Name 2 live vaccines
Chicken Pox, MMR
When is DTAP absolutely contraindicated
When seizure occurred after previous DTAP
Peanuts can be easily ___________
In terms of nutrition, toddlers are considered ___________
In terms of nutrition the ____________ of food is more important than the _____________ of food for preschoolers.
If lighter fluid (hyrdocarbon) is ingested what symptoms will the child present with?
respiratory symptoms (think fumes)
If a corrosive poison is ingested what symptoms will the child present with?
tongue edema, mouth sores, pharynx problems
Tip for parents with children diagnosed with Failure to thrive:
be persistent through 10-15 minutes of food refusal
Teaching for family after child underwent high rectum malformation surgery:
report changes in stool patterns to doctor, do not want firm stools
The neonatal period is the first _____ days
The postnatal period is days _________ through __________
28 days; 1 year
What is the major determinant of neonatal death in the US?
Low birth weight is < ______ g?
What is the #1 cause of death in children > 1 year?
What is family centered care?
Recognizing the family as the constant in a child's life
What does family centered care strive to do?
address the needs of all family members
families are given the opportunity to display caring
giving the family the skills to care
Atraumatic care goal
first do no harm
3 principles of atraumatic care:
prevent separation, promote sense of control, minimize bodily injury
is part of primary prevention of disease
flushed cheeks, white strawberry tongue, rash shows increased density on neck and groin and transverse lines on elbow, Koplik's spots
Small, irregular red spots with a bluish-white center appearing on the buccal mucosa in association with measles
decreases morbidity and mortality in rubella (measles)
Rubella (measles) is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.
viral; droplet; 10-20
Mumps is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.
viral; droplet or contact; 14-21
Whooping cough (pertussis) is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.
bacterial; droplet or contact; 6-20
Chicken pox(varicella) is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ weeks.
viral; airborne; 2-3
German measles is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.
viral; direct; 14-21
fever, headache, malaise, parotitis (may lead to orchitis & meningoencephalitis
Whooping Cough (pertussis)
short rapid cough followed by crowing of "whoop" sound
Usual cause of death with pertussis (whooping cough)?
Greatest danger of German measles if nurse or family member is pregnant?
teratogenic effect on fetus
Chicken Pox (varicella) complications
secondary bacterial infections, encephalitis, pneumonia, hemorrhage and chronic or transient thrombocytopenia
What vaccines should not be given to immunocompromised patients?
Live vaccines (Varicella and MMR)
Denial of chronic illness by family member is considered maladapative only if ...
it delays treatment
Protest stage of separation anxiety
cry and scream, cling to parent
Despair stage of separation anxiety
crying stops, evidence of depression
Detachment phase of separation anxiety
denial or resignation but not contentment; may seriously affect attachment to parent after separation
A child's concept of illness is more important than intellectual maturity in predicting __________.
The F in the FLACC pain scale for infants stands for:
The L in the FLACC pain scale for infants stands for:
legs (normal, relaxed, tense, kicking, drawn up)
The A in the FLACC pain scale for infants stands for:
activity (quiet, sqirming, arched, jercking)
The first C in the FLACC pain scale for infants stands for:
cry (none, moaning, whimpering, scream)
The second C in the FLACC pain scale for infants stands for:
consolability (content, easy or difficult to console)
Physiological anorexia occurs at what age?
What is physiological anorexia?
picky eaters with strong taste preferences, 18 months of age
The incidence of Vitamin C deficiency is increased with exposure to what?
What autosomal disorder is similar to Type 2 diabetes mellitus?
Maturity Onset Diabetes of the Young (MODY)
What should be tested during illness and whenever glucose is greater than or equal to 240 mg/dL without illness?
urine testing for ketones every 3 hours
What leads to cretinism, mental retardation and growth retardation?
Failure to thrive
< 5th percentile in weight
Manifestations of failure to thrive
developmental delays, apathy, withdrawn behavior, no fear of strangers, avoidance of eye contact, wide eyed gaze & continual scan of environment, stiff & inyielding or flaccid & unresponsive, minimal smiling
Guidelines for feeding a child with failure to thrive
primary core staff to feed child, quiet, unstimulating atmosphere, calm, even temperment throughout meal, give directions, be persistent (10 -15 min of meal refusal), rhythm of feeding, develop a structured routine
Good control of HgbA,C
Poorly controlled HgbA,C
greater than equal to 8
equal loss of fluid and electrolytes
lose more fluid than electrolytes
lose more electrolytes than fluid
Treat mild to moderate dehydration with
ORS (oral rehydration solution)
Treat severe dehydration with
IV rehydration is necessary
To determine daily maintenance fluid requirement calculate child's weight in kg and then:
allow 100 mL/Kg for first 10 Kg of body weight
allow 50 mL/Kg for next 10 Kg of body weight
allow 20 mL/Kg for remaining body weight
bananas, rice, applesauce, toast, tea
BRATT diet is contraindicated for
diarrhea due to poor nutritional value
Primary etiology of cleft lip/cleft palate
maternal drug use or poor maternal nutrition
Avoid what in the mouth for patients with cleft lip/palate following a palatoplasty to maintain the integrity of the surgically repaired palate?
suction, tongue depressors, themometers, pacifiers, spoons, straws
congenital aganglionic megacolon, accumulation of stool with distension
Esophageal Atresia (EA)/Transesophageal Fistual (TEF)
failure of esophagus to develop as a continuous passage
An infant with an excessive amount of frothy saliva in the mouth or difficulty with secretions and unexplained episodes of cyanosis should be suspected of?
Esophageal Atresia (EA)/Transesophageal Fistual (TEF)
Clinical manifestations of Esophageal Atresia (EA)/Transesophageal Fistual (TEF)
3 C's: coughing, choking, cyanosis
If Esophageal Atresia (EA)/Transesophageal Fistual (TEF) is suspected, place child on immediate ____________.
NPO (child may need intubated)
Hypertrophic Pyloric Stenosis (HPS)
constriction of pyloric sphincter, palpable as an olive like mass in the upper abdomen
Primary clinical manifestation of Hypertrophic Pyloric Stenosis (HPS)
telescoping or invagination of one portion of intestine into another
Primary clinical manifestation of intussusception?
currant jelly stools
Classic triad of intussusception signs and symptoms
abd pain, abd mass, bloody stools
The classic triad of intussusception signs and symptoms is only present in what percent of cases?
A patient with intussusception may present initially with ...
screaming, irritability, lethargy, vomitting, diarrhea, constipation, fever, dehydration and shock
Intussusception is an ___________.
If child waiting for intussusception surgery passes a normal stool what should a nurse do?
Inform the physician immediately, it may have resolved itself
Celiac disease signs and symptoms
steatorrhea (fatty stools), general malnutrition, abdominal distension, vitamin deficiencies (A,D,E,K)
Celiac disease definition
intolerance to gluten, BROW (barley, rye, oat, wheat)
Identifying kids with GERD
frequent spit ups or acid smelling breath, some have respiratory symptoms instead of any of these symptoms
Positioning for GERD
elevate HOB 30 degrees during feeding and for 1 hour after
If poisoning is suspected ...
do NOT induce vomiting
Signs a corrosive poison has been ingested
severe burning pain with swelling in the mouth, throat and stomach, violent vomiting, hemoptysis
Treatment for a corrosive poison ingestion
dilute with water or milk
Signs a hydrocarbon poison has been ingested
altered sensory, respiratory symptoms due to pulmonary involvement, primary danger is bronchitis and chemical pneumonia
Treatment for a hydrocarbon poison ingestion
Antidote for acetaminophen
Toxic dose of acetaminophen is
bleeding tendency, coma, diaphoresis, tinnitus
Iron chelation therapy
may turn urine red or orange, mush have working kidneys, may cause hypotension or shock if given quickly
Diagnostic level for lead poisoning is
If shock is imminent what should a nurse do?
elevate the legs, restrict activity and keep warm
Sickle cell anemia
splenic sequestration, RBC's clump in the spleen and it may become engorged and rupture
What organ needs close monitoring with sickle cell anemia?
Sickle cell patients are at increase risk for what?
bacterial infections due to immunocompromise (especially after splenectomy)
What test is a definitive test for sickle cell anemia?
Sickle cell crisis is caused by:
increased oxygen demands, trauma, infection/fever, physical and emotional stress, dehydration or hypoxia
What sports would be good for a sickle cell patient?
golf, bowling, baseball (low oxygen requirements)
Type of sickle cell crisis: Vasa-occlusive thrombolytic crisis (VOC)
severe joint, chest and leg pain, high spiking fever, tissue engorgement
Type of sickle cell crisis: Splenic sequestriation crisis
profound anemia (pallor), hypovolemia (decreased blood pressure), shock, medical emergency
Type of sickle cell crisis: Aplasic crisis
profound anemia, pallor, can't be treated with antibiotics because it is viral, treatment is packed RBC's
Prophylactic antibiotics are given for what ages in sickle cell kids as the immune system develops?
2 months to 5 years
If given early in a sickle cell crisis this may help to reduce ischemia
What count should be monitored with sickle cell?
reticulocyte count (bone marrow)
Frequent blood transfusions may increase __________.
What is the treatment for hemosiderosis?
Iron chelation - feroxamine plus Vitamin C
Hydroxyurea handling caution
Demerol is contraindicated for use in what disease?
Sickle cell due to risk for seizures
Hemophilia signs and symptoms
Hemophilia may not occur until what age?
6 months of age
Despite the pain it may cause a patient with hemophilia needs to do what exercises?
ROM and joint moving to prevent contractures
A prolonged PTT may indicate what disease?
drug for mile hemophilia
blood in a joint cavity
During episodes of hemarthrosis a nurse should ...
elevate and immobilize the joint, ROM after bleeding stops to prevent contractures
Most common type of leukemia with best prognosis
ALL acute lymphoid leukemia
Most rare type of leukemia with poor prognosis
AML acute Myelogenous leukemia
What organs are most severely affected with leukemia?
liver and spleen
What is leukemia?
overproduction of WBC's but low leukocyte count, it leads to anemia, infection and bleeding as well as infiltration, enlargement and fibrosis of liver, spleen and lymph nodes
Induction therapy is what phase of therapy for leukemia and occurs for how many weeks?
the first stage occurring for 4-6 weeks
What phase of therapy for leukemia is needed if there is CNS involvement?
CNS prophylactic therapy or intrathecal chemotherapy
What does the 3rd phase of leukemia therapy, Intesification (consolidation) therapy do?
eradicate residual leukemic cells
At home PO Methotrexate is given when to a leukemia patient?
During the Maintenance therapy to preserve remission
Who is the most likely match for hematopoietic stem cell transplantation (HSCT)?
After HSCT, red patch rash on palms and feet means what?
What should be done prior to HSCT?
A round of induction therapy to wipe out WBC's
What is contraindicated for visitors to bring to a patient with leukemia?
Fresh flowers and fruit
What is kept at a leukemia patients bedside to treat anaphylaxis?
Why should weight loss be reported for a patient with leukemia?
chemotherapeutic agents are dosed by weight, to prevent overdose
When should antiemetics be given for chemo patients?
Reglan, Zofran 30 minutes prior to starting, ran continuously with and then 1 more dose afterwards
irratibility, pica, malnourishment, exercise, intolerance, inattentive/cognitive delays, beeturia, bluish sclera
Length of time between S1 and S2 should ____________ on inspiration?
If there is fixed time between S1 and S2 what could this indicate?
Since children have arrhythmias normally how to you tell if it is a "real" arrhythmia?
Have child hold their breath when auscultating, normally there is an increase in HR during inspiration and a decrease in HR during exhalation
Congenital Heart Defect (CHD) clinical manifestations
cyanosis, decreased oxygen saturation, lethargic or restless, may have murmur, abnormal or arrhythmic HR, CHF s/s, tachypnea, retractions, nasal flaring
Normal signs and symptoms of CHF
crackles in lungs (fluid), SOB, edema, poor tissue perfusion
Interventions for CHD
Oxygen administration, thermoregulation, cardiac medications, special feeding
Name 3 Increased Pulmonary Blood Flow Defects
Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA)
What is an Increased Pulmonary Blood Flow Defect?
an abnormal connection between 2 sides of the heart, it leads to increased blood volume on the right side of the heart and too much blood to the lungs causing right sided CHF
Atrial Septal Defect (ASD)
Blood shunts from left to right, hypertrophy of Right Atrium
Signs and symptoms of ASD
s/s of CHF, murmur over area of shunting, atrial arrhythmias (b/c of SA mode is in RV), poor activity tolerance, poor nutrition, poor growth, pulmonary manifestations later
Treatment for ASD
may wait unitl 18 months to allow hole to close on it's own before surgery is performed to repair
Ventricular Septal Defect (VSD)
Blood shunts left to right, hypertrophy of Right Ventricle
Signs and symptoms of VSD
s/s of CHF, murmur, high risk for endocarditis, Eisenmenger syndrome in severe cases
When the left to right shunts cause pulmonary hypertension, vascular hypertrophy, and eventually shift the L=>R shunt to a R=>L shunt, and cause late cyanosis.
Treatment for VSD
Cardiac medications such as antihypertensives, digoxin, diuretics and antibiotics
decrease work load of the heart
increase cardiac output
prophylaxis, infection occurs when fluid is in th elungs
Keep the Patent Ductus Arteriosus open
block the action of aldosterone
What enhances the effects of digoxin?
A fall in the serum potassium level
Patent Ductus Arteriosus
normally closes w/in hours to days in term infant, may be delayed in premies, if not, the systemic resistances pushes blood from the aorta into the pulmonary artery (left to right shunt)
Signs and symptoms of PDA
CHF, hypertrophy of the left atrium and left ventricle, pulmonary congestion, increased risk for endocarditis and pulmonary obstructive diseases
Management of PDA
wait to see if it closes, ventilator support, fluid restriction, admin of Indomethacin, admin of NSAIDS
Prostaglandin inhibitor, may help to get the PDA closed
Ibuprofen works to inhibit prostaglandin which may help to get the PDA closed
Name 2 Obstructive Defects
Coarction of the Aorta (COA), Aortic Stenosis
What is an obstructive defect?
blood can not exit the heart because of a stenosis of some type
What is a Coarction of the Aorta (COA)?
Narrowin gof the descending aorta, common in Turner's Syndrome.
Why do symptoms of COA start several days after birth rather than immediately?
the PDA will act compensatory, once the PDA closes symptoms will appear
Signs and symptoms of COA
CHF, left ventricular hypertrophy, murmur, increased blood pressure and bounding pulses in upper extremities, decreased blood pressure and weak or absent pulses in lower extremities (feet often cyanotic & cold)
Treatment for COA
Mechanical ventilation, cardiac meds, prostaglandins (to keep PDA open), surgical resection, 2 anastomosis