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Terms in this set (97)
When part of the bowel folds up into itself causing a sausage shaped mass.
Intermittent pain with jelly like stools (bloody) are normal. Pain can occur every 15-20 minutes.
Intense pain causes spasms of the pyloric muscle that leads to vomiting (non-bloody) after every episode. Vomiting tends to resolve once intussusception is reduced.
Signs/Symptoms of Heart Failure
Impaired myocardial contractility:
Weak peripheral pulses
Decreased urine output!!!
Loss of appetite
Pulmonary congestion: Dyspnea, tachypnea, and orthopnea
Systemic venous congestion:
Hepatomegaly (larger liver)
Peripheral edema (Periorbital in children)
Neck vein distension
Variety of congenital malformations that occurs when esophagus and trachea do not properly separate or develop.
Upper esophagus ends in a blind pouch and lower esophagus connects to primary bronchus or trachea via small fistula.
Clinical manifestations are frothy saliva, coughing, choking, and drooling. Clients may also develop apnea and cyanosis during feeding.
Aspiration is GREATEST RISK. Keep baby SUPINE with head of bed at 30 degrees. Maintain NPO and keep suction equipment ready.
First foods to give children
Kids are developmentally ready for foods at age 4-6 as iron stores have declined.
Iron fortified cereals should be offered. Rice cereal is preferred due to low risk of allergy and easy of digestion.
Fruit juice and pureed fruit are typically offered next as source of Vitamin C.
These are followed by strained vegetables.
Do not give allergy inducing foods before age 1 (peanuts, eggs, seafood, WHOLE MILK)
Tetralogy of Fallot
Hole between the lower chambers of the heart
Ventricular septal defect
Stenotic pulmonary valve
Thickened right chamber (Has to pump more)
Overriding Aorta (Doesn't directly pump out from left ventricle)
Babies will have O2 sats 65-85% normally.
If the infant has trouble breathing then they should first be placed in "Knee to chest position". Flexing legs provides relief of dyspnea as this angle improves oxygenation by reducing the volume of blood shunted.
Abnormal Chest tube output for infants
Greater than 3 mL/kg/hr for 3 consecutive hours
5-10 mL/kg in 1 hour should be reported IMMEDIATELY to HCP.
This indicates postoperative hemorrhage.
Treating bouts of acute diarrhea in children
Oral rehydration and then solid foods (Not BRAT like in adults)
Do not use antidiarrheal medications in children. They may be harmful by prolonging some bacterial infections and causing fetal paralytic ileus
Hypertrophied pyloric muscle causes postprandial projectile vomiting secondary to an obstruction.
"Olive shaped mass" is palpated in epigastric area just to the RIGHT of the umbilicus.
Emesis is nonbilious (Formula in/formula out) which leads to progressive dehydration (Biggest issue)
Infants will be constantly hungry despite regular feedings. High hematocrit due to dehydration. Elevated BUN is also a sign of dehydration.
More dangerous than hyperglycemia because of brain issues are glucose depleted.
Early features include sweating, weakness, tachycardia, tremor, and hunger.
In CF, secretions from exocrine glands are thicker and stickier than normal. Abnormal secretions plug smaller airway passages and ducts in the GI tract.
The thick secretions block pancreatic ducts, resulting in a deficient amount of pancreatic enzymes to enter the bowel to aid in digestion and nutrient absorption.
Systemic vasculitis of childhood that presents with greater than 5 days of fever, nonexudative conjuncitivitis, lymphadenopathy, mucositis, hand and foot swelling, rash.
First line treatment is IV immunoglobulin and aspirin to prevent coronary artery aneurysms. IVIG watch for pulmonary edema and fluid overload if given in large quantities -> Heart failure.
Kawasaki is one of the FEW times aspirin can be used with children.
Parents need to monitor closely for FEVER.
Irritability, temporary joint pain and desquamation (Skin peeling) are common
Iron deficiency anemia
Insufficient dietary intake
Delayed introduction of solid food
Consumption of cow's milk before age 1 year.
For toddlers, excessive milk intake. They will drink milk instead of eating iron rich foods.
Administer iron between meals and with orange juice.
Place medicine in the back of the mouth to avoid staining.
Keep no more than a 1 month supply at hand.
Black tarry stools are EXPECTED finding with iron.
Child is born with section of distal large intestine missing nerve cells so it is unable to relax. As a result there is no peristalsis and stool is NOT passed.
These newborns have distended abdomen and will not pass meconium within 24 hours. They have difficulty feeding and will vomit green bile.
A potentially fatal complication of Hirschprung's Disease is enterecolitis
Occurs with Hirschprung's. Inflammation of the colon leading to sepsis and death
Presents with fever, explosive foul smelling diarrhea, lethargy, and RAPIDLY WORSENING ABDOMINAL DISTENSION
Tooth goes out of socket. Needs to be put in less than one hour or tooth will die.
Put it on the middle third of the sternum, slightly below nipple line.
During compressions, the sternum is compressed approximately 1/3rd of the anteroposterior chest diameter at a rate of 100-120/min.
Can occur due to water intoxication when parents dilute formula.
Infants have immature renal system so they cannot excrete excess water.
Symptoms of hyponatremia are irritability, lethargy, and can lead to hypothermia and seizures.
Honey is not recommened for children under age 1 due to immature gut.
Botulinum toxin produces muscle paralysis. Children present with constipation, diminished DTRs and generalized weakness.
1 gram = ___ mL
How many ounces in a cup
Left to right heart shunt
Patent ductus arteriosus
Atrial septal defect
Ventricular septal defect
Blood shifts from high pressure left side to lower pressure right side. This increases pulmonary blood blow leading to pulmonary congestion causing increased work of breathing.
Clinical manifestations include
Tachycardia even at rest
Diaphoresis during feeding or exertion
Signs of congestive heart ailure
Increased metabolic rate with poor weight gain.
Right to left congenital heart defects
AKA Cyanotic defect
Tetralogy of Fallot
Impedes pulmonary blood flow and causes cyanosis
Foods that have inhibitory effect on dental caries
Dairy products (Milk, yogurt, cheese)
Fruits and vegetables
First visit to dentist
Genetic inborn error of metabolism. Individuals with PKU lack the enzyme for converting amino acid phenylalanine into amino acid tyorisne. As phenylalanine builds up neurotoxicity occurs.
Low phenylalanine diet is only treatment. Diet needs to keep in safe range 2-6 mg/dL. Lifetime dietary restrictions are needed.
Eliminate high-protein/phenylalanine foods (meats, eggs, milk) from the diet.
Encourage consumption of foods low in phenylanine (Fruits and vegetables)
Nutrients in cow's milk required for proper bone development in children and adolescents.
Need 500 mg per day.
Vitamin D enhances calcium absorption.
Parents should server beans, dark green vegetables, and calcium fortified cereals and juices.
Harsh Systolic Murmur
Ventricular Septal DEfect
Systolic Ejection Murmur
Chest Circumference vs Abdominal Circumference
By age 2, chest circumference will exceed abdominal circumference resulting in a taller and more slender appearance.
Fast paced during first year of life.
Birth weight should DOUBLE by first 6 months and triple by 12 months,
At birth head circumference is bigger than chest but it equalizes by 1 year.
Head circumference increases by 1 inch during second year and then slows to a growth rate of 0.5 inches per year until age 5.
Weight gain in children
Weight gain slows during toddler years with an average weight gain of 4-6 lbs. By age 30, current weight should be approximately 4 times greater than birth weight.
12 month old
Walk first step independently, Crawl up stairs
USe 2 finger pincer grasp
Can say 3-5 words
May have separation anxiety
Can walk up and down stairs with help
Throw a ball overhand
Jump in place
Builds 3-4 block towers
Turns 2-3 book pages
Can use a cup and spoon
10+ word vocabulary
Identifies common objects
Has temper tantrums
2 years old
Walks up and down stairs alone, 1 step at a time
Can kick a ball
Can now run without falling
Builds 6-7 block towers
Turns 1 page at a time now
Can draw a line
300+ word vocabulary
2-3 word phrases
Can state own name
Begins parallel play. Starting to gain independence
3 years old
Walks up stairs with alternating feet
Can now pedal a tricycle
Can jump forward
Can now draw a circle
Feed self without help
Grips a crayon with fingers instead of a fist
Asks lots of why questions
Can state own age
Begins associative play
Toilet trained except for wiping
Fuses at 2 months
Fuses at 18 months
Hemophilia A vs B
Hemophilia A lacks VIII, Hemophilia B lacks IX
Affects kids age 6-30 months.
3 stages of anxiety: Protest, despair, detachment
Encourage parents to leave favorite toys, books, pictures
Establish daily schedule
Maintain close, calming presence when the child is upset
Facilitate phone/video calls with parents
Provide opportunities for child to play and participate in activities
Risks for Failure to Thrive
Young parent age
Unplanned or unwanted pregnancy
Lower levels of education
SINGLE PARENT HOME
Prolonged breast/bottle feeding
poverty, food insecurity
Mild uterine withdrawal bleeding caused by physiologic responses to transplacental maternal estrogen exposure.
Bleeding should stop in a few days when hormone levels return to normal.
Developmental maturity achievement for child.
Should be based on developmental milestones.
Ambulate to and sit on the toilet
Remain dry for several hours or through a nap
Pull clothes up and down
Understand a two step command
Express need to use toilet
Imitate toilet habits
Primary enuresis is bed-wetting in children who have never had bladder control
Secondary enuresis occurs in a child who has had a previous period of bladder control.
1. Encourage fluids during the day but restrict at evening meal
2. Have child void before bed
3. Use alarms that wake child when voiding begins
4. Use POSITIVE REINFORCEMENT and motivation (calendar that shows wet and dry nights)
5. Avoid use of pullups
6. Have child assist with wet linen changes but it is not punishment
7. Awaken child at specified time each night to void.
Attempts to hold head up when prone
Maintains fisted hands
Cries when upset
Looks at parents when speaking
Gains head control when held.
Holds rattle when placed in hand
Makes cooing sounds
Smiles in response to talking
Can now roll and sit without support
Can hold objects with a palmar grasp and puts things in mouth
Begins to laugh and starts to make some consonant sounds
Can recognize parents voice
Can sit without help
Begin to crawl
May pull to stand
Moves objects between hands
Can use a crude pincer grasp
Babbles and imitates sounds
May say "mama"
Stranger danger starts
N95 particle respirator
As needed precautions with risk of splash or body fluid contact.
Do not need to limit exposure if there is immunity
Sickle Cell Crisis
Elevated bilirubin due to hemoglobin breakdown (From excessive hemolysis)
Elevated reticuloytes due to anemia (More RBC being made)
Acute anemia occurs during sickle cell crisis and hemoglobin level gets lower.
Administering Medications for hemophilia patient
Administer medications SubQ if possible to prevent IM hematoma.
Avoid aspirin and NSAIds due to risk of bleeding.
Firm pressure should be held on the site without rubbing or massaging due to the risk of bleeding and hematoma formation. Superficial bleeding should be controlled using ICE PACKS not heat packs.
Growth Hormone REplacement
Growth hormone does not guarantee the same growth rate as peers.
Replacement therapy stops when bone growth begins to cease.
Replacement is better as soon as growth delays are noted.
Replacement is daily SubQ injections
Child assessment when Asleep or quiet
1. Auscultate heart and lungs while calm
2. Palpate fontanels
3. Percuss abdomen (palpate and percussion should be done together in a head to toe direction)
4. Inspect eyes (Eyes, ears, mouth should be performed near end)
5. Moro reflex
MAKE BELIEVE MAGICAL
Misperceptions of contraindications to immunizations
Currently taking abx
Mild site reactions
Recent infection exposure
Rooting and sucking are natural reflexes but you should STOP BEFORE PERMANENT TEETH ERUPT
Fetal Alcohol Syndrome
Short palpebral fissures
THIN UPPER LIP
Avoid medications such as ibuprofen and aspirin that have platelet inhibition properties
Avoid IM injections
Avoid contact sports
Dental hygiene is necessary to prevent gum bleeding
MEDIC ALERT BRACELETS SHOULD BE WORN
Regular diet for Hemophilia
Dehydration is for sickle cell not hemophilia
Eczema. Chronic skin disorder characterized by pruritis, erythema, and dry skin.
Alleviate pruritis and keep skin hydrated to prevent scratching. Scratching leads to new lesions and predisposes to secondary infections.
Can often present as night coughing until the child vomits
Autosomal recessive disorder. Mutation of a gene that impairs chloride transport and sodium absorption resulting in thickened secretions.
Results in recurrent sinus and pulmonary infections
Pancreatic insufficiency - mucus plugs in the pancreas obstruct the release of pancreatic enzymes leading to malabsorption of FAT SOLUBLE VITAMINS (A, D ,E ,K) -> Weight loss
Infertility - Cystic fibrosis causes congenital absence of vas deferens resulting in low sperm levels and infertility. Females can have thick cervical secretions that obstruct sperm entry.
Unilateral or bilatearl retinal tumor is most common childhood intraocular malignancy.
Found in children under TWO. Usually recognized when parents report a white "glow" of the pupil. Light reflecting off the tumor will cause the pupil to appear white instead of normal red reflex.
Autism Spectrum Disorder
Has a BIG GENETIC COMPONENT.
Congenital defect in which the urethral opening is on the underside of the penis. Condition is corrected around age 6-12 by surgically redirecting urethra to the penis tip.
Postop, the client will have a catheter or stent to maintain patency while the new meatus heals. Urinary output is an important indication of urethral patency. Fluids are encourage and absence of urinary output indicates a kink or obstruction occurred.
Infection of the middle ear resulting from dysfunction of the Eustachian tube. OM occurs in infants and children under 2, often following a respiratory tract infection.
Clinical manifestations are High fever (up to 104), ear pain, irritability/restlessness, loss of appetite and PULLING OF AFFECTED.
The tympanic membrane will be bulging and red not retracted.
Amoxicillin can be given and symptoms should be better between 48-72 hours (diarrhea is common side effect)
Administering a rectal suppository
Clean gloves and position based on age (Infant is supine with legs up, older child is side lying)
Lubricate the tip with water soluble jelly NOT PETROLEUM
Insert the suppository using the fifth finger if the child is under 3 years old
Angle it so it follow rectal wall.
Hold the buttocks together for several minutes to prevent immediate expulsion
IF a BM occurs within 10-30 minutes observe for the presence of suppository.
Is from HiB, which is covered in standard vaccinations.
Sore throat, dysphagia, drooling, respiratory distress
Sitting up and leaning forward to breathe. VERY DANGEROUS
Bowing of legs, occurs when toddlers learn to walk. It dissappears at 18-24 weeks after they develop strength in legs and lower back.
After learning how to walk the legs get longer and the knees go inward.
For children aged 6 and older.
Child is positioned 10 ft from the chart and asked to read.
Testing visual acuity in infants
Following a target, usually a bright colored object or a human face is a method for testing acuity in infants
Duchenne muscular dystrophy
Most common kind of childhood muscular dystrophy
Condition is X LINKED RECESSIVE.
Disease onset is 2-5 years.
proximal Muscles of lower extremities and pelvis are affected first. Calf muscles hypertrophy initially in response to proximal muscle weakness and are later replaced by fat.
There is no cure, most children are wheelchair bound by adolescence and die by age 20-30 from respiratory failure.
Ice collar around the neck to help with pain and bleeding risk.
Analgesics are given. Acetaminophen
DO NOT SUCTION or use a straw.
Low grade fever is expected, and ear pain afterwards is normal. It is referred pain.
Chewing gum can reduce spasms in the muscles around teh throat.
Collection of symptoms resulting from various causes of glomerular injury.
Hypoalbuminemia from the protein lost in blood
Edema caused by low serum protein and albumin
Hyperlipidemia related to increased compensatory protein and lipid production by liver
Inflammation in the meninges and spinal cord.
Can lead to hydrocephalus and increased ICP.
Priority of care is immediate antibiotic therapy. Lumbar puncture is done to find the organism.
Seizures can occur in infants with a high pitched cry.
Also, Nuchal rigidity is a telltale sign.
Tinea Corporis is a fungal infection of the skin, hair and nails
Highly contagious and spreads via contact.
Management is proper hygiene, limiting contact with personal items, and treatment with proper shampoos and topical medications (Terbinafine)
Neonates cannot shiver due to lack of muscle tissue and immature nervous systems.
Brown adipose tissue is developed during third trimester. Once its depleted, nonshivering thermogenesis is less effective and neonate may experience cold stress.
Caused by group A beta hemolytic strep.
Clinical manifestations are periorbital and facial/generalized edema, HYPERTENSION, and oliguria due to fluid retention (Decreased kidney filtration)
The urine is tea colored and cloudy due to infection and presence of protein and blood.
Severe hypertension is a complication that must be identified early.
Daily weights are the MOST ACCURATE INDICATOR OF FLUID LOSS OR GAIN
A serious and life threatening emergency in which a client has been seizing for over 5 minutes. Grunting and dazed appearance are common signs.
STOP THE SEIZURE BEFORE FIGURING OUT THE CAUSE.
Give IV Benzos to acutely stop. (Diazepam and lorazepam)
Used for treating developmental dysplasia of the hip from the first 6 months of life.
Wear for 3-5 months or until hip joint is stable.
Regularly assess skin
Dress child in shirt and knee socks
AVOID LOTIONS AND POWDERS
However, lightly massage skin under the strap to promote circulation
1 diaper underneath the straps
Classic symptom of Cystic fibrosis
Floppy muscle tone
Classic symptom of downs syndrome
Neonatal abstinence syndrome
Commonly seen with opioid use.
Autonomic nervous system symptoms - Stuffy nose, sweating, frequent yawning and sneezing, tachycardia, tachypnea.
CNS Symptoms: Irritability, high pitched cry, abnormal sleep, hypertonicity
GI Symptoms - poor feeding, vomiting, and diarrhea
Acute asthma exacerbation leading to rapid, labored respirations using accessory muscles.
In the case of severe obstruction, from airway narrowing swelling and copious mucus, wheezing and breathing are not heard due to lack of airflow.
SIlent chest is ominous sign and emergency priority.
Caused by HiB.
Dysphonia, Dysphagia, Drooling and distressed respiratory effort
Tripod position opens airway and helps air flow.
Mouth open, neck and chin extended, trunk leaning forwards
Otitis Media risk factors
Fluid pools in mouth and reaches eustachian tube.
Regular pacifier use
Recurring exposure to tobacco smoke
Drinking from a bottle lying down
Lack of immunizations, specifically pneumococcal.
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