functional limitation that prevents or interferes with a person's ability to perform age-expected activites.
Barrier imposed by society, the environment, or one's self in response to perceived differences.
Technology sometimes results in what kind of chronic conditions?
A rapid increase in __________ with its associated chronic conditions has developed in response to societal lifestyle changes.
an example of a research based health orientation model which depicts the child's changing awareness of the chronic condition as the child goes through the developmental sequence.
Health orientation models portray what?
the relationship between client and professional as a partnership, with each individual bringing a different type of expertise to the situation. Focus shifts from treatment to prevention.
A good coping mechanism is to...
view oneself as normal and to gain social support from family members, peers, and professionals is an important strategy
What does the Public law 94-142, the education for all handicapped children acto f 1975 require?
A free, appropriate public educaiton for all children ages 5-18 yrs regardless of the severity of the disability. This education must be provided in the least restrictive environment that is appropriate for the child, which can range from a regular classroom placement to the child's home.
American Disabilities Act of 1990
Impacts educational experience of children with chronic health conditions. Law prohibits dicrimination based on disability and requires institutions to make reasonable accomodations for individuals with disabilities.
Children and their families must learn how to manage...
Condition-related information and be able to determine what and how much information to ttell to whom, when, and where.
Who can educate children about health conditions and work to decrease stigma and misinformation?
What age group finds that the best coping strategy is to talk with another child with the same condition?
Older children; they also find that it decreases the sense of isolation. They also find that electronic support groups may be beneficial in connecting some of these children. However a normalization strategy for some is to limit contact with others who have the same condition.
How should you respond to children who are dealing with stares and stigmatizing responses?
Anticipate occurances, listen and explore the child's concerns, and coach the children.
What is a good way to coach children to react to negative responses using role playing?
Frontal approach: When other children are staring at you, ask them if they have a question.
What is a potential life outcome for adolescents with terminal illnesses?
to often acknowledge the terminal nature of the illness and plan optimistically for the future
Professionals who provide open, direct information help caregivers navigate the demands and challenges of caregiving for a child with chronic issues. What else is an important action related to this?
Facilitating a sense of hope
What is one of the main challeges of a caregiver for children with a chronic illness?
Learning the skills required to care for the child.
Caregivers often express that professionals undermine their role and do not give them adequate respect and recognition. In addition to learning management skills themselves, caregivers must...
negotiate with the child regarding when and how to shift responsibility for care to the child
involves having a person relieve the usual caregiver of caregiving responsibilites for a period of time (Has many positive benefits: decreased stress & increased coping for families, delayed or prevented institutionalization for children, and increased opportunities for socialization for children
Caregivers of children with chronic issues often say they, "just have to" What are some coping strategies?
2. mastering skills and knowledge
3. balancing "taking charge" and "Letting go"
4. Social supports
5. focusing on the positive and Downward Comparisons (assuming another's situation is worse than one's own)
6. Brieft breaks and relaxation
cognitive and behavioral strategies used by a family of a child with a chronic condition in order to view it as normal
Perspectives of siblings are increasingly being addressed in research showing that having a sibling with a chronic illness has what kind of effect on the healthy sibling?
Both positive and negative
tendency for all individuals and cultures to believe their values are the best and the most correct
There are a higher proportion of children with disabilites living in __________ than those in urban areas or those not livng in poverty
Nurses need to assess the readiness of the _________ to learn and will need to adjust the pace and the amount of information based on that assessment.
Caregivers...Nurses should also be sensitive to the responses of caregivers to the teaching and to assess their understanding of the info by asking appropriate questions or by having them demonstrate the newly acquired skill
What is important to discuss with an adolecent, even if they do have a chronic condition?
Puberty, reproduction capacity, safe sex practices, and intimate relationships
As the child and family interact with others they may be subject to __________________, stares, and inappropriate questions and advice.
what is the most abundant body fluid?
Four key physiological factors are responsible for the fluid and electrolyte difference between children and adults. These are...
1. percentage and distribution of body watner
2. body surface area
3. rate of basal metabolism
4. status of kidney function
a charged particle found in body fluid
body fluid that is outside the cells and includes interstital, intercascular, and lymphatic fluid; ecf contains large amts of Na+, chloride, and bicarb
Infants have a higher proportion of their total body water in...
extracellular fluid, therefore, fluid vol deficits can rapidly intensify in them. This also helps id why cardiovascular compromise becomes evident quicer in dehydrated infants
T/F: Children and infants have a greater BSA than adults
True, This helps account for fluid and electrolyte differences between the age groups
Who has a higher BMR, children or adults?
Children, fluid intake per kg of body weight perday must exceed the per kg fluid requirements of an adult
substance that is dissolved in a solution
Disrtrobution and movement of body fluids between ICF and ECF compartments are affected by:
type of soultes present, type of membrane to be crossed, and changes in the permeability of the capillary beds
pressure of blood against the capillary walls generated when the heart contracts
What is the major ECF electrolyte?
Sodium, resposible for maintaining osmolarity
concentration of a solute within a solution measured by the number of moles per leiter of water
concentration of solute within a solution measured by the number of moles per kg of water
Hyponatremia can be caused by administration of:
excessive amts of Sodium bicarb, baking soda, diarrhea, vomiting, ng suctioning, diuretics, water intoxication, malnutrition, excessive sweating, burns, diabetic ketoacidosis, renal disease, and cystic fibrosis
3.5-5.0...K+ has vital roles in body including transmission of nerve impulses, and contraction of cardiac muscles. Potasium imbalance greatly affects the heart muscle contraction
Know how to calculate maintenece fluid
on page 659
Water loss can be caused by a prolonged fever, this loss of water leads to...
Increased Hct, BUN, and serum osmolarity
What is a common side effect of respiratory acidosis?
Numbness or tingling in the toes and fingers, lightheadedness, and confusion...child may faint
state in which the loss of sodium and water are equal
sodium loss is greater than water loss, results in sodium level falling below 130
water loss is greater than sodium loss. Might occur when infants or children experience vomiting or diarrhea with reduced water intake or when they have diabetes insipidus or are treated for diarrhea with fluids containing high concentrations of electrolytes
Degrees of Dehydration
1. Minimal or none
2. Mild to moderate
1. <3% of body wt
2. 3-9% loss of body wt
3. >9% loss of body wt
How is shigella spread?
Person to person contact, fecal-oral transmission, or by ingestion of contaminated food.
What are the most common intestinal parasites that cause disease?
Giardia and Cryptosporidium.
How is Giardia transmitted?
Through ingestion of cysts either from contact with an infected individual or from food or water contaminated with infected feces.
Finding leukocytes in the ________ should prompt further investigation to rule out invasive bacterial disease as this most commonly occurs in E.coli and Shigella an dCamylobacter infections.
Good handwashing can do what?
minimize the spread of gastroenteritis (esp wash hands after changing diapers or using the BR and before cooking food)
Nurses should model what kind of behavior when it comes to caring for hospitalized children?
cleansing of child environment and food prep areas with appropriate cleaning products and isolating ill children as much as possible from other children and family members
How should you clean a child after having diarrhea?
with warm water and mild soap. then apply a protective ointment to buttocks. Change diapers frequently to protect the skin
How are normal capillary dynamics maintainted?
by balancing hydrostatic and osmotic pressures both within the capillaries and within the surrounding interstitial spaces
What 4 mechanisms may cause edema?
increased blood hydrostatic pressure, decreased blood ospmotic pressure, increased interstitial fluid osmotic pressure, and impaired lymphatic drainage
Why are diruretics given?
to promote fluid excretion through the kidneys
What is the focus of care in actue care?
airway brething circulation and pain mgmt
Fire related burns
in 2004 est 310,000 ppl died as a result of a fire related burn, 96,000 of whom were under the age of 20
Four major types of burns?
Thermal (most common in kids), electrical, chemical, and radiation.
How do thermal burns occur?
from flames, flash, inhalation, scalds, or contact with hot objects
What is a major cause of electrical burns in kids?
Inserting objects into electric sockets or chewing on electrical wires
How can scald burns occur?
From immersing in hot water (common in chlid abuse cases)
Know how they calculate burns in peds patients
page 681, read over it a little bit
What drugs may be given for children with major burns?
IV narcotics such as Morphine Sufate
What is overall goal of burn care?
to close the wound asap, either by allowing it to heal on its own (secondary intention) or surgically grafting the wound
removal of dead tissue fromthe burn site, associated with severe pain
Extensive full thickness burns require what?
A permanent skin graft, an auto graft,
What must happen when an autograft is placed on the wound?
Must be immobilized
A childs BMR will increase to about twice as normal after a burn, what should you increase as a result?
Increase caloric intake and protien. Offer a variety of foods
What is the GU system resposible for?
maintenence of homeostasis of the body (water and electrolytes) and for the exrection of waste products
What makes up the GU system
kidneys, bladder, urethra, and ureters
The bladder presents itself in young children close to the anterior abdominal wall, and ___________, lowers into the pelvis
Which kidney is lower, R/L?
Right is lower than left
Excretory functions include the kidneys ability to clear the body of what?
urea, cratinine, uric acid, phosphates, sulfates, nitrares, and phenols, along with excess fluids, electrolytes, and drugs
Newborns should void within how many hrs after birth?
99% of newborns void within 48 hrs after birth
the amt of fluid that is filtered by glomeruli, a semi permeable membrane. At birth, the fluid that is filtered by GFR is lower than in adults
in the seventh week of gestation, develpoment of the kidney begins, continues up to 32-36wks
most common GU tract issue?
T/F boys who are uncirumcised are less likely to have a UTI
FALSE! They are MORE likely. UTI is most common in uncircumcised males under 3 months and in females under one year
Most common organisms that infect the urinary tract?
E. coli, proteus, pseudomonas, candida (page 699)
difficulty or painful urination. Presenting s/sx of UTI also include malodorus urine, urinary freqency, fever, vomiting, diarrhea, irritability, poor feeding, or loos of appetite
Cystitis is typically distinguished from pylonephritis, how?
fever >101, chills and back pain
How to diagnose UTI?
UA with urine C&S, bladder scan. Need adequate specimen of 5-10mls!
What will diagnose a UTI?
the presence of bacteria (bacteriuria) and wbc's (pyuria). Lab must confirm positive urine culture with greather than 100,000 CFU's
Children should drink no more than how much oz of water before bed?
Renal scanning with dimercptosuccinic acid to id a UTI may be more helpful that what?
traditional IVP, which is still used to rule out UTI...this newer method however is more effective for kids who need longterm follow up
Treament for UTI goals?
Erradicating the infection, preventing reinfection, correcting underlying causes of infection, and preserving renal function
What is an adverse reaction to ditropan?
What can an untreated UTI lead to?
renal scarring (once scarring occurs, pt may develop kidney stones, HTN, end stage renal disease, and possible pregnancy complications
involuntary voiding beyond expected potty training age. Differs from incontinence in that incontinence results from a structural abnormality, usually an anatomic malformation (Test question!)
Child who hasn't achieved a period of dryness for at least 3 months is referrd to as what?
primary enuretic. Secondary enuresis occurs when a child has been dry for at least 3-6 months and then resumes wetting.
wetting that occurs only during the night
Is enuresis a symptom or disease?
Organic factors of enuresis are...
neurologic developmental delay, UTI's, structural disorders of the urinary tract such as obstructive lesions
When do most kids gain bowel control?
Between 2 1/2-3 1/2 yrs of age
what is the typical sequence for potty training?
nocturnal bowel control, then daytime bowel control, then daytime control of voiding, and finally nighttime control of voids
How can enuresis be treated?
DDAVP and Tofranil
Elimination diet is hlepful, what should you eliminate to help with enresis?
dairy, beverages with artificial coloring, carbonation, citric fruit, sugary foods, and caffine
What is VUR?
Vesicoureteral reflux- backflow of urine from bladder to kidneys. Most common anatomic disorder of the GU tract
How do you dx VUR?
Cystogram, or voiding cystourethrogram (graded on a scale of 1-5)
How does surgery help VUR?
reimplants ureter into a position on the trigone that allows for sufficient submucosal lenth to prevent reflux
Uretheral meatus is on ventral surface of penis (1/250 live male births have this)
downward curvature of the penis and an incomplete foreskin
When does tx for hypospadias occur?
before 18 months, assess infant for other GU defects before surgery
failure of one or both testes to descend through the inguinal canal into the scrotum. After ONE year of age, spontaneous descent does not occur
How can you decrease the caregivers anxiety about UDT?
explain that child shold have appropriate referrals for fertility testing when appropriate and should preform testicular self exam beginning at adolescence. Issue of fertility is of GREAT concern to parents
How often should child be instructed to preform testicular exam after surgery?
once a month to assist in early detection of tumors
Inguinal hernia and hydroceale
inguinal hernia- scrotal or inguinal swelling, or both, that includes the abdominal contents
hydrocele- collection of peritoneal fluid in the scrotal sac.
---Children who recieve dialysis and those with ventriculo-peritoneal shunts are at an increased risk for both. Treatment for inguinal hernia is usually suurgery performed on an outpatient basis
What can be come enstrangulated?
a hernia, then becomes edematous and twisted
Acute Glomerular Nephritis (AGN)
acute or sudden inflammation of the glomeruli within the kidney, peaks at age 7. Can result in acute renal failure.
Agents causing AGN are usually bacterial or viral. What's the most common organism?
Beta-hemolytic streptococcus, a primary site of infection is typically the throat or the skin, or incase of the Henoch-Schonlien nephritis (HSN) there is an upper respiratory tract infection in many children that precedes nephritis
What is the clinical manifestation of AGN?
Hematuria (also dependent and periorbital edema, diminished urine output, proteinuria, HTN, fatigue, diminished GFR, elevated serum sodium levels, and elevated K+.
Tests for AGN?
1. serum complement (c3) test for complement cascade of the immune system (usually low)
2. antistreptolysin O titer which if elevated means a strep infection has been present
3. culture of primary site of infection such as the throat
Nephrotic Syndrome (NS)
Clinical entity characterized by massive proteinuria and hypoalbuminemia (low levels of albumin in the blood). African Americans have higher incidence of NS. Edema is the 1st clinical feature and dx is dependent upon proteinuria. Lasix, Corticosteroids, cortisone, and prednisone are good treatments for NS. Daily weights is a nursing intervention, teach family daily weights.
Hemolytic uremic syndrome is a result of?
E. Coli from contaminated beef.
Clinical manifestations of HUS are a triad of symptoms which include?
acute renal failure, thrombocytopenia, and anemia. history may include bloody diarrhea, decreased urinary output, and slight abdominal pain
What test can determine the presence of Ecoli and shigella bacteria from HUS?
Dialysis is most often reserved for the children who are ______ for 24 hours or have oliguria and are extremely hypertensive, hyperkalemic, or experienceing seizures.
Anuric (without urine output)
Treament for HTN is?
hydralazine (Apresoline) and catopril (Capoten)
What are 3 main types of causes of Acute Kidney Injury (AKI)?
prerenal, intrarenal, and postrenal. AKI can be life threatening and is associated with disorders like ischemic insults, exposure to drugs, an underlying infection, or HUS. Can be reversable or progress to chronic kidney infection.
Prerenal failure is characterized by?
sudden decrease in renal blood flow or perfusion to kidneys
Intrarenal failure isassociated with?
damage to the tissues
Postrenal failure results from?
an obstruction of urine at some point between the kidney and the urinary meatus
What should you do if metabolic acidosis is presnt?
replace the lacking renal buffer with sodium bicarbonate
requires the placement of a catheter into the peritoneal cavity for the purposes of removing excess fluids, solutes, and nitrogenous wastes
continuous form of dialysis
Chronic Renal Failure (CRF)
Is a progressive disease that is considered chronic when aprox 50% of renal function remains or when GFR is less than 60ml/min
condition in which toxic nitrogenous waste products, blood urea, and creatinine buildup in the system. If not corrected, progresses to ESRD
CRF has been estimated to affect what percentage of pediatric population?
1.5 and 3.0 per million
What are some treament options for CRF and ESRD?
erythropoetin, growth hormone (to boost linear growth), immunosuppressive therapy (used esp if child is going to require renal transplantation...usually reserved for children in ESRD for whom medication and dietary mgmt of fluid and electrolyte balance and HTN have been unsuccessful. May or may not have been maintained on dialysis for a long period of time prior to the transplant)
Cyclosporine, azathioprine (Imuran), and prednisone or other immunosuppresive drugs are used to suppress the natural immune response but after renal transplantation...
inmmunosuppresive medications are required for life. Postrenal transplant patients are at high risk for VUR, so assemssment is vital!
What are the signs of a kidney infection?
fever, flank pain, burning on urination, cloudy or blood tinged urine, and sometimes abdominal cramping.
complex and rare serious congenital anomaly affecting the urologic and musculoskeletal systems. Occurs more frequently in males. Bladder is outside the body. Epispadias is characterized by the urethral opening on the dorsal side of the penis.
Surgical mgmt of bladder exstrophy?
preformed within first 48hrs but may be deferred secondarily to the infants stability or until further testing is preformed. Its high risk for infection
Clients with exstrophy have high level of sexual functioning (T/F)