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Chapter 1, Family-centered Nursing Care

Family: whatever the individual considers it to by; should remain constant in the child's
life; nurses should perform comprehensive family assessments to identify strengths and
weaknesses of families; consider the child's opinion when giving care
Nuclear Family: Two parents and their children (biologic, adoptive, step, foster)
Traditional Nuclear Family: married couple and their biologic children (blood)
Single-parent family: one parent and one or more children
Blended family (reconstituted): at least one stepparent, step-sibling, or half sibling
Extended Family: At least one parent, one or more children, and other individuals
either related or not related
Gay/Lesbian Family: two members of the same sex that have a common-law tie and
may or may not have children
Foster Family: a child or children that have been placed in an approved living
environment away from the family of origin--usually with one or two parents
Binuclear Family: parents that have terminated spousal roles but continue their
parenting roles
Communal Family: individuals that share common ownership of property and goods
and exchange services without monetary consideration
Parenting Styles: Dictatorial or authoritarian (control with unquestioned rules),
Permissive or laissez-faire (exert little or no control over the child's behaviors) and
Democratic or authoritative (set rules and explain them, negatively reinforce deviation
from the rules)
Genogram: medical history for parents, siblings, aunts, uncles, and grandparents

Chapter 2, Physical Assessment Findings
Temperature Expected values: Birth-1 year, 97.7-98.9 F; 1-12 years, 98.1-99.9 F;
12 and older, 97.8-98.0 F
Pulse expected values: Birth-1 week, 100-160; 1-3 weeks, 100-220; 3months-2
years, 80-150; 2-12 years, 70-110, 12 and older, 50-90
Respirations expected values: newborn, 30-60 with short periods of apnea;
newborn-1year, 30; 1-2 years, 25-30; 2-6 years, 21-24; 12 and older, 16-18
Expected B/P: infants, 60-80/40-50; 1 year, 94-107/50-60; 3 years, 100-113/59-68; 6
years, 104-117/67-76; 10 years, 110-123/73-82; 16 years, 122-138/79-87
Posterior fontanel: should be flat and closes between 2-3 months; anterior closes
between 12-18 months
Strabismus: should be further evaluated in children between 4-6 years; use the cover/
uncover test
Internal ear: pull pinna down and back to visualize in infants; pull pinna up and back to
visualize in children older than 3
Teeth: infants should have 6-8 teeth by age 1; should have 20 deciduous and 32
permanent teeth
Sucking reflex: stroke the infant's cheek or the edge of the mouth; should turn head
toward side that is touched; birth-4 months involuntary and for life voluntary

Palmar grasp: elicited by placing an object in an infant's palm; infant should grasp the
object; birth-6 months
Plantar grasp: elicited by touching the sole of an infant's foot; the infant's toes curl
downward; birth-8 months
Moro Reflex: elicited by startling the infant; the arms and legs should symmetrically
extend and then abduct while fingers spread to form a c shape; birth-4 months
Tonic neck reflex: elicited by turning an infant's head to one side; the infant should
extend the arm and leg on that side and flex the arm and leg on the opposite side; birth-4
Babinski reflex: elicited by stroking the outer edge of the sole of an infant's foot up
toward the toes; the toes should fan our; birth-1 year
Stepping reflex: elicited by holding an infant upright with his feet touching a flat
surface; infant should make stepping movements; birth-4 weeks
Cranial nerves: "on old olympus' towering tops a fin and german viewed some hops"
olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic,
glossopharyngeal, vagus, spinal accessory, and hypoglossal
Olfactory: can identify smells through both nostrils
Optic: visual acuity is in tact
Oculomotor: no nystagmus present
Trochlear: able to look down with both eyes
Trigeminal: able to clench teeth together
Abducens: able to look laterally with eyes
Facial: has symmetric facial movements
Acoustic: no vertigo present
glossopharyngeal: gag reflex intact
vagus: has clear speech
Spinal accessory: both shoulders have equal strength
Hypoglossal: tongue is midline
Romberg test: able to stand with slight swaying while eyes are closed
***left testicle hangs slightly lower than the right; skin on scrotum has a rugated
appearance and is loose

Chapter 3, Health Promotion of the Infant (birth-1 year)
Weight: infants gain about 5-7 oz. per week the first 6 months; infants triple their
weight by the end of the first year
Height: infants grow about an inch per month for the first 6 months then 1/2 inch the
next 6 months
Head circumference: increases 0.6 in. per month the first 6 months, 0.2 in. the next
6 months
Teething: should have 6-8 teeth by the end of the first year; for teething pain, use cold
teething rings, otc gels, or tylenol; do not use ibuprophen unless over 6 months!!!clean
their teeth with cool wet washcloths; do not give bottles if asleep; avoid prolonged
exposure to milk or juice because of dental caries

Birth: Hep B
One month: has a head lag; has a grasp reflex
2 months: lifts head off mattress; holds hands in an open position; DTaP, RV, IPV,
Haemophilus influenzae B (Hib), PCV, and Hep B
3 months: raises head and shoulders off mattress; no longer has grasp reflex, keeps
hands loosely open
4 months: rolls from back to side; places objects in mouth; DTaP, RV, IPV, Hib, PVC
5 months: rolls from front to back; uses palmar grasp dominantly
6 months: rolls from back to front; holds bottle; DTaP, IPV, PVC, Hep B, RV
7 months: bears full weight on feet; moves objects from hand to hand
8 months: sits unsupported; begins using pincer grasp
9 months: pulls to a standing position; has a crude pincer grasp
10 months: changes from prone to sitting position; grasps rattle by its handle
11 months: walks while holding on to something; places objects into a container
12 months: sits down from a standing position without assistance; tries to build a twoblock tower without success
***Get the yearly flu vaccine between 6-12 months
Sensorimotor: Piaget; birth-24 months; three things occur, such as separation (learn
to separate themselves from other objects in the environment), object permanence
(occurs @ 9 mths), and mental representation (recognition of symbols)
Psychosocial development: Erikson; trust versus mistrust; infants trust they will be
fed, comforted, stimulated, and caring needs will be met
Separation anxiety: develops between 4-8 months; will protest loudly when
separated from parents
Stranger fear: occurs between 6-8 months; they fear strangers
Appropriate toys for birth-1 year: rattles, mobiles, teething toys, nesting toys,
playing pat-a-cake, playing with balls, reading books
Breastfeeding: provides completed diet during the first 6 months
***Iron-fortified formula is an acceptable alternative to breast milk; NEVER GIVE COW'S
Solids: introduce solids around 4-6 months of age; begin when the infant is interested
in solid foods; begin with iron-fortified rice cereal; introduce new foods one at a time,
over a 5-7 day period;start veggies and fruits between 6-8 months, followed by meats;
delay giving milk, eggs, wheat, citrus fruits, peanuts, pb, and honey until after the first year
of life; decrease breast and increase solids
Weaning: accomplished when infants are able to drink from cups with handles; replace
feedings one at a time, with the bedtime feeding being last
Car seats: place in a rear facing until the first year of life or 20 pounds
Cribs: remove mobiles at 4-5 months of age; should sleep on their backs; slats should
be 6cm apart; do not use pillows or big blankets

Chapter 4, Health Promotion of the Toddler, 1-3 years
Weight: at 30 months, the toddler should weight 4X their birth weight

Height: Toddlers from about 3 inches per year

15 months: walks without help, creeps up stairs, uses a cup well, builds a tower of two
18 months: assumes a standing position, manages a spoon without rotation, turns
pages in a book two or three at a time
2 years: walks up and down stairs, build a tower of six or seven blocks
2.5 years: jumps in place w/ both feet, stands on one foot momentarily, draws circles,
has good hand-finger coordination
Piaget: sensorimotor stage transitions to the preoperational stage; object permanence
is fully developed, they have and demonstrate memories that relate to them; domestic
mimicry is evident; do not understand others' viewpoints
Language: speak about 400 words with 2-3 word patterns
Erikson: autonomy versus shame and doubt; independence is paramount, separation
anxiety continues; punishment and obedience orientation begin; see themselves as
separate from their parents; increase exploration; have gender identity by 3 years of age
Play: solitary play evolves into parallel play, where they may observe other children and
may play nearby; plays with toys that can be pushed or pulled, looking at books, playing
with blocks, tossing balls, and filling empty containers
12-15 months: IPV, Hib, PCV, MMR
12-23 months: Hep A, given in 2 doses 6 months apart
15-18 months: DTap
12-36 months: yearly flu vaccine
Nutrition: picky eaters; should have 24-30 oz. of milk; may switch to 2% at 2 years;
juice consumption should be 4-6 oz. per day; 1 tbsp for each year of age; exposure of a
new food should be 8-15 times before they accept it; if fam. hx. of allergy, then introduce
cows' milk, chocolate, citrus fruits, egg whites, seafood, and nut butters gradually; finger
foods are preferred
Car seats: rear facing until 20 pounds; front facing until 4 years and/or 40 lb.

Chapter 5, Health promotion of the preschooler (3-6 years)
Weight: gain about 4.5-6.5 per year
Height: grow about 2.5-3 inches per year
3 years: rides a tricycle, jumps off bottom step, stands on one foot for a few seconds
4 years: skips and hops on one foot, throws a ball overhead
5 years: jumps rope, walks backward heel to toe, moves up and down stairs easily
Piaget: preoperational phase of cognitive development; have preconceptual thought
(2-4, make judgments base on appearance) and intuitive thought (4-7, can classify info and
become aware of cause-and-effect)
Artificialism: everything is made by humans
Animism: inanimate objects are alive
Imminent justice: a universal code exists that determines law and order
Erikson: initiative versus guilt; may take on new experiences but may feel guilt when
they do not accomplish the task

Pretend Play: this is healthy and allows them to determine the difference between
real and fantasy
Play: playing has shifted to associative play; not highly organized by does exist between
children; activities include playing ball, putting puzzles together, riding tricycles, playing
pretend, role playing painting, sewing cards and beads, and reading books
4-6 years: DTaP, MMR, varicella, IPV
36-59 months: yearly flu vaccine
Nutrition: need 13-19 G protein in addition to adequate calcium, iron, folate, and
vitamins A & C

Chapter 6, Health Promotion of the school-age child (6-12 years)
Weight: gain about 4.4-8.8 lbs. per year; wt. gain typically occurs between 9-12 years of
Height: usually grow 2 inches per year
Females: budding breasts, appearance of pubic hair, onset of
Males: enlargement of testicles with looseness in the scrotum
adn appearance of pubic hair
***Permanent teeth erupt, visual acuity improves to 20/20
Piaget: concrete operations; sees weight and volume as
unchanging, understands simple analogies, understands time, able
to solve problems and becomes self-motivated
Erikson: is in the industry versus inferiority stage; has
advancements in learning, motivated by tasks that increase selfworth, fears ridicule by peers and teachers
***peer pressure begins to take effects, they are more modest, and they place emphasis
on privacy issues; prefer the company of the same gender and they may rival same-gender
Play: competitive and cooperative play is dominant--At 6-9 years they play simple board
and number games, play hopscotch, jump rope, collect rocks-stamps-cards-coins, ride
bicycles, build models, join organized sports for skill building; At 9-12 years they make
crafts, build models, collect things, engage in hobbies, solve jigsaw puzzles, play board and
card games, and join organized competitive sports
***get yearly flu vaccine and Tdap, HPV and MCV4 vaccines between 11-12 years
***Screen school age children or scoliosis by examining if there is a lateral curvature of
the spine
Car Safety: they should remain in a booster seat until they are 80 pounds or 4'9"
because this is when the adult seat belt will fit properly--keep children less than 13 years
of age in the back seat

Chapter 7, Health Promotion of the Adolescent (12-20 years)
***The final 20-25% of height if achieved; girls may cease to grow 2-2.5 years after
menarch--they will gain 15.5-55 lb. and grow 2-8 in.; boys tend to stop growing between

18-20 years--they will grow 4-12 inches adn gain 15.5-66 lbs.
***Acne will occur
Sexual maturation for girls: order for girls is breast buds, growth of pubic hair,
and onset of menstruation
Sexual maturation for boys: increase in size of testes and scrotum, appearance of
pubic hair, rapid growth of genitalia, growth of axillary hair, appearance of downy hair on
upper lip, and change in voice
Piaget: formal operations; capable of thinking at an adult level, able to think abstractly,
capable of evaluating the quality of their own thinking, capable of making decisions,
capable of using deductive reasoning
Erikson: identity versus role confusion; they develop an identity that is influenced by
expectations of their family
Vocationally: solidify work habits and plan for future college and careers
***Give any missed immunizations and screen for scoliosis

Chapter 8, Safe Administration of Medication
***IM meds are absorbed more slowly in newborns and faster in infants; newborns need
reduced dosages because of limited renal excretion abilities; children have a faster
metabolism than adults until about age 12; pediatric doses are based on body weight, BSA,
and maturation of body organs; newborns are highly sensitive to drugs that affect the
6 Rights: right patient, right medication, right dose, right time, right route, and right
***Always assess for patient allergies!!!
***Consider the oral route the preferred route for children and mL as the preferred
***If using IV, always check the IV site for redness, edema, and patency
***Do not crush enteric coated or time-released tablets; divide tablets only if scored
Gastrostomy Tubes: do not mix medications with enteral feedings; use liquid forms;
check tube placement; flush tubing with warm water before and after each medication
Rectal: used as a substitute for oral meds; cut the suppository lengthwise for partial
dosing; insert with the apex entering first, then gently push beyond rectal sphincter and
hold the buttocks together until the urge to expel has passed (5-10 minutes)
Otic: Remember to pull the auricle down and back when giving otic solutions for
children up to 3, and up and back for older than 3; the parent must hold the child; warm
otic solutions before instilling
Nasal: hyperextend the child's neck for nasal meds to prevent the medication from
sliding down into the throat
SQ: apply EMLA cream 60 minutes before an injection; change the needle if used to
puncture the rubber top of a vial; insert needle at 90 deg. or 45 deg. if minimal sq tissue;
use upper arm, abdomen, or anterior thigh
Intradermal: insert at a 15 deg. angle, inject a small bubble just beneath the skin; use
the surface of the forearm; used for local anesthetics, tb skin test, and allergy testing

IM: apply EMLA 60 minutes prior, change needle if punctured the rubber top of a vial,
use the smallest gauge possible, vastus lateralis is the recommended site for infants and
children less than 2 years of age; after age 2, the ventral gluteal site can be used
Vastus Lateralis: 22-25 g; 0.625-1 inch; 0.5 mL for infants to 2.0 mL for children;
supine, side lying, sitting positions; recommended for infants and children less than 2 years
of age
Ventrogluteal: 22-25 g; 0.625-1 inch; 2.0 mL for children; supine, side lying, and prone
positions; can be used for 2 and older, less painful than vastus lateralis, free of any nerves
or blood vessels
Deltoid: 22-25 g; 0.625-1inch; 0.5 mL for infants to 1.0 mL for children; supine, side
lying, and sitting positions; not as painful as vastus lateralis, less local side effects than with
vastus lateralis, should not be used in infants/children with underdeveloped muscles, and if
muscle size is appropriate it may be used for immunization of toddlers and children
IV: use for continuous and intermittent IV medications

Chapter 9, Pain Management
***Monitor pain 15min. after IV meds, 30 min. after IM pain meds, 30-60 min. after oral
***Monitor children who are on opioid medications very closely for resp. depression
CRIES Neonatal postoperative tool: pain rated on a scale of 0-10; behavior
indicators are crying changes in v/s, changes in expression, altered sleep patterns; used
from 32 wks gestation-20 wks of life
FLACC postoperative pain tool: faces, legs, activity, cry, and consolability; used
from 2 months-2 years
FACES Pain Rating Scale: rating scale that uses drawings of happy and sad faces to
depict levels of pain; used for 3 years and older
Visual Analog Scale (VAS): pain is rated on a scale of 0-10; child points to the
number that best describes the pain he is experiencing; used 7 years and older but may
be affective in those as young as 4.5 years
Noncommunicating Children's Pain checklist: pain is rated on a scale of 0-18;
behavior indicators include vocalization, socialization, facial expressions, activity level,
movement of extremities, and physiologic changes; used for children 3-18 years of age
(for children with or without cognitive impairments)
***Use caution when giving meds to newborns less than 3 months because of their
immature liver function
Opioids for children: used for moderate pain and include morphine, oxycodone, and
EMLA: contains prilocaine and lidocaine in the form of a cream or disk; use for any
procedure where the skin will be punctured; place an occlusive dressing over the dressing
after application; use 60 minutes prior to a procedure
Fentanyl: use for children over 12 years; used to provide continuous pain control; onset
of 12-24 hours and a duration of 72 hours; treat resp. depression w/ Narcan

Chapter 10, Hospitalization, Illness, and Play

Separation Anxiety: has three behavioral responses; protest (screaming), despair
(developmental regression), & detachment (lack of interaction with unfamiliar people)
Infant: cannot describe symptoms; lack of understanding; experiences stranger anxiety
between 6-18 months; displays physical behaviors as expressions of discomfort due to
inability to verbalize; may have sleep deprivation due to noises and procedures
Toddler: limited ability to describe symptoms; poor sense of body image and
boundaries; limited ability to follow directions; may have separation anxiety; may have an
intense reaction to any type of procedure due to the intrusion of boundaries
Preschooler: limited understanding of the illness; limited ability to describe symptoms;
fears related to magical thinking; ability to understand cause and effect inhibited by
concrete thinking; has separation anxiety, my have fears of bodily harm, may believe the
illness and/or hospitalization is punishment
School-age Child: awareness of body functioning; an describe symptoms, understands
cause and effect, fears loss of control, may sense when not being told the truth, and may
experience stress from being separated from peers and regular routine
Adolescent: understands cause and effect, develops body-image disturbances,
experiences feelings of isolation from peers, worries about outcome and impact on
school/activities, and may not adhere to treatments/regimen due to peer influence
Onlooker play: child observes others at play
Solitary play: child plays alone
Parallel play: children playing independently but among other children; this is
characteristic of toddlers
Associative Play: children playing together without organization, which is
characteristic of preschoolers
Cooperative Play: organized playing in groups, which is characteristic of school-age
Play activities for infants: birth-3 mths., visual and auditory; 3-6 mths., noisemaking objects and soft toys; 6-9 mths., teething toys and social interactions; 9-12 months,
large blocks, toys that pop apart, and push/pull toys
Play activities for toddlers: cloth books, large crayons and paper, push/pull toys,
tricycles, balls, puzzles with large pieces, educational television and videos
Play activities for preschoolers: associative, imitative, & imaginative play, drawing,
painting, riding a tricycle, swimming, jumping, and running, educational television and
Play activities for school-age: games that can be played alone or with another
person, team sports, musical instruments, arts and crafts, collections
Play activities for adolescents: team sports, school activities, reading and listening
to music, peer interactions

Chapter 11, Death and Dying
Palliative care: end of life care; focuses on the process of dying, rather than extending
life; pain control, symptom management, and support of the child and family must be given;

top priority; use education, support, and honest communication; provide an environment
that is much like home as possible; encourage physical contact
Birth-3 years: have little to no concept of death; egocentric thinking, mirror parental
emotions; react in response to the changes, may regress
3-6 years: egocentric thinking, magical thinking, interpret separation as punishment,
view dying as temporary
6-12 years: start to respond to logical of factual explanations; begin to have an adult
concept of death; experience fear of the disease process, the death process, the unknown,
and loss of control; fear is often displayed through uncooperative behavior; may be
curious about the funeral and what happens to the body afterward
12-20 years: adult-like concept of death; may have difficulty accepting death, rely more
on peers rather than the influence of their parents; may be stressed by changes; may
experience guilt and shame

Chapter 12, Meningitis and Reye Syndrome
Meningitis: inflammation of the meninges, which are the membranes that protect the
brain and spinal cord; often preceded by viral infections; usually requires supportive care;
contagious; risk factors include viral illnesses (measles, mumps, herpes), bacterial
meningitis (otitis media, tonsilitis), immunosuppression, injuries, overcrowded living
conditions; they may report photophobia, headache, irritability, vomiting, drowsiness; lab
tests include blood cultures and sensitivity tests to see what antibiotic to use, CBC,
cerebrospinal fluid should be will see increased CSF pressure, WBC,
protein...decreased glucose and CSF that appears cloudy for bacterial and clear for viral;
isolate the child ASAP for droplet precautions; initiate IV fluids, minimize exposure to
light, keep room cool, and give antibiotics, corticosteroids, anticonvulsants, and analgesics;
complications after the sickness include ICP; make sure the child gets the Hib and PVC
Lumbar puncture: empty bladder, place in fetal position, administer sedatives, apply
EMLA, label 3 test tubes, monitor the site for hematoma and/or infection, have child
remain in bed 4-8 hours in flat position to prevent leakage which causes a spinal headache
Meningitis in Newborns: no illness at birth, but progresses within a few days; poor
muscle tone, weak cry, and poor feeding, fever or hypothermia, nuchal rigidity is not
usually present, bulging fontanels is a late sign
Meningitis in 2 months-2 years: seizures with a high-pitched cry, fever and
irritability, bulging fontanels, possible nuchal rigidity, poor feeding, vomiting, brudzinski's
and kernig's signs do not assist with the diagnosis
Meningitis 2 year-adolescence: seizures, nuchal rigidity, positive brudzinski's and
kernig's signs, fever and chills, headache, vomiting, photophobia, irritability and restlessness
that may progress to drowsiness, delirium, stupor, and coma; petechia or purpuric type
rash, involvement of joints, and chronic draining ear

Brudzinski's and Kernig's Signs

Nuchal Rigidity (neck stiffness)

Lumbar Puncture

Reye Syndrome: A life-threatening disease that leads to multisystem failure; preceded
by viral infections; primarily affects the liver and brain causing liver dysfunction and
cerebral edema; bleeding and poor blood clotting with lethargy progressing to coma and
potential for cerebral herniation; hypoglycemia and shock occur; Using aspirin for treating
viral infections can cause the development; there are five stages; the lab tests are Liver
enzymes, which will be elevated, serum ammonia level which is elevated, serum
electrolytes, low blood glucose, Hgb, Hct, and platelets, and coagulation times may be
extended; a liver biopsy will be performed; a lumbar puncture will be performed; maintain
hydration, insert a catheter, avoid extreme flexion, extension, or rotation; maintain head in
a midline position, keep hob elevated 30 degrees; monitor pain, insert nasogastric tube,
assist with intubation and maintain ventilation if required, take seizure precautions, keep
family informed, provide private time if death is imminent---medications are osmotic
diuretics and insulin
Liver biopsy: takes a piece of liver tissue, via a large-bore needle, and sends the tissue
to the pathology department; maintain NPO prior to procedure, monitor for hemorrhage
after the procedure, assess vitals frequently; limit postprocedure activities

Stage I: lethargy, vomiting, anorexia, early liver dysfunction, brisk pupillary reaction,
ability to follow commands
Stage II: confusion/disorientation/delirium, combativeness, hyperventilation, hyperactive
reflexes, sluggish pupillary response, response to painful stimuli
Stage III: coma, seizures, flexion rigidity
Stage IV: deeper coma, extension rigidity, fixed large pupils and loss of corneal reflexes,
brainstem dysfunction, and minimal liver dysfunction
Stage V: hypotonia, seizures, respiratory arrest, and absence of liver function

Chapter 13, Seizures
Seizures: abrupt, abnormal, excessive, and uncontrolled electrical discharges of
neurons within the brain that may cause alterations in level of consciousness and/or
changes in motor and sensory abilities and/or behavior; can be abrupt in nature or slow
and insidious onset
Tonic: stiffening of muscles
Clonic: rhythmic jerking of the extremities
Tonic-clonic seizure: may begin with an aura; begins with a 10-20 second tonic
episode and loss of consciousness; a 1-2 minute clonic episode follows a tonic episode;
breathing may stop during the tonic phase and become irregular during the clonic phase;
cyanosis may accompany breathing irregularities; biting of the cheek or tongue may occur
during the clonic phase; incontinence may accompany the seizure; a period of confusion
and sleepiness follows the seizure during the postictal phase
Tonic Seizure: only the tonic phase is experienced; usually lasts a few seconds; loss of
consciousness does not occur; tonic seizures are much less common than tonic-clonic
Clonic Seizures: only the clonic phase is experienced; fatigue does not usually follow
the seizure; clonic seizures are much less common than tonic-clonic seizures
Absence Seizure: most common in children; loss of consciousness that lasts seconds;
blank staring is associated with this type; baseline neurologic function is resumed after the
seizure, with no apparent sequela
Myoclonic Seizure: consists of brief jerking or stiffening of the extremities; may be
symmetric or asymmetric; lasts for seconds
Atonic or akinetic seizure: muscle tone is lost for a few seconds; confusion
follows; loss of muscle tone frequently results in falling
Complex Partial seizure: has associated automatisms(behaviors the child is
unaware of, such as picking at clothes or smacking the lips), loss of consciousness that
lasts for several minutes, and amnesia may occur immediately prior to and after the
Simple partial seizure: consciousness is maintained throughout the event, seizure
activity may consist of unusual sensations, a sense of deja vu, autonomic abnormalities
(changes in HR and abnormal flushing, unilateral abnormal extremity movements, pain,
offensive smell)
Unclassified: (idiopathic) do not fit into other categories; account for half of all

seizure activity and occur for no known reason

EEG: this test can be performed to identify the origin of the seizure; it records electrical
activity; administer sedatives; assist with positioning; abstain from caffeine; wash hair
before and after procedure
Care during a seizure: protect from injury, position to provide patent airway,
suction oral secretions, turn to the side, loosen clothing, DO NOT RESTRAIN, do not
attempt to open the jaw or insert an airway during seizure activity; do not use padded
tongue blades
Care post seizure: maintain the child in a side-lying position; check v/s, assess for
injuries, perform neurologic checks, allow the child to rest if necessary, reorient and calm
the child, reinstitute seizure precautions, have them describe the period before, during,
and after the seizure, determine if the child experienced an aura, try to determine the
possible trigger, and document the onset and duration
Seizure Medications: Valium, Dilantin, Tegretol, Depakene, and Cerebyx; used for
seizure control; monitor therapeutic serum medication levels; should be given the same
time every day and be aware of any food/medication interactions
Vagus Nerve Stimulation: performed under general anesthesia; device is implanted
into the left chest wall and connects to an electrode that is placed at the left vagus nerve;
it is programmed to administer intermittent vagal nerve stimulation at a rate specific to
the child's needs; the child may initiate vagal nerve stimulation by holding a magnet over
the device at the onset of seizure activity to weaken or abort the seizure
Status Epilepticus: seizure activity that lasts longer than 30 minutes or continuous
seizure activity in which the child does not enter a postictal phase

Chapter 14, Head Injury
ICP signs: severe headache, deteriorating level of consciousness, restlessness,
irritability, agitation, dilated and fixed---constricted and fixed---slow to react or
nonreactive pupils, alterations in breathing pattern, intermittent gasping respirations,
abnormal posturing, difficulty waking up, bulging fontanels, visual disturbances
Decorticate: arms, wrists, and fingers flexed and bent inward onto the chest and the
legs extended and adducted
Decerebrate: a backward arching of the head
and arms with legs rigidly extended and toes
pointing downward
Flaccidity: no muscle tone
***If a sample of fluid makes a yellow stain
surrounded by blood on a paper towel, and tests
positive for glucose, it indicates CSF leakage
Glasgow Coma Scale: scores of 8 or less are
associated with severe head injury and coma;
scores between 9-12 indicate moderate head
injury; scores of 13 ore greater reflect minor head

Nursing Care: ensure the spine is stabilized, monitor v/s, level of consciousness, pupils,
ICP, motor activity, maintain patent airway, provide mechanical ventilation, give oxygen,
hyperventilate the child and keep the PaCo2 between 30-35 mm Hg, keep the HOB at 30
degrees, minimize suctioning, avoid coughing, insert a catheter
Medications: corticosteroids (Decadron and Solu-Medrol) for acute cerebral edema,
Mannitol for acute cerebral edema, Dilantin to prevent seizures, Analgesics (morphine or
fentanyl) to control pain
***On the ATI test, our first priority with head injuries is to keep the neck stabilized!

Chapter 15, Visual and Hearing Impairments
Strabismus: misalignment of the eyes
Refractive errors: nearsightedness, farsightedness, astigmatism
Amblyopia: decreased acuity in one eye
E Snellen: chart used for children that cannot read
Snellen: chart used for children that can read
***20/70-20/200 is considered partially sighted for school vision
Myopia: nearsighted; sees close objects clearly, but not distant objects; eye rubbing,
headaches, dizziness, difficulty reading, poor school performance, clumsiness--corrected
by biconcave lenses that help focus light rays on the retina
Hyperopia: farsightedness, sees distant objects clearly but not objects that are close,
normal vision until age 7, usually able to accommodate--may be corrected using convex
lenses that help focus light rays on the retina
Astigmatism: uneven vision in which only parts of letters on a page may be seen,
headaches and vertigo, the appearance of normal vision because tilting the head enables
all letters to be seen--may be corrected with a special lens to correct refractive errors
Strabismus: misaligned eyes, frowning or squinting, difficulty seeing print clearly, one
eye closed to enable better vision, head tilted to one side, headache, dizziness, diplopia,
photophobia, and crossed eyes--may be corrected with eye exercises or patching of the
strong eye
Conductive Hearing loss: involves interference of sound transmission, which may
result from otitis media, external ear infection, foreign bodies or excessive ear wax
Sensorimotor hearing loss: involves interference of the transmission along the
nerve pathways, which may result from congenital defects or secondary to acquired
Central Auditory imperception: involves all other hearing losses

Chapter 16, Oxygen and Inhalation Therapy
Pulse Oximetry: measures the oxygen saturation of the blood; expected range is
95-100%, and below 86% is life threatening emergency; if less than 90%, it indicates
Nebulized Aerosol Therapy: this breaks up medications into minute particles that
are dispersed throughout the respiratory tract; these droplets are much finer than those
created by inhalers; treatments can cause tachycardia or jitteriness

Metered-dose inhaler or dry powder inhaler: a spacer may be used to keep

the medication in the device longer; fungal infections can be an issue with corticosteroid
use; make sure all equipment is clean and the child rinses his/her mouth after use
Chest Physiotherapy: percussion, vibration, and postural drainage; gravity and
positioning loosen respiratory secretions and move them into the central airways where
they can be removed by coughing or suctioning; schedule an hour before or 2 hr. after
meals; to drain apical sections of the upper lobes, use fowler's...the posterior sections of
the upper lobes, use side-lying...right lobe, on the left side with a pillow under the chest
wall....left lobe, trendelenburg position; the person claps rhythmically on the chest wall to
break up the secretions
Hypoxemia: develops when there is an inadequate level of oxygen in the blood;
hypovolemia, hypoventilation, and interruption of arterial flow can lead to hypoxemia
Early signs of hypoxemia: tachypnea, tachycardia, restlessness, pallor of the skin
and mucous membranes, elevated b/p, symptoms of resp. distress; decreased SaOs levels,
adventitious cough, visualization of secretions, and absence of spontaneous cough
Late signs of hypoxemia: confusion and stupor, cyanosis of the skin and mucous
membranes, bradypnea, bradycardia, hypotension, cardiac dysrhythmias
Hypercarbia: signs of restlessness, hypertension, and headache
***don't let oxygen blow directly onto the faces of infants
Oxygen hood: small plastic hood that fits over the infant's head; use 4-5 L, ensure
neck, chin, or shoulders do not rub against the hood
Oxygen tent: tent that fits over the crib or bed and can provide oxygen and humidity;
use for older than 3 months, set the tent on a high flow rate, then adjust the flow meter;
keep the tent around the perimeter of the bed; keep the child warm and dry; monitor the
temperature at all times
Nasal cannula: safe, easy, well tolerated; can be used by children who are cooperative;
may cause skin breakdown and dry mucous membranes; provide humidification
Oxygen toxicity: results from high concentrations of oxygen during a long duration
of oxygen therapy; signs of toxicity include nonproductive cough, substernal pain, nasal
stuffiness, n/v, fatigue, headache, sore throat and hypoventilation
***For endotracheal suctioning, make sure you use sterile water or 0.9% socium
chloride, and only suction for 5 seconds at a time
***Be sure to provide tracheostomy care every 8 hours

Chapter 17, Acute Infectious Respiratory Illnesses
Tonsillitis: the tonsils filter viruses and bacteria which helps protect the resp. tracts
and gi tracts; enlarged tonsils can block the nose, throat, and disrupt the eustacian tube
causing hearing loss; when they become inflamed and reddened, it is called acute
tonsillitis; small patches of yellowish puss may become visible; child will have difficulty
swallowing, history of otitis media and hearing difficulties; use Tylenol, Amoxicillin, Tylenol
w/ codeine to treat viral tonsillitis symptoms
Tonsillectomy: preop--encourage the use of warm salt-water gargles and throat
lozenges & encourage fluid intake and monitor hydration; postop--side lying to help w/

drainage, elevate HOB while awake, assess for bleeding, frequent swallowing, clearing of
the throat, restlessness, bright red emesis, tachycardia, and/or pallor, assess the airway and
v/s, monitor for any difficulty breathing r/t oral secretions/edema/bleeding, provide an ice
collar and analgesics, keep throat moist, give pain meds, encourage clear liquids and fluids
after the gag reflex returns, give soft diet, discourage coughing/throat clearing/nose
blowing, do not put pointed objects in the mouth, & tell parents that there may be blood
clots or blood-tinged mucous in the vomit---no swimming for 2 weeks!!!
***Children have short, narrow airways that can become obstructed by mucous; short
respiratory tracts allow infections to travel quickly to the lower airways; small surface
areas for gas exchange; infectious agents have easy access to the middle ear through the
short and open Eustachian tubes
Nasopharyngitis: common cold; self-limiting virus; persists for 7-10 days; s/s of nasal
inflammation, rhinorrhea, cough, dry throat, sneezing, and nasal qualities hear in voice,
fever, decreased appetite, and irritability
Pharyngitis: strep throat; caused by GABHS; s/s of inflamed throat with exudate, pain
with swallowing, headache, fever, abd. pain, cervical lyphadenopathy, truncal/axillary/
perineal rash
Bacterial tracheitis: infection of the lining of the trachea; s/s of thick purulent
drainage from the trachea that can obstruct the airway and cause resp. distress
Bronchitis: self-limiting and requires symptomatic relief; s/s persistent cough as a
result of inflammation
Bronchiolitis: mostly caused by RSV; affects the bronchi and bronchioles; s/s include
pharyngitis, rhinorrhea, intermittent fever, cough, wheezing, nasal flaring, retractions,
cyanosis, increased respiratory rate
Allergic rhinitis: caused by seasonal reaction to allergens; s/s watery rhinorrhea,
nasal congestion, itchiness of the nose, eyes, and pharynx, itchy watery eyes, nasal quality
of the voice, dry/scratchy throat, snoring, poor sleep leading to poor performance in
school, and fatigue
Pneumonia: s/s high fever, cough that may be unproductive or productive of white
sputum, retractions and nasal flaring, rapid/shallow respirations, chest pain, adventitious
breath sounds, pale color that progresses to cyanosis, irritability, anxiety, agitation, fatigue,
abd. pain, diarrhea, lack of appetite, vomiting, sudden onset usually following a viral
Bacterial epiglottitis: EMERGENCY!!! caused by haemophilus influenzae; s/s sitting
with chin pointing out, mouth opened, and tongue protruding, drooling, anxiety with
respiratory distress, absence of spontaneous coughing, dysphonia, dysphagia, inspiratory
stridor, sore throat, hight fever, and restlessness
Acute laryngitis: self-limiting viral infection; s/s of hoarseness
Acute laryngotracheobronchitis: s/s low-grade fever, restlessness, hoarseness,
barky cough, inspiratory stridor, and retractions
Acute Spasmodic laryngitis: may result from allergens; s/s of barky cough,
restlessness, difficulty breathing, hoarseness, and nighttime episodes of laryngeal

Chapter 18, Asthma

Asthma: a chronic inflammatory disorder of the airways that results in intermittent
and reversible airflow obstruction of the bronchioles; manifestations are mucosal edema,
bronchoconstriction, and excessive secretion production; pulmonary function tests are
the most accurate way for diagnosing asthma---during an asthma attack, position the pt.
for better breathing (high-fowler's), administer oxygen, get IV access, assess airway
patency, listen to lung sounds, monitor s/s
Mild-intermittent asthma: symptoms occur less than twice a week
Mild Persistent asthma: symptoms occur more than twice a week, but not daily
Moderate Persistent asthma: daily symptoms occur in conjunction with
exacerbations twice a week
Severe persistent asthma: symptoms occur continually, along with frequent
exacerbations that limit the child's physical activity and quality of life
S/S of asthma: dyspnea, coughing, wheezing, mucous production, use of accessory
muscles, poor oxygen saturation, tachycardia and premature ventricular contractions
Meds for asthma: bronchodilators (albuterol, atrovent & terbutaline; provide rapid
relief, watch for tremors and tachycardia when taking albuterol and observe for dry
mouth when on Atrovent; know to give albuterol in an EMERGENCY!!!---Antiinflammatory agents decrease inflammation; includes corticosteroids (flovend &
prednisone) and leukotriene modifiers (singulair, Intal, and Xolair); monitor for
hyperglycemia, black/tarry stools, fluid retention, cold sores, and make sure they drink
plenty of fluids
Hypoxemia: decreased PaO2 of less than 80
Hypocarbia: decreased PaO2 of less than 35 early in attack
Hypercarbia: increased PaO2 greater than 45 later in attack
Forced vital capacity: volume of air exhaled from full inhalation to full exhalation
forced expiratory volume: amount of air able to be blown our as quickly as
possible during the first second of a forceful exhalation after inhaling fully
Peak expiratory flow rate: the maximum airflow exhaled forcefully in one second;
measured by the peak expiratory flow meter

Chapter 19, Cystic Fibrosis
Cystic Fibrosis: dysfunction of the exocrine glands that causes the glands to produce
thick, tenacious mucous; organs affected are the lungs, pancreas, small intestine, and liver;
the child will have salty sweat; it is from an autosomal recessive trait and both parents
must be carriers of the gene; at birth, there will be distention of the abd., vomiting and
inability to pass stool; s/s are fatigue, chronic cough, thick/yellow-grey mucous, positvie
sputum culture, fever, sob, dyspnea, wheezing, cyanosis, barrel-shaped chest, clubbing,
difficulty exhaling air (hyperventilation of lungs), large/loose/fatty/sticky/foul-smelling
stools, failure to gain wt., delayed growth patterns, distended abdomen, thin arms/legs,
delayed puberty
Labs: a sweat chloride test will measure the amount of chloride on the skin; normal
amount is less than 40; values greater than 40 are suggestive of cystic fibrosis, and greater

than 60 are indicative of cystic fibrosis

Treatments: respiratory treatments include chest physiotherapy, breathing exercises,
assistance with coughing, and aerosol therapy; use oxygen; promote nutritional intake and
provide pancreatic enzymes at meals and with snacks; make sure each meal is high-caloric
and high protein; take vitamins that are water-soluble, such as A, D, E, and K; stool
softeners should be used; provide meticulous skin and oral hygiene; give abx. through a
port; encourage adequate fluid and salt intake
Medications: bronchodilators (albuterol), antibiotics, Pulmozyme (decreases viscocity
of mucous), & pancreatic enzymes (pancrease)

Chapter 20, Cardiovascular Disorders
Congenital Heart Disease: anatomic defects of the heart prevent normal blood
flow to the pulmonary and/or systemic system; many children are dx. in the first year;
many have an increased incidence of other anatomic defects; risk factors include rubella in
early pregnancy, Down syndrome, diabetes, alcohol/drug use---be sure to cluster all care
for the child with heart problems, feed every 3 hours, keep hob elevated
Medications for heart diseases: Digoxin (do not give if pulse is <90 in infants and
<70 in children--if they vomit, do not give it again), Captopril or Vasotec (monitor b/p
fefore and after administered and monitor for hyperkalemia), Laxix or Diuril (monitor for
hypokalemia and monitor I&O)
Ventricular Septal Defect: hole in the septum between the right and left ventricle
that results in increased pulmonary blood flow (left to right); loud harsh murmur, heart
failure, and failure to thrive
Atrial Septal Defect: a hole in the septum between the right and left atria that
results in increased pulmonary blood flow (left to right shunt); loud, harsh murmur, mild
heart failure, enlarged rt. atrium, and increased oxygen saturation in the right atrium
Patent Ductus Arteriosus: the normal fetal circulation conduit between the
pulmonary artery and the aorta fails to close and results in increased pulmonary blood
flow (left to right shunt); murmur, wide pulse pressure, bounding pulses, asymptomatic
Pulmonary stenosis: narrowing of the pulmonary valve or artery that results in
obstruction of blood flow from the ventricles; systolic ejection murmur, exercise
tolerance, right ventricle enlargement, cyanosis
Aortic Stenosis: narrowing at, above, or below the aortic valve; murmur, left ventricle
enlargement, chest pain, dizziness, chest pain, and syncope
Coarctation of the aorta: narrowing of the lumen of the aorta, that results in
obstruction of blood flow from the ventricles; increased b/p and oxygen saturation to
upper extremities compared to the lower extremities, nosebleeds, headaches, leg pain,
weak lower extremity pulses
Transposition of the great Arteries: the aorta is connected to the right
ventricle instead of the left, and the pulmonary artery is connected to the left ventricle
instead of the right; murmur, severe cyanosis, cardiomegaly, HF
Tricuspid Atresia: complete closure of the tricuspid valve that results in mixed
blood flow; severe cyanosis, hf, chronic hypoxemia, failure to thrive, growth retardation

Tetralogy of Fallot: four defects that result in mixed blood flow; pulmonary stenosis,
ventricular septal defect, overriding aorta, and right ventricular hypertrophy; murmur,
cyanosis, severe dyspnea, clubbing, clot formation, child frequently in squatting position,
failure to thrive and growth retardation
Manifestations of Heart Failure: tachycardia, murmurs, extra sounds, diaphoresis,
decreased urinary output, fatigue, pallor or mottling, cool extremities, weak peripheral
pulses, slow capillary refill, cardiomegaly, anorexia, failure to thrive,
Manifestations of Pulmonary Congestion: tachypnea, crackles, retractions, nasal
flaring, use of accessory muscles, stridor, grunting, recurrent respiratory infections, and
exercise intolerance
Manifestations of Systemic Venous Congestion: hepatomegaly, enlarged
spleen, peripheral edema, ascites, and neck vein distention
Manifestations of hypoxemia: cyanosis, poor weight gain, tachypnea, dyspnea,
clubbing, and polycythemia
Tet/Hypercyanotic spells: acute cyanosis, hyperpnea to detect anemia,
polycythemia, and electrolyte imbalances
Heart Cath: check for allergies to iodine and shellfish, make sure the child is NPO for
4-6 hours prior, obtain v/s, locate and mark dorsalis pedis and posterior tibial pulses on
both extremities; administer presedation; afterwards, assess pulses, v/s, and insertion site,
monitor I&O and monitor for hypoglycemia
Rheumatic Fever: inflammatory disease that occurs as a reaction to Group A strep
infection of the throat; usually occurs within 2-6 weeks following an untreated or partially
treated upper resp. infection (GABHS); s/s include hx. of upper resp. infection, fever,
fatigue, sore throat, poor appetite, large joints that have painful swelling, pink rash on the
trunk, irritability---dx. with a throat culture for GABHS, the major criteria for dx. is
carditis, sq nodules, polyarthritis, rash, and chorea...the minor criteria for dx. is fever and
arthraligia; medications used are penicillin or erythromycin

Chapter 21, Hematologic Disorders
Epistaxis: common, may be spontaneous or induced by trauma to the nose, may
produce anxiety, rarely and emergency; have the child tilt the head forward, apply
pressure to the lower nose, cotton or tissue can be packed into the bleeding side,
encourage mouth breathing, apply ice to the bridge of the nose, keep child calm and no
rubbing or picking---No need for a humidifier!
Iron Deficiency Anemia: most common anemia, prolonged anemia can lead to
growth retardation and developmental delays; may have sob, tachycardia, dizziness, pallor,
nail bed deformities, fatigue, irritability, abd. pain, low-grade fever, and thinning hair
Normal Hgb Values: 2 mths., 9-14; 6-12 years, 11.5-15.5; 12-18 yrs., 13-16 male &
12-16 female
Hct Normals: 2 mths., 28-42; 6-12 yrs., 35-45; 12-18 yrs., 37-49 male, 36-46 female
Iron Supplements: give 1 hr. before or hr. after giving milk or antacid, diarrhea and
constipation are common, admin. on an empty stomach, give vit. c to increase absorption,
use a straw, use z-track if giving IM---legumes, fruits, nuts, green leafies, iron-fortified

foods, poultry, and red meats are good sources of iron

Sickle Cell Anemia: there is abnormal sickling of RBC's which obstructs blood flow
and causes hypoxia; s/s are pain, sob, fatigue, tachycardia, pallor, nail bed deformities,
lethargy, impaired healing, n/v, low-grade fever and muscle weakness; sickledex is the
screening tool that will detect if the child has sickle cell anemia, but the Hgb
electrophoresis is definitive; opioids can be given for pain; there is the vaso-occlusive
crisis, which lasts from 4-6 days and has severe pain, swollen joints, anorexia, vomiting and
liver failure if chronic; there is the sequestration phase where there is excessive pooling
of blood in the liver and spleen; the aplastic phase is extreme anemia with decreased RBC
production; hyperhemolytic phase is an increased rate of RBC destruction leading to
anemia, jaundice, and reticulocytosis
Hemophilia: impaired ability to control bleeding; excessive bruising with minor falls;
recessive disorder; prolonged PTT; give factor VIII to prevent and treat hemorrhage by IV
infusion---corticosteroids are used to treat hematuria and NSAIDS are used to treat
chronic synovitis

Chapter 22, Acute infectious Gastrointestinal Disorders
Signs of dehydration: dry pale skin, cool lips, dry mucous membranes, decreased
skin turgor, diminished urinary output, concentrated urine, thirst, rapid pulse, sunken
fontanels, and decreased b/p
Isotonic dehydration: water and sodium are lost in equal amounts, hypovolemic
shock may occur
Hypotonic dehydration: less stuff, more fluid
Hypertonic: less fluid, more stuff
Mild dehydration: up to 5% loss of wt, v/s in normal limits, slight thirst, urine-specific
gravity greater than 1.020, cap. refill greater than 2s
Moderate dehydration: up to 10% wt. loss, cap. refill between 2-4s, thirst and
irritability, pulse increased, mucous membranes dry, skin turgor decreased, urine-specific
gravity greater than 1.020
Severe dehydration: up to 15% wt. loss, cap. refill greater than 4s, tachycardia,
extreme thirst, mucous membranes dry, anterior fontanel sunken, oliguria or anuria
Pathogens that caused diarrhea: Rotavirus (fecal-oral, dx. w/ enzyme
immunoassay stool sample), E.Coli (dx. with sobitol-MacConkey agar stool sample),
Salmonella (person to person or undercooked meats, dx. with fram stained stool culture),
C.diff (contact with spores, dx. with stool culture), C. botulinum (contaminated foods, dx.
with blood in stool/stool culture), staphylococcus (undercooked food, dx. of organism in
food, stool, blood), pinworm (fecal-oral beginning when eggs are inhaled or swallowed; dx.
with tape test), and giardia lamblia (person to person, dx. with enzyme immunoassay stool
sample)---Give Flagyl or tinidazole for c.diff and giardia; give mebendazole, albendazole,
and pin-rid for pinworms

Chapter 23, Gastrointestinal Structural and Inflammatory Disorders
GER: gastric contents reflux back up into the esophagus; may result in failure to thrive,

bleeding, and difficulty swallowing; position the child's head elevated, administer Prilosec
or Zantac; surgical manipulation may be needed, which is called Nissen fundoplication
Hypertropic pyloric stenosis: thickening of the pyloric sphincter, which creates an
obstruction; vomiting occurs 30-60m after a meal, constant hunger, olive-shaped mass in
RUQ, failure to gain weight; a surgical incision will be made into the pyloric sphincter
Hirschsprung's Disease: lack of ganglionic cells; stool accumulates; a rectal biopsy
will be done; s/s of ribbon like stools; surgical removal of the aganglionic section may be
Meckel's diverticulum: complication resulting from failure of the
omphalomesenteric duct to fuse during embryonic development; s/s of bloody stools,
bright red mucous, abd. pain; do surgery to remove diverticulum
Intussusception: telescoping of the intestine over itself; palpable sausage shaped mass
in RUQ will be felt; stools are mixed with blood and mucus that looks like red jelly; if the
pt. has a brown stool then it has relieved itself; do an air enema or surgical removal of the
Appendicitis: inflammation of the appendix caused by obstruction of feces or
lymphoid tissue; RLQ pain at McBurney's point, fever, tachycardia, and vomiting; remove
the appendix.....labs will show increased WBC's and increased band counts
Cleft Lip: incomplete fusion of the oral cavity; position upright , on back, or onside to
maintain integrity of the repair; apply restraints to keep pt. from pulling at repair site, use
saline on sterile swab to clean incision site, apply abx. ointment to lip
Cleft Palate: incomplete fusion of palatine plates; change positions frequently, may be
placed on abdomen, monitor packing, which should be removed in 2-3 days, avoid placing
anything in the mouth, do not give anything that will be used to suck

Chapter 24, Enuresis and Urinary Tract Infections
Enuresis: uncontrolled or unintentional urination after the child has achieved bladder
control; child must be at least 5 before he/she can be dx. with enuresis; medications used
are antidiuretics (desmopressin acetate), antidepressants (tofranil), anticholinergics
(ditropan); bladder stretching exercises can be done
UTI: pt. will have dysuria, foul-smelling urine, left flank pain; abx. will be used; most
common cause is E. Colli

Chapter 25, Structural Disorders of the Genitourinary Tract and
Reproductive System
***Any structural defects should be repaired between 6-15 months of age due to the
impact of body image
Hypospadias: when the location of the urethral meatus is below the glans penis or on
the ventral surface of the penis
Epispadias: occurs when the location of the urethral meatus is on the dorsal side of
the penis
Phimosis: the narrowing of the preputial opening of the foreskin that prevents the
foreskin from retracting over the glans penis

Cryptochidism: the failure of one or both testicles to descend through the inguinal
Hydrocele: an abnormal collection of fluid in the scrotum
Ambiguous genitalia: congenital malformations that prevent visual identification of a
chid's sex
Chordee: a fibrous band on the ventral side of the penis resulting in a ventral
curvature of the penis

Chapter 26, Renal Disorders
Acute Glomerulonephritis: an antibody-antigen disease that occurs as a result of
certain strains of group A B-hemolytic streptococcal infection; seen in ages 6-7; renal
manifestations occur 10-21 days post infection; s/s anorexia, decreased urine output,
pallor, reports of discomfort, dyspnea, orthopnea, moist crackles, distended neck veins,
facial edema, mild-severe hypertension, pale appearance and lethargy; meds include
diuretics and antihypertensives
Nephrotic Syndrome: proteins pass into the urine, resulting in decreased serum
osmotic pressure; cause is unknown; s/s wt. gain over a short period, poor appetite,
anorexia, n/v, diarrhea, irritability, hyperlipidemia, hypoalbuminemia, proteinurea, edema,
dark-frothy urine, and decreased urine output; meds include prednisone, lasix (eat foods
high in K) and Cytoxan (give if they cannot take prednisone)

Chapter 27, Fractures

Types of Fractures
Types of Fractures

Fracture: occurs when the resistance between a bone and an applied stress yields to
the applied stress, resulting in a disruption to the integrity of the bone; healing is faster in
children due to a thicker periosteum and good blood supply; epiphyseal plate injuries may
result in altered bone growth
Plastic deformation: the bone is bent no more than 45 degrees
Buckle (torus): a bulge or raised area is present at the fracture site
Greenstick: a fracture occurs in only one cortex of the bone

Spiral Fracture: occurs from a twisting motion

Complete: fragments remain attached
Incomplete: Bone fragments are still attached---fracture line can be transverse,
oblique, or spiral
Simple or closed: the fracture occurs without breaking the skin
Open or compound: the fracture occurs with an open wound and bone protruding
Complicated Fracture: results in injury to other organs and tissues
Crepitus: grating sound created by the rubbing together of bone fragments
Deformity: may observe internal rotation of extremity, shortened extremity, and
visible bone with open fracture
Compartment Syndrome: occurs when pressure within one or more of the
muscle compartments of the extremity compromises circulation resulting in an ischemiaedema cycle with compromised neurovascular status
Ostemyelitis: infection within the bone secondary to a bacterial infection from an
outside source, such as with an open fracture or from a bloodborne bacterial source; s/s
will appear ill, will not want to use the extremity, the site will be tender and there will be
warmth, erythema, edema and fever
***The first sight of neurovascular function is pain!!!

Chapter 28, Musculoskeletal Congenital Disorders
Clubfoot: may be due to abnormal embryonic development; complex deformity of the
ankle and foot; prenatal ultrasounds can dx.; can be fixed with exercises, serial casting, or
Talipes equinovarus: plantar flexion with feet bending inward
Talipes Calcaneus: dorsiflexion of feet with toes higher than heels
Talipes equinus: plantar flexion of feet with toes lower than heels
Talipes varus: inversion of feet
Talipes valgus: eversion of feet
Developmental dysplasia of the hip: abnormal development of the hop
structures; pt. will have asymmetrical gluteal and thigh folds, limited abduction of hips, one
knee that appears shorter; the dr. can test with the barlow and ortalani tests by adduction
and abduction; older children can be tested with the trendelenburg sigh; x ray can dx.
older than 4 mths.; to correct, a pavlik harnis can be used from birth-6 mths. and it keeps
the hips in a continually abducted position; a hip spica cast can be used if the infant is
older than 6 mths.
Scoliosis: complex deformity of the spine that also affects the ribs; there will be
asymmetry of the scapula, ribs, flanks, shoulders, and hips; have the child bend over and
observe the spine; to fix scoliosis, there is special bracing and surgery; surgery is needed
for curves greater than 40 degrees; after surgery the pt. has to be log rolled while turning
so the spine does not move; the child will receive blood after the corrective surgery

Chapter 29, Chronic Neuromuscular Disorders
Cerebral Palsy: nonprogressive impairment of motor function, especially that of

muscle control, coordination and posture; most common permanent disability in children;
exact cause is unknown; warning signs are poor head control or absence of smiling in a 3
month old, difficulty with dressing and diaper changes due to stiff arms or legs, the child
may push away or arch the back, floppy or limp body parts, inability to sit up without
support in an 8 month old, feeding difficulties & painful muscle spasms; pt. will have
persistent moro or tonic reflexes, hypertonicity, increased deep tendon reflexes, clonus,
poor control of motion/balance/posture; dyskinetic--movements increase with stress but
are absent with sleep; athetoid--involuntary jerking movements that appear slow, writhing,
and wormlike; dystonic--slow twisting movements occur that affect the trunk and
extremities; ataxic--wide-based gait and difficulty with coordination, poor ability to do
repetitive movements, difficulty with quick or precise movements; to dx. do an MRI and
complete neuro assessment; always have suction equipment handy; meds used include
Lioresal (muscle relaxant), valium (muscle relaxant)
Spina Bifida: defects in intrauterine closure of the boney spine; meningocele--spinal
defect and sac-like protrusion are present but only spinal fluid and meninges are present
in the sac; myelomeningocele--the sac includes meninges, spinal fluid, and nerves; high risk
of latex allergies; linked to insufficient folic acid during pregnancy; elevated alphafetoprotein may indicate the presence of a neural tube defect; mom should be assessed
between 15-20 weeks gestation to see if there are elevated AF proteins; monitor for
ICP!!!! Meds used areditropan and detrol (antispasmodics to improve bladder capacity
and continence; closure of the sac is done ASAP to prevent injury, a shunt may be placed
for ICP
Down Syndrome: chromosomal abnormalities; usually have an IQ around 50; have a
small head, flattened forehead, low-set ears, upward slant to the eyes, protruding tongue,
underdeveloped nasal bone, hypotonia, congenital heart defects; dx. with chromosomal
analysis; child will need speech, physical, and occupational therapy
Juvenile idiopathic arthritis: group of chronic autoimmune inflammatory diseases
affecting joints and other tissues; no definitive dx. is available; peak is between 1-3 yrs.;
rarely life-threatening; s/s of joint swelling, stiffness, redness, warmth, mobility limitations,
fever, rash, nodules under skin, delayed g&d, enlarged lymph nodes; meds used are NSAIDs
(controls pain/inflammation), Rheumatrex (slows joint degenerations), Corticosteroids
(provide relief of pain/inflammation), Enbrel; NEVER USE ASPIRIN DUE TO REYE
Muscular Dystrophy: inherited disorders w/ progressive degeneration of symmetric
skeletal muscle groups; Duchenne muscular dystrophy is the most common form; onset
between 3-7 yrs. with life span reaching into early adulthood; family will report delays in
walking, changes in gait, and difficulties w/ running, climbing stairs & riding a bike; s/s are
muscular weakness in the lower extremities, muscular hypertrophy, mild delay in motor
skill development, unsteady gait, mild cognitive delay, cardiovascular complications; dx.
with dna analysis; serum creatine kinase will be elevated; meds are prednisone to increase
muscle strength
RAST: test that detects the presence of a latex allergy; allergy response includes
urticaria, wheezing, and possibly anaphylaxis

Chapter 30, Skin infections and infestations

Pediculosis: head lice; female lice lay eggs that attach to the hair follicle and hatch in
7-10 days; lice can live up to 1 month on the hose, but only 48 hours off the host; the
itching is from the lice saliva and movement; begins with generalized itching, progresses to
visible lesions from scratching; apply otc pediculicide shampoo, use a comb to remove nits,
do not wash hair for 1-2 days, wash everything and treat in hot water, seal items in sealed
bags for 2 weeks and vacuum areas well---pediculosis humanus capitis
Scabies: contagious skin infestation from a microscopic mite; appears as a grayishbrown, threadlike burrow with a black dot at the end; accompanied by itching that can
leave sores that become infected; apply topical medication from neck to toes, give clean
clothes/towels/bedding, leave on skin for 8-12 hours, and bathe to remove medication
Lyme disease: Caused by a spirochete, which is contained within the saliva and feces
of ticks; has symptoms of viral-like illnesses; has three stages; stage one, rash of red ring
3-31 days after tick bite; stage 2, neurologic, cardiac, and musculoskeletal involvement;
stage 3, musculoskeletal pain in joints and supporting structures, as well as neurological
problems; give oral abx., use amoxicillin for younger than 8 yrs. and doxycycline for older
than 8 yrs., treat for a period of 14-21 days; monitor for 30 days following a tick bite-borrelia burgdorferi
Impetigo: red macule that becomes a vesicle and ruptures; thick honey crusted
exudate; spreads easily; use aluminum acetate in water and topical antibacterial or oral
Warts: appears as a well-circumscribed grey or brown papule w/ rough papillomatous
texture; use destructive therapy; avoid irritation
Cold Sores and Fever blisters and genital herpes: group of vesicles on
inflamed skin, usually around lips or genitalia; accompanied by burning sensation, driesexfoliates-heals within 8-10 days; use aluminum acetate during weeping stage and topical
or oral antiviral medication may be used to lessen the duration and decrease severity
Tinea capiis: ringworm, head; circular scaly patches with or without areas of alopecia;
progresses to the neck or hairline; administer griseofulvin for 6-8 weeks or oral lamisil
for 2-4 wks; use an antifungal like litrimin or manistat 7 use a selenium sulfide shampoo
Tinea Corporis: ringworm, body, appears as circular scaly red patches; clear center
that spreads peripherally to the edges of the lesion; administer griseofulvin for several
months, use topical antifungal medications for 1-2 weeks, even after resolution; apply
mycostatin ointment or solution to affected areas---trichophyton tonsurans
candidiasis: appears as inflamed areas with white exudate that peel and bleed easily

Chapter 31, Dermatitis and Acne
Contact Dermatitis: inflammatory reaction of the skin; caused when the skin
comes into contact with chemicals or other irritants
Diaper dermatitis: caused by detergents, soaps, and/or chemicals; may be the result
of Candida Albicans; red/inflamed skin on areas in most contact with urine, feces and/or
chemicals; candida makes satellite lesions; apply zinc oxide

Contact dermatitis: the result of urushiol, an oil found in poisonous plants; redness/
swelling/blisters/pruritis; rinse exposed areas, use calamine lotion or ammonium acetate,
apply corticosteroid gel
Seborrheic dermatitis: cradle cap, unknown etiology; thick/yellowish/scaly
adhesions occur on scalp, eyelids, and external ear canals; treat by scrubbing the scalp
with shampoo
Atopic Dermatitis: type of eczema; pruritus and associated with a history of
allergies that are inherited types; new lesions will develop with continued scratching;
cannot be cured, but is well controlled; use atarax or benadryl; use topical corticosteroids
to reduce or control flare-ups, and nonsteroidal agents during flare-ups; antibiotics are
used to treat the secondary infections
Acne: acne may be genetic; more common in males; hormonal fluctuations cause flareups in females; one treatment is Retin-A, interrupts abnormal keratinization that causes
microcomedones, inform the child that it may irritate the skin, instruct to apply 20-30m
after washing the face, use a pea-size amount and apply at night, use sunscreen; Another
med is benzoyl peroxide which inhibits the growth of p. acnes, may bleach bed linens and
clothes; topical antibacterial agents inhibit growth of p. acnes and there may be an allergic
reaction to it, avoid exposure to sun, and use sunscreen; Accutane affects factors involved
in the development of acne, side effects include dry skin and mucous membranes, dry
eyes, decreased night vision, headaches, photosensitivity, elevated cholesterol and
triglycerides, depression, suicidal ideation, and/or violent behaviors, it is contraindicated
for women of childbearing age!!!

Chapter 32, Burns
Thermal: flames, steam, hot liquid
Chemical: exposure to a chemical
Electrical: when electrical pulses move through the body
Radiation: from therapeutic treatment for cancer
Burn management: has three phases, which are emergent (occurs first 24-48 hr. after
burn occurs), acute (begins when emergent is finished and wound is covered by tissue),
rehabilitative (begins when most of the burn is healed and ends when reconstructive or
corrective procedures are complete--may be many years)
Superficial burn: damage to epidermis, pink-red w/ no blisters, heals in 5-10 days w/
no scarring, ex. sunburn
Superficial partial thickness burn: damage to entire epidermis and some parts of
the dermis, pink-red color w/ blisters, pain present, heals within 14 days, no scarring, ex.
flame or burn scalds
Deep Partial thickness burn: damage to the entire epidermis and parts of the
dermis, red-white w/ no blisters, pain present, scarring likely, possible grafting, heals in
14-36 days, ex. flame and burn scalds
Full thickness burn: damage to entire epidermis, dermis, and possible damage to sq
and nerve damage, red-tan-black-brown-white, no blisters, as burn heals the pain returns,
heals within weeks-months, scarring present and grafting required, ex. burn scalds, grease,

tar, or electrical burns

Deep full thickness: damage to all layers of the skin that extends to muscle, tendons
and bones, black in color with no pain; heals within weeks-months; scarring present; ex.
flame, electrical, chemical burns
Labs: will have elevated Hgb, Hct and K, decreased Na
Fluid Replacement: use 0.9% sodium chloride, lactated ringers during early stages;
albumin or synthetic plasma expanders during the first 24 hr.
Septic Shock: confusion, increased capillary refill time, spiking fever, decreased bowel
sounds, decreased urine output
Silver Nitrate 0.5%: used on wounds that are exposed to air or with modified or
occlusive dressings, may affect joint movement, reduces fluid evaporation, bacteriostatic
against pseudomonas and staphylococcus, inexpensive; does not penetrate eschar, stains
clothes and linen, discolors the wound, painful on application
Silver sulfadiazine 1% (silvadene): used with occlusive dressings, maintains joint
mobility, effective against gram-negative and gram-positive bacteria; may cause transient
neutropenia, does not penetrate eschar, painful to remove from the wound, decreases
granulocyte formation, contraindicated with children who have sulfa allergies
Mafenide acetate (sulfamylon): used on wounds that are exposed to air, used as a
solution for occlusive dressings to keep the dressing moist, penetrates eschar and goes
into underlying tissues, effective w/ electrical and infected wounds, biostatic against grampositive and gram-negative; painful to apply and remove cream, may cause metabolic
acidosis or hypercapnia, inhibits wound healing, and may cause hypersensitivity
Bacitracin: used on wounds that are exposed to air or with modified dressings,
maintains joint mobility, bacteriostatic against gram-positive organisms, painless and easy
to apply; limited effectiveness on gram-negative organisms

Chapter 33, Diabetes Mellitus
Diabetes Mellitus: chronic hyperglycemia due to problems w/ insulin secretion or
insulin resistance
Hypoglycemia: blood glucose level less than 70; hunger, shakiness, nausea, anxiety,
irritability, pale cool skin, diaphoresis, shallow respirations, tachycardia, palpitations,
difficulty thinking, change in emotional behavior, slurred speech, headache---if having an
episode, treat w/ 15-20g carbs (4 oz. orange juice, 2 oz. grape juice, 8 oz. milk, glucose
tablet); after giving the carbs, if blood returns to normal limits, give 7g protein
Hyperglycemia: blood glucose levels greater than 250; thirst, frequent urination,
hunger, warm/dry/flushed/poor turgor skin; dry mucous membranes, weakness, rapid
weak pulse---if hyperglycemic, give insulin
Labs: Diagnostic---Fasting glucose >126; symptoms of diabetes + casual plasma glucose
concentration >200; 2 hr. glucose >200 w/ an oral glucose tolerance test; HbA1C, show
what they have done in a few months
Rapid Acting: Humalog, duration of 3-4 hr.
Short Acting: Humulin R, duration of 5-7 hr.

Intermediate Acting: Humulin N, duration of 18-24 hr.

Long Acting: Lantus, duration of 10.4-24 hr.

Lipohypertrophy: not rotating sites will cause this
DKA: life threatening condition characterized by hyperglycemia >300, resulting
in the breakdown of body fat for energy and an accumulation of ketones in the
blood and urine; onset is rapid and mortality rate is high; s/s n/v, abd. pain,
frequent urination, thirsty, hungry, confused, change in mental status, dehydration
signs, kussmaul resp. pattern (rapid deep resps.); provide fluids (0.9% sodium
chloride), give regular insulin bolus dose followed by continuous IV infusion,
monitor K levels, admin. sodium bicarbonate slow IV infusion

Chapter 34, Growth Hormone Deficiency
Achondroplasia: genetic disorder that causes nonproportional dwarfism;
long trunk with shortened upper arms and legs, large head with prominent
forehead, flattened bridge of the nose, shortened hands and fingers and
decreased muscle tone---not successfully treated w/ GH; pt. will have delayed
eruption of permanent teeth, underdeveloped jaws
***GH secretion is stimulated by administering glucose or having the child
***GH deficiency without hormone replacement may result in disruption of
vertical growth, delayed epiphyseal closure, retarded bone age, delayed sexual
development, and premature aging later in life

Chapter 35, Immunizations
Active Immunity: long-term and occurs over time as the body produces
antibodies in response to an infection or to an immunization and becomes
immune as a result
Passive Immunity: temporary and occurs after immunization w/ antibodies
in the form of immune globulins for individuals who require immediate
protection against a disease to which exposure has already occurred, when
passed between mother and her fetus, and when transmitted to an infant through
breast milk
DTap: Diphtheria and tetanus toxoids and acellular pertussis vaccine; Doses @
2,4,6,15 &18 mths. and again 4-6 yrs.; s/s after vaccine include crying, seizures,
fever and irritability; may be an occurrence of encephalopathy, seizures, and
uncontrollable crying
DTap: tetanus and diphtheria toxoids and pertussis vaccine; one dose 11-12
Hib: haemophilus influenza type b; doses @ 2,4,6,12,&15 mths.; fever, crying,

Rotavirus: RotaTeq, three doses beginning at 6 wks w/ doses 4-10 wks apart
and should be completed before 32 wks.; Rotarix requires 2 doses beginning @ 6
wks with the next does 4 wks. later, should be completed by 8 mths.; use caution
in children who are immunocompromised; may cause diarrhea and vomiting in
IPV: inactivated polio vaccine; doses @ 2,4,6,&18 mths. and again @4-6 yrs.;
Beware if allergic to streptomycin, neomycin, or bacitracin!!! rare paralytic
MMR: measles, mumps, rubella; doses at 12-15 mths. and at 4-6 yrs.; joint pain,
risk for anaphylaxis and thrombocytopenia; do not take if allergic to gelatin and
Varicella: one does at 12-15 mths. and again at 4-6 yrs.; may cause a rash, do
not take if allergic to gelatin and neomycin
PCV: pneumococcal conjugate; doses @ 2,4,6,12&15 mths.; may cause mild
local reactions
Hep A: two doses @ 6 mths. apart after 12 mths. of age
Hep B: within 12 hr. after birth with additional doses @ 1-2 & 6-18 mths.;
beware if allergic to baker's yeast
Seasonal Influenza: annually beginning @ 6 mths. with the inactivated, and 2
yrs. the live attenuated; beware if allergic to eggs!!! May be a risk for GuillainBarr syndrome
MCV4: meningococcal vaccine; one dose @ 11-12 yrs.; history of Guillain-Barr
HPV2, HPV4: human papilloma virus; three doses over a 6 month interval for
females 11-12 yrs. w/ the 2nd dose 2 months after the 1st dose and the 3rd dose
6 mths. after the 2nd dose; HPV4 can be given to males starting @ 9yrs.;
hypersensitivity to yeast; rare risk for Guillain-Barr syndrome
***Give IM in the vastus lateralis or ventrogluteal for infants and young children,
and in the deltoid for older children and adolescents
***Instruct parents to avoid aspirin due to Reye syndrome
***Make sure parents pre medicate children before coming in for the vaccine

Chapter 36, Communicable Diseases
Varicella (chickenpox): direct, droplet, contaminated objects; malaise, fever,
lesions beginning as macules and progress to papules before crusting over
Rubella: direct contact, droplet; fever, mild rash, malaise--can be a teratogenic
effect on the fetus
Rubeola: direct contact, droplet; high fever, enlarged lymph nodes, koplik spots
on buccal mucosa, red rash beginning in hairline

Pertussis (whooping cough): droplet; nighttime cough, thick mucus plug

that dislodges when coughing, eyes bulge and tongue protrudes
Erythema infectiosum (fifth disease): respiratory secretions and blood;
Mumps: direct contact, droplet; fever, malaise, anorexia for 24 hr., swollen
tender painful parotid glands, and earache
Epstein Barr virus (mono): direct contact; malaise, fatigue, loss of appetite,
fever, sore throat, splenomegaly, elevated WBC, liver enzyme elevation, palatine
petechia---a ruptured spleen could happen---participation in contact sports is
***Health department must be notified if the case is pertussis, mumps or measles
Reye Syndrome: follows an episode of viral illness, may be associated with
the use of aspirin; nursing care will be provided in the ICU
***Rubeola, pertussis, and chickenpox can all lead to pneumonia

Chapter 37, Otitis Media
Acute Otitis Media: infection of the structures of the middle ear; usually
triggered by a bacterial infection, a viral infection, allergies, or enlarged tonsils; s/s
are rubbing/pulling on ear, crying, lethargy, bulging yellow or red tympanic
membrane, temp. as high as 104 F, and hearing difficulties; pull pinna down and
back with younger than three and up and back if older than 3 yrs. to look at
tympanic membrane w/ pneumatic otoscope; meds to give are tylenol, amoxil/
augmentin/zithromax, & benzocaine ear drops for topical relief---long-term
complication of numerous ear infections include speech delays
Myringotomy: placement of tubes in the eardrum to equalize pressure; do
not get water into the chid's ears and eliminate 2nd hand smoke

Chapter 38, HIV/AIDS
HIV: viral infection in which the virus infects t-lymphocytes causing immune
dysfunction; this will lead to organ dysfunction and opportunistic infections; HIV
infections that progress to AIDS place children at risk for malignancies; s/s are
chills, anorexia, nausea, wt. loss, weakness, fatigue, headache, night sweats
Mildly symptomatic children: will have two or more of the following
symptoms-- lymphadenopathy, hepatomegaly, splenomegaly, recurrent upper resp.
infections/sinusitis/otitis media, dermatitis or parotitis
Moderately symptomatic: will have many of the following--anemia,
bacterial meningitis/pneumonia/sepsis, oropharyngeal candidiasis, cardiomyopathy,
cytomegaloviris infection w/ onset before 1 mth. of age, recurrent or chronic
diarrhea, hepatitis, herpes/stomatitis/bronchitis/pneumonitis/esophagitis, herpes
zoster, nephropathy, persistent fever, toxoplasmosis, disseminated varicella

Severely Symptomatic: has multiple or recurrent bacterial infections

(meningitis, septicemia, pneumonia), esophageal or pulmonary candidiasis
(bronchi, trachea, lungs), cytomegalovirus disease, pneumocystis jiroveci, HIV
encephalopathy w/ developmental delays, HSV stomatitis/bronchitis/pneumonitis/
esophagitis, kaposi's sarcoma, brain or burkitt's lymphoma, disseminated or
extrapulmonary mycobacterium tuberculosis, pneumocystitis jiroveci pneumonia,
or wasting syndrome
Stage 1: 500 cells; 29% or more
Stage 2: 200-499 cells; 14-28%
Stage 3: less than 200 cells; less than 14%; many conditions, such as candidiasis,
herpes, encephalopathy, kaposi's sarcoma, burkitt's lympoma, mycobacterium
turberculosis, pneumocystis jiroveci pneumonia, leukoencephalopathy, salmnella
septicemia, and wasting syndrome
Medications: HAART therapy will be used; it involves 3-4 HIV meds in
combination; the meds include fuseon, retrovir, rescriptor or sustiva, norvir or
agenerase or viracept; monitor cbc, wbc, & liver function tests---antibiotics used
are TMP-SMZ, (pneumonia) zovirax (herpes), & amphcin (fungal)

Chapter 39, Organ Neoplasms
Wilm's tumor: malignancy that occurs in the kidneys or abd.; metastasis is
rare; treatment may be a combo of surgery, chemo or radiation; a mass or
swelling that is firm, non tender, and unilateral; causes urinary symptoms; never
palpate!!! Administer Neupogen to stimulate WBC production and Procrit to
stimulate RBC formation and Neumega to stimulate platelet formation
Neuroblastoma: malignancy that occurs in the adrenal gland, sympathetic
chain of the retroperitoneal area, head, neck, pelvis, or chest; treatment will be
a combo of surgery, chemo or radiation; asymmetrical, firm, non tender mass that
crosses the midline; causes urinary symptoms
Chemotherapy medications: Oncovin, Adriamycin, Cytoxan, Dactinomycin
and Platinol

Chapter 40, Blood Neoplasms
Leukemia: malignancies that affect the bone marrow and lymphatic system;
causes an increase in the production of immature WBC's; bone marrow
infiltration causes crowding of cells that produce RBC's, platelets & mature
WBC's; most common type of cancer in childhood; s/s for low-grade fever, pallor,
increased bruising, listlessness, enlarged liver/lymph nodes/joints, abd/leg/joint pain,
constipation, vomiting, anorexia, and unsteady gait; bone marrow biopsy is the definitive
way to dx. leukemia; a cerebrospinal fluid analysis will also be performed; hematopoietic
stem cell transplants are done during the first remission and after a second remission,

after the tumor ells are destroyed, the child is given donor bone marrow or other stem
cells...implantation may take 2-6 wks...put pt. in private positive-pressure room with HEPA

Chapter 41, Bone and Soft Tissue Cancers

Osteosarcoma: usually occurs in the metaphysis of long bones, most often
the femur; frequently needs amputation; generally affects males during puberty;
alkaline phosphatase will be elevated
Ewing's sarcoma: occurs in the shafts of long bones and of trunk bones;
treatment includes surgical bx., intensive radiation, chemo, but no amputation;
usually affects 4 yrs. and older;
Rhabdomyosarcoma: originates in skeletal muscle in any part of the body,
but it most commonly occurs in the head and neck, with the orbit of the eye
frequently affected; surgical biopsy, radiation, chemo rather than surgery; affects
caucasian children more than african american
Elavil: can be used for neuropathic pain or phantom pain; monitor for
drowsiness, orthostatic hypotension, seizures, mania, anticholinergic effects, and
cardiac dysfunction
Chapter 42, Pediatric Emergencies
***A toxic dose of Tylenol is 150 mg/kg or higher; antidote is mucomyst given
orally---can cause liver failure
***Aspirin poisoning, give activated charcoal, gastric lavage, sodium bicarbonate,
oxygen and ventilation, vitamin K, and hemodialysis for severe cases---will have n/
v, ringing in ears and lightheadedness
***Iron poisoning, have pt. vomit or use lavage, do chelation therapy using desferal
***gas, kerosene, lighter fluid, paint thinner, turpentine, do NOT induce vomiting,
intubate, treat chemical pneumonia
***household cleaners, batteries, denture cleaners, bleach...maintain airway
maintenance, NPO, do not neutralize or induce vomiting, give analgesics for pain
***Lead poisoning...chelation therapy using calcium EDTA---can lead to mental
impairment and blindness

Chapter 43, Psychosocial Issues of Infants, Children &
Failure to thrive: inadequate growth resulting from inability to obtain or use
calories required for growth; they fall below the 5th percentile; can be organic
(physical) or definable psychosocial cause unrelated to disease

Good Luck!!! XOXO