Professional Documents
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Peds Ati Review
Peds Ati Review
Family: whatever the individual considers it to by; should remain constant in the child's
life; nurses should perform comprehensive family assessments to identify strengths and
weaknesses of families; consider the child's opinion when giving care
Nuclear Family: Two parents and their children (biologic, adoptive, step, foster)
Traditional Nuclear Family: married couple and their biologic children (blood)
Single-parent family: one parent and one or more children
Blended family (reconstituted): at least one stepparent, step-sibling, or half sibling
Extended Family: At least one parent, one or more children, and other individuals
either related or not related
Gay/Lesbian Family: two members of the same sex that have a common-law tie and
may or may not have children
Foster Family: a child or children that have been placed in an approved living
environment away from the family of origin--usually with one or two parents
Binuclear Family: parents that have terminated spousal roles but continue their
parenting roles
Communal Family: individuals that share common ownership of property and goods
and exchange services without monetary consideration
Parenting Styles: Dictatorial or authoritarian (control with unquestioned rules),
Permissive or laissez-faire (exert little or no control over the child's behaviors) and
Democratic or authoritative (set rules and explain them, negatively reinforce deviation
from the rules)
Genogram: medical history for parents, siblings, aunts, uncles, and grandparents
Chapter 2, Physical Assessment Findings
Temperature Expected values: Birth-1 year, 97.7-98.9 F; 1-12 years, 98.1-99.9 F;
12 and older, 97.8-98.0 F
Pulse expected values: Birth-1 week, 100-160; 1-3 weeks, 100-220; 3months-2
years, 80-150; 2-12 years, 70-110, 12 and older, 50-90
Respirations expected values: newborn, 30-60 with short periods of apnea;
newborn-1year, 30; 1-2 years, 25-30; 2-6 years, 21-24; 12 and older, 16-18
Expected B/P: infants, 60-80/40-50; 1 year, 94-107/50-60; 3 years, 100-113/59-68; 6
years, 104-117/67-76; 10 years, 110-123/73-82; 16 years, 122-138/79-87
Posterior fontanel: should be flat and closes between 2-3 months; anterior closes
between 12-18 months
Strabismus: should be further evaluated in children between 4-6 years; use the cover/
uncover test
Internal ear: pull pinna down and back to visualize in infants; pull pinna up and back to
visualize in children older than 3
Teeth: infants should have 6-8 teeth by age 1; should have 20 deciduous and 32
permanent teeth
Sucking reflex: stroke the infant's cheek or the edge of the mouth; should turn head
toward side that is touched; birth-4 months involuntary and for life voluntary
Palmar grasp: elicited by placing an object in an infant's palm; infant should grasp the
object; birth-6 months
Plantar grasp: elicited by touching the sole of an infant's foot; the infant's toes curl
downward; birth-8 months
Moro Reflex: elicited by startling the infant; the arms and legs should symmetrically
extend and then abduct while fingers spread to form a c shape; birth-4 months
Tonic neck reflex: elicited by turning an infant's head to one side; the infant should
extend the arm and leg on that side and flex the arm and leg on the opposite side; birth-4
months
Babinski reflex: elicited by stroking the outer edge of the sole of an infant's foot up
toward the toes; the toes should fan our; birth-1 year
Stepping reflex: elicited by holding an infant upright with his feet touching a flat
surface; infant should make stepping movements; birth-4 weeks
Cranial nerves: "on old olympus' towering tops a fin and german viewed some hops"
olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic,
glossopharyngeal, vagus, spinal accessory, and hypoglossal
Olfactory: can identify smells through both nostrils
Optic: visual acuity is in tact
Oculomotor: no nystagmus present
Trochlear: able to look down with both eyes
Trigeminal: able to clench teeth together
Abducens: able to look laterally with eyes
Facial: has symmetric facial movements
Acoustic: no vertigo present
glossopharyngeal: gag reflex intact
vagus: has clear speech
Spinal accessory: both shoulders have equal strength
Hypoglossal: tongue is midline
Romberg test: able to stand with slight swaying while eyes are closed
***left testicle hangs slightly lower than the right; skin on scrotum has a rugated
appearance and is loose
Chapter 3, Health Promotion of the Infant (birth-1 year)
Weight: infants gain about 5-7 oz. per week the first 6 months; infants triple their
weight by the end of the first year
Height: infants grow about an inch per month for the first 6 months then 1/2 inch the
next 6 months
Head circumference: increases 0.6 in. per month the first 6 months, 0.2 in. the next
6 months
Teething: should have 6-8 teeth by the end of the first year; for teething pain, use cold
teething rings, otc gels, or tylenol; do not use ibuprophen unless over 6 months!!!clean
their teeth with cool wet washcloths; do not give bottles if asleep; avoid prolonged
exposure to milk or juice because of dental caries
Birth: Hep B
One month: has a head lag; has a grasp reflex
2 months: lifts head off mattress; holds hands in an open position; DTaP, RV, IPV,
Haemophilus influenzae B (Hib), PCV, and Hep B
3 months: raises head and shoulders off mattress; no longer has grasp reflex, keeps
hands loosely open
4 months: rolls from back to side; places objects in mouth; DTaP, RV, IPV, Hib, PVC
5 months: rolls from front to back; uses palmar grasp dominantly
6 months: rolls from back to front; holds bottle; DTaP, IPV, PVC, Hep B, RV
7 months: bears full weight on feet; moves objects from hand to hand
8 months: sits unsupported; begins using pincer grasp
9 months: pulls to a standing position; has a crude pincer grasp
10 months: changes from prone to sitting position; grasps rattle by its handle
11 months: walks while holding on to something; places objects into a container
12 months: sits down from a standing position without assistance; tries to build a twoblock tower without success
***Get the yearly flu vaccine between 6-12 months
Sensorimotor: Piaget; birth-24 months; three things occur, such as separation (learn
to separate themselves from other objects in the environment), object permanence
(occurs @ 9 mths), and mental representation (recognition of symbols)
Psychosocial development: Erikson; trust versus mistrust; infants trust they will be
fed, comforted, stimulated, and caring needs will be met
Separation anxiety: develops between 4-8 months; will protest loudly when
separated from parents
Stranger fear: occurs between 6-8 months; they fear strangers
Appropriate toys for birth-1 year: rattles, mobiles, teething toys, nesting toys,
playing pat-a-cake, playing with balls, reading books
Breastfeeding: provides completed diet during the first 6 months
***Iron-fortified formula is an acceptable alternative to breast milk; NEVER GIVE COW'S
MILK!!!
Solids: introduce solids around 4-6 months of age; begin when the infant is interested
in solid foods; begin with iron-fortified rice cereal; introduce new foods one at a time,
over a 5-7 day period;start veggies and fruits between 6-8 months, followed by meats;
delay giving milk, eggs, wheat, citrus fruits, peanuts, pb, and honey until after the first year
of life; decrease breast and increase solids
Weaning: accomplished when infants are able to drink from cups with handles; replace
feedings one at a time, with the bedtime feeding being last
Car seats: place in a rear facing until the first year of life or 20 pounds
Cribs: remove mobiles at 4-5 months of age; should sleep on their backs; slats should
be 6cm apart; do not use pillows or big blankets
Chapter 4, Health Promotion of the Toddler, 1-3 years
Weight: at 30 months, the toddler should weight 4X their birth weight
Pretend Play: this is healthy and allows them to determine the difference between
real and fantasy
Play: playing has shifted to associative play; not highly organized by does exist between
children; activities include playing ball, putting puzzles together, riding tricycles, playing
pretend, role playing painting, sewing cards and beads, and reading books
4-6 years: DTaP, MMR, varicella, IPV
36-59 months: yearly flu vaccine
Nutrition: need 13-19 G protein in addition to adequate calcium, iron, folate, and
vitamins A & C
Chapter 6, Health Promotion of the school-age child (6-12 years)
Weight: gain about 4.4-8.8 lbs. per year; wt. gain typically occurs between 9-12 years of
age
Height: usually grow 2 inches per year
Females: budding breasts, appearance of pubic hair, onset of
manarche
Males: enlargement of testicles with looseness in the scrotum
adn appearance of pubic hair
***Permanent teeth erupt, visual acuity improves to 20/20
Piaget: concrete operations; sees weight and volume as
unchanging, understands simple analogies, understands time, able
to solve problems and becomes self-motivated
Erikson: is in the industry versus inferiority stage; has
advancements in learning, motivated by tasks that increase selfworth, fears ridicule by peers and teachers
***peer pressure begins to take effects, they are more modest, and they place emphasis
on privacy issues; prefer the company of the same gender and they may rival same-gender
parents
Play: competitive and cooperative play is dominant--At 6-9 years they play simple board
and number games, play hopscotch, jump rope, collect rocks-stamps-cards-coins, ride
bicycles, build models, join organized sports for skill building; At 9-12 years they make
crafts, build models, collect things, engage in hobbies, solve jigsaw puzzles, play board and
card games, and join organized competitive sports
***get yearly flu vaccine and Tdap, HPV and MCV4 vaccines between 11-12 years
***Screen school age children or scoliosis by examining if there is a lateral curvature of
the spine
Car Safety: they should remain in a booster seat until they are 80 pounds or 4'9"
because this is when the adult seat belt will fit properly--keep children less than 13 years
of age in the back seat
Chapter 7, Health Promotion of the Adolescent (12-20 years)
***The final 20-25% of height if achieved; girls may cease to grow 2-2.5 years after
menarch--they will gain 15.5-55 lb. and grow 2-8 in.; boys tend to stop growing between
18-20 years--they will grow 4-12 inches adn gain 15.5-66 lbs.
***Acne will occur
Sexual maturation for girls: order for girls is breast buds, growth of pubic hair,
and onset of menstruation
Sexual maturation for boys: increase in size of testes and scrotum, appearance of
pubic hair, rapid growth of genitalia, growth of axillary hair, appearance of downy hair on
upper lip, and change in voice
Piaget: formal operations; capable of thinking at an adult level, able to think abstractly,
capable of evaluating the quality of their own thinking, capable of making decisions,
capable of using deductive reasoning
Erikson: identity versus role confusion; they develop an identity that is influenced by
expectations of their family
Vocationally: solidify work habits and plan for future college and careers
***Give any missed immunizations and screen for scoliosis
Chapter 8, Safe Administration of Medication
***IM meds are absorbed more slowly in newborns and faster in infants; newborns need
reduced dosages because of limited renal excretion abilities; children have a faster
metabolism than adults until about age 12; pediatric doses are based on body weight, BSA,
and maturation of body organs; newborns are highly sensitive to drugs that affect the
CNS
6 Rights: right patient, right medication, right dose, right time, right route, and right
documentation
***Always assess for patient allergies!!!
***Consider the oral route the preferred route for children and mL as the preferred
measurement
***If using IV, always check the IV site for redness, edema, and patency
***Do not crush enteric coated or time-released tablets; divide tablets only if scored
Gastrostomy Tubes: do not mix medications with enteral feedings; use liquid forms;
check tube placement; flush tubing with warm water before and after each medication
Rectal: used as a substitute for oral meds; cut the suppository lengthwise for partial
dosing; insert with the apex entering first, then gently push beyond rectal sphincter and
hold the buttocks together until the urge to expel has passed (5-10 minutes)
Otic: Remember to pull the auricle down and back when giving otic solutions for
children up to 3, and up and back for older than 3; the parent must hold the child; warm
otic solutions before instilling
Nasal: hyperextend the child's neck for nasal meds to prevent the medication from
sliding down into the throat
SQ: apply EMLA cream 60 minutes before an injection; change the needle if used to
puncture the rubber top of a vial; insert needle at 90 deg. or 45 deg. if minimal sq tissue;
use upper arm, abdomen, or anterior thigh
Intradermal: insert at a 15 deg. angle, inject a small bubble just beneath the skin; use
the surface of the forearm; used for local anesthetics, tb skin test, and allergy testing
IM: apply EMLA 60 minutes prior, change needle if punctured the rubber top of a vial,
use the smallest gauge possible, vastus lateralis is the recommended site for infants and
children less than 2 years of age; after age 2, the ventral gluteal site can be used
Vastus Lateralis: 22-25 g; 0.625-1 inch; 0.5 mL for infants to 2.0 mL for children;
supine, side lying, sitting positions; recommended for infants and children less than 2 years
of age
Ventrogluteal: 22-25 g; 0.625-1 inch; 2.0 mL for children; supine, side lying, and prone
positions; can be used for 2 and older, less painful than vastus lateralis, free of any nerves
or blood vessels
Deltoid: 22-25 g; 0.625-1inch; 0.5 mL for infants to 1.0 mL for children; supine, side
lying, and sitting positions; not as painful as vastus lateralis, less local side effects than with
vastus lateralis, should not be used in infants/children with underdeveloped muscles, and if
muscle size is appropriate it may be used for immunization of toddlers and children
IV: use for continuous and intermittent IV medications
Chapter 9, Pain Management
***Monitor pain 15min. after IV meds, 30 min. after IM pain meds, 30-60 min. after oral
meds
***Monitor children who are on opioid medications very closely for resp. depression
CRIES Neonatal postoperative tool: pain rated on a scale of 0-10; behavior
indicators are crying changes in v/s, changes in expression, altered sleep patterns; used
from 32 wks gestation-20 wks of life
FLACC postoperative pain tool: faces, legs, activity, cry, and consolability; used
from 2 months-2 years
FACES Pain Rating Scale: rating scale that uses drawings of happy and sad faces to
depict levels of pain; used for 3 years and older
Visual Analog Scale (VAS): pain is rated on a scale of 0-10; child points to the
number that best describes the pain he is experiencing; used 7 years and older but may
be affective in those as young as 4.5 years
Noncommunicating Children's Pain checklist: pain is rated on a scale of 0-18;
behavior indicators include vocalization, socialization, facial expressions, activity level,
movement of extremities, and physiologic changes; used for children 3-18 years of age
(for children with or without cognitive impairments)
***Use caution when giving meds to newborns less than 3 months because of their
immature liver function
Opioids for children: used for moderate pain and include morphine, oxycodone, and
fentanyl
EMLA: contains prilocaine and lidocaine in the form of a cream or disk; use for any
procedure where the skin will be punctured; place an occlusive dressing over the dressing
after application; use 60 minutes prior to a procedure
Fentanyl: use for children over 12 years; used to provide continuous pain control; onset
of 12-24 hours and a duration of 72 hours; treat resp. depression w/ Narcan
top priority; use education, support, and honest communication; provide an environment
that is much like home as possible; encourage physical contact
Birth-3 years: have little to no concept of death; egocentric thinking, mirror parental
emotions; react in response to the changes, may regress
3-6 years: egocentric thinking, magical thinking, interpret separation as punishment,
view dying as temporary
6-12 years: start to respond to logical of factual explanations; begin to have an adult
concept of death; experience fear of the disease process, the death process, the unknown,
and loss of control; fear is often displayed through uncooperative behavior; may be
curious about the funeral and what happens to the body afterward
12-20 years: adult-like concept of death; may have difficulty accepting death, rely more
on peers rather than the influence of their parents; may be stressed by changes; may
experience guilt and shame
Chapter 12, Meningitis and Reye Syndrome
Meningitis: inflammation of the meninges, which are the membranes that protect the
brain and spinal cord; often preceded by viral infections; usually requires supportive care;
contagious; risk factors include viral illnesses (measles, mumps, herpes), bacterial
meningitis (otitis media, tonsilitis), immunosuppression, injuries, overcrowded living
conditions; they may report photophobia, headache, irritability, vomiting, drowsiness; lab
tests include blood cultures and sensitivity tests to see what antibiotic to use, CBC,
cerebrospinal fluid should be collected...you will see increased CSF pressure, WBC,
protein...decreased glucose and CSF that appears cloudy for bacterial and clear for viral;
isolate the child ASAP for droplet precautions; initiate IV fluids, minimize exposure to
light, keep room cool, and give antibiotics, corticosteroids, anticonvulsants, and analgesics;
complications after the sickness include ICP; make sure the child gets the Hib and PVC
vaccines!!!
Lumbar puncture: empty bladder, place in fetal position, administer sedatives, apply
EMLA, label 3 test tubes, monitor the site for hematoma and/or infection, have child
remain in bed 4-8 hours in flat position to prevent leakage which causes a spinal headache
Meningitis in Newborns: no illness at birth, but progresses within a few days; poor
muscle tone, weak cry, and poor feeding, fever or hypothermia, nuchal rigidity is not
usually present, bulging fontanels is a late sign
Meningitis in 2 months-2 years: seizures with a high-pitched cry, fever and
irritability, bulging fontanels, possible nuchal rigidity, poor feeding, vomiting, brudzinski's
and kernig's signs do not assist with the diagnosis
Meningitis 2 year-adolescence: seizures, nuchal rigidity, positive brudzinski's and
kernig's signs, fever and chills, headache, vomiting, photophobia, irritability and restlessness
that may progress to drowsiness, delirium, stupor, and coma; petechia or purpuric type
rash, involvement of joints, and chronic draining ear
Reye Syndrome: A life-threatening disease that leads to multisystem failure; preceded
by viral infections; primarily affects the liver and brain causing liver dysfunction and
cerebral edema; bleeding and poor blood clotting with lethargy progressing to coma and
potential for cerebral herniation; hypoglycemia and shock occur; Using aspirin for treating
viral infections can cause the development; there are five stages; the lab tests are Liver
enzymes, which will be elevated, serum ammonia level which is elevated, serum
electrolytes, low blood glucose, Hgb, Hct, and platelets, and coagulation times may be
extended; a liver biopsy will be performed; a lumbar puncture will be performed; maintain
hydration, insert a catheter, avoid extreme flexion, extension, or rotation; maintain head in
a midline position, keep hob elevated 30 degrees; monitor pain, insert nasogastric tube,
assist with intubation and maintain ventilation if required, take seizure precautions, keep
family informed, provide private time if death is imminent---medications are osmotic
diuretics and insulin
Liver biopsy: takes a piece of liver tissue, via a large-bore needle, and sends the tissue
to the pathology department; maintain NPO prior to procedure, monitor for hemorrhage
after the procedure, assess vitals frequently; limit postprocedure activities
Stage I: lethargy, vomiting, anorexia, early liver dysfunction, brisk pupillary reaction,
ability to follow commands
Stage II: confusion/disorientation/delirium, combativeness, hyperventilation, hyperactive
reflexes, sluggish pupillary response, response to painful stimuli
Stage III: coma, seizures, flexion rigidity
Stage IV: deeper coma, extension rigidity, fixed large pupils and loss of corneal reflexes,
brainstem dysfunction, and minimal liver dysfunction
Stage V: hypotonia, seizures, respiratory arrest, and absence of liver function
Chapter 13, Seizures
Seizures: abrupt, abnormal, excessive, and uncontrolled electrical discharges of
neurons within the brain that may cause alterations in level of consciousness and/or
changes in motor and sensory abilities and/or behavior; can be abrupt in nature or slow
and insidious onset
Tonic: stiffening of muscles
Clonic: rhythmic jerking of the extremities
Tonic-clonic seizure: may begin with an aura; begins with a 10-20 second tonic
episode and loss of consciousness; a 1-2 minute clonic episode follows a tonic episode;
breathing may stop during the tonic phase and become irregular during the clonic phase;
cyanosis may accompany breathing irregularities; biting of the cheek or tongue may occur
during the clonic phase; incontinence may accompany the seizure; a period of confusion
and sleepiness follows the seizure during the postictal phase
Tonic Seizure: only the tonic phase is experienced; usually lasts a few seconds; loss of
consciousness does not occur; tonic seizures are much less common than tonic-clonic
seizures
Clonic Seizures: only the clonic phase is experienced; fatigue does not usually follow
the seizure; clonic seizures are much less common than tonic-clonic seizures
Absence Seizure: most common in children; loss of consciousness that lasts seconds;
blank staring is associated with this type; baseline neurologic function is resumed after the
seizure, with no apparent sequela
Myoclonic Seizure: consists of brief jerking or stiffening of the extremities; may be
symmetric or asymmetric; lasts for seconds
Atonic or akinetic seizure: muscle tone is lost for a few seconds; confusion
follows; loss of muscle tone frequently results in falling
Complex Partial seizure: has associated automatisms(behaviors the child is
unaware of, such as picking at clothes or smacking the lips), loss of consciousness that
lasts for several minutes, and amnesia may occur immediately prior to and after the
seizure
Simple partial seizure: consciousness is maintained throughout the event, seizure
activity may consist of unusual sensations, a sense of deja vu, autonomic abnormalities
(changes in HR and abnormal flushing, unilateral abnormal extremity movements, pain,
offensive smell)
Unclassified: (idiopathic) do not fit into other categories; account for half of all
Nursing Care: ensure the spine is stabilized, monitor v/s, level of consciousness, pupils,
ICP, motor activity, maintain patent airway, provide mechanical ventilation, give oxygen,
hyperventilate the child and keep the PaCo2 between 30-35 mm Hg, keep the HOB at 30
degrees, minimize suctioning, avoid coughing, insert a catheter
Medications: corticosteroids (Decadron and Solu-Medrol) for acute cerebral edema,
Mannitol for acute cerebral edema, Dilantin to prevent seizures, Analgesics (morphine or
fentanyl) to control pain
***On the ATI test, our first priority with head injuries is to keep the neck stabilized!
Chapter 15, Visual and Hearing Impairments
Strabismus: misalignment of the eyes
Refractive errors: nearsightedness, farsightedness, astigmatism
Amblyopia: decreased acuity in one eye
E Snellen: chart used for children that cannot read
Snellen: chart used for children that can read
***20/70-20/200 is considered partially sighted for school vision
Myopia: nearsighted; sees close objects clearly, but not distant objects; eye rubbing,
headaches, dizziness, difficulty reading, poor school performance, clumsiness--corrected
by biconcave lenses that help focus light rays on the retina
Hyperopia: farsightedness, sees distant objects clearly but not objects that are close,
normal vision until age 7, usually able to accommodate--may be corrected using convex
lenses that help focus light rays on the retina
Astigmatism: uneven vision in which only parts of letters on a page may be seen,
headaches and vertigo, the appearance of normal vision because tilting the head enables
all letters to be seen--may be corrected with a special lens to correct refractive errors
Strabismus: misaligned eyes, frowning or squinting, difficulty seeing print clearly, one
eye closed to enable better vision, head tilted to one side, headache, dizziness, diplopia,
photophobia, and crossed eyes--may be corrected with eye exercises or patching of the
strong eye
Conductive Hearing loss: involves interference of sound transmission, which may
result from otitis media, external ear infection, foreign bodies or excessive ear wax
Sensorimotor hearing loss: involves interference of the transmission along the
nerve pathways, which may result from congenital defects or secondary to acquired
conditions
Central Auditory imperception: involves all other hearing losses
Chapter 16, Oxygen and Inhalation Therapy
Pulse Oximetry: measures the oxygen saturation of the blood; expected range is
95-100%, and below 86% is life threatening emergency; if less than 90%, it indicates
hypoxemia
Nebulized Aerosol Therapy: this breaks up medications into minute particles that
are dispersed throughout the respiratory tract; these droplets are much finer than those
created by inhalers; treatments can cause tachycardia or jitteriness
drainage, elevate HOB while awake, assess for bleeding, frequent swallowing, clearing of
the throat, restlessness, bright red emesis, tachycardia, and/or pallor, assess the airway and
v/s, monitor for any difficulty breathing r/t oral secretions/edema/bleeding, provide an ice
collar and analgesics, keep throat moist, give pain meds, encourage clear liquids and fluids
after the gag reflex returns, give soft diet, discourage coughing/throat clearing/nose
blowing, do not put pointed objects in the mouth, & tell parents that there may be blood
clots or blood-tinged mucous in the vomit---no swimming for 2 weeks!!!
***Children have short, narrow airways that can become obstructed by mucous; short
respiratory tracts allow infections to travel quickly to the lower airways; small surface
areas for gas exchange; infectious agents have easy access to the middle ear through the
short and open Eustachian tubes
Nasopharyngitis: common cold; self-limiting virus; persists for 7-10 days; s/s of nasal
inflammation, rhinorrhea, cough, dry throat, sneezing, and nasal qualities hear in voice,
fever, decreased appetite, and irritability
Pharyngitis: strep throat; caused by GABHS; s/s of inflamed throat with exudate, pain
with swallowing, headache, fever, abd. pain, cervical lyphadenopathy, truncal/axillary/
perineal rash
Bacterial tracheitis: infection of the lining of the trachea; s/s of thick purulent
drainage from the trachea that can obstruct the airway and cause resp. distress
Bronchitis: self-limiting and requires symptomatic relief; s/s persistent cough as a
result of inflammation
Bronchiolitis: mostly caused by RSV; affects the bronchi and bronchioles; s/s include
pharyngitis, rhinorrhea, intermittent fever, cough, wheezing, nasal flaring, retractions,
cyanosis, increased respiratory rate
Allergic rhinitis: caused by seasonal reaction to allergens; s/s watery rhinorrhea,
nasal congestion, itchiness of the nose, eyes, and pharynx, itchy watery eyes, nasal quality
of the voice, dry/scratchy throat, snoring, poor sleep leading to poor performance in
school, and fatigue
Pneumonia: s/s high fever, cough that may be unproductive or productive of white
sputum, retractions and nasal flaring, rapid/shallow respirations, chest pain, adventitious
breath sounds, pale color that progresses to cyanosis, irritability, anxiety, agitation, fatigue,
abd. pain, diarrhea, lack of appetite, vomiting, sudden onset usually following a viral
infection
Bacterial epiglottitis: EMERGENCY!!! caused by haemophilus influenzae; s/s sitting
with chin pointing out, mouth opened, and tongue protruding, drooling, anxiety with
respiratory distress, absence of spontaneous coughing, dysphonia, dysphagia, inspiratory
stridor, sore throat, hight fever, and restlessness
Acute laryngitis: self-limiting viral infection; s/s of hoarseness
Acute laryngotracheobronchitis: s/s low-grade fever, restlessness, hoarseness,
barky cough, inspiratory stridor, and retractions
Acute Spasmodic laryngitis: may result from allergens; s/s of barky cough,
restlessness, difficulty breathing, hoarseness, and nighttime episodes of laryngeal
obstruction
Tetralogy of Fallot: four defects that result in mixed blood flow; pulmonary stenosis,
ventricular septal defect, overriding aorta, and right ventricular hypertrophy; murmur,
cyanosis, severe dyspnea, clubbing, clot formation, child frequently in squatting position,
failure to thrive and growth retardation
Manifestations of Heart Failure: tachycardia, murmurs, extra sounds, diaphoresis,
decreased urinary output, fatigue, pallor or mottling, cool extremities, weak peripheral
pulses, slow capillary refill, cardiomegaly, anorexia, failure to thrive,
Manifestations of Pulmonary Congestion: tachypnea, crackles, retractions, nasal
flaring, use of accessory muscles, stridor, grunting, recurrent respiratory infections, and
exercise intolerance
Manifestations of Systemic Venous Congestion: hepatomegaly, enlarged
spleen, peripheral edema, ascites, and neck vein distention
Manifestations of hypoxemia: cyanosis, poor weight gain, tachypnea, dyspnea,
clubbing, and polycythemia
Tet/Hypercyanotic spells: acute cyanosis, hyperpnea to detect anemia,
polycythemia, and electrolyte imbalances
Heart Cath: check for allergies to iodine and shellfish, make sure the child is NPO for
4-6 hours prior, obtain v/s, locate and mark dorsalis pedis and posterior tibial pulses on
both extremities; administer presedation; afterwards, assess pulses, v/s, and insertion site,
monitor I&O and monitor for hypoglycemia
Rheumatic Fever: inflammatory disease that occurs as a reaction to Group A strep
infection of the throat; usually occurs within 2-6 weeks following an untreated or partially
treated upper resp. infection (GABHS); s/s include hx. of upper resp. infection, fever,
fatigue, sore throat, poor appetite, large joints that have painful swelling, pink rash on the
trunk, irritability---dx. with a throat culture for GABHS, the major criteria for dx. is
carditis, sq nodules, polyarthritis, rash, and chorea...the minor criteria for dx. is fever and
arthraligia; medications used are penicillin or erythromycin
Chapter 21, Hematologic Disorders
Epistaxis: common, may be spontaneous or induced by trauma to the nose, may
produce anxiety, rarely and emergency; have the child tilt the head forward, apply
pressure to the lower nose, cotton or tissue can be packed into the bleeding side,
encourage mouth breathing, apply ice to the bridge of the nose, keep child calm and no
rubbing or picking---No need for a humidifier!
Iron Deficiency Anemia: most common anemia, prolonged anemia can lead to
growth retardation and developmental delays; may have sob, tachycardia, dizziness, pallor,
nail bed deformities, fatigue, irritability, abd. pain, low-grade fever, and thinning hair
Normal Hgb Values: 2 mths., 9-14; 6-12 years, 11.5-15.5; 12-18 yrs., 13-16 male &
12-16 female
Hct Normals: 2 mths., 28-42; 6-12 yrs., 35-45; 12-18 yrs., 37-49 male, 36-46 female
Iron Supplements: give 1 hr. before or hr. after giving milk or antacid, diarrhea and
constipation are common, admin. on an empty stomach, give vit. c to increase absorption,
use a straw, use z-track if giving IM---legumes, fruits, nuts, green leafies, iron-fortified
bleeding, and difficulty swallowing; position the child's head elevated, administer Prilosec
or Zantac; surgical manipulation may be needed, which is called Nissen fundoplication
Hypertropic pyloric stenosis: thickening of the pyloric sphincter, which creates an
obstruction; vomiting occurs 30-60m after a meal, constant hunger, olive-shaped mass in
RUQ, failure to gain weight; a surgical incision will be made into the pyloric sphincter
Hirschsprung's Disease: lack of ganglionic cells; stool accumulates; a rectal biopsy
will be done; s/s of ribbon like stools; surgical removal of the aganglionic section may be
done
Meckel's diverticulum: complication resulting from failure of the
omphalomesenteric duct to fuse during embryonic development; s/s of bloody stools,
bright red mucous, abd. pain; do surgery to remove diverticulum
Intussusception: telescoping of the intestine over itself; palpable sausage shaped mass
in RUQ will be felt; stools are mixed with blood and mucus that looks like red jelly; if the
pt. has a brown stool then it has relieved itself; do an air enema or surgical removal of the
area
Appendicitis: inflammation of the appendix caused by obstruction of feces or
lymphoid tissue; RLQ pain at McBurney's point, fever, tachycardia, and vomiting; remove
the appendix.....labs will show increased WBC's and increased band counts
Cleft Lip: incomplete fusion of the oral cavity; position upright , on back, or onside to
maintain integrity of the repair; apply restraints to keep pt. from pulling at repair site, use
saline on sterile swab to clean incision site, apply abx. ointment to lip
Cleft Palate: incomplete fusion of palatine plates; change positions frequently, may be
placed on abdomen, monitor packing, which should be removed in 2-3 days, avoid placing
anything in the mouth, do not give anything that will be used to suck
Chapter 24, Enuresis and Urinary Tract Infections
Enuresis: uncontrolled or unintentional urination after the child has achieved bladder
control; child must be at least 5 before he/she can be dx. with enuresis; medications used
are antidiuretics (desmopressin acetate), antidepressants (tofranil), anticholinergics
(ditropan); bladder stretching exercises can be done
UTI: pt. will have dysuria, foul-smelling urine, left flank pain; abx. will be used; most
common cause is E. Colli
Chapter 25, Structural Disorders of the Genitourinary Tract and
Reproductive System
***Any structural defects should be repaired between 6-15 months of age due to the
impact of body image
Hypospadias: when the location of the urethral meatus is below the glans penis or on
the ventral surface of the penis
Epispadias: occurs when the location of the urethral meatus is on the dorsal side of
the penis
Phimosis: the narrowing of the preputial opening of the foreskin that prevents the
foreskin from retracting over the glans penis
Cryptochidism: the failure of one or both testicles to descend through the inguinal
canal
Hydrocele: an abnormal collection of fluid in the scrotum
Ambiguous genitalia: congenital malformations that prevent visual identification of a
chid's sex
Chordee: a fibrous band on the ventral side of the penis resulting in a ventral
curvature of the penis
Chapter 26, Renal Disorders
Acute Glomerulonephritis: an antibody-antigen disease that occurs as a result of
certain strains of group A B-hemolytic streptococcal infection; seen in ages 6-7; renal
manifestations occur 10-21 days post infection; s/s anorexia, decreased urine output,
pallor, reports of discomfort, dyspnea, orthopnea, moist crackles, distended neck veins,
facial edema, mild-severe hypertension, pale appearance and lethargy; meds include
diuretics and antihypertensives
Nephrotic Syndrome: proteins pass into the urine, resulting in decreased serum
osmotic pressure; cause is unknown; s/s wt. gain over a short period, poor appetite,
anorexia, n/v, diarrhea, irritability, hyperlipidemia, hypoalbuminemia, proteinurea, edema,
dark-frothy urine, and decreased urine output; meds include prednisone, lasix (eat foods
high in K) and Cytoxan (give if they cannot take prednisone)
Chapter 27, Fractures
Types of Fractures
Types of Fractures
Fracture: occurs when the resistance between a bone and an applied stress yields to
the applied stress, resulting in a disruption to the integrity of the bone; healing is faster in
children due to a thicker periosteum and good blood supply; epiphyseal plate injuries may
result in altered bone growth
Plastic deformation: the bone is bent no more than 45 degrees
Buckle (torus): a bulge or raised area is present at the fracture site
Greenstick: a fracture occurs in only one cortex of the bone
muscle control, coordination and posture; most common permanent disability in children;
exact cause is unknown; warning signs are poor head control or absence of smiling in a 3
month old, difficulty with dressing and diaper changes due to stiff arms or legs, the child
may push away or arch the back, floppy or limp body parts, inability to sit up without
support in an 8 month old, feeding difficulties & painful muscle spasms; pt. will have
persistent moro or tonic reflexes, hypertonicity, increased deep tendon reflexes, clonus,
poor control of motion/balance/posture; dyskinetic--movements increase with stress but
are absent with sleep; athetoid--involuntary jerking movements that appear slow, writhing,
and wormlike; dystonic--slow twisting movements occur that affect the trunk and
extremities; ataxic--wide-based gait and difficulty with coordination, poor ability to do
repetitive movements, difficulty with quick or precise movements; to dx. do an MRI and
complete neuro assessment; always have suction equipment handy; meds used include
Lioresal (muscle relaxant), valium (muscle relaxant)
Spina Bifida: defects in intrauterine closure of the boney spine; meningocele--spinal
defect and sac-like protrusion are present but only spinal fluid and meninges are present
in the sac; myelomeningocele--the sac includes meninges, spinal fluid, and nerves; high risk
of latex allergies; linked to insufficient folic acid during pregnancy; elevated alphafetoprotein may indicate the presence of a neural tube defect; mom should be assessed
between 15-20 weeks gestation to see if there are elevated AF proteins; monitor for
ICP!!!! Meds used areditropan and detrol (antispasmodics to improve bladder capacity
and continence; closure of the sac is done ASAP to prevent injury, a shunt may be placed
for ICP
Down Syndrome: chromosomal abnormalities; usually have an IQ around 50; have a
small head, flattened forehead, low-set ears, upward slant to the eyes, protruding tongue,
underdeveloped nasal bone, hypotonia, congenital heart defects; dx. with chromosomal
analysis; child will need speech, physical, and occupational therapy
Juvenile idiopathic arthritis: group of chronic autoimmune inflammatory diseases
affecting joints and other tissues; no definitive dx. is available; peak is between 1-3 yrs.;
rarely life-threatening; s/s of joint swelling, stiffness, redness, warmth, mobility limitations,
fever, rash, nodules under skin, delayed g&d, enlarged lymph nodes; meds used are NSAIDs
(controls pain/inflammation), Rheumatrex (slows joint degenerations), Corticosteroids
(provide relief of pain/inflammation), Enbrel; NEVER USE ASPIRIN DUE TO REYE
SYNDROME!!!
Muscular Dystrophy: inherited disorders w/ progressive degeneration of symmetric
skeletal muscle groups; Duchenne muscular dystrophy is the most common form; onset
between 3-7 yrs. with life span reaching into early adulthood; family will report delays in
walking, changes in gait, and difficulties w/ running, climbing stairs & riding a bike; s/s are
muscular weakness in the lower extremities, muscular hypertrophy, mild delay in motor
skill development, unsteady gait, mild cognitive delay, cardiovascular complications; dx.
with dna analysis; serum creatine kinase will be elevated; meds are prednisone to increase
muscle strength
RAST: test that detects the presence of a latex allergy; allergy response includes
urticaria, wheezing, and possibly anaphylaxis
Contact dermatitis: the result of urushiol, an oil found in poisonous plants; redness/
swelling/blisters/pruritis; rinse exposed areas, use calamine lotion or ammonium acetate,
apply corticosteroid gel
Seborrheic dermatitis: cradle cap, unknown etiology; thick/yellowish/scaly
adhesions occur on scalp, eyelids, and external ear canals; treat by scrubbing the scalp
with shampoo
Atopic Dermatitis: type of eczema; pruritus and associated with a history of
allergies that are inherited types; new lesions will develop with continued scratching;
cannot be cured, but is well controlled; use atarax or benadryl; use topical corticosteroids
to reduce or control flare-ups, and nonsteroidal agents during flare-ups; antibiotics are
used to treat the secondary infections
Acne: acne may be genetic; more common in males; hormonal fluctuations cause flareups in females; one treatment is Retin-A, interrupts abnormal keratinization that causes
microcomedones, inform the child that it may irritate the skin, instruct to apply 20-30m
after washing the face, use a pea-size amount and apply at night, use sunscreen; Another
med is benzoyl peroxide which inhibits the growth of p. acnes, may bleach bed linens and
clothes; topical antibacterial agents inhibit growth of p. acnes and there may be an allergic
reaction to it, avoid exposure to sun, and use sunscreen; Accutane affects factors involved
in the development of acne, side effects include dry skin and mucous membranes, dry
eyes, decreased night vision, headaches, photosensitivity, elevated cholesterol and
triglycerides, depression, suicidal ideation, and/or violent behaviors, it is contraindicated
for women of childbearing age!!!
Chapter 32, Burns
Thermal: flames, steam, hot liquid
Chemical: exposure to a chemical
Electrical: when electrical pulses move through the body
Radiation: from therapeutic treatment for cancer
Burn management: has three phases, which are emergent (occurs first 24-48 hr. after
burn occurs), acute (begins when emergent is finished and wound is covered by tissue),
rehabilitative (begins when most of the burn is healed and ends when reconstructive or
corrective procedures are complete--may be many years)
Superficial burn: damage to epidermis, pink-red w/ no blisters, heals in 5-10 days w/
no scarring, ex. sunburn
Superficial partial thickness burn: damage to entire epidermis and some parts of
the dermis, pink-red color w/ blisters, pain present, heals within 14 days, no scarring, ex.
flame or burn scalds
Deep Partial thickness burn: damage to the entire epidermis and parts of the
dermis, red-white w/ no blisters, pain present, scarring likely, possible grafting, heals in
14-36 days, ex. flame and burn scalds
Full thickness burn: damage to entire epidermis, dermis, and possible damage to sq
and nerve damage, red-tan-black-brown-white, no blisters, as burn heals the pain returns,
heals within weeks-months, scarring present and grafting required, ex. burn scalds, grease,
Rotavirus: RotaTeq, three doses beginning at 6 wks w/ doses 4-10 wks apart
and should be completed before 32 wks.; Rotarix requires 2 doses beginning @ 6
wks with the next does 4 wks. later, should be completed by 8 mths.; use caution
in children who are immunocompromised; may cause diarrhea and vomiting in
infants
IPV: inactivated polio vaccine; doses @ 2,4,6,&18 mths. and again @4-6 yrs.;
Beware if allergic to streptomycin, neomycin, or bacitracin!!! rare paralytic
poliomyelitis
MMR: measles, mumps, rubella; doses at 12-15 mths. and at 4-6 yrs.; joint pain,
risk for anaphylaxis and thrombocytopenia; do not take if allergic to gelatin and
neomycin!!
Varicella: one does at 12-15 mths. and again at 4-6 yrs.; may cause a rash, do
not take if allergic to gelatin and neomycin
PCV: pneumococcal conjugate; doses @ 2,4,6,12&15 mths.; may cause mild
local reactions
Hep A: two doses @ 6 mths. apart after 12 mths. of age
Hep B: within 12 hr. after birth with additional doses @ 1-2 & 6-18 mths.;
beware if allergic to baker's yeast
Seasonal Influenza: annually beginning @ 6 mths. with the inactivated, and 2
yrs. the live attenuated; beware if allergic to eggs!!! May be a risk for GuillainBarr syndrome
MCV4: meningococcal vaccine; one dose @ 11-12 yrs.; history of Guillain-Barr
syndrome
HPV2, HPV4: human papilloma virus; three doses over a 6 month interval for
females 11-12 yrs. w/ the 2nd dose 2 months after the 1st dose and the 3rd dose
6 mths. after the 2nd dose; HPV4 can be given to males starting @ 9yrs.;
hypersensitivity to yeast; rare risk for Guillain-Barr syndrome
***Give IM in the vastus lateralis or ventrogluteal for infants and young children,
and in the deltoid for older children and adolescents
***Instruct parents to avoid aspirin due to Reye syndrome
***Make sure parents pre medicate children before coming in for the vaccine
Chapter 36, Communicable Diseases
Varicella (chickenpox): direct, droplet, contaminated objects; malaise, fever,
lesions beginning as macules and progress to papules before crusting over
Rubella: direct contact, droplet; fever, mild rash, malaise--can be a teratogenic
effect on the fetus
Rubeola: direct contact, droplet; high fever, enlarged lymph nodes, koplik spots
on buccal mucosa, red rash beginning in hairline
after the tumor ells are destroyed, the child is given donor bone marrow or other stem
cells...implantation may take 2-6 wks...put pt. in private positive-pressure room with HEPA
filtration