Pediatrics in Review PDF

PEDIATRICS IN REVIEW  PEDIATRIC NURSING CONSIDERATIONS Hospitalization stressors Family-centered care-understand that family is constant Atraumatic care-prepare pt for unfamiliar tx or procedures Developmentally appropriate communication Anticipatory guidance for families and child...

PEDIATRICS IN REVIEW  PEDIATRIC NURSING CONSIDERATIONS Hospitalization stressors Family-centered care-understand that family is constant Atraumatic care-prepare pt for unfamiliar tx or procedures Developmentally appropriate communication Anticipatory guidance for families and children regarding what to expect with G&D, disease processes, procedures and surgery Prioritize nursing interventions Mortality and morbidity- birth- 1mo congenial abnormalities,1st year- SIDS, childhood- accidents, Teens=accidents, homicide, suicide; boys greater than girls  NEWBORNS Growth and Development-wt loss x 3-5 days then gain 1 oz/day & back to birth wt by 2 weeks. Birth wt doubles at 6 months and triples at 1 year. Know milestones such as: rolling over (front to back 4 mo, back to front 6 mos, lifting head and shoulders 4 mo, sitting w/o assist 9 mo, pincer grasp 9 mo etc. Neonatal respiratory distress syndrome- lack of pulmonary surfactant. Risk factors for jaundice- risks=bruising, DAT, sepsis, poor feedings, history of sibling with jaundice, prematurity. Prevent with early and frequent feedings. Congenital hip dysplasia-risk breech, 1st born, female, LGA. Hip ultrasound breech girls @ 6 wks Newborn screenings-CHD, hearing screen, metabolic screening, and jaundice. Cleft lip and cleft palate-concern for effective suck/feedings and wt gain. Neonatal hypoglycemia-risks=SGA, Preterm, LGA, GDM, beta blockers, and perinatal stress Apgar scores= assesses HR, Tone, Color, Cry/grimace and respiratory effort; assigned at 1 and 5 mins. 7 or greater is normal. Sepsis-risk= maternal GBS+, Chorio (fever), PROM First meconium stool should occur in the 1st 24 hours. Concern for imperforate anus, Hirschsprung's, cystic fibrosis if no passage of meconium.  INFANTS SIDS and safe sleep- place supine; risks=prematurity, low birth wt, maternal smoking, co- sleeping, overheating, and objects in crib. Plagiocephaly- change positions and tummy time to prevent Pyloric stenosis-olive shaped mass and projectile vomiting. Requires surgery Vaccination schedules-Hep B for newborns, live vaccines begin at 12 months, influenza annually Hydrocephalus-sx bulging fontanel & dilated scalp veins; often requires a shunt Tracheoesophageal fistula- newborn that is excessively spitty, history of polyhydramnios in pregnancy. RN will not be able to pass OG tube and concern of aspiration; requires surgery. Interventions=increase HOB, NG tube to continuous wall suction, & IVFs. GERD- peaks at 4 months of age. Interventions= hold upright, burp often, smaller more frequent meals, add rice cereal to milk if bottle feeding. Hirschsprung’s disease-sx vomiting, constipation due to absence of nerves (no ganglion cells) in portion of bowel resulting in the muscle within the bowel not contracting and moving material through the GI Diaper dermatitis-if satellite lesions present then most likely yeast. Check mouth for thrush.  CHILDHOOD CONDITIONS Otitis Media- risk factors= smoking, cleft palate, day care attendance RSV-viral; suction and cool mist; sx peak on day 3; monitor for RDS (nasal flaring, retractions, grunting, and tachypnea RR greater than 60 in 0-2 mo, 50 in 2-12 mo, 40 in kids over 12 mos) Airway obstruction-sx strong cough, inability to speak, and respiratory difficulty. Poisoning-assess pt, ensure they have poison control number out Reye syndrome-avoid aspirin when treating fever Allergic reaction-froglike croaking sounding cough, swollen lips, agitated, hives. Tx prepare to give epinephrine Epiglottitis-risk unvaccinated or immune compromised; caused by h. influenzae B. Sx=fever, sore throat, muffled voice, tripod sitting with drooling with noisy, difficulty breathing. DO NOT swab throat. Emergent condition prepare for intubation.  CHILDHOOD CONDITIONS Scabies- sx pruritus with rash (from mite under the skin) “S” shaped and between fingers. Very contagious. Treat environment, patient, and everyone in house regardless of symptoms. Lice-contagious but only treat others in the home if symptoms. Primary sx is pruritus. Must treat patient and environment and comb all nits out before returning to school. Separate kids hats, scarfs and coats; don’t allow sharing. Educate parents to wash clothes, towels, linens in hot water (greater than 130 degrees) Burns-know the degrees, initial management includes pain control, maintaining homeostasis, thermoregulation, replacing fluids and electrolytes, assess airway if face involved/smoke inhalation. Secondary is prevention of infection. Edema r/t increased capillary permeability. Eczema-pruritus, dry patches of skin. Wet compresses help, keep nails trimmed to prevent infection from scratching, apply emollients after baths, avoid bubble baths and chemicals. Less frequent baths with mild soaps or water only baths Head injury- assess Glasgow Coma Scale by monitoring behavior, eye opening, verbal response, motor movement, pupil response. If unconscious=ensure patient is medicated to prevent increasing ICP.  CHILDHOOD CONDITIONS Seizures- generalized (both hemispheres), Complex partial (travel from one focal area to another), absence (silent; stares blankly and is unresponsive) Shingles- herpes zoster, viral; painful rash that usually follows the dermatomes, that does not usually cross midline. Risks=unvaccinated, had chickenpox before 1 year of age, mother had Chickenpox late pregnancy, and immune compromised. Tx with antiviral med. Diabetes– type 1 has rapid onset. Sx increased thirst, frequent urination, wt loss, increased appetite, fatigue. Peer support groups are helpful. Tx with insulin and monitor A1c levels. Scoliosis- if brace recommended pt will wear for 23 hours/day.8-10 times more common & worse in girls. Sickle cell anemia- inherited defective hemoglobin. RBC misshapen and break down and is made worse by dehydration. Blocks blood flow to organs. Painful. Concern for stroke which is the SCA major cause of death in children under age 5. Osteomyelitis-bone infection; sx fever and bone pain. Tx with IV antibiotics. Measles-risk unvaccinated or immune compromised. Sx Koplik spots, rash, fever, cough, inflamed eyes, and runny nose.  CHILDHOOD CONDITIONS Group A strep pharyngitis- sx sore throat, fever, vomiting, rash. Tx antibiotics. Complications include scarlet fever, acute glomerulonephritis, rheumatic fever. Appendicitis- abdominal pain, guarding, fever, vomiting, increased WBC count. Concern for rupture and sepsis. Usually surgical some cases treated clinically with IV antibiotics. Duchenne Muscular Dystrophy- more common in males; progressive muscle weakness of skeletal muscles starting in preschool. *Gower sign- climb up their thighs with hands to stand, difficulty climbing stairs. Leukemia- caused by unrestricted proliferation of immure blood cells Hemophilia- commonly due to deficiency of a factor involved in blood clotting. Severe dehydration- wt loss of 10% or greater often due D&V; IVF replacement at 1.5 x maintenance. Fever increases fluid requirement. CHD, increased ICP, and renal issues decrease fluid requirements.  CHILDHOOD CONDITIONS UTIs- sx foul smelling urine, increase urinary frequency, pain with urination, abd pain, fever, enuresis. Collect clean catch urine sample midway thru urination in sterile container. Prevention=educating patient and family of adequate fluid intake, preventing constipation, girls wipe from front to back, completely and frequently emptying bladder. Educate parents of sx to ensure early tx. Hypospadias- surgical repair ~6 mo old. Stent or catheter will drain urine into diaper for 5-10 days, prophylactic antibiotics until stent/catheter removed, child may have bladder spasms, No tub bath. Tylenol PRN pain. Following kidney transplant- monitor for signs of rejection (fever, swelling and tenderness over graft area, increased blood pressure. Nephrotic syndrome- sx weight gain, facial edema, irritability, decreased urine output. STIs- Gonorrhea sx dysuria foul smelling yellow, green or cloudy vaginal discharge, unusual rash or sore, bleeding b/t period. Trichomoniasis=yellowish green vaginal discharge, irritation and burning with urination. Chlamydia (most common) sx= vaginal pain and white, yellow or gray foul smelling discharge, dysuria. HSV painful blisters and ulcers to genital area.  FRACTURES Fractures occur when there is a break in continuity, can result in torn blood vessels, and blood clots. Sx of fracture= pain, swelling, deformity, decreased movement, color change, change in sensation, change in quality in pulses. Initial management= immobilize fracture, apply ice, loosen or remove restrictive clothing, keep NPO, assess neurovascular status, elevate extremity, if compound stop bleeding and cover to prevent infection. Fractures are Simple or Compound. Compound fractures force a break in the skin, have increased risk of infection and hemorrhage. Education on cast care= keep cast clean and dry, do not place anything in the cast, elevate extremity, preform ROM exercises in nearby joints. 5 Ps to assess ischemia in a patient with a fracture- pain, pallor, pulse, paralysis, and paresthesia. Paresthesia is an ominous sign.  CARDIAC Rubella contracted during pregnancy can increase the unborn baby’s risk for heart defects. Clubbing of the nails results from chronic hypoxia and is a sign of a cardiac condition Coarctation sx b/p lower in legs than in arms Tetralogy of Fallot-Tet spells=squatting to increase return of venous blood to the heart. Kawasaki disease- results in inflammation and weak blood vessels leading to aneurysm. Sx include cervical lymphadenopathy, erythema of palms and soles, bilateral conjunctival inflammation, prolonged fever, and inflammation of pharynx with red crackled lips, and a strawberry tongue. Tx with aspirin and IVIG. Post-cardiac catheterization- RN will keep pressure dressing on and assess dressing every 30 mins for signs of bleeding or formation of hematoma, check for symmetric and equal pulses especially below cath site, and ensure patient lays still for 4-6 hours. Considerations when administering digoxin include notifying provider if child has missed 2 or more doses, if 1 dose is missed don’t give an extra dose just give the next scheduled dose, if dose is vomited do not give another dose until next scheduled dose is due, and withhold dose if apical pulse indicates bradycardia.  ADVOCATE AND EDUCATE Terminally ill patients- RN should help improve quality of life by advocating for the patient and providing pain and symptom relief. Support families with therapeutic communication and validating their feelings. Provide children with disabilities as much independence as possible. Give them safe choices. Parents may experience shock upon learning of a chronic or complex health condition diagnosis for their child. The 1st sign is often denial. Child abuse-risk is parent abused as a child, family hx of metal health issues or substance abuse, transient or non-biological caretakers. RNs are mandatory reporters of child abuse. Shaken-Baby Syndrome-sx subdural and retinal hemorrhages but no external signs of trauma followed by death. Prevention involves education in postnatal period that include RN teaching parents dangers of shaking a baby, methods to calm a baby, and talking about normal crying.  AUTISM AND DOWN SYNDROME Autism Spectrum Disorders are complex neurodevelopmental disorders of unknown etiology based on two behavior domains: difficulties in social communication and social interaction and unusually restricted, repetitive behavior, interest, or activities. There is a relatively high risk of recurrence of ASD in families with one affected child. Autism Spectrum Disorder (ASD) research shows a genetic link, there is no link between vaccinations and ASD. There is a relatively high risk of recurrence of ASD in families with one affected child. Physical characteristics of Down syndrome include a protruding abdomen, broad, short feet and hands, and hypotonia. When interacting with a child with Down Syndrome, the nurse should activities based on developmental level, not chronological age. Although children with trisomy 21 are born to parents of all ages, there is a statistically greater risk in older women, particularly those older than 35 years of age. Increased risk of leukemia.