Pediatric Nursing Week 5 Study Guide PDF

PEDIATRIC NURSING week 5 Julie Vandergrifft, BSN, RN CHAPTER 19 the school-age child  -Define each key terms listed -Contrast two major theoretical viewpoints of personality development during the schoo...

PEDIATRIC NURSING week 5 Julie Vandergrifft, BSN, RN CHAPTER 19 the school-age child  -Define each key terms listed -Contrast two major theoretical viewpoints of personality development during the school years. CHAPTER 19.1 -Describe the physical and psychosocial development of children from 6 to 12 years of age, listing-age specific events objectives and type of guidance where appropriate. -Discuss how to assist parents in preparing a child for school. -List two ways in which school life influences the growing child. GENERAL Ages 6 to 12 years CHARACTERISTICS (1 OF 2) -More engrossed in fact than fantasy -Develop first close peer relationships outside the family group -Often judged by their performance -Sense of industry and development of positive self-esteem directly influenced by peer group GENERAL Erikson: stage of industry CHARACTERISTICS Freud: sexual latency (2 OF 2) Piaget: concrete operations  PHYSICAL GROWTH Muscular coordination Important to note Slows until just before improved puberty Size is not correlated Lower center of with emotional maturity Weight gain is more gravity rapid than increase in Problems can occur height when a child faces higher expectations Brain has reached because he or she is approximately adult size taller and heavier than peers  Sex role development influenced by parents Differential treatment and identification: in the family & in society Influence of school environment Aggressive behavior more accepted in boys than girls GENDER Incorporation of traditionally masculine and feminine positive attributes may lead to fuller IDENTITY human functioning. https://youtu.be/Ko5FvrncrRw? si=vUk5vqYOvlWp2aYD  SEX EDUCATION Lifelong process Accomplished less by talking or formal instruction than by the whole climate of the home Questions should be answered simply Correct names for genitalia should also be used Private masturbation is normal SEXUALLY TRANSMITTED INFECTIONS (STIS) Education on how to prevent STIs and HIV/AIDS should be presented in simple terms. Factual and concrete information is an essential component. Facts concerning harmful effects of drugs and unprotected sex should be communicated to the child without scare tactics.  PHYSICAL, MENTAL, EMOTIONAL, AND SOCIAL DEVELOPMENT THE 6-YEAR-OLD THE 7-YEAR-OLD THE 8-YEAR-OLD CHILD CHILD CHILD Energetic and on-the-go Likes to start tasks but does not Sets high standards for Wants to do everything always complete themselves Can play alone for a longer them Good sense of humor period of time Talks for a purpose rather than More modest Creative for the sake of Enjoys being active but also Enjoys group activities talking enjoys periods of rest Behaves better for company Vocabulary consists of 2500 words than for family Requires 11 to 13 hours of sleep per Hero-worship evident night  PHYSICAL, MENTAL, EMOTIONAL, AND SOCIAL DEVELOPMENT THE 9-YEAR-OLD THE 10-YEAR- THE 11 & 12- CHILD OLD CHILD YEAR-OLD CHILD Dependable The 10-year-old child Intense, observant, energetic Shows more interest in family Marks beginning of May be argumentative and activities preadolescence meddlesome Assumes more responsibility Girls more physically mature Hormone influence on More likely to complete tasks than boys physical growth more More able to accept criticism for Begins to show self-direction apparent their actions Wants to be independent Need freedom within limits Worries and mild compulsions are Group ideas more important and recognition they common than individual ones are no longer infants Sexual curiosity continues  AGE-APPROPRIATE ACTIVITIES -COMPETITIVE AND COOPERATIVE PLAY IS PREDOMINANT Children from 6 to 9 years of age: -Play simple board and number games -Play hopscotch -Jump rope -Collect rocks, stamps, cards, coins, or stuffed animals -Ride bicycles -Build simple models -Join organized sports (for skill building) Children from 9 to 12 years of age: -Make crafts -Build models -Collect things/engage in hobbies -Solve jigsaw puzzles -Play board and card games -Join organized competitive sports https: //yout u.be/H LATCHKEY xZLreK PUts? CHILDREN si=5WY Z25u6s PVBVz Subject to higher rate of accidents and are at w- risk of feeling isolated and alone Back-up adult should be available to the child in case of emergencies  IMMUNIZATIONS The centers for disease control and prevention (CDC) immunization recommendations for healthy school-age children 6 to 12 years of age include: -If not given between 4 and 5 years of age, children should receive the following vaccines by 6 years of age: -Diphtheria and tetanus toxoids and pertussis (DTaP); Inactivated poliovirus (IPV); Measles, mumps, and rubella (MMR); and varicella -Yearly seasonal influenza vaccine; trivalent inactivated influenza vaccine or life, attenuated influenza vaccine by nasal spray -11 to 12 years: Tetanus and diphtheria toxoids and pertussis vaccine (TDaP); Human papillomavirus vaccine (HPV); and memingococcal vaccine (MCV4) HEALTH SCREENINGS -Scholiosis: school-age children should be screened for scoliosis by examining for a lateral curvature of the spine before and during growth spurts. Screening can take place at school or at health care facilities.  PET OWNERSHIP Infections can occur via -Pets that have close contact with the pet’s saliva, contact with children -Allows the ill child who feces, or urine or by have the potential of feels separated from inhalation or skin contact transmitting disease. other people to feel with organisms. companionship and positive attitude. Risk factors can be further -Children with reduced if children are disabilities especially cautioned not to kiss pets, do benefit from -Age of child, allergies, not allow animals to sleep in interacting with pets. and immune issues are bed with them, and are major deciding factors. encouraged to perform hand hygiene. SKIN DEVELOPMENT AND Main function is protection FUNCTION Acts as body’s first line of defense against disease Prevents passage of harmful physical and chemical agents Prevents loss of water and electrolytes Can regenerate and repair itself  SKIN INFECTIONS: BACTERIAL causitive organism manifestations mangagement Reddish macule becomes vesicular Erupts easily leaving moist Topical bactericidal or triple erosion on the skin, secretions dry antibiotic ointment impetigo Staphylococcus forming honey-colored crusts Oral or parenteral antibiotics Spreads peripherally and by direct contact for severe cases Pruritus common Cleanse with soap and water Bathe using antibacterial soap pyoderm Staphylococcus Streptococcus Launder washcloths and towels Deeper infection into the dermis separately to prevent bacterial spread Possible systemic effects Apply mupirocin to lesions (fever, lymphangitis) Systemic antibiotics Staphylococcus aureus Apply warm moist compresses Clean skin often Topical antibiotic medications Folliculits Methicillin-resistant Infection of a hair follicle Systemic antibiotics for severe cases Incision, draining, and irrigation of severe Staphylococcus aureus (MRSA) lesions For MRSA infections, soak in diluted bleach solution Apply warm moist compresses Clean skin often Topical antibiotic medications Furnicle (boil) & Larger swollen, red lesion Systemic antibiotics for severe cases Incision, draining, and irrigation of severe Carbumcle (multiple boils) Staphylococcus aureus of a single hair follicle MRSA lesions For MRSA infections, soak in diluted bleach solution Streptococcus Firm, swollen, red area of the skin Oral or parenteral antibiotics Rest and immobilize affected area Acute care for Cellulitis and subcutaneous tissue Staphylococcus systemic manifestations Possible systemic effects (fever, malaise) ‘Haemophilus influenzae Staphlococcal Rough-textured skin with macular erythema Systemic antibiotics Burow’s solution or saline for gentle cleansing Compresses of Scalded Skin Staphylococcus aureus R Epidermis becomes wrinkled within 0.25% silver nitrate Syndrome 2 days with large bullae appearing Ointments should be completely washed off between applications. Cortisone creams should be avoided because they do not resolve the underlying cause. How to apply topical medications: Best absorbed after a warm bath PARENT Applied by stroking in direction of hair growth Use proper amount of ointment. TEACHING Elbow restraints can prevent an infant from scratching while allowing freedom of movement.. Topical steroids should not be used when a viral infection is present.  SKIN INFECTIONS: VIRAL causitive organism manifestations mangagement Individualized destructive therapy Elevated, rough, gray-brown firm papules Can occur anywhere on the skin Verruca (warts) Human papillomavirus Can be single or in groups (surgical removal, electrocautery, cryotherapy, laser) Caustic solution applied to wart Verruca plantaris Wear insoles with holes to decrease Flat warts on the plantar surface of the feet pressure for 2 to 3 days (plantar warts) Possibly surrounded by hyperkeratosis Soak affected area for 20 min Repeat treatment until wart falls off Near a mucocutaneous area (lips, Apply Burrow solution Cold sore, fever blister Herpes simplex virus type 1 nose, buttock, genitalia) during weeping stage Group of vesicles that itch and burn Oral antiviral (acyclovir) After drying, form a crusty area to reduce duration followed by exfoliation Oral antiviral (valacyclovir) Healing occurs in 8 to 10 days for genital herpes Genital herpes Possible lymphadenopathy Herpes simplex virus type 21 Neurologic pain, hyperesthesias, or itching Herpes zoster Shingles Varicella zoster virus Same virus as chicken pox Use oral or topical analgesics Apply moist compresses Oral antiviral (acyclovir) Resolves spontaneously in 18 months Complicated cases: remove pox chemically or with Molloscum contagiosum Poxvirus Flesh-colored papules on stalks (extremities, face, trunk) curettage, cryotherapy or electrodessication  SKIN INFECTIONS: FUNGAL causitive organism manifestations mangagement Use of selenium sulfide shampoos Trichophyton tonsurans Scaly, circumscribed lesion with Oral griseofulvin Tinea capitis (ringworm alopecia on the scalp Kerion-griseofulvin and oral corticosteroids for 2 weeks Microsporum audouinii of the scalp) Pruritic Complicated cases: oral ketoconazole Microsporum canis Treat infected pets (especially cats), if necessary Tinea corporis (ringworm Trichophyton rubrum Round or oval erythematous scaling patch Trichophyton mentagrophytes Spreads peripherally and unilaterally Oral griseofulvin of the body) Microsporum canis and clears centrally Topical antifungal (tolnaftate, clotrimazole) Apply wet compresses Epidermophyton floccosum Medial and proximal aspect of the thigh and crural folds or take sitz bath May include the scrotum Pruritic Wear light-colored socks, Tinea cruris (jock itch) Trichophyton rubrum well-ventilated shoes Round erythematous scaling patch Trichophyton mentagrophytes Spreads peripherally and clears centrally Treat infected pets (Tinea corporis) Between toes or on the plantar surface of the feet Clotrimazole or ciclopirox Tinea pedis (athlete’s Trichophyton rubrum Maceration and fissuring lesions between twice a day for 2 to 4 weeks Trichophyton interdigitale the toes and patches with tiny vesicles ciclopirox or clotrimazole foot) Epidermophyton floccosum griseofulvin for severe infections on the plantar surface of the foot Found in moist areas of the skin surface Topical antifungal ointment Candidiasis (moniliasis) White exudate, peeling inflamed (miconazole, nystatin) Candida albicans areas that bleed easily Pruritic  SKIN INFECTIONS: BITES & STINGS manifestations mangagement Use antipruritic agent. Variable, from no reaction to hypersensitivity reaction Administer oral and topical antihistamines. Mosquitoes, fleas, flies Papular urticaria Take baths. Firm papules Local reaction: small red itchy wheal that is warm to the touch Scrape or pull out stinger as quickly as possible.; Cleanse with soap and water. Bees, wasps, hornets, fire ants, Apply cool compresses.; Apply home products (baking soda, lemon juice). Systemic reaction (mild to severe): generalized edema, pain, yellow jackets nausea and vomiting, confusion, respiratory problems, and shock Administer topical and oral antihistamines.; Epinephrine and corticosteroids for severe cases. Bites on warm parts of the body Variable, from no reaction to hypersensitivity reaction Systemic steroids for severe cases Chiggers Papular urticaria Firm papules Remove by pulling straight up with steady, even Attaches to the skin with head embedded Firm, discrete, pruritic nodule at pressure with tweezers to remove the tick. Ticks Remove any remaining parts using a sterile needle. site Possible urticaria or persistent localized edema Cleanse site with soap and disinfectant. Mild sting leads to transient erythema and blister Cool compresses Brown recluse spider Pain 2 to 8 hr following bite Antibiotic, corticosteroids Star-shaped purple area in 3 to 4 days Analgesic for pain Necrotic ulceration in 7 to 14 days Possible skin graft Mild sting leads to swollen, painful, and erythematous site Cleanse bite with antiseptic.; Apply cool compresses. Black widow spiders Dizziness, weakness, and abdominal pain Administer antivenin.; Administer muscle relaxant. Possible delirium, paralysis, seizures, and death Administer analgesics Intense pain; Erythema, burning, numbness; Restlessness and vomiting Position site in dependent position. Keep child calm. Administer antivenin. Analgesic for pain. Admit to Scorpions Ascending paralysis: seizures, weakness, increase in pulse, thirst, salivation, dysuria, pulmonary edema leading to coma and death intensive care unit for close monitoring Death for children less than age 4 in the first 24 hr  Lyme disease Antibiotic (2- to 3-week course) for clients who have confirmed disease -Tick infected with Borrelia burgdorferi Doxycycline for children older than 8 years -Can appear in any of these stages: and amoxicillin or cefuroxime for children Stage 1: under 8 years. Cefuroxime for children -3 to 30 days following bite who have an allergy to penicillin -Erythema mirgrans at site -Chills, fever, itching, headache, fainting, stiff neck, muscle weakness, bull’s eye rash at the site of the bite Stage 2: -Occurs 3 to 10 weeks following bite -Systemic involvement begins (neurologic, cardiac, and musculoskeletal) -Paralysis or weakness in the face, muscle pain, swelling in large joints (knees), fever, fatigue, splenomegaly Stage 3: -2 to 12 months following bite -Systemic involvement is advanced (musculoskeletal pain that includes the muscles, tendons, bursae, and synovia); possible arthritis, deafness, cardiac complications, and encephalopathy. -Abnormal muscle movement and weakness, numbness and tingling, speech problems.  SKIN INFECTIONS: INFESTATIONS manifestations mangagement 1% permethrin shampoo Spinosad 0.9% topical suspension for Pediculosis capitis (head lice): children 4 years and older. Benzyl alcohol 5% in infants 6 months and older. Intense itching Small, red bumps on the scalp Nits (white specks) on the Remove nits with a nit comb, repeat in 7 days after shampoo treatment Pediculus humanus capitis hair shaft Wash clothing, bedding in hot water with detergent. Place items unable to be laundered in a sealed plastic bag for 14 days. Difficult cases: use malathion 0.5% Intensely itchy, especially at night Rash, especially between fingers, popliteal folds, and inguinal regions Thin, pencil-like marks on the skin. Mites Apply a scabicide (5% permethrin cream) over the entire body to remain on the skin for 8 to 14 hr; repeat in 1 to 2 weeks. Treat entire family and persons that have look like black dot on end of a grayish-brown burrow INFANTS been in contact with infected person during and 60 days after infection. Scabies mite: Sarcoptes scabiei Widespread on the body Pimples on the trunk Blisters on the palms of the Wash underwear, towels, clothing, and sleepwear in hot water. Vacuum carpets and furniture. Apply calamine lotion or cool compresses hands and soles of the feet YOUNG CHILDREN: Most common on head, until itching subsides following treatment. Difficult cases: May use oral ivermectin. neck, shoulders, palms, and soles OLDER CHILDREN: Most common on hands, wrists, genitals, and abdomen  BURNS CHILD’S GRADES OF TYPES OF BURNS RESPONSE BURNS -Thermal—caused by fire or Moderate: -Skin is thinner, leading to more -Partial-thickness burns involving 15% to scalding vapor or liquid serious depth of burn with lower -Chemical—caused by corrosive 30% of body surface temperatures and shorter exposures. -Full-thickness burns involving less than powder or liquid -Immature response systems in 10% of body surface -Electrical—caused by electrical young children can cause shock and Major: current passing through the body heart failure. Partial-thickness involving 30% or more -Radiation—caused by x-rays or -Large body surface area of child of body surface radioactive substances results in greater fluid, electrolyte, Full-thickness burns involving 10% or and heat loss. more of body surface -Increased BMR results in increased *Both types are considered open protein and calorie needs. wounds that have the added danger of infection* THE 6 C’S OF BURN CARE Clothing Cooling Cleaning Chemoprophylaxis Covering Comforting (pain relief)  Establish an airway: Cyanosis, singed nasal hair, charred lips, and stridor are indications that flames may have been inhaled. An endotracheal tube may be inserted to protect the airway. An endotracheal tube may be inserted to protect the airway. Establish an intravenous line. EMERGENCY Obtain blood and other body fluids for laboratory CARE testing. A nasogastric tube may be inserted to empty stomach and prevent complications.  PATIENT-CENTERED CARE NURSING CARE Minor burns -Stop the burning process. -Place the child in a horizontal position and roll him in a blanket to extinguish the fire. -Remove clothing or jewelry that can conduct heat. -Apply tepid water soaks for run water over the injury. -Do not use ice. -Flush chemical burns with large amounts of water. -Cover the burn with a clean cloth to prevent contamination. -Cleanse with mild soap and tepid water (avoid excess friction). -Removing blisters is controversial. -Use antimicrobial ointment. -Apply dressing. -Nonadherent: fine-mesh gauze Hydrocolloid: occlusive dressing -Provide warmth -If necessary, child is seen in a health care facility for medical care. -Provide analgesia. -Check immunization status. Administer tetanus vaccine if it has been more than 5 years since last immunization -Educate the family to avoid using greasy lotions or butter on burns. -Educate the family to monitor for manifestations of infection.  PATIENT-CENTERED CARE NURSING CARE Major burns -Maintain airwary and ventilation!! -Provide humidified 100% supplemental oxygen as prescribed. -Monitor vital signs. -Maintain cardiac output. -Initiate IV access with large-bore catheter. Multiple access points can be necessary. -Fluid replacement is important during the first 24 hrs. -Isotonic crystalloid solutions (lactated Ringer’s) are used during the early stage of burn recovery. -Colloid solutions (albumin or plasma), may be used after the first 24 to 48 hr of burn recovery. -Maintain urine output of 0.5 to 1 mL/kg/hr if the child weighs less than 30 kg (66 lb). -Maintain urine output of 30 ml/hr if the child weighs more than 30 kg (66 lb). -Be prepared to administer blood products as prescribed. -Monitor for manifestations of septic shock, and notify the provider of findings. -Alterations in sensorium (confusion). -Spiking fever -Mottled or cool extremities -Decreased bowel sounds -Tachycardia -Tachypnea -Decreased urine output  PATIENT-CENTERED CARE NURSING CARE Major burns Manage pain -Establish ongoing monitoring of pain and effectiveness of pain management. -Avoid IM or subcutaneous injections. -Use IV opioid analgesics (morphine sulfate, midazolam, and fentanyl). -Monitor for respiratory depression when using opioid analgesics. -Administer pain medications prior to dressing changes or procedures. -Use nonpharmacologic methods for pain control (guided imagery, music therapy, therapeutic touch) to enhance the effects of analgesics and promote improved pain management. Prevent infection -Follow standard precautions when performing wound care. -Restrict plants and flowers due to the risk of contact with pseudomonas. -Change position frequently to prevent contractures and prolonged pressure. -Limit visitors. -Use reverse isolation if prescribed. -Monitor for manifestations of infections, and report it to the provider. -Use client-designated equipment (blood pressure cuffs and thermometers). -Administer tetanus toxoid if indicated. -Administer antibiotics if infection is present.  PATIENT-CENTERED CARE NURSING CARE Major burns Provide nutritional support -Increase caloric intake to meet increased metabolic demands and prevent hypoglycemia. -Increase protein intake to prevent tissue breakdown and promote healing. -Provide enteral therapy or total parenteral nutrition (TPN) if necessary due to decreased gastrointestinal motility and increased caloric needs. -Administer vitamins A and C to facilitate cell growth, and zinc for wound healing. Restore mobility -Maintain correct body alignment, splint extremities, and facilitate position changes to prevent contractures. -Maintain active and passive range of motion. -Assist with ambulation as soon as the child is stable. -Apply pressure dressings to prevent contractures and scarring. -Closely monitor areas at high risk for pressure injury (heels, sacrum, back of head). Provide psychological support -Provide developmentally appropriate support for the child. -Assist with coping. -Use family-centered approach. -Make referrals as needed. -Change position frequently to prevent contractures and prolonged pressure. -Limit visitors. -Use reverse isolation if prescribed. -Monitor for manifestations of infection, and report to the provider. -Use client-designated equipment (blood pressure cuffs and thermometers). -Administer tetanus toxoid if indicated.  SUNBURNS AND FROSTBITE SUNBURNS FROSTBITE -Common skin injury caused by -Results from freezing of a body part overexposure to sun -Chilblain: a cold injury with erythema and -Can be minor epidermal burn to serious formation of partial-thickness burn with blisters vesicles and ulcerative lesions that occur -Goal of treatment: as a result of Stop exposure. vasoconstriction Treat inflammation. -In exposure to extreme cold, warmth is Rehydrate skin. lost in the periphery -Sunscreen of the body before the core Topical partially absorbs UV light temperature drops. Have an SPF rating to evaluate -In extreme cases, the head and torso effectiveness in should be warmed before the extremities blocking sun rays to ensure survival. -Sunblock -A deep purple flush appears with the Reflects sunlight return of sensation, Zinc oxide and titanium dioxide are which is accompanied by extreme pain. effective. -Can result in necrosis and may require amputation of the affected extremity  CLIENT EDUCATION -The child should continue to perform range-of-motion exercises and to work with a physical therapist to prevent contractures. -Assess the wound for infection and perform wound care. -Perform age-appropriate safety measures for the home (covering electrical outlets, supervising children when in the bath, keeping irons out of reach of children, teaching the dangers of playing with matches.) -Avoid sun exposure between 1000 and 1400, wear protective clothing, and apply sunscreen to prevent sunburn. -Expected delays in growth and weight for up to three years post burn injury. -Increased risk of bone remodeling. CARE AFTER DISCHARGE -Initiate a referral for home health services. -Initiate a referral to occupational therapy for evaluation of the home environment and assistance to relearn how to perform ADLs. -Initiate a referral to social services for community support services.  COMPLICATIONS Inhalation injury Shock/systemic sepsis Direct thermal injury NURSING ACTIONS -Occurs with burns to the face and lips. Damage occurs to the -Administer IV crystalloid solutions for the first 24 hr followed by colloid solutions. tracheobronchial tree after inhalation of heated gases and toxic chemicals produced during combustion. -Meticulously monitor I&O. -Can be delayed 24 to 48 hr. -Monitor laboratory findings, noting indications of anemia and infections. -Findings include wheezing, increased secretions, hoarseness, wet -Monitor vital signs. rales in the lungs, singed nasal hairs, laryngeal edema, and -Assess sensorium. carbonaceous secretions. Carbon monoxide injury -Assess capillary refill in extremities. -Occurs when incident takes place in an enclosed area. -Findings include mucosal erythema and edema followed by sloughing Wound infections of the mucosa. NURSING ACTIONS NURSING ACTIONS: Maintain airway and ventilation, and provide 100% oxygen as prescribed. -Assess for discoloration, edema, odor, and drainage. -Assess for fluctuations in temperature and heart rate. Pulmonary problems -Obtain a wound culture. -Administer antibiotics as prescribed. Include edema, bacterial pneumonia, aspiration, embolus, and pulmonary insufficiency. -Monitor laboratory findings, noting indications of anemia and infection. NURSING ACTIONS -Maintain surgical aseptic technique with dressing changes. -Maintain airway via intubation, sometimes tracheostomy. -Administer oxygen as prescribed.