Unit 2: Health Promotion: Infant, Toddler, Preschooler, School Age and Adolescent 

(20 questions) - Review along with the TABLES listed and the Major Theories of Development document. 

Health promotion

Focuses on maintaining or enhancing the physical and mental health of children

Partnership development is the key strategy for success when implementing a health promotion activity.

Principles of Health Supervision

- Providing services proactively

- Optimizing child’s level of functioning

- Ensuring child is growing and developing appropriately

- Promoting best possible health of child

- Preventing injury and illness through child teaching

Three Components of Health Supervision

- Developmental surveillance and screening

- Injury and disease prevention

- Health promotion

Health Promotion

- Growth

- Developmental Milestones

- Physical Systems Focused

- Nutritional Requirements

- Anticipatory Guidance

- Immunizations

______________________________________________

- Newborn/Infant

     - Neonate (birth to 27/28 days)

     - Infant (1 month to 12 months)

- Toddler 

- Preschooler

- School Age

- Adolescent

Developmental Changes in the Newborn/Infant

*difference between growth, development, and maturation. 

Growth

○ increase in physical size (doubles birth weight by 6 months of age and triples birth weight by 12 months of age)

Development

○ sequential process by which infants and children gain various skills and functions

Maturation

○ increase in functionality of various body systems of developmental skills

Assessing Newborns and Infants for Developmental Milestones

Nurse may ask the parent if the skill is present or the infant may demonstrate the skill during the assessment

The nurse may elicit the skill from the infant

Screening tools may be used to assess development:

○ Denver II Developmental Screening Test: a quick screen to determine whether a child is achieving developmental milestones in the areas of gross motor, fine motor, language, and personal social skills. It can be used with children from birth to 6 years of age. 

○ Ages and Stages: identifies infants and young children whose social and emotional development requires further evaluation to determine if referral for intervention services is necessary. Example: 

○ Learn the Signs. Act Early: From birth to 5 years, your child should reach milestones in how he plays, learns, speaks, acts and moves. (it’s like a CDC website w/ resources)

Assessing growth and development of a premature infant 

Use the infant’s adjusted age to determine expected outcomes

• Subtract the number of weeks that the infant was premature from the infant’s chronological age

Plot growth parameters and assess developmental milestones based on adjusted age

Newborn Reflexes: Sucking, Rooting, Grasp, Babinski, Moro, Tonic neck, Dance/step 

*Know how to assess newborn reflexes and at what age they are expected to disappear

Dance/Step 

• With one foot on a flat surface the infant puts the other foot down as if to "step"

• Appears: birth

• Disappears: 4-8 weeks

**they are instinctively trying to walk

Sucking

• Reflexive sucking when nipple or finger is placed in infant’s mouth 

• Appears: birth

• Disappears: 2-5 months 

**helps latch on to nipple so they can feed

Rooting/root reflex

• When the infant’s cheek is stroked, the infant turns to that side, searching with mouth 

• Appears: birth

• Disappears: 2-5 months

**helps find a nipple to feed

Moro

• With sudden extension of the head the arms abduct and move upward and the hands form a “C” 

• Appears: birth 

• Disappears: 4 months

**occurs when they are startled or feel like they are falling 

Tonic neck/Asymmetric tonic neck reflex 

• While lying supine, extremities are extended on the side of the body to which the head is turned and opposite extremities are flexed (also called the fencing position)

• Appears: birth

• Disappears: 4 months

**idk why but they look like superman about to take off.

Grasp/Palmar grasp

• Infant reflexively grasps when palm is touched

• Appears: birth

• Disappears: 4-6 months

**motor development and facilitate bonding. 

Plantar reflex

• Infant reflexively grasps with bottom of foot when pressure is applied to plantar surface

• Appears: birth

• Disappears: 9 months

**motor development also 

Babinski

• Stroking along the lateral aspect of the sole and across the plantar surface results in fanning and hyperextension

• Appears: birth

• Disappears: 12 months

**reflects immature corticospinal tract - normal for them before 12 months

Infant Milestones

TABLE 9.1

(info from this table that is on the study guide)

Fine pincer grasp

Posterior fontanel closes by 8 weeks

Social smile occurs by 2 months

Head turns to locate sounds by 3 months

Steady head control is achieved by 4 months

Able to roll from tummy to back and from back to tummy by 5-6 months

Plays “peek-a-boo” after 6 months

Able to transfer objects from hand to hand by 7 months

Able to sit unsupported at 8 months

Able to crawl at 10 months

Waves “bye-bye” at 10 months

Fine pincer grasp appears at 10-12 months 

Able to walk with assistance at 10-12 months

Says a few words in addition to “mama” and/or “dada” at 12 months

Can sit down from standing position without help at 12 months

Table 25.3 - Development of gross motor skills in infancy

**cruising - walking holding something to support themselves

Infant safety

Infant car seat rear facing in the back seat, BACK to sleep, crib rails up, never leave child alone on a raised, unguarded surface, never leave infant alone in bath, fence swimming pools, fence stairways, baby proof the home (keep all medications & household cleaning items high and locked, cover electrical outlets).

Toddler/Preschooler Milestones

Table 11.1 and 12.1

(info from this table that is on the study guide)

Bowlegged

Potbellied

Temper tantrums are common

Appears bowlegged and potbellied (lordosis)

Anterior fontanel closed between 12 and 18 months

Throws ball overhand by 18 months ⚽

Kicks ball by 24 months 

Can walk up and down the stairs by 24 months (2 feet on each step) 

Walks with wide stance at 24 months

**things w their feet by 24 mo 

Feeds self with spoon and cup at 2 years

Daytime toilet training can begin by age 2 years

Two-to three- word sentences are spoken by 2 years

**eating, speaking, and pooping (essentials) accomplished by 2 years

Own first and last name can be stated by 2 ½ to 3 years

All primary teeth (20) are present by 3 years

Three-to four- word sentences are spoken by 3 years

Names what has been drawn by 3 years

Copies a circle (drawing) with facial figures by 3 years

Rides Tricycle by 3 years

Stands on one foot for a few seconds by 3 years

Uses sentences of four or five words by 4 years

Draws 3-part stick figures by 4 years

Can walk up and down the stairs using alternate footing by 4 years

Can skip and hop on one foot by 4 years

Uses sentences of 6-8 words by 5 years

Can tie shoelaces by 5 years

Throws and catches ball well by 5 years

Skates with good balance by 5 years

Toddler safety:

Leading cause of death in toddlers/preschooler is unintentional injury. 

MUST focus on safety education. 

Car seats and booster seats must be used in the backseat of the car at all times. Swimming lessons and Pool fences for drowning prevention

Curious about the world around them and like to explore. Accidental poisoning is a safety issue. Use of ipecac syrup is NO LONGER recommended (rapid-acting emetic) → Teach parents that it is NOT recommended to induce vomiting in any way because it may cause more damage. CALL Poison control center. 

School-age and Adolescents Milestones

Tables 14.1, 15.1 and 15.2

(info from this table that is on the study guide)

Develops concepts of numbers by 6 years

Knows right and left hands by  6 years

Likes table games and simple card games by  6 years

Uses table knife for cutting meat by 7 years

Mechanical in reading by 7 years

Can count backwards from 20 by 8 years

Likes the reward system by 8 years

Puberty:

Girls sequence of maturational changes/puberty: can begin anytime between 8-13 years old in this order: breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation 2 years after first signs (breast changes)

Boys sequence of maturational changes/puberty: can begin anytime between 9 ½ and 14 years old in this order: enlargement of testicles, growth of pubic hair/axillary hair/hair on upper lip/hair on face, rapid increase in height, changes in larynx causing voice changes, nocturnal emissions ( also known as wet dreams or nocturnal orgasms)

School age/adolescent safety:

Leading cause of death is unintentional injury. 

MVA (motor vehicle accidents) refuse to ride with an impaired person or one who is driving recklessly, ALWAYS wear a seatbelt, passenger seat for 12 years of age or older, discourage distractions while driving-cell phones, texting, eating or smoking; if drinking alcohol or any drugs call someone to pick you up, never drive under the influence

Learn how to swim and basic water safety rules

Ask about depression (sadness, withdrawn) and thoughts of suicide or hurting self/others

Growth milestones

When does birth weight double? 5-6 months

When does birth weight triple? 12 months 

When does birth length double? 4 years

When does a child use scissors? 4 years

When does a child tie his/her own shoes? 5 years

Concepts of bodily injury

Infants: remember pain after 6 months

Toddlers: fear intrusive procedures

Preschoolers: fear of body mutilation

School-age: fear of loss of control over their bodies

Adolescent: concerned about change in body image

Review Pediatric Growth and Developmental Theories: Erikson, Freud, Piaget, Kohlberg 

FROM BIRTH TO ADOLESCENCE 

Erikson

1 is a bun - rust colored bun

2 is a shoe - shane is sitting in his auto inside of a shoe

3 is a tree - there is an inn & tia sitting on a tree covered by a quilt 

4 is a dinosaur - the dinosaur is dusty and he feels inferior 

5 is a skydive - skydiver falls and dents the car and is confused

Trust vs mistrust 

• Infancy to 1 year 

• Goal is to promote consistency 

Autonomy vs shame and doubt 

• Toddlerhood (1-3 years)

• Goal is to promote freedom and encouragement to master new tasks 

Initiative vs guilt

• Preschooler (3-6 years)

• Conscience develops to maintain initiative without impinging on others. Child initiates play activities.

Industry vs inferiority

• School age (6-12 years)

• Focus on achievement and learning rules. Gains sense of self-worth

Identity vs role confusion

• 12-18 years 

• Sense of self concept. Identification of roles and integration of own values into society. Focus on peers. 

Unit 3: Medication Dosage Calculations (5 questions)

Unit 4: Care of the Hospitalized Child 

(8 questions) 

Slide 5: Stressors and nursing interventions

Two main stressors seen across age groups: 

Separation anxiety

• 3 phases

• Protest phase (cry, scream, inconsolable)

• Despair phase (crying stops, depression/withdrawn)

• Detachment/denial

• Most intense in toddler age groups

• Important way to minimize/manage → encourage parental presence/ minimize separation as much as possible

Loss of control

• Developmentally appropriate promotion of freedom/ autonomy. 

• Maintain routine, education/ promote understanding, effective communication

Slide 17: Autism 

What is it?

• Complex neurodevelopmental disorders

• Persistent deficits in social communication and social interaction that may cause significant challenges

Occurs in

• 1 in 36 children in the US (CDC, 2020)

Etiology

• Unconfirmed, research ongoing

Clinical manifestations

• Social, language, behavioral 

• Vary 

Diagnostic evaluation

• Routine & formal screening- should begin at 9 months per AAP

• MCHAT

  • 

Prognosis

Early identification and intervention (i.e. therapy) are key

Nursing care management

• Family support and coping, family-centered care

• Connection to clinical and community resources

• Multidisciplinary team approach

• Safety precautions (i.e. self injurious behaviors)

• Anticipatory guidance

• During hospitalization: Assess function of child, maintain structured routine and keep stimulation to a minimum (single room instead of shared room)

Slide 26: Hearing impairment

When caring for a child who is hearing impaired, the nurse should do the following:

• If the child has a hearing aid, encourage its use. Make sure it is in place before beginning to speak.

• Look directly into the child’s face. To enhance lip reading, ensure the child’s complete attention before beginning to speak.

• Speak clearly. Slow speech slightly. Do not speak loudly.

• Eliminate background noise.

• Use visual aids to assist communication. These include pictures, hands, and written messages for older children.

• If the child uses American Sign Language to communicate, have a diagram of commonly used words readily available. Use an interpreter for more complex discussions.

Slide 28: Visual impairment

Working with a Child who has a visual impairment

• Orient the child to the hospital environment on admission or clinical space during office visit.

• Never touch the child without first identifying yourself and explaining what you plan to do.

• When describing objects or the environment to a child who is blind or visually impaired, use familiar terms.

• Identify the source of noises for the child.

• Keep all items in the room in the same location and order.

• Provide explanations and allow the child to progress through care in steps to learn the sequencing.

• Allow the child to have as much control over the situation as possible.

• Supervise the child and counsel parents to supervise the child as needed

Slide 29: Nursing assessment of child w/ disability

Nursing assessment of the child with disabilities

• Assess intellectual skills and level of adaptive functioning

• Social interaction, competence in independent activities of daily living (ADLs), and communication

• Alternate between questions and demonstrations when conducting the assessment

• Look directly at the child and speak in a direct and simple yet non condescending manner using vocabulary appropriate for the child’s developmental level, not the child’s age.

• Ask the child for as much of the necessary information as possible, rather than relying solely on the parents to provide the information

• Allow extra time

• Follow the least invasive to most invasive order of assessment

Slide 37: Minors who may give consent

Emancipated minor - has established independence from his/her parents through marriage, pregnancy, or service in the armed forces, or by a court order.

Emancipated minor is considered legally capable of signing an informed consent.

Slide 38: Legal and ethical considerations of informed consent

Slide 44: IV access

Site selection and equipment

Provide atraumatic care: use topical anesthetic (for IV access and IM)

• Peripheral IV most common

• Securement of peripheral intravenous site

  • Infiltration is harder to detect in infants and children than it is in adults

• Infusion pumps

• Safety catheters and needleless systems

Maintenance

Complications (requires frequent assessment for infiltration: redness, swelling, leaking)

Removal

Unit 5: Pain Management, Chronic Illness and End of Life 

(7 questions)

Chronic illness 

Slide 21: Developmental factors

Effect on understanding of death

Effect on behavioral response to death

Effect on ability to communicate about death

By 6 years of age, children recognize death as permanent

By ages 9-10, children understanding of death is the same as an adult (inevitable, universal and irreversible)

Slide 24: Nursing management for child that's dying

Be verbally supportive

Do not reinforce denial

Do not argue

Recognize anger as normal response (do not take it personally)

Actively listen, use stillness

Encourage expression of feelings

Offer spiritual support if appropriate

Assist with grieving process and support resources

Encourage family to create memories

Allow progression through stages of grieving

Encourage family participation in care and activities as appropriate

Pain (5 questions)

Slide 9: Pain assessment scales

Slide 10: Tools bv age

Neonatal Infant Pain Scale (NIPS) 

• Used to evaluate pain in preterm and full term neonates up to 6 weeks after birth

• Evaluates facial expression, cry, breathing patterns, arm movements, leg movements, and state of arousal. 

• 

Slide 11: Signs an infant is in pain

Slide 12: Face, Legs, Activity, Cry, Consolability (FLACC) 

Face, Legs, Activity, Cry, Consolability (FLACC)

• Used with children between 2 months and 7 years or until child can self-report

Slide 13: FACES

Wong Baker FACES Pain Rating Scale 

• For toddler, preschooler, school age, adolescent 

• 

Slide 14: Numeric pain scale

Numeric pain scale

• 9 years - adult 

• Rate from 0-10, 0 being no pain, 10 being the worst pain 

Summarizing the pain scales

NIPS: Neonatal infant pain scale 

• Preterm- up to 6 weeks 

• Evals facial expression, cry, breathing patterns, arm movements, leg movements, and state of arousal. 

FLACC: Face, legs, activity, cry, consolability

• 2 months - 7 years 

• Assesses from 0-2, 0 being normal, 2 being signs of severe pain 

FACES

• Toddler, pre-schooler, school age, adolescent

• Uses emojis 

Numeric pain scale

• 9 y/o - adult

• Uses #

Slide 18: opioid SE

Slide 20: Non opioid analgesic

Nonsteroidal Anti-inflammatory Agents (NSAID’s):

• Used for relief of mild to moderate pain

• As a general rule, aspirin is not given in pediatrics (Reye syndrome)

• NSAID’s have analgesic, antipyretic and anti-inflammatory actions

• Ibuprofen dose is usually 5-10 mg/Kg/dose every 6-8 hours PRN

• Do not give these agents to cancer patients or those with bleeding disorders!!

Acetaminophen

• Most widely used in pediatrics

• Dose is 10-15 mg/kg/dose every 4-6 hours PRN

• Analgesic and antipyretic

• Often used in combination with opioids (i.e. Percocet)

Slide 26: Pediatric Pain Pearls

Pain assessment is considered the 5th vital sign.

Guidelines are available regarding when you should treat pain.

Morphine sulfate is the gold standard for sedation/pain

Naloxone is the reversal agent for the opioid agents.

Be consistent with using the same pain scale (must be appropriate for age and developmental level).

IV narcotics are second witness medications at most institutions.

Units 6 and 7: Respiratory Dysfunctions (10 questions)

** It is highly recommended that you read the material in the book if you are not understanding any concept from the slides. This will help reinforce learning.

Assessing respiratory function in children history

Pattern of Respirations

– Rate (rapid (tachypnea), normal, slow (bradypnea))

– Depth (normal, shallow (hypopnea), too deep (hyperpnea))

– Ease (effortless, labored (dyspnea), difficulty breathing except in upright position (orthopnea), retractions → inspiratory or expiratory, nasal flaring)

– Labored Breathing (continuous, intermittent, worsening, sudden onset, at rest or on exertion, associated with wheezing, grunting or chest pain) 

Cough

– When is the cough heard (night, early am, daytime)

– Nature/character of cough (croupy, wheezy, dry, wet,  productive)

– Frequency of cough

Cyanosis, halitosis (associated with sore throat, lung infections), chest pain

Effective auscultation

Make certain the child is relaxed and not crying, talking, or laughing. Record if child is crying.

Check that room is comfortable and quiet.

Warm stethoscope before placing it against skin.

Apply firm pressure on chest piece but not enough to prevent vibrations and transmission of sound.

Avoid placing stethoscope over hair or clothing, moving it against the skin, breathing on tubing, or sliding fingers over chest piece, which may cause sounds that falsely resemble pathologic findings.

Use a symmetric and orderly approach to compare sounds on each side.

Lung sounds

– Inspiration and expiration (all lung fields)

– Wheezing: produced as air passes through narrowed passageways (obstruction) → sounds like high pitched whistling noise. 

– Crackles: result from the passage of air through

fluid or moisture (fluid in lungs) → sounds like popping or crackling 

Acute infectious disorders

Nasopharyngitis (common cold)

Common Cold definition:

–Viral upper respiratory infection

Pathophysiology:

–RSV

–Influenza

–Rhinovirus

–Adenovirus

Epidemiology

• Toddlers get 6-9 colds per year

• Immunity increases with repeated exposure to viral organisms and children will get fewer respiratory tract infections

Signs and symptoms

Fever, Headache, malaise, Nasal congestion, Rhinorrhea (thin watery discharge), Thick and purulent (the color is not an accurate indicator of viral vs bacterial), Nasal blockage, Irritable/restless, Decreased activity, Sore throat, Poor feeding (anorexia), Cough, Muscle aches, Abdominal pain, V/D

Nursing interventions

No specific treatment, Comfort measures, Antipyretics, Rest, Increase fluids, NO decongestants under 4 years old, Saline + suction

Influenza positive? – Antivirals

Teaching! –Hand washing , –Elbow cough/sneeze

Sinusitis

Sinusitis definition:

– Bacterial infection of the paranasal sinuses

Pathophysiology:

– Mucosal swelling

– Decreased ciliary movement

– Thickened nasal discharge

– Young children

• Maxillary and ethmoid

– >10 years

• Frontal

Signs and symptoms

Greater than 10 days of:

– Cough, Nasal congestion, Fever, Halitosis, Facial pain, Irritability, Poor appetite

Nursing interventions 

Antibiotics as ordered, Normal saline nasal spray, Increased fluids, Comfort measures, Teaching → Handwashing & Elbow cough/sneeze

Pharyngitis & Tonsillitis

–aka sore throat and inflamed tonsils

Ice collar

Pharyngitis/Tonsillitis definition:

– Inflammation of the throat mucosa and/or tonsils

Pathophysiology:

– Viral process

– Group A beta-hemolytic strep (bacterial)

– Gonorrhea

Signs and symptoms

Abrupt onset: Fever, Sore throat,  Headache

Anterior cervical adenopathy

Abdominal pain

Tonsils/pharynx with inflammation, redness, exudate, petechiae 

Strep throat mimics → common cold virus, COVID, flu, croup, mononucleosis, measles, chicken pox

Nursing interventions

Diagnosis

– Rapid strep

– Culture

Treatment

Bacterial

•  Antibiotic Treatment

  • Penicillin

•  Return to school after 24 hours of antibiotic treatment and fever free

Viral

• Supportive care

• Saline gargles

• acetaminophen/ibuprofen 

Nursing care post tonsillectomy 

Promoting airway clearance

• Place child in side-lying or prone position

• Sitting position when awake

Maintaining fluid volume

• IV fluids initially

Minimize blood loss

• Discourage coughing, clearing the throat, blowing nose

Pain management

• Ice collar

• Pain medications (analgesics, local anesthetics – tetracaine lollipops or ice pops)

NPO until child is fully alert and able to swallow

• Cool water, crushed ice, flavored ice pops, diluted juice

• Avoid: citrus, brown or red fluids

• Avoid: milk products because they can coat the mouth and throat causing the child to clear the throat which can lead to bleeding

  • No milk, pudding, ice cream

• Start soft foods 1-2 days post-op

TEACHING

• Post op hemorrhage may occur between 5-10 days postop

  • Restlessness, vomiting blood, tachycardia, pallor, frequent clearing of the throat or swallowing – NOTIFY SURGEON ASAP

Croup syndromes

• Croup syndromes are a group of respiratory conditions characterized by inflammation and swelling of the upper airway, leading to a barking cough, hoarseness, and sometimes stridor (a high-pitched wheezing sound).

Toxic appearing child in tripod positioning 

ACUTE EPIGLOTTITIS 

• Medical emergency

• This is a severe, rapidly progressing infection causing inflammation of the epiglottis

Bacterial croup

– Haemophilus influenza type b

Pathophysiology

– Inflammation of the epiglottis

• Thumb sign on XR indicates enlarged epiglottis

• 

Signs and symptoms

High fever

TOXIC appearing (can indicate shock presenting as lethargy, cyanosis, abnormal breathing, irritability, tachypnea, tachycardia)

Tripoding → Leaning forward, Holding body up with hands, Open mouth with chin out

Dysphonia → Muffled voice

Dysphagia → Painful swallowing

Dyspnea → Trouble breathing

Drooling

Nursing management of epiglottitis 

Do NOT attempt to visualize the throat (could cause complete

obstruction) 

• Do NOT leave the child unattended

• Do NOT place the child in a supine position

• Provide 100% oxygen in the least invasive manner

• If complete airway occlusion occurs, tracheostomy may be necessary 

• Ensure emergency equipment is available (resuscitation equipment and suction)

LIFE THREATENING

• Absence of spontaneous cough

• Presence of drooling

• Agitation

____________________________________________________

ACUTE LARYNGOTRACHEOBRONCHITIS

• The most common form of croup, usually caused by a viral infection, leading to inflammation of the larynx, trachea, and bronchi.

Viral croup

– Inflammation of the upper airway

Pathophysiology

– Parainfluenza

– RSV

– Influenza

Characteristic of croup

Night-time cough

Barky cough

Signs and symptoms

Monitor for respiratory distress

– Inspiratory stridor

– Suprasternal retractions

– Nasal flaring

– Decreased pulse-ox

Nursing interventions

Home Management such as:

– Cool mist vaporizer

– Elevate Head of Bed

– Shower steam

– Keep comfortable

– Increase PO fluids

Hospital Management

– Monitor for respiratory distress

– Provide cool mist humidified oxygen

– Elevate HOB

– Medications as ordered

• Oxygen, epinephrine nebulizer, corticosteroids (dexamethasone)

____________________________________________________

ACUTE SPASMODIC LARYNGITIS  aka “spasmodic croup”

• Recurring night laryngeal obstruction

• Subsides in a few hours

• No fever

• May be allergic related

• Sleep with humidified air as preventive

Acute infectious disorders: Bronchiolitis 

Bronchiolitis 

– Inflammation of the bronchioles

Pathophysiology:

– RSV

– Adenovirus

– Parainfluenza

Signs and symptoms

• Tachypnea

• Wheezing

• Cough

• Rhinorrhea

• Sneezing

• Difficulty feeding

Nursing interventions

• Nasal and/or nasopharyngeal suctioning

• Frequent respiratory assessments

• ?RR <60, O2 sats 90% or > 

• Positioning

• Monitor pulse oximeter

• Saline nebulizer

• Oxygen as ordered (if O2 sats <90%)

• Oral and/or IV hydration

• Rarely is inhaled bronchodilator, racemic epinephrine is needed

• NO antibiotics

• NO cough suppressants

Respiratory syncytial virus (RSV) bronchiolitis PREVENTION

Palivizumab (Synagis)

– Humanized monoclonal antibody

– Given IM monthly

– Starts at the beginning of RSV season

– Maximum of five doses

Candidates

– Infants born before 29 weeks of gestation

– Infants in the first year of life with significant heart disease

– Preterm infants (<32 weeks) with chronic lung disease

Acute infectious disorders: Pneumonia

Pneumonia definition:

– Inflammation/infection of the alveoli and the pulmonary parenchymal

Pathophysiology:

– Viral

– Bacterial

– Aspiration

Signs and Symptoms

– Fever

– Cough

– Tachypnea

– Decreased breath sounds

– Crackles

– Difficulty feeding

Nursing interventions

• Administer Oxygen as ordered

• Administer Antibiotics as ordered

• Chest PT

• Monitor Pulse Ox

• Lay on affected side 

• Monitor s/s of dehydration

Acute Non-Infectious Disorder: Foreign Body Obstruction

Foreign Body (FB) Obstruction definition

– Occlusion to lungs due to offending object

Pathophysiology:

– Lodged in the main stem or lobar bronchus

Signs and symptoms 

Cough

Gagging

Wheezing

Stridor (FB is lodged in the upper airway)

Asymmetric breath sounds

Inability to speak (complete obstruction)

Unresponsive (complete obstruction)

Nursing interventions

Prevention/Teaching

– Dangers of certain foods (hotdogs, grapes, round candies, popcorn)

– Toy age requirements (beads, small magnets)

– Heimlich maneuver (>1 year old)

Emergency measures

– Activate emergency response

– Perform Heimlich maneuver

– Place IV

– Prepare for endoscopy

– X-ray

Chronic respiratory disorders

Asthma

Asthma definition:

– Chronic airway inflammation with heightened airway reactivity (smooth muscle spasms and constriction) causing airway obstruction, bronchial hyper-responsiveness and recurring symptoms

Status Asthmaticus definition:

– Medical emergency

– Respiratory distress even with treatment

Epidemiology

More than 7 million children in the US have asthma

Primary cause of school absences

Third leading cause of hospitalizations in children under 15 years

Signs and Symptoms

– Dyspnea: shortness of breath

– Wheezing

– Chest tightness

– Non-productive cough (especially at night and early morning)

– Tachypnea

– Hypoxia

– Prolonged expiration

– Retractions

– Nasal flaring

Triggers

Allergens

– Outdoor: trees, shrubs, weeds, grasses, molds, pollen, air pollution, spores 

– Indoor: dust/dust, mites, mold, cockroach, antigen

Changes in weather or temperature

Irritants

– Tobacco smoke, wood smoke, odors, sprays

Cold air

Animals

– cats, dogs, rodents, horses

Medications

– aspirin, NSAID, antibiotics, beta-blockers

Foods

– nuts, milk/dairy

Nursing intervention

Avoid triggers

Monitor pulse ox

Administer oxygen/medications as per orders

– Short acting beta-2 agonist: Albuterol

• Rescue medication

• With symptoms

• Prior to activity for exercise-induced asthma

– Inhaled corticosteroids: Pulmicort (budesonide) or Flovent (fluticasone)

• Prevention

– Systemic corticosteroids: Prednisone (PO) or solumedrol (IV)

– Airway Tray available

Teaching

– Asthma action plan

– Medication administration

– Avoiding triggers

• Avoid second-hand smoking

• Cover pillows/mattresses with dustproof covers

• Wash bedding in hot water weekly and dry completely

• Keep windows and doors closed during pollen season, use AC

• Child should not be present during cleaning activities

• Use wet mop bare floors weekly and wet dust

• Avoid carpets/stuffed animals

Cystic fibrosis

Cystic Fibrosis definition:

– Multisystem autosomal recessive trait disorder

Pathophysiology:

– Over production of thick mucous resulting in insult to the respiratory, GI and reproductive systems

• Doesn’t affect the stomach tho 

– The epithelial cells fail to conduct chloride and water transport

abnormalities occur 

– The sweat glands build a larger amount of chloride leading to a

salty taste of the skin and alterations in electrolyte balance and dehydration

Signs and symptoms

• Cough

• Recurrent URI

• Clubbing (associated with chronic hypoxia)

• Barrel chest (indicates air trapping)

• Intestinal obstruction

• Frothy/foul-smelling stool (steatorrhea)

• Failure to thrive

Nursing interventions

Diagnoses

– Positive Newborn screening

– Confirmed by sweat chloride test

Management

– Chest PT

– Monitor pulse ox

– Administer oxygen as per orders

– Medication administration as per orders

• Pancreatic enzymes capsules are given with meals/snacks

• Dosing is based on grams of consumed fat

• Swallowed whole or sprinkled on small amount of food 

– Monitor signs and symptoms of dehydration

Diet

– High-calorie

– High-protein