-Dictatorial or authoritarian:
-Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations
-Ex: The child
... [Show More] is never allowed to watch television on school nights
-Permissive:
-Parents exert little or no control over the child’s behaviors, and consult the child when making decisions
-Ex: The child assists with deciding whether he will watch television
-Democratic or authoritative:
-Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting
-Ex: The child can watch television for 1 hr on school nights after completing all of his homework and chores
-Parents negatively reinforce deviations form the rules
-Ex: The privilege is taken away but later reinstated based on new guidelines
Chapter 2: Physical assessment findings
1. Vital signs
-Usually vital signs are all high except for BP
-Temperature:
-3 – 6 months 99.5
-1 year 99.9
-3 year 99.0
-5 years 98.6
-7 years 98.2
-9 – 11 years 98.1
-13 years 97.9
-Pulse: -Newborn 80 – 180/min
-1 weeks – 3 months 80 – 220/min
-3 months – 2 years 70 – 150/min
-2 – 10 years 60 – 110/min
-10 years and older 50 – 90/min
-Respirations:
-Newborn – 1year 30 – 35/min
-1 – 2 years 25 – 30/min
-2 – 6 years 21 – 25/min
-6 – 12 years 19 – 21/min
-12 years and older 16 – 19/min
-Blood pressure:
-Low as a baby but increases the older they get
-Infants:
-Systolic: 65-78
-Diastolic: 41-52
2. Head
-Fontanels should be flat
-Posterior fontanel:
-Closes by 6-8 weeks
-Anterior fontanel:
-Closes by 12-18 months
3. Teeth
-Infants should have 6-8 teeth by 1 year old
-Children and adolescents should have teeth that are white and smooth, and begin replacing the 20 deciduous teeth with 32 permanent teeth
4. Infant Reflexes
Tonic Neck Reflex (Fencer Position) Birth to 3 – 4 months Sucking and Rooting Reflex Birth to 4 months
Moro Reflex (Fall backward) Birth to 4 months
Startle Reflex (Loud Noise) Birth to 4 months Plantar Reflex Birth to 8 months
Babinski Reflex Birth to 1 year
Chapter 3: Health promotion of infants (2 days to 1 year)
1. Physical Development
-Weight:
-Doubled by 5 months
-Tripled by 12 months
-Quartered by 30 months
-Height:
-2.5 cm (1 in) per month for the first 6 months
-Length:
-Increases by 50% by 12 months
-Dentition:
-First teeth erupt between 6-10 months
2. Motor skill development
▪ 1 Month
o Head lag
o Strong grasp reflex
▪ 2 Months
o Lifts head when prone
o Holds hand in open position | Grasp reflex fades
▪ 3 Months
o Raises head and shoulders when prone | Slight head lag
o No grasp reflex | Keeps hands loosely open
▪ 4 Months
o Rolls from back to side
o Grasp objects with both hands
▪ 5 Months
o Rolls from front to back
o Palmar grasp dominantly
▪ 6 Months
o Rolls from back to front
o Holds bottle
▪ 7 Months
o Bears full weight on feet | Sits, leaning forward on both hands
o Moves objects from hand to hand
▪ 8 Months
o Sits unsupported
o Pincer grasp
▪ 9 Months
o Pulls to a standing position | Creeps on hands and knees instead of crawling
o Crude pincer grasp | Dominant hand is evident
▪ 10 Months
o Prone to sitting position
o Grasps rattle by its handle
▪ 11 Months
o Walks while holding onto something | Walks with one hand held
o Places objects into a container | Neat pincer grasp
▪ 12 Months
o Stands without support briefly | Sits from standing position without assistance
o Tries to build a two-block tower w/o success | Can turn pages in a book
3. Cognitive development
-Piaget: sensorimotor (birth to 24 months)
-Object Permanence: objects still exists when it is out of view
-Occurs at 9-10 months
4. Language development
-3-5 words by the age of 1 year
5. Psychosocial development
-Erikson: Trust vs. Mistrust:
- Learn delayed gratification
-Trust is developed by meeting comfort, feeding, simulation, and caring needs
-Mistrust develops if needs are inadequately or inconsistently met or if needs are continuously met before being vocalized by the infant
6. Social development
-Separation Anxiety: protest when separated from parents
-Begins around 4-8 months
-Stranger Fear: ability to discriminate between familiar and unfamiliar people
-Begins 6-8 months
7. Age appropriate activities
-Rattles
-Playing pat-a cake
-Brightly colored toys
-Playing with blocks
8. Nutrition
-Breastfeeding provides a complete diet for infants during the first 6 months
-Solids are introduced around 4-6 months
-Iron-fortified cereal is the first to be introduced
-New foods should be introduced one at a time, over a 5-7 day period to observe for allergy reactions
-Juice and water usually not needed for 1st year
-Appropriate finger foods:
-Ripe bananas
-Toast strips
-Graham crackers
-Cheese cubes
-Noodles
-Firmly cooked vegetables
-Raw pieces of fruit (except grapes)
9. Injury prevention
-Avoid small objects (grapes, coins, and candy)
-Handles of pots and pans should be kept turned to the back of the stove
-Sunscreen should be used when infants are exposed to the sun
-Infants and toddlers remain in a rear-facing car seat until age 2
-Crib slats should be no farther apart than 6 months
-Pillows should be kept out of the crib
-Infants should be placed on their backs for sleep
Chapter 4: Health Promotion of Toddlers (1 to 3 years)
1. Physical development
-Weight:
-30 months: 4 times the birth weight
-Height:
-Toddlers grow 7.5 cm (3 in) per year
-Head circumference and chest circumference:
-Usually equal by 1 to 2 years of age
2. Cognitive development
-Piaget: sensorimotor stage transitions to preoperational stage 19 – 24 months
-Object Permanence: fully developed
3. Language development
-1 year: using one-word sentences
-2 years: 300 words, multiword sentences by combining 2-3 words
4. Psychosocial Development
-Autonomy vs. Shame and Doubt
-Independence is paramount for toddlers who are attempting to do everything for themselves
-Use negativism or negative responses to express their independence
-Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as they begin to explore the environment beyond those most familiar to them
5. Age appropriate activities
-Parallel play: Toddlers observe other children and then might engage in activities nearby
-Appropriate activities:
-Playing with blocks
-Push-pull toys
-Large-piece puzzles
-Thick crayons
-Toilet training can begin when toddlers have the sensation of needing to urinate or defecate
6. Motor skill development
▪ 15 Months
o Walks without help | Creeps up stairs
o Uses a cup well | Builds 2 tower blocks
▪ 18 Months
o Runs clumsily | Throws overhand | Jumps in place w/ both feet | Pulls/Pushes toys
o Manages a spoon w/o rotation | Turns pages 2-3 pages /time | Builds 3-4 blocks | Uses crayon to scribble spontaneously | Feeds self
▪ 24 Months (2 years)
o Walks backwards | Walks up/down stairs w/ 2 feet on each step
o Builds 6-7 blocks | Turns pages 1 @ a time
▪ 30 Months (2.5 years)
o Balances on 1 leg | Jumps across floor / off chair w/ both feet | Walks tiptoe
o Draws circles | has good hand-finger coordination
7. Nutrition
-Whole milk at 1 year old
-Can start drinking low-fat milk after 2 years of age
-Juice consumption should be limited to 4-6 oz. per day
-Foods that are potential choking hazards:
-Nuts
-Grapes
-Hot dogs
-Peanut butter
-Raw carrots
-Tough meats
-Popcorn
Chapter 5: Health Promotion of Preschoolers (3-6 years)
1. Physical development
-Weight:
-Gain 2-3 kg (4.5-6.5 lb) per year
-Height:
-Should grow 6.9-9 cm per year
2. Fine and gross motor skills
▪ 3 Years
o Toe and heel walks
o Tricycle
o Jumps off bottom step
o Stands on one foot for a few seconds
▪ 4 Years
o Hops on one foot | Skips
o Throws ball overhead
o Catches ball reliably
▪ 5 Years
o Jumps rope
o Walks backward
o Throws and catches a ball
3. Cognitive development
-Piaget: preoperational stage
-Moves from totally egocentric thoughts to social awareness and the ability to consider the viewpoint of others
-Magical thinking:
-Thoughts are all-powerful and can cause events to occur
-Animism:
-Ascribing life-like qualities to inanimate objects
4. Psychosocial development
-Erikson: Initiative vs. guilt:
-Preschoolers become energetic learners, despite not having all of the physical abilities necessary to be successful at everything
-Guilt can occur when preschoolers believe they have misbehaved or when they are unable to accomplish a task
-During stress, insecurity, or illness, preschoolers can regress to previous immature behaviors or develop habits (nose picking, bed-wetting, thumb sucking)
5. Age appropriate activities
-Preschooler’s transition to associative play
-Play is not highly organized, but cooperation does exist between children
-Appropriate activities:
-Playing ball
-Putting puzzles together
-Riding tricycles
-Playing pretend dress up activities
-Role-playing
6. Sleep and rest
-On average, preschoolers need about 12 hours of sleep
-Keep a consistent bedtime routine
-Avoid allowing preschoolers to sleep with their parents
Chapter 6: Health promotion of School-Age children (6-12 years)
1. Physical development
-Weight:
-Gain 2-3 kg (4.4-6.6 lb.) per year
-Height:
-Grows 5 cm (2 in.) per year
2. Cognitive development
-Piaget: Concrete operations
-Able to see the perspective of others
3. Psychosocial development
-Erikson: Industry vs. Inferiority
-A sense of industry is achieved through the development of skills and knowledge that allows the child to provide meaningful contributions to society
-A sense of accomplishment is gained through the ability to cooperate and compete with others
-Peer groups play an important part in social development
4. Age appropriate activities
-Competitive and cooperative play is predominant
-Play simple board and number games
-Play hopscotch
-Jump rope
-Ride bicycles
-Join organized sports (for skill building)
5. Sleep and rest
-Need 9 hrs of sleep at age 11
6. Dental health
-The first permanent teeth erupt around 6 years of age
Chapter 7: Health promotion of Adolescents (12 to 20 years)
1. Physical development
-Girls stop growing at about 2-2.5 years after the onset of menarche
-In girls, sexual maturation occurs in the following order:
-Breast development
-Pubic hair growth
-Axillary hair growth
-Menstruation
-In boys, sexual maturation occurs in the following order:
-Testicular enlargement
-Pubic hair growth
-Penile enlargement
-Growth of axillary hair
-Facial hair growth
-Vocal changes
2. Cognitive development
-Piaget: Formal operations
-Increasingly capable of using formal logic to make decisions
3. Psychosocial development
-Erikson: Identity vs. role confusion
-Adolescents develop a sense of personal identity and to come to view themselves as unique individuals
4. Age-appropriate activities
-Nonviolent videogames
-Nonviolent music
-Sports
-Caring for a pet
-Reading
Chapter 8: Safe Medication Administration
1. Oral
-This route of medication administration is preferred for children
-Avoid mixing medication with formula or putting it in a bottle of formula because the infant might not take the entire feeding, and the medication can alter the taste of the formula
-Use the smallest measuring liquid medication for doses of liquid medication
-Avoid measuring liquid medication in a tsp. or tbsp.
-Administer the medication in the side of the mouth in small amounts
-Stroke the infant under the chin to promote swallowing while holding the cheeks together
2. Otic
-Children younger than years:
-Pull the pinna downward and straight back
-Children older than 3 years:
-Pull the pinna upward and back
3. Intramuscular
-Use a 22-25 gauge, 1/2-1 inch needle
-Vastus lateralis is the recommended site in infants and small children
-Other sites:
-Ventrogluteal and deltoid
4. Intravenous
-Avoid terminology such as “bee sting” or “stick”
-Apply EMLA to the site for 60 minutes prior to attempt (helps numb)
-Keep equipment out of site until procedure begins
-Perform procedure in a treatment room (don’t do it in their room)
-Allow parents to stay if they prefer
-Swaddle infants
-Offer nutritive sucking to infants before, during, and after the procedure
Chapter 9: Pain management
1. Atraumatic measures
-Use play therapy to explain procedures, allowing the child to perform the procedure on a doll or toy
2. Pharmacological measures
-Give medications routinely, vs. PRN, to manage pain that is expected to last for an extended period of time
3. Pain assessment tool
-Flacc: 2 months- 7 years
-Faces: 3 years and older
-Oucher: 3-13 years
-Numeric scale: 5 years and older
Chapter 10: Hospitalization, illness, and play
1. Infant
-Experiences stranger anxiety between 6-18 months
-Displays physical behaviors as expressions of discomfort due to inability to verbalize
2. Toddler
-Limited ability to describe illness
-Limited ability to follow directions
-Experiences separation anxiety
-Can exhibit an intense reaction to any type of procedure
-Behavior can regress
3. Preschooler
-Fears related to magical thinking
-Can experience separation anxiety
-Might believe illness and hospitalization are a punishment
-Explain procedures using simple, clear language
-Avoid medical jargon
-Give choices when possible, such as, “Do you want your medicine in a cup or spoon?”
4. School-age child
-Ability to describe pain
-Increasing ability to understand cause and effect
-Provide factual information
-Encourage contact with peer group
5. Adolescent
-Perceptions of illness severity are based on the degree of body images
-Develops body image disturbance
-Experiences feelings of isolation from peers
-Provide factual information
-Encourage contact with peer group
Chapter 11: Death and Dying
1. Grief and mourning
-Anticipatory grief:
-When death is expected or a possible outcome
-Complicated grief:
-Extends for more than 1 year following the loss
2. Current stages of development
-Infants/toddlers (birth-3 years):
-Have little to no concept of death
-Mirror parental emotions
-Can regress to an earlier stage of behavior
-Preschool (3-6):
-Magical thinking allows for the belief that thoughts can cause an event such as death resulting in feeling guilt and shame
-Interpret separation from parents as punishment for bad behavior
-View dying as temporary
-School-age (6-12):
-Begin to have adult concept of death
-Fear often displayed through uncooperative behavior
-Adolescent (12-20):
-Can have adult-like concept of death
-Can have difficulty accepting death
-Rely more on peers than the influence of parents
-Can become increasingly stressed by changes in physical appearance
3. Physical manifestations of death
-Sensation of heat when the body feels cool
-Decreased sensation and movement in lower extremities
-Swallowing difficulties
-Bradycardia/hypotension
-Cheyne-strokes respirations
4. After death
-Allow family to stay with the body as long as they desire
-Allow family to rock the infant/toddler
-Remove tubes and equipment
-Offer to allow family to assist with preparation of the body
Chapter 12: Acute Neurological disorders
1. Meningitis
-Viral (aseptic) Meningitis: supportive care for recovery
-Bacterial (septic) Meningitis: contagious infection
-Hib and PCV vaccines decrease the incidence
-Newborns:
-Poor Muscle Tone
-Weak Cry
-Poor Suck | Refuses Feedings
-Vomiting/Diarrhea
-Bulging Fontanels (late sign)
-3 Months – 2 Years:
-Seizures with a High-Pitched Cry
-Bulging Fontanels
-Poor Feedings | Vomiting
-Possible nuchal rigidity
-Brudzinki’s sign and Kernig’s sign not reliable for diagnosis
-2 Years – Adolescence:
-Seizures (often initial sign)
-Nuchal rigidity
-Fever/chills
-Headache/vomiting
-Irritability/restlessness that can progress to drowsiness/stupor
-Petechiae or purpuric type rash (with meningococcal infection)
-+ Brudzinski Sign: flexion of extremities with deliberate flexion of the neck
-+ Kernig’s Sign: resistance to extension of the leg from a flexed position
-Laboratory Tests
-Blood Cultures | CBC | CSF Analysis
-Viral CSF
-Clear Color | Slightly Elevated WBC S Protein | Normal Glucose | - Gram
-Bacterial CSF
-Cloudy Color | Elevated WBC | Elevated Protein | Decreased Glucose |
+Gram
-Diagnostic Procedures
-Lumbar Puncture (Definitive Diagnostic Test)
-Empty Bladder
-EMLA Cream 45min – 1-hour prior
-Side-lying Position, Head Flexed, Knees Drawn up to Chest
-Remain in Flat Position to prevent Leakage and Spinal HA
-Nursing care:
-Droplet precautions
-Maintain NPO status if the client has decreased LOC
-Decrease environmental stimuli
-Medications:
-IV antibiotics for bacterial infections
-Complications:
-ICP:
-Newborns and Infants
-Bulging or Tense Fontanels
-Increased Head Circumference
-High-Pitched Cry | Irritability
-Distended Scalp Veins
-Bradycardia | Respiratory Changes
-Children
-Headache
-N/V
-Diplopia
-Seizures
-Bradycardia | Respiratory Changes
2. Reye Syndrome
-Affects the liver (liver dysfunction) and brain (cerebral edema)
-Follows a viral illness (Influenza | Gastroenteritis | Varicella)
-Giving Aspirin for treating fevers
-Laboratory tests:
-Elevated liver enzymes (ALT and AST)
-Elevated serum ammonia
-Diagnostic procedures:
-Liver biopsy/CSF analysis
Chapter 13: Seizures
1. Risk factors
-Febrile Episode
-Cerebral Edema
-Intracranial Infection / Hemorrhage
-Brain Tumors / Cyst
-Toxins or Drugs
-Lead Poisoning
-Hypoglycemia
-Electrolyte imbalances
2. Generalized seizures
-Tonic-clonic seizures: -Also known as Grand mal
-Tonic Phase (10-30 seconds)
-Loss of Consciousness | Loss of Swallowing Reflex | Apnea leading to Cyanosis
-Tonic Contraction of entire body: arms and legs flexed, head and neck extended
-Clonic Phase (30-50 seconds)
-Violent jerking movements of the body
-Postictal State (30 minutes)
-Remains semiconscious but arouses with difficulty and confused
-No recollection of the seizure
-Absence seizure: petit mal or lapses
-Onset between ages 5 – 8 years and ceases by the teenage years
-Loss of Consciousness lasting 5 – 10 seconds
-Minimal or no change in behavior
-Resembles daydreaming or Inattentiveness
-Can drop items being held, but the child seldom falls
-Lip Smacking | Twitching of Eyelids or Face | Slight Hand Movements
-Myoclonic seizure:
-Brief contraction of muscle or groups of muscle
-No postictal state
-Atonic or akinetic seizure:
-Muscle tone is lost for a few seconds
3. Diagnostic procedures
-EEG:
-Abstain from caffeine for several hours prior to the procedure
-Wash hair (no oils or sprays) before and after the procedure to remove electrode gel
4. Nursing care
-Initiate Seizure Precautions:
-Pad side rails of Bed | Crib | Wheelchair
-Keep bed free of objects that could cause Injury
-Have Suction and Oxygen Equipment available
-During a Seizure:
-Protect from Injury (move furniture away, hold head in lap)
-Maintain a position to provide a patent airway
-Suction Oral Secretions
-Side-lying Position (decreases risk of aspiration)
-Loosen restrictive clothing
-Do NOT restrain the child
-Do NOT put anything in the child’s mouth
-Do NOT open the jaw or insert an airway during seizure
-This can damage teeth, lips, or tongue
-Remain with the child
-Note onset, time, and characteristics of seizure
-Allow seizure to end spontaneously
-Post-Seizure:
-Side-lying position to prevent aspiration and facilitate drainage of secretions
-Check for breathing, V/S and position of head
-NPO until swallowing reflex has returned
5. Medications
-Antiepileptic Drugs (AEDs):
-Diazepam (Valium) | Phenytoin | Carbamazepine | Valporic Acid |
6. Therapeutic procedures
-Focal Resection: of an area of the brain to remove epileptogenic zone
-Corpus Callostomy: separation of two hemispheres in the brain
-Vagal Nerve Stimulator
7. Complications
-Status Epilepticus:
-Prolonged Seizure Activity that Lasts >30 minutes or Continuous seizure activity in which the client does not enter a Postictal Phase
-Maintain Airway, Administer oxygen, IV access
Chapter 14: Head injury
1. Physical assessment findings
-Minor injury:
-Vomiting
-Pallor
-Irritability
-Lethargy/drowsiness
-Severe injury: Increased ICP
-Infants:
-Bulging fontanel
-Irritability (usually 1st sign)
-High-pitched cry
-Poor feeding
-Children:
-Nausea/headache
-Forceful vomiting
-Blurred vision
-Seizures
-Late signs:
-Alterations in pupillary response
-Posturing (flexion and extension)
-Decreased motor response
-Decreased response to painful stimuli
-Cheyne-stokes respirations
-Seizures
-Flexion: severe dysfunction of the cerebral cortex
-Extension: Severe dysfunction at the level of the midbrain
2. Nursing care
-Ensure the spine is stabilized until a spinal cord injury is ruled out
-Implement actions to decrease ICP:
-Keep the head midline with the bed elevated 30 degrees, which will also promote venous draining
-Avoid extreme flexion, extension, or rotation of the head and maintain in midline neutral position
-Keep the client’s body in alignment, avoiding hip flexion/extension
-Minimize oral suctioning
-Nasal suctioning is contraindicated
-Instruct the client to avoid coughing and blowing the nose
-Insert and maintain indwelling catheter
-Administer stool softeners to avoid straining
3. Medications
-Mannitol:
-Osmotic diuretic used to treat cerebral edema
-Antiepileptic:
-Used to prevent or treat seizures
-Corticosteroid: dexamethasone
-To help decrease edema
4. Therapeutic procedures
-Craniotomy: to help relieve pressure
5. Complications
-Epidural hematoma:
-Bleeding between the dura and the skull
-Subdural hemorrhage:
-Bleeding between the dura and the arachnoid membrane
-Brain herniation:
-Downward shift of brain tissue
Chapter 15: Cognitive and sensory impairments
1. Visual impairments
-Myopia: Nearsightedness
-Sees close objects clearly, but not objects in the distance
-Hyperopia: Farsightedness
-Sees distant objects clearly, but not objects that re close
-Strabismus:
-Esotropia: inward deviation of the eye
-Exotropia: outward deviation of the eye
-Occlusion therapy:
-Patch stronger eye to make weaker eye stronger
2. Visual screening
-Snellen letter, tumbling E, or picture chart
-Place the client 10 feet from the chart with heels on the 10-foot mark
Chapter 16: Oxygen and Inhalation therapy
1. Metered-dose Inhaler
-Shake the inhaler 5-6 times
-Attach the spacer
-Helps facilitate proper inhalation
-Take a deep breath and then exhale
-Tilt the head back slightly, and press the inhaler
-While pressing the inhaler, begin a slow, deep breath that lasts for 3-5 seconds
-Hold the breath for 5-10 seconds
2. Dry powder inhaler
-DO NOT shake
3. Chest physiotherapy
-Is a set of techniques that includes manual or mechanical percussion, vibration, cough, forceful expiration (or huffing), and breathing exercises
-Helps loosen respiratory secretions
-Schedule treatments before meals or at least 1 hr after meals and at bedtime
-Administer bronchodilator medication or nebulizer treatment prior 4
4. Hypoxemia
-Early signs:
-Tachypnea
-Tachycardia
-Restlessness
-Use of accessory muscles
-Nasal flaring
5. Oxygen toxicity
-Can result from high concentrations of oxygen, long duration of oxygen therapy, and the child’s degree of lung disease
-Hypoventilation and increased PaCO2 levels allow for rapid progression into unconscious state
Chapter 17: Acute and infectious respiratory illnesses
1. Tonsillitis
-Physical assessment findings:
-Report of sore throat with difficulty swallowing
-Mouth odor/mouth breathing
-Fever
-Tonsil inflammation with redness and edema
-Laboratory tests:
-Throat culture:
-For GABHS
-Medications:
-Antipyretics/analgesics: acetaminophen
-Antibiotics: for Tx of GABHS
-Tonsillectomy: for recurring tonsillitis
-Side-lying position after then elevate HOB when child is awake
-Assess for evidence of bleeding:
-Frequent swallowing/clearing the throat
-Avoid red-colored liquids, citrus juice, and milk-based foods
-Discourage coughing, throat clearing, and nose blowing in order to protect the surgical site
-Avoid straws: can damage surgical site
-Alert parents that there can be clots or blood-tinged mucus in vomitus
-Limit activity to decrease the potential for bleeding
-Fully recovery usually occurs in 14 days
2. Croup syndromes
-Bacterial epiglottis (acute supraglottis):
-Expected findings:
-Drooling
-Dysphonia: thick, muffled voice and froglike croaking sound
-Dysphagia
-High fever
-Nursing care:
-Avoid throat culture/putting tongue blade in the mouth
-Prepare for intubation
-Administer ABX therapy starting with IV, then transition to oral to complete a 10-day course
-Droplet isolation precautions for first 24 hr after IV ABX initiated
3. Influenza A and B
-Expected findings:
-Sudden onset of chills and fever
-Body aches
-Antivirals can be given but must be within 48 hrs of onset
-Amantadine, Zanamivir, Oseltamivir
Chapter 18: Asthma
1. Triggers to asthma
-Allergens
-Smoke
-Exercise
-Cold air or changes in the weather or temperature
2. Expected findings
-Dyspnea
-Cough
-Audible wheezing
-Use of accessory muscles
3. Medications
-Bronchodilators: albuterol
-SE: tremors/tachycardia
-Anticholinergics: atropine/ipratropium
-Dries you up
-Corticosteroids: prednisone
-Rinse mouth afterwards
4. How to use a peak flow meter
-Ensure the marker is zeroed
-Close lips tightly around the mouthpiece
-Blow out as hard and as quickly as possible
-Repeat 3 more times
-Record highest number
5. Complications
-Status asthmaticus:
-Airway obstruction that is often unresponsive to treatment
-Prepare for emergency intubation
Chapter 19: Cystic Fibrosis
1. Cystic fibrosis
-Both biological parents carry the recessive trait for CF
-Characterized by mucus glands that secrete an increase in the quantity of thick, tenacious mucus, which leads to mechanical obstruction of organs
2. Expected findings
-Early manifestations:
-Wheezing, rhonchi
-Dry, nonproductive cough
-Increased involvement:
-Dyspnea
-Paroxysmal cough
-Obstructive emphysema and atelectasis on chest x-ray
-Advanced involvement:
-Cyanosis
-Barrel-shaped chest
-Clubbing of fingers and toes
-GI findings:
-Large, frothy, bulky, foul-smelling stools (steatorrhea)
-Failure to gain weight or weight loss
-Delayed growth patterns
-Distended abdomen
-Thin arms and legs
-Deficiency of fat-soluble vitamins (Vitamin A,D,E,K)
-Integumentary findings:
-Sweat, tears, and saliva having high content of sodium and chloride
3. Diagnostic procedures
-Sweat chloride test (most definitive)
4. Nursing care
-Chest physiotherapy
-High protein/calorie
-Give pancreatic enzymes within 30 min of eating a meal or snack
-Multivitamin A,D,E,and K
5. Medications
-Bronchodilators: albuterol
-Anticholinergics: ipratropium bromide
-Dornase alfa (pulmozyme): decreases viscosity of mucus and improves lung function
Chapter 20: Cardiovascular disorders
1. Defects that INCREASE pulmonary blood flow
-Ventricular septal defect (VSD):
-A hole in the septum between the right and left ventricle that results in increased pulmonary blood flow (left-to-right shunt)
-Expected finding:
-Loud, harsh murmur at the left sternal border
-Atrial septal defect (ASD):
-A hole in the septum between the right and left atria that results in increased pulmonary blood flow (left-to-right shunt)
-Expected findings:
-Loud, harsh murmur with a fixed split second heart sound
-Patent ductus arteriosus (PDA):
-Connection between pulmonary artery and aorta stays open after birth causing mixing of blood
-Expected findings:
-Murmur (machine hum)
-Bounding pulses
2. Defects that DECREASE pulmonary blood flow
-Tricuspid atresia:
-A complete closure of the tricuspid valve that results in mixed blood flow
-Tetralogy of Fallot:
-Pulmonary stenosis, right ventricular hypertrophy, overriding aorta, and ventricular septal defect (PROV)
3. Obstructive defects
-Pulmonary stenosis:
-A narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles
-Expected findings:
-Systolic ejection murmur
-Aortic stenosis:
-A narrowing of the aortic valve
-Coarctation of the aorta:
-A narrowing of the lumen of the aorta
-Expected findings: (BP/pulse elevated on top, but not on the bottom)
-Elevated blood pressure in the arms
-Bounding pulses in the upper extremities
-Decreased blood pressure in the lower extremities
-Cool skin of lower extremities
-Weak or absent femoral pulses
4. Mixed defects
-Transportation of the great arteries: [Show Less]