FINAL REVIEW Flashcards
1
Q
Major stressor of children ages 6 to 30 months
A
SEPARATION ANXIETY, also called anaclitic depression.
2
Q
What are the 3 stages of separation anxiety
A
protest, despair, detachment
3
Q
Describe the protest stage of separation anxiety
A
cries, screams, searches for parents, avoids strangers, may verbally/physically attack strangers,
4
Q
Describe the despair stage of separation anxiety
A
inactive, withdrawn, depressed, regressive behavior, may refuse to eat/drink
5
Q
Describe the detachment/denial stage of separation anxiety
A
increased interest, interacts with strangers, appears happy, difficult to reverse damaging psychological effects at this point
6
Q
T/F: A toddler throwing a temper tantrum once the parent returns is a sign of abuse and should be investigated further
A
False. If the child is very “clingy” but seems unhappy, this is normal reaction to a child experiencing separation anxiety
7
Q
T/F: It is normal for a child to be “hot and cold” towards parents after being discharged from a inpatient experience
A
True. Both young and older children may switch between aloofness towards parents, followed by clingy/demanding behavior towards parents.
8
Q
Informed consent should include…
A
- The person must be capable of giving consent
- he or she must be over the age of 18
- must be considered competent (i.e., possess the mental capacity to make choices and understand their consequences) - The person must receive the information needed to make an intelligent decision.
- The person must act voluntarily, exercising freedom of choice without force, fraud, deceit, duress, or other forms of constraint or coercion.
8
Q
T/F: One universal informed consent is the only paperwork required for a hospital stay
A
false. Written informed consent of the patient, parent, or legal guardian is usually required for medical or surgical treatment of a minor, including many diagnostic procedures.
One universal consent is not sufficient.
9
Q
Who is allowed to sign informed consent forms for children
A
As long as children are minors, their parents or legal guardians are required to give informed consent before medical treatment is rendered or any procedure is performed.
If the parents are married to each other, consent from only one parent is required for nonurgent pediatric care. If the parents are divorced, consent usually rests with the parent who has legal custody
If there wasn’t a parent available to give consent during an emergency situation, they can withdraw consent later. If the legal caregivers disagree on the treatment course, it is within the health care providers’ scope to request consultation of a hospital ethics board.
10
Q
T/F: A nurse can explain the procedure, risks, benefit’s, and alternatives to a procedure.
A
FALSE: A nurse can only REINFORCE what the patient has been told and witness the signature.
11
Q
When can verbal consent be used for informed consent?
A
If parents are unavailable to sign consent forms, verbal consent may be obtained via the telephone in the presence of two witnesses. Both witnesses record that informed consent was given and by whom.
12
Q
What is the age of majority,
A
the age at which a person is considered to have all the legal rights and responsibilities of an adult. In most states, 18 years is the age of majority
13
Q
What is an emancipated minor
A
legally under the age of majority but is recognized as having the legal capacity or social status of an adult under circumstances prescribed by state law, such as pregnancy, marriage, high school graduation, independent living, or military service.
14
Q
How can you treat a child when the parents do not consent
A
If the child is accompanied by a grandparent, child care provider, teacher, or others.
Parental refusal to give consent for life-saving treatment or to prevent serious harm can occur and requires notification to child protective services to render emergency treatment.
15
Q
When can adolescents receive care without their parent’s knowledge
A
All 50 states have enacted legislation that entitles adolescents to consent to treatment without the parents’ knowledge to one or more “medically emancipated” conditions such as sexually transmitted infections, mental health services, substance abuse and addiction, pregnancy, and contraceptive advice. Consent to abortion is controversial, and statutes vary widely by state.
16
Q
How do you prepare a child for oral medication
A
give them ice or a popsicle to numb their tastebuds
mix with sweet things
avoid giving with dairy
if it causes nausea, give bubbly drink before and after
pinch the nose when swallowing
don’t combine with foods the child NEEDs to eat in case they refuse to eat later
16
Q
What is the most accurate means for measuring small amounts of medication
A
the plastic disposable calibrated oral syringe
Molded plastic cups with measuring lines are often supplied with over-the-counter medications for cough and fever, but most families in one study could not accurately measure a 5-mL dose within 0.5 mL
17
Q
T/F: In infants up to 11 months old and children with neurologic impairments, blowing a small puff of air in the face frequently elicits a swallow reflex.
A
True
18
Q
What techniques can you use when using an oral syringe for med admin
A
Infants: give them a bottle with milk the same time as syringe insertion. slowly dribble med into side of mouth
Children: have them help you, release the med against the inner cheek toward the lower teeth little by little as the child swallows
If the child fights the med admin, have the parent hold them sitting up in the lap, and slowly admin
19
Q
What syringe should you use for IM injection volumes less than 1 mL
A
the tuberculin syringe, calibrated in 0.01-mL increments, is appropriate.
20
Q
How much solution remains in a standard needle hub after plunging
A
0.2 ml
21
Q
How do you prevent IM drugs from getting into SQ tissue
A
The Z-track method is performed by using the nondominant hand to move skin slightly laterally at the injection site just prior to inserting the needle. This action will shift the subcutaneous skin over the muscle below. Maintain the skin in this displaced position while giving the injection, then remove the needle before releasing the skin. The skin and subcutaneous tissue slide back to their original position, creating an interruption in the needle’s pathway and minimizing the risk of fluid leaking from the muscle into subcutaneous tissue.
22
Q
What size needles do you generally use for IM meds
A
Smaller-diameter (25- to 30-gauge) needles
23
How much med can be administered at once to pediatric muscles
Usually 1 mL is the maximum volume that should be administered in a single site to small children and older infants. The muscles of small infants may not tolerate more than 0.5 mL.
24
Where is the best place to admin IM meds in infants
anterolateral thigh or vastus lateralis
25
How can you mitigate pain when giving an injection to a child
make the site cold before, apply pressure to site before
26
When do you expect to have to measure I/Os
* Current IV therapy * Recent major surgery * Medications that include diuretic or corticosteroid therapy * Severe thermal burns or injuries * Renal disease or damage * Congestive heart failure * Dehydration * Diabetes mellitus * Oliguria * Respiratory distress * Chronic lung disease
27
How do you calculate the output in a diaper
weigh all dry diapers to be used and note in an indelible marker the dry weight of the diaper; when there is fluid (urine or liquid stool) in the diaper, the amount of output can be approximated by subtracting the weight of the dry diaper from the weighed amount of the wet diaper.
The volume of fluid in milliliters is equivalent to the weight of the fluid measured in grams.
28
How do you use urine to assess whether a pt is hydrated
The specific gravity as a measure of urine osmolality assists in assessing the degree of hydration.
29
Describe A traditional nuclear
A traditional nuclear family consists of a married couple and their biologic children. Children in this type of family live with both biologic parents and, if siblings are present, only full brothers and sisters (i.e., siblings who share the same two biologic parents). No other persons are present in the household (i.e., no steprelatives, foster or adopted children, half-siblings, other relatives, or nonrelatives).
30
Describe The nuclear family
The nuclear family is composed of two parents and their children. The parent-child relationship may be biologic, step, adoptive, or foster. Sibling ties may be biologic, step, half, or adoptive. The parents are not necessarily married. No other relatives or nonrelatives are present in the household.
31
Describe a blended family
A blended family or household, also called a reconstituted family, includes at least one stepparent, stepsibling, or half-sibling. A stepparent is the spouse of a child’s biologic parent but is not the child’s biologic parent. Stepsiblings do not share a common biologic parent; the biologic parent of one child is the stepparent of the other. Half-siblings share only one biologic parent.
32
Describe a extended family
An extended family or household includes at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. Parent-child and sibling relationships may be biologic, step, adoptive, or foster.
33
Describe a single-parent family
The contemporary single-parent family has emerged partially as a consequence of the women’s rights movement and also as a result of more women (and men) establishing separate households
34
Describe a binuclear family
the binuclear family refers to parents continuing the parenting role while terminating the spousal unit. The degree of cooperation between households and the time the child spends with each can vary. In joint custody, the court assigns divorcing parents equal rights and responsibilities concerning the minor child or children. These alternate family forms are efforts to view divorce as a process of reorganization and redefinition of a family rather than as a family dissolution.
35
Describe an authoritarian parenting style
Authoritarian parents try to control their children’s behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. The message is: “Do it because I say so.”
often results in rigidly conforming behavior in the children, who tend to be sensitive, shy, self-conscious, retiring, and submissive.If not, this style of parenting may be associated with both defiant and antisocial behaviors.
36
Describe an permissive parenting style
Permissive parents exert little or no control over their children’s actions. They avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. These parents consider themselves to be resources for the children, not role models. If rules do exist, the parents explain the underlying reason, elicit the children’s opinions, and consult them in decision-making processes. They employ lax, inconsistent discipline; do not set sensible limits; and do not prevent the children from upsetting the home routine. These parents rarely punish the children.
37
Describe an authoritative parenting style
Authoritative parents combine practices from both of the other parenting styles. They direct their children’s behavior and attitudes by emphasizing the reason for rules and negatively reinforcing deviations. They respect the individuality of each child and allow the child to voice objections to family standards or regulations. Parental control is firm and consistent but tempered with encouragement, understanding, and security. Control is focused on the issue, not on the withdrawal of love or the fear of punishment.
Parents’ realistic standards and reasonable expectations produce children with high self-esteem who are self-reliant, assertive, inquisitive, content, and highly interactive with other children.
38
Describe the impact of social media on preschool age children
frequent use carries risks for increased rates of obesity; disrupted sleep; and delays in cognitive, social, and language development, potentially related to diminished parent-child interaction in preschoolers (Table 27.2).
Research has demonstrated that there is limited benefit of digital technology for children younger than 2 years of age, also likely related to diminished parent-child interaction. The benefits of digital technology use are related to the type of content viewed and used. For example, high-quality programming, such as Sesame Street, can bolster cognitive and social outcomes in preschool-age children, and applications from similar organizations (e.g., PBS or Sesame Workshop) can promote literacy skills.
39
What is the difference between growth, development, maturation, and differentiation
Growth— an increase in number and size of cells as they divide and synthesize new proteins; results in increased size and weight of the whole or any of its parts
Development— a gradual change and expansion; advancement from lower to more advanced stages of complexity; the emerging and expanding of the individual’s capacities through growth, maturation, and learning
Maturation— an increase in competence and adaptability; aging; usually used to describe a qualitative change; a change in the complexity of a structure that makes it possible for that structure to begin functioning; to function at a higher level
Differentiation— processes by which early cells and structures are systematically modified and altered to achieve specific and characteristic physical and chemical properties; sometimes used to describe the trend of mass to specific; development from simple to more complex activities and functions
40
Describe the 3 phases of the prenatal period
Germinal: Conception to approximately 2 weeks old
Embryonic: 2– 8 weeks old
Fetal: 8– 40 weeks old (birth)
41
Describe the 2 phases of the infancy period
Neonatal: Birth to 27 or 28 days old
Infancy: 1 to approximately 12 months
The infancy period is one of rapid motor, cognitive, and social development. Through mutuality with the caregiver (parent), the infant establishes a basic trust in the world and the foundation for future interpersonal relationships. The critical first month of life, although part of the infancy period, is often differentiated from the remainder because of the major physical adjustments to extrauterine existence and the psychologic adjustment of the parent.
42
Describe the 2 phases of the early childhood period
Toddler: 1– 3 years old
Preschool: 3– 6 years old
This period, which extends from the time children attain upright locomotion until they enter school, is characterized by intense activity and discovery. It is a time of marked physical and personality development. Motor development advances steadily. Children at this age acquire language and wider social relationships, learn role standards, gain self-control and mastery, develop increasing awareness of dependence and independence, and begin to develop a self-concept.
43
Describe the middle childhood period
Middle childhood— 6– 11 or 12 years old
Frequently referred to as the school age, this period of development is one in which the child is directed away from the family group and centered around the wider world of peer relationships. There is steady advancement in physical, mental, and social development with emphasis on developing skill competencies. Social cooperation and early moral development take on more importance with relevance for later life stages. This is a critical period in the development of a self-concept.
44
Describe the 2 phases of the late childhood period
Prepubertal: 10– 13 years old
Adolescence: 13 to approximately 18 years old
The tumultuous period of rapid maturation and change known as adolescence is considered to be a transitional period that begins at the onset of puberty and extends to the point of entry into the adult world— usually high school graduation. Biologic and personality maturation are accompanied by physical and emotional turmoil, and there is redefining of the self-concept. In the late adolescent period, the young person begins to internalize all previously learned values and to focus on an individual, rather than a group, identity.
45
Describe the cephalocaudal, or head-to-tail, directional trend of growth in infants
The head end of the organism develops first and is large and complex, whereas the lower end is small and simple and takes shape at a later period. The physical evidence of this trend is most apparent during the period before birth, but it also applies to postnatal behavior development. Infants achieve control of the heads before they have control of their trunks and extremities, hold their backs erect before they stand, use their eyes before their hands, and gain control of their hands before they have control of their feet.
46
Describe the the proximodistal, or near-to-far, developmental trend in infants
embryonic development of limb buds, which is followed by rudimentary fingers and toes. In infants, shoulder control precedes mastery of the hands, the whole hand is used as a unit before the fingers can be manipulated, and the central nervous system develops more rapidly than the peripheral nervous system. These trends or patterns are bilateral and appear symmetric— each side develops in the same direction and at the same rate as the other.
47
Describe the the differentiation, developmental trend in infants
describes development from simple operations to more complex activities and functions, from broad, global patterns of behavior to more specific, refined patterns. All areas of development (physical, cognitive, social, and emotional) proceed in this direction.
48
Describe the different theories (freud/psychosex, erikson/psychosocial, Piaget/cognitive, and Kohlberg/Moral judgement) opinion on the development of personality and cognitive function from:
(birth to 2 years old)
FREUD: ORAL
ERIKSON: TRUST/MISTRUST
PIAGET: SENSORIMOTOR
49
Describe the different theories (freud/psychosex, erikson/psychosocial, Piaget/cognitive, and Kohlberg/Moral judgement) opinion on the development of personality and cognitive function from:
(2-4 years old)
FREUD: ANAL
ERIKSON: AUTONOMY VS SHAME/DOUBT
PIAGET:PREOPERATIONAL THOUGHT, PRECONCEPTUAL PHASE (SPECIFIC TO SPECIFIC THOUGHT)
50
Describe the different theories (freud/psychosex, erikson/psychosocial, Piaget/cognitive, and Kohlberg/Moral judgement) opinion on the development of personality and cognitive function from:
(4-7 years old)
FREUD: PHALLIC
ERIKSON: INITIATIVE VS GUILT
PIAGET: PREOPERATIONAL THOUGHT (REASONING)
51
Describe the different theories (freud/psychosex, erikson/psychosocial, Piaget/cognitive, and Kohlberg/Moral judgement) opinion on the development of personality and cognitive function from:
(7-11 years old)
FREUD: LATENCY
ERIKSON: INDUSTRY VS INFERIORITY
PIAGET: CONCRETE OPERATIONS (BEGINNING REASONING/LOGIC)
52
Describe the different theories (freud/psychosex, erikson/psychosocial, Piaget/cognitive, and Kohlberg/Moral judgement) opinion on the development of personality and cognitive function from:
(11-15 years old)
FREUD: GENITAL
ERIKSON: IDENTITY VS ROLE CONFUSION
PIAGET: FORMAL OPERATIONS (DEDUCTIVE/ABSTRACT REASONING)
53
If signs of readiness for a physical exam are not observed, the nurse should do what to prepare the child
* Talk to the parent while essentially “ignoring” the child; gradually focus on the child or a favorite object, such as a doll.
* Make complimentary remarks about the child, such as about his or her appearance, dress, or a favorite object.
* Tell a funny story or play a simple magic trick.
* Have a nonthreatening “friend” available, such as a hand puppet to “talk” to the child for the nurse
54
if a child refuses to cooperate during a physical exam, the nurse should...
* Assess the reason for uncooperative behavior; consider that a child who is unduly afraid may have had a traumatic experience.
* Try to involve child and parent in the process.
* Avoid prolonged explanations about the examining procedure.
* Use a firm, direct approach regarding expected behavior.
* Perform examination as quickly as possible.
* Have the attendant gently restrain the child.
55
What should you always examine last in children
Perform traumatic procedures last (eyes, ears, mouth [while crying]). Elicit reflexes as the body part is examined. Elicit Moro reflex last.
56
Describe the FLACC Postoperative Pain Tool
Face (0– 2) Legs (0– 2) Activity (0– 2) Cry (0– 2) Consolability (0– 2)
2 months old to 7 years old
57
Describe the Wong-Baker FACES Pain Rating Scale
Consists of six cartoon faces ranging from smiling face for “no pain” to tearful face for “worst pain”
For children as young as 3 years old.
58
Describe using the numeric scale to identify pain
Explain to the child that at one end of the line is 0, which means that person feels no pain (hurt). At the other end is usually a 5 or 10, which means the person feels the worst pain imaginable. The numbers 1– 5 or 1– 10 are for very little pain to a whole lot of pain. Ask the child to choose the number that best describes their own pain.
For children as young as 5 years old, as long as they can count and have some concept of numbers and their values in relation to other numbers.
59
How fast does a newborn grow in the first 6 months
Weight gain of 150– 210 g (5– 7 oz) weekly
60
when does the posterior fontanel close
2 months. Crawling reflex also disappears
61
when does a newborn stop constantly being in a flexed position
2 months
62
When should a baby be able to hold their head up by
3 months fades, 4 months gone. will also begin losing primitive reflexes
63
A baby should be double their birth weight by
5 months
64
When would you expect teething to begin
5-7 months
65
When do babies start holding things and putting it in their mouths
5 months
66
when do babies start sitting
5 months sitting supported, 6 months on their own
67
When does a baby begin to respond to their name
7 months
68
When does a baby start to stand while holding onto something
8 months
69
When does pincer grip develop
8 months old
70
When does a baby start to crawl
9 months
71
When does a baby start to take steps when standing
10 months
72
When should the chest and head circumference be the same
12 months
73
At what age is a baby expected to be triple their birth weight
12 months
74
Erikson’s phase I (birth to 1 year old) is concerned with...
acquiring a sense of trust while overcoming a sense of mistrust. The trust that develops is a trust of self, of others, and of the world. Infants “trust” that their feeding, comfort, stimulation, and caring needs will be met.
75
Describe the clinical manifestations of down syndrome
Depressed nasal bridge (saddle nose)
Small ears and narrow canals Short pinna (vertical ear length)
Protruding tongue
Neck skin excess and Short and broad neck
Pectus excavatum or carinatum Congenital heart defects common
Umbilical hernia Small penis
Short stature Hyperflexibility and muscle weakness Hypotonia
Reduced birth weight Learning difficulty (average intelligence quotient [IQ] of 50) Hypothyroidism common Impaired immune function Increased risk of leukemia
76
What are some things you need to educate parents with a newborn that has down syndrome
The newborn will not be clingy or molding when held. They will have very little muscle tone so wrap them snugly in a blanket before picking up. The decreased muscle tone and abnormal shape of nose might make breathing difficult. The tongue will often protrude, it does not mean they don't want to feed. If they accidentally push food out of their mouth, refed them. The child may be prone to constipation and obesity. As the child ages, their skin will become dry and cracked.
77
What are the characteristics and treatment for asthma
Wheezing, cough, labored respirations
Inhaled corticosteroids, bronchodilators
78
What are the characteristics and treatment for croup
Acute Epiglottitis (bacterial, might need intubation, rapid onset, drooling) Tx: airway protection antibiotics, corticosteroids, fluids, humidified O2
Acute LTB (viral, slow onset) Tx: humidified O2, nebulized epi, Heliox)
Acute Spasmodic Laryngitis (viral, sudden @ night), Tx: cool mist, reassurance
Acute Tracheitis (Viral, Moderately progressive), Antibiotics Fluids
79
What are the characteristics and treatment for RSV
* Fever * Irritability, restlessness * Decreased appetite and fluid intake * Sneezing * Nasal mucus (abundant) causing mouth breathing * Vomiting or diarrhea may be present * Decreased activity
Supplemental oxygen if saturations ≤ 90%; bronchodilators (optional) Suction nasopharynx
80
T/F: The most common reason a child needs CPR is from a heart attack
False. Cardiac arrest in children occurs more frequently due to prolonged hypoxemia secondary to inadequate oxygenation, ventilation, and circulation (shock) than due to a cardiac condition.
81
What is the first intervention a nurse should perform when a child stops breathing
Apnea signals the need for rapid, vigorous action to prevent cardiac arrest. In such situations, nurses must initiate action immediately and notify emergency personnel.
82
T/F: the sequence for CPR is A-B-C (airway, breathing or ventilation, and chest compressions)
False: American Heart Association guidelines changed this recommended sequence to C-A-B to reduce the amount of time to the initiation of chest compressions
83
What should the depth of CPR compressions be for children
should be at least one-third of the anteroposterior diameter of the chest (4 cm in infants and 5 cm in older children).
84
Describe the rate, depth, and breath rate during CPR
Chest compressions should be at a rate of 100 to 120 per minute and chest compression depth should be at least 2 inches (5 cm) but not more than 2.4 inches (6 cm). Each breath should be delivered at a rate of 1 breath every 6 seconds.
85
When should you start CPR on an infant
Rescuers should start CPR if the child is unresponsive and not breathing or not breathing normally or if they failed to detect a pulse within 10 seconds.
86
What is GERD
The normal intermittent relaxation of the lower esophageal sphincter results in involuntary backflow of stomach contents into the esophagus, known as gastroesophageal reflux (GER).
GERD is when GER is severe enough to cause dysphagia, esophagitis, and aspiration
87
How do you treat GERD
Treatment may include medications to reduce gastric acidity such as antacids, histamine-blocking agents, or proton pump inhibitors, and medication to increase gastric motility. In severe cases, surgical treatment may be considered.
88
What is the most common cause of emergency abdominal surgery in childhood.
Acute appendicitis
89
What are Sx of appendicitis
the first symptom of appendicitis is periumbilical pain, followed by nausea, right lower quadrant pain, and, later, vomiting with fever
Perforation of the appendix can occur within approximately 48 hours of the initial complaint of pain
90
What are the Sx of celiac disease
The term celiac disease is often used to describe a symptom complex with four characteristics:
(1) steatorrhea (fatty, foul, frothy, bulky stools),
(2) general malnutrition,
(3) abdominal distention, and
(4) secondary vitamin deficiencies.
91
What does an undiagnosed person with celiac look like
Malnutrition Muscle wasting (especially prominent in legs and buttocks) Anemia Anorexia Abdominal distention
Irritability Uncooperativeness Apathy
92
How do you Dx people with celiac
Positive serologic markers should be followed by an upper GI endoscopy with biopsy. The diagnosis of celiac disease is based on a biopsy of the small intestine demonstrating the characteristic changes of mucosal inflammation, crypt hyperplasia, and villous atrophy
93
Describe Congenital Heart Disease (CHD)
CHD includes primarily anatomic abnormalities present at birth that result in abnormal cardiac function. The clinical consequences of congenital heart defects fall into two broad categories: heart failure (HF) and hypoxemia.
94
What are the four classifications of CHD
(1) increased pulmonary blood flow;
(2) decreased pulmonary blood flow;
(3) obstruction to blood flow out of the heart; and
(4) mixed blood flow, in which saturated and desaturated blood mix within the heart or great arteries.
95
Defects With Increased Pulmonary Blood Flow
Atrial septal defect— Abnormal opening between the atria, allowing blood from the higher-pressure left atrium to flow into the lower-pressure right atrium.
Clinical manifestations— Patients may be asymptomatic. Spontaneous closure of ASDs are most likely to occur in younger patients
Ventricular septal defect— Abnormal opening between the ventricles. May vary in size from a small pinhole to absence of the septum, which results in a common ventricle. VSDs are frequently associated with other defects
Clinical manifestations— HF is common. There is a characteristic murmur. Surgical treatment
Atrioventricular canal defect---allows blood to flow between all four chambers of the heart. The directions and pathways of flow are determined by pulmonary and systemic resistance, left and right ventricular pressures, and the compliance of each chamber, although flow is generally from left to right. It is the most common cardiac defect in children with Down syndrome.
Clinical manifestations— Patients usually have moderate to severe HF. There is a characteristic murmur. There may be mild cyanosis that increases with crying.
Patent ductus arteriosus— Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life. The continued patency of this vessel allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, which causes a left-to-right shunt.
Clinical manifestations— The amount of shunting will determine the degree of clinical manifestations. There is a characteristic machinery-like murmur. Patients may be asymptomatic or show signs of HF.
96
Describe the different obstructive defects of the heart
Coarctation of the aorta Description— Localized narrowing near the insertion of the ductus arteriosus, which results in increased pressure proximal to the defect (head and upper extremities) and decreased pressure distal to the obstruction (body and lower extremities).
Clinical manifestations— There may be high blood pressure and bounding pulses in the arms, weak or absent femoral pulses, and cool lower extremities with lower blood pressure.
Aortic stenosis Description— Narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion.
Clinical manifestations— Newborns with critical AS demonstrate signs of decreased cardiac output with faint pulses, hypotension, tachycardia, and poor feeding. Children show signs of exercise intolerance, chest pain, and dizziness when standing for a long period.
Pulmonic stenosis Description— Narrowing at the entrance to the pulmonary artery. Resistance to blood flow causes right ventricular hypertrophy and decreased pulmonary blood flow.
Clinical manifestations— Patients may be asymptomatic; some have mild cyanosis or HF. Progressive narrowing causes increased symptoms.
97
Describe Heart Defects With Decreased Pulmonary Blood Flow
Tetralogy of fallot Description— The classic form includes four defects: (1) ventricular septal defect (VSD), (2) pulmonic stenosis, (3) overriding aorta, and (4) right ventricular hypertrophy.
Clinical manifestations— Some infants may be acutely cyanotic at birth; others have mild cyanosis that progresses over the first year of life as the pulmonary stenosis worsens. There is a characteristic murmur. There may be acute episodes of cyanosis and hypoxia, called blue spells or tet spells.
Tricuspid atresia Description— The tricuspid valve fails to develop; consequently, there is no communication from the right atrium to the right ventricle. Blood flows through an atrial septal defect (ASD) or a patent foramen ovale to the left side of the heart, through the VSD to the right ventricle and out to the lungs.
Clinical manifestations— Cyanosis is usually seen in the newborn period. There may be tachycardia and dyspnea. Older children have signs of chronic hypoxemia with clubbing.
98
Describe Mixed Defects of the Heart
Transposition of the great arteries, or transposition of the great vessels
Description— The pulmonary artery leaves the left ventricle, and the aorta exits from the right ventricle, with no communication between the systemic and pulmonary circulations.
Clinical manifestations— Vary according to the type and size of the associated defects. Newborns with minimum communication are severely cyanotic and have depressed function at birth. Those with large septal defects or a patent ductus arteriosus may be less cyanotic but have symptoms of HF. Heart sounds vary according to the type of defect present. Cardiomegaly is usually evident a few weeks after birth.
Total anomalous pulmonary venous connection Description— Rare defect characterized by failure of the pulmonary veins to join the left atrium. Instead, the pulmonary veins are abnormally connected to the systemic venous circuit via the right atrium or various veins draining toward the right atrium, such as the superior vena cava. The abnormal attachment results in mixed blood being returned to the right atrium and shunted from the right to the left through an atrial septal defect (ASD).
Clinical manifestations— Most infants develop cyanosis early in life. The degree of cyanosis is inversely related to the amount of pulmonary blood flow— the more pulmonary blood, the less cyanosis.
Truncus arteriosus Description— Failure of normal septation and division of the embryonic bulbar trunk into the pulmonary artery and the aorta, which results in development of a single vessel that overrides both ventricles. Blood from both ventricles mixes in the common great artery, which leads to desaturation and hypoxemia. Blood ejected from the heart flows preferentially to the lower pressure pulmonary arteries, so pulmonary blood flow is increased and systemic blood flow is reduced.
Clinical manifestations— Most infants are symptomatic with moderate to severe HF and variable cyanosis, poor growth, and activity intolerance.
Hypoplastic left heart syndrome Description— Underdevelopment of the left side of the heart with significant hypoplasia of the left ventricle including atresia, stenosis, or hypoplasia of the aortic and/ or mitral valves, and hypoplasia of the ascending aorta and arch. Most blood from the left atrium flows across the patent foramen ovale to the right atrium, to the right ventricle, and out the pulmonary artery.
Clinical manifestations— There is mild cyanosis and signs of HF until the patent ductus arteriosus closes, then progressive deterioration with cyanosis and decreased cardiac output, leading to cardiovascular collapse. The condition is usually fatal in the first months of life without intervention.
99
How do you diagnose Kawasaki disease
Classic Kawasaki disease criteria include fever for 5 calendar days along with four of five clinical criteria
1. Changes in the extremities: In the acute phase, edema or erythema of the palms and soles; in the subacute phase, periungual desquamation (peeling) of the hands and feet
2. Bilateral conjunctival injection (inflammation) without exudation
3. Changes in the oral mucous membranes, such as erythema, cracking of the lips, oropharyngeal reddening; or “strawberry tongue” (large papillae are exposed)
4. Rash: Maculopapular, diffuse erythroderma, or erythema multiforme-like 5. Cervical lymphadenopathy (typically unilateral > 1.5 cm)
100
What are the 3 phases of Kawasaki disease
acute, subacute, and convalescent.
Acute: throughout. During this stage, the child is typically very irritable. Laboratory tests may demonstrate an elevated white blood cell count, elevated liver function tests, and elevated markers of inflammation (ESR and CRP).
Subacute: The subacute phase begins with resolution of the fever and lasts until all clinical signs of Kawasaki disease have disappeared. During this phase, coronary artery aneurysms may become evident, and previously dilated vessels may continue to increase in size. Irritability persists during this phase. Lab work shows a normochromic, normocytic anemia as well as thrombocytosis. Inflammatory markers start to resolve
Convalescent: all clinical signs of Kawasaki disease have resolved, and laboratory values are returning to normal. The entire illness lasts 6 to 8 weeks until the child has regained his or her usual temperament, energy, and appetite and all blood tests are back to normal.
101
What is Idiopathic thrombocytopenia (ITP)
an acquired hemorrhagic disorder characterized by (1) thrombocytopenia, (2) absence or minimal signs of bleeding (easy bruising, mucosal bleeding, petechiae) in most childhood cases, and (3) normal bone marrow with a normal or increased number of immature platelets
Clinical manifestations: Easy bruising * Petechiae * Ecchymoses * Most often over bony prominences Bleeding from mucous membranes * Epistaxis * Bleeding gums * Internal hemorrhage
102
Name Clinical Manifestations of Sickle Cell Disease
Extremities: Painful swelling of hands and feet (sickle cell dactylitis, or hand-foot syndrome), painful joints
Abdomen: Severe pain resembling acute surgical condition
Cerebrum: Stroke, visual disturbances
Chest: Symptoms resembling pneumonia, protracted episodes of pulmonary disease
Liver: Obstructive jaundice, hepatic coma
Kidney: Hematuria
Genitalia: Priapism (persistent painful penile erection)
Possible growth retardation
Chronic anemia (hemoglobin level of 6 to 9 g/ dL) Possible delayed sexual maturation
Marked susceptibility to sepsis
103
What is vasoocclusive crisis (sickle cell)
vasoocclusive crisis (VOC), preferably called a “painful episode,” is characterized by ischemia severe pain that may last from minutes to days or longer. Dactylitis (swelling in hands and feet) is often the first painful manifestation of VOC in children, usually occurring from 6 months to 2 years old.
104
What is Sequestration crisis (sickle cell)
Sequestration crisis is a pooling of a large amount of blood, usually in the spleen and infrequently in the liver, that causes a decreased blood volume and may ultimately cause shock.
Perry, Shannon E.; Hockenberry, Marilyn J.; Cashion, Kitty; Alden, Kathryn Rhodes; Olshansky, Ellen; Lowdermilk, Deitra Leonard. Maternal Child Nursing Care - E-Book (Kindle Locations 79869-79870). Elsevier Health Sciences. Kindle Edition.
105
What is Aplastic crisis (sickle cell)
Aplastic crisis is diminished RBC production, usually triggered by viral infection that may result in profound anemia.
106
What is Hyperhemolytic crisis (sickle cell)
an accelerated rate of RBC destruction characterized by anemia, jaundice, and reticulocytosis.
107
What is acute chest syndrome (ACS) (sickle cell)
is acute chest syndrome (ACS), which is clinically similar to pneumonia. It is the presence of a new pulmonary infiltrate and may be associated with chest pain, fever, cough, tachypnea, wheezing, and hypoxia
108
What is A CVA (stroke) (sickle cell)
a major complication, often caused by a vascular event as sickled cells block the blood vessels in the brain, resulting in cerebral infarction, which causes variable degrees of neurologic impairment.
109
Name some risk factors for Acute lymphoblastic leukemia
* Ionizing radiation (primarily of historical importance) * Race (i.e., White) * Genetic conditions (i.e., Down syndrome, Bloom syndrome, and others) * Birth weight more than 400 g
110
Name some risk factors for Wilms tumors
* Congenital anomalies (i.e., aniridia, Beckwith-Wiedemann syndrome, other congenital and genetic conditions) * Race (White and Black)
111
When would surgery be most effective as a cancer treatment
Surgery is most successful when the tumor is encapsulated and localized (confined to the site of origin). Surgery may be used for palliation when the cancer is regional (metastasized to an area adjacent to the original site) or advanced (widespread throughout the body). Generally, the best prognosis is directly related to early detection of the tumor because that facilitates surgical removal.
112
When would you use radiation to treat cancer
With surgery and or chemo
It can be used for curative purposes and for palliation to relieve symptoms by shrinking the size of the tumor. Recent advances in radiation therapy that allow the beam to be aimed precisely
can cause nausea, anorexia, mucosal ulceration, loose stool, alopecia, dry skin, bone marrow suppression,
113
Name the 3 types of biologic cancer treatments
(1) those that do not target cancer cells directly but stimulate the body’s immune system to act against cancer cells and that are collectively referred to as immunotherapy or biologic response modifier therapy;
(2) those that use antibodies or segments of genetic material to target cancer cells directly; and
(3) therapies that interfere with specific molecules involved in tumor growth and progression and that are referred to as targeted therapies
114
What do you do once you've administered chemo to a patient
it is standard practice to observe the child for 1 hour after the infusion for signs of anaphylaxis (e.g., rash, urticaria, hypotension, wheezing, nausea, vomiting).
Emergency equipment (especially blood pressure monitor, bag valve mask, and suction) and emergency drugs (especially oxygen, epinephrine, antihistamine, aminophylline, corticosteroids, and vasopressors) must be readily available.
115
Difference between childhood and adult cancer
Unlike many cancers in adults, childhood cancers are not strongly linked to lifestyle or environmental risk factors. And only a small number of childhood cancers are caused by DNA (gene) changes that are passed from parents to their child
116
Describe types of UTis, their manifestations, and how you Dx
Lower UTIs are often characterized by symptoms of irritation to the bladder, such as hesitancy to void, dysuria, frequency of voiding, and urine incontinence.
Upper UTIs or kidney infections (pyelonephritis) tend to present with fever and may lead to renal scarring that may be associated with decreased kidney function, hypertension, and renal disease over time. Upper UTIs may also present with additional symptoms of flank pain, nausea, or vomiting.
Diagnosis of UTI is made based on the presence of both pyuria and at least 50,000 colonies/ mL of a single uropathic organism in an appropriately collected specimen
117
The single most important host factor influencing the occurrence of UTI is
urinary stasis.
118
A child who exhibits the following should be evaluated for urinary tract infection (UTI):
* Incontinence in a toilet-trained child * Frequency or urgency of voiding * Dysuria * Gross hematuria
119
What is Acute glomerulonephritis (AGN)
Common features include oliguria, edema, hypertension and circulatory congestion, hematuria, and proteinuria.
Most cases are postinfectious and have been associated with pneumococcal, streptococcal, and viral infections.
Acute poststreptococcal glomerulonephritis (APSGN) is the most common of the postinfectious renal diseases in childhood and the one for which a cause can be established in most cases.
120
Describe the differences between type 1 and type 2 diabetes
type 1: onset early in life, caused by leukocyte antigen, thirsty, hungry, pee a lot, are generally underweight, no pancreatic function, no natural insulin secretion at all, very little resistance to insulin, antibodies against Islet cells, results in a lot of chronic complications, KETOACIDOSIS COMMON, metformin is ineffective
type 2: onset later in life, gradual, mostly effects females, pt is overweight, most of the pancreas works, insulin production is initially high and then very low, extreme insulin resistance, ketoacid infrequent, changing the diet/metformin is often effects
121
What disease is the most common cause of hyperthyroidism in children
Graves disease (GD) is the most common cause of hyperthyroidism in children
GD-associated hyperthyroidism is caused by autoantibodies to the TSH receptor causing excess secretion of TH. Most cases of GD in children occur in adolescence, with a peak incidence between 12 and 14 years old.
Clinical features include irritability, hyperactivity, short attention span, tremors, insomnia, emotional lability, poor concentration, nervousness, and palpitations or tremor
Exophthalmos (protruding eyeballs), which is observed in many children, is accompanied by a wide-eyed staring expression, increased blinking, eyelid lag, lack of convergence, and absence of wrinkling of the forehead when looking upward.
122
How should you counsel the parents of a child that i newly diagnosed with Graves disease
Children with hyperthyroidism need a quiet, unstimulating environment that is conducive to rest. Increased metabolic rate may cause heat intolerance and increased food intake in these patients. Mood swings and irritability can disrupt relationships, creating difficulties within and outside the home. Nurses can help parents understand the medical reason for behavior changes and offer ways to minimize them. A school consultation is important to provide education and suggest ways to assist a child after diagnosis.
123
The earliest indication of hypoparathyroidism may be
anxiety and mental depression followed by paresthesia and evidence of heightened neuromuscular excitability,
124
Describe the Chvostek sign: (hypoparathyroidism)
Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland
125
Describe the Trousseau sign: (hypoparathyroidism)
Carpal spasm elicited by pressure applied to nerves of the upper arm
126
Describe Tetany: (hypoparathyroidism)
Carpopedal spasm (sharp flexion of wrist and ankle joints), muscle twitching, cramps, seizures, and stridor
127
Signs of hypothyroidism
Decreased growth
* Dry skin * Puffiness around eyes * Sparse hair * Constipation * Sleepiness * Mental decline
128
What disease is the most common cause of hypothyroidism in children
Lymphocytic thyroiditis (Hashimoto disease,
Enlarged thyroid gland Usually symmetric Firm Freely movable Nontender
Sense of fullness Hoarseness Dysphagia
129
How do you Dx hypoparathyroidism
The diagnosis of hypoparathyroidism is made based on clinical manifestations associated with decreased serum calcium and increased serum phosphorus.
130
How do you treat hypoparathyroidism
administration of calcium and vit d
131
