Peds Final Exam Study Guide PDF

Study Guide for Growth and Development (Infant through Adolescent) Chapter 25-29 Overview This study guide covers physical growth, physiologic changes, Erikson’s psychosocial stages, gross motor development, fine motor development, and social/emotional development across five stages: Infant, Toddler, Preschooler, School-aged, and Adolescent. Infants (Birth to 1 Year) Physical Growth and Development Weight: Birth weight doubles by 6 months; triples by 1 year. Height: Increases by 50% by the end of the first year. Head Circumference: Increases rapidly; indicates brain growth. Teeth: First tooth erupts around 6 months. Physiologic Changes Neurologic: Rapid brain development; primitive reflexes fade by 3-6 months. Digestive: Immature at birth; enzymes for digestion fully develop by 1 year. Immune: Passive immunity decreases; active immunity builds with vaccinations. Cardiovascular: Heart rate slows; blood pressure increases. Erikson’s Psychosocial Theory Stage: Trust vs. Mistrust Task: Developing trust through consistent caregiving. Key Caregiver Role: Provide physical and emotional needs reliably. Gross Motor Development Lifts head by 2 months; rolls over by 4-6 months; sits unsupported by 6-8 months. Crawls at 9 months; walks with assistance at 12 months. Fine Motor Development Grasps reflexively at birth; develops a pincer grasp by 9-10 months. Transfers objects between hands at 6 months. Social/Emotional Development Smiles socially at 6-8 weeks. Develops attachment to caregivers. Separation anxiety appears by 8-10 months. Toddlers (1-3 Years) Physical Growth and Development Weight: Slows; gains about 4-6 pounds per year. Height: Increases by about 3 inches per year. Fontanelles: Anterior fontanelle closes by 18 months. Physiologic Changes Neurologic: Myelination of spinal cord completes, improving motor skills. Digestive: Improved chewing; less risk of choking. Urinary: Bladder control improves; potty training begins. Erikson’s Psychosocial Theory Stage: Autonomy vs. Shame and Doubt Task: Developing independence while minimizing shame. Key Caregiver Role: Offer choices and encourage self-care. Gross Motor Development Walks independently by 12-15 months. Climbs stairs with support by 2 years. Runs and kicks a ball by 2-3 years. Fine Motor Development Stacks 3-4 blocks by 18 months; 6-7 blocks by 2 years. Turns pages in a book. Begins drawing simple shapes. Social/Emotional Development Parallel play (plays alongside but not with others). Strong attachment to caregivers; may exhibit temper tantrums. Begins to express autonomy with "no" frequently. Preschoolers (3-5 Years) Physical Growth and Development Weight: Gains about 4-5 pounds per year. Height: Grows 2.5-3 inches per year. Body Shape: Loses toddler chubbiness; appears more lean. Physiologic Changes Neurologic: Coordination improves. Immune: More resilient; fewer infections. Dental: Primary teeth fully developed. Erikson’s Psychosocial Theory Stage: Initiative vs. Guilt Task: Developing initiative through play and imagination. Key Caregiver Role: Encourage creativity and exploration. Gross Motor Development Hops and balances on one foot by age 4. Throws and catches a ball. Rides a tricycle. Fine Motor Development Draws shapes and simple people by age 4-5. Uses scissors and utensils. Dresses and undresses independently. Social/Emotional Development Cooperative play emerges. Understands sharing and taking turns. Forms friendships; may have imaginary friends. School-aged Children (6-12 Years) Physical Growth and Development Weight: Gains 5-7 pounds per year. Height: Grows about 2 inches per year. Puberty: Early signs may appear by age 10-12. Physiologic Changes Muscle Development: Gains strength and coordination. Dental: Loses primary teeth; permanent teeth erupt. Immune: Fully functional; fewer illnesses. Erikson’s Psychosocial Theory Stage: Industry vs. Inferiority Task: Building competence through achievements. Key Caregiver Role: Encourage effort and acknowledge accomplishments. Gross Motor Development Improved balance and coordination. Participation in team sports. Can ride a bike. Fine Motor Development Writes neatly; uses tools like rulers and scissors accurately. Builds complex models or crafts. Social/Emotional Development Peer relationships become important. Understands rules and fairness. May experience self-esteem issues. Adolescents (13-18 Years) Physical Growth and Development Weight/Height: Growth spurts; girls earlier than boys. Puberty: Secondary sexual characteristics develop. Skeletal Growth: Growth plates close by late adolescence. Physiologic Changes Endocrine: Hormonal changes drive puberty. Cardiovascular: Increase in heart size and blood volume. Neurologic: Continued brain development, particularly prefrontal cortex. Erikson’s Psychosocial Theory Stage: Identity vs. Role Confusion Task: Developing a personal identity and sense of self. Key Caregiver Role: Support independence while maintaining guidance. Gross Motor Development Skills fine-tuned; peak physical performance possible. Participation in advanced sports and activities. Fine Motor Development Refinement of complex tasks such as writing or playing musical instruments. Social/Emotional Development Peer relationships and social acceptance are critical. Emotional independence develops; focus on identity and values. Risk-taking behaviors may increase. Study Guide for Foundations of Pediatric Nursing (Chapters 31, 32, 35, 36) Overview This study guide addresses communication strategies, vaccines, normal pediatric vital signs, pain scales, and weight-based medication dosing. Each section includes detailed points to aid understanding and application in pediatric nursing practice. Communication in Pediatric Nursing General Principles Family-Centered Care: Include parents and caregivers in communication; consider family dynamics. Age-Appropriate Strategies: Tailor communication techniques to the child's developmental level. Active Listening: Show empathy, ask open-ended questions, and confirm understanding. Nonverbal Communication: Use facial expressions, gestures, and visual aids to enhance understanding. Age-Specific Techniques Infants (Birth-1 Year): ○ Focus on tone of voice and facial expressions. ○ Communicate through touch (gentle stroking or holding). Toddlers (1-3 Years): ○ Use simple words and short sentences. ○ Allow choices to foster independence. ○ Use play as a communication tool. Preschoolers (3-5 Years): ○ Explain procedures in simple, concrete terms. ○ Use storytelling and drawings to communicate. ○ Address fears with reassurance. School-Aged Children (6-12 Years): ○ Provide detailed explanations using age-appropriate language. ○ Encourage questions and involve them in care decisions. ○ Respect their need for privacy. Adolescents (13-18 Years): ○ Engage in direct, honest communication. ○ Respect independence and confidentiality. ○ Discuss procedures and conditions openly, encouraging participation. Vaccines General Principles Schedule: Follow the CDC's recommended immunization schedule. Storage: Maintain the cold chain to ensure vaccine efficacy. Consent: Obtain informed parental consent before administration. Documentation: Record the vaccine name, lot number, expiration date, site, and route of administration. Vaccine Types Live Attenuated: ○ Examples: MMR, Varicella. ○ Strong immune response but not for immunocompromised patients. Inactivated: ○ Examples: Polio (IPV), Hepatitis A. ○ Requires multiple doses for effectiveness. Subunit/Conjugate: ○ Examples: Hepatitis B, Hib, HPV. ○ Fewer side effects, highly targeted. mRNA: ○ Example: COVID-19 vaccines (e.g., Pfizer, Moderna). ○ Effective and quick to produce. Key Vaccines and Timing Birth: Hepatitis B (1st dose). 2 Months: DTaP, IPV, Hib, PCV, Rotavirus. 4 Months: Second doses of the above. 6 Months: Third doses; influenza annually starts. 12-15 Months: MMR, Varicella, Hep A, boosters for Hib and PCV. 4-6 Years: DTaP, IPV, MMR, Varicella boosters. Common Side Effects Local reactions: Redness, swelling, or pain at the injection site. Systemic reactions: Mild fever, irritability, or fatigue. Normal Pediatric Vital Signs Age Group Heart Rate Respiratory Rate Blood Pressure Temperatur (beats/min) (breaths/min) (mmHg) e Newborn 120-160 30-60 60-90/30-60 97.7-99.5°F Infant (1-12 100-150 25-50 80-100/55-65 97.7-99.5°F mo) Toddler (1-3 90-140 20-30 90-105/55-70 97.5-98.6°F yr) Preschooler 80-120 20-25 95-110/60-75 97.5-98.6°F (3-5) School-aged 70-110 15-20 100-120/60-80 97.5-98.6°F (6-12) Adolescent 60-100 12-20 110-135/65-85 97.5-98.6°F (13-18) Pain Scales Types of Pain Scales 1. FLACC Scale (Face, Legs, Activity, Cry, Consolability): ○ Used for infants and nonverbal children. ○ Scores range from 0-10 based on observed behaviors. 2. Wong-Baker FACES Scale: ○ Appropriate for children 3+. ○ Child selects a face corresponding to their pain level. 3. Numeric Pain Scale: ○ Used for children 8+ who can understand numerical values. ○ Pain rated from 0 (no pain) to 10 (worst pain). 4. NIPS (Neonatal Infant Pain Scale): ○ Used for newborns. ○ Measures behaviors like crying, facial expressions, and body movements. Pain Management Non-Pharmacologic: Distraction, play therapy, music, swaddling, or breastfeeding. Pharmacologic: Acetaminophen, ibuprofen, opioids for severe pain, weight-based dosing. Weight-Based Dosing General Principles Accuracy: Calculate doses based on weight in kilograms (1 kg = 2.2 lbs). Safe Dose Range: Verify the prescribed dose falls within the recommended range (e.g., mg/kg/dose or mg/kg/day). Reassessment: Monitor for therapeutic effects and side effects. Common Calculations 1. Converting Pounds to Kilograms: ○ Weight in kg=Weight in lbs÷2.2\text{Weight in kg} = \text{Weight in lbs} \div 2.2Weight in kg=Weight in lbs÷2.2 2. Dose Calculation: ○ Dose (mg)=Weight (kg)×Dose per kg\text{Dose (mg)} = \text{Weight (kg)} \times \text{Dose per kg}Dose (mg)=Weight (kg)×Dose per kg 3. Example: ○ A child weighs 10 kg; prescribed 10 mg/kg/dose. ○ Total dose = 10 kg×10 mg/kg=100 mg10 \, \text{kg} \times 10 \, \text{mg/kg} = 100 \, \text{mg}10kg×10mg/kg=100mg. Common Medications Acetaminophen: 10-15 mg/kg every 4-6 hours. Ibuprofen: 5-10 mg/kg every 6-8 hours (for children over 6 months). Amoxicillin: 20-40 mg/kg/day divided every 8-12 hours. Double-Checking Verify calculations with a second nurse or pharmacist. Confirm with dosing guidelines and references. Study Guide for Nursing Care of the Child with an Infection (Chapter 37) Overview This study guide covers the differences between bacterial, viral, and fungal infections, strategies for preventing infectious diseases, fever management, and specific information on Lyme disease. Understanding these key concepts is essential for pediatric nursing practice to effectively manage and prevent infections in children. Bacterial vs. Viral vs. Fungal Infections Bacterial Infections Characteristics: ○ Caused by single-celled organisms (bacteria). ○ Can be localized (e.g., skin infections) or systemic (e.g., pneumonia). ○ Often treated with antibiotics. Common Examples: ○ Streptococcus (Strep throat, scarlet fever): Red, inflamed throat, fever, and rash. ○ Staphylococcus (Impetigo, cellulitis): Pus-filled lesions, redness, and warmth. ○ Escherichia coli (E. coli): Diarrhea, abdominal cramps. ○ Meningococcus: Meningitis with fever, headache, and stiff neck. Signs and Symptoms: ○ Localized redness, swelling, or drainage of pus. ○ Fever, chills. ○ Fatigue, malaise. ○ Specific symptoms based on infection site (e.g., sore throat for strep, cough for pneumonia). Treatment: ○ Antibiotics: Broad-spectrum or targeted based on culture results. ○ Symptom management: Pain relief, hydration, fever control. Viral Infections Characteristics: ○ Caused by viruses that are not treatable with antibiotics. ○ Often self-limiting, but some require antiviral medications. Common Examples: ○ Respiratory syncytial virus (RSV): Respiratory distress, wheezing, coughing (common in infants). ○ Influenza: Fever, cough, sore throat, muscle aches. ○ Varicella (Chickenpox): Vesicular rash, fever. ○ Coxsackievirus (Hand, Foot, and Mouth Disease): Vesicular rash, mouth sores, fever. Signs and Symptoms: ○ Fever, malaise, muscle aches. ○ Cough, sore throat, nasal congestion. ○ Rash (specific to the virus). ○ Gastrointestinal symptoms (e.g., vomiting, diarrhea). Treatment: ○ Supportive care: Hydration, rest, fever control. ○ Antiviral medications (for some viruses like influenza, herpes simplex). ○ Immunizations: Prevention through vaccines (e.g., MMR, varicella). Fungal Infections Characteristics: ○ Caused by fungi (e.g., molds or yeasts). ○ Often affect the skin, nails, or mucous membranes, but can become systemic. Common Examples: ○ Candida (Thrush, Diaper Rash): White patches in the mouth, itchy rash in diaper area. ○ Tinea (Ringworm, Athlete's Foot): Itchy, circular rash with raised borders. ○ Histoplasmosis: Respiratory symptoms after exposure to fungal spores. Signs and Symptoms: ○ Red, scaly, itchy rashes (ringworm, athlete’s foot). ○ Oral thrush (white patches on the tongue and inside of the cheeks). ○ Respiratory distress or symptoms (histoplasmosis). Treatment: ○ Antifungal medications: Topical treatments (e.g., clotrimazole) for superficial infections, oral or IV antifungals (e.g., fluconazole) for systemic infections. ○ Good hygiene: Preventing fungal growth through clean, dry skin. Preventing Infectious Diseases Hand Hygiene Key Strategy: Handwashing with soap and water is the most effective method to prevent the spread of infections. Alcohol-based hand sanitizers: Use when soap and water are not available. Teach children: Proper handwashing technique and the importance of washing hands after using the bathroom, eating, or coughing/sneezing. Vaccination Immunization Schedule: Follow the CDC-recommended vaccination schedule to prevent viral and bacterial infections. Key Vaccines: Measles, Mumps, Rubella (MMR), Diphtheria, Tetanus, Pertussis (DTaP), Polio, Influenza, Hepatitis B, etc. Infection Control in Healthcare Settings Isolation precautions: Use appropriate isolation for children with contagious diseases (droplet, contact, airborne). Personal Protective Equipment (PPE): Proper use of gloves, masks, gowns, and eye protection to prevent cross-contamination. Disinfection: Regular cleaning and disinfecting of surfaces in healthcare settings. General Preventative Measures Promote healthy habits: Encourage good nutrition, adequate hydration, and adequate sleep. Environmental control: Maintain clean and sanitized environments to limit exposure to pathogens. Reduce exposure to sick contacts: Avoid close contact with individuals who are symptomatic or have been diagnosed with contagious diseases. Fever Management Understanding Fever Definition: A body temperature above the normal range, typically above 100.4°F (38°C). Purpose: Fever is often a response to infection and helps the immune system fight off pathogens. Assessment Temperature Monitoring: Use a thermometer (oral, rectal, axillary) to accurately assess temperature. Signs of Severe Illness: High fever (above 104°F), persistent fever for more than 72 hours, or fever associated with other symptoms like a stiff neck or severe headache. Fever Management Strategies Antipyretics: Acetaminophen (Tylenol) or ibuprofen (Advil) for reducing fever. Always check proper dosage based on age and weight. Hydration: Encourage fluid intake to prevent dehydration, which can occur with fever. Cooling Measures: Use cool compresses, lukewarm baths, or fans to help reduce temperature. Avoid cold water or ice baths as they can cause shivering, which raises body temperature. Dress appropriately: Dress the child in light clothing to help lower body temperature. Monitor: Regularly monitor the child’s temperature and behavior to assess if the fever is responding to treatment. When to Seek Medical Attention Infants: Any fever in an infant younger than 3 months should be evaluated by a healthcare provider immediately. Severe symptoms: Seizures, difficulty breathing, persistent vomiting, or signs of dehydration. Lyme Disease Overview Cause: Lyme disease is caused by the bacterium Borrelia burgdorferi, transmitted by the bite of an infected black-legged tick (deer tick). Endemic Areas: Common in areas with high tick populations (e.g., northeastern U.S., upper Midwest, parts of the Pacific Coast). Signs and Symptoms Early Stage: ○ Erythema migrans: A characteristic "bull's-eye" rash (red center with a lighter ring around it) around the tick bite site (occurs in 70-80% of cases). ○ Flu-like symptoms: Fever, chills, headache, fatigue, muscle and joint aches. Later Stages: ○ Neurologic symptoms: Meningitis, facial palsy. ○ Cardiac symptoms: Heart block or irregular heartbeats. ○ Arthritis: Joint pain, particularly in the knees. Diagnosis Clinical Evaluation: Based on history of tick exposure and the presence of the characteristic rash. Laboratory Tests: ELISA (enzyme-linked immunosorbent assay) followed by a Western blot test for confirmation. Treatment Antibiotics: Early-stage Lyme disease is typically treated with oral antibiotics (e.g., doxycycline or amoxicillin). Late-stage Lyme disease: May require intravenous antibiotics for more severe symptoms like arthritis or neurologic involvement. Prevention Tick Prevention: ○ Wear long sleeves and pants when in tick-infested areas. ○ Use insect repellent containing DEET. ○ Check for ticks after outdoor activities. ○ Remove ticks promptly using fine-tipped tweezers. Study Guide for Nursing Care of the Child with an Alteration in Intracranial Regulation/Neurologic Disorder (Chapter 38) Overview This study guide covers key concepts related to altered states of consciousness, epilepsy, hydrocephalus, and increased intracranial pressure (ICP). It includes the Glasgow Coma Scale, the management of epilepsy, and the treatment of hydrocephalus, essential for pediatric nursing care. States of Consciousness (Glasgow Coma Scale) Purpose of the Glasgow Coma Scale (GCS) Purpose: The GCS is a clinical scale used to assess the level of consciousness in a patient, helping to determine the severity of brain injury. Key Areas Assessed: Eye opening, verbal response, and motor response. Components of the GCS 1. Eye Opening (4 points): ○ 4: Spontaneous eye opening. ○ 3: Eye opening in response to speech. ○ 2: Eye opening in response to pain. ○ 1: No eye opening. 2. Verbal Response (5 points): ○ 5: Oriented, converses appropriately. ○ 4: Confused conversation. ○ 3: Inappropriate words. ○ 2: Incomprehensible sounds. ○ 1: No verbal response. 3. Motor Response (6 points): ○ 6: Obeys commands. ○ 5: Localizes pain. ○ 4: Withdraws from pain. ○ 3: Abnormal flexion (decorticate). ○ 2: Abnormal extension (decerebrate). ○ 1: No motor response. Total GCS Score The total GCS score ranges from 3 to 15. ○ 3-8: Severe brain injury (coma). ○ 9-12: Moderate brain injury. ○ 13-15: Mild brain injury. Clinical Application Monitoring: Use GCS to assess consciousness level and track changes in response to treatment. Indications: Used in head trauma, stroke, and other neurological disorders. Epilepsy Overview Definition: Epilepsy is a chronic neurological disorder characterized by recurrent seizures due to abnormal electrical activity in the brain. Prevalence: Common in children, with many outgrowing seizures as they age. Types of Seizures 1. Focal Seizures: ○ Originate in one part of the brain. ○ Symptoms depend on the area of the brain affected (e.g., jerking, sensory disturbances, altered consciousness). ○ Can be simple (no loss of consciousness) or complex (with altered consciousness). 2. Generalized Seizures: ○ Affect both sides of the brain. ○ Tonic-Clonic Seizures (Grand Mal): Loss of consciousness, body stiffening (tonic phase), followed by jerking (clonic phase). ○ Absence Seizures: Brief episodes of staring and loss of awareness, common in children. ○ Myoclonic Seizures: Sudden, brief jerks of a muscle or group of muscles. Diagnosis EEG (Electroencephalogram): Measures electrical activity in the brain, used to diagnose seizures. MRI or CT Scan: Used to rule out structural causes (e.g., tumors, abnormalities). Treatment 1. Antiepileptic Medications (AEDs): ○ Common AEDs: Phenytoin, valproic acid, lamotrigine, levetiracetam. ○ Medication choice depends on seizure type and child's age. 2. Ketogenic Diet: High-fat, low-carbohydrate diet used when seizures are resistant to medication. 3. Surgical Treatment: If seizures are not controlled by medication, surgery may be considered (e.g., removal of brain tissue causing seizures). 4. Vagus Nerve Stimulation: A device implanted under the skin that sends electrical signals to the brain to prevent seizures. Management and Nursing Care Safety: Protect the child from injury during a seizure (e.g., prevent choking, keep them safe from sharp objects). Seizure Log: Keep a record of the frequency, duration, and nature of seizures to aid treatment. Medication Adherence: Ensure the child adheres to their antiepileptic medication regimen. Education: Teach parents how to respond during a seizure (e.g., turn the child on their side, do not restrain). Hydrocephalus (Increased ICP) Overview Definition: Hydrocephalus is the accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, causing increased intracranial pressure (ICP). Causes: Can be congenital (e.g., due to neural tube defects) or acquired (e.g., due to tumors, infections, head injury). Signs and Symptoms of Increased ICP In Infants: ○ Bulging fontanelles (soft spots on the head). ○ Increased head circumference. ○ Vomiting. ○ High-pitched crying. ○ Poor feeding. In Older Children: ○ Headache (often worse in the morning). ○ Vomiting. ○ Papilledema (swelling of the optic disc). ○ Changes in level of consciousness. ○ Altered gait, balance, and coordination. ○ Seizures. Diagnosis Ultrasound: In infants with open fontanelles, ultrasound can visualize enlarged ventricles. CT or MRI Scan: Used in older children to assess ventricular size and cause of hydrocephalus. Treatment 1. Surgical Intervention: ○ Ventriculoperitoneal (VP) Shunt: A common surgical treatment where a shunt is inserted to drain excess CSF from the ventricles to the peritoneal cavity. ○ Endoscopic Third Ventriculostomy (ETV): A procedure to create an opening in the third ventricle to allow CSF flow. 2. Shunt Care and Monitoring: ○ Infection Prevention: Shunts can become infected, requiring antibiotics or removal. ○ Shunt Malfunction: Monitor for signs of increased ICP or failure of the shunt (headache, vomiting, lethargy). ○ Long-Term Follow-Up: Children with hydrocephalus need ongoing assessments for shunt function, growth, and development. Nursing Management ICP Monitoring: Observe for signs of increased ICP (headache, vomiting, altered consciousness). Positioning: Keep the head of the bed elevated to promote CSF drainage and decrease ICP. Post-Operative Care: After shunt placement, monitor for infection, bleeding, or shunt malfunction. Educating Families: Teach parents how to care for the child post-surgery, recognize signs of shunt malfunction, and follow up regularly with a pediatric neurologist. Study Guide for Nursing Care of the Child with an Alteration in Sensory Perception/Disorder of the Eyes or Ears (Chapter 39) Overview This study guide covers key concepts related to alterations in sensory perception, including common disorders of the eyes and ears in pediatric patients. Focus areas include conjunctivitis, visual impairment, and otitis media. Understanding the signs, symptoms, diagnosis, and management of these conditions is crucial in providing effective care. Conjunctivitis (Pink Eye) Overview Definition: Conjunctivitis is the inflammation or infection of the conjunctiva, the thin membrane that lines the eyelid and covers the white part of the eye. Types: 1. Bacterial: Caused by bacteria, often characterized by purulent discharge. 2. Viral: Often associated with upper respiratory infections, usually has a watery discharge. 3. Allergic: Triggered by allergens, resulting in itching and watery eyes, but no discharge. 4. Irritant: Caused by foreign bodies or chemicals in the eye, leading to redness and discomfort. Signs and Symptoms Bacterial: ○ Redness, swelling, and purulent discharge (yellow or green). ○ May affect one or both eyes. ○ Eyelids may be stuck together, especially in the morning. Viral: ○ Red, watery eyes, often with a gritty sensation. ○ Often accompanied by cold-like symptoms (e.g., sore throat, cough). Allergic: ○ Itchy, watery eyes with redness. ○ Often affects both eyes simultaneously. ○ Associated with sneezing and nasal congestion. Irritant: ○ Redness, watering, and a foreign body sensation. ○ Occurs after exposure to chemicals, smoke, or dust. Diagnosis Clinical Examination: Based on symptoms, physical examination, and patient history. Culture and Sensitivity: In bacterial conjunctivitis, culture may be performed to identify the causative organism. Treatment Bacterial: ○ Antibiotic eye drops or ointments (e.g., erythromycin, gentamicin). ○ Typically resolves in 7–10 days with treatment. Viral: ○ Supportive care: Artificial tears, cool compresses, and proper hygiene. ○ Antiviral medications: Rarely used, except in cases of herpes simplex virus. Allergic: ○ Antihistamine eye drops or oral antihistamines. ○ Avoidance of allergens and use of cool compresses. Irritant: ○ Flushing with saline to remove the irritant. ○ Symptomatic treatment with artificial tears. Nursing Care Education: ○ Teach parents about the importance of hygiene (e.g., handwashing, cleaning eye discharge) to prevent spread. ○ Instruct on proper administration of eye drops or ointments. ○ Advise on when to seek medical care if symptoms worsen or fail to resolve. Visual Impairment Overview Definition: Visual impairment in children refers to partial or total loss of vision that may occur due to congenital conditions or acquired disorders. Prevalence: Early detection is critical to managing visual impairment and preventing developmental delays. Causes 1. Congenital: ○ Retinopathy of prematurity (ROP): A disorder in premature infants where abnormal blood vessels form in the retina. ○ Cataracts: Clouding of the lens that can affect vision from birth or early childhood. ○ Congenital glaucoma: Increased pressure within the eye that damages the optic nerve. 2. Acquired: ○ Amblyopia (Lazy eye): Decreased vision in one or both eyes due to abnormal visual development. ○ Strabismus: Misalignment of the eyes that can lead to amblyopia if untreated. ○ Trauma or injury: Any injury to the eye can lead to permanent vision loss. ○ Infections: E.g., congenital rubella syndrome causing cataracts. Signs and Symptoms Infants: ○ Lack of eye contact or poor tracking of objects. ○ Constantly turning the head to one side or holding objects close to the face. Older Children: ○ Squinting, covering one eye, or tilting the head to see clearly. ○ Difficulty reading, participating in sports, or performing tasks that require sharp vision. Diagnosis Visual Screening: Performed during well-child visits to detect signs of visual impairment early. Comprehensive Eye Exam: By an ophthalmologist, including assessment of the retina, optic nerve, and visual acuity. Treatment Eyeglasses or Contact Lenses: Corrective lenses for refractive errors (nearsightedness, farsightedness, astigmatism). Surgical Intervention: For conditions like cataracts, strabismus, or congenital glaucoma. Vision Therapy: Used for conditions like amblyopia or strabismus to improve eye coordination and vision. Low Vision Aids: Special devices (e.g., magnifying glasses, braille) for children with severe visual impairments. Nursing Care Promote Early Detection: Encourage regular eye exams and screenings. Provide Emotional Support: Help children and families adjust to the diagnosis, offer resources (e.g., support groups), and address self-esteem issues. Adaptive Aids: Educate families on tools and strategies to assist children with visual impairments in school and daily activities. Injury Prevention: Encourage the use of protective eyewear during sports and activities that pose a risk to eye health. Otitis Media (Middle Ear Infection) Overview Definition: Otitis media is an infection or inflammation of the middle ear, commonly occurring in young children. It can be acute or chronic. Prevalence: A very common childhood illness, especially in children under 3 years old. Causes Bacterial or Viral Infection: Often follows an upper respiratory infection (cold, flu) or allergic rhinitis. Eustachian Tube Dysfunction: Swelling or blockage of the Eustachian tube, leading to fluid buildup in the middle ear. Types 1. Acute Otitis Media (AOM): Sudden onset of symptoms such as fever, ear pain, and irritability. 2. Otitis Media with Effusion (OME): Fluid buildup without infection, often seen after AOM or as a chronic condition. 3. Chronic Otitis Media: Persistent or recurrent ear infections, potentially leading to hearing loss. Signs and Symptoms Infants/Young Children: ○ Ear pulling, irritability, crying. ○ Difficulty sleeping (worsened when lying down). ○ Decreased appetite. ○ Fever. Older Children: ○ Ear pain, which may worsen when chewing or lying down. ○ Hearing difficulties. ○ Drainage from the ear (if the eardrum ruptures). Diagnosis Otoscope Examination: The healthcare provider uses an otoscope to visualize the ear canal and tympanic membrane (eardrum). Signs of otitis media include a red, bulging eardrum and fluid behind the eardrum. Tympanometry: A test to assess the movement of the eardrum and middle ear pressure. Treatment 1. Acute Otitis Media (AOM): ○ Antibiotics: Typically prescribed if bacterial infection is suspected (e.g., amoxicillin). ○ Pain management: Acetaminophen or ibuprofen for fever and pain relief. ○ Warm compresses: To relieve ear pain. 2. Otitis Media with Effusion (OME): ○ Observation: Many cases resolve on their own, but if symptoms persist, a referral for further evaluation may be needed. ○ Hearing Tests: Monitoring for hearing loss, particularly in children with recurrent OME. 3. Chronic Otitis Media: ○ Myringotomy: Surgical procedure to drain fluid from the middle ear. ○ Tympanostomy tubes: Small tubes placed in the eardrum to help prevent fluid buildup and reduce the frequency of infections. Nursing Care Pain Relief: Provide medication as prescribed and ensure comfort (e.g., warm compresses). Preventative Education: Educate parents on preventing ear infections (e.g., avoiding secondhand smoke, breastfeed infants to reduce risk). Monitor Hearing: For children with recurrent or chronic otitis media, assess for signs of hearing loss, and refer to an audiologist if necessary. Post-Operative Care: If the child has had tympanostomy tubes inserted, educate parents on care instructions to prevent infection and ensure proper tube function. Study Guide for Nursing Care of the Child with an Alteration in Gas Exchange/Respiratory Disorder (Chapter 40) Overview This study guide covers key respiratory disorders in pediatric patients, including tonsillitis, asthma, and cystic fibrosis. Understanding the pathophysiology, symptoms, diagnosis, and management of these conditions is essential for providing comprehensive nursing care. Tonsillitis Overview Definition: Tonsillitis is the inflammation of the tonsils, typically caused by viral or bacterial infections. Etiology: ○ Viral Tonsillitis: Caused by common viruses (e.g., rhinovirus, adenovirus). ○ Bacterial Tonsillitis: Often caused by Streptococcus pyogenes (Group A Streptococcus), leading to strep throat. Signs and Symptoms Sore throat: Painful swallowing. Red, swollen tonsils: May have white or yellow spots (in bacterial cases). Fever: Common, especially in bacterial tonsillitis. Bad breath (halitosis). Difficulty swallowing or breathing (especially in severe cases). Ear pain: Due to shared nerve pathways. Diagnosis Throat Culture: A throat swab to test for Streptococcus pyogenes (Group A strep). Rapid Antigen Detection Test (RADT): A quick test to detect streptococcal infection. Physical Examination: Inspection of the throat, tonsils, and lymph nodes. Treatment Viral Tonsillitis: ○ Supportive care: Rest, hydration, and pain relief (e.g., acetaminophen or ibuprofen). ○ Throat lozenges or saltwater gargles for relief. Bacterial Tonsillitis: ○ Antibiotics: Penicillin or amoxicillin (if caused by Group A strep). ○ Complete the entire course of antibiotics to prevent complications like rheumatic fever or glomerulonephritis. Severe or Recurrent Tonsillitis: ○ Tonsillectomy: Surgical removal of the tonsils for children with frequent infections or complications. Nursing Care Pain Management: Administer pain relief medication as prescribed and encourage fluid intake. Monitor for Complications: Watch for signs of respiratory distress or difficulty swallowing. Pre-Operative Education: If tonsillectomy is planned, educate the family on the procedure, recovery process, and post-operative care (e.g., avoiding spicy or acidic foods, managing pain). Asthma Overview Definition: Asthma is a chronic inflammatory disease of the airways, leading to reversible airflow obstruction, bronchospasm, and difficulty breathing. Etiology: Environmental triggers (e.g., allergens, respiratory infections, cold air, smoke) and genetic factors contribute to asthma development. Pathophysiology Airway Inflammation: Swelling of the airway lining, increased mucus production. Bronchoconstriction: Tightening of the smooth muscles around the airways. Airway Hyperresponsiveness: Exaggerated response to triggers, leading to wheezing, coughing, and shortness of breath. Signs and Symptoms Wheezing: A high-pitched whistling sound during exhalation. Coughing: Often worse at night or early morning. Shortness of Breath: Difficulty breathing, especially during physical activity. Chest Tightness: Feeling of pressure in the chest. Diagnosis History and Physical Exam: Identifying triggers, family history, and symptom patterns. Pulmonary Function Tests (PFTs): Measures lung function and airway obstruction. Peak Flow Meter: Measures the maximum speed of exhalation, helping to assess the severity of asthma. Allergy Testing: To identify potential allergens triggering asthma symptoms. Treatment 1. Medications: ○ Quick-relief (Rescue) Medications: Short-acting beta-agonists (SABA) (e.g., albuterol) to relieve acute bronchospasm. Anticholinergics (e.g., ipratropium) for additional relief in acute episodes. ○ Long-term Control Medications: Inhaled Corticosteroids (e.g., fluticasone, budesonide) to reduce airway inflammation. Leukotriene Modifiers (e.g., montelukast) to decrease airway constriction. Long-acting beta-agonists (LABA) (e.g., salmeterol) used in combination with inhaled corticosteroids. Mast Cell Stabilizers (e.g., cromolyn) to prevent allergic reactions. 2. Allergen and Irritant Avoidance: ○ Avoid exposure to asthma triggers (e.g., smoke, pet dander, pollen). ○ Regular cleaning of bedding and home to reduce allergens. 3. Asthma Action Plan: ○ Develop a written plan with medication instructions for daily management and response to worsening symptoms or exacerbations. Nursing Care Education: Teach the child and family how to use inhalers, nebulizers, and peak flow meters correctly. Encourage Medication Adherence: Ensure consistent use of preventive medications, even when symptoms are absent. Symptom Monitoring: Help families recognize early signs of an asthma exacerbation and when to seek emergency care. Support during Exacerbations: Provide supportive care during asthma attacks, ensuring that the child has access to rescue medications. Cystic Fibrosis Overview Definition: Cystic fibrosis (CF) is a genetic disorder characterized by thick, sticky mucus that affects the lungs, pancreas, and other organs, leading to respiratory and digestive complications. Etiology: Caused by mutations in the CFTR gene, leading to defective chloride ion transport in epithelial cells, causing mucus to become thick and difficult to clear. Pathophysiology Respiratory System: Thick mucus obstructs the airways, leading to chronic respiratory infections, bronchiectasis, and progressive lung damage. Digestive System: Blockage of pancreatic ducts impairs enzyme secretion, leading to malabsorption of nutrients, steatorrhea (fatty stools), and poor growth. Sweat Glands: Excessive salt in sweat, leading to dehydration and electrolyte imbalances. Signs and Symptoms Respiratory: ○ Persistent cough, often with thick, mucus production. ○ Wheezing and shortness of breath. ○ Recurrent lung infections (e.g., pneumonia, bronchitis). ○ Cyanosis (bluish tint to skin due to low oxygen levels). Digestive: ○ Poor growth or failure to thrive despite adequate nutrition. ○ Steatorrhea (greasy, foul-smelling stools). ○ Abdominal pain and bloating. Other: ○ Salty-tasting skin. ○ Digital clubbing (enlarged fingertips) due to chronic hypoxia. Diagnosis Newborn Screening: Most infants are screened for CF at birth through a blood test. Sweat Test: Measures the amount of chloride in sweat; elevated levels are indicative of CF. Genetic Testing: Identifies mutations in the CFTR gene. Chest X-ray and Pulmonary Function Tests: Assess lung function and detect signs of lung damage. Treatment 1. Respiratory Management: ○ Chest Physiotherapy (CPT): Regular physical therapy to loosen and clear mucus from the lungs. ○ Inhaled Medications: Bronchodilators (e.g., albuterol) to open the airways. Mucolytics (e.g., dornase alfa) to thin mucus. Inhaled Antibiotics (e.g., tobramycin) for chronic lung infections. Corticosteroids to reduce inflammation. 2. Nutritional Support: ○ Pancreatic Enzyme Replacement Therapy (PERT): To aid digestion and nutrient absorption. ○ High-calorie Diet: CF patients often require higher caloric intake to meet their energy needs. ○ Fat-soluble Vitamins: Supplementation with vitamins A, D, E, and K. 3. Lung Transplantation: For patients with end-stage lung disease, a lung transplant may be necessary. Nursing Care Promote Airway Clearance: Assist with CPT, administer prescribed inhaled medications, and encourage regular exercise. Monitor Nutrition: Ensure adequate caloric intake and administer enzyme replacements as prescribed. Provide Psychosocial Support: Offer emotional and psychological support to children and families coping with chronic illness. Education: Teach families about CF management, including medication adherence, nutrition, and airway clearance techniques. Study Guide for Nursing Care of the Child with an Alteration in Perfusion/Cardiovascular Disorder (Chapter 41) Overview This chapter covers cardiovascular disorders in pediatric patients, specifically Kawasaki disease and Patent Ductus Arteriosus (PDA). These conditions affect the circulatory system and require specific nursing care to manage symptoms and prevent complications. Kawasaki Disease Overview Definition: Kawasaki disease is an acute systemic vasculitis that primarily affects children under five years old, causing inflammation of blood vessels throughout the body. It is one of the leading causes of acquired heart disease in children. Etiology: The exact cause is unknown, but it is believed to involve an autoimmune response, possibly triggered by an infection or environmental factors. Genetic predisposition may also play a role. Pathophysiology Vascular Inflammation: The inflammation of medium-sized arteries, including the coronary arteries, is a hallmark. This can lead to aneurysms, thrombosis, or narrowing of the arteries, increasing the risk of heart disease. Multisystem Involvement: The disease affects multiple organs, including the heart, skin, eyes, and mucous membranes. Signs and Symptoms Fever: High fever lasting more than five days. Conjunctivitis: Bilateral, non-purulent eye redness without discharge. Rash: A polymorphous rash that can affect the trunk, arms, and legs. Swollen Hands and Feet: Red, swollen hands and feet, followed by peeling of the skin, particularly on the fingers and toes. Lymphadenopathy: Enlarged lymph nodes, often unilateral. Mucosal Changes: Red, cracked lips, a “strawberry tongue” (red, swollen tongue with papillae), and erythema of the oral mucosa. Diagnosis Clinical Criteria: Diagnosis is made based on clinical criteria, which include fever lasting at least five days, along with four of the following: ○ Conjunctivitis ○ Rash ○ Swollen hands or feet ○ Mucosal changes ○ Cervical lymphadenopathy Laboratory Tests: Elevated inflammatory markers (e.g., ESR, CRP) and possible thrombocytosis (elevated platelet count). A normal echocardiogram does not rule out Kawasaki disease in the early stages. Treatment 1. Intravenous Immunoglobulin (IVIG): ○ Administered to reduce inflammation and the risk of coronary artery aneurysms. ○ IVIG is most effective when given within the first ten days of illness. 2. Aspirin: ○ High doses of aspirin are given in the acute phase to reduce inflammation and prevent clot formation. ○ After fever subsides, aspirin is continued at a low dose for its antiplatelet effects. 3. Corticosteroids (in severe cases): ○ May be used if the child does not respond to IVIG treatment. 4. Supportive Care: ○ Hydration, pain management, and fever control. ○ Careful monitoring of the cardiovascular status, especially for signs of coronary artery involvement (e.g., echocardiography). Nursing Care Monitor for Cardiac Complications: Monitor for signs of coronary artery involvement (e.g., chest pain, arrhythmias, heart murmurs). Regular echocardiograms are essential. Pain and Fever Management: Administer medications as prescribed for fever (aspirin and acetaminophen) and ensure comfort. Fluid and Electrolyte Balance: Ensure proper hydration and monitor for signs of dehydration, especially during the febrile phase. Education: Educate parents about the importance of follow-up care, including echocardiograms to monitor for coronary artery changes and the long-term effects of the disease. Patent Ductus Arteriosus (PDA) Overview Definition: Patent Ductus Arteriosus (PDA) is a congenital heart defect in which the ductus arteriosus, a vessel that connects the pulmonary artery to the aorta, fails to close after birth. This causes abnormal blood flow between the two arteries. Etiology: PDA is common in premature infants but can occur in full-term infants as well. Risk factors include prematurity, maternal rubella, and genetic conditions. Pathophysiology Abnormal Blood Flow: In a normal circulatory system, the ductus arteriosus closes shortly after birth, directing blood flow to the lungs and away from the aorta. In PDA, the ductus remains open, allowing oxygenated blood from the aorta to flow back into the pulmonary artery, increasing pulmonary blood flow and workload on the heart. Increased Pulmonary Blood Flow: This leads to pulmonary overcirculation, which can strain the right side of the heart and lead to respiratory distress, failure to thrive, or other complications. Signs and Symptoms Heart Murmur: A characteristic continuous "machinery" murmur heard during auscultation. Respiratory Distress: Tachypnea, increased work of breathing, and poor feeding. Poor Weight Gain: Due to inadequate oxygenation and energy expenditure. Increased Pulmonary Pressure: Can lead to pulmonary edema, leading to difficulty breathing and cyanosis. Fatigue: In severe cases, children may be lethargic or show signs of congestive heart failure. Diagnosis Physical Examination: Detection of a continuous heart murmur. Echocardiography: Confirmatory test for PDA, showing the flow of blood through the ductus arteriosus. Chest X-ray: May show signs of increased pulmonary vascular markings or cardiomegaly. Treatment 1. Medical Management: ○ Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Indomethacin or ibuprofen are commonly used to encourage closure of the ductus arteriosus by inhibiting prostaglandin production. 2. Surgical Management: ○ Ligation of the Ductus Arteriosus: In cases where medical therapy is ineffective or the PDA is large, surgical closure may be required. ○ Catheter-based Closure: A minimally invasive procedure that uses a catheter to place a device to close the ductus. 3. Supportive Care: ○ Oxygen Therapy: To ensure adequate oxygenation and support respiratory function. ○ Nutritional Support: In infants, tube feeding may be necessary if the infant cannot feed adequately due to respiratory distress. Nursing Care Monitor Respiratory Status: Closely observe for signs of respiratory distress, tachypnea, and cyanosis. Administer oxygen as needed. Cardiac Monitoring: Monitor for signs of heart failure, including edema, tachycardia, and poor feeding. Post-Procedure Care: After surgical or catheter closure, monitor for complications such as bleeding or infection. Educate families on the importance of follow-up care and developmental milestones. Education: Provide parents with information about PDA, treatment options, and potential outcomes, including the need for further interventions or long-term monitoring. Study Guide for Nursing Care of the Child with an Alteration in Bowel Elimination/Gastrointestinal Disorder (Chapter 42) Overview This chapter addresses common gastrointestinal (GI) disorders in children, specifically dehydration and appendicitis. Understanding the pathophysiology, signs and symptoms, diagnosis, treatment, and nursing care for these conditions is essential for effective pediatric nursing care. Dehydration Overview Definition: Dehydration is the loss of body water and essential electrolytes, leading to an imbalance in the body’s fluid levels. It can range from mild to severe, depending on the amount of fluid lost. Etiology: Common causes of dehydration in children include gastrointestinal illnesses (vomiting and diarrhea), excessive heat, excessive sweating, and inadequate fluid intake. Pathophysiology Fluid Loss: Dehydration occurs when there is an excessive loss of fluids through the skin, gastrointestinal tract, or kidneys, or inadequate fluid intake. Electrolyte Imbalance: Along with water loss, there is often a loss of electrolytes such as sodium, potassium, and chloride, leading to disturbances in cellular function. Impact on Organ Function: Severe dehydration can lead to hypovolemic shock, renal failure, and multi-organ dysfunction if left untreated. Signs and Symptoms Mild Dehydration: ○ Thirst ○ Dry mouth and lips ○ Decreased urine output ○ Slightly decreased skin turgor (elasticity) Moderate Dehydration: ○ Sunken eyes ○ Dry mucous membranes ○ Irritability or lethargy ○ Rapid heart rate (tachycardia) ○ Decreased urine output with darker urine ○ Decreased skin turgor Severe Dehydration: ○ Sunken fontanelles (in infants) ○ Deeply sunken eyes ○ Extreme lethargy or unconsciousness ○ Cold, clammy skin with delayed capillary refill ○ Very low urine output or anuria (no urine output) ○ Hypotension (low blood pressure) ○ Shock Diagnosis Physical Examination: Assess for signs of dehydration, including skin turgor, mucous membranes, and fontanelles. Laboratory Tests: ○ Serum Electrolytes: Assess levels of sodium, potassium, and chloride. ○ Urine Output and Specific Gravity: Helps assess dehydration severity and kidney function. ○ Blood Urea Nitrogen (BUN): Can be elevated in dehydration. ○ Electrolyte Imbalance: Look for signs of hyponatremia or hypernatremia. Treatment 1. Oral Rehydration: ○ Oral Rehydration Solution (ORS): Contains water, salts, and glucose to promote absorption of fluid and electrolytes. Recommended for mild to moderate dehydration. ○ Small, Frequent Sips: Encourage the child to take small amounts of the ORS frequently. 2. Intravenous Fluids: ○ Isotonic Fluids: (e.g., normal saline, Ringer’s lactate) for moderate to severe dehydration, especially if the child cannot tolerate oral fluids. ○ Adjust Fluid Type: Adjust fluids based on electrolyte imbalances, including potassium supplementation if necessary. 3. Monitor Electrolyte Imbalance: ○ Correct any electrolyte abnormalities (e.g., potassium, sodium) through IV fluids. Nursing Care Monitor Fluid Status: Regularly assess weight, urine output, heart rate, and respiratory rate to monitor the effectiveness of fluid replacement. Administer Fluids: Administer oral or IV fluids as ordered, ensuring safe administration to avoid overhydration. Monitor Vital Signs: Closely monitor blood pressure, heart rate, respiratory rate, and oxygenation for signs of shock or further deterioration. Educate Parents: Educate parents on the signs of dehydration, the importance of maintaining hydration during illness, and when to seek medical care. Prevention: Emphasize the importance of appropriate fluid intake, particularly during periods of illness. Appendicitis Overview Definition: Appendicitis is the inflammation of the appendix, a small, tube-shaped pouch attached to the large intestine. It is one of the most common causes of emergency abdominal surgery in children. Etiology: Appendicitis usually occurs due to obstruction of the appendix lumen by fecal matter, a foreign body, or lymphatic tissue swelling, leading to bacterial infection. Pathophysiology Appendiceal Obstruction: Blockage leads to increased pressure within the appendix, causing reduced blood flow, bacterial proliferation, and eventual inflammation. Perforation: If untreated, the appendix can rupture, causing peritonitis (infection of the abdominal cavity), which can be life-threatening. Signs and Symptoms Early Signs: ○ Abdominal Pain: Begins around the umbilicus and then shifts to the lower right quadrant (McBurney's point). ○ Anorexia: Loss of appetite. ○ Nausea/Vomiting: Often after the onset of pain. ○ Fever: Low-grade fever may develop as the inflammation progresses. Advanced Symptoms: ○ Severe Abdominal Pain: Pain becomes more localized and intense as the appendix becomes more inflamed. ○ Rebound Tenderness: Pain increases when pressure is released from the abdomen. ○ Signs of Peritonitis: Rigid abdomen, guarding, and severe generalized pain if the appendix ruptures. ○ Tachycardia and Hypotension: In cases of sepsis due to rupture. Diagnosis Physical Examination: ○ Tenderness: On palpation of the right lower quadrant (McBurney's point). ○ Rebound Tenderness: Pain upon releasing pressure after palpation. ○ Rovsing’s Sign: Pain in the right lower quadrant when palpating the left side of the abdomen. Laboratory Tests: ○ Elevated White Blood Cell (WBC) Count: Indicates infection or inflammation. ○ C-reactive Protein (CRP): Can be elevated in appendicitis. Imaging: ○ Ultrasound: Preferred for pediatric patients to visualize an enlarged appendix or other complications. ○ CT Scan: Can also be used, but is generally avoided in children due to radiation exposure. Treatment 1. Pre-Operative: ○ IV Fluids: To maintain hydration and correct any electrolyte imbalances. ○ Antibiotics: Broad-spectrum antibiotics (e.g., ceftriaxone, metronidazole) to treat any potential infection, especially if rupture is suspected. ○ NPO (Nil Per Os): Withhold food and fluids to prepare for surgery. 2. Surgical Management: ○ Appendectomy: Removal of the appendix is the primary treatment. This can be performed via open surgery or laparoscopically. ○ Drainage: If perforation has occurred, a drain may be placed to prevent infection from spreading. 3. Post-Operative Care: ○ Pain Management: Administer prescribed analgesics (e.g., acetaminophen, opioids as needed) for pain control. ○ Wound Care: Monitor surgical site for signs of infection. ○ Antibiotics: Continue antibiotics post-surgery if there was a perforation or abscess. ○ Early Ambulation: Encourage movement to prevent complications such as atelectasis or deep vein thrombosis (DVT). Nursing Care Pain Management: Administer medications for pain control and assess the child’s pain regularly. Monitor for Complications: Watch for signs of perforation, peritonitis, or infection (fever, increased heart rate, abdominal distension). Pre-Operative Education: Prepare the child and family for the appendectomy procedure, explaining the steps and what to expect post-surgery. Post-Operative Education: Teach the family about wound care, signs of infection, and when to seek medical attention. Hydration and Nutrition: Once the child is stable post-surgery, introduce fluids and solid food gradually. Monitor intake and output. Study Guide for Nursing Care of the Child with an Alteration in Urinary Elimination/Genitourinary Disorder (Chapter 43) Overview This chapter addresses urinary tract infections (UTIs) and vesicoureteral reflux (VUR), two common genitourinary disorders in pediatric patients. Both conditions can have significant impacts on kidney function and overall health, making early recognition and appropriate nursing interventions essential. Urinary Tract Infection (UTI) Overview Definition: A urinary tract infection (UTI) occurs when bacteria invade the urinary system, including the kidneys (pyelonephritis), bladder (cystitis), or urethra (urethritis). Etiology: Most UTIs are caused by bacteria, typically Escherichia coli (E. coli) from the gastrointestinal tract. Risk factors include improper hygiene, urinary retention, congenital urinary tract abnormalities, and sexual activity in older children. Pathophysiology Bacterial Entry: Bacteria enter the urinary tract via the urethra and ascend through the urinary system, causing inflammation and infection in the kidneys, bladder, or urethra. Infection Sites: UTIs can affect: ○ Lower Urinary Tract: Bladder and urethra (cystitis). ○ Upper Urinary Tract: Kidneys (pyelonephritis), which can lead to more severe complications such as kidney scarring. Inflammation: Infection causes inflammation, leading to increased pressure in the urinary system, discomfort, and potential renal damage if untreated. Signs and Symptoms Infants: ○ Fever ○ Irritability ○ Poor feeding ○ Vomiting ○ Diarrhea ○ Failure to thrive ○ Foul-smelling urine Children: ○ Dysuria (painful urination) ○ Frequency and urgency of urination ○ Hematuria (blood in urine) ○ Abdominal or back pain ○ Fever ○ Foul-smelling or cloudy urine ○ Bedwetting or urinary incontinence (especially in previously potty-trained children) Diagnosis Urinalysis: The presence of leukocytes, nitrates, and bacteria in the urine indicates infection. Urine Culture: Identifies the specific pathogen responsible for the infection and guides antibiotic therapy. Blood Cultures: May be performed if there is concern for systemic infection (e.g., fever, sepsis). Ultrasound or Voiding Cystourethrogram (VCUG): Used in recurrent UTIs or if there is suspicion of structural abnormalities. Treatment 1. Antibiotics: ○First-line agents: Trimethoprim-sulfamethoxazole (Bactrim), amoxicillin, or cephalosporins. ○ Oral or Intravenous Therapy: Oral antibiotics are used for uncomplicated UTIs, while intravenous antibiotics may be necessary for severe cases or pyelonephritis. ○ Duration: Typically 7-14 days, depending on the severity of the infection. 2. Symptomatic Treatment: ○ Pain Management: Antipyretics (e.g., acetaminophen) for fever and pain. ○ Increased Fluid Intake: Encourage the child to drink fluids to help flush bacteria from the urinary tract. 3. Prevention: ○ Hygiene: Teach proper perineal hygiene (wiping front to back). ○ Void Regularly: Encourage children to urinate frequently to prevent urinary retention. ○ Antibiotic Prophylaxis: For recurrent UTIs, low-dose prophylactic antibiotics may be prescribed. ○ Avoid Constipation: Ensure the child does not have constipation, as it can contribute to UTIs. Nursing Care Assess Symptoms: Monitor for signs of UTI, including fever, dysuria, and changes in urine appearance. Administer Antibiotics: Ensure the child completes the full course of antibiotics as prescribed. Pain Management: Administer antipyretics as prescribed and ensure adequate fluid intake. Hydration: Encourage fluids to flush bacteria from the urinary system. Education: Educate the child and family about preventing UTIs through proper hygiene, hydration, and frequent urination. Monitor for Complications: Watch for signs of pyelonephritis, kidney scarring, or sepsis, especially if fever and pain worsen. Vesicoureteral Reflux (VUR) Overview Definition: Vesicoureteral reflux (VUR) is a condition in which urine flows backward from the bladder into the ureters and kidneys, increasing the risk of infection and kidney damage. Etiology: VUR is often congenital, due to an abnormality in the structure of the ureterovesical junction (where the ureter meets the bladder). Secondary VUR can result from a UTI or bladder dysfunction. Pathophysiology Backflow of Urine: In normal urine flow, the ureter passes through the bladder wall, preventing backflow. In VUR, this mechanism fails, allowing urine to flow backward, increasing the risk of pyelonephritis and kidney damage. Kidney Damage: Chronic VUR can lead to kidney scarring, which may impair renal function and lead to hypertension or kidney failure if not treated. Signs and Symptoms Infants and Young Children: ○ Recurrent UTIs ○ Fever ○ Irritability ○ Poor feeding ○ Vomiting ○ Failure to thrive Older Children: ○ Dysuria ○ Frequent urination ○ Abdominal pain or flank pain ○ Recurrent UTIs, often with kidney involvement (pyelonephritis) Diagnosis Ultrasound: Can show signs of hydronephrosis (swelling of the kidneys) or other structural abnormalities. Voiding Cystourethrogram (VCUG): The gold standard for diagnosing VUR, it shows the reflux of urine from the bladder into the ureters and kidneys. Renal Scintigraphy: May be used to evaluate kidney function and detect scarring. Treatment 1. Antibiotic Prophylaxis: ○ Low-dose antibiotics (e.g., trimethoprim-sulfamethoxazole, nitrofurantoin) are given to prevent UTIs in children with VUR, particularly during the early years of life. 2. Surgical Management: ○ Reimplantation of the Ureter: Surgical correction is considered for children with severe VUR (grade III-V) or those who have recurrent UTIs despite prophylactic antibiotics. This procedure repositions the ureter to prevent backflow. 3. Endoscopic Treatment: ○ Deflux Injection: A minimally invasive procedure where a substance is injected at the base of the ureter to prevent urine reflux. 4. Monitoring and Follow-Up: ○ Regular Imaging: Monitoring of kidney function and VUR progression through periodic ultrasound or VCUGs. ○ Urologic Follow-up: Close follow-up to monitor for any complications, including kidney damage or hypertension. Nursing Care Assess for UTIs: Monitor for symptoms of UTI, especially recurrent or persistent infections, in children with VUR. Administer Antibiotics: Ensure adherence to prophylactic antibiotics as prescribed to prevent infections. Monitor for Complications: Watch for signs of kidney damage, including poor growth, high blood pressure, or abnormal kidney function tests. Provide Education: Teach parents about the importance of medication adherence and the potential need for surgical intervention. Educate about the importance of hydration and avoiding constipation. Post-Operative Care: If surgery is required, monitor for signs of infection or complications, and provide education on care after surgery. Study Guide for Nursing Care of the Child with an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder (Chapter 44) Overview This chapter covers three important pediatric conditions affecting mobility and neuromuscular or musculoskeletal function: spina bifida, developmental dysplasia of the hip (DDH), and muscular dystrophy. These conditions can impact the child’s development and require early diagnosis and appropriate nursing care to improve outcomes. Spina Bifida (Meningocele, Myelomeningocele) Overview Definition: Spina bifida is a congenital defect in the closure of the neural tube during fetal development. It results in defects in the spinal cord and vertebrae. ○ Meningocele: The meninges (protective covering of the brain and spinal cord) protrude through an opening in the spine, but the spinal cord remains intact. ○ Myelomeningocele: The most severe form, where both the meninges and spinal cord protrude through the opening, often causing significant neurological deficits. Pathophysiology Meningocele: In this condition, the fluid-filled sac (meningocele) protrudes through the spinal defect, but the spinal cord itself remains unharmed. However, there can be some risk of nerve damage or infection. Myelomeningocele: The spinal cord and nerves are exposed to the external environment. This exposes the child to risks of infection, paralysis, and nerve damage below the level of the defect. Signs and Symptoms Meningocele: ○ Visible sac or cyst on the back, usually in the lower lumbar or sacral region ○ Minimal neurological deficits, depending on the location of the defect ○ May have difficulty with movement or sensation, but no complete paralysis Myelomeningocele: ○ Visible sac with spinal cord and nerve tissue exposed ○ Partial or complete paralysis below the defect ○ Loss of sensation or motor function in the affected area ○ Bowel and bladder dysfunction (incontinence or retention) ○ Hydrocephalus (increased fluid in the brain) ○ Orthopedic deformities, such as clubfoot Diagnosis Prenatal Ultrasound: Can detect the presence of a neural tube defect before birth. Amniocentesis: Can detect elevated alpha-fetoprotein (AFP) levels in the amniotic fluid, which are associated with spina bifida. Postnatal: Confirmation through physical examination and imaging (e.g., MRI or CT scan) to assess the extent of the defect. Treatment 1. Surgical Repair: ○ Meningocele: Surgery to close the opening and protect the spinal cord, often performed within the first few days of life. ○ Myelomeningocele: Surgical closure within the first 24-72 hours of life to prevent infection and damage to the exposed spinal cord. ○ Shunt Placement: If hydrocephalus is present, a ventriculoperitoneal (VP) shunt may be required to drain excess cerebrospinal fluid. 2. Ongoing Care: ○ Physical Therapy: To improve motor skills and prevent deformities. ○ Bowel and Bladder Management: Teaching the family and child techniques to manage incontinence, including catheterization. ○ Orthopedic Care: To address deformities such as clubfoot or scoliosis. ○ Neurological Monitoring: Monitoring for changes in sensation, muscle strength, and any signs of infection or increased intracranial pressure. Nursing Care Preoperative Care: ○ Keep the sac covered with a sterile, moist dressing to prevent rupture and infection. ○ Monitor for signs of infection or neurological deterioration. Postoperative Care: ○ Monitor vital signs and neurological status. ○ Promote proper positioning to prevent pressure on the surgical site. ○ Administer medications as ordered (e.g., antibiotics, pain management). ○ Provide family education on care techniques and assist with adaptive devices or mobility aids. Long-Term Care: ○ Assist with school and social integration. ○ Provide ongoing emotional and psychological support. Developmental Dysplasia of the Hip (DDH) Overview Definition: Developmental dysplasia of the hip is a condition where the hip joint is improperly formed, causing the ball (femoral head) to not fit securely into the socket (acetabulum). Risk Factors: ○ Family history of DDH ○ Breech birth position ○ First-born child ○ Female gender (more common in girls) ○ Tight swaddling practices Pathophysiology Shallow Hip Socket: In DDH, the acetabulum is too shallow, preventing the femoral head from staying securely in place. Dislocation: In more severe cases, the femoral head can be completely dislocated from the acetabulum. Signs and Symptoms Infants: ○ Asymmetry of the legs (unequal leg length or folds of the skin on the thighs) ○ Limited hip abduction (difficulty moving the legs apart) ○ Positive Ortolani or Barlow tests (used to detect hip instability in newborns) ○ Clicking or popping sound when moving the legs Older Children: ○ Limping or waddling gait ○ Uneven leg lengths ○ Difficulty walking or pain when walking ○ Hip pain, especially when bending or rotating the hip Diagnosis Physical Exam: Ortolani and Barlow maneuvers in newborns to detect hip instability. Ultrasound: In infants under six months, ultrasound is the imaging technique of choice to evaluate the hip joint. X-Rays: In children older than six months, X-rays are used to assess the alignment of the hip joint. Treatment 1. Pavlik Harness: ○ A soft harness worn by infants to keep the hip joint in place while it develops. This is the most common treatment for DDH in infants. 2. Surgical Intervention: ○ If the hip joint does not stabilize with a Pavlik harness, surgery may be required, particularly in older children. This may involve hip reduction, pelvic osteotomy, or even hip replacement in severe cases. 3. Post-Surgical Care: ○ Immobilization and physical therapy to promote normal joint development and function. Nursing Care Monitoring: Monitor for proper positioning of the hip and signs of irritation or pressure sores from the Pavlik harness. Education: Teach parents about the importance of wearing the Pavlik harness and how to properly care for the baby. Pain Management: Administer analgesics as needed post-surgery or after wearing the harness for extended periods. Physical Therapy: Encourage early mobility and promote exercises to strengthen the hip and leg muscles. Muscular Dystrophy (MD) Overview Definition: Muscular dystrophy is a group of genetic disorders characterized by progressive muscle weakness and degeneration. ○ The most common type is Duchenne Muscular Dystrophy (DMD), which primarily affects boys and is caused by a deficiency in the protein dystrophin, essential for muscle fiber stability. Pathophysiology Dystrophin Deficiency: In MD, the absence or dysfunction of dystrophin leads to muscle fiber degeneration and replacement by fibrous tissue, ultimately causing muscle weakness and atrophy. Progressive Nature: The condition progresses from the lower limbs to the upper limbs and, eventually, the respiratory and cardiac muscles. Signs and Symptoms Early Signs (Typically in Toddlerhood): ○ Difficulty walking or running ○ Muscle weakness (starting in the legs and pelvis) ○ Frequent falls and difficulty standing from a sitting position ○ Gower’s sign (using hands to push off the legs to stand up) Later Signs (In Childhood): ○ Progressive muscle weakness, especially in the legs ○ Difficulty with fine motor skills (e.g., holding objects) ○ Scoliosis (curved spine) ○ Respiratory complications (weakness of diaphragm) ○ Cardiomyopathy (heart muscle weakness) Diagnosis Genetic Testing: Detects mutations in the dystrophin gene. Creatine Kinase (CK) Levels: Elevated CK levels are indicative of muscle damage. Muscle Biopsy: Confirms muscle fiber degeneration and absence of dystrophin. Electromyography (EMG): Can assess the electrical activity in muscles and detect abnormalities. DNA Analysis: To detect specific mutations associated with DMD. Treatment 1. Corticosteroids: ○ Prednisone or deflazacort to slow the progression of muscle weakness. 2. Physical Therapy: ○ Stretching exercises, strengthening routines, and mobility aids to prevent joint contractures and maximize mobility. 3. Orthopedic Interventions: ○ Braces, splints, and assistive devices (e.g., wheelchairs) to support mobility as muscle strength declines. 4. Respiratory Support: ○ Non-invasive ventilation (e.g., BiPAP) to support breathing as respiratory muscles weaken. 5. Cardiac Care: ○ Treatment for cardiomyopathy, including medications like ACE inhibitors and beta-blockers. 6. Gene Therapy: ○ Ongoing research into gene therapies aimed at correcting the dystrophin defect. Nursing Care Monitor Mobility: Regular assessments of motor function and assist with mobility aids as needed. Manage Respiratory Function: Ensure proper respiratory support, especially as the disease progresses. Promote Skin Integrity: Prevent pressure sores from prolonged immobility or use of assistive devices. Provide Education: Educate families on how to manage the disease, use assistive devices, and access support services. Psychosocial Support: Provide emotional support for both the child and family, addressing issues related to progressive disability and quality of life. Study Guide for Nursing Care of the Child with an Alteration in Tissue Integrity/Integumentary Disorder (Chapter 45) Overview This chapter discusses common pediatric integumentary disorders that affect skin integrity, including diaper dermatitis, impetigo, atopic dermatitis, and burns. It covers pathophysiology, signs and symptoms, diagnostic techniques, and nursing care for these conditions, providing a comprehensive approach to managing skin issues in children. Diaper Dermatitis Overview Definition: Diaper dermatitis, also known as diaper rash, is an inflammation of the skin in the diaper area. It is commonly caused by prolonged contact with moisture, irritants in urine and stool, or infections. Types: ○ Irritant Contact Dermatitis: The most common type, caused by prolonged contact with urine or stool. ○ Candidiasis: A fungal infection that occurs in the diaper area, often following the use of antibiotics. Pathophysiology Moisture and Friction: Prolonged exposure to urine and stool leads to skin irritation and breakdown. Infection: Bacteria (e.g., Staphylococcus or Streptococcus) or fungi (e.g., Candida albicans) can further irritate the skin and cause infections. Signs and Symptoms Irritant Contact Dermatitis: ○ Red, inflamed skin in the diaper area ○ Tender or painful skin, especially when touched ○ Skin may appear shiny or swollen ○ May develop in areas where the diaper rubs Candidiasis: ○ Red, raised lesions with well-defined borders ○ Satellite lesions (small, red spots surrounding the main rash) ○ May involve the folds of the skin (e.g., groin, thighs) Diagnosis Clinical Diagnosis: Based on physical examination and characteristic appearance. Fungal Culture: In cases of suspected candidiasis, a culture may be performed to confirm the presence of Candida albicans. Treatment Irritant Contact Dermatitis: ○ Frequent diaper changes to keep the area clean and dry ○ Use of a barrier cream or ointment (e.g., zinc oxide) to protect the skin ○ Avoiding harsh soaps or wipes with alcohol Candidiasis: ○ Topical antifungal creams (e.g., nystatin) ○ Keeping the area dry and avoiding moisture accumulation Nursing Care Skin Care: Educate parents about the importance of gentle cleansing, frequent diaper changes, and the use of protective creams or ointments. Preventive Measures: Suggest the use of super-absorbent diapers and avoid tight-fitting diapers. Infection Control: Teach caregivers how to apply antifungal medications if needed and monitor for signs of secondary infection. Comfort Measures: Provide comfort to the child, such as allowing air exposure to the affected area to reduce moisture. Impetigo Overview Definition: Impetigo is a highly contagious bacterial skin infection, commonly caused by Staphylococcus aureus or Streptococcus pyogenes. It most often affects children and presents with lesions on the face, hands, or around the mouth. Types: ○ Non-bullous Impetigo: Characterized by honey-colored crusted lesions. ○ Bullous Impetigo: Characterized by large, fluid-filled blisters. Pathophysiology Bacterial Infection: Impetigo occurs when bacteria invade the skin, often after a break in the skin (e.g., cut, insect bite). Contagion: It is highly contagious, spreading through direct contact or by touching contaminated objects (e.g., towels, sheets). Signs and Symptoms Non-bullous Impetigo: ○ Small, red papules that evolve into vesicles and rupture, leaving a honey-colored crust ○ Typically around the nose, mouth, or hands ○ Itching or mild pain Bullous Impetigo: ○ Large, fluid-filled blisters that rupture and form crusts ○ Often seen on the trunk, arms, or legs Diagnosis Clinical Diagnosis: Based on the appearance of the skin lesions. Culture: A bacterial culture may be done to identify the specific organism causing the infection. Treatment Topical Antibiotics: Such as mupirocin for localized cases. Oral Antibiotics: For widespread or severe cases, such as cephalexin or clindamycin. Good Hygiene: Regular handwashing and cleaning of the infected area to prevent spreading. Nursing Care Infection Control: Teach caregivers and the child about the importance of hand hygiene and not sharing personal items. Lesion Care: Instruct parents to clean the lesions gently with soap and water and apply prescribed topical medications. Monitoring: Watch for signs of systemic infection, such as fever or swollen lymph nodes, which may require oral antibiotics. Comfort: Provide relief from itching and discomfort with over-the-counter antihistamines or soothing creams. Atopic Dermatitis (Eczema) Overview Definition: Atopic dermatitis, also known as eczema, is a chronic inflammatory skin condition characterized by dry, itchy, and inflamed skin. It often starts in infancy and is linked to other atopic conditions like asthma and allergic rhinitis. Risk Factors: ○ Family history of allergies or asthma ○ Environmental triggers (e.g., allergens, temperature changes) ○ Dry skin or skin barrier dysfunction Pathophysiology Immune System Dysfunction: Atopic dermatitis involves an overactive immune response, leading to inflammation and damage to the skin barrier. Environmental Triggers: Factors such as allergens, harsh soaps, and weather conditions can exacerbate flare-ups. Signs and Symptoms Infants: Red, itchy patches on the cheeks, scalp, and limbs, often with weeping or crusted areas. Older Children: Lesions may appear on the elbows, knees, or wrists, and the skin may become thickened and leathery (lichenification) with repeated scratching. Adults: Eczema may persist into adulthood, often in the same locations (e.g., hands, neck). Diagnosis Clinical Diagnosis: Based on the characteristic appearance of the skin lesions and the patient’s history of atopic conditions. Skin Prick Test: To identify specific allergens or triggers. Treatment Moisturization: Regular use of emollients to keep the skin hydrated and protect the skin barrier. Topical Corticosteroids: For flare-ups, topical steroids like hydrocortisone or betamethasone can reduce inflammation. Topical Calcineurin Inhibitors: Such as tacrolimus, for long-term management. Antihistamines: To relieve itching, especially during flare-ups. Nursing Care Moisturizing Routine: Educate caregivers on the importance of applying emollients regularly to prevent dryness and irritation. Avoiding Triggers: Help identify and avoid known allergens or irritants. Comfort Measures: Teach the child to avoid scratching, which can exacerbate the condition, and use soothing baths or anti-itch creams. Skin Monitoring: Regularly check for signs of infection, as skin breakdown can lead to secondary bacterial infections. Burns Overview Definition: Burns are injuries to the skin caused by heat, chemicals, electricity, or radiation. In children, burns are commonly caused by hot liquids, flames, or electrical injuries. Types: ○ Thermal Burns: From heat sources like fire, hot water, or steam. ○ Chemical Burns: From exposure to toxic chemicals. ○ Electrical Burns: From contact with electrical sources, potentially causing internal damage. ○ Radiation Burns: From exposure to the sun or radiation treatments. Pathophysiology Damage to Skin Layers: Burns cause damage to the epidermis, dermis, and sometimes subcutaneous tissue, leading to fluid loss, pain, and risk of infection. Systemic Effects: Severe burns can lead to hypovolemic shock, electrolyte imbalances, and respiratory distress. Signs and Symptoms First-Degree Burns: Redness, pain, and swelling limited to the epidermis (e.g., sunburn). Second-Degree Burns: Blisters, redness, swelling, and pain affecting both the epidermis and dermis. Third-Degree Burns: Charred or white appearance, no pain (nerve endings may be destroyed), damage to all skin layers and possibly deeper tissues. Diagnosis Clinical Diagnosis: Based on the appearance of the burn and the circumstances of the injury. Burn Severity Assessment: Using the "rule of nines" or Lund-Browder chart to estimate burn surface area. Treatment First-Degree Burns: Cool the burn with water, apply soothing lotions like aloe vera, and provide pain relief. Second-Degree Burns: Clean and dress the wound with sterile dressings, manage pain, and monitor for infection. Third-Degree Burns: Immediate medical attention, possibly requiring surgical intervention (e.g., skin grafts). Fluid Resuscitation: For extensive burns, intravenous fluids are necessary to replace lost fluids and prevent shock. Nursing Care Wound Care: Educate caregivers on proper wound care, including cleaning, dressing, and infection prevention. Pain Management: Provide adequate pain relief, including topical anesthetics and systemic analgesics. Hydration: Ensure proper fluid intake and monitoring for signs of dehydration. Psychosocial Support: Address emotional and psychological needs, as burns can cause long-term scars, both physical and psychological. Rehabilitation: Assist with physical therapy to regain mobility if the burn affects joints or muscles. Study Guide for Nursing Care of the Child with an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder (Chapter 46) Overview This chapter covers a range of hematologic and neoplastic disorders in pediatric patients, including anemia, sickle cell anemia, hemophilia, idiopathic thrombocytopenic purpura (ITP), Wilms tumor, and acute lymphoblastic leukemia (ALL). It focuses on understanding the pathophysiology, signs and symptoms, diagnostic approaches, and nursing care interventions for these conditions. Anemia Overview Definition: Anemia is a condition in which there is a deficiency in the number or quality of red blood cells or hemoglobin, leading to decreased oxygen transport to tissues. Causes: ○ Iron Deficiency Anemia: Most common in children, caused by insufficient iron intake. ○ Vitamin B12 or Folate Deficiency: Less common but can affect red blood cell production. ○ Chronic Disease Anemia: Due to conditions like kidney disease or inflammatory disorders. Pathophysiology Anemia results in reduced oxygen delivery to tissues, causing fatigue, pallor, and compensatory mechanisms like increased heart rate. Signs and Symptoms Fatigue, pallor (pale skin and mucous membranes) Weakness, dizziness, or lightheadedness Tachycardia, shortness of breath In severe cases, growth delay or developmental delays Diagnosis Complete Blood Count (CBC): Shows low hemoglobin (Hb) or hematocrit (Hct), and low red blood cell count. Iron Studies: For iron deficiency anemia (e.g., low serum ferritin and iron levels). Vitamin B12 or Folate Levels: If suspected vitamin deficiencies. Treatment Iron Supplementation: For iron-deficiency anemia. Dietary Modifications: High iron foods, vitamin B12, and folate-rich foods. Blood Transfusions: In severe cases or if there is significant blood loss. Nursing Care Monitor Vital Signs: Assess for tachycardia, increased respiratory rate, and other signs of compensatory mechanisms. Dietary Education: Educate families on iron-rich foods and the proper use of supplements. Prevent Fatigue: Encourage rest and balance activity to prevent exhaustion. Monitor Growth and Development: Keep track of weight, height, and developmental milestones. Sickle Cell Anemia Overview Definition: Sickle cell anemia is a genetic disorder where red blood cells are abnormally shaped (sickle-shaped) and prone to clumping, leading to blockages in blood flow. Causes: Autosomal recessive inheritance, caused by a mutation in the hemoglobin gene. Pathophysiology Sickling of red blood cells leads to obstruction in blood vessels, causing pain, tissue damage, and hemolysis (destruction of red blood cells). Episodes of sickling, called sickle cell crises, cause acute pain and organ damage. Signs and Symptoms Pain Crises: Sudden severe pain in the chest, abdomen, back, or joints. Fatigue, Pallor, Jaundice: Due to hemolysis and anemia. Swelling: Especially in hands and feet (dactylitis). Delayed Growth: Children may have stunted growth and development due to chronic anemia. Diagnosis Hemoglobin Electrophoresis: Diagnoses sickle cell disease by identifying abnormal hemoglobin S. Complete Blood Count (CBC): Shows anemia with sickle-shaped red blood cells. Treatment Pain Management: Opioids, NSAIDs, and hydration for pain crises. Hydroxyurea: Medication to reduce sickling and frequency of pain crises. Blood Transfusions: To treat severe anemia and reduce the risk of stroke. Bone Marrow Transplant: The only curative treatment, though limited in availability. Nursing Care Pain Management: Administer pain relief measures and encourage hydration. Hydration and Oxygenation: Ensure adequate fluid intake and oxygenation to prevent sickling. Infection Prevention: Administer vaccinations and prophylactic antibiotics, as children with sickle cell disease are at higher risk for infections. Education: Teach families about recognizing the signs of sickle cell crisis and the importance of preventive care. Hemophilia Overview Definition: Hemophilia is a genetic bleeding disorder in which blood does not clot properly due to a deficiency in clotting factors (commonly factor VIII or IX). Causes: X-linked recessive inheritance, primarily affecting males. Pathophysiology Deficiency in Clotting Factors: Results in prolonged bleeding times, particularly after injury or surgery. Bleeding into joints (hemarthrosis) is common. Signs and Symptoms Easy bruising, frequent nosebleeds Prolonged bleeding after cuts or procedures Hemarthrosis (bleeding into joints) leading to pain, swelling, and decreased mobility Spontaneous internal bleeding, particularly in muscles and joints Diagnosis Clotting Factor Levels: Low levels of specific clotting factors (factor VIII or IX) confirm the diagnosis. CBC: May show normal platelet count and hemoglobin levels, but prolonged clotting times. Treatment Factor Replacement Therapy: Regular infusions of the missing clotting factor to prevent or control bleeding. Desmopressin (DDAVP): For mild hemophilia A to stimulate the release of stored factor VIII. Gene Therapy: Research is ongoing to provide long-term solutions by introducing functional clotting genes. Nursing Care Bleeding Precautions: Educate the child and family to avoid activities that may cause injury and implement safety measures. Monitor for Bleeding: Check for signs of internal bleeding, especially in joints and muscles. Factor Administration: Teach caregivers how to administer factor replacement therapy and monitor for side effects. Emotional Support: Provide psychosocial support to cope with chronic medical treatments and potential limitations. Idiopathic Thrombocytopenic Purpura (ITP) Overview Definition: ITP is an autoimmune disorder where the immune system destroys platelets, leading to an increased risk of bleeding. Causes: Often follows a viral infection, but the exact cause is unknown (hence "idiopathic"). Pathophysiology Platelet Destruction: Autoantibodies attack platelets, resulting in thrombocytopenia (low platelet count) and bleeding tendencies. Signs and Symptoms Purpura and Petechiae: Small red or purple spots on the skin due to bleeding. Easy bruising, nosebleeds, and gum bleeding Heavy Menstrual Bleeding in adolescent girls Fatigue due to anemia from prolonged bleeding. Diagnosis Platelet Count: Very low platelet count with normal white blood cell and red blood cell counts. Bone Marrow Biopsy: To rule out other causes of thrombocytopenia. Treatment Corticosteroids: To suppress the immune system and increase platelet count. Intravenous Immunoglobulin (IVIG): Used to increase platelet count quickly. Platelet Transfusions: For severe bleeding or very low platelet counts. Splenectomy: If other treatments are ineffective, removal of the spleen may be considered. Nursing Care Monitor for Bleeding: Carefully observe for signs of internal or external bleeding. Educate on Precautions: Instruct on avoiding activities that could lead to injury or bleeding. Medications: Administer steroids or IVIG as prescribed and monitor for side effects. Emotional Support: Provide emotional support, especially if the child requires prolonged treatment or hospitalizations. Wilms Tumor Overview Definition: Wilms tumor is a kidney cancer that primarily affects children, often diagnosed between ages 2 and 5. Causes: The exact cause is unknown, but it is associated with genetic mutations and certain syndromes (e.g., WAGR syndrome). Pathophysiology Abnormal Kidney Growth: Wilms tumor develops from immature kidney cells that proliferate uncontrollably, forming a mass. Signs and Symptoms Abdominal mass or swelling, often discovered during routine examinations. Hematuria (blood in urine) or high blood pressure. Pain or discomfort in the abdomen. Fever, nausea, and vomiting. Diagnosis Ultrasound or CT Scan: To identify the presence of a mass in the kidney. Biopsy: To confirm the diagnosis. Treatment Surgical Removal: The primary treatment is nephrectomy (removal of the affected kidney). Chemotherapy and Radiation: Used after surgery, depending on the stage of the tumor. Renal Sparing Surgery: In some cases, only part of the kidney is removed. Nursing Care Preoperative Care: Provide emotional support and prepare the child and family for surgery. Postoperative Care: Monitor for complications such as infection, bleeding, and kidney function. Education: Teach about chemotherapy side effects, medication adherence, and follow-up care. Acute Lymphoblastic Leukemia (ALL) Overview Definition: ALL is the most common type of cancer in children, characterized by uncontrolled proliferation of immature white blood cells (lymphoblasts) in the bone marrow. Causes: Genetic mutations, exposure to radiation, or certain environmental factors may play a role. Pathophysiology Uncontrolled Lymphocyte Production: Leukemia cells crowd out normal blood cells, leading to anemia, infections, and bleeding. Signs and Symptoms Fever, Fatigue, Pale Skin Bruising, Bleeding Gums Bone or Joint Pain Enlarged Lymph Nodes or Spleen Diagnosis Bone Marrow Aspiration and Biopsy: To confirm the presence of leukemia cells. CBC: Shows low red blood cells, platelets, and elevated white blood cells with immature forms. Treatment Chemotherapy: The main treatment, which is divided into induction, consolidation, and maintenance phases. Stem Cell

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