Pediatric Nursing

I. Pediatric Cardiovascular

Congenital Heart Defects A. General concepts 1. Definition: present at birth - consequences are congestive heart failure and hypoxemia 2. Etiology: usually not known - associated with maternal factors: a. infection b. alcoholism c. age over 40 years d. diabetes mellitus, type one e. genetics, chromosomal changes 3. Findings of congenital heart defects a. child small for age b. physiological failure to thrive c. exercise intolerance d. dyspnea while feeding e. squatting position f. clubbing of fingers g. cyanosis and/or pallor may be associated with poor perfusion h. unusual pulsations 4. Physical consequences of congenital heart defects a. increased workload; pulmonary hypertension; decreased systemic output; cyanotic defects

Nursing care of the child with a congenital heart defect 1. decreases oxygenation to the entire system c.b. preparation depends on level of growth and development c. Common types: C. blood flows from heart's arterial (left) to venous (right) side or a "left to right shunt". but child may appear pink 1. thrombus formation is always a concern D. physiological. concern: formation of thrombus with embolus d. not systemically. can lead to hypoxemia and polycythemia c. Cyanotic defect: infant/child is usually "blue". Pathology a. blood flow patterns may be affected B. size of defect will determine severity of condition 2. EKG: noninvasive. Emotional. painless. but only within heart itself b. post procedure – child may have difficulty complying with keeping insertion point in correct position E. results far more severe than acyanotic d. presence of diaper rash may postpone procedure b. infants and young children may require mild sedation 2. Acyanotic defect . Cardiac catheterization a.infant/child is "pink" but child may develop cyanosis 1. and psychological interventions . unoxygenated blood mixes with oxygenated. Diagnostics 1. Pathology: hole in the heart's internal wall a. via a "right to left shunt" b.

2. Assisting the child and family to adjust to special needs 3. Goals of treatment a. child will maintain adequate oxygenation and physiological stability b. family will understand signs and symptoms of the condition, and how to manage each of them c. child will attain milestones of normal growth and development d. when child has surgery, child and family will be prepared, know prognosis, and know how to give home care afterward e. improve cardiac function f. remove accumulated fluid g. decrease cardiac demands h. improve tissue oxygenation 4. Nursing interventions a. recognize CHF FINDINGS OF CONGESTIVE HEART FAILURE

b. monitor height, weight, vital signs, pulses, pulse oximeter, intake and output c. medications: digoxin (Lanoxin), furosemide (Lasix) or chlorothiazide (Diuril), ACE inhibitors: Capoten, Vasotec d. monitor serum potassium level e. recognize and treat pain appropriately: pharmacological and nonpharmacological interventions f. maintain a safe environment g. conserve energy h. maintain proper nutrition, with small, frequent feedings – monitor sodium intake, fluid restriction may be required i. support and discuss treatment with parents j. place in proper position - slanting position with head elevated, older babies in infant seats, occasional knee-chest 5. Teaching points a. inform parents about findings of infection b. discuss possible behavior changes the child may exhibit

c. counsel parents about high-risk children requiring antibiotic prophylaxis for dental work Acquired Cardiovascular Disorders occur after birth as a result of infection, autoimmune responses, environmental or familial tendencies F. Hyperlipidemia: excessive lipids 1. Etiology: dietary, heredity 2. Pathophysiology a. increased lipids and cholesterol b. causes atherosclerosis, leading to coronary heart disease 3. Diagnosis: lab tests: increased LDL, lipids and cholesterol; decreased HDL 4. Management a. diet: ADA diet in two steps: i. < 30 kcal from fat; < ten from saturated fat; < 300 mg/L cholesterol ii. < 30 kcal from fat, < seven from saturated fat; < 200 mg/L cholesterol b. medications: colestipol (Colestid), niacin (Nicor), cholestyramine (Questran) 5. Nursing interventions a. encourage screening for at risk children with family history b. teach dietary guidelines or refer to dietician G. Bacterial endocarditis: inflammation of the valves of the inner lining of the heart 1. Etiology: possible causative agents a. strept b. staph c. fungi 2. Pathophysiology a. organisms enter blood stream (vascular dissemination) b. form vegetation on endocardium 3. Diagnostics a. EKG changes b. sedimentation rate evaluated c. WBC elevated d. blood cultures 4. Management a. high doses of antibiotics 5. Nursing interventions a. monitor for signs of infection b. provide rest periods 6. Teaching points a. need for long-term IV therapy b. side effects of antibiotics c. high-risk children need prophylactic antibiotic therapy before dental work or other invasive procedures II. Pediatric Respiratory Respiratory Infections A. General concepts 1. Etiology: bacterial, viral; often influenced by age, season, preexisting disorder, living conditions 2. Findings: increased respiratory and heart rate, fever, nausea/vomiting, nasal discharge and blockage, mucus production, coughing, adventitious lung sounds 3. Nursing care goals a. child will not exhibit findings of respiratory distress, will be able to clear secretions, and remain comfortable with a patent airway b. child will not spread infection to others c. child will ingest adequate fluids, and maintain hydration

4. Management a. medications: antibiotics, antipyretics b. possible: anti-inflammatory, anti-mucolytics, bronchodilators, oxygen as needed 5. Nursing interventions a. chest physiotherapy b. provide nutrition and encourage fluids - Jello, soup, puddings c. promote rest and comfort d. prevent spread of infection e. ease respiratory efforts - warm mist 6. Teaching points a. handwashing b. avoid contact with affected children B. Respiratory failure: inability to maintain adequate oxygenation 1. Predisposing factors a. obstructive anomalies, aspiration b. infections, tumors, anaphylaxis c. restrictive conditions: respiratory distress, cystic fibrosis, pneumonia, pneumothorax d. paralytic conditions 2. Findings a. restlessness, mood changes b. changes in LOC c. increasing rates of respiration and pulse d. dyspnea 3. Management a. frequent observation and physical exams, with pulse oximeter b. correct hypoxemia, maintain ventilation and deliver oxygen c. monitor for side effects and expected outcomes of therapy C. Airway obstruction and basic life support 1. Cardiac arrest is usually due to prolonged hypoxemia secondary to inadequate ventilation, oxygen or circulation 2. When following guidelines for pediatric life support, consider not just the child's age, but also size. Individual anatomy and development will vary. 3. Airway clearance techniques a. determine conscious versus unconscious child b. for infants and toddlers: back blows and chest thrusts c. for preschool and school-age: modified Heimlich maneuver ("astride") Infant Respiratory Disorders D. Respiratory distress syndrome (RDS): "hyaline membrane disease" 1. Definition: related to development delay in lung maturation 2. Etiology a. premature infants: usually due to surfactant deficiency b. newborns: birth asphyxia, multiple gestations, diabetic mother c. older children: trauma, drowning 3. Pathophysiology a. decrease in amount and/or quality of pulmonary surfactant b. in older children, surfactant may be washed out by drowning or fluid aspiration c. increased alveolar surface tension d. impaired gas exchange

e. hypotension d. hypoperfusion 4. expiratory grunting c. nasal flaring d. Respiratory related a. tachypnea. increased respiratory effort . Systemic related a. retractions e. tachypnea f. flaccid body b. shock a. Findings Findings of Respiratory Distress Syndrome The transition from respiratory-related to systemic related indicates a progressive severity of the disease 1. nonresponsive c. increased pulmonary resistance f. rales b. apnea 2.

Teaching points: a. Management a.b. lungs develop cystic areas (sacs) and atelectasis (collapsed alveoli). oxygen (possible mechanical ventilation) b. physical exam. calcium c. provide supplemental oxygen at home as needed 5. Diagnostics a.at risk: a. pallor d. continued mechanical ventilation affects the growth of new cells and paralyzes cilia e. medications: possible medications: surfactant. mucus moves less 3. mechanical ventilation presses lung tissue b. diet: increased calorie formulas and hydration d. diuretics. nasal flaring d. chest radiograph confirmation – diffuse pattern over both lung fields that resembles ground glass 6. alveolar walls become thick. foreign-body aspiration. drowning. need for meticulous care by nurses due to subtle changes possible in infant’s oxygenation status E. incorrect positioning . Nursing interventions: a. or trauma c. pulse oximeter b. bronchodilators. Bronchopulmonary dysplasia: (BPD). provide age appropriate toys d. paradoxic "seesaw" respirations c. Etiologies a. hypoxia 5. b. glucose. observe for fluid overload or pulmonary edema c. cyanosis with activity e. expiratory grunt. possible apnea f. inform parents about equipment b. frequent respiratory assessment F. prematurity b. bronchial epithelium is damaged c. anti-inflammatory agents in gradually decreasing amounts c. Apnea: cessation of breathing for over 20 seconds 1. products of inflammation introduced. Pathophysiology a. electrolyte status d. Management: a. increased work of breathing c. substernal retractions e. maintain acid base balance and tissue perfusion c. methyl-xanthines 7. prophylactic antibiotics. medications: diuretics. tachycardia and tachypnea b. cyanosis g. infants requiring oxygen and/or lengthy mechanical ventilation b. provide rest periods b. frequent respiratory assessment. Findings a. fibrotic d. serum: ABG's. chronic obstructive lung disorder 1. positioning of infant c. lung immaturity 2. inotropes. suction as indicated 8. oxygen therapy (possible mechanical ventilation) and chest physiotherapy to maintain ventilation and oxygenation b. Nursing interventions: a. infants surviving RDS c. Etiology . restlessness 4.

color changes.first central. Etiology: often acute viral nasopharyngitis. hypotonia Diagnostics: laboratory tests. medications: based on type and underlying condition Respiratory Conditions G. central . obstructive . gastroesophageal reflux e. chest x-rays. upper GI series Management a. or the "common cold" 2. then obstructive Findings a. 5. organism invades mucous membranes b. Pathophysiology a. pneumocardiography. edema. 4. usually self-limiting .absence of respiratory effort and air movement b. vasodilation and increased mucus production c. Upper respiratory tract infections (URI) 1. EEG. hypoglycemia Pathophysiology: dependent on type of apnea: a. depend on type (above) b.respiratory effort but no air movement c. ECG. home apnea monitoring and basic life support (BLS) training to family b. mixed . seizure g. d.2. 3. infections f.

purulent nasal discharge c. chronic nasal congestion. Etiology: viral. Management a. warm mist (possible) . medications 1. antibiotics 2. assess for presence of earache (otitis media). low grade fever. Findings a. decongestants 5. Management: a. halitosis 3. CT 4. antihistamines 5. antipyretics 3. temperature over 38. medications: antipyretics.3 degrees Celsius and refusal to eat . Nursing care a. rest e.may indicate complications H. cool mist humidifier c. bacterial. cough. tenderness over sinus areas e. colored nasal discharge. analgesics 4. Sinusitis 1. decongestants (oral or nasal). Findings: nasal congestion. Diagnostics: sinus x-rays. irritability 4. headache d. monitor respirations b. sneezing.3. obstructive deformities. adequate fluids d. analgesics b. cold that does not improve b. URI. cystic fibrosis 2.

Diagnostics: history. monitor for complications such as acute rheumatic fever and acute glomerulonephritis b. Etiology: streptococcus (bacterial). very sore throat iii. headache b. place child on side d. mouth breathing. moisture compress to neck – cold or warm d. Findings a. analgesics b. fever 4. rest. as airway narrows. soft foods – avoid highly seasoned food 7. 6. "sicker" with sudden onset ii. supportive: antibiotics. antipyretics and analgesics – no ASA d. possible antipyretics and analgesics 5. assess any vomitus c. snores at night e. Nursing interventions a. if adenoiditis is present. epiglottitis) . fever iii. throat culture b. monitor fluid intake c. Tonsillitis 1. sore throat c. "kissing tonsils" b. Management a. halitosis d. adenoidectomy may be done with tonsillectomy. high fever iv. soft foods as throat is very sore K. Croup syndromes (including laryngitis. assess for frequent swallowing – bleeding may be the cause b. fluids. child needs quiet activity b. avoid fluids with red or brown color f. Nursing interventions a. Etiology: bacterial. Acute pharyngitis 1. Pathophysiology: infection and inflammation enlarge tonsils. Findings a. rhinitis 3. or viral (often accompanies tonsillitis) 2. pharyngeal tonsils are also known as the adenoids 3. cough. viral i. gradual onset ii. palatine tonsils usually visible during oral exam b. viral in association with pharyngitis 2. monitor for bleeding c. physical exam. surgery: tonsillectomy done after 3 episodes of tonsillitis in one year c. rapid strep 4. throat culture 5. Diagnostics a. bacterial i. it hinders swallowing and breathing a. antipyretics. Teaching points: teach parents a.I. cool liquids or ice chips J. medicate for pain as needed e. tracheitis. Management a. medications: penicillin for strep.

barking cough iii. inspiratory stridor ii. harsh/brassy cough. hoarse voice . signs of croup i.Similarities and Differences of Diseases Included in the Croup Syndromes 1. Definition: several airway-blocking infections. common in children a.

purulent secretions. younger children with "true croup" (spasmodic croup) d. classic: "barky" harsh cough. edema narrows the airway 4. stridor. laryngotracheobronchitis (LTB). retractions. distressed inspiratory efforts 5. supraglottal area: epiglottitis 2. laryngitis. types.iv. subglottal area: acute spasmodic croup. it could precipitate laryngospasm . epiglottitis manifests the four "D's" i. epiglottitis) c. bacterial: same as above with antibiotics. tracheitis ii. Findings a. dysphonia (hoarse voice) iv. cool air/mist. Pathophysiology: mucosa inflamed.fever. Etiology a. teach parent and child signs of impending airway obstruction b. epiglottitis is a medical emergency. dysphagia (difficulty swallowing) iii. respirations. antipyretics b. usually viral b. report increased pulse. never attempt to directly visualize epiglottis with tongue depressor. nebulized racemic epinephrine and inhaled steroids iii. bacterial: child looks "sicker" c. occasionally bacterial (tracheitis. Nursing interventions a. older children with tracheitis and epiglottitis 3. viral i. drooling ii. respiratory distress b. increased restlessness c. dyspnea if severe b. possible intubation c. hoarseness. by primary area affected: i. fluids ii. tracheotomy may be necessary 6. Management a. if inpatient.

viral: RSV (respiratory syncytial virus) most common b. Teaching points a. antiviral. chest x-ray 5. otitis media and conjunctivitis may also be present 4.Lower Airway Disorders L. mild: fluids. check immunization schedule. leads to edema. sneezing. possibly bronchodilators. Management depends on severity a. low-grade fever. Pneumonia: inflammation of lung parenchyma . prophylaxis: respiratory syncytial virus immune globulin in high risk infants 6. RSV/viral nasal washing. Maintain contact secretion precautions c. admit each child to single room or with other RSV infected children b. Findings . assess fluid volume status 7. Nursing interventions a. virus spreads via direct contact b. Etiology a. Diagnostics: history. Pathophysiology a. severe: hospitalization. occasionally bacterial 2. Bronchiolitis: acute infection at bronchiolar level 1. teach handwashing and use of contact precautions c. rhinorrhea (nasal discharge). humidification. rest b. No vaccines for 9 months after child receives these M. usually mild URI b. RSV – IVIG may interfere with immune response. enters body via nose or eye c. adventitious lung sounds c. can progress to atelectasis 3. productive cough. IV fluids.infection is rare in children older than 2 years of age a. steroids and mechanical ventilation. mucus accumulation and cellular debris which obstruct bronchioles d.

Aspiration of foreign body 1. cyanosis. Pathophysiology: most substances become lodged in bronchi. fluids c. Long-term respiratory dysfunction: asthma/reactive airway disease 1. progressing to more severe with retractions. Pathophysiology a.1. medical conditions. cluster nursing care N. liquids. triggers are: allergens. then supportive therapy 6. chest physiotherapy.change clothing frequently c. genetic predisposition b. balloons 3.depends on type a. sometimes bacterial c. types: intrinsic. fluoroscopy. occupational . alveoli infiltrate and cell destruction b. oxygen. cool mist tent . malaise. administer pneumococcal vaccine to at risk individuals 6. lethargic c. vegetative matter into air passages. treatment of secondary complication risk d. bacterial agent can reach circulatory system via pulmonary lymphatics d. exercise.antibiotics. restless. infection. aspiration . triggers terminal airways. gagging. increased WBC . most commonly viral b. and stridor 4. Findings: sudden coughing. has an allergic component 2. productive cough 4. Teaching points a. adventitious lung sounds. Nursing interventions a. substance aspirated and extent of obstruction 3. sometimes aspiration of foreign substance 2. chest physiotherapy. Findings a. Diagnostics a. bronchoscopy 5. dyspnea. Diagnostics: chest x-ray. Etiology: child aspirates solids. c. nonproductive cough. cellular debris falls into lumen c. respiratory distress. fluids b.oxygen. Etiology: usually classified by anatomic distribution or pathogen a. recognize signs of FB aspiration b. extrinsic. can be abrupt or insidious b. may occur as a complication of another illness 3. wheezing. stress.chest x-Ray reveals consolidation in lungs or presence of fluid 5. Definition: chronic inflammatory disorder of the airways. viral . Etiology a. and severity is determined by location. bacterial . fever. most common in older infants and children up to three years of age 2. administer back blows or Heimlich maneuver as indicated 7. Nursing interventions a. Management . medications. frequent assessment of respiratory status b. paper clips O. parents need to know most likely causes to prevent aspiration 1. aluminum tabs from soda cans 4. manifested by periods of exacerbations and remissions.supportive therapy. Management: direct laryngoscopy or bronchoscopy to remove object. peanut butter 2.

resulting in bronchoconstriction with additional granulocyte response with more inflammatory presence . with mast cell. trigger leads to an immediate phase reaction (cell activated. Pathophysiology a.3. eosinophils and histamine released with other mediators of inflammation) b.

leukotriene modifiers (Zileuton) . Definition: inherited autosomal recessive trait . Nursing Interventions a. goals: normal growth and development. later phase reaction (additional inflammation and hyperresponsiveness) d. oxygen. Teaching points a. also called controllers 1. stay with child if at all possible . monitor fluid volume status 9.anti-allergic and anti-inflammatory 4. child and family must comply with medications and treatments b. classic: hacking cough. monitor child for respiratory distress and/or need for nebulizer treatments. Pathophysiology a. correct use of metered-dose inhaler (MDI) with a spacer c. nedocromil . medications 1. Diagnostics a.anti-inflammatory 2.abnormal mucus secretion and obstruction 2. restlessness 5. short acting beta adrenergics 2. cough may be nonproductive at first. use of bronchodilators b. genetic origin b. pulmonary function tests (PFT) c. allergy testing 6. Etiology a. use of peak flow meter d. methylxanthines (theophylline) bronchodilator 6. usually stop in 20-30 minutes b. mucous glands produce a thick mucoprotein that accumulates instead of a thin freely flowing secretion . Findings a. exercise-induced bronchospasm – acute and reversible. bronchodilator treatments. systemic corticosteroids 7.have parent stay during acute phase of illness d. wheeze on expirations. dyspnea b. b. bronchospasm and obstruction cause most symptoms 4. Acute management a. long term control (preventor) medications: to achieve and maintain control of inflammation. Complications a. change in LOC. CBC with differential d. chest x-ray. status asthmaticus – emergency situation P. cromolyn sodium . to productive with mucus c. good control b. IV fluids. risks include overuse of bronchodilators 10. place semi-high Fowler’s position c. Cystic fibrosis 1. skin testing. steroids (inhaled. long acting beta adregenics (Albuterol) used for acute exacerbations 5. physical exam. patent airway. basic defect exocrine gland dysfunction 3. history b.mediator of inflammation 2. preventive: allergen control and avoidance c. anticholinergics 3. IV and/or oral) c. Management a. quick relief (rescue) medications to treat acute symptoms and exacerbations 1.nonsteroidal anti-inflammatory 3.c. possibility of intubation 8. corticosteroids .

Management a. Findings a. high protein. Assessment of cerebral function: 2. antibiotics (Pseudomonas aeruginosa . clubbing of fingers and toes 5. medications: bronchodilators. failure to grow b. gastrointestinal 1. frequent hospitalizations to treat respiratory infections c.Cepacia. D-Nase . affects respiratory. Increased intracranial pressure (ICP) . respiratory 1. Know stage of growth and development and developmental milestones B. high caloric well balanced diet. chest x-ray: patchy atelectasis c. Observe spontaneous and elicited reflex responses – having parent present may be helpful 5. sweat chloride test . General concepts: 1.decreases viscosity of mucus d. meconium ileus 2. and staph aureus) c. barrel-shaped chest 3.Pilocarpine over 60 mEq/L is diagnostic of CF b. Infants primarily reflexive 4. vitamins ADEK should be added b.iontophoresis . Diagnostics a. Children under 2 unable to respond to directions 3. prolapse of rectum 4. Pediatric Neurology A. thick tenacious mucus causes patchy atelectasis cough 2.b. monitor IV fluids III. gastrointestinal and reproductive systems 4. Include family history and health history 6. Nursing interventions a. stool analysis 6. enzymes administered with meals and snacks to replace pancreatic enzymes 7. CPT b. steatorrhea 3. Pediatric Neurology III.

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nausea. vomiting. diplopia. Etiology a. b. lesion. infection) b. lethargy. widened cranial sutures.1. 3. infant: bulging fontanels. child: headache. seizures Diagnostics: . congenital or acquired (from trauma. high-pitched crying. irritable 4. also see Pediatric Oncology (See section XI of this lesson) Pathophysiology: swelling caused by irritation or bleeding into brain tissue Findings a. 2.

pain management should be monitored c. may not bathe child if ICP is unstable g. fentanyl. which equals mean arterial blood pressure minus ICP b. Versed and Vecuronium may be added c. oxygen d. changes from baseline neurological status. pupillary reaction and vital signs/neuro signs b. support family Hydrocephalus . . CAT Scan – MRI Management a. e. antihypertensives.C. Nursing interventions: a. Pathophysiology: depends on type a. Etiology: congenital. ICP monitor – ventricular tap may be required to relieve accumulated CSF e. acquired. anti-seizure. principle of maintaining cerebral perfusion pressure (CPP). noncommunicating: obstruction of the flow of CSF through the ventricular system Findings a. nutrition – may require tube feeding if long term d. communicating: impaired absorption of CSF within the subarachoid space 5. minimize external stimuli 6. 3.imbalance in the production and absorption of CSF in the ventricles 1. may need artificial tears h. positioning – HOB is elevated 15-30 degrees head is maintained in midline. and often same as increased ICP b. observe/monitor – LOC. cluster care to allow periods of rest f. maintain patient airway: mechanical ventilation. or idiopathic 2. a. in severe cases. medications: osmotic diuretics.

monitor for increased intracranial pressure c. observe for abdominal distention for possible catheter complications d. pupils slow to constrict to light III. Etiology: cerebral. Complications: shunt infection and malfunction Seizures 1. monitor head circumference g. poor feeding III. Teaching points a. Pathophysiology a. infant (signs of increased intracranial pressure) I. seizure may be a finite event. usually greater than 38. ataxia 4. vomiting IV. dizziness III. status epilepticus is continuous seizure lasting more than 30 minutes or a series of seizures from which the child does not regain a premorbid level of consciousness f. high-pitched cry V. . with limited manifestations d. elevated temperature II. post-traumatic. monitor fluid volume status f. keep diaper off perineal dressing 7. febrile. Definition: brief malfunctions of the brain's electrical system that result from cortical neuronal discharge 2. NPO – feed after bowel sounds return e.D. eats poorly IV. headaches II. may have an aura e. Findings a. teach family signs of infection I. assess pain level – acetaminophen with or without codeine c. idiopathic. older child (signs of increased intracranial pressure) I. no contact sports II. possible generalized seizure with neurological symptoms 4. home care I. "setting sun" eyes. neuro and vital signs b. child should be as active as possible. may include altered levels of consciousness. spreads throughout brain reaching midbrain reticular regions c. no scalp vein IV lines 6. changes in respirations c. irritability IV. increased head circumference II. Management a. Nursing interventions: a.8 degrees Celsius (101. trigger electrical discharges affecting nearby normal cells b. surgical placement of ventriculoperitoneal (VP) shunt in neonates. diplopia V.8 degrees Fahrenheit) b. measure head circumference d. determined by site of origin b. sedation may be required 5. Diagnostics: a. infants and older children placed on unoperated side to prevent pressure on operative site b. most common neurologic dysfunction in children 3. CT SCAN – MRI I. variable pulse. biochemical. bulging fontanels. involuntary movements and changes in perception c. altered level of consciousness b. febrile seizures: occur in association with a fever. 8.

6. Etiology: unknown. 5.E. seizure care. a. Management: see seizure precautions. medications – antiepileptic drugs Nursing interventions a. face IV. simple partial with motor signs II. skull films. observe seizure – protect from injury I. tonic-clonic (grand mal) II. most common I. airway suction and oxygen II. possible lumbar puncture g. anticonvulsant drug level. complex partial with psychomotor seizures b. and remove restrictive clothing b. international classification: partial and generalized a. Pathophysiology: see seizures 4. supportive: I. may be nonrecurrent (acute) such as febrile episode or recurrent (chronic) such as epilepsy 5. eyes V. order of onset II. Definition: chronic seizure disorder with recurrent and unprovoked seizures 2. clear area. simple partial with sensory signs III. partial: limited to a particular local area of the brain I. Diagnostics – goal is to ascertain the type and cause of seizure. physical exam to include neurological assessment c. CT. safety – loosen clothing. movement III. CBC – glucose level d. Diagnostics: toxicology screen. most common I. electrolytes. postictal care a. place on floor. detailed and accurate history b. respirations . ABG’s. absence (petit mal) 3.MRI – EEG Epilepsy 1. generalized: involves both hemispheres of the brain I.

G. basal ganglia. child can participate in most activities for age c. disorders characterized by early onset and impaired movement and posture. support musculoskeletal integrity f. condition is incompatible with life beyond a few days 2. both cerebral hemispheres are absent c.missed developmental milestones b. fluids V. moist sterile nonadherent dressing –usually saline IV. non-progressive . teaching points I. WBC e. diagnostics: I. nursing interventions I. language deficits and intellectual involvement . physical exam II. and nerves. incontinence of urine or stool VII. unknown cause b. meningomyelocele: contains meninges. may be accompanied by perceptual problems. spina bifida cystica: visible defect with an external sack-like protrusion I. protect skin integrity II. cause: abnormality in extrapyramidal or pyramidal motor system (cortex. stay with child until fully conscious 7. long-term care medication regime b. ROM VIII. d. no diaper VI. can occur prenatally.degeneration of the brain to a spongy form mass with no bony covering a. initial care I. etiology: incomplete closure of vertebrae and neural tube. Anencephaly .myelography III. findings vary widely to degree of spinal defect . or postnatally d. maintain bladder and bowel function III. MRI – ultrasound – CT. protect sac from rupturing and drying out II. Teaching points a. VI. most serious b. findings of infection Cerebral palsy (CP) 1. meningocele: encases meninges and spinal fluid but no neural elements. avoid rectal temperatures II. long term I.the higher the location the more symptoms the infant will have. teach parents how to measure head circumference after closure II. spinal fluid. positioning – on abdomen VII. perinatally. no neurological deficit II. do not restrain b. early surgical closure of lesion IX. assess for presence of latex allergy III. duration VIII. may require VP shunt III. varying neurological deficit c. Spina bifida (SB) a. Etiology a. assess postictal status c. cerebellum) c. pathophysiology I.F. assess trigger factors -possibly video games with flashing lights if sensitive Neural tube defects (NTDs) 1. spina bifida occulta: defect not visible externally II.

. distinctive facial features b. spastic.2. primitive reflexes persist e. high metabolic rate. promote socialization 6. communication and self-help b. Spasticity • May involve either one or both sides • Impaired fine and gross motor skills • Individual's attempts at motion increase the abnormal posturing and overflow of motion to other parts of body • Hypertonic movements 3. Mixed • Combination of athetosis and spaticity H. spastic movement in one or more extremity c. athetoid movements d. Findings a. Diagnostics: physical exam. Teaching points a. Ataxic • Rapid repetitive movements performed poorly • Poor integration of movements when individual reaches 4. mixed Classification of Cerebral Palsy 1.dressing. treat what child demonstrates c. attention deficit disorder (ADD) c. CT. correct associated problems as effectively as possible d. early recognition. Athetoid • Characterized by slow irregular twisting snakelike movements occurring in the upper extremities • Involuntary movement of oral muscles which may result in drooling and dysarthria 2. leading to increased calorie expenditure 3. EEG. disturbances in gait. impairments in speech and swallowing 4. classifications: athetoid. teach ADL. walking e. Associated with late maternal age 2. abnormal posture f. Management a. feeding. incorporate play into treatment plan 7. chromosome 21. ROM d. multi-disciplinary approach b. gain optimal appearance and function c. Pathophysiology: depends on which region of chromosome 21 was altered a. hearing or visual losses. associated defects: mental retardation and cognitive impairment. e. offer support for family resources Down syndrome (trisomy 21) 1. establish locomotion. primary disturbances: abnormal muscle tone and coordination b. Nursing interventions a. speech training is begun early c. ataxic. long term problem and a financial concern d. Etiology: extra group G chromosome. mental retardation (varies from severe retardation to low average intelligence) d. dermatologic changes b. usually diagnosed by exclusion Pathophysiology a. heart defects c.assess children at risk b. MRI 5.

cognitive Nursing interventions a. long-term disorder c.possible sequela to microbial infection or administration of vaccines 2. Pathophysiology a. Guillain-Barre syndrome . II. genetic counseling b. e. an unknown factor inflames spinal and cranial nerves b. short. physical exams b. support family Teaching points a. Etiology: unknown . almond shaped eyes VI. assess sight and hearing c. low slung ears b. broad hands with simian crease 4. flat occiput III.infectious demyelinating polyneuritis 1. supportive: specific to body system affected b. large space between great toe and second toe Diagnostics a. nerves conduct impulses poorly resulting in paralysis of muscles innervated by involved nerves . body features I. allow extra time when giving instructions d. 5. short. 7. broad neck III. protruding tongue IV. chromosome analysis Management a. high-arch palate V. promotion of developmental progress c. financial referrals Infectious Neurological Disorders I. incomplete embryogenesis Findings a. facial features I. brachycephaly II. 6. dry skin IV.3. treat what the child exhibits b. inflammation compresses and demyelinates nerves c.

CSF analysis c. based on physiologic needs and body system affected: possible tracheostomy. Findings a. long-term: integumentary.acute flaccid paralysis . physical assessment b. Botulism . usually 2 to 3 weeks after onset. preceded by mild influenza-like illness or sore throat b. Management a. plateau – findings remain constant iii. musculoskeletal and respiratory systems d. paresthesia usually ascend from feet/legs upward progressing to total paralysis 4. acute . ventilatory support. may have residual disability J. short term: supportive and symptomatic b. gradual progression of symptoms i. assess for progress of disease especially swallowing and breathing b. recovery – begins to improve and progress to complete recovery. multi-disciplinary approach b. may require tube feedings e. EMG findings – acute muscle denervation 5. Teaching points a. medications: IV immunoglobulin and steroids. muscle tenderness. IV fluids and plasmapheresis c. possible immunosuppressive agents 6. c.onset of findings ii. ROM g. neuro and vital signs c. support child and family 7. long-term process c. Diagnostics: a. ascending flaccid paralysis 3.d. assess skin integrity d. Nursing interventions: a. maintain Foley f.

severe nausea and vomiting e. life threatening progressive respiratory paralysis 3. Findings a. assess for swallowing difficulties 5. acute noninflammatory encephalopathy and hepatopathy 3. coma 4. related to cerebral edema and fatty changes in liver b. wound 2. medications i. observe for and report signs of neuromuscular weakness b. Etiology a. respiration. Reye's syndrome (toxic encephalopathy) 1. child must rest during recovery b. difficulty speaking. child will tire easily c. normal bowel elimination may not return for a while. Nursing interventions a. vomiting and dysphagia. supportive: dependent on body system affected b. Pathophysiology a.1. Diagnostics: liver biopsy a. Teaching points a. toxins. profoundly impaired consciousness f. liver dysfunction g. weakness. diplopia. blurred vision. classic. no enemas or cathartics K. protect ventilation. and provide nutrition c. food poisoning from anaerobic bacillus: clostridium botulisum contaminated food b. Findings a. CNS findings usually appear within 12 to 36 hours b. Management a. drugs (salicylate association). Etiology: follows a common viral illness. lethargy. botulism antitoxin 4. viral upper respiratory infection c. three types: infantile. genetics 2. fever d. ammonia levels .

Etiology: can be caused by pneumococcal or meningococcal bacteria (most serious) or can be caused by a virus. Diagnostics: assess for pre-existing disorders. maintain seizure precautions d. possible lumbar puncture 5. Nursing interventions a. assess IV lines. may have N/G tube f. pupils may be affected 4. glucose and blood flow to brain. positioning. Complications: hemorrhage. LOC may be altered g. monitor fluid volume status 7. infection. CAT SCAN. teach parent to talk to child but don’t ask them to do things like "squeeze my hand" M. otorrhea and test for glucose if drainage present 8. assess children at risk b. directly related to force of impact and secondary forces i. supportive: dependent on body system affected b. HOB up 30° once cervical spine injury is ruled out ii. cerebral function depends on oxygen. sleepy f. continuously monitor affected child c. Management a. long-term process b. cerebral edema and hypoxia can occur quickly 3. Meningitis: acute inflammation of the meninges and CNS 1. neuro and vital signs b. types: primary and secondary c. quiet environment e. assess LOC f. Etiology: force to the scalp. Teaching points a. steroids. motor vehicle crashes and bicycles 2.b. neuro and vital signs d. acceleration injury ii. Foley e. meninges or brain – usual causative agents are falls. vomiting e. . Nursing interventions a. Teaching points a. Findings: neurological status depends on ICP a. Pathophysiology: elastic pliable skill of infant and young child absorbs much of direct energy a. deceleration injury b. observe for rhinorrhea. MRI. level of comfort g. keep parents informed about status and equipment. anticonvulsants. may or may not be conscious b. control ICP: medications: sedating agents. EEG 5. avoid aspirin and other salicylates in children with viral diseases such as influenza or varicella disease 6. Head trauma 1. irritable c. pale d. long-term rehabilitation possible 6. skull. monitor ICP c. cerebral edema and brainstem herniation through the tentorium 7. Management a. keep parents informed and teach about the equipment c. acute i. Traumatic Neurological Conditions L. take history of event. ventilatory support.

immunizations are available to prevent several types IV. tissue damage v. Nursing interventions a. the two systems function synergistically. nuchal rigidity h. auto-immune. Pathophysiology: most common route of infection by vascular dissemination from an infection elsewhere a. Three types of tissues 1. Definition: diminished or deficient secretion of pituitary hormones. V.IV fluids b. inflammation ii. environment: medium through which chemical message travels from the site of synthesis to area of cellular action B. Impulses transmitted via the nervous system stimulate the hypothalamus to secrete releasing or inhibiting factors B. blood cell count and presence of glucose and protein content b. target cells in end organ that receive chemical message 3. sedation of child may be required. Findings a. Versed. Endocrine function 1. Teaching points a. acquired. positive Kernig and Brudzinski signs 4. irritable g. congenital. medications: antibiotics 6. respiratory isolation precautions until causative agent identified c. neuro and vital signs d. exudate iii. chills c. lumbar puncture: definitive diagnostic tool. bacterial meningitis is an emergency b. Diagnostics a. CSF is tested for gram stain. hypoplasia. 3. primarily GH (Somatotropin) 2. Etiology: tumors. monitor electrolytes c. Management: treated as bacterial until causative agent is identified a. infective process i. Demerol or Fentanyl may be used 5. malnutrition. endocrine + autonomic systems = neuroendocrine system 2. assess peripheral vascular collapse if causative agent is meningococci 7. WBC accumulation iv. maintain quiet environment e. LOC alterations f. monitor fluid status .2. fever b. organisms then spread into CSF and throughout subarachnoid space b. Hypopituitarism 1. neuroendocrine system: synthesizes and releases chemical substances that then regulate bodily function: messages are carried by nerve impulses in the nervous component and by blood in the endocrine system. trauma . headache d. monitor for seizures f. vomiting e. irradiation. Pediatric Endocrinology The endocrine system A. brain becomes hyperemic and edematous 3. cells that send chemical message via hormones 2.

absence or regression of secondary sex characteristics c. radioimmunoassay of plasma GH levels e. hormone replacement therapy: growth hormone 7. decreased urine output. assign nurse of same sex as child d. anorexia.3. educate child and family about long term process C. Nursing interventions: a. plan realistic goals with child and family 8.030 b. SIADH: syndrome of inappropriate antidiuretic hormone 1. idiopathic. normal intelligence. Teaching points a. example: slow growth. early identification of affected child 7. premature activation of hypothalamic-pituitary-gonadal axis b. Findings a. nausea. show parent how to administer daily hormone replacement sc b.releasing hormone (LHRH) injections monthly 6. Management a. MRI d. family history b. development of breasts in prepubertal females b. early development of sexual hair c. stomach cramps . and decreased serum sodium 4.inhibits somatic growth in all body cells 4. usually dependent on hormone involved and age of onset (dwarfism) b. x-rays of hand and wrist for centers of ossification 6. or brain tumors 3.unusually early activation of maturation process that is considered normal later in life 1. Management a. Nursing interventions a. Pathophysiology: leads to gonadotropin deficiency .pituitary origin: luteinizing hormone . adrenal disorders 3. inflammatory disorders. Definition: manifestations of sexual development before age nine in boys or age eight in girls 2. provide support and guidance to parents and child b. Teaching points a. Diagnostics a. ultimate height less than if puberty had been normal 4. history of growth patterns of child c. head trauma.occurs most often in girls a. long-term problem b. Etiology: infections. Definition: hypersecretion of antidiuretic hormone or ADH (vasopressin) 2. child may be embarrassed c. Pathophysiology a. child will be the same as peers D. urine SG > 1. after puberty. hypothalamic . kidneys reabsorb too much free water b. increased specific gravity (SG). Findings a. isolated menses d. early increased release of LH and FSH c. directed toward specific cause b. Pathophysiology a. Findings . support child and parents during period of diagnosis b. weakness. Etiology: brain lesions. short stature. depends on cause b. delayed puberty 5. development of secondary sex characteristics 5. "Precocious puberty" . early acceleration of linear growth with early closure of growth plates d.

Nursing interventions a. assess children at risk. increased cholesterol and triglycerides g. lowered tolerance to heat d. monitor for signs of fluid overload d. Definition: hypersecretion of thyroid hormones. thyroid irradiation 3.lower sodium levels cause neurological findings 5. life-long problem b. F. history and physical b. weight gain. Findings: depend on extent of dysfunction and age of child at onset a. lethargy. hypotonia. assess patients at risk for early identification b. nervousness. intolerance to cold e. decreased BMR (basal metabolic rate) f. common childhood endocrine disorder 2. Findings a. b. exophthalmos (eyes bulge) . no mental retardation 5. Nursing Interventions: a. idiopathic. Pathophysiology a. lifelong hormone replacement (levothyroxine) b. when brain has grown. dry skin. electrolytes. large tongue c. familial 3. Etiology: auto-immune response to TSH (thyroid-stimulating hormone) receptors. feeding problems b. puffy eyes. monitor I & O. causing increased BMR or hyperactivity of thyroid gland 2. protect client from cold 7.c. Etiology a. absent or underdeveloped gland b. rest c. increased TSH c. Hyperthyroid: "Graves' disease" 1. decreased serum sodium . anemia e. seizure precautions if sodium level low E. Hypothyroidism 1. correct underlying etiology c. constipation. neuro status d. allow rest periods or cluster care d. child needs periodic blood tests to monitor hormone levels. sparse hair d. if findings develop after two to three years. I & O – daily weights c. hypoglycemia 6. appetite. heart rate b. Management a. developmental delay and/or retardation if T4 low at birth and thyroid replacement not started f. gradual weight loss despite voracious appetite c.under 120 mEq/L child becomes symptomatic . slowed growth. encourage child to exercise when able 8. observe for signs of fluid overload 6. decreased serum T3 and T4 d. congenital or acquired deficiency in thyroid hormones b. increased weight (edema) d. increases in: BMR. Teaching points a. restrict fluids to correct hyponatremia b. monitor administration of replacement hormone – can’t be increased too fast c. Management a. decreased triiodothyronine (T3) or thyroxine (T4) 4. Diagnostics a. Definition: deficiency of thyroid hormone (TH).

producing osmotic diureses (polyuria) f. insomnia i. elevated serum T3 and T4 levels d. additional findings: fatigue. antithyroid drugs G. hyperglycemia 1. when glucose level exceeds kidney's threshold (about 180 mg/dl) kidney then "spills" glucose into urine (glycosuria) e. decreased TSH levels 5. poor school performance. myopathy f. urinary fluid loss causes excessive thirst (polydipsia) 4. potassium iodine (thyro-block) e. prostration c. vomiting 3. less insulin means glucose is blocked from entering the cells . 6. Diagnostics a.type 1 1. provide nutrition appropriate for activity level e. polyuria. quiet non-stimulating environment c. side effects of propylthiouracil -sore throat and fever b. hyperthermia 5. administer moisturizing eye drops for child with exophthalmos d. assess behavior patterns before and after medication b. hunger. 2. mood instability g. hypertension 6. Etiology: genetic. Diagnostics a. findings 1. can be a life threatening situation b. the three "polys" of diabetes: polydipsia. starved for glucose g. Nursing interventions a.most common endocrine disorder of childhood.Propylthiouracil or Tapazole to decrease amount of circulating thyroid hormone b. propranolol (Inderal). personality changes. tachycardia 7. Teaching points a. history and physical b. bacterium or possible chemical irritant 3. antibodies destroy the insulin-secreting Beta cells c. surgery (subtotal thyroidectomy) – check voice quality after surgery. enuresis 5. Management a. trigger directs islet cell antibodies against cell surfaces b. fasting blood glucose . diarrhea 4. weight loss. usually with trigger factors of virus. Concern: thyrotoxicosis or “thyroid storm” from sudden release of hormone: from vigorous palpation or surgery a.the concentration in bloodstream increases (hyperglycemia) d. Definition: deficiency of hormone insulin . increased blood pressure 4. palpable thyroid enlargement (goiter) c. Pathophysiology a. child may need to reduce activities for a while 8. elevated radioactive iodine uptake e. presence of thyroid antibodies f. treat with cooling blanket d. acute onset of severe irritability 2. Diabetes mellitus . linear growth and bone age accelerated h. auto-immune response. establish a routine with child and parents 7. Findings a. polyphagia 2.e. antithyroid therapy .

b. oral glucose tolerance test c. urine tests for presence of ketones and/or glucose d. glycosylated hemoglobin (A1c) reflects average blood glucose levels for past 2 to 3 months 6. Management a. medications: insulin (rapid-acting-Lispro, short-acting - regular, intermediate-acting-NPH). Insulin needs are affected by food intake, exercise, emotions, growth spurts and illness b. other: diet, age appropriate activity levels. No special foods - need sufficient calories. Must eat snacks - and meals at the same time each day. c. self-blood glucose monitoring d. insulin pump delivers insulin continuously 7. Concerns: "honeymoon period" and insulin regulation, compliance, sick day management, ketones 8. Complications a. DKA (diabetic ketoacidosis) or extreme hyperglycemia (blood sugar >350 mg/dl) 1. etiology: not enough or no insulin - body chooses alternate source of energy - fat 2. findings 1. fruity breath, decreased level of consciousness 2. nausea/vomiting, abdominal pain 3. 10 percent dehydration 4. increased urine output 5. Kussmaul's respirations 6. metabolic acidosis b. management 1. place on cardiac monitor 2. regular insulin (IV drips and then subcutaneous) 3. frequent monitoring of blood glucose 4. frequent monitoring of electrolytes; neuro checks 9. Hypoglycemia a. etiology: most common cause of insulin therapy and bursts of physical activity, without additional food or with missed meals before meals or when insulin is peaking b. findings 1. fatigue 2. nervousness 3. pallor 4. sweating 5. palpitations 6. hunger 7. loss of coordination 8. seizures 9. coma c. management 1. 10 to 15 mg f simple carbohydrate - honey of low fat milk 2. followed by complex carbohydrate such as slice of bread or crackers 3. occasionally glucagons is prescribed - for home treatment works in about 10 minutes 10. Nursing interventions a. assess child frequently neuro and vital signs b. blood glucose levels c. administer insulin as ordered d. support child family e. arrange meetings with team members - dietary, PT, and social worker 11. Teaching points a. family may be overwhelmed with diagnosis b. use teaching aids to facilitate their success - booklets, videos

c. d. e. f. V. Pediatric Gastrointestinal

illness management insulin should never be omitted dose may change fluid balance is a concern

A. Dehydration

1. Definition: occurs when total output of fluid exceeds total intake a. 60% of fluid lost from extracellular fluid (ECF) b. 40% of fluid lost from intracellular (ICF) c. insensible fluid loss – lost through skin, urinary loss, fecal loss, and respiratory tract 2. Differences compared to adults a. are less able to concentrate urine b. as infants, they have immature kidney and immune regulatory systems c. have a higher metabolic rate d. have more body surface in relation to body mass e. because more of body weight is fluid, children need more fluid and lose more urine per kilogram of body weight 3. Types of dehydration (serum sodium determines type) a. isotonic: occurs in conditions in which electrolyte and water deficits occur in balanced proportions. Primary form of dehydration in children. b. hypotonic: occurs in conditions in which electrolyte deficit exceeds the water deficit c. hypertonic: occurs in conditions in which water loss exceeds electrolyte loss 4. Pathophysiology a. decreased fluids and electrolytes from ECF b. leads to eventual loss of fluid from ICF

calcium e. contraction of stomach antrum & duodenum c. assess vomitus b. assess child for dehydration c. cause stimulates emetic center of brain b. Nursing interventions a. Definition: forceful ejection of gastric contents through the mouth 8. fluid losses must be replaced b. Management a. neurologic lesions. obstruction. chloride. Nursing interventions a. fontanels in infant d. Vomiting 7.c. projectile 10. Findings of dehydration 7. Teaching points a. electrolyte losses: monitor sodium. provide anti-emetic medications if needed 11. Pathophysiology a. types of vomiting: regurgitation. detect and treat the underlying cause b. motion sickness. Tracheoesophageal fistula (TEF) and esophageal atresia (EA) . teach parents to start feeding child slowly with clear fluids when tolerated Upper GI Disorders C. mechanism of vomiting involves autonomic nervous system 1. Etiology: infection. increased heart rate 3. potassium. pallor. keep child NPO d. monitor urine output and specific gravity. monitor electrolytes f. IV) 2. and inflammatory process 9. shock 5. prevent dehydration. position child to avoid aspiration when vomiting e. psychological causes. daily weight c. encourage child to brush teeth or rinse mouth after vomiting 12. Management of pediatric dehydration a. electrolyte loss and acid-base disturbance c. cellular dysfunction. forceful. acid-base balance disturbance: metabolic acidosis 6. monitor the 4 first signs and 3 second signs of dehydration b. administer fluids (oral. NG. salivation. allergy. sweating 2.

surgical emergency 7. Etiology: congenital. Pathophysiology: most common a. IV therapy. NPO. Definition: failure of esophagus to develop as a continuous passage and a failure of the trachea and esophagus to separate into distinct structures 2. assess each newborn for the malformation b. care of gastrostomy tube e. anorectal. cyanosis with feeds c. chest and abdominal x-rays 6. place in position least likely to cause aspiration b. Nursing interventions a. coughing b. intermittent suctioning c. tube feedings are begun when tolerated f. distal segment is connected to trachea or primary bronchus 4. depend on type of defect e. findings of respiratory distress c. Definition: transfer of gastric contents in the esophagus .1. choking 5. and renal abnormalities in addition to TEF) 3. pre-op: airway patency. position . teach parents the care of the gastrostomy tube and how to administer feedings b.head of crib elevated 30 degrees d. increased oral secretions d. Diagnostics: history. TEF – proximal esophageal segment terminates in a blind pouch b. Findings a. Management a. VATER syndrome (combination of vertebral. idiopathic. suctioning techniques if appropriate D. observe initial oral feeding – sterile water 8. Gastroesophageal reflux disease: GERD 1. Teaching points a. prevention of aspiration pneumonia c.

pre-op: IV fluids. assess IV sites 3. frequent feedings initially. surgery: Nissen fundoplication 5. proton pump inhibitors (Nexium or Protonix) f. Pathophysiology a. metabolic alkalosis d. Management a. unknown cause b. acid foods and solutions. chyme c. Nursing interventions a. medication administration schedule should be followed to receive optimal benefit E. gradually increasing 7. abdominal x-ray. progressive.2. Definition: circumferential muscle of the pyloric sphincter becomes thickened resulting in elongation and narrowing of the pyloric channel 2. teach parents to have child avoid caffeine. scintigraphy – detects radioactive material in esophagus after feeding of the material and also assesses gastric emptying 4. pathologic – very common – If GERD occurs often and findings persist. Etiology: physiological. monitor feeding position and feeding tolerance b. olive-shaped mass in right upper abdominal quadrant e. Management a. barium swallow. position child flat or head slightly elevated b. post-op 1. Diagnostics: history. begin feeding clear liquids with glucose and electrolytes . upper GI series. Pyloric stenosis 1. usually begins at two to four weeks of age b. electrolytes 6. document vomiting episodes and stools 3. monitor IV fluids and electrolyte replacement 2. monitor for vomiting 2. none if child is thriving without findings c. firm. slowly pylorus constricts. medications – H2-receptor antagonists (Tagamet or Pepcid). NPO. surgery (pyloromyotomy) also called Fredet-Ramstedt Procedure b. Teaching points a. irritability. endoscopy. functional. Diagnostics: history. pylorus then enlarges and contracts with more force to attempt gastric emptying d. Nursing interventions a. chocolate. and resistance persists until next cycle 4. position: prone with head of bed elevated or flat prone following feeding and at night e. monitor electrolyte levels 6. check I & O d. pre-op 1. edema b. access patency of N/G tube if present 4. upper GI. hyperplasia of circular muscles of pylorus 3. more frequent feeds with frequent burping d. crying. Etiology a. trigger irritates mucoid lining of pylorus. and spicy foods b. hypertrophy. diet: thicken feeds. ultrasound. narrowed pylorus resists passing of fluid. nonbilious vomiting after eating c. treat it – hiatal hernia and coughing may lead to GERD 3. palpable. monitor nutritional status c. movable. give small. post-op: small. esophageal pH. Findings a. depends on the severity of findings b. manometry studies. hunger 5. older children should avoid tobacco and alcohol c. decrease caffeine intake. projectile.

dehydration. exercise. nausea 4. palpable. medication. Findings a. rectal exam. enemas. palpation and percussion 5. Diagnostics: abdominal x-rays. this disorder may run in families c. laxatives 6. establish bowel routine for parents 7. Nursing interventions a. emotions. Etiology a. child may vomit after surgery b. Management a. systemic disorders (hypothyroid) 3. Teaching points a. Teaching points a. regular toileting habits b. assess operative site for drainage or inflammation 8. Constipation 1. anorexia. triggered by diet. bowel routine . Definition: infrequent passage of firm or hard stools 2. provide dietary modifications that promote bowel elimination appropriate for age c. medications: stool softeners. dietary modifications b. abdominal pain and cramping b. fluids. movable fecal mass c. prevention: higher fiber diet.4. malaise. assess child’s usual pattern of bowel elimination b. child will be discharged when able to tolerate feedings Lower GI Disorders F. or neurogenic b. structural disorders (Hirschsprung's disease) c.

severe) b. and oats 4. goals: restore fluid and electrolyte balance and return bowel to normal functioning b. Etiology: absorption problem with genetic predisposition.irritates mucosal lining b. diarrhea (stools: pale and watery. Pathophysiology a. parasitic). atrophy of villi and decreased absorptive surface d. possibly immune abnormality 3. increased stooling c. antidiarrheals H. Findings (most often appears between ages of one and five years) a. Pathophysiology: a. food intolerance. possible metabolic acidosis f. increases secretion and decreases absorption c. increased intestinal water permeability and dehydration in younger children. medications. stress. decreased tearing in infants 4. increasing levels of glutamine in the small intestine. malabsorption. viral. moderate. increased heart & respiratory rate d. e. damages microvilli. Etiologies: intestinal infections (bacterial. fluids: oral rehydration or parenteral rehydration c. Findings a. dehydration (mild. dry hot skin e. causative factor . Celiac disease 1. gluten is found in the grain of wheat. overfeeding. toxic to mucosal cells c. vitamins and electrolytes e. permanent intolerance of gluten b. Definition: gluten-sensitive enteropathy (GSE) = (celiac sprue) 2. inability to digest gliadin (byproduct of gluten). dry mucous membranes f. can be acute or chronic 3. abnormal intestinal water and electrolyte transport d. offensive odor) . medications: antibiotics. barley. Diarrhea 1.G. malabsorption of fats. decreased urine. Management a. colon disease 2. rye. carbohydrates.

anorexia h. Nursing interventions a. d. abdominal pain 5. Teaching points a. sausage-shaped abdominal mass e.I. child may need hospitalization b. pressure on bowel leads to bleeding c. assess for steatorrhea d. non-surgical hydrostatic reduction . reading food labels Intussusception 1. Findings a. everything moves fast c. Management a. possible mesenteric ischemia d. currant jelly stools d. Diagnostics: barium enema – abdominal x-ray. diet: gluten-free with vitamin supplements b. serum anti-gliadin antibody (AGA) c. air pressure c. trigger – bowel (proximal segment) “telescopes” inside itself causing obstruction b. monitor for barium excretion and passage of brown stool that indicates intussusception has resolved d. monitor episodes of diarrhea c. peritonitis. surgery 7. Diagnostics a. abdominal distention failure to thrive vomiting muscle wasting f. is common in children with cystic fibrosis 3. monitor fluid status b. steroids 7. priority goal: restore bowel to normal position and function quickly. Definition: one of the most frequent causes of intestinal obstruction between ages of three months and five years 2.reveals mucosal inflammation. usually post operative care if child has surgery 8. sudden acute abdominal pain b. most common site: ileocecal valve 4. Etiology: unknown – possible hypertrophic response to the virus. perforation. provide diet high in calories – fruits. villous atrophy and crypt hyperplasia d. e. c. vegetables – low fat 8. Teaching points a. gluten free diet restrictions b. parents may feel guilty they didn’t know about child’s condition b. serologic testing to detect antibodies 6. history (symptoms occur three to six months after infant begins eating grains) b. or shock e. crisis: IV fluids. bilious vomiting c. Management a. . water-soluble contrast. and stabilize fluids b. assess pain c. monitor tolerance of new diet – weight gain b. steatorrhea g. if not successful. edema and possible bowel necrosis. rectal exam reveals mucus and blood 6. jejunal biopsy . Nursing interventions a.barium. lethargy 5. Pathophysiology a.

constipation. distended abdomen. monitor comfort level c. signs of fecal impaction 4. then reanastomose 6. Management a. intestine does not propel stool c. temporary ostomy for three to six months. rectal biopsy. reluctance to ingest fluids. hardened fecal material. provide nutrition as ordered e. and wavy b. Teaching points a. distended abdomen. Findings a. assess colostomy d. most common in school-aged children . Diagnostics: history and physical exam. Definition: inflammation of vermiform appendix (blind sac at end of cecum) 2. Hirschsprung's disease 1. stool builds up. bile-stained vomitus. Definition / etiology: congenital aganglionic megacolon 2. assess fluid and electrolyte status b. radiographic barium enema. virus. parasites. surgical correction: remove aganglionic portion b. colostomy care – as child will be discharged b. newborn: failure to pass stool or merconium in first 24 hours of life. parents should be told that toilet training may be difficult K. Nursing interventions a. wide. "ribbon-like" stools . foreign body b. Pathophysiology a. colon dilates. absence of autonomic (parasympathetic) ganglion cells. constipation results with risk of intestinal rupture 3. anorectal manometry – reveals absence of ganglion cells 5. later: failure to thrive. make referrals for home care assistance 7. Etiology a. Appendicitis 1.flat. assess N/G f. usually at rectum and part of large intestine b.J.

generalized but usually localizes to lower right quadrant 2.stooped posture f. may order HCG serum human gonadotropin on adolescent females to rule out ectopic pregnancy 6. nausea. activity level at home b. antibiotics d. Management a. distention. MRI. guarding of abdomen . laboratory tests (CBC with WBC). colicky abdominal pain 1. analgesics 7. if known c. abscesses and fistula form d. IV fluids c. monitor IV fluids – comfort level 2. Pathophysiology a. Nursing interventions a. vomiting c. decreased bowel sounds e. Teaching points a. prevent fluids as bowel sounds return if ordered 8. possible perforation leading to peritonitis 4. possible also C Reactive Protein (CRP) a. capillary occlusion and engorgement of capillary walls c. Diagnostics: physical exam. caution: do not give enemas or cathartics or use heating pad if suspected appendicitis VI. trigger obstruction increased mucus accumulation b. postoperative 1. possible fever and chills d. rebound tenderness 5. check drainage tubes if present 4.3. most intense pain at McBurney's point b. when can return to school. Genitourinary System . Findings a. surgical removal (open or laparoscopic) b. eventually. position in semi Fowlers 3.

structural defect. . Nausea/vomiting. Definition a. oliguria. bacterial (E. urgency) -Fluids (increased BP.80% of cases). medications) c. Edema) UT Findings: -2 Clusters G-I (Anorexia. bacteria in urine and inflammatory response b. may involve any structure in urinary system: kidney (pyelonephritis). Common findngs: renal and urinary tract (UT) disorders Renal Findings: -Urination (polyuria. Persistent diaper rash) B. bladder (cystitis) or urethra c. extrinsic (example: Foley catheter. physiological b. coli. findings will point to location d. ureters. Pathophysiology . peak age: toddler to preschool age 2. Painful or frequent urination. improper perineal hygiene 3. Failure to thrive) -Lower Body (Abdominal & back pain. Thirst/dehydration. Urinary tract infection 1. Etiology a.A.

analgesics d. persistent diaper rash. involve child in planning. behavioral conditioning . tricyclic antidepressant. antipyretics c. possible pyelonephritis: similar signs but with fever. desmopressin (DDAVP) b. Etiology a. dysuria. Nursing interventions a. Enuresis 1. Nursing interventions a. feeding problems. do not punish child if enuresis occurs Upper Urinary Tract Disorders D. limit fluid at night. primary (congenital anomaly) . and due to CNS or psychological reasons b. foul smelling urine ii. dysuria iii. back pain. void before bedtime iii. enuresis. urine tests. have the child participate in activities ii. over two years i. Definition: inability to control bladder functions. hygiene – wipe front to back for girls b. secondary: treat underlying cause 5. Management a. do not delay urination c. Findings often depend on age a. secondary (acquired. Diagnostics: history. careful history b. due to infection. if age appropriate 6. fluids (IV and oral) 7. medications. trauma 3. Vesicourethral reflux (VUR) 1. provide adequate or increased fluid intake d. nocturnal. Etiology a. and lethargy 5. secondary: child has been toilet trained and becomes incontinent again i. findings as above ii. often due to maturation. nausea/vomiting ii. frequency and urgency. Teaching points a. organism usually ascends through urethra to bladder b.abnormal insertion of ureters into bladder b. with a structural defect. Teaching points a. radiographic testing 6.bladder training iv. help parents understand problem and treatment plan b. antimicrobials b. Definition: retrograde flow of bladder urine into the ureters during voiding 2. primary i. failure to thrive. primary: never dry at night. monitor for irritability 8.a. Diagnostics: urine culture and serum testing. imagery. under two years: often nonspecific resembling GI disturbance i. urine flows back from ureters into kidney 4. if child is maintained on daily low dose antibiotics – giving dose at bedtime allows medications to remain in bladder overnight C. usually associated with UTI) . serum culture 4. or "bed wetting" very common 2. medications 1. imipramine (Tofranil) 2. Management a. abdominal distention b. daytime incontinence in toilet-trained. check diaper every half-hour c.

impetigo) b. residual urine from ureters remains in bladder until next void c. low-dose antibiotics. Chronic nephrosis (nephrotic syndrome) . Findings: UTI with chronic findings and recurrences 5. potassium) 7. immune complexes trapped in glomerular capillary loop c. possible institution of seizure precautions if indicated d. surgery: for severe cases. decreased filtration of plasma results in excessive acummulation of water and retention of sodium f. CRP. urine culture 6. importance of finishing medications as ordered b. Teaching points a. edema (periorbital and peripheral) c. Findings a. fluid balance. radiographic studies b. medications: for grades 1 to 4. and behavior b. monitor I & O 8. monitor vital signs. Pathophysiology a. nutrition (low in sodium. Management a. possible fluid restriction e. Diagnostics a. onset appears after latent period of about ten days 4. Nursing interventions a.3. infection (usually group a b-hemolytic strep) provokes immune complex response b. Acute glomerulonephritis (AGN) 1. lethargy f. provide frequent rest periods 8. adequate or increased fluid intake b. increases chance for and perpetuates infection d. findings of recurrence F. previous acute bacterial infection (pharyngitis. mild hypertension e. Diagnostics: urine testing. Pathophysiology a. protein. Definition: immune complex disease that occurs after a streptococcal infection (A B-hemolytic strep) 2. supportive with careful regulation of fluid balance. serum (antibody. usual post-op care if child has surgery c. Nursing interventions a. history of antecedent strep infection 6. monitor b. grade 4 or grade 5 7. if needed d. oliguria b. medications: antihypertensives. WBC). decrease lumen functions and GFR (glomerular filtration rate) e. underlying systemic disorder 3. all children in family should be screened for possible reflux E. Teaching points a. Management a. Etiology a. voiding cystourethrogram c. which injures capillary walls d. recovery spontanteous and uneventful in most cases b. ESR. bladder reflux b. complement. vesicoureteral reflux grading system: grade 1 to 5 4. moderate proteinuria g. hematuria ("smoky" or "tea-colored" urine) d. I & O. throat culture. activate inflammatory response. no specific treatments. loss of appetite 5. assess child’s appearance – presence of edema c. daily weights c.

BUN and creatinine will be elevated. findings of infection G. periorbital edema e. pallor 5. diet: no added salt but high in potassium and protein b. and antistreptolysin O(ASO) titer 6.triggers kidneys to produce renin. progressive weight gain b. hypoalbuminemia. laboratory tests – CBC . malaise c. oliguria . loss of appetite f. activity should increase as protein in the urine decreases f. Etiology: not fully understood . place child in semi-Fowler’s or Fowler’s to treat periorbital edema 8. puffiness of face c. Pathophysiology: mainly occurs in children between 2 and 7 years-old a. seizure precautions if appropriate e. abdominal mass or swelling – firm. urine tests will show massive proteinuria. lethargy h. especially albumin b. colloidal osmotic pressure in capillaries decreases c. Management – mainly supportive of what child demonstrates a. Findings a.possibly renal lesions or other processes a. immunosuppressants. generalized edema (insidious) d. nontender b. types 1. increased presence in urine. Findings a. glomerular alteration and increased permeability to plasmaproteins. how to test urine at home for presence of protein b. hyperlipemia and edema 2.urine smoky brown (resembles tea or cola) g. Teaching points a. restrict fluid intake d. fatigue.1. Diagnostics a. diuretics 7. dietary restrictions c. and angiotensin which stimulates the release of aldosterone and increases the reabsorbtion of water and sodium f. medications: corticosteroids. hydrostatic pressure is greater than colloidal osmotic pressure resulting in fluid accumulation in interstitial spaces and body cavities d. Wilm’s tumor 1. shift in plasma fluid leads to hypovolemia e. assess volume and character of urine c. secondary: develops as part of systemic illness 3. Etiology: probably arises from malignant undifferentiated cluster of cells – favors left kidney 3. monitor vital signs and body weight and I&O b. decrease plasma volume. Nursing interventions a. hypovolemia . Pathophysiology a. decreased blood pressure also causes release of ADH leading to increase in water absorption 4. primary (idiopathic nephrosis): restricted to glomerular injury 2. Definition: most common renal and intraabdominal tumor of childhood 2. aldosterone increases g. respiratory findings if metastasis 5. plasma protein losses. Definition: massive proteinuria. cells regenerate an abdominal structure – renal function is impaired 4. chest and abdominal x-rays b. Diagnostics: history.

underlying conditions c. obstruction e.. Nursing interventions a. pathogen attaches to GU tract c. Diagnostics: identify "triad" from history and lab testing 6. support family b. Etiologies a. monitor laboratory results e. Definition: most common acquired renal failure in children a. thrombocytopenia 3. endotoxins. hemolytic anemia 2. keep parents informed of treatment plan as everything happens quickly I. surgical removal – possible chemotherapy. findings of infection H. Etiology: unknown.post signs on bed "do not palpate abdomen" b. for anemia: transfusions – fresh frozen plasma (FFP) c. thrombocytopenia (due to platelets trapped in small vessels) 4. infection 3. prior URI b. occurs most often in children under four 2. inflammation . for renal symptoms: fluids.glomerular vessels less capable of filtration e. Findings a. usually reversible 2. pre-op . coxsackie). treatment of hypertension e. Pathophysiology a. correction of electrolyte disorders 7. coli. Pathophysiology a. enzyme deficiency.6. Hemolytic uremic syndrome (HUS) 1. child should avoid contact sports c. Management a. Management a. urine output and pulmonary status 8. accompanying hemorrhagic manifestations such as bruising or rectal bleeding d. supportive b. monitor I&O c. anemia occurs (due to RBC fragmentation) f. decreased antioxidants 3. burns (thermal injuries) d. severe loss of function of kidneys. Acute renal failure 1. prepare for dialysis d. monitor transfusion response 8. Teaching points a. hypertension 5. acute renal failure b. rickettsia. actinomycin D and radiation 7.assess BP. acute disorder shows the "triad" 1. some association with genetics. triad e. post-op . possible renal impairment b. rapid onset of pallor c. possible dialysis or peritoneal dialysis for the child who has been anuric for 24 hours d. Definition: sudden. dehydration b. usually follows an acute GI or upper respiratory infection (URI) b. monitor vital signs b. severe reduction in glomerular rate . Teaching points a. GU tract produces toxins that damage capillary walls d. bacteria (E. Nursing interventions a.

high calcium) d. immunosuppressants (post transplant) e. antihypertensives. an elevated BUN c. usually related to imbalances in fluids and electrolytes b. failure to thrive. Nursing interventions a. fluid and electrolyte imbalances c. Management a. diet: modified (decreased sodium. include parents when formulating plan of care c. kidney transplant c. uremia. seizures) c. if appropriate 8. correcting underlying cause 2. Findings a.uremia (urea in blood) c. final stage: end-stage renal disease (ESRD) is irreversible 4. progressive nephron destruction b. renal scan) 6. fluid restriction. physical exam. oliguria 5. hypertension. nutritional needs and appropriate snacks b. supportive therapy b. congenital anomalies. monitor status (for example. monitor laboratory results d.b. pallor. laboratory testing. anemia. potassium. Pathophysiology: irreversible and permanent a. medications: antihypertensives. nausea and vomiting b. Chronic renal failure (CRF) 1. infection and cardiac failure J. phosphorus. increased fatigue on exertion e. decreased feeding. I & O c. hemodialysis). laboratory reports) f. laboratory testing d. increase in sodium in distal tubules stimulated renin mechanism e. diuretics. Teaching points a. neuro signs. dialysis b. cortical and tubular necrosis 4. growth hormone. monitor level of dehydration and volume restoration to avoid water intoxication and hyponatremia b. dialysis (peritoneal. Diagnostics a. radiographic studies 6. bleeding tendencies d. assess potassium in food and fluid e. anorexia. insert Foley c. erythropoietin. history b. anorexia. acute: fluids. hypertension. lethargy. protein. monitor vital signs especially blood pressure f. decrease renal blood flow f. managing complications 3. Diagnostics: history. often nonspecific (edema. Definition: progressive deterioration of kidneys so that they can no longer maintain normal chemical structure of body fluids under normal conditions 2. Etiology: immunological injury. underlying disease/condition 3. radiographic (ultrasound. diuretics 7. skin: sallow. Findings a. distribution throughout nephron . possible complications: acute and chronic renal damage. decreased tubular reabsorption of sodium from the proximal tubule d. give psychological support . treatment directed at 1. muddy appearance 5. electrolytes. Management a.

prepare child and parents for possible dialysis and/or transplantation 8. splaying at the urethra with failure of tubular formation and diastasis of pelvic bone 2. Cryptorchidism 1. Etiology/pathophysiology a. need to follow treatment plan and take medications as ordered 9.7. monitor body fluid volume and electrolyte balance b. preservation of optimum sexual function b. failure of abdominal wall and underlying structures. preservation of renal function 2. treament objectives 1. chordee. assess for findings of infection f. the earlier in gestation. post-op pressure dressing must not be removed by anyone other than the health care provider. Definition: failure of one or both testes to descend normally through inguinal canal into scrotum 2. Concerns: bone demineralization. bladder develops outside c. anemia. to fuse in utero b. failure to thrive. Concerns: urinary incontinence. prevent organs from drying out. or b. hormonal 3. post-op (antibiotics.associated with genital abnormalities 3. fluids. bed rest) 5.related to genetics. decrease in the hormonal stimulation necessary for descent 3. infection control 2. defect almost always associated with epispadias 4. including the ventral wall of the bladder. monitor rate of growth and development e. usually repaired before child goes to school 5. Definition: urethral meatus below normal placement on glans penis or anywhere along ventral (underside) surface of penile shaft 2. compression bandage. body image/self esteem M. retention of wastes. Etiology: idiopathic . the more severe the defect d. environment. Hypospadius 1. VUR. or surgery (orchiopexy). surgery: staged procedure c. Pathophysiology: interruption in normal development around seven to eight weeks gestation. infection N. Management: surgical correction (with urinary catheter and stents postop). abnormal testes. Definition: externalization of bladder. signs of rejection of new kidney b. Etiology: abnormalities in chromosomal complement. monitor vital signs. attainment of urinary control 3. pre-op 1. transplant concern Genitalia Problems K. L. Etiology: congenital . or hormones 2. embryogenesis. Concerns: stenosis. medications (HCG) to assist in descent (older child). Ambiguous genitalia 1. Nursing interventions a. especially blood pressure c. Management: wait up to one year for descent. Teaching points a. adequate reconstructive repair 4. Pathophysiology a. Pathophysiology: incomplete development in utero 4. Bladder exstrophy 1. Management a. monitor ABG’s for metabolic acidosis d. when normally male begins differentiating from female .

Pediatric Musculoskeletal System .3. laparotomy. radiographic contract). Diagnostics: history. biopsy 4. physical exam. genetics lab test. Concerns: body image/self esteem. tests to determine gender (endoscopy. family support VII. ultrasound.

Pathologic changes occur due to 1. posterior fontanel fuses at two months 6. Tendons and ligaments are more flexible 3. bend. Children's musculoskeletal differences 1. self care as condition permits 5. pulmonary. which is usually 18 to 21 years of age B. Concerns 1. Skull is pliable during infancy. anterior fontanel fuses at 18 months. Affects normal growth and development 3. cardiovascular.General Concepts: A. buckle. absorb shock 2. muscular. decreased muscle strength and mass. possible bone demineralization 3. dietary modification 3. Bones are more pliable and porous. decreased range of motion and decreased joint movement 4. Skeletal maturation completes when epiphysis fuses with diaphysis. GI. behavioral. so stronger and more active osteogenesis 5. play/exercise . GU. decreased metabolism 2. Immobilization in children 1. psychologic. integumentary 2. Affects multiple systems 1. Thicker periosteum. hydration 2. Bones produce callus that speeds healing 4. activity as condition permits 4. economic 2.

child abuse 3. many types: greenstick. comminuted. Pathophysiology 1. Fractures in children 1. spiral (may indicate child abuse). 3. transverse.C. pediatric risks 1. break at epiphyseal plate (growth plate between epiphysis and metaphysis) may affect future limb growth . fractures are seldom complete breaks (bone is flexible) 2. osteogenic diseases. complete or incomplete 5. classification: simple (closed) or compound (open). pathologic 4. birth injuries. external hemorrhage creates risk of critical blood loss 2. trauma. oblique. Definition: break or disruption in bone continuity 2. Etiology: usually due to mobility and immature motor and cognitive skills.

Findings: swelling. pain. bone growth. neurovascular status. bruising. pain. muscle rigidity.4. Concerns: proper bone healing and alignment. compartment syndrome . diminished functional use of affected part 5. edema. Management: cast or traction to realign. possible surgery 7. laboratory testing 6. Diagnostics: x-rays.

Etiology: 95% of cases talipes equinovarus . manual manipulation.and post-natal positioning 3. Definition: developmental dysplasia of the hips (DDH). Findings: plantar-flexed foot/feet. pre. Definition: congenital malformation of one or both feet 2. Findings a. or dislocation 2.Structural Musculoskeletal Disorders D. knock knees common in preschool age and older 3. bowlegs (genu varum) common in infants and toddlers b. casting or surgery F. limited abduction . Etiology: congenital 2. Pathophysiology: head of femur is improperly seated in acetabulum in hip 4.foot is pointed downward and inward 3. Management: serial manipulation and casting after birth. Findings a. possible surgery E. Etiology: congenital. Genu varum (bowleg) and genus valgum (knock knee) 1. Hip dysplasia 1. Management: most resolve spontaneously .pathologic forms may require night splints. with inverted heel and adducted forefoot 4. Clubfoot 1.

body develops compensatory curve to maintain posture and balance 4. Scoliosis 1. spica cast. asymmetry of gluteal skin folds d. Etiology a. Pathophysiology a. Findings .b. most commonly diagnosed during adolescent growth spurt 3. skin integrity. traction. short femur on affected side (Galeazzi's sign) c. surgery. Management: Pavlik harness. paralytic) b. Definition: lateral curvature of the of spine and rotation of vertebral bones 2. curved spine deforms rib. Bryant's traction 7. increased laxity 5. associated with neuromuscular disorders or trauma (paralytic) c. check for Ortolani maneuver and Barlow's test from birth to 2 or 3 months of age c. waddling gait (bilateral dislocations) e. Concerns: compliance. congenital d. avascular necrosis from improper positioning of harness G. Diagnostics a. radiographic studies 6. congenital. for children already walking. physical exam/screening at birth and monitor for hip dysplasia throughout first year of life b. idiopathic b. dependent on type (idiopathic.

plastic shell. but existing cortex loses blood vessels and necrotic area will detach (sequestrum) d. bed rest c. exercise and bracing to hold curve (Milwaukee brace rarely used. radiographic studies 6. pain and discomfort . Definition: inflammation of joints 2." or asymmetric rib cage c. decreased range of motion at affected bone c. microbe affects metaphysis of long bone.long term b. Management a. provide diversional activities for age 8. Staphylococcus aureus is the most common pathogen 3. may continue IV therapy at home b. waist angles uneven 5. surgery . body image/self esteem. or direct entry via open fracture or external fixation devices. Definition: bacterial bone infection 2. may require long-term IV access (4 to 6 weeks) b.surgery is quite complex 7. if curve progresses. increased white blood cells iii. possible immobilization with splints or cast d. initially. blood culture b.custom-molded jacket) b. Etiology: auto-immune with probable genetic predisposition 3. erythema over involved bone b. "rib hump. laboratory: blood cultures and bone aspirate cultures i. Management a. inflammation b. legs are different lengths d. Juvenile rheumatoid arthritis (JRA) . pus forms and spreads along the shaft of the bone c. visible curve (either C or S shaped curves) b. skin integrity. Wilmington and Boston orthoses . or TLSO . school work at home if appropriate d. irritability. radiographic studies (often negative for ten to 14 days). compliance with exercises and bracing. Findings a. possible surgery 7. erythrocyte sedimentation rate (ESR) will increase ii. bone scan 6. restlessness. Pathophysiology . Diagnostics a. fever 5. monitor antibiotic levels b.arthrodesis .new name Juvenile Idiopathic Arthritis 1. monitor nutrition – high calorie liquids e. Pathophysiology a. Diagnostics: screening. play activities within limits of physical ability Other Musculoskeletal Disorders I. physical therapy at home c. Nursing interventions a. new bone starts to form. Concerns a. airway clearance Infectious Musculoskeletal Conditions H. Osteomyelitis 1. IV antibiotics. perform range of motion if possible – no weight bearing d. Teaching points a. pain. "honeycombed" areas contain infective material 4.a. Etiology: endogenous (in-body) sources. localized tenderness. monitor level of comfort c.

preserve joint function 2. morning stiffness d. intermittent joint pain. Teaching points a. ischemic aseptic necrosis of femoral head. effusion of the joint and increased fluid c. body image. long-term disorder c. Legg-Calve-Perthes disease: osteochondritis 1. prevent contractures c. monitor for compliance with therapy – physical and occupational b. decreased mobility e. Definition: aseptic necrosis of femoral head 2. monitor pain/discomfort – possible application of moist heat d. erosion and fibrosis of the articular cartilage d. cytotoxic agents methotrexate c. immunosuppressives. heat. Nursing interventions a. relieve findings b. Diagnostics a. provide family and child support services. disturbance in blood supply b. HLA testing (human leucocyte antigen) b. electrical stimulation. significant disability 5. decreased range of motion. surgery for joint replacement 7. treatment objectives 1. increased ESR and CRP: c-reactive protein (sign of rheumatic fever) 2. whirlpool. swelling c. exercise needs J. laboratory testing .chronic inflammation b. usually self-limiting . trigger inflames synovium . leukocytosis in early stages 4. other: PT and OT. anemia 3. rest/activity. further deterioration occurs with bone erosion e. Management a.widening of joint spaces followed by gradual fusion and articular destruction with soft tissue swelling 6. radiographic testing and x-rays -. splinting.a. prevent physical deformities 3. slow acting antirheumatic drugs (SAARDS). decreased ability to perform ADL’s 8. usual developmental milestones – age appropriate toys d. positioning. stiffness. may have sudden inability to walk on one leg b. medications: nonsteroidal anti-inflammatory drugs (NSAIDS) naproxen. Etiology: disturbance of circulation to the femoral epiphysis 3. decrease in joint's range of motion and function 4. Findings a. multidisciplinary approach b.no definitive serologic tests 1. Pathophysiology a. corticosteroids. assess for altered patterns of growth and development due to decreased activity. ultrasound.

Findings a. Diagnostics: history. decreased range of motion 5. traction – conservative therapy must be continued for 2 to 4 years d. function. bone scan. possible surgery 7. intermittent painful limp on one side c. mostly outpatient activities 8. increased pain after extended period of activity d. corrective devices such as braces.4. play and exercise activities for a child who feels well but must remain relatively inactive . Teaching points a. radiographic studies. MRI 6. bed rest b. Nursing interventions a. and care of corrective devices b. parents must learn purpose. non weight bearing range of motion c. Management a. casts. application. insidious onset b.

VIII. Pediatric Integumentary System .

measurements: depth. shearing. laundry detergents. more easily hurt by endotoxins and infection. staging: partial or full thickness. stool. size. ostomy drainage. bacterial. closed c. shearing) & vascular damage 7. Mechanical forces (tearing. Medications 5. fistula C. Harder to regulate body temperature B. Child's body absorbs more of topical products 3. Pediatric differences: thinner skin 1. Factors impacting wound healing . wound healing. location. "tunneling". Assessment a. complex (involving muscle. Temperature 11. acute or chronic: etiology of pressure. Infectious processes (viral.General Concepts A. shearing and tearing forces 2. Soap. Newborn's skin thinner. bone) 2. IV infiltration 10. friction. and topical products 4. open. Hydration and nutrition 3. Allergy 9. modes of skin care 1. Bodily secretions: urine. trauma b. Age 2. Tape and adhesive products 8. Factors in skin condition 1. Wounds. fungal) 6.

remove or eliminate causative factors b. f. secondary or tertiary wound closure b. Modes of caring for skin disorders a. non-surgical: skin care products. Principles of successful wound management a. nutrition. type: primary. c. oxygenation nutritional deficiencies infection underlying systemic condition topical products utilized medications 3. measurement: decreasing size. 4. apply appropriate topical products: encourage moist wound healing and process of occlusion. . d. nutrition c. e. surgical: debridement. perfusion. healthy lifestyle b. b.a. viable tissue. provide appropriate systemic support: fluids. decreased exudate. Evaluation of successful wound healing a. skin grafts and flaps c. color 5.

Nursing interventions a. macule. pustule and even vesicles possible c. Teaching points a. provide hypoallergenic diet if appropriate 8. apply emollient preparation immediately after bathing e. itching. forehead and eyebrows or behind ears 4. keep child’s fingernails short c. lab tests (eosinophils. IgE) 6. remove irritants and allergens. Findings: usually nonpruritic oily scales on scalp. remove allergens b.Noninfectious Skin Conditions D. Definition: recurrent inflammatory reaction of skin that may also involve the eyelids and external ear canal 2.itching and findings of exacerbation 4. Diagnostics a. mild detergents c. Seborrheic dermatitis (in infants: cradle cap) 1. Etiology: probable dysfunction of sebaceous glands 3. goals: control itching. hydration creams. products: wet compresses. medications: antihistamines 7. provide family support regarding nutrition and recurrent nature of this disorder E. erythema b.increased histamine release with inflammatory response . Management a. moisturize. physical exam c. Teaching points: teach parents how to clean scalp and shampoo hair . acute weeping areas with excoriated red plaques 5. clothe lightly to decrease sweating d. exacerbated by stress and certain foods 3. Definition: inflammation of the skin 2. baby oil 5. dry skin. Findings a. and prevent secondary problems (infections) b. Pathophysiology: trigger. Atopic dermatitis (eczema) 1. family history b. multifactorial with family history of allergies or asthma. hydrocortisone cream. creams/ointments. Management: scalp hygiene with mild baby shampoos. papule. Etiology: genetic tendency. occlusive dressings. provide rest periods f.

treat underlying cause G. Findings: red. skin protectants/moisture barriers to keep skin dry c. inflammation b. detergents. moisture. Diaper dermatitis ("diaper rash") 1. prolonged and repetitive contact with irritant (especially urine ammonia. macules/papules. excoriation. cleaning and frequent diaper changes b. topical antifungals and steroids d. with macules/papules and erosion c. if diarrhea. 4. maceration 5. fecal enzymes.F. heat b. Etiology a. Definition: inflammatory skin disorder caused directly or indirectly by wearing of diapers 2. concern: secondary infection. Pathophysiology a. can lead to secondary fungal infection (especially candida albicans) 3. ammonia in urine. excoriated. which is formed by urea breakdown from fecal bacteria). Management a. Contact dermatitis .

Pathophysiology: starts in area of broken skin . red and excoriated skin 5. Definition: most common skin problem treated by doctors during adolescence 2. nutrition. papules. general: good cleansing of skin. topicals: vitamin A. antipruritic) cold compresses. education needed on myths and realities of causative agents and treatment modalities e. Etiology: multifactorial (heredity. pores become plugged and dilated d. allergens. topical antibiotics. stress importance of compliance to treatment program Infectious Disorders I. group A beta-hemolytic streptococcus 3. Findings: whiteheads (closed comedomes). allergic: blisters after weeping. pustules. Findings a. rupture causes local inflammation. nodules. emotions) 3. Etiology: multiple factors and irritants foods. internal fatty acids form whiteheads f. plants 3.1. possible bacterial invasions c. Findings: irritant and allergic types a. Teaching points a. pruritic. topical benzoyl peroxide c. Pathophysiology a. Management a. body image d. inflamed. sometimes with pustules 4. pruritic lesions where irritant touched b. possibility of scarring b. and no squeezing or picking at lesions b. primary: macules-vesicles of bulla that rupture . fatty acids are oxidized on skin and form blackheads OR e. solutions. Management: topical (antiinflammatory. increased sebaceous glands secrete more sebum c. lesions 4. Definition: inflammatory reaction of the skin to chemical substances natural or synthetic 2. Etiology: staphylococcus aureus. medications: oral antibiotics and possible estrogen for girls 6. Definition: bacterial infection of skin 2. Acne vulgaris 1. blackheads (open comedomes). puberty – increased androgens – involves hair follicle and sebaceous gland complex b.highly contagious for seven to ten days 4. irritant: causes dry. Impetigo contagiosa 1. supportive care – prevent further exposure to offending substance if possible H. hormones.

tends to heal without scarring unless secondary infection 5. treatment of choice: systemic antibiotics d. occasional discoloration) b. Etiology: strep. fever. easily bleeds. warm moist compresses. Definition: infection of dermis and/or subcutaneous tissue 2. Cellulitis 1. possible skin culture. Management a. Herpes simplex type one . Concerns: secondary infection. "streaking" frequently seen. alteration in skin integrity K. Findings a. enlarged lymph nodes. Pathophysiology a. rest of affected area and child 7. short fingernails 6. headache 5. careful removal of crusts/debris with warm soapy solution or Burow's solution b. secondary: honey-colored crusts. aureus. affected area (red. Haemophilus influenza 3. Management: oral or parenteral antibiotics. S. Diagnostics: CBC.b. topical antibiotics for early small lesions c. highly contagious for days c. Concerns: highly contagious (good hand washing. starts in area of broken skin b. edema. tender. CT 6. no sharing towels or eating utensils) J. pruritic c. possible incision and drainage. cultures. malaise. can occur on any part of the body 4. superficial erosion.

Concern: may spread to groin. pain. smears. secondary infection. sun exposure. which then come in contact with breaks in the skin or mucous membranes a. itching 5. education on mouth rinsing after inhaled steroid 6. and inner aspects of the cheeks 2. Etiology: HSV-1 or HSV-2. Epstein Barr (infectious mononucleosis). buttocks . Findings a. oral antifungals (swish and swallow) after feeding . possible ulcerations in oral mucosa c.symptomatic: fluids. pruritis. Varicella zoster 3. Moniliasis candidiasis (thrush) 1. vesicles. "cold sore" b. stress. menstruation 4. white plaques on tongue. Findings a. possible antiviral or antibiotic if secondary infection. Pathophysiology: acquired via birthing process. Management . body image. cytomegalovirus (CMV). pain. prodromal period common c. fever blister 2.1. Diagnostics: history. gums or buccal mucosa b. then reactivated by fever. Definition: oral candidiasis characterized by white adherent patches on the tongue. HSV-1 affects areas above the waist.topical application also b. candida albicans 3. often depend on location in body b. HSV-2: affects areas below the waist. genital c. analgesics 7. virus dormant within nerve cells. Concerns: highly contagious. trauma. Etiology: fungus. Definition: oral herpes. paresthesias. palate. HSV-2 is sexually transmitted Fungal Infections of Skin L. inhaled steroids 4. physical exam. Pathophysiology: virus infects body fluids. increased skin sensitivity at site 5. tissue cultures (Acyclovir Valtrex) 6. Management a. antibiotics. cold sore.

M. Pathophysiology a. contact with contaminated fomites (nonliving "host") . the skin 2. Tinea (ringworm) 1. animal contact. not in. Definition: superficial infection that lives on. transmitted person to person. Etiology: dermatophytes 3.

Pediculosis (lice) 1. associated with poor hygiene. good hygiene b. teach client never share clothing/hair brushes c. no sharing of towels. overuse of OTC products.b. friction from tight clothing 4. compliance. maintain medication schedule as ordered – maybe for several weeks or months b. Teaching points a. contagion. linens or hair brushes Infestations N. Nursing interventions a. Definition: lice infestation . especially for feet 5.

lice are highly contagious. Temperature-Related Disorders A. Pathophysiology a. grayish brown threadlike lines) b.pediculus humanus capitis (parasite) 3. Definition: mite infestation 2. mites. papular rose-colored dermatitis 5. these lice live only on humans. in hospital. female mite burrows into epidermis. Etiology: infestation of the scalp .2. Pathophysiology: a. lays eggs b. Findings a. creams . Management a. papule like eczema in infants 5. Management a. all pierce skin and suck blood. eggs and excrement all cause intense pruritis (due to histamine release) 4. pubic area (pubis) and eyelashes c. nits (tiny silvery or grayish-white specks) and pruritis b. Caused by cold 1. Concerns a. lindane (Kwell) shampoo is neurotoxic in children under five c.Nix (creme rinse) for infants and children b. infested client requires contact isolation. wash clothes and bedding in hot water d. body (corporis). For information on isolation see Lesson 2: Safety and Infection Control O. teach client to prevent recurrence and spread: wash clothes in hot water. no sharing of clothes or hair brushes 6. compliance and recurrence b.Elmite is the medication of choice b. Types . types include: scalp (capitis). Definition a. Findings a. with females laying eggs (nits) at the base of hair shaft 4. Scabies (itch mite) 1. all persons in close contact with affected child will need treatment IX. pruritis. scabicide topicals. with corporis. anti-steroidal agents may be included c. Etiology: mite (sarcoptes scabiei) 3. burrows (fine. are transmitted by direct and indirect contact b. topical medicated shampoos or body ointments .

edema of hands and feet. fourth degree 2.then red with swelling. immersion in water bath Sunburn 1. rewarm in 100 to 108 degree Fahrenheit water . medications. window or glass. Management a.toddler II. loss of body part c. cover area immediately but no massaging b. third. Factors influencing degree of burn a. anatomy and physiology of burns I. give analgesics and sedatives for severe pain during rewarming d. no direct sun between 10 am to 3 pm 5. amount of local tissue destroyed or damaged II. hypothermia: cooling of the body's core temperature to injurious levels (below 35 degrees Celsius) 3. trauma. second. thermal types most common in children 3. depth I. topical products 4. fourth degree: complete necrosis. altitude. frostbite I. hemorrhagic vesicles IV. burning. time of day c. related to length of exposure and temperature II. C. chilblain: redness. underlying condition. genetic makeup and skin type b.immerse affected part c. flame related . age of child I. Etiology: overexposure to ultraviolet light waves UVA (minor burning) UVB (tanning. Etiologies: thermal. second degree (cold after rewarming): blisters and possible bulla III. electrical. mottling. mottled II. season of year. chilblain: skin (usually extremities) becomes red and swollen when it is intermittently exposed to cold temperatures frostbite: tissue damage when ice crystals form in tissue . II.I. hot water scalds . B. Prevention a. chemical. concurrent inhalation injury. Management: like a first degree burn (see next page) Thermal injuries (burns) 1. avoid sun b. underlying conditions. Pathophysiology a. gangrene. types: first. Findings a. apply child appropriate topical sunscreens and blocks liberally d. hypothermia: heat lamps. third degree: cyanosis. blanching. secondary to irradiation. severity affected by: location. wear good clothing with a tight weave and eye wear c. Definition: overexposure to the sun 2. decreased sensation. light reflected by snow or water d. Definition: injuries to skin resulting from extreme heat sources 2. harmful effects) 3. may burn or itch b. local necrosis.older children b.

moderate (1020% TBSA) or uncomplicated major (>20% TBSA). GU: decreased fluids. tendons. superficial (first degree) burn: localized pain. possible ileus. integumentary: burned. CNS: possible encephalopathy. color: brown/tan/black/red: dependent on severity) III. pulmonary edema c. c. cardiovascular: dehydration. fluid volume changes faster than cardiovascular system can respond c. may affect many body systems d. 6. full thickness: third and fourth degree III. neuroendocrine: increased ADH and aldosterone g. very painful. with variable pain (often severe). relatively large surface area increases risk for losses of fluid and heat d. 8. burn damages tissue Multi-systemic response and potential complications a. moist c. ARDS. full thickness (fourth degree) burn I. possible blister b. so tissue damage is more severe b. do not disturb any blisters that form d. coma. partial thickness: first and second degree II. fluid is lost to circulating volume (the "oliguric" phase) d. GI: ischemia . scar tissue formation and poor healing i. leathery. metabolic: increased basal metabolic rate. 7. I. increased risk for dehydration and acidosis due to: diarrhea. full thickness (third degree) burn I. apply cool water to burn b. fluid lost to air c. thinner skin. do not apply anything to the burn 3. aspiration pneumonia. may be life threatening. tough.not painful Management: priority is to stop the burning process EMERGENCY TREATMENT OF BURNS 1."burn shock" b. increasing BUN and creatinine e. tendons and bone may be exposed. fluid leaks into interstitial spaces. fourth degree: involves muscle. IV. Curling's ulcer d. extent of burn determines responses: local or systemic Local response a. blanches with pressure. infection.decreased bowel sounds. fascia and bone.edema b. redness. vital signs f. Put out fire 2. denuded skin. anemia: associated with major burns Burn injuries differ in children a. cellular damage and fluid movements . possible post-inhalation injury. If burn is minor: a. dry surface. determined by the amount of systemic disruption beyond what the body could normally compensate. altered LOC h. If burn is serious: a. blistered. immature immune system increases risk of infection f. pulmonary: respiratory distress. wound dull and dry II. Wound appears dull and dry and ligaments. 5. partial thickness (second degree) burn: open wound.4. dull dry. II. bone may be exposed . and because child's body requires higher proportion of water than adult's e. long term: scars mature more slowly and keloids more severe Findings a. remove burned clothing/jewelry c. severity: classified as minor (<10% TBSA). seizures. insensible fluid loss. assess respiratory status and establish airway . ligaments.

pre-medicate for pain before any dressing change iii. debridement: surgical. care of the child with a burn wound i. Concerns in burn cases a. debride loose debris or necrotic tissue. support surfaces. usually covered with xeroform dressing (nursing does not change this dressing) vii. weigh client and provide fluids and electrolytes. infection. cover the burn: prevent infection. donor site. maintain ABC: airway. breathing. long term: Jobst pressure stockings and body wraps. antibiotic therapy 8. heat loss. enzymatic. arrange for transport to emergency health care facility e. wound healing. body image and self esteem . permanent): allograft and autografts vi. psychological. shock. cover burn with clean cloth d. circulation 2. and dressing (fine mesh or occlusive). range-of-motion activities 9. then cover with antimicrobial v. cleanse wounds with mild solutions. skin grafts (temporary. keloid formation. provide adequate pain control 7. Use Parkland formula for burn shock 3. long-term: nutrition. hydrotherapy iv. tetanus prophylaxis c. pain. acute: airway status. contractures. tetanus prophylaxis.b. pain control. and further deterioration 5. remove constrictive clothing or jewelry. care of full thickness burn 1. mild analgesic f. provide sufficient nutrition and calories to prevent negative nitrogen balance and meet body demands 6. fluids b. aseptic technique ii. add antimicrobial ointment. superficial: cleanse with solutions. resuscitate if necessary c. 4.

X. Pediatric Hematology Blood Components .

Carry oxygen to cells and move carbon dioxide back to lungs. Blood typing . Hemoglobin: the iron component of RBCs 4. Erythrocytes 1. Average life span: 120 days 3.A. 2.

persons with type B can receive type B or type O blood c.a. Life span eight to ten days . Plasma proteins 1. Leukocytes increase with infections or inflammation: C. Measuring plasma proteins helps assess nutritional status D. persons with type O can receive only type O blood B. persons with type A can receive type A or type O blood b. Small fragments of cells 2. Include albumin and globulins 2. Platelets 1.

3. Sickle cell anemia (SCA) . Essential to blood clotting/coagulation Disorders of Red Blood Cells E.

to prevent sickling phenomenon ii. hydration c. findings of infection c. Findings a. prophylaxis with penicillin recommended h. how to increase fluid intake especially in hot weather F. sequestration crisis – pooling of blood in liver and spleen iii. Teaching points a. impaired growth d. while 1 in 375 is affected with sickle cell disease 3. 1 in 2 African-Americans carries the trait.1. Pathophysiology: abnormal. how to administer prophylactic antibiotics b. x-rays of involved bones 6. apply to affected areas as ordered d. also known as Cooley's anemia 3. Definition: one of a group of diseases in which normal adult hemoglobulin (HbA) is partly or completely replaced by abnormal sickle hemoglobin (HbS) 2. painful exacerbations called crises: i. Nursing interventions a. obstruction caused by sickled RBCs ii. kidney) due to ischemia and infarction d. generalized microvascular occlusion (vaso-occlusive crisis) 4. Definition: inherited blood disorder characterized by deficiencies in rate of production of specific globin chains in hemoglobin 2. hypoxia c. aims of therapy i. medicate for discomfort as ordered 8. genetic counseling 7. hemoglobin electrophoresis c. Diagnostics a. oxygen d. Etiology: autosomal recessive disease. organ dysfunction (spleen. to trust medical emergency sickle cell crisis b. newborn screening (sickled ex) b. result from i. severe anemia. accurate I & O e. splenomegaly 5. Management a. trigger – RBC’s shape becomes sickled and clump b. Pathophysiology a. hemoglobin and hematocrit b. pallor b. formulate teaching plan for patient and family b. Diagnostics a. RBC destruction b. chronic transfusion therapy to maintain hemoglobin of ten gm/dl . vaso-occlusive – painful distal ischemic usually hands and feet ii. analgesics e. liver. antibiotics f. Etiology: autosomal recessive disorder. folic acid g. Findings a. microcytic RBCs c. Therapeutic management a. encourage fluids c. B-Thalassemia 1. hyperhemolytic crisis increased destruction of RBC 5. chronic production and destruction of RBC's resulting in insufficient amounts of normal circulating hemoglobin 4. electrophoreses (hemoglobin) 6. aplastic crisis – diminished RBC production iv.

referral for chelation counseling c. genetic counseling Disorders of Excess Bleeding Summary of bleeding disorders in children: .b.

bleeding time. monitor for bleeding episodes b. Nursing interventions a. internal bleeding 5. epistaxis (nosebleed). should not use aspirin to relieve pain use Tylenol (acetaminophen) H. Pathophysiology a. Pathophysiology a. prolonged bleeding time 4. Definition: and acquired hemorrhagic disease 2. antibody. petechiae. Diagnostics: bone marrow aspiration 6. auto-immune disorder b. Findings: excessive bruising. and/or administration of antidiuretic: desmopressin acetate (DDAVP) . Management: steroids. Etiology: congenital (autosomal dominant) bleeding disorder. body makes too little von Willebrand's factor and factor VIII b. splenectomy for chronic disease 7. should not participate in contact sports b. provide for age appropriate diversional activities 8. menorrhagia 5. Management: replacement of missing clotting factor. Von Willebrand's disease 1. Etiology: unknown but often occurs one to two weeks after a febrile viral illness 3. may be acute and self-limiting or chronic 4.G. Idiopathic thrombocytopenic purpura (ITP) 1. Teaching points a. affects both males and females 3. platelets are killed and fewer are made c. Definition: hereditary bleeding disorder 2. Diagnostics: platelet count. and bone marrow aspiration 6. Findings: excessive bleeding of mucous membranes: gums. immunoglobulins (IVIG).

bruising. Definition: group of bleeding disorders in which there is a deficiency of one of the factors necessary for coagulation of blood 2. Pathophysiology a. pallor. child should wear medical identification b. Therapeutic management a. rest. Pathophysiology: missing or defective factor VIII or factor IX blood components necessary for blood coagulation 4. Etiology: x-linked recessive disorder 3. congenital (example: Faconi's anemia) b. a diuretic (DDAVP) c. Definition: bone marrow failure 2. Nursing interventions a. support family e. result: pancytopenia 4. HPV) c. Teaching points a. Management a. Aplastic anemia 1. longterm loss of range of motion of affected joints 5. prevent bleeding while appropriate exercise b. factor VIII concentrate b.I. chloramphenicol 3. brushing teeth with soft toothbrush c. and platelets (thrombocytes) b. acquired due to exposure to overwhelming infection (hepatitis. antithymocyte globulin (ATG). antilymphocyte globulin (ALG) b. chemicals. if severe. ice. most often in muscles and joints (hemathrosis) b. PTT. replacement of missing clotting factor. genetic counseling for parents . fatigue. pressure to bleeding site 7. elevation. Diagnostics: history of bleeding episodes. bone marrow transplant is treatment of choice J. Etiologies a. causative agents such as antineoplastic agents. mild-severe prolonged bleeding. leukocytes. recognize and control bleeding d. Diagnostics: bone marrow aspiration 6. prophylactic treatment with clotting factor before surgery and some other procedures d. assess school activities 8. immobilization. myelosuppression 5. Findings a. assay procedures for specific factor deficiencies 6. Findings: petechiae. bone marrow stops making erythrocytes. desmopressin acetate. Hemophilia 1.

platelets. Sudden tendency to bruise IV. Pediatric Oncology I. Management a. bruising. degraded fibrinogen) c. Findings a. control of underlying etiology b. altered serum levels of clotting-related factors (increased PT. hypoxemia. Nursing Interventions a. oxygen 7. Etiology a. monitor any severely ill child to recognize presence of this disorder XI. monitor IV infusions. liver disease 3. Unusual mass II. decreased platelets. administer Heparin as ordered c. PTT. unexplained weight loss V. PTT and TT (Thrombin time) 6. petechiae b. TT. fibrinolytic mechanism causes extensive destruction of clotting factors 4. rapid conversion of fibrinogen to fibrin with aggregation and destruction of platelets d. Rapid. Change in vision or eye . factor replacement c. shock. the first stage of the coagulation process is abnormally stimulated b. bleeding. intracranial hemorrhage. Pallor III. infections.K. Cardinal findings of cancer in children I. Definition: disorder of coagulation 2. blood transfusions b. hypoxia. clotting mechanism is triggered in circulation. clotting. triggered by endothelial damage such as trauma. fresh frozen plasma (FFP) and RBC transfusions d. Pathophysiology a. Disseminated intravascular coagulation (DIC) 1. Diagnostics: PT. thrombin is generated in greater amounts than the body can neutralize c. local and widespread fibrin deposition in blood vessels causes obstruction and necrosis e. vitamin K e. progressive organ failure 5. secondary disorder of coagulation that complicates other disorders b.

relieve discomfort III. VI. III. Definition: cancer of blood-forming tissues Pathophysiology of acute lymphoid leukemia (ALL) and acute myelogenous leukemia (AML) I. hemorrhage and anemia IV. and bone marrow aspiration Management I. Recurrent fever VII. bone marrow transplant Nursing interventions I. highly vascular organs such as spleen and liver are most severely affected Findings I. combination chemotherapy to achieve a remission II. Persistent headache. . Change in balance or gait Leukemias . symptoms caused by infiltration and replacement of any tissue of the body with non-functional leukemia cells.most common cancer in children I. mucosal ulceration. hepatosplenomegaly. often with vomiting VIII. bone or joint pain IV. anemia. acute or insidious onset II. V. V. thrombocytopenia. stiff neck Diagnostics: history. II. infection. malignancies of the bone marrow and lymphatic system II. leukemia cells demonstrate the neoplastic properties of solid cancers IV. peripheral blood smear. bleeding III. neuropathy. manage problems of drug side effects – nausea and vomiting. VI. unrestricted proliferation of immature WBCs III. radiation if CNS involved or intrathecal administration of methotrexate III. anorexia. lymphadenopathy. physical findings. meningeal irritation – irritable. monitor for infection. lethargic. prepare child and family for diagnostic procedures II.II. IV. alopecia and moon face.

school work for child when appropriate Lymphomas . provide nutritional snacks VI. long term treatment plan II. multidisciplinary approach III. refer for needed services – financial or home care Teaching points I. V.VII. encourage parents to ask questions when unsure IV.

C. Pathophysiology a. neoplasm of lymphatic system b. multinucleated cells (Reed-Sternberg cells) . Hodgkin's disease 1. Definition: malignancy of the lymph nodes 2. characterized by giant.

Sed Rate. chemotherapy and radiation b. encourage to ask questions when unsure d. urinalysis. provide age appropriate diversional activities d. refer to appropriate resources if sterility may result from irradiation and/or chemotherapy 7. painless. multidisciplinary approach c. Diagnostics: lymphangiography.3. night sweats c. fever 4. Nursing Interventions a. weight loss. anorexia. long term treatment plan b. CT Scan. particularly in supraclavicular area b. characterized by painless enlargement of lymph nodes. CBC. preparation for diagnostic procedures b. treatment based on staging of disease (stages I-IV) 6. Non-Hodgkin's lymphoma . Teaching points a. school work for child when appropriate D. explain side effects of treatment c. Management a. chest x-ray 5. malaise. Findings a.

most common solid tumor in children c. nontender mass in the abdomen that crosses the midline b. ataxia b. MRI. positioning considerations depend on procedure done e. solid tumors of the nervous system b. chemotherapy 5. increased intracranial pressure. enlarged lymph nodes in cervical or axillary region b. Pathophysiology a. Management a. surgical debulking. Pathophysiology: a. visual changes. radiation G. glioblastoma 1. if appropriate f. medicate for discomfort as indicated 6. Other tumors . behavioral changes 3. treatment is dependent on staging criteria b. refer for needed resources F.1. often has metastasized by the time it is diagnosed 2. Findings a. solid tumor found only in children under four years-old b. Diagnostics: history. neuro signs b. vomiting. chemotherapy. and lumbar puncture 4. headache. distant metastasis may cause periorbital edema (swelling around eyes) 3. Findings a. c. staging I-IV 2. surgical debulking b. CT Scan. painless. EEG. proliferation of either B. primary sites are adrenal gland or retroperitoneal because it starts from embryonic neural crest cells of the adrenal gland and sympathetic nervous system. firm.lymphocytes b. Therapeutic management a. bone marrow and/or mediastinal involvement 3. radiation c. Nursing interventions a. prepare child and family for diagnostic and operative procedures – possible shaving of head d. vital signs c. begin feeding when ordered g. Pathophysiology a. location extremely important 2. Teaching points a. astrocytoma. Neuroblastoma 1. Findings a. ependymoma.or T. seizures. Therapeutic management: combination of chemotherapy and radiation E. child’s post operative appearance b. bulging fontanel in infants. monitor dressing and ICP. Brain tumors: medulloblastoma.

Findings: localized pain. non-tender. decrease in physical activity 3. MRI. and radioisotope bone scans 4. humerus. grows from undifferentiated mesenchymal cells of skeletal muscle c. originates from bone-forming mesenchyme b. related to site of tumor and compression of adjacent organs c. surgery not routinely recommended J. more common in males 2. Ewing sarcoma 1. Rhabdomyosarcoma 1. most common in shaft of femur. Therapeutic management: surgical approach a. intensive radiation therapy of the malignant bone b. most common in distal femur d. Pathophysiology a. Pathophysiology a. often metastasized when diagnosed 2. CT scans. scapula c. or amputation b. limp. decrease in physical activity 3. Osteosarcoma 1. combined with chemotherapy c. Findings: localized pain. combination chemotherapy c. Diagnostics: history. physical assessment. symptoms often vague. most common in head and neck. similar to otitis media or "runny nose" 3. surgical resection . high-dose irradiation of the primary tumor b. especially the orbit d. firm mass b. plus combination chemotherapy before and/or after surgery I. tibia. soft tissue neoplasm b. Therapeutic management a. creating malignant osteoid tissue c. Findings a. metastasis to lung 2. arises not from osteoid tissue but in bone marrow spaces b.Summary overview of other tumors in children: H. Therapeutic management a. limb salvage with prosthetic bone replacement. staging I-IV e. chest x-ray. highly malignant. Pathophysiology a.

The effects also may vary from child to child. The care of the unconscious child focuses on respiratory management. The primary indicator of neurological status is LOC (level of consciousness). strabismus. Acute bacterial meningitis is a medical emergency. and then to flaccid paralysis. "vesiculation. Clinical effectiveness of anticonvulsants varies with the drug's serum level. The sudden appearance of a fixed or dilated pupil is an emergency. though there may be a familial predisposition. ultrasound and CT scan 4. neurological assessment. The progression from decorticate posture to decerebrate posturing. Nursing interventions a. Do not do any diagnostic tests that require head movement until cervical spine injury has been ruled out. anorexia. Most viruses are associated with rashes (characteristic of each disorder. with evidence of genetic inheritance in certain cases 2. monitoring intake and output. Children with congenital neurological disabilities will often develop complications in other body systems. It may bring with it certain problems in perception. and cloudy appearance Due to pharmacokinetics and dynamics. Febrile seizures are generally a one-time event. roseola) Pediatric Neurology • • • • • • • • • • • • • • • • • • Abnormal posturing is an ominous sign A positive Babinski is normal in children until one year of age Myelinization continues until adolescence Abnormal CSF findings include: decreased glucose. pharmacokinetics and dynamics. red. enucleation. sometimes warts. Status epilepticus is an emergent situation. Pathophysiology: congenital malignant tumor of the retina. Findings: cat's eye reflex (whitish glow in pupil). Teaching points a. indicates deterioration of neurologic function. common side effect of the majority of anticonvulsants include drowsiness. mechanism of action. Diagnostics: ophthalmoscopic exam under general anesthesia. Children are more likely than adults to have neuromuscular or extrapryamidal side effects from psychotherapeutic drugs." or proliferation. . such as chicken pox. Management a. treatment depends on stage of tumor. painful eye 3. and/or intellectual function. requiring swift action and treatment. chemotherapy b. these children need periodic tests of blood and of liver enzymes. Cerebral palsy is a neuromuscular disorder. language. rubella. A newborn's brain is about two-thirds the size of an adult's. and reaches 80% adult size in one year. lethargy. Sometimes dyscrasias or liver damage can occur. demonstrate positive aspects of prosthesis – show pictures of other affected children after surgery b. Retinoblastoma 1. nausea. involve parents in care and teach about diagnostic procedures 6. hence. positive culture. providing appropriate medications and evaluating outcomes. genetic counseling for parents Viral Infections • • • Viruses are parasites that cannot reproduce or meet own metabolic needs.K. Skin cells react to virus with swelling. ataxia. radiation therapy. stages I-V 5. assess child for this when parents report a strange light in the child’s eye b.

adventitious lung sounds. In head trauma. Central cyanosis in a newborn usually means severe hypoxia and possible cardiac etiology. cyanosis.• • • Do not restrain a child experiencing a tonic-clonic seizure. include poor weight gain. underlying disorder and agent involved. interventional and electrophysiologic. Normal hormone levels are related to age and stage of puberty. green (lower right). Electrodes for cardiac monitoring are usually color coded: white (upper right). RSV is transmitted by direct contact with the fomite. hyperlipidemia. chronic respiratory infection. Signs of increased breathing work are tachypnea. Cardiac catheterization serves many purposes: diagnostic. shortness of breath and fatigue. pressure changes and anatomic defects. Asthma is not a disease but an inflammatory disorder. natural defenses. acute rheumatic fever. The incidence and severity of respiratory tract infections and disorders is related to the child's age. and never place anything in the mouth. Kawasaki disease. black (upper left). CHF signs usually show either left or right sided heart disorders. the primary mechanism of injury is acceleration-deceleration accidents. It also monitors cardiac oxygen saturation. Oxygen is a drug that requires a prescription and frequent monitoring. Children's airways are smaller. while wheezing indicates a lower airway disorder. Asthma is not wheezy bronchitis. and distended neck veins. Pediatric Endocrine • • The body secretes hormones at various times during the day (influences of diurnal and circadian rhythm). Stridor usually indicates an upper airway concern. abnormal positioning. Epiglottitis. edema. activity intolerance. The best way to stop the spread of RSV is meticulous hand washing. hepatosplenomegaly. retractions. acute tracheitis and status asthmaticus are acute medical emergencies. . Acquired cardiac disorders include bacterial endocarditis. Respiratory rate is an important indicator of respiratory status. size. These can lead to thrombus. and fatigue during eating. These signs may include increased heart rate. Pediatric Cardiovascular • • • • • • In a cardiac history. and red (lower left). Acrocyanosis is a common finding in a newborn. more flexible and shorter than adult's and are therefore more prone to obstruction than adults. Pediatric Respiratory • • • • • • • • • • • • The principal functions of the respiratory tract are to allow air movement (ventilation) and exchange (diffusion) of oxygen and carbon dioxide. and cardiomyopathy. Bleeding from the nose or ears calls for evaluation. Conditions that increase or decrease compliance and/or resistance will make breathing harder. • In cyanotic heart disorders. major concerns are polycythemia or increased hemoglobin and hematocrit.

suspect tracheoesophageal fistula. The GI tract has both intake (fluid. minerals. the composition and volume of body fluids. dwarfism. . The 3 C's . Blood glucose monitoring by finger-stick reflects glucose currently and for last several hours. detect and correct abnormalities.• • • • • • • • • • • • The pituitary gland stimulates target organs to produce specific hormones. A major concern of precocious puberty is rapid bone growth. and their fluid-regulation systems have not matured.) and output functions. consistency. and time (duration). Dehydrated infants and children face greater morbidity risk than adults because children differ in body composition and metabolic rate. Associated terms for hypopituitary function include: short stature. The focus of diabetic management is the inter-relationship of diet. etc. gastric esophageal reflux is very common in infants. these in return signal pituitary to stop stimulation (negative feedback loop). edema and/or lethargy. Pediatric Gastrointestinal • • • • • • • • • • • • • Infants and children have a much smaller stomach capacity than adults. Acute renal failure should be suspected in a child with decreased urine output. in equilibrium. glycosylated hemoglobin levels indicate long-term compliance and true diabetic status. the goals are to control hematologic manifestations and any renal complications. chokes and turns blue with feeding. Potassium should only be added to IV fluids when the urine output is sufficient. color. The vast majority of children with new-onset diabetes mellitus type 1 (IDDM) will experience a "honeymoon" period when their bodies secrete insulin and their need for exogenous insulin decreases. when sufficient. heat or vigorously shake insulin. should be evaluated for Hirschsprung's disease.cough. Untreated infant hypothyroidism will lead to mental retardation. The treatment of metabolic acid-base disturbance is oriented toward correcting the underlying problem. Whenever a newborn coughs. Oral potassium tastes very bitter. which can result in early fusion and short stature. the body cannot properly metabolize fats. Children with SIADH develop an expanded circulatory volume but not edema. Peristaltic waves may reverse occasionally during infancy. Bilious vomiting indicates source below the ampulla of Vater. activity and insulin administration. proteins and carbohydrates. In managing HUS. choke. mix it with a little strongly flavored fruit juice. recovering from surgery or in shock. remember the acronym ACCT: amount. vitamins. Dehydration can lead to shock. Never freeze. When insulin is absent. For a child with an endocrine disorder. Children with urine output less than one ml/Kg/hour should be closely monitored for possible renal failure. and cyanosis. UTI management aims to eliminate the underlying cause. and who is dehydrated. never discontinue medication abruptly. When assessing diarrhea or constipation. constitutional delay. and prevent recurrences. Secretory cells don't reach adult levels until two to three years of age. One Gm of diaper weight = one cc of urine. Any newborn failing to pass meconium stool within the first 24 hours of life and who is prone to constipation or decreased frequency of stooling in the first month of life. Pediatric Genitourinary • • • • • • • The kidney's function is to maintain. Kidney function in an infant is nearly that of an adult by 12 months of age. The effects of hypokalemia or hyperkalemia can be devastating.

but the infant's anatomy. For a child with a fracture. dislocation and sprains are less common. Pediatric Musculoskeletal • • • • • • • • Since many musculoskeletal disorders begin with trauma. Pediatric Temperature-Related • • • • • • • • • The extent of a burn injury is expressed as percentage of total body surface area (TBSA) The larger the percentage of TBSA that is burned. Children under one year of age generally do not experience fractures. Children typically have longer treatment plans than adults due to their increased metabolic rate and rate of cell turnover. Dry wounds do not heal. Paresthesia 5. overwhelming sepsis. girls more than boys. In managing alterations in skin integrity. the criterion for choice of gender and rearing is not genetic sex. and extent of disease Cure rate is improving for most types of pediatric malignancies. Immediate care for a major burn is ABC: airway establishment and patency. Pediatric Hematology • • • For a child with altered platelet function or bleeding disorder. . Open fractures increase the risk of infection. it is important to assess the five P's of ischemia: 1. Leukemia affects not only the blood. Wound debridement promotes healing and prevents infection. Pain and point of tenderness 2. Perform invasive procedures very cautiously. do not administer acetylsalicylic acid (aspirin. Children with low WBC may not exhibit common findings of infection such as purulent drainage. Children's soft tissues are resilient. breathing and absence of respiratory distress. Paralysis Children with structural defects/disorders require regular follow-up evaluation until they reach skeletal maturity. including the central nervous system. location and type of tumor. don't put it into a wound. it is important to assess ABC (airway. the greater the risk for burn shock. Pediatric Oncology • • • • Findings of pediatric malignancies vary according to the child's age. Children in casts or traction need to be monitored for alterations in skin integrity routinely. it is necessary to individualize the type of treatment and medications to the particular causative agent. In a child with ambiguous genitalia. give antibiotics immediately because this child risks rapid. Immobilization has multi-system effects. ASA) or take rectal temperatures.distal to the facture 3. Pallor 4. Potassium should not be administered during the initial oliguric phase of a burn injury. and circulation with fluid initiation. Pulse . Wounds heal by the process of moist wound healing and occlusion. however the late effects of treatment are of increasing concern and incidence. Morphine is the medication (or opioid) of choice for pain in children with sickle cell disease. breathing and circulation) first. but should be added when diuresis occurs. In a febrile client with granulocytopenia. but can metastasize to major organ systems (extramedullary disease).• • UTIs are extremely common in young children. If you wouldn't put it into an eye.

and anemia. bleeding.• • Nursing care includes monitoring the child for the development of acute complications of treatment including fever. Pediatric oncologic emergencies include: acute tumor lysis syndrome. . septic shock. superior vena cava syndrome.

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