Peds Exam 1

Atraumatic Care

prevent separation of child and parents, promote sense of control, prevent pain/trauma, respect cultural differences

Illness/Hospitalization

may be stressful or vulnerable. change from normal routines, may react based on parents reactions

Stage of Protest

ages 1-2, can be angry or against care, could be screaming biting or kicking

Stage of Despair

depressed, not happy no matter what you do, not interested in toys or care

Stage of Detachment/Denial

makes connections with doctors or nurses, blames parents for being in the hospital, detaches from parents

Separation Anxiety in todlers

pleads with parents to stay, looks for parents, temper tantrums, may regress (pacifiers, accidents, bottles)

Separation anxiety in preschoolers

tolerates brief periods of separation (trusting adults), looks for pacifier, more subtle behaviors

Separation Anxiety in Adolesence

being away from friends/peers, no control makes them upset, wants to see friends in person rather than phone calls, often bored lonely or depressed

Siblings reactions to sickness

can feel guilty, jealous, or sad; must prepare siblings for what they might see in hospital, drain tubes etc,

Support for D/C

have favorite blanket/pillow, give pain meds before leaving, info about med side effects for kids

Death in Infants newborn-1

not aware of death, aware of changes in parents care and routine; affects parents more

Death in Toddlers

egocentric, only care about what is going to happen to them; explaining through stories of others does not help, may think they are going to sleep, and care about what will hurt; older toddlers may ask who is going with them

Death in Preschoolers, 4-5 years old

may feel guilty; if you do something bad this will happen to you, may feel like a punishment, death is like going to sleep

Death in school aged kids: 5-12 year olds

fears about dying, body image issues, concerned about what and why this is happening; older teens feel isolated from peers, become depressed and isolated

Nursing interventions for Death

pain and symptom management, try to die pain free and with dignity, parents may be in denial about what is happening and become mad

Interventions for preschool aged

reassure child did nothing wrong, use simple language, support and clarify what death is, encourage parents to stay and support child

School aged children death interventions

give anticipatory information, tell them what to expect (sport may be more difficult etc), allow changes such as routines, encourage contact with peers, encourage rest

Strategies for talking with dying child

be flexible, communicate through drawing/playing, let them know they are loved and will be remembered, help find sense of accomplishment, encourage physical closeness

Brachial Palsy (erb palsy)

1 arm is damaged from forceps, upper plexus injury, affected are is fully extended with internal rotation and pronated wrist, recovery in few months

Facial Paralysis

Cranial nerve 7 injury from forceps, absent movement on affected side of face

Nursing care for brachial palsy

immobilize arm on upper abdomen, passive ROM x1 week after, shirts= affected 1st then undressing is unaffected arm first, football hold

Nursing care for facialparalysis

assist with feeding, soft large nipple or gavage(syringe) feeding, prevent dehydrated eyes

Phrenic Nerve Palsy

C3-C5 injury affects lungs and diaphragm, s/s include tachycardia*, low SpO2, accessory muscle, pallor and tachypnea

Nursing Care for Phenic Nerve Palsy

mechanical ventilation d/t 1 sided lung paralysis, family emotional support, extended recovery

Caput Succedaneum

serosanguinous fluid under scalp all over head, forceful birth injury risk for skin break and infection, no Tx d/t subsiding in weeks

Cephalhematoma

ruptured blood vessel, localized bloody fluid under scalp, no tx resolves in weeks

Subgaleal Hemorrhage

bleeding into subgaleal compartment, only internal, s/s = feeling movement of fluid from front to back of head, larger head circumference, monitor closely and watch vital signs along with pallor and tachycardia

Clavical Fractures

most frequent break during birth, caused by force; s/s include palpable spongy mass, edema & hematoma at site of fracture; infant hesitant to move affect side, immobilize upper arm

Nursing care for clavical fractures

evaluate for large gestational age (LGA) baby, avoid lying on affected side, careful dressing, do not hold baby up from under arms, no tx unless ping-pong ball type fracture

Physiological Jaundice (hyperbilirubinemia)

benign version, occurs over 24 hours after birth, d/t breastfeeding, s/s = jaundice, excessive bilirubin in blood

Nursing care for Physiologic Jaundice

increase feeding frequency and avoid supplements, increase number of BM’s to excrete bilirubin, avoid sugar water and cessation of feedings, last line intervention for this type is phototherapy

Hemolytic Disease of the Newborn (pathological jaundice)

Rh incompatibility, occurs within 24 hours after birth, mom produces Rh+ blood cells to attack newborn, perform direct Coombs test to check for antibodies in babies blood, complication is encephalopathy

Prevention of hemolytic disease

RhoGAM, injection for mom 3 weeks after 1st birth

Nursing care for Pathological Jaundice

#1 is phototherapy- promotes bilirubin excretion, infants skin must be exposed to light, second line is exchange transfusion w/o antibodies

Phototherapy management

as much skin as possible is showing, eyeshield to protect infant, monitor bilirubin with TCB test, increased stools, and fluid volume; watch for hypo/hyperthermia

Apnea of Prematurity

no breath for over 20 seconds, provide gentle tacile stimulation, then iv caffiene, then nasal CPAP, then put on monitor for resp and hr, observe for color changes, suction if filled w/ mucus, final resort is BVM

Respiratory Distress syndrome

almost always seen in premature infants, surfactant deficiency→ collapsed alveoli, #1 s/s is tachycardia and pronounced intercostal or substernal retractions, tachypnea and cyanosis later s/s

Management of Respiratory Distress

establish adequate oxygenation, maintain acid-base balance, give exogenous surfactant, DO NOT bottle/nipple feed → TPN or other nutrition given, put pt. in side lying w/ towel behind back to support side (sniffing position)

Feeding for first year

birth-6 months → breast or formula milk, add oral Vit D and iron supplement only for breast feeding

4-6 months → strained or pureed foods

6-7 months→ finger foods like crackers, fruit and veggies (most nutrition still from milk)

9-12 months→ chopped food or cereals (iron fortified)

Rickets in Children

softening and weakening of bones, usually d/t prolonged Vit D and calcium deficiency

Food Allergies

specifics parts of foods that caused allergen reactions in newborns, systemic reaction is anaphylaxis and growth failure, gi → abd pain, N/V/D, respiratory → cough, wheezing, rhinitis, skin→ puritis, rash, atopic dermatitis

Emergency Management of Anaphylaxis

Epi pen, observe for adverse reactions → tachycardia, htn, iritability, headache, nausea and tremors if given Epi must go to ER*

Growth Failure/Failure to Thrive

inadequate calorie intake, inadequate calorie absorption (underlying disease), increased metabolism (hyperthyroidism and increased crying), infant should not have eyebags, bony arms, or sunken in chest

Failure to thrive diagnosis

thumb sucking 1st s/s of hunger, weight that falls below 5th percentile for age

Failure to thrive clinical manifestations

developmental delays, withdrawn, feeding disturbances (underlying GI issue), no fear of strangers (missed milestones), minimal smiling

Sudden Infant Death Syndrome (SIDS)

sudden death in infant younger than 1 that remain unexplained, risk factors→ maternal smoking, co-sleeping, prone sleeping, soft bedding w/blankets and pillows, low APGAR score, sibling of 2 or more SIDS victims

SIDS prevention

supine sleeping, no co-sleeping, no pillows or blankets, breast feed baby(prevent viral illness), keep infant in parents room for first year

Primary Enuresis

not fully potty trained, urinary accidents

Secondary Enuresis

fully potty trained child, accidents due to a secondary condition 7-8 years old

Diagnosis of Enuresis

chronologic or developmental age of at least 5 years old, 2-3 times per week for 3 or more months, may have urgency or frequency

Treatment for Enuresis

hormone replacement: desmopressin, tricyclic antidepressants or anticholinergics; nonpharm is limiting fluid/caffeine intake, wake up at night to pee

Encopresis

repeated involuntary stool incontinence that can be primary or secondary

Etiologies for encopresis

may follow psychological stress, may be secondary to constipation or impaction (could be scared to go and hold stool)

Management of Encopresis

high fiber, prune juice, green vegetables, x-ray for fecal impaction, toilet child 10-15 minutes after meals

ADHD

developmentally inappropriate degree of intention, impulsiveness and hyperactivity, must complete neurologic evaluation

Management of ADHD

behavioral therapy, pharmacologic therapy, environmental manipulation, appropriate classroom placement

Clinical Manifestations of posioning

gagging, choking, cough, burning throat and stomach, N/V, lethargy, weakness; children discover things by putting them in their mouth

Respiratory Manifestations of poisionings

tachypnea, cyanosis, retractions, grunting

Emergency treatment of poisoning

assess, terminate the exposure, identify the poisoning, prevent absorption. #1 thing to do is call poison control

Gastric Decontamination of poisoning

ipecac and activated charcoal, not indicated to do at home, only in the hospital

Tylenol Poisoning

occurs in 4 stages, can be fatal→ hepatotoxicity, tx is acetylcysteine (mucomyst)

Aspirin (Acetylsalicylic Acid) Poisoning

Acute= TINITUS, n/v, hyperventilation

later = hyperactivity, fever, confusion, seizures, renal failure, resp fail, mx for bleeding tendencies

Lead poisoning levels

<5 normal, 5-14= poisoning, always check before kindergarten→ tx is chelation

Physical Abuse

Deliberate infliction of physical injury on a child, shaken baby syndrome

Parental Predisposition characteristics for abuse

alcohol/drug, past history of abuse, young parents

Child predisposition for abuse

crying alot, needing attention, twins making 2x the work, developmental delays

Environmental predispositions for abuse

low income, multiple kids, geographical location

Sexual Abuse

defined as any form of sexual exploitation in children, most of the time the abuse comes from in the family

Munchausen by proxy

one of the parents (mom) is making up s/s for the child to get attention from providers, need excuses, prescriptions ect.

Manifestations of child maltreatment

History is incompatible with degree of injury, how injury occurred is vague, stories contradict themselves, bruising in a nonmobile area such as cheek

Clinical signs of abuse

growth failure or malnutrition, poor hygiene, unclean or inappropriate dressing

Intellectual Disability

has 3 components= intellectual functioning, adaptive functioning, and the onset of the disability younger than 18

Early signs of cognitive impairment

irritability or non-responsiveness to environment, gross motor delays, fine motor delays, behavior difficulties

Etiology of cognitive issues

genetic, biochemical, and infectious disease processes, trauma against mother or child, prenatal

Promotion of childs development

encourage child to play with someone at the same developmental age, must discipline them the same as other children

Slight to moderate hearing loss

residual hearing is sufficient to use a hearing aid

Severe to profound hearing loss

disability precludes successful processing of linguistic information through hearing with or without a hearing aid

Manifestations of hearing loss in a child

lack of startle reflex, absence of babbling by age 7, general indifference to sound, lack of response to words

Medical tx for hearing loss

antibiotics to treat otitis media, hearing aids

Surgical tx for hearing loss

tympanoplasty tubes for chronic otitis media, cochlear implants- surgically implanted prosthetic device

Care for the hearing impaired child

speak at eye level and with good lighting, attract child’s attention before speaking

Prevention of hearing loss

treat existing and prevent recurrent infections, prevent hearing loss that can begin prenatally

Causes of Visual Impairments

genetics, perinatal or postnatal infections; gonorrhea, chlamydia, rubella, syphilis, toxoplasmosis, trauma

Nursing assessment of vision

infancy- can see shadows of person moving, response to visual stimuli, expect binocularity by 4 months

childhood- visual acuity testing

Care of hospitalized blind child

speak to them so they know you are there, encourage independence and provide a safe environment

Autism Spectrum Disorder

complex neurodevelopment disorders of brain function, range from mild to severe, cause is unknown

Diagnostic criteria for ASD

restricted repetitive and stereotyped patterns of behavior, interests, and activities, they see the world in a particular way, delays or abnormal functioning with onset before 3 years old

Assessing patterns of respiratory pattency

rate, depth, ease of breathing, monitor for labored breathing, check color of lips (cyanosis), note LOC, monitor for dehydrations

Factors influencing Respiratory infections

short, open eustachian tubes, airway diameter, shorter respiratory tract

Nursing interventions for respiratory infections

positioning, mx vital signs, mx hydration status, provide gentle chest percussion, last resort is O2 since it is hard to ween off

Acute Streptococcal Pharyngitis

upper airway infection (strep throat), tx is amoxicillin, must complete 24 hours of antibiotics before returning to school, need to change toothbrush and pillow case, younger children may become anorexic

Tonsilitis

may occur with pharyngitis, tonsils enlarge to look like they are touching, can obstruct airway

Post-Tonsillectomy interventions

watch for signs of hemorrhage (high hr, low bp and pale), give cold drinks (vasoconstriction), avoid red or brown foods, citrus and hot foods

Otitis Media

an inflammation of the middle ear without reference to etiology or pathogenesis, child may pull on ears

Otitis Media with effusion

fluid in the middle ear space without symptoms of acute infection

Acute otitis media s/s

follows an upper resp. tract infection, ear ache(otalgia), can have purulent drainage

Chronic Otitis Media s/s

hearing loss, difficulty communicating, tinnitus, vertigo or ear fullness

Myringotomy

surgical inscision of the eardrum to alleviate pain

Tympanostomy

tube placement and adenoidectomy to treat chronic otitis media

RSV

transmitted through close contact, put on droplet precautions; may have rhinorrhea, coughing, sneezing, wheezing and fevers, Tachypnea >70!