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
3 principles of atraumatic care:
prevent separation, promote sense of control, minimize bodily injury
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
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
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
Denial of chronic illness by family member is considered maladapative only if ...
it delays treatment
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 L in the FLACC pain scale for infants stands for:
legs (normal, relaxed, tense, kicking, drawn up)
The second C in the FLACC pain scale for infants stands for:
consolability (content, easy or difficult to console)
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
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
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
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
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
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
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)
Identifying kids with GERD
frequent spit ups or acid smelling breath, some have respiratory symptoms instead of any of these symptoms
Signs a corrosive poison has been ingested
severe burning pain with swelling in the mouth, throat and stomach, violent vomiting, hemoptysis
Signs a hydrocarbon poison has been ingested
altered sensory, respiratory symptoms due to pulmonary involvement, primary danger is bronchitis and chemical pneumonia
Iron chelation therapy
may turn urine red or orange, mush have working kidneys, may cause hypotension or shock if given quickly
Sickle cell anemia
splenic sequestration, RBC's clump in the spleen and it may become engorged and rupture
Sickle cell patients are at increase risk for what?
bacterial infections due to immunocompromise (especially after splenectomy)
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
Despite the pain it may cause a patient with hemophilia needs to do what exercises?
ROM and joint moving to prevent contractures
During episodes of hemarthrosis a nurse should ...
elevate and immobilize the joint, ROM after bleeding stops to prevent contractures
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
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
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
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
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
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.
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
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)