NRSG 329

Development

Progressive increase in function of body

Physiological, psychological and cognitive changes due to growth, maturation and learning

Growth

Increase in physical size, measured in metres or kilograms

Maturation

Total way in which a person grows and develops, as dictated by inheritance

Cephalocaudal growth

Growth pattern of g/d moving from the head down to the body

Proximodistal grwoth

Growth pattern moving from centre of body outwards towards extremities

When in infancy does birth weight double?

4-6 months

When in infancy does birth weight triple?

By 1 year

Weight gain in infancy

Increases 2 lbs per month for first 6 months, then 1 lb per month until 1 year

Neonate age

Birth to 28 days

Infant age

First year

Toddler age

1 to 3 years

Preschool age

3 to 5 years

School age

6 to 9 years

Adolescent

13 to 18 years

Adult

18 + years

Stages of Erikson's Psychosocial Theory

Infant: trust vs mistrust

Toddler: autonomy vs shame

Preschool: initiative vs guilt

School age: industry vs inferiority

Adolescence: identity vs confusion

Stages of Piaget's Cognitive Theory

0-2: sensorimotor

2-7: preoperational

7-11: concrete operational

12-15: formal operational

Stages of Kohlberg's Moral Theory

4-7: preconventional

7-12: conventional

12-21: post-conventional

Nurse's role in infant care

Promoting nutrition, progressing to solid foods, teaching newborn care

Nurse's role in toddler care

Safety promotion, sleep, dental and nutritional health, discipline, support/encouragement, education

Nurse's role in preschooler care

Appropriate play, reading, nutrition, sleep, anticipatory guidance

Nurse's role in school-age care

Injury prevention, nutrition, anticipatory guidance

Nurse's role in adolescent care

Communication/relationships, importance of peers, safety promotion, nutrition, sexuality

Anticipatory guidance

Information that helps prepare families for unexpected physical and behavioral changes in their child/teen d/t current or approaching stages of development

Developmental factors for 0-1 years

Reflexive movements, lack of body control, reaches for/mouths objects. becomes mobile, poor balance, limited ability to obey verbal instructions

Risks for injury in 0-1 years

Can wiggle off surfaces, choke, scald, poision, get shocked and cannot rely on verbal commands

Developmental factors for 5-14 years

Increased independence, less concrete thinking, increased development of abstract thinking and understanding of relationships between things, new environments

Risks for injury 5-14 years

Falls, more dangerous activities, may not generalize and only understand specific risks, learn safety best through direct experiences, sports injuries

Fears in infants

Loss of support, loud noises, bright lights, sudden movements, strangers, separation anxiety, animals

Fears in toddlers/preschoolers

Separation from parents, the dark, loud or sudden noises, injury, strangers, certain persons and situations, large objects and machines, change in environment

Fears in school-age

Supernatural beings, injury, storms, the dark, staying alone, TV/movies, injury, death, tests, failure

Fears in adolescents

Inept social performance, social isolation, sexuality, drugs, divorce, crowds, gossip, public speaking, pain

Differences in respiratory tract of children

Smaller and fewer alveoli, smaller lungs, smaller nares and mouth, larger tongue/lymph tissue, floppier epiglottis, flexible larynx + positioned more anterior, less developed chest wall, obligate nose breathing, RR is irregular

Signs of respiratory distress

Crying, nasal flaring, accessory muscle use, positioning, increased RR and HR, anxiety, restlessness, apprehensiveness, O2 sats below 92, grunting, sweating, wheezing, colour changes

Respiratory distress

Outwardly evident, physically labored ventilation or respiratory efforts

Clinically evident that patient is compensating and beginning to not adequately ventilate or oxygenate

Respiratory failure

Prolonged respiratory disrress that results in impairment of lungs to maintain adequate gas exchange, causing hypoxemia

Respiratory arrest

Emergent/acute situation where there is a cessation of respiratory function

ARIs are most common in children who are:

HIV positive, under 2 years of age, malnourished, weaned early, have poorly educated parents and have difficulty accessing healthcare

Asthma

Chronic, obstructive process characterized by increased inflammation of airways, mucous production and smooth muscles tightening + spasming

S/S of asthma

Rapid/shallow breathing, cough, chest tightness, SOB, audible wheezing, anxiety, sweating, paleness, indrawing, decreased sats, cyanotic lips/nail beds

Tx of asthma

Bronchodilators, maintain airways, frequent assessment + VS, elevate HOB, oxygen, nebs, steroids, fluids to loosen secretions, support/education

Croup

Laryngotracheobronchitis (LTB)

Always viral

Slow and progressive with URI

Causes mucosal inflammation and edema, airway obstruction and hypoxia

S/s of croup

Accessory muscle use, barking cough, stridor, hoarseness, restlessness, fear, low grade fever, respiratory distress, worse at night

Tx of croup

Pain meds/antipyretics, supplemental O2, cool mist/cold air therapy, fluids, steroids, frequent assessment/VS, nebs, no sedation or abx, education/support

Epiglottitis

Bacterial, serious obstructive inflammatory process, affects children aged 2-5 or older, onset is abrupt, rapid and progressive

Medical emergency

4 cardinal signs of epiglottitis

Drooling, distress, dysphagia, dysphonia

Tx of epiglottitis

Do not leave alone without medical attention or look in mouth with tongue depressor, X-ray to confirm diagnosis, intubation or trach, 1:1, O2, IV fludis and abx

Bronchiolitis

Commonly caused by RSV, affects epithelial cells in resp. tract, causes varying degrees of obstruction, typically occurs during first 2 years of life (peak 3-6 mos)

Respiratory Syncytial Virus

Causes 50% of bronchiolitis cases, recovery is 8-15 days, lives on hands for 30 minutes, leading cause of bronchiolitis and pneumonia in infants, almost all will contract it by 3 y/o, plays role in asthma and COPD pathogenesis

Primary symptoms of RSV

Congestion, runny nose, mild cough, mild fever

Severe symptoms of RSV

Rapid/shallow breathing, tachycardia, retractions, nasal flaring, fatigue or lethargy, vomiting after coughing, poor appetite

Tx of RSV

Frequent assessment, ensure calm environment, avoid unnecessary impingements, humidified O2, antipyretics, ventolin, fluids, cool mist/air

What is Synagis

Monoclonal antibody given to premature, small or health challenged babies to prevent RSV

Gives enough antibodies to fight RSV for about 30 days, given head month during RSV season

Route of temperature checking for chilren

<6 = axilla

>6 = oral

Rarely done rectally

What is a febrile seizure?

Tonic clonic seizure brought on by rapid rise in temperature, occurs between 6mos to 3 years (most common from 18-22 mos)

What electrolytes should we watch in peds?

Sodium, potassium, calcium

What conditions increased fluid requirements?

Vomiting, diarrhea, sweating, fever, sepsis, infections, blood loss, burns

What conditions decrease fluid requirements

Kidney diseases, cardiac issues, metabolic complications, IV fluid infusions

What are maintenance fluid requirements?

Refer to volume of water required by body to replace obligatory fluid losses

Components of hydration status assessment

Behaviour (LOC), weight, HR, T, skin colour/turgor, perfusion, mucous membranes, sunken/round fontanelles and eyes, i/o, serum electrolytes

Gastroesophageal reflux disease

When lower esophageal sphincter is too relaxed or open, stomach contents come back up into espophagus

Common in 3 mos to 1 year

S/S of GERD

Burping, not eating, fussing around mealtimes, gagging, choking, vomiting, weight loss, bleeding regurgitation

Tx of GERD

PPIs, antacids, raise HOB, avoid eating before lying down, avoid trigger foods, burp babies more often, smaller/more often meals, avoid second hand smoke, keep upright to feed

Pyloric stenosis

Narrowing of lower stomach sphincter due to overgrowth of pylorus, leading to a GI obstruction

Occurs most often in 2-5 week old, Caucasian, full-term baby boys

S/s of pyloric stenosis

Projectile vomiting after eating, malnutrition, irritability, dehydration, olive-shaped mass in URQ, may lead to jaundice

Tx of pyloric stenosis

Surgery, fluids, feed slowly!

Cleft lip/palate

Common congential abnormality causing a small opening or split in roof of mouth, more common in boys

Complications of cleft lip/palate

Difficulty feeding, hearing loss, speech difficulty, dental decay

Tx of cleft palate/lip

Provide oral care after feeds, keep upright for feeds, surgery to correct

Intussusception

Slipping of one part of intestine into another part just below it, occurs most often in boys 2mos to 2yrs

S/s of intussusception

Jelly-like stool mixed with blood and mucus, NV, green coloured stool, sausage-like lump in middle of abdomen

Tx of intussusception

Air enema, ultrasound guided enema, surgery (anastomosis)

Appendicitis

Inflammation/rupture of appendix

S/S of appendicitis

RLQ pain, guarding, rebound tenderness

Tx of appendicitis

Appendectomy, antibiotics

Signs that infants are ready for foods

Once they are able to sit up, are around 6mos, show interest in food, extrusion reflex disappears, able to hold tongue flat and close lip over spoon, can keep food in mouth or turn away when they do not want it

Failure to thrive

Children who's current weight or rate of weight gain is significantly lower than that of other children of similar age and gender

Height and weight below 5th percentile

Medical causes of failure to thrive

Chromosome abnormalities, hormone deficiencies, damage to major organs, cerebral palsy, chronic infections, metabolic disorders, complications of pregnancy and low birth weight

Non-medical causes of failure to thrive

Emotional deprivation from parent, poverty, inadequate understanding of dietary needs from parent, exposure to infections/parasites/toxins, poor eating habits

Clinical manifestations of failure to thrive

Thin, lethargic, dehydration, lack of appropriate weight gain, easily fatigued, lack of appropriate social interactions, inability to meet g/d milestones

Overweight percentiles

85th to less than 95th

Obese percentiles

Greater than 95th

Complications of childhood obesity

T2D, increased depression, low self-esteem, asthma, sleep apnea, cardiac concerns, chronic metabolic conditions

Type 1 diabetes

Characterized by autoimmune destruction of pancreatic beta cells that produce insulin, resulting in absolute insulin deficiency

Target BG levels

Under 6 = 6-12

6-12 = 4-10

Adolescent = 4-7

Management of DKA

Resuscitation, correcting imbalances, transition to daily routine, education

Managing BGs during exercise

Eat a snack beforehand!

If exercising less than 1h, need one good snack

If more than 1h, may need multiple

Check BG after and before bed to prevent hypo

Type 2 diabetes

Caused by insulin resistance or inability of pancreas to keep up with body's demands for insulin

Risks for T2D diagnosis

Obesity, apple body shape, acanthosis nigricans, hypertension, family history, ethnicity

Acute pain

Brief pain with a sudden onset

Chronic pain

Pain that lasts longer than 3 months

Recurrent pain

Pain which comes and goes

Drug tolerance

Physiological adaptation resulting in a need for larger dose of a drug to maintain the desired analgesic effect

Physical dependence

Physiological effect of withdrawal symptoms following abrupt discontinuation of opioids

Addiction

Maladaptive behavioural pattern characterized by drug-seeking and intense cravings for mind-altering purposes rather than medical effect

QUESTT pain assessment

Question the child, Use a pain scale, Evaluate behavioural and physiological changes, Secure parent's involvement, Take cause of pain into account, Take action and evaluate results

Infant response to pain

Crying, screaming, body tension, change in behavior, inconsolability, may not eat

Toddler response to pain

Crying, screaming, withdrawal, hiding, tension, may localize

Preschooler response to pain

Cry, localize, may be subdued, less moving around

School-aged response to pain

Body image concerns, may assume pain is punishment, all or nothing response