Pediatrics PDF

PEDIATRICS BROUGHT TO YOU BY © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 79 ...

PEDIATRICS BROUGHT TO YOU BY © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 79  PEDIATRIC MILESTONES INFANCY Birth - 1 year fontanelle closure weight length teeth Anterior (larger) 6 months: First teeth to → Diamond-shaped Should double show are the → Closes in 12-18 months from birth weight Should be growing lower ½ - 1 inch Posterior 12 months: central incisors every month → Triangle shaped Should triple (usually show around → Closes 8 - 12 weeks from birth weight 10 months of age) motor skills language Raises head & chest 2 Head control improving Makes verbal months Moves head side to side noise (coos) Should be smiling Begins to PLAY 4 Rolls from prone to supine Rolls on the floor Babbling months Holds & reaches for toys rhymes with four! (copies noises) Head leads body when pulled to sit 6 Can sit up w/support Babbles months Stranger anxiety begins Tripod sit Sits without support 8-9 Crawling Stands with pulling & holds onto object months Pincer Grasp Object Permanence Realizing that object s that are ou t of 10-12 sight still Walking exist Simple words months Separation anxiety like “dada” 80 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  PEDIATRIC MILESTONES TODDLER 1-3 years 15 months 18 months 24 months 30 months Kicks a ball gross motor Climbs stairs Able to stand Walks on tiptoes independently Pulls toys Think Climbs on & off furniture Terrible Two's! Uses their hands a lot for: Builds tower of 6-7 cubes fine motor reaching, grabbing, Right/left-handed releasing, stacking blocks Scribbles, paints, to point Turns book pages & imitates strokes Full pincer grasp Removes shoes and socks Turns doorknobs developed Stacks four cubes Puts round pegs into holes receptive language Understands 100-150 words Points to named body Understands “no” Follows a series Follows commands parts/pictures in books Understands 200 words of 2 independent without gestures Listens to simple stories Says: “what’s this?” commands Looks at adults when Says: “my” & “mine” communicating expressive language Vocab: 40-50 words Vocab: 15-20 words Sentences of 2-3 words Repeats words Vocab: Uses names of familiar Babbles sentences 150-300 words objects Use descriptive words: hungry, hot, cold signs of delay Not walking Does not: use two-word Persistent tiptoe sentences, imitate walking Not speaking 15 words actions, or follow basic Does not develop a Does not understand the instructions mature walking pattern function of common Cannot push a toy household items with wheels 81 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  PEDIATRIC MILESTONES PRESCHOOL 3-6 years 3 years 4 years 5 years Throws ball overhead gross motor Climbs well and runs easily May be able to: Kicks ball forward Skip Pedals tricycle Can bounce a ball back Swim Walks up & down stairs Skate with alternating feet Hops on one foot Climb Bends over without falling Alternating feet going up Swing & down steps Undresses self Uses scissors fine motor Copies circles Copies capital letter Can draw a person and some letters Tower of 9-10 Draws circles, squares, & May dress/undress themselves Holds a pencil traces a cross or diamond Can use a fork, spoon, & knife Screws and unscrews lids Draws a person with 2-4 body parts Mostly cares for own toileting needs Turns book pages one at a time Laces shoes Most of the child’s speech can be understood Understands most sentences Speaks in complete sentences Explains how an item is used Understands physical relation Tells a story Participates in long & detailed conversations Follows a 3-part command 75% of speech understood by Talks about past, future, communication Half of the conversation outside observers and imaginary events understood by outside family Stays on topic in conversation Answers questions that use Says: “why?” "why" and “when” Knows the name of familiar animals 3 or 4-word sentences Can count to 10 Talks about past Knows at least one color Says name & address Vocab: 1,000 words Uses language to engage in Recalls part of a story Says their name, make-believe Speech should be completely age, & gender Can count a few numbers intelligible, even if the child has Uses pronouns and plurals Vocab: 1,500 words Speech is generally grammatical correct Vocab: 2,000 words Can't jump in place or ride a tricycle Sad often Falls a lot while walking Can’t stack 4 blocks Little interest in playing Can’t build a 4+ block tower Can’t throw a ball overhead with other kids signs of delay Does not grasp crayon with Unable to separate from their parents from parents Is extremely aggressive, fearful, No make-believe play passive, or timid. Can't copy a circle Can’t copy a circle Easy distracted No short paragraphs Doesn’t say 3+ word sentences Doesn’t understand simple Can’t use the words “me” & “you” Can not do ADLs by themselves instructions Ignores other children or doesn’t (brush teeth, undress, wash & dry Unclear speech & drooling show interest in interactive games Little interest in other kids Still clings or cries if parents leave Rarely engages in fantasy play 82 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  PEDIATRIC MILESTONES PHYSIOLOGICAL CHANGES early 10-13 Middle 14-16 Late 17-20 Adolescence years Adolescence years Adolescence years Pubic hair becomes Pubic hair spread more coarse in texture Mature pubic hair laterally, begins to & takes on adult distribution & curl, pigmentation distribution coarseness increases Testes, scrotum, & Breast enlargement Growth & penis continue to grow Male disappears enlargement of testes The skin around the & lengthening of the Adult size & shape scrotum darkens penis of testes, scrotum, Glands penis develops and penis Lengthy look due to extremities growing May experience Scrotum skin faster than the trunk breast enlargement darkening Voice changes First menstrual period (average age Pubic hair becomes is 12 years) coarse in texture female Breasts bud and Amount of hair increases Mature pubic hair areola continue to distribution and enlarge (no separation Areola & papilla coarseness of the breasts) separate from the contour of the breasts to Pubic hair begins to form a secondary mound curl & spread over the mons pubis 83 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  PEDIATRIC CPR ( 12 yr 12 -20 60 - 90 100 - 120 Infant: Check brachial pulse child: Check carotid pulse BREATHS /MIN BEATS/M IN 2 CALL FOR HELP ✹ Active the emergency response system / shout for nearby help ✹ Delegate someone else to call 911 / get the AED 3 CHEST COMPRESSIONS ✹ 2 minutes of CPR before retrieving the AED single rescuer ✹ Rate of 100 - 120 compression/min 30:2 compression-to-breath ratio ✹ ✹ Depth: Infant: Equal to one-third of chest's Two rescuers anterior-posterior diameter 15:2 compression-to-breath ratio Child: 2 inches ✹ 2 - finger 2 - thumb compression encircling hand technique technique 4 CONTINUE UNTIL SIGNS OF HELP ARRIVE OR AED BECOMES AVAILABLE 84 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  PIAGET'S STAGES OF COGNITIVE DEVELOPMENT Saying Piaget's cognitive Stages is Fun Sensorimotor Stage 0 - 2 years ✹ Development through our 5 senses ✹ Development through motor response ✹ OBJECT PERMANENCE is developed ✹ Egocentric ➥ Can only see the world from one's own point of view Realizing that objects that are out of sight still exist Preoperational Stage 2 - 7 years ✹ Symbolic thinking Magical thinking ✹ Imagination ANIMISM - thinks objects are alive ✹ Plays pretend ✹ Asks a lot of questions (intuition) concrete operational Stage 7 - 11 years ✹ Develop concrete cognitive operations ➥ Sorting blocks in a certain order ✹ CONSERVATION is developed CONSERVATION ✹ Conductive reasoning (Mathematical advancements) Understanding that something stays the same in volume even though its shape changes. Formal Operational Stage > 11 years ✹ More rational, logical, organized, moral, and consistent thinking ✹ Hypothetical thinking - Can think outside the present ✹ Abstract concepts ➥ Love, hate, failures, successes ✹ Deductive reasoning 85 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  VARIATIONS IN PEDIATRIC ANATOMY & PHYSIOLOGY NORMAL EDEMA RESPIRATORY NT HEAD SIZE Head is the fastest growing part of INFA Narrow airways ↓ alveoli than an adult Head & neck muscles are not well Thousands of alveoli grow each day LT developed ADU Floppy airways from less cartilage BRAIN & SPINAL CORD ↑ ↑ O2 requirements ↑ risk for hemorrhage Sutures & fontanels makes the skull EARS ↑ risk for cervical spin injury ↑ RISK FOR EAR INFECTION short, wide, & flat IMMUNE SYSTEM ↑ RISK FOR INFECTION Immature immune systems ↓ inflammatory response Limited exposure to disease (losing immunity from maternal CARDIOVASCULAR The transition from fetal circulation → normal circulation NERVOUS SYSTEM Infants hearts are thinner Myelinization is incomplete and less compliant Myelinization happens in cephalocaudal direction SKIN Epidermis is thinner Cephalocaudal Blood vessels are closer to the direction (head to tail) Head control before walking! KIDNEYS proximodistal (inward outward) GFR is slower ↓ ↑ risk for dehydration 86 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  SUDDEN INFANT DEATH SYNDROME (SIDS) Sudden death of a previously healthy infant younger than 1 year of age RISK FACTORS AGE: 1 - 6 months (↑ Socioeconomic status THERE ARE Preterm Lack of prenatal care NO Sleep position Genetic SIGNS OR SYMPTOMS! Sudden death Nicotine exposure Leading cause of death in infants EDUCATION / PREVENTION Sleep in supine position Bedding Firm mattress Avoid smoking No co-bedding Normal room temp Encourage pacifier use ABCS OF SAFE SLEEPING A alone B On their back C In a crib 87 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  NEURAL TUBE DEFECTS Spina Bifida NORMAL SPINE typically diagnosed during pregnancy The neural tube closes: where the spinal column fails to close. 3rd - 4th week of gestation “split spine” CAUSES NOT KNOWN... BUT MANY FACTORS HINDER NORMAL CNS DEVELOPMENT Drugs Chemicals Malnutrition Genetics SPINA BIFIDA OCCULTA MILDEST FORM Typically asymptomatic Defect of the vertebral Does not need immediate body WITHOUT May have dimpling, medical care if asymptomatic. protrusion of the abnormal patches of If symptoms are present, spinal cord or meninges. hair, or discoloration near the client may get an MRI. the spine. MENINGOCELE Meninges herniate Sac protruding through a defect from the spinal area. Surgical correction in the vertebrae. Most are covered of the lesion Usually minor or with skin. no neurological deficits. MOST MYELOMENINGOCELE SEVERE FORM Multiple surgical procedures Paralysis The spinal cord often Protrusion of ends at the point the meninges, of the defect. cerebrospinal fluid, and spine. = Hypoxia Absent motor Hemorrhage Skin may be Freq. catheterization causes... exposed as well. & sensory function beyond that point. ➥ Latex allergy ➥ UTIs / pyelonephritis ➥ Renal damage 88 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  BRONCHIOLITIS (RSV) BRONCHIOLITIS small airways in the lungs inflammation PATHO ✹ Respiratory syncytial virus (RSV) ✹ Very contagious ✹ Starts as an upper respiratory infection & moves into the chest INITIAL CONTINUED EMERGENT SIGNS & SYMPTOMS Grunting ✹ Upper respiratory symptoms ✹ Lower respiratory tract symptoms Nasal congestion Tachypnea Nasal flaring Runny nose Cough Cyanosis Cough Wheezing Hypoxia Sneezing Respiratory failure ✹ Fever Apneic episodes ✹ Self-limited illness & supportive care ✹ Hydration ✹ Airway maintenance TREATMENT Oxygen Suctioning ✹ Hospitalization Saline nose drops & then suction the Only necessary if the child nares with a bulb syringe to remove the has severe symptoms secretions before feeding or at bedtime ✹ Use contact & standard Position the child at a 30 - 40° angle Most child precautions during care re can be ma n naged at home 89 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  REYES SYNDROME Rare disease affecting young children recovering from a viral illness (flu or chicken pox) Exact cause unknown CAUSE Triggered due to the intake of salicylates or salicylate-containing products such as aspirin to treat a viral illness ENCEPHALOPATHY / CEREBRAL EDEMA SIGNS & SYMPTOMS "CHILDS" C Confusion H ACUTE FATTY LIVER FAILURE I Irritability LABS ↑ LIVER ENZYMES L Lethargy ↑ AST D Diarrhea & vomiting ↑ ALT S Seizures Educate on ✹ Early recognition & treatment products that contain ✹ Education on prevention! Salicylates: TREATMENT ✹ Aspirin ✹ Swelling of the brain occurs Alka-Seltzer Managing & preventing increased ICP Pepto-Bismol Seizure precautions Kaopectate 90 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  INTUSSUSCEPTION ILEUM TELESCOPES INTO THE CECUM ↓ TELESCOPES OBSTRUCTION = PAIN ↓ COMPRESSION OF BLOOD VESSELS ↓ PATHO BLOOD FLOW DECREASES ↓ BOWEL ISCHEMIA ↓ RECTAL BLEEDING (CURRANT JELLY STOOLS!) ✹ Intermittent pain / cramping ✹ Child draws up their legs toward ✹ NOT COMPLETELY KNOWN SIGNS & SYMPTOMS the abdomen in severe pain THIS IS ✹ May be due to a virus that while crying BECAUSE CAUSES TELESCOP ING causes swelling ✹ Vomiting & diarrhea INTERMITT IS ENT ✹ Condition child is born with ✹ Currant-jelly stools (bloody) Diverticulum ✹ Lethargy Polyps ✹ Sausage-shaped mass in the upper mid-abdomen ✹ May spontaneously be reduced Diagnostic / Treatment ✹ ✹ Antibiotics AIR or BARIUM ENEMA TREATMENT works to diagnose ✹ Decompression via NG tube & also helps reduce ✹ Provide comfort & emotional the intussusception support to the parents ✹ Monitor for signs of perforation & shock ✹ May need air or barium enema 91 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  HYPERTROPHIC PYLORIC STENOSIS NARROWING A hypertrophied pyloric muscle causes narrowing of the pyloric canal ↓ PATHO Thickness creates a narrow stomach outlet HYPERTROPHIED NORMAL PYLORUS MUSCLE HYPERTROPHIC PYLORIC STENOSIS ↓ ↓ ↓ Increase in size Pylorus Narrowing Opening from the stomach into the small intestines Stomach contains acid w ✹ Projectile vomiting becomes deple hich SIGNS & SYMPTOMS ted when vomiting whic ✹ Non-bilious emesis h leads to METABOLIC ✹ Olive-shape mass palpable in the right upper quadrant ALKALOSIS ✹ Infants will be hungry constantly despite regular feedings ↑PH & ↑HCO3 ✹ Weight loss ✹ DEHYDRATION! ↑ Hematocrit from hemoconcentration ↑ BUN ✹ Monitor... I&O’s Pyloromyotomy Vomiting episodes & stools TREATMENT Cut the muscle of the pylorus ✹ Obtain daily weights ↓ ✹ Provide comfort & emotional support Relieving the gastric to the parents ✹ Educate about surgery 92 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  EPIGLOTTITIS WHAT IS THE EPIGLOTTIS? Piece of cartilage of the PATHO EPIGLOTTIS Function: leading to an Closes the entry to the trachea upper airway during swallowing.... obstruction AKA prevents aspiration ✹ Most common cause: Haemophilus influenza type B CAUSES PEDS inciden t falling due to ✹ Streptococcus pneumonia Hib vaccinati on ✹ Tachycardia ✹ Drooling / dysphagia ✹ Sore throat ✹ Tripod position SIGNS & SYMPTOMS ✹ High fever ✹ Sitting forward with the neck ✹ Anxious / apprehensive / agitation extended to breath - mouth open ✹ ✹ Retractions ✹ ✹ ✹ Stridor ✹ Absent cough! ✹ Never leave the client Do not visualize the throat with a tongue blade. ✹ Asses oxygen status Take oral temperature or take throat culture. ✹ IV access Why? NURSING MANAGEMENT It can cause REFLEX LARYNGOSPASMS ✹ May need emergency intubation ✹ Calm environment Stay with parents ✹ NPO Don’t restrain the child Help to avoid crying ✹ Medications Antipyretics Corticosteroids ✹ Do not place them in supine position. It becomes harder to breathe. IV Fluids 93 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  LARYNGOTRACHEOBRONCHITIS “CROUP” larynx, trachea, & bronchi LARYNGO TRACHEO BRONCHI ITIS PATHO ↓ ↓ ↓ ↓ occur as a result of viral infection Most commonly caused by Larynx Trachea Bronchi Inflammation the Parainfluenza virus ✹ Croup Vs. Epiglottitis SIGNS & SYMPTOMS ONSET Sudden (at night) Rapid (within hours) 3 s ’s Symptoms occur at night FEVER Fluctuating High Stridor COUGH Yes No Subglottic swelling DYSPHAGIA No Yes CAUSE Viral Bacterial Seal-bark cough EMERGENCY Not typically Yes HOME CARE SEEK HELP Self-limiting When the child is indicating (Usually resolves on its own) respiratory distress TREATMENT ✹ Corticosteroids (↓ ) ✹ Child is confused/restless ✹ Racemic epinephrine ✹ Blue lips/nails ✹ ✹ ↑ respiration rate ✹ ✹ Retractions ✹ Calm environment for the child ✹ ✹ Drooling/can’t swallow 94 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  FEVER MANAGEMENT NORMAL TEMP FEVER 97.5°F to 98.6°F > 100.4°F (38.0°C) 36.4°C to 37.0°C SIGNS & SYMPTOMS TREATMENT ✹ Administer antipyretics (ibuprofen) Do not administer aspirin ✹ Flushed skin ✹ Diaphoresis (sweating) ✹ Monitor for S&S of dehydration & electrolyte imbalances ✹ Chills Tepid water for 20-30 min. ✹ Sponge bath ✹ Restlessness ✹ Remove excess clothing ✹ Lethargy & coverings to ↓ the temp ✹ Cool compress on the forehead Febrile Seizure WHAT IS IT? SIGNS & SYMPTOMS Seizures associated with a FEVER ✹ Rapid ↑ in core temperature Not related to: Usually ✹ Child may be drowsy during intracranial infection does no have lon t postictal period g te complica rm tions viral illness such as epilepsy or intelle ctual disabilit y RISK FACTORS TREATMENT ✹ 6 months - 5 years ✹ NOT anticonvulsants therapy ✹ Rapidly developed fever ✹ Rectal Diazepam ✹ HIGH fever ✹ Educate the parents to seek help if... ✹ Family history of febrile seizures Last > 5 min ✹ Certain vaccines Repeated seizures DTP & MMR 95 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  CYSTIC FIBROSIS (CF) CF is an ✹ Multisystem disorder of the EXOCRINE GLANDS Autosomal recessive with increased production of thick mucus genetic disorder ✹ from properly functioning PATHO ✹ EXOCRINE GLANDS: Produce & transfer secretions Dad is a Mom is a carrier of carrier of ↓ ✹↑ ↑ resistance to ciliary action CF gene CF gene mucus plugging ↓ Cystic Fibrosis CHEST PT DIAGNOSIS ✹ ✹ Positive sweat sodium chloride test ✹ Genetic screen ✹ Stimulates cough Helps loosen mucus Builds up strength and endurance ✹ Treatment of the mucus of respiratory muscles Postural drainage ✹ TREATMENT Huff coughing 1-2 hour increments Bronchodilators, mucolytics, ✹ ✹ Treat & prevent infection Wear a mask, hand washing, up-to-date on vaccines, avoid those who are sick. ✹ Nutrition ✹ Prevent GI blockage Fluids & stool softeners ✹ ↑ protein, ↑ fat, ↑ calorie A, K, E, D All Kids Eat Donuts ✹ ✹ Pancreatic enzymes: Pancrelipase or Pancreatin Can swallow a capsules or sprinkle enzymes 96 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  MANIFESTATIONS OF CF NOSE & SINUSES RESPIRATORY Sinusitis INFECTION: Thick mucus creates Pseudomonas PANCREAS Staph. aureus Pancreas secretes thick mucus Pneumonia Deficient in pancreatic enzymes: Bronchitis Thick mucus blocked airways Weight loss Deficiency of protein Failure to thrive Barrel-shape chest Insulin deficiency Hyperglycemia Pneumothorax LIVER CARDIOVASCULAR Pulmonary hypertension from THICK mucus puts strain on the heart Gallstones Right-sided heart failure Biliary cirrhosis INTEGUMENTARY STOMACH & INTESTINES Sweat glands produce Fecal impaction ↑ Rectal prolapse Salty sweat & salty tears which leads to Intussusception Dehydration Back up of stool in intestine Constipation Vomiting REPRODUCTIVE Cramping Anorexia BOYS RLQ pain Meconium ileus in infants BOTH HAVE Steatorrhea DELAYED PUBERTY GIRLS foul-smelling stools 97 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  FETAL CIRCULATION IN UTERO FORAMEN OVALE How can blood Blood is SHUNTED from the right atrium be shunted from the right pressure difference! foramen Ovale atrium to the Blood flows from left atrium? high resistance ↓ to low resistance Lungs: High resistance SUPERIOR from all the fluid. So the VENA CAVA DUCTUS AORTA FORAMEN ARTERIOSUS RIGHT ATRIUM OVALE ↓ Blood goes from the interior vena cava to the right atrium as well as some coming from DUCTUS ARTERIOSUS the superior vena cava. Blood is SHUNTED from ↓ the pulmonary artery RIGHT ATRIUM the ductus arteriosus Liver not fully functioning yet INTERIOR VENA CAVA ↓ DUCTUS VENOSUS LIVER AORTA DESCENDING AORTA oxygenated to oxygenate the fetus ↓ placenta. It passes the LIVER DUCTUS VENOSUS SHUNTED UMBILICAL ↓ VEIN to the inferior vena cava the Ductus Venosus FROM PLACENTA → BLOOD GOES UMBILICAL TO PLACENTA ← ARTERIES BACK TO THE PLACENTA TO GET OXYGENATED THE PLACENTA IS THE "LIFELINE" AGAIN! BETWEEN MOTHER & BABY The Placenta is like "temporary lungs" MEMORY A think AWAY SHUNTS TRICK for the fetus while in utero 2 Umbilical Takes deoxygenated TO KNOW Arteries AWAY Ductus venosus 1 Umbilical START vein to the placenta Foramen ovale Gives oxygen rich Ductus arteriosus TO 98 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  DEVELOPMENT DYSPLASIA OF THE HIPS (DDH) DISLOCATION ✹ Abnormal development of the hip joint PATHO ✹ SUBLUXATION Partial dislocation so they have the ability to dislocate & relocate easily DYSPLASIA Hip joint doesn't have the proper ✹ Ultrasound for in utero DIAGNOSIS ✹ X-ray for those older than 6 months ✹ Barlow test & Ortolani Listen for any noises during the exam. Barlow ortolani Test Test COMPLICATIONS ✹ Avascular necrosis of the femoral head RISK FACTORS ✹ FEMALE → more lax ligaments ✹ ↓ ROM from maternal hormones ✹ Leg-length discrepancy ✹ Breech positioning ✹ Early osteoarthritis ✹ Oligohydramnios ✹ Femoral nerve palsy Early detection & treatment are crucial. in early infancy, so you want to manipulate them to grow properly. If Instructions > 6 months for ✹ Pavlik harness: Pavlik Harness 4 months - 2 Years TREATMENT ✹ ✹ Closed reduction: ✹ Do not adjust the straps or remove ✹ Spica cast is worn after surgery to maintain reduction is in the harness ✹ Check for redness, irritation or > 2 Years or no improvements ✹ with surgery or harness ✹ Place long knee socks and undershirt ✹ 99 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.  SCARLET FEVER PATHO ✹ Complication of group A streptococcal infection AKA Strep throat Scarlet Fever ✹ Not all children who have strep will develop scarlet fever think Strep! ✹ TRANSMISSION: Droplets & respiratory tract secretions. Transmission happens in close contact such as schools & daycares. SIGNS & SYMPTOMS Begins on the NECK & CHEST ✹ and spreads outwards to THE EXTREMITIES! ✹ RED RASh! Rash is usually not Sandpaper-like rash seen on the palms & soles of the feet ✹ Pharyngitis ✹ S' s of ✹ Scarlet fever: ✹ Tender cervical nodes Strawberry tongue ✹ Tonsils are red Sandpaper rash ✹ Take antibiotics as directed.... COMPLICATIONS TREATMENT Finish the medication