Growth and Development Review PDF

Growth and Development! Infant: Birth to 1 Year Toddler: 1 to 3 Years...

Growth and Development! Infant: Birth to 1 Year Toddler: 1 to 3 Years Preschooler: 3 to 5 Years School-Age Child: 6 to 12 Years Growth and Adolescent: 13 + Development Growth and Development Piaget Infant: Birth to 1 Year Sensorimotor stage: Birth to 2 years Psychosocial Development: Trust vs. Mistrust Infants learn trust when their needs are consistently met. Preoperational stage: Ages 2 to 7 If needs are not met, they may develop mistrust Concrete operational stage: Ages 7 to 11 Biological Development o Weight doubles by 6 months, triples by 1 year Formal operational stage: Ages 12 and up o Length increases by 2.5 cm per month until 6 months, then by 50% at 1 year o Posterior fontanel closes at 6-8 weeks, anterior fontanel at 12-18 months o Vision focuses at 4 weeks Motor Skills: Injury Prevention: o Fine motor: Grasping o Choking hazards are a major concern o Gross motor: Head control, sitting, crawling o Motor vehicle accidents (Car seat safety!) Cognitive Development: (Sensorimotor phase – Piaget) o Sensory-motor functions, reflexes, voluntary movements o Drowning o Object permanence develops around 6-8 months o Suffocation Nutritional Needs: Nursing Interventions: o Breast milk or formula for the first 6 months o Encourage parents to hold and stay with the infant o Introduction of solids at 6 months, starting with iron-fortified cereals o Introduce vegetables and fruits one at a time o Provide opportunities for non-nutritive sucking (pacifiers) o Avoid honey until 1 year of age due to the risk of botulism o Offer toys for comfort and stimulation o Vitamin D to prevent rickets  Growth and Development HESI Example Question: Toddler: 1 to 3 Years Psychosocial Development: Autonomy vs. Shame and Doubt A mother brings her 6-month-old infant to a well-baby checkup. The nurse is providing education on nutritional needs. Which o Toddlers strive for independence and control over their bodies. statement made by the mother indicates a need for further teaching? o Encouraging autonomy builds confidence. A. "I will start introducing iron-fortified cereals now." o Discouraging exploration can lead to shame and doubt. B. "I can begin offering pureed vegetables and fruits one at a time." Biological Development: C. "I can start giving my baby honey now to help prevent allergies." o Growth slows down D. "I will continue breastfeeding for at least 6 more months." o Birth weight quadruples by 2.5 years o Height increases by 7.5 cm per year o 20/40 vision is acceptable Motor Skills: Toilet Training: o Fine motor: Improved dexterity, throwing a ball at 18 months o Sphincter control develops around 18-24 months o Gross motor: Walking at 12 months, running at 18 months, stairs at Injury Prevention: 2 years, jumping at 2.5 years o Falls Cognitive Development: o Choking o Preoperational stage (2-7 years), Preconceptual sub- Electrical outlets phase (2-4 years) o Nursing Interventions: o Symbolic thought, egocentric and intuitive thinking o Maintain toilet training routines in the hospital Language Development: o Encourage independent behaviors o Vocabulary expands rapidly from 4 words at 1 year to 300 words at 2 years o Provide rewards for good behavior o Simple sentences by 3 years o Offer choices o Be assertive Growth and Development HESI Example Question: Preschooler (3 to 5 Years) Psychosocial Development: Initiative vs. Guilt A nurse is teaching the parents of a 2-year-old toddler about injury prevention. Which teaching strategy is most appropriate o Preschoolers are eager to take initiative and be praised for their efforts. for this age group? A. Explain to the toddler the consequences of touching o Parental reactions (rewards/punishments) shape their conscience. electrical outlets. o Magical thinking is prominent B. Use simple language and short instructions while showing the toddler how to stay away from dangerous areas. Biological Development: C. Read a story to the toddler about the importance of avoiding falls and choking hazards. o Growth stabilizes D. Use a detailed picture book to demonstrate various safety o Weight gain: 2-3 kg per year concerns. o Height increase: 6-9 cm per year  Nutritional Needs: Motor Skills: o 90 calories per kilogram of body weight o Gross motor: Skipping, hopping on one foot, jumping rope, swimming, skating o 100 milliliters of fluid per kilogram of body weight o Fine motor: Improved drawing, riding a tricycle/bicycle, catching a ball more Social Development: consistently o Play becomes more social Cognitive Development: o Risk of abduction increases due to lack of stranger danger awareness o Preoperational stage continues (2-7 years), Intuitive phase (4-7 years) Injury Prevention: o Reasoning is still not logical; centration (focus on one aspect) is common o Drowning o Time is abstract o Motor vehicle accidents (running into the street) Language Development: Nursing Interventions: o Stuttering for less than 6 months is normal o Involve parents in care o Speech delay is not normal o Give clear explanations to alleviate fear o Use toys for distraction and comfort o Reassure the child that they did not cause their illness or their sibling's illness Growth and Development HESI Example Question: School-Age Child: 6 to 12 Years Psychosocial Development: Industry vs. Inferiority A nurse is caring for a 5-year-old child. Which interventions should the nurse implement to support the child’s cognitive and social o Children strive to gain new skills and knowledge for a sense of competence. development? (Select all that apply.) A. Use clear and simple explanations to alleviate the child's fears. o Competition is healthy. B. Reassure the child that they are not responsible for causing their o Independence grows, but peer approval is a strong motivator. illness. C. Provide detailed explanations of the treatment plan using medical Biological Development: terminology. o Weight gain slows: 4-7 pounds per year D. Involve the parents in the child’s care. E. Emphasize the concept of time to help the child understand when o Height increase: About 5 cm per year procedures will occur. o Loss of baby teeth and eruption of permanent teeth o Dental health is crucial Cognitive Development: o Concrete operational stage (7-11 years) Injury Prevention: o Conservation, decentration (understanding multiple o Sports injuries (concussions, head injuries if helmets are not worn) perspectives) o Risk-taking behaviors o Understanding of right and wrong based on standards of behavior Nursing Interventions: o Numerical pain scales can be used after age 7 o Provide privacy Social Development: o Explain treatments clearly o Peer pressure (both positive and negative) o Encourage continuation of schoolwork o Increased stress from extracurricular activities, social media, and potential cyberbullying o Efficient language skills  Growth and Development HESI Example Question: Adolescent: 13 to 19 Years Psychosocial Development: Identity vs. Role Confusion A nurse is caring for an 8-year-old child who has been admitted to the hospital for surgery. Which nursing intervention is most o Adolescents are developing their sense of self and personal identity. appropriate to support the child’s psychosocial development? o Autonomy, emotional, cognitive, and behavioral development are ongoing A. Encourage the child to participate in competitive games with their peers. o Peer support is essential. B. Offer the child choices to promote a sense of independence. o Exploration of sexual identity C. Use a visual pain scale to assess the child’s pain level. Biological Development: D. Allow the child to wear their favorite pajamas to help reduce stress. o Predictable but highly variable physical growth and sexual maturation o Growth spurts begin earlier in girls Cognitive Development: o o Formal operational stage Abstract thinking, considering past experiences and future consequences HESI Example Question: o Formal logic and decision-making abilities improve Social Development: A 16-year-old adolescent is hospitalized for a chronic illness. Which nursing intervention is the most appropriate to support o Family and peer relationships evolve their psychosocial development? o Romantic relationships emerge A. Discourage the adolescent from spending too much time with peers to focus on recovery. o Social environment influences behavior B. Ensure the adolescent has minimal involvement in treatment Mental health concerns become more prominent (eating disorders, ADHD, anger, o decisions to reduce stress. suicide risk) C. Prioritize the adolescent's privacy and confidentiality during Nursing Interventions: interactions. o Prioritize privacy and confidentiality D. Emphasize the importance of the adolescent's family making decisions regarding their care. o Create a quiet and non-threatening environment o Encourage participation in treatment decisions Age 3: Gross motor: Walking upstairs with alternate feet, tricycle riding, jumping forward Fine motor: Drawing circles, feeding self, gripping crayons Language: 3-4 word sentences, asks "why" questions, can state own age Social: Associative play, toilet training Integumentary Age 4: Developmental Gross motor: Walking downstairs with alternate feet, Disorders balancing on one foot, catching a ball Skills by Age: Fine motor: Drawing squares, cutting with scissors, tying knots Language: Names 2 or more colors, tells stories Social: Imaginative and group play, focus on self Age 5: Gross motor: Skipping, walking backwards, jumping rope Fine motor: Drawing triangles, tying shoelaces, printing letters and numbers Language: Counting to ten, full sentences, knows days of the week Eczema Impetigo Bacterial skin infection often caused by poor hygiene, infected bites, or scratches Inflammatory skin condition often associated with a family history More common in hot, humid weather Signs and Symptoms: Redness, scaling, papules, vesicles, oozing, crusting Nursing Interventions: Signs and Symptoms: Vesicles or pustules that progress to honey-colored crusts, burning, itching o Avoid skin irritants and excessive bathing Nursing Interventions: o Apply cool, wet compresses intermittently o Contact precautions (highly contagious) o Administer antihistamines, topical steroids, or antibiotics as prescribed o Keep lesions open to air to dry o Prevent scratching o Apply warm saline compresses 2-3 times daily o Keep the skin clean o Administer topical and oral antibiotics as prescribed o Use mild detergent for laundry o Promote proper hand hygiene o Educate on preventing infection Use separate towels and linens Lice Scabies Signs and Symptoms: Scalp scratching, presence of nits (small white eggs) in the hair Parasitic skin infection caused by mites burrowing into the skin Nursing Interventions: Signs and Symptoms: Intensely itchy rash, especially at night, burrows (fine, o Apply medicated shampoo or lotion to kill lice grayish-red lines), papules o Remove nits with a fine-tooth comb Nursing Interventions: Discard comb or soak in boiling water for 10 minutes o o Apply topical scabicide as prescribed o Wash clothing and linens daily in hot water and dry on high heat for at least 20 o Wash all clothing, bedding, and linens in hot water and dry on high heat minutes o Do not share clothing, hats, or brushes o Seal non-washable items in plastic bags for at least 4 days o Treat siblings if necessary Burns Children are at higher risk due to thinner skin Nursing Considerations: o Assess ABCs (Airway, Breathing, Circulation) first o Begin fluid resuscitation for burns covering 10% or more of body surface area Hematologic o Assess adequacy of fluid resuscitation (heart rate, urine output, capillary refill, sensory status) o Remove burned clothing and jewelry Disorders o Cover wounds with a clean cloth and keep the child warm  Nursing Interventions: Sickle Cell Crisis o Hydration (oral or IV) o Oxygen therapy Red blood cells become sickle-shaped and clump together, obstructing blood flow and causing pain o Pain management Signs and Symptoms: o Blood transfusions o Severe pain o Promote positions that keep limbs extended and elevate the o Fever head of the bed no more than 30 degrees Painful swelling of hands, feet, and joints o o Avoid pulling, straining, or manipulating painful joints o Abdominal pain o Monitor for signs of anemia, decreased perfusion, and shock o Splenic sequestration (profound anemia, hypovolemia, shock) o Hyperhemolytic crisis (anemia, jaundice, reticulocytosis) o Educate on the importance of vaccinations and the hereditary nature of the disease o Aplastic crisis (anemia, pallor) Iron Deficiency Anemia Results from inadequate iron intake or absorption Nursing Interventions: Signs and Symptoms: o Increase oral iron intake through diet and supplements o Pallor o Give iron supplements between meals with fruit juice to enhance o Weakness absorption o Fatigue o Administer IM iron injections using the Z-track method or IV iron as prescribed o Low hemoglobin and hematocrit o Educate about expected dark stools and constipation o Microcytic and hypochromic red blood cells o Liquid iron can stain teeth; drink with a straw and brush teeth immediately after Aplastic Anemia Hemophilia Deficiency of all blood cell types (pancytopenia) due to bone marrow failure Signs and Symptoms: X-linked recessive bleeding disorder caused by a deficiency in clotting factors Pancytopenia (low red blood cells, white blood cells, and platelets) Signs and Symptoms: o o Fatigue o Abnormal bleeding o Weakness o Tachycardia o Epistaxis o Petechiae o Joint bleeding o Bleeding o Easy bruising Nursing Interventions: o Prepare for bone marrow transplant o Administer immunosuppressive medications and colony-stimulating factors as prescribed o Provide blood transfusions as needed  Nursing Interventions: Von Willebrand Disease o Monitor for bleeding and maintain bleeding precautions Hereditary bleeding disorder caused by a deficiency or defect in von Willebrand factor, which helps platelets adhere to damaged blood vessels o Administer clotting factor replacement therapy as prescribed Signs and Symptoms: o Administer desmopressin (DDAVP) for Hemophilia A o Epistaxis o Monitor for hematuria o Bleeding gums o Assess neurological status regularly o Easy bruising o Control joint bleeding with RICE (Rest, Ice, Compression, Elevation) o Excessive menstrual bleeding Nursing Interventions: o Avoid contact sports o Administer desmopressin (DDAVP) o Ensure the child wears a medical alert bracelet o Administer von Willebrand factor replacement therapy as prescribed o Control bleeding and maintain bleeding precautions o Ensure the child wears a medical alert bracelet Beta Thalassemia (Cooley’s Anemia) Autosomal recessive disorder characterized by reduced production of Nursing Interventions: hemoglobin o Administer blood transfusions as prescribed Signs and Symptoms: o Monitor for iron overload, a common complication of frequent o Frontal bossing and maxillary prominence transfusions o Wide-set eyes with a flattened nose o Prepare for splenectomy if necessary o Greenish-yellow skin tone o Educate on the importance of vaccinations o Severe anemia o Hepatosplenomegaly o Provide genetic counseling Leukemia Pediatric Cancer of the blood-forming tissues, resulting in an overproduction of immature white blood cells Oncology Signs and Symptoms: Anemia (fatigue, pallor) Conditions o o Infection (fever) o Bleeding (petechiae) o Bone and joint pain o Hepatosplenomegaly o Lymphadenopathy  Nursing Interventions: o Administer blood transfusions as needed Hodgkin’s Disease o Provide small, frequent meals that are easy to chew o Administer parenteral or enteral nutrition if oral intake is inadequate o Monitor for chemotherapy side effects: Type of lymphoma characterized by the presence of Reed-Sternberg cells in the ▪ Severe bone marrow suppression (infection, bleeding) lymph nodes ▪ Nausea and vomiting (administer antiemetics) Signs and Symptoms: ▪ Diarrhea or constipation (administer stool softeners or antidiarrheals as needed) o Painless, enlarged lymph nodes, especially in the neck, underarms, or groin ▪ Hemorrhagic cystitis (monitor urine output and color) o Abdominal pain ▪ Peripheral neuropathy (assess for numbness, tingling, and weakness) o Weight loss ▪ Mucositis (provide oral care and prescribe mouth rinses and topical anesthetics) o Educate on hair loss and regrowth o Fever o Protect from infection, a leading cause of death in immunosuppressed children o Night sweats o Itching Nursing Interventions: o Administer chemotherapy and/or radiation therapy as prescribed Nephroblastoma (Wilms’ Tumor) o Monitor for pancytopenia (low blood cell counts) o Manage nausea and vomiting with antiemetics Most common kidney cancer in children, usually affecting one kidney o Encourage fluids and nutrition; provide small, frequent meals Signs and Symptoms: o Monitor for weight loss o Firm, non-tender abdominal mass o Provide oral care for mucositis o Abdominal pain o Suggest wigs or head coverings o Hypertension o Provide scalp hygiene and head coverings in cold weather o Hematuria (blood in the urine) o Do not remove skin markings for radiation therapy o Avoid sun exposure o Monitor for hematuria o Avoid rectal temperatures, suppositories, and enemas o Institute neutropenic and bleeding precautions Osteosarcoma Most common type of bone cancer in children, often affecting the long bones of the legs Nursing Interventions: Signs and Symptoms: o Avoid palpating the abdomen o Pain at the tumor site, often worse at night Swelling Handle the child carefully to avoid tumor rupture o o o Limping o Prepare for surgery (nephrectomy) o Fractures o Administer chemotherapy and/or radiation therapy as prescribed Nursing Interventions: o Monitor for complications of surgery, chemotherapy, and radiation therapy o Prepare for surgery (limb salvage surgery or amputation), chemotherapy, and/or radiation o Provide emotional support to the child and family therapy o Manage pain effectively o Address phantom limb pain if amputation is necessary o Provide emotional support to the child and family Brain Tumor Signs and Symptoms: o Headache, especially in the morning o Vomiting Seizures Metabolic and Endocrine o o Behavioral changes o o Vision problems Balance problems Disorders Nursing Interventions: o Monitor for signs of increased intracranial pressure (ICP) o Institute seizure precautions o Assess neurological status regularly o Prepare for surgery, chemotherapy, and/or radiation therapy o Provide emotional support to the child and family Fever Dehydration Body temperature above 100.4°F (38°C) Fluid volume deficit Nursing Interventions: Isotonic, Hypertonic, Hypotonic o Monitor vital signs o Remove excess clothing and blankets Nursing Interventions: o Reduce room temperature o Treat the underlying cause o Apply cool compresses o Monitor vital signs, weight, intake and output, skin turgor, and mucous membranes o Administer sponge baths with lukewarm water o Administer oral or IV rehydration solutions as prescribed (Oral hydration o Administer antipyretics as prescribed standard) o Do not administer aspirin to children due to the risk of Reye's syndrome o Monitor for dehydration and electrolyte imbalance Signs and Symptoms of Diabetes Mellitus Hyperglycemia: Type 1 Diabetes: Autoimmune disorder that destroys insulin-producing cells in the pancreas, leading to absolute insulin deficiency o Polyuria (increased urination) Type 2 Diabetes: Body becomes resistant to insulin, leading to relative o Polydipsia (increased thirst) insulin deficiency o Polyphagia (increased hunger) o Weight loss o Blurry vision o Fruity breath odor Signs and Symptoms of Diabetic Signs and Symptoms of Hypoglycemia: Ketoacidosis (DKA): o Kussmaul respirations (deep, rapid breathing) o Headache o Fruity breath odor o Hunger o Nausea and vomiting o Sweating o Abdominal pain o Tremors o Dehydration o Confusion o Lethargy o Seizures (if untreated) o Coma (if untreated) Type 1 Diabetes Management: Insulin therapy (injections or insulin pump) Blood glucose monitoring Carbohydrate counting Healthy diet and regular exercise Type 2 Diabetes Management: Healthy diet and regular exercise Oral medications and/or insulin therapy Blood glucose monitoring DM: Nursing DKA Management: Fluid replacement Pediatric Gastrointestinal Interventions Insulin therapy Electrolyte monitoring and replacement Hypoglycemia Management: Disorders Administer 15 grams of fast-acting carbohydrate (glucose tablets, juice, candy) Recheck blood glucose in 15 minutes If still low, repeat treatment Once blood glucose is stable, provide a snack or meal General Diabetic Care: Educate on diabetes management Encourage healthy coping mechanisms Provide emotional support Vomiting Diarrhea Nursing Interventions: Nursing Interventions: o Maintain a patent airway o Assess the characteristics of the stool o Position the child on their side to prevent aspiration o Monitor for signs of dehydration and electrolyte imbalance o Monitor the amount, frequency, and characteristics of vomit o Monitor for metabolic acidosis o Assess for signs of dehydration o Provide oral rehydration or IV fluids as prescribed o Provide oral rehydration or IV fluids as prescribed o Maintain skin integrity o Administer antiemetics as prescribed o Avoid Loperamide Constipation Cleft Lip and/or Palate Congenital abnormalities that occur when the lip or roof of the mouth does not fuse properly during pregnancy Nursing Interventions: Nursing Interventions: Cleft Lip Repair: Encourage a high-fiber diet o o ▪ Protect the surgical site o Increase fluid intake ▪ Position the infant upright or on their back o Administer stool softeners or laxatives as prescribe ▪ Administer pain medication as prescribed Cleft Palate Repair: o PEG o ▪ Maintain airway patency ▪ Prevent injury to the surgical site ▪ Encourage feeding and monitor intake ▪ Provide emotional support to the child and family Esophageal Atresia and Gastroesophageal Reflux Disease Tracheoesophageal Fistula Congenital defects that occur when the esophagus (the tube that carries food from the mouth to the stomach) does not develop properly Condition in which stomach contents back up into the esophagus, Signs and Symptoms: o The "3 Cs" (Coughing, Choking, Cyanosis) causing heartburn and other symptoms Frothy saliva Nursing Interventions: o o Vomiting o Abdominal distention o Assess for respiratory distress before and after feedings o Respiratory distress during and after feedings o Keep the infant upright for 30 minutes after feedings Nursing Interventions: o Maintain a patent airway o Provide small, frequent feedings o Keep the infant NPO (nothing by mouth) o Elevate the head of the bed o Thicken formula with rice cereal as prescribed o Provide IV fluids o Burp frequently during and after feedings o Suction as needed Lactose Intolerance Hypertrophic Pyloric Stenosis Thickening of the pyloric sphincter (the muscle that connects the stomach to the small Inability to digest lactose (the sugar in milk) due to a deficiency of intestine), obstructing the flow of food from the stomach the enzyme lactase Signs and Symptoms: Nursing Interventions: o Projectile vomiting o Eliminate dairy products or provide lactose-free alternatives o Olive-shaped mass in the abdomen o Administer lactase enzyme replacements as prescribed o Failure to thrive o Provide supplements for potential vitamin D and calcium Nursing Interventions: deficiencies o Monitor intake and output, vomiting episodes, stools, weight, and signs of dehydration and electrolyte imbalance o Prepare for surgery (pyloromyotomy) Celiac Disease Appendicitis Inflammation of the appendix, a small, finger-shaped pouch that extends from the colon Autoimmune disorder triggered by gluten (a protein found in wheat, barley, and rye) Signs and Symptoms: Signs and Symptoms: o Pain in the right lower quadrant of the abdomen (McBurney's point) Diarrhea o o Nausea and vomiting o Abdominal pain and distention o Fever o Vomiting o Loss of appetite o Weight loss Nursing Interventions: Nursing Interventions: o Maintain NPO status o Strict gluten-free diet for life o Administer IV fluids and antibiotics as prescribed o Provide vitamin and mineral supplements o Prepare for surgery (appendectomy) Hirschsprung’s Disease Intussusception Congenital condition in which nerve cells are missing from a part of the colon, Condition in which one part of the intestine slides into another part causing a blockage Signs and Symptoms: Signs and Symptoms: o Sudden, severe abdominal pain o Failure to pass meconium (first stool) within 48 hours of birth o Currant jelly-like stools o Abdominal distention o Vomiting o Vomiting o Lethargy o Constipation Nursing Interventions: o Monitor for signs of perforation (fever, tachycardia, respiratory distress, altered mental Nursing Interventions: status) o Prepare for surgery (colostomy or pull-through procedure) o Administer IV fluids and antibiotics as prescribed o Provide pre- and post-operative care o Prepare for hydrostatic reduction or surgery Abdominal Wall Defects Omphalocele: Herniation of abdominal contents through the umbilical cord Gastroschisis: Herniation of abdominal contents through a defect in the abdominal wall, usually to the right of the umbilical cord Respiratory Epiglottitis Bacterial form of croup - inflammation of the epiglottis. Nursing Interventions: Considered an emergency due to rapid progression to severe respiratory distress. Maintain a patent airway. Occurs in children 2 to 8 years old. Assess breath sounds, observe for nasal flaring, retractions, or stridor. Signs and Symptoms: Do not measure oral temperature or attempt to visualize the pharynx or High fever. take a throat culture as this can lead to a spasm and obstruct the airway. Red and inflamed throat. Keep the child NPO and do not leave them unattended. Painful swallowing. Avoid the supine position and do not restrain the child. No cough, but a muffled voice and drooling. Administer IV fluids, antibiotics, analgesics, corticosteroids, and Agitation, tachypnea, retractions, struggling to breathe, and stridor. antipyretics. Tachycardia. Provide cool mist oxygen and nebulized epinephrine. Tripod position. Have resuscitation equipment available. Laryngotracheobronchitis Bronchitis Inflammation of the larynx, trachea, and bronchi. Inflammation of the trachea and the bronchi associated with upper respiratory infections. The most common type of croup. Usually mild. Gradual onset preceded by an upper respiratory infection. Signs and Symptoms: Nursing Interventions: Fever. Dry, hacking, non-productive cough that is worse at night and becomes Same as for epiglottitis. productive in 2 to 3 days. Administer heliox (a mixture of helium and oxygen) to reduce Nursing Interventions: the work of breathing and relieve airway obstruction. Monitor for respiratory distress. Maintain isolation precautions if the patient still has an upper Provide cool, humidified air. respiratory infection. Increase fluid intake. Respiratory Syncytial Virus (RSV) Acute viral infection that is highly contagious through direct contact with respiratory secretions. Nursing Interventions: Common cause of respiratory infection and bronchiolitis. Signs and Symptoms: Implement contact precautions. Rhinorrhea. Maintain a patent airway with the head of the bed elevated 30 to 40 Eye and ear drainage. degrees. Pharyngitis. Administer cool humidified oxygen. Cough. Wheezing. Monitor pulse oximetry and suction as needed. Fever. Administer antiviral and antipyretic medications. Tachypnea. Retractions. Administer IV fluids for dehydration. Cyanosis. Palivizumab can be given for high-risk infants. Apneic episodes. Cough suppressants are given with caution because they interfere with Respiratory distress increases as RSV progresses. clearing of secretions. Pneumonia Inflammation of the pulmonary parenchyma, alveoli, or both. Can be caused by a virus, mycoplasma agent, bacteria, or aspiration. Nursing Interventions: Signs and Symptoms: Fever. Treat symptomatically. Cough. Malaise. Administer oxygen with cool humidified air. Rhinitis. Sore throat. Administer antipyretics and antibiotics if the cause is Irritability. Lethargy. bacterial. Poor feeding. Headache. Perform chest physiotherapy or postural drainage and Chills. suction mucus. Abdominal pain. Chest pain. Monitor for weight loss as this is a sign of dehydration. Asthma Chronic inflammatory disease of the airways. Nursing Interventions: Signs and Symptoms (usually come on in the early morning, at Assess airway patency and respiratory status. night, or both): Wheezing. Administer oxygen by nasal cannula or face mask. Dyspnea. Administer quick-relief (rescue) medications. Chest tightness. Initiate an IV line. Non-productive cough. Test for allergies. May have the production of a frothy, clear, gelatinous sputum. Teach the family and patient how to administer inhalers Pale or flushed or cyanotic. and recognize signs of an acute asthma attack. Nursing Interventions: Cystic Fibrosis Monitor respiratory status. Perform chest physiotherapy (CPT), percussion, or postural drainage. Autosomal recessive trait with no cure. Use a flutter mucus clearance device, handheld percussors, or Secretions are thicker and stickier, causing obstructions in small passageways of the respiratory, GI, and reproductive systems. special vests. Signs and Symptoms: Emphysema. Use a positive expiratory pressure (PEP) mask to move secretions Hypoxemia. through the upper airway. Wheezing. Administer aerosolized or IV antibiotics. Cough. Administer oxygen. Dyspnea. Cyanosis. Provide a high-calorie, high-protein, high-fat diet. Barrel chest. Monitor stools. Meconium ileus. Frothy stools. Administer pancreatic enzyme replacements within 30 minutes of Rectal prolapse. eating and with all snacks. Pancreatic fibrosis. Provide salt replacement. High level of sodium and chloride in sweat, giving it a salty taste. Sudden Infant Death Syndrome (SIDS) Most frequently occurs in the winter, during sleep, and in male infants 2 to 3 months of age. Incidence is lower in breastfed infants. Risk Factors: Prone sleep position. Soft bed or excessive sheets in the bed. Overheating. GU Disorders Co-sleeping. Maternal smoking or substance abuse during pregnancy. Exposure to smoke. Prevention: Place infants in the supine position to sleep. Educate mothers on risk factors like smoking around the child. Glomerulonephritis Kidney disorder characterized by inflammatory injury to the glomeruli. Nursing Interventions: Caused by an immunologic reaction or autoimmune disease. Assess airway patency, vital signs, and weight. Can lead to kidney failure, hypertension, encephalopathy, pulmonary edema, or heart failure. Signs and Symptoms: Assess for a bounding, increased pulse or distended hand and neck veins. Periorbital or facial edema that is more prominent in the morning. Assess for elevated central venous pressure and dysrhythmias. Anorexia. Limit activity. Decreased urine output. Cloudy, smoky brown-colored urine. Administer diuretics. Pallor. Initiate seizure precautions. Irritability. Remember that these patients are at risk for fluid volume overload and Lethargy. usually have peripheral or periorbital edema in the acute phase. Older children may have abdominal pain, flank pain, or headaches. Hypertension. Proteinuria. Foam in the urine. Nephrotic Syndrome Kidney disorder characterized by proteinuria, hypoalbuminemia, and edema. Signs and Symptoms: Nursing Interventions: Weight gain. Monitor vital signs, weight, intake and output. Leg or ankle edema. Ascites. Monitor urine specific gravity and protein. Periorbital or facial edema that is more prominent in the morning. Monitor for edema. Low urine output. Dark and frothy urine. Administer corticosteroid therapy or immunosuppressant Blood pressure is normal or slightly decreased. therapy. Lethargy. Anorexia. Administer diuretics and plasma expanders. Pallor. Enuresis Cryptorchidism Inability to control bladder function even though the child Condition in which one or both testes fail to descend into has reached an age where they should (usually 5 years the scrotal sac. old). Nursing Interventions: Nursing Interventions: Medical or surgical treatment may be initiated after the Perform urinalysis and culture to rule out infection. age of 1 year. Limit fluid intake at night. Older children may be prescribed human chorionic Initiate a reward system. gonadotropin (hCG) to stimulate testosterone. Involve children in the cleanup. Epispadias & Hypospadias Bladder Exstrophy Congenital defects involving abnormal placement of the urethra within the male genitalia. Congenital abnormality characterized by extrusion of the urinary bladder Epispadias: Dorsal urethra opening. to the outside of the body. Hypospadias: Ventral urethra opening. Nursing Interventions: Can lead to bacteria entering into the urine. Monitor output and signs of infection or renal function. Treatment: Surgery is usually done before the age of toilet training (16 to 18 months). Maintain integrity of the exposed bladder. Circumcision may not be performed to preserve skin for surgical reconstruction. Nursing Interventions (post-op): Prevent bladder tissue from drying while allowing for drainage of urine. Apply a pressure dressing. Cover the exposed bladder with a sterile dressing. Monitor vital signs. Administer antibiotics. Encourage fluids. Avoid applying petroleum jelly to the bladder mucosa because it tends to Monitor intake and output. dry out, adhere to the bladder mucosa, and damage the delicate tissue Provide pain medications and anticholinergics for bladder spasms. when the dressing is removed. Administer antibiotics. Head Injury Open Head Injury: Fracture or penetration of the skull. Closed Head Injury: Blunt trauma (e.g., someone gets hit really hard and they have a bleed inside their brain, but Neurological there is no opening in the skull). Monitor for signs of increased intracranial pressure (ICP). Disorders Signs and Symptoms: Depend on the stage Nursing Interventions: Immobilize the neck and spine after a head injury if a spinal injury is suspected. Early Signs: Maintain a patent airway and administer oxygen. Change in level of consciousness (earliest indicator of improvement or deterioration). Keep the head and body midline. Slight changes in vital signs. Provide a calm, quiet environment. Infants may be irritable with a high-pitched cry, bulging fontanels, and increased head Implement seizure precautions. circumference. Keep the child NPO. Macewen sign (cracked pot sound on the head). Monitor for decreased responsiveness. Setting sun sign (sclera shows above the iris). Monitor for nose and ear drainage (look for blood or clear fluid, which would indicate CSF). Dilated scalp veins. Monitor for an epidural hematoma: One dilated, non-reactive pupil and drainage from the Children may have headache, nausea, vomiting, visual disturbances, and seizures. nose and ear that needs to be tested for the presence of glucose (positive glucose Late Signs: indicates CSF leakage). Significant decrease in the level of consciousness. Signs of a Brainstem Injury: Deep and rapid respirations, bradycardia, wide pulse pressure, and dilated and unequal pupils. Decorticate posturing (flexion) or decerebrate posturing (extension). Cheyne-Stokes respirations. Hydrocephalus Increased cerebrospinal fluid (CSF) due to a tumor, Nursing Interventions: hemorrhage, infection, or trauma. Surgical intervention: Ventriculoperitoneal shunt (VP shunt) Leads to head enlargement. to drain CSF accumulating in the brain to the peritoneal Signs and Symptoms: cavity or the right atrium of the heart. Infants: Increased head circumference, Macewen sign, Pre-op: Monitor intake and output, provide small, frequent dilated scalp veins, setting sun eyes, and bulging anterior feedings. fontanels. Post-op: Monitor vital signs and neurological status, keep the child flat, monitor for signs of ICP (if this occurs, elevate the head Children: Behavior changes, headaches on awakening, of the bed 15 to 30 degrees), monitor head circumference, and nausea, vomiting, ataxia, and nystagmus. monitor for infection. Meningitis Infection of the central nervous system. Signs and Symptoms: Fever. Chills. Nursing Interventions: Headache. Implement respiratory isolation precautions for at least 24 Vomiting. Diarrhea. hours after antibiotics are started. Poor feeding or anorexia. Nuchal rigidity. Perform neurological and level of consciousness Poor or high-pitched cry. assessments. Altered level of consciousness. Bulging fontanels in infants. Monitor for seizures and hearing loss. Positive Kernig's sign (inability to extend legs when thigh is flexed anteriorly at the hip). Assess nutritional status and intake and output. Positive Brudzinski's sign (neck flexion causes adduction and flexion movements of the lower extremities). Muscle or joint pain. Ear drainage. Petechiae or purpuric rashes. Reye’s Syndrome Neural Tube Defects Acute encephalopathy that follows a viral illness or the administration of aspirin. Failure of the neural tube to close, leading to a central nervous system deficit. Signs and Symptoms: May have sensory motor deficits, dislocated hips, clubfoot, or hydrocephalus. Viral illness 4 to 7 days before the onset of symptoms. Types: Fever. Spina Bifida Occulta: Spine fails to close in the lumbosacral area, spinal cord is intact and usually not visible, meninges are not exposed, and neurological deficits are usually not Nausea and vomiting. present. Neurological deterioration. Spina Bifida Cystica: Protrusion of the spinal cord and meninges, defect causes failure of the vertebrae and neural tube to close, leading to a sac-like protrusion in the lumbar or Increased blood ammonia levels. sacral area. Nursing Interventions: Meningocele: Protrusion involves the meninges in a sac-like cyst that contains CSF in the midline of the back, neurological deficits are usually not present. Provide rest and decreased stimulation in the environment. Myelomeningocele: Protrusion of the meninges, CSF, neural roots, and part of the spinal Assess neurological status. cord; the sac is covered by a thin membrane but is prone to rupture, and neurological deficits are evident. Signs and Symptoms: Depend on the type and spinal cord deficit. Flaccid paralysis of the legs. Altered bladder and bowel function. Hip and joint deformities. Hydrocephalus. Nursing Interventions: Evaluate the sac and measure the lesion. Perform a neurological assessment. Monitor for ICP. Musculoskeletal Measure head circumference and assess for bulging fontanels. Protect the exposed sac: Cover with a sterile, moist dressing. Disorders Change the sac dressing regularly using aseptic technique Monitor for infection. Assess for drainage. Place the patient in the prone position. Turn the head to the side for feedings. Prepare for surgery. Developmental Dysplasia of the Hips Abnormal development of the hip; head of the femur is not in the proper place. Nursing Interventions: Depend on the age. Signs and Symptoms (Neonate): Shortening of the limb on the affected side. Birth to 6 Months: Splinting of the hips with a Pavlik harness Restricted abduction of the hip on the affected side. continuously to maintain flexion, abduction, and external Limited range of motion. rotation; worn continuously for 3 to 6 months. Unequal gluteal and thigh folds. 6 to 18 Months: Gradual reduction by traction if necessary, Positive Ortolani click: When the examiner abducts the thighs and applies gentle hip spica cast for 2 to 4 months, then flexion abduction is pressure forward over the greater trochanter, a clicking sensation indicates dislocating the femoral head and moving it into the acetabulum. applied for 3 months. Positive Barlow test: When the examiner adducts the hips and applies pressure Older Child: May need operative reduction and down and back with the thumbs, they can feel the femoral head move out of the acetabulum. reconstruction. Deformities Marfan Syndrome Congenital Clubfoot: Disorder of connective tissue that affects the skeletal, cardiac, Deformity of the ankle and foot. eye, and skin systems. Nursing Interventions: Perform manipulation and casting weekly until 8 to 12 weeks of age. Patients are tall and thin and usually have vision and cardiac Surgery may be needed. problems. Idiopathic Scoliosis: Nursing Interventions: Spinal deformity that involves lateral curvature or spinal rotation. Nursing Interventions: Monitor for vision problems and curvature of the spine. Diagnose during the pre-adolescent growth spurt. Administer cardiac medications as needed. Look for asymmetry of the ribs and hips when the child bends forward (Adams test). Instruct the family that the child should not play competitive Monitor progression. athletics or contact sports. Surgery or bracing may be needed. Defects with Increased Pulmonary Blood Flow Atrial Septal Defect (ASD): An abnormal opening between the atria, leading to increased oxygenated blood flow to the right side of the heart. Signs and symptoms can include those of decreased cardiac output: decreased peripheral pulses, feeding difficulties, irritability, restlessness, lethargy, tachycardia, oliguria, pale cool extremities, and hypotension. Atrioventricular Canal Defect: Incomplete fusion of the endocardial cushions, often seen in children with Down syndrome. Cardiovascular This condition can also present with a murmur, cyanosis (especially when crying), and signs of decreased cardiac output. Patent Ductus Arteriosus (PDA): The shunt connecting the aorta and pulmonary artery fails to close. Conditions PDA is characterized by a murmur, a wide pulse pressure, and potentially signs of decreased cardiac output. Ventricular Septal Defect (VSD): An abnormal opening between the ventricles. Most VSDs close spontaneously within the first year of life. Signs and symptoms include a murmur and, in some cases, signs of heart failure. Defects with Decreased Pulmonary Obstructive Defects Blood Flow Aortic Stenosis: Narrowing of the aortic valve, restricting blood flow from the left ventricle to the aorta. Tetralogy of Fallot: Four defects occur together: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.2 This obstruction can lead to decreased cardiac output, left ventricular hypertrophy, and pulmonary congestion. The direction of blood shunting depends on the balance between pulmonary and systemic resistance.2 Children with aortic stenosis may present with a murmur, signs of decreased cardiac output, exercise Key signs include cyanosis at birth, a murmur, episodes of hypoxia and cyanosis ("tet spells"), clubbing of the intolerance, chest pain, and dizziness. fingers, and poor growth.2 Coarctation of the Aorta: Localized narrowing near the ductus arteriosus. Nursing Interventions for Tet Spells: A key sign is higher blood pressure in the upper extremities compared to the lower extremities. Place the child in a knee-chest position.2 Other signs include bounding pulses in the arms, weak femoral pulses, cool lower extremities, and potential Administer 100% oxygen.2 signs of heart failure or decreased cardiac output. Administer morphine/fentanyl Headaches, dizziness, epistaxis, and fainting due to hypertension may also occur. Administer IV fluids. Pulmonary Stenosis: Narrowing at the entrance to the pulmonary artery. Tricuspid Atresia: The tricuspid valve fails to develop, blocking blood flow between the right atrium and This condition can result in right ventricular hypertrophy and reduced pulmonary blood flow. ventricle.2 In severe cases, cyanosis may be present at birth, along with a murmur and signs of decreased cardiac Blood must take alternative routes through an ASD or patent foramen ovale.2 output. This defect often presents with cyanosis, tachycardia, shortness of breath, and clubbing.2  General Nursing Interventions for Mixed Defects Cardiac Defects Hypoplastic Left Heart Syndrome: The left side of the heart is underdeveloped. Close Monitoring: Regularly assess vital signs, respiratory status, and lung sounds. Infants with this condition often exhibit mild cyanosis and signs of heart failure. Heart Failure Management: Be vigilant for signs of heart failure, such as periorbital Without intervention, this defect is fatal within the first few months of life. or dependent edema. Implement fluid restrictions as needed. Total Anomalous Pulmonary Venous Connection: The pulmonary veins fail to connect to the left atrium, causing mixed blood to return to the right atrium. Nutritional Support: Provide high-calorie nutrition to support growth and This defect is characterized by right-sided heart hypertrophy, signs of heart failure, and development. cyanosis. Positioning: If respiratory distress occurs, place the child in a reverse Trendelenburg Truncus Arteriosus: A single blood vessel arises from the heart instead of separate pulmonary position (head elevated) to ease breathing. artery and aorta. Note: It is crucial to remember that the sources provided are a review of pediatric Infants may present with a murmur, hypoxemia, cyanosis, heart failure, and poor growth. nursing content and may not cover all possible cardiovascular conditions or the Transposition of the Great Arteries: The aorta arises from the right ventricle, and the full complexity of their management. Consulting with healthcare professionals for pulmonary artery arises from the left ventricle. accurate diagnosis, treatment, and ongoing care is essential. This results in two separate circulatory systems with no communication. Severe cyanosis at birth and cardiomegaly are prominent signs. Heart Failure Additional Signs of Heart Failure Decreased Cardiac Output: The sources frequently mention "signs of decreased cardiac output" as a common feature of various heart defects. This points to the importance of recognizing these signs as potential indicators of heart failure. The specific signs associated with decreased cardiac Murmur: An abnormal heart sound, often heard as a whooshing or swishing sound, output include: can be indicative of various heart defects that can lead to heart failure. Decreased Peripheral Pulses: A weak or absent pulse in the extremities, suggesting reduced Cyanosis: A bluish discoloration of the skin, particularly around the lips and blood flow. fingertips, suggests inadequate oxygenation of the blood. This can be a sign of severe heart defects that compromise blood flow to the lungs. Feeding Difficulties: Infants may have trouble sucking or tiring easily during feeding, reflecting the heart's inability to pump blood efficiently. Exercise Intolerance: Children with heart failure may tire easily during physical activity or have difficulty keeping up with their peers. Irritability, Restlessness, Lethargy: These behavioral changes can be subtle signs that the body is not receiving enough oxygen due to compromised heart function. Shortness of Breath: Labored breathing or difficulty catching their breath, especially during exertion or when lying down, can be a sign of fluid buildup in the Tachycardia: A rapid heart rate, often an attempt to compensate for the heart's reduced lungs (pulmonary edema), a complication of heart failure. pumping ability. Edema: Swelling in the legs, ankles, feet, or even the face (periorbital edema) can Oliguria: Reduced urine output, indicating poor kidney perfusion, which can be a consequence indicate fluid retention, a common consequence of heart failure. of heart failure. Pale, Cool Extremities: Inadequate blood flow to the extremities can cause them to appear pale and feel cool to the touch. Hypotension: Low blood pressure, a sign of the heart's inability to maintain adequate circulation. Important Considerations: It's crucial to recognize that the sources provide a general overview, and not all children with heart failure will exhibit all of these signs. The specific symptoms can vary based on the underlying cause of the heart failure, the child's age, and the severity of the condition. Intellectual It's essential to seek immediate medical attention if a child Disability displays any signs of heart failure. Early diagnosis and treatment are crucial for managing the condition and improving outcomes.  Nursing Care for Children with Down Down Syndrome Syndrome Definition: Down syndrome is a genetic disorder caused by the presence of an extra copy Developmental Milestones: Regular monitoring of developmental progress of chromosome 21 (trisomy 21).