Pediatrics Set I Growth & DEvelopment

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Growth

increase in physical size

Development

increase in abilities (skills)

Cephalocaudal development

skills develops head downward through body towards feet.

Proximodistal development

skills develops from center to extremities.

Anticipatory guidence

Nurses use this to predict upcoming development task and needs of child.

Development Theory

Erikson

Erikson's Psychosocial Stages of Development

Eight Psychosocial stages - each has a unique developmental task; birth through old age; stages have 2 possible outcomes: either a healthy one or unhealthy.

Trust vs. mistrust

Birth to 1 yr.

Autonomy vs. shame/doubt

1 to 3 yrs.

Initiative vs. guilt

3 to 6 yrs.

Industry vs. inferiority

6 to 12 yrs.

Identity vs. role confusion

12 to 18 yrs.

Piaget

Four stages of cognitive development.

Sensorimotor

Birth to 2 yrs.

Preoperational

2 to 7 yrs
Young child thinks by using words as symbols; logic is not well developed..

Preoperational

Transductive reason (Stage Name)
Unrealistic cause/effect relationships, "magical thinking"

Concrete operational

7 to 11 yrs.
More accurate understanding of cause/effect.Concept of conservation - matter doesn't change when its form is altered.A child can reason well in this stage if concrete objects are used in teaching.

Formal Operational

11 years to adulthood.Mature intellectual thought, can think abstractly, can consider different outsomes

Bandura

Social Learning Theorist - a child can learn attitudes, beliefs, and customs through social contact.

Social learning behaviors

If positively rewarded, they repeat behaviors.

Self-Efficacy

this is the expectation that someone can produce a desired event

T

(T/F) Regression is normal in a hospitalized child (1-3yrs.) / might start wetting the bed again.

6 months

Birth weight doubles by ___.

1 year

Birth weight triples by ___.

1 year

Height increases by about a foot each ___.

6 months

Teeth erupt at about ____ months.

6-8 teeth

How many teeth should be showing at 1 year?

1 year

Baby should beable to feed itself by ____.

2 years

Birth weight should quadruple by ____.

33 months

By ____ months, eruptinon of deciduous teeth is complete (20 teeth present)

Parallel play

Kids play next to but not with each other (jealousy)

1000

Toddlers have _______ word vocabulary.

2000

Preschoolers have ________ word vocabulary.

12-18 months

Anterior fontanel closes at ____ months.

2 - 3 months

Posterior forntanel closes at _______ months.

many childhood communicable diseases can be prevented thru

immunizations

streptococcal infections can lead to

serious cardiac complications

parasitic infections generally involve

the entire family and home enviornment

the most common cause of injury to a child is

trauma

SIDS

sudden and unexpected death of an apparently healthy infant during sleep

common skin disorders include

nevi, rashes, and eczema

neurologic disorders include

reyes syndrome and meningitis

miningomyelocele

the most serious form of spina bifida, may cause paralysis or other disorders

hydrocephalus can be detected by

OFC measurements

what food must children with celiac disease avoid

anything with gluten

gluten

a protein substance that remains when starch is removed from cereal grains. Ex. gives cohesiveness to dough

structural defects of the hear can result in

abnormal shunting of oxygenated and de-oxygenated blood

shunting

moving oxygenated blood into vital areas and bypassing less vital areas

leukemia

cancer of white blood cells

leukemias can be

acute or chronic

cystic fibrosis

a fatal disorder in which a thick, sticky mucus clogs passages to the lungs pancreas and liver

serious respiratory tract illnesses include

RSV,LTB, epiglottitis, and asthma

illness of the GI tract places the young child at high risk for

fluid and electrolyte imbalances or dehydration

Urinary tract infections problems

structural, autoimmune, cancerous, or infections

the most common reproductive disorder concerns

ambiguous genitalia and cryptorchidism

ambiguous genitalia

when the appearance of genitalia can't be used to determine sex

cryptorchidism

failure of one or both testes to move into the scrotum as the male fetus develops

solid foods are introduced

4-6months of age

nephrotic syndrome

loss of large amounts of plasma protein resulting in systemic edema

roseola

Any rose-colored rash marked by maculae or red spots on the skin

pediatrics

the area of care that deals with children and adolescents

Pediatric Susceptibility to URI

Immature immune system
Small airway (small tubular passage ways)
Decrease ability to clear airway
Everything in mouth
School aged siblings

reyes syndrome

this disorder is associated with aspirin intake, usually seen in children recovering from viral illness

s/sx of URI

fever, dyspnea, with thick tenacious sputum and mucus and edema of the throat

tx of URI

antibiotics, humidity, and rest. O2 may be nec.

Pneumonia

Inflammation of lungs
Alveoli bathed in exudate (interferes w/gas exchange)
Viral or bacterial
Often extension of URI

Pneumonia Symptoms

Dry cough progressing to productive cough
Paroxysmal cough
Fever
Respiratory distress
Anorexia
Cranky, irritable
Cyanosis (late symptom)

Pneumonia Treatment

Rest
Humidified O2
Nebulizer Tx
Chest physiotherapy
Antibiotics
Increased fluids
Close observation

croup is a syndrome that results in

a harsh barky cough

Laryngotraceobronchitis (Croup)

Inflammation of the larynx, trachea and bronchi
Usually viral (often follows a cold)
Narrowing of air passages causing varying degrees of airway obstruction
Common age 3months- 3yrs
More common in winter

Laryngotraceobronchitis (Croup) Symptoms

Restlessness
Hoarseness
Brassy, barking cough (classic symptom)
Inspiratory stridor - narrowed airway
Respiratory distress
Fever (low grade)
Condition usually occurs suddenly during the night
With a hx of croup, if showing signs during the daytime, admitted to hospital.

Laryngotraceobronchitis (Croup) Treatment

Close observation - make sure airway patent
Bedrest
Cool humidified environment - cool mist humidifier (clean 2x's day)
Encourage fluids - thins secretions
Antipyretics - Tylenol, Motrin, if fever
Corticosteroids - decrease airway inflammation (used for severe cases)
Epinephrine - opens airway (used for severe cases)

Epiglottitis

Inflammation of the glottis
Escalation of croup
Edema of tissues above the vocal cords
Narrowing of airway that can lead to complete obstruction
* Throat examined with extreme care as throat stimulation can lead to laryngoaspasm and obstruction
DO NOT TRIGGER THE GAG REFLEX DO NOT EXAMINE THR CHILD'S THROAT WITH TONGUE DEPRESSOR

Epiglottitis Symptoms

Anxious, apprehensive, fearful expression
Severe respiratory distress
High fever
Absence of cough
Drooling of saliva(w/refusal to swallow due to an extreme sore throat)
Dyspnea with rapid progression of distress
Red inflamed throat with cherry red epiglottis
Muffled, croaking voice
Very ill appearance

Epiglottitis Treatment

Corticosteroids
Epinephrine
Antibiotics
Cool mist humidifier
Oxygen
Close monitoring of respiratory status and O2 saturation

Bronchitis

Inflammation of bronchi
Viral or bacterial
Main concern is airway obstruction and pneumonia
Often related to URI (moves down)

Bronchitis Symptoms

Dry non-productive cough- worse at night
Cough eventually breaks and is productive of purulent tenacious (hard to break up) sputum
Improves when cough begins to break up
Fever
Malaise
Fatigue
Anorexia

Bronchitis Treatment

Antibiotics (prevents movement to the lungs)
Cool mist humidifier
Rest
Increased fluids
Nebulizer Tx
Expectorants (thins secretions)
Postural drainage > chest physiotherapy
1st nebulizer
2nd cupping & clapping (not after meal)
3rd postural drainage

Bronchiolitis

Common in infants
Inflammation of bronchioles with mucous plugs blocking small tubules
Air trapped and can not pass out on expiration
Increased CO2 levels and respiratory acidosis
Viral origin, does not respond to antibiotics
Respiratory synctial Virus (RSV) 50% of cases
Respiratory distress common symptom

Bronchiolitis Treatment

Rest
Humidified o2
Nebulizer treatments (best when sleeping)
Fluids
Chest physiotherapy
Close monitoring
Babies often vulnerable to resp. arrest

Tonsillitis

Inflammation of the tonsillar structures in the oropharynx
Bacterial or viral
Inflammation of tonsils
Erythema and exudate (whit mucous) in throat

Tonsillitis Symptoms

Dyspahgia- difficulty swallowing
Bad breath
Mouth breathing - abdominal pain
Nasal muffled voice
Persistent cough
Fever
WBC count is elevated
Ear infection may develop (usually in Eustachian)

Tonsillitis Treatment

Rest
Antibiotics
Increased fluids
Nebulizer tx
Cool mist humidifier
Frequent recurrence may require tonsillectomy

Tonsillectomy Pre-op

Routing assessment
Bleeding and clotting times
Explain procedure
Informed consent
Reassure child and parents
NPO midnite b4 surgery
No URI

Tonsillectomy Post- op

Pulse and respirations frequently
Observe for signs of bleeding
Restlessness
Rapid pulse
Frequent swallowing
N&V
Bright red & flank bleeding
Ice collar
Ice pops (no red ice pops)
Soft diet
No straws
Not hot beverages
No carbonated beverages
Analgesics
Discourage swallowing of secretions
Discourage coughing and clearing of throat

Otitis media

Middle ear infection
Extension of URI > Eustachian tube
Fluid build up behind tympanic membrane
Microbial growth supported by warm, dark, moist environment
Bacterial or viral

Otitis media Symptoms

Earache (pulling at ears) - Major Symptom
Fever
Irritability, cranky
Anorexia
Crying
Otoscopic exam reveals red, bulging TM
Purulent drainage possible

Otitis media Treatment

Antibiotics (if viral usually won't give)
Analgesics
Antipyretics (decrease fever)
Decongestants
Assessment of hearing if frequent infections - especially if fl remains in ear
Myringotomy with insertion of tubes

Myringotom

Incision of eardrum
Drainage of fluid
Insertion of tubes to continue draining fluids
Tubes can remain in place for weeks- months
Avoid immersing head in water
Avoid blowing nose forcefully
Not always effective, may need to be repeated

Bronchial Asthma

Lower airway disorder characterized by bronchospasm, increased thickened secretions and mucosal edema
Common disorder
Most common chronic condition of childhood
Can be precipitated by allergies, URI, emotional stress

Bronchial Asthma Symptoms

Hacking, irritative, non- productive cough
SOB, flared nares
Prolonged expiratory phase
Audible wheeze
Restlessness
Increasing respiratory difficulty

Bronchial Asthma Treatment

Prevention - avoid allergens, treat URI, cool mist humidifier in home, air purifier
Children w/food allergies tend to be more prone
Rest
Bronchodilators - used to open airway and relax smooth muscle during acute attack
Corticosteroids - often nebulizer for acute attacks attacks
Intal(cromolyn sodium) used to prevent
Education regarding meds, prevention and treatment

Group A Beta Hemolytic Streptococcus Aureus

Promptly treated to avoid:
Rheumatic carditis - invasion of mitral valves
Glomerulonephritis - attacks nephrons
Gullain Barre syndrome - body's immune system attacks your nerves
URI symptoms persisting beyond 5-7 days require a throat culture (probably not viral)
Positive throat cultures are treated with Antibiotics
Follow up culture to ensure resolution

Rheumatic carditis

invasion of mitral valves

Glomerulonephritis

attacks nephrons

Gullain Barre syndrome

body's immune system attacks your nerves

Sudden Infant Death Syndrome (SIDS)

Exact cause unknown
Common in premature infants
Peaks in 10-12 weeks with over ½ cases occur by 3 months
Infant suffers from apnea and dies in sleep
Parents devastated
Apnea monitor
SIDS Foundation
*infants sleep on back*

Infectious Mononucleosis

Caused by Epstein Barr Viris (EBV) - one of the herpes viruses
Transmitted by droplets in saliva, cough, sneezes, contact w/mucous membranes
"kissing disease"
Child has extreme soar throat

s/sx of Infectious Mononucleosis

Flu like
HA
Low grade fever, anorexia
Cervical lymphadenopathy (swollen lymph glands in neck)
Enlarged spleen or liver

dx of Infectious Mononucleosis

CBC and Mono Test

Infectious Mononucleosis Treatment

Symptomatic
Rest, Fluids
Analgesics
If liver/spleen enlarged > greatest risk of rupture is during 2 to 4 weeks of illness
Strenuous exercise & contact sports should be avoided while organs are enlarged
Systemic steroids to reduce pharyngeal inflammation
Edema
Fatigue & weakness for several weeks

Lyme disease

Bacterial infection - Borrelia
Tick bites

Lyme disease Sx

appear 3 to 31 days after bite:
"bulls-eyed" ring rash
Flu like symptoms

Lyme disease Tx

Antibiotics
w/out rash can go undetected:
Goes thru the blood > settles in tissues & multiply > chronic symptoms as pain, loss of muscle function, psychiatric disturbances, etc.
Early detection is best
Prevention

Pediculosis

Infestation w/head lice
Highly contagious
Nits attach firmly to head shaft

Pediculosis Tx

Prediculocidal shampoo (RID or Nix)
Manual removal
Keep home until knit free
Wash clothes, bedding, towels

scabies

Infestation w/itch mite
Burrows under skin & lays eggs
Contagious

scabies Tx

Scabicide (rinse off in shower, on for 8-12 hrs)
Keep home until resolved
Wash clothes, beeding, towels

Dermatophytoses (Tinea)

Superficial fungal infection of skin
Scaly red patches, itching
Areas of baldness (capitis)
Blister of toes w/vesicles & burring (pedis)

Tinea Capitis

ringworm of scalp

Tinea Corporus

ringworm of body

Tinea Pedis

athletes foot

Dermatophytoses (Tinea) Tx

Topical antifungal creams, powders, sprays
Oral Griseofuluin
Keep area clean & dry

Impetigo

Infection of skin caused by Straphylococcal & Streptococcal bacteria
Red raised area, vesicles form, rupture, creating honey yellow crust; face & hands
Highly contagious; keep home from school
Separate towels & washcloths

Impetigo Tx

Antibiotics
Frequent hand washing, don't touch
Can be dangerous in newborns

Infantile Eczema

Non-specific dermatitis
Common when new foods are introduced
High incidence of food allergies
Increase incidence of Asthma

Infantile Eczema Tx

Protect from scratching
Mitts on hands
Aveeno baths

Dermatitis

Contact or irritant
Exposure to irritating substance
Redness, warmth, vesicles, burning

Dermatitis Tx

Avoiding irritant
Hydrocortisone cream

Acne Vulgaris

Overactive sebaceous glands
Hormonal & hereditary factors
Papules (solid), pustules (contains pus), & comedones (blackheads) on face, chest, & back

Acne Vulgaris Tx

Facial cleaning, Benzoyl peroxide
Don't pick or squeeze
Accutane or Retin-A

Congenital Heart Disease

Heart damage resulting from developmental defects
Classified as:
Cyanotic - causes cyanosis
ayonotic- no cyanosis

Congenital Heart Disease Cyanotic

causes cyanosis

Congenital Heart Disease Acyanotic -

doesn't cause cyanosis

Congenital Heart Disease Cyantoic defects (lack of O2)

R to L shunting deoxygenated blood mixing w/oxygenated blood

Congenital Heart Disease Acyanotic defects (O2)

L to R shunting
Pressure is higher due to L side

Cyanotic Defects

Deoxygenated blood(venous) & Oxygen blood (arterial) mixes
systemic circulation due to left ventricles sending this mixed blood to the body
* will cause cyanosis*

Cyanotic Defects Tricuspid Atresia

No opening b/w the R atrium & L ventricle
No blood flows from R atrium to L ventricle, which decreases pulmonary blood flow
* will cause cyanosis*

Transposition of Great Cyanotic Defects Vessels (TGV):

Aorta and the pulmonary artery are reversed, so that each connect to the wrong side of heart
High death rate
* will cause cyanosis*

Cyanotic Defects Tetrology of Fallot

Combination of 4 major defects:
Ventricular Septal Defect (VSD):
Pulmonary Stenosis:
Overriding aorta:
Right Ventricular Hypertrophy:

Cyanotic Defects Tetrology of Fallot: Ventricular Septal Defect (VSD):

A hole in the septum separating the R & L ventricles

Cyanotic Defects Tetrology of Fallot: Pulmonary Stenosis:

Narrowing of pulmonary artery

Cyanotic Defects Tetrology of Fallot: Right Ventricular Hypertrophy:

Enlarged R ventricle due to heart pumping harder in an attempt to increase blood flow to lungs

Cyanotic Defects Tetrology of Fallot: Right Ventricular Hypertrophy:

Enlarged R ventricle due to heart pumping harder in an attempt to increase blood flow to lungs

Acyanotic Defects:

Patent Ductus Arterious:
Ductus Arterious connects fetal pulmonary artery to fetal aorta (closes after birth)
Patent is when ductus remains open
can lead to pulmonary hypertension
Coarctation:
Aorta narrows, obstructing blood flow
Coarctation is further away from heart
Atrial Septal Defect:
Abnormal opening b/w the R and L atria

Acyanotic Defects: Coarctation:

Aorta narrows, obstructing blood flow
Coarctation is further away from heart

Acyanotic Defects: Atrial Septal Defect:

Abnormal opening b/w the R and L atria

Acyanotic Defects: Ventricular Septal Defect:

Abnormal opening b/w R and L ventricle

Acyanotic Defects:Pulmonary Stenosis:

Narrowing of the R ventricular outflow tract, including valve, which decreases blood flow to lungs
Valve replacement

Acyanotic Defects:Aortic Stenosis:

L ventricular outflow tract,
Aortic valve malfunction causes the heart to work harder to pump blood to the body

Congenital Heart Disease Symptoms

Generalized cyanosis (cyanotic defects)
Cyanosis on exertion (crying, feeding, straining)
Dyspnea & fatigue (especially w/feeding)
FTT (failure to thrive)
Tachypnea, murmurs, dysthrymias
Growth delays
Clubbing of fingernails & squatting (cyanotic defects)
Squatting is the PED for of orthopnea
Small for age
Delicate, frail body
Tachycardia
Difference in pulse b/w upper & lower extremities (coarctation of aorta)
Susceptibility to infection, especially URI's

Congenital Heart Disease Treatment

Symptomatic initially
Surgical repair performed as soon as child able to tolerate
Major defects are repaired in stages
Digoxin & Lasix (tx's CHF)
Antihypertensives
Low Na diet, supplements, vitamins, & iron

Congenital Heart Disease Nursing Care

Assess rate & quality of pulse
Monitor respirations, observe for cyanosis & dyspnea
Avoid temperature extremes
Daily wt's
Monitor G&D
Feed slowly, rest periods
I&O
Administer drugs as prescribed
Protect from infection

Kawasaki Disease

Systemic vasculitis
Under age 5
Cause unknown
Inflammation of small vessels, pericarditis, aneurysm formation
Stasis & blood clot formation
25% of children develop heart damage

Kawasaki Disease Sx

High fever
Red and dry conjunctiva
Inflammation of pharynx & oral mucosa
Strawberry tongue
Perineal rash
Redness of palms & soles of feet
ECG changes & CHF can develop

Kawasaki Disease Tx

IV fl's
Gamma Globulin (given IV) - "immunoglobulin" boost body's immune system
Antipyretic > ASA very effective
Heparin
Rest
Close monitoring for CHF, Resp. distress & Thrombus
Recovery common

Iron Deficiency Anemia

Deficiency of dietary iron
Common in school aged child, adolescence, & infants fed cow's milk

Iron Deficiency Anemia Tx

Iron rich diet & iron supplement
Take w/food
Change stool's color (tarry green)
Discolors teeth (in liquid form, use straw)
Iron take w/Vit C to enhance absorption

leukemia

Cancer of blood forming organs
WBC production increases, cells are immature & poorly formed

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