenta

What initiates breathing for the fetus during the birthing process?

The respiratory center is in the medulla and is stimulated to initiate to breathe; a decrease in oxygen and increase of carbon dioxide in the blood also stimulates respiratory center

What are the differences between pediatric and adult respiratory anatomy?

- Bronchi and bronchioles are much smaller - airway of an infant is about the size of a cat's airway - Few alveoli - More flexible trachea - Tonsils and lymphoid tissue enlarged - Larger heads and tongue - Obligate nose breathers

What is the normal respiration rate for an infant?

30-60 bpm

What are the cardinal signs of respiratory distress in pediatrics?

- Restlessness - Increased respiratory rate - Increased pulse rate - Retractions Other signs include: - Nasal flare - Grunting - Adventitious or absent breath sounds - Use of accessory muscles/head bobbing

What is the hallmark symptom seen that differentiates respiratory distress from respiratory failure?

Change in mental status

What does the mnemonic WETFROG stand for?

W - wheezing E - effort T - tachycardia F - flaring (nasal) R - retractions O - oxygenation G - grunting

- Most common infection in children - Most common cause is bacterial but can sometimes be viral - Caused due to pediatrics having horizontal and shorter eustachian tubes - If viral, can be resolved on their own. Bacterial will need to be treated with antibiotics - Repeat infections may require tympanostomy tubes (ear tubes)

Otitis media (ear infections)

- Infection of the outer ear canal - Pruritus, erythema, ear pain and drainage - May require antibiotics and corticosteroids

Otitis externa (swimmer's ear)

- Inflammation of sinuses - Bacterial, viral, or fungal in nature - Must have symptoms for at least 7-10 days before sinusitis can be accurately diagnosed - Antibiotics for treatment - Sinus rinsing - prevention

Sinusitis

- Inflammation of tonsils - Bacterial or viral - strep is common culprit - If strep is negative - supportive care only - If strep is positive - treat with penicillin - Repeat strep infections may require removal

Tonsillitis

- Inflammation of the epiglottis - Medical emergency - 4 D's - Characterized by tripod positioning and child drooling - Intubation required and corticosteroid administration

Epiglottitis

What are the 4 D's?

- Dysphagia (difficulty swallowing) - Dysphonia (hoarseness or difficulty speaking) - Drooling - Distress (difficulty breathing or lack of oxygen)

- Inflammation of larynx - Caused by parainfluenzae virus, influenza A & B, RSV and mycoplasma pneumonia (or many other respiratory viruses) - Most common in kids ages 3m-3y - Seal-like cough is cardinal symptom; also have stridor - Treatment: epinephrine, corticosteroids, humidified air/oxygen - Avoid upsetting child - may worsen

Croup (laryngotracheobronchitis)

- Abnormal communication between trachea & esophagus - can occur with esophageal atresia - Diagnosis is usually made in utero - Surgical repair is done shortly after birth - May require surfactant, ECMO, and mechanical ventilation

Tracheoesophageal fistula (tef)

- Abnormal laryngeal cartilage - May partially occlude upper airway causing stridor - Most outgrow by age 2 - Educate on feeding, positioning, and worsening symptoms

Laryngomalacia

- Inflammation of bronchioles - Viral or bacterial (viral is most common) - Most common virus is RSV - Increased mucus production and inflammation - Suctioning, oxygen, and hydration - Immunization for preemies

Bronchiolitis

- Inflammation of lung parenchyma - Bacterial, viral, allergic, fungal, or aspiration - Antibiotics usually needed; supplemental oxygen - Pneumococcal vaccine

Pneumonia

- Bacterial infection caused by Bordetella pertussis - Most severe in infants under 2 months - Paroxysmal cough is cardinal sign - which causes bradypnea and bradycardia - Treatment: azithromycin - DTap and Tdap vaccines have decreased incidence

Pertussis (whooping cough)

- Multisystem disorder of exocrine glands, leading to increased production of thick mucus - mucus is about 3x as thick as a healthy person's mucus - Autosomal recessive trait - Affects bronchioles, small intestines, pancreatic & bile ducts, reproductive organs, liver - Chronic use of accessory muscles leads to development of barrel chest

Cystic fibrosis

How is cystic fibrosis diagnosed?

- Sweat test - cardinal test - Fecal fat collection - presence of steatorrhea - Chest x-ray - DNA analysis of amniotic fluid in utero - Meconium ileus in newborns

What does the assessment of a patient with cystic fibrosis include?

- Physical assessment: airway, breathing - PFTs (pulmonary function tests) - History of respiratory infections - Nutritional status - Social issues

These interventions are implemented for which diagnosis? - Monitor for respiratory distress - Encourage coughing and deep breathing - Administer meds - Provide high calorie diet - Give pancreatic enzymes - Administer fat-soluble vitamins - Avoid pulmonary treatments immediately after meals

Cystic fibrosis

- Chronic inflammatory disorder of lower airways - Characterized by hyper-reactivity to stimuli which results in spasms of bronchial muscles - Increased respiratory effort and increased airway resistance - Bronchial smooth muscle constricts, edema in the lower airways and production of thick mucus increases - Expiration is impaired

Asthma

How is asthma diagnosed?

- Reversible airway constriction (pulmonary function tests) 20% improvement after bronchodilator administration - Chest x-ray - Presence of wheezing and dry cough - Repeated episodes

- Chronic obstructive pulmonary disease occurring in infants after prolonged oxygen therapy and mechanical ventilation - Usually NICU babies or graduates - Possibility of lifelong oxygenation issues

Bronchopulmonary dysplasia

- Sudden, unexpected death of infant under 1 year during sleep - First symptom is cardiac arrest - Autopsy reveals pulmonary edema - Prevention is key: back to sleep; firm mattress; avoid loose bedding; no toys in crib

SIDS (sudden infant death syndrome)

What is the normal flow of the heart?

Superior and inferior vena cava bring oxygen-poor blood to the right atrium --> right ventricle --> pulmonary artery to the lungs Reoxygenated blood leaves the lungs moves through the pulmonary veins to the left atrium --> left ventricle --> aorta --> rest of the body

S/S associated with heart defects: - Pink-typically normal oxygen saturations - May be asymptomatic - Blood shunts from left to right - Symptoms include: Fatigue Feeding difficulties Respiratory distress

Acyanotic Defect

S/S associated with heart defects: - Cyanosis - Abnormal oxygen saturations - Feeding difficulties - Failure to thrive - Tachypnea - Clubbed fingers

Cyanotic Defect

Heart Defect: - One great vessel leaving the heart instead of aorta and pulmonary artery - VSD present - Cyanosis is early sign, tachypnea, diaphoresis, CHF - Treatment: surgery (separating pulmonary arteries from main truncus; Close VSD; Create connection between right ventricle and pulmonary arteries) -Causes oxygen-poor and oxygen-rich blood to mix in the same artery

Truncus Arteriosus

Heart Defect: - The aorta and pulmonary artery are reversed - Results in 2 separate circulatory systems that do not mix (pulmonary artery comes off the left side instead of the right) - Profound cyanosis due to the lack of oxygen from the reversed great arteries - Prostaglandins to keep PDA open to allow mixing of blood

Transposition of Great Arteries (TGA)

What are the treatment options for TGA?

- Balloon atrial septostomy - Arterial switch within first week or two of life

Heart Defect: - Narrowing of the aorta - Will get worse if PDA closes - try and keep open - Blood pressure increased in upper extremities and decreased in lower extremities - At risk for aortic rupture, aortic aneurysm - Difficulty feeding, chest pain (older children with mild defect), easily fatigued, poor perfusion to lower extremities

Coarctation of the Aorta

Heart Defect: - Left side of the heart is underdeveloped - Right ventricle overworked - PDA must be kept open - Low oxygen saturations = cyanosis (Avoid oxygen supplementation Treatment: - Heart transplant - Staged reconstruction (3 surgeries) - Palliative Care

Hypoplastic Left Heart Syndrome (HLHS)

What are the three staged reconstruction surgeries for hypoplastic left heart syndrome (HLHS)?

- The Glenn (completed around 3-6 months of age) - The Fontan (completed around age 2-3) - The Norwood (completed around age 5-7)

Heart Defect: - 4 Defects (Right ventricular hypertrophy, Aorta displacement, Pulmonary stenosis, Septal defect (ventricular) - Limits blood flow to lungs - Appear cyanotic, especially as PDA closes - "Tet spells" - Surgically repaired

Tetralogy of Fallot

Heart Defect: - Blood flows from the aorta to pulmonary artery - This is a normal finding in utero but should close on own after birth - If not, extra blood flow to the lungs can overload the lungs - Symptoms: fast breathing, a hard time breathing, more respiratory infections, tire more easily, poor growth - Treatment: ibuprofen, surgery/cardiac cath

Patent Ductus Arteriosus (PDA)

Heart Defect: - Hole between right & left atria - seen in utero but should close after birth - Left to right shunting - oxygenated blood mixes with deoxygenated blood - Typically asymptomatic - Treatment: may close on its own, cardiac catheterization, open-heart surgery - Many kids go years without detection - chronic high BP readings are an indicator

Atrial Septal Defect

Heart Defect: - Hole between right and left ventricles - Most close on their own, especially if small - Left to right shunting - Can be asymptomatic - Shortness of breath, feeding difficulties, failure to thrive - Treatment: none if no signs of CHF, Digoxin, Surgery

Ventricular Septal Defect

Which areas are the most common sites of fractures in children?

Distal radius Hand Elbow Clavicle Radius Tibia

A type of fracture that occurs when a bone breaks into three or more pieces - caused by serious trauma such as a car accident or fall from a great height Most commonly occur in the long bones

Comminuted fracture

Occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone - "chip fracture" commonly seen in the elbow

Avulsion fracture

Occurs when one of the bones is broken with a twisting motion - creates a fracture line that wraps around the bone and looks like a corkscrew May be seen in child abuse situations; children injured in jumpers

Spiral fracture

A partial break in a bone that occurs when a bone bends and cracks, rather than breaking into multiple pieces. Most common fracture in children

Greenstick fracture

Why do children heal faster from fractures?

The periosteum is stronger, thicker and more flexible in children

What are the 5 P's that should be assessed for compartment syndrome?

Pain Pallor Paralysis Pulselessness Paresthesias

What are some complications of fractures in children?

Osteomyelitis Fat embolism Compartment syndrome

What type of medication can be given to patients who are experiencing pain from fractures/traction?

Muscle relaxers

Which assessments should be completed for a child with traction?

- Assess the equipment - Assess the child's alignment - Assess skin - Assess extremity - Pin care - Pad under the extremity

- Caused by a shortened Achilles tendon, which causes the foot to turn in and under - Congenital abnormality where the foot is twisted out of its normal position - Unknown etiology (risk factors include a parent or sibling with the same abnormality, maternal smoking during pregnancy, and male) - Involves muscles, tendons, and bones - Treatment: serial casting, corrective surgery

Club foot

- Abnormal development of the hip socket - Can be congenital (born with weakened hip muscles) or developmental (improper swaddling) - Unilateral in 80% - Can self resolve - Treatment: Plavick harness, Spica cast (hygiene care is priority)

Hip Dysplasia

- Deviation from normal spinal alignment - Idiopathic or Compensatory (uneven leg length - having one leg shorter than the other causes the hips to tilt; shoulders tend to tilt the other way to compensate) - Occurs more in girls than boys - Usually becomes noticeable during a growth spurt - S/S: Truncal asymmetry, Uneven shoulder & hip height, One sided rib hump, Prominent scapula Treatment: Exercise treatment (mild); Bracing with Boston Brace (moderate); Spinal fusing surgery (severe)

Scoliosis

- Brittle bone disease - S/S: multiple and frequent fractures; blue sclera; thin, soft skin; short stature - Treatment: supportive care, gentle, calcium, Vitamin D

Osteogenesis Imperfecta

- Degeneration of muscle - Group of inherited conditions (Dystrophin gene found on X-chromosomes - more common in males) - Progressive muscle weakness and wasting - Gowers sign: when laying flat on stomach, they use their arms instead of hip and legs due to weakness - Most common - Duchenne (start to see symptoms around the age of 5 - stumbling while running, can't run and kick a ball) - Late S/S: wheelchair, respiratory failure (weak diaphragm), scoliosis, dilated cardiomyopathy, arrhythmias

Muscular Dystrophy

- Term for range of nonspecific clinical symptoms characterized by abnormal motor patterns and postures (loss of coordination) - Often no specific cause identified - Most common movement disorder of childhood (Lifelong condition; higher rates in premature and low birthweight infants)

Cerebral Palsy

What are the normal vital signs for infants (0-12 months)?

HR: 100-180 Blood Pressure 72/37 - 104/56 RR: 30-53

What are the normal vital signs for toddlers (1-2 years)?

HR: 90-140 BP: 86/42 - 106/63 RR: 20-37

What are the normal vital signs for preschoolers (3-5 years)?

HR: 80-120 BP: 89/46 - 112/72 RR: 20-28

What are the normal vital signs for school-age (6-9 years)?

HR: 75-118 BP: 97/57 - 115/76 RR: 18-25