Infancy (birth-1 year)

Infancy

STAGES

Infancy

TOYS

 Infancy

FACTS

Infancy

Interventions

Infancy

Safety

 Infancy

Gross motor

Fine motor

Infancy

Toddler (1-3 years)

toddler

STAGES

toddler

FACTS

toddler

TOYS

toddler

 Major milestones

Safety

toddler

toddler

Interventions

toddler

Communication

Preschoolers (3-6 years)

preschooler

STAGES

preschooler

FACTS

preschooler

TOYS

 preschooler

Major milestones

preschooler

Interventions

preschooler

Safety

 preschooler

Communication

School-aged (6-12 years)

School-aged

STAGES

 Industry vs. Inferiority

School-aged

FACTS

School-aged

Interventions

School-aged

Safety

School-aged

Major milestones

 School-aged

Communication

Adolescents (12-18 years)

 Adolescent

STAGES

Adolescent

FACTS

Adolescent

Interventions

Adolescent

Communication

 PEDS

• Goal of peds-to improve the quality of health care for children and their families.

• Disparities in peds- related to race, ethnicity, socioeconomic status, and geographic factors.

• Development: the most dramatic time of physical, motor, cognitive, emotional, and social development occurs during infancy.

• Nutrition- an essential component for healthy growth development is human milk (infants)

• New morbidity -also known as pediatric social illness, refers to the behavior, social, and educational problems that children face.

• Mortality: your able to die (subject to death)

• Morbidity: status of being dead

• Infant mortality rate- number of deaths during the first year of life per 1000 live births. Neonatal mortality- less than 28 days of life. Post-neonatal mortality- 28 days to 11 months

• Birth weight is a major factor in infant mortality. The lower the birth weight the higher the mortality rate.

• LBW is higher in African Americans then in any other race.

• Injuries: the most common cause of death and disability to children in the US.

o Suicide has surpassed motor vehicle accidents as the leading cause of injury mortality.

o Child development stages partially determines the types of injuries that are most likely to occur at a specific age.

o -infants: roll over, they can fall from surfaces

o -crawling infant: natural tendency to put things in their mouth (aspiration or poisoning)

o -mobile toddler: may experience falls, burns, and collisions with their ability to explore.

o Most fatal injuries occur later in childhood and adolescents.

Childhood Morbidity

• Acute illness- an illness with symptoms severe enough to limit activity or require medical attention. Respiratory illnesses account for 50% of all acute conditions.

• Family Centered Care- recognizes that family is the constant in the child’s life. The approach to the planning, delivery, care and evaluation of health care is a partnership between health care providers, patients, and their family.

• Atraumatic Care- care that minimizes the physiologic and physical stress experienced by children and their families.  (non-traumatic)

o -role of the nurse: promoting the health and well-being of the child and family.

o -establishment of therapeutic relationship

o -advocacy: making sure family is aware of available health services and treatments.

o -disease prevention and health promotion

o -educating parents and child

o -maintaining a safe environment

o -offer support and counseling if needed

o -ethical decision making

Family

• Family structure- consist of individuals, each with a socially recognized status or position who interact with one another on a regular basis. 

• US census bureau uses four definitions of families: traditional nuclear family, nuclear family, blended family, and extended family or household.

o Traditional Nuclear: consist of married couple, and their biologic children.

o Nuclear family: composed of two parents and their children. (steps and bio) (parents may not be married)

o Blended family: includes one step-parent, step sibling, or half sibling.

o Extended family: atleast one parent, one or more kids and one or more members related or nonrelated. (grandparents..etc)

Communication, physical, and developmental assessment: (NOTES)

• Infants: birth-12 months (trust vs. mistrust)

o -parents job to meet needs (establishing bonds)

o -fearful of unfamiliar people

o -Foster the trust to they don’t go to the mistrust.

o -research shows, you CAN NOT spoil an infant. They are meant to be held and loved. That’s how needs are met.

o -babies are started easily by loud noise.

o -physical assessments can be done while parents hold the child.

o -infants respond more to physical contact.

• Toddlers: 1-3 yrs of age. (autonomy vs. shame)

• -accidents happen at this age

• -teach safety proof to parents/family. (cover outlets)

• -child wants to explore independence. (move/walk)

• -have parents get on their level to safety proof the home.

• -foster autonomy, but still keep safety

• -get on their level with when communicating.

• -direct and concrete language, they are unable to interpret words.

• -QUESTION: give them options. (time for meds, after meds you can have either apple juice of orange juice)

• Egocentric- child is all about them. They don’t understand concepts. Fav word is NO. **** QUESTION: (I don’t have to share)

• Negativism-

• Toilet training- gives them a sense of autonomy.-**start when they feel the need to potty*

• Preschool 4&5 (initiative vs. guilt)

o -like to mimic parents (easy bake ovens, tool boxes)

o -like to do good, be good.

o -know right from wrong at this age

o -letting them be helpers at this age is essentials (hall monitors, BR monitors)

▪ -helps them to feel like leaders

o -simple explanations.

o -be honest with this group

o -Magical thinkers (imaginary friends) can’t think abstractly, only concrete. (LITERAL): “my brothers chicken pox jumped on me)

o -Don’t understand cause and effect.

o -fear of body mutilation, or body harm. (band aids)

o QUESTION: FIRM & CONSISTENT PARENTING

• School Age (6-12) Industry vs. Inferiority

o -creative and hands on projects

o -curious creatures. Who, what when where and how.

o -understanding of human body

o -crafty

o -love to participate in activities (busy bees)

o -foster industry by letting them engage

• Adolescence (13-18) Identity vs. Role Confusion

o -trying to figure it all out (life)

o -this group has a lot of stress

o -confidentiality/privacy

o -don’t impose opinions

o -this group likes to find things out things on there on.

o -BODY IMAGE, PEER PRESURE (want to fit it)

o Build a foundation with this group:

▪ -spend time together

▪ -respect their views

▪ -tolerate differences

▪ -praise good points

▪ -respect privacy

▪ -set good examples

o Communicate Effectively:

▪ -give undivided attention

▪ -Listen

▪ -be calm/open minded

▪ -try not to over act

▪ -AVOID judging

▪ -avoid the third degree

Physical assessment

Least invasive to most invasive

****Physical assessment: sit child on parent’s lap, auscultate heart & lungs, then examine ear & throat

• 1st: Respirations (1 full minute, irregular breathing)

o -infants and small children: belly breathers

o -Toddlers and older: chest breathers

o Smaller the child, higher their respirations, due to increased metabolism

• 2nd- Heart Rate

o -use stethoscope for 1 full minute. (apical pulse, at the PMI)

o -rhythm is irregular

o Listen to apical HR through stethoscope

o Sometimes children have an s3 & that is normal

o Murmur is a swishing sound

• 3rd- Blood Pressure

o -Right size cuff

o -should be at least 40% overlap & should cover 80% of the area

o If overlap is less than 20%: you need a BIGGER cuff

• 4th- Temperature- MOST INVASIVE

o -oral or axillary (depending on age)

o Can start doing oral when the child is ready & can hold it in their mouth

• Pain- Fifth

o -assessing infant for pain: FLACC scale

o Don’t do pain assessment in the middle of PA

o DO PAIN FIRST

• Height and weight:

o -Less than 36 months- measuring length of child.

o -lying down, knees flat, heels of feet (mark), head (mark)

o -remove the child THEN measure the marks with tape measure.

o -greater than 36 months-measure height

o -up to 36 months- weigh on peds scale (completely NUDE) (true weight)

o -after 36 months- use regular doctor scale.

o WEIGHT doubles by 6 mo, triples by 1 yr

• Measuring Head circumference:

o -up to 36 months: upon every admission

o -head circumference increases 2cm per month from birth-3 months.

o Average 32-33 cm at birth.

o -average head size 43 cm (17 inches) at 6 months.

o -average head size 46 cm (18 inches) at 12 months.

o FONTALES: soft spots

o -Open when born due to the brain needing to fully grow.

o -Grows fasted in 1 and ½ year.

o Anterior (diamond shape)- closes at 12-18 months

o Posterior (triangle shape)- closes first 6-8 weeks

o **Fontanelles can be full when crying & soft when child is calm, that is normal.

GROWTH & DEVEOPMENT

Infant: p.430, Toddler: p. 499, Preschool: p. 529, School-age: p. 584, Adolescent: p. 652

• INFANCY: Birth-1 year (trust vs. mistrust)

• Rapid growth and development

• Weight triples by first birthday

• Height increases -1 ft

• Teeth erupt -6 months of age

• Body systems functioning at more mature states

• Brain complexity increases

• Infants prefer solitary play

• Interested in putting things in hands, transferring objects hand-to-hand, feeling things, noises, lights, building blocks

• Interested in people and faces

• Communication skills developing drastically, beginning to make sounds to communicate, recognize descriptive words, recognize their name

• Highly at risk for delay in growth and development due to illness or hospitalization

Sensorimotor stage

o INFANCY- MAJOR DEVELOPMENTAL MILESTONES

• Loose newborn reflexes

• startle-see if child has hearing problems goes away about 4 months. Make loud noise, arms and legs spread out.

• tonic neck-turn baby neck, arm reaches out. Goes away at 6 months

• palmar and plantar grasp-goes away at 2 months. Index finger in their hand, they will grasp you.

• Rolls over (stomach to back- 5 months, back to stomach-6 months)

• Sits supported (leaning forward on their hands for support): 7 mo

• Sits unsupported: 8 mo

• Stands with support (9-11 months)

• Able to say 1 or 2 words (10 months)

• Uses pincer grasp well (10 months)

• ****Question: if baby can’t hold their head up (head lag) by 4 mo it is a concern.

o INFANCY- FINE MOTOR DEVELOPMENT

• Grasping object- (2 to 3 months)

• Transfer object between hands- (7 months)

• Pincer grasp age- (10 months)

• Remove objects from container- (11 months)

• Build tower of two blocks (12 months)

—12 months

o INFANCY-GROSS MOTOR DEVELOPMENT

• Head control- (4 mo)

• Rolling over- (5 to 6 months)

• Sit alone- (7-8) months

• Move from prone to sitting position (10 months)

o INFANCY- LOCOMOTION

• Cephalocaudal direction of development

• Crawling age- 6 to 7 months (on belly, army crawl)

• Creeping age- 9 months (on hands and knees, what we think of as crawling)

• Walk with assistance-11 months

• Walk alone-12 months

o INFANCY- NURSING INTERVENTIONS

• Encourage parents to hold and stay with infant as much as possible

• Provide opportunities for sucking

• Provide toys that give comfort or stimulate interest (rattles, non-glass mirrors)

• Pain control (trust) Pain prevents healing.

o INFANT SAFETY

• Back to sleep (safest way to sleep)

• No toys in crib (increase of SIDS)

• Avoid blankets in cribs

• No bottle in crib (ear infections)

• NOTHING IN CRIB

• Avoid small toy pieces

• Block stairs

• Stabilize easily turn-over items

• Locked cabinets, doors

• Animal safety

• Burns

• Rear facing Car seat

• TODDLER (1-3 YEARS) AUTONOMAY VS. SHAME

• 1-3 yrs of age

• Displays independence and negativism

• Gain pride in their accomplishments

• Growth slows during this time, but by age 2, BW x4, and ½ of adult height.

• Pot-belly appearance

• By age 33 months, all 20 deciduous teeth present

• Walking, talking, kicking, riding tricycle, running are intact motor development

• Toilet training during this time

• Likes to dress/undress themselves

• Preoperational developmental stage from sensorimotor

• Cause and effect relationships understood

• Parallel play

• Increasing amounts of independency

• 3yr olds typically have ~1000 words and 3-word sentences

• Expressive jargon

• Temper tantrums

• Highly at risk for delay in growth and development due to illness or hospitalization

o TODDLER- MAJOR DEVELOPMENTAL MILESTONES

• Walks up and down stairs

• Undresses self

• Scribbles on paper

• Kicks a ball

• Has a vocabulary of 1,000 words - uses short sentences

o TODDLER- COMMUNICATION

• Give short, clear instructions

• DO NOT give choices if none exist

• Offer a choice of two alternatives when possible

• Approach positively and slowly, allowing time for the toddler to adjust

• Tell toddler what you doing say names of objects

o TODDLER- NURSING INTERVENTIONS

• Toilet-training procedures

• Do not begin toilet-training in hospital

• Accept regression during hospitalization

• Encourage independent behaviors - feeding, hygiene, dressing self

• Give short explanations

• Reward appropriate behavior

o TODDLERS & NEGATIVISM

o Negativism is all about control

o Method for reducing negativism: reduce opportunities to the word “no”

o Instead of “do you want to go to sleep now”, tell the child when bed time is and say it is after a specific time like after reading a story

o TODDLER SAFETY

• KEEP POISON CONTROL # POSTED AT ALL TIMES!!!

• PRESCHOOLERS (3-6 YEARS)

• Growth is slow and steady

• Gain -3-5lbs/yr

• Height -2-3 in/yr

• Stature changes from short to slender, long-legged

• Better coordination

• Skips, jump ropes, swim, hop on one foot, catch/throw ball

• Can write a few letters/numbers

• Can learn general hygiene practices

• Associative play (groups w/ similar activities)

• Fantasy/dramatic play (pretend play)

• Magic is real, animism

• Gaining more independency and self-expression

• -2000 word vocabulary, expressive speech, complete sentences

• Why, when , how, what? QUESTIONS

• Tattle-tell, tell secrets (often family secrets), exaggerated speech (excitability when talking, etc)

• Take things literally when told things (raining cats and dogs)

• Physiological conflict (body mutilation) Band-aids on hand

• Need to be truthful and HONEST with this age

o PRESCHOOLERS- DEVELOPMENT OF SEXUALITY

• Form strong attachment to the opposite sex parent while identifying with the same-sex parent

• Modesty becomes a concern

• Sex role limitation, “dressing up like Mommy or Daddy”

• Sexual exploration more pronounced

• Questions arise about sexual reproduction

o PRESCHOOLERS- MAJOR DEVELOPMENTAL MILESTONES

• Uses scissors

• Rides bicycle with training wheels (ONLY WITH TRAINING WHEELS)**

• Throws a ball

• Holds a bat

• Writes a few letters

• All parts of speech are well-developed

o PRESCHOOLER- COMMUNICATION

• Allow time for child to integrate explanations

• Verbalize frequently to the child

• Use drawings and stories to explain care

• Use accurate names for body functions

• Allow choices

o PRESCHOOLERS- NURSING INTERVENTIONS

• Encourage parental involvement

• Provide safe versions of medical equipment for play (toy stethoscope)

• Give clear explanations about illness - explain that child is not responsible for the illness

• Allow child to draw

****QUESTION: APPROPRIATE TOYS FOR PRESCHOOLER: SAND BOX, FINGER PAINTS, PICTURE BOOKS

****QUESTION: to prepare a preschooler for surgery: read hospitalization picture books with them a few days before surgery.

• SCHOOL-AGED (6-12 YEARS)

• Girls/boys close in growth/proportions

• Long bones continue to grow, legs length increases drastically

• Muscles increasing in proportion to fat

• Fine motor skills more refined

• Growth spurt for girls by 9-10 yrs, boys by 10-12 yrs (boys about 2 years behind girls of same age)

• Loss of deciduous teeth begins ~6 yrs, and permanent teeth (22-26 teeth) by age 12, molars still have to come in

• Conversations with others

• Cooperative play with others (ex a card game)

• Reading and writing skills well-developed

• Abstract thinking vs literal

• Recognize sexuality differences of girls/boys

o SCHOOL-AGE CHILDREN- MAJOR DEVELOPMENTAL MILESTONES

• Possesses reading ability

• ****Rides a two-wheeled bike

• Jumps rope

• Plays organized sports

• Mature use of language

o SCHOOL-AGE CHILDREN- COMMUNICATION

• Provide concrete examples of pictures or materials to accompany verbal descriptions

• Assess knowledge before planning teaching

• Allow child to select rewards following procedures

• Teach techniques such as counting or visualization to manage difficult situations

• Include child in discussions and history with parent

• ****Be honest in explanations and all communications

o SCHOOL-AGE CHILDREN- NURSING INTERVENTIONS

• Provide gowns, covers, and underwear

• Explain treatments and procedures

• Encourage school work

• Encourage hobbies, favorite activities

• ADOLESCENTS (12-18 YEARS)

• Puberty changes

o Girls- breast buds, pubic hair 10-11 yrs (range 8-13)

o Boys- testicular development/pubic hair age 11-12 (range 8-14), voice changes

o Growth spurts- girls -12, boys -14

o Menarche -12-13 yrs

o Spermarche -13-14 yrs (first ejaculation)

• Lots of emotional changes secondary to hormonal developments/surges

• Formal operational thoughts, understand complex concepts

• Strong independence-provide a safe environment

• Group interactions, peers important

• Interested in opposite sex (or alternatives)

• Masturbation

• Sexual acts interest/experiments

• Privacy important!!!

o ADOLESCENT- COMMUNICATION

• Provide written as well as verbal explanations

• Direct history and explanations to teen alone, then include parents

• Allow for safe exploration of topics by suggesting the teen is similar to other teens

• Arrange meetings for discussion with other teens

o ADOLESCENT- NURSING INTERVENTIONS

• Provide privacy

• Interview separately from parents when possible

• Encourage participation in care and decision-making

• Encourage peer visitation

• Provide information on sexuality

• Separation anxiety

o Protest phase

▪ Cry and scream, cling to parent

o Despair phase

▪ Crying stops; evidence of depression

o Detachment phase

▪ Denial; resignation but not contentment

▪ May seriously affect attachment to parent after separation

• PAIN

▪ FACT: children are undertreated for pain

▪ FACT: analgesia is withheld for fear of the child becoming addicted

▪ FALLACY: analgesia should be withheld because it may cause respiratory depression in children (not true)

▪ FALLACY: infants do not feel pain (not true)

o PAIN SCALES:

▪ FACES pain-rating scale

▪ Numeric scale

▪ FLACC scale

o Facial expression

o Legs (normal relaxed, tense, kicking, drawn up)

o Activity (quiet, squirming, arched, jerking, etc)

o Cry (none, moaning, whimpering, scream, sob)

o Consolability (content, easy or difficult to console)

o NONPHARMACOLOGIC INTERVENTIONS

▪ Based on age

▪ Swaddling, pacifier, holding, rocking

▪ Distraction

▪ Relaxation, guided imagery

▪ Cutaneous stimulation

o ANALGESICS

▪ Opioids

▪ NSAIDs

▪ Dosage is based on body weight up to 50 kg

• Communication Techniques when interviewing children & their families: (p. 97)

o Play is the most important technique for children

o Infants play technique:

▪ Infants respond to activities that register on their physical senses

▪ Patting, stroking, & other skin play convey messages

▪ Repetitive actions like stretching infants’ arms out to the side while they are lying on their back & then folding the arms across the chest or raising & revolving the legs in a bicycling motion, will elicit pleasurable SOUNDS

▪ Colorful items to catch the eye or interesting sounds, such as ticking clock, chimes, bells, or singing, can be used to attract children’s ATTENTION

o Older infants play technique:

▪ Older infants respond to simple games

▪ Pee-a-boo is good for initiating a safe communication, after this eye contact the nurse is not viewed as a stranger anymore, now a friend

▪ Clapping an infant’s hands together for pat-a-cake or wiggling the toes for “this little piggy” delights them

▪ Talking to a foot or other part of the child’s body is another effective way

• Assessing Toilet Training Readiness:

o ****WHEN CHILD EXPRESSES THE NEED TO POTTY

o Physical:

▪ Voluntary control of anal & urethral sphincters, usually by ages 22-30 months

▪ Ability to stay dry for 2 hours; decreased #s of wet diapers, waking dry from nap

▪ Regular bowel movements

▪ Gross motor skills of sitting, walking, & squatting

▪ Fine motor skills to remove clothing

o Mental:

▪ Recognition of urge to defecate or urinate

▪ Verbal or nonverbal communication to indicate when wet or has urge to defecate or urinate

▪ Cognitive skills to imitate appropriate behavior & follow directions

o Psychologic:

▪ Expressing willingness to please parent

▪ Ability to sit up on toilet for 5-8 min without fussing or getting off

▪ Curiosity about adults’ or older siblings’ toilet habits

▪ Impatience with wet diapers; desire to be changed immediately

o Parental:

▪ Recognition of child’s level of readiness

▪ Willingness to invest the time required for toilet training

▪ Absence of family stress or change, such as divorce, moving, new sibling, or imminent vacation

• Regression:

o Regression is normal for a child that is hospitalized

o For example: if the child wets the bed in the hospital, it’s okay

• Dental Health:

o Its recommended that a child have an oral exam by 6 months of age

Common Childhood Illnesses

• Otitis Media (OM)

o presence of fluid in the middle ear along with acute signs of illness symptoms of middle ear inflammation.

o Etiology of Otitis Media:

▪ Most prevalent disease of childhood (most cases in 24 months of life)

▪ Linked to feeding methods (breast fed is least likely to get OM compared to formula fed infants) Breast milk protect against viruses b/c it contains secondary immunoglobulin A, which limits exposure of the eustachian tube to pathogens and foreign proteins. 

▪ Secondhand smoke

▪ Pre-existing viral infections (RSV and Flu)

o Pathophysiology of Otitis Media:

▪ Dysfunction of Eustachian tube

o Clinical manifestations of Otitis Media:

▪ Pain

▪ In infant seen as irritable, holding or pulling of ears

▪ Older child may verbalize pain

▪ Temperature common (104º F)

▪ Enlarged lymph nodes

▪ Rhinorrhea

▪ Vomiting and diarrhea

▪ Loss of appetite

o Diagnostics of Otitis Media:

▪ -visual of tympanic membrane, reveals purulent drainage, bulging fontanel, and reddened.

▪ -asses the tympanic mobility

o Therapeutic management of Otitis Media:

▪ -long term antibiotic therapy, surgery, immunotherapy.

▪ -placement of tympanostomy tube with chronic OM (3 episodes in 6 months)

o Medical surgical treatment of Otitis Media:

▪ Antibiotics- amoxicillin 10-14 days 

▪ Analgesic/antipyretics

▪ Myringotomy with placement of tubes for recurrent OM

▪ Hearing evaluation – to detect loss

o Nursing considerations of Otitis Media:

▪ pain relief

▪ teaching/educate of taking meds

▪ repositioning child

▪ ****no propping bottles

▪ ****eliminate smoke exposure

▪ ****QUESTION: REACCURANCE OF OTITIUS MEDIA: ASK PARENTS ABOUT SMOKING

o Prevention of recurrence of Otitis Media:

▪ routine immunization with PCV vaccine (pneumococcal conjugate)

▪ flu vaccine in children 6 months of age.

▪ breast feeding vs. bottle feeding for first months

▪ avoid propping of bottles

▪ decrease of discontinue pacifier use after 6 months.

• Seizures: Generalized

o with-out a focal onset indicates that initial involvement is from both hemispheres. Loss of consciousness and impairment of motor function occur from onset. There is no aura. These can occur at any time if the day or night.

o Causes of seizures in children:

▪ Birth injuries (anoxia) or congenital defects of CNS

▪ Acute infections in late infancy and early childhood

▪ In children older than 3 years, usually is idiopathic

o Pathophysiology of seizures:

▪ abnormal and spontaneous electrical discharge initiated by a group of hypoexcitable cells referred to epileptogenic focus.

▪ Generalized seizure occurs when neuronal excitation from the epileptogenic focus spread to the brainstem, particularly the midbrain and reticular formation.

o Clinical Manifestation/signs and symptoms of seizures:

▪ Tonic-Clonic (grand mal) – most dramatic of all, occur without warningand consist of two phases. Tonic and Clonic

▪ Tonic phase- 10-20 seconds

• eyeroll upward, loss of consciousness, falls if standing, stiffens, flexed arms, increase salivation and loss of swallow reflex.

▪ Clonic phase- 30 seconds but can vary

• Violent jerking

• May foam at mouth

• May be incontinent

o Diagnostic procedures of seizures:

▪ Thorough history

▪ Physical/neurological assessment

▪ Lab test (depending on child’s age)

▪ EEG obtained for all children with seizure activity

o Therapeutic Management of seizures:

▪ Drug therapy

▪ Ketogenic diet

▪ Vagus nerve stimulation

▪ Epilepsy surgery

o Drug therapy of seizures:

o Antiepileptic drugs

o Phenobarbital

▪ Febrile seizures, neonatal seizures

▪ for other seizures: front-line IV choice if patient does not respond to diazepam (Diazepam is incompatible with many drugs. To give IV, push slowly and directly into the vein)

▪ High dosage may require respiratory support

o Phenytoin (Dilantin)

• QUESTION: KNOW SIDE AFFECT TO WATCH WITH DILANTIN IS BLEEDING OF GUMS

▪ older drug (1st line)

▪ PO or slow IV push (<50 mg/min)

▪ Precipitates when mixed with glucose

▪ Side effects: Gingival hyperplasia, ataxia, rashes, acne, hirsutism, osteoporosis

▪ Onset 5 to 30 minutes; duration

▪ 12 to 24 hours

o Nursing interventions of seizures:

▪ Observe and document episode (teach/educate family)

▪ Protect from injury

▪ Stay calm

▪ Remain with child

▪ Privacy if possible

▪ Side lay for air way

▪ Vitals signs, suction PRN

▪ Nothing in MOUTH

▪ QUESTION: WHAT ACTION BY THE NURSING ASSISNTANT MUST THE NURSE CHECK: THE NA PUTTING A TONGUE DEPRESSOR AT THE BEDSIDE

• Bacterial Meningitis: acute inflammation of the meninges and CSF

o Acute inflammation of the CNS

o Decreased incidence following use of Hib vaccine

o Can be caused by various bacterial agents

▪ H. influenza type B (Hib vaccine)

▪ Streptococcus pneumoniae (PCV vaccine)

▪ Group β streptococci

▪ Escherichia coli

o Pathophysiology of Meningitis:

▪ Most common route of infection is vascular dissemination from a focus of infection elsewhere

▪ Organism from nasopharynx enter blood stream and CSF

▪ Invasion by direct extension from near infections

▪ Gain entry through penetrating wounds to skull or thru opening in sinus or skin from procedures

▪ Infection process: inflammation, exudation, white blood cell accumulation, and varying degrees of tissue damage.

o Clinical Manifestations of Meningitis::

• Children/Adolescents

o Fever

o Chills

o Headache

o Vomiting

o Seizures (often and initial sign)

o Irritability

o Agitation

o Confusion/photophobia

• Infants and young children (3 months and 2 yrs)

o Fever

o Hypothermia

o Poor feeding

o Vomiting

o Seizures

o Irritability

o Restlessness

• Neonates

o Hard to diagnose

o Refuse feeding

o Poor sucking

o Vomit/diarrhea

• Diagnostics of Meningitis::

o Lumbar puncture (fluid pressure is measured, samples for a culture)

• Therapeutic of Meningitis::

o Isolation precautions (droplet)

o Antimicrobial therapy

o Hydration

o Maintenance of ventilation

o Control of seizures

o Control of temperature

• Nursing Interventions of Meningitis::

o Give medications

o Decrease ICP

o Pain relief

o Positioning

o Decrease environmental stimuli

o Assess vitals

o Safety precautions

o Observe for respiratory distress

****QUESTION: KNOW SIGNS & SYMPTOMS OF ICP IN INFANTS: IRRITABILITY, BULGING FONTANELLES,HIGH PITCHED CRY

• Iron Deficiency Anemia: caused by inadequate supply or loss of iron. Most prevalent nutritional disorder worldwide.

• Etiology of Iron Deficiency Anemia:

o Any factor that decreases the supply of iron, impair its absorption, increases the body’s need for iron, or affects the synthesis of hemoglobin.

• Pathophysiology of Iron Deficiency Anemia:

o Iron required for hemoglobin production

o Effect – decreased hemoglobin and reduced oxygen carrying capacity of the blood

o A decrease in the oxygen carrying capacity of blood and a reduction in the amount of oxygen available to the cells. (anemia)

• Clinical manifestations of Iron Deficiency Anemia:

o Insidious and obscure

o Related to duration of deficiency

o May be underweight or overweight and pale (porcelain like), poor muscle development and prone to infection

▪ Milk babies – fed too much milk, not enough solid foods

o Enhances leakage of plasma proteins – edema, retarded growth

o Irritability, tachycardia, fatigue, pallor (unhealthy pale appearance), headache, muscle weakness.

• Diagnostic of Iron Deficiency Anemia:

o CBC

o Peripheral smear, bone marrow aspiration (anemia)

• Nursing interventions of Iron Deficiency Anemia:

o Physical examinations/family history

o Nutritional teaching/education

o Be aware of how much milk the baby is being fed or adolescents diets/eating habits

o Encourage age appropriate foods with enough iron. (green beans, beef)

o Iron supplements taken with citric acid. (helps reduce iron to the most soluble state. (iron with orange juice)

• Tonsillitis: tonsils are masses of lymphoid tissue located in the pharyngeal cavity. The tonsil filters and protects the respiratory tract from invasions of pathogens. Also play a role in antibody formation.  Tonsillitis is inflammation of the tonsils.

• Etiology of Tonsillitis:

o Inflammation of tonsils

o Viral or bacteria

o Frequent URI’s and abundant lymphoid tissue increase risk for young child

• Pathophysiology of Tonsillitis:

o Lymphoid tissue encircling the nasal and oral pharynx that get inflamed.

o Palatine tonsils are visible during examination. (usually look enlarged)

• Clinical manifestations of Tonsillitis:

o Inflammation

o Enlarged from edema, palatine may meet midline (kissing tonsils)

o Difficulty swallowing/breathing

o Cough/sore throat

• Diagnostics of Tonsillitis:

o Throat cultures

o Important to determine if viral or bacterial.

o Tonsillectomy (surgical removal of palatine tonsils) NO red foods.

o Adenoidectomy (surgical removal of the adenoids) recommend for children who difficult nasal breathing.

• Nursing interventions of Tonsillitis:

o Providing comfort

o Soft/liquid diet

o Cool-mist vaporizer

o Gargle warm saltwater

o Pain/medication management

o Safety

o Report signs of URI (upper resp. infection)

• Appendicitis: inflammation of the vermiform appendix (blind sac at end of the cecum). Most common cause emergency abdomen surgery in childhood.

• Etiology of Appendicitis:

o Causes of appendicitis is obstruction of the lumen of the appendix, usually by hardened fecal material (fecalith)

• Pathophysiology of Appendicitis:

o Appendix ruptures r/t obstruction with bacterial and fecal contamination in the peritoneal cavity

o Inflammation spreads rapidly through abdomen (peritonitis)

• Clinical manifestations of Appendicitis:

o RLQ pain

o Fever

o Rigid abdomen

o Decrease or absent bowel sounds

o Vomiting

o Pallor

o Lethargy

o Most intense sight of pain at McBurney point (right side of abdomen, diagonal from umbilicus)

o IF PAIN STOPS, EMERGENCY DUE TO ALREADY RUPTURED

• Medical surgical treatment of Appendicitis:

o Removal appendix

o IV fluids and electrolytes esp if dehydrated

o If rupture add decompression if the GI tract, and possible irrigation of peritoneal cavity

• Diagnostics of Appendicitis:

o CBC

o Urinalysis

o CT scan

• Nursing interventions of Appendicitis:

o Assessment/history

o Vitals

o Reposition comfortably

o Safety

o Pain relief

o Do NOT admin enemas or laxative. 

• Erikson Stages: (psychosocial) MEMORIZE

• Reflexes: (page 264)

• Fontanelles:

• Suggested Toys

Peds Vital Signs

Peds Temperature Ranges

Immunizations

• Vaccines:

o Minimize pain: use a topical numbing cream (EMLA or LMX4), vapocolant, or sucrose solution (neonates)

o When to with-hold vaccines: severe febrile illness, contraindications (immune system-live virus [varicella, MMR, flu], pregnancy-MMR, severe allergic reactions-flu/eggs)