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441 Cards in this Set

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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
Care is managed, what does this mean?
HMO dictates the care allowed for the person.
As a nurse caregiver it is important to take care of the ill person, as well as:
ourselves. It takes a toll.
Children in a family of a sibling w/ a disability tend to:
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.
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.
Mother-father differences:
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.
Single -parent families:
Can be an enormous burden, nurses should assist the parent in finding financial and supportive services that can ease the burden of care.
Siblings:
Usually has a negative effect, although this appears to be changing.
Try to value each child and avoid comparisons.
Box 41-5
Coping w/ ongoing stress and periodic crises:
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.
Concurrent stresses within the family:
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
What is parental empowerment?
a process of recognizing, promoting, and enhancing competance.
Trade-off parenting:
can help minimize stress.
Kids w/ disabilities:
are at a higher risk for abuse
All of these have helped to increase the life expectancy of a child:
Surfactant
Safety
Immunizations
Treatment of AIDS
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
Adjustment:
gradually follows shock, and is usually characterized by an open admission that the condition exists.
Reintegration and acknowledgment:
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.
Establishing a support system:
If the family receives emotional support and guidance early, their is an increased likelihood that they will cope successfully.
The child w/ Special Needs:
Developmental aspects:
The impact of a chronic illness or disability is influenced by the age at onset.
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
Health education and Self-Care
This promotes coping.
Ex. A child w/ Crohn's disease should understand that this disorder is associated w/ growth failure and delayed puberty.
Responses to parental behavior
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.
What else influences the child's emotional response?
The type of illness or disability. Children w/ more severe disorders often cope better than those w/ milder conditions
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.
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:
provide support at the time of diagnosis!
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.
Parent-to-parent Support:
Just being w/ another parent who has shared similiar experiences is helpful; does not have to be same diagnosis.
Nurses can advocate for methods that foster:
parent empowerment.
Ex. nurses can suggest reimbursement for travel and child care.
Through ongoing contacts w/ the ill child the nurse observes:
1.) The child's responses to the disorder
2.)explores the child's understanding of the disorder
3.)provides support
The presence of a child w/ special needs in a family may result in what?
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.
It is important to establish realistic future goals, or realisitc vocations for the child w/ the illness/disability; why is this?
Waiting until the child finishes school or the parents retire, will cause more stress. Planning for the future should be a gradual process.
Prolonged survival leads to new decisions and problems such as:
Independent living
Marriage, employment, insurance coverage
Reproductive decisions (Should kids w/ Downs be having their own baby?)
Establish a realistic future w/ the parent's, if the child only has 3 years to live you should:
tell them. Also, people w/ Downs can live quite a long time, who will care for the child when the parent is gone?
What is cognitive impairment?
A general term that encompasses any type of mental difficulty or deficiency in a child under 18.
Cognitive impairment is used synonymously with what word?
Intellectual disability
How is a cognitive impairment/ intellectual disability diagnosis made?
The diagnosis is made after a period of suspicion by family or health professionals.
In some instances diagnosis is made at birth.
If the child is not diagnosed with a cognitive impairment until after age 18; it is usually:
a drug overdose, car accident, etc.
How is a cognitive impairment classified?
The results of standardized tests are used in making the diagnosis of cognitive impairment (CI)
A more useful approach for applications classification would be based on what?
Educational potential
Educable mentally retarded constitues what percentage of the population?
85%
Can teach the basics such as ABC's basic math, etc.
Trainable mentally retarded constitues what percentage of those w/ cognitive impairment?
10%
Can train to brush teeth, feed themselves, etc.
A functional impairment w/ at least 2 of the following 10 would constitute a diagnosis of Cognitive Impairment:
Communication (Autism)
Home living
Community Use
Leisure
Health and Safety
Self-care
Social Skills (Autism)
Functional academics
Self-direction
Nursing Care of the Child w/ Impaired Cognitive Function:
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
Down Syndrome is the MOST common chromosome abnormality occurring in:
1 in 800 live births
What is the etiology of Downs?
unknown etiology (likely multiple causality)
What is the most common cause of genetic impairment?
Down Syndrome
Does Down Syndome occur more often in Caucasion or African-American families?
Caucasion
Women over the age of 40 are likely to deliver a baby with Downs 1 in:
110
Women ages 35-39 are likely to deliver a baby with Downs 1 in:
400
Down sydrome's diagnositc evaluation is done by:
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.
Hearing Impairments can range from:
mild to profound
Define deaf:
A person whose hearing disability precludes processing linguistic information w/ or w/out a hearing aid
Hard of hearing
Generally able to hear w/ a hearing aid
The terms deaf & dumb, mute or deaf-mute are:
unacceptable
Hearing tests done early, such as on newborns can:
help tremendously
Promoting communication in the deaf:
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.
Autism Spectrum Disorders (ASDs)
What is Autism?
Complex neurodevelopmental disorder accompanied by intellectual and social defects.
Asperger's syndrome is?
An autism spectrum disorder that is pervasive (Spreading widely)
Risk of autism is:
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.
What is the etiology of Autism Spectrum Disorders? (ASDs)
A genetic disorder of prenatal and postnatal brain development
What else might be interacting with the genetic suscepibility of ASDs?
Immune and environmental factors
There is a relatively high risk of?
Recurrence of ASDs in families w/ one affected child (can run in families)
What are the clinical manifestations of ASDs?
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*
Nursing Care mngmt of ASDs
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
Autism often becomes a family disease, with parents frequently expressing guilt and shame. It is important as nurse's to:
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.
Who is most susceptible to respiratory dysfunction?
Wimpy White Males
Fun Facts:
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
Upper respiratory tract
nose, pharynx
lower respiratory tract
bronchi and bronchioles
Croup syndromes
infections of epiglottis, larynx
What are the risk factors for respiratory infections?
#1 IS AGE
Immune system
Allergies, asthma
Cardiac anomalie
Cystic fibrosis
DAY CARE!
Why do these kids have a higher risk for resp. infections?
because everything is shorter and smaller, things get congested.
What are the clinical manifestations of resp. infections?
Vary w/ age
Generalized signs and symptoms and local manifestations differ in young children.
Cough, sore throat, nasal blockage or discharge.
LUNG SOUNDS
crackles
wheezes (high pitched)
listen on angel for test
Nursing Care mngmt. for respiratory infections:
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
Sings/symptoms of influenza:
body aches & fever
What is Otitis Media?
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.
Infectious Mononucleosis
(Mono)
enlarged spleen.
Therapeutic management: Rest and fluids
Prognosis: Good
Croup Syndrome
sounds like a seal, hoarseness, barking like cough, inspiratory stridor, and varying degrees of respiratory distress.
What does croup syndrome affect?
The larynx, trachea, and bronchi

Epiglottis, laryngitis, laryngotrachebronchitis (LTB) , tracheitis (swelling)
Vaccinations for influenza
not for immunocompromised or egg allergy.
What are the clinical manifestations of acute epiglottis?
Sore throat, pain, tripod positioning, retractions, stridor, distress
What is important in regards to therapeutic management of acute epiglottis?
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
What vaccination can prevent acute epiglottis?
Haemophilus influenzae type B vaccine
What is acute laryngitis?
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
What is acute laryngotracheobronchitis, (LTB)
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)
What is acute spasmodic croup?
Midnight croup
usually happens at night
Inflammation is mild or absent
Most often affects kids ages 1-3
What is bacterial tracheitis?
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.
Infections of the lower airway are considered:
the reactive portion of the respiratory tract.
Includes bronchi and bronchioles
Cartilaginous support not fully developed until adolescence
Constriction of airways.
Bronchitis AKA Tracheobronchitis should be treated w/
lots of fluids
Bronchitis and RSV is most common in the:
spring and winter
What are the clinical manifestations of RSV and Bronchiolitis?
Wet faced kids, drool, runny nose.
Need lots of fluid, antibiotics, rest.
COOL AIR humidifiers, hot shower.
*They are coming out w/ a vaccine
Pertussis (Whooping cough) is making a comeback, why?
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
Tuberculosis (TB) is most common in:
the homeless population. Screening is called the PPD test.

Caused by mycobacterium tuberculosis, human and bovine varieties.
What is acute respiratory distress syndrome, (ARDS)?
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
What is asthma?
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)
What is cystic fibrosis (CF)
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
What is the first indication of CF?
meconium ileus at birth
(overfilled intestines w/ meconium)
Essentially CF causes:
a mucous bulid up in the intestines and lungs
(They don't have pancreatic enzymes)
Is there a cure for CF?
No, the only thing that can be done is a multi organ transplant
How do we test for CF?
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)
What are the respiratory manifestations of CF?
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
Therapeutic management of CF:
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.
Food sensitivity or hypersensitivity:
cow's milk intolerance:(lactose intolerant)
Food intolerance:
Systemic
Gastrointestinal
Respiratory
Cutaneous (Shows up on the skin)
What are the clinical manifestations of GI dysfunction?
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
What is dehydration?
When output exceeds intake
(happens quick w/ infacts)
Water balance in infants:
body surface area
Basal metabolic rate
Kidney fx.
Fluid requirements
What is oral rehydration therapy (Ort)?
ORT is one of the major worldwide health advances of the last decade (Pedialite, not gatorade b/c Pedialite is Sugar-free)
Why is ORT so great?
Because it is safer, less painful, and less costly than IV rehydration
Oral rehydration solution enhances and promotes what?
reabsorption of H20 and Na
Reduces vomiting, diarrhea, and duration of the illness.
What is the #1 killer to kids in foreign countries?
Diarrhea
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
Incidence of HIRSCHSPRUNG DISEASE?
1 in 5000 live births; more common in males and in Down Syndrome
What is treatment for HIRSCHSPRUNG DISEASE?
removal of the colon
Most frequent infections in the world:
Intestinal Parasitic Disease
In humans caused by a variety of organisms
What are the two most common parasitic diseases in the US?
Giardiasis (found by endoscopy)
Pinworms (Scotch tape on rectum at night)
What is the most common congenital malformation of the GI tract?
Meckel Diverticulum
Occurs in 2-4% of the pop.
Pathophysiology: Ulceration, bleeding, intestinal obstruction where the umbillical cord was
What are facial malformations that occur during embryonic development?
Cleft Lip and/ or cleft palate
May appear separately or together
How is Cleft lip treated?
Surgically
The closure of the lip defect preceded correction of the palate
Z-plasty to minimize retraction of scar
How is the suture protected w/ cleft lip?
Logan Bow or other methods
When is surgery performed for cleft palate?
Typically 12-18 mths

Effect on speech development
What is very important for children who have had cleft lip and/or cleft palate surgery?
Non nutrive sucking for speach development
Post op. the child should be:
supine or side-lying, keep the incisions clean, restraints as needed. encourage breast feeding for a tighter seal.
What is esophageal atresia and tracheoesophageal fistula?
Failure of the esophagus to develop in a continuous passage
May occur separately or in combination
Basically the esophagus does not route correctly
How does the pt. with esophageal atesia or a tracheoesohageal fistula get nutrition?
tube feed until corrected. lots of suctioning to prevent pneumonia
What is a hernia?
a protrusion of portion of an organ through an abnormal opening
danger of incarceration/ strangulation
Diaphragmatic, hiatal, umbilical/abdominal wall defects
What is hypertrophic pyloric stenosis (HPS)?
Constriction of pyloric sphincter w/ obstruction of gastric outlet
What is INTUSSUSCEPTION?
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
What is treatment for INTUSSUSCEPTION?
Air or saline enema, if doesn't work, then surgery
What is CELIAC DISEASE?
gluten-induced enteropathy (intestinal disease) and celiac sprue (malabsorption, diarrhea, wight loss)
What are the four characteristics of CELIAC DISEASE?
Statorrhes (fat in stool)
General malnutrition
Abdominal distention
Vitamin deficiencies
What is the CELIAC DISEASE DIET?
NO:
B:barley
R:rye
O:oats
W:wheat
undiagnosed celiac disease can lead to:
cancer
What are the clinical manifestations of anorexia nervoas?
Severe weight loss
Altered metabolic activity
Amenorrhea, bradycardia, decreased BP
Hypothermia, cold intolerance
Dry skin, brittle nails and hair
appearance of lanugo
What is BULIMIA characterized by?
binge eating
purging
up to 8 or more cycles per day
often the pt. can be a bit overweight
What are the pediatric indicators of cardiac dysfunction?
poor feeding
tachypnea/tachycardia
failure to thrive/ poor weight gain/ activity intolerance
prenatal history
family history of cardiac disease
Can SIDS be caused by cardiac issues?
yes
In cardiac dysfunction will the primary anatomic abnormalities be present at birth?
yes
What are some of the factors that cause cardiac dysfunction?
infection
autoimmune responses
environment
familial tendencies
history and physical exam for cardiac dysfunction:
inspection
auscultation
palpation and percussion
diagnostic eval. for cardiac dysfunction:
electrocardiogram
echocardiograph
cardiac catheterization
when a child is receiving any treatment such as a cardiac catheterization, what is important to remember?
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
Following cardiac catheterization you observe the dressing to be blood soaked, what do you do?
apply more pressure w/ another ABD pad. Never remove, call DR. immediately
If a pt. had cardiac catheterization what are you assessing for?
popliteal pulses, cap. refill, lower extremities
What is the incidence of congenital heart disease? (CHD)
5 to 8 per 1000 live births
What is a major cause of death in the first year after life? (after prematurity)
(CHD)Congenital Heart Disease
What is the most common anomaly in CHD?
Ventricular Septal Defect
Often children w/ CHD have another recognized anomaly, what is it?
Trisomy 21, 13, 18
A mom w/ Rubella in the first trimester can lead to?
CHF in baby
What are the circulatory changes at birth?
The umbilical vein and arteries close.
Foramen ovale closes
Ductus arteriosus closes
Ductus venosus closes
What are the 4 types of heart defects?
1.)Defects of increase pulmonary blood flow
2.)Obstructive defects
3.)Defects of decreased pulmonary blood flow
4.)Mixed defects
Defects of increased pulmonary blood flow affect which side of the heart?
the left side
Fluids are backing up, leads to CHF
Defects of decreased pulmonary blood flow affect which side of the heart?
the right side
Cyanosis
An abnormal connection between the two sides of the heart is:
an increased pulmonary blood flow defect.
Can be either the septum or the great vessles
What are some of the other causes of increased pulmonary blood flow defects?
Atrial Septal Defect
VSD
Patent Ductus arteriosus
(Know chart on pgs. 194 & 195 in ATI book)
What are the obstructive defects?
Coarctation of the aorta
Aortic stenosis
Pulmonic stenosis
Types of Decreased pulmonary blood flow defects
Tetralogy of Fallot
Tricuspid atresia
What are mixed defects?
Transposition of great arteries or vessels
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.
What are the signs and symptoms of Congestive Heart Failure?
They vary w/ age
Fluid congestion
Poor feeding and growth, irritability, SOB, excessive sweating, decreased urine
What is nursing care for CHF?
Digoxin, diuretics, vasodilators
Do we use fluid restriction in kids?
No, not often. They dehydrate way too fast.
If CHF is left untreated what can happen?
The heart muscle becomes damaged.
What are the goals of treatment for CHF?
Improve cardiac function
Remove accumulated fluid and sodium
Improve tissue oxygenation
Nursing care of the child and family
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.
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.
What does rheumatic fever affect?
joints, skin, brain, serous surfaces, and heart
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
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
What is Kawasaki disease?
Monocutaneous lymph node syndrome
Acute systemic vasculitis of unknown cause
75% of Kawasaki cases are:
in kids under 5
Kawasaki is also
self-limiting
In a person w/ Kawasaki they are at an increased risk of
coronary artery aneurysm
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
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
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?
Isolation is not necessary, unless the child is immunosuppressed
Rubeola is what?
Measles
A respiratory infection
Is rubeola (measles) contagious?
Yes, very
MMR vaccine
What are the signs/symptoms of rubeola? (measles)
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
What are the potential complications of rubeola?
ear infections, encephalitis (inflammation of the brain)
Pneumonia, NVD, Croup, Thrombocytopenia, problems w/ fetus if pregnant
When is MMR given for rubeola/measles?
12-15 months old and again at 4-6 years old
NO VACCINE for pregnant women, or certain allergies
What is mumps (paperas) ?
A viral disease that affects the parotid glands
Signs/symptoms of mumps (paperas)
can affect one side or both
Rare complications
Swollen, painful parotid glands, fever weakness, fatigue
What is rubella (German measles)?
"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
What is scarlet fever? (Strawberry tongue)
AKA Scarlatina
Sometimes occurs w/ strep throat
Signs/symptoms of scarlet fever?
Red rash, sunburn appearance, Pastia's lines,
Otitis media, meningitis, endocarditis; others
Pediatric autoimmune neuropsychiatric disorders are associated with what?
disorders associated w/ streptococcal infections
What is conjunctivitis?
Infections of the eye
Treated w/ ophthalmic eye drops
HIGHLY CONTAGIOUS via skin to skin contact
Wipe eye with warm cloth
Immobilization was once though to be restorative for patients with illness and injury, we now know what?
immobilization has serious consequences:
physical
social
psychological
What is essential for physical growth and development?
physical activity, it can serve as a means of communication and as a means of learning
If a child has a spica cast or hip abductor, socially the child may feel what?
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
In order to heal the child needs:
blood flow
Children NEED to play, and when they are confined to a bed this is:
very difficult
Traumatic injuries can cause soft-tissue injury, what is this?
injuries to muscles, ligaments, and tendons
Sports injuries
Mishaps during play
If a soft-tissue injury does occur what should you do right away?
Apply ice immediately (within 30 minutes) will reduce swelling
Therapeutic management of soft tissue injuries:
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)
What is a fracture?
A common injury in kids
Methods of treatment are different than adults
Rare in infants, except w/ motor vehicle crashes
What is the most frequently broken bone in childhood?
Clavicle, especially in kids under 10

Most common in school age is bike, and sports injuries
The weakest point of the long bones is the what?
cartilage growth plate (epiphyseal plate)
Epiphyseal injuries are a:
frequent site of damage during trauma
May affect future bone growth
What is treatment for epiphyseal injuries?
open reduction and internal fixation to prevent growth disturbances
What is a simple or closed fracture?
Does not produce a break in the skin
Compound or open?
fractured bone protrudes through the skin
complicated
bone fragments have damaged other organs or tissues
Comminuted
small fragments of bone are broken from fractured shaft and lie in surrounding tissue
Plastic
Bone has a bend with no break
Buckle
Small crack in it
Greenstick
broken more than half way through but stops before a complete break
Complete
full break
complete w/ periosteal hinge
full break w/ some attachment
Fiberglass cast
they can still swim & pick the color
Cast care at home
Do not scratch inside can cause infection
Cast is removed w/
a saw
What is congenital club foot?
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
How is bilateral club foot treated?
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.
What is scoliosis?
The most common spinal deformity
one hip higher than the other or one shoulder higher than the other
A complex spinal deformity in three planes includes:
lateral curvature
spinal rotation causing rib asymmetry
Thoracic hypokyphosis
May be congenital or develop during childhood
Scoliosis is caused by what?
multiple potential causes, most cases idiopathic
When does scoliosis usually become noticeable?
after a preadolescent growth spurt
may have complaints of ill fitting clothes
school screening is controversial
What is the diagnostic evaluation for scoliosis?
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
What is therapeutic management of scoliosis?
Team approach to treatment
Bracing
Exercise
Surgical intervention from severe curvature(instrumentation and fusion)
Harrington rods
Lugue rods
Standard thoracolumbosacral (TLSO) braces are available for what?
Idiopathic scoliosis
Available in color and design for kids
Provide needed support for spine curvature
Nursing Care management for scoliosis
Concerns of body image is a big one to kids
concerns of prolonged treatment of condition
pre op. care
post op. care
family issues
What is OSGOOD-SCHLATTER DISEASE?
pain below the knee cap
pain aggravated by activity and relieved by rest
Nursing care of OSGOOD-SCHLATTER DISEASE:
manage pain
ice knee after exercising
maintain limited
activity
collaborate w/ physical therapist
OSGOOD SCHLATTER DISEASE is caused by what?
repetitive injury and repair to the tibia where the patellar tendon attaches. Often wear small brace just under the knee to support tendon.
What is cerebral palsy? (CP)
Characterized by abnormal muscle tone and coordinatioon
Incidence 1.5-3 per 1000 live births
What is the most common permanent physical disability in childhood?
Cerebral Palsy
15-60% of these children will also have epilepsy
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:
CP
Most common reason for CP
anoxia
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
Diagnostic evaluation of CP
Infants at risk warrant careful assessment during early infancy
Neurologic exam and history
Neuroimaging
Metabolic and genetic testing
What are the possible motor signs of CP?
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
Possible behavioral signs of
CP
excessive irritability
no smiling by age 3 months
feeding difficulties
persistent tongue thrusting
frequent gagging or choking w/ feeds
CP and IQ
Wide variation
30-50% of CP pt.'s are cognitively impaired
Difficult to assess
rigid, atonic, and quadiparetic have highest incidence of profound impairment
What are the goals of therapy for CP?
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)
Therapeutic management for CP
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
Diplegia
both arms or both legs
monoplagia
only one extremity
triplegia
3 extremities
paraplegia
pure cerebral paraplegia of lower extremities
Medications can now be given to decrease spasticity
Nursing Care mngmt. of CP
Assist the family in devising and modifying equipment and activities
Medication administration( is very difficult)
Safety precautions
Recreational activities
Support family
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
Attention Deficit Hyperactivity Disorder
Signs/Symptoms
Hyperactivity
Impulsivity
Distractibility
Inattention
Nursing Care for ADHD
Evaluate by using a rating scale
Discuss pharmacological intervention (Ritalin)
Discuss psychosocial intervention (behavioral therapy, rewards, and positive versus negative reinforcement)
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
Hospice
terminal illness when the pt. is expected to die w/in 6 months
palliative care
quality of life
History of pediatrics
Late 1800s
little to offer, few physicians, ease of symptoms
Early to mid 1900s
sweeping changes, antibiotics, CPR, anesthesia, parents and siblings excluded, distancing from the dying
evolution of pediatrics
milk stations
school nurses's
inclusion of parents
Definition of palliative care
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)
What are the barriers to care?
Money
language
culture
geography
education