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441 Cards in this Set
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- Back
Perspective of care on children w/ special needs:
Trends in care should have a developmental focus, as well as be: |
family centered.
There needs to be family-health care provider communication. The relationship needs to be therapeutic. Consider their culture And decision making is shared. **Normalization |
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Care is managed, what does this mean?
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HMO dictates the care allowed for the person.
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As a nurse caregiver it is important to take care of the ill person, as well as:
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ourselves. It takes a toll.
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Children in a family of a sibling w/ a disability tend to:
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suffer as well; because the life of the child w/ the disability tends to take over the family.
No trips to Disney etc. When a child has a disability the ENTIRE family suffers. |
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The family of the child w/ special needs is all impacted:
How are the roles of the parents affected? |
1.) The burden of care can be placed primarily on one parent
2.) financial burden 3.)fear of the child dying causes stress 4.) pressure from relatives 5.) hereditary nature of the disease (if applicable) 6.) fear of pregnancy 7.) long wait times for appts. |
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Mother-father differences:
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Both parents tend to react differently:
Some moms experience peaks-and-valleys periodic crisis patterns, whereas most fathers tend to experience a steady gradual recovery. |
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Single -parent families:
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Can be an enormous burden, nurses should assist the parent in finding financial and supportive services that can ease the burden of care.
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Siblings:
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Usually has a negative effect, although this appears to be changing.
Try to value each child and avoid comparisons. Box 41-5 |
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Coping w/ ongoing stress and periodic crises:
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Help the family cope w/ stress by providing anticipatory guidance, emotional support, and assess and identify specific stressors and aid the family in developing coping mechanisms and problem solving strategies and work collaboratively w/ parents so that they become empowered in the process.
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Concurrent stresses within the family:
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As the family deals w/ other life stressors in addition to a special needs child it is important to take a look at their:
Coping mechanisims: behaviors that reduce tension |
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What is parental empowerment?
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a process of recognizing, promoting, and enhancing competance.
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Trade-off parenting:
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can help minimize stress.
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Kids w/ disabilities:
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are at a higher risk for abuse
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All of these have helped to increase the life expectancy of a child:
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Surfactant
Safety Immunizations Treatment of AIDS |
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Assisting family members in managing feelings:
Shock and Denial: |
The initial diagnosis of a chronic illness or disability is often met w/ intense emotion, shock, disbelief and denial.
Normal response |
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Adjustment:
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gradually follows shock, and is usually characterized by an open admission that the condition exists.
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Reintegration and acknowledgment:
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The adjustment process culminates in the development of realistic expectations for the child and reintegration of family life w/ the illness now in manageable perspective.
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Establishing a support system:
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If the family receives emotional support and guidance early, their is an increased likelihood that they will cope successfully.
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The child w/ Special Needs:
Developmental aspects: |
The impact of a chronic illness or disability is influenced by the age at onset.
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Coping mechanisms:
Hopefulness |
A sense of hopefulness can produce increased participation and a sense of well-being.
Help the child achieve the highest level possible |
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Health education and Self-Care
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This promotes coping.
Ex. A child w/ Crohn's disease should understand that this disorder is associated w/ growth failure and delayed puberty. |
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Responses to parental behavior
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One of the most important factors influencing the child's adjustment. Children's perspective of their mothers' support and maternal perceptions of the psycosocial impact of the child's illness on the family were shown to be of the two greatest predictor's of the child's overall adjustment.
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What else influences the child's emotional response?
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The type of illness or disability. Children w/ more severe disorders often cope better than those w/ milder conditions
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Nursing Care of the Family and Child w/ Special Needs:
Assessment: |
A nurse may meet a family at any point of adjustment process. The assessment needs to include:
The family's ability to cope: w/ previous stress influences the current situation. Knowledge of concurrent stresses such as financial, marital, career or unemployment helps identify families who have fewer resources Awareness of family's reaction to the ill child. |
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The diagnosis is a critical time for parents and can influence how they preceive their health care providers throughout care therefore; it is important to:
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provide support at the time of diagnosis!
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Each family member must be individually supported so that the family system is strong:
Parents: |
are equal to professionals and experts regarding their child.
Support groups should be encouraged. |
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Parent-to-parent Support:
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Just being w/ another parent who has shared similiar experiences is helpful; does not have to be same diagnosis.
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Nurses can advocate for methods that foster:
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parent empowerment.
Ex. nurses can suggest reimbursement for travel and child care. |
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Through ongoing contacts w/ the ill child the nurse observes:
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1.) The child's responses to the disorder
2.)explores the child's understanding of the disorder 3.)provides support |
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The presence of a child w/ special needs in a family may result in what?
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parents paying less attention to the other children.
Siblings may display negative attitudes toward the child or be angry. The nurse should use anticipatory guidance and question the parents about the best way to have siblings respond to their child and guide them through ways to meet the other kid's needs for attention. |
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It is important to establish realistic future goals, or realisitc vocations for the child w/ the illness/disability; why is this?
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Waiting until the child finishes school or the parents retire, will cause more stress. Planning for the future should be a gradual process.
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Prolonged survival leads to new decisions and problems such as:
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Independent living
Marriage, employment, insurance coverage Reproductive decisions (Should kids w/ Downs be having their own baby?) |
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Establish a realistic future w/ the parent's, if the child only has 3 years to live you should:
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tell them. Also, people w/ Downs can live quite a long time, who will care for the child when the parent is gone?
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What is cognitive impairment?
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A general term that encompasses any type of mental difficulty or deficiency in a child under 18.
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Cognitive impairment is used synonymously with what word?
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Intellectual disability
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How is a cognitive impairment/ intellectual disability diagnosis made?
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The diagnosis is made after a period of suspicion by family or health professionals.
In some instances diagnosis is made at birth. |
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If the child is not diagnosed with a cognitive impairment until after age 18; it is usually:
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a drug overdose, car accident, etc.
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How is a cognitive impairment classified?
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The results of standardized tests are used in making the diagnosis of cognitive impairment (CI)
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A more useful approach for applications classification would be based on what?
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Educational potential
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Educable mentally retarded constitues what percentage of the population?
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85%
Can teach the basics such as ABC's basic math, etc. |
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Trainable mentally retarded constitues what percentage of those w/ cognitive impairment?
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10%
Can train to brush teeth, feed themselves, etc. |
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A functional impairment w/ at least 2 of the following 10 would constitute a diagnosis of Cognitive Impairment:
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Communication (Autism)
Home living Community Use Leisure Health and Safety Self-care Social Skills (Autism) Functional academics Self-direction |
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Nursing Care of the Child w/ Impaired Cognitive Function:
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Educate the child and family (Early intervention)
Teach child self-care skills Promote child's optimal development Play and Exercise Communication Socialization Sexuality (Sterilization?) Helping families adjust to future care: (Long term) Care for the child during hospitilization |
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Down Syndrome is the MOST common chromosome abnormality occurring in:
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1 in 800 live births
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What is the etiology of Downs?
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unknown etiology (likely multiple causality)
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What is the most common cause of genetic impairment?
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Down Syndrome
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Does Down Syndome occur more often in Caucasion or African-American families?
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Caucasion
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Women over the age of 40 are likely to deliver a baby with Downs 1 in:
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110
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Women ages 35-39 are likely to deliver a baby with Downs 1 in:
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400
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Down sydrome's diagnositc evaluation is done by:
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Head, face, eyes, nose, and ears (upward slant of almond shaped eyes, flat nasal bridge,)
Chest, neck, and abdomen Genitalia and skin (mottled skin) Hands, feet, musculoskeletal(hypotonic, floppy muscles) Congenital heart disease Hypothyroidism Increased incidence of leukemia Transverse palmar crease (simian crease) in hand. |
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Hearing Impairments can range from:
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mild to profound
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Define deaf:
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A person whose hearing disability precludes processing linguistic information w/ or w/out a hearing aid
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Hard of hearing
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Generally able to hear w/ a hearing aid
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The terms deaf & dumb, mute or deaf-mute are:
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unacceptable
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Hearing tests done early, such as on newborns can:
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help tremendously
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Promoting communication in the deaf:
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lip reading
Cued speech Sign language Speech-language therapy Additional aids Socilization (schools for the deaf) Many deaf people are against cochlear implants, as this suggests their is something wrong w/ them. |
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Autism Spectrum Disorders (ASDs)
What is Autism? |
Complex neurodevelopmental disorder accompanied by intellectual and social defects.
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Asperger's syndrome is?
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An autism spectrum disorder that is pervasive (Spreading widely)
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Risk of autism is:
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1 in 166 children.
Four times as common in males Usually the person will have a strange obsession such as collecting manequins or washing machines. |
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What is the etiology of Autism Spectrum Disorders? (ASDs)
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A genetic disorder of prenatal and postnatal brain development
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What else might be interacting with the genetic suscepibility of ASDs?
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Immune and environmental factors
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There is a relatively high risk of?
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Recurrence of ASDs in families w/ one affected child (can run in families)
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What are the clinical manifestations of ASDs?
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Peculiar and bizarre characteristics primarily in:
Socialization Communication Behavior Difficulty w/ eye and body contact Language delay *Be careful touching kids w/ autism. Silicone valley has the highest amount of Autism* |
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Nursing Care mngmt of ASDs
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It is a severely disabling condition
There is no cure for autism Numerous therapies have been used such as: Behavior modification Provide a structured routine Decrease unacceptable behavior |
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Autism often becomes a family disease, with parents frequently expressing guilt and shame. It is important as nurse's to:
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stress the importance of family counseling
*Autism society of America is a good source of information *Manage clients at home or long-term placement facilities. |
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Who is most susceptible to respiratory dysfunction?
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Wimpy White Males
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Fun Facts:
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Right lung is slightly larger than the left
The surface area of lungs is roughly the same size as a tennis court A sneeze travels 100 mph A person breathes 17,000 a day |
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Upper respiratory tract
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nose, pharynx
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lower respiratory tract
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bronchi and bronchioles
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Croup syndromes
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infections of epiglottis, larynx
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What are the risk factors for respiratory infections?
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#1 IS AGE
Immune system Allergies, asthma Cardiac anomalie Cystic fibrosis DAY CARE! |
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Why do these kids have a higher risk for resp. infections?
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because everything is shorter and smaller, things get congested.
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What are the clinical manifestations of resp. infections?
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Vary w/ age
Generalized signs and symptoms and local manifestations differ in young children. Cough, sore throat, nasal blockage or discharge. |
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LUNG SOUNDS
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crackles
wheezes (high pitched) listen on angel for test |
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Nursing Care mngmt. for respiratory infections:
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Ease respiratory effort (Sit them up, raise hob, raise crib mattress)
Promote rest and comfort Prevent spread of infection (wash hands) Reduce temp. Promote hydration and nutrition Family support and home care |
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Sings/symptoms of influenza:
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body aches & fever
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What is Otitis Media?
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A middle ear infection, mostly between 6-36 months.
2nd hand smoke causes increased risk. Also can cause hearing loss. Sometimes kids will get tubes in their ears and then be on antibiotics for 10-14 days. |
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Infectious Mononucleosis
(Mono) |
enlarged spleen.
Therapeutic management: Rest and fluids Prognosis: Good |
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Croup Syndrome
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sounds like a seal, hoarseness, barking like cough, inspiratory stridor, and varying degrees of respiratory distress.
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What does croup syndrome affect?
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The larynx, trachea, and bronchi
Epiglottis, laryngitis, laryngotrachebronchitis (LTB) , tracheitis (swelling) |
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Vaccinations for influenza
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not for immunocompromised or egg allergy.
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What are the clinical manifestations of acute epiglottis?
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Sore throat, pain, tripod positioning, retractions, stridor, distress
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What is important in regards to therapeutic management of acute epiglottis?
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There is the potential for respiratory obstruction. The throat is already inflamed do not use a tongue blade.
Protect airway, inflammation can close the throat.....emergency |
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What vaccination can prevent acute epiglottis?
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Haemophilus influenzae type B vaccine
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What is acute laryngitis?
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Most common in older children and adolescents
Usually caused by a virus chief complaint is hoarseness Generally self-limiting and w/ out long-term sequelae Treatment:symptomatic salt water gargles |
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What is acute laryngotracheobronchitis, (LTB)
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Most common of the croup syndromes
Generally affects children less than 5 yrs. old Organisms responsible are RSV, para influenza virus, Mycoplasma pneumonia, influenza A and B (Deep snore sound, strider, barking cough) |
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What is acute spasmodic croup?
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Midnight croup
usually happens at night Inflammation is mild or absent Most often affects kids ages 1-3 |
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What is bacterial tracheitis?
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Infection of the mucosa of the upper trachea
Distinct entity with features of croup and epiglottis Clinical manifestations similar to LTB May be a complication of LTB THICK, PURULENT SECRETIONS result in respiratory distress. |
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Infections of the lower airway are considered:
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the reactive portion of the respiratory tract.
Includes bronchi and bronchioles Cartilaginous support not fully developed until adolescence Constriction of airways. |
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Bronchitis AKA Tracheobronchitis should be treated w/
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lots of fluids
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Bronchitis and RSV is most common in the:
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spring and winter
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What are the clinical manifestations of RSV and Bronchiolitis?
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Wet faced kids, drool, runny nose.
Need lots of fluid, antibiotics, rest. COOL AIR humidifiers, hot shower. *They are coming out w/ a vaccine |
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Pertussis (Whooping cough) is making a comeback, why?
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In the US it occurs most often in kids who have not been immunized. As illegals move in the rates are going up in Southern Cali and Texas
Highly contagious Risk to young infants Vaccines |
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Tuberculosis (TB) is most common in:
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the homeless population. Screening is called the PPD test.
Caused by mycobacterium tuberculosis, human and bovine varieties. |
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What is acute respiratory distress syndrome, (ARDS)?
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Also referred to as adult RDS
Characterized as respiratory distress and hypoxia w/ in 72 hours after serious injury or surgery in person w/ previously normal lungs Acute lung injury |
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What is asthma?
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A chronic inflammatory disorder of airways
Bronchial hyperresponsiveness Episodic Limited airflow or obstruction that reverses spontaneously or w/ treatment Can also have exercise induced asthma Airways need to be opened w/ a steroid inhaler (Bronchodilator) |
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What is cystic fibrosis (CF)
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An exocrine gland dysfunction that produces multi-system involvement
Most common lethal GENETIC illness among white kids Approximately 3% US white pop. are symptom free carriers Meconium ileus at birth |
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What is the first indication of CF?
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meconium ileus at birth
(overfilled intestines w/ meconium) |
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Essentially CF causes:
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a mucous bulid up in the intestines and lungs
(They don't have pancreatic enzymes) |
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Is there a cure for CF?
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No, the only thing that can be done is a multi organ transplant
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How do we test for CF?
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Sweat chloride test (most reliable diagnostic procedure)
When positive the sodium and chloride will be 2-5 times greater than the control. Also, 72 hour fecal fat test. (Increased sweat electrolytes) |
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What are the respiratory manifestations of CF?
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They are present in almost all CF patients but onset/extent is variable. Some are more/less severe.
The stagnation of mucous and bacterial colonization result in destruction of lung tissue Tenacious secretions are difficult to expectorate. Children w/ CF need lots of respiratory therapy |
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Therapeutic management of CF:
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Prevent/minimize pulmonary complications
Provide a high-calorie, high-protein diet Encourage appropriate activity: no football, etc. anything that compromises breathing Antibitoics for tx. of infection. Bronchodilators, pancreatic enzymes Lung transplant survival rate is not so good. |
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Food sensitivity or hypersensitivity:
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cow's milk intolerance:(lactose intolerant)
Food intolerance: Systemic Gastrointestinal Respiratory Cutaneous (Shows up on the skin) |
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What are the clinical manifestations of GI dysfunction?
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Failure to thrive
Spitting up/regurgitation N/V/D constipation Abdominal pain, distension, GI bleeding Jaundice Dysphagia(inability to swallow) Hypoactive, hyperactive, or absent bowl sounds |
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What is dehydration?
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When output exceeds intake
(happens quick w/ infacts) |
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Water balance in infants:
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body surface area
Basal metabolic rate Kidney fx. Fluid requirements |
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What is oral rehydration therapy (Ort)?
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ORT is one of the major worldwide health advances of the last decade (Pedialite, not gatorade b/c Pedialite is Sugar-free)
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Why is ORT so great?
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Because it is safer, less painful, and less costly than IV rehydration
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Oral rehydration solution enhances and promotes what?
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reabsorption of H20 and Na
Reduces vomiting, diarrhea, and duration of the illness. |
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What is the #1 killer to kids in foreign countries?
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Diarrhea
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What is HIRSCHSPRUNG disease?
(also called congenital aganglionic megacolon) |
A mechanical obstruction from inadequate motility of intestine
(An enlarged, swollen colon) Absence of ganglion cells |
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Incidence of HIRSCHSPRUNG DISEASE?
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1 in 5000 live births; more common in males and in Down Syndrome
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What is treatment for HIRSCHSPRUNG DISEASE?
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removal of the colon
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Most frequent infections in the world:
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Intestinal Parasitic Disease
In humans caused by a variety of organisms |
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What are the two most common parasitic diseases in the US?
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Giardiasis (found by endoscopy)
Pinworms (Scotch tape on rectum at night) |
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What is the most common congenital malformation of the GI tract?
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Meckel Diverticulum
Occurs in 2-4% of the pop. Pathophysiology: Ulceration, bleeding, intestinal obstruction where the umbillical cord was |
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What are facial malformations that occur during embryonic development?
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Cleft Lip and/ or cleft palate
May appear separately or together |
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How is Cleft lip treated?
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Surgically
The closure of the lip defect preceded correction of the palate Z-plasty to minimize retraction of scar |
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How is the suture protected w/ cleft lip?
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Logan Bow or other methods
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When is surgery performed for cleft palate?
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Typically 12-18 mths
Effect on speech development |
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What is very important for children who have had cleft lip and/or cleft palate surgery?
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Non nutrive sucking for speach development
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Post op. the child should be:
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supine or side-lying, keep the incisions clean, restraints as needed. encourage breast feeding for a tighter seal.
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What is esophageal atresia and tracheoesophageal fistula?
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Failure of the esophagus to develop in a continuous passage
May occur separately or in combination Basically the esophagus does not route correctly |
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How does the pt. with esophageal atesia or a tracheoesohageal fistula get nutrition?
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tube feed until corrected. lots of suctioning to prevent pneumonia
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What is a hernia?
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a protrusion of portion of an organ through an abnormal opening
danger of incarceration/ strangulation Diaphragmatic, hiatal, umbilical/abdominal wall defects |
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What is hypertrophic pyloric stenosis (HPS)?
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Constriction of pyloric sphincter w/ obstruction of gastric outlet
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What is INTUSSUSCEPTION?
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Telescoping or invagination of one portion of intestine into the other
Occasionally due to intestinal lesions Often cause is unknown Ex. The sleeve of a sweater folding into itself |
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What is treatment for INTUSSUSCEPTION?
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Air or saline enema, if doesn't work, then surgery
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What is CELIAC DISEASE?
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gluten-induced enteropathy (intestinal disease) and celiac sprue (malabsorption, diarrhea, wight loss)
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What are the four characteristics of CELIAC DISEASE?
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Statorrhes (fat in stool)
General malnutrition Abdominal distention Vitamin deficiencies |
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What is the CELIAC DISEASE DIET?
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NO:
B:barley R:rye O:oats W:wheat |
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undiagnosed celiac disease can lead to:
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cancer
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What are the clinical manifestations of anorexia nervoas?
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Severe weight loss
Altered metabolic activity Amenorrhea, bradycardia, decreased BP Hypothermia, cold intolerance Dry skin, brittle nails and hair appearance of lanugo |
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What is BULIMIA characterized by?
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binge eating
purging up to 8 or more cycles per day often the pt. can be a bit overweight |
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What are the pediatric indicators of cardiac dysfunction?
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poor feeding
tachypnea/tachycardia failure to thrive/ poor weight gain/ activity intolerance prenatal history family history of cardiac disease |
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Can SIDS be caused by cardiac issues?
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yes
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In cardiac dysfunction will the primary anatomic abnormalities be present at birth?
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yes
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What are some of the factors that cause cardiac dysfunction?
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infection
autoimmune responses environment familial tendencies |
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history and physical exam for cardiac dysfunction:
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inspection
auscultation palpation and percussion |
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diagnostic eval. for cardiac dysfunction:
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electrocardiogram
echocardiograph cardiac catheterization |
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when a child is receiving any treatment such as a cardiac catheterization, what is important to remember?
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help to ease the child's worries, by explaining to them what will be happening, show an example on a doll, b-4 having the procedure done
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Following cardiac catheterization you observe the dressing to be blood soaked, what do you do?
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apply more pressure w/ another ABD pad. Never remove, call DR. immediately
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If a pt. had cardiac catheterization what are you assessing for?
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popliteal pulses, cap. refill, lower extremities
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What is the incidence of congenital heart disease? (CHD)
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5 to 8 per 1000 live births
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What is a major cause of death in the first year after life? (after prematurity)
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(CHD)Congenital Heart Disease
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What is the most common anomaly in CHD?
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Ventricular Septal Defect
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Often children w/ CHD have another recognized anomaly, what is it?
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Trisomy 21, 13, 18
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A mom w/ Rubella in the first trimester can lead to?
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CHF in baby
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What are the circulatory changes at birth?
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The umbilical vein and arteries close.
Foramen ovale closes Ductus arteriosus closes Ductus venosus closes |
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What are the 4 types of heart defects?
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1.)Defects of increase pulmonary blood flow
2.)Obstructive defects 3.)Defects of decreased pulmonary blood flow 4.)Mixed defects |
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Defects of increased pulmonary blood flow affect which side of the heart?
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the left side
Fluids are backing up, leads to CHF |
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Defects of decreased pulmonary blood flow affect which side of the heart?
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the right side
Cyanosis |
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An abnormal connection between the two sides of the heart is:
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an increased pulmonary blood flow defect.
Can be either the septum or the great vessles |
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What are some of the other causes of increased pulmonary blood flow defects?
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Atrial Septal Defect
VSD Patent Ductus arteriosus (Know chart on pgs. 194 & 195 in ATI book) |
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What are the obstructive defects?
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Coarctation of the aorta
Aortic stenosis Pulmonic stenosis |
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Types of Decreased pulmonary blood flow defects
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Tetralogy of Fallot
Tricuspid atresia |
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What are mixed defects?
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Transposition of great arteries or vessels
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What are the signs/treatment for mixed defects?
|
Complete cyanosis due to desaturation
Because only unoxygenated blood makes it to the systemic system, not good!! Immediate surgery is needed. |
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What are the signs and symptoms of Congestive Heart Failure?
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They vary w/ age
Fluid congestion Poor feeding and growth, irritability, SOB, excessive sweating, decreased urine |
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What is nursing care for CHF?
|
Digoxin, diuretics, vasodilators
|
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Do we use fluid restriction in kids?
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No, not often. They dehydrate way too fast.
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If CHF is left untreated what can happen?
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The heart muscle becomes damaged.
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What are the goals of treatment for CHF?
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Improve cardiac function
Remove accumulated fluid and sodium Improve tissue oxygenation |
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Nursing care of the child and family
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Help the family adjust to the disorder
Educate the family about the disease Help families manage the illness at home Prepare child and family for invasive procedures Provide postoperative care Plan for discharge and homecare. In many of these cases a heart transplant is needed. These families are living in a constant state of emergency. The parents need oxygen in the home, must know CPR, etc. |
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What is rheumatic fever?
|
RF is an inflammatory disease that occurs after Group A streptoccoal pharyngitis.
Infrequently seen in US; big problem in 3rd world. |
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What does rheumatic fever affect?
|
joints, skin, brain, serous surfaces, and heart
|
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Rheumatic heart disease is:
|
the most common complication of RF
Damage to valves as a result of RF Many elderly people have had valve replacements, due to RF |
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What is the problem w/ heart transplantation?
|
Although a person is getting a bad heart replaced, they will now be immunocompromised.
Also there is a risk of rejection Organ donation issues |
|
Types of transplantation
|
ortotropic
heterotopic |
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What is Kawasaki disease?
|
Monocutaneous lymph node syndrome
Acute systemic vasculitis of unknown cause |
|
75% of Kawasaki cases are:
|
in kids under 5
|
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Kawasaki is also
|
self-limiting
|
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In a person w/ Kawasaki they are at an increased risk of
|
coronary artery aneurysm
|
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How do we monitor for Hematologic and Immunologic dysfunction?
|
CBC
History and physical exam Comments made by the parent regarding child's lack of energy Frequent infection Bleeding |
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What are the initial signs of anemia?
|
Fatigue
SOB headache difficulty concentrating dizziness pale skin |
|
Nursing care for anemia:
|
Identify underlying cause
Promote a healthy diet or a vitamin supplement Teach family (signs and symptoms, alter daily activities, evaluate status of anemia |
|
Anemia decreases
|
oxygen carrying capabilities
|
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What are the signs and symptoms of iron-deficiency anemia?
|
Asymptomatic (mild anemia)
Decreased Hgb and Hct Irritability, fatigue, delayed motor development, SOB, decreased activity level, and pale skin Remember an overweight child can be diagnosed w/ iron-deficiency anemia |
|
10-20% of infants & Toddlers have:
|
Iron-deficiency Anemia
Give Flintstones vitamins to toddlers |
|
Nursing care for iron-deficiency anemia
|
Identify early
Understand that primary goal is prevention Assist w/ obtaining recommended iron-fortified formula and cereal Discuss the Women infants and Children programs (WIC) Administer oral iron supplements |
|
Sickle cell anemia is a hereditary what?
|
hemoglobinopathy (a genetic disease caused by the presence of an abnormal hemoglobin in the blood)
|
|
In areas of the world where malaria is common, individuals w/ the sickle cell trait tend to have what?
|
survival advantages over those w/ out the trait.
|
|
Sickle cell anemia is a autosomal recessive disorder, what does this mean?
|
Any chromosome other than sex (X and Y) chromosomes , recedes, or does not dominate,
|
|
9% of which culture are carriers?
|
9% of African Americans have the sickle cell trait.
|
|
If both parents have the sickle cell trait, each offspring will have a what?
|
1 in 4 chance of having the disease
|
|
What is the pathophysiology of sickle cell anemia?
|
Partial or complete replacement of normal Hgb with abnormal Hgb S
Hgb in the RBCs takes on an elongated "sickle" cell shape |
|
Sickled cells are rigid and obstruct what?
|
capillary blood flow
|
|
Microscopic obstructions lead to what?
|
engorgement and tissue ischemia
|
|
Hypoxia occurs and causes what?
|
sickling
|
|
Nursing management for Sickle Cell Disease:
|
monitor child's growth-watch for failure to thrive
Careful multi-system assessment ASSESS PAIN Observe for presence of inflammation or possible infection Monitor for signs of shock O |
|
Pain control is frequent w/ Sickle Cell Disease, many pt.'s will have:
|
PCA pumps
|
|
What leads to the inflammation caused by Sickle Cell anemia?
|
Because a sickle cell is not smooth, it leads to inflammation of the veins, caused by irritation.
Sickled cells have difficulty passing through the veins, and there is not as much oxygen. Causes pain in joints as well. |
|
What is the prognosis for sickle cell anemia?
|
No cure (except for possibly bone marrow transplants)
Strokes in 5-10% of kids due to the clumping of the cells Frequent bacterial infections may occur because of immunocompromise Bacterial infectionis LEADING CAUSE OF DEATH in younk kids w. sickle cell |
|
What are the precipitating factors for a sickle cell crisis?
|
Anything that increases the body's need for oxygen or alters transport of oxygen such as:
trauma infection, fever physical and emotional stress increased blood viscosity caused by dehydration hypoxia |
|
How is sickle cell diagnosed?
|
Cord blood in newborns
Newborn screening done in 43 states Genetic testing to identify carriers and children who have sickle cell disease Sickle turbidity test (testing the thickness of the blood) |
|
What is Hemophilia?
|
A decrease or absence of clotting factors
|
|
What are the signs and symptoms of hemophilia?
|
Present w/ bleeding or known family history of bleeding disorders
Hemathrosis (blood effusion w/ in a joint) Soft tissue bleeding |
|
Nursing care for hemophilia:
|
Initiate prompt treatment of bleeding episodes
Ensure pt. safety and prevent complications For severe hemophilia administer recombinant (tissue plasma regenerator) products Educate family about proper administration of factor products Mom & Dad will need to learn how to start an I.V., because meds. are given I.V. push Soft toothbrushes, helmets, safety. AND No, a paper cut will not make you bleed to death. |
|
What are the manifestations of hemophilia?
|
Bleeding tendencies range from mild to severe
Symptoms may not occur until 6 months of age Mobility leads to injuries from falls and accidents |
|
What is hemarthrosis?
|
Bleeding into joint spaces of knee, ankle, elbow, leading to impaired mobility
|
|
What is Ecchymosis?
|
Bruising, in this case caused by hemophilia
|
|
How can hemophilia be diagnosed early?
|
By amniocentesis, while mom is pregnant.....hemophilia tends to run in families
Genetic testing done on family members to identify carriers Diagnosis on basis of hx. labs, and exam |
|
What would lab results in a patient w/ hemophilia reveal?
|
Low levels of Factor VII, or IX, prolonged partial thromboplastin time
Normal: Platelet count, parathormone (PT), and fibrinogen |
|
Medical management of Hemophilia:
|
DDAVP:
IV or nasal spray Causes 2 to 4 times increase in factor VIII activity Used for mild hemophilia Replace missing clot factors Transfusions: At home w/ prompt intervention to reduce complications Following major or minor hemorrhages |
|
What is the most common clotting disorder?
|
von Willebrand's Disease
|
|
Signs/symptoms of von Willebrand's Disease
|
Epistaxis (nose bleeds)
Bleeding from the oral cavity Menorrhagia (heavy period) Easy bruising |
|
Nursing Care for von Willebrand's Disease
|
Administer Desmopressin (DDAVP)
Administer Humate-P and/or cryoprecipitate or fresh frozen plasma (FFP) Recommend medical alert Instruct parents about common sites of bleeding Control bleeding Avoid the use of Aspirin or NSAIDS |
|
What is Epistaxis?
|
Nosebleed
Isolated and transient epistaxis is common in childhood Recuurent or severe episodes may indicate underlying disease such as: Vascular abnormalities, leukemia, thrombocytopenia, clotting factor deficiency diseases (von Willebrand's and hemophilia) |
|
Renal System Assessment
|
Physical exam
History taking Observation of symptoms Lab, radiologic, or other evaluation methods |
|
What is vesicoureteral reflux (VUR)
|
the back flow of urine from bladder back up to the kidneys
|
|
What are the signs and symptoms of Vesicoureteral Reflux (VUR)
|
Recurrent UTI
flank pain abdominal pain enuresis |
|
Nursing Care for Vesicoureteral Reflux
|
Surgery to reimplant the ureter
Medical management (dye) Educate the pt. about signs/symptoms of UTI and the importance of medication Postsurgical-manage intake & output, pain control and infection |
|
What is the most comon presentation of glomerular injury in children
|
Nephrotic syndrome
|
|
Characteristics of nephrotic syndrome
|
proteinuria
hypoalbuminemia edema massive urinary protein loss **Dipstick test for protein |
|
What are the changes taking place in nephrotic syndrome?
|
Glomerular membrane:
normally impermeable to large proteins becomes permeable to proteins especially albumin albumin is lost in urine (hyperalbuminuria) serum albumin decreased (hypoalbuminemia) fluid shifts from plasma to interstitial spaces |
|
Nephrotic syndrome management
|
supportive care
DIET: low -to-moderate protein Sodium restrictions when large amount of edema present STEROIDS: 2 mg/kg divided into BID doses Prednisone is drug of choice IMMUNOSUPPRESSANT therapy (Cytoxan) Diuretics |
|
Family Issues w/ Nephrotic System
As kids get older this disease becomes more difficult to keep up with |
Chronic condition w/ relapses
Developmental milestones Social isolation lack of energy immunosuppressionm/protection change in appearance caused by edema self-image (If everybody gets to eat a hambureger, this child wants one too) |
|
How do we prepare the family for home care w/ nephrotic syndrome?
|
Discharge to home Instructions
Follow-up urine culture *Recurrent symptoms typically occur in 1 to 2 weeks after therapy Encourage adequate fluids even after infection low-dose, long-term antibiotics to prevent relapses or reinfections explain rational to enhance compliance |
|
What are the sings/symptoms of Wilm's Tumor Nephroblastoma?
|
It is a painless abdominal mass in one or both kidney's
|
|
Nursing care for Wilm's Tumor Nephroblastoma
|
Health history and nursing assessment
explain lab & diagnositic tests administer chemotherapy and give post radiation care assess fx. of remaining kidney ensure high-calorie, high-protein diet give dietary supplements |
|
Wilms' Tumor is usually diagnosed by age 3. After you have palpated the tumor once, should you palpate it again?
|
No, and it can be on both kidneys.
Usually have to remove the entire kidney |
|
Renal failure can be:
|
acute or chronic
Dehydration is the #1 cause |
|
What is the definition of acute renal failure?
|
The kidney's suddenly are unable to regulate volume and composition of urine
|
|
Is acute renal failure common in kids?
|
No
|
|
What is the principle feature of acute renal failure? (ARF)
|
oliguria (urine output less than 400)
|
|
Is acute renal failure usually reversible?
|
Yes
|
|
What are the complications of ARF?
|
Hyperkalemia
Hypertension Anemia Seizures Hypervolemia Cardiac failure w/ pulmonary edema |
|
Who can a pt. receive transplantation of a kidney from?
|
living related donor
cadaver donor *The primary goal is long-term survival of grafted tissue Role of immunosuppressant therapy |
|
How do we observe general aspects of cerebral fx?
|
In infants and young kids: observe spontaneous and elicited refelx responses
family hisotry health histroy: Have there been any head injuries or febrile seizures, injestion or inhalation of something Physical exam: |
|
If you suspect a head injury what MUST BE CLOSELY MONITORED ?
|
LOC for 24 hrs. look for changes
|
|
Intracranial pressure
The brain makes up |
80%
|
|
Cerebralspinal (CSF) fluid makes up
|
10%
|
|
Blood makes up
|
10%
|
|
Clinical manifestations of
Increased ICP in Infants |
Irritabilility, poor feeding
High-pitched cry, difficult to soothe Fontanels: tense, bulging Cranial sutures: seperated EYES: SETTING SUN SIGN SCALP VEINS: distended |
|
Clinical manifestations of
Increased ICP in Children |
HEADACHE
VOMITING; w/ or w/out seizures Diplopia (double vision) or blurred vision |
|
A child comes in vomiting and complains of a headache, is this normal?
|
NO
This MUST be taken seriously this could be a head injury |
|
What are the LATE signs of Increasing Intracranial Pressure?
|
Decreased LOC
Decreased motor response to command Decreased sensory responses to painful stimuli Alterations in pupil size and reactivity Papilledema (swelling of the octic nerve) Decerebrate (elimination of cerebral function) Decorticate posturing (pt. is rigidly still w/ arms flexed, fists clenched, and legs extended Cheyne-Stokes respirations (marked apnea lasting 10-60 seconds) |
|
ABNORMAL POSTURING (Evident of brain seizures)
Decorticate |
Flexor Posturing To the Cord
|
|
Decerebrate
|
Extensor Posturing
Lots of E's |
|
Flaccid
|
relaxed, flabby muscle tone
|
|
What is the pediatric Glasgow Coma Scale?
|
It is a Three part Assessment of:
eyes verbal response motor response |
|
If the child gets a score of 15 on the Pediatric Glasgow Coma assessment what does this mean?
|
Unaltered LOC
|
|
What about a score of 3?
|
extremely decreased LOC
(worst possible score on the scale) |
|
If a child is in a coma, what do we as nurse's need to be aware of?
|
RESPIRATIONS!!
Keep the child clean, quiet room Assess the parameters every 15 min.- 2 hours depending on severity |
|
Neurolical Assessment Glasgow Coma Scale
EYES |
Looking at the right and left eyes for size and reaction of pupil
Do the eyes open: spontaneously 4 To speech 3 To pain 2 None 1 |
|
Neurolical Assessment Glasgow Coma Scale
Best motor response |
Obeys commands 6
Localizes pain 5 Flexion Withdrawl 4 Flexion abnormal 3 Extension 2 None 1 |
|
Neurolical Assessment Glasgow Coma Scale
Best responses to auditory and/or visual stimulants |
Orientation 5
Confused 4 Inappropriate words 3 Incomprehensible words 2 None 1 Endotracheal tube or trach T |
|
Neurological Exam
|
Vital signs
Skin: bites, injury, needle marks Eyes: dilated, constricted Postruing: Refelxes: brisk, flaccid, or none |
|
What is a concussion?
|
A transient and reversible bruise to the brain
Results from trauma to the head Instantaneous loss of awareness and responsiveness lasting for minutes to hours Generally followed by amnesia and confusion |
|
Key to watch for w/ concussion
|
Increased confusion decreased arousability
|
|
Skull fractures in children can indicate what?
|
Child abuse, just because of how difficult it is to fracture the skull, it takes a great deal of force.
|
|
Fracture of the underside of the skull can tear what?
|
the meningeal artery, causing severe hemorrhage w/ hypovolemic hypotension
|
|
What is bacterial meningitis?
|
Accute inflammation of the meninges and CSF
|
|
What can decrease the incidence of bacterial meningitis?
|
The "Hib" vaccine
|
|
What bacterial agents can cause meningitis?
|
Streptococcus pneumoniae
Group B streptococci Escherichia coli |
|
If a child is diagnosed w/ bacterail meningitis where will they be in the hospital?
|
Isolation
|
|
Bacterial meningitis is a droplet infection from what?
|
nasopharyngeal secretions
|
|
What is the most definitive diagnostic test for bacterial meningitis?
|
Lumbar Puncture (LP)
Child needs to lie very still and curve their back for placement Watchg for signs of shcok Help parents' present if possible |
|
What is nonbacterial meningitis?
|
Aseptic meningitis
Causitive agents are primarily viruses Frequently associated w/ other diseases: measles, mumps, herpes, leukemia Onset: abrupt or gradual |
|
What are the manifestations of nonbacterial meningitis? (Aseptic meningitis)
|
headache
fever malaise Treatment is primarily symptomatic Whatever needs to be treated....headache gets NSAIDS, etc. |
|
What is rabies?
|
an acute infection of the CNS
|
|
Signs/symptoms of rabies
|
flu like symptoms
alterations in mental status seizures hyperexcitability respiratory arrest |
|
Nursing care for rabies
|
clean wound and administer vaccine (rapid, short term)
Must receive vaccination w/ in the incubation period or it is 100% fatal. After initial vaccination you receive the immunogloulin on day 3, 7, 14, & 28 |
|
What is Reye's Syndrome?
|
Uncommon
A disorder defined as toxic encephalopathy associated w/ other characteristic organ involvement. Characterized by fever, profoundly impaired consciousness, and disordered hepatic fx. |
|
What is a seizure?
|
malfunctions of the brain's electrical system
Determined by the site or origin Occur w/ a wide variety of CNS conditions |
|
signs/symptoms of a seizure
|
chane in LOC
involunatry movements posturing changes in perception, behaviors, or sensations Many people will have a premonition of a seizure b4 it happens Service dogs can be used to sense a seizure and guide a person to a safe spot b4 it happens |
|
What is epilepsy defined as?
|
Two or more unprevoked seizures
Caused by a variet of pathologic processes in the brain |
|
Optimal treatment and prognosis of epilelpsy requires what?
|
An accurate diagnosis and determination of the cause.
The lowest effective dose of medication is given. |
|
What causes hydrocephalus (bulging fontanelles)
|
an imbalance in the production and absorption of cerebral spinal fluid (CSF)
|
|
What is the pathophysiology of hydrocephalus?
|
Impaired absorption of CSF w/ in the subarachnoid space.
Obstruction through the ventricular system Communicating and noncommunicating hydrocephalus |
|
What can be done to therapeutically manage hydrocephalus?
|
Most often surgery is needed. A ventriculoperitoneal shunt can be placed to help drain the fluid down into the stomach. Frequent surgeries will be needed as they grow bigger.
**ALWAYS, watch for changes in LOC |
|
Disorders of pituitary fx:
|
may be due to organic defects or have an idiopathic etiology
single hormonal problem or a combination w/ other hormonal deficiencies. Clinical manifestations depend on the hormone involved. may result in an overproduction or hormone deficiency |
|
What are the signs/symptoms of Hypopituitary (Growth Hormone Deficiency)
|
Growthof less than 2 inches per year
Delayed closure of the anterior fontanel, delayed dental eruption, decreased muscle mass, delayed puberty, and hypoglycemia |
|
Nursing Care for Hypopituitary (Growth hormone deficiency)
|
Adminster human recombinant growth hormone (GH)
Plot growth measurements on a growth chart Provide supportive resources Treat child appropriate to age Teach parents about condition and treatment |
|
Is replacement w/ GH usually successful?
|
Yes, in about 80%: usually given at bedtime
|
|
As the epiphyseal closure nears dosage is :
|
increased
|
|
When is GH therapy finished?
|
When radiologic evidence shows that the closure of the epiphyseal has taken place.
|
|
What is pituitary hyperfunction?
GIGANTISIM |
An excess of growth hormone b4 closure of epiphyseal shafts results in overgrowth of long bones.
Reach heights of 8 ft. or more Vertical growth plus increased muscle Weight generally in proportion to height They do not go through puberty |
|
Excess GH AFTER the epiphyseal closure is called what?
|
ACROMEGALY
|
|
What are the typical features of of acromegaly?
|
overgrowth of:
head lips, tongue, jaw, nose nasal, mastoid sinuses malocclusion of the teeth Surgery can be done to control tumors on pituitary |
|
What is precocious pubery defined as?
|
sexual development before age 9 in boys or before age 8 in girls
Occurs more frequently in girls |
|
What are some of the potential causes of precocious puberty?
|
Disorder of gonads, adrenal glands, or hypothalamic-pituitary gonadal axis
95% of cases have no known causitive factor |
|
What can be used to treat precocious puberty?
|
LUPRON
Slows prepubertal growth to normal ratesTreatment is discontinued at age for normal pubertal changes to resume |
|
Should children dress according to their appearance?
|
No, parents should be educated to dress the children based on their developmental level, and actual age.
|
|
Juvenile hypothyroidism can be congenital or aquired. With congenital the thyroid gland is what?
|
hypoplastic (underdeveloped)
|
|
What about acquired juvenile hypothyroidism?
|
caused by partial or complete thyroidectomy for CA or thyrotoxicosis
Following radiation for Hodgkin or other malignancy *Rarely occurs from dietary insufficieny in the U.S. |
|
What are the clinical manifestations of Juvenile Hypothyroidism?
|
Mental decline
Constipation Sleepiness Myxedematous skin changes dry skin sparse hair puffiness around eyes |
|
What is the therapeutic management for juvenile hypothyroidism?
|
Oral TH replacement (centroid)
Prompt treatment needed for brain growth in infant May administer in increasing amounts over 4 to 8 weeks to avoid symptoms of hyperthyroidism Compliance w/ medical regimen is crucial |
|
What is a Goiter?
|
Hypertrophy (increased size) of the thyroid gland
Congenital: Usually results from maternal ingestion of antithyroid drugs during pregnancy Acquired:result of neoplasm, inflammatory disease, dietary deficiency (but rarely in kids) or increased secretion of pituitary thyrotropic hormone |
|
Throid enlargement/goiter at birth can what?
|
compromise the newborn's airway
|
|
An enlarged thyroid/goiter may become noticeable during what?
|
rapid periods of growth
|
|
Large goiters may be obvious smaller may,
|
only be noticed on palpation.
TH replacement necessary for treatment of hypothyroidism |
|
What is the most common cause of hyperthyroidism in children?
|
Graves' Disease
Believed to be caused by autoimmune response to TSH receptors but no specific etiology |
|
What is hyperthyroidism (Graves' Disease)
|
an enlarged thyroid and exopthalmos (bulging eyeball)
|
|
Peak incidence of hyperthyroidism Graves' Disease is?
|
12 to 14 years of age but may be presen at birth
Famillial association |
|
Therapy for Graves' Disease (hyperthyroidism) is controversial because of what?
|
It is retarding the rate of hormone secretion
|
|
DISORDERS OF PANCREATIC HORMONE SECRETION:
What is diabetes characterized by? |
Total or partial deficiency of the hormone insulin
|
|
What is the most common endocrine disorder of childhood?
|
Diabetes mellitus (DM)
|
|
Peak incidence of Diabetes Mellitus is between which ages?
|
10-15 yrs. of age
75% diagnosed before age 18 |
|
What is Type 1 Diabetes characterized by?
|
by destruction of beta cells, usually leading to absolute insulin deficiency. Typically onset in childhood and adolescence but can occur at any age
|
|
Most Diabetes of childhood is what?
|
Type 1
|
|
Diabetes is most prominant in which race?
|
Caucasions
|
|
Can children do their own insulin therapy
|
YES
|
|
Type 2 Diabetes arises because of what?
|
Insulin resistance
|
|
Type 2 Diabetes onset is usually at what age?
|
after 40
|
|
Are Native American, Hispanic, or African American kids at an increased risk of Type 2 DM?
|
No
|
|
Treatment for Type 2 DM
|
Insulin injections
|
|
Type 2 DM IS becoming more common in kids due to what?
|
obesity and sedentary lifestyles
|
|
Therapeutic management of Type 1 DM
|
Nutrition
Exercise Teach pt. and family how to manage hypoglycemic episodes illness management Management of DKA |
|
Patient Education:
DM and Insulin Therapy |
Nature of the disease
Meal planning Insulin therapy: types of insulin, duration, onset and peak action, mixing and administration of types of insulin, rotation of injection sites Insulin pump therapy in some cases Glucose monitoring |
|
More than 1/2 of the dermatologic problems in kids are forms of what?
|
Dermatitis
A sequence of inflammatory changes in the skin |
|
The location and manner of these reactions produce what?
|
Lesions
|
|
Are the changes usually reversible?
|
Yes
|
|
Therapeutic management for dermatitis:
|
dressings
topical therapy: agents methods topical steroids Systemic therapy (oral or I.V.) Relief of symptoms |
|
What is the most common complain w/ skin lesions?
|
Pruritis (itching)
Reccomend cool bath or compress Prevent scratching: mittens, cover for younk kids, short nails, antipruritic medications |
|
What is Dermatophytosis?
|
A fungal infection
Superficial infections that live on the skin |
|
Ringworm is caused by what?
|
A group of filamentous fungi
(Contagious, no school) Transmission from person to person or infected animal to human Examples: tinea capitis, tinea corporis, tinea pedia, candidiasis |
|
Contact dermititis is what?
|
a reaction of the skin to a chemical
|
|
What is chacracteristic of contact dermatitis?
|
a sharp delineation between inflamed and normal skin
Primary irritant Sensitizing agent Ex. diaper dermatitis, reaction to wool, reaction to specific chemical |
|
Poison Ivy, Oak and Sumac produces what?
|
localized lesions caused by urushiol from plant's leaves and stems
|
|
Sensitivity may develop after what?
|
One or two exposures and may change over time
|
|
Penetrates through the epidermis and bonds with what?
|
the dermal layer
|
|
Foreign bodies:
Splinters of wood |
splinters of wood can be removed w/ needle and tweezers
**Or the body will reject on its own |
|
Cactus spines can be removed:
|
with glue or scotch tape
|
|
May require medical treatment if difficult to see or remove such as:
|
fish hook, piece of glass
|
|
Arthropod bites and stings may cause what?
|
mild-to-moderate discomfort
|
|
How are bites and stings managed?
|
with symptomatic measures and prevention of secondary infection
|
|
With bees the stinger penetrates the skin, so be sure to:
|
remove the stinger as soon as possible
(Even if the stinger is no loger there, you still probably have the poison) |
|
Sensitization to bee stings may result in what?
|
anaphylaxis (reaction)
|
|
What is pediculosis Capitis?
|
Head Live
Very common, especially in school aged kids |
|
The adult louse lives only 48 hours w/ out a human host; a female louse has a life span of:
|
30 days
|
|
Nits hatch in
|
7 to 10 days (very hard to kill)
|
|
What is treatment for head lice?
|
pediculicides and removal of knits
Preventing spread and recurrence |
|
What are infections that are transmitted by arthropods?
|
Rickettsiae: Rocky Mountain spotted fever transmitted by infected fleas, ticks, and mites
|
|
What is Lyme Disease?
|
The most common tickborne disorder in the US
There are vaccines against Lyme disease in areas w/ woods |
|
Focus on prevention of Lyme Disease:
|
check everybody when they come back from the forest
|
|
What is the main cause of diaper dermatitis?
|
usually from irritation of urine and feces (especially when the child is on antibiotics)
detergents inadequately rinsed from clothing chemical irritants (especially from diaper wipes, with alcohol) candidiasis of diaper area *Treat w/ antifungal cream and breast milk |
|
What is atopic dermatitis?
|
Eczema
A type of pruritic eczema that begins during infancy Hereditary tendency Three forms |
|
Infantile atopic dermatitis usually what?
|
undergoes spontaneous remission by 3 yrs.
|
|
With childhood 90% have manifested Atopic Dermatits by age 5. The majority of children w/ infantile AD have a family history of what?
|
eczema, asthma, or food allergies
|
|
Management of Atopic Dermatitis
|
relieve pruritis, hydrate skin, reduce inflammation, prevent/control secondary infection.
|
|
Parents if kids with Atopic Dermatitis (Eczema) need to be assured:
|
that the lesions will not produce scarring (unless secondarily infected) and that the disease is not contagious. However, the child may have repeated exacerbations and remissions
|
|
Acne occurs predominantly in:
|
adolescence
|
|
What is the pathophysiology of Acne?
|
Involves hair follice and sebacious glands
Comedogenesis (white head) Therapeutic management general measures/overall health OTC medications can be proactive |
|
What is frostbite?
|
Blisters that appear 24 to 48 hours after rewarming
|
|
How is frostbite treated?
|
Similiar to burns
Place child in warm area, remove wet/cold clothes and replace with warm clothing Do not massage area Encourage child to rest and slow rewarming Instruct parents to call health care provider if problems arise |
|
Tissue damage is caused by what?
|
Ice crystals in the tissues
|
|
Infectious Disorders:
|
Communicable diseases
Nursing Assessment Preventing spread of disease |
|
In order to identify potential infectious cases, the nurse must:
|
operate under a high index of suspicion for common childhood illnesses
|
|
Incidence has declined w. increased
|
immunizations, antibiotics and antitoxins, recent exposure to infectious agents, and prodromal (early) symptoms
|
|
It is important to gather an immunization history. Children should be vaccinated. They are not always due to:
|
lack of money
illegal aliens afraid of records |
|
What is the primary prevention of disease?
|
Immunization is #1
Control the spread of disease to others Reduce risk of cross-transmission of organisims Infection control policies: wash hands |
|
Caution for Compromised Children needs to be taken. Children w/ immunodeficiency are:
|
receiving steroid therapy
on other immunosuppressive therapies (chemo) generalized malignancies immunologic disorder |
|
What is chicken pox?
|
Varicella-zoster virus
Herpes zoster Red, itchy rash, no loger contagious whendry |
|
The Varicella virus hides on the nerve root and can later become what?
|
shingles
|
|
Care managent of chicken pox
|
refrain from scratching
cool oatmeal bath, lotion, rest, treat fever |
|
The chicken pox vaccination did not come along until 1995. Should the elderly receive the vaccination?
|
Yes, because they could still get shingles
|
|
What is roseola?
|
The human herpes virus 6 or 7
|
|
Roseola usually occurs in kids of what age?
|
6-12 months
Usually a mild illness |
|
What are the signs/symptoms of roseola?
|
Fever for up to a week, can be over 103 degrees; may also have cold symptoms; rash may follow fever
|
|
What is treatment for roseola?
|
tepid sponge baths for fever; clear liquids; rest until fever resolves
|
|
What is Erythema Infectiosum? (Fifth disease)
|
Human PARVOVIRUS
Rash in 3 stages: " SLAPPED FACE" appearance disappears by 1-4 days Maculopoular rash on extremities; lasts 7 days or more Rash subsides but reappears if skin irritated or traumatized by heat, cold, friction |
|
Is it necessary to isolate the child w/ Erythema Infection?
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Isolation is not necessary, unless the child is immunosuppressed
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Rubeola is what?
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Measles
A respiratory infection |
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Is rubeola (measles) contagious?
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Yes, very
MMR vaccine |
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What are the signs/symptoms of rubeola? (measles)
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fever, runny nose, conjunctivitis, sore throat
After 2-3 days KOPLIK's spots on inside of cheeks- classic sign. Fever spikes 104-105 Red blotchy rash spreads from head to feet fades in about 1 week. PHOTOSENSITIVITY |
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What are the potential complications of rubeola?
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ear infections, encephalitis (inflammation of the brain)
Pneumonia, NVD, Croup, Thrombocytopenia, problems w/ fetus if pregnant |
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When is MMR given for rubeola/measles?
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12-15 months old and again at 4-6 years old
NO VACCINE for pregnant women, or certain allergies |
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What is mumps (paperas) ?
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A viral disease that affects the parotid glands
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Signs/symptoms of mumps (paperas)
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can affect one side or both
Rare complications Swollen, painful parotid glands, fever weakness, fatigue |
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What is rubella (German measles)?
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"German" comes from latin "germanus" means similiar to rubeola
Also known as 3 DAY MEASLES A mild disease Fine, pink rash sometimes achy joints Avoid if pregnant |
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What is scarlet fever? (Strawberry tongue)
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AKA Scarlatina
Sometimes occurs w/ strep throat |
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Signs/symptoms of scarlet fever?
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Red rash, sunburn appearance, Pastia's lines,
Otitis media, meningitis, endocarditis; others |
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Pediatric autoimmune neuropsychiatric disorders are associated with what?
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disorders associated w/ streptococcal infections
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What is conjunctivitis?
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Infections of the eye
Treated w/ ophthalmic eye drops HIGHLY CONTAGIOUS via skin to skin contact Wipe eye with warm cloth |
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Immobilization was once though to be restorative for patients with illness and injury, we now know what?
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immobilization has serious consequences:
physical social psychological |
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What is essential for physical growth and development?
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physical activity, it can serve as a means of communication and as a means of learning
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If a child has a spica cast or hip abductor, socially the child may feel what?
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isolated due to the need for heavy equipment or being in traction. The child may become depressed and nurse and family will need to let child express their feelings, such as anger and isolation
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In order to heal the child needs:
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blood flow
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Children NEED to play, and when they are confined to a bed this is:
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very difficult
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Traumatic injuries can cause soft-tissue injury, what is this?
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injuries to muscles, ligaments, and tendons
Sports injuries Mishaps during play |
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If a soft-tissue injury does occur what should you do right away?
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Apply ice immediately (within 30 minutes) will reduce swelling
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Therapeutic management of soft tissue injuries:
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Rice and ICES
Rest the injured part Ice immediately for a max of 30 minutes at a time Compression w/ wet elastic bandage Elevation of the extremity Immobilization and support (casts or splints) |
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What is a fracture?
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A common injury in kids
Methods of treatment are different than adults Rare in infants, except w/ motor vehicle crashes |
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What is the most frequently broken bone in childhood?
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Clavicle, especially in kids under 10
Most common in school age is bike, and sports injuries |
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The weakest point of the long bones is the what?
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cartilage growth plate (epiphyseal plate)
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Epiphyseal injuries are a:
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frequent site of damage during trauma
May affect future bone growth |
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What is treatment for epiphyseal injuries?
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open reduction and internal fixation to prevent growth disturbances
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What is a simple or closed fracture?
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Does not produce a break in the skin
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Compound or open?
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fractured bone protrudes through the skin
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complicated
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bone fragments have damaged other organs or tissues
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Comminuted
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small fragments of bone are broken from fractured shaft and lie in surrounding tissue
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Plastic
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Bone has a bend with no break
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Buckle
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Small crack in it
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Greenstick
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broken more than half way through but stops before a complete break
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Complete
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full break
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complete w/ periosteal hinge
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full break w/ some attachment
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Fiberglass cast
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they can still swim & pick the color
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Cast care at home
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Do not scratch inside can cause infection
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Cast is removed w/
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a saw
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What is congenital club foot?
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inversion or bending of the foot inward
eversion or bending of the foot outward Plantar flexion w/ toes lower than the heel dorsiflexion w/ toes higher than the heel |
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How is bilateral club foot treated?
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the feet are casted. Nursing care is the same for any cast. Goal is for pt. to achieve painless, plantigrade (walking on the entire sole and heel of the foot on the ground. Serial casting is often the treatment.
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What is scoliosis?
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The most common spinal deformity
one hip higher than the other or one shoulder higher than the other |
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A complex spinal deformity in three planes includes:
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lateral curvature
spinal rotation causing rib asymmetry Thoracic hypokyphosis May be congenital or develop during childhood |
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Scoliosis is caused by what?
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multiple potential causes, most cases idiopathic
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When does scoliosis usually become noticeable?
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after a preadolescent growth spurt
may have complaints of ill fitting clothes school screening is controversial |
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What is the diagnostic evaluation for scoliosis?
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standing radiographs to determine degree of curvature
asymmetry of shoulder, height, scapular, or flank shape, or hip height Often have primary curve and compensatory curve to align head with gluteal cleft |
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What is therapeutic management of scoliosis?
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Team approach to treatment
Bracing Exercise Surgical intervention from severe curvature(instrumentation and fusion) Harrington rods Lugue rods |
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Standard thoracolumbosacral (TLSO) braces are available for what?
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Idiopathic scoliosis
Available in color and design for kids Provide needed support for spine curvature |
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Nursing Care management for scoliosis
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Concerns of body image is a big one to kids
concerns of prolonged treatment of condition pre op. care post op. care family issues |
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What is OSGOOD-SCHLATTER DISEASE?
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pain below the knee cap
pain aggravated by activity and relieved by rest |
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Nursing care of OSGOOD-SCHLATTER DISEASE:
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manage pain
ice knee after exercising maintain limited activity collaborate w/ physical therapist |
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OSGOOD SCHLATTER DISEASE is caused by what?
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repetitive injury and repair to the tibia where the patellar tendon attaches. Often wear small brace just under the knee to support tendon.
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What is cerebral palsy? (CP)
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Characterized by abnormal muscle tone and coordinatioon
Incidence 1.5-3 per 1000 live births |
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What is the most common permanent physical disability in childhood?
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Cerebral Palsy
15-60% of these children will also have epilepsy |
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A group of permanent disorders of the development of movement and postures causing activity limitations that are attributed to non progressive disturbances that occurred in the developing fetal or infant brain is:
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CP
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Most common reason for CP
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anoxia
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Etiology of CP
Prenatal brain abnormalities: |
80% are caused by unknown brain abnormalities
Intrauterine exposure to chorioamnionitis (inflammation in the placenta) 12% of infants born prior to 36 weeks Peri ventricular leukemia Resluts of shaken bay syndrome |
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Diagnostic evaluation of CP
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Infants at risk warrant careful assessment during early infancy
Neurologic exam and history Neuroimaging Metabolic and genetic testing |
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What are the possible motor signs of CP?
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Classic sign: poor head control after 3 months
Stiff or rigid limbs floppy tone unable to sit w/ out support at 8 months clenched fists after age 3 months |
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Possible behavioral signs of
CP |
excessive irritability
no smiling by age 3 months feeding difficulties persistent tongue thrusting frequent gagging or choking w/ feeds |
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CP and IQ
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Wide variation
30-50% of CP pt.'s are cognitively impaired Difficult to assess rigid, atonic, and quadiparetic have highest incidence of profound impairment |
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What are the goals of therapy for CP?
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To establish locomotion, communication, and self-help skills (they should function as well as they can on their own)
to gain optimal appearance and integration of motor function to correct associated defects as effectively as possible to provide educational opportunities adapted to the child's capabilities to promote socialization experiences (even though they are disabled they still want to be social) |
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Therapeutic management for CP
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ankle foot braces may be worn
orthopedic surgery to correct spastic deformities pharmacological agents to treat pain related spasms and seizures BOTULINUM A INJECTIONS Dental hygiene (lots of good care) Physical/occupational therapy |
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Diplegia
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both arms or both legs
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monoplagia
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only one extremity
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triplegia
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3 extremities
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paraplegia
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pure cerebral paraplegia of lower extremities
Medications can now be given to decrease spasticity |
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Nursing Care mngmt. of CP
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Assist the family in devising and modifying equipment and activities
Medication administration( is very difficult) Safety precautions Recreational activities Support family |
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Autism Spectrum Disorders
Nursing Care |
Promote awareness of the need for early intervention
Promote early language development Encourage social competence Stay aware of the child's physical boundaries and reluctance to be touched |
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Attention Deficit Hyperactivity Disorder
Signs/Symptoms |
Hyperactivity
Impulsivity Distractibility Inattention |
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Nursing Care for ADHD
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Evaluate by using a rating scale
Discuss pharmacological intervention (Ritalin) Discuss psychosocial intervention (behavioral therapy, rewards, and positive versus negative reinforcement) |
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Fetal Alcohol Spectrum Disorder
Signs/Symptoms |
Facial dysmorphic features
low birth weight, failure to thrive, microcephaly Developmental delays, hyperactive behavior, learning & attention difficulties Nursing Care: Develop prevention programs Provide information about the effects of alcohol (thin upper lip, indistinct philitrum, microcephaly, low nasal bridge, minor ear abnormalities, flat midface, epicanthal folds |
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Hospice
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terminal illness when the pt. is expected to die w/in 6 months
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palliative care
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quality of life
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History of pediatrics
Late 1800s |
little to offer, few physicians, ease of symptoms
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Early to mid 1900s
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sweeping changes, antibiotics, CPR, anesthesia, parents and siblings excluded, distancing from the dying
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evolution of pediatrics
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milk stations
school nurses's inclusion of parents |
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Definition of palliative care
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An approach that improves quality of life for patients and families w/ a life-threatening illness through prevention and relief of suffering by means of early identification, impeccable symptom control and treatment of physical, psychosocial, and spiritual issues. (WHO 1988)
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What are the barriers to care?
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Money
language culture geography education |