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Birth to 1 yr"
Greater than 12 yrs."
Trust vs Mistrust
Birth to 1 yr
Autonomy vs Shame and Doubt
Initiative vs Guilt
Industry vs Inferiority (achievement)"
Identity vs Role Confustion"
Sensorimotor - Sensation in which simple learning takes place (object permanence)"
Birth to 2 yrs
Preoperational - Egocentrism, children interpret objects as of use to them, thinking is concrete
Concrete Operational, can classify, sort facts, conservation (volume, weight, number stay the same even if outward appearance changes), more social."
Formal Operations - adaptable, flexible, can think in abstract, can test hypothesis
Most important factor in child development
H & P - what would you want to know when caring for a child??
Birth history, Growth history, Developmental history Immunizations, Likes/Fears, Family structure, Family history- congenital anomalies, siblings
A child doubles their birth weight by??
A child triples their birth weight by?
Posterior fontanel closes at?
Anterior fontanel closes by?
Fine motor - Grasping object (palmer) by??
Fine motor - Transfer object between hands by??
Fine motor - Pincer grasp by??
Fine motor - Remove objects from container by??
Fine motor - Build tower of two blocks by??
Gross motor - rolling stomach to back or back to stomach by??
Gross motor - sitting by??
Gross motor - move from prone to sitting by?
Crawling age is?
Creeping age is?
Walk with assistance age is??
Walk alone age is?
Recommended routine immunizations are??
Hepatitis A, Hepatitis B (at birth), Diphtheria, Tetanus, Pertussis (DTaP), Polio Rotavirus Measles, Mumps, Rubella (MMR) Pneumococcal, Haemophilus influenza B (Hib), Varicella (chickenpox), Influenza Meningococcal, Human papilloma virus (HPV)
Babies are obligate nose breathers for how many weeks?
The tongue is disproportionally ?"
Pharyngitis can be caused by??
- Viral Infections (80-90%)
- Strep Throat (10-20%)
S/S of Pharyngitis:
- Abdominal Pain
- Tonsils and throat red and inflamed"
Respiratory infections are contagious until??
24 hrs after ABX therapy initiated
Drug therapy for Pharyngitis
- 1st line - PCN, Amoxicillin, Augmentin
- 2nd line - Cepalosporins, Azithromycin, if allergy to PCN or resistant strain
Nursing therapy for Pharyngitis
- Warm or cold compresses to the neck
- Warm saline gargles
- Cool liquids, Ice Chips
How many infections of tonsils or adenoids before removal?"
3 or more in 1 yr
Nursing care for Tonsillitis
- Soft to liquid diet
- Cool mist vaporizer
- Warm salt water gargle
- Throat lozenges
Medications for Tonsillitis:
- Analgesics - Tylenol w/ codeine, Lortab (hydrocordone/acetaminophen) elixer
- Antipyretics - no NSAIDS
- Antiemetics - Zofran
Post Op care for tonsilectomy:
- Positioning: on side or abdomen until awake then sitting up
- No coughing, blowing nose, straining,
- May have dark brown drainage, foul breath, ear
- pain, & low-grade fever are common.
- Watch for hemorrhage (bright red, fresh
- Watch for frequent swallowing, tachycardia, pallor! Suction equipment & oxygen at bedside
- Ice collar; food and fluids restricted until child fully
- awake; then cool water, ice chips, popsicles, diluted fruit juice,
- NO STRAWS
A toddler is what age group?
Temper tantrums and obstinacy occur in which stage?
Toddlers achieve sphincter control at?
A toddler can throw a ball overhand at what age?
Toddlers use one word sentences at what age?"
Toddlers use multiword sentences at what age?
Toddlers begin mastering grammar rules by what age?
What age group has the most deaths from injury?
What is the preschool period?"
The average yearly weight gain for pre-schoolers is?
The average yearly increase in height for pre-schoolers is?
The Erickson stage for pre-schoolers is?
- Developing sense of initiative
- Chief psychosocial task of preschool period
- Feelings of guilt, anxiety, and fear may result from thoughts that differ from expected behavior Development of superego (conscience)
- Learning right from wrong/moral development
Which group uses "magical thinking"?
Which group starts to have "spiritual development"?"
Pre-schoolers develop strong attachments to which sex parent?
Opposite sex parent
What are some "fears" of pre-schoolers?"
- Being left alone
- Animals (e.g., snakes, large dogs)
- Sexual matters
- Objects or people associated with pain
Varicella (chickenpox) occurs primarily in which age group?
Children under 15 yrs
What disease can you get if you have had the chickenpox?
Zoster (herpes zoster/shingles)
Which precautions should you follow for chickenpox?
Standard Contact Airborne Until all lesions are crusted over and no new lesions
Rubeola (measles) had what kind of precautions?
What are the nursing considerations for the mumps?
- Analgesics for pain
- encourage fluids
- soft/bland food
- heat/cool to neck
- tight fitting underpants
What are the precautions for pertussis (whooping cough)?
What are the nursing considerations for pertussis (whooping cough)?
Provide O2 with humidification
The school age period is what ages?
School age relationships revolve around which people?
Same sex peers
School age children master the concept of?
Conservation (changing the shape of things doesn't alter their properties)
Boys use which form of bullying?
Girls use which form of bullying?
Psychological (rumors, ostracism)
Previously well behaved children may begin to do what at school age?
Teeth can be "replanted" in what space of time?
Most common cause of severe injury and death in school age children is?
Motor vehicle crashes - pedestrian or passenger
What are the two types of AD/HD medications?"
Adolescence is what age group??
Beginning of puberty to 18-20 yrs or at cessation of body growth
What is the FEMINIZING hormone??
What is the MASCULINIZING?
Androgens are responsible for what in the early teen?
- 9-13 yrs
- appearance of breast buds
- 2-6 mo after Thelarche
- Growth of pubic hair on Mons Pubis
- Approx. 12 yrs
- Initial appearance of menstruation
A child must be what age to have Motrin?
Over 6 months
Decongestants should not be given before what age?
Whay is the biggest nursing consideration for tonsillectomy?"
BLEEDING (Watch for frequent swallowing, tachycardia, pallor!)
Acute systemic vasculitis of unknown cause
You should avoid which 2 medications in children with a URI?
- Cough suppressants
What is Otitis Media (OM)??
An inflammation of the middle ear without reference to etiology or pathogenesis
Who gets more ear infections (OM)?"
Boys Under 2 yrs
What syndrome has a "barking" cough?
What lung sound will you hear with croup?
What is Acute Epiglottitis is??
- A serious obstructive inflammatory process requiring IMMEDIATE MEDICAL ATTENTION!
- It is usually caused by Haemophilus influenzae type b (Hib)"
What are the clinical manifestations of Acute Epiglottitis??
- Fever, sore throat, pain
- Tripod positioning (leaning forward, chin out, mouth
- open, tongue out)
- Inspiratory stridor (“frog-like”
- croaking sound on inspiration),
- Mild hypoxia
- Irritable, restless, anxious, frightened
Therapeutic management for Acute Epiglottitis:
- Potential for respiratory obstruction
- Medical emergency(nasotracheal
- intubation or trachesostomy possible)
- Medications: Racemic epinephrine treatments, Heliox, Steriods, ABX
Nursing care management for Acute Epiglottitis:
- Examination only where emergency airway equipment available
- Do NOT attempt examination of throat
- Delay start of IV or any procedure that may agitate child
- Apply oxygen
- Prepare for intubation
- Reduce anxiety/keep comfortable
- Prevention: Hib vaccine
What is the most common of the croup syndromes?
Acute Laryngotracheobronchitis (LTB)
What are the manifestatons of LTB?
- Inspiratory stridor
- Suprasternal retractions
- Barking or "seal like" cough
- Increasing respiratory distress and hypoxia
- Can progress to resp. acidosis, resp. failure and death"
Therapeutic management of LTB
- Airway management
- Maintain hydration, orally or intravenously
- High humidity with cool mist
- Medications: Nebulizer treatments (Racemic Epinephrine), Corticosteroids (Dexamethsone (Decadron), Oral prednisolone)
- Vigilant observation and assessment
- Intubation equipment available
Which respiratory issue causes the most hospitalizations for children under 1 yr?"
Severe RSV in the 1st year can lead to development of what, in later years?
RSV season is which months and when does it peak?
- December or January
- Peaks in late March
What is the pathophysiology of RSV?
- Affects the epithelial cells of the respiratory tract
- Bronchiolar mucosa swells
- Lumina fills with mucus and exudate
- Symptoms at peak 5-7 days
What are the clinical manifestations of RSV??
- Usually happens after an URI or may have no symptoms except slight lethargy
- poor feeding or irritability
- S/sx progress to severe runny/stuffy nose
- Wheezing, retractions, crackles, dyspnea, tachypnea, diminished breath sounds
- Apnea may be 1st symptom in very young infants
How do you diagnose RSV?
Antibody tests on secretions via nasopharyngeal (NP) swab
How can you prevent RSV (prophylaxis)?
- Synagis (palivizumab)- specialized monoclonal antibody is given to children who were premies
- children with congenital heart problems and other chronically ill children
- Very expensive - $900/mo
Nursing care management for RSV:
- Assigned to private rooms or in with other RSV children
- Contact and droplet precautions
- Certain RNs care for only the RSV children
- Infants may have copious nasal secretions
- Feeding is difficult but should PO intake
- Saline drops
- Suctioning (NP or BBG) is done and parents are also taught to use bulb syringe
- Pulse oximetry
- Humidified oxygen administration
- Cluster care
- Bronchodilator therapy if responsive
- IV fluids if feeding difficulties
Definition of asthma
- Chronic inflammatory disorder of airways with wheezing, breathlessness
- chest tightness
- Non productive cough usually in the morning or at night
Drug therapy for Asthma:
- Reliever” (rescue) medications SVNs or fast acting inhalers Albuterol, levalbuterol, metaproterenol, terbutaline: short acting Atrovent- reduces
- hospital admissions with use during ED visits
- Corticosteroids during exacerbations
- IV methylprednisolone (Solumedrol)
- Oral Prednisone, prednisolone (Orapred/Prelone)"
EIB stands for??
Exercise Induced Bronchospasm (Asthma)
What is a good exercise for children with Asthma??
Swimming (air is moisturized)
What is Status Asthmaticus?
- Respiratory distress continues despite vigorous therapeutic measures
- May lead to coma & death if not recognized & treated PICU
- Concurrent infection in some cases: PNA, influenza
Therapeutic intervention for Status Asthmaticus"
- Back to back treatments
- Magnesium sulfate
- Emergency treatment: Epinephrine 0.01 ml/kg subcutaneously (maximum dose 0.3 ml)
What is the most lethal genetic disease among white children?
Cystic Fibrosis (CF)
Clinical manifestations of Cystic Fibrosis:
- Increased viscosity of mucous gland secretions
- Striking elevation of sweat electrolytes
- Increase is several organic and enzymatic constituents of saliva
- Abnormalities in autonomic nervous system function
The most reliable test for Cystic Fibrosis is?
Sweat Chloride test Sodium and Chloride will be 2-5 times greater than controls
What shape will the chest be in someone with CF?
How does CF affect the GI tract?
- Thick secretions block ducts
- Prevents pancreatic enzymes from reaching duodenum
- Impaired digestion/absorption of fat & protein
Someone with CF may have what type of stools?
Bulky Loose Frothy Foul smelling
What is the prognosis for CF:
Incurable Life expectancy 37.4 yrs
What is cardiac output??
- volume of blood pumped by the heart in ONE MINUTE
- HR x Stroke Volume
What is Stroke volume??
volume of blood pumped by the heart in ONE BEAT
What is an Atrial Septal Defect (ASD)?
A hole located between right and left atria. Since pressure is higher on the left side of the heart, blood gets pushed through the hole from left to right. This may cause the right atrium to become enlarged
What is Patent Ductus Arteriosis (PDA)?
Failure of the fetal ductus arteriousus (artery connecting the aorta and the pulmonary artery) to close within first weeks of life
What is coarctation of the aorta?"
- An obstructive disorder, usually just past left subclavian artery (narrowing of the artery).
- It signifcantly decreases blood flow to abdomen and legs with the majority of the blood shunted to the heart and arms
What is Aortic Stenosis?
- A narrowing of the aortic valve
- Obstructs blood flow from left ventricle
- Creates pulmonary HTN
Tetralogy of Fallot has which 4 defects??
- Pulmonary stenosis
- Ventricular septal defect
- Overriding aorta
- Right ventricular hypertrophy
What kind of blood is pumped to the body with Tetralogy of Fallot?
What are the clinical manifestations of Tetralogy of Fallot?
- Cyanosis- mild to acute “Blue spells” or “tet spells” Occur when oxygen demand exceeds oxygen supply
- Usually during crying or feeding Systolic murmur- moderate intensity
- Risk for emboli, seizures, loss of consciousness and
In TOF, what distinctive shape does the heart have?
What drug can be given to children with Ductus Arteriosus to keep the ductus open until surgery can be performed?
What is Hypoplastic Left Heart?
Underdevelopment of the left side of the heart.
What disease occurs after having Rheumatic Fever occurs?"
How is Rheumatic Fever (RF) diagnosed?
Antistreptolysin O titer (ASO)
What does RF affects??
- Serous surfaces Heart
Rheumatic Heart Disease (RHD) is
- Damage to heart valves from RF
- Most common complication of RF
What is Kawasaki disease??
Acute systemic vasculitis of unknown etiology (inflammation of arterioles, venules and capillaries with potential damage to coronary arteries)
Obesity is associated with the early onset of?
What is the diagnostic criteria for Kawasaki Disease?
- Red eyes with no discharge
- Palms of hand and soles of feet are red, swollen & peeling
- Dry, cracked, reddened lips
- Oropharyngeal reddening- “strawberry tongue”
- Polymorphous rash
- Cervical lymphadenopathy (one > 1.5 cm)"
What are the 3 phases of Kawasaki Disease?
- Fever - unresponsive to ABX and antipyretics, development of S/S, extreme irritability
- Resolution of fever,
- S/S start to go away, still irritable
- S/S resolved but labs still abnormal
What are the long term complications of Kawasaki Disease?
- MI resulting from thrombotic occlusion of a coronary aneurysm
- myocardial ischemia from stenosis of aneurysm
What is the TX for Kawasaki Disease?
- IVIG (Gamma globulin) Only if sure it’s kawasaki and it’s early in the disease
- High dose ASA therapy - anti-inflammatory effects Followed by low-dose
- ASA therapy - Antiplatelet effects Lovenox of Plavix for children with large CA aneurysms
Nursing management of Kawasaki Disease includes monitoring cardiac status. How?"
- I & O
- Daily weights
- IV fluids with care
- Watch for signs of CHF
How do you relieve S/S of Kawasaki Disease?
- Cool cloths, soft clothes
- Mouth care, lip moisturizer
- Clear liquids,
- Soft foods
- Comfort, quiet and respite care for parents
What education should you provide parents of children with Kawasaki Disease?"
- Reassure parents that irritability is normal and may continue for up to 2 months
- Joint stiffness- Passive ROM exercises helpful Desquamation will continue for up to 3 weeks
- No immunizations for 11 months
- Follow-up essential
What are the Effects of Anemia on Circulatory System?
- Hemodilution: decreased peripheral resistance
- Increased cardiac circulation and turbulence: May
- have murmur & lead to cardiac failure
- Growth retardation
- Delayed sexual maturation
- Cyanosis usually not evident
Therapeutic mgmt of Anemia:
- Transfusion of hemorrhage
- Nutritional intervention for anemias
- IVF to replace intravascular volume
What is the nurse care mgmt for Anemia?
- Prepare family/child for tests: Explain test, supportive person with child, allow child to play w/equipment, child participation, Topical application.
- Decrease O2 demands: assess energy level & minimize excessive demands
- Prevent complicatons: INFECTIONS
- Support family
What is IRON DEFICIENCY ANEMIA?
- Caused by inadequate supply of dietary iron
- Newborn has iron stores from mother for 1st 5-6 months
- Children 12-36 months at risk because of cow’s milk
What is the pathophysiology of SICKLE CELL ANEMIA?
- Obstruction & Destruction
- Partial or complete replacement of normal Hgb with abnormal Hgb S
- Hgb in the RBCs takes on an elongated “sickle” shape
- & RBC are destroyed
- Sickled cells are rigid and obstruct capillary blood flow causing obstruction
- Stasis with enlargement
- Infarction with ischemia and destruction
- Replacement with fibrous tissue-scarring
What is the prognosis with having SICKLE ANEMIA??
- No cure
- Supportive care- prevent sickling episodes
- Frequent bacterial infections may occur because of immunocompromise
- Bacterial infection is leading cause of death in young children with sickle cell disease
- Strokes in 5% to 10% of children with disease
Precipitating factors of SICKLE CELL ANEMIA
- Anything that increases body’s need for oxygen or alters transport of oxygen
- Physical and emotional stress
- Increased blood viscosity caused by dehydration
What is SICKLE CELL CRISIS?
Acute exacerbations that vary in severity and frequency
What is VASO-OCCLUSIVE THROMBOTIC?
- Most common type of crisis; very painful
- Stasis of blood with clumping of cells in microcirculation→ ischemia→infarction
- Signs: fever, pain, tissue engorgement
What is SPLENIC SEQUESTRATION??
- Life threatening: death can occur within hours
- Blood pools in the liver & spleen
- S/SX: profound anemia, hypovolemia, and shock
What is APLASTIC CRISIS?
- Diminished production and increased destruction of RBCs
- Triggered by viral infection or depletion of folic acid
- S/SX: profound anemia (hyperhemolytic crisis), pallor, jaundice
How is SICKLE CELL ANEMIA diagnosed?
- Cord blood in NB
- Newborn screening done in 43 states
- Genetic testing to identify carriers and children who have disease
- Sickle-turbidity test, then electrophoresis
- May be diagnosed as a toddler after acute respiratory or GI infection
Medical mgmt of SICKLE ANEMIA:
- Prevent sickling & treat medical emergencies of SCD
- Aggressive treatment of infection
- Possible prophylactic antibiotics from 2 months to 5 years
- Monitor reticulocyte count regularly to evaluate bone marrow function
- Blood transfusion, if given early in crisis, may reduce ischemia
- Frequent transfusion increases hemosiderosis (iron in tissues)
- Treat with iron chelation such as feroxamine + vitamin C to promote iron excretion
- Rx: hydroxyurea(cytotoxic) decreases production of abnormal blood cells and decreases pain
Medical mgmt of SICKLE ANEMIA:
- Rest: Minimize energy expenditure and oxygen use
- Hydration: Oral, IV
- Electrolyte replacement: Hypoxia resulting in metabolic acidosis which means more sickling
- Analgesics: For severe pain from vasocclusion
- Blood replacement: To treat anemia and reduce viscosity of blood
- Antibiotic therapy: To treat any existing infection
Nursing care mgmt of SICKLE ANEMIA:
- Monitor child’s growth; watch for failure to thrive (FTT)
- Careful multisystem assessment
- Assess pain
- Observe for presence of inflammation or possible infection; dehydration
- Carefully monitor for signs of shock
- Treat normally
- Assess for complications: CVA, chest syndrome (pulmonary infiltrate)