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Toddler age range
1 to 3 years
Major parental responsibility is ____ while alowing the child the opportunity for s____ and p____ independence.
Major parental responsibility is SAFETY while allowing thechild the opportunity for SOCIAL and PHYSICAL independence.
Toddlers want to p____ parents.
Toddlers like r____.
Good approach with toddlers is to allow for a c____ between ____ items.
Good approach with toddlers is to allow for a CHOICE between TWO items
Toddlers have a brief a____ s____.
Toddlers have a brief ATTENTION SPAN.
Typical toddler will:
- Throw t____ t____
- Want to be i____
- Start to speak in s____ s_____
- Typical toddler will:
- Throw TEMPER TANTRUMS
- Want to be INDEPENDENT
- Start to speak in SHORT SENTENCES
Toddler Growth & Dev.
- Weight increases by __ to __ lbs/yr
- By __ mo. birth weight q ____
- Toddler Growth & Dev.
- Weight increases by 4 to 6 lbs/yr
- By 30 mo. birth weight QUADRUPLES
Toddler Growth & Dev.
- Height increases by __ in./yr.
- Height at __ mo. of age is thought to be __ the potential adult height
- Height increases by 4 in./yr.
- Height at 30 mo. of age is thought to be 1/2 the potential adult height
Toddler Growth & Dev.
- Anterior fontanel closes by __ to __ mo.
- Posterior fontanel closes by __ mo.
- Check both fontanel until __ yrs. of ago
- Anterior fontanel closes by 12 to 18 mo.
- Posterior fontanel closes by 2 mo.
- Check both fontanel until 2 yrs. of age
Developmental milestones - Gross Motor Skills:
- __ to __ mo - begins to w___
- __ to __ mo - walks a____ and b____
- __ mo - r____, t____/k____ ball, climb s____, initiates o____ h____, j____ with 2 feet
- __ mo - b____, h____, j____ on one foot, uses t____, climbs s_____ using a____ feet
- 12 to 16 mo - begins to WALK
- 16 to 18 mo - walks ALONE and BACKWARDS
- 24 mo - runs, THROWS/KICKS ball, climb STAIRS, initiates ORAL HYGIENE, JUMPS with two feet
- 36 mo - BALANCES, HOPS, JUMPS on one foot, uses TRICYCLE, climbs STAIRS using ALTERNATE feet
Developmental Milestones - Fine Motor Skills
- __ to __ mo - drinks from c____, holds s____, build t____ of b____, prefers f____-f____
- __ to __ mo - places o____ in appropriately shaped o____, improved self-f____
- __ mo - builds tower of __ to __ blocks, turns p____ of b____, can u____ self, can f____ self with s____ and c____
- __ mo - hold c____ by hands and spoon with two f____, copies a c____
- 12 to 16 mo - drinks from CUP, holds SPOON, build TOWER of BLOCKS, prefers FINGER-FEEDING
- 16 to 18 mo - places OBJECTS in appropriately shaped OPENINGS, improved self-FEEDING
- 24 mo - builds tower of 6 to 7 blocks, turns PAGES of BOOK, can UNDRESS self, can FEED self with SPOON and CUP
- 36 mo - hold CUP by hands and spoon with two FINGERS, copies a CIRCLE
- Voluntary control of a____ and u____ sphincters begins at about __ to __ mo.
Voluntary control of ANAL and URETHRAL sphincters begins at about 18 to 24 mo.
- Waking up dry after n____ or in the m____ is a sign of m____.
Waking up dry after NAPTIME or in the MORNING is a sign of MATURITY
- Child needs to be able to communicate b____ n____.
Child needs to be able to communicate BATHROOM NEEDS.
- Milk should be limited to no more than __ oz/day
- Like rituals, may f____ certain type of p____/g____
- High candidate for a____
- May have "f____ j____"
- N____ meals are a____ at any time (soup for b____ or cereal for d____)
- Milk should be limited to no more than 24 oz/day
- Like rituals, may FAVOR certain type of PLATE/GLASS
- High candidate for ANEMIA
- May have "FOOD JAG"
- NUTRITIOUS meals are ACCEPTABLE at any time (soup for BREAKFAST or cereal for DINNER)
- Cut food into s___ pieces
- High c____ items (P____, H____ D____, H____ C____)
- Think about the d____ of the t____
- Cut food into SMALL pieces
- High CHOKING items (PEANUTS, HOT DOGS, HARD CANDY)
- Think about the DIAMETER of the TRACHEA
- E____ covers on o____
- C____/D____ latches
- Watch around a____
- Watch s____ and p____
- Playing in the r____
- Avoid e____ while playing
- Remember c____ s____ safety
- ELECTRICAL covers on OUTLETS
- CABINET/DRAWER latches
- Watch around ANIMALS
- Watch STOVE and PANS
- Playing in the ROAD
- Avoid EATING while playing
- Remember CAR SEAT safety
Toys for hospitalized pediatric patients:
- S____ A____
- S____ with P____
- Utilize P____
- STUFFED ANIMALS
- STORYBOOKS with PICTURES
- Utilize PLAYROOM
Toddler Growth & Dev.
- Erickson Stage - A____ vs. S____ & D____
- Piaget Stage - P____ (E____)
- Erickson Stage - AUTONOMY vs. SHAME & DOUBT
- Piaget Stage - PREOPERATIONAL (EGOCENTRIC)
Types of Play:
- S____ - Plays by s____
- P____ - Playing i_____ but in a g____
- A____ - play t____ but with own a____
- C____ - assigning r____ and working t____ (like playing pirate ship or school teacher)
- SOLITARY - Playing by SELF
- PARALLEL - Playing INDEPENDENTLY but in a GROUP
- ASSOCIATIVE - Play TOGETHER but with own AGENDA
- COOPERATIVE - Assigning ROLES and working TOGETHER (like playing pirate ship or school teacher)
Preschool Growth and Development:
Age range of preschool child?
3 to 5 years of age
Preschool Growth & Dev.
- P____ g____ slows down as mastery of and refinement of m____, s____, and c____ a____ happen.
PHYSICAL GROWTH slows down as mastery of and refinement of MOTOR, SOCIAL, and COGNITIVE ABILITIES happen.
Preschool Growth & Development:
- For each year child gains __ lbs.
- For each year child grows ___ to __ in.
- For each year child gains 5 lbs.
- For each year child grows 2 1/2 to 3 in.
Preschool Growth & Dev.
- By __ yrs. all d____ t____ erupted (all __ primary teeth)
By 3 yrs. all DECIDUOUS TEETH erupted (all 20 primary teeth)
Preschool Growth & Dev.
- Hand p____ by __ yrs. of age
- Visual acuity __/__ (3 years)
- Visual acuity __/__ (4 years)
- Some time during p____ years __/__ vision is established
- Hand PREFERENCE by 3 yrs. of age
- Visual acuity 20/40 (3 years)
- Visual acuity 20/30 (4 years)
- Some time during PRESCHOOL years 20/20 vision is established
Preschool Growth & Dev.
- G____ resembles more of an adults
- R___ faster, j____ higher
- Increased m____ s____ based on exposure
- Q____, more s____-c____
- GAIT resembles more of an adults
- RUN faster, JUMP higher
- Increased MOTOR SKILLS based on exposure
- QUICKER, more SELF-CONFIDENT
Preschool Sexual Curiosity:
- Normal part of t____
- Begin to notice d____ between s____
- May begin to t____ themselves
- R____ touching in p____ not OK
- Be concerned if touching is e____
- In general, i____ the behavior and d____ the child
- Normal part of TODDLERHOOD
- Begin to notice DIFFERENCES between SIBLINGS
- May begin to TOUCH themselves
- REINFORCE touching in PUBLIC not OK
- Be concerned if touching is EXCESSIVE
- In general, IGNORE the behavior and DISTRACT the child
Preschool Growth and Dev.
- T____ more, speaking to i____ objects (especially the 3 yrs)
- S____-I____ begins to develop during the preschool years with i_____ play
- H_____ tasks can be assigned, make them age appropriate (__ yr olds can set the table)
- Be c____ and m____ behavior
- D____ - timeout should be __ minute per year of the child
- TALKING more, speaking to INANIMATE objects (especially the 3 yr olds)
- SELF-IMAGE begins to develop during the preschool years with IMAGINATIVE play
- HOUSEHOLD tasks can be assigned, make them age appropriate (5 yr olds can set the table)
- Be CONSISTENT and MODEL behavior
- DISCIPLINE - timeout should be 1 minute per year of the child
Preschool Growth & Dev.
- S____ F____ - children pretend empty box is fort, creating a mental image for something that is not there.
SYMBOLIC FUCTIONING - children pretent empty box is fort, creating a mental image for something that is not there.
- E____ - Can't see any other view but their own
- A____ - Attributing life to inanimate objects (have banana say dinner prayer)
ANIMISM - Attributing life to inanimate objects (have banana say dinner prayer)
- Explain they did not cause the i____ and are not being p____
- Use s____ w____ - remember developmental level
- T_____ play
- Fear of m____ by procedures
- Let them h____ the equipment
- C____ books, puzzles, c____ & pasting, dolls, building b____, clay and play d____
- Explain they did not cause the ILLNESS and are not being PUNISHED
- Use SIMPLE WORDS - remember developmental level
- THERAPEUTIC play
- Fear of MUTILATION by procedures
- Let them HANDLE the equipment
- COLORING books, puzzles, CUTTING & pasting, dolls, building BLOCKS, clay and play DOUGH
- Erickson Stage - I____ vs. G____
- Piaget Stage - P____
- Erickson Stage - INITIATIVE vs. GUILT
- Piaget Stage - PREOPERATIONAL
- E____ - Uncontrolled, involuntary voiding a____ bladder control has been established
ENURESIS - Uncontrolled, involuntary voiding AFTER bladder control has been established.
- 92% of children establish d____ t____ dryness by __ yrs old
92% of children establish DAY TIME dryness by 5 yrs old.
Causes of Enuresis:
- E____ toilet training demanded by p____, child may r____ and continue to w____ the bed.
- Parents not alert to n____ of child and may not recognize r____ to toilet trains
- S____ events can precipitate bed-w____
- U____ T____ I____
- S____ disorders
- Abnormalities of u____ tract
- S____ disorders
- Maturational delay of n____ system
- Small b____ capacity
- EARLY toilet training demanded by PARENTS, child may REBEL and continue to WET the bed
- Parents not alert to NEEDS of child and may not recognize READINESS to toilet trains
- STRESSFUL events can precipiate bed-WETTING
- URINARY TRACT INFECTIONS
- SLEEP disorders
- Abnormalities of URINARY tract
- SEIZURE disorders
- Maturational delay of NERVOUS system
- Small BLADDER capacity
Urinary Tract Infections (UTI)
- One of the most c____ c____ of childhood
- Up to 10% of children will have a f____ UTI within the first __ years of life
- UTI is a b____ description because it is often impossible to l____ where the infection is
- F____ have a higher incidence of UTI due to short u____, a____ design
- U____ males have higher incidence of UTI than their c____ counterparts
- U____ s____ is the single-most important host factor due to not going e____, not e____ bladder enough
- One of the most COMMON CONDITIONS of childhood
- Up to 10% of children will have a FEBRILE UTI within the first 2 years of life
- UTI is a BROAD description because it is often impossible to LOCALIZE where the infection is
- FEMALES have a higher incidence of UTI due to short URETHRA, ANATOMICAL design
- UNCIRCUMCISED males have higher incidence of UTI than their CIRCUMCISED counterparts
- URINARY STASIS is the single-most important host factor due to not going ENOUGH, not EMPTYING bladder enough
Signs/Symptoms of a UTI in Infants:
- Decreased f____
- D____, V____, J____
- Strong-smelling u____
- Decreased FEEDING
- DIARRHEA, VOMITING, JAUNDICE
- Strong-smelling URINE
Signs/Symptoms of UTI in Older Children:
- Increased f____
- Increased FREQUENCY
Dx of UTI
- S____ A____ (gold standard for children < 2 yrs old)
- U____ A____
- C____ urine
- H____ fluid intake can make a f____ low organism count, so DO NOT encourage children to d____ a lot of water p____ to visit to primary care provider
- SUPRAPUBIC ASPIRATION (gold standard for children < 2 yrs old)
- URINARY ANALYSIS
- CATH. urine
- HIGH fluid intake can make a FALSELY low organism count, so DO NOT encourage children to DRINK a lot of water PRIOR to visit to primary care provider
What is the most common causative organism of UTI?
Tx for a UTI:
- A____ (Abx) (P____, C____)
- Proper h____
- Adequate f____ intake
- No b____ baths
- No s____ soaps
- C____ underpants
- Take all m____
- V____ frequently
- A____ fluid (c____ / a____ juices)
- ANTIBIOTICS (Abx) (PENICILLIN, CEPHALOSPORINS)
- Proper HYGIENE
- Adequate FLUID intake
- No BUBBLE baths
- No SCENTED soaps
- COTTON underpants
- Take all MEDS
- VOID frequently
- ACIDIC fluids (CRANBERRY / APPLE juices)
What disease process is termed "hidden testes?"
- When normal fetal d____ of t____ does not occur at the end of the __ month.
When the normal fetal DESCENT of TESTES does not occcur at the end of the 7th month.
- Testes remain h____ in the a____ or i____ canal
- Common in l____ birth weight infant
- Testes are w____ in the a____, s____ cells begin to deteriorate, if both testes are affected s____ results
- I____ h____ often accompanies this condition
- May descent during f____ year of life
- Testes remain HIDDEN in the ABDOMEN or INGUINAL canal
- Common in LOW birth weight infant
- Testes are WARMER in the ABDOMEN, SPERM cells begin to deteriorate, if both testes are affected STERILITY results
- INGUINAL HERNIA often accompanies this condition
- May descent during FIRST year of life
With Crytochidism, administer h____ c____ g____ (hCG) and may precipitate the d____ of the testes to the s____ s____.
With Cryptochidism, administer HUMAN CHORIONIC GONADOTROPIN (hCG) and may precipitate the DESCENT of the testes to the SCROTAL SAC.
With Crytochidism, O____ (testicle fixation) is performed.
With Cryptochidism, ORCHIOPEXY (testicle fixtion) is performed.
With Cryptochidism, nursing care includes being t____ and s____, try to anticipate related f____ and f____ and promote the child's a____.
With Cryptochidism, nursing care includes being THOUGHTFUL and SENSITIVE, try to anticipate related FEELING and FEARS and promote the child's ADJUSTMENT.
This is an excessive amount of fluid in the sac that surrounds the testicle.
Hydrocele is a common occurence in the n____.
Tx of Hydrocele is s____ if Hydrocele persists. It is same d___ surgery. R____ post-op care given.
Tx of Hydrocele is SURGICAL if Hydrocele persists. It is same DAY surgery. ROUTINE post-op care given.
With H____, it is a congenital (born with) defect in which the urinary m____ is located not at the end of the penis but along the v____ shaft. It may be accompanied by c____ (downward curvature of the penis caused by fibrotic band of tissue).
With HYPOSPADIAS, it is a congenital (born with) defect in which the urinary MEATUS is located not at the end of the penis ut along with VENTRAL shaft. It may be accompanied by CHORDEE (downward curvature of the penis caused by fibrotic band of tissue).
The nurse may discover Hypospadias during r____ newborn care.
Mild cases of Hypospadias may not need s____. C____ is avoided because the f____ may be useful in the repair.
Mild cases of Hypospadias may not need SURGERY. CIRCUMCISION is avoided because the FORESKIN may be useful in the repair.
Surgical Tx of Hypospadias is done before the p____ years (3-6 yrs) to avoid "c____ a____" and allow for achivement of s____ i____.
Surgical Tx of Hypospadias is done before the PRESCHOOL years (3-6 yrs) to avoid "CASTRATION ANXIETY" and allow for achievement of SEXUAL IDENTITY.
T____ T____ is the twisting of the testicle and is accompanied by immediate p___, s____ of the testicle, discoloration of the s____, and immediate s____ to preserve t____ function.
TESTICULAR TORSION is the twisting of the testicle and is accompanied by immediate PAIN, SWELLING of the testicle, discolration of the SCROTUM, and immediate SURGERY to preserve TESTICULAR function.
N____ s____ is a disorder where the basement membrane of the glomeruli become permeable to plasma proteins.
NEPHROTIC SYNDROME is a disorder where the basement membrane of the glomeruli become permeable to plasma proteins.
Nephrotic syndrome usually occurs between __ - __ years of age.
Nephrotic syndrome usually occurs between 2 - 3 years of age.
With Nephrotic Syndrome, there are periods of e____ and r____, and it is most often i____ (don't know why happened).
With Nephrotic Syndrome, there are periods of EXACERBATION and REMISSION, and it is most often IDIOPATHIC (don't know why happened).
S/S of Nephrotic Syndrome:
- E____ starts mild, then progresses to s____
- Elevated l____ levels
- U___ has high a____ (protein) and few _ _ _s (related to damaged glomeruli allowing for a____ and b____ cells to enter the urine)
- Levels of p____ in the b____ falls (lose in urine) (hypoalbuminemia)
- EDEMA starts mild, then progresses to SEVERE
- Elevated LIPID levels
- URINE has high ALBUMIN (protein) and few RBCs (related to damaged glomeruli allowing for ALBUMIN and BLOOD cells to enter the urine)
- Levels of PROTEIN in the BLOOD falls (lose in uring) (hypoalbuminemia)
Treatment of Nephrotic Syndrome:
- Goals of treatment are to minimize e____, prevent i____, reduce the loss of p____ in the u____, and prevent t____ from the medication
- Oral s____ for 1-2 mo.
- IV a____ and d____
- Nursing care: watch labs for n____ (steroids mask infection), examine s____, p____, I___ & O___, w____, d____ (avoid s____ foods), abdominal girth (a____)
- Goals for treatment are to minimize EDEMA, prevent INFECTION, reduce the loss of PROTEIN in the URINE, and prevent TOXICITY from the medication
- Oral STEROIDS for 1-2 mo.
- IV ALBUMIN and DIURETIC
- Nursing Care: watch labs for NEUTROPENIA (steroids mask infection), examine SKIN, POSITIONING, INPUT & OUTPUT, WEIGHT, DIET (avoid SALTY foods), abdominal girth (ASCITIIES)
A____ G_____ is an allergic reaction to a group of A beta hemolytic streptococcal infection. Antigen-antibody copmlexes becomes trapped in the membranes of the golmerulia, causing inflammation and decreased glomerular filtration.
ACUTE GLOMERULONEPHRITIS is an allergic reaction to a group of A beta hemolytic streptococcal infection. Antigen-antibody complexes becomes trapped in the membranes of the glomerulia, causing inflammation and decreased glomerular filtration.
Acute Glomerulonephritis may occur after s____ f____ or s____ infections.
Acute Glomerulonephritis may occur after SCARLET FEVER or SKIN infections.
A____ G____ is the most common form of nephritis in children.
ACUTE GLOMERULONEPHRITIS is the most common form of nephritis in children.
A____ G____ occurs most often in boys 3 - 7 years of age.
ACUTE GLOMERULONEPHRITIS occurs most often in boys 3 - 7 years of age.
A____ G____ occurs in both k____, but the prognosis is excellent, which doesn't mean youll have p____ damage.
ACUTE GLOMERULONEPHRITIS occurs in both KIDNEYS, but the prognosis is excellent (doesn't mean you'll have PERMANENT damage)
Manifestations of Acute Glomerulonephritis (AGN):
- 1-3 weeks after s____ infection
- E___ usually p____ (around orbit of eye)
- H___ (bloody urine)
- Slight-moderate p____ (protein in urine)
- E____ ASO, BUN & c____ levels
- I____ (excessive sensativity)
- L____ (listless or unenergetic)
- H____ (elevated BP)
- 1-3 weeks after STREPTOCOCCAL infection
- EDEMA usually PERIORBITAL (around orbit of eye)
- HEMATURIA (bloody urine)
- Slight-moderate PROTEINURIA (protein in urine)
- ELEVATED ASO, BUN & CREATINE levels
- IRRITABILITY (excessive sensativity)
- LETHARGY (listless or unenergetic)
- HYPERTENSION (elevated BP)
Laboratory Manifestations of Acute Glomerulonephritis (AGN):
- Increased s____ g____, a____, R__ B__ C__, W__ B__ C__, and c___ found in urine
- H____k____ (increased potassium) may produce c____ toxicity (if o____ - small production of urine)
- Increased SPECIFIC GRAVITY, ALBUMIN, RED BLOOD CELLS, WHITE BLOOD CELLS, and CASTS found in urine
- HYPERKALEMIA (increased potassium) may produce CARDIAC toxicity (if OLIGURIC - small production of urine)
Treatment & Nursing Care of Acute Glomerulonephritis (AGN):
- Limit a___ until gross h____ (blood in urine) subsides
- U____ regulary examined
- Do not over t___ child (wear out)
- Prevent i____
- Dietary s____ and f____ restrictions are based on the h___ (high BP) and e___ (swelling) present
Foods high in p____ (banana) are restricted during times of o___ (small production of urine)
Nursing care is s___, prevent i____, f____, monitor I___ & O___ as wells as v___ s___.
Monitor b___ p___, s___, c___ h___ f___, r___ failure
- Limit ACTIVITY until gross HEMATURIA (blood in urine) subsides
- URINE regularly examined
- Do not over TIRE child (wear out)
- Prevent INFECTION
- Dietary SODIUM and FLUID restrictions are based on the HTN (high BP) and EDEMA (swelling present)
- Foods high in POTASSIUM (banana) are restricted during times of OLIGURIA (small production of urine)
- Nursing care is SUPPORT, prevent INFECTION, FEVER, monitor INPUT & OUTPUT as well as VITAL SIGNS
- Monitor B/P, SEIZURES, CHF, RENAL failure
C____ D____ is one that can be transmitted, directly or indirectly, from one person to another.
P____ are organisms that cause disease.
I___ P____ is the time between invasion by the patogen and onset of clinical symptoms.
P____ P____ refers to the initial stage of a disease: the interval between the earliest symptoms and the appearance of a typical rash or fever (children often contagious at the time, but may not know they have disease and therefore spread it to daycare/school envoronment)
- Must have w____ and i___ consent
- Asess for a____ including baker's y____, e___, and n____
- Live v___ vaccines contraindicated if i____ or p____
- Mild i____/i___ it is OK to give vaccines but serious i____, high f___ wait and r____
- With IMMUNIZATIONS:
- Must have WRITTEN and INFORMED consent
- Assess for ALLERGIES including baker's YEAST, EGGS, and NEOMYCIN
- Live VIRUS vaccines contraindicated if IMMUNOCOMPROMISED or PREGNANT
- Mild ILLNESS/INFECTION it is OK to give vaccines but serious INFECTION, high FEVER wait and RESCHEDULE
D____ - "Strangulation Disease" - White/grey m___ develops in throat causing r____ disress (where "strangulation" comes from)
Diphtheria - "strangulation disease" - White/grey MEMBRANE develops in throat causing RESPIRATORY disress (where "strangulation comes from)
Diphtheria is the c___ c___ with purulent n___ drainage.
Diphtheria is the COMMON COLD with purulent NASAL drainage.
Diphtheria has a 2-5 day i____ period.
Diphtheria has a 2-5 day INCUBATION period
Prevention / Treatment of Diphtheria:
- _ _ _ _ vaccine
- IV a____ (abx) and a____
- Provide o____ and s____
- DTaP vaccine
- IV ANTIBIOTICS (abx) and ANTITOXIN
- Provide OXYGEN and SUCTIONING
Nursing Care of Diphtheria:
- Observe for r____, c____ and c___ n___ s___ involvement
- I____ (by self)
- Identify contacts for t____ (Tx)
- Observe for RESPIRATORY, CARDIAC and CNS involvement
- Identify contacts for TREATMENT (Tx)
P____ is also referred to as "Whooping Cough" and has f____, c____, and c____ present.
Pertussis is also referred to as "Whooping Cough" and has FEVER, COLD, and COUGH present.
With Pertussis, spells of c____, accompanied by a noisy g____ for air that creates a "w____"
With pertussis, spells of COUGHING, accompanied by a noisy GASP for air that creates a "WHOOP"
Incubation period for Pertussis is __ to __ days (10 days on average).
Incubation period for Pertussis is 5 to 21 days (10 days on average).
Prevention / Treatment of Pertussis includes:
- _ _ _ _ vaccine
- E_____ in unvaccinated child
- C____ M____ test
- A____ (abx) therapy
- DTaP vaccine
- Erythromycin in unvaccinated child
- COOL MIST test
- ANTIBIOTIC (abx) therapy
With Pertussis the individual is contagious for several w____.
With Petussis the individual is contagious for several WEEKS.
Pertussis Nursing Interventions: i____ (by self), bed r____, provide a____ support during coughing spells, monitor for d____ (fluids, feedings).
Pertussis Nursing Interventions: ISOLATE (by self), bed REST, provide ABDOMINAL support during coughing spells, monitor for DEHYDRATION (fluids, feedings).
I____ (the f___) is a contagious respiratory illness caused by i_____ virus. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the f___ is by getting the f____ vaccination each year.
IFLUENZA (the FLU) is a contagious respiratory illness caused by INFLUENZA virus. It can cause mild to severe illness, and at time can lead to death. The best way to prevent the FLU is by getting the FLU vaccination each year.
Some people, such as o____ people, young c____, and people with certain h____ conditions are at a h____ r____ for serious flu complications.
Some people, such as OLDER people, young CHILDREN, and people with certain HEALTH conditions are at a HIGH RISK for serious flu complications.
The Flu usually come on s_____ and may include these symptoms:
- F____ (usually high)
- H____ (HA)
- Extreme t____
- Dry c____
- Sore t____
- R____ or s_____ nose
- M____ aches
- May or may not have s____ symptoms such as n____, v____, and d____, also can occur but are more common in c____ than adults
- These symptoms are usually referred to as "F___-l____ symtoms"
- The Flu usually come on SUDDENLY and may include these symptoms:
- FEVER (usually high)
- HEADACHE (HA)
- Extreme TIREDNESS
- Dry COUGH
- Sore THROAT
- RUNNY or STUFFY nose
- MUSCLE aches
- May or may not have STOMACH symptoms, such as NAUSEA, VOMITING, and DIARRHEA, also can occur but are more common in CHILDREN than adults
- These symptoms are usually referred to as "FLU-LIKE symptoms"
R____ is also referred to as German Measles and presents with m____ fever and c____ symptoms preceded by rose-colored, maculopapular r____. G____ at ears and back of neck are enlarged.
RUBELLA is also referred to as German Measles and presents with MILD fever and COLD symptoms preceded by rose-colored, maculopapular RASH. GLANDS at ears and back of neck are enlarged.
Incubation period for Rubella is __ to __ weeks (18 days on average). It is contagious until r____ fades (usually 5 days).
Incubation period for Rubella is 2 to 3 weeks (18 days on average). It is contagious until RASH fades (uaually 5 days).
Nursing Interventions for Rubella are to provide s____ treatment and c____ measures. Avoid exposing any woman who might be in the early months of p____, because Rubella can cause fetal a____.
Nursing Interventions for Rubells are to provide SYMPTOMATIC treatment and COMFORT measures. Avoid exposing any woman who might be in the early months of PREGNANCY, because Rubella can cause fetal ABNORMALITIES.
R____ is also called the sixth disease, and it presents with persistent high f____ (103-105 degrees F), then it drops rapidly as the r___ appears. The m____ rash is nonpruritic and b____ easiliy.
ROSEOLA is also called the sixth disease, and it presents with persistent high FEVER (103-105 degrees F), then it drops rapidly as the RASH appears. The MACULOPAPULAR rash is nonpruritic and BLANCHES easily.
The incubation period for Roseola is __ weeks.
The incubation period for Roseola is 2 weeks.
Prevention / Treatment for Roseola are n____. Fever may precipitate c_____.
Prevention / Treatment for Roseola are NONE. Fever may precipitate CONVULSIONS.
Roseola is contagious until r____ disappears.
Roseola is contagious until RASH disappears.
Nursing interventions for roseola are r___ and q___ should be provided. Teach parents t____-reducing techniques and prevention of s____.
Nursing interventions for Roseola are REST and QUIET should be provided. Teach parents TEMPERATURE-reducing techniques and prevention of SEIZURES.
F___ D____ also known as erythema infectiosum, human parovirus B19. Child has "s___ c___" appearance, generalized r___ apperas, subsides and reappears if s___ is irritated by s___ or h___.
FIFTH DISEASE also known as erythema infectiosum, human parovirus B19. Child has "SLAPPED CHEEK" appearance, generalized RASH appears, subsides and reappears if SKIN is irritated by SUN or HEAT.
Incubation period for Fifth Disease is __ - __ days and the prevention / treatment are n___.
Incubation period for FIfth Disease is 4 - 14 days and the prevention / treatment are NONE.
Fifth Disease is contagious during the i___ p___.
Fifth Disease is contagious during the INCUBATION PERIOD.
Nursing interventions for Fifth Disease:
- This is a b___ condition unless the child is i___
- I___ is not required
- Condition may last __ - __ weeks
- This is a BENIGN condition unless the child is IMMMUNOCOMPROMISED
- ISOLATION is not required
- Condition may last 1 - 3 weeks
V___ Z___ or C___ P____ - Prodromal sign include mild f___ followed by m___, p___, v___, P____, and s___. All stages of the lesion are present on the body at the s____ time.
VERICELLA ZOSTER or CHICKEN POX - Prodromal sign include mild FEVER followed by MACULES, PAPULES, VESICLES, PUSTULES, and SCABS. All stages of the lesion are present on the body at the SAME time.
Incubation period for Chicken Pox is __ - __ weeks (14 - 17 days on average)
Incubation period for Chicken Pox is 2 - 3 weeks (14 - 17 days on average).
Prevention / Treatment of Chicken Pox:
- V___ is available
- A___ (Zovirax) or i___ g___ (VZIG) is given to i____ children who are exposed.
- VACCINE is available
- ACYCLOVIR (Zovirax) or IMMUNE GLOBULIN (VZIG) is given to IMMUNOSUPPRESSED children who are exposed.
Chicken Pox is contagious __ days after appearance of r___.
Chicken Pox is contagious 6 days after appearance of RASH.
Nursing interventions for Chicken Pox:
- Trim f___ to prevent scratching (removal of s___ may cause scars)
- C___ lotion may reduce i____
- I____ from others
- Trim FINGERNAILS to prevent scratching (removal of SCABS may cause scars)
- CALAMINE lotion may reduce ITCHING
- ISOLATE from others
M___ or parotitis presents with f___, h___ (HA), g___ near ear and toward jaw line ache and develop painful s___, P___ gland is enlarged, condition may be b____.
MUMPS or parotitis presents with FEVER, HEADACHE (HA), GLANDS near ear and toward jaw line ache and develop painful SWELLING, PAROTID gland is enlarged, condition may be BILATERAL.
Incubation period for Mumps is __ - __ days (18 days average).
Incubation period for Mumps is 14 - 21 days (18 days on average).
Prevention / Treatment of Mumps:
- _ _ _ vaccination given after __ mo. of age.
MMR vaccination given after 15 mo of age
Mumps is contagious until s___ subsides.
Mumps is contagious until SWELLING subsides
Nursing interventions for Mumps are encourage f___, apply i___, c___ to neck for comfort and i___.
Nursing interventions for Mumps are encourage FLUIDS, apply ICE, COMPRESSION to neck for comfort, and ISOLATE.
What do you do when 8 month old had some vaccines, but doesn't know which ones, no records.
Every reasonable effort should be made to locate a patient's immunization record. However, if it cannot be located, then the recommendation is to revaccinate according to their current age. The concern is the risk of localized reaction with the more immunogenic vaccines like tetanus and diphtheria-containing vaccines. In some situations you may want to do some serologic testing for antibody
What would you do with 5 year old who has records, up to day on all vaccines except never has varicell vaccine. Parent reports child had chicken pox and gives accurate description?
May do serological testing to verify and do not need to give vaccine if exposed already.
What do you do with 12 year old who never had Hib or varicells vaccine, has no history of chicken pox and other immunizations are up to date?
No need to give Hib vaccine but can receive varicella vaccination.
P___ I___ (these don't last)
- N___ A___ P___ I___ - immunite acquired from mother if infant is breastfed
- A___ A___ P___ I___ - provied immediate protection like tetanus, dose does not last
- PASSIVE IMMUNITY (these don't last)
- - NATURAL ACQUIRED PASSIVE IMMUNITY - immunity acquired from mother if breastfed
- - ARTIFICIALLY ACQUIRED PASSIVE IMMUNITY - provided immediate protection like tetanus, dose does not last
A___ I ___
- N___ A___ A___ I___ - resistance is inborn, some races have greater natural immunity to some diseases
- A___ A___A___ I___ - acquired by having the disease or receiving vaccine (Hep B, MMR)
- ACTIVE IMMUNITY
- NATURALLY ACQUIRED ACTIVE IMMUNITY - resistance is inborn, some races have greater natual immunity to some diseases
- ARTIFICIALLY ACQUIRED ACTIVE IMMMUNITY - acquired by having the disease or receiving vaccine (Hep B, MMR)
Priority nursing Dx for pt. with Gastrointestinal Problems:
- F___ and e___ balance
- Greater shifts in children due to more b___ w___
- Greater body s___ a___
- Greater m___ needs (__ - __x more than adults)
- Greater h___ production
- FLUID and ELECTROLYTE balance
- - Greater shifts in children due to more BODY WATER
- - Greater bod SURFACE AREA
- - Greater METABOLIC needs (2 - 3x more than adults)
- - Greater HEAT production
IV maintenance fluid and rehydration:
- 1-10 Kg = ___ mL/kg/d
- 11-20 Kg = ___ mL/kg/d
- > 20 kg = ___ mL/kg/d
- 1-10 kg = 100 mL/kg/d
- 11-20 kg = 50 mL/kg/d
- > 20 kg = 20 mL/kg/d
What are signs of dehydration?
- No t___
- D___ urine output
- Poor s___ t___
- Depressed f___
- Dry m___ m___
- No TEARS
- DECREASED urine output
- Poor SKIN TURGOR
- Depressed FONTANEL
- Dry MUCOUS MEMBRANES
GI problems: Fluid volume deficit / nutrition < required:
- Focus on providing adequate n___ and freedom from i___
- Monitor strict I___ & O___
- W___ (lbs)
- Checking _ _ site hourly and also to make sure f___ is running at the correct v___
- Focus on providing adequate NUTRITION and freedom from INFECTION
- Monitor strict INPUT & OUTPUT
- WEIGHT (lbs)
- Checking IV site hourly and also to make sure FLUID is running at correct VOLUME
Dehydration: why is diarrhea so concerning?
- Body will go into m___ a___ - dumping all _ _ _ _ with prolonged diarrhea
Body will go into METABOLIC ACIDOSIS - dumping all HCO3 with prolonged diarrhea
Dehydration: why is vomiting so concerning?
- Body will go into m___ a___ - Losing all a___ with prolonged vomiting
Body will go into METABOLIC ALKALOSIS - Losing all ACID with prolonged vomiting
- Tx is C____ (surgical lip repair) by __ mo of age
- Done when w___ gain is good
- Infant free from i___
- Surgery improves infant s___ ability
- Surgery improves infant a___
- Tx is Cheiloplasty (surgical lip repair) by 3 mo of age
- Done when WEIGHT gain is good
- Infant free from INFECTION
- Surgery improves infant SUCKING ability
- Surgery improves infant APPEARANCE
Congenital Malformation - Cleft lip is a f___ or opening in the upper l___. Failure of the m___ and median n___ process to unit during development usually between __ and __ week of gestation. May be accompanied by c___ p___.
Congenital malformation - Cleft lip is a FISSURE or opening in the upper LIP. Failure of the MAXILLARY and median NASAL process to unit during development usually between 7th and 8th week of gestation. May be accompanied by CLEFT PALATE.
Postoperative Tx of Cleft Lip:
- Physician may order e___ r___ to keep the infant from scratching the lip (introduce infant to them prior to s___)
- Prevent infant from s___ and excessive c___ through c___ and giving p___ relief
- Small amount of sterile w___ will cleanse mouth after f___
- Feeds by d___ (1-2 weeks) until w___ is completely healed
- Physician my order ELBOW RESTRAINTS to keep the infant from scratching the lip (introduce infant to them prior to SURGERY)
- Prevent infant from SCRATCHING and excessive CRYING through CUDDLING and giving PAIN relief
- Small amount of sterile WATER will cleanse mouth after FEEDING
- Feeds by DROPPER (1-2 weeks) until WOUND is completely healed
- Failure of hard p___ to fuse m___ during __ to __ week of gestation. Open pathway o___ and n___
- Difficult to f___ (special bottles or feeding tube)
- Increased risk for i___
- Increased risk for a___
- Failure of hard PALATE to fuse MIDLINE during 7th to 12th week of gestation. Open pathway ORALLY and NASALLY
- Difficult to FEED (special bottles or feeding tube)
- Increased risk for INFECTION
- Increased risk for ASPIRATION
Tx for Cleft Palate:
- Goals of therapy - union of the c___, improved f___, improved s___, improved d___ development, improved s___-i___
Goals for therapy - union of the CLEFT, improved FEEDING, improved SPEECH, improved DENTAL development, improved SELF-IMAGE
Tx for Cleft Palate:
- Usually done at __ - __ mo
- Fluids taken by c___
- Soft f___ should be done with a s___ into the side of the m___, s___ should not touch the t___ of the m___
- E___ r___ are used to prevent the child from placing his/her fingers or objects into the m___
- M___ is kept clean at all times, follow feeds with a sterile w___
- Keep c___ to a minimum using d____ techniques
- E___ infections or d___ decay may accompany a cleft palate
- Usually done at 12-18 mo.
- Fluids taken by CUP
- Soft FLUIDS should be done with a SPOON into the side of the MOUTH, SPOON should not touch the TOP of the MOUTH
- ELBOW RESTRAINTS are used to prevent the child from placing fingers or objects into the mouth
- MOUTH is kept clean at all times, follow feeds with a sterile WATER
- Keep CRYING to a minimum using DISTRACTION techniques
- EAR infections or DENTAL decay may accompany a cleft palate
GI Disorders: Failure to Thrive
- Wt < __ - __ percentile
- O___ causes: c___ heart, m___ syndromes
- Treat u___ disease
- Wt < 3 - 5 percentile
- ORGANIC causes - CONGENITAL heart, MALABSORPTION syndromes
- Treat UNDERLYING disease
Failure to Thrive (FTT):
- Organic Causes - c___ h___ disease, m___ diseases
- Non-organic causes - environmental n___, lack of p___-i___ interaction, lack of i____ regarding n___ needs.
- Organic causes - CONGENITAL HEART disease, MALABSORPTION diseases
- Non-organic causes - environmental NEGLECT, lack of PARENTAL-INFANT interaction, lack of INFORMATION regarding NUTRITION needs
Signs & Symptoms of Failure to Thrive (FTT):
- W___ loss
- F___ to gain
- Below ___ percentile in w___ & h___
- WEIGHT loss
- FAILURE to gain
- Below 3rd percentile in WEIGHT & HEIGHT
Tx of Failure to Thrive (FTT):
- M____ approach
- P___ (dr.)
- S___ worker
- D___ (food)
- P___ is uncertain
- MULTIDISCIPLINARY approach
- PHYSICIAN (dr.)
- SOCIAL worker
- DIETICIAN (food)
- PROGNOSIS is uncertain
GI Disorders: Diarrhea
- Different in i___, it is a sudden i___ in stools from the normal pattern with f___ consistency and color that is g___ or m___ or b___
Different in INFANTS, it is a sudden INCREASE in stools from the normal pattern with FLUID consistency and color that is GREEN or MUCUS or BLOOD
GI Disorders: Diarrhea
- Acute - Caused by i___ or i___ in response to m___, f___ or p____
- Chronic - > __ weeks caused by m___, long-term i___ disease, or a___ response
Acute - Caused by INFLAMMATION or INFECTION in response to MEDICATION, FOOD or POISONING
Chronic - > 2 weeks caused by MALABSORPTION, long-term INFECTIOUS disease, or ALLERGIC response
Signs of Diarrhea:
- M___ or e___ severity
- W___, f___ stools
- L___, no appetite
- May have t___
- Decreased u___ output
- MILD or EXTREME severity
- WATER, FORCEFUL stools
- LISTLESS, no appetite
- May have TEMPERATURE
- Decreased URINE output
Tx of Diarrhea:
- D___ solid food intake, rest b___
- Oral r___ solutions such as P___ or I___ (liquid or popsicles) are preferred with gradual introduction of s___, b___ diet
- Regular i___ is usually resumed within __ - __ days
- BRAT diet (b___, r___, a___, and t___) is NOT n___
sound enough to support g___ and d____
- DECREASE solid food intake, rest BOWEL
- Oral REHYDRATING solutions such as PEDIALYTE or INFALYTE (liquid or popsicles) are preferred with gradual introduction of SOFT, BLAND diet
- Regular INTAKE is usally resumed within 2-3 days
- BRAT diet (BANANAS, RICE, APPLESAUCE, and TOAST) is NOT NUTRITIONALLY sound enough to support GROWTH and DEVELOPMENT
- Inflammation of the s___ and the i___
- Most common cause - i___, f___ intolerance, over-f___, improper f___ preparation, ingestion of high amounts of s____
- Tx is oral r___ solutions
F___ feeds are held, but b___ is allowed with r___ solutions because b___ milk's o____, a____ properties and e___ content (more easily broken down)
- Inflammation of the STOMACH and the INTESTINES
- Most common cause - INFECTION, FOOD intolerance, over-FEEDING, improper FORMULA preparation, ingestion of high amounts of SORBITAL
- Tx is oral REHYDRATING solutions
- FORMULA feeds are held, but BREASTFEEDING is allowed with REHYDRATION solutions because BREAST milk's OSMOLARITY, ANTIMICROBIAL properties and ENZYME content (more easily broken down)
Nursing Care for Diarrhea and Gastroenteritis:
- Strict I___ & O___
- Good s___ care
- Frequent d___ changes
- Daily w___
- Monitor e___
- Educate parents regarding h___ w___ and f___ preparation
- Strict INPUT & OUTPUT
- Good SKIN care
- Frequent DIAPER changes
- Daily WEIGHT
- Monitor ELECTROLYTES
- Educate parents regarding HAND WASHING and FOOD preparation
GI disorders - Gastroesophageal Reflux (GER)
- Results when the l___ e____ s____ is r____ or not competent, which allows stomach content to be easily regurgitated into the e___
- Many i___ have a m___ degree, but some do have significant reflux
- Symptoms usually d___ significantly around __ year related to s____ foods and infant s____ upright
- Results when the LOWER ESOPHAGEAL SPHINCTER is RELAXED or not competent, which allows stomach content to be easily regurgitated into the ESOPHAGUS
- Many INFANTS have a MILD degree, but some do have significant reflux
- Symptoms usually DECREASE significantly around 1 year related to SOLID foods and infant STANDING upright
Gastroesophageal Reflux (GER) S/S:
- W___ loss
- F___ (crabby)
- H___ (food)
- F____ to T___
- WEIGHT loss
- FAILURE to THRIVE
Gastroesophageal Reflux (GER) Tx:
- Notation of when does the infant v___, type of f___, f___ techniques and infant's e___
- Prolonged e___ monitoring, _ _ monitoring is the gold standard
- Therapy depends on the severity - f___ techniques, m___ (Z___ - decreased acid production in stomach; R___ (moves stuff through gut faster), p____
- Notation of when does the infant VOMIT, type of FORMULA, FEEDING techniques and infant's EATING
- Prolonged ESOPHAGEAL monitoring, pH monitoring is the gold standard
- Therapy depends on severity - FEEDING techniques, MEDICATIONS (ZANTAC - decreased acid production in stomach; REGLIN - moves stuff through gut faster), POSITIONING
GI disorders - Pyloric Stenosis
- O___ of the lower end of the stomach (p___) caused by an overgrowth (h____) of the circular m___ of the pylorus or by s___ of the sphincter
- B___ with this
- OBSTRUCTION of the lower end of the stomach (PYLORUS) caused by an overgrowth (HYPERTROPHY) of the circular MUSCLES of the pylorus or by SPASMS of the sphincter
- - BORN with this
Symptoms of Pyloric Stenosis:
- Appear at __ - __ weeks
- P___ v___ immediately after feeding
- Infant is constantly h___, and will eat immediately after v___
- D___ (sunken f___, sking t___)
- May feel olive-shaped m___ in u___ r___ q___ of abdomen
- E___ disturbance
- Appear at 2 - 3 weeks
- PROJECTILE VOMITING immediately after feeding
- Infant is constantly HUNGRY, and will eat immediately after VOMITING
- DEHYDRATION (sunken FONTANELS, skin TENTING)
- May feel olive-shaped MAS in UPPER RIGHT QUADRANT of abdomen
- ELECTROLYTE disturbance
Tx of Pyloric Stenosis
- P____ - enlarge the pyloric muscle so food can easily pass through
PYLOROMYOTOMY - enlarge the pyloric muscle so food can easily pass through
Nursing care for Pyloric Stenosis:
- _ _ fluids
- T___ feeds
- Frequent b___
- Monitor I___ & O___
- Resume o___ feeding immediately (make sure t___)
- Avoid o___
- IV fluids
- THICKEN feeds
- Frequent BURPING
- Monitor INPUT & OUTPUT
- Resume ORAL feeding immediately (make sure TOLERATING)
- Avoid OVERFEEDING
GI Disorders: Intussusception
- S___ of one part of the i___ into another part just below it
- The m___ (blood vessels/nerves) gets pulled along with it
- SLIPPING ofone part of the INTESTINE into another part just below it
- The MESENTERY (blood vessels/nerves) gets pulled along with it
- At first the b___ becomes o___ but then s___ occurs as p____ forces the structures more tightly
- This is a m___ e____
- If not taken care of, b___ will r___ causing p___. This will place the patient as risk for i___, h___, h___ shock
- At first the BOWEL becomes OBSTRUCTED but then STRANGULATION occurs as PERISTALSIS forces the structures more tightly
- This is a MEDICAL EMERGENCY
- If not taken care of, BOWELS will RUPTURE causing PERITONITIS. This will place the patient at risk for INFECTION, HEMORRHAGE, and HYPOVOLEMIC shock
S/S of Intussusception:
- S___ onset
- Severe p___ in a___
- B___ vomiting (always bad)
- C___, j___ stools (from movements of mucous and blood)
- F___ (afebrile)
- R___ abdomen
- SUDDEN onset
- Severe PAIN in ABDOMEN
- BILIOUS vomiting (always bad)
- CURRANT, JELLY stools (from movements of mucous and blood)
- FEVER (afebrile)
- RIGID abdomen
Tx of Intussusception:
- B___ enema
Nursing Care of Intussusception:
- R___ post-operative care
ROUTINE post-operative care
GI Disorders: Appendicitis
- Acute i___ of the a___
- Most c___ reason for emergency a___ surgery in childhood
- Average age of occurence is __ years of age
- Acute INFLAMMATION of APPENDIX
- Most COMMON reason for emergency ABDOMINAL surgery in children
- Average age of occurence is 10 years of age
S/S of Appendicitis:
- T___ of the lower right q___ "M_B____ Point"
- R___ tenderness of right lower q___when pressure is released of pressure causes p___
- TENDERNESS of the lower right QUADRANT "McBURNEY'S Point"
- REBOUND tenderness of right lower QUADRANT when pressure is released of pressure causes PAIN
Tx of Appendicitis:
- _ _ fluids
- F___ soon after surgery
- May have d___
- Routine d___ changes/care
- R___ post-op care
- IV fluids
- FEED soon after surgery
- May have DRAIN
- Routing DRESSING changes/care
- ROUTINE post-op care
GI Disorders - C___ disease also known as gluten enteropathy
- __ mo to __ years becomes evident
- Gluten found in w___, b___, o____, r___
- CELIAC disease also known as gluten enteropathy
- 6 mo to 2 years becomes evident
- Gluten found in WHEAT, BARLEY, OATS, RYE
S/S of Celiac Disease:
- F___ to T___
- S___ large
- Stools b___ / f___ because of u____ contents
- I____ (easily angered)
- FAILURE to THRIVE
- STOOLS large
- Stools BULKY / FROTHY because of UNDIGESTED contents
- IRRITABILITY (easily angered)
Dx & Tx of Celiacs:
- Dx confirmed by serum _ _ _ test
- Small b____ biopsy
- Characteristics m____ syndrome and a____ distention with a____ buttocks
- Tx lifelong d___ restricted in wheat, barley, oats, rye
- Nursing must teach family importance of d___ compliance
- Long-term b___ pathology can occur if d___ compliance is not l____
- Dx confirmed with serum IgA test
- Small BOWEL biopsy
- Characteristics MALABSORPTION syndrome and ABDOMINAL distention with ATROPHIC buttocks
- Tx lifelong DIETARY restricted in wheat, barley, oats, rye
- Nursing must must teach family importance of DIETARY compliance
- Long-term BOWEL pathology can occur if DIETARY copmliance is not LIFELONG
Ingestions of Poisons:
- Treat the c____first
- Assess the c____ - c____ evaluation of v___ s____, initiate _ _ _ if indicated, and treat other s____ (seizure)
- Terminate the e____ - empty m____, wash s____, fresh a___
- I____ the poison - ask p____ and w____, look for c___, call p___ control center for advice
- Remove and prevent a____
- Treat the CHILD first
- Assess the CHILD - CONTINUOUS evaluation of VITAL SIGNS, initiate CPR if indicated, treat other SYMPTOMS (seizure)
- Terminate the EXPOSURE - empty MOUTH, wash SKIN, fresh AIR
- IDENTIFY the poison - ask PATIENT and WITNESS, look for CLUES, call POISON control center for advice
- Remove and prevent ABSORPTION
More on Poisons:
- S___ of I____ is no longer recommended for immediate t___ at home
- P____ should be instructed to call the P____ Control Center
- G____ l____ may be used on i____, u____ patient, s____, or rapidly a____ substance
- SYRUP of IPEC is no longer recommended for immediate TREATMENT at home
- PARENTS should be instructed to call the POISON Control Center
- GASTRIC LAVAGE may be used on INFANTS, UNCONSCIOUS patient, SEIZURES, or rapidly ABSORBED substance
Specific Antidotes for Poisoning:
- Poison - Carbon Monoxide - Antidote - O___
- Poison - Acetominophen - Antidote - N-a____
- Poison - Opiods - Antidote - N____
- Poison - Digoxin - Antidote - D___
- Poison - Certain Bites - Antidote - A_____
- Poison - Carbon Monoxide - Antidote - OXYGEN
- Poison - Acetominophen - Antidote - N-ACTYLYSTEINE
- Poison - Opiods - Antidote - NALOXONE
- Poison - Digoxin - Antidote - DIGIBIND
- Poison - Certain Bites - Antidote - ANTIVENIN
- A___ C____ - odorless, tasteless, fine, black powder
- Absorbs many c____
- creates a s____ complex
- May mix with s___
- May induce v____ which i____ risk of a_____
- ACTIVATED CHARCOAL - odorless, tasteless, fine, black powder
- Absorbs may COMPOUNDS
- Creates a STABLE complex
- May mix with SODA
- May induce VOMITING which INCREASES risk of ASPIRATION
Diabetes Mellitus - IDDM or Type I Diabetes
- I___ producing cells of the p___ aren't f___ (don't work at all)
- This is a m___ disorder
- INSULIN producing cells of the PANCREAS aren't FUNCTIONING (don't work at all)
- This is a METABOLIC disorder
Type I Diabetes present with a triad of symptoms (3 P's)
- P___ (excess thirst)
- P___ (excess urine)
- P ___ (constantly hungry)
- POLYDIPISIA (excess thirst)
- POLYURIA (excess urine)
- POLYPHAGIA (constantly hungry)
Type I Diabetes - Honeymoon Phase:
- A period of r___ of the "honeymoon phase" of the disease may occur within a few w___ of beginning i___ administration. There is a d___ in i___ need and improved m___ control. This phase is t___.
A period of REMISSION of the "honeymoon phase" of the disease may occur within a few WEEKS of beginning INSULIN administration. There is a DECLINE in INSULIN need and improved METABOLIC control. This phase is TEMPORARY.
Type I Diabetes Dx Blood Tests:
- B___ g___ is a random b___ g___ level obtained at any time and requires no preparation of the pt. The results should be w___ n___ l___ for both n____ pt. and d____ pt. who have good control of their disease
BLOOD GLUCOSE is a random BLOOD GLUCOSE level obtained at any time and requires no preparation of the pt. The results should be WITHIN NORMAL LIMITS for both NONDIABETIC and DIABETIC pt. who have good control of their disease.
Type I Diabetes Dx Blood Tests:
- F___ b___ g___ is a standard and reliable test for d___. Blood glucose is measured in the f___ pt., usually in the m___.
FASTING BLOOD GLUCOSE is a standard and reliable test for DIABETES. Blood glucose is measures in the FASTING pt., usually in the MORNING.
Type I Diabetes Dx Blood Tests:
- G___ T___ T___ results plotted on a g___, very time consuming
GLUCOSE TOLERANCE TEST results plotted on a GRAPH, very time consuming.
Glycosylated Hemoglobin Test HbA 1c
- Reflects g___ levels over a period of m___
- Values are found to be e____ in all children with newly diagnosed d___
- Values of __ - __% represent g___ metabolic control
- Values > __% indicate p___control
- Typical values in n___ are __ - __ %
- __ % is considered a___ control for children
- Reflects GLYCEMIC levels over a period of MONTHS
- Values are found to be ELEVATED in all children with newly diagnosed DIABETES
- Values of 6 - 9 % represent GOOD metabolic control
- Values > 12 % indicate POOR control
- Typical values in NONDIABETICS are 4 - 6 %
- 7.5 % is considered ACCEPTABLE control for children
Diabetic Ketoacidosis DKA
- Referred to as a diabetic c___ (although a person may have DKA w/o being in a c___)
- Results if a pt. with d___ contracts secondary i___ and does not follow s___-c___
- May happen if T___ _ D___ is u____
- P___ controlled individual
- Referred to as a diabetic COMA (although a person may have DKA w/o being in a COMA)
- Results if a pt. with DIABETES contracts secondary INFECTION and does not follow SELF-CARE
- May happen if TYPE I DIABETES is UNRECOGNIZED
- POORLY controlled individual
Tx and Nursing Care of IDDM:
- Ensure normal g___ and d___ through m___ control
- Enable the child to cope with a c___ illness
- H___ and a___ childhood
- Well ___ into the family
- Prevent c____ (best done by m___ blood glucose at c___ normal levels)
- Ensure normal GROWTH and DEVELOPMENT through METABOLIC control
- Enable the child to cope with CHRONIC illness
- HAPPY and ACTIVE childhood
- Well INTEGRATED into the family
- Prevent COMPLICATIONS (best done by MAINTAINING blood glucose at CONSISTENTLY normal levels)
Triad of Management of IDDM:
- Well-balanced d___ (low g___ food)
- Precise i___ administration (r___ sites, c___ amount)
- Regular e___
- Well-balanced DIET (low GLYCEMIC food)
- Precise INSULIN administration (ROTATE sites, CORRECT amount)
- Regular EXERCISE
- Used as the specific d___ for the control of d____ m___
- I___ cannot be taken o___ because it is a p___ and would be broken down by g___ juices
- Most children can perform self-i___ after __ years of age
- Used as a specific DRUG for the control of DIABETES MELLITUS
- INSULIN cannot be taken ORALLY because it is a PROTEIN and would be broken down by GASTRIC juices
- Most children can perform self-ADMINISTRATION after 7 years of age
Four types of insulin based on this criteria:
- O___ - how soon the insulin starts working
- P___ - when the insulin works the hardest
- D___ - how long the insulin lasts in your body
- ONSET - how soon the insulin starts working
- PEAK - when the insulin works the hardes
- DURATION - how long the insulin lasts in your body
- R___ A___ (Lispro) - reaches the blood within __ minutes after injection. The insulin peaks __ - __ minutes later and may last as long as __ hours.
RAPID ACTING (Lispro) reaches the blood within 15 minutes after injection. The insulin peaks 30 - 90 minutes later and may last as long as 5 hours
- S___ A___ (R___) usually reaches the blood within __ minutes after injection. The insulin peaks __ - __ hours later and stays in the blood for about __ - __ hours.
SHORT ACTING (REGULAR) usually reaches the blood within 30 minutes after injection. The insulin peaks 2 - 4 hours later and stay in the blood for about 4 - 8 hours
- I___ A___ (NPH and Lente) reaches the blood __ - __ hours after injection. The insulin peaks at __ - __ hours and stays in the blood for about __ - __ hours.
INTERMEDIATE ACTING (NPH and Lente) reaches the blood 2 - 6 hours after injection. The insulin peaks at 4 - 14 hours and stays in the blood for about 14 - 20 hours.
- L___ A___ (ultralente) takes __ - __ hours after injection. to start working. It has no p___ or a very small peak __ - __ hours after injection. The insulin stays in the blood between __ - __ hours.
LONG ACTING (ultralente) takes 6 - 14 hours after injection to start working. It has no PEAK or a very small peak 10 - 16 hours after injection. The insulin stays in the blood between 20 - 24 hours.
More on Insulin:
- Some insulin can be m___ together which makes it easier to i___ two kinds of i___ at the same time.
- BUT...you cannot a___ the amount of one i___ w/o c___ the amount you get of the other
- Some insulin can be MIXED together which makes it easier to INJECT two kinds of INSULIN at the same time.
- BUT...you cannot ADJUST the amount of one INSULIN w/o CHANGING the amount you get of the other
The insulin drip - What must you do when you start an insulin drip and why?
Check the BS, run insulin for 5-10 minutes to coat the tubing, otherwise pt. not getting the correct dose b/c insulin binds to the tubing (unit will have specific instructions)
More facts about insulin:
- Research being done on intran___ and i___ insulin
- Insulin can cross the m___ and increase s___ levels
- The d___ is not long enough to be a total r____
- Research results still p____
- Research being done on INTRANASAL and INHALED insulin
- Insulin can cross the MUCOSA and increase SERUM levels
- The DURATION is not long enough to be a total REPLACEMENT
- Research results still PENDING
H___ increased glucose concentration in the blood. I___ of the body to p___ insulin. Caused by i___ insulin control. Superimposed by an i___.
HYPERGLYCEMIA increased glucose concentration in the blood. INABILITY of the body to PRODUCE insulin. Caused by INEFFECTIVE insulin control. Superimposed by an INFECTION.
- Serum g___ level exceed r___ threshold
- > ___ glucose will start to "___" into the u___
- Along with an o___ diversion of u___ comes increased t___, increased u___ output
- Serum GLUCOSE level exceed RENAL threshold
- > 180 glucose will start to "SPILL" into the urine
- Along with an OSMOTIC diversion of URINE comes increased THIRST, increased URINE output
S/S of Hyperglycemia:
- Gradual o___
- Dry m___ and s___
- F___/a___ breath
- Weak p___
- B____ vision
- Gradual ONSET
- Dry MOUTH and SKIN
- FRUITY/ACETONE breath
- NAUSEA / VOMITING
- Weak PULSE
- BLURRED vision
H____ (insulin shock) occurs when blood glucose levels become abnormally low. This is cause by too much i___. May be related to poorly planned e___, reduced d___, and errors made in i___.
HYPOGLYCEMIA (insulin shock) occurs when blood glucose levels become abnormally low. This is caused by too much INSULIN. May be related to poorly planned EXERCISE, reduced DIET, and errors made in INSULIN.
S/S of Hypoglycemia:
- Poor b___
- Poor BEHAVIOR
Tx of Hypoglycemia:
- S___ in some form (OJ, hard candy)
- C___ product (glucagon, vomiting may occur)
- After pt. feels better have p___ and s___ (sandwich, milk, cheese)
- SUGAR in some form (OJ, hard candy)
- COMMERCIAL product (glucagon, vomiting may occur)
- After pt. feels better have PROTEIN and STARCH (sandwich, milk, cheese)
S____ E____ - This is a separate response from hypoglycemia. It occurs when blood glucose levels decrease to the poing where s___ hormones (e___, g___ hormone, and c___) cause r___ hypoglycemia. Prevention is to d___ insulin and i___ amount of f___ eaten.
SOMOGYI EFFECT - This is a separate response from hypoglycemia. It occurs when blood glucose levels decrease to the poing where STRESS hormones (EPINEPHRINE, GROWTH hormone, and CORTICOSTEROIDS) cause REBOUND hypoglycemia. Prevention is to DECREASE insulin and INCREASE amount of FOOD eaten.
D___ P___ - term used to describe an a___ early-morning i___ in blood sugar (glucose) usually between __ a.m. and __ a.m. in people with d___. It is more common in people with T___ __ diabetes than in those with T___ __ diabetes. Don't really know why it happens, but it may be related to the h___ that are released during s___. Also known as the D___ E___.
DAWN PHENOMENON - term used to describe an ABNORMAL early-morning INCREASE in blood sugar (glucose) usually between 4 a.m. and 8 a.m. in people with DIABETES. It is more common in people with TYPE I diabetes than in those with TYPE II diabetes. Don't really know why it happens, but it may be related to the HORMONES that are released during SLEEP. Also known as the DAWN EFFECT.
- Exact cause is unknown. Some researchers believe it's due to the natural overnight release of h___, including g___ hormone, c___, g___ and e___ that i___ insulin resistance.
Exact cause is unknown. Some researchers believe it's due to the natural overnight release of HORMONES, including GROWTH hormone, CORTISOL, GLUCAGON, and EPINEPHRINE that INCREASE insulin resistance.
- High morning blood sugar may have other c___. I___ insulin the night before, i___ medication dosages or eating c___ snacks at bedtime may cause blood sugar to be e___ in the morning. C___ your blood sugars t___ the night will help you and your doctor to determine if you have the dawn phenomenon or if there's another reason for an e___ morning blood sugar reading.
High morning blood sugar may have other CAUSES. INSUFFICIENT insulin the night before, INCORRECT medication dosages or eating CARBOHYDRATE snacks at bedtime may cause blood sugar to be ELEVATED in the morning. CHECKING you blood sugars THROUGHOUT the night will help you and your dictor to determine if you have the dawn phenomenon of if there's another reason for an ELEVATED morning blood sugar reading.
- Based on the results of blood testing t___ the night, your doctor may recommend one of the following options to prevent or correct high blood sugar levels in the morning - not eating a c___ snack at bedtime, adjusting your d___ of medication or i___, switching to a different m___, using an insulin p___ to administer e___ insulin during early morning hours.
Based on the results of blood testing THROUGHOUT the night, you doctor may recommend one of the following options to prevent or correct high blood sugar levels in the morning - not eating a CARBOHYDRATE snack at bedtime, adjusting your DOSAGE of medication or INSULIN, switching to a different MEDICATION, using an insuline PUMP to administer EXTRA insulin during early morning hours.
Why can't a child take an oral pill for their Type I diabetes?
Gastric acid breaks down the protein in the insulin