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285 Cards in this Set
- Front
- Back
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Describe the eyes at birth. |
* Visual acuity develops from birth through early childhood. * The eyeball occupies a larger space, making it injury prone. * Color discrimination is incomplete at birth. * Retinal vascularization is incomplete at birth. |
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Describe the ears at birth. |
* Hearing is intact at birth. * Recurrent ear disorders(or ear infections) may affect hearing. * Placement of Eustachian tubes and enlarged adenoids make ears prone to infection. |
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What are you observing when assessing the eyes? |
* Assess positioning and symmetry. * Check for presence of strabismus, nystagmus,and squinting. * Assess if eyelids open equally (failure toopen fully is ptosis). * Note variations in eye slant and the presence of epicanthal folds(trisomy 21). * Assess for eyelid edema, sclera color,discharge, tearing, and pupillary equality, as well as size and shape of the pupils. (equal round reactive to light) * Blocked tear ducts |
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What kind of information are you looking for when taking a health history of a present illness affecting the eyes or ears? |
* Onset and progression– what does it look like, anything make it better? When did you notice it? * Fever * Nasal congestion * Eye or ear pain * Eye rubbing * Ear pulling * Headache * Lethargy * Behavioral changes – may not be paying attention to the teacher – do a hearing and eye test first |
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What are some signs and symptoms of visual impairment? |
* Any age: dull, vacant stare * Infant: does not “fix and follow,” does not make eye contact, is unaffected by bright light, does not imitate facial expression * Toddler and older child: rubs, shuts, and covers eyes; squints and blinks frequently; holds objects close or sits close to television; bumps into objects; displays head tilt or forward thrust, c/o (complaints of) headache, c/o blurry vision or photophobia |
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How is testing of the eyes performed during a physical examination? |
• Extraocular movements (up down side to side w/head still) • Pupillary light response and accommodation • Symmetry of corneal light reflex • Presence of red reflex with an ophthalmoscope – if not equal or absent, needs to be referred • Age-appropriate visual acuity test |
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What are some common medical treatments for eye and ear disorders? |
• Warm compress to moisten • Corrective lenses • Patching – refractive error, lazy eye, strabismus • Eye muscle surgery • Pressure-equalizing (PE) tubes • Hearing aids (amplifiers) • Cochlear implants |
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How is allergic conjunctivitis treated? |
Topical antihistamine drops unless allergic rhinitis accompanies it, in which oral antihistamine would be used. |
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What are some types of infectious diseases of the eye? |
* Conjunctivitis * Nasolacrimal duct obstruction (blocked tear duct) – teach that it’s benign and won’t affect vision, gentle tear duct massage * Eyelid lesions * Periorbital cellulitis |
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What are the types of conjunctivitis? |
* Bacterial - includes purulent drainage, mild pain * Viral - watery drainage, photophobia, lymphadenopathy * Allergic - itchy, watery or stringy discharge |
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What is the nursing management of conjunctivitis? |
–Symptom alleviation •Eye drops or ointment (massage to getinto conjunctiva) keep hands clean!! •Compresses •Reduction of allergens –Prevention of spread of infection |
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What is the nursing assessment of a nasolacrimal duct obstruction? |
–Tearing or discharge from one or both eyes –Redness of lower lid of affected eye –Possible culture of drainage |
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What is the nursing management of a nasolacrimal duct obstruction? |
–Typically spontaneous resolution by age 12months –Parent education (won't affect eyesight) –Nasal lacrimal duct massage, warm compresses |
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What is a hordeolum and what are the symptoms? |
A disorder of the eyelid called a 'stye'. Has acute onset, short duration, is caused by Staph Aureus, is common on the outer eyelid and may resolve without intervention. Warm compresses and gentle massage for treatment |
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What is a chalazion? |
A cyst or blocked oil gland that is common on the inner eyelid. |
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What is a blepharitis? |
An inflammation of the eyelid. May be difficult to treat. Often needs antibiotics. |
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What is periorbital cellulitis? |
•Bacterial infection of eyelids and tissues surrounding the eye |
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What is the medical management of periorbital cellulitis? |
IV antibiotics followed by oral antibiotics If it does not respond to eye drops, An abscess can occur if not taken care of properly |
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What is the nursing assessment of a periorbital cellulitis? |
* pain around eye * restricted eye movement * reddish-purple eyelid * edema |
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What is the nursing management of periorbital cellulitis? |
* warm soaks * IVantibiotic administration * family education– bacteremia can occur (bacteria in the blood) – teach warm soak – teach what to expect and what improvement looks like |
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The nurse caring for achild with periorbital cellulitis accurately explains to the parents thattreatment consists of the use of an antibiotic ointment. True of False? |
False. The nurse caring for a child with periorbital cellulitis accurately explains to the parents that treatment consists of intravenous antibiotic administration during the acute phase followed by completion of the course with oral antibiotics. Rationale:Following intravenous antibiotic administration the parents are taught to apply warm soaks to the eye area for 20 minutes every 2 to 4 hours and administer intravenous antibiotics as prescribed. |
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What are the visual disorders? |
* Refractive errors – most common cause of eye difficulties inchildren * Astigmatism - uneven corneal curvature * Strabismus - misalignment of the eye * Amblyopia - lazy eye * Nystagmus– can be indicative of a neuro condition (repetitive uncontrolled movements) * Glaucoma– can see in infant period (increased pressure in the eye) * Cataracts – can alsosee in infant period (clouding of the clear lens of the eye) |
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What is hyperopia and myopia? |
* Hyperopia - far sightedness * Myopia - near sightedness |
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What is the nursing assessment of astigmatism? |
–Visual complaints (blurry vision, eye fatigue, head tilting, etc.) –Visual acuity testing and refractive errorevaluation |
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What are the two types of strabismus? |
Exotropia - facing outward
Esotropia - facing inward (true cross eyes) |
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What is a Hirschberg test? |
To test for strabismus or amblyopia. |
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What are the signs and symptoms of infantile glaucoma?
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• Infant keeping eyes closed most of the time or rubbing eyes • Corneal enlargement and clouding • Enlarged appearance of the eye • Photophobia • Tearing or conjunctivitis • Eyelid squeezing or spasm |
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What is the nursing assessment of congenital cataracts? |
* Lack of visual awareness * Nored reflex in affected eye |
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What is the nursing management of congenital cataracts? |
–Providing post-operative care –Family education (eye patching) –Follow-up assessments |
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What are the risk factors for retinopathy of prematurity? |
• Low birthweight - <3lbs • Early gestational age - <30wks • Changes in oxygen tension and duration/concentration of supplemental oxygen Sepsis, hypothermia |
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What are the symptoms of retinopathy of prematurity? |
* nystagmus * cross eyes * near-sighted * white looking pupils (most babies recover without lasting visual impairments) |
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What is a blowout fracture? |
A fracture of the lower orbital bone. |
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What is a traumatic hyphema? |
Blood in the anterior chamber of the eye caused by a traumatic event. |
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What should be observed when examining the ear? |
* note for presence of inflammation or anything in the ear canal - teach not to put anything in the ear * visualize the tympanic membrane - color, landmarks and light reflex |
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What should the tympanic membrane look like? |
Should be pearly grey, no holes and a reflective cone of light. There should be no bulging or retraction. |
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What is tympanometry? |
A test of the function of the middle ear. It is done by creating variations of air pressure in the ear canal. |
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The nurse is assisting with a diagnostic testto determine the extent of effusion of the middle ear. What is the name forthis test? a.culture of ear discharge b.tympanic fluid culture c.tympanometry d.tympanotomy |
c.tympanometry. Tympanometry determines effusion of the middle ear. Rationale: With tympanometry, a probe in the ear canal measures movement of the eardrum to determine effusion in the middle ear. Cultures determine specific bacteria present and appropriate antibiotic coverage. Tympanectomy is not a diagnostic test, but rather ear tubes surgery. |
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What is acute otitis media? |
An ear infection caused by fluid trapped in the ear that has grown bacteria and become infected. |
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What is otitis media with effusion? |
Fluid behind the eardrum without acute infection. There are often no symptoms or maybe the child is sitting closer to the television because of fullness in the ears. May be referred for pressure equalizing, or myringotomy, tubes. Can cause conduction hearing loss. |
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What is congenital hearing loss typically due to? |
Recessive gene inheritance |
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What are the different types of delayed-onset hearing loss? |
* Conductive hearing loss–Results when transmission of sound through the middle ear is disrupted, as in the case of OME * Sensorineural hearing loss–Caused by damage to the hair cells in the cochlea or along the auditory pathway * Mixed hearing loss –Occurs when the cause may be attributed to both conductive and sensorineural problem |
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What are the levels of hearing loss? |
• 0 to 20 dB: normal • 20 to 40 dB: mild loss • 40 to 60 dB: moderate loss • 60 to 80 dB: severe loss • Greater than 80 dB: profound loss (ASHA,2011b) |
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What is otitis externa? |
Swimmer's ear. A very painful infection of the outer ear between the eardrum and the outside of the ear. Typically caused by water that sits in the ear from swimming. To prevent reinfection, ear plugs should be used while swimming |
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What is the biggest cause of problems for children under 5 years of age? |
Respiratory problems. |
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Describe the nasal anatomy of an infant. |
–Infants are obligate nose breathers; newborns produce very little mucus (which clears bacteria), making them more susceptible to infections. –Newborns have very small nasal passages,making them more prone to obstruction; sinuses are not developed, making them less prone to sinus infection. |
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Describe the throat anatomy of an infant. |
–Infants’ tongues relative to oropharynx are larger; placement of tongue (swelling) can lead to airway obstruction. –Children have enlarged tonsillar and adenoid tissue, which can lead to airway obstruction. |
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Why are young children more susceptible to ear infections? |
Eustachian tubes are shorter and more horizontal, facilitating transfer of pathogens into middle ear; lymphoid and tonsillar tissue are normally enlarged and may obstruct passage of air |
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Why are infants more susceptible to respiratory infections? |
• Neonates obligate nose breathers; any obstruction in nasal passages interferes with breathing and eating • Newborns have less respiratory mucus to function as cleaning agent • Narrower airways increase airway resistance and child’s risk for obstruction by edema, mucus or foreign objects • Infant’s airway walls have less cartilage and are more flexible thus more susceptible to collapse – will use accessory muscles to compensate (retraction) – always look at the patient • Retractions more common due to immaturity of intercostal muscles • Increased respiratory and metabolic rates increase O2 need |
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Where does the bifurcation of the trachea happen in children as opposed to adults? |
Third vertebrae in children as opposed to the 6th vertebrae in adults. |
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What is the nursing health assessment of a child with a respiratory disorder? |
–Health History – environmental history as well, smokers?, allergens?, animals? - increased incidence of conditions – boggy nares mean chronic allergies –Physical Examination •Inspection and Observation •Color: cyanosis or pallor •Nose and oral cavity: swelling, redness, exudate •Cough and other airway noises: stridor, wheezing, grunting; cough productive/non? •Respiratory effort: retractions, location?•Appearance of the child – do they look restless, clubbing, hydration status •Auscultation - wheezes, crackles, pops? •Percussion- dull & flat may be pneumonia •Palpation of sinuses, nodes & pulses - may be painful |
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Name some adventitious breath sounds and what they sound like |
* Stridor - inspiratory sound due to edema in the upper airway * Wheezing - high pitched sound on expiration which may occur with obstruction inlower trachea or bronchioles * Rales - –Crackling sounds heard when alveoli become fluid filled, may occur with pneumonia |
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What are some common medical treatments for respiratory disorders? |
•Oxygen •High humidity •Suctioning •Chest physiotherapy and postural drainage •Saline gargles •Saline lavage - washing of sinuses with saline •Chest tubes •Bronchoscopy |
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The nurse is caring for a child with cysticfibrosis. Which of the following treatments would be used to promote mucusclearance through percussion or vibration? a.suctioning b.chest tube c. bronchoscopy d. chest physiotherapy |
d.chest physiotherapy. Chest physiotherapy promotes mucus clearance through percussion or vibration. Rationale: Suctioning removes secretions via bulb syringe or suction catheter, chest tubes remove air or fluid though a drain inserted into the pleural cavity, and bronchoscopy is the introduction of a bronchoscope into the bronchial tree for diagnostic purposes. |
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What are some acute Infectious disorders? |
•Common cold, sinusitis •Influenza •Pharyngitis, tonsillitis, and laryngitis(viral) –may get strep •Croup syndromes– do they have stridor, are they able to maintain their O2 levels •Respiratory syncytial virus (RSV) – babies are the ones with issues with this – vaccine but very expensive and the sickest kids get it •Pneumonia and bronchitis |
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Describe sinusitis. |
•Maxillary and ethmoid sinuses most commonly affected in young children, frontal sinuses after age 10 •Acute (symptoms lasting <30 days) or chronic (symptoms longer than 4 to 6 weeks) •Therapeutic Management: antibiotics, saline drops, supportive care, cool humidifier, hydration, etc. saline spray |
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What is the nursing assessment and nursing management of sinusitis? |
•Nursing Assessment: persistent signs and symptoms of cold; pain over sinus cavities •Nursing Management: normal saline nose drops or spray, cool mist humidifier, adequate fluid intake, family education about completion of therapy |
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Describe the flu. |
•Transmission via inhalation of droplets or contact with fine-particle aerosols •Two types: Viral & Bacterial |
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Describe viral influenza. |
* Respiratory syncytial virus (RSV) * Adenoviruses * Influenza virus * Coxsackie viruses –hand foot and mouth Disease – may refuse to eat * Parainfluenza viruses – causes croup |
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Describe bacterial influenza. |
* Streptococcal infections:group A beta-hemolytic streptococcus (GABHS) Diagnosis: throat culture or rapid strep screen |
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What is the nursing assessment and nursing management of the flu? |
•Nursing Assessment: risk factors; common signs and symptoms •Nursing Management –Supportive –Immunization –Antiviralsie Tamiflu– within 72hours |
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What are the "Four D's" and which condition does it refer to? |
In epiglottitis the four D's alert the nurse that this is an emergent situation * Dyspnea - difficulty breathing * Dysphagia - difficulty or pain swallowing * Dysphonia - difficulty speaking * Drooling |
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Describe epiglottitis. |
•Most often due to H. influenzae type b •Inflammation and swelling of epiglottis primarily affecting children 2-8yrs •Life threatening emergency situation •Hib vaccine part of childhood vaccination series •Respiratory distress, sudden onset fever, sore throat, the four D's, agitation •Child is anxious, restless, looks ill and tripods •Therapeutic Management: airway maintenance and support •Get practitioner there asap while keeping things calm, IV lines for hydration, Not feeding |
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What is the nursing management of epiglottitis? |
–Position of comfort –Keep child and caregiver calm –Oxygen administration –No visualization of throat –Administer IV Abx/Steroidsas indicated –NPO status maintained –Readily available emergency equipment –Tracheotomy tray at bedside! |
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Describe Croup. |
•Laryngotracheobronchitis •Inflammation of larynx and trachea •Parainfluenza virus most common cause •Nursing Assessment: Inspiratory stridor, be sure if this is present that it is not affecting O2 rate •Cough at night (barklike); lateral neck x-ray to rule out epiglottitis •Usually responds well to treatment, can be caused by a foreign body dislodged in the throat- maybe a soft tissue x-ray of the neck? Nothing cold for fluid intake |
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What is the treatment for croup? |
•Nebulized epinephrine
•Systemic or nebulized corticosteroids •Fluids •Rest •Comfort •Supplemental cool mist |
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Describe bronchiolitis. |
•Acute, typically viral, infection of the bronchioles (RSV, usually) •Usually young children •Causes inflammation of the bronchioles •Wheezing is classic manifestation •Using accessory muscles to breathe |
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What are the signs and symptoms of bronchiolitis (RSV)? |
•Onset of illness with a clear runny nose (sometimes profuse) •Pharyngitis •Low-grade fever •Development of cough 1 to 3 days into theillness, followed by a wheeze shortly thereafter •Poor feeding •Lung sounds may be all over the place – everything, IV fluids,may thin out formula or breast milk with pedialyte |
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What are the lab and diagnostic tests run for bronchiolitis (or RSV)? |
•Pulse oximetry: oxygen saturation might be decreased significantly. •Chest radiograph: might reveal hyperinflation and patchy areas of atelectasis or infiltration •Blood gases: might show carbon dioxide retention and hypoxemia •Nasal-pharyngeal washings: positive identification of RSV can be made via enzyme-linked immunosorbent assay (ELISA) or immunofluorescent antibody (IFA) testing |
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What is the treatment for bronchiolitis (RSV)? |
•Usually home management with rest, adequate fluid intake, fever management •Hospitalized if dehydrated or exhibit respiratory distress –Bronchodilators –Steroids –Humidified oxygen –IV fluids –Ribavirin: only specific treatment for RSV •Prevention:RSV-IGG, and Synagis |
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Describe pneumonia. |
•An acute inflammation of thepulmonary parenchyma •Can be primary disease orcomplication of another; viruses most common in children and infants, bacterialmost common in neonates •Mycoplasma pnumoniae infection most common in older children (>5yrs) in fall and winter •High fevers and respiratory rate |
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What are the lab tests and diagnostic tests run for pneumonia? |
•Pulse oximetry: oxygen saturation might be decreased significantly or within normal range •Chest x-ray: varies according to child age and causative agent •Sputum culture: may be useful in determining causative bacteria in older children and adolescents •White blood cell count: might be elevated inthe case of bacterial pneumonia |
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What is the treatment for pneumonia? |
•Viral pneumonia: supportive •Bacterial pneumonia: antibiotics •Usually at home •Hospitalized: oxygen therapy,chest physiotherapy, IVs, and antipyretics, non-opioid analgesics |
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What is the nursing management of pneumonia? |
•Monitor VS and breath sounds q2h •Supportive care – supplemental O2 •Antibiotics •Restore and maintain hydration •TCDB (turn, cough, deep breathe) •Chest physiotherapy •Incentive Spirometry •Ambulation when appropriate •Pain assessment and management •Family teaching |
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Describe Tb. |
•Highly contagious; inhalation of droplets of Mycobacterium tuberculosis or Mycobacterium bovis |
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What is the nursing assessment and management of Tb? |
•Nursing Assessment –Screening for high risk –Variable presentation •Nursing Management –Hospitalization –Infection prevention |
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What are the risk factors for Tb? |
•HIV infection •Incarceration or institutionalization •Positive recent history of latent TBinfection •Immigration or travel to endemic countries •Exposure at home to HIV-infected or homeless persons, illicit drug users, persons recently incarcerated, migrant farm workers, or nursing home residents |
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What are some acute Noninfectious respiratory disorders? |
•Epistaxis– bloody nose •Foreign body aspiration •Respiratory distress syndrome •Acute respiratory distress syndrome •Pneumothorax – collapsed lung – can happen in growing boy |
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Describe epistaxis including nursing assessment and management. |
•Majority of cases benign •Nursing Assessment –History of irritating factors –Inspection of nasal cavity •Nursing Management –Positioning of child –Pressure application –Ice or cold application |
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What is respiratory distress syndrome? |
•Most commonly seen in premature infants •Pathophysiology: lack of surfactant; right-to-left shunting and hypoxemia; leakage of fluid and fibrin leads to hyaline membrane, which leads to decreased gas exchange •Someone who's been in a fire or near drowning |
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What is the nursing assessment and management of respiratory distress syndrome? |
•Nursing Assessment: signs of respiratory distress; fine rales and diminished breath sounds •Nursing Management –Respiratory function –Temperature regulation; infection prevention; fluid and electrolyte balance; adequate nutrition |
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What are the signs and symptoms of a pneumothorax? |
–Chest pain might be present as well as signs of respiratory distress such as tachypnea, retractions, nasal flaring, or grunting. |
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What are the risk factors for a pneumothorax? |
–Chest trauma or surgery, intubation and mechanical ventilation, or a history of chronic lung disease such as cystic fibrosis |
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What is a pneumothorax? |
the presence of air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung. |
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What are some chronic respiratory disorders? |
•Allergic rhinitis •Asthma •Chronic lung disease (bronchopulmonary dysplasia) •Cystic fibrosis –no cure •Apnea - SIDS |
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Describe allergic rhinitis. |
•Seasonal usually related to outdoor allergens such as tree, grass, and weed pollens, cats, dogs, dander, horses, etc. •Perennial usually related to dust mites and mold •Predisposes to otitis media, sinusitis, and asthma, eczema •Fluid intake, no pets, rip up carpets, etc. |
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What is the nursing assessment of allergic rhinitis? |
–Health History: signs and symptoms; risk factors –Physical Examination •Inspection and Observation (allergic shiners, allergic salute) •Auscultation –Laboratory and Diagnostic Tests: allergy skinand RAST tests |
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What is the treatment for allergic rhinitis? |
• Environmental controls and avoidance of allergens (dust, animal dander, etc) • Antihistamines, decongestants, and nasal lavages • Steroids and immunotherapy (most effective with seasonal allergies) |
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Describe asthma. |
• Characterized by chronic inflammation, bronchoconstriction, increased mucus production • Wheezing, coughing, and dyspnea • Airways are damaged over time • Classified by severity of symptoms – mild, moderate, severe • Reactive Airway Disease common dx in infant, toddlers and may or may not lead to asthma in older child • Season change can make it worse |
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How is asthma diagnosed?
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• Diagnostic – CXRreveals hyperinflation of airways –PFT reveal reduced peak expiratory flow rate –Wheezing and dry cough indicate an asthmaepisode –Restlessness, fatigue, tachypnea,prolonged expiration Chronicuse of accessory muscles (retractions) leads to barrel chest in children with frequent exacerbations – can get clubbing from chronic hypoxia |
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What is the nursing management of asthma? |
•Assess for cyanosis or marked respiratory distress •Assess VS – HR, BP,RR, SpO2, temp •Encourage po fluids if appropriate •Maintain IV access •Avoid cold liquids •Monitor airway response to treatment – constantly assess and reassess •Position in High Fowlers and cluster nursing care to conserve child’s energy |
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What are the typical pharmacological treatments for asthma? |
•Usually combination therapy –goal is prevention of acute exacerbation •Short-acting inhaled beta-2agonists ie “rescue inhalers” – Albuterol/Xopenex •Inhaled corticosteroids – Flovent, Pulmicort •Oral corticosteroids – Prednisolone/Prednisone •Leukotriene Inhibitors – Singulair •Antihistamines – Zyrtec, Claritin •May need supplemental Oxygen delivery if hospitalized |
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What kind of education is required for patients, and families of patients, with asthma? |
• Family education related to self-management –Peak flow meter, triggers –Asthma Action Plan • Education about appropriate Medication administration –Metered dose inhaler (MDI) with spacer –Nebulizer (for more severe symptoms) –Oral medications Nasal Sprays |
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What is chronic lung disease? |
•Formerly bronchopulmonary dysplasia (BPD) •Continued oxygen need at 28 days of age; mostcommon in premature infants •Therapeutic Management: anti-inflammatory inhaled medications; short-acting bronchodilators; supplemental long-term oxygen therapy •Nursing Assessment: tachypnea and increased work of breathing •Nursing Management: education; nutritional support; fluid restriction, diuretics, follow-up, developmental support, parent support |
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Describe Cystic Fibrosis |
•Autosomal recessive trait •Multisystem disorder of exocrine glands leading to increased production of thick mucus in bronchioles, small intestines and pancreatic and bile ducts •Lung problems most serious threat to life; thick, sticky secretions pool in bronchioles, causing atelectasis and serve as medium for bacterial growth •Pancreatic ductsbecome clogged and prevent pancreatic enzymes from reaching duodenum, impairingdigestion and absorption •Small intestines, inthe absence of pancreatic enzymes are unable to absorb fats and proteins; thusgrowth and puberty are delayed (may see‘failure to thrive’) |
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What lab and diagnostic tests are performed to confirm Cystic Fibrosis? |
•Sweat chloride test: considered suspicious if the level of chloride in collected sweat is above 50 mEq/Land diagnostic if the level is above 60 mEq/L •Pulse oximetry: oxygen saturation might be decreased,particularly during a pulmonary exacerbation. •Chest radiograph: might reveal hyperinflation, bronchial wall thickening, atelectasis, or infiltration •Pulmonary function tests: might reveal a decrease in forced vital capacity and forced expiratory volume, with increases in residual volume |
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What are the treatments and nursing management of Cystic Fibrosis? |
•Maximizing lung functioning –Promote removal of secretion from lungs –Prevent and treat lung infections –Manage pulmonary complication •Medications –Inhaled recombinant human deoxyribonuclease (DNase) –Antibiotics –Pancreatic enzymes and vitamins A, D, E, K –Mucolytics to thin secretions –For transplant, need young pediatric lungs |
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Describe apnea. |
•Apnea is absence of breathing for longer than 20 seconds, may be accompanied by desaturation and/or bradycardia •May be central oroccur with illnesses such as sepsis or respiratory infection •May be associated with hypothermia, hypoglycemia, infections, hyperbilirubinemia •Apnea of prematurity secondary to an immature respiratory system •Therapeutic management varies depending on the cause – may be given caffeine |
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Describe SIDS. |
Sudden Infant Death Syndrome •Sudden death of a previously healthy infant younger than 1 year age •More common in males, most frequently occurs between ages 2-4 months •Increased incidence in winter |
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What are the risk factors for SIDS? |
* prematurity * infections * brain stem defects * use of soft bedding * sleeping in prone position * exposure to second hand smoke * maternal prenatal smoking |
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What is SIDS planning and implementation? |
•Educating parents about risk factors •Education regarding preventative measures – Back to sleep campaign, pacifier use during naps and at bedtime, avoid co sleeping with caregiver •Place infant in cribon a firm mattress, supine position, avoid soft bedding and blankets •Nursing management of family experiencing loss of child from SIDS includes providing emotional support, allowing family to spend time with child |
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What are the interventions to Minimize Psychosocial Impact of Chronic Respiratory Conditions? |
•Promoting child’s self-esteem through education and support •Allowing school-age child to take control of management of the disease •Assess family’s coping skills and ability and willingness to care for the child and adhere to therapy •Promoting family coping through education and encouragement •Arrange for additional support when necessary •Providing culturally sensitive education and interventions |
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What are some methods for preventing infectious diseases? |
•Hand washing •Adequate immunization •Proper handling and preparation of food •Judicious antibiotic use (educate on virusesand waiting – antibiotics don’t work on viruses) •Cohorting when hospitalized (rooming people with same disease) or isolation room •Transmission based precautions (PPE,respirator masks) Maintaining skin integrity |
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Why are infants and young children more susceptible to infection? |
* Newborn displays a decreased inflammatory response to invading organisms * Cellular immunity is generally functional at birth, and humoral immunity occurs when the body encounters and then develops immunity to new diseases.(babies putting things in their mouths) * the infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies * disease protection from immunization is incomplete |
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What is the first line of defense upon invasion of bacteria, fungus, cell debris and other foreign substances? |
Neutrophils |
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What responds to allergic disorders and parasitic infections? |
Eosinophils
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What responds to allergic disorders and hypersensitivity reactions and is used to study chronic inflammation? |
Basophils |
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What is the main source of producing an immune response, responds to viral infections and tumors? |
Lymphocytes (B lymphocytes, T lymphocytes and natural killer cells) |
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What is the second line of defense when it comes to immunity? |
Monocytes. They respond to larger and more severe infections than neutrophils by phagocytosis, leukemias and lymphomas, chronic inflammation |
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When taking a health history, what information is necessary to obtain? |
•Any known exposure to infectious or communicable disease •Recent travel out of the state/country,relatives/friends visiting – have you been exposed to anything?? Any relatives visiting? Exchange student? Adoptive child? Etc. •History of immunization and childhood communicable diseases – are your immunizations up to date? •Fever, sore throat, rash, swollen glands •Lethargy, malaise •Poor feeding or decreased appetite •Vomiting, diarrhea, cough, rash – how long had the cough? Is it productive? Any blood? Which symptoms came first? |
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What assessments are made during a physical examination? |
•Inspection and observation (wear gloves if there is a rash!) –Skin, mouth, throat, and hair for lesions orwounds –Hydration status and vital signs •Palpation –Palpate skin: temperature, texture, turgor, moisture. –Palpate rash if present - will not blanch if it's a bad, like measles –Palpate lymph nodes. |
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What are some common lab tests for infectious diseases? |
•Complete blood count (CBC) •Erythrocyte sedimentation rate (ESR)– looking for inflammation •C-reactive protein (CRP) – also for inflammation •Blood culture and sensitivity •Stool culture •Urine culture •Wound culture •Throat culture |
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The nurse is assisting with lab testing to measure the type of protein produced in the liver that is present during episodes of acute inflammation. Which of the following tests is the nurse performing? a.complete blood count b.erythrocyte sedimentation rate c. C-reactive protein d.blood culture and sensitivity |
c.C-reactive protein. C-reactive protein measures the type of protein produced in the liver that is present during episodes of acute inflammation. Rationale: Complete blood count evaluates white blood cell count. Erythrocyte sedimentation rate determines the presence of inflammation or infection. Blood culture and sensitivity detects the presence of bacteria or yeast and what antibiotics they are sensitive to. |
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What are some Common Treatments and Medications for Infectious Disorders? |
•Treatments –Hydration –Fever reduction •Medications –Antibiotics –Antivirals –Antipyretics –Antipruritics (antihistamines) –make sure that the caregiver knows the dosing! (and make a trial run of an antihistamine – may make them hyper!) |
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What are some infectious diseases that require air-borne precautions? |
* Measles * varicella * Tb |
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What are some infectious diseases that require droplet precautions? |
* Diphtheria * Pertussis (whooping cough) * Influenza * Mumps * Rubella * Scarlet Fever |
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What are some infectious diseases that require contact precautions? |
* diphtheria * pediculosis (lice infestation) * scabies (mite infestation) * multidrug-resistant bacteria. |
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What does contact precautions require over and above standard precautions? |
* Private room * Gloves at all times * Gowns at all times |
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What does droplet precautions require over and above standard precautions? |
* Private room * Gloves at all times * Gowns at all times * Mask at all times |
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What does air-borne precautions require over and above standard precautions? |
* Private room with negative air pressure ventilation ventilated outside (or mask the child in a private room with door closed) * Mask or respirator worn by personnel, depending on disease * Susceptible health care personnel should not enter room of child with measles or chicken pox. Those with proven immunity need not wear a mask. |
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How is a fever triggered? |
•Infection stimulates the release of endogenous pyrogens. •Pyrogens act on the hypothalamus and trigger prostaglandin production, which increases the body’s set temperature. •This triggers the cold response (shivering, vasoconstriction, decrease in peripheral perfusion)–This decreases heat loss and resets body temperature. •Fever occurs as a result. •With infants with fever – boost feeding to maintain hydration •When fever isn’t budging with meds – red flag |
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The nurse accurately explains to parents of a child with a fever that antipyretics will help change the course of the infection. True or False? |
False. Antipyretics will not help change the course of the infection. Rationale:Antipyretics provide symptomatic relief but do not change the course of the infection. The major benefits of decreasing fever are increasing comfort in the child and decreasing fluid requirements, which helps to prevent dehydration. |
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How is a fever managed in a child with an infectious disease? |
•Assess temperature at least every 4 to 6hours, 30 to 60 minutes after antipyretic is given and with any change in condition. •Use same site and device for temperature measurement. •Administer antipyretics per physician order when the child is experiencing discomfort or cannot keep up with the metabolic demands of the fever. •Notify physician of temperature per institution or specific order guidelines. •Assess fluid intake and encourage oral intake or administer intravenous fluids per physician order. •Keep linens and clothing clean and dry. |
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What are some Nursing Interventions to Promote Comfort for a Child With an Infectious Disease? |
•Assess pain and response to interventions frequently. •Administer analgesics and antipruritics as ordered. •Apply cool compresses or baths to areas of pruritus. •Provide fluids frequently. •Provide cool mist humidification. •Dress the child in light clothing. •Use diversional activities and distraction. |
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What are some Key Teaching Points for a Child With an Infectious Disease? |
•Assess child’s and family’s willingness to learn. •Provide family with time to adjust to diagnosis. •Repeat information. •Teach in short sessions. - about PPE and why it’s needed •Gear teaching to level of understanding of the child. •Provide reinforcement and rewards. •Use multiple modes of learning involving many senses (pictures) |
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What are the outside sources that put toddlers and preschoolers at risk for infection? |
–Toilet training –Daycare: hotbed of pathogens! –Objects in mouth –Small animals: bites, scratches. - cat scratch fever, turtles carry salmonella sometimes |
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What outside sources (not anatomical) puts school-age children at risk for infection? |
* Lack of hygiene * sharing clothing, bedding, combs and food with friends |
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What outside sources (not anatomical) puts adolescents at risk for infection? |
–Immunizations: some get behind; some immunity has wornoff. MMR, tetanus –Sexual contact: STIs; should be seen alone during portion of their visit. – pictures may be helpful to show them what can happen! –Drug/ETOH use risks increase: results in STI increase – education is pertinent!! |
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What are the different types of infectious diseases? |
•Bacterial infections (e.g., sepsis) meningitis •Viral infections (e.g., viral exanthems (rash)and rabies) •Zoonotic infections - animals, bats •Vector-borne infections – insects, ticks •Parasitic and helminthic infections (e.g., roundworm and pediculosis capitis [head lice]) scabies •Sexually transmitted infections – a lot are asymptomatic!! |
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What are the stages of infectious diseases? |
1. Incubation 2. Prodrome 3. Illness 4. convalescence |
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What is incubation? |
The initial stage of infection. It is the time of entrance of the pathogen into the body to the appearance of first symptoms. Pathogens grow and multiply |
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What is prodrome? |
The time from onset of non-specific symptoms such as fever, malaise, and fatigue to more specific symptoms. |
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Describe the illness stage. |
Time during which child demonstrates signs and symptoms specific to an infection type |
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What is convalescence? |
Time when acute symptoms of illness disappear |
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Name some bacterial infections that occur in children. |
•Sepsis •Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) •Scarlet fever- penicillin •Diphtheria •Pertussis - whooping cough – send the person to get the test with a mask on! This cough lasts at least a month! Boosters can be given to pregnant women @ 27 weeks – baby will get this in utero •Tetanus – can start as benign as a splinter |
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What is sepsis and who is more susceptible? |
Generalized infection spread throughout the body via the blood stream. * Neonates at high risk due to inability to localize infectious organisms – hypothermia /hyperthermia (100.4 or greater is afever) – vaccines can often cause a low grade fever * Immunocompromised children * Children with invasive devices– PICC line,IV, portacath |
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What are the lab and diagnostic tests ordered for sepsis? |
•Complete blood count: WBC levels will usually be elevated •C-reactive protein: elevated •Blood culture: positive in septicemia •Urine culture: may be positive •Cerebrospinal fluid analysis: may reveal increased WBCs and protein and low glucose •Stool culture: may be positive for bacteria or other infectious organisms •Culture of tubes, catheters, or shunts suspected to be infected •Chest radiograph: may reveal signs of pneumonia |
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Describe MRSA. |
•Staph aureus infection resistant to certain antibiotics •Transmission occurs through direct person to person contact, respiratory droplets, blood or sharing personal items •SA resistant to heat and drying and can be found on fomites months after contamination!! •Skin and soft tissue infections in children –Red, swollen, painful, warm to touch –Fever, fluctuance (fluid inside), purulent drainage may be present –Abscessed hair follicles and pimples common presentations in infants and toddlers –Keep wound covered! |
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What are the risk factors for MRSA? |
* Risk factors varied –Contact sports, –abrasions and cuts in skin –poor hygiene –crowded living conditions * Diagnosis determined through culture of drainage * Antimicrobial therapy can be administered in home setting * Teaching includes proper hand hygiene, keeping cuts covered,discourage sharing of personal items, proper completion of medication therapy and follow up care |
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Describe scarlet fever. |
•Infection due to group A streptococcus •Nursing assessment: fever >101 F; chills; body aches; loss of appetite;nausea, vomiting; red swollen pharynx; erythematous rash on face, trunk, extremities; strawberry tongue; + throat culture (may have pain from throat swelling) •Nursing Management: penicillin, education,fluid intake, cool mist humidifier; droplet precautions if hospitalized •Strep rash sometimes happens |
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Describe Diptheria. |
* Low grade fever, obstructive laryngotracheitis * Dx with nose and throatcultures * Bacterial * Partof childhood immunizations * Antibiotics, isolation * Most frequently in winter * Vocal cord paralysis, myocarditis, ascending Paralysis, neurological complications as well Communicable for 2 – 4 weeks (in isolation) IV, antitoxin, maintaining airway |
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Describe Pertussis. |
•Whooping cough (paroxysmal cough) coughing fits can happen at night •Nursing Assessment –Lack of immunization –Paroxysmal coughing spells •Nursing Management –High-humidity environment –Frequent suctioning –Fluids Droplet precautions |
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The nurse caring for a 4-year-old childdocuments headache, spasms, clamping of the jaw, difficulty swallowing, andstiff neck. Which of the following infections should the nurse suspect? a. tetanus b.pertussis c.diphtheria d.scarlet fever |
a. tetanus. Tetanus manifests as headache,spasms, crankiness, and cramping of the jaw (lockjaw), followed by difficulty swallowing and a stiff neck. Rationale:Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. Diphtheria causes infections in the nose, larynx, tonsils, or pharynx. Scarlet fever manifests as a fever greater than 101°F, chills, body aches, loss of appetite, nausea, and vomiting. Not transmitted person to person, will be in the ICU |
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What are some viral infections occurring in children? |
•Viral exanthems (rash) •Infectious mononucleosis “kissing disease”, (epstein barr) •Mumps MMR •Zoonoticinfections –Cat scratch fever –Rabies – there are vaccines |
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Describe Mono. |
* Fever, sore throat, headache, muscle aches, lymphadenopathy, HSM (hepatosplenomegaly) abdominal pain (must have symptoms for 10 days or test will be Negative) * Hepatitis and elevated liver enzymes can be complication of Monospot test * Epstein Barr virus (a herpes virus) * Resp secretions and “close personal contact” * Common in group settings of adolescents * Rest, symptom management, restrict activity Good hygiene, Hydration, nutrition |
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Describe rotavirus. |
* Diarrhea, vomiting, fever * Fecal/oral transmission from infected individual * No Rx avail; treatment symptomatic * Dehydration, fluid electrolyte imbalances * Common in day care and preschool settings Good hygiene! * Oral vaccination is available liquid form-have a vaccine for this |
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Describe Fifth Disease. |
* Multisystem symptoms, usually “slapped face” rash; fever * Diagnosed by clinical findings; rash is diagnostic! * Human Parvovirus * Outbreaks in schools, usually elementary or middle school, in spring * Self limiting, lasts 4-14 days * Children not contagious after appearance of rash; may attend school if feeling OK. * Goodhand washing * Some recommend pregnant teachers stay home from school if there is an outbreak; resp secretions mode of transmission |
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Describe Chicken Pox. |
* Varicella zoster: herpes virus – live vaccine (may get an Outbreak aftervaccination) – need a negative pressure Room and keep fingernails trimmed or infants with mittens * Fever,rash, shingles in older people * Very contagious: direct contact and airborne * Most often in children under 10; late winter, early spring * Vaccination now available * Pruritis: can cause secondary infection * Isolation: exclude from school until all lesions are crusted over * Treatment: symptomatic |
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Describe Cat Scratch Disease. |
•Bacteria found in cat saliva or cat fleas •Supportive management •Nursing Assessment: interaction with cats or kittens; headache, fatigue, lymphadenopathy •Nursing Management: antibiotics if ordered;standard precautions; education for prevention and control; care of bites or scratches from cats; flea control in cats •Cat bites may turn into cellulitis |
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Describe Sexually Transmitted Diseases. |
* Human Papilloma Virus– most common STI in the U.S. –May be asymptomatic depending on strain –Some strains cause genital warts, other strains alter the DNA of cells and cause cancer –Can occur in genital area and throat * Prevention through HPV vaccination – administered to males and females at 11-12 yrs * Routine PAP smear/HPV testing * Treatment includes medications and/or surgery * Role of RN??? Education of parents and children |
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Describe measles (rubeola). |
–Fever, cough, rhinorrhea, malaise, conjunctivitis, Koplik spots after 2-3 days (white spots in the mouth), reddish/brown rash appearing after 5 days – can stay in the air 2 hours after the person has left the building!! –Contagious 4 days before and 4 days after rash appears –Can lead to miscarriage or preterm labor in pregnant woman –Death occurs in 1/1000 children (1,000,000 children in developing countries each year |
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What is the treatment for measles (rubeola)? |
•Prevention is first line of defense – MMR vaccine at 15 months of age •Treatment may include immune globulin and age specific doses of Vitamin A •Institute airborne precautions •Supportive care based on symptoms •Monitor for signs of complications such as pneumonia or encephalitis (inflammation of the brain) |
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Describe mumps (rubulavirus). |
•Fever, achiness, malaise followed by parotitis (swollen salivary glands on sides of face) in some instances– swollen neck, the most preventable of childhood disease, but can cause fetal demise!! •Prevention through MMR vaccine •Treatment is supportive –May use ice/heat collar –Maintain bedrest –Provide child with non-irritating fluids/softfoods –Maintain IV hydration if unable to tolerate po –Maintain droplet precautions, monitorfor airway obstruction, signs of CNS involvement |
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Describe Rubella (German Measles). |
•Characteristic pinkish red maculopapular rash lasting for approx. 3 days •No prodrome in children but present in teens –Includes fever, h/a, malaise, sore throat,cough, lymphadenopathy, anorexia * Most benign of all preventable childhood illness however highly injurious to unborn fetus * Maintain Droplet precautions * Provide comfort measures * Educate regarding importance of MMR vaccination |
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Describe Rabies. |
•Preventable viral infection of the CNS •Transmitted through close contact with infected animal •Incidence has declined steadily in the U.S. but continues to be a major health problem in other parts of the world •Bats and raccoons common carriers •Treatment includes thorough cleansing of wounds with virucidal agent followed by immunoprophylaxis–IM injections day 0-1, 3,7,14 of human rabies vaccine, well tolerated, still common in other countries |
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What are vector-borne infections? |
Diseases transmitted by ticks, mosquitoes, orother insect vectors |
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Name some types of vector-borne infections. |
–Lyme disease – from infected deertick –Babesiosa (Lyme co-infection) –Erlichiosis (Lyme co-infection) –Rocky Mountain spotted fever –EEE - mosquitos –West Nile Virus - mosquitos |
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Describe Lyme. |
* Spirochete: bite from infected deer tick * Early stage: bullseye rash; fever, headache, muscle aches * Late stage: neurological symptoms, arthritis, joint swelling * Dx: Elisa, western blot, spinal fluid, symptoms; difficult to dx * Treatment: antibiotics, Amoxicillin 28 days children who can’t take Doxycycline * Common in Northeast, named for town in CT. * Avoid tick infested areas, remove ticks from body immediately |
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How do you remove a tick? |
•Use fine-tipped tweezers. •Protect fingers with a tissue, paper towel,or latex gloves. •Grasp tick as close to the skin as possible and pull upward with steady, even pressure. •Do not twist or jerk the tick. •Once the tick is removed, clean site with soap and water and wash your hands. •Save the tick for identification in case the child becomes sick. |
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How does skin differ in children and adults? |
•Infant’s epidermis is thinner and blood vessels are closer to the surface. – Little sc fat that allows rapid heat lossand causes problems with thermoregulation –Allows substances to be absorbed through skinquicker •Infant’s skin contains more water than olderchildren/adults –Epidermis is loosely bound to the dermis. –Friction may easily cause separation oflayers, resulting in blistering or skin breakdown. •Infant’s skin is less pigmented, therefore at risk for UV damage. – no sunblock before 6 months |
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What are the functions of skin? |
•Sensitivity to pressure, pain, touch and temperature •First line of defense against infectious organisms •Thermoregulation through sweating, shivering and subcutaneous insulation •Protects underlying tissues and organs from injury •Synthesizes Vitamin D •Excretes water, salt and electrolytes – children are susceptible if out in the sun •Regenerates itself through shedding of old cells and replacement with new cells |
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What are the causes of Integumentary Disorders in Children? |
•Exposure to infectious microorganisms - rashes •Hypersensitivity reactions – contact dermatitis •Hormonal influences- acne •Injuries – burns, lacerations, scars, keloids •Genetic components– lupus, atopic dermatitis |
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Explain why a CBC would be run for a pediatric patient with a skin disorder. |
* To evaluate Hgb and Hct and WBC count, in particularly individual WBCs and platelet count. * Looking for infection or inflammatory process. * WBC differential is helpful in evaluating the source of infection. * Eosinophils may be elevated in a child with atopic dermatitis. |
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Why would an ESR be run for a child with a skin disorder? |
* It is a non specific test used to detect the presence of infection or inflammation * The sample needs to be sent to the lab immediately because if it's allowed to sit, it can read as a falsely low result. |
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Why would a potassium hydroxide prep be run for a child with a skin disorder? |
* Reveals branching hyphae (fungus) when viewed through a microscope * Helps to identify a fungal infection |
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Why would a culture of a wound or skin drainage be collected for a child with a skin disorder? |
Allows for microbial growth and organism identification |
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Why would immunoglobulin E be collected from a child with a skin disorder? |
* Measures serum IgE * Indicates atopic dermatitis * Often elevated in atopic or allergic dermatitis |
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What is patch or skin testing? |
* Tests for allergens * Atopic or contact dermatitis * Emergency equipment is kept close by in the event of anaphylaxis. |
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What are the bacterial infections of the skin? |
•Folliculitis – occlusion of hair follicle •Cellulitis – localized infection and inflammation of skin and subcutaneous tissue •Staphylococcal scalded skin syndrome – SA causes toxin release results in exfoliation, diffuse erythema •Impetigo – honey crusted lesions, contagious, sometimes notably clear vesicular •Usually caused by SA and group A betahemolytic strep |
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Describe impetigo |
•Highly contagious! Superficial skin infection •Either staph or strep •Clinical manifestations –Small red macules –Vesicles or pustules, don’t break them! –Honey-colored crusts–Regional lymphadenopathy –Lesions rapidly spread to adjacent skin according to linear pattern of child’s scratching –Itchy!! – keep fingernails short |
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What is the treatment for Impetigo? |
•Treatment –Soaking in warm water to remove crusts –Frequent handwashing with antibacterial soap –Keep fingernails short and clean –Antibiotic therapy •Topical, oral as indicated •May return to school/daycare 48hrs after abx (antibiotic) therapy initiated •Continue with full course of prescription •Clean bedding and clothing daily |
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Describe Cellulitis |
•Acute inflammation of the skin involving dermis, epidermis and underlying connective tissue •Usually group A beta hemolytic streptococcus or SA •Pathophysiology: skin infections, soft tissue swelling, may be from nearby abscess or sinusitis •Clinical manifestations –Erythema –Fever (elevated WBC) –Swelling –Pain –Warmth –outline area and reevaluate later |
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What is the diagnosis, treatment and nursing management of cellulitis? |
•Diagnosis: WBC cultures •Treatment: systemic antibiotics •Nursing management –Monitor VS, site of infection –Institute Contact Precautions if indicated –Promote comfort – warm compress, antipyretics, analgesics –Prevent complication – keep nails short, apply DSD (dry sterile dressing) –May x-ray to be sure it’s not close to the bone –On contact precautions if it’s tested + for MRSA |
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What are the clinical manifestations of a candidiasis infection in children? |
* Thrush in the mouth * Yeast infection in the diaper area |
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What are the fungal infections of the skin? |
•Tinea pedis:fungal infection on the feet (athlete’s foot) •Tinea corporis:fungal infection on the arms or legs •Tinea versicolor:fungal infection on the trunk and extremities •Tinea capitis:fungal infection on the scalp, eyebrows, or eyelashes •Tinea cruris:fungal infection on the groin (jock itch) |
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Name the types of inflammatory skin conditions. |
•Acute hypersensitivity reactions –Diaper dermatitis, contact dermatitis, erythema multiforme, and urticaria (Hives) •Chronic hypersensitivity disorder–Atopic dermatitis (eczema) •Chronic inflammatory skin disorders not from hypersensitivity–Seborrhea and psoriasis |
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Describe contact dermatitis. |
•Causes –Response to an antigenic substance exposure –Allergy to nickel or cobalt in clothing,hardware, or dyes –Exposure to highly allergenic plants: poisonivy, oak, and sumac •Complications –Secondary bacterial skin infection –Lichenification or hyperpigmentation |
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What is the nursing assessment for urticaria (hives)? |
•Detailed history of new foods, medications, symptoms of recent infection, changes in environment, or unusual stress •Inspect the skin for raised edematous hives on body or mucous membranes. •Assess airway and breathing as hypersensitivity may affect respiratory status. |
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What causes urticaria? |
•Foods •Drugs •Animal stings (bee stings) •Infections •Environmental stimuli •Stress Anxiety, fear |
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What is the management for urticaria? |
•Assess airway! Administer epinephrine if emergency •If No airway involvement- identify and remove trigger •Discontinue Abxtherapy •Administer antihistamines, corticosteroids, topical antipruritics as indicated •Child will need medicalert bracelet if reaction severe |
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What is eczema? |
•Chronic superficial inflammatory skin disorder characterized by severe pruritis •In infancy red papules may appear first on cheeks and then spread to rest of face/scalp •Childhood characterized by dry, scaly, popular patches on wrists, hands, ankles, antecubital and popliteal spaces •Adolescent eczema characterized by lichenification (large dry thickened lesions/plaques) on flexor folds, face, neck, back, upper arms, dorsal aspects of hands, feet, fingers, toes |
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What is the management for eczema? |
•Oatmeal baths - no hotwater •Promote skin hydration– do not use products with alcohol in them •Keep skin moisturized- emollients •Maintain skin integrity – keep fingernails short and clean •Prevent infection •May need topical corticosteroids or abx if secondary infections occur, antihistamines |
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What is seborrhea? |
•Chronic inflammatory dermatitis occurring on skin or scalp (use a fine tooth comb and some mineral oil to get it off) •Common in infants –cradle cap •Educate family on treatment and benign nature •For infants – massage mineral oil to scalp, shampoo and brush, may use selenium sulfide shampoo •For adolescents – antidandruff shampoo may be indicated |
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Describe psoriasis. |
•Chronic inflammatory skin disease with periods of remission and exacerbation •Familial in nature •Psoriatic plaques with silvery or yellow white scale and sharply demarcated borders present •Educate family on treatment with skin moisturizers, emollients, anti inflammatory creams as prescribed |
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What is pediculosis capitis? |
•Commonly referred to as head lice •Frequently occurs in outbreaks at daycares and school settings–Transmitted by direct contact with hair of infested people–They do NOT JUMP from person to person •Extreme pruritisis most common sign, adult nits may be seen, reinfestation is common •Contact precautions should be instituted but school age children no longer quarantined at home •Treatment includes washing hair with pediculocide |
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What is the treatment for pediculosis capitis? |
•Treatment includes cleansing scalp with pediculicidal agents •Suffocation of nits imperative, they can survive 8-10 days away from human host •Delouse environment with daily washing of clothing and linens •Inform caregivers that all members of household/contacts should be checked •Treatment plan must befollowed •Re-infestation common– provide support can be frustrating |
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Describe scabies. |
•Contagious skin condition caused by the mite sarcoptes scabiei (like webbed areas of the body) •Affects children of all ages, socioeconomic levels •Rash presents as papules, vesicles or nodules •Characterized by severe pruritis, especially at night •Burrows often found in webs of fingers, body creases, axilla, waistline and near genitalia •Dx by skin scraping and inspection under microscope |
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What is the treatment for scabies? |
•Treatment is use of scabicidal lotion, applied for 8-12 hours before washing off •Lotion may be applied to scalp and forehead of clients older than 2 months •Treat all family members and close contacts •Clothing, bedding,towels changed daily washed in hot water or sealed in plastic bags for four days before use •Child may return to school following treatment •Eurax, Elimite, Kwell should not be used on infants/young children due to risk of neurotoxicity and seizures |
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Describe burns. |
•Injury to the skin and subcutaneous tissue caused by thermal, chemical, electrical or radioactive causes •Can range from mild redness and slight tenderness to massive tissue destruction covering a large surface area •Second leading cause of injury or death in clients under age 14 |
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What are the classifications of burns? |
•Superficial: involve only epidermal injury;heal without scarring in 4 to 5 days •Partial thickness: involve epidermis and portions of dermis; heal with minimal scarring in about 2 weeks •Deep partial thickness: take longer to heal;may scar; result in changes in nail, hair, and sebaceous gland function •Full thickness: result in significant tissue damage and extend through epidermis, dermis, and hypodermis; extensive scarring results; significant time to heal needed – no pain |
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What are the laboratory and diagnostic tests for burns? |
•Electrolytes and complete blood count •Culture of wound drainage •Nutritional indices •Pulmonary status •Scanning for inhalation injury •Electrocardiographic monitoring for electrical injury |
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What is the criteria for transfer to a burn unit? |
•Partial thickness burns greater than 10% oftotal body surface area •Burns that involve the face •Burns that involve the hands and feet, genitalia, perineum, or major joints •Electrical burns, including lightning injury •Chemical burns •Inhalation injury •Burn injury in children who have preexisting conditions that might affect their care •Persons with burns and traumatic injuries •Persons who will require special social,emotional, or long-term rehabilitative care •Burned children in a hospital without qualified personnel or equipment for the care of children |
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What are the Nursing Interventionsfor Children with Extensive Burns? |
•Promoting oxygenation and ventilation •Restoring and maintaining fluid volume •Preventing hypothermia •Cleansing the burn •Preventing infection •Managing pain with atraumaticcare •Treating infected burns Providing burn rehabilitation |
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What are the classifications for acne? |
* Mild (primarily non-inflammatory lesions - or comedones) * Moderate (comedones plus inflammatory papules or pustules localized to face or back) * severe (Lesions similar to moderate acne but more widespread and/ or presence of cysts or nodules. Associated with more frequent scarring) |
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What are some teaching points for avoiding animal bites? |
•Never provoke a dog with teasing or rough housing. •Get adult permission before interacting with a dog, cat, or other animal that is not your pet. •Do not bother an eating, sleeping, or nursing dog. •Avoid high-pitched talking or screaming around dogs. •Display a closed fist first for the dog tosniff. •Keep ferrets away from the face. •If a cat hisses or lashes out with the paw, leave it alone. |
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What injuries regarding the neurologic system are infants and young children more susceptible to? |
•First 3 to 4 weeks’ gestation–Infection, trauma, teratogens, and malnutrition can cause physical defects and may affect normal CNS development. •Birth–Cranial bones well developed, but not fused:increased risk for fracture–Brain is highly vascular: increased risk for hemorrhage–Infants and young children have proportionately large, heavy head compared to adults, lack neck strength •Child–Spinal cord is mobile: high risk for cervical spine injury and compression fractures |
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What are the Factors AffectingNeurologic Disease in Children? |
•Prematurity •Difficult birth •Infection during pregnancy •Nausea, vomiting, headaches •Changes in gait •Falls •Visual disturbances •Recent trauma |
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Describe Inspection andObservation of a Child With a Neurologic Disorder. |
•Level of consciousness (LOC) – measure of responsiveness of brain to stimuli •Vital signs •Head, face, and neck •Cranial nerve function •Motor function •Reflexes – corneal, pupillary, muscle, plantar absent in deep coma •Sensory function •Increased intracranial pressure (ICP) |
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Describe Intracranial pressure |
•Most common finding seen in illnesses of the CNS •CNS closed, nonelastic system, if a growth or inflammation develops, pressure rises •Pathophysiology is directly related to etiology •Signs and symptoms dependent upon age of child •Infants – poor feeding, vomiting, irritability, lethargy, increased head circumference, separated sutures, bulging fontanels, “sunsetting” eyes, shrill cry, seizure activity •Older children –headache, visual disturbance, nystagmus, abnormal posturing (decerebrate, decordicate)AMS (altered mental status), N/V, papilledema, seizures, inc BP/Temp |
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What does decorticate posturing indicate? |
Damage to the cerebral cortex. |
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What does decerebrate posturing indicate? |
Damage at the level ofthe brain stem. |
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What is the Brudzinski's sign? |
Brudzinski’s sign; present when client’s head is flexed while in supine position resulting in involuntary flexion of knees or hips –Common sign in meningitis |
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What is the Kernig's sign? |
Present when client’s leg is raised with flexed knee and any resistance or pain is felt –Common finding indicating meningealirritation |
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What are the 5 states of consciousness? |
•Full consciousness: the child is awake andalert; is oriented to time, place, and person; and exhibits age-appropriatebehaviors. •Confusion: disorientation exists; the child may be alert but responds inappropriately to questions. •Obtunded: the child has limited responses to the environment and falls asleep unless stimulation is provided. •Stupor: the child only responds to vigorous stimulation. •Coma: the child cannot be aroused, even with painful stimuli. |
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What are some Common Laboratory andDiagnostic Tests run for neurological disorders? |
•Lumbar puncture (LP) •Head and neck radiograph •Fluoroscopy •Cerebral angiography •Ultrasound •Computed tomography (CT) •Electroencephalogram (EEG) •Magnetic resonance imaging (MRI) •Positron emission tomography (PET) •Intracranial pressure (ICP) |
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What Medications are Used toTreat Neurologic Disorders? |
•Antibiotics •Anticonvulsants •Benzodiazepines •Analgesics •Osmotic diuretics •Corticosteroids |
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What are some Medical Treatmentsfor Neurologic Disorders? |
•Shunt placement •Ventilation •PT/OT/ST •External ventricular drainage (EVD) •Ventricular tap •Vagalnerve stimulator •Ketogenicdiet |
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Describe Seizures. |
•Most common alteration in NS seen in children •Alterations in firing of neurons in brain resulting in “seizure activity” •Partial seizures –begin locally in one hemisphere of brain •Generalized seizures –originate in both hemispheres, no aura but LOC •Epilepsy is a chronic disorder characterized by recurrent seizures |
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What are some common reasons for a child to have a seizure? |
* febrile seizures * headinjury * lead toxicity * drugs * genetic disorders * neoplasms |
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How many childhood seizures are due to epilepsy? |
Less than 1/3 |
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What's the difference between partial and generalized seizures? |
Partial involve one area of the brain and generalized involve the entire brain. |
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What are the risk factors for epilepsy? |
•Family history of seizures or epilepsy •Any complications during the prenatal, perinatal,or postnatal periods •Changes in developmental status or delays in developmental milestones •Any recent illness, fever, trauma, or toxinexposure |
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What is the nursing management for epilepsy? |
–Seizure precautions –Anxiety reduction –Treatment management –Family support and education |
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What is the nursing assessment of febrile seizures? |
* a core temperature increasing rapidly to 39 degrees C (102.2F) * generalized tonic-clonic seizure (grand mal) * postictal drowsiness (post-seizure) |
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Describe neonatal seizures. |
•Seizures occurringduring first 4 weeks of life •Associated with underlying conditions - hypoglycemia, hypocalcemia, neonatal infection/sepsis, Intracranial hemorrhage •Prognosis dependent upon underlying cause and severity of insult |
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Name some neural tube defects. |
–Anencephaly (no brain) –Encephalocele –Spina bifida occulta,meningocele, myelomeningocele –Microcephaly |
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What is microcephaly? |
•Head circumference >3 standard deviations below mean for age and sex •Congenital or acquired •Nursing Assessment: small head, normal face, loose wrinkled scalp; delay in motor function and speech; mental retardation Nursing Management: supportive |
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What is hydrocephalus? |
•Imbalance between CSF production and absorption •Results in enlarged ventricles and increased ICP •Acquired or Congenital but Etiology unknown in up to 50% of cases •Surgical interventionwith shunt placement required in most instances •Post operative prophylaxis with antibiotics •Education and management focuses on prevention of infection and recognizing malfunction |
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What is assessed in a child with hydrocephalus? |
•Infants – increased head circumference, high pitched cry, bulging fontanelle, irritability, seizures •Toddlers – “sunsetting” eyes, seizure activity, irritability, papilledema, decreased LOC, increasing blood pressure •Older children may report headaches, exhibit ataxia or balance/coordination deficit •ALL children can present with vomiting, lethargy and irregular breathing pattern (Cheyne-Stokes) |
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What is the nursing management of a child with hydrocephalus? |
–Maintaining cerebral perfusion –Minimizing neurologic complications –Maintaining adequate nutrition –Promoting growth and development –Preventing and recognizing shunt infection and malfunction –Supporting and educating child and family |
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What are the signs and symptoms of a shunt infection? |
•Elevated vital signs •Poor feeding •Vomiting •Decreased responsiveness •Seizure activity •Signs of local inflammation along the shunttract |
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Describe craniosynostosis. |
•Premature closure of cranial sutures •Nursing Assessment: usually present at birth;palpable bony ridge •Nursing Management –Surgical correction required –Observing for changes in hemoglobin and hematocrit and for pain, hemorrhage, fever, infection, and swelling –Encouraging parent-child interaction –Providing support and education regarding procedures |
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What is Positional Plagiocephaly? |
•Asymmetry of head without fused sutures •Conservative treatment •Nursing Assessment: flattening on one side posteriorly to posterior flattening with anterior bulging •Nursing Management: repositioning |
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What are the Types of Infectious Disorders of the Neurologic System ? |
•Bacterial meningitis •Aseptic meningitis •Encephalitis •Reye syndrome |
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Describe Bacterial Meningitis. |
Infants may have subtle symptoms-irritability, fever>100.4, poor feeding, lethargy –Child over two may have GI upset and cold like prodromal signs –Hyper-reactive reflexes –Kernig’s sign: resisting leg extension –Brudzinski sign: head up->legs/hips flex–Nuchal rigidity –Photophobia –Elevated temperature |
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What is the nursing management of bacterial meningitis? |
–Ensuring proper ventilation –Reducing inflammatory response –Preventing injury to brain –Reducing fever –Infection control (Droplet,Contact) –Education related to testing, procedures –droplet precautions |
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Describe aseptic meningitis. |
•Most common type; usually viral cause •Antibiotics until bacterial ruled out; then antivirals •Nursing Assessment: headache, malaise, photophobia, poor feeding, nausea, vomiting, irritability, neck pain, +Kernig’s and Brudzinski’s signs •Nursing Management: similar to that for bacterial meningitis; comfort measures; home management if neurologic status stable and child tolerating oral intake |
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Describe encephalitis. |
•Protozoan, bacterial, fungal, or viral causes •Treatment: hospitalization with supportive care •Nursing Assessment: fever, flu-like symptoms, altered LOC, headache, lethargy, drowsiness, generalized weakness, seizure activity; neurologic exam indicating changes in sensorium; LP, MRI, CT and EEG •Nursing Management: similar to that for child with meningitis; education for prevention |
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What is Reye Syndrome? |
•Serious condition causing brain and liver to swell. •Incidence and etiology: linked to ASA use in children, also follows viral illness: chicken pox, flu, croup, URI •Pathophysiology: liver failure, cerebral edema, death if treatment not initiated •Clinical manifestations –Initially mild symptoms of viral infection –Signs of recovery may be present –24–48 hours later child worsens –Neurological symptoms develop – AMS (altered mental status), lethargy, irritability, confusion, hyperreflexia |
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What is the nursing management of Reye's Syndrome? |
–Early recognition and treatment –Maintaining cerebral perfusion, managing and preventing increased ICP –Providing safety measures –Monitoring fluid status –Educating child and family |
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What are the most common types of head injuries? |
* Skull fracture * contusion * concussion * subdural/epidural hematoma * Most common type of childhood injury causing death and disability |
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Describe concussion. |
•“mild traumatic brain injury” involves some transient loss of consciousness (LOC) •Injury related to stretching, compression or shearing of nerve fibers •Assess for LOC, amnesia of event, subtle change in personality, headache, nausea and/or vomiting, dizziness, photophobia, poor concentration and/or problems with memory •Teach caregiver signs/sx,wake child every 2 hours for neuro assessment if event happens at naptime/bedtime •Children with LOC >5minutes or amnesia of event admitted to inpatient unit for observation * Educate caregivers that child may require extensive recuperative time before safely resuming activity |
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Describe non-accidental head trauma
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* It is the leading cause of traumatic death and morbidity in infancy * Causes: shaken baby syndrome, blows to the head, intentional cranial impacts against objects |
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What are the Signs and Symptoms ofAcute Stroke in Children? |
•Weakness on one side or hemiplegia •Facial droop •Slurred speech •Speech deficits |
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The nurse observes a child for neurologicdisorders. What is the earliest indicator of improvement or deterioration ofneurologic status? a.vital signs b.level of consciousness c.motor function d.reflexes |
b.level of consciousness. Level of consciousness is the earliest indicator of improvement or deterioration of neurologic status. Rationale:While all the choices may indicate deterioration of neurologic status, the level of consciousness is the first indicator of improvement or deterioration in neurologic status. Consciousness consists of alertness, which is a wakeful state and includes the ability to respond to stimuli, and cognition, which includes the ability to process stimuli and demonstrate a verbal or motor response. |
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What are the Types ofNeuromuscular Disorders? |
•Neurologic insult–Trauma or hypoxia to the brain or spinal cord •Genetic dysfunction •Structural abnormality •Autoimmune in nature–Following a viral infection •Result of each is muscular dysfunction. |
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What are the CongenitalNeuromuscular Disorders? |
•Structural disorders –Spina bifida occulta –Meningocele –Myelomeningocele (neural tube defects) •Genetic neuromuscular disorders –Various types of muscular dystrophy –Spinal muscular atrophy |
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What is involved in Eliciting History ofPresent Neurologic Disorder? |
•Changes in gait •Recent trauma •Poor feeding •Lethargy •Fever •Weakness •Alteration in muscle tone •History of attainment of developmental milestones |
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How is the physical exam performed for a child with a neuromuscular disorder? |
•Inspection and Observation - Motor Function: playing? Muscle atrophy? -- - Reflexes: persistence of primitive reflexes - - Sensory Function: withdrawal from pain •Palpation: muscle tone •Auscultation: impairment of resp function |
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What laboratory and diagnostic tests are run for neuromuscular disorders? |
•CAT, MRI •Creatine kinase (CK); muscular dystrophies •EMG •Muscle biopsy •Dystrophin (abs. in DuchenneMD) •Genetic testing |
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What is the nursing assessment of neural tube defects? |
•Health History: lack of prenatal care, folic acid •Physical Examination: visible; flaccid paralysis, •Laboratory and Diagnostic Tests: MRI, CT, myelography |
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What are the Teaching Topics for Parents of Children With Myelomeningocele? |
•Positioning – side lying or prone •Defect/sac surgically repaired during first48 hours after birth •Preventing infection – moistened sterile,saline soaked dressings •Promote adequate nutrition •Promoting bowel and bladder elimination •Monitoring for latex allergy •Preventing signs and symptoms of complications such as increased ICP |
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Describe muscular dystrophy. |
•inherited condition; group of disorders–Weakness, wasting of voluntary muscles, males - no cure, universally fatal (teens to 20's) |
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What are the Nursing Management Goals for a Child With Duchenne Muscular Dystrophy? |
•Promote nutrition –Low calorie, high protein diet –High fiber, high fluid diet •Promote self – help skills –3 hours/day of ambulation to maintain muscle strength –Splinting and bracing to maintain lower extremity stability •Refer family members for genetic counseling •Preventing complications and maximizing quality of life •Preventing infection (deep breathing, chest PT) |
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What is metatarsus adductus? |
A common foot deformity noted at birth that causes the front half of the foot, or forefoot, to turn inward. |
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What is the therapeutic management for muscular dystrophy? |
Physical therapy to preserve walking. |
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What is the nursing assessment for muscular dystrophy? |
* Health History: genetic history * Physical Examination - Inspection and Observation: Gower’s sign - Auscultation and Palpation: resp. weakness,contractures |
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What is Gower's sign? |
A 5 step process for a child to get up from a sitting position on the floor. |
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The nurse is caring for a child with myotonic muscular dystrophy. The nurse accurately states that this form of muscular dystrophy is the most common neuromuscular disorder of childhood, and is universally fatal (usually by the teens or 20s). True or False? |
False. Duchenne muscular dystrophy is the most common neuromuscular disorder of childhood, and is universally fatal (usually by the teens or 20s). Rationale:The incidence of Duchenne muscular dystrophy is about 1 in 3,600 live male births (Sarant, 2007). The hips, thighs, pelvis, and shoulders are affected initially; as the disease progresses, all voluntary muscles as well as cardiac and respiratory muscles are affected. |
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The nurse caring for children with neuromuscular disorders knows that which of the following is the most common movement disorder of childhood? a.spina bifida b.cerebral palsy c.muscular dystrophy d.spinal muscular atrophy |
b.cerebral palsy. Cerebral palsy is the most common movement disorder of childhood. Rationale:Cerebral palsy is the most common movement disorder of childhood; it is a lifelong condition and one of the most common causes of physical disability in children. The incidence is about 2.5 in every 1,000 live births (Hirtzet al., 2007). |
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Describe cerebral palsy |
•Non-progressive motordisorder of CNS resulting in alterations in movement and posture •Classified as spastic,athetoid, ataxic, mixed •Causative factors may include, trauma, hemorrhage, anoxia, infection •1/3 of children withCP have some degree of intellectual disability •Pathophysiology: non progressive abnormal motor function. Specific cause unknown |
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What is the therapeutic management of cerebral palsy? |
–Physical, Occupational, and Speech Therapy –Pharmacological Management: manage spasticity |
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What are the different types of classifications of cerebral palsy? |
* Spastic * Athetoid (or dyskinetic) * Ataxic * Mixed |
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Describe spastic cerebral palsy. |
* Has hypertonicity and permanent contractures with 3 different types based on the limbs involved - hemiplagia (both limbs on one side) - quadriplagia (all four limbs) - diplagia or paraplagia (lower limbs) |
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What are the characteristics of spastic cerebral palsy? |
* Most common form * Poor control of posture, balance and movement * Exaggeration of deep tendon reflexes * Hypertonicity of affected extremities * Continuation of primitive reflexes * In some children, failure to progress to protective reflexes |
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Describe athetoid, or dyskinetic, cerebral palsy. |
* Abnormal involuntary movements * Infant is limp and flaccid * Affects all extremities and possibly, face, neck and tongue * Uncontrolled, worm-like, writhing, or twisting movements that increase with stress * Dysarthria and drooling possible as well |
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Describe ataxic cerebral palsy. |
* Affects balance and depth perception * Rare form * Poor coordination * Unsteady and wide-based gait |
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What are the complications of cerebral palsy? |
* Mental impairments * seizures * growthproblems * impaired vision or hearing * abnormal sensation or perception * hydrocephalus |
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What is the Focus of Nursing Care of the Child With Cerebral Palsy? |
•Promoting growth and development •Promoting mobility •Maintaining optimal nutritional intake •Providing support and education to the child and family |
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What is Guillan-Barre Syndrome? |
An autoimmune attack on the peripheral nervous system with an unknown etiology and ongoing research debating vaccine involvement. |
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What is the nursing assessment of Guillan-Barre Syndrome? |
–Health History: HX of viral/bacterial URI –Physical exam: reports of pain (lowerextremities), symmetrical weakness or paralysis, ataxia, decreased or absent tendon reflexes, dysphagia |
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What is the goal of treatment of Guillan-Barre Syndrome? |
–Symptomatic and focuses on lessening the severity and speeding recovery –Keep the body functioning until the nervous system recovers –May include plasma exchange and administration of intravenous immunoglobulins |
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What causes botulism? |
–Toxin produced in the immature intestines of young children resulting from infection with the bacterium Clostridium botulinum –On rare occasions can cause serious paralyticillness –Mainlya food-borne infection but can also be contracted through wound infections or intestinal infections in infants |
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What are the signs and symptoms of botulism? |
* Constipation * poor feeding * listlessness * generalized weakness * weak cry |
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Describe Botulism. |
•AVOID HONEY in children under 1 year of age •Nsg priority – ASSESS AIRWAY •Proper pt positioning to maximize ventilation •Treated with Baby BIG(Botulism immuno-globulin) •If found and treated early, patients can have complete recovery without deficit •Supportive care and education to family regarding expected outcomes |
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The nurse working in the ER knows that trauma or unintentional injury is a leading cause of childhood morbidity and mortality in the United States. True or False? |
True. Trauma or unintentional injury is a leading cause of childhood morbidity and mortality in the United States. Rationale:Injuries are the leading cause of death in children younger than 1 year of age and account for a significant percentage of childhood morbidity. The child isat increased risk for trauma based on the developmental factors of physical and emotional immaturity; additionally, adolescents display belief of invincibility. |
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What are the Signs and Symptoms of Musculoskeletal Illness? |
•Limp or other changes in gait •Recent trauma (determine the mechanism ofinjury) •Recent strenuous exercise •Fever •Weakness •Alteration in muscle tone •Areas of redness or swelling |
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What are the nursing assessments of a patient with a musculoskeletal illness? |
•Elicit health historyincluding PMHx, HOPI(history of present illness), ROS (review of systems) •Physicalexamination •Inspection/Observation: observe posture and alignment of trunk, inspect extremities for symmetry, note any obvious deformities, observe child’s gait •Palpation: performactive ROM, assess neurovascular status of affected extremity, note capillary refill, color, sensation, movement (CSM), assess peripheral pulses, evaluatemuscle strength |
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What are some Congenital StructuralAnomalies Involving the Skeleton? |
•Pectus excavatum (funnel chest) •Pectus carinatum (chest bowed outward) •Limb deficiencies •Polydactyly or syndactyly (extra fingers or toes or webbed fingers ortoes) •Metatarsus adductus (feet turned inward) •Congenital clubfoot (twisted out of shape or position) •Osteogenesis imperfecta (brittle bones) |
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Describe Congenital hip dysplasia. |
•Variety of conditions in which femoral head and acetabulum are improperly aligned •Occurs in 1-2/1000births affecting females 4-6x more than males •Unilateral in 80% ofaffected children •Etiology unknown •Family historyincreases risk |
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What is the assessment of an infant with congenital hip dysplasia? |
•Dx should be made in newborn period •Early treatment = highest success rate •Physical findings –shortening of affected limb, unequal knee height with thighs flexed to 90 deg. angle toward abdomen •Positive Ortolani “clicking sound” with hip abduction •Positive Barlow sign if able to feel hips dislocated |
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What is the Barlow maneuver? |
Easily performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. If the hip is dislocatable - that is, if the hip can be popped out of socket with this maneuver - the test is considered positive. |
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What is the planning and implementation of care of a child with congenital hip dysplasia? |
•Correction involves positioning hip into a flexed, abducted position to press head of femur against acetabulum and deepen its contour •<3 months of age – Pavlik harness worn for 3-6 months •>3 months – skin traction followed by spica cast •>18 months –traction, operative reduction and rehabilitation (PT/OT) |
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What is the family education associated with congenital hip dysplasia? |
•Pavlik harness – proper application, sponge bathing, skin assessment –T-shirt and knee socks worn under brace to prevent skin irritation –Diaper under straps and changed without removing harness –Car seat modification •Modification of positioning for nursing and eating •Ensure child has adequate stimulation with toys/activities •Encourage activities that stimulate upper extremities •PT/OT |
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What assessment is made prior to casting a child with congenital hip dysplasia? |
•Color (note cyanosis or other discoloration) •Movement (note inability to move fingers ortoes) •Sensation (note whether loss of sensation is present) •Edema •Quality of pulses |
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What are the signs of compromise with casting a child with congenital hip dysplasia? |
•Compartment Syndrome - complication of casted extremity •Increased pain •Increased edema •Pale or blue color •Skin coolness •Numbness or tingling •Prolonged capillary refill •Decreased pulse strength (or absence of pulse) |
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What are some types of acquired musculoskeletal disorders? |
•Rickets (vitamin D deficiency causing soft,deformed bones) •Slipped capital femoral epiphysis (upper end of femur slips out of hip socket) •Legg-Calvé-Perthes disease(disruption of blood flow to hip joint) •Osteomyelitis (an infection in the bone) •Septic arthritis (inflammation of joint from bacteria) •Toxic synovitis (transient inflammation of joint) •Spinal curvature(scoliosis) |
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Describe Osteomyelitis. |
* Infection of the bone * Staphylococcus aureus most common causative organism in older children * Haemophilius influenze in younger children * Results in abscess formation and edema reducing blood flow and causing death of bone tissue |
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What is the nursing assessment of osteomyelitis? |
•Detailed health history –Generalized malaise, fever, irritability,tachycardia, dehydration possible •Recent soft tissue infection •Recent trauma to thebone? •Pain, tenderness,swelling, redness or decreased mobility of affected extremity |
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How is osteomyelitis diagnosed and treated? |
•Aspiration to identify causative organism •Lab studies includeCBCD, CRP, ESR, BLC •CT/Xray •Surgical intervention may be necessary for I&D (incision and drainage) •Limited weight bearing/immobilization •Long term IV Abx treatment 3-6 weeks transitioning to oral therapy for additional time •PT |
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What is the education necessary for osteomyelitis patients and families? |
•Importance ofcompleting Abx regimen as ordered •IV site care •Activity with PT orassistive devices •Diet – supplementation calcium/protein if necessary to promote bone healing •S&S of infection |
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Describe scoliosis. |
•Lateral curvature ofthe spine •Functional –compensatory due to unequal leg lengths/poor posture •Structural – permanent accompanied by damage to vertebrae, occurs most often during rapid growth spurt in adolescence •Structural primarily idiopathic •Family predisposition •Common in diseases where unequal muscle balance occurs ie CP, MD (muscular dystrophy), myelomeningocele |
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What is the assessment of scoliosis? |
•Painless onset •ASymmetry •Unequal shoulder heights, waist angles, scapula prominences •Detailed health history as parents/child may be first to notice change in posture, clothing falling unevenly •Screening by school nurse begins in 5th grade as mandated by law in many states |
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What is the planning and implementation of scoliosis? |
•Prepare child for xray •Treatment varies depending on degree of curvature •Strengthening exercises to improve posture, muscle tone and flexibility of spine •Seen by orthopedic surgeon if severe •Bracing worn until spinal growth complete •Electrical stimulation •Surgical intervention with spinal instrumentation |
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What is the client/ family teaching for scoliosis? |
•Brace wear – 23hours/day, off to shower, bathe,swim, t-shirt under brace •Encourage Activity while in brace •Addressing self esteem concerns/issues •Importance of compliance with follow up •Pre-op teaching if surgical intervention required |
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What condition is associated with a blue sclera? |
Osteogenesis imperfecta. |
