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ADHD

• This is one of the most common mental disorders affecting children
• Considered as a chronic and debilitating disorder
• Impacts the individual in many aspects of life: academic & professional achievements, interpersonal relationships, and daily functioning
• It can lead to poor self-esteem and social function in children when not appropriately treated
• It is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork
• More common in boys
• Boys tend to have hyperactivity and other externalizing symptoms
• Girls tend to have inattentive type

Diagnosis of ADHD

• Requires the presence of persistent symptoms that have occurred over a period of time and are noticeable over the past 6 months
• Symptoms must be present before an individual is 12 years old
• Symptoms must have caused difficulties in more than one setting

Types of ADHD

• Inattentive Type
• Hyperactive-impulsive type
• Combined type

Inattentive Type

• A person does not pay close attention to details or makes careless mistakes in school or job tasks
• They have problems staying focused on tasks or activities
• They don't seem to listen when spoken to
• They do not follow through on instructions and don't complete schoolwork, chores, or job duties
• They have problems organizing tasks and work
• They avoid or dislike tasks that require mental effort
• They often lose things needed for tasks or daily life
• They are easily distracted
• They forget daily tasks

Hyperactive Impulsive Type

• A person fidgets with or taps hands and feet and squirms in their seat
• They are not able to stay seated
• They run about or climb where it is inappropriate
• They are unable to play or do leisure activities quietly
• They're always on the go
• They talk too much
• They blurt out an answer before a question has been finished
• They have difficulty waiting for their turn
• They interrupt or intrude on others

Causes of ADHD

• Genetics
• Low birth weight
• Premature birth
• Exposure to toxins during pregnancy
• Extreme stress during pregnancy

Treatments for ADHD

• Behavioral therapy
• Parent-Child Interaction Therapy
• Medication
• Pyschostimulants are first Line Drug
• Amphetamines, the only FDA approved medication
• Methylphenidate Ritalin is helpful if behavioral intervations prove insufficient

Amenorrhea

• Absence of menses

Primary Amenorrhea

• Absence of secondary sex characteristics and no uterine bleeding by 14-15 years of age
• Absence of uterine bleeding with secondary sex characteristics by 16 to 16 1/2 years of age
• No uterine bleeding after sexual maturity rating 5 or after breast development for 4 years Primary amenorrhea etiology may be anatomic, hormonal, genetic, or idiopathic
• Thorough history and physical exam will provide clues to etiology

Secondary Amenorrhea

• Defined as absence of menses for 6 months or atleast 3 menstrual cycles established previously
• Irregular menstrual cycles = common in the 1st year or 2 after menarche
• Early cycles maybe anovulatory resulting in regular, irregualr, or absent breeding
• Cycle lengths greater than 90 days are rare and should be investigated
• Girls with later onset of menarche will take longer to establish regular ovulatory cycles
• Pregnancy is the most common cause of secondary amenorrhea
• Other causes include hyperandrogenism, and exercise- induced amenorrhea

Autism

• Complex neurological disorder that affects the functioning of the brain
• Typically appears in the first 3 years of life
• The spectrum of disabilities ranges from mild to severe
• Characteristics of autism include:
  • Impairment in social interaction
  • Impairment in communication
  • Restricted or repetitive patterns of behavior, interests, and activities
• It was first described by Leo Kanner in 1943
• Kanner called the syndrome "early infantile autism"
• It was also often misdiagnozed as childhood schizophrenia
• Early psychologists thought children became autistic due to "cold and unnurturing" mothers
• This theory was proven false in 1979
• It is classified as a delevopmental disability
• Occurs mostly in males in ratio of about 4:1
• Happens in approximately 1 out of 250 births
• has a 10-17% annual growth rate
• It remains throughout the individual's lifetime
• Symptoms can lessen with proper intervention

More Facts About Autism

• Found throughout the world
• There is no cure but research is being done
• Educational treatment is the most effective
• It is linked to:
  • Genetics ex fragile x syndrome
  • Recurrence if 1 child is affected
• Impairment in social interaction
• Impairment in communication
• Restricted or repetitive patterns of behavior, interests, and activities
• Unfavorable events such as uterine bleeding, induced labor, prolonged labor, hyperbilirubinemia

Manifestation of Autism: Skills

• Social skills manifest as:
• Deficits or differences
• Lack of awareness of the existence or feelings of others
• Aloof and distant from others
• Does not seek opportunities to interact with others
• Fails to produce appropriate facial expressions to certain occasions
• Unwillingness to engage in cooperative play
• Appears not to listen when spoken to

Manifestation of Autism: Communication

• Difficulties in using and understanding both verbal and non verbal language
• Failure to intitate or sustain conversation
• May echo words
• Abnormalities of pitch
• Uses screaming, crying, tantrums, aggression
• Repeating words instead of normal language
• Has difficulty with change in environment and routine

Manifestation of Autism:Behavior

• Unusual and repetitive movements of the body that intefere with the ability to attend to tasks OR activities
• Laughing, crying, distress with no apparent reason
• Marked distress over changes in trivial events
• Does not seek opportunities to interact with others
• Unreasonable insistience on routines

Early Autism Symtoms

• Symptoms appear between birth and 18 months
• Feeding problems- ex: no nursing skills
• Little desire to be held or cuddled or apathetic and unresponsive
• In absence of crying
• Repetitive movements like hand shaking
• Sleeping problems or wants to be left alone

Autism Symptoms Between 18 Months to 2 Years

• Difficulties in toilet training, speaking, or loss of speech
• Only few hours of sleep

Other Common Characteristics of Autism

• Unresponsive to normal teaching methods
• Seems deaf
• Overly sensitive to pain.
• No fear of real danger.
• Uneven gross and fine motor skills.
• May have attachment objects.
• Noticeable physical over-activity or extreme under activity
• Seems to "tune out" Doesn't play with toys or have prolonged tantrums
• May use an adults arm to do tasks or not interact with others

Diagnostic Criteria for Autism

To be diagnosed:

• A total of six or more items from (1), (2), & (3), with at least two from (1), & one each from (2) and (3):
• Qualitative impairment in social interaction
• Lack of multi nonverbal behaviors such as face.
• Failure to develop peer relationships appropriate to developmental level.
• Lack of emotional reciprocity or a lack of spontaneous sharing

Autism - Manifestations in Communication

• Delayed speech and marked impairment in the ability to initiate or sustain a conversation
• Stereotyped motor mannerisms complex whole body movements
• Delays or abnormal functioning in at least 1 of the following area with onset of before age 3 years
• In use of social communication or imaginative play and not better accounted by Rhett's disorder or childhood disintegrative disorder.

Autism Prognosis and Treatment

• Autism is usually a severe disabling condition
• Some children improve with language
• Will need lifelong adult supervision.
• aggravation of psychiatric symptoms occurs in about half of the children during Adolescence.
• girls have the tendency for continued deterioration
• Educational practices should focus on communication skills, behavior, functional academics,gross and fine motor skills social and leisure skills, vocational and independence and structure routine and organization.
• Assessment in hospital, obtain information from the family in routines, child skills and question about family support

Autism: Best Nursing Practices During Hospital Stay

• Determine best way to communicate for the client
• Nurses should speak calmly in short phrases, allowing time between instructions.
• Hyperactive is a safe consistant environment away from unpredictable behavior
• Hyper active children should wear padded weighted vests
• Social stories and comic story conversations protect from bullying
• Haloperiodol and thiordiazine can prevent behaviors, and ssri can reduce aggression..

Nursing diagnosis of Autism

• Risk for injury
• Impaired verbal communication
• Impaired social interaction
• Caregiver role strain

Burns

• Occurs when there is injury to the tissue of the body caused by heat, chemicals, electric current, or radiation
• 2nd leading cause of accidental deaths in childhood
• Burns from hot liquid are most common in children younger than age 3
• Electrical burns are common in toddlers and adolescents
• Risk factors for burns are low socioeconomic status and single parents
• Calculation of Burn Area is performed using Lund and Browder Chart (TBSA)

Burn Severity

• Minor burn - 10% TBSA, 1st & 2nd degree burn
• Moderate burn 10%-20% TBSA, 2nd degree burn
• Major burn - 20% TBSA, 2nd degree burn
• All 3rd degree burns greater than 10%, depending on age of child
• all burna involving hands,face ,eyes, ears,feet and genitals.
• All major burns injuries involving fractures _All poor risk patients with head injuries

Burn Wound Assessment and Complications

• First degree - pink to red, slight edema
• 2nd degree (Partial thickness)- pink or red with blisters
• edematous, weeping and elastic, wound moist and painful, hair does not pull out easily
• reddened areas blanch on pressure, yellowish, sensitive to touch and cold air.
• 2nd degree - full thickness
• destruction of epithelial cells
• reddened areas do not blanch
• -not painful and inelastic
• -Color caries from waxy white to brown
• -Destruction of epithelium, fat, muscles, and bone Major Complications:
• Acute infection, -sepsis, pneumonia, UTI,Shock, phlebitis, Curling's ulcer, Paralytic lleus, Renal failure
• CNS dysfunction, Anemia, Malnutrition, depression and death

Burn Management

• G & D delays, Scarring, disfigurement, contractures, Psychological trauma
• Fluid Resuscitation - PLR IS used as an isotonic solution
• Burn maybe treated by open or closed.
• Hydrotherapy/ whirlpool bath- is used cleaning wound with isotonic saline solution..
• Debridement is the removal of dead or damaged tissue.
• Skin grafting Allografting and Autografting Topical threrapy of -Silver Sulfadiazine - drug of choice Escharotomy -cut into eschar.
• Bacitracin Opthalmic Ointment-use if child's affected to prevent conjunctivitis

Nursing Actions For Burns

Priorities of Care

• Obtain history of the burn
• Obtain a Fluid balance
• The Wound and signs of infection Assess the level of comfort and emotional status
• Decreased cardiac output -Use a high oxygen environement to combat hypoxemia
• Monitor for respitory distress and apply 02
• Imbalanced nutrition
• High calioric intake and protein

Cerebral Palsy

• Comprehensive diagnostic term used to designate a group of nonprogressive disorders resulting from malfunction of the motor centers and pathways of the brain
• It is generally characterized by paralysis, weakness, incoordination, or ataxia.
• Occurs in approximately 2 per 1,000 live births
• Major cause of disability among children

Causes of Cerebral Palsy

• Prenatal factors
  • Infection due to rubella, toxoplasmosis
  • herpes simplex, and cytomegalovirus.
  • Maternal anoxia, anemia, placental infarcts, abruptio placentae.
  • Prenatal cerebral hemorrhage, maternal Rh or ABO incompatibility.
  • Prenatal trauma or injury
  • Genetic factors
  • Toxins and drugs
• Perinatal Factors • Anoxia from any cause such as Anesthetic and analgesic Prolonged labor or previa • Cerebral trauma during birth
• Postnatal factpors
• Head Trauma, infections (meningitis and encephalitis)
• Vascular incidents or issues

Classifications of Cerebral Palsy

• Spasticity: 40%-50%; usually appears by age 6 months • Persistent primitive reflexes; delay of normal posture control, spastic paresis • Arms pressed against body with forearm bent at right angle and hand flexed against forearm; in milder cases, fingers overextended and rotation of wrist on reaching • Legs usually more involved than arms, but may be less involved. • Mild cases: wide-based gait walking , Moderate cases: slow and labored movements walking jerky; balance poor • Severe cases: unable to sit or walk
• Dyskinetic (extrapyramidal) coordination and movements are affected Dysthnesia Athethoid 20%-25% accentuated by emotional stress
• Involuntary activity known as athetosis jerky, writhing and irregular walk with incoordination
• Ataxia - 1%-10%Improvement when well rested and calm Difficulty achieving and maintaining balance, motor incoordination; gait and nystamus
• A Mixture of different types the most common mix spastic and Athetoid

Diagnosing Cerebral Palsy

Hemiplegia (35%-40%) Limited to one side of the body,Arm usually involved more than leg.

• Diplegia (10%-20%)-Parts of both sides of body legs usually involved more than arms
• Paraplegia (10%-20%) -only legs involved Quadriplegia (15%-20%) four extremities involved, equally
• Monoplegia (rare) -Only one extremity involved
• Triplegia (rare) - Three extremities involved Classified by Degree of Severity-Mild - fine precision movement is impaired
• moderate-gross and fine movements and speech impaired
• Severe-no usual activities of living (walking) Common associated findings include
• Seizures, Hearing problems. Visual defect, Mental retardation , Language, Growth disorders, reflux
• Early signs: asymmetrical movements., irritability,Difficulty in feeding, high-pitched early . Later signs includes Failure to normal development, Persistence of infantile reflexes Weakness Preferences for one hand

Correction or alleviation of specific neuromotor deficits by:

Administration of antispasticity medications dantrolene diazepam

• Administration of medications the ReglanOrthopedic of scoliosis
• Selective dorsal rhizotomy surgical section of nerve in an attempt to decrease activity Family's role in rehabilation key to success

Nursing Care For Cerebral Palsy

• Assessment
• Function to perform daily activities Development tool
• Nutritional status
• Neuromuscular function and mobility
• Speech vision, parents compliance Nursing Goal: Establish Locomotion, prevent deformity and promote self help Fatigue intervention
• Encourage sitting and walking at age
• Apply and help with braces and carry on therapies to strengthen

More Info On Helping Children With Cerebral Palsy

• Aid with activities, unimanual
• Prevent physical injury
• Ensure safe environment
• Use toys that can allow maximum function
• Use restraints in the vehicle, watch the patient and assess the family

Colic

• Colic - all fussy babies will not suffer. Most infants
• They normally cry 2 -3 hours aday
• *Risk factprs- abdominal discomfort digestions high intential hormones such as formula or breast milk or overfeeding. Immature digestion systems stimulation and anxiety

Steps to Understand Colic Symptoms

• Paroxysm - a sudden outburst
• Paroxysmal Crying
• When does it start. Infant
• When does it stop- temperament for 3 hours.
• Do they use a screaming cry with screams or crying, and what are the behavior symptoms like

Diagnosing and Treating Colic

• Must assess timing Current diet, any allergies

• Teach to carry a specific way

• Medical- Change to Casein. A breastfeeding mom must avoid all food allergens. Medications like anti gas

Nursing Interventions

• The goal is provide balanced diet

• give extra calorie
• Monitor child's weight give vitamin • Promote general health •
• Provide a family
• Regualr health
• Dental care • Early intervention provide comfort and support for their child.

Dysmenorrhea

• Signs and symptoms- Cramping,abdominal, a backache and leg ache
• It is painful menses not related to any pelvic disease
• The point begins with menstrual flow EToilogy is debate
• Clearly related to egg cycles, it is over production of prostaglandin is an overproduction of tissue
• Therapeutics- NSAIDS. But if a parent is throwing up then consider 1 or 2 days before the onset
• Cyclic estrogen therapy and oral contraceptives as well

Alternative options for Dysmenorrhea Treatment

• Simple exercises pelvic rocking and breathing
• Adequate personal hygiene may help decrease stress in diet
• Include limited caffine and Herbal teas, add vitamins and magnesium
• All adolescence to know periods are a normal function Health teaching can be done during femininty questions and answers-

Burns Overview

• burn occurs when there is injury to the tissue of the body caused by heat, chemicals, electric current, or radiation. Second leading cause of accidental deaths in childhood.
• Children are most common to burn themselves with Hot liquids if under 3yrs, electric burns may be seen is teens and toddlers too. Risk factors include Low socioeconomic single parents
• Minor bunrs in children involve 10% of total body, all major burns are 20% and over or on the Face hands feet. 3rd degree burns are always bad
• 0-pink to red, slight edema- 2nd reddened with blisters, edematic 3destruction fat not painful, waxy

Burn Treatment

• • PLRisotonic open or clased
• Hydrot, showers cleaning
• Silver and ointements
• Topical therapy, skin and grafts
• Acute infection sepsis, Mal Nutrition , Anemia
• Long -G and delays
• The nurse is to Obtain a history, look at their comfort
• Risk to injury/ Infection; promote nutrition
• gas of exchange and maintaine 100- make sure that a rich 02 is used

Important Things About Maintaining Burns

• Maintaing adequate output of urine
• Rich oxygen
• warm and humid Meticulous skin care adminitering pain meds
• NO FEVER
• Monitor for gas exchange
• H2 blockers for stress. small frequent meals

Cerebral Palsy

• Cp is when it starts on the test,
• It is when it starts to affect their life, motor skills, language, it can cause poor head control or feeding- babies are not meant to do a lot
• It is caused to damage before and during development It is tested through tone assessment- vision and speech It should be done in therapy, but also, a positive environment with meds. Use wheel chairs safely

Failure to Thrive (FTT)

-It starts to have an affect on their life and the motor skills of the 3 things need to be correct Social, medical, nutrition

• the the failure happens there in energy
• They will need to have high fiber high calorie diet. -The assessment has to be a nurturing environment nurses provide oxygen to give them a good environment

Failure to Thrive Categories

• Inadequate absorption
• Cystic fibrosis, celiac, crowns
• inadequate calorie intake
• The are not getting enough to eat , poor parent skill malnutrition

Other Medical Conditions

• Febrile seizes occur with a change In fever or after 6 months old but before 5 year. Usually familial, and IV Valium is the emergency med
• 101.8 degrees Fahrenheit.
• Suction and roll pt to their side with a soft material

Cleft Lip and Palate

• Cleft lip Is a congenital, involving one or more clefts in the upper degree is from a notch or split Cleft palate in Includes ranging from tissue, genetic in origin, or teratogenic, can lead to other infection due with ear inf
• In terms of what to do at the house
• Repair is 1 to 2 months for lip. 6-18 for plate.
• You have to support before and after the procedure You need to be in good status and be fed with the nipples

Early Discharge Problems

• Premature infants may have a high-pitched neurological
• You have to follow the use of restraints
• You should reduce stress , get images
• When you do the operation or the baby, they need to be set at a correct position, clean, and fed correctly
• Some mothers will use more milk then needed,

Colic Review

• That most babies cry the most 2-3 hours for that day. Risk factors- digestion
• Parxoyms start and stop, be assess
• Moms do a food evaluation. With medication allgeries
• Look at home the baby feel to ensure the child has a good bond

FTT Tips

• Provide a good well with vitamin or minerals and give a
• Family , make sure they understand how it
• Give care a child has when there are many
• Offer parents for positive behavior for the care of the baby

Hydrocephalus Information

• Is an increase fluid that pushes a part
• Can lead to head trauma or spinal issues
• It is identified by a bulb or big head, with some
• There are surgical and medical process and after the operation needs to
• Lie flat on operation side

Sepsis in Newborns and Long Term Effects by Inefficient Leukocytes and More

• Use clean practices in the the hospital
• Tell moms that with breast milks, a great benefit, that would have to get in all the vitamins they can get from the -In early pregnancy, it can come from a a uti and get passed
• Is a disease that is found in the blood a good response and if the white blood cells were

More Details On Newborn Sepsis

• There are two types One is is less the 3day of a quick reaction
• The is through 3 weeks
• Sign is the nurse feels that the baby is not getting well , unstable and jaundice,
• The is to make sure there are is
• A lab work and fluid control is neededs
• Be sure to provide for family to let them help

Neural Tube Defects

• Occultia is the opening is in the spina bifida- fluid from the sac. or a stroke. and all that
• For the nurses they want to keep the baby in a lower position for at least one day

Otitis Media

• Affects the middle ear and eustachian tube
• Can be acud=te for short term
• Long term for the child can be hard Signs
• Ear may seem full if there is a blockage . with or with out
• Look at the history
• How to clean
• What to say?
• Will go away when they get older

Improv Perforarte and Malformations

• It has to do is with what the number is to the
• Is one for 5000 births and has defects
• After to the pull, make sure that the

Intussusception: Information and Review

• In Intussusception one slides over the other. In 3-13 mnoths and cystic fibrosis. A common sign is dark stool but its from decreased
• Is not usually a big concern. The major concern is you have to look
• One is going in so can not get more in it- and that is with an
• Some people have vomiting and can have mucus.
• You want see to it and it is important that we check that child
• With fluid, you see if is going to pass , make sure it all comes out before you release, monitor the fluid balajmce

LGA

• Large gestational . And they can also go back
• Get everything in good status and monitor. -Is a blood disorder and if they need fluids give fluids and can create heart failure check temperature and provide warmth
• Monitor for complications

SIDS Review

• Happens in first year of life and strikes people
• That put infants to sleep , have them stay for side way Babies can breathe so their is no need to side ways for
• It all leads to SIDS to reduce the number of all the children being safe

Final Review

• Sids- a a good idea about everything else, and to make sure the child is safe from problems
• In addition, they have to make sure and see from every angle and you have to be sure that the child is also safe