PEDS week 3 (Ch 3, 5, 19,20)

adjusted age formula

1month=4.5 weeks, full term=40 weeks

chronological age-weeks premature= adjusted age in weeks

adjusted age formula until….

what should we not adjust?

age 3

vaccine schedule

assessment of genetic disorders

skeletal, vision/hearing, skin, metabolic, internal/external six development

growth abnormalities (not flexing with curve)

recurrent infections, immunodeficiencies

speech delay, behavior

loss of miletones

adaptive tasks for parents with chronically ill children

accept child, manage condition daily, meet childs developmental needs

cope (ongoing), build a support system

educate others

time of periods of anticipated stress for parents with chronically ill children

diagnosis, developmental milestones, starting school, recognizing limitation

adolescence, childhood, death

support for siblings of chronically ill children

promote relationship

help siblings cope

involve them- teach them about disorder, ask to get supplies, visit child

normalization

adapting environment for a child with a disability so every child can have a normal experience reguardless of diagnosis

age appropriateness

integrating disabled kids in class with kids their age

encourage child engagement in age-appropriate activities- reorient them to whats normal

positive v negative coping behaviors of parents of children with disabilites

positive= educating others, doing research

negative=in denial, self-harming, ignoring or hurting child

CI and Intellectual disability

restrictions in intellectual functioning, adaptive functioning, and a disability that originates before the age of 22

early signs of cognitive impairment

dysmorphic syndrome (downs, fragile x, FXS)

irritability/non responsiveness to environment

breathing/feeding difficulties

gross or fine motor delay

speech delay

behavior difficulties

what do we call a delay in multiple different areas of development

global delays

nursing care of child w a CI

demonstration with some explanation

one step directions with lots of repetition

non-verbal communication with message boards

mainstream peer experiences (allow child in class)

sexuality w adolescents (educate safety)

increase interactive play rather than self stimulation

indepcendence w ADLs

How should we promote limit setting with discipline in children with CI

make rules same for each environment

at home, siblings get same punishment for breaking rules

s/s of down syndrome

almond shaped eyes (go up)

hypotonic

simian crease

Plantar crease between big and second toes

large ventricular septal defect

vision/hearing issues, protruding tongue

down syndrome developmental delays

<1yr old = 3 month delay

1 yr old = 6 mos + to one year delay

Assisting/educating parents of children with DS

feeding= tongue thrusts out, feed differently

low tone= need reinforcement and PT

respiratory health= get all vaccines, stay away from sick, hand hygiene

for parents= offer counseling and genetic counseling

Autism s/s

some degree of CI, savants

communication impairment

Nursing care with ASD

never touch child without letting them know, reassure them

decrease stimulation

cluster care can be overwheming

behavioral pain assessment tool ages

infants - 4 years old

self report rating scales pain assessment tool

not valid for children under 4 years old

multidimensional pain assessment tool

for more chronic pain

assess things like eating, sleeping, communication, participation in ALDs

important concept about using pain assessment tools

which ever format is used NEEDs to be consistently used

neonatal infant pain scale (NIPS)

birth to 1 month

behavioral scale, 0-7

six indiacors

mild, mod, severe scores of NIPS

mild= 1-2

mod= 3-4

severe= 5+

mild, mod, severe of pain tools on a 0-10 scale

mild= 1-3

mod= 4-6

severe= 7+

assessing infant pain- steps

assess basic needs first (maybe they are just tired or hungry), then implement medication

FLACC behavioral pain assessment tool

one month- 3 years

can be used for a child with a CI

out of 10 scale

behavioral

FACES pain scales

six cartoon faces

smiling face= no pain

tearful face= worst pain

used as young as 3 yo but mainly preschool years

describe physical feelings along with faces (2= mosquito bite…)

Cognitive Impairment pain scale

Flacc and draw where you pain is in different colors

what is always needed with pain scales?

vitals

non pharmacologic pain intervention for young children

guided imagery, physical presence/comfort

acute vs chronic pain

acute under 3 mos

chronic longer than 3 mos

numeric pain ratings

8 yrs old or older

NIPS goal

<3

FLACC goals

<4

Numeric goals

<4

behavioral interventions for infant pain

change diaper, hold/swaddle, pacifier

behavioral interventions for young children

distraction, guided imagery

behavioral interventions for teens

focus on them, ask what is going on

pain management without drugs

describe sensation they will feel w what you are doing

avoid pushing, pulling, pinching or heat

avoid OVER description

stay w child

bubbles, imagery, movies, music, thought stopping

CHILD LIFE SPECIALIST

med administration tips

therapeutic hugging

no nostril pinching unless it is by child

alternative is suppository, can use IVP

PCA pumps for 7-8 and above

what does a child’s pain rating need to be in order to recieve medication?

modserate= medicate, dont want anyone in severe pain

steps to manage opioid induced resp depression in children

stop medication, assess ABC

give oxygen and reveral agent, call provider

Acute failure to thrive s/s

dehydration

developmental delays

apathy, unresponsive, withdrawn

feeding/eating disorders

wide eye gaze, decreased smiling

no stranger danger

stiff or flaccid muscles, frontal bossing (focus on reversing the cause)

acute failure to thrive management

reverse cause

referral to PT, OT, nutritionist

classifications of Acute Failure to Thrive

inadequate caloric intake (formula is expensive)

inadequate absoroption (celaic, CF)

increased metabolism (diabetes, hyperthyroidism)

defective utilization (genetic like T21 or metabolic)

cleft lip/palate causes

from genetic factors found utero or at birth, more common w males

cleft lip/palate long term management

speech therapist, orthodonist, hearing loss, more surgeries

cleft lip surgery

chleioplasty, 2-3 months

cleft lip post op info

glue = leave alone, sutures = keep moist, vaseline, antibiotic cream

keep baby on back, feed with slow flow nipple or syringe

Cleft lip/palate labs

CBC w differentials, urine analysis, Chem 7 (BMP)

cleft palate

more common in females

commonly associated with syndromes, can include nostrils and absence of septum

cleft lip

can include nose nasal cartilage, septum, and dentition

cleft palate surgery

palatoplasty, 6-9 months

cleft palate post op info

feeding cup, syringe, special needs feeder, pigeon nipple (can stay on back or belly)

cleft palate long term problems

speech, middle ear effusion, hearing loss, dental

brief resolving unexplained events

unexplained respiratory pause lasting 20 seconds or more or with seizures reflux, pain, or cold.

unexplained respiratory pause less than 20 seconds accompanies by pallor, cyanosis, bradycardia, or hypotension

w/w out accompaning apnea

brief resolving unexplained events treatment

depending on cause

unknown etiology= home monitoring

testicular torsion- definition, peak onset, treatment

complete or parcial venous occlusion

peak onset 13 years old (puberty)

surgical emergency (6 hours to fix)

s/s of testicular torsion

red, warm, edematous, immobile/fixed

nausea, vomiting, abdominal pain

no cremaster reflex

(never fever or infection)