Download Nursing Review

Nursing Review 1
Pediatric Pearls
Ana H. Corona, DNP, FNP-BC
Nursing Instructor
Revised: September 2013
References: Nursing NCLEX LPN/RN Review 2007, Frye’s 3000 Nursing
Bullets, Pediatric Pearls Review 2006, CDC, 2012, Speech Over Software
Pediatric Nursing
• The infancy period lasts from birth to age 1.
• The toddler stage includes ages 1 to 3.
5/25/2017
2
Erickson
• According to Erikson, from birth to age 12
months, the child is in the trust-versusmistrust stage of psychosocial
development.
• To build trust, the infant needs consistent
care, love, and human touch.
5/25/2017
3
Growth & Development
• By age 3 to 4 months, an infant with normal
motor development should be able to lift and
control his head.
• Head lag is common in infants younger than age
3 months.
• After age 4 months, an infant should receive
supplemental iron.
• In infants ages 6 to 12 months, separation from
the mother evokes a more intense response
than any other stimulus.
5/25/2017
4
Growth & Development
• For the first 6 months of life, most infants are
weighed and measured monthly.
• At age 6 months, an infant should begin to
receive solid foods one at a time and 1 week
apart.
• Most infants double their birth weight by age 5 to
6 months and triple it by age 1 year.
• A 6- to 8-month-old infant should be able to sit
without assistance.
• The concept of object permanence develops
between ages 6 and 8 months.
• An 8-month-old infant engages in imitating
words.
5/25/2017
5
Growth & Development
• Between ages 10 and 12 months, a child begins
to show emotions, such as affection, jealousy,
and anger.
• By age 1, an infant usually has tripled his birth
weight and can take steps with support.
• During the oral stage of development (from age
1 to 18 months), the infant receives satisfaction,
relieves tension, and derives pleasure from
sucking and chewing.
• The most appropriate toy for a toddler age 18
months is one that helps to develop motor
coordination.
5/25/2017
Growth & Development
• Toilet sitting can begin at 18 months.
• Toilet training is usually unsuccessful before ages
15 to 18 months because sphincter control
develops at this age.
• Toilet training should begin when a child shows
signs of readiness, such as staying dry for 2
hours or longer and verbalizing the urge to
urinate.
• Most children achieve daytime bladder and bowel
control between ages 2 and 3.
• Failure to achieve toilet training by age 5 doesn’t
usually indicate pathology, but should be
investigated
by
a
physician.
5/25/2017
7
Growth & Development
• When determining which information to give a
hospitalized child about a procedure, the nurse
should consider the child’s developmental age,
not his chronological age.
• If parents report that their child holds his breath
during tantrums, the nurse should advise the
parents that this behavior won’t harm the child.
• Negativism is a normal sign of increasing
autonomy in a toddler.
• Parents should react with patience and humor
and should avoid head-on confrontations with
the child.
5/25/2017
8
Growth development
• A child begins to understand cause-andeffect relations at age 2, during the
sensorimotor stage.
• Between ages 2 and 3, a child engages in
parallel play and begins to interact with
others.
• By age 3, a child should be able to stand on
one foot.
• In a child age 3, having and frequently
speaking to an imaginary friend are normal
behaviors.
5/25/2017
9
Freud
• According to Freud, conflicts that arise in
the phallic stage (Oedipus or Electra
complex) are resolved when the child
identifies with the parent of the same sex.
• The oral stage occurs between birth and
age 18 months.
5/25/2017
10
The psychosexual stages of
development are
•
•
•
•
•
the oral stage (infancy birth to age 1),
the anal stage (toddlerhood ages 1 to 3)
the phallic stage (preschool ages 3 to 6)
the latency stage (school ages 6 to 12) and
the genital stage (adolescence and young
adulthood 12 to 18).
5/25/2017
11
Piaget
• According to Piaget, between the ages of
2 and 7, the child is in the egocentric stage
and isn’t particularly concerned about
rules.
• Masturbation is most common at age 4
and during adolescence.
• Modeling is a form of behavior in which
children imitate the behavior of a
significant other, such as a parent.
5/25/2017
12
Young’s Rule
• To calculate a pediatric dose using
Young’s rule, the nurse should multiply the
adult dose by the child’s age in years and
divide the result by the sum of the child’s
age plus 12.
5/25/2017
13
Clark’s Rule
• To calculate a pediatric dose using Clark’s
rule, the nurse should multiply the adult
dose by the child’s weight in pounds and
divide the result by 150.
5/25/2017
14
Bone Age
• To determine bone age, X-rays of the
tarsals and carpals are obtained to
determine the degree of ossification.
• This technique is used primarily when the
child is shorter or taller than expected for
his chronological age.
5/25/2017
15
Orthopedic Nursing
• A spica cast dries completely in 24 to 72 hours.
• In patients younger than age 3, developmental
dysplasia of the hip is the most common disorder
of the hip
• Growth disturbances, such as bone shortening or
overgrowth, may occur in children as a result of a
fracture of the epiphyseal plate.
• Greenstick fractures are the most common
fractures in children.
• The parent of a child who has a cast should watch
for edema, which causes decreased capillary refill.
• When caring for a child who is in traction, the
nurse should make sure that the body is in
alignment, especially the shoulders, hips, and
5/25/2017
16
legs.
Pagets Disease
• Bowlegs are a sign of Paget’s disease.
Scoliosis
• Signs include limping walk, uneven
hemline, and asymmetrical breasts.
5/25/2017
17
Legg-Calvé-Perthes disease
• Treatment consists of restricting weight
bearing and using a device, such as an
abduction brace or a harness sling, to
protect the affected joint while
revascularization and bone healing occur.
• Legg-Calvé-Perthes disease, or coxa
plana, is manifested in aseptic necrosis of
the head of the femur.
5/25/2017
18
Ortolani’s click
• Clinical manifestations of congenital
dislocation of the hip include gluteal folds,
with deeper creases apparent on the
affected side, and limited hip abduction on
the affected side which produces a click.
5/25/2017
19
Bryant’s Traction
• A child in Bryant’s traction who is younger
than age 3 or weighs less than 30 lb (13.6
kg) should have:
• The buttocks slightly elevated and clear of
the bed.
• The knees should be slightly flexed, and
the legs should be extended at a right
angle to the body.
• The body provides the traction mechanism.
5/25/2017
20
Bucks traction
• With running traction (Buck’s traction), the
patient may not be turned without
disrupting the line of pull.
• With balanced suspension traction, the
patient may be elevated, turned slightly,
and moved as needed.
5/25/2017
21
Bradford Frame
• A Bradford frame is commonly used to
immobilize a child who has a spica cast.
• A Bradford frame is used for long-term
immobilization of a child, such as a patient
with extensive burns or meningocele.
5/25/2017
22
Mist Tent
• To help calm a child who is frightened of a
mist tent, the nurse may suggest that a
parent lie with the child in the tent.
• When in a mist tent (Croupette), a child
may require soft restraints.
5/25/2017
23
Restraints
The nurse should use elbow restraints to protect
an infant with:
• Eczema
• A scalp vein infusion
• One who is recovering from cleft lip repair or eye
surgery.
The nurse should remove a child’s protective mitts
twice each shift to let the child exercise his
finger.
5/25/2017
24
Chicken Pox
• Rash has four stages: macules, papules,
vesicles, and crusts.
• Lesions of various stages occur at the
same time during the illness.
• A child with chickenpox requires
respiratory isolation.
5/25/2017
25
Measles
• Koplik’s spots are small, irregular, red
spots with minute, bluish white centers
that appear on the buccal mucosa of
patients with measles (rubeola).
5/25/2017
26
Thrush
• Thrush is candidiasis (Candida albicans)
of the oral mucous membranes.
• It’s characterized by aphthae, or small
ulcers, in the mouth.
5/25/2017
27
Cleft Palate
• An infant with a cleft palate is at increased risk
for otitis media.
• In an infant who has had corrective surgery for a
cleft lip or palate, the nurse should place oral
medication in the side of the mouth.
• A Logan bar is used postoperatively to prevent
suture line strain in a child who has had a cleft
lip repair.
• Although a cleft palate can be repaired at any
time, the optimal time for corrective surgery is
before the child begins speaking and learns
faulty speech habits.
5/25/2017
28
Increased Intracranial Pressure
• In an infant, a bulging fontanel is the most
significant sign of increasing intracranial
pressure.
• In setting-sun sign, which reflects
prolonged increased intracranial pressure
in children, the eyes are forced downward
so that a rim of sclera shows above the
irises.
5/25/2017
29
Suction
• To avoid hypoxia and apnea, the nurse
should suction an infant quickly and
gently.
• A longer period of suctioning may be used
if the nurse administers oxygen with a
handheld resuscitation bag between
periods of suctioning.
5/25/2017
30
Nursing Skills
• When a neonate receives phototherapy
with a fiberoptic light, it isn’t necessary to
cover his eyes or genitals.
• To facilitate emptying of the stomach after
feeding, the neonate is positioned on his
right side.
• In a toddler, the first signs of respiratory
distress are increased respiratory and
pulse rates.
5/25/2017
31
Nursing Skills
• When feeding an infant who has a tracheostomy
tube, the nurse should cover the opening of the
tracheostomy tube (stoma) with moistened
gauze.
• An infant with a gastrostomy tube should receive
a pacifier during feeding unless contraindicated
to provide normal sucking activity and satisfy
oral needs.
• In a neonate who is large for gestational age,
the serum glucose level should be measured.
• In children, the normal fasting glucose level is 60
to 100 mg/dl
5/25/2017
32
An infant
When
feeding
with aangastrostomy
infant who has
tubeashould
tracheostomy
receive tube,
a pacifier
the nurse
duringshould
feeding
cover
unless
thecontraindicated
opening of the to provide
In a neonate who is large for gestational age, the serum glucose level should be measured.
tracheostomy
normal
suckingtube
activity
(stoma)
and with
satisfy
moistened
oral needs.
gauze.
Nursing Skills
• To change a diaper, a nurse shouldn’t lift an
infant by the legs.
• The nurse should roll the infant to the side, put
the diaper in place, and then roll the infant onto
the diaper.
• When lifting an infant, the nurse should maintain
two points of contact with the infant’s body at all
times.
• For an infant, the nurse should start an I.V. line in
a peripheral vein or a vein in the temporal region.
5/25/2017
33
To change
The
When
For
an
nurse
lifting
infant,
should
aan
diaper,
the
infant,
nurse
rollathe
the
nurse
should
infant
nurse
shouldn’t
start
to
should
theanside,
lift
I.V.
maintain
anput
line
infant
the
intwo
aby
diaper
peripheral
points
the legs.
in of
place,
contact
vein and
or awith
then
vein
the
roll
in infant’s
the
thetemporal
infant
body
onto
at
region.
all
thetimes.
diaper.
Nursing Skills
• A preoperative method used to teach a child
about postoperative events is to describe these
events using a life-size doll that has an incision, a
dressing, a cast, or an I.V. line, as appropriate.
• The nurse shouldn’t hand-carry a hospitalized
infant or child.
• The patient should be transported in a stroller,
wheelchair, or bed.
• When examining an infant’s ear with an
otoscope, the nurse should pull the earlobe down
and back.
5/25/2017
34
A preoperative method used to teach a child about postoperative events is to describe these events using a
The patient
When
nurse
examining
shouldn’t
shouldanbe
hand-carry
infant’s
transported
ear awith
hospitalized
in aanstroller,
otoscope,
infant
wheelchair,
theornurse
child.
orshould
bed. pull the earlobe down and back.
life-size doll that has an incision, a dressing, a cast, or an I.V. line, as appropriate.
Nursing Skills
• When taking a child’s temperature rectally,
the nurse should insert the thermometer
only 1½ inches (3.8 cm).
• When performing cardiopulmonary
resuscitation on an infant, the
administrator should compress the
sternum ½ to 1 inch (1 to 2.5 cm), using
two fingers.
• A crying infant must be calmed before his
vital signs are obtained.
5/25/2017
35
When performing
taking a child’s
cardiopulmonary
temperature rectally,
resuscitation
the nurse
on anshould
infant,insert
the administrator
the thermometer
should
only
compress
1½ inches
the(3.8
A crying infant must be calmed before his vital signs are obtained.
cm).
sternum
½ to 1 inch (1 to 2.5 cm), using two fingers.
Nursing Assessment
• A positive Babinski’s reflex (toe fanning
when the sole is stroked from heel to toe)
is normal in the neonate and may persist
for up to 18 months.
• To stimulate the rooting reflex and
promote feeding of a bottle-fed infant, the
nurse should stroke his cheek.
5/25/2017
36
A positive Babinski’s reflex (toe fanning when the sole is stroked from heel to toe) is normal in the neonate
Nursing
To
stimulate
Assessment
the rooting reflex and promote feeding of a bottle-fed infant, the nurse should stroke his cheek.
and may persist for up to 18 months.
Medications
• To administer an I.V. drug in an infant or an
older patient with small veins, the nurse
should use a 21 or 23 gauge winged set,
dilute the drug as prescribed, and infuse it
slowly to prevent vein injury.
• When placing a rubber band tourniquet on
an infant’s head before starting a scalp vein
infusion, the nurse should place a second
rubber band crosswise under the band to
facilitate lifting and cutting the tourniquet
when it’s removed.
5/25/2017
37nurse
When placing a rubber band tourniquet on an infant’s head before starting a scalp vein infusion, the
To administer an I.V. drug in an infant or an older patient with small veins, the nurse should use a 21 or 23
Medications
should
place a second rubber band crosswise under the band to facilitate lifting and cutting the tourniquet
gauge winged set, dilute the drug as prescribed, and infuse it slowly to prevent vein injury.
when it’s removed.
Medications
• When administering an injection to an infant, the
nurse should ask another nurse to divert the
child’s attention and assist as needed.
• The nurse shouldn’t administer a drug to a child
at bedtime unless it’s specifically prescribed
because it may stimulate the child.
• When administering an oral medication to a
toddler, the nurse should have the child place
the medication on the back of his tongue and
swallow it with fruit juice or water.
5/25/2017
38
When
The
nurse
administering
shouldn’t administer
an oral
injection
medication
ato
drug
an infant,
totoaachild
toddler,
theat
nurse
bedtime
theshould
nurse
unless
should
ask it’s
another
have
specifically
nurse
the child
to
prescribed
divert
place the
thebecause
child’s
medication
it may
on
attention
stimulate
the
back of
and
the
hischild.
assist
tongue
as and
needed.
swallow it with fruit juice or water.
Medications
• The nurse should communicate at eye level with
a child
• When administering drugs or other forms of
treatment to a child, the nurse should allow the
child to make choices when appropriate.
• Making choices allows the child to exercise a
certain degree of control and autonomy.
• When administering an oral drug to an infant,
the nurse should place it in the side of the mouth
and encourage swallowing by gently lifting the
infant’s chin with the thumb and stroking the
infant’s neck
5/25/2017
39
When administering an
drugs
oralordrug
other
to forms
an infant,
of treatment
the nursetoshould
a child,place
the nurse
it in the
should
side of
allow
the the
mouth
childand
to make
The nurse
Making
choices
should
allows
communicate
the child at
to eye
exercise
level awith
certain
a child
degree of control and autonomy.
choices when
encourage
swallowing
appropriate.
by gently lifting the infant’s chin with the thumb and stroking the infant’s neck
Steroids
• Because steroids mask symptoms of
infection, they should be administered to
children with extreme caution.
• Steroids should be administered with food
to a child.
5/25/2017
40
Because steroids mask symptoms of infection, they should be administered to children with extreme
Steroids should be administered with food to a child.
caution.
Urine
• To obtain a urine specimen in an infant, a
specimen bag (Hollister U bag) is used.
• To determine how much urine is contained in a
diaper, the nurse should weigh the wet diaper,
subtract the weight of a dry diaper, and convert
each gram to a milliliter (1 gram in weight = 1
milliliter in volume).
• In a child, a urinary tract infection causes
incontinence (in a toilet-trained child), strongsmelling urine, and urinary frequency or
urgency.
5/25/2017
41
In adetermine
To
child, a urinary
how much
tract infection
urine is contained
causes incontinence
in a diaper, (in
theanurse
toilet-trained
should weigh
child),the
strong-smelling
wet diaper, subtract
urine, and
the
To obtain a urine specimen in an infant, a specimen bag (Hollister U bag) is used.
Urine
weight of
urinary
frequency
a dry diaper,
or urgency.
and convert each gram to a milliliter (1 gram in weight = 1 milliliter in volume).
Glomerulonephritis
• Acute glomerulonephritis, the most common
noninfectious renal disease of childhood, is
commonly caused by a reaction to streptococcal
infection.
• Children with acute glomerulonephritis with
edema, oliguria, azotemia, and hypertension
usually must restrict their intake of sodium,
protein, fluids, and potassium.
5/25/2017
42
Children
Acute
glomerulonephritis,
with acute glomerulonephritis
the most common
with edema,
noninfectious
oliguria,renal
azotemia,
disease
and
of hypertension
childhood, is commonly
usually must
caused
Glomerulonephritis
by a reaction
restrict
their intake
to streptococcal
of sodium, infection.
protein, fluids, and potassium.
Emancipated Minors
• Emancipated minors are individuals
younger than the age of majority (usually
age 18 or 21)
• Are not under parental control, such as
married minors, those who serve in the
military, and college students who live
away from home.
5/25/2017
43
Are not under parental control, such as married minors, those who serve in the military, and college
Emancipated minors
Minors are individuals younger than the age of majority (usually age 18 or 21)
students who live away from home.
Adolescence
• The most effective birth control method for a
teenage girl is abstinence and second most
effective method is oral contraceptive use.
• In a male patient who has reached puberty, the
major complication of mumps is sterility caused by
orchitis.
• Gonorrhea is asymptomatic and progresses without
detection in most teenage girls; as a result, the
fallopian tubes can be damaged.
• An adolescent’s eating habits are significantly
influenced by his peer group.
• Acne vulgaris is one result of the hormonal
changes of adolescence and is caused by
androgenic stimulation of sebum production.
5/25/2017
44
Acnemost
The
Gonorrhea
vulgaris
effective
is asymptomatic
is one
birth
result
control
ofand
the
method
progresses
hormonal
for achanges
without
teenagedetection
ofgirl
adolescence
is abstinence
in mostand
teenage
and
is caused
second
girls;by
most
asandrogenic
a effective
result, themethod
fallopian
is
Adolescence
In
An
aadolescent’s
male patienteating
who has
habits
reached
are significantly
puberty, theinfluenced
major complication
by his peer
ofgroup.
mumps is sterility caused by orchitis.
oral contraceptive
tubes
stimulation
can be
of damaged.
sebum
use.
production.
The Dying Child
• A School age child and an adolescent who has a
terminal illness should be told the truth about his
prognosis.
• Resentment and denial are common responses.
• After a child dies, the nurse should give the family
members time with the body, compliment them (as
appropriate) on the excellent care that they
provided, and give them the name of a person to
contact if they have questions.
• Children ages 3 to 5 don’t conceive of death in final
terms, but fear separation from parents.
• Children ages 5 to 9 view death as a destructive
force or, conversely, as an angel coming in the
night. They accept death as a final state, but don’t
believe that they are targets.
5/25/2017
45
After a child dies, the nurse should give the family members time with the body, compliment them (as
A Schoolages
Children
age child
5 to 9and
view
andeath
adolescent
as a destructive
who has aforce
terminal
or, conversely,
illness should
as be
an told
angel
thecoming
truth about
in thehis
night. They
The Dying
Resentment
appropriate)
Children
ages
Child
and
on3 the
to
denial
5excellent
don’t
areconceive
common
care that
ofresponses.
death
they provided,
in final terms,
and give
but fear
themseparation
the name from
of a person
parents.
to contact if they
prognosis.
accept
death as a final state, but don’t believe that they are targets.
have questions.
Dying Child
• The diagnosis should be explained to the child,
and he should be allowed to die in comfort,
surrounded by his family.
• A preschool-age child who has a fatal disease
isn’t likely to ask if he’s going to die, but may
express anxiety about death through play
therapy or other activities.
• Most developmental theorists recommend
helping the child by answering the child’s
questions honestly and reassuring him that he
won’t be alone.
• It’s appropriate for the parents and family of a
dying child to tell the child that they will miss him
and that they are sad because they will be
separated.
5/25/2017
46
It’spreschool-age
The
A
Most
appropriate
diagnosis
developmental
should
forchild
thetheorists
be
who
parents
explained
hasrecommend
and
a fatal
family
to the
disease
of
child,
helping
a dying
isn’t
andthe
likely
child
hechild
should
to
to ask
by
tellbe
answering
the
if he’s
allowed
child
going
that
the
to to
die
they
child’s
die,
inwill
comfort,
but
questions
miss
mayhim
surrounded
express
honestly
and that
anxiety
by
and
they
Dying Child
his family.
about
reassuring
are
sad
death
because
him
through
that
they
he
play
will
won’t
therapy
be be
separated.
alone.
or other activities.
Cystic Fibrosis
• A child who has cystic fibrosis should take pancreatic
enzyme replacements with meals and snacks.
• A diagnosis of cystic fibrosis is confirmed by a pilocarpine
iontophoresis sweat test. Sodium and chloride
concentrations of 50 to 60 mEq/L strongly suggest cystic
fibrosis.
• Cystic fibrosis, which is transmitted as an autosomal
recessive trait, causes dysfunction of the exocrine gland,
sweat glands, and respiratory and digestive systems.
• In the neonate, a common manifestation of cystic fibrosis
is meconium ileus caused by obstruction of the small
intestine by viscous meconium.
• Neonates who have cystic fibrosis but don’t have
meconium ileus at birth have good appetites, but gain
weight slowly.
5/25/2017
47
Neonates
A
Cystic
In
diagnosis
the neonate,
fibrosis,
who
of cystic
have
which
a common
cystic
fibrosis
is transmitted
manifestation
fibrosis
is confirmed
but
as don’t
anofby
autosomal
cystic
have
a pilocarpine
meconium
fibrosis
recessive
isiontophoresis
meconium
ileus
trait,
at causes
birth
ileus
sweat
have
dysfunction
caused
test.
goodSodium
by
appetites,
obstruction
of the
and
exocrine
but
chloride
of
gain
the
Cystic
A
childFibrosis
who has cystic fibrosis should take pancreatic enzyme replacements with meals and snacks.
concentrations
gland,
small
weight
intestine
sweat
slowly.glands,
by
of 50
viscous
to
and
60respiratory
meconium.
mEq/L strongly
and digestive
suggest cystic
systems.
fibrosis.
Tay-Sachs
• Tay-Sachs disease is caused by a
congenital enzyme deficiency and is
characterized by progressive mental and
motor deterioration and cherry-red spots
on the macula.
• Although no cure exists for Tay-Sachs
disease, serum analysis for
hexosaminidase A deficiency allows
accurate identification of genetic carriers
of the disease.
5/25/2017
48
Although nodisease
Tay-Sachs
cure exists
is caused
for Tay-Sachs
by a congenital
disease,
enzyme
serum deficiency
analysis forand
hexosaminidase
is characterized
A deficiency
by progressive
allows
mental
Tay-Sachs
and motoridentification
accurate
deteriorationofand
genetic
cherry-red
carriers
spots
of the
ondisease.
the macula.
Sickle Cell Anemia
• To prevent infection in patients with sickle cell
anemia, penicillin prophylaxis is started at age 2
months.
• During early childhood, signs and symptoms of
sickle cell anemia include jaundice, pallor, joint
swelling, bone pain, chest pain, ischemic leg
ulcers, and increased susceptibility to infection.
• Infants with sickle cell anemia should receive
standard well-baby care, including
immunizations.
5/25/2017
49
During early childhood, signs and symptoms of sickle cell anemia include jaundice, pallor, joint swelling,
To prevent
Infants
withinfection
sickle cell
in anemia
patientsshould
with sickle
receive
cellstandard
anemia, penicillin
well-babyprophylaxis
care, including
is started
immunizations.
at age 2 months.
bone pain, chest pain, ischemic leg ulcers, and increased susceptibility to infection.
Leukemia
• Signs and symptoms of leukemia include fatigue,
anorexia, low-grade fever, and decreased white
blood cell, red blood cell, and platelet counts.
• The most common causes of death include
hemorrhage and infection.
• Allopurinol is used in children with leukemia to
prevent accumulation of uric acid.
• A common symptom of acute lymphocytic
leukemia in toddlers and preschoolers is leg pain.
• The peak age for the diagnosis of acute
lymphocytic leukemia is ages 2 to 4.
• A patient who is undergoing therapy for acute
lymphocytic leukemia should have his urine and
feces checked for blood.
5/25/2017
50
A patient
Signs
andwho
symptoms
is undergoing
of leukemia
therapy
include
for acute
fatigue,
lymphocytic
anorexia,leukemia
low-grade
should
fever,have
and decreased
his urine and
white
feces
blood cell,
Leukemia
Allopurinol
A
The
common
most common
peak
age
is
symptom
used
for the
in
causes
of
children
diagnosis
acute
of death
lymphocytic
with
of acute
leukemia
include
lymphocytic
leukemia
hemorrhage
to prevent
inleukemia
toddlers
accumulation
and infection.
isand
ages
preschoolers
of2uric
to 4.acid. is leg pain.
red bloodfor
checked
cell,
blood.
and platelet counts.
Lead Poisoning
• In a child, anemia is the first sign of lead
poisoning.
• An early sign of lead poisoning is
drowsiness.
• Late signs of lead poisoning are seizures
and irreversible brain damage.
• If a child has a blood lead level greater
than 45 mg/dl, the physician may order
chelation therapy (EDTA).
5/25/2017
51
Lead
In
An
Late
If
aaearly
child
child,
signs
Poisoning
sign
has
anemia
of a
lead
ofblood
lead
poisoning
is the
poisoning
lead
first
level
sign
areis
greater
seizures
of
drowsiness.
leadthan
poisoning.
and45irreversible
mg/dl, the brain
physician
damage.
may order chelation therapy (EDTA).
The Child with HIV
• In most neonates who are born with human
immunodeficiency virus– positive blood,
acquired immunodeficiency syndrome develops
within 4 months.
• An infant who is infected with human
immunodeficiency virus during gestation
typically begins to show signs and symptoms,
such as fever, adenopathy, rash, diarrhea, and
failure to thrive, between ages 2 and 4 months.
5/25/2017
52 signs
An infant who is infected with human immunodeficiency virus during gestation typically begins to show
In most neonates who are born with human immunodeficiency virus– positive blood, acquired
The symptoms,
and
Child with HIV
such as fever, adenopathy, rash, diarrhea, and failure to thrive, between ages 2 and 4
immunodeficiency syndrome develops within 4 months.
months.
Immunizations
• Immunization for hepatitis B should be
dministered at birth ( ), 1-2 months ( ), and
6-18 months of age ( ), CDC (2012).
• If a child with a febrile illness is scheduled for an
immunization, the immunization should be
postponed.
• If an immunization schedule is interrupted, it
should be restarted from the last immunization
administered, not from the beginning.
• A measles-mumps-rubella vaccine shouldn’t be
given before age 12 months.
• Pertussis vaccine shouldn’t be given to a child
whose blood test results show human
immunodeficiency virus antibodies.
1st dose
2nd dose
3rd dose
5/25/2017
53
Pertussis
If
an immunization
vaccine shouldn’t
schedulebe
is interrupted,
given to a child
it should
whose
beblood
restarted
test results
from the
show
last human
immunization
immunodeficiency
administered,
Immunization
Immunizations
If
A
ameasles-mumps-rubella
child with afor
febrile
hepatitis
illness
Bvaccine
should
is scheduled
shouldn’t
be administered
forbe
angiven
immunization,
atbefore
birth, 1age
month,
the12immunization
months.
and 6 months
should
of age.
be postponed.
not from
virus
antibodies.
the beginning.
Dental
• A child should have a fluoride treatment
twice a year.
• Wisdom teeth appear between ages 17
and 21.
• The lower central incisors erupt first in an
infant, at approximately age 4 to 6 months.
• Eruption is the normal presentation of a
tooth as it penetrates the gum.
5/25/2017
54
A child
Dental
Wisdom
The
Eruption
lower
should
teeth
iscentral
theappear
have
normal
incisors
a between
fluoride
presentation
erupt
treatment
ages
firstof
in
17
aan
and
tooth
twice
infant,
21.
as
a year.
at
it penetrates
approximately
the gum.
age 4 to 6 months.
Cardiac
• Tetralogy of Fallot consists of 4 separate defects:
ventricular septal defect (VSD), overriding aorta,
pulmonary stenosis, and right ventricular
hypertrophy.
• The hallmark of tetralogy of Fallot is cyanosis,
which usually appears several months after birth,
but may be present at birth if the neonate has
severe pulmonary stenosis.
• The heart of a child with Tetralogy of Fallot
appears boot-shaped on X-ray films because the
right ventricle is enlarged.
• VSD occurs when the septum between the left and
right ventricles does not close during the first 8
weeks of gestation.
• In an infant, feeding problems, such as fatigue,
tachypnea, and irritability during feeding, may be55
5/25/2017
early signs of a congenital heart defect.
In anheart
Tetralogy
The
VSD
hallmark
occurs
infant,
of
of feeding
Fallot
when
aofchild
tetralogy
the
consists
with
problems,
septum
Tetralogy
of of
Fallot
4between
such
separate
isofas
cyanosis,
Fallot
fatigue,
the
defects:
appears
left which
and
tachypnea,
ventricular
right
boot-shaped
usually
ventricles
and
appears
septal
irritability
on
does
defect
X-ray
several
not
during
(VSD),
films
close
months
because
feeding,
overriding
during
after
may
the
the
birth,
aorta,
first
right
bebut
early
8ventricle
weeks
may
signs
be
of
Cardiac
pulmonary
present
is
gestation.
of
enlarged.
a congenital
at birth
stenosis,
heart
if the and
defect.
neonate
right has
ventricular
severe hypertrophy.
pulmonary stenosis.
Cardiac
• Congenital heart defects are classified as cyanotic
or acyanotic.
• In cyanotic congenital heart defects, unoxygenated
blood is shunted from the right side of the heart to
the left, where it flows through the left ventricle to
all parts of the body, causing cyanosis.
• Infants with congenital heart defects are at
increased risk for heart failure.
• Infants with congenital heart defects should be
given small, frequent feedings. The typical
schedule is every 3 hours instead of the usual
every 4 hours.
• Failure to thrive is usually associated with a heart
defect.
• Before administering digoxin to an infant, the nurse
5/25/2017
56
should take the apical pulse for 1 full minute.
Infants
In
cyanotic
withcongenital
congenitalheart
heartdefects,
defects should
unoxygenated
be givenblood
small,
is frequent
shunted feedings.
from the right
The side
typical
of the
schedule
heart to
is the
every
Congenital
Cardiac
Infants
Failure
Before
administering
with
to thrive
heart
congenital
isdefects
usually
digoxin
heart
are
associated
defects
classified
to an infant,
are
with
asatthe
cyanotic
aincreased
heart
nursedefect.
or
should
risk
acyanotic.
for
take
heart
thefailure.
apical pulse for 1 full minute.
left,
3
hours
where
instead
it flows
of through
the usualthe
every
left ventricle
4 hours. to all parts of the body, causing cyanosis.
Kawasaki Disease
• Kawasaki disease is characterized by a high
temperature for 5 days or longer
• strawberry tongue
• red, dry lips
• cervical lymphadenopathy
• Carditis
• edema of the hands
• rash on the soles or palms and
• bilateral congestion of the ocular conjunctivae.
5/25/2017
57
Kawasaki Disease
Meningitis
• I.V. antibiotic therapy is used to treat a child who
has bacterial meningitis so that the drug will
penetrate the blood-brain barrier.
• To promote rest for a young child with
meningitis, environmental stimulation should be
decreased.
• A consistent finding in a child with
meningococcal meningitis is purpuric skin rash.
• The nurse should position a child with
meningococcal meningitis on the side if
opisthotonos (back arching) occurs.
5/25/2017
58
Theantibiotic
I.V.
nurse should
therapy
position
is used
a child
to treat
withameningococcal
child who has bacterial
meningitis
meningitis
on the side
so that
if opisthotonos
the drug will(back
penetrate
arching)
the
Meningitis
To
A
consistent
promote rest
finding
for ainyoung
a childchild
withwith
meningococcal
meningitis, environmental
meningitis is purpuric
stimulation
skinshould
rash. be decreased.
blood-brain barrier.
occurs.
Hydrocephalus
• Hydrocephalus may be congenital or may be
caused by a tumor, infection, or hemorrhage.
• Dilated scalp veins indicate long-standing
increased intracranial pressure.
• The preferred treatment of hydrocephalus is the
placement of a ventriculoperitoneal shunt to
drain the cerebrospinal fluid from the ventricles
to an extracranial compartment, usually the
peritoneum.
5/25/2017
59
The preferred treatment of hydrocephalus is the placement of a ventriculoperitoneal shunt to drain the
Hydrocephalus
Dilated
scalp veins
mayindicate
be congenital
long-standing
or may increased
be causedintracranial
by a tumor,pressure.
infection, or hemorrhage.
cerebrospinal fluid from the ventricles to an extracranial compartment, usually the peritoneum.
Cerebral Palsy
• Most infants with cerebral palsy are long
and thin, move asymmetrically, have
difficulty feeding, and cry excessively or
feebly.
5/25/2017
60
Most infants with cerebral palsy are long and thin, move asymmetrically, have difficulty feeding, and cry
Cerebral Palsy
excessively or feebly.
Abuse
• Child neglect is abandonment or failure to
provide a safe, secure environment for a child.
• Clues to physical abuse of a child include
inconsistent stories from parents about how the
injuries occurred, lack of permission for the child
to speak, wounds that don’t match the stated
cause of injury or multiple wounds at various
stages of healing, and unexplained injuries.
• In reporting suspected cases of child abuse to
the appropriate authorities, the key word to use
is “suspected.”
• A spiral fracture of the humerus may indicate
child abuse
5/25/2017
Clues to physical abuse of a child include inconsistent stories from parents about how the injuries 61
occurred,
In reporting suspected cases of child abuse to the appropriate authorities, the key word to use is
Child
Abuse
lack
A
spiral
ofneglect
permission
fracture
is abandonment
of for
thethe
humerus
child or
tomay
failure
speak,
indicate
towounds
provide
childthat
aabuse
safe,
don’tsecure
matchenvironment
the stated cause
for a of
child.
injury or multiple
“suspected.”
wounds at various stages of healing, and unexplained injuries.
The Hospitalized Child
• A sick or injured child who has limited
communication skills may be able to
express his feelings or concerns by
drawing a picture with crayons or markers.
• Accidents are the leading cause of death
in children and are commonly age-related.
For example, toddlers are injured in falls
and teenagers are injured in sports.
• Separation anxiety is a major source of
stress for a hospitalized toddler.
5/25/2017
62
Accidents
A
sick or injured
are thechild
leading
whocause
has limited
of death
communication
in children and
skills
aremay
commonly
be ableage-related.
to express his
Forfeelings
example,
or toddlers
concerns
The Hospitalized
Separation
anxiety
Child
is a major source of stress for a hospitalized toddler.
by drawing
are
injured in
a picture
falls and
with
teenagers
crayonsare
or markers.
injured in sports.
The Hospitalized Child
• The primary purpose of play therapy for a hospitalized
child is to allow him to express his feelings and
frustrations.
• A child shouldn’t be asked a “yes” or “no” question
unless the nurse plans to follow the child’s wishes.
• To promote rest in a very young child in a hospital
setting, the first nursing action is to decrease
environmental stimulation.
• To promote sleep in a very young child in a hospital
setting, the nurse should ask the parents about the
child’s sleep rituals.
• The nurse should maintain a child’s bedtime ritual, such
as reading a story or holding a favorite blanket or toy to
promote sleep.
5/25/2017
63
Thepromote
To
primary
nurse
should
rest
sleep
purpose
inmaintain
ina avery
ofvery
play
young
a
young
therapy
child’s
child
child
bedtime
for
inina ahospitalized
hospital
hospital
ritual, setting,
such
setting,
child
asthe
reading
is
thefirst
tonurse
allow
nursing
a story
should
him action
to
or express
ask
holding
is
the
toparents
ahis
decrease
favorite
feelings
about
blanket
and
the or
A child shouldn’t be asked a “yes” or “no” question unless the nurse plans to follow the child’s wishes.
frustrations.
environmental
child’s
toy
to promote
sleep rituals.
stimulation.
sleep.
Accidental Ingestion
• Treatment for a conscious toddler who has
swallowed liquid drain cleaner is dilute vinegar
solution.
• Most poisonings in children younger than age 6
occur when the child takes a substance orally.
• For a child older than age 1 who has ingested a
noncorrosive poison, treatment includes
administration of 15 ml of syrup of ipecac mixed in
warm water.
• After a child is given syrup of ipecac, he should
bend over toward his knees.
• If the first dose is ineffective, a second dose may
be ordered by the physician.
• Tincture of ipecac shouldn’t be used because it’s
stronger than syrup of ipecac and is itself a poison.
5/25/2017
64
For a child older than age 1 who has ingested a noncorrosive poison, treatment includes administration of
Accidental
Treatment
Most
After
If
Tincture
the apoisonings
first
child
ofdose
for
Ingestion
ipecac
isagiven
isconscious
inineffective,
shouldn’t
children
syrup toddler
ofyounger
be
aipecac,
second
used
who
than
because
hedose
has
should
age
swallowed
may
it’s
6 bend
occur
be
stronger
ordered
over
when
liquid
than
toward
the
drain
by syrup
the
child
his
cleaner
physician.
takes
knees.
of ipecac
isadilute
substance
andvinegar
is itself
orally.
solution.
a poison.
15 ml of syrup of ipecac mixed in warm water.
Endocrine
• A child’s failure to grow above the third
percentile in 2 years may be related to
hypopituitarism.
5/25/2017
65
A child’s failure to grow above the third percentile in 2 years may be related to hypopituitarism.
Endocrine
Thyroid
• For the first few months of levothyroxine
(Synthroid) therapy, a child may have temporary
hair loss.
• In an infant, hypothyroidism causes inactivity,
excessive sleeping, and minimal crying. The
infant may be described as a “good baby.”
• Cretinism is suspected when the mother reports
that her baby sleeps all the time and doesn’t cry.
He may even be described as a “good baby.”
5/25/2017
66
Cretinism
In an infant,
is suspected
hypothyroidism
when causes
the mother
inactivity,
reports
excessive
that her baby
sleeping,
sleeps
and
allminimal
the timecrying.
and doesn’t
The infant
cry. He
maymay
be
For the first few months of levothyroxine (Synthroid) therapy, a child may have temporary hair loss.
Thyroid
described
even
be described
as a “good
as baby.”
a “good baby.”
Reye’s Syndrome
• For a child who is suspected of having
Reye’s syndrome, the nurse should ask
the parents if the child received aspirin
during the current or a recent illness.
5/25/2017
67
For a child who is suspected of having Reye’s syndrome, the nurse should ask the parents if the child
Reyes Syndrome
received aspirin during the current or a recent illness.
GI
• The nurse may offer finger foods to a child
age 3 who has a poor appetite.
• Children who have chronic protein-calorie
malnutrition are small for their age,
physically inactive, mentally sluggish, and
susceptible to infection.
• An infant who has gastroesophageal reflux
should receive formula thickened with
cereal.
5/25/2017
68
Children who have chronic protein-calorie malnutrition are small for their age, physically inactive, mentally
Theinfant
GI
An
nursewho
mayhas
offer
gastroesophageal
finger foods to a reflux
child age
should
3 who
receive
has aformula
poor appetite.
thickened with cereal.
sluggish, and susceptible to infection.
GI
• After surgical reconstruction of an
imperforate anus and formation of a
temporary colostomy, an infant should
remain prone, with the hips elevated.
• Obesity is the most common nutritional
problem in children.
5/25/2017
69
After surgical reconstruction of an imperforate anus and formation of a temporary colostomy, an infant
Obesity is the most common nutritional problem in children.
should remain prone, with the hips elevated.
Pyloric Stenosis
• The classic signs and symptoms of pyloric
stenosis are a palpable olive-sized mass
(called a pyloric olive) in the right upper
quadrant, strong peristaltic movements
from left to right during meals, and
projectile vomiting.
5/25/2017
70olive)
The classic signs and symptoms of pyloric stenosis are a palpable olive-sized mass (called a pyloric
Pyloric
in
the right
Stenosis
upper quadrant, strong peristaltic movements from left to right during meals, and projectile
vomiting.
Celiac Disease
• Treatment of a child with celiac disease
includes following a lifelong gluten-free
diet.
• Gluten is found in wheat, oats, and barley.
• The child who has celiac disease may eat
rice.
• An infant with celiac disease has fatty,
foul-smelling feces.
5/25/2017
71
Celiac
Treatment
Gluten
The
An
infant
child
Disease
is with
found
who
of aceliac
has
child
in wheat,
celiac
with
disease
celiac
disease
oats,
has
and
disease
fatty,
may
barley.
eat
foul-smelling
includes
rice. following
feces. a lifelong gluten-free diet.
Ascites
• For a child who has ascites as a result of
chronic liver disease, the nurse should use
the semi-Fowler position to promote
respiratory functioning.
5/25/2017
72
For a child who has ascites as a result of chronic liver disease, the nurse should use the semi-Fowler
Ascites
position to promote respiratory functioning.
Biliary Atresia
• Biliary atresia is congenital absence or
underdevelopment of one or more of the
biliary structures.
• It causes jaundice and early liver damage.
As the condition worsens, the child’s
growth may be retarded and portal
hypertension may develop.
5/25/2017
73
It causes jaundice and early liver damage. As the condition worsens, the child’s growth may be retarded
Biliary atresia
Atresia is congenital absence or underdevelopment of one or more of the biliary structures.
and portal hypertension may develop.
Intussusception
• The passage of normal brown feces
usually indicates that intussusception, or
telescoping of a segment of the colon, has
corrected itself.
5/25/2017
74
The passage of normal brown feces usually indicates that intussusception, or telescoping of a segment of
Intussusception
the colon, has corrected itself.
Hirschsprung’s Disease
• Hirschsprung’s disease (congenital
megacolon) is the congenital absence of
parasympathetic ganglia in the distal
portion of the colon and rectum, which
results in a lack of peristalsis.
5/25/2017
75
Hirschsprung’s disease (congenital megacolon) is the congenital absence of parasympathetic ganglia in the
Hirschsprungs Disease
distal portion of the colon and rectum, which results in a lack of peristalsis.
Dehydration
• On an infant, the abdomen is the ideal place to
check skin turgor.
• In infants, normal urine output is 1 to 3 ml/kg of
body weight per hour.
• To maintain fluid balance, normal saline solution
should be used when giving an enema to an
infant.
• When caring for an infant who has had six to
eight episodes of diarrhea a day for 4 days, the
nurse should assess for electrolyte imbalance.
• In an infant, one of the first signs of dehydration
is sunken fontanels.
5/25/2017
76
When caring for an infant who has had six to eight episodes of diarrhea a day for 4 days, the nurse should
Onan
Dehydration
To
In
infants,
maintain
aninfant,
infant,
normal
one
fluid
the of
balance,
abdomen
urine
the first
output
normal
signs
is the
is 1of
ideal
saline
todehydration
3 place
ml/kg
solution
to
of check
body
isshould
sunken
weight
skin
befontanels.
turgor.
used
per hour.
when giving an enema to an infant.
assess for electrolyte imbalance.
Bottle Feeding
• A bottle-fed infant is ready for the addition
of solids to his diet when he meets these
criteria:
• He has doubled his birth weight.
• He demands 8 to 10 feedings in a 24-hour
period.
• He drinks more than 1 qt of formula a day.
• He always seems hungry.
5/25/2017
77
Bottle
A
He
bottle-fed
hasFeeding
demands
drinks
always
doubled
more
seems
infant
8 to
than
his
10
is
hungry.
birth
ready
1
feedings
qt weight.
offor
formula
the
in aaddition
24-hour
a day. of
period.
solids to his diet when he meets these criteria:
Breastfeeding
• Breast-fed infants tend to pass feces that
are looser and pastier than those of bottlefed babies.
• The most desirable diet for an infant up to
age 6 months is breast milk.
• A pacifier shouldn’t be given to a neonate
who is in the learning stage of breastfeeding.
• To prevent oral burns in the infant, breast
milk shouldn’t be thawed or rewarmed in a
microwave oven.
5/25/2017
78
Breast-fed
Breastfeeding
The
To
A pacifier
prevent
most desirable
shouldn’t
infants
oral burns
tend
diet
beinto
given
for
the
pass
an
infant,
toinfant
feces
a neonate
breast
up
that
toare
milk
age
who
looser
shouldn’t
6ismonths
in the
andlearning
be
is
pastier
breast
thawed
than
stage
milk.
orthose
rewarmed
of breast-feeding.
of bottle-fed
in a microwave
babies. oven.
Diet
• A pediatric diet is normally ordered as “diet for
age”.
• Diet should include sufficient nutrients and
calories to promote growth and development.
• Solids are introduced to the infant in the following
order: rice cereal, fruits, oatmeal, vegetables, and
meat.
• The American Academy of Pediatrics
recommends introducing one food at a time to an
infant.
• The first food is cereal, usually rice.
• To leave room for other nutritious food, toddlers
shouldn’t drink more than 24 ounces of milk daily.
• An infant should be weaned from the bottle
5/25/2017
79
between the ages of 10 and 12 months.
A pediatric
Diet
Solids
The
To
An
leave
infant
American
first
should
are
food
room
should
introduced
diet
include
isAcademy
for
is
cereal,
be
normally
other
sufficient
weaned
tousually
nutritious
the
of ordered
Pediatrics
infant
from
nutrients
rice.
the
food,
inas
the
bottle
recommends
“diet
and
toddlers
following
calories
for
between
age”.
shouldn’t
order:
to
introducing
the
promote
rice
ages
drink
cereal,
ofgrowth
one
more
10 food
and
fruits,
than
and
12
at24
oatmeal,
development.
a
months.
time
ounces
tovegetables,
an
of infant.
milk daily.
and meat.
PKU
• Phenylketonuria is an inborn error of
phenylalanine metabolism that causes high
serum levels of phenylalanine that might lead to
cerebral damage and mental retardation.
• To prevent brain damage, treatment of
phenylketonuria must begin within the first few
weeks of life.
• Protein intake must be monitored in the child
who has phenylketonuria.
• An infant who has phenylketonuria should be fed
a low-phenylalanine formula and should have
plasma phenylalanine levels monitored
frequently.
5/25/2017
80
An infant who hasis phenylketonuria
Phenylketonuria
an inborn error of
should
phenylalanine
be fed a low-phenylalanine
metabolism that causes
formula
high
andserum
should
levels
haveofplasma
PKU
To
Protein
prevent
intake
brain
must
damage,
be monitored
treatment
in the
of phenylketonuria
child who has phenylketonuria.
must begin within the first few weeks of life.
phenylalanine levels
that might
monitored
lead tofrequently.
cerebral damage and mental retardation.
Dermatology
• Telangiectatic nevi (stork bites) are normal neonatal skin
lesions that are characterized by flat red or purple areas on
the back of the neck, upper eyelids, upper lip, and bridge of
the nose. They regress by age 2.
• Strawberry hemangiomas are raised, red birthmarks that
may continue to spread up to age 1 year. Complete
shrinkage and absorption of hemangiomas may take 7 to
10 years.
• Cavernous hemangiomas resemble strawberry
hemangiomas, but don’t disappear with age.
• A sign of tinea capitis in the child is a scratch on the scalp.
• Poor hygiene is a contributing factor to the development of
impetigo.
• Permethrin (Nix) shampoo for head lice is effective if there
are no lice in the hair and no eggs (nits) fixed to hair shafts.
5/25/2017
81
Permethrin hemangiomas
Telangiectatic
Strawberry
(Nix)
nevi
shampoo
(stork bites)
are
for head
raised,
are normal
lice
redisbirthmarks
effective
neonatalif skin
that
theremay
lesions
arecontinue
nothat
lice are
intothe
characterized
spread
hair and
up to
noage
by
eggs
flat
1 year.
(nits)
red orfixed
purple
to
Dermatology
Cavernous
A
Poor
signhygiene
of tinea
hemangiomas
iscapitis
a contributing
in theresemble
child
factor
is astrawberry
toscratch
the development
onhemangiomas,
the scalp.
of impetigo.
but don’t disappear with age.
areas
Complete
hair
shafts.
on the
shrinkage
back of and
the neck,
absorption
upperofeyelids,
hemangiomas
upper lip,
may
andtake
bridge
7 toof10the
years.
nose. They regress by age 2.
Wilm’s Tumor
• The most common intra-abdominal tumor
in children is Wilms’ tumor
(nephroblastoma).
• When assessing a child with Wilms’ tumor,
the nurse should avoid palpating the
abdomen and thus the mass.
5/25/2017
82
When assessing a child with Wilms’ tumor, the nurse should avoid palpating the abdomen and thus the
Wilms
The
most
Tumor
common intra-abdominal tumor in children is Wilms’ tumor (nephroblastoma).
mass.
Tumor
• Medulloblastoma, the most common brain
tumor in children, is characteristically
found in the cerebellum.
5/25/2017
83
Medulloblastoma, the most common brain tumor in children, is characteristically found in the cerebellum.
Tumor
Congenital Abnormalities
• Down syndrome (trisomy 21) is the most
common chromosomal disorder.
• Polydactyly (more than the normal number
of fingers or toes) is a congenital anomaly.
5/25/2017
84
Congenital
Down
Polydactyly
syndrome
Abnormalities
(more(trisomy
than the
21)
normal
is thenumber
most common
of fingers
chromosomal
or toes) is adisorder.
congenital anomaly.
Epiglottitis
• Expiratory grunting is an abnormal breath sound
that’s heard as an infant attempts to breathe out
against a closed glottis.
• The nurse shouldn’t put anything (including a
thermometer) in the mouth of a child who is
suspected of having epiglottiditis.
• Clinical manifestations of epiglottitis are constant
drooling, agitation or restlessness, and the
absence of spontaneous cough.
5/25/2017
85
Clinical
Expiratory
The
nurse
manifestations
grunting
shouldn’tisput
an
ofanything
abnormal
epiglottitis
(including
breath
are constant
sound
a thermometer)
that’s
drooling,
heard
agitation
inas
theanmouth
infant
or restlessness,
of
attempts
a child who
toand
breathe
isthe
suspected
absence
out against
ofof a
Epiglottitis
closed glottis.
having
spontaneous
epiglottiditis.
cough.
Asthma
• Theophylline, steroids, and terbutaline are
commonly used to treat children with asthma.
• A child who has asthma can promote expansion
of the lungs by blowing a pinwheel.
• Discharge instructions to the parents of a child
with asthma include instructing the child and
parent to use a peak flow monitor to track the
peak expiratory flow readings.
5/25/2017
86
Discharge instructions to the parents of a child with asthma include instructing the child and parent to use a
Theophylline,
Asthma
A
child who has
steroids,
asthmaand
canterbutaline
promote expansion
are commonly
of theused
lungstoby
treat
blowing
children
a pinwheel.
with asthma.
peak flow monitor to track the peak expiratory flow readings.
Croup
• Clinical manifestations of croup are
hoarseness, a barking or brassy cough,
respiratory distress, and stridor.
• The nurse should teach the parent of a
child who has croup not to administer
cough medication because it may worsen
the child’s respiratory distress by inhibiting
the body’s natural response to clear the
throat by coughing
5/25/2017
87 it
The nurse should teach the parent of a child who has croup not to administer cough medication because
Clinical
Croup
may
worsen
manifestations
the child’s of
respiratory
croup aredistress
hoarseness,
by inhibiting
a barking
theor
body’s
brassy
natural
cough,
response
respiratory
to clear
distress,
the throat
and stridor.
by
coughing
Respiratory
• Prolonged use of oxygen in the neonate may
cause retrolental fibroplasia and may cause
blindness.
• Arterial oxygen saturation usually is
maintained at less than 94%.
• Bronchopulmonary dysplasia is an iatrogenic
disease that’s caused by intubation and
ventilation.
5/25/2017
88
Prolonged
Respiratory
Arterial
Bronchopulmonary
oxygen
use of
saturation
oxygen
dysplasia
in
usually
the
is neonate
anisiatrogenic
maintained
may cause
disease
at less
retrolental
that’s
than caused
94%.
fibroplasia
by intubation
and mayand
cause
ventilation.
blindness.
Respiratory
• When the nurse performs chest percussion
therapy on a child, percussions (clapping)
should be confined to the area around the
rib cage.
• In an infant, signs of impending airway
obstruction include increased pulse and
respiratory rate; substernal, suprasternal,
and intercostal retractions; nasal flaring; and
restlessness.
• An infant who is receiving oxygen through a
nasal cannula should be monitored for
mouth breathing.
5/25/2017
89
In an infant,
When
the nurse
signs
performs
of impending
chest airway
percussion
obstruction
therapyinclude
on a child,
increased
percussions
pulse and
(clapping)
respiratory
should
rate;
besubsternal,
confined to
An infant who is receiving oxygen through a nasal cannula should be monitored for mouth breathing.
the area around
suprasternal,
andthe
intercostal
rib cage.retractions; nasal flaring; and restlessness.
Circumcision
• Circumcision performed by a rabbi is
called a bris.
• If the nurse notices that a girl or woman
has been circumcised, she must be careful
to avoid showing disgust or surprise but
should discuss her observation with the
patient or with the parent, if the patient is a
child.
5/25/2017
90
If the nurse notices that a girl or woman has been circumcised, she must be careful to avoid showing
Circumcision
disgust
or surprise
performed
but should
by a rabbi
discuss
is called
her observation
a bris.
with the patient or with the parent, if the patient is a
child.
Speech
• Preschool children commonly stutter
because their vocabulary is increasing more
quickly than their ability to produce words.
• This speech pattern is a common
characteristic of language development.
• In answering parents’ questions about their
child’s condition, the nurse should use clear,
simple explanations.
• Listening is the most effective
communication technique to use with a child
who stutters.
5/25/2017
91
In answering
Preschool
children
parents’
commonly
questions
stutter
aboutbecause
their child’s
theircondition,
vocabulary
the
is nurse
increasing
should
more
usequickly
clear, simple
than their ability to
Speech
This
Listening
speech
is the
pattern
mostiseffective
a common
communication
characteristic
technique
of language
to use
development.
with a child who stutters.
produce words.
explanations.
Attention Deficit
• Attention deficit hyperactivity disorder and
learning disabilities are more common
among boys than girls.
• The nurse should use time-outs to help
control the behavior of the hyperactive
child.
5/25/2017
92
Attention
The
nursedeficit
Deficit
should
hyperactivity
use time-outs
disorder
to helpand
control
learning
the behavior
disabilities
of are
the more
hyperactive
common
child.
among boys than girls.
Autistic Child
• An autistic child is difficult to understand
because of withdrawal, unresponsiveness,
and severely impaired speech.
• symptom of childhood-onset autism is the
inability to focus because of impulsiveness
and inattention.
• The nurse should encourage parents to
communicate with their hearing-impaired
child through mime, gestures, and body
language.
5/25/2017
93
Theautistic
An
nurse should
child is encourage
difficult to understand
parents to communicate
because of withdrawal,
with their hearing-impaired
unresponsiveness,
child
andthrough
severely
mime,
impaired
Autistic Child
symptom
of childhood-onset autism is the inability to focus because of impulsiveness and inattention.
speech. and body language.
gestures,
Pain
• Children age 7 and older can use patientcontrolled analgesia.
• The youngest age at which it’s appropriate
to use the face scale to indicate the
severity of pain is age 3.
• Naloxone (Narcan) is given to a neonate
who is experiencing the effects of maternal
narcotic administration during labor and
delivery.
5/25/2017
94
Naloxone (Narcan) is given to a neonate who is experiencing the effects of maternal narcotic administration
Children
Pain
The
youngest
age 7age
andatolder
which
can
it’suse
appropriate
patient-controlled
to use theanalgesia.
face scale to indicate the severity of pain is age 3.
during labor and delivery.
Preemie
• To determine the adjusted, or correct, age
of an infant who was born prematurely, the
nurse should take the chronological age
and subtract the number of weeks that the
infant was born prematurely.
• A premature neonate has a decrease in
surfactant that leads to decreased oxygen
consumption.
5/25/2017
95
To determine the adjusted, or correct, age of an infant who was born prematurely, the nurse should take the
Preemie
chronological age and subtract the number of weeks that the infant was born prematurely.