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anything marked w/ this sticker is an NCLEX -

heavy topic I should NOT be over-looked !!!!

-V

anythingmarkedw
this is
generally importantto the
WHAT I LEARNED IN BOATING SCHOOL [nursing school] IS…

(based on what was expected of us from the ATI quiz bank)

Helpful Sources :)
Infants: https://youtu.be/rX01wVc2BR0?si=FBOytqlGA6yvVL5a
Toddlers: https://youtu.be/Fm8-ImJly1M?si=zEBniCj3LGxRcgBQ ·
Preschoolers: https://youtu.be/N4VOuoe9w5s?si=gbZ-TE4WjwNu_kjJ
School-Age: https://youtu.be/3rzT_hfSqyI?si=Q3T33UikBWHhISJl
Note: you can copy and paste these into the search engine but you should also be able to access the whole Pediatric
NCLEX review playlist here:
https://youtube.com/playlist?list=PLQrdx7rRsKfXmfA3CoozS5N767bLpnrbm&si=Fv6VlVbqn8uCRqJy

SEPARATION FROM PARENTS:

● Protest: active phase of separation from parents: kicking, screaming, biting,
crying, running away
● Despair: realization that protest is ineffective: quiet, “settled down”
● Detachment: unimpacted by loss of the caregiver. When caregiver reunited, child
may seem uninterested or ambivalent; seen especially in children w/ prolonged
separation

DEVELOPMENTAL PERCEPTION OF DEATH:

● Infants/Toddlers: they don’t know anything, they don’t care; can sense parental emotions and regress d/t
parental stress
● Preschooler: death is temporary (d/t lack of concept of time); the individual will come back to life; magical
thinking
● School-Aged Children: “death is a monster that comes for me”, “death is a punishment”, “Sickness is a
punishment”, fear of the unknown, curious about the body after death/funeral
● Adolescent: adult-like concept of death, difficulty accepting death, rely more on peers than guardian
* development if
anything /t not covered in one of these
-

sections is covered in the chart & the end of the i HIGHLY recommend
pdf memorizingthe chart
-

ERIKSON’S STAGES:
● Infant-18 months: Trust Vs. Mistrust
● 18 months-3 years: Autonomy vs. Shame and Doubt; parallel play: toddlers observe other children and
might engage in activities nearby
● 3-5 years: Initiative vs. Guilt; superego: develops w/i first 5 years of life in response to parental punishment
and approval; “makes you feel bad when you have eaten the cookie w/o permission”; wants you to always
do the right thing; “Is that the right thing to do?”
● 5-13 years: Industry vs. Inferiority
● 13-21 years: Identity vs role confusion

INFANT REFLEXES:
● Stepping: (birth to 4 weeks) holding infant upright w/ feet touching flat surface; infant makes stepping
movements
● Tonic neck reflex: (birth to 3-4 months) elicited by turning infant’s head to one side; infant extends the arm
and leg on that side and flexes the arm and leg on the opposite side
● Sucking and rooting: (birth to 4 months) stroking an infant’s cheek or edge of mouth; infant turns head to
side that is touched and starts to suck
● Palmar grasp: (birth to 4 months) placing object in infant’s palm and infant grasps object
● Moro: (birth to 4 months) head and trunk in semi-sitting position to fall backward to an angle of at least 30
degrees, infant’s arms and legs symmetrically extend and abduct while fingers spread to form C shape
● Plantar: (birth to 8 months) touch sole of foot and toes curl downward
● Babinski: (birth to 1 year) stroking outer edge of sole of infant’s foot up toward toes, toes fan upward and
outward

BABY SAFETY:
● SIDS: know your ABCs; also fans and other things make them sleep better… story time, apparently my
mom had to run the vacuum cleaner outside my sister’s room to get her to stop crying because she sucks
 ● Shaken Baby syndrome: know sx Convulsions (seizures), ↓ alertness, extreme irritability or changes in
behavior, lethargy, sleepiness, not smiling, ↓ LOC, loss of vision, no breathing, pale or bluish skin
● Choking: training classes are available and recommended by parents to unchoke the baby; if it’s blue, you
probably should start; no circular foods like grapes
● Car Seat Safety:
○ Car seat angle @45 degrees, rear facing (until 2 years old), harness straps @ or below baby’s
shoulders, harness straps snug (if you can pinch them, they’re too close), chest clip @ center of
baby’s chest w/ level @ armpits, if cold, place blanket OVER straps, remove bulky clothing
BEFORE strapping in, remove headbands or other hats and things that could slip over baby’s face
● Burns: turn pots/pan handles away from the edge, teach child early to not touch or play w/ stove; water
temp in the house should not exceed 120 ℉ or 49 ℃
● Rolling over: Don’t let them roll over off a cliff–That’s not good
● Other preventable injuries, bodily harm, drowning, falls, poisoning, motor-vehicle injuries, suffocation

HELMET/BIKE SAFETY: helmet must fit properly: cannot cover ears or eyes; bike WITH the flow of traffic and
ALWAYS walk a bike through intersections

WHEN TO CALL 911 OR CALL THE PROVIDER:

● Seizure lasts <5 minutes
● If tonsillectomy post op pt starts swallowing excessively
● If a pt has a respiratory infection a/w stridor/wheezing OR is having an asthma exacerbation (w/ wheezing),
and the respiratory noise stops abruptly, call provider/911 bc airway is now BLOCKED
● If pt had ↑ ICP, head trauma, brain surgery, or a ventriculoperitoneal shunt and the pt is now leaking clear
fluid from ears/nose, that is CSF and that’s obviously bad
● Post myelomeningocele correction pt that has a head circumference that is either enlarged (to previous
measurements) OR that has enlarged beyond the head:chest proportion (in babies) d/t CSF building up in
the brain (hydrocephalus)
● Spiral fractures; indicative of abuse

LAB VALUES: (that I could find based on the ATI textbook…don’t

wanna look them up and they be not ATI-safe)
Infant:
● Sodium: 134-150 mEq/L
● Calcium: 8.8-10.8 mg/dL
● Chloride: 90-110 mEq/L
● Potassium: 4.1-5.3 mEq/L
Children >10yr:
● LDL: <190 mg/dL
General:
● BG: 60-250 mg/dL
● If sugar 250-300 mg/dL, admin 5% dextrose in NS

INFANT BODY CHANGES:

Full-term newborn measurements:
○ Head circumference: 33-35cm
○ Length: 48-54 cm (or 19-21 in)
○ Weight: 2700-4000g (6-9lb)
○ Note: newborns lose 10% of body weight by 3-4 days and will gain it back 10th-14th day
○ BMI: kg/m2
Key development:
○ Posterior fontanel closure: 2 months (or as late as 6 months)
○ Anterior fontanel closure: 12-18 months
○ Weight changes:
■ @6 months, birth weight doubled
■ @12 months, birth weight tripled
○ Height: 0.5-1 inch per month
Dentition:
○ @6-10 months: first teeth (lower central incisors)
○ @end of 12th month, bb should have 6-8 teeth
○ Teething sx: sucking or biting on objects, drooling, difficulty sleeping, fever, rub ears, ↓ appetite for solid
foods
○ Teething tx: frozen teething rings, ice cube wrapped in washcloth and OTC teething gel,
acetaminophen/ibuprofen (only if irritability interferes with sleeping)
■ acetaminophen/ibuprofen <3 days
■ Ibuprofen >6mo
○ Hygiene: clean teeth with cool, wet washcloths; no milk or juice while falling asleep ( → dental caries)

POSITIONING NEEDS:
● Supine: infant should stay in this position when sleeping, 30-60 min in this position after LP, nonruptured
appendicitis,
● Prone: infant can be put in this position if being watched, myelomeningocele
● Trendelenburg: postop to ruptured appendicitis
● Lateral recumbent: during/post seizure for drainage, LP (positioning may be modified),
ventriculoperitoneal shunt (on unoperated side), if pt is immobile and needs to be turned q2h
● Semi-Fowlers or Fowlers: nose bleed, breathing difficulty, prevent aspiration, post-feeding for GERD,

PREMATURE BABIES:
● Highest risk for physical, emotional, and sexual abuse
● Developmental age will be however many weeks premature you are born minus your physical age
○ Ex: Gestational age 30 weeks, physical age is 8 months, bb born 8 weeks early so 8 months - 8
weeks is 6 months. The Developmental Age of this child is 6 months

NAEGELE’S RULE: last period - 3 months + 7 days is estimated due date

NUTRITION:
● Infant Diet:
○ Breast feeding: Exclusively for first 6 months; Vitamin D (400 units)
○ Formula w/ iron; no cow milk or honey
○ Introduce solid foods when:
■ Extensor tongue reflex is gone or ↓ : reflex that pushes food down throat using the tongue
instead of the swallowing muscles
■ When teeth start coming in
■ Small pieces
■ Simple foods one at a time w/ days between to identify allergies
■ No grapes
● Toddler Diet:
○ Switch from whole milk to low fat milk after 2 years
○ Trans fatty acids and satty-fattys avoided
○ Diet include 1 cup of fruit and 1 cup of vegetables
○ Fruit juice <4-6 oz per day
○ Food small, bite-size
○ No drinking or eating during play or when lying down
● Preschooler Diet: Nutrition: 5-2-1-0: 5 servings of fruit and vegetables daily, 2 hours or less of screen time,
1 hour of physical activity, 0 sugar-sweetened beverages
● POST OP FEEDING: small/frequent electrolyte solution feeding
● FTT/GER/GERD: Iron-fortified cereal, Provide same caretaker, Provide scheduled foods (not PRN), Put
iron-fortified cereal IN the formula to thicken
● Tonsillectomy Dietary considerations: no straws, spoons, no dairy (bc dairy coats the mouth → cough and
cough is bad post tonsillectomy)
● Cleft palate dietary considerations: you should EXPECT to see formula come out of nose; burp 2-3 times
during feeding
 ● DM Type 1 Considerations: if shaky, consume 10-15 g of simple carbs, 4 oz of orange juice, 6 oz of regular
soft drink, 4 glucose tablets, or 2 tsp of sugar; sugar needs change when sick or ↑ activity
○ Insulin must be given in the hip during vigorous exercises to prevent absorption in only the lower
extremities
○ Vial of insulin lasts 28-30 days w/ or w/o refrigeration

IMMUNIZATION SCHEDULE: (the condensed version; when the first dose of each are given)
● Birth: hepatitis B (HepB) [note: @ birth, 1 month after, 6 months after first dose]
● 2 mo: DTaP, RV, IPV, Hib, PCV, Hep B
● 6-12 mo: influenza vax (IM)
● 12-15 mo: varicella
● 12-23 mo: Hep A [2 doses 6 mo apart]
● 3-6 yr: yearly influenza
● 4-6 yr: MMR
● 11-12 yr: TDaP, HPV, Meningococcal
● 18 yr: Meningococcal monosaccharide

NOTE: you must complete ALL of DTaP before receiving Td (adult tetanus); once ALL of DTaP
AND Td are complete, TDaP can be given.

PAIN SCALE, TX AND THERAPY:

● CRIES and PIPP: for premature infants
● FACES: 3-6 years old (bffr just use numbers @ age 4y)
● NUMERICAL: >4 years [developmental note: 4 year olds should know numbers]

*COLD VS HEAT THERAPY:*

● Cold: reduce swelling, stops bleeding, numbing sore tissues, minimizing tissue damage,
post-injury
○ Nose bleeds (do not tilt the head back; people say to do that but that’s a misconception)
● Heat: soothe stiff joints, relax muscles
○ CI: nose bleeds

*Thought-Stopping*: repeat memorized facts about the pain such as “The pain will stop soon. The pain will
stop soon. The pain will stop soon.

NOTE: electrical burns reduce the amount of pain the pt perceives d/t the electrical currents damaging the
nerves.

MEDICATIONS/TX:
● cryoprecipitate: the liquid portion of plasma that contains clotting factors like Fibrinogen and Factor VIII;
NOTE: no longer used d/t ↓ ability to 100% remove ALL HIV/AIDs DNA
● Infectious disease meds:
● Antihistamine like diphenhydramine: control pruritus; monitor for drowsiness
● Antibiotics/Antiviral
● NSAIDS or acetaminophen: ↓ fever; proper dosage of acetaminophen (acetylcysteine for
overdose)
● Remember aspirin no go w/ virus bc Reye Syndrome
● Seizure meds: baclofen, diazepam, Botulinum Toxin A, valproic acid, other antiepileptic meds
● methylphenidate: psychostimulant to ↑ dopamine and norepinephrine levels
● Gradually ↑ dose to therapeutic levels
● Give last dose of day prior to 1800 to prevent insomnia
● SE: insomnia, anorexia, nervousness, hyper/hypotension, tachycardia, anemia
● NI: avoid caffeine, store properly
● Metronidazole or Tinidazole: for C. diff and G lamblia
ACUTE RENAL FAILURE: d/t hemolytic anemia, nephrotoxicity of meds, dec renal perfusion, sepsis,
hypovolemia; sudden, reversible
● Condition where kidneys cannot concentrate urine, conserve electrolytes, excrete waste: toxin buildup +
fluid/electrolyte imbalance
● Complication: HTN, pulmonary edema, CHF, altered LOC, seizures, electrolyte imbalance, hyperkalemia,
metabolic acidosis, hyperphosphatemia, uremia
● If acute continues to progress, becomes chronic (or ESRD–end stage renal disease)
● Tx: dialysis, kidney transplantation, atniHRN, VS and urine specific gravity, I/O, diuretics, polystyrene
sulfonate to dec K, PRBC
● Sx: n/v/d, lethargy, fever, dec output, skin elastic, dry mcus, edema, crackles, tachypnea, HR disturbed, inc
serum creatinine, hypocalcemia, hyperkalemia, proteinuria, hematuria

NEPHROTIC SYNDROME: increased glomerular membrane permeability causes increased protein waste out of
nephrons
● Massive proteinuria: affects albumin, osmotic pressure, edema, liver, lipid levels, kidney function,
infection, thromboembolism, steroid resistance, renal failure
● Congenital, secondary, or idiopathic
● Fluid shift and electrolyte shift
● Sx: n/v, abd ascites, weakness, fatigue, irritable, IUGR, weight gain, periorbital edema (waking),
generalized edema (throughout the day), anasarca, stretched or tight skin, pallor, breakdown, tachypnea,
WOB, inc BP (or dec if renal failure), crackles
● Tx: corticosteroids, IV albumin (watch fluid shift, may need furosemide), diuretics, long-term tx, if steroid
resistant then use immunosuppressives (if steroids used for long periods of time)
● Dx: urine dipstick, CBC, CMP
● NI: prevent infection, promote diuresis, monitor relapse, steroids mask infection

ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS: inflammation of glomerulus d/t strep or infection

● Immune process of strep injures glomeruli → inflamm → change in glomer structure/function
● Complication: uremia and renal failure
● hx/sx: fever, lethargy, headache, dec urine, abd pain, vomiting, anorexia, inc BP, edema, heart and lung
congestion, inc WOB or cough, crackles, heart gallop
● Dx: dipstick (proteinuria, hematuria, tea/cola/green color), CBC/CMP (inc creat/BUN/ESR), streptococcus
(inc ASO titer and DNAase)
● NI: antihypertensives, Na/Fluid restriction, weights, I/O, edema, neuro assessment, fatigue, cluster care, no
strenuous activity until dec protein/hematuria, dialysis, no NSAIDs bc dec GFR

CLEAN CATCH URINE SAMPLE:

● Clean perineum, genitalia, surrounding area
● Put the bag on around the genitalia (including the scrotum) and ensure a tight seal
● Lie pt on their side and perform the perez reflex: if the baby’s spine is stroked from tailbone up, it
stimulates a cry and the baby’s head will rise. Additionally, it trains the baby’s muscle tone. More
importantly, it stimulates urinary output in babies)

PERITONEAL DIALYSIS:
● Peritoneum acts as dialysis membrane and ultra-filters blood to dec excess fluid/waste
● Pros: dietary freedom, inc independence (continuous ambulation), steadier electrolyte balance, at home (via
home training course)
● Cons: higher risk of infection, peritonitis, sepsis, HTN and other cardiac issues, seizures, obstructed cath,
dialysate leak, hyperglycemia, inc triglyceride levels, inc protein loss, parental stress and burnout
● NOTE: pee prior to dialysis to have as much room as possible in the peritoneum

METABOLIC DISORDERS AND THINGS:

GALACTOSEMIA:
● Metabolic disorder w/ ↓ galactose enzymes
● Sx: high galactose in their blood, refusal to feed, vomiting, lethargy, jaundice, cataracts, sepsis
● NI: special lactose-free diet to prevent multiorgan failure
 GLYCOGEN STORAGE DISEASE: (aka von Gierke disease) : recessive
● A change in the way the body uses and stores glycogen → chronic ↓ BG → muscle weakness and
liver damage
● Sx: hypoglycemia sx, hyperphagia, pallor, seizures, muscle cramps, slow growth, hepatomegaly,
low muscle tone, hyperlipidemia
CELIAC DISEASE:
● Damage to the small intestine occurs d/t immune response to gluten
● Sx: n/v/d/c, fatigue, weight loss, bloating and gas, abd pain, anemia, loss of bone density
(osteoporosis), itchy/blistery rash (dermatitis herpetiformis), mouth ulcers, headaches, fatigue,
nervous system injury, joint pain, elevated liver enzymes, steatorrhea (fatty stools)

LEAD POISONING:
● interferes w/ enzyme processes of biosynthesis of heme (iron component of Hgb) → hypochromic,
microcytic anemia; affects bone marrow, erythroid cells, nervous system, kidney
● Sx: anorexia, fatigue, abd pain, behavioral probs, pallor
● Dx/Lab: >10 ug/dL requires follow up; normal lead levels = 0
● Tx: chelation (removal of heavy metals from body via PO/IV chelating agents); ↑calcium and iron
consumption to ↑ excretion of lead
● Complications: encephalopathy, seizures, brain damage (at high levels)
● Sources: old paint, contaminated soil, glazed pottery and stained glass products, lead pipes, clothing of
parents who work in certain jobs, certain folk remedies, old painted toys or furniture

HEART FAILURE NURSING INTERVENTIONS:

● Infant: 30 minutes per feeding (give ample time but not too long), gradually ↑ caloric density of formula,
position infant semi-upright during feedings, provide gavage feeding if RR over 80/min
● Manage fluid volume: low sodium
● Telemetry
● Promote activity tolerance
● ↓ anxiety and powerlessness
● Digoxin, diuretics, antihypertensives
● Promote skin integrity

APLASTIC ANEMIA: deficiency in ALL blood cells (pancytopenia)

● Complications: severe overwhelming infection, hemorrhage, death
● Hx: inherited, immune-mediated, myelosuppressive meds, radiation therapy
● Sx: epistaxis, gingival oozing, inc bleeding with menstruation, headache, fatigue, ecchymoses, petechiae,
purpura, oral ulcerations, tachycardia, tachypnea
● NI: safety, prevent/avoid hemorrhage, stool softener (dec anal fissures), irradiated and leukocyte-depleted
RBC or platelets, limit HLA antigen exposure; neutropenic precautions
● Tx: transfusion, HSCT (from HLA), inc dose cyclophosphamide)
● NOTE TO HANNAH: don’t confuse with pernicious anemia

SICKLE CELL ANEMIA: abnormal reaction to areas w/ low O2 → sickling of RBC (hemoglobinopathy–abnormal
Hgb shape)
● Complications: painful, organ damage, renal failure, clots (sickled cells get “lodged” and cause more
sickling when the body doesn’t get enough O2), Intrahepatic cholestasis, leg ulcers, retinal detachment
○ Think of complications of clotting: stroke, ulcer, delayed growth, priapism (blood no flow from
erect pp)
● Tx: HOP to it: Hospitalize, Oxygen (helps return to normal shape), Pain control
○ Prevent vaso-occlusive episodes (IV hydration), antibiotics (bc dysfunctional spleen), O2,
monitor HxH/reticulocytes, monitor electrolytes (if hemolysis, increases sodium)
○ Cholecystectomy (remove gallstones), splenectomy (if recurrent sequestration), hydroxyurea (inc
fetal Hgb to dec vaso occlusive events), L-glutamine (dec vaso-occlusive events), HSCT
● Prevention: identify stressors, stay away from high altitudes, hydrate, decrease exercise
● Dx:
 ○ Hgb SS, asymptomatic until 3-4 months bc of Hgb F
○ Make sure to x-ray or other scans to determine organ/tissue damage from vaso-occlusion (bc Hgb
electrophoresis doesn’t distinguish between Hgb SS and Hgb AS)
○ Reticulocyte elevated (sickle cells have short lifespan)
○ Inc bili, platelet, ESR
○ Peripheral blood smear: shows sickle shaped cells and target cells

HYPERCYANOTIC CRISIS TX: ALWAYS knee-to chest position THEN O2

ENCOPRESIS: fecal incontinence or soiling when impacted stool collects in colon and rectum; a too full colon
starts leaking liquid/full stools around the retained stool
● Tx: laxatives, stool softener, ample time on the toilet
● Problem can take years to resolve on its own or can be surgically removed

PYLORIC STENOSIS:
Hypertrophic pyloric stenosis is thickening of pyloric sphincter → obstruction
● Sx: vomiting after feed, non bilious vomitus and sometimes blood-tinged; constant hunger; olive-shaped
mass in right upper quadrant of abdomen, peristaltic wave that moves from L→R when lying supine,
failure to gain weight and manifestations of dehydration
● Dx: blood electrolytes, ultrasound, upper GI series
● Tx: pyloromyotomy (laparoscopy)
● NI: fluids, NG tube, monitor I/O, NPO (preop), daily weights, manifestations of infection

APPENDICITIS:
● Inflammation of appendix d/t obstruction of lumen
● Sx: abd pain in RLQ, rigid abdomen (d/t possible blood collection), ↓ bowel sounds, fever, diarrhea,
constipation, lethargy, tachycardia/tachypnea (and shallow breathing), anorexia, vomiting
● Dx: CBC and urinalysis and CT
● NI of unruptured appendix: avoid heat to abd, enemas, or laxatives, IV fluid replacement, IV antibiotics,
respiratory status, maintain airway, supplement O2, VS, analgesics, assess bowel sounds and surgical site
● NI of ruptured appendix:
○ PREOP: place NG tube for decompression, electrolyte/fluid replacement, IV antibiotics, supine
positioning
○ POSTOP: assess respiratory status, maintain airway, O2, VS, analgesic, assess surgical site for
bleeding or other weird things, assess bowel sounds, IV fluids and antibiotics, NPO, NG tube to
low continuous suction, wound irrigation, drain care, positioning (Trendelenburg and lateral
rotation)
● Complications of repair: peritonitis
○ Sx: fever, sudden relief followed by diffuse ↑ pain, irritability, rigid abd, abd distention,
tachycardia, rapid, shallow breathing, pallor, chills
○ Tx: fluids, antibiotics, NG tube, surgical wound care w/ irrigation or dressings

GASTROENTERITIS: contact precautions

● Illness triggered by infection and inflammation of digestive system; sx depend on the virus/ bacteria that
infected the system
● Types of infections: rotavirus, E.coli, Salmonella, C. diff, C. botulinum, Staphylococcus, G. lamblia,
Shigellosis, Caliciviruses, Yersinia enterocolitica
● Regardless of what type of illness the intestines are suffering from, always maintain contact precautions bc
contact w/ fecal matter will spread the illness
● Tx/Dx depends on what type of infection the pt is suffering from; For example, avoid antibiotics for E. coli
and Salmonella. Second example, avoid antimotility agents for E. coli, Salmonella, Shigella.
● Other Tx/NI: obtain baseline HxW, daily weights, avoid rectal temp, I/O, initiate IV fluids, oral rehydration
● Metronidazole or Tinidazole: for C. diff and G lamblia

BILIARY ATRESIA: congenital

● Blockage in tubes (ducts) that carry bile from liver to gallbladder
 ● Can occur d/t bile duct forming inside or outside the liver in an abnormal fashion
● Complete blockage from liver to gallbladder → liver damage and cirrhosis of the liver
● Sx: dark urine, jaundice (usually yellow sclera is first sx), splenomegaly, floating stools, foul-smelling
stools, pale or clay-colored stools, slow or ↓ weight gain/growth, abd distention
● Tx: Kasai procedure connects liver to the small intestine, going around the abnormal ducts (can be a
temporary/permanent fix); liver transplant
● Tx has been effective if: the first few stools passed are yellow-ish and transition into a normal brown color
(this signifies that the bile is being passed)

INTUSSUSCEPTION:
● Proximal segment of bowel telescopes into a more distal segment → lymphatic and venous obstruction →
edema in the area → ischemia and ↑ mucus in the intestine
● Sx: sudden episodic abdominal pain, screaming w/ drawing knees to chest during episodes of pain, abd
mass (sausage-shaped), red currant jelly stools, vomiting, fever, tender/distended abdomen
● Dx: ultrasound
● NI: stabilize child prior to procedure, IV fluids, NG tube for decompression
● Tx: air enema, hydrostatic enema
● Complications: reoccurring; surgery required

STOMA/OSTOMY CARE:
● Assess skin surrounding stoma for sx of inflammation, infection, swelling, drainage
● GI ostomy: tuck ostomy into diaper; replace weekly; check q4h; still needs to be potty trained; apply
paste/barrier cream before putting on pouch
○ Note: you CAN put infants on stomach (explanation was: “no nerve endings on stoma” but idk
why you’d put an infant on their stomach unless you’re actively watching them…)
● Tracheostomy: adequate humidification and hydration to thin secretions and ↓ risk of mucus plugging
○ Suction only if necessary to maintain patency of tube (NO ROUTINE SUCTION); only aspirate 3
times
○ Suction if the following findings are present: audible/noisy secretions, crackles, restlessness,
tachypnea, tachycardia, mucus in airway
○ Aseptic technique
○ Check ties frequently and change if soiled
○ Keep emergency trach tube at bedside (ONE SIZE SMALLER)
○ ACCIDENTAL DECANNULATION: occurs w/i first 72 hours after surgery d/t immature trach
tract; replacement difficult; have additional staff member present when moving tube to prevent
decannulation
○ Monitor for tracheoesophageal fistula: complication d/t mucosal ischemia/abrasion s/t prolonged
intubation, use of high cuff pressures, and movement of tube tip during frequent dressing changes
and suction; 3 C’s: CHOKING, COUGHING, CYANOSIS; tx w/ airway stent
○ NOTE: when suctioning, remove the trach. catheter. When not suctioning, put catheter back in;
don’t irrigate w/ NS

CYSTIC FIBROSIS: recessive

● Mucus glands secrete ↑ quantity of thick, tenacious mucus → mechanical obstruction of pancreas, lungs,
liver, small intestine, reproductive system
● Expected findings: meconium ileus, distended abdomen vomiting, frequent respiratory infections
○ Respiratory:
■ Early flair ups: wheezing, rhonchi, dry/nonproductive cough
■ Late flair ups: dyspnea, paroxysmal cough, obstructive emphysema and atelectasis
■ Advanced: cyanosis, barrel-shaped chest, clubbing of fingers and toes, bronchitis,
bronchopneumonia
○ GI: large, frothy, bulky, greasy, foul-smelling stools (steatorrhea), voracious appetite (early), loss
of appetite (late), failure to gain weight or weight loss, delayed growth, distended abdomen, thin
arms and legs, deficiency of fat-soluble vitamins, anemia, reflux, prolapse rectum, constipation
○ Integumentary: sweat, tears, saliva; Sweat Chloride Test shows an ↑ amount of Chloride in the
sweat
 ○ Endocrine and reproductive: viscous cervical mucus, ↓ or absent sperm, ↓ insulin production
● Tx: airway clearance (chest physiotherapy, positive expiratory tx, huffing, bronchodilator, oxygen), ↑
protein and calories, pancreatic enzymes before eating (<30 min of eating), laxatives or stool softeners for
constipation, tx GERD, salty foods during hot weather, albuterol, insulin (oral glycemic meds no work),
antibiotics specific to respiratory infection (gentamicin)
● NI: watch for hemoptysis or pneumothorax
○ Also daily multivitamin and fat-soluble vitamins
● Things NCLEX love:
○ Do NOT ↑ fiber bc → malabsorption of fiber → bulky stools → obstruction and toxicity
○ Mucus buildup in literally all the organs: MAINTAIN PATENT AIRWAY
○ Make sure pancrelipase is given no more than 30 minutes prior to eating
○ Chest physiotherapy, vibrating vest

EPIGLOTTITIS: medical emergency d/t Haemophilus influenzae

● Sx: drooling, agitation, absence of spontaneous cough, tripod position (sitting upright w/ chin pointing out,
mouth opened and tongue protruding), dysphonia (thick and muffled voice–froglike), dysphagia (difficulty
swallowing), stridor, retractions, sore throat, high fever, restlessness
● Dx: radiograph
● NI: protect airway, prevent obstruction of airway (through cultures, tongue blades, etc), prepare for
intubation, O2, SaO2, corticosteroids, IV fluids, antibiotic therapy, droplet precautions
● Emergency procedure: tracheotomy

TRACHEOMALACIA: collapse of airway when breathing. When child exhales, the trachea narrows or collapses
● Sx: dyspnea, vibrating noise/cough
● Tx: humidified air, careful feedings, antibiotics for infections, BiPAP

PERTUSSIS:
● DROPLET: direct/indirect contact w/ respiratory secretions
● Sx: paroxysmal cough upon inspiration, coughing fits, violent and rapid coughing, runny nose, congestion,
sneezing, mild fever, mild cough (during catarrhal stage)
● NI: monitor for airway obstruction or ↓ wheezing (can indicate full obstruction); cardiopulmonary monitor
● Tx: antibiotics (especially macrolides like erythromycin or sulfonamides like TMP-SMX)
● Complications: pneumonia, seizures, apnea, encephalopathy, death, ear infections, hemorrhage, weight loss,
hernias, loss of bladder control, syncope, rib fractures

RUBELLA:
● Droplet
● Sx: low-grade fever and sore throat, headache, malaise, cough, lymphadenopathy, red rash starting on face
and spreading to rest of body (2-3 days)
● Complications: birth effects in fetus of women infected during pregnancy
● Tx: tx the sx, not the disease bc it is VIRAL (don’t use aspirin)

RUBEOLA (measles):
● Airborne
● Sx: mild to moderate fever, conjunctivitis, fatigue, cough, runny nose, red eyes, sore throat, Koplik spots in
mouth, red/reddish-brown rash on face spreading downwards, spike in fever w/ rash
● Complications: ear infections, pneumonia, encephalitis, death, laryngitis
● Tx: no specific tx bc it is viral; don’t use aspirin

VARICELLA:
● Airborne AND contact
● Sx: fever, fatigue, loss of appetite, headache, macules starting in center of trunk and spreading to face and
proximal extremities, macules→papules→vesicles→crust formation→scabs
● Tx: acyclovir
● Complications: pneumonia, bleeding, bacterial infection of skin, encephalitis
INFECTIOUS MONONUCLEOSIS/EPSTEIN BARR VIRUS:
● Precaution: Droplet (kissing disease lol)
● Sx: fever, lethargy, sore throat, lymphadenopathy, loss of appetite, headache, ↑ WBC, atypical
lymphocytes, splenomegaly, hepatic involvement
● Complications: ruptured spleen; NOTE: development may be altered w/ mono d/t ↓ physical activity/contact
sports bc of ↑risk of rupturing the spleen
● Tx: no specific tx bc it is viral (don’t use aspirin)

PEDICULOSIS: (head lice)

● Spread via direct contact w/ infected person, bedding, objects
● Lifespan of lice is 1 month (48hr w/o human host)
● Females lay eggs at night, close to the skin surface, nits hatch 7-10 days
● Tx: wash/dry clothes and linens in HOT water w/ HOT dryer setting (Hot dry for at least 20 min); boil
combs, brushes, hair accessories for 10 min or soak in lice-killing products for 1 hour, lock personal items
for at least 14 days in plastic bags

IMPETIGO: infection d/t staphylococcus

● reddish macule becomes vesicular → eruption → moist erosion on skin → secretions dry → honey-colored
crusts → spreads peripherally and through direct contact
● Sx: honey-colored crusts, pruritus
● Tx: topical bactericidal or triple antibiotic ointment, oral or parenteral antibiotics, vancomycin (if MRSA
present)
● Complications: MRSA

CHANCRE: lesion of primary syphilis; 4 weeks after infection, heals in 1-2 months; a single erythematous papule at
inoculation site and later erodes and forms a painless ulcer

PARALYTIC POLIOMYELITIS: (or polio)--Contact (w/ poop) and Droplet Precautions

● Virus spreads from person-person and infects a person’s spinal cord → paralysis
● Lives in infected person’s throat and intestines, contaminates food, water, unsanitary conditions
● Infected person can spread virus to others <2 weeks before/after symptoms start (even if asymptomatic)
● Sx: sore throat, fever, tiredness, nausea, headache, stomach pain, meningitis, paralysis
● Tx: no tx
● Post-polio syndrome: weakness, paralysis, may be wheelchair-bound
● NOTE: Even if you get away w/o serious damage, the damage is done–muscle fibers are replaced w/
scarring (muscle-wasting) that is permanent. If they have somehow managed to be recovered w/o serious
damage, they will suffer from post-polio syndrome later in life (PPS)

REYE SYNDROME:
● Aspirin + virus = reye syndrome
● Aspirin + asthma = reye syndrome
● Aspirin + <16 years old = ↑ risk of reye syndrome
● Sx: persistent or recurrent vomiting, listlessness, personality changes, disorientation or confusion

CEREBRAL PALSY;
● Nonprogressive impairment of motor function, especially that of muscle control, coordination, and posture
● Sx: abnormal perception and sensation, visual, hearing, speech impairments, seizures, cognitive disabilities,
gagging or choking w/ feeding, poor succ, consistent tongue thrusting, asymmetric crawl, early hand
preference, toe walking, persistent primitive reflexes (moro/tonic neck), hyperreflexia, rigid posture,
extremities, scissoring (?), extension of legs, arching back, difficulty diapering child, stiff posture
● Spastic (pyramidal), dyskinetic (extrapyramidal), ataxic (non-spastic, extrapyramidal)
● NI: maintain patent airway, suction always available, admin meds for pain, adequate nutrition, high fiber to
prevent constipation, skin care
● Tx: baclofen ( ↓ muscle spasms), diazepam (skeletal muscle relaxant), Botulinum toxin A ( ↓ spasticity),
antiepileptics (valproic acid, carbamazepine)
TRACTION:
● Skeletal traction: placing a pin, wire, screw in fractured bone + weights attached so bones can be pulled
into the correct position
● Skin traction: splints, bandages, adhesive tapes below the fracture + weights to pull the body part into the
right position
● Cervical Traction: metal brace around your neck and attached to body harness or weights
● NEVER mess with the weights because then the affected body part will quickly shift back into the incorrect
spot
● Clean the pins w/ CHG; don’t shave or wash the area w/ the pins bc of risk for infection
● There should NEVER be a time when neurovascular levels are diminished (cap refill should be good,
pulses good, etc)
● Contact the provider if: meds don’t relieve the pain, skin around the pin site is red, hot, swollen or drainage

CUSHING’S TRIAD: physiological nervous system response to acute elevations of ICP → systemic HTN,
bradycardia, respiratory distress

BILATERAL PHEOCHROMOCYTOMA: type of neuroendocrine tumor that grows from chromaffin cells (cells
responsible for producing hormones found in adrenal glands)
● 5 P’s: pressure (HTN), pain (headache), perspiration, palpitation, pallor

STRABISMUS:
● Esotropia: inward deviation of eye
● Exotropia: outward deviation of eye
● Sx: abnormal corneal light reflex or cover test, 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, crossed eyes
● Tx: laser surgery, occlusion therapy
● Occlusion therapy: patch strong eye (unaffected eye) and remove patch for 1 hour each day. This prevents
amblyopia

OTHER THINGS TO KEEP IN MIND:

● The palmer grasp is replaced by the pincer grasp
● Smoking → ↑ risk of otitis media
● If a surgery was performed to remove a brainstem tumor, the priority for any nurse is to monitor temp
q30min
● Antistreptolysin titer: big fancy word for blood test to measure antibodies against Group A Streptococcus
(which is responsible for a lot of heart and lung issues like carditis and rheumatic fever)
● Cleft palate cautions: you’re gonna be worried about nutritional deficits a lot but apparently ATI sees
language deficits as more serious than nutritional deficits
 Motor Skill Development and Developmental Milestones
age skill cognitive language social client education
1-2 months lift head from prone position, observes cries, sounds, calms when caregiver should talk, read,
strong grasp reflex, bilateral everything startled by loud picked up, facial sing, cuddle, and position bb
extremity, opens hands briefly noises contact + smiles on their stomach when
when spoken to awake
3-4 mo lying on back holding object w/ opens mouth when cooing noises, smiles, moves, talk in positive manner,
both hands, pushes up on elbows notices breast or constant sounds, makes sounds to allow infant to reach for
when in prone position, holds bottle (when responds to talking get attention; objects,
head unsupported, brings hand to hungry), shows by making sounds, slight chuckling, talk/read/sing/routine feeds,
mouth, grasps objects w/ both interest in hands turns head toward interest in allow bb to put safe/clean
hands, palmar grasp by observation familiar voice or environment object in mouth
sound of rattle
5-6 mo roll over, hold bottle w/ both puts objects in high pitched squeal, laughs, enjoys reciprocal play,
hands, pushes up w/ arms mouth, grabs toy stick out tongue and looking at self in read/sing/play music, point
straight when in prone position, blows, alternates mirror, to items that infant looks at,
holds bottle sounds w/ another recognizes discuss w/ provider about
person familiar people initiation of complementary
solid foods
7-8 mo sitting up, leaning forward on
both hands, moves objects from
hand to hand , sits leaning Kinda the mixture between 5-6 months and 9-10 months???
forward on both hands, begin
using pincer grasp
9-10 mo crawling on hands and knees, bang 2 objects various sounds w/ shy w/ strangers, repeat sounds, show infant
holding rattle w/ handle, able to together, looks for long syllables, lift various facial how to wave "bye-bye",
get into sitting position objects when arms to be picked expressions, look shake head "no",
independently, sits unsupported, dropped or hidden up, comprehends when name is peek-a-boo, blocks in
uses fingers to move food simple commands called, reacts containers, consume various
towards themselves, crude pincer w/ gestures when familiar foods, develomental
grasp face leaves room, screening assessment
smiles or laugh
when playing
games
11-12 mo walk w/ hand held, place objects place block in waves "bye-bye", plays games w/ safe environment, dec
in container, neat pincer grasp, container, loooks calls others screen time, encourage baby
pulls up to a standing position, for hidden toys parent/guardian by noises, teach positive
drinks from cup without lid, their special name, behavior
picks things up w/ pincer grasp, comprehends the
walks holding onto furniture, word "no"
build 2 block tower
15 mo takes few steps independently, stacks 2 small tries to speak one or mimics others assist w/ learning to speak
uses fingers to feed self blocks, attemtpts two words other while playing, by repeating and adding to
to use things in than "mama" and claps hands what they say allow child to
correct manner "dada", follows when excited, assist w/ daily activities,
(phone, book, cup) simple directions w/ shows affection encourage blocks (stack
both gesture and them and knock them over)
words, ask for
things by pointing
18 mo walks independently, climbs mimics someone tries to say 3 or points to inquire about toilet training
on/off furniture, scribbles, drinks doing chores, more different something of w/ provider, allow child to
from lidless cup, fingers to feed plays w/ toys words, one-step interest, assists play/interact w/ others, give
self, attempts using a spoon directions w/ putting on child simple choices, read a
clothes, lok sat book and discuss pictures
pages in book w/
others
24 mo kicks a ball, runs, walks up a few plays w/ many gestures (blowing notices emotions allow child to throw, roll,
stairs (w/ or w/o help), uses a toys kiss or affirmative of others (looks kick a ball, provide
spoon simultaneously, nodding), points to sad when consistent routines for
tries to use knobs, things in book when someone is sleeping and eating, allow
buttons, switches asked, says at least crying), looks for child to explore and learn
on toys, holds 2 words together, reaction of others new things
something in one points to two or
hand while using more body parts
the other hand when asked
30 mo (2.5 hands to twist items (doorknob), uses pretend play, speaks about 50 parallel play or child names pictures, book,
years) takes some clothes off demonstrates words w/ 2 or more plays w/ others, colors, body parts, draw w/
independently, jumps off ground simple problem words/verbs at a follows simple crayons or chalk, how to
w/ both feet, turns book pages solving, follows time, identifies routines play w/ others
one at a time (while book is two-step pointed items in
being read) instructions, boook
knows at least one
color when asked
3 years strings beads or other items returns combines 3-4 words calms down w/i encourage child to play w/
together, puts on some clothes demonstration of to creat simple 10 min after others, give child healthy
independently, uses fork, rides drawing circle, sentences, talks in being left in care and simple food choices,
on tricycle, stands on one foot, avoids touching conversation w/ of others, notices teach child opposites,
jumps off bottom step, builds hot objects after others using other children counting numbers, play
towers w/ 9-10 blocks receiving a back-and-forth and joins them in matching games w/ child,
warning exchanges, says first play encourage child to say their
name after being name and age, screen time
asked <1 hour/day w/ supervision
4 years catches large ball, serves names a few says simple pretends to be reinforce positive behaviors
themselves food, poors drinking colors, tells what sentences w/ four or something else in positive manner, allow
liquids, unbuttons buttons, holds comes next in more words, says during play, child to play w/ others,
crayon between fingers and well-known story, some words from a inquires about provide calm environment
thumb draws person w/ 3 song,story nursery playing w/ other during bedtime, provide
or more body rhythme, talks about children, response when child ask
parts at least one thing comforts others questions, allow child to
that happened who are hurt or help w/ simple chores,
during their day, sad, likes to encourage counting items
answers simple assist others,
questions like "what changes behavior
is a coat for?" based on their
location (library,
grocery store)
5 years buttons some buttons, hops/skips counts to 10, tells a story w/ at follows rules or teach child about safe
on one foot, throws ball identifies some least 2 events, uses takes turns when touching, allow child to
overhead, laces shoes numbers between or identifies simple playing w/ other perform tasks
1-5 and letters rhymes, answers children, independently, use words to
when pointed to, simple questions sings/dances/acts assist child w/
uses words about about a book or in front of others, understanding of time, allow
time, pays story, keeps a performs simple time for active play daily,
attention for 5-10 conversation going chores at home allow for creative play time
minutes during w/ more than 3
activities, writes back-and-forth
some letters of exchanges
their name