Pediatrics Unit 4

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d14racer24
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132795
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Pediatrics Unit 4
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2012-02-07 01:00:15
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Pediatrics Nursing School age neurological spina bifida cerebral palsy seizure meningitis mental impairment fractures adolescence acne impetigo scabies burns depression anorexia bulimia
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Review for Unit 4 Nursing Pediatrics
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  1. School Age G&D:
    - __ - __ years of age
    - Physical growth is s___ until the spurt prior to p___
    - Average weight gain is __ - __ pounds per year
    - Average height is __ inches/year
    - First permanent teeth to erupt are 6 year m___
    - Loss of primary teeth (d___/baby teeth) begins about __ years, about __ permanent teeth erupt/year
    - What do you do if a permanent tooth falls out? Put it in m___ - s___ help keep tooth alive
    • 6 - 12 years of age
    • Physical growth is SLOW until the spurt prior to PUBERTY
    • Average weight gain is 4 - 6 lbs/year
    • Average height is 2 inches/year
    • First permanent teeth to erupt are 6 year MOLARS
    • Loss of primary teeth (DECIDUOUS/baby teeth) begins about 6 years, about 4 permanent teeth erupt/year
    • What do you do if a permanent tooth falls out? Put it in MILK - SUGAR help keep tooth alive
  2. School Age Developmental Milestones - Fine Motor
    - __ - __ years learning to w___ and p___. G___ motor exceeds f___ motor skills
    - __ - __ years h___-e___ coordination and fine motor skills are well e___. Can make detailed d___
    - __ - __ years are r___ and enjoys projects with h___
    • 6 - 7 years learning to WRITE and PRINT. GROSS motor exceeds FINE motor skills
    • 8 - 10 years HAND-EYE coordination and fine motor sills are well ESTABLISHED. Can make detailed DRAWING
    • 11 - 12 years are READING and enjoys projects with HANDS
  3. School Age Developmental Milstones - Social / Verbal
    - __ - __ year - Boisterous, out g___, and a know it a___, can be w___
    - __ - __ year - questions p___ and i___, strong sense of h___, enjoys c___, outings, group p___/outings
    - __ - __ year - intense t___ loyalty, best f___ period, wide m___ swings, likes p___, wants u___ independence
    • 6 - 7 year - Boisterous, out GOING, and a know it ALL, can be WHINY
    • 8 - 10 year - questions PARENTS and IDEAS, strong sense of HUMOR, enjoys CLUBS, outings, Group PROJECTS/outings
    • 11 - 12 year - intense TEAM loyalty, best FRIEND period, wide MOOD swings, likes PRIVACY, wants UNREASONABLE independence
  4. What can Schol Age children do?
    - D___ self completely
    - S___ becomes important
    - Egocentric thinking replaced by social a___ of others (hopefully)
    - Learning c___ & e___ relationships
    - Can tell t___
    - Understand p___, p___, and f___
    • DRESS self completely
    • SOCIALIZATION becomes important
    • Egocentric thinking replaced by social ACCEPTANCE of others (hopefully)
    • Learning CAUSE & EFFECT relationships
    • Can tell TIME
    • Understand PAST, PRESENT, and FUTURE
  5. Hospitalized School Age Child:
    - P___ and m___ are important
    - Participation in c___ and p___ with staff
    - Staying involved with p___ and s___ activities important
    - May need support from p___ more than willing to admit
    • PRIVACY and MODESTY are important
    • Participation in CARE and PLANNING with staff
    • Staying involved with PEERS and SCHOOL activities important
    • May need support from PARENT more than willing to admit
  6. Toys for School Age Child:
    - V___ games
    - P___
    - H___
    - B___ games
    - C___ games
    • VIDEO games
    • PUZZLES
    • HOBBIES
    • BOARD games
    • CARD games
  7. School Age G&D:
    - Erickson Stage - I___ vs. I___ (they like to do and accomplish things)
    - Piaget Stage - C___ o___ (7-11 years)
    • Erickson Stage - INDUSTRY vs. INFERIORITY (they like to do and accomplish things)
    • Piaget Stage - CONCRETE OPERATIONS (7-11 years)
  8. Neurological Disorders:
    - Causes of A___ L___ of C____ (LOC)
    - Fall of __ mm Hg or below of PaO2 (oxygen saturation)
    - Rise above __ mm Hg of PaCO2
    - Low b___ p___ causing cerebral h___
    - F___ (__ degree in f___ increases oxygen need by __%)
    - D___ (sedatives, antiepileptics)
    - I___ i____ p___ (ICP)
    • Causes of ALTERED LEVEL of CONSCIOUSNESS (LOC)
    • Fall of 60 mm Hg or below of PaO2 (oxygen saturation)
    • Rise above 45 mm Hg of PaCO2
    • Low BLOOD PRESSURE causing cerebral HYPOXIA
    • FEVER (1 degree in FEVER increases oxygen need by 10%)
    • DRUGS (sedatives, antiepileptics)
    • INCREASED INTRACRANIAL PRESSURE (ICP)
  9. Nursing Interventions for Neurological Disorders:
    - A___
    - S___
    - S___ integrity
    - Timing of m___ (give when supposed to maintain in bloodstream)
    - V___ s___
    - F___ coping
    • AIRWAY
    • SAFETY
    • SKIN integrity
    • Timing of MEDICATIONS (give when supposed to, to maintain in blood stream)
    • - VITAL SIGNS
    • - FAMILY coping
  10. Neurological Disorders:
    - H___ is a condition characterized by an increased CSF within the ventricles of the b___, which causes p___ changes in the brain and increase in h___ size. Results from an imbalance between p___ and a___ of CSF or improper f___ of the ventricles
    HYDROCEPHALUS is a condition characterized by an increased CSF within the ventricles of the BRAIN, which causes PRESSURE changes in the brain and increase in HEAD size. Results from an imbalance between PRODUCTION and ABSORPTION of CSF or improper FUNCTION of the ventricles.
  11. Hydrocephalus:
    - Most often associated with s___ b___
    - Can be associated with m___
    - Could be a c___ malformation
    - Post h___ hyrdocephalus (blocking) (occurs a lot w/ premies)
    • Most often associated with SPINA BIFIDA
    • Can be associated with MENINGITIS
    • Could be a CONGENITAL malformation
    • Post HEMORRHAGIC hyrocephalus (blocking) (occurs a lot w/ premies)
  12. S/S of Increased Intracranial Pressure (ICP) in infants:
    - I___
    - Increased h___ c___
    - Wide s___ lines
    - S___ eyes
    - H___-p___ cry
    - B___ fontanel
    • IRRITABILITY
    • Increased HEAD CIRCUMFERENCE
    • Wide SUTURE lines
    • SUNSET eyes
    • HIGH-PITCHED cry
    • BULGING fontanel
  13. S/S of Hyrocephalus:
    - I___ ICP
    - Decreased p___
    - Decreased b___ p___
    - I___
    - V___
    - H___ (HA)
    - S___
    - Unequal p___
    • INCREASED ICP (Intracranial Pressure)
    • Decreased PULSE
    • Decreased BLOOD PRESSURE
    • IRRITABILITY
    • VOMITING
    • HEADACHES (HA)
    • SEIZURES
    • Unequal PUPILS
  14. Dx and Tx of Hyrdocephalus:
    - Dx - T____i____ (cheap and easy method), daily h___ c___, u___ s___ (U/S), _ _ scan, _ _ _ (imaging), v___ tap (to drain and determine pressure)
    - Tx - R___ (usually in premies), v___p___ shunt, s___ tap
    • Dx - TRANSILLUMINATION (cheap and easy method), daily HEAD CIRCUMFERENCE, ULTRA SOUND (U/S), CT scan, MRI, VENTRICULAR tap (to drain & determine pressure)
    • Tx - RESERVOIR (usually in premies), VENTRICULOPERITONEAL shunt, SPINAL tap
  15. Post-Operative Care - S/S of Shunt Malfunction:
    - Infant - I___, f___ behavior, v___ s___, b___ fontanel, s___ lines widening, s/s of i___, monitor i___ & o___
    - Older Child - H____ (HA), changes in b___, changes in l__ of c___, s/s of i___, monitor i___ & o___
    • Infant - IRRITABILITY, FEEDING behavior, VITAL SIGNS, BULGING fontanel, SUTURE lines widening, s/s of INFECTION, monitor INPUT & OUTPUT
    • Older Child - HEADACHE (HA), changes in BEHAVIOR, Changes in LEVEL of CONSCIOUSNESS, s/s of INFECTION, monitor INPUT & OUTPUT
  16. Care of Shunt in Hydrocephalus:
    - Do not p___ shunt (unless p___)
    - Shunt is made up of little v___
    - P____ changes the p___ within the v____
    • Do not PUMP shunt (unless PRESCRIBED)
    • Shunt is made up of little VALVES
    • PUMPING changes the PRESSURE within the VENTRICLES
  17. Neurological Disorders:
    - S___ b___ (divided spine) is a c___ embryonic neural tube defect in which there is an imperfect closure of the s____ vertebrae
    - Two forms: O___ (hidden), C___ (sac or cyst - can see it)
    • SPINA BIFIDA (divided spine) is a CONGENITAL embryonic neural tube defect in which there is an imperfect closure of the SPINAL vertebrae
    • Two forms - OCCULTA (hidden), CYSTICA (sac or cyst - can see it)
  18. Spina Bifida Occulta (less severe, hidden):
    - Minor variation of the disorder in which the opening is s___ and there is no associated p___ of structures
    - May be a tuft of h___ or d___
    - Usually b___, although b___ / b___ sphincter dysfunctions can occur
    • Minor variation of the disorder in which the opening is SMALL and tehre is no associated PROTRUSION of structures
    • May be a tuft of HAIR or DIMPLE
    • Usually BENIGN, although BOWEL / BLADDER sphincter dysfunctions can occur
  19. Spina Bifida Cystica:
    - Developing of a c___ mass in the midline of the opening in the s___
    - M___ membranes over a t___ that contains portion of the m___ and _ _ _ (fluid). Vary in size from a walnut to a newborn's h___
    - M____ resembles meningocele, but contain s___ cord and n___ routes. THere may be associated p___ of the legs, poor control of the b___ and b___ functions. H___ is common complications.
    - Detect by a___ U/S (ultasound) or elevated A___ F___ P___ (AFP)
    • Developing of a CYSTIC mass in the midline of the opening in the SPINE
    • MENINGOCELE membranes over a TUMOR that contains portion of the MEMBRANES and CSF (fluid). Vary in size from a walnut to a newborn's HEAD
    • MENINGOMYELOCELE resembles meningocele, but contain SPINAL cord and NERVE routes. There may be associated PARALYSIS of the legs, poor control of the BOWEL and BLADDER functions. HYDROCEPHALUS is common complications.
    • Detect by ANTENATAL U/S (ultrasound) or elevated ALPHA FETAL PROTEIN (AFP)
  20. Spina Bifida - Prevention of neural tube defects is?
    Folic Acid
  21. Associated Problems with Spina bifida:
    - Congenital dislocated h___
    - C___ feet
    - S___ (s-curvature of spine)
    - H___ (90% with myelomeningocele)
    - N___ bladder
    - Poor a___ and s___ tone
    • Congenital dislocated HIPS
    • CLUB feet
    • SCOLIOSIS (s-curvature of spine)
    • HYRDOCEPHALUS (90% with myelomeningocele)
    • NEUROGENIC bladder
    • Poor ANAL and SPHINCTER tone
  22. Spina Bifida:
    - Tx is s____ closure
    - M____ approach - H____, O____ problems, Relating to u___ / b___ function
    - H____ refers to a pt. that is disabled from b___ (therefore not relearning). The aim is m___ the child's disability and put to constructive use the u___ part of the body.
    - Eventual use of w___, arm b___, c___. B___ training.
    • Tx is SURGICAL closure
    • MULTIDISCIPLINARY approach - HYDROCEPHALUS, ORTHOPEDIC problems, relating to URINARY / BOWEL function
    • HABILITATION refers to a pt. that is disabled from BIRTH (Therefore nor relearning). The aim is MINIMIZE the child's disability and put to constructive use the UNAFFECTED part of the body.
    • Eventual use of WHEELCHAIR, arm BRACES, CRUTCHES. BOWEL training
  23. Nursing Care with Spina Bifida:
    - Main objectives include prevention of i___, prevent i___ to s___, correct p___, good s___ care, n___ (high f___, increased and regular f___, s____ PRN), monitoring for signs of _ _ _ (irritability, high-pitched cry, vomiting)
    Main objectives include prevention of INFECTION, prevent INJURY to SAC, correct POSITION, good SKIN care, NUTRITION (high FIBER, increased and regular FLUIDS, SUPPOSITORIES PRN), monitoring for signs of ICP (irritability, high-pitched cry, vomiting)
  24. C___ P____ (CP) is a nonprogressive injury to the m___ centers of the brain causing n___m___ problems of s___ d____ (involuntary movements)
    CEREBRAL PALSY (CP) is a nonprogressive injury to the MOTOR centers of the brain causing NEUROMUSCULAR problems of SPASTICITY DYSKINESIA (involuntary movements)
  25. Cerebral Palsy (CP):
    - Disease is often precipitated by many factors including maternal i___ (viral), k___ (when bilirubin or jaundice levels get high & bilirubin crossed blood-brain barrier), low birth w___ (#1 major risk factor), a___ injury b___, d___ or a___ birth
    Disease is often precipitated by many factors including maternal INFECTION (viral), KERNICTERUS (when bilirubin or jaundice levels get high & bilirubin crossed blood-brain barrier), low birth WEIGHT (#1 major risk factor), ANOXIC injury BEFORE, DURING or AFTER birth
  26. Cerebral Palsy (CP) categories:
    - S___ - involves damage to the c___ of the brain, spasms occur with m___, related to cerebral a___, when child tries to move, j___ movement result, E___, w___, and other coordinated movements are difficult
    SPASTIC - involves damage to the CORTEX of the brain, spasms occur with MOVEMENT, related to cerebral ASPHYXIA, when child tries to move JERKY movement results, EATING, WALKING, and other coordinated movements are difficult
  27. Cerebral Palsy (CP) categories:
    - A___ - I___, purposeless movements that interfere with n___ motion, often associated with h___b___
    ATHETOID - INVOLUNTARY, purposeless movements that interfere with NORMAL motion, often associated with HYPERBILIRUBINEMIA
  28. Cerebral Palsy (CP) Categories:
    - A___ - U___ movements and a___ (gross incoordination of muscle movements) from a lesion in the c____.
    ATAXIC - UNCOORDINATED movements and ATAXIA (gross incoordination of muscle movements) from a lesion in the CEREBELLUM
  29. Cerebral Palsy (CP) Categories:
    - M___ - Usually a combination of s___ and ____.
    MIXED - usually a combination of SPASTIC and ATHETOID
  30. Cerebral Palsy (CP) Manifestations:
    - M___ to s___
    - Disease is suspected during i___
    - Persistent r___ (moro / tonic reflex maintained)
    - Early preference for one h___
    - Poor s___, t___ thrust
    - S____ of limbs
    - S___ of legs
    - S___
    - R___ over too early (worry that they're s___)
    • Persistent REFLEX (moro/tonic reflex maintained)
    • Early preference for one HAND
    • Poor SUCK, TONGUE thrust
    • SPASTICITY of limbs
    • SCISSORING of legs
    • SEIZURES
    • ROLLING over too early (worry that they're SPASMING)
  31. Cerebral Palsy Tx:
    - Goal of treatment is to a___ them in making the most of their a___ and to guide them in becoming well-a___ adults, performing to their m___ ability.
    - Parents need to a___ the child and p___ in care and maximizing the child's p____
    • Goal of treatment is to ASSIT them in making the most of their ASSETS and to guide them in becoming well-ADJUSTED adults, performing to their MAXIMUM ability
    • Parents need to ACCEPT the child and PARTICIPATE in care and maximizing the child'd POTENTIAL.
  32. Tx Protocol for Cerebral Palsy (CP):
    - Establish c___
    - Establish l___ (walking, using braces, wheelchair)
    - Use and optimize existing m___ functions
    - May need v___ for muscle spasms
    - Provide i___ stimulation
    - Promote s____
    - Provide m___d___ approach to care
    - Feeding goals prevent a___
    - Having CP doesn't mean have m___ deficiencies
    • Establish COMMUNICATION
    • Establish LOCOMOTION (walking, using braces, wheelchair)
    • Use and optimize existing MOTOR functions
    • May need VALIUM for muscle spasms
    • Provide INTELLECTUAL stimulation
    • Promote SOCIALIZATION
    • Provide MULTIDISCIPLINARY approach to care
    • Feeding goals prevent ASPIRATION
    • Having CP doesn't mean have MENTAL deficiencies
  33. Nerological Disorders:
    - S___ are the most commonly observed neurological dysfunction in children. More common in children under the age of __.
    SEIZURES are the most commonly observed neurological dysfunction in children. More common in children under the age of 2.
  34. Causes of Seizures:
    - F___ (afebrile)
    - I____
    - N___ (cancerous tumor)
    - Cerebral a___
    - M___ disorders
    - I____ CNS
    • FEVER
    • INFECTION
    • NEOPLASM (cancerous tumor)
    • Cerebral ANOXIA
    • METABOLIC disorders
    • IMMATURE CNS
  35. Types of Seizures:
    - T___-c___ or g___ m___ - T___ is a stiffening (c___) of muscles, c___ is alternating contraction (s___) followed by relaxation of muscles
    TONIC-CLONIC or GRAND MAL - TONIC is a stiffening (CONTRACTION) of muscles, CLONIC is alternating contraction (SPASM) followed by relaxation of muscles
  36. Presentation of Tonic-Clonic (Grand Mal) Seizure:
    - A___ (see halo of light)
    - T___ phase
    - C___ phase (spasms followed by relaxation)
    - I____ (bladder)
    - P___ state (disoriented, sleepy)
    - A___ (breathing)
    - C___ (blue)
    - Loss of c___
    - D___ pupils, not r___ to light
    • TONIC phase
    • CLONIC phase (spasms followed by relaxation)
    • INCONTINENCE (bladder)
    • POSTICTAL state (disoriented, sleepy)
    • APNEA (breathing)
    • CYANOSIS (blue)
    • Loss of CONSCIOUSNESS
    • DILATED pupils, not REACTIVE to light
  37. Types of Seizures:
    A___ or P___ m___ - momentary loss of c____, minor movements in f___, e___, and/or h___, and p___ is maintained
    ABSENCE or PETIT MAL - momentary loss of CONSCIOUSNESS, minor movements in FACE, EYES, and/or HAND, and POSTURE is maintained
  38. Petit Mal (absence) seizure characteristics:
    - Last __ - __ seconds
    - Child appears i____, d__d___
    - Poor p___ in school
    - Usually occurs between __ - __ year of age
    • Last 5 - 10 seconds
    • Child appears INATTENTIVE, DAYDREAMING
    • Poor PERFORMANCE in school
    • USUALLY occurs between 4 - 12 years of age
  39. Types of Seizures:
    - P___ (simple p___ or J___) - J___ may begin in one area of the body that cannot be s___. Person stays a___ and a___; jerking may proceed from one area of the body to a___ and somtimes spread to become a g___ seizure (g___ m___)
    - What to do - no i____ action, r___ and provide e___ support, m___ evaluation, keep s___
    • PARTIAL (simple PARTIAL or JACKSONIAN) - JERKING may begin in one area of the body that cannot be STOPPED. Person stays AWAKE and AWARE; jerking may proceed from one area of the body to ANOTHER and somtimes spread to become a GENERALIZED seizure (GRAND MAL)
    • - What to do - no IMMEDIATE action, REASSURE and provide EMOTIONAL support, MEDICAL evaluation, keep SAFE
  40. Types of Seizures:
    - A___ seizures (d___ a___) - more frequent occurence in the m___ with jerking motions on a____; suddenly c____, after __ seconds to __ minute, person recovers and can s___ and w___ again.
    - What to do - no f___ a___ needed (unless hurt during fall), thorough m___ evaluation
    • ATONIC seizures (DROP ATTACKS) - more frequent occurence in the MORNING with jerking motions on AWAKENING; suddenly COLLAPSES, after 10 seconds to 1 minute can STAND and WALK again
    • What to do - no FIRST AID needed (unless hurt during fall), thorough MEDICAL evaluation
  41. Tx of seizures:
    - Aimed at determining t___, s___, or c___ of the disorder.
    - Complete h___
    - P___ and n____ exam
    - C_, M_ _, E_ _
    • Aimed at determining TYPE, SITE, or CAUSE of the disorder
    • Complete HISTORY
    • PHYSICAL and NEUROLOGICAL exam
    • CT, MRI, EEG
  42. Medications for Tonic-Clonic Seizuers:
    - Phenytoin (D____)
    - Carbazepine (T___)
    - Phenobarbital (L___)
    - Fospheytoin (C___)
    - Make sure to monitor t____ l___ for all seizure medications.
    • Phenytoin (DILANTIN)
    • Carbazepine (TEGRETOL)
    • Phenobarbital (LUMINAL)
    • Fospheytoin (CEREBYX)
    • Make sure to monitor THERAPEUTIC LEVELS for all seizure medications.
  43. Medications for Absense (Petit Mal) Seizures
    - Ethosuximide (Z___)
    - Valporic Acid (D___)
    - Make sure to monitor t___ l____ for all seizure medications.
    • Ethosuximide (ZAROTIN)
    • Valporic Acid (DEPAENE)
    • Make sure to monitor THERAPEUTIC LEVELS for all seizure medications.
  44. Febrile Seizures:
    - Cause u____
    - B___ affected more than g___
    - Most are g____ and last < __ minutes, if longer, then seek immediate m___ attention.
    - Severity of t____ seems to be the biggest factor (> ___._ degrees)
    - Reassure parents that ___ % of children will not have seizure d____
    - A___p___ (Tylenol, fever reducing techniques)
    • Cause UNKNOWN
    • BOYS affected more than GIRLS
    • Most are GENERAL and last < 5 minutes, if longer , then seek immediate MEDICAL attention
    • Severity of TEMPERATURE seems to be the biggest factor (> 101.1 degrees)
    • Reassure parents that 95 % of children will not have seizure DISORDER
    • ANTYPYRETICS (Tylenol, fever reducing techniques)
  45. M____ is an inflammation of the meninges ( the covering of the brain and spinal cord). Two types: B____ (more severe) and v___.
    MENINGITIS is an inflammation of the meninges (the covering of the brain and spinal cord). Two types: BACTERIAL (more severe) and VIRAL.
  46. Meningitis:
    - Organisms may invade the meninges indirrectly by the way of the blood stream from the t____, s____, t____, l____, e____, f___ of the skull
    Organisms may invade the meninges indirectly by the way of the blood stream from the TEETH, SINUSES, TONSILS, LUNGS, EARS, FRACTURE of the skull.
  47. - V____ m____ is a serious but rarely fatal to persons with a normal immune system.
    - 90% from e____v____
    - Found in s____ (caregivers can contract)
    - Spread through contact with r____ secretions
    - Incubation is __ - __ days
    - Dx by l____ p____ (L/P)
    - No t___, only supportive
    - Symptoms usually last __ - __ days and the pt. recovers completely. Often the symptoms between b____ and v____ are the same
    • VIRAL MENINGITIS is a serious but rarely fatal to persons with a normal immune system
    • 90% from ENTEROVIRUS
    • Found in STOOL (caregivers can contract)
    • Spread through contact with RESPIRATORY secretions
    • Incubation is 3- 7 days
    • Dx by LUMBAR PUNCTURE (L/P)
    • No TREATMENTS, only supportive
    • Symptoms usually last 7 - 10 days and the pt. recovers completely. Often the symptoms between BACTERIAL and VIRAL are the same.
  48. B____ M____ is a serious condition, often referred to as purulent because a thick exudate surround the meninges and adjacent structures
    BACTERIAL MENINGITIS is a serious condition, often referred to as purulent because a thick exudate surrounds the meninges and adjacent structures.
  49. S/S of Bacterial Meningitis:
    - H___ (HA)
    - D____
    - D____
    - I____
    - R____
    - F____
    - V____
    - S____-n_____ (nuchal rigidity)
    - H___-p____ cry
    - C____
    - R___ with petechiae
    • HEADACHE (HA)
    • DROWSINESS
    • DELIRIUM
    • IRRITABILITY
    • RESTLESSNESS
    • FEVER
    • VOMITING
    • STIFF-NECK (nuchal rigidity)
    • HIGH-PITCHED cry
    • CONVULSIONS
    • RASH with petichiae
  50. Dx and Nursing Care for Bacterial Meningitis:
    - Dx by L____ p____ (L/P) or s____ t___
    - IV for h____ and e_____ balance
    - A____ (Abx) for atleast __ - __ days
    - Nursing care includes dimly l___ room, monitor v___, i___ & o___, a___p___ to keep fever down
    • Dx by LUMBAR PUNCTURE (L/P) or SPINAL TAP
    • IV for HYDRATION and ELECTROLYTE balance
    • ANTIBIOTICS (Abx) for atleast 10 - 14 days
    • Nursing care includes dimly LIT room, monitor VITALS, INPUT & OUTPUT, ANTIPYRETICS to keep fever down
  51. Mental Impairments:
    - Type of d____ disability characterized by m____ and p____ impairment
    - Focus has shifted from _ _ alone to a r____-orientated concept of cognitively impaired person functioning in the e____
    - Goal is to n___ person and family as much as possible
    • Type of DEVELOPMENTAL disability characterized by MENTAL and PHYSICAL impairment
    • Focus has shifted from IQ alone to a RELATIONSHIP-orientated concept of cognitively impaired person functioning in the ENVIRONMENT
    • Goal is to NORMALIZE person and family as much as possible
  52. Causes of Mental Impairments:
    - P_U
    - Hypot___
    - Fetal a___ syndrome
    - D___ syndromee
    - M____f____ of the brain (hydroc____, microc_____)
    - M_____ infections (CMV)
    - B____ injuries
    - A___ after delivery
    - M____ (bacterial or viral)
    - L___ poisoning
    - E____
    - H____
    - E____ depravation
    • PKU
    • HYPOTHYROIDISM
    • Fetal ALCOHOL syndrome
    • DOWN syndrome
    • MALFORMATIONS of the brain (HYDROCEPHALUS, MICROCEPHALY)
    • MATERNAL infections (CMV)
    • BIRTH injury
    • ANOREXIA after delivery
    • MENINGITIS (bacterial or viral)
    • LEAD poisoning
    • ENCEPHALITIS
    • HEREDITARY
    • EMOTIONAL Deprevations
  53. Mental Impairments:
    - M___ - educable mental impairment - long-term goal is i____ with supervision in place, mental age of __ - __ years
    - M____ - trainable mental impairment - w___, lives in group home or s____
    - S____ - provide s___, maximize p___
    - P____ - provide s____, maximize p____, basic c___ needs
    • MILD - educable mental imairment - long-term goal is INDEPENDENCE with supervision in place, mental age of 8 - 12 years
    • MODERATE - trainable mental impairment - WORKING, lives in group home or SUPERVISION
    • SEVERE - provide SUPERVISION, maximize POTENTIAL
    • PROFOUND - Provide STIMULATION, maximize POTENTIAL, basic CARE needs
  54. Mental Impairements or with any limitation/disability:
    - Early r_____ is key
    - Early t____
    - Early s____ programs
    - Early s___ programs
    • Early REFERRAL is key
    • Early THERAPY
    • Early STIMULATION programs
    • Early SPEECH programs
  55. Nursing Interventions for Muskuloskeletal Disorders:
    - M____
    - P____
    - S____ integrity
    - G____ and d_____
    • MOBILITY
    • PAIN
    • SKIN integrity
    • GROWTH and DEVELOPMENT
  56. C___f____ is one of the most common defomities of the skeletal system. It is a c____ anomaly characterized by a foot that has been twisted i___ or o_____.
    CLUBFOOT is one of the most common deformities of the skeletal system. It is a CONGENITAL anomally characterized by a foot that has been twisted INWARD or OUTWARD
  57. Clubfoot:
    - The type and extent of surgery depends on how severe the deformity is. The defect involved tight and short tendons around the foot and ankle. The surgery involves l___ some tendons and s____ other tendons to place the bones and joints in n____ positions. A c___ is applied to the foot after surgery to maintain its p____ while it heals.
    The tyipe and extent of surgery depends on how severe the deformity is. The defect involves tight and short tendons around the foot and ankle. The surgery involves LENGTHENING some tendons and SHORTENING other tendons to place the bones and joints in NORMAL positions. A CAST is applied to the foot after surgery to maintain its POSITION while it heals.
  58. Clubfoot:
    - 50% of the time c____ works -- if not then will do s____
    50% of the time CASTING works -- if not then will do SURGERY
  59. Developmental h___ d____ (congenital h___ d____) refers to the sublaxation or dislocation either partial or complete. Head of the femur is displaced from acetabulum (hip socket)
    Developmental HIP DYSPLASIA (congenital HIP DYSPLASIA) refers to the sublaxation or dislocation either partial or complete. Head of the femur is displaced from acetaubulum (hip socket)
  60. Manifestations of Hip Dysplasia:
    - Usually discovered during routine e___
    - B____ test
    - O____ sign "click"
    - A_____ of skin folds
    - K___ of unequal length
    • Usually discovered during routine EXAM
    • BARLOW'S test
    • ORTOLANI'S sign "click"
    • ASYMMETRY of skin folds
    • KNEES of unequal length
  61. Treatment of Hip Dysplasia:
    - Begin Tx i____ upon detection
    - P____ harness to maintain hips in a position of f____ and a____
    - Severe dislocation may require s____ cast
    - Parents must be c____ and return to clinic every 1-2 weeks for a____
    • Begin Tx IMMEDIATELY upon detection
    • PAVLIK harness to maintain hips in a position of FLEXION and ABDUCTION
    • Severe dislocation may require SPICA cast
    • Parents must be COMPLIANT and return to clinic every 1-2 weeks for ASSESSMENT
  62. S____ is an s-shaped curvature of the spine. During adolescence, s____ is more common in g___. Many curvatures do not progress and require only periodic e____.
    SCOLIOSIS is an s-shaped curvature of the spine. During adolescence, SCOLIOSIS is more common in GIRLS. Many curvatures do not progress and require only periodic EVALUATION.
  63. Untreated Scoliosis can lead to:
    - B___ pain
    - F___
    - D___
    - H___ and l___ complications
    - D____doesn't stop with maturity and may be aggravated with p____
    • BACK pain
    • FATIGUE
    • DISABILITY
    • HEART and LUNG complications
    • DETERIORATION doesn't stop with maturity and may be aggravated with PREGNANCY
  64. Two types of Scoliosis:
    - S____ - caused by poor posture, curve is flexible and easily correctable. May be c___ and happen in utero
    - F___ - caused by changes in the shape of the v___ or s___. Hips and shoulders appear uneven and cannot correct by standing straighter
    • STRUCTURAL - caused by poor posture, curve is flexible and easily correctable. May be CONGENITAL and happen in utero
    • FIXED - caused by changes in the shape of the VERTEBRAE or SPINE. Hips andshoulders appear uneven and cannot correct by standing straighter
  65. Tx of Scoliosis:
    - Tx is aimed at s___ down or s____ the progression of the curvature and preventing more severe scoliosis. Curves up to 20 degrees do not require treatment, but are f____.
    - Curve 20-40 degrees requires M______ brace
    - M___ brace puts pressure on the c___, p____, and c___ (arched) part of the spine. It is worn 23 hr/day over a t-shirt to protect the s___.
    • Tx is aimed at SLOWING down or STOPPING the progression of the curvature and preventing more severe scoliosis. Curves up to 20 degrees do not require treatment but are FOLLOWED
    • Curve 20-40 degrees requires MILWAUKEE brace
    • MILWAUKEE brace puts pressure on the CHIN, PELVIS and CONVEX (arched) part of the spine. It is worn 23 hr/day over a t-shirt to protect the SKIN.
  66. D____ M____ D____ is the childhood of progressive muscle degeneration. It is a sex-linked inherited disorder that only happens in m____. Onset is between __ - __ years of age.
    DUCHENNE'S MUSCULAR DYSTROPHY is the childhood progressive muscle degenration. It is a sex-linked inherited disorder that only happens in MALES. Onset is between 2-6 years of age
  67. Manifestations of Duchenne's Muscular Dysrtophy:
    - Delayed m___ development
    - Calf muscles h____
    - Progressive w___
    - C____
    - Frequent f____
    - Contracture of a____ and h___
    - G___ maneuver (characteristic way of rising off the floor using ams and not legs)
    • Delayed MOTOR development
    • Calf muscles HYPERTROPHIED
    • Progressive WEAKNESS
    • CLUMSY
    • Frequent FALLS
    • Contracture of ANKLES and HIPS
    • GOWER'S maneuver (characteristic way of rising off the floor using arms and not legs)
  68. Dx of Duchenne's Muscular Distrophy:
    - Increased c____ p____ levels
    - Muscle b___ reveals degeneration of muscle f____ and replaced by f____ and c____ tissue
    - E_____m____ (EMG) - graphic record of muscle contraction as a result of electric stimulation shows decrease in the amplitude and duration of motor unit potentials
    • Increased CREATINE PHOSPHOKINASE levels
    • Muscle BIOPSY reveals degeneration of muscle FIBERS and replaced by FAT and CONNECTIVE tissue
    • ELECTROMYELOGRAM (EMG) - graphic record of muscle contraction as aresult of electric stimulation shows decrease in the amplitude and duration of motor unit potentials
  69. Duchenne's Muscular Dystrophy:
    - The disease will become p____ worse, and w___c____ confinement may occur. Death results from c___ failure or r____ tract infection. Mental r____ is not uncommon.
    The disease will become PROGRESSIVELY worse, and WHEELCHAIR confinement may occur. Death results from CARDIAC failure or RESPIRATORY tract infection. Mental RETARDATION is not uncommon.
  70. Tx of Duchenne's Muscular Dystrophy:
    - S____
    - Maintain q___ of life
    - P___ support
    - N____ support
    - P____t____
    - S____ / f____ assistance
    - R____ care
    - H____ care
    • SUPPORTIVE
    • Maintain QUALITY of life
    • PSYCHOLOGICAL support
    • NUTRITIONAL support
    • PHYSIOTHERAPY
    • SOCIAL / FINANCIAL assistance
    • RESPITE care
    • HOSPICE care
  71. - F___ is a break in a bone that is mainly caused by a____
    - Common o___ children related to f____ during p___ or m___ v___ accidents
    • FRACTURE is a break in a bone that is mainly caused by ACCIDENTS
    • Common in OLDER children related to FALLS during PLAY or MOTOR VEHICLE accidents
  72. Types of Fractures:
    - S___ fracture - bone broken, skin intact
    - C____ fracture - bone broken and sticking out of skin
    - G____ fracture - incomplete fracture in which one side of the bone is broken and the other side is bent. Common in chldren due to the flexible bone, more likely to s___ (not a clean break)
    - S___ fracture - caused by a forceful twisting motion. If the story does not make sense, a___ should be suspected related to the manual twisting of the extremity
    • SIMPLE fracture - bone broken, skin intact
    • COMPOUND fracture- bone broke and sticking out of skin
    • GREENSTICK fracture - incomplete fracture in which one side of the bone is broken and the other side is bent. Common in children due to the flexible bone, morel likely to SPLINTER (not a clean break)
    • SPIRAL fracture - caused by a forceful twisting motion. If the story does not make sense, ABUSE should be suspected related to the manual twisting of the extremity
  73. General Assessment for Fractures:
    - V___ bone
    - P___
    - S___
    - G___ or p____
    - Unable to u___ - may be able to use due to intact periosteum
    • VISIBLE bone
    • PAIN
    • SWELLING
    • GUARDING or PROTECTING
    • Unable to USE - may be able to use due to intact periosteum
  74. Fractures occuring in the e___ plate (end part of a long bone) may effect growth of the limb.
    Fractures occurring in the EPIPHYSEAL plate (end part of a long bone) may effect growth of the limb.
  75. 5 P's of Fractures:
    - P___
    - P___
    - P___
    - P___ (felling of pins and needles)
    - P___
    • PAIN
    • PALLOR
    • PULSELESSNESS
    • PARETHESIA (feeling of pins and needles)
    • PARALYSIS
  76. Immediate Tx of Fractures: PRICE Therapy
    - P___
    - R___
    - I___
    - C___
    - E___
    - Sometimes can't do s___ right away b/c so much e___. If use PRICE therapy may be able to get into s___ sooner.
    • PROTECTION
    • REST
    • ICE
    • COMPRESSION
    • ELEVATION
    • Sometimes can't do SURGERY right away b/c so much EDEMA. If use PRICE therapy may be able to get into SURGERY sooner.
  77. Tx of Fractures:
    - Depends on the s____ and t___ of break
    - C___
    - T___
    • Depends on the SEVERITY and TYPE of break
    • CASTING
    • TRACTION
  78. Tx of Fractures: Types of Traction
    - S___
    - B___ (pin sites can be source of i____)
    - Bed p____, w___, pulleys, p___, pin sites, a___ strips, a___ wraps, s____, c____
    • SKIN
    • BONE (pin sites can be source of INFECTION)
    • Bed POSITION, WEIGHTS, pulleys, PINS, pin sites, ADHESIVE strips, ACE wraps, SPLITS, CASTS
  79. Assessment of Traction and Casts:
    - C____
    - T____ of uninvolved joints / muscles
    - W___ of uninvolved joints / muscles
    - C____
    • CIRCULATION
    • TIGHTNESS of uninvolved joints / muscles
    • WEAKNESS of uninvolved joints / muscles
    • CONTRACTURES
  80. Nursing Reponsibilities for Fractures:
    - N___v___ checks
    - Peripheral p____ rate and quality
    - C___
    - C___ refill
    - W___ "hot spots" - indicate i____
    - M___ and s____
    • NEUROVASCULAR checks
    • Peripheral PULSE rate and quality
    • COLOR
    • CAPILLARY refill
    • WARMTH "hot spots" - indicate INFECTION
    • MOVEMENT and SENSATION
  81. Why is a callus good?
    - Provide new b___ tissue for holding the bone f____ together.
    Provide new BONE tissue for holding the bone FRAGMENTS together.
  82. Adolescence:
    - Defined as the period of life beginning with the appearance of s____ s___ characteristics and ending with the cessation of g___ and e___ maturity
    - Divided into 3 periods - E___, M____, L___
    • Defined as the period of life beginning with the appearance of SECONDARY SEX characteristics and ending with the cessation of GROWTH and EMOTIONAL maturity
    • Divided into 3 periods - EARLY, MIDDLE, LATE
  83. Adolescence:
    - Adult-like thinking begins arounnd __ years of age
    - P____ solving
    - Use a____ thinking
    - Family c____ develop
    • Adult-like thinking begins around 15 years of age
    • PROBLEM solving
    • Use ABSTRACT thinking
    • Family CONFLICTS develop
  84. Main Challenges of Adolescence:
    - Adjusting to rapid p___ changes
    - Adjusting to rapid p___l___ changes
    - Maintaining p___
    - Coping with social s____ and p___
    - Maintaining o___ communication
    - Developing p____ healthcare choices
    - Developing positive l___ choices
    • Adjusting to rapid PHYSICAL changes
    • Adjusting to rapid PHYSIOLOGICAL changes
    • Maintaining PRIVACY
    • Coping with social STRESSES and PRESSURES
    • Maintaining OPEN communication
    • Developing POSITIVE healthcare choices
    • Developing positive LIFESTYLE choices
  85. Adolescence G&D:
    - Age __ - __ years
    - A____ growth gives g____ appearance
    - G___ spurt - a r___ period of growth in which the body reaches a___ height and weight before age ___
    • Age 11 - 19 years
    • ASYNCHRONOUS growth give GANGLING appearance
    • GROWTH spurt - a RAPID period of growth in which the body reached ADULT height and weight before age 18
  86. Adolescent Boys:
    - P____ begins with hormonal changes about __ - __ years old
    - Enlargement of t___ and pigmentation of s___ are f____ changes to notice
    - This is followed by enlargement of the p____
    - Production of s____ around __ - __ years old
    • PUBERTY begins with hormonal changes about 10 - 13 years old
    • Enlargement of TESTICLES and pigmentation of SCROTUM are FIRST changes to notice
    • This is followed by enlargement of the PENIS
    • Production of SEMEN around 13-14 years old
  87. Adolescent Girls:
    - P____ changes occur __ mo to __ years b___ they occur in boys
    - Puberty is rocognized early by the onset of m____
    - F___ deposits happen first in the h___ and l___ as p____ to puberty
    - First menstrual period is called m____
    - This usually happens at __ - __ years old, but can be __ - __ years of age
    • PUBERTY changes occur 6 mo to 2 years BEFORE they occur in boys
    • Puberty is recognized early by the onset of MENSTRUATION
    • FAT deposits happen first in the HIPS and LEGS as PRECURSOR to puberty
    • First menstrual period is called MENARCHE
    • This usually happens at 12 - 13 years old, but can be 10 - 15 years of age
  88. Development of Girls:
    - Breast "b___" occur first
    - Increase in h___
    - Increase in w___
    - Increase in P____ hair
    • Breast "BUDS" occur first
    • Increase in HEIGHT
    • Increase in WEIGHT
    • Increase in PUBIC hair
  89. What hormone is it that accelerates bone growth in girls?
    Estrogen
  90. Adolescent G&D:
    - Erickson Stage - I___ vs. R___ C____ - According to Erickson major developmental task of adoselcence is to est. a sense of i____
    - Piaget Stage - C____ development - during adolescent reflects a____ reasoning and l___. This stage is called the period of f____ o____
    • Erickson Stage - IDENTITY vs. ROLE CONFUSION - According to Erickson major developmental task of adolescence is to est. a sense of IDENTITY
    • Piaget Stage - COGNITIVE development - during adolescent reflects ABSTRACT reasoning and LOGIC. This stage is called the period of FORMAL OPERATIONS
  91. Adolescent Erickson Stage - Identity vs. Role Confusion:
    - Rapid and marked p___ change
    - Preoccupation w/ a____
    - Examines and r_____ self, family, peer group and community
    - P___ groups important
    - If s____ develops c____ in self
    • Rapid and marked PHYSICAL change
    • Preoccupation w/ APPEARANCE
    • Examines and REDEFINES self, family, peer group, and community
    • PEER groups importatnt
    • If SUCCESSFUL develops CONFIDENCE in self
  92. Adolescent Piaget Stage - Formal Operations
    - Able to logically m______ unobservable concepts
    - A____ and flexible
    - Can deal with c____
    - Uses s____ approach to problem solve
    • Able to logically MANIPULATE onobservable concepts
    • ADAPTABLE and flexible
    • Can deal with CONTRADICTIONS
    • Uses SCIENTIFIC approach to problem solve
  93. The hospitalized Adolescent:
    - Direct q____ to adolescent
    - Hospitalization disrupts a____
    - Should share a room with a p____
    - T____ and q____ should also occur w____ the parent present
    - Focus for teaching...how will this effect me t____ - not so much the l___ term
    For prolonged hospitalization need to maintain own i____
    • Direct QUESTIONS to adolescent
    • Hospitalization disrupts ACTIVITIES
    • Should share a room with a PEER
    • TEACHING and QUESTIONS should also occur WITHOUT parent present
    • Focus for teaching...how will this effect me TODAY - not so much the LONG term
    • For prolonged hospitalization need to maintain own IDENTITY
  94. Integumentary Disorders:
    - S___ is largest living o___
    - Main function is p___
    - The body's f___ line of defense against d____
    - Prevents passage of harmful p___ and c____ agents
    - Prevents the loss of e____
    - S___ has the greatest c___ to r____ and r___ itself
    • SKIN is the largest living ORGAN
    • Main function is PROTECTION
    • The body's FIRST line of defense against DISEASE
    • Prevent's passage of harmful PHYSICAL and CHEMICAL agents
    • Prevents the loss of ELECTROLYTES
    • SKIN has the greatest CAPACITY to REGENERATE and REPAIR itself
  95. Integumentary Disorders: Nursing Priority
    - Maintaining s___ i___ is priority nursing diagnosis
    Maintaining SKIN INTEGRITY is priority nursing diagnosis
  96. Skin Terms:
    - M____ - flat rash (freckle)
    - V____ - elevated, fluid-filled blister (cold sore, chickenpox)
    - C___ - scab
    - E____ - black and blue purple mark (bruise)
    - P____ - elevated area (pimple)
    - P____ - elevated, pus filled (impetigo, acne)
    - W___ - raised red, irregular (mosquito bite, allergic rxn)
    • MACULE - flat rash (freckle)
    • VESICLE - elevated, fluid-filled blister (cold sore, chickenpox)
    • CRUST - scab
    • ECCHYMOSIS - black and blue purple mark (bruise)
    • PAPULE - elevated area (pimple)
    • PUSTULE - elevated, pus filled (impetigo, acne)
    • WHEAL - raised red, irregular (mosquito bite, allergic rxn)
  97. Acne Vulgaris - i____ of the sebaceous g___ and hair f____ in the skin
    - H____ influences at p___ cause increased secretion of s___
    - G___ factors and s____ play a role
    - May last __ years or more
    - D____ due to body image (face, back)
    • Acne Vulgaris - INFLAMMATION of the sebaceous GLANDS and hair FOLLICLES in the skin
    • HORMONES influences at PUBERTY cause increased secretion of SEBUM
    • GENETIC factors and STRESS plays a role
    • May last 10 years or more
    • DISTRESSING due to body image (face, back)
  98. Tx of Acne:
    - No longer thought that certain f____ trigger the condition (chocolate, peanuts, and cola drinks)
    - Regular, well-balanced d___ is recommended
    - Benefit from s____ (if not on t____)
    - General h___ (cleanliness, rest, low stress)
    - S____ causes more irritation
    - T____ medicated skin preparations (benzoyl peroxide)
    - A___ (Abx) may be needed in more s___ cases
    • No longer thought that certain FOODS trigger the condition (chocolate, peanuts, and cola drinks)
    • Regular, well-balanced DIET is recommended
    • Benefit from SUNSHINE (if not on TETRACYCLINE)
    • General HYGIENE (cleanliness, rest, low stress)
    • SQUEEZING causes more irritation
    • TOPICAL medicated skin preparations (benzoyl peroxide)
    • ANTIBIOTICS (Abx) may be needed in more SERIOUS cases
  99. I____ e____ or atopic dermatitis is an i____ of genetically hypersensative skin
    - Breakdown occurs of d____ cells and forms intradermal v____
    - Chronic s____ produces w____ and results in l_____ or coarsening of the s___ fold
    - Causes thought to be a____
    - S____ rather than disorder
    • INFANTILE ECZEMA or Atopic Dermatitis is an INFLAMMATION of genetically hypersensative skin
    • Breakdown occurs of DERMAL cells and forms intradermal VESICLES
    • Chronic SCRATCHING produces WEEPING and results in LICHENIFICATION or coarsening of the SKIN fold
    • Causes thought to be ALLERGIC
    • SYMPTOM rather than disorder
  100. Triad of Atopic Dermatitis (Eczema)
    - A____
    - H___ fever (a____)
    - Stuff tends to run in the f_____
    • ASTHMA
    • HAY fever (ALLERGIES)
    • Stuff tends to run in the FAMILY
  101. S/S of Atopic Dermatitis (Eczema):
    - Can occur at any a___, most common during the first __ years
    - I____ (pruritic) lesions form vesicles that w____, and c___ over
    - More severe on f___, but can occur a____ on the body, particularly the skin f___
    - Worse in the w___ versus the s____
    - Has periods of r____
    • Can occur at any AGE, most common during the first 2 years
    • ITCHY (pruritic) lesions form vesicles that WEEP, and CRUST over
    • More severe on FACE, but can occur ANYWHERE on the body, particularly the skin FOLDS
    • Worse in the WINTER versus the SUMMER
    • Has periods of REMISSION
  102. Treatment goals for Atopic Dermatitis (Eczema):
    - H___ skin, relieve i___, and prevent i___
    - E____ bath - o___ with a mixture of c___S___ and b____ s___
    - Wash with s___ substitute
    - May keep b___ to a minimum
    - Bath oil like A___ K____ to be used as l___ heal. Best done a___ pt. has soaked and s___ is well h____
    • HYDRATE skin, relieve ITCHING, prevent INFECTION
    • EMOLIENT bath - OATMEAL with a mixture of CORNSTARCH and BAKING SODA
    • Wash with SHAMPOO substitute
    • May keep BATHING to a minimum
    • Bath oil like ALPHA KERI to be used as LESIONS heal. Best done AFTER pt. has soaked and SKIN is well HYDRATED
  103. Pt. Teaching with Topical Therapy for Atopic Dermatitis (Eczema):
    - A____ is best when an o____ is applied after a w___ bath
    - M____ should be applied by stroking in the direction of h___ growth (c___ or r___ motions can inflame hair f___)
    - Teach how much o___ to apply
    - The use of e___ restraints can prevent an infant from s____ while allowing f____ of movement
    - Do not use t___ steroids when a v___ infection is present
    • ABSORPTION is best when an OINTMENT is applied after a WARM bath
    • MEDICATION should be applied by stroking in the direction of HAIR growth (CIRCULAR or RUBBING motions can inflame hair FOLLICLES)
    • Teach how much OINTMENT to apply
    • The use of ELBOW restraints can prevent an infant from SCRATCHING while allowing FREEDOM of movement
    • Do not use TOPIC steroids when a VIRAL infection is present
  104. I___ is an infectious disease caused by staphylococci or group A betahemolytic streptococci
    IMPETIGO is an infectious disease caused by taphylococci or group A betahymolytic streptococci
  105. Impetigo:
    - O____ comes in contact with b___ in skin
    - C____
    - Treatment is systemic oral a____ (Abx), wash l____, b____ ointment, educate parents to w___ hands, treat c___, and remember that n___ may occur as a complication of beta-hemolytic streptococci infections
    • ORGANISM comes in contact with BREAK in skin
    • CONTAGIOUS
    • Treatment is systemic oral ANTIBIOTICS (Abx), wash LESIONS, BACTROBAN ointment, educate parents to WASH hands, treat CUTS, and remember that NEPHRITIS may occur as a complication of beta-hymolytic streptococci infections
  106. Fungal Infections:
    - T___ C____ (r___w___ of the scalp) - may cause a___ (hair loss), Tx is G___f___ (8-12 weeks)
    - T____ C____ (ringworm of the s___) - Tx is topical a___f___ twice/daily
    - T___ P____ (a___ feet) - Tx is t___ ointment, d___ feet, c___ socks, well v___ shoes
    - T___ C____ (Thighs, groin, scrotum "j___ i___") - Fungal p____, stress good h____
    • TINEA CAPITIS (RINGWORM of the scalp) - may cause ALOPECIA (hair loss), Tx is GRISEOFULVIN (8-12 weeks)
    • TINEA CORPORIS (ringworm of the SKIN) - Tx is topical ANTIFUNGAL twice/daily
    • TINEA PEDIS (ATHLETE'S feet) - Tx is TOPICAL ointment, DRY feet, CLEAN socks, well VENTED shoes
    • TINEA CRURIS - (Thighs, groin, scrotum "JOCK ITCH") - Fungal POWDERS, stress good HYGIENE
  107. Pediculosis:
    - Pediculosis C___ (head l___) - most c___ form, examine f___ members / playmates
    - Pediculosis C___ (body l____)
    - Pediculosis P____ (c___ or pubic l___) - in all cases their survival depends on the b____ they extract from the infected persons, main symptom is i___, in all cases Tx is aimed at ridding the pt. of the p___, treating the e___ skin (worry about other i___ occurring), preventing the i___ of others, and r__i____ can occur
    • Pediculosis CAPITIS (head LICE) - most COMMON form, examine FAMILY members / playmates
    • Pediculosis CORPORIS (body LICE)
    • Pediculosis PUBIS (CRABS or pubic LICE) - in all cases their survival depends on the BLOOD they extract from the infected persons, main symptom is ITCHING, in all cases Tx is aimed at ridding the pt. of the PARASITE, treating the EXCORIATED skin (worry about other INFECTIONS occurring), preventing the INFECTION of others, and REINFECTION can occur
  108. - S____ is a parasitic infection caused by the itch mite Sarcoptes scabiei
    - Seen w___ wide, is c____
    - Caused by the adult f___ mite, who burrows under the s___ and lays e___
    - Burrow seen under the s___, usually between the f____, thrives on m___ body folds, but in young children can be seen on h___/p___/s____ of feet
    - Burrows contain the e___ and f___ of the mite
    - I____ is intense especially at n___
    - Tx is Permethrin (E____) for children > __ mo.
    • SCABIES is a parasitic infection caused by the itch mite Sarcoptes scabiei
    • Seen WORLD wide, is CONTAGIOUS
    • Caused by the adult FEMALE mite, who burrows under the SKIN and lays EGGS
    • Burrow seen under the SKIN, usually between the FINGERS, thrives on the MOIST body folds, but in young children can be seen on HEAD/PALMS/SOLES of feet
    • Burrows contain the EGGS and FECES of the mite
    • ITCHING is intense especially at NIGHT
    • Tx is Permethrin (ELIMITE) for children > 2 mo.
  109. P___ worms - Dx by tape test at a___ opening.
    PIN worms - Dx by tape test at ANAL opening
  110. - B___ often occur during childhood
    - Leading cause of a____ death in the home for children ___ - __ years of age
    - Most likely to occur in e___ a.m. and a___ school
    • BURNS often occur during childhood
    • Leading cause of ACCIDENTAL death in the home for children 1 - 4 years of age
    • Most likely to occur in EARLY a.m. and AFTER school
  111. Types of Burns:
    - T___ - due to fire or scalding vapor or liquid
    - C____ - due to a corrosive powder or liquid
    - E____ - due to electrical current passing through the body
    - R___ - due to x-rays or radioactive substance
    • THERMAL - due to fire or scalding vapor or liquid
    • CHEMICAL - due to a corrosive powder or liquid
    • ELECTRICAL - due to electrical current passing through the body
    • RADIATION - due to x-rays or radioactive substance
  112. Systems affected by burns:
    - C____v_____
    - G____i____
    - N____
    - R____
    - R____
    - I____m____
    • CARDIOVASCULAR
    • GENITOURINARY
    • NEURO
    • RESPIRATORY
    • RENAL
    • INTEGUMENTARY
  113. Why children respond differently to burns:
    - T____ skin causes a more serious depth of burn with l___ temperature and s____ exposure than adults
    - L____ body surface area causes greater f___, e____, and h___ loss
    - Increased basal m____ rate results in increased p____ and c____ needs
    - Small m___ and f___ content in the body results in p___ and c____ deficiencies when o___ intake is limited
    - S___ is more e____ in children, causing pulling on the scarring areas and resulting in formation of a larger s___
    - Immature i____ system increases risk for i___ that complicate burn t___
    - Prolonged i____ and t___ required for burns adversely affects g___ and d____
    • THINNER skin causes a more serious depth of burn with LOWER temperature and SHORTER exposure than adults
    • LARGE body surface area causes greater FLUID, ELECTROLYTE, and HEAT loss
    • Increased basal METABOLIC rate results in increased PROTEIN and CALORIE needs
    • Small MUSCLE and FAT content in the body results in PROTEIN and CALORIE deficiencies when ORAL intake is limited
    • SKIN is more ELASTIC in children, causing pulling on the scarring areas and resulting in formation of a larger SCAR
    • Immature IMMUNE system increases risk for INFECTION that complicate burn TREATMENT
    • Prolonged IMMOBILIZATION and TREATMENT required for burns adversely affects GROWTH and DEVELOPMENT
  114. Classification and First-aid Treatment of Burns:
    - First Degree - S____ / P___
    - Second Degree - Deep p___ t____
    - Third Degree - F___ t____
    • First degree - SUPERFICIAL / PARTIAL
    • Second Degree - Deep PARTIAL THICKNESS
    • Third Degree - FULL THICKNESS
  115. Classification and First-Aid Treatment of Burns: First Degree (Superficial / Partial thickness)
    - S__b___
    - Leaves skin p___, r___
    - P____ - Relief by c____
    - May be slightly e____
    • SUNBURN
    • Leaves skin PINK, RED
    • PAINFUL - Relief by COOLING
    • May be slighly EDEMATOUS
  116. Classification and First-Aid Tx of Burns: Second Degree (Deep Partial Thickness):
    - Destruction of e___ and upper layers of d___
    - P____ - sensative to t___ or c___ air
    - R___ or w___, w___ fluid, b____
    - E____
    - H___ without surgery, usually no s___
    - Hair f____ intact
    - Injury to deeper parts of d____
    • Destruction of EPIDERMIS and upper layers of DERMIS
    • PAINFUL - Sensitive to TOUCH or COOL air
    • RED or WHITE, WEEPS fluid, BLISTER
    • EDEMATOUS
    • HEALS without surgery, usually no SCAR
    • Hair FOLLICLES intact
    • Injury to deeper parts of DERMIS
  117. Classification and First-Aid Tx of Burns: Third Degree (Full Thickness):
    - Total destruction of the e____ and d___
    - P____
    - D___ and l___ as eschar develops
    - Requires skin g____, skin cannot r__g____
    - Involves u___l___ tissue (f__, t____, f___, b___)
    • Total destruction of the EPIDERMIS and DERMIS
    • PAINLESS
    • DRY and LEATHERY as eschar develops
    • Requires skin GRAFTING, skin cannot REGENERATE
    • Involves UNDERLYING tissue (FAT, TENDONS, FASCIA, BONE)
  118. Tx of Burns: First Degree
    - Immerse in c___ water to halt burning process; apply an a___m____ ointment
    Immerse in COLD water to halt burning process; apply an ANTIMICROBIAL ointment
  119. Tx of Burns: Second Degree (Deep Partial Thickness):
    - If area is small treat as a f___ d___ burn, otherwise treat as for deep d___ burn
    - Deep Dermal - Immmerse in c___ water to halt burning process, cover with s___ dressing or c___ cloth to prevent c____ and decrease p___ from contact with air; avoid breaking b___, seek m___ attention immediately
    • If area is small treat as a FIRST DEGREE burn, otherwise treat as for deep DERMAL burn
    • Depp Dermal - Immerse in COLD water to halt burning process, cover with STERILE dressing or CLEAN cloth to prevent CONTAMINATION and decrease PAIN from contact with air; avoid breaking BLISTERS, seek MEDICAL attention immediately
  120. Tx of Burns: Third Degree (Full Thickness):
    - Halt the burning process by immersing in c___ water or rolling in a b___; wrap in c___ sheet or other s___ dressing; provide blanket for w___, have victim l___ down, DO NOT apply o___ or any other s___; take pt. to nearest e____ dept. immediately
    Halt the burning process by immersing in COLD water or rolling in a BLANKET; wrap in CLEAN sheet or other STERILE dressing; provide blanket for WARMTH, have victim LIE down, DO NOT apply OINTMENT or any other SUBSTANCE; take pt. to nearest EMERGENCY dept. immediately
  121. Emotional / Behavior Problems: Depression
    - Not as e___ to identify in children
    - Many children have difficulty expressing their f___ and will "a___ o___" their concerns
    - D___ is common to children
    - M___ are resolved in a s____ time and p___ normal
    • Not as EASY to identify in children
    • Many children have difficulty expressing their FEELINGS and will "ACT OUT" their concerns
    • DEPRESSION is common to children
    • MANIFESTATIONS are resolved in a SHORT time and PERFECTLY normal
  122. Depression Continued:
    - Major depressive or mood disorder is characterized by a p___ behavior change from baseline that interferes with s___, f___ life, and/or age-specific a___
    Major depressive or mood disorder is characterized by a PROLONGED behavior change from baseline that interferes with SCHOOL, FAMILY life, and/or age-specific ACTIVITIES
  123. Symptoms of Depression:
    - W___d____
    - Sudden drop in g____
    - H___ banging
    - T___ (failure to attend)
    - L___ / S____
    • WITHDRAWAL
    • Sudden drop in GRADES
    • HEAD banging
    • TRUANCY (failure to attend)
    • LYING / STEALING
  124. Tx of Depression:
    - O___p___ and may include p____ meds
    OUTPATIENT and may include PRESCRIPTION meds
  125. Nursing Responsibilities for Depression:
    - Recognizing the s___ of depression and initiating appropriate and prompt r___
    - E___ parents and s___ personnel concerning the i___ of children at risk
    • Recognizing the SIGNS of depression and initiating appropriate and prompt REFERRAL
    • EDUCATING parents and SCHOOL personnel concerning the IDENTIFICATION of children at risk
  126. Emotional / Behavioral Problems:
    - S___ is the third leading cause of d____ in adolescent children after accidents and homicide.
    - Adolescent suicides are not intended for d____, but a cry for h___
    - Risk of s___ increases when there is a plan of a____
    - I____ places adolescent at g___ risk for suicide
    • SUICIDE is the third leading cause of DEATH in adolescent children after accidents and homicide
    • Adolescent suicides are not intended for DEATH, but a cry for HELP
    • Risk of SUCCESS increases when there is a plan of ACTION
    • ISOLATION places adolescent at GREATER risk for suicide
  127. Suicidal Behaviors:
    - Suicidal I____ - thoughts of suicide
    - Suicidal G___ - attempt at suicide that doesn't result in injury
    - Suicidal A___ - action that is seriously intended to cause death (although it may be unsuccessful)
    • Suicidal IDEATION - thoughts of suicide
    • Suicidal GESTURE - attempt at suicide that doesn't result in injury
    • Suicidal ATTEMPT - action that is seriously intended to cause death (although it may be unsuccessful)
  128. Emotional / Behavioral Problems:
    - A___ N___ is a form of self-starvation seen mostly in adolescent g___, only 10% are m___
    ANOREXIA NERVOSA is a form of self-starvation seen mostly in adolescent GIRLS, only 10% are MALE
  129. Criteria for Anorexia Nervosa:
    - Failure to maintain the m____ normal w___ for age and h____ (less than __ % of expected weight)
    - Intense fear of g___ weight
    - Excess influence of body weight on self-e____
    - A_____ (stoppage of period)
    • Failure to maintain the MINIMUM normal WEIGHT for age and HEIGHT (less than 85 % of expected weight)
    • Intense fear of GAINING weight
    • Excess influence of body weight on self-EVALUATION
    • AMENORRHEA (stoppage of period)
  130. Etiology of Anorexia Nervosa:
    - May be g___
    - Adolescent has average to superior i____ and are o___a____ who expect to be p____ in all areas
    - Family may be affluent with focus in "t____," d___ and e___
    - Families are often d___f____ - o___p____, lack of p____, inability to resolve c____
    • May be GENETIC
    • Adolescent has average to superior INTELLIGENCE and are OVERACHIEVERS who expect to be PERFECT in all areas
    • Family may be affluent with focus in "THINNESS," DIET and EXERCISE
    • Families are often DYSFUNCTIONAL - OVERPROTECTIVE, lack of PRIVACY, inability to resolve CONFLICT
  131. S/S of Anorexia Nervosa:
    - Severe w___ loss
    - D___ skin
    - Loss of h____
    - A_____ (stoppage of period)
    - L___ hair over the back and extremities (fine, soft hair)
    - C___ intolerance
    - Low b___ p___
    - A___ pain
    - C____
    - Preoccupation with f___ and p____
    - H___ is denied
    - Complaints of b___ and abdominal pain after e____ small amounts of f___
    • Severe WEIGHT loss
    • DRY skin
    • Loss of HAIR
    • AMENORRHEA (stoppage of period)
    • LANUGO hair over the back & extremities (fine, soft hair)
    • COLD intolerance
    • Low BLOOD PRESSURE
    • ABDOMINAL pain
    • CONSTIPATION
    • Preoccupation with FOOD and PREPARATION
    • HUNGER is denied
    • Complaints of BLOATING and abdominal pain after EATING small amounts of FOOD
  132. Tx and Nursing Care for Anorexia Nervosa:
    - Tx is c___ and involves several m____ (modes)
    - Some hospitals have e___ d___ units
    - Brief period of hospitalization may occur due to correct e___ imbalance, establish a m____ restoration of n___, and stabilize the pt. w____. Hospitalization also provide brief time-out from a d___f_____ home environment
    • Tx is COMPLEX and involves several MODALITIES (modes)
    • Some hospitals have EATING DISORDER units
    • Brief period of hospitalization may occur due to correct ELECTROLYTE imbalance, establish a MINIMUM restoration of NUTRIENTS, and stabilize the pt. WEIGHT. Hospitalization also provides brief time-out from a DYSFUNCTIONAL home environment
  133. Tx and Nursing Care for Anorexia Nervosa:
    - T____ include individual and families - p____t____ and p____c____ therapy
    - A____d____ may be helpful
    - Nurse plays an important role that the a____ is relaxed and n___p____ (not inflicting punishment)
    - Nurses working with adolescents must be a___ to the condition, lack of r____ is a big obstacle to Tx
    • THERAPIES include individual and families - PSYCHOTHERAPY and PHARMACOLOGICAL therapy
    • ANTIDEPRESSANTS may be helpful
    • Nurse plays an important role that the ATMOSPHERE is relaxed and NONPUNITIVE (not inflicting punishment)
    • Nurses working with adolescents must be ALERT to the condition, lack of RECOGNITION is a big obstacle to Tx
  134. Prognosis for Anorexia Nervosa:
    - Most pt. g___ weight in hospital, however this does not predict future s____
    - Complications include g____, cardiac a____ (dying because of this due to e___ imbalance), inflammation of the i____, k___ problems
    - Approximately 50% i____, 30% improve but continue to have d___f____ eating problems and a d___ body image (although they f___ well at school/work), 15% remain c___ ill through a___h____
    • Most pt. GAIN weight in hospital, however this does not predict future SUCCESS
    • Complications include GASTRITIS, cardiac ARRYTHMIAS (dying because of this due to ELECTROLYTE imbalance), inflammation of the INTESTINE, KIDNEY problems
    • - Approximately 50% IMPROVE, 30% improve but continue to have DYSFUNCTIONAL eating problems and a DISTORTED body image (although they FUNCTION well at school/work), 15% remain CHRONICALLY ill thorugh ADULTHOOD
  135. Emotional / Behavioral Problems:
    - B____ is compulsive eating
    - Estimated that 5% of college w___ and 1% of college m___ have this condition
    - Mother/Daugher relationship is usually d____
    - D___ / A____ may be family problem
    - The b___ / p___ cycle is thought to be a coping mechanism for dealing with g___, d___, and low self-e____
    - I___ behaviors are characteristic of adolescents with bulimia
    • BULIMIA is compulsive eating
    • Estimated that 5% of college WOMEN and 1% of college MEN have this condition
    • Mother / Daughter relationship is usually DISTANT
    • The BINGE / PURGING cycle is thought to be a coping mechanism for dealting with GUILT, DEPRESSION, and low self-ESTEEM
    • IMPULSIVE behaviors are characteristic of adolescents with bulimia
  136. Signs of Bulimia:
    - R___ episodes of uncontrolled e___ followed by self-induced v___
    - Misuse of l____ or d____
    - E___ imbalance (laxative / diuretic use)
    - Erosion of tooth e____ (frequent vomiting)
    - M___ weakness
    • RECURRENT episodes of uncontrolled EATING followed by self-induced VOMITING
    • Misuse of LAXATIVES or DIURETICS
    • ELECTROLYTE imbalance (laxative/diuretic use)
    • Erosion of tooth ENAMEL (frequent vomiting)
    • MUSCLE weakness
  137. Nursing Role related to Bulimia:
    - E____
    - P____
    - I____
    - R___ to proper people to h___
    • EDUCATE
    • PREVENT
    • IDENTIFY
    • REFER to proper people to HELP

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