Growth is an increase in
physical size
Development
is an increase in capability or function
-development does not always follow growth and
... [Show More] chronological age
-chronological age and developmental age are two different things
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Cephalocaudal development is development that moves from the...
head downward through the body and towards the feet
Proximodistal development is development that moves from the...
center of the body outward to the extremities
Define play...
play is the "work" of children
-it is how they learn new things. socialize and learn to use coping skills
-in addition to growth and developmental level, you must also think about the client's disease when choosing toys
-for children with a heart defect, you would not give them something to do that will excite and increase their heart rate because that would increase the workload on the heart and we NEVER want to increase the workload on the heart of a client with heart disease
You are taking care of a 5 month old baby. What toy is most appropriate for an infant?
rattle- working on grasp reflex
When a baby is born, they have... grasp reflex
involuntary
You are caring for an 11 year old boy in the hospital. What would be an appropriate activity for him?
-playing video games in the room
-coin collecting
-watching TV
-reading his favorite book
When does the anterior fontanel close?
12 to 18 months
When does the posterior fontanel close?
2 to 3 months
Why are new foods introduced to infants one at a time?
allergies, and they also have immature GI tracts
Why are peanuts so dangerous when aspirated?
when peanuts are wet, they will swell and crumble
-dangerous for airway, hard to remove and allergy risk
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When giving an IM injection why is the ventrogluteal muscle contraindicated in children who have not been walking for at least a year?
the ventrogluteal muscle is not developed well enough
When viewing the auditory canal in the young child how is the earlobe positioned?
down and back
-bigger they are, harder you pull
What are the most common reason for failed toilet training?
they are not ready
-never make toilet training punishable
-takes boys longer
How many cups of milk should a 15- month old toddler consume daily?
2 to 3 cups
At what age does the best friend stage occur?
9 to 10 years
What are the leading causes of death from accidental injury in infants up to 1 year of age?
suffocation, motor vehicle related injuries, and drowning (bathtub or small amount of water)
-falls are leading cause of ER visits
Car seat safety: general guidelines
-do not place car seat in the front passenger side of the car because of airbags
-place infants <20 pounds in the middle of the back seat in the rear-facing, semi-reclined car seat; this provides the best protection for their heavy head and weak neck
-in children 12 to 23 months of age, a convertible car seat for age and weight is recommended and can be positioned facing forward
-car seats should be used, regardless of age, until the child weighs at least 30 pounds
-never place padding under or behind an infant or child in a car seat (during car crash padding can become compressed leading to slack in the harness)
-booster seats can be used for children 4 to 8 years
Hyperthermia and car seat safety
-can occur from being left in a vehicle in hot weather (greater than 80 degrees)
-develops rapidly because infants are not able to regulate their body temperature
-forgetting to get infants out of the car has been related to busy schedules, distractions such as cell phones and other mental preoccupations
Between ages 6 and 12, what is the major cause of severe accidental injury?
motor vehicle accidents
-helmet safety
Teach stranger safety...
including not talking or texting to anyone they don't know on the internet, social media sites, or phone
What happens to the growth rate between 6 and 12 years?
decreases
A school age child requires, on average, how many calories per day?
2400 calories
How much earlier do girls experience the onset of adolescence than boys?
about 1 to 2 years
What is the first step in collecting vital signs or an assessment?
always begin with observation
Distraction techniques
-used to make sure we are getting most accurate set of vital signs (pen lights, age appropriate toys, stickers)
-don't forget to talk to the parents, even before you talk to the child. You need a trusting relationship with them
Order to obtain vital signs
-least invasive first
-observe before touching or even talking to them
-progression of obtaining vital signs: respiration, heart rate (done at same time), blood pressure, temperature
-in infants and toddlers, always count RR and HR for one full minute because of irregularities due to their immature nervous system regulation
-if vital signs cannot be taken without disturbing the child, then record the behavior with the measurements
Rectal temperature
considered the most reliable route for measurements in infants and children
-do not get rectal temperatures on newborns, it is too risk to perforate the anus
-contraindicated in any child who has diarrhea, rectal lesions, is receiving chemotherapy, is immuno-suppressed, or has no rectum
No rectum known as?
imperforated anus or anorectal malformation
Axillary temperature
may be done in all ages when an oral route is not possible
Oral temperature
start at age 5 to 6 years, child is more likely to cooperate at this age
Tympanic temperature
all ages, less sensitive for children less than 3 years of age
Testing Tip
always note when the temperature was taken
DO NOT add or subtract a degree
Oxygen saturation
used to obtain a "picture" of the blood oxygen level through the skin
-check perfusion, skin temperature, and edema to determine best location for the sensor probe; also consider the child's activity level
-common sites are fingers and toes
-the oxygen saturation on the oximeter display should correlate with the child's radial pulse
Communication for newborns (birth to 1 month)
-primary mode of communication is nonverbal
-they express themselves through crying
-respond to human voice and presence
-touch has a positive effect
-nursing strategy: encourage parent to touch infant
Communication for infants (1 month to 12 months)
-communication is still primarily nonverbal
-begin verbal communication with vocalizations, starting with repeating consonants
-communicate through crying and facial expressions
-attentive to human voice and presence, but minimal comprehension of words
-responds to touch through patting, rocking and stroking
-nursing strategy: speak in gentle-toned voice, cuddle, pat, rub to calm, and encourage the presence of parents
Communication for toddlers and preschoolers (1 to 5 years)
-evolving verbal skills
-use of language to express thoughts
-children ages 3 to 4, form 3-4 word sentences, called telegraphic speech
-concrete and literal thinking; may misinterpret phrases
-vocabulary depends on development and family's use
-may ask a lot of questions (preschooler); ask "why" to everything
-short attention span
-limited memory
-cognitive development: egocentric, magical thinking, animism (thoughts of toys behaving like humans), object permanence (objects still exist when child can't see them)
-nonverbal communication: express themselves through dramatic play and drawing, play is work of the child
Communication of the school-age child (6 to 12 years)
-cognitive development: able to use logic, begin to understand others points of view, begin to understand cause and effect, developing and understanding of body function
-verbal communication: big vocabulary, receptive and expressive language is more balanced, misinterpretation of phrases is still common
-nonverbal communication: can interpret nonverbal messages, expression of thoughts and feelings
Communication of adolescents (13-18 years)
-abstract thinking without full adult comprehension
-interpretation of medical terminology is limited
-strive for independence
-trust and understanding build rapport
-need privacy
-nursing strategies: straightforward approach; talk in private area, conduct at least part of the interview without parent present
Communication with children with physical or developmental disabilities
-if unable to communicate, may feel helplessness, fear, or anxiety
-family may experience fear and anxiety
-nursing strategy: use gestures, picture boards, writing tablets, use a system of head nods, eye blinks
What are observable signs of respiratory distress in children?
-use of accessory muscles
-nasal flaring
-sternal retractions
-grunting with respiration
-any illness that affects the lungs ability to get oxygen in and carbon dioxide out will cause respiratory distress
-illnesses that can cause respiratory distress include pneumonia, atelectasis, pneumothorax, and plural effusion
-the amount of respiratory distress depends on the degree of airway disease
What is laryngotracheobronchitis?
-a viral infection that can result in: slight to severe dyspnea, barking or brassy cough, and elevated temperature
-commonly known ans croup
-viral organisms responsible for croup include: parainfluenza, adenovirus, and RSV
-sound like a barking seal
Treatment for LTB:
-manage children at home with mild croup; at home most episodes can be treated with:
---steam from hot showers
---cool temperature therapy: cold air outside, open freezer --> helps constrict the swollen blood vessels in the trachea that are causing swelling (opens up airways)
-if symptoms worsen or there is no improvement:
---nebulized epi or corticosteriods may be prescribed by the primary healthcare provider or administered in the emergency department
-nebulized epi has a rapid onset; generally see improvement in 10 to 15 minutes; always watch for a relapse and return of symptoms when epi wears off
What is epiglottis?
-a serious obstructive inflammatory process: there is absence of a cough, presence of dysphagia, drooling, and rapid progression to severe respiratory distress
-primary organism cause: H-flu
-prevention: Hib vaccine
-caused by infection of the epiglottis, can lead to partial or full occlusion of the airway
-considered a medical emergency
-look worse than they sound, the less noise they make, the worse they airway obstruction
-never try to visualize the throat or tongue with a tongue depressor
-help children remain comfortable
What is RSV?
-leading cause of lower respiratory tract illness in children less than 2 years of age, caused by an acute viral infection that affects the bronchioles
-can be life threatening in infants
Risk factors for RSV
-prematurity
-congenital disorders; like congenital heart defects
-smoke, in any form
-in premature infants and those with congential disorder, the focus is on prevention; this includes avoiding sick contacts and immunization with the RSV vaccine (Synagis, RespiGam)
Signs and symptoms of RSV
-begin with simple URI
-nasal discharge
-mild fever
-wheezing
-nonproductive paroxysmal cough
-tachypnea with flaring nares
-dyspnea and retractions
-know the onset of signs/symptoms, because RSV will become worse at days 2 to 3 and can progress to life threatening respiratory distress
HINT
signs and symptoms can range from mild to severe; can progress from a simple cough and runny nose to copious amounts and mucous, to severe respiratory distress
Treatment of mild RSV
treat symptoms (supportive care: antipyretics)
Treatment for severe RSV
-IV fluids
-albuterol sulfate (Proventil) (may not be very effective)
-antipyretics
-suction
-oxygen: may need to intubation and mechanical ventilation
What is pneumonia?
disease marked by inflammation of the lungs
-causes can be bacterial, viral, fungal, or aspiration of a foreign substances
Signs and symptoms of pneumonia
-the same as generalized respiratory distress
-fine crackles or rhonchi, with a cough that is either productive or non-productive
-decreased or absent breath sounds over the affected lung fields
-chest pain
-back or abdominal pain
-fever, usually very high
Treatment of pneumonia
depends on the type of pneumonia
-first priority is always ABC's
-oxygen
-plenty of fluids to keep them hydrated
-antibiotics for bacterial pneumonia, supportive care for viral
-supportive care: hydration, antipyretics, and nebulizers
***childhood vaccines help prevent the most common types of bacterial pneumonia. encourage parents to have their children vaccinated!
What is cleft palate/ cleft lip?
an orofacial defect that affects the oropharynx and increases the risk of malnutrition and aspiration
-these defects occur during fetal development
Treatment for a cleft palate, pre-op
-infants must be fed with an elongated nipple or medicine dropper down the side of the mouth to prevent aspiration
-burp frequently because they swallow lots of air--> anytime a baby is swallowing a lot of air, it puts them at risk for abdominal distention, and abdominal distention puts them at risk for vomiting and aspiration
If a baby is born with both a cleft lip and palate, which problem do they correct first?
the cleft lip
-repairing the cleft lip assists with feeding and promotes parental bonding
Treatment for cleft palate, post-op
-the goal is to protect the suture line
-position the child supine or side-lying following a cleft lip repair
-do not place in the prone position
-with a cleft palate avoid putting hard or rough foods or utensils in the child's mouth; you do not want anything that will disrupt the suture line; soft diet until well healed
When is the best time for a cleft palate repair to be done?
-before speech develops, usually between ages 1 and 2 years of age
What is gastroesophageal reflex or GERD?
A disorder characterized by a backwash or reflux of gastric contents into the esophagus
-GERD is the chronic form of GE reflex
-with both, you have the risk for aspiration of gastric contents into the lungs, which can lead to pneumonia
Treatment/positioning for GERD
-use upright position with feeding and for 30 minutes after
-upright position, along with frequent burping during feedings comprise what's known as reflux precautions
-can thicken formula to make it better tolerated
What is pyloric stenosis?
the disorder results in projectile vomiting during or after feeding
Signs and symptoms of pyloric stenosis
-on assessment of the abdomen, it's possible to feel an olive shaped mass in the epigastric region, near the umbilicus--> this is the enlarged pylorus
-projectile vomiting, because there is pressure behind the vomitus
Diagnosis of pyloric stenosis
abdominal ultrasound
Treatment for pyloric stenosis
-hydration and electrolyte replacement
-intake and output
-monitor urine specific gravity to assess hydration status
-daily weights
-surgery
What is intussusception?
name for the condition where a piece of the bowel telescopes in on itself forming an obstruction
Signs and symptoms of intussusception
-sudden onset
-cramping and abdominal pain
-drawing up of knees
-inconsolability
-episodes of pain
-classic symptom: currant jelly stools (texture with blood and mucous)---> sometimes an air contrast, barium, or ultrasound guided saline enema can be done. the pressure of the edema going through the bowel with these procedures will push out the telescoped area
-monitoring the stools closely (can lead to bowel perforation)
-after enema or surgery they skill keep them in the hospital for several days because it might occur again
What is Hirschprungs disease?
a congenital anomaly also known as aganglionic mega colon, that results in a mechanical obstruction
-usually affects the sigmoid colon
Signs and symptoms of Hirschprungs disease
-the presenting symptoms is constipation
-no nerves: no peristalsis in that section of colon
-abdominal distention
-ribbion- like stools that have a foul smell
Treatment of Hirschprungs diease
surgery to remove the portion of the bowel that is diseased
What is head lice?
this is a common problem in which the main symptoms is scalp itching
-lice can spread to other parts of the body besides for the head
-direct contact with lice or nits is how it is spread
Treatment for head lice
-antiparasitic medications
-will often need re-treatment
What are pin worms?
the primary symptoms of this condition is intense rectal itching often manifested by:
-general irritability
-restlessness
-poor sleep
-bed wetting
-distractibility
-short attention span
How are pin worms spread?
hands to mouth--> playing outside without washing hands
-the whole family should be treated
How doe you collect a pin worm specimen for diagnosis?
tape test
-tape to rectum, early in morning before first bowel movement
Treatment for pin worms?
-mebendazole (Vermox): 1 die usually repeated in 2 weeks
-good hand washing
-keep fingernails short
What is infectious mononucleosis?
this is an infectious disease commonly known as the "kissing disease"
Signs and symptoms of mono
-sore throat
-fatigue
-swollen lymph nodes
-liver and/or spleen enlargement
What virus causes mono?
Epstein-Barr virus, spread through direct intimate contact (water fountain)
Treatment for mono
-rest, analgesics, increased fluids, and good nutrition
-the spleen will be enlarged; limit participation in contact sports to prevent injury
What is tonsillectomy and adenoidectomy?
this surgical procedure is frequently performed for children with recurrent upper respiratory infections or obstructive sleep issues
How should a client be positioned after a tonsillectomy?
-place on their side and elevate head of the bed
-they may also be placed in the prone position
-the purpose of all of these positions is to prevent aspiration
Why are brown and red fluids not given post op tonsillectomy?
we do not want anything to be confused with blood
What would indicated hemorrhaging is occurring post op tonsillectomy?
frequent swallowing
How many days post-op tonsillectomy is the client at risk for hemorrhage?
-up to 10 days
-why? the scabs on the surgical sites will begin to slough off at 7 to 10 days, no chips or rough foods for several days
Common complaints post-op tonsillectomy?
sore throat and a slight ear pain (too much ear pain = infection)
-low grade temperature
-bad breath = old blood in throat
-bad breath may also be the sign of a foreign body in the nose
-the bad breath is caused from infection in the area, the treatment is to remove the foreign body
What is otitis media?
this is an infection of the middle ear characterized by a building, bright red, tympanic membrane and is usually preceded by an upper respiratory infection
-fluid or puss behind the ear causing pressure--> building--> could lead to ruptured membrane--> hearing loss or infection
Treatment for otitis media
-careful use of antibiotics
-avoid chewing; they need soft foods
-teach parent that the child may not be able to hear them well
-avoid smoke of any kind
-may require tympanostomy tube, or PE (pressure equalizing) tubes; these keep the middle ear drained; they are temporary and when they fall out, it is okay
-if the have PE tubes in their ears, they must wear earplugs in the bathtub or when swimming (anytime there is a risk of getting water in the ears)
Prevention of otitis media
-have baby sitting up for feedings
-no bottle propping
-gentle nose blowing (forceful can push germs into tubes)
-play "blowing" games with upper respiratory infections--> keeps middle ear clear
-avoid smoke of any kind
What is cystic fibrosis?
this is a genetic disease that involves symptoms related to the exocrine glands and commonly involves both the GI system and the respiratory system
-pancreatic enzymes must be given to help improve digestion with every meal and every snack; take within 30 minutes of eating, and the beads should not be crushed or chewed
-nutrition is a major concern; usually underweight from digestive problems; must be on a well-balanced, high fat and high calorie diet
Signs and symptoms/ diagnosis of CF
-steatorrhea is the term for fatty, frothy stools seen in clients with CF; the stools have this appearance because client has such a poor intestinal absorption
-have trouble absorbing fat soluble vitamins, because they do not absorb well; require the water- miscible forms of fat soluble vitamins to improve absorption; these are available in a multi-vitamin form, sometimes referred to as ADEKs
-the sweat chloride test is the diagnostic test for CF--> parents will kiss baby and the baby tastes salty, hyponatermia
-The earliest sign in a newborn with CF is a meconium ileus --> with CF the mucous secretions are thick and sticky, which makes the stool too thick and sticky to pass
-CF is an inherited disease, but you mUST get the gene from both parents. this makes it an autosomal recessive disorder
-intense pulmonary therapy everyday to loosen respiratory secretions
What are the fat soluble vitamins?
A,D, E and K
What is down syndrome?
the is the most common birth defect in the United States, and is also known as Trisomy 21
-advanced maternal age increases the risk of having a baby with down syndrome; the primary aim in genetic counseling is to inform the parents of their risks
What type of infections are down syndrome children most prone to developing?
respiratory infections because they have a poor immune system
What is the most common type of physical defect associated with Down Syndrome?
congenital heart defect
What is celiac disease?
this is a genetic disorder causing malabsorption due to an intestinal intolerance to gluten
Treatment for celiac disease?
-teach that it is a lifelong disorder
-no food with gluten (vegetable proteins)
-they cannot have BROWN: barley, rye, oats, and wheat
-can have RCS: rice, corn, and soy
What is sickle cell disease?
this is a hereditary form of anemia in which the normal hemoglobin is partly or completely replaced by abnormal hemoglobin and sickle-shaped RBC's
Signs and symptoms of sickle cell anemia?
-pain in the areas of involvement
-anorexia (loss of appetite)
-exercise intolerance
-fatigue, malaise
Sickle cell crisis
decreased blood flow--> decreased oxygen--> pain
Treatment of sickle cell
-bed rest
-hydration: push apart sickle cells and improve circulation
-analgesics
-antibiotics
-blood transfusions
-oxygen: beneficial if hypoxic, prevents further sickling
-hydroxyurea
What is Duchenne Muscular Dystrophy?
This is the most common and severe muscular dystrophy of childhood and is inherited as a X- linked recessive trait
-is specific to male children because it is X - linked recessive trait; the age of onset is early childhood; typically ages 3 to 5 years old
Signs and symptoms of Duchenne Muscular Dystrophy?
-lordosis (curvature of lower spine)
-waddling gait
-frequent falls: weakness in the muscles
-toe walking
-Gower sign: climbing sign of DMD; climbing or walking up one self to get into standing position
Treatment for Duchenne Muscular Dystrophy?
-maintain optimum muscle function with physical therapy
-prevent contracture
-steroids may help improve muscle strength and respiratory function
-support groups and palliative care as disease progresses
What are Tet spells?
these are "hyper cyanotic" spells are seen in children with the congenital heart defect of Tetralogy of Fallot
-caused my insufficient blood flow to the lungs
Treatment for hyper cyanotic tet spells?
-put infants in the knee-chest position--> this decreases venous return from the lower extremities (the desaturated blood) and increases systematic resistance which diverts the blood to the pulmonary artery for oxygenation
-100% O2
-morphine for sedation
-monitor cardiac output
Prevention of Tet spells
-quiet play
-minimize stress
-respond to crying quickly (beating down in chest, increasing pulmonary resistance)
-heart failure in infants and small children is usually due to congenital heart defects
Congenital heart defects
congenital heart defects are a structural defect of the heart or great vessels that is present at birth
What are urinary tract infections?
these are a very common, but potentially serious infection, that occurs most often in children 2-6 years of age, with a greater risk in females
Signs and symptoms of UTI's under 2 years of age
-in newborns and children less than 2 years, the signs and symptoms may be nonspecific- may even seem to be a GI problem
-failure to thrive
-feeding problems
-vomiting and diarrhea
-if left untreated, renal tissue may be destroyed and scarring can occur, can lead to kidney failure
-tendency for infections to re-occur, so family teaching is very important (symptoms + foul smelling urine)
Causes of UTI?
-renal anomalies
-constipation
-bubble baths
-poor hygiene
-pin worms
-sexual activity- including sexual abuse
Why are girls more prone to UTIs than boys?
the female urethra is about 1 1/2 inches long at maturity, but it's only 3/4 inch long in young females; it provides a ready pathway for micro-organisms to invade
Signs and symptoms of UTI over the age of 2
-classic symptoms of UTI are seen in children greater than 2
-frequnecy
-dysuria
-fever
-flank pain
-hematuria
-foul smelling urine
Diagnosis of UTI
-requires a properly collected urine specimen
-most accurate method is catheterization [Show Less]