Children's Health Exam 1 Notes PDF

lOMoARcPSD|24277719 StudyThis NSG 3600: Children’s Health— Exam #1 Unit 1 & 2 Review/Study Guide Mendellin Includes: Book, PPT, Mini Lesson, Lecture Notes, Key points Unit 1: Growth & Development & Immunizations and Infectious diseases...

lOMoARcPSD|24277719 StudyThis NSG 3600: Children’s Health— Exam #1 Unit 1 & 2 Review/Study Guide Mendellin Includes: Book, PPT, Mini Lesson, Lecture Notes, Key points Unit 1: Growth & Development & Immunizations and Infectious diseases Growth & Development Principals of Pediatric Nursing Family Centered Care o Family is recognized as the constant in a child’s life o Systems must support, respect, encourage, and enhance the strength and competence of the family o The needs of all family members must be addressed  Parent needs to be involved in care  Depending on age child needs to be involved in care  Organize day by talking to family before performing any procedure Concept of “enabling” o Families are given opportunities to display caring abilities and make develop new ones Concept of “empowerment” o Families are encouraged to maintain or acquire a sense of control and make positive changes Accomplished through the parent-professional partnership Therapeutic/ Atraumatic Care o The goal of providing atraumatic care is “first, do no harm.” Three principles to help achieve this goal are:  Prevent separation  Promote sense of control  Minimize bodily injury Advocacy o Ensuring that families are informed: health services and care available, treatments and procedures o Ensuring that families are involved in their child’s care o Ensuring that families are encouraged to support or change health care practices Consent***  Informed consent o Requirements for obtaining o Eligibility for giving  Guardianship & Custody court ordered  Age of majority/ competence o “Emancipated Minor” o “Assent”  Treatment without parental consent o Parens Patriae is the power of the state to act as guardian for those who are unable to care for themselves, such as children or disabled individuals Growth and Development  Continuously assess height and weight Sequential trends so Downloaded by Chris Sisemore ([email protected])  lOMoARcPSD|24277719 o Sequential trends are based on the concept that each child will normally pass through each stage of growth and development in a predictable sequence o These patterns, or trends, are universal and basic to all human beings, but each human being accomplishes these in a manner and time unique to that individual Newborn/Infant: Birth to 1 Year Reflexes and neurological  Rooting: head turns and begins to suck when the check/lower lip is development: How to perform stroked stroke cheek/lip this reflex?  Sucking: sucking motion of lips, mouth, and tongue survival reflex  Palmar & palmar grasping: palms of hands/ soles of feet are stroked, causing fingers or toes to scrunch up  Moro: startle response with sudden jarring causes extensions of the head. Arms abduct & move upward. Hands for a “c”  Babinski: turning of foot & fanning out toes with sole stroked a Ongoing Physical development  Rapid growth  Double birth weight at 6m and triple at 1 year  Birth length increases by 50% at 12 months. Fine Motor  Transfer objects between hands  Scribble  Stack large objects 6-12m  Pincer grasp 9-12m Gross Motor  Raise head and chest while on belly/ roll on side 3m  No head lag 6m  Turn over 7 m  Sits unsupported 8-9m  Crawl & pull up 8-10m Cognitive Development Piaget Theory  Sensorimotor: (Birth to age 2)  primary means of cognition is through the senses Language Development  Crying, babbling, imitation influenced by social interaction  Social smile 2m (6-8 weeks)  Mama/dada 9-12m plus a few words Psychosocial development:  Trust vs Mistrust (newborn to 1 year) Erikson Theory  recognize that there are people that will meet their basic needs.  Result: Faith & Optimism Nutrition  Breast milk or Formula  Intro to solids 4-6 months Downloaded by Chris Sisemore ([email protected])  lOMoARcPSD|24277719  Encourage self-feeding  Finger foods  Wean to cup 9-12m  Family mealtime  Change to whole milk: 12 m Age-appropriate activities  Solitary Play: (hospitalization)  Mobiles  Rattles  Squeak toys  Cloth picture books  Balls  Colored blocks  Activity boxes Anticipatory Guidance:  Teach parents what to expect with G&D  Sleep-wake patterns: have a nighttime routine  Nutrition  Safety: don’t leave them unattended Common Injuries  Head Injury  Fracture from falls  Burns  MVA: Improperly installed car seat  Choking  Suffocation by cord or string Injury Prevention  Child proofing house  Safety locks  Crib  Car seat  Warming bottles  No hot food or liquids  CLOSE SUPERVISION  No walkers  No long cords or removable toys  Test water temp 3 months  Pain relief varies by child o Mild pain  NSAID (Ibuprofen); Non-opioid analgesic (acetaminophen), comfort measures, distraction o Moderate pain  Distraction, regularly timed analgesics including milder Opioids combined with  acetaminophen Downloaded by Chris Sisemore ([email protected])  lOMoARcPSD|24277719 o Severe pain  Produces signs such as pallor, sweating, dilated pupils, increased BP and RR, muscle tension  Give strong analgesics like morphine Age-Appropriate and Therapeutic Play  Provide sense of control and security Preparation for Procedures Parental presence during procedure → comfort & support Provide atraumatic care o Assess child’s temperament o Provide activities to relieve anxiety or distract child:  dolls, drawings, books,  handling equipment o Involve child: read stories, provide safe medical equipment for play, include dolls/stuffed animals or models o Give positive reinforcement Procedure room Common Injuries and Prevention by Age Group  Most common: o Motor Vehicle Accidents (MVA): drinking/driving, baby car seats o Burns o Drowning o Firearms o Poisoning PRIORITY** CALL POSION CONTROL FIRST o Suffocation/Aspiration Infant Toddler Preschooler School age Adolescents  Head injury  Fracture from falls  Falls  Poisonin  Sports injury  Being struck  Burns g by another  MVA  Drowning  Being struck person or  Choking  Firearms by another object  Suffocation  Poisoning person or  Burns object  Sports injuries  Burns so Downloaded by Chris Sisemore ([email protected])  lOMoARcPSD|24277719  Animal or  Overexertion insect bite  MVA Immunizations and Infectious diseases Immunization Reactions  102-103 Temp probably not form vaccine give Tylenol or Motrin (try to let body fight it first)  Immunizations among the safest and most reliable drugs available  Serious reactions rare; mild side effects more common  Side effects usually occur within a few hours or days: Normal o Local tenderness, erythema, swelling at injection site o Low-grade fever o Drowsiness, eating less, prolonged crying  Treatment of side effects ~ cold compress to area, comfort measures  Don’t give child aspirin who already has a virus Immunization Contraindication  Severe febrile illness  Known allergy to vaccine  **minor illness such as a cold is not a contraindication**  Severely immunocompromised children should not receive live viruses  Children receiving immunoglobulin therapy should not get MMR and varicella vaccines for minimum of 3 months Isolation/Precautions Airborne & Contact  Varicella  Rubeola Droplet & Contact  Rubella  Hib  Influenza  Mumps  Pertussis  Scarlet Fever  Pneumococcal Disease Standard  Tetanus Mono  Mode of Transmission: saliva/blood (kissing) Varicella (Chicken Pox) *  If you have had chickenpox, you can get shingles  Etiology: varicella zoster virus Head  Clinical Manifestations: rash on trunk and face, lesions begin as macule and progress to vesicle then crust, pruritic, ROSE  Isolation: contact & airborne precautions treadectderdderdere Terest Downloaded by Chris Sisemore ([email protected])  lOMoARcPSD|24277719  Nursing care: o Supportive (anti-pruritic lotions, baths, antihistamines) o Oral acyclovir to shorten duration o No aspirin Rubella (German/3-day Measles)  Not contagious after the rash starts  Etiology: rubeola virus,  Clinical Manifestations: sore throat, lymphadenopathy, mild fever, ne light pink maculopapular rash face to chest to body  Isolation: droplet and contact  Nursing Care: o Supportive care (antipyretics) o Educate on isolation while active (1 week after rash starts) Rubeola Measles Etiology: caused by morbillivirus Clinical Manifestations: moderate fever, cough, conjunctivitis, photophobia, Koplick’s spots appear 2 days before rash, rash 3-4 days, fever to 1050, rash fades and temperature drops 4-7 days Isolation: airborne and contact Nursing care: supportive (antipyretics,High Fever bedrest, fluids) OLA- Koplick Spots Haemophilus Influenza Type B HIB  Etiology: Haemophilus inuenza type b bacteria  Clinical Manifestations: upper respiratory infection, OM, sinusitis  Isolation: droplet and contact  Nursing Care: antibiotic as prescribed  Educate: Handwashing, completing antibiotics (usually the answer) Influenza Etiology: influenza virus A, B, or C, Clinical Manifestations: rapid onset of high fever, myalgia, headache, sore throat, nonproductive cough Isolation: droplet and contact Nursing care: o Supportive (antipyretics, bedrest) o Isolated until signs/symptoms subside Reye's syndrome o No aspirin Mumps Etiology: paramyxovirus see Downloaded by Chris Sisemore ([email protected])  lOMoARcPSD|24277719 Clinical Manifestations: mild and systemic-low-grade fever, malaise, anorexia, ear pain, headache, parotid glands enlarge Isolation: droplet and contact Nursing care: supportive Cankillachild Pertussis (whooping cough) 100 day coccines Etiology: Bordatella pertussis bacteria in 4 years Clinical Manifestations: mild respiratory illness with “whooping” cough Isolation: droplet and contact Nursing Care: antibiotics as prescribed, keep open airway, monitor oxygen saturation Tetanus Etiology: Clostridium tetani, occurs in cut or deep puncture wound Clinical Manifestations: headache, stiff neck and jaw that become muscle spasms, may progress in body and lead to seizures Isolation: standard opisthotonus se.ve typgrextension Nursing Care: antibiotics as prescribed, surgical debridement, tetanus immune globulin (TIG) If they have a puncture wound find out if they’ve had their tetanus vaccine yet Scarlet Fever strep throat Etiology: Group A beta-hemolytic streptococci, often follows pharyngeal infection with GAS, Sglating Clinical Manifestations: acute onset fever, sore throat, rhinitis, tender cervical nodes, sandpaper-like rash appears 12- 48 hours after onset of sx, fades 3-4 days, tips toes and fingers peel, day 4-5 bright red strawberry tongue appearance Isolation: droplet and contact Nursing care: antibiotic as prescribed, supportive care for pharyngitis and fever Scarletina rash Usually in kids that have strep Every child that has strep needs to be treated if not they’re at risk for glomerulonephritis Pneumococcal Disease  Etiology Streptococcus pneumonia bacteria  Clinical Manifestations: upper respiratory infection, high fever, pleuritic chest pain, cough, chills, dyspnea, dry or productive cough with hemoptysis  Isolation: droplet and contact  Nursing care: penicillin or other antibiotics, IVF  Note: viral pneumonia treated with supportive care only  Nonviral: antibiotics (strep-pneumonia) Mononucleosis Etiology: Epstein-Barr Virus o Peak incidence - 15-17yo o Mode of Transmission - saliva/blood Clinical Manifestations: fever, pharyngitis, cervical and occipital lymphadenopathy, fatigue, hepatosplenomegaly. Diagnostics: Monospot test Treatment: bedrest and avoidance of contact sports (spleen need to heal and shrink); may give steroids if the pharyngitis is causing respiratory difficulties rootestloceloolton Downloaded by Chris Sisemore ([email protected])