exam 3 key points

Clinical Overview for Pediatric care

The nurse's role centers on family centered care, promoting adaptation, coping, and a sense of control for both patients and siblings

Altered family roles

When one parent remains at the hospital and the other assumes responsibility for work, finances, and household management. Siblings may feel neglected

Altered family roles (nursing role)

-Assess for caregiver role strain, sibling emotional well being, and marital stress

Normalization

A positive adaptation strategy where families strive to maintain routines and activities that mirror typical family life. The child included in social,recreational. and school activities, whenever possible.

Normalization (nursing role)

Encourage realistic goal setting.

Mainstreaming

Integreation of children with disabilities into a general education setting with necessary accommodations.

Mainstreaming (nursing role)

Have a IEP in place and collaborate with teachers.

Communication and emotional support

-Preschoolers think illness is a punishment

-School aged children need factual, honest information about treatments and outcomes.

-Adolescents desire autonomy

Conductive hearing loss

Serous otitis media, impacted cerumen, foreign bodies, tympanic perforation

Vomiting and Fluid Loss Assessment

Note…

-Frequency, amount, and color

-Onset and duration

-Associated symptoms

-hydration status

-weight changes

Levels of dehydration: Severe

Greater than or equal to 10% of the child's body weight.

Oral Rehydration Therapy

Usually for patients with mild-moderate dehydration like if a patient was having diarrhea

Teaching for parents with infection children (diarrhea)

-Dispose of diapers in a closed container

-Wash hands

-Clean toys and surfaces

-Don't share stuff among siblings

Fluid requirements and red flags

Fever, tachypnea, vomiting/diarrhea, burns

Hirschsprung's Disease

Absence of ganglion cells leads of obstruction

Failure to pass meconium within 48 hours

Pyloric Stenosis

Pre-op rehydration and electrolyte correction

Peptic Ulcer Disease

-Epigastric Pain relieved by eating

-hematemesis

-anemia

Crohn's disease

-Inflammation throughout entire GI tract

-Diarrhea/abd pain, weight loss

Ulcerative Colitis

-Inflammation from colon to anus

-Bloody diarrhea, rectal bleeding, abd cramping

-Colectomy= curative

Intussusception

Currant Jelly stools (blood mucus), cramping pain, knee-to-chest

Malrotation/Volvulus

Abnormal rotation of intestine = risk of twisting and necrosis of intestine

Normal renal parameters for reference

Urine output= 1-2mL/kg/hr

<1 indicates early renal compromise

Acute glomerulonephritis

Immune reaction to a recent strep infection (10-21 days after pharyngitis/impetigo)

Acute glomerulonephritis CMS

-Cloudy urine

-Periorbital edema

-HTN

-Oliguria

-Mild proteinuria

Acute glomerulonephritis (nursing)

Monitor B/P closely, HTN is hallmark

Acute glomerulonephritis (teaching)

Complete all antibiotics to prevent development of antibiotic resistance

Acute glomerulonephritis (prevention)

Avoid reinfection by proper wiping hygiene

Nephrotic Syndrome

CMs
-Proteinuria
-Hypoalbuminemia
-Periorbital edema
-Weight fain
-Decreased UO, frothy urine

Monitor weight daily (best indicator of fluid status)

AKI

-Hyperkalemia (>7) life threatening

AKI (priority)

Immediate: Monitor EKG, adminster emergency meds (calcium gluconate, insulin + glucose, bicarbonate)

Vesicoureteral Reflux

Predisposing to pyelonephritis and renal scarring

Vesicoureteral Reflux (teaching)

-Reinforce importance of voiding regularly and completing antibiotic courses

UTI

-Obtain clean catch or cath urine sample

-Easier to obtain female by having them face towards the tank

-Teach front to back wiping and importance of completing antibiotics

Pyelonephritis

Bacterial infection ascending from bladder to kidneys

Pyelonephritis CMS

-High fever

-chills

-flank pain

-costovertebral tenderness

-leukocytosis

Cardiac Function Review

Tachycardia is an early sign of heart failure

Digoxin

-Signs of toxicity (any level over 4)

-Monitor K levels

-Low K levels increase digoxin toxicity risk

Congenital heart defects overview

Tetralogy of Fallot (decreased pulmonary blood flow)

Tetralogy of Fallot (interventions)

-Keep infant calm by providing O2

-Knee-chest position

Coarctation if the Aorta

Narrowing of ductus arteriosus= increased pressure in upper extremities and lower pressure in lower extremities

Ductal Lesions

-Maintain patency with prostaglandin E infusion

-Echocardiogram confirms anatomy and function

Kawasaki Disease

-Bilateral conjunctivitis

-Strawberry tongue

-Cervical lymphadenopathy

Post Cardiac cath

If bleed, apply pressure above puncture site

Infective endocarditis

Prophylactic antibiotics for before procedures

Sickle Cell disease

Avoid dehydration at all times

-oxygen can worsen crisis, so routine use not recommended unless SpO2 is <92

-Adequate hydration and rest minimizes sickling and delay the cycle

Hemophilia

Treat bleeding promptly with Factor 8 VIII IX as ordered (can be done at home)

Immunologic

Adolescents with chronic illness should receive Hep B booster if planning tattoos or piercings

Primary Prevention

Immunizations

Chicken Pox (varicella)

Contagious 1 day before rash onset until all lesions have crusted (6 days)

Bacterial Conjunctivitis

Remove all crusts and drainage before applying drops

Hand washing education

Most effective way of infection prevention in addition to vaccinations

Pain, Cancer

Administer opioid on a scheduled basis