fin de niños

When does the posterior fontanel close?

Closes by 2 months of age

When does the anterior fontanel close?

Between 12-18 months

What age do you always take apical pulse first?

Birth-2

What age do you start taking radial pulse

2 years old

When performing assessment, what age do you use minimal physical contact initially?

Toddlers

What age has the hardest time coping with being alone in the hospital?

Toddlers

What age is bowlegged normal?

Toddlers

What is an appropriate play activity for a 7 month old infant to encourage visual stimulation?

Peek a Boo

When is object permanence developed and how do you know?

Age 2 and when the child is actively seeking for the hidden object

How can you encourage preschoolers (5 year olds) to make friends?

Actively involve child in finding practical methods to deal with the frightening experience by scheduling a play date

What age would you explain procedures and menu to select own food?

School age (6-12)

Why would you want to show a colonoscopy bag to a school age child?

Have heightened concern about body integrity

What are the 3 reasons why adolescents engage in risky behavior?

Peer pressure, belief that they invulnerable, impulsivity

What locations do infants have atopic dermatitis? (Eczema)

Generalized, especially cheeks, scalp, trunk, and extensor surfaces of extremities

Interventions for atopic dermatitis

Hydrate the skin, relieve pruritus, prevent and minimize flare-ups or inflammation, and prevent and control secondary infection

How do you apply steroid medication to atopic dermatitis?

Thin layer rubbed into specific areas- pat them dry

What does impetigo look like?

Seen on kids faces, reddish macula's, vascular appearance (red sores or blisters) and they rupture easily and form honey-colored crusts

What skin condition is very contagious?

impetigo

What skin condition does not leave scarring?

Impetigo

What do you give a child before immunizations to minimize pain?

EMLA cream (topical lidocaine) apply to skin 1 hour before

What is Piagets formal operational stage?

Think in abstract terms at the age of 11-15 years

What are s/s of moderate dehydration?

irritability, dry mucous membrane, tachycardia, oliguria, normal to sunken fontanel

What is the earliest sign of moderate dehydration?

Tachycardia

What is the cap refill time in moderate dehydration?

2-4 seconds

What is the cap refill time in severe dehydration?

Greater than 4 seconds

What is Hirschsprung disease?

No peristaltic waves causing constant constipation

What does the stool look like in Hirschsprung disease?

Ribbon like stool

What is the surgery for Hirschsprung disease?

Surgical trans anal pull-through, to remove ganglionic section (affected part of bowel)

What is esophageal atresia?

Esophageal and trachea weren't completely separated during development

What are the three C's signs in esophageal atresia?

Coughing, choking, cyanosis

How do you know a baby has esophageal atresia?

NG tube does not go down at birth

What is the treatment for esophageal atresia?

Intermittent or continuous suctioning (maintain airway) & prevent pneumonia

What would a parent complain of if their child has pyloric stenosis?

Projectile vomiting after feeds

What can excessive vomiting in pyloric stenosis cause?

Metabolic alkalosis

What is intussusception?

Bowel telescopes into the other segment of the bowel

What does the stool look like with intussusception?

Currant jelly-like stool containing blood + mucus

What indicates that intussusception has resolved?

Passage of normal stool-\> report to HCP

What is gastroschisis?

Protruding abdominal contents with NO sac protecting it

What do you do for gastroschisis?

Keep the gastro content moist

What is the main medication for gastric distress?

Corticosteroids- prednionse (want to redue inflammation)

What are the s/s of UTI in an infant?

Failure to gain weight, vomiting, persistent diaper rash

What is hydrocele?

Fluid in the scrotum -\> common in newborns and can resolve spontaensouly by 12 months

What are the s/s of nephrotic syndrome?

Facial edema, fatigue, frothy appearance (proteinuria)

What is the treatment for nephrotic syndrome?

Corticosteroids (prednisone)

What is important to ask parents with glomerulonephritis?

Has your child had strep throat recently?

What are S&S of glomerulonephritis?

Hematuria (dark colored pee-cola pee), HTN, proteinuria, excess fluid volume

What is treatment for glomerulonephritis?

Antibiotics for strep and antihypertensives and diuretics for hypertension and fluid overload

What are the benefits of peritoneal dialysis for teens?

Gives them control over their disease management and can do it at home and at night

What is acute infectious pharyngitis (strep throat) caused by?

GABHS

What are children at risk for when they have acute infectious pharyngitis?

Rheumatic fever

How do you treat rheumatic fever?

Penicillin

What is a sign of a possible complication for post op tonsillitis?

Continuous swallowing\= hemorrhage, report to HCP

What are s/s of croup (acute laryngotracheobronchitis)?

Barking or seal-like cough, usually high fever in middle of night, and stridor

Treatment for croup

Decadron and nebulized epinephrine

What respiratory infection is a medical emergency?

Acute epiglottitis

What are s/s of acute epiglottis?

Frog like stridor and drooling, in tripod position leaning forward, cant swallow with tongue out

Interventions for acute epiglottis?

Have intubation device ready and no throat inspection

What is important nutritional support with cystic fibrosis?

-Vitamins A,D,E,K is given
-Highest caloric intake- high protein & high carbs
-pancreatic enzymes should be taken in beginning of meals/snacks or within 30 minutes of eating (do not crush enzymes, can be sprinkled on food in powder form)

What are important post op teaching and implantation for cardiac catheterization?

Patient should lie flat and not flex or elevate leg (should be kept straight for 4-6 hours); vitals every 5-15 minutes and you assess pulse FIRST

What medication keeps the PDA open?

Prostaglandin E

What age would you explain a surgery to?

8 years old (school age) because they like to ask alot of questions

What fluid would you give a child for severe dehydration?

.9% sodium chloride or lactated ringer (glucose, electrolytes)

What medication keeps the PDA closed?

Indomethacin/ibuprofen

What heart disease would you need to keep the PDA open and why?

Hypoplastic left heart syndrome needs prostaglandin E to keep it open until surgery is completed because if PDA closes the child has no way of getting blood into circulation

What do you want to make sure you are doing with care management of heart failure?

Cluster care should involve uninterrupted sleep, do not want to disturb them, let them rest

What is rheumatic fever caused by?

Strep throat

What are S/S of Kawasaki disease?

Strawberry tongue, inflammation, peeling palms, rash on trunk, swollen lymph, NO COUGH

What does Kawasaki disease target?

Targets coronary arteries of heart and can lead to aneurysms (blood clots)

What are the three medications you take for Kawasaki disease?

-IV gamma globulin for 7 days to prevent coronary aneurysm
-Aspirin to control fever and symptoms of inflammation
-Anticoagulants once fever is gone

What are the three signs of low platelet count you should look for in children with cancer?

Ecchymosis, petechiae, and spontaneous bleeding (gums and nose)

What are side effects of chemotherapy?

Hair loss, nausea, vomiting, and fatigue

What is the management of nausea for chemotherapy side effects?

Administer antiemetics 30 minutes before chemo and routinely for 24 hours after

What diet should chemotherapy patients be on?

High protein, high calorie, full fat (remove food that has alot of odor when nauseated)

What do you need to explain to patients about hair with chemotherapy?

Explain that hair regrows in 3-6 months (may have slightly different color or texture)

What are the effects of steroids with cancer patients?

Cushingoid appearance (round puffy face), weight gain, increased susceptibility to infection

What is leukemia?

Proliferation of immature or abnormal WBC- low leukocyte (WBC) count

What are patients with leukemia prone to?

Fractures

What is a s/s of acute lymphatic leukemia?

Left sided abdominal enlargement (splenomegaly)

What age is Hodgkin lymphoma common in?

15-19 years of age

What are s/s of Hodgkin lymphoma?

Painless, enlarged, firm lymph

How do you diagnose Hodgkin lymphoma?

A lymph node biopsy and the presence of Reed-Sternberg cells

What age is Non-Hodgkin lymphoma common in?

14 year and younger

What is the main symptom of brain tumor?

Headache

What is neuroblastoma?

"Silent" tumor found in adrenal gland and primary site is abdomen

When is neuroblastoma usually diagnosed?

When it is already metastasized

What is osteosarcoma?

Most common bone cancer in children

What is the common tumor site?

Femur

What are the S/S of osteosarcoma?

-Localized pain or swelling at affected site
-Limping, decrease physical activity, cant hold heavy objects
-Palpable mass-end of the bones (misunderstood as growing pain)
-Fever and respiratory distress

What is the treatment for osteosarcoma?

Surgery to remove mass + chemotherapy

What is Ewing sarcoma?

Bone tumor in marrow spaces that originates in shafts of long bones

What are s/s of Ewing sarcoma?

Systemic symptoms -\> fever and respiratory distress

Management and teaching for ewing sarcoma

Limb salvage or amputation; limb salvage requires follow-up lengthening procedure to encourage bone to continue growing

What is Wilms tumor?

nephroblastoma- kidney tumor

What are s/s of wilms tumor?

-Painless swelling or mass in abdomen
-Firm, non-tender, confined to one side of abdomen

What is important pre op education for Wilms tumor?

Do not palpate tumor or abdomen (in all 4 quadrants) because it can rupture and send cancer cells throughout the body

What is rhabdomyosarcoma?

Soft tissue sarcoma

Where is rhabdomyosarcoma commonly found?

In the eye

What is the purpose of palliative care?

Control of pain, symptoms, support -\> comfort " to achieve highest possible quality of life for patients and families"

What is sickle cell anemia?

abnormal hemoglobin that looks rigid and sickle-shaped

What is the main management for sickle cell anemia?

HOB- hydration, oxygenation, and pain management