healing occurs spontaneously over 2-4 years but may require a hip replacement later on in life; marked distortion of the head of the femur may lead to an imperfect joint or degenerative arthritis of hip in later life
for children under 2 or under 20-30lbs, legs are suspended vertically
Buck skin traction
pulls in only one direction, it's essential that the child don't slip down in the bed and the bed not be placed in high-Fowler's position
pulls in 2 directions
Crutchfield, carries added risk of infection from skin bacteria from the pins
weights are to hang freely, weights out of reach of child, ropes are not on pulley, ben linens are not on traction ropes, countertraction is in place
treatment is radical resection or amputation
treatment is radiation and chemo
Duchenne's Muscular Dystrophy
sex linked only in boys, signs- Gower's maneuver, diagnosis is muscle biopsy
Juvenile rheumatoid arthritis
high fever over 103 for over 10 days, nonpruritic rash, aspirated joint fluid is yellow to green and sloudy with low viscosity
polyarticular form of juvenile rheumatoid arthritis
involves 5 or more joints often small joints
pauciarticular form of juvenile rheumatoid arthritis
involves 4 or less joints usuallyu larger one, children may be at risk for iridocyclitis so they need periodic slit lamp eye exams
infection of bone, bone scan is diagnostic, IV antibiotics for 4-6 weeks, bed rest adn no weight bearing until cleared
S-shaped curvature of spine, functional-caused by poor posture, structural- caused by changes to shape of verebrae, curves up to 20 degrees no treatment, over 20 Milwaukee brace (get them clotehs that will cover it up and look nice)
what dr looks at when looking for scoliosis
asymmetry, one shoulder may be higher, a scapula may be prominent, arm to body spaces may be unequal, hip may protrude, one arm may appear longer when person bends forward
Tracheoeesophageal fistula (esophageal atresia/TEF)
earliest sign- mother develops polyhydramnios, at birth the child will vomit or choke when given first feeding therefore assessment of newborn's first feeding is essential
diarrhea can result in
treatment for diarrhea
rest intestine by reducing intake of solids, take oral rehydrating solutions
projectile vomiting immediately after feeding is big sign, infant is constantly hungry. surgery is treatment... if infant is dehydrated give IV fluids, thicken feedings and place infant on right side after feedings
most common, route of entry is mouth...sign-child scratches anal area, can do scotch tape test, Meds: Vermox (not for pregnant women), Antiminth, Povan (may cause red stools), have child wash hands well and have short fingernails
caused by disposal of human feces into the soil, chronic cough without fever is characterisitc
slipping of one part of intestine into another part below it, sign- currant jelly stools, this is an emergency, barium enema is treatment of choice
associated w/ Reye's syndrome, antidote is N-acetylcysteine (Mucomyst)
absence of ganglionic innervation to the muscle of a segment of bowel, ribbionlike stools common, treatment- sugery and anastomosis...when given enema at home give saline not tap water
gluten products like wheat, barley, oats, and rye cause this, stools are large, bulky, frothy, steatorrhea, treatment is lifelong diet of restricting gluten products
protein deficiency but adequate calories are consumed, often in children 1-4 who has been weaned from breast, earliest sign white streak in hair
deficiency in Vit D, Vit D and sun exposure needed
deficiency of both protein and calories
deficiency in Vit C, bleeding of gums, loose teech and lack of enegy, sources Vit C- citrus fruids and raw leafy veggies, Vit C is destroyed by heat
Group A hemolytic strep (Acute Pharyngitis)
inflammation of the throat, 80% caused by a virus
signs of acute pharyngitis
conjunctivitis, rhinitis, cough, and hoarseness with a graudal onset and persisting no longer than 5 days
treatment for pharyngitis
when a throat culture is positive give penicillin for 10 days, erythromycin if allergic to penicillin
life threatening medical emergency, caused by H influenzae type B... child insists on sitting up, leans forward with mouth open and drools, may have froglike croak but cough is absent...a tongue blade may trigger a spasm and result in resp. arrest
immediate tracheotomy or endotracheal intubation
inherited recessive trait, both parents carry gene, affects the following systems: respiratory: airways get obstructed by thick secretions, Digestive: poor absorption of food, bulky foul smelling stools from undigested fats, Skin: loss of sodium and chloride gives a salty skin, Reproductive: decrease sperm motility
manifestations of cystic fibrosis
barrel chest, enlarged R ventricle, clubbing of fingers
best diagnostic study for cystic fibrosis
sweat test...you should give this child liberal amounts of salt especially during hot weather
nursing care for cystic fibrosis
postural drainage, chest clapping thearpy, pursed lip breathing, prevent resp. infections, promote growth and development, give immunizations, oral pancreatic prep is given with meals and snacks
unexpected death of an apparently healthy infant between 2 weeks and 1 year, peak is 2-4 months, lay child on side or supine
nursing care for SIDS
let the parents know the infant died of a disease called sudden infant death syndrome, the disease cannot be predicted or prevented, they are not responsible for the death
spread by direct contact with the secretions, it can survive for up to 6 hours, place on standard contact (isolation) precautions
diagnosis for RSV
ELISA test; nasoharyngeal washings
ventrical septal defect, atrial septal defect, and patent ductus arteriosus do what to the pulmonary blood flow
they increase the pulmonary blood flow because of a left to right shunt
ventricular septal defect
most common heart anomaly, opening between the right and left ventricles of the heart, increased pressure in the left ventricle forces blood into the right
signs of VSD
loud harsh murmur with a systolic thrill
coarctation of the aorta
when there is a narrowing of the aortic arch or the descending aorta, an obstructive defect
symptoms of coarctation of the aorta
marked difference in the blood pressure and pulses of the upper and lower extremities, may not develop symptoms till late childhood
treatment of coarctation of the aorta
a graft surgery is done called anastomosis, graft does not grow so best time to do surgery is between 2 and 4 yrs old
if coarctation of aorta is untreated what can happen
hypertension, CHF, and infective endocarditis
patent ductus arteriosus
happens when ductus arteriosus doesn't close, blood continues to pass from aorta, where pressure is higher, to the pulmonary artery, causes oxygenated blood to be recycled
symptoms of patent ductus arteriosus
in infancy may go unnoticed, as child grows dyspnea, full and bounding radial pulse, wide pulse pressure, has a characteristic machinery type murmur
the defects associated with tetralogy of fallot
narrowing of pulmonary artery, hypertrophy of RV, dextroposition of the aorta, and VSD
signs associated with tetralogy of fallot
cyanosis, clubbing of fingers and toes, will squat to breathe easier, feeding problems, growth retardation, resp. infections, polycythemia, severe dyspnea on exerction
an increase in red blood cells, happens when body tries to compensate for lack of oxygen
paroxysmal hypercyanotic episodes
also called tet spells, when spontaneous episodes of cyanosis, resp. distress, weakness, and syncope occur
what to do when infant has a tet spell
place in knee chest position
complications associated with tetralogy of fallot
cerebral thrombosis caused by polycythemia, esp if dehydration occurs, Iron deficiency anemia
treatment for tetralogy of fallot is designed to
increase pulmonary blood flow to relieve hypoxia
drug therapy used to open a constricted ductus arteriosus and allow oxygenation of body till surgery is performed for tetrology of fallot
IV prostaglandin E therapy
Pt teaching about iron intake
milk contains very little iron; eat leafy greens, boiled egg yolk, Cream of Wheat, or fortified cereals.
give between meals, vit c helps in absorption- don't give w/ milk, liquid preparations take through straw due to discoloration of teeth, injection form must be given deep IM; increase fluids and tarry green stools expected.
malignancy of lymph system; Reed-Sternburg cells present. Classic symptom is painless lump along neck. Low grade fever, anorexia, wt loss also seen. Tx is usually chemo and radiation.
Stage I Hodgkin's
restricted to single site or localized in a group of lymph nodes. Pt is asymptomatic.
Stage II Hodgkin's
2 or more lymph nodes on same side of diaphragm.
Stage III Hodgkins
lymph node involvement on both sides of diaphragm; adjacent organ or spleen.
Stage IV Hodgkins
diffuse disease; poor prognosis.
Sickle cell disease
RBC's abnormally shaped; carries less oxygen and clumping can lead to clot blocking blood flow causing extreme pain (vaso-occlusive crisis= more common)
sickle cell crisis where spleen becomes massive, circulatory collapse and shock are present, blood pressure plummets, death occurs within hours of symptoms.
Sickle cell anemia
severe form of sickle cell disease; offspring has 1 in 4 chance of getting in both parents have trait. Chronic state of anemia 6-9 g/ dl or lower levels of hemoglobin.
Sickle cell crisis
painful and can be fatal. Severe abdominal pain, muscle spasms, leg pain, swollen joints, hematuria, fever and vomiting. Tend to decrease w/ age and immunizations pare important.
Sickle cell dx
sickledex or hemoglobin electrophoresis.
Sickle cell tx
analgesics to relieve pain, packed RBC's may be transplanted, splenectomy not usually recommended. Main goals are: prevent dehydration, hypoxia, and infection.
group of hereditary blood disorders where the pt cannot produce enough mature hemoglobin. RBC's are abnormal in size & shape and rapidly destroyed.
May be misdiagnosed with iron deficiency anemia. Pt pale and spleen enlarged. Sometimes can live normally without being detected.
aka Cooley's anemia; becomes evident within 6 months or life. Jaundice is mild and then muddy bronze color. Spleen grows enormously causing abdominal distention and pressure on organs.
Appearance in Cooley's anemia
expansion in bone marrow in face changes contour like overgrowth of upper jawbone; becomes thin and can have pathological fracture.
maintain hemoglobin levels to prevent deformities and provide for growth and development. Prophylactic antibiotics.
Care for dying child
listen to parents input on care, ask open ended q's, children should be allowed to have as much control as possible, know that children are generally aware of their condition and understanding concept of death is at 9 to 10 years of age.
inspected daily, may be rinsed with 1 part hydrogen peroxide to 4 parts saline. Water-Pik & soft tooth sponge are helpful.