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Loading... Birth weight doubled by _____, tripled by _____. Birth length increased by 50% at _____. Posterior fontanel closes by _____. A child can socially smiles at _____. 6 months; 12 months 12 months 8 weeks (2 months) 2 months

A child should be able to turn head to locate 3 months sounds at _____. Moro reflex disappears around _____. 4 months

A child should be able to achieve steady head 4 months control at _____ of age. A child can turn completely over at _____ of 5 to 6 months age. A child can play peek-a-boo after _____ of age. A child should be able to transfers objects hand to hand at _____. A child develops stranger anxiety at _____. A child should be able to sit unsupported at _____. The infant crawls at _____. Fine pincer grasp appears at _____. A child should be able to waves bye-bye at _____. 6 months 7 months 7 to 9 months 8 months 10 months 10 to 12 months 10 months

A child should be able to walks with assistance at _____. The infant says a few words in addition to "mama" or "dada" at _____. From birth to one year, the baby explores environment by _____ and _____ means. From birth to one year is what stage of Erikson's theory?

10 to 12 months 12 months motor; oral Trust vs Mistrust (Developing a sense of trust) mobiles rattles squeaking toys picture books balls colored blocks activity boxes 30 months 2 years 12 - 18 months 18 months

What are some age-appropriate toys for hospitalized infants?

Birth weight quadruples by _____. Achieves 50% of adult height by ___. Anterior fontanel closes by _____. A child should be able to throw a ball overhand at _____.

The nurse tells a mother that her child should 24 months be able to kicks a ball at _____. A child should be able to feeds self with spoon and cup at _____. 2 years

Day time toilet training can usually be started 2 years of age around _____. A child should be able to speak two to three 2 years (24 months) word sentences at _____. A child should be able to speak three to four 3 years word sentences at _____ of age. A child should be able to states his/her own first and last name by _____. 2.5 to 3 years

Is temper tantrums common among toddlers Yes (1 to 3 years)?

What is the import developmental task of a toddler according to Erikson's theory?

Developing a sense of autonomy. board and mallet push/pull toys toy telephone stuffed animals storybooks with pictures Toddlers benefit from being taken to the hospital playroom, as mobility is very important to their development.

What are some age-appropriate toys for the hospitalized toddler?

What can the nurse do to promote the developemental task of a toddler?

Each year gain about 5 lbs What are the average weight and height gain and grows 2.5 to 3 for preschool children (3 to 5 years old)? inches. A child can use sissors at _____ of age. A child should be able to ties shoelaces at _____ of age. Visual acuity approaches 20/20 at _____. A preschool child thinking is _____ and _____. 4 years 5 years Preschool age (3 to 5 years) egocentric; concrete

A child should be able to use sentences of 5 3 to 5 years to 8 words at _____ of age. Preschool At this stage of developement, a child learns 3 to 5 years sexual identity (curiosity and masturbation Preschool common). At this stage of development, imaginary playmates and fears are common. Preschool (3 to 5 years)

At child at this development stage begins to Preschool stands erect with more slender posture. (3 to 5 years) At this stage of development, a child learns to Preschool run, jump, skip, and hop. (3 to 5 years) A child at this developmental stage learns colors and shapes. Preschool (3 to 5 years)

Imaginary playmates and fears are common Preschool at this stage of development: (3 to 5 years) Aggressiveness at _____ is replaced by more 4 years; independence _____ at 5 years. Preschool child's major developmental taks according to Erikson theory is: At this stage of development, the child appears to be bowlegged and potbellied. At this stage of development, all primary teeth (20) are present. Developing a sense of initiative TODDLER (1 TO 3 YEARS) TODDLER (1 TO 3 YEARS)

egocentricity; Nursing implications of hospitalized (Explain that he/she did not preschoolers (3-6 years) needs to emphasize cause the illness and that understanding of the child's _____. painful procedures are not a punishment for misdeeds.) _____ or medical play to allow the child to act out their experiences is helpful for _____. At this stage of development, fear of mutilation from procedures is common. Therapeutic play; Preschoolers Preschool (3 to 5 years) coloring books puzzles cutting and pasting dolls building blocks clay toys that allow the preschooler to work out hospitalization experiences.

Toys and play for the hospitalized preschooler include:

The _____ needs preparation for procedures. He or she needs to understand what is and what is not going to be "fixed." Simple preschooler explanations and basic pictures are helpful. (3 to 6 years) Let child handle equipment or models of the equipment. _____ are learning to name body parts and are concerned about their bodies. During hospitalization, enforced separation Toddlers (1-3 years) toddler's

from parents is the greatest threat to the (1 to 3 years) _____ psychological and emotional integrity. Security objects or favorite toys from home should be provided for _____. toddlers (1 to 3 years)

Normal gain in weight and height for school- Each year gain 4 to 6 pounds age child (6 to 12 years) are: and about 2 inches in height. Loss of primary teeth and eruption of most permanent At this stage of development fine and gross motor skills mature. During this developmental stage, girls may experience menarche. school-age child (6 to 12 years) school-age child (6 to 12 years) school-age (6 to 12 years)

At this stage of development, a child should school-age child be able to dresses self-completely. (6 to 12 years) At this stage of development, egocentric thinking is replaced by social awareness of others. school-age child (6 to 12 years)

At this stage of development, a child learns to school-age child tell time and understands past, present, and (6 to 12 years) future. At this stage of development, a child learns cause and effect relationships. school-age child (6 to 12 years)

Socialization with peers becomes important school-age child at this stage of development: (6 to 12 years) A child's molars should erupt at _____. 6 years

According to Erikson's theory, developing a school-age child sense of industry occurs at this stage: (6 to 12 years) A child should be able to write script at _____. 8 years

The hospitalized _____ may need more school-age child support from parents than they wish to admit. Maintaining contact with peers and school activities is important during hospitalization for a _____.

school-age child

For school-age child, _____ and _____ are important, and should be respected during hospitalization.

privacy; modesty e.g., close curtains during procedures, allow privacy during baths, etc.

Participation in care and planning with staff fosters a involvement; sense of _____ and _____ for a school-age accomplishment child (6-12 years). board games card games Toys for the hospitalized school-age (6 to 12 hobbies (such as stamp years) child include: collecting, puzzles, and video games) School-age children are in Erikson's stage of _____, meaning they like to do and industry; Peers accomplish things. _____ are also becoming important for this age child. Girls' growth spurt during adolescent begins _____ than boys (may begin as early as ___ earlier; 10 for girls). Boys catch up to girls' growth at age _____ and continue to grow. Girls finish growth around _____, boys around _____. 14 15; 17

Adult-like thinking begins around age _____. 15; problem solve; abstract They can _____ and use _____ thinking. Secondary sex characteristics begins at this developmental stage: At this stage of development, family connflict commonly occurs. ADOLESCENCE (12 to 19 YEARS) ADOLESCENCE (12 10 19 YEARS)

Hospilalization of adolescents disrupts _____ and _____ activities; they need to maintain school; peer contact with both. Illness, treatments, or procedures which alter the adolescent body image can be viewed as devastating by the _____.

For this develpmental stage, teaching about procedures should include time without parents present. For this developmental group, some assessment questions should be asked without parents' presence. When teaching adolescent needs, the focus should be on _____.

adolescent (12 to 18 years)

adolescent here and now i.e., how will this affect me today? Infants: After 6 months, their cognitive development allows them to remember pain. Toddlers: Fear intrusive procedures. Preschoolers: Fear body mutilation. School age: Fear loss of control of their body. Adolescent: Major concern is change in body image.

Infants' concept of bodily injury:

Toddlers' concept of bodily injury Preschoolers' concept of bodily injury School ages' concept of bodily injury: Adolescents' concept of bodily injury:

MMR VACCINE Generally administered at _____ months of age and repeated at _____ 12 to 15; 4 to 6; 11 to 12 years or by _____ years. In times of measles epidemic, it is possible to give measles protection at _____ and repeat 6 months; 15 months the MMR at _____. Measles vaccine is contraindicated for persons with history of anaphylactic reaction neomycin; eggs; to _____ or _____, those with known altered immunodeficiency; pregnant _____ and _____ women. MMR vaccine may be given to those with HIV and breastfeeding women. T or F MMR vaccines are administer _____ at separate sites. A child may have a light transient ___ 2 True subcutaneously rash

weeks after administration of MMR vaccine. DTaP Vaccine administration begins at age ____, administer three doses at _____ intervals. 2 months; 2 months

DTaP Vaccine: Booster doses given at _____ 15; 18 months; 4 to 6 years. to _____; and at _____. DTaP Vaccine: administer _____ (separate site from other vaccine). intramuscularly

DTaP Vaccine is not given to children past the ______ birthday; they receive _____ which contains full strength protection 7th; Td against tetanus and lesser strength diphtheria protection. When pertussis vaccine is contraindicated, give _____, until 7th birthday. Contraindications to pertussis vaccine include: 1. _____ within 7 days of previous dose of DTP. 2. History of _____. 3. _____ symptoms after receiving the vaccine. 4. _____ allergic reactions to the vaccine. DT (full strength diphtheria and tetanus without pertussis vaccine)

Encephalopathy; seizures; Neurologic; Systemic

Parents should be instructed to begin _____ acetaminophen (Tylenol); 10 administration after the immunization to 15 (normal dosage is _____ mg/kg). IPV is recommended for all person under the 18 age of _____. IPV is administer at _____ of age and again 2 months; 4 months; 6 to 15 at _____ of age. Boosters are given at _____ , months; 4 to 6 years and _____. Administer IPV _____ or _____ at separate site. subcutaneously; IM

IPV is contraindicated for those with history of anaphylactic reaction to neomycin; streptomycin _____ or _____.

PRP-OPMs can be given as early as ____ of 2 months age. DaTP/Hib combinations should not be used as primary immunizations at ages ___, ___, 2; 4; 6 months or ___. Children at high risk who were not immunized with Hib previously should be immunized after age _____. Hib is administer ______. 5 intramuscularly

_____ offers protection against bacteria that causes serious illness (epiglottitis, bacterial meningitis, septic arthritis) in small children Hib or those with chronic illnesses such as sickle cell anemia. _____ offers protection against hepatitis B. Typically, given to all _____ prior to hospital Hepatitis B vaccine; discharge. newborns; 0; 18 Vaccinate all children _____ to _____ years of age. Hepatitis B vaccine is contraindicated for common baker's yeast persons with anaphylactic reaction to _____. Hepatitis B vaccine is administer trough _____ site at _____ , _____, and _____ of age. IM; 0 to 2 months; 1 to 4 months; 6 to 18 months

_____ offers protection against chickenpox. It is also a school entry requirement in 33 states. VARICELLA vaccine And it is safe for children with asymptomatic HIV infection. VARICELLA vaccine is administer at _____ 12 to 18 months; 12 months of age (must beat least _____). Give _____ and _____ vaccines on same day MMR; varicella or >30 days apart (separate site). Irritability, fever ( medical emergency give prostaglandin to keep ductus open. Assessment of child with CHD Check for murmur, cyanosis, clubbing (>age 2), poor feeding, FTT, fatigue, respiratory infections

Maintain nutrition status with small frequent meals Feeding a child with with high-calorie formula. Maintain hydration to CHD prevent thrombus formation. Risks of cardiac catheterization arrhythmias, bleeding, perforation, phlebitis, arterial obstruction at entry site

Cyanotic: abnormal circulation, all blood entering Basic differences circulation is oxygenated between cyanotic and Acyanotic: abnormal circulation with unoxygenated acyanotic defects. blood entering the systemic system Therapeutic digoxin levels Digoxin administration Digoxin toxicity What exacerbates Digoxin toxicity? 0.8-2ng/ml Check for bradycardia and hold. Do NOT skip doses, not miss with meals Vomiting is early sign, also, anorexia, diarrhea, and abdominal pain, fatigue, muscle weakness Hypokalemia

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Answer

Loading... When does birth length double When does the child sit unsupported 4 years 8 months

When does a child achieve 2 years

50% of adult height When does a child throw a 18 months ball overhand When does a child speak two to three word 2 years sentences When does a child use scissors 4 years

When does a child tie his 5 years or her shoes Which gender's growth spurt occurs first? Girls: as early as 10 years of age

What kind of behavior is considered common in the Temper tantrum toddler? When does a child form his or her identify? Rebellion against family values is common for which age group? Adolescence

Adolescence

Concepts of bodily injury: After 6 months, their coginitive development Infants alows them to remember pain Concepts of bodily injury: They fear intrusive procedures toddlers Concepts of bodily injury: They fear body mutilation Preschoolers Concepts of bodily injury: Fear loss of control of their bodies School age children Concepts of bodily injury: Major concern is a change in body image Adolescents What is a major cause of death in children and Accidents adolescents? What kind of children pose a serious threat to Children with German measles

their unborn siblings? What kind of hx should be Hx of reactions, sz, nerologic symtptoms after obtained prior to previous vaccine, systematic alergic reactions administration of DPAT? What kind of hx should be Hx of anaphylactic reactions to eggs, or obtain prior to the neomycin administration of MMR? Pertussus fatalities continue to occurr in which group in the US? Which type of administration method invalidates the mantoux test? Is the common cold a contraindication for immunization? Nonimmunized infants

subQ rather than ID

No

Irritability Fever ( Si de 3

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Loading... *Ductus arteriosis CONSTRICTS CV Changes at Birth *Pulmonary vascular bed OPENS * Ductus arteriosis ____ *Pulmonary vascular resistance * Pulmonary vascular bed ____ DECREASES * Pulmonary vascular resistance *Systemic vascular resistance ____ INCREASES * Systemic vascular resistance ____ *Foramen ovale CLOSES d/t * Foramen ovale __ d/t ___ BLOOD FLOW FROM LEFT TO RIGHT ACYANOTIC congenital heart diseases that cause Pulmonary blood flow: _____ * A/V septal defects * Patent ductus arteriosus * Atrioventricular canal

_____ _____ ACYANOTIC congenital heart diseases that cause obstructed blood flow from ventricles: ____ ____ ____ CYANOTIC congenital heart diseases that cause Pulmonary blood flow: ____ ____ CYANOTIC congenital heart diseases that cause mixed blood flow: ____ ____ ____ ____ NCLEX After a pediatric client has a cardiac cath, which intervention would the nurse consider to be of highest priority during the immediate post procedure period? 4. Apply direct pressure to 1. Encourage intake of small entry site of 15 minutes. amounts of fluid. 2. Teach the parents signs of CHF. 3. Monitor the site for signs of infection. 4. Apply direct pressure to entry site of 15 minutes. NCLEX 1. Encourage fluids and regular diet. Which of the following home care instructions in included for a child postcatheterization? 1. Encourage fluids and regular diet.

* Coarctation of aorta * Aortic stenosis * Pulmonic stenosis

* Tetralogy of Fallot * Tricuspid atresia

* Transposition of great arteries * Total anomalous pulmonary venous return * Truncus arteriosus * Hypoplastic L heart syndrome

2. Encourage physical activities. 3. The child can routinely bathe after returning home. 4. The child may return to school the next day. Patent Ductus Arteriosus * Diagnosis - Continuous ____ below left ____ - Dx with ____, cardiac ___ * Treatment - ____ for preterm only - ____ Transposition of the Great Arteries * Pathophysiology - ____ blood enters ____ and ____ - ____ circulation * Clinical manifestations - Initially appears ____ - ____ develops within a few hours of life NCLEX Which of the following statements is correct for a child with tetralogy of Fallot? 1. The condition is commonly referred 2. They experience hypercyanotic, or to as blue tets. tet spells. 2. They experience hypercyanotic, or tet spells. 3. They experience frequent respiratory infections. 4. They experience decreased or absent pulses in the lower extremities. NCLEX Administration of which of the following drugs 4. Prostaglandin E1 Patent Ductus Arteriosus * Diagnosis - Continuous MURMUR below left CLAVICLE - Dx with X-RAY, cardiac ECHO * Treatment - INDOMETHACIN for preterm only - SURGERY Transposition of the Great Arteries * Pathophysiology - UNOXYGENATED blood enters RA and RV - PARALLEL circulation * Clinical manifestations - Initially appears NORMAL - CYANOSIS develops within a few hours of life

would be the most important in treating transposition of the great arteries? 1. Digoxin 2. Diuretics 3. Antibiotics 4. Prostaglandin E1 NCLEX Which of the following cardiovascular disorders is considered acyanotic? 1. Patent ductus arteriosus 2. Tetralogy of Fallot 3. Tricuspid atresia 4. Truncus arteriosus Psychosocial Factors * ____ * ____ * ____ * ____

1. Patent ductus arteriosus

* Separation * Bonding * Feeding * Care

NCLEX A 2-year-old child has a known cardiac defect and is in congestive heart failure. Which assessment finding indicates to the nurse a toxic 3. Bradycardia, nausea, and vomiting dose of digoxin? 1. Tachycardia and dysrhythmia 2. Headache and diarrhea 3. Bradycardia, nausea, and vomiting 4. Tinnitus and nuchal rigidity Kawasaki Disease * Pathophysiology - VASCULitis (BV inflamm) - PANCARDitis (inflamm of ALL structures of heart) - ECTASIA (dilation of tubular vessel) on echocardiogram 2. Strawberry tongue 1st sign - HIGH (not low) fever

Kawasaki Disease * Pathophysiology - ____itis - ____itis - ____ on echocardiogram

NCLEX When assessing a child with suspected Kawasaki disease, which of the

following symptoms is common? 1. Low-grade fever 2. Strawberry tongue 3. Pink moist mucous membranes 4. Bilateral conjunctival infection with yellow exudate NCLEX A nurse is giving discharge instructions to the parents of a child with Kawasaki disease. Which of the following statements shows an understanding of the treatment plan? 1. A regular diet can be resumed at 3. My child should use a soft-bristled home. toothbrush. 2. Black, tarry stools are considered normal. 3. My child should use a softbristled toothbrush. 4. My child can return to playing football next week." NCLEX Which of the following statements best defines the term cardiogenic shock? 1. Decreased cardiac output 2. A reduction in circulating blood volume 3. Overwhelming sepsis and circulating bacterial toxins 4. Inflow or outflow obstruction of the main bloodstream. NCLEX Which of the following signs is considered a late sign of shock in children? 1. Tachycardia 2. Hypotension 3. Delayed capillary refill 4. Pale, cool, mottled skin NCLEX

1. Decreased cardiac output CAUSES 2. A reduction in circulating blood volume RESULTING IN GLOBAL HYPOPERFUSION

2. Hypotension

3. Low-grade fever

A child with suspected bacterial endocarditis arrives at the emergency department. Which of the following findings is expected during assessment? 1. Weight gain 2. Bradycardia 3. Low-grade fever 4. Increased hemoglobin level NCLEX A nurse is teaching wound care to parents after cardiac surgery. Which of the following statements is most appropriate? 1. Lotions and powders are acceptable. 4. If the sterile adhesive strips over 2. Your child can take a complete the incision bath tomorrow. fall off, call the physician. 3. Tingling, itching, and numbness are normal sensations at the wound site. 4. If the sterile adhesive strips over the incision fall off, call the physician. NCLEX A child with an atrial septal repair is entering postoperative day 3. Which of the following interventions would be most 4. Administer an analgesic as needed. appropriate? 1. Give the child nothing by mouth. 2. Maintain strict bed rest. 3. Take vital signs every 8 hours. 4. Administer an analgesic as needed. NCLEX 2. To observe the child for signs of A chld with a cyanotic heart defect is increased intracranial pressure. being discharged home to await surgical repair. In the discharge teaching, the nurse instructs the parents: 1. To prevent the child from crying

at all. 2. To observe the child for signs of increased intracranial pressure. 3. In cardiopulmonary resuscitation. 4. To identify growth and development milestones. Monro - Kellie Hypothesis Once sutures have fused, the skull is a rigid compartment filled to capacity with non-compressible contents: brain ____% blood ____% CSF ____% If one component increases in volume, another component must ____ or ICP will ____. Normal ICP Adult ___-___ mm Hg Child ___-___ mm Hg (Accept values < ___ mm Hg) Cerebral Perfusion Pressure - blood pressure gradient across the brain CPP = ________ Keep above ____ Causes of Increased ICP ____ lesions (__,__,__) ____ injury (__,__) ____ problems (__natremia,__failure, __failure,__acidosis) Subarachnoid/intracerebral ____ Increased ICP MASS lesions (TUMORS, ABSCESSES, HEMATOMAS) ISCHEMIC injury (STROKE, HYPOXIA) METABOLIC problems (HYPOnatremia, LIVER failure, RENAL failure, CPP = MAP ICP Keep above 60 Monro - Kellie Hypothesis brain 80% blood 10% CSF 10% If one component increases in volume, another component must DECREASE or ICP will INCREASE.

Normal ICP Adult 3 - 15 mm Hg Child 0 - 10 mm Hg (Accept values < 20 mm Hg)

____ Malfunction

Diabetic Ketoacidosis) Subarachnoid/intracerebral HEMORRHAGE SHUNT Malfunction PUPILLARY dysfunction MOTOR weakness SENSORY deficits CRANIAL nerve palsies HEADACHE pain Deterioration in level of CONSCIOUSNESS SEIZURE

S/S of Increased ICP ____ dysfunction ____ weakness ____ deficits ____ nerve palsies ____ pain Deterioration in level of ____ ____ LATE S/S of Increased ICP Severe deterioration of ___ ____ ____edema ____ing Change in ____ signs Impaired brain stem ____ S/S of Increased ICP in an INFANT ____ feeding ____ity ____-pitched cry ____, ____ fontanel ____ing ____ scalp veins ____ head circumference TX for Elevated ICP (slide#1) 1st: ___'s! Stabilize ____ - ____-____ CO2 ____active drugs ____ drugs (Osmotic/Loop) ____osmolar therapy with ____% saline Positioning: ____, HOB ___, ____/____ alignment

Severe deterioration of LOC VOMITING PAPILLedema POSTURing Change in VITAL signs Impaired brain stem REFLEXES S/S of Increased ICP in an INFANT POOR feeding IRRITABILity HIGH-pitched cry TENSE, BULGING fontanel VOMITing DISTENDED scalp veins INCREASED head circ TX for Elevated ICP (slide#1) 1st: ABCs! Stabilize AIRWAY - LOW-NORMAL CO2 VASOactive drugs DIURETICS (Osmotic/Loop) HYPERosmolar therapy with 3% saline Positioning: SUPINE, HOB UP, HEAD/NECK alignment

TX for Elevated ICP (slide#2) ____tion Maintain ____ temp ____ ____ Drainage ____ control ____ regimen Avoid clustering ____ Avoid ____ exercises Provide a ____ environment Syndrome of Inappropriate ADH Secretion - ____ H2O reabsorption ____ serum osmolality ____ serum Na ( ____ deposited in tissues unless excreted - __ infusion __ nts/week Beta-thalassemia Medical/Nursing Management Medical Tx: Chronic ____ Sometimes ____ectomy ____ transplant Nursing Issues: Blood Transfusions ____ therapy Risk of infection, postsplenectomy Patient/Family Education Aplastic Anemia Pancytopenia Neutrophils < ____ Platelets < ____ Hemoglobin (RBCS) ____ Reticulocytes < ____% Etiology Primary (congenital): ____ Secondary (acquired): ____ (viral, toxic, pharmacologic) Coagulation Disorders

Moderate: 3 7 g/dl Severe: < 3 g/dl SICKLE CELL complication STROKE (or high-risk for it) Tx: * Blood transfusion q 3-4 wks * Desferoxamine (Chelation therapy) binds iron, allows excretion to occur (b/c RBC destruction from SCD -> iron overload -> iron deposited in tissues unless excreted - SC infusion 5 nts/week Beta-thalassemia Medical/Nursing Management Medical Tx: Chronic transfusions Sometimes splenectomy Bone marrow transplant Nursing Issues: Blood Transfusions Chelation therapy Risk of infection, postsplenectomy Patient/Family Education Aplastic Anemia Pancytopenia Neutrophils < 500 Platelets < 20,000 Hemoglobin (RBCS) DEC. Reticulocytes < 1% Etiology Primary (congenital): Fanconis anemia Secondary (acquired): Injury (viral, toxic, pharmacologic) Coagulation Disorders

____ A (factor VIII) aka classic hemophilia ____ B (factor IX) aka Christmas Disease ____ C (factor XI) ____ disease (vWF) Hemophilia A & B Lab Findings Platelets: ____ Bleeding time: ____ (clot formation) PT (or INR): ____ (extrinsic pathway) PTT: ____ (intrinsic pathway) Hemophilia A & B Medical/Nursing Management Monitor for ____ episodes/complications First aid for bleeding: ____ Administer ____containing product ____ infusions ____-derived or recombinant DDAVP (Mild Hemophilia A) Hemophilia Patient/Family Education Emergency treatment of bleeding IV ____ administration Anticipatory guidance: ____ precautions Physical activity Monitoring for complications von Willebrands Disease

Hemophilia A (factor VIII) aka classic hemophilia Hemophilia B (factor IX) aka Christmas Disease Hemophilia C (factor XI) Von Willebrands disease (vWF) Hemophilia A & B Lab Findings Platelets: normal Bleeding time: normal (clot formation) PT (or INR): normal (extrinsic pathway) PTT: prolonged (intrinsic pathway) Hemophilia A & B Medical/Nursing Management Monitor for bleeding episodes/complications First aid for bleeding: RICE Administer factorcontaining product Factor infusions Plasma-derived or recombinant DDAVP (Mild Hemophilia A) Hemophilia Patient/Family Education Emergency treatment of bleeding IV factor administration Anticipatory guidance: Safety precautions Physical activity Monitoring for complications von Willebrands Disease

vWf transports Factor ____ Types: decreased, abnormal or near absence of vWF Results in : mucosal bleeding, epistaxis, easy bruising, menorrhagia Treat with ____, and vWF replacement Differences in Adult and Child Cancer Origin Cause Prevention and screening Metastasis at diagnosis Response to treatment Cure rate Childhood Cancer Treatment Modalities ____ (biopsy, resect, debulk) ____ (rapidly dividing cells) ____ therapy (shrink, residual) ____ transplant ____ response modifiers LYMPHOMA From lymphoid and hematopoietic systems HODGKINs Disease Older children/adolescents Focal, painless enlarged ____ tissue Dx: Node biopsy and staging Tx: Chemotherapy & radiation Atrial Septal Defect * Pathophysiology

vWf transports Factor VIII Types: decreased, abnormal or near absence of vWF Results in : mucosal bleeding, epistaxis, easy bruising, menorrhagia Treat with DDAVP, and vWF replacement

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Childhood Cancer Treatment Modalities Surgery (biopsy, resect, debulk) Chemotherapy (rapidly dividing cells) Radiation therapy (shrink, residual) Bone marrow transplant Biologic response modifiers LYMPHOMA From lymphoid and hematopoietic systems HODGKINs Disease Older children/adolescents Focal, painless enlarged lymph tissue Dx: Node biopsy and staging Tx: Chemotherapy & radiation Atrial Septal Defect * Pathophysiology

- Blood flow ____ to ____ - ____ congestion * Clinical manifestations - Symptomatic? ____ - ____ ____ failure * Treatment - ____ for ___ ___ failure - ____ repair Ventricular Septal Defect * Pathophysiology - Blood flow ____ to ____ - Heart ____ - ____ congestion * Clinical manifestations - Symptoms? ____ - ____ ____ failure * Treatment - May ____ by age ___ Patent Ductus Arteriosus * Pathophysiology - ____ to ____ shunt - Fibers dont respond to ____ ____ at birth * Clinical manifestations - Symptomatic? ____ - Sounds? ____ - ____ pulses, ____ pulse pressure - ____ ____ failure FACTORS KNOWN TO ELEVATE INTRACRANIAL PRESSURE

- Blood flow LEFT to RIGHT - PULMONARY congestion * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - CONGESTIVE HEART failure * Treatment - DIURETICS for CHF - SURGICAL repair Ventricular Septal Defect * Pathophysiology - Blood flow LEFT to RIGHT - Heart ENLARGEMENT - PULMONARY congestion * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - CONGESTIVE HEART failure * Treatment - May CLOSE by age TWO Patent Ductus Arteriosus * Pathophysiology - LEFT to RIGHT shunt - Fibers dont respond to INCREASED O2 at birth * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - Sounds? MURMUR - BOUNDING pulses, WIDER pulse pressure - CONGESTIVE HEART failure Elevate ICP Hypercapnia Hypoxemia Respiratory Procedures Vasodilating Drugs Positioning Valsalva Maneuver Coughing Emotional Upset REM sleep Arousal from sleep Hyperthermia

Seizures Clustering of Activities SICKLE CELL Life-threatening complications ____ Sequestration: Trapping of blood in ____, can result in shock/rupture Infection/____: Fever, S&S infection Leading cause of death in SCD pts < __ (#) yrs Hemolytic/Aplastic: ____ failure SCD Medical/Nursing Management ____ transfusion PT teaching: Living with chronic illness Pain Management - Opioids: ATC, PCA, __->__ transition (avoid ____) - NSAIDS (motrin) Adequate ____ Adequate ____ Support coping Observe for complications Acute Lymphocytic Leukemia Proliferation of abnormal lymphoblasts, causes pancytopenia Presenting symptoms: ____, ____ pain, ____ (color), ____ing TX: 3 Treatment phases (chemo) Induction (4 weeks) Consolidation (6 months) Maintenance (2 - 3years) For relapse, further ____ SICKLE CELL Life-threatening complications Splenic Sequestration: Trapping of blood in spleen, can result in shock/rupture Infection/Sepsis: Fever, S&S infection Leading cause of death in SCD pts < 5 yrs Hemolytic/Aplastic: Bone marrow failure SCD Medical/Nursing Management Blood transfusion PT teaching: Living with chronic illness Pain Management - Opioids: ATC, PCA, IV -> oral transition (avoid meperidine) - NSAIDS (motrin) Adequate oxygenation Adequate hydration Support coping Observe for complications Acute Lymphocytic Leukemia Presenting symptoms: Fever, bone pain, pallor, bruising 3 Treatment phases (chemo) Induction (4 weeks) Consolidation (6 months) Maintenance (2 - 3years) For relapse, further chemo and bone marrow transplant

and ____ transplant Acute Myelogenous Leukemia ____ proliferation of ____ cells in ____ Presenting symptoms: ____-like, ____ing, or as in ALL TX: Induction phase Intensive ____ Increased incidence of ____ S/S of Hydrocephalus Assess: ____ circ, ____ fontanel, ____ sutures Same S/S as ICP ____ache, ____ing, ____edema, ____ (musc), ____ity, ____argy, ____-pitched neuro cry, ____sion, ____s, ____ nerve dysfunction ____ ventricles on CT/MRI Status Epilepticus Nursing Tx/Interventions 1. ____ 2. ____ 3. ____ ALSO: ____ diet ____ Acute Myelogenous Leukemia Malignant proliferation of myeloid cells n bone marrow Presenting symptoms: Flu-like, bleeding, or as in ALL TX: Induction phase Intensive chemotherapy Increased incidence of DIC Hydrocephalus Assess: HEAD circ, BULGING fontanel, SEPARATED sutures Same S/S as ICP HEADache, VOMITing, PAPILLedema, ATAXIA (musc), IRRITABILity, LETHargy, HIGH-pitched neuro cry, CONFUsion, SEIZUREs, CRANIAL nerve dysfunction ENLARGED ventricles on CT/MRI Status Epilepticus Nursing Tx/Interventions 1. Stabilize airway! 2. Safety precautions 3. Medications Ativan or Valium Dilantin (Phenytoin); Fosphenytoin Tegretol Depakote Phenobarbital ALSO: Ketogenic diet

Education NSG Management of GHD > Assessment > Nursing diagnoses - ____ growth/developmt r/t inadeq ____ secretion - Disturbed ____ image r/t ____ stature - Deficient ____ r/t tx > Outcome identification > Planning/implementation - ____ injections of ____ > Evaluation > ____ teaching re: ____ Acquired Hypothyroidism Clinical manifestations * ____ rate of growth * Weight ____ * ____ (bowels) * ____ skin * ____ or ____ hair * ____ (energy) * ____ intolerance * ____ of face, eyes, hands * ____ deep tendon reflexes * ____ puberty Tx = Med: ____ Hyperthyroidism Clinical manifestations * ____ rate of growth * Weight ____ despite ____ appetite * ____, ____ skin * ____cardia * ____ changes * Heat ____ * Emotional ____ * _____somnia, ____ tremors NSG Management of GHD > Assessment > Nursing diagnoses - Delayed growth/developmt r/t inadeq GH secretion - Disturbed body image r/t short stature - Deficient knowledge r/t tx > Outcome identification > Planning/implementation - SQ injections of GH > Evaluation > Pt/Family teaching re:tx Acquired Hypothyroidism Clinical manifestations * Decreased rate of growth * Weight gain * Constipation * Dry skin * Thinning or coarse hair * Fatigue * Cold intolerance * Edema of face, eyes, hands * Delayed deep tendon reflexes * Delayed puberty Tx = Med: Levothyroxine Hyperthyroidism Clinical manifestations * Increased rate of growth * Weight loss despite excellent appetite * Warm, moist skin * Tachycardia * Ophthalmic changes * Heat intolerance * Emotional lability * Insomnia, fine tremors

Tx: * ____ medication * ____ therapy * Subtotal ____ectomy Congen. Adrenal Hyperplasia Clinical manifestations * Male fetus: ____ * Female fetus: virilized _____ Enlarged ____ Fusion of ____ ____ appearance to labia ____ism (genitals) * Children (often toddlers) present with: adrenarche, ____ growth velocity, ____ bone age, acne, ____ism (hair) HEMATOLOGY Red Blood Cells Life span: ____ days, removed by ____ Types of hgb: ____ and ____ Hgb molecule has __(#) heme, __(#) globin chains White Blood Cells Early inflammatory response: neutrophils Immunity: lymphocytes Inflammatory/phagocytic: monocytes, macrophages Platelets Life span: ____ days ____ # in inflamm. states SICKLE-CELL pathophysiology RBC sickling caused by: ___emia(O2), ___osis(pH), ____hydration, stress,

Tx: * Antithyroid medication * Radioactive iodine therapy * Subtotal thyroidectomy Congen. Adrenal Hyperplasia Clinical manifestations * Male fetus: no phys changes * Female fetus: virilized external genitalia Enlarged clitoris Fusion of labial folds Rugae appearance to labia Pseudohermaphroditism * Children (often toddlers) present with: adrenarche, accelerated growth velocity, advanced bone age, acne, hirsutism HEMATOLOGY Red Blood Cells Life span: 120 days, removed by SPLEEN Types of hgb: A (adult) and F (fetal) Hgb molecule has 4 heme, 4 globin chains White Blood Cells Early inflammatory response: neutrophils Immunity: lymphocytes Inflammatory/phagocytic: monocytes, macrophages Platelets Life span: 10 days INC. # in inflamm. states SICKLE-CELL pathophysiology RBC sickling caused by: hypoxemia, acidosis, dehydration, stress,

infection, ____ extremes Sickled RBC destruction -> ____ Accumulated RBCs in spleen -> ____ damage & fibrosis Sickled RBCs obstruct capillaries/____, impair ____ -> pain, ____ dysfunction Hemophilia (A & B) Clinical Manifestations: Hemat____, Hem____, Hemat____, Epistaxis (nose ____),Intracranial ____, Other ____ (neck, abdomen, mouth) Dx History, Thromboplastin Generation test Severity (based on % of factor) Mild: __-__% of normal Moderate: __-__% Severe: < __% TYPES of Cerebral Palsy * ____- tense, contracted muscles (most common) * ____- poor sense of balance, falls/stumbles * ____- constant, uncontrolled motion of limbs, head, and eyes * ____- tight muscles that resist effort to make them move * ____- uncontrollable shaking, interfering with coordination SICKLE CELL Life-threatening complications ____-occlusive episode:

infection, temp extremes Sickled RBC destruction -> anemia Accumulated RBCs in spleen -> spleen damage & fibrosis Sickled RBCs obstruct capillaries/vessels, impair circulation -> pain, organ dysfunction Hemophilia (A & B) Clinical Manifestations: Hematomas, Hemarthroses, Hematuria, Epistaxis, Intracranial bleed, Other bleeding (neck, abdomen, mouth) Dx History, Thromboplastin Generation test Severity (based on % of factor) Mild: 5-35% of normal Moderate: 1-5% Severe: < 1% TYPES of Cerebral Palsy * SPASTIC- tense, contracted muscles (most common) * ATAXIC- poor sense of balance, falls/stumbles * ATHETOID- constant, uncontrolled motion of limbs, head, and eyes * RIGIDITY- tight muscles that resist effort to make them move * TREMOR- uncontrollable shaking, interfering with coordination SICKLE CELL Life-threatening complications Vaso-occlusive episode:

-PAIN due to ____ (acute, chronic) ____ *S/S= severe ____ache, ____ signs *Evaluate c transcranial ____ *Tx: ____ transfusion q 3-4 wks Tx: ____ therapy: Desferoxamine SC infusion __ nts/week Acute ____ Syndrome *S/S= pneumonia-like picture, ____emia, pain *Tx= Transfusion or ____ transfusion, ____ support Beta-thalassemia

-Pain due to ischemia (acute, chronic) Stroke *S/S= severe headache, neuro signs *Evaluate c transcranial doppler *Tx: blood transfusion q 3-4 wks Tx: Chelation therapy: Desferoxamine SC infusion 5 nts/week Acute Chest Syndrome *S/S= pneumonia-like picture, hypoxemia, pain *Tx= Transfusion or exchange transfusion, Respiratory support

Beta-thalassemia Mediterranean, Middle East, Africa, South Mediterranean, Middle China, Southeast Asia East, Africa, South Synthesis beta ____ chain impaired China, Southeast Asia RBCs w/ less ____ Synthesis beta Hgb chain impaired ____ in marrow destroyed RBCs w/ less Hgb Increased erythropoietin, RBCs in marrow destroyed but ineffective ____ Increased erythropoietin, production but ineffective RBC Bone marrow ____ (abnormal production multiplication of cells) Bone marrow hyperplasia Sequelae (a secondary Sequelae: condition resulting from a Severe anemia disease): Impaired growth/ Severe ____ development ____ growth/ Without treatment: death development by 5 6 years Without treatment: ____ by 5 6 years Aplastic Anemia Dx'd with: ____ aspirate, ____ studies Aplastic Anemia Dx's with: bone marrow aspirate, chromosome studies

Tx: ____ therapy may induce remission (ATG, cyclosporin, steroids) Only cure is ____ Nursing Management: Potential for infection Potential for injury Inadequate tissue perfusion

Tx: Immunosuppressive therapy may induce remission (ATG, cyclosporin, steroids) Only cure is bone marrow transplant Nursing Management: Potential for infection Potential for injury Inadequate tissue perfusion

14 yo with sickle cell disease, * What are your initial nursing admitted from ER for fever and pain. actions? 3 day hx increasing chest pain, fever * When will you reassess? to 38.5. Wt = 45 kg * What kinds of medical orders do Admit VS: T= 38.4ax, HR= 140, you expect? RR= 32, BP= 142/88, 02 sat 90% on * Which, if any, of these results is room air. Rates pain as 9/10 on 0-10 concerning? And, why? scale. Points to upper right chest as CXR results show a right pain location, also back and upper lobe opacity. ? abdomen. Infiltrate. Has an implanted port in rt chest, CBC results: H/H = 7.0 / accessed in ER, now with 20 (norm =13-16/37-49) D5%/0.45NS at 25 ml/hr. Retic count = 1.5 (norm = CBC, retic count, and blood cultures 0.5-1.5) drawn, chest xray done. WBC = 15,000 (norm = 4.5 * What are your nursing priorities? 11.0) * What else do you need to assess? segs:80%, bands:10% (norm * What other information would be segs = 54 - 62, bands = useful in planning care? 3 - 5) Lymphoma From lymphoid and hematopoietic systems NON-HODGKINs Lymphoma Peak 7-11 years S/S: Depend on location (mediastinal mass, pleural effusion, lymphadenopathy) Pain, edema, generalized Often advanced at dx With mediastinal mass, Lymphoma From lymphoid and hematopoietic systems NON-HODGKINs Lymphoma Peak 7-11 years S/S: Depend on location (mediastinal mass, pleural effusion, lymphadenopathy) Pain, edema, generalized Often advanced at dx With mediastinal mass,

risk of ____ distress and superior vena cava syndrome Treatment with multi-agent ____ High risk of ____ lysis syndrome Wilms Tumor Arises in ____, primordial cells S/S: ____ swelling, pain, ____uria, ____ BP, malaise Dx: CT/MRI Surgery to remove ____ or ____, ____therapy Pre-op: monitoring, no ____ palpation (fragile outer capsule of tumor) Postop: Care as for major abd surgery, large abd incision Fluids, BP, pain Neuroblastoma From neural crest cells: brain, adrenal medulla, pelvis, mediastinum, sympathetic ganglia S/S: caused by ____ on adjacent structures, ____ Dx: scans, lab tests (depending on location), biopsy Staging: based on age, markers present, histology, extent of spread (62% have ____) Treatment: surgical removal, intensive ____, radiation (stage III), BMT

risk of respiratory distress and superior vena cava syndrome Treatment with multi-agent chemotherapy High risk of tumor lysis syndrome Wilms Tumor Arises in kidney, primordial cells S/S: abdominal swelling, pain, hematuria, INC. BP, malaise Dx: CT/MRI Surgery to remove tumor/kidney, chemo Pre-op: monitoring, no abdominal palpation (fragile outer capsule of tumor) Postop: Care as for major abd surgery, large abd incision Fluids, BP, pain Neuroblastoma From neural crest cells: brain, adrenal medulla, pelvis, mediastinum, sympathetic ganglia S/S: caused by compression on adjacent structures, metastases Dx: scans, lab tests (depending on location), biopsy Staging: based on age, markers present, histology, extent of spread (62% have mets) Treatment: surgical removal, intensive chemo, radiation (stage III), BMT

CHF * Treatment: - ____ - Meds: ____ - Positive ____ - ____ support * Nursing management - 1st: ____ ~ ____ assessment ~ ____ support, ____ c child - Nursing diagnoses ~ ____ Cardiac output ~ Fluid volume ____ ~ Imbalanced nutrition: ____ than body reqs - ____ identification and planning - Evaluation and family ____

CHF * Treatment: - SURGERY - Meds: DIURETICS - Positive INOTROPES (CO) - NUTRITIONAL support * Nursing management - 1st: ASSESSMENT ~ PHYSICAL assessment ~ FAMILY support, INTERACTION c child - Nursing diagnoses ~ DECREASED cardiac output ~ Fluid volume EXCESS ~ Imbalanced nutrition: LESS than body reqs - OUTCOME identification and planning - Evaluation and family TEACHING

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Loading... What is the leading cause of death in infants? What level of preventative care is a child wearing a helmet? How does Erikson describe school age children? How do children intrepret blood being taken from them? Birth Defects Congenital Anomalies Secondary 6-12 years initiave vs guilt learn to carry out tasks want to be good at things Make a hole in them and their insides will come out.

Can grasp large objects but Fine and gross motor skills for a 5 monthj not small ones old? Roll from belly to back What is a big danger with small children and foods? How do you give ear drops to a small child? How do you give vitamin K? Rational for potty training at 2 years? What age and weight can a car seat be turned forward facing? At what age are testicular tumors more likely? Choking Pull ear down and back IM Their bodies are not ready until they are two. Age one year 20 pounds Adolescents

What accounts for 75% of all cases of spina Myelomeningocele bifida? What is myelomeningocele? Symptom of hip dysplasia What usually occurs with hip dysplasia? Back bone and spinal canal do not close before birth. Hips POP when ortiloni maneuver is preformed. neural tube disorders. Big head with rapid increase in diameter Vomit sleepy irritability seizures downward deviation of eyes (sunsetting) Appear 2-3 weeks after infection Slightly raised temperature swollen glands rash of pink spots that start on face conjunctivitis

Symptoms of hydrocephalous

Symptoms of Rubella

Symptoms of Roseola

Persistant high temperature higher than 102 for 3-4 days in an otherwise well child lowered fever with onset of rash appears on trunk and spreads Begins in broken skin Usually with staph red macules-vesicles most common in nose and mouth wash with topical ointment 3x day oral or parenteral antibiotics Fungus clean environment wash in HOT water tx entire family with NIX or Kwell caused by Deer Tick bite Caused by spirochete stage 1 rash stage 2 most serious, involves neuro TX oral doxycycline, less than 8 is amoxicillin or penicillin firm PALPABLE elevation of skin less than 1 cm elevated lesion less than 1 cm filled with fluid eating disorder characterised by low body weight and body image distortion Virus usually HPV Intense puritis especially at night Fine grayish threadlike lines human parvovirus B 19

Impetigo

How do you treat cellulitis? What causes ringworm?

How to manage head lice?

Lyme Disease

Papule vesicle

anorexia nervosa What causes a wart? S/S of scabies? What causes 5th disease?

Side effects of wearing a cast?

muscle loss atrophy increased sensitivity

What do you do with evulsed tooth if you do not want to put it back into your mouth put in cold milk or cold water until you can see a dentist? Hepatitis vaccine 1st injection 2nd one month later 3rd is 6 months from 1st DTaP IPV MMR Leukemia Bone marrow Aspiration Biopsy Lumbar Puncture most common malignant tumor of kidneys swelling or mass in abdomen firm. nontender mass increased abdominal girth HA with projectile vomiting causes obstruction in CSF circulation Causes increased ICP

What injections will a 5 year old have? Most common form of childhood cancer? How is leukemia diagnosed?

Wilm's Tumor

Symptoms of brain tumor?

Dehydration What should you watch for in a child using clotting problems because of diuretics? hypokalemia maybe no s/s of pain loss of movement stiffness loss of ROM avascular is arthritis disease of pelvic kidney It could lead to Rhumatic fever if untreated.

S/S of necrosis

pyelonephrosis Why should you treat strep?

Isotonic Dehydration How much fluid loss is there with mild dehydration? What causes diarrhea most often in children?

loss of water and electrolytes in equal proportions Loss of less than 50ml/kg of fluid Rotavirus Respiratory compromise hypovolemic shock local infections sepsis little or no pain because of nerve damage Accidents next is homocide check for tenting color, dry, moist? one of the biggest emergencies Trachea swells shut needs trach or will die malnutrition dehydration electrolyte imbalance tooth erosion damage to voice potential for gastric rupture abnormal narrowing in blood vessel or other tubal organ May be called stricture Noise over turbulent flow, bruit ultrasound or MRI to Diagnose current jelly stools Avoid Wheat. Breast Buds

Complications of 3rd degree burns in children

What is the leading cause of death in adolescents? assess skin turgor?

epiglottis

Complications of bulemia

Stenosis

Intussusception How do you treat celiac disease? First signs of puberty in females?

First signs of puberty in males?

enlarged testicles 2 months 4 months 6-18 months 11-16 years 2 months 4 months 6 months 12-18 months 4-6 years 2 months 4 months 6 months 12-15 months 2 months 4 months 6 months 15 months 6 months 9 months 18 months 4-6 years 12-18 months 4-6 years 12-18 months Before onset of s/s- 1 week after rash 4-14 days unknown blood/resp during high temp until after rash 5-15 days unknown 14-21 days 7 days before and 5 days after rash appears 14-21 days

Hep B

DTaP

Hib

Prevnar

IPV

MMR Varicella Communicability of 5th disease (Erythema Infectiosum) Incubation of transmission communicibality of roseola incubation transmission Chicken pox incubation Rubella communicability incubation

transmission

resp direct and indirect prevent with MMR Koplik's spots (bluish spots in mouth and oral mucosa Vitamin A decreases mortality and morbidity Disease is transmittable to others time between invasion of organism and outbreak of infection time between beginning and non specific s/s appearance of disease Time between time when s/s begin to disappear and complete return to wellness.

measles

communicability

Incubation Period

prodromal period illness stage convalescent