Pediatric nursing

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busdriverre
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52334
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Pediatric nursing
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2010-12-02 22:46:48
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pediatric nursing
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pediatric nursing - fall semester
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  1. Family structures
    • nuclear - mom, dad, children, dual income
    • blended - 2 parents, kids from prev. marriages
    • extended - parents & relatives
    • binuclear - divorced
    • polygamous - many wives
    • communal/cohabitating - 2 families in 1 home
    • single parent
  2. Duvall's Developmental Theory
    • Stage I - married w/no kids
    • Stage II - families w/kid(s) <3 yrs old
    • Stage III - families with preschoolers aged 3-6 yrs
    • Stage IV - families with school age kids
    • Stage V - families w/teenagers
    • Stage VI - launching stage - children start leaving home
  3. Family Systems Theory
    stressor experienced by one or more members affects the entire family
  4. Family APGAR
    • Adaptation
    • Partnership
    • Growth
    • Affection
    • Resolve
  5. Family Centered Care
    • the importance of family is emphasized
    • involves families beliefs & customs
  6. Family Focused Care
    health care provider instructs family on what to do
  7. Erikson's Stages of Development
    • Infant - Trust vs Mistrust
    • Toddler - Autonomy vs Shame & Doubt
    • Preschooler - Initiative vs Guilt
    • School Age Child - Industry vs Inferiority
    • Adolescent - Identity vs Role Confusion
  8. Trust vs Mistrust
    • birth - 1 year
    • mistrust develops when basic needs are not consistently met
  9. Autonomy vs Shame & Doubt
    • 1-3 years
    • focus is on the ability to control their bodies themselves and their environment
    • important to encourage the child
  10. Initiative vs Guilt
    • 3-6 years
    • begin to initiate activities
    • develop a conscious and sense of guilt
  11. Industry vs Inferiority
    • school age - 6-12 yrs
    • like to do activities where they can complete
    • age where kids start to cheat in order to win or complete a task
    • learn to compete and cooperate
    • job is to make friends & socialize
  12. Identity vs Role Confusion
    • adolescents 12-18 yrs
    • preoccupied with how they look and how they are perceived by others
    • can develop role confusion when they try to integrate many other roles into their lives
  13. Conservation
    • able to distinguish just because one is bigger doesn't mean it holds more than a fat one
    • thinking biggest has more
  14. Object Permanence
    realizing that just because something disapperas its not gone ex. peek-a-boo
  15. Increased Fluid Needs
    • fever
    • V/D
    • high-output renal failure
    • diabetes insipidus
    • burns
    • shock
    • tachypnea
  16. Decreased Fluid Needs
    • congestive heart failure
    • renal failure
    • head trauma/meningitis (too much fluid increases ICP)
  17. Signs of dehydration
    • dry skin & mucus membranes
    • poor skin turgor
    • sunken eyes
    • depressed fontanel
    • gray or ashen color
    • rapid and weak pulse
    • decreased BP
    • oligura
    • decreased tears
    • irritability
    • delayed capillary refill >2-3 seconds
  18. Weighing Diapers
    1 gm = 1 mL
  19. Gastroenteritis
    • group of clinical syndromes manifested by nausea, vomitting & diarrhea
    • Rotavirus is leading cause of pediatric gastroenteritis
  20. Viral Agents
    • more common in winter
    • Rotavirus most common in children 6-24 months
    • Norwalk - common in daycares & cruise ships in ice & seafood
  21. Bacterial Agents
    • more common in summer
    • most recover w/o treatment
    • salmonella
    • shigella
    • e-coli
  22. Hypernatremia in Dehydration
    • warm doughy sin texture
    • hypertonia (stiffness)
    • hyper-reflexia
    • lethargy w/irritability when touched
  23. Hypokalemia in Dehydration
    • weakness
    • ileus with abdominal distention
    • cardiac arrhythmias
  24. Management of Gastroenteritis
    • assess dehydration
    • oral rehydration - avoid carbonated beverages
    • normal diet as soon as possible
    • continue to breast feel
    • protect skin from breakdown
    • anti-diarrheal meds discouraged
  25. Hirschsprung's Disease
    • congenital aganglionic megacolon
    • absence of parasympathetic ganglion cells in the colon
    • peristalsis is normal
    • results in obstruction and dilation of the bowel
    • fecal mass palpable
    • infant fails to pass meconium
    • surgically remove aganglionic portion
    • surgical emergency if bowel perforates
  26. Gastroesophageal Reflux (GER)
    • gastric contents flow back into esophagus
    • failure of the sphincter at the junction of the esophagus and the stomach
    • GERD - GER with complications
  27. S/S of GI Reflux
    • spitting up
    • vomiting
    • weight loss
    • gagging, choking at the end of feedings
    • respiratory problems
    • heartburn
  28. Diagnostic Testing for GI Reflux
    • pH probe
    • swallow study
    • endoscopy
  29. Management of GI Reflux
    • change to soy formula
    • frequent burping
    • small feedings < 30 minutes
    • elevate HOB
    • lay on right side after feeding
    • thicken formula with rice cereal
    • monitor weight
  30. Meds for GI Reflux
    • H2 Blockers: cimetidine, ranitidine, famotidine
    • Proton pump inhibitors - omeprazole, lanzoprazole
    • increase gastric emptying - Reglan, erythromycin
  31. Surgical management of GI Reflux
    • Nissen Fundoplication - fundus of stomach is wrapped around lower end of esophagus
    • G-Tube
  32. Inflammatory Bowel Disease
    • 2 distinct disorders that invole inflammation of the GI tract:
    • ulcerative colitis
    • Crohn's Disease
  33. Crohn's Disease
    • cobblestoned lesions
    • can occur anywhere in the GI tract
    • moderate diarrhea
    • significant growth retardation
    • NO rectal bleeding
    • greatly increased risk of cancer
  34. Ulcerative Colitis
    • continuous superficial lesions on the mucosa
    • involves rectum and distal colon
    • severe diarrhea
    • little growth retardation
    • slight increased risk of cancer
  35. Management of IBD
    decrease inflammation
  36. Management of IBD
    • decrease inflammation
    • high protein, high calorie, low fiber diet
    • surgery: removing diseased colon cures UC
    • ileo pouch
  37. Surgical management of Crohn's
    only to manage complications - ulcerations can reoccur
  38. Cleft Lip and Cleft Palate
    • noted on ultrasound 14-16 weeks
    • lip repaired with cheiloplasty
    • feeding, speech & hearing affected w/cleft palate
    • ESSR: Elevate & Enlarge nipple, Stimulate sucking, Swallowing upright, Rest (limit feedings to 30-40 minutes)
  39. Post-op care after cleft palate repair
    • watch for respiratory difficulties
    • no sharp objects in mouth
    • crying will alter suture line
  40. TE Fistula and Esophageal Atresia
    • TE Fistula: trachea and esophagus fail to separate, they open into each other
    • Esophageal Atresia: esophagus doesn't develop fully, just ends
  41. Management of TE Fistula
    • g-tube for feeding
    • surgical repair
    • suction to remove mucus that could be inhaled
  42. Pyloric Stenosis
    • obstruction of the circular muscle of the pyloris
    • palpable pyloric - "olive mass"
    • projectile vomiting; no where for food to go
    • pyloris (lower part of stomach) narrows so food doesn't leave stomach
  43. Intussusception
    • bowel folds into itself like a collapsed telescope
    • abrupt onset, pain
    • "current jelly" diarrhea
    • mass in RUQ
  44. Volvulus
    • twisting of the intestine
    • surgical emergency
  45. Acute Appendicitis
    • inflammation of the appendix
    • peritonitis if ruptures
    • McBurney point pain
    • Rovsing sign: pain in RLQ when any part of abdomen is palpated
    • if ruptures: sudden relief of pain
  46. Biliary Atresia
    • blockage or lack of the common bile duct
    • does not cause kernicterus-liver still functions to conjugate bilirubin and once conjugated it can't cross BBB
  47. S/S of Biliary Atresia
    • jaundice
    • pale stool and dark urine (no bile in intestines)
    • pruritis from jaundice
  48. Management of biliary atresia
    • ksasi procedure to make a biliary tree
    • vitamin K to manage bleeding
    • cholestyramine to control itching
  49. Short Bowel Syndrome
    • malabsorption due to decreased bowel
    • caused by anything that needs surgery and decreases bowel
    • vit B12 and fat soluble vitamins given
  50. Celiac Disease
    • gluten sensitivity (wheat, barley, rye & oats)
    • digestive disease that damages small intestine & interferes with absorption
    • impairs absorption
    • gluten causes immune system to destroy the villi so nutrients can't be absorbed
    • causes protein deficiency
    • delays in getting teeth
    • bone density changes due to hypocalcemia
  51. Diagnosis for Celiac Disease
    • fecal fat content measured
    • positive response to gluten free diet
    • celiac crisis: severe acute episodes of watery diarrhea
  52. Abdominal Wall Defects
    • gastroschisis: protrusion of intra-abdominal contents through a defect in the abdominal wall
    • no sac present
    • Omphalocele: protrusion of viscera into base of umbilical cord
    • sac is covered with peritoneum but no skin
  53. Pediatric blood gas values
    • pH: 7.35 - 7.45
    • PO2: 80-100
    • PCO2: 35-45
    • HCO3: 22-26
  54. Simple ABG Analysis
    • Assess PaCO2
    • if PaCO2 is >45 = resp acidosis
    • if PaCO2 is <35 = resp alkalosis
    • Assess the HCO3
    • if HCO3 is >26 = metabolic alkalosis
    • if HCO3 is <22 = metabolic acidosis
  55. Apparent Life Threatening Event
    • apnea with change in color, muscle tone and/or choking
    • can be caused by child abuse or Munchhausen
  56. SIDS
    • sudden unexplained death of an infant under 12 months
    • occurs while sleeping
    • using a pacifier helps
    • 1st symptom is a cardiac arrest
  57. Croup Syndromes
    • upper airway illnesses caused by swelling of the larynx and epiglottis
    • Big 3: epiglotitis, laryngotracheobronchitis, bacterial tracheitis
  58. Epiglotitis
    • swelling of the epiglotits
    • life threatening
    • progresses rapidly
    • DO NOT INSPECT VISUALLY: can cause laryngospasm
    • thumb sign on lateral x-ray
    • S/S: drooling r/t can't swallow, tripod
  59. Epiglotitis S/S
    • high fever
    • appears very ill
    • 4 D's: drooling, dysphagia, dysphonia, distressed respiratory effort
    • keep trach tray at bedside
  60. Croup
    • afebrile, some inspiratory stridor
    • does not appear ill
    • viral invasion of upper airway
    • abrupt onset usually at night - barking cough
    • large amounts of thin secretions
    • AP x-ray (anterior to posterior)
    • steeple sign on x-ray
    • cool mist
    • albuterol
  61. Bacterial Tracheitis
    • secondary infection of upper trachea after a viral infection
    • croupy cough and stridor
    • thick secretions
  62. Bronchiolitis
    • caused by RSV virus
    • inflammation of lower respiratory tract causing an obstruction of small airways
    • contact precautions
    • CPT therapy (clapping on back)
  63. S/S of Bronchiolitis
    • fever
    • respiratory distress:
    • - tachypnea
    • - retractions
    • - wheezing
    • - prolonged expiration
    • - rales
  64. RSV
    • infection of respiratory mucosa
    • 2 subtypes: Type B - mild, Type A - more virulent
    • forms a layer that impairs cilia function
    • occurs in winter from Nov to March
    • contracted thru direct contact w/nasal secretions
    • viruses can live on surfaces
    • no immunity - can be reinfected
  65. RSV Diagnosis
    • based on S/S
    • enzyme immune assay
    • WBC slightly elevated
    • chest x-ray
  66. Cystic Fibrosis
    • inherited autosomal recessive disorder affecting
    • both parents are carriers: 25% chance of infected child
    • : 50% chance child will be a carrier
    • : 25% chance child will be OK
    • no cure
    • copious amounts of mucus produced
    • elevated sweat salts (skin will taste salty)
  67. Normal Pediatric Blood Values
    .................2 years............ 12 years

    • RBC's: ......4-4.9 ................4-5.3
    • Hct: ...........31-37 ..............34-44
    • Hgb: .........10.5-12.7........ 11.2-14.8
    • WBC: ........5.3-11.5 .........4.5-10.1
    • Platelets: .....204-405....... 165-335
  68. Polycythemia
    • increase in RBC's
    • S/S: clubbing of fingers, redness to skin, viscous blood
  69. RBC's
    • reticulocytes: immature red blood cell
    • old RBC's rmvd by spleen
    • carry surface antigents
  70. Neutrophils
    • 1st responder
    • polymorphonucleated (poly's): mature neutrophils, 90%

    bands: immature, 10%
  71. Thrombocytes (platelets)
    • very sticky
    • live 7-10 days
    • release substances that stabilize clots
  72. Absolute Neutrophil Count (ANC)
    • Normal: 1500-7200
    • ANC <1000: moderate risk for infection
    • ANC <500: severe risk for infection
  73. Anemia
    • decreased number of RBC's
    • OR
    • decrease in the concentration of hemoglobin
  74. Iron Deficiency Anemia
    • most common type
    • vitamin C enhances iron absorption
    • babies need an iron supplement after 6 months old
    • management: iron fortified formula, iron therapy
  75. Iron-rich foods
    • meats
    • beans
    • egg yolks
    • greens
    • dried fruits
    • grains & enriched breads & pastas
  76. Signs of iron overdose
    • abdominal pain
    • bloody diarrhea
    • vomiting
    • SOB
    • shock
  77. Sickle Cell Disease
    • sickle cell trait = carrier
    • sickle cell anemia = has disease
    • autosomal recessive
    • 50% risk child will be a carrier
    • 25% risk child will have disease
    • 25% risk child will be health
    • RBC's become sickled with any decrease in oxygen
    • high calorie, high protein diet
    • folic acid & vitamin C supplements
  78. Screening & Diagnosis of Sickle Cell Disease
    • screen all newborns
    • sickledex done after 6 months
    • hemoglobin electrophoresis
  79. Factors contributing to sickle cell crisis
    • fever
    • dehydration
    • altitude
    • temp extremes
    • vomitingemtional distress
    • fatigue
    • alcohol
    • pregnancy
    • anything that causes blood to be thicker
  80. Major types of sickle cell crisis
    • vaso occlusive - vessels are occluded by sickled cells
    • splenic sequestration - spleen fills w/blood and enlarges, sickled cells get trapped in small blood vessels causing blood to get trapped
    • aplastic crises - abnormal drop in reticulocytes
    • acute chest syndrome
  81. Dactylitis
    • painful
    • swelling of an entire digit
    • caused by vaso occlusive crisis
  82. Hemophilia
    • inherited coagulation disorder due to deficiency of clotting factors (lowers clotting ability leading to bleeding)
    • Hemophilia A: classic- missing factor 8
    • Hemophilia B: Christmas - missing factor 9
    • Hemophilia C: factor 11
    • **Carrier mom & normal dad will have infected son
    • Von Willebrand - asbence of a protein and factor 8
  83. Splenic Sequestration
    • life threatening
    • blood pools in the spleen
    • S/S: anemia, hypovolemia, shock
  84. Aplastic Crises
    • decreased production and increased destruction of RBC's
    • S/S profound anemia, pallor, fatigue
  85. Hemophilia Lab Findings
    • prolonged PT
    • prolonged PTT
    • normal fibrinogen
    • normal platelets
  86. Anemia management
    • no cure
    • focuses on replacing factor VIII
    • no ASA or Motrin
    • prevent bleeding: soft toothbrush, electric razor, no contaqct sports
  87. Disseminated Intravascular Coagulation (DIC)
    • formation of small clots in the blood vessels in the body
    • as the clots consume protein & platelets normal coagulation is disrupted leading to bleeding
    • the small clots may also disrupt blood flow to organs
    • tiny clots damage small vessels
    • always a secondary disorder
  88. DIC Lab findings
    • decreased platelets
    • prolonged PT & PTT
    • FSP is increased
    • D-dimer is increased
  89. Idiopathic Thrombocytopenic Purpura (ITP)
    • low platelet count (thrombocytopenia) with no known cause (idiopathic)
    • results in bruising (purpura)
    • blood doesn't clot because of low number of platelets
  90. Leukemia
    • cancer of blood-forming organs
    • ALL - acute lymphoblastic leukemia: cancer of lymphoid cells in the bone marrow and lymphoid organs of the body
    • AML - acute myelogenous leukemia: cancer of myeloid cells in the bone marrow which help fight bacteria infections
  91. Symptoms of ALL
    • bone & joint pain
    • fever
    • fatigue
    • petechiae
    • repeated infections
  92. Diagnosis of ALL
    • not diagnosed thru blood count
    • bone marrow - definitive
  93. Anemia
    • decrease in RBC's
    • decrease in hemoglobin
    • decrease in volume of packed RBC's
  94. Assessment for Bleeding
    platelet count <20,000 at risk for spontaneous bleeding
  95. Wilms Tumor
    • tumor in kidneys
    • don't palpate - can rupture
  96. Tumor Lysis Syndrome
    • metabolic abnormalities that occur when tumor cells breakdown rapidly
    • more likely to occur during first chemo treatment
    • leads to hyperkalemia, hyperuricemia, hyperphosphatemia and hypocalcemia
    • kidneys become overwhelmed and cannot excrete them so the blood levels rise
  97. Nasopharyngitis
    • inflammation of the nasal passages and of the upper pharynx
    • occurs with the common cold
  98. Pharyngitis
    • inflammation of pharynx and tonsils
    • S/S: sore throat
    • diagnosis: throat culture
    • treatment: if strep-antibiotic - if strep isn't treated can lead to glomuleral nephritis & rheumatic fever
  99. Tonsillitis
    • treatment same as pharyngitis
    • assess for bleeding: excessive swallowing, vomiting bright red blood

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