Pedi He Sire View

TOPICS TOPICS
• PEDIATRIC HEALTH • DISORDERS OF CHILDREN

PEDIATRIC ASSESSMENT – RESPIRATORY DISORDERS
– GASTROINTESTINAL
HESI • GROWTH & DEVELOPMENT

– INFANT
DISORDERS
– GENITOURINARY TRACT
REVIEW
DISORDERS
– TODDLER
– NEUROLOGIC DISORDERS
– PRESCHOOL
– NEUROMUSCULAR,
– SCHOOL AGE MUSCULAR and ARTICULAR
– ADOLESCENT DISORDERS
– HEMATOLOGIC DISORDERS
– CARDIOVASCULAR
DISORDERS
– CANCER
PEDIATRIC HEALTH PEDIATRIC HEALTH

ASSESSMENT ASSESSMENT
• General considerations for • General considerations for
PEDIATRIC the child: the family:
HEALTH – Introduce self & allow child some
warm-up time
– Choose quiet setting for
assessment
ASSESSMENT – Maintain eye contact, bend to

child’s level
– Ask open-ended question to elicit
responses
– Child is perceptive of caregiver’s – Listen attentively & provide
nonverbal communication appropriate feedback
– Respect child’s responses – Encourage parents to express
– Respect need for privacy as concerns & ask questions
appropriate for age – Communicate importance of
– Incorporate play into assessment parent’s role in conjunction with
as appropriate health team
– Use language appropriate to
cognitive level
Pediatric HESI Review 1

DEVELOPMENTAL AGE DEVELOPMENTAL AGE
PERIODS PERIODS
• Prenatal: Conception to birth • Infant
• Infancy: Birth to 12 or 18 • Toddler
DEVELOPMENTAL months
– Neonatal - Birth to 28 days
• Preschool
• School-age
AGE PERIODS • Early Childhood: 1 - 6 years • Adolescent
– Toddler: 1 - 3 years
– Preschool: 3 - 6 years
• Middle Childhood: 6 - 11 years
– School age
• Later Childhood: 11 - 19 years
– Prepubertal: 10 - 13 years
– Adolescence: 13 - 18 years
PHYSICAL GROWTH & PHYSICAL GROWTH &

DEVELOPMENT DEVELOPMENT
• General characteristics: • Gr. & Dev. Milestones:
– Best health indicator is steady & – 1-2 mo. smiles
INFANT increasing ht., wt., & head & chest – 2 mo. lifts head from prone
circumference
GROWTH & – Ht. increases 50% over birth
position & briefly holds it erect
– 3 mo. vocalizes in response to
DEVELOPMENT length by 12 mo. voices
– Wt. tripled by 12 mo. – 4 mo. head control
– Head & chest circumference – 4 mo. purposefully grasps objects
equalize during 1st. yr. – 4-5 mo. rolls from abdomen to
– Posterior fontanel closes by 2mo. back
– Anterior fontanel closes by 18 mo. – 6-7 mo. sits
– 6-7 mo. anything grasped goes
into mouth
– 6-7 mo. rolls from back to
abdomen

PHYSICAL GROWTH & DEVELOPMENTAL DEVELOPMENTAL
DEVELOPMENT THEORIES THEORIES
– 9 mo. crawls rapidly, keeping belly • Psychosocial development: • Psychosexual development:
off floor Erikson Freud
– 9 mo. moves from crawling to – Psychosocial crisis is TRUST vs – Oral stage of dev.
sitting position MISTRUST • Erogenous zone is mouth, lips,
– 9 mo. pulls up – Significant other is “maternal” tongue, & teeth
– 9 mo. pincer grasp rather than person – Sexual activity takes form of:
palmar grasp – Quality of caregiver-child • Sucking, swallowing, chewing, &
– 10. mo walks with support biting
relationship is crucial factor
– 11 mo. stands alone – Infant meets world by:
– Attentive care shows that needs
• Crying, tasting, sucking, eating, &
– 12 mo. walks alone will be met promptly & that life is
early vocalization
predictable.
• Grasping & touching to explore tactile
– Consistent delayed needs variations in the environment
gratification fosters uncertainty
– Comfort commonly obtained from
a security object
DEVELOPMENTAL SOCIAL SOCIAL

THEORIES DEVELOPMENT DEVELOPMENT
• Cognitive development: • Language: – Dev. motor skills through
Piaget – Crying 1st means of verbal manipulating toys
– Sensorimotor stage from birth to communication – Play is basically solitary
18 mo. – Throaty vocalizations by 5 wks. • Socialization:
– Dev. progresses from reflexive – By 8 mo. combined syllables – Attachment to significant other
activity to purposeful acts (mama, dada begins @ birth & becomes
– Dev. of intellect & knowledge of – by 1 yr. several short words with increasingly evident after 6 mo
environment gained through the meaning – Stranger anxiety begins around 6
senses – Soothing tone can be comforting mo.
– At completion of stage, infant • Play: – Caregiver’s cuddling & warmth
achieves a sense of object can help ease fears
permanence – Facilitates learning
– Discipline & setting limits begins
• Retains a mental image of the absent – Learns about environment through
with negative voice, stern eye
object senses of touch, taste, hearing,
contact, or timeout
• Sees self as separate from others smell, & sight

NUTRITION & FEEDING NUTRITION & FEEDING NUTRITION & FEEDING
• Breast milk has following • Ready to use formula should be • Finger foods between 8-10 mo.
advantages over cow’s milk: refrigerated once open & – Avoid hot dogs, nuts, grapes,
– Immunologic & antibacterial discarded after 24 hr. carrots, popcorn, peanuts, & hard
components not in cow’s milk round candies for fear of choking
• Whole milk should not be given
– Less risk of allergies before 12 mo. • Common food allergies:
– More easily digested, convenient, • By 6 mo. infant ready to have – Cow’s milk,egg, soy products,
& economical peanut, chocolate, corn & wheat
solid foods introduced
• Ideally, weaning from breast or – Introduced progressively and one • Common clinical manifestations
bottle begins @ age 6 mo at a time of food allergies:
• Adequate fluid intake reflected – Start with cereal with iron (wheat – Abd. pain, diarrhea, nasal
by: & mixed last) congestion, cough, wheezing,
vomiting & rashes
– At least 6 wet diapers in 24 hr. – Next fruits, then veggies, and last
• Never microwave breast milk meats
– Juices after 6 mo.
IMMUNIZATIONS INJURY PREVENTION HOSPITALIZATION
• Generally follow an age-based • See Nursing 2504 Pediatric • Major stressor is Separation
schedule Seminar PowerPoint Notes Anxiety
• Contraindications include: – Seen between 6 mo & 30 mo
– Severe febrile illness – Traumatic for both infant and
– Immunodeficiency parent
– Known allergy to the vaccine • Major issue is that of
stimulation & regular routine
• See Nursing Pediatric – Without appropriate stimulation,
infant exhibits failure to thrive
Seminar
– Experiences mainly painful stimuli
and interruption of sleeping &
eating routine

HOSPITALIZATION SELECTED HEALTH FEVER
PROBLEMS
• Guidelines for intervention: • Defined as a body temp > than
– Human contact when parent not • Fever 38.0 C (100.4 F) rectally or 37.8
available
• Iron Deficiency Anemia C (100. F) orally
– Stimulation through soothing • Common causes in infancy:
voices, music, being rocked, etc.
– UTI
– Reduce environmental stimulation
– Respiratory tract infections
• Turn off TV
– Otitis media
• Dim lights
• One toy or activity @ time – Viral infections
– Ensure toys safe, clean & large • Associated clinical findings
enough so not to be ingested provide important indications of
– Assure parents of their importance seriousness
& abilities as caregivers – Active with fever of 104.F
– Encourage favorite comfort items generally of less concern than
from home lethargic with fever of 102 F
FEVER FEBRILE SEIZURES CARE DURING

SEIZURE
• Comfort measures: • Defined as transient disorders • Turn child onto side
– External cooling of children that occur in • Do not try to restrain
• Remove blankets & clothing association with fever • Do not put anything into the
• Reduction of room temperature
• Fever defined as a body temp. mouth
• Cooling blankets
> 38 C (100.4 F) rectally or > • Allow child to drool
• Tepid baths with lukewarm water
– Avoid rubbing alcohol as can result in
37.8 C (100 F) orally
– May use a suction bulb to remove
too rapid cooling & chilling – Commonly do not recur after initial saliva or fluids
– Antipyretics occurrence (60%)
• Acetaminophen & NSAIDS • Call Dr if any of following
– Others have 2-3 over the years
• Never ASA R/T Reye’s syndrome stopping by age 5 or 6 occurs:
– Maintain adequate fluid intake – Average body temp at which sz – Sz lasts > 3 min
occurs is 40C (104F) – Another sz occurs
– Boys more than girls – Child’s neck is stiff
– ↑ susceptibility in families – Child delirious or difficult to
awaken after sz

IRON DEFICIENCY IRON DEFICIENCY IRON DEFICIENCY
ANEMIA ANEMIA ANEMIA
• Results from inadequate – Usually related to lg. intake of milk • Long-term therapy:
supplies of iron to synthesize & foods that do not contain – ↑ intake of iron & ↓ consumption
hemoglobin adequately supplemental iron of cow’s milk
• Etiology: • Assessment findings: • Teaching Guidelines:
– Pallor – Provide iron-fortified formula if
– Inadequate dietary intake of iron
– Tachycardia < 12 mo.
– Insufficient iron stores
– Lethargy – Limit cow’s milk to < 24 oz/d if
• Pathology:
– Irritability > 12 mo.
– Full-term's iron stores adequate
– Hb. < 9 g/dL – ↑ intake of iron-rich foods
for 1st. 5-6 mo.
– ↑ susceptibility to infection – Administer iron in 3 divided doses
– Premie or infant from multiple
– Impaired cognitive ability ( a long- between meals
birth, iron stores adequate for only
term consequence) • Give with vitamin C-rich fluids
2-3 mo.
• administer with dropper placed @
– Occurs around 9 -24 mo. back of mouth, away from teeth
• Expect black, tarry stools
OTHER SELECTED PHYSICAL GROWTH &

HEALTH PROBLEMS DEVELOPMENT
• Sids • General characteristics:
• Shaken Baby Syndrome – Physical growth & weight slower
• Meningitis
TODDLER – Characteristic protruding abdomen
• Atopic Dermatitis (Eczema) GROWTH & results from underdeveloped

abdominal muscles
• Seizures DEVELOPMENT – Bow-legged since legs bear the
wt. of the relatively lg. trunk
– Anterior fontanel closes between
12-18 mo.
• Refer to RNSG 2504 Pediatric – Fine motor skills include:
PowerPoint Notes • Undressing
• Drawing simple lines
• Building simple things

• Gr. & Dev. Milestones: • Psychosocial development: • Erikson, cont:
– 12-15 mo. walks Erikson – Begins to master:
– 15 mo. climbs stairs – Psychosocial crisis is Autonomy • Differentiation of self from others
– 18 mo. climbs vs Doubt & Shame • Separation from parents
– Significant other is the “paternal” • Control of bodily functions
– 2 yrs. runs
person • Communication with words
– 3 yrs. walks backward & hops on • Acquisition of socially acceptable
1 foot – Psychosocial theme is “To hold
behavior
on; to let go”
– 3 yrs. throws a large ball • Egocentric interactions with others
– Ready to give up dependence to
– 3 yrs. puts on simple clothes – Negativism - often says “no”,
assert his budding sense of
– 3 yrs. walks on tiptoe even when means “yes” to assert
control, independence &
– 3 yrs. achieves fairly good bowel independence
autonomy
& bladder control – Ritualism helps child venture out
– Often continues to seek a familiar
& away from safety of parents
security object during times of
stress – Has temper tantrums
DEVELOPMENTAL DEVELOPMENTAL DEVELOPMENTAL

THEORIES THEORIES THEORIES
• Psychosexual development: • Cognitive development: • Moral development: Kohlberg
Freud Piaget – Makes judgments on basis of
– Anal stage of dev. – Sensorimotor phase between 12 avoiding punishment or obtaining
• Erogenous zone is anus & buttocks & 24 mo. a reward
• Sexual activity centers on expulsion – Preoperational phase from about – Discipline patterns affect moral
& retention of body waste 2 yrs - 4 yrs. development
– Conflict between “holding on” & – Egocentric thinking • Physical punishment & withholding
“letting go” gradually resolves as privileges tends to give toddler a
– Focuses on the here & now negative view of morals
bowel training progresses
– Absolute thinking - perceives • Withdrawing love & affections as
things as good or bad, right or punishment leads to feeling of guild
wrong • Appropriate disciplinary actions
include providing simple
– Increased use of language &
explanations, praising appropriate
dramatic play behavior, & using distraction when
the toddler is heading for danger

SOCIAL SOCIAL SOCIAL
DEVELOPMENT DEVELOPMENT DEVELOPMENT
• Language: • Samples of safe toys to provide • Common Fears:
– Begins to use short sentences opportunities for exploring the – Loss of parents - Separation
– Has a vocabulary of about 300 environment: Anxiety
words by 2 yrs – Play dough – Stranger anxiety
– Tends to ask many “what” – Blocks – Large animals
questions – Housekeeping toys – Loud noises
– Containers – Going to sleep
• Play: – Toy telephone • Effects of Hospitalization
– Is the major socializing medium – Wooden puzzles – Primary issue = Separation
– Typically parallel – Cloth books – May interpret being in hospital or
– Short attention span causes him – Simple musical instruments painful procedures a punishment
to change toys often for something he did “bad”
– Continues to separating from – Regressive behaviors
parents
SOCIAL NUTRITION & FEEDING NUTRITION & FEEDING

DEVELOPMENT
• Guidelines for intervention: • Most toddlers prefer to feed – Prepare foods attractively
– Encourage caregivers to assure themselves – Limit concentrated sweets &
child of their return when need to • At risk for aspiration of small empty calories
leave & to follow through – Set child @ high chair @ family
foods not easily chewed
• Leave a familiar object belonging to table
them to assure a return • Most experience “food jags” – Allow sufficient time to eat, but
– Medical play kits helpful • Most experience episodes of remove food when toddler begins
– Provide for activity in a safe & physiologic anorexia R/T playing with it
supportive environment alternating periods of fast & slow – Avoid using food as a reward or
– Use simple explanations to allay growth punishment
fears
• Feeding suggestions:
– Provide basic 4 food groups in
small portions
– Offer limited number of foods @
time

SELECTED HEALTH PHYSICAL GROWTH &
PROBLEMS DEVELOPMENT
• Lead Poisoning • General characteristics:
– Coordination & muscle strength ↑
PRESCHOOL rapidly
• Refer to RNSG 2504 Pediatric GROWTH & – Handedness clearly established

by 4 yrs.
PowerPoint Notes DEVELOPMENT – Appears taller & thinner
– Grows 2.5 - 3 inches /yr.
– Gains 5 lb/yr
– Can use scissors successfully &
tie shoelaces
– 20 teeth present
• By 5 yrs may begin to lose deciduous
teeth
• By 5 yrs may have first permanent
teeth (molars)

• Psychosocial development: • Psychosexual development: • Cognitive development:
Erikson Freud Piaget
– Psychosocial crisis of Initiative vs • Phallic stage of development – Still in Preoperational thought
Guilt • Forms concepts not as complete or
• Sexual pleasure centers on the logical as adult’s
– Significant other is the family
genitalia & masturbation • Makes simple classifications
– Psychosocial theme is “To make,
to make like, to play” • Oedipal stage occurs, marked • Reasons from specific to specific
– Dev. a conscience & guilty

by jealousy & rivalry toward – Thinking remains egocentric,
same-sex parent & love of the becomes magical
feelings
– Is energetic, enthusiastic, & has opposite-sex parent – Judgements dominated by
– By late preschool period, this perception & are illogical
an active imagination
typically resolves & a strong – Magical thinking
– Uses simple reasoning & can
tolerate longer periods of delayed identification with the same-sex – Animism
gratification parent • Perception that all objects have life &
feeling

DEVELOPMENTAL SOCIAL SOCIAL
THEORIES DEVELOPMENT DEVELOPMENT
• Moral development: Kohlberg • Language: • Play:
– Conscience emerges – Talks incessantly – Big task is learning to relate with
– Obey rules out of self-interest – Engages in long monologues, age-mates
– An “eye for an eye” guides their even if no one is listening – Play mainly associative
behavior – Asks many “why” questions – Understands concept of sharing
– Begins to use self-control & tries – Tend to boast & exaggerate – Needs regular socialization with
to be “good” to avoid feelings of – Enjoy rhymes age-mates
guilt – By 5 yrs. speak in sentences of – May have an imaginary friend
– Little understandings of reasons adult length & use all parts of – Play & activity suggestions:
for rules speech • Dress-up clothes
• Decides whether to break rule • Housekeeping toys
– May stutter as ideas come faster
depending on punishment
than speech • Dolls & other toys that encourage
– Family’s religious beliefs & • Usually disappears spontaneously if pretending
customs are important & can be child not pressured • Bikes & climbing toys for big muscles
deeply meaningful & comforting • Paper & crayons for creativity

• Common Fears: • Effects of hospitalization: • Guidelines for intervention:
– Has more fears than @ any other – Primary issue is body mutilation – Reassure not to blame for
time • May think he caused illness or injury hospitalization
– The dark because he way “bad” – Preparation for any medical
• Feels loss of control over usual procedure
– Being left alone, especially @ routines
bedtime • Do not overload with too much info
• May exhibit regressive behaviors
– Animals, especially big dogs – Medical play
– Fears injury & pain
– Ghosts – Encourage expressive play
– Afraid of intrusive procedures &
– Body mutilation • Provide for playroom & toys in room
have a literal interpretation of
– Pain words – Be consistent
• Often imagine things are worse than – Involve parents in care
they are – Allow for regressive behavior
– Encourage independence in ADL
– Watch medical vocabulary
• “Fix” instead of “take out”

• Head Lice • General characteristics:
• Pin worms – Girls often grow faster than boys
• ADHD (Attention-Deficit
SCHOOL-AGE – Appears thinner & more graceful
Hyperactivity Disorder) GROWTH & than preschoolers
– Musculoskeletal growth leads to
• Communicable Diseases DEVELOPMENT greater coordination & strength
• Impetigo • Muscles still immature & can be
injured from overuse
– Lungs & alveoli fully mature, so ↓
• Refer to RNSG 2504 Pediatric resp. infections
PowerPoint Notes – Eustachian tube more downward
so ↓ otitis media
– All 20 deciduous teeth lost &
replaced by 28 of 32 permanent
teeth

– Puberty begins • Psychosocial development: • Psychosexual development:
• Sex education a must Erikson Freud
– Responsible sexuality & dangers
– such as Aids, pregnancy, STDs
– Psychosocial crisis of industry vs – Latency period, extending from
inferiority about age 5 through 12,
– Significant others expand to represents a stage of relative
include school & instructive adults sexual indifference before puberty
– Sense of industry grows out of a & adolescence
desire for real achievement – Dev. of self-esteem closely linked
– Engages in tasks & activities he with a dev. sense of industry in
can carry out gaining a concept of one’s value &
worth
– Learns rules & how to compete
with others
– Play is cooperative
– School activities important

DEVELOPMENTAL DEVELOPMENTAL SOCIAL
THEORIES THEORIES DEVELOPMENT
• Cognitive development: • Moral development: Kohlberg • Peer relationships gain in
Piaget – Increased desire to please others importance
– Stage of concrete operations – Observes & to some extent, • Group activities, including team
– Marked by inductive reasoning, internalizes standards of others sports consume much time &
logical operations – Wants to be considered “good” by energy
– Can distinguish fact from fantasy those whose opinions matter to
• More knowledgeable about body
– Concept of time becomes clear him
& social dev. centers on body &
– Does not deal with abstractions or its capabilities
socialized thinking
• Formal & informal clubs
– Asks questions
– Collecting & sorting objects (eg., • School very important; favorite
baseball cards, Beanie Babies) teachers serve as role models

• Play: • Common Fears: • Guidelines for intervention:
– Becomes more competitive & – Failure @ school – Encourage to talk about interests
complex – Bullies – Allow to help with self care &
– Team sports – Intimidating teachers treatments
– Secret clubs, gangs • Effects of Hospitalization: – Give opportunities to make
– Rules & rituals important choices whenever possible
– Common fears include:
– Coordination & motor skills • Disability & possibly death
– Still a need for comfort from
improve as child given opportunity caregivers & parents
• Unknown events & procedures
to practice • Loss of control & independence – Reassure that crying is OK
– Enjoy active sports & games as • Interruption of daily routine – Peer interaction important
well as crafts & fine motor – Primary issue is control • Cards, visits, etc
activities
– Loss of contact with peers big
– Enjoy activities requiring balance issue
& strength
– School routines interrupted

• Appendicitis • General characteristics:
• Rheumatic fever – Rapid rate of physical
ADOLESCENT – Encompasses puberty
GROWTH & • Girls begin between ages 8-14 yrs
– Complete within 3 yrs
• Refer to RNSG 2504 Pediatric DEVELOPMENT • Boys begin between ages 9-16 yrs
– Complete by age 18 - 20
PowerPoint Notes
– Hormonal changes
– Sexual maturity reached
– Most girls reach “reproductive
maturity 2-5 yrs after onset of
menstruation
– Ultimately ht., wt., & body build
influenced by diet, exercise, &
heredity

• Psychosocial development: • Psychosexual development: • Cognitive development:
Erikson Freud Piaget
– Psychosocial crisis is identity vs – In the genital stage – In developmental stage of formal
role confusion – Focus in on genitals as erogenous operations
– Significant others are the peers zone – Moves from deductive to abstract
– Energy focused within the self, & – A time of heightened sexual drive reasoning
the adol. is described as • Experiences conflict between own – Thinks beyond the present &
egocentric or self-absorbed need for sexual satisfaction & forms theories about everything
society’s expectations
– Try on new roles in transition & – Develops a systematic approach
experiment with the environment – Core concerns include body to problems
until finding a role that fits image dev. & acceptance by the
opposite sex
– Lack of commitment R/T changing
interests
• Illustrated by parents buying
expensive equipment & having it
given up next yr

DEVELOPMENTAL SOCIAL DEVELOPMENT SOCIAL DEVELOPMENT
THEORIES
• Moral development: Kohlberg • A period of rebellion & • Degree of sexual intimacy
– Marked by the development of an uncertainty as the adol. defines experienced depends, to a large
individual conscience & a defined an identity separate from part, on peer group codes & the
set of moral values parental authority adolescent’s expectations &
– Control of conduct is now internal • Peer relationships become all value system
– Dev. a respect for law & order important for advice & support – Needs accurate, complete
• Being found attractive by information on sexual matters
members of the opposite sex is – Must know how pregnancy occurs
and how it is prevented
important
• Group parties & dates occupy • Common fears:
much of the social time – Relationships with persons of
opposite sex
• Automobile ownership important
– Homosexual tendencies
• A job & earning money – Ability to assume adult roles
important
SOCIAL DEVELOPMENT SOCIAL DEVELOPMENT SOCIAL DEVELOPMENT
• Effects of Hospitalization: • Guidelines for intervention: • When possible, provide for

– Primary issue is body image – Allow to participate in treatment special activity area limited to
• Self-esteem, independence & body decisions & have as much control adolescent use
image are negatively impacted when as possible
hospitalized • Allow favorite foods to be
– Respect privacy & confidentiality brought in
– Fears loss of control through
– Provide opportunities for
enforced dependency & loss of • Approach with caring,
expression of feelings
identity understanding, & acceptance
– arrange for age-compatible
– Fears bodily injury & pain
roommate, if possible
– Inability to gain independence
– Have phone @ bedside
from family
– Encourage to wear own clothing
– Adjustment required R/T
separation from peers & lack of – Use scientific & medical
emotional support terminology to prepare for
procedures

INJURY PREVENTION INJURY PREVENTION SELECTED HEALTH
PROBLEMS
• Are risk-takers & often do not • Particularly prone to swimming • Acne
consider safety before acting & diving accidents, and safety of • Mono
• Contribute substantially to the these areas must be taught
number of motor vehicle • Needs instruction as to how to
accidents through: avoid sports injuries
• Refer to RNSG 2504 Pediatric
– Inexperience & poor judgment • Smoking & use of alcohol & PowerPoint Notes
– Reckless driving or speeding other drugs should be
– Driving under the influence of discouraged
alcohol or other drugs • Other issues:
– Failure to use safety belts – Body piercing
– Peer pressure for unsafe driving – Tattoos
practices
– Suntanning
DISORDERS
• RESPIRATORY DISORDERS
DISORDERS OF • GASTROINTESTINAL
DISORDERS RESPIRATORY
CHILDREN • GENITOURINARY TRACT DISORDERS OF
DISORDERS
• NEUROLOGIC DISORDERS
CHILDREN
• NEUROMUSCULAR,
MUSCULAR & ARTICULAR
DISORDERS
• HEMATOLOGIC DISORDERS
• CARDIOVASCULAR
DISORDERS
• CANCER

OVERVIEW OVERVIEW
• Resp. infections easily spread • Infants ↓ 3 mo have lower

from one structure to another infection rate R/T protective
within the resp. tract function of maternal antibodies
RESPIRATORY – R/T the contiguous nature of the • Rate ↑ between 3- 6 mo, &
SYSTEM OVERVIEW mucous membrane lining the continues to remain high during
entire tract
toddler & preschool yrs.
• Resp infections account for the – Amount of lymphoid tissue ↑
majority of acute illness in throughout middle childhood &
children repeated exposure to organisms
– Etiology influenced by age, gives increasing immunity as
season, living conditions, & children grow older
preexisting medical problems • Children exhibit a response to
• Most infections caused by resp. infection with systemic
viruses symptoms (diarrhea, fever, etc)
OVERVIEW ASSESSMENT
• Poor tolerance of nasal • Fever:

congestion - esp. in infants who RESPIRATORY SYSTEM – May be absent in the NB
are obligatory nose breathers – Greatest @ 6 mo to 3 yrs.
until 2-4 mo. ASSESSMENT: – May be high, even with mild
• Increased susceptibility to ear ASSOCIATED SIGNS & infections
infection R/T shorter, broader, & SYMPTOMS – May dev. febrile sz.
more horizontally positioned • Uncommon after 3 - 4 yr.
eustachian tubes • Anorexia:
• Increased severity of resp. – Common
symptoms R/T smaller airway – Freq. initial evidence of illness
diameters – Often extends into convalescence
• Resp. rate higher

ASSESSMENT ASSESSMENT ASSESSMENT
• Vomiting: • Abdominal Pain: • Respiratory Sounds:

– Sm. Children vomit readily with – Common complaint – Sounds associated with
illness • Nasal Blockage respiratory disease:
– May be a clue to onset of infection • Cough
– Sm. passages of infants easily
• May precede other signs by several • Hoarseness
blocked by mucosal swelling &
hr. • Grunting
exudation
• Diarrhea: • Stridor
– Can interfere with respiration & • Wheezing
– Usually mild, but may become feeding in infants
severe – Auscultation:
– May irritate upper lip & skin • Wheezing
– Often accompanies viral resp, surrounding nose
• Crackles
infections
• Cough: • Absence of sound
– Is a frequent cause of dehydration
– Common feature
– May persist several months after
disease
• Sore Throat: • Overall physical should focus – Dyspnea, stridor, grunting, nasal
– Frequent complaint of older on following: flaring, head bobbing (infant)
children – Alertness, changes in mental – Sputum
– Young children (unable to status – Bad breath
describe sym.) may not complain – Activity level & complaints of
even when highly inflamed fatigue
– Often leads to refusal to take oral – Skin color changes, particularly
fluids or solids cyanosis
– Respiratory rate & pattern &
apnea
– Retractions: presence, location, &
severity
– Adventitious lung sounds
– Cough, productive or
nonproductive

• NURSING ALERTS • NURSING ALERTS

RESPIRATORY SYSTEM
• Advise family to seek medical • Children with severe respiratory NURSING
evaluation is: distress should not be given IMPLEMENTATIONS
– Breathing becomes difficult anything by mouth to prevent & THERAPEUTIC
– Abdominal pain develops aspiration & to ↓ the work of
– Sore throat pain is so severe that breathing MANAGEMENT
child is unable to eat or drink • Early signs of inpending airway
• Prolonged fever or appearance obstruction include:
of fever during early – ↑ P&R
convalescence is a sign of – Retractions
secondary bacterial infection & – Flaring of nares in infants
should be reported ASAP – ↑ restlessness
IMPLEMENTATION IMPLEMENTATION IMPLEMENTATION
• Ease respiratory efforts • Prevent spread of infection • Promote hydration

– Moisture to soothe inflamed – Careful handwashing! – IV fluids if not able to maintain
membranes – Remove affected children from adequate po fluids
– Hummidification / nebulilization / p contact with other children – Encourage adequate fluid intake
– Use of O2 – Isolation procedures • Sm. amts. of favorite fluids @ freq.
intervals
– Parent at bedside – Antibiotic therapy if indicated
• Use of high-calorie liquids
• Promote rest – Encourage good chest – Juices
physiotherapy – Water flavored with Jello, etc
• Promote comfort – (Do not use if diarrhea present)
– Nose drops & throat irrigations • Reduce temperature
• Oral rehydration solutions
– Decongestants – Antipyretics, (ibuprofen or – Infalyte or Pedialyte for infants
acetaminophen) – Sports drinks such as Gatorade for older
– Use of either hot or cold
compresses – Cool environment – Do not awaken to give fluids
– Antipyretics – Remove clothing & blankets – Observe freq. of voiding
– Cough suppressants – Strict I&O

IMPLEMENTATION RESPIRATORY
DISORDERS
• Provide nutrition • Asthma
– IV fluids while loss of appetite SELECTED • Cystic fibrosis
– Do not urge food on anorexic • Croups
children as may precipitate N&V RESPIRATORY
• Otitis media
or an aversion to feeding DISORDERS OF
– Offer sm. feedings of foods such • Pneumonia
as gelatin, soup, & puddings CHILDREN • Respiratory Syncytial Virus
• Family support & home care • Tonsillitis
– Recognize parental concern &
need for info. & support
– Explain therapy & child’s behavior
– Encourage family-centered care • Refer to RNSG 2504 Pediatric
– Ensure family knows S&S of PowerPoint Notes
Resp. complications
OVERVIEW
• Dysfunction of the GI tract can

cause significant problems with
GASTROINTESTINAL the exchange of fluids,
GASTROINTESTINAL electrolytes & nutrients
DISORDERS OF
SYSTEM OVERVIEW • Problems can affect overall
CHILDREN health, growth & development
• Children easily become
dehydrated if vomiting &/or
diarrhea a symptom
• Meeting nutritional needs a
major goal
– Use ht & wt to determine
– Many conditions chronic & extend
over lifetime

OVERVIEW ASSESSMENT
• Diarrhea & vomiting occur more • Most important basic nursing

frequently in children GI SYSTEM assessments:
– More prone to fluid & electrolyte – Measurements of intake & output
imbalances ASSESSMENT: – Measurements of height & weight
• Dehydration most commonly ASSOCIATED SIGNS – Abdominal examination
results from abnormal fluid & SYMPTOMS – Stool & urine tests
losses such as from excessive – Abdominal pain
vomiting or diarrhea – Bowel sounds
– Urinary output
– Stool output
– Fever
– Dietary history
ASSESSMENT IMPLEMENTATION
• NURSING ALERT • Obtain accurate weights

GI SYSTEM • IV fluids / TPN if unable to
• In any instance in which severe NURSING ingest sufficient fluid/foods orally
abd. pain is observed, the nurse IMPLEMENTATIONS • Monitor IV replacement therapy,
must be aware of the danger of & THERAPEUTIC checking IV site frequently
administering laxatives or • Monitor hydration status with
enemas as such measures MANAGEMENT strict I&O
stimulate bowel motility & ↑ the • Maintain skin integrity
risk of perforation
– Provide good hygiene
– Skin care
– Carefully washing & drying diaper
area with every change
• Promote comfort

IMPLEMENTATION IMPLEMENTATION
• If postoperative, monitor for • Support parents by encouraging

wound infection them to express feelings &
• Note & record frequency & concerns SELECTED GI
characteristics of stools • Promote a positive self-concept DISORDERS OF
• Monitor abdominal girth to in older child by allowing to
express feelings about the CHILDREN
assess for increasing distention
– Distended abd. ↓ resp. efforts disorder &/or dietary restrictions
• Prepare child & parents for • Offer pacifier while infant is NPO
procedures & treatments • Prevent infection by good
– Surgery handwashing & appropriate
– Ostomies isolation
– Enemas • Refer parents & child to
– Bowel preps nutritional counseling & various
– TPN, etc appropriate community agencies
GASTROINTESTINAL GASTROINTESTINAL
DISORDERS DISORDERS
• Megacolon • Pyloric stenosis
• Biliary atresia • Rotavirus
• Gastroesophageal reflux • Esophageal atresia
GENITOURINARY
• Celiac disease • Anorectal malformations TRACT DISORDERS
• Lactose intolerance OF CHILDREN
• Failure to thrive
• Intussusception • Refer to RNSG 2504 Newborn
• Necrotizing enterocolitis Congenital Conditions and
• Intussusception Pediatric PowerPoint Notes
• Cleft lip & palate
• Crohn’s disease
• Ulcerative colitis

OVERVIEW
• Kidney development not

complete until end of 1st. year GENITOURINARY
– Can’t concentrate or dilute urine TRACT
GENITOURINARY well
ASSESSMENT:
SYSTEM OVERVIEW – Newborn more prone to
developing severe acidosis ASSOCIATED SIGNS
– Sodium excretion ↓ in infancy & SYMPTOMS
• In the newborn, urinary tract
disorders generally associated
with malformations of other body
systems
• Health history findings • Health history findings • Health history findings

possibly pointing to renal possibly pointing to renal possibly pointing to renal
dysfunction in the neonate: dysfunction in the infant: dysfunction in the older child:
– Poor feeding – Same findings as neonate PLUS: – Poor appetite
– Failure to thrive • Persistent diaper rash – Vomiting
– Frequent urination • Foul-smelling urine – Excessive thirst
• Straining on urination
– Crying on urination – Incontinence
• Pallor
– Poor urinary stream • Fever – Frequent urination
– Dehydration – Painful urination
– Convulsions – Bloody urine
– Rapid respirations (acidosis) – Fatigue
– Enlarged kidneys or bladder – Abd., flank, or back pain
– Other anomalies – Swelling of the face

• Older child (cont.) • Physical assessment might • Physical assessment cont.

– Edema reveal signs & symptoms – Early signs of uremic
– Hypertension suggestive of renal encephalopathy
– Growth failure dysfunction such as: • Lethargy
• Poor concentration
– Seizures – Abnormal rate & depth of
respirations • Confusion
– Hypertension – Signs of congenital anomalies

• Hypospadias or Epispadias
– Fever
• Ear anomalies (low-set, floppy,
– Growth retardation malformed)
– Abdominal distention • Prominent epicanthal folds
– Signs of circulatory congestion • Beak-like nose
• Peripheral cyanosis • Small chin
• Slow cap refill time
• Pallor
• Peripheral edema
• NURSING ALERTS • Accurate measurement of

GU SYSTEM weights
• A child who exhibits the NURSING • Accurate measurement of blood
following should be evaluated IMPLEMENTATIONS pressure
for UTI: & THERAPEUTIC • Accurate measurement of
– Incontinence in a toilet-trained intake & output
child MANAGEMENT • Prepare children & parents for
– Strong-smelling urine tests, collection of urine
– Frequency &/or urgency samples, & other procedures
• Use of Fleet enemas in children • Observe characteristics of urine
with acute or chronic renal collected & perform tests on
failure is potentially lethal R/T urine collected
hyperphosphatemia • Administer meds as ordered

– Assess for fluid volume deficit by • Assess urinary status by • Help improve child’s self-
monitoring: observing appearance & color of concept by providing positive
• ↑ edema urine, & noting S&S such as: feedback, emphasizing
• Daily abdominal girth
– Frequency strengths, & encouraging social
• Daily weight
• Daily I&O – Burning interaction & pursuit of interests
• Blood pressure – Enuresis • Refer child & family to
– Prevent skin breakdown – Urinary retention community health resources
• Frequent position changes – Flank pain
• Providing good skin care
• If post-op, monitor for wound
• Scrotal supports in boys
infection
– Maintain or improve nutritional
status • Provide support to family by
– Monitor for signs of infection answering question & providing
information about diagnosis,
tests, & treatments
GENITOURINARY
TRACT DISORDERS
• Exstrophy of bladder
• Vesicoureteral reflux (VUR)
SELECTED GU • Undescended testicle
NEUROLOGIC
DISORDERS OF • Hypospadias DISORDERS OF
CHILDREN • Epispadias CHILDREN
• Nephrotic syndrome
• Acute glomerulonephritis
• Refer to RNSG 2504 Pediatric

PowerPoint Notes

OVERVIEW
• In 1st year of extrauterine life,

the number of brain neurons ↑ NERVOUS SYSTEM
rapidly
CENTRAL NERVOUS • Brain weight doubles by end of
ASSESSMENT:
SYSTEM OVERVIEW first year & triples by age 6 yrs. ASSOCIATED SIGNS
• CNS myelinization, which & SYMPTOMS
enables progressive
neuromuscular function, follows
the cephalocaudal &
proximodistal sequence
• Components of pedi. neuro. – Sensory status • Periodic neurologic checks

exam: • Vision should include:
• Hearing
– General – Vital signs
• Taste
• Affect – LOC
• Smell & touch
• Social interaction – Eyes:
• Cranial nerve function
• Denver Developmental Screening • Pupil size
Test – Motor function
• Equality
• Emotional state • Muscle tone
• Reaction to light
– Head circumference • Strength
• Extraocular movements
• Gait abnormalities
– Fontanel assessment in infants • Corneal reflex
• Posture
– Mental status • Visual disturbances
– Cerebellar status
• LOC – Motor & sensory function
• Balance
• Orientation – Head circumference & fontanel
• Coordination
• Reasoning ability inspection in infants
• Memory – Reflexes
– Reflexes

• Clinical manifestations of ↑ • Clinical manifestation of ↑ ICP • NURSING ALERTS

ICP in an infant & young child in an older child commonly
commonly include: include: • Lack of response to painful
– Irritability & restlessness – Headache stimuli is abnormal & must be
– Tense, bulging anterior fontanel in – Anorexia reported immediately
child < 18 mo. – Vomiting, often projectile without
• The sudden appearance of a
– High-pitched cry nausea
fixed & dilated pupil is a
– Change in feeding habits – Cognitive, personality, &
behavioral changes
neurosurgical emergency
– ↑ Occipital frontal circumference
– Diplopia, blurred vision • 3 key reflexes that demonstrate
– Crying with cuddling & rocking
– Seizures neurologic health in infants are:
– “Setting sun” sign
– Moro
– Macewen’s (“cracked pot”) sign in
an infant with unfused crainal – Tonic-neck
sutures – Withdrawal reflexes
• NURSING ALERTS • Monitor vital signs

NEUROLOGIC SYSTEM • Measure occipital frontal
• When opioids are used, bowel NURSING circumference as ordered
elimination must be closely IMPLEMENTATIONS & • Assess neurologic status &
monitored because of their THERAPEUTIC assess all signs of ↑ ICP
constipating effect • Encourage parents to express
MANAGEMENT their feelings, fears, & anxieties
• Promote parent-infant
relationship:
– Encourage parent participation
with ADLs
– Encourage cuddling & tactile
stimulation

• Provide family teaching with • Help prevent skin / sac

special emphasis of: breakdown SELECTED
– Infection control • If post-op, monitor for wound
– Recognizing early S&S of ↑ ICP infection
NEUROLOGIC
– Bladder & bowel management • Institute procedures for Latex DISORDERS OF
– Shunt management allergy prevention CHILDREN
– Developmental needs
– Effects of immobilization & ways
to minimize them
– Need for lifelong care
• Assess family’s ability to care for
infant, & refer for further
assistance if necessary
NEUROLOGIC
DISORDERS
• Neural tube defects
– Spina bifida occulta
NEUROMUSCULAR, NEROMUSCULAR,
– Meningocele MUSCULAR & MUSCULAR &
– Myelomeningocele ARTICULAR ARTICULAR
• Hydrocephalus
DISORDERS OF DISORDERS OF
• Down syndrome
CHILDREN CHILDREN: OVERVIEW
• Refer to RNSG 2504 Newborn

Congenital Conditions &
Pediatric PowerPoint Notes

OVERVIEW OVERVIEW OVERVIEW
• The most frequent reasons for • Bone growth occurs at the • Because a child’s bones are still
immobility are congenital epiphyseal plate, a very growing:
defects vascular area – Some bony deformities due to
• The major effects of – These cells highly sensitive to the injury can be remodeled or
influence of growth hormone, straightened
immobilization are:
estrogen, & testosterone – Some deformities can progress
– Loss of muscle strength,
– During adolescence, the with growth
endurance, & muscle mass
epiphyseal plate converts to bone • Because a child’s bones are
– Bone demineralization leading to
& growth stops more plastic:
osteoporosis
– This is an area susceptible to – More force required to fracture a
– Loss of joint mobility &
injury through fracture, crushing or bone
contractures
slippage
– Decreased metabolism • A child’s bones heal much faster
– Damage to this area can disrupt
• Muscle disuse, over time, bone growth than adult’s
affects all other systems of body
OVERVIEW OVERVIEW
• Treatment for these disorders • Psychological effects of

often involves immobility immobilization commonly NEUROMUSCULAR,
– Casts include: MUSCULAR &
– Traction – Altered body image ARTICULAR
– Body frames – Altered perception of external
• Impact of immobility depends in environment SYSTEM
large part on the child’s – Sensory deprivation ASSESSMENT
developmental level – Impaired mastery of
developmental psychosocial tasks
• Play, social interaction, & self-
care help the immobilized child
gain self-esteem &
independence & promote
normal growth & development

• Initial assessment should • Clinical manifestations of • NURSING ALERTS

obtain a complete health history prolonged immobilization may
of problems pertaining to this include: • Numbness, tingling, change in
system, focusing on: – Joint contractures & pain sensation & loss of motion are
– Trauma – Muscle atony & weakness sym. of neurologic impairment
– Delayed walking or other – Fatigue & should be evaluated
developmental abnormalities – Diminished reflexes immediately
– Pain – Delayed healing • The 5 “Ps” of ischemia from
– Structural abnormalities – Orthostatic hypotension vascular (circulatory) injury
– Any physical limitations or lifestyle – S&S of thrombus formation are:
alterations imposed by the
– Anorexia – Pain Paralysis
problem
– Constipation – Pallor Paresthesia
– Mobility aids used
– Pulselessness
NEUROMUSCULAR,
• NURSING ALERTS • NURSING ALERTS MUSCULAR, &
ARTICULAR
• A fracture should be strongly • The classic S&S of Pulmonary SYSTEMS
suspected in a small child who Emboli are:
refuses to walk – Chest pain IMPLEMENTATIONS
• Skeletal traction is NEVER – Dyspnea & THERAPEUTIC
released by the nurse, nor are – Petechial hemorrhages of the MANAGEMENT
weights lifted that are applying chest & shoulders
traction • Treat the dyspnea by elevating
• A plastic bag of frozen veg.such the head & administering O2
as peas, serves as a convenient
ice pack for soft tissue injuries

• Protect skin integrity by turning • Promote normal urinary • Help maintain adequate cardiac
frequently & inspecting for early elimination by monitoring freq. & output by changing position
signs of breakdown amt. of urination & assessing for freq., & providing active or
• Promote adequate hydration by bladder distention passive range of motion
offering favorite drinks • Promote normal activity as exercises
• Promote good nutrition by condition & restrictive devices • Help prevent urinary tract
offering high-protein, high allow infections through good
caloric foods in sm., freq., & • Provide diversional activities hydration, promotion of frequent
attractively arranged servings spaced with adequate rest voiding, provision of acid-ash
• Promote normal bowel • Help prevent respiratory foods ( cereal, fish, poultry,
elimination by keeping child well complications through good cranberry or apple juice &
hydrated, including fiber in diet, hydration & changing position meats)
& providing for privacy @ toilet freq.
• Prevent contractures by • Promote effective coping by SELECTED

maintaining proper body providing play therapy, NEUROMUSCULAR,
alignment, minimizing flexed anticipatory teaching, &
positions, & providing active & explanations of physical MUSCULAR &
passive ROM restrictions & restraining devices ARTICULAR
• Promote self-care by allowing • Provide patient & family DISORDERS OF
child to help plan daily routines, teaching while in hospital & for
select foods, determine the time home care CHILDREN
for bathing, select clothing, etc. • Prepare child & family for each
• Promote normal growth & dev. procedure & planned therapy
by providing regular social • Refer family to support
contact & diversional activities organizations

DISORDERS DISORDERS
• Developmental dysplasia of the • Refer to RNSG 2504 Newborn

hip (DDH) Congenital Conditions and
• Clubfoot Pediatric PowerPoint Notes HEMATOLOGICAL
• Cerebral palsy DISORDERS OF
• Muscular dystrophy CHILDREN
• Juvenile rheumatoid arthritis
• Scoliosis
• Legg-Calve’ Perthes disease
• Osteomyelitis
• Fractures
• Traction
OVERVIEW OVERVIEW
• Blood consists of liquid plasma • Platelets contain coagulation

& formed elements: factors & help regulate
– Erythrocytes homeostasis through a
HEMATOLOGIC – Leukocytes sequence of events known as
SYSTEM OVERVIEW – Thrombocytes the coagulation process
• RBCs primarily transport O2 to • The major blood-forming organs
& CO2 away from body tissues are bone marrow, the lymphatic
• Typical lifespan of RBC = 120 system & the reticuloendothelial
days system
• WBCs protect the body against • Children with hematological
infection dysfunction commonly undergo
a multitude of invasive
• There are 5 types of WBCs
diagnostic tests, procedures, &
treatments

OVERVIEW ASSESSMNET
• Children with hematological • Health history questions

dysfunction commonly depend should focus on:
on others for care & support HEMATOLOGIC – Bleeding or bruising tendencies
• During the 1sr. 6 mo. of life, fetal SYSTEM – Medication use
hemoglobin is gradually – Family history of bleeding
replaced by adult hemoglobin, & ASSESSMENT problems
it is only after this that • Physical assessment findings
hemoglobin disorders can be of possible hematologic
diagnosed problems include:
– Skin:
• Pallor, flushing, jaundice, purpura,
petechiae, ecchymoses, cyanosis,
brownish discoloration
– Eyes: – Gastrointestinal: • NURSING ALERTS

• Jaundiced sclera, conjunctival pallor, • Anorexia, hepatomegaly,
retinal hemorrhage, blurred vision splenomegaly
– Mouth: – Musculoskeletal: • Never administer aspirin or any
• Gingival & mucosal pallor • Weight loss, decreased muscle aspirin-containing compound to
– Lymph nodes: mass, bone pain, joint swelling, pain the child with hemophilia
• Lymphadenopathy, tenderness
– Cardiac:
• Tachycardia, murmurs, signs &
symptoms of congestive heart failure
– Pulmonary:
• Tachypnea, orthopnea, dyspnea
– Neurologic:
• Headache, vertigo, irritability,
depression, impaired thought
processes, lethargy

• Relieve pain by assessing the – Application of pressure &/or cold

HEMATOLOGICAL child’s need for pain medication – Administration of factor VIII or
SYSTEM NURSING & provide prescribed medication other substances
• Monitor for signs of infection
IMPLEMENTATIONS • Position the child for maximum
comfort • Encourage optimal nutrition
& THERAPEUTIC
• Implement therapeutic • Support the child & family by
MANAGEMENT measures as appropriate which allowing them to ventilate their
may include: fears, concerns & anger
– Oral & IV fluids • Provide patient & family
– Electrolyte replacement to counter teaching, covering:
acidosis caused by hypoxia – Disease process, including
– O2 therapy to promote adequate genetic aspects & early
oxygenation recognition
– Immobilization devices
IMPLEMENTATION HEMATOLOGICAL
DISORDERS
– Home management of chronic • Sickle cell anemia
condition
– Prevention of crisis or bleeding
SELECTED • Hemophilia
episode ( Injury prevention ) HEMATOLOGICAL
– Measures to control bleeding DISORDERS OF
– Pain control
• Encourage child & family to lead
CHILDREN • Refer to RNSG 2504 Pediatric
as normal a lifestyle as possible PowerPoint Notes
• Refer the family to support
groups

OVERVIEW
• Congenital heart disease is

the most common form of
CARDIAC cardiac disease in children
CARDIAC SYSTEM
DISORDERS IN • The cardiovascular system’s
OVERVIEW basic function is to pump
CHILDREN oxygenated blood to tissues &
remove metabolic waste
products from tissues
• Valves within the heart &
pressure differences between
the four heart chambers
regulate blood flow through the
heart & into systemic circulation
• Developmental delays often • Heart defects are described as – Any time there is a defect
occur in children with cardiac either Acyanotic Heart Defects connecting systemic & pulmonary
disorders, particularly cyanotic or Cyanotic Heart Defects circulation,blood will go from high
to low pressure (path of least
heart defects • Acyanotic heart defects are resistance)
• Activity limitations may be congenital defects in which no – Normally pressure is higher in
essential, but may be difficult to deoxygenated (or poorly systemic circulation, so blood will
impose oxygenated) venous blood be shunted from systemic to
• With many defects, an older enters systemic arterial pulmonary circulation
child may be allowed to self-limit circulation – Blood leaving aorta is completely
oxygenated
activities according to how he • Oxygenated blood is shunted
feels from systemic to pulmonary – Increased blood volume on right
side of heart results in hypertrophy
• Surgical procedures will be circulation
of right ventricle
required to repair the defect – Most acyanotic heart defects will
result in CHF

• Types of acyanotic defects • Cyanotic heart defects are • In over 90% of congenital heart
include: congenital heart defects in defects, the exact etiology is
– Left to right shunting through an which deoxygenated blood unknown
abnormal opening: enters systemic arterial • The primary cause of congestive
• PDA, ASD, VSD circulation heart failure in the 1st 3 years of
– Obstructive lesions that restrict • Blood entering peripheral life is congenital heart disease
ventricular outflow:
tissues has much lower O2
• Aortic valvular stenosis, pulmonic
stenosis, coarctation of aorta • Types of cyanotic defects
include:
– Tetralogy of Fallot, Tricuspid
atresia, transposition of the great
vessels, truncus arterios,
– total anomalous pulmoary venous
communication, hypoplastic left
heart syndrome
• The reasons for CHF are • The major diagnostic test for – Check pressure dressing over site
basically : cardiac disorders is cardiac for bleeding
– 1. The heart is unable to meet the Catheterization which provides – Monitor heart rate for signs of
body’s oxygenation & nutritional the following information: Bradycardia, tachycardia, &
needs due to: dysrhythmia
– O2 saturation in heart chambers
• Excessive volume – Monitor intake & output
– Pressures within chambers
• Excessive pressure load on the heart
– Changes in cardiac output
– 2. Diminished myocardial
functioning – Anatomic abnormalities
• Post-Catheterization care:
– Check extremity distal to cath site
for color, temp., pulse, & cap. refill
– Keep extremity distal to cath. site
extended for 6-8 hr.

• Health history findings of • Significant physical

significance include: assessment findings may
– Family history of congenital heart include:
CARDIAC SYSTEM disorders – Failure to thrive
ASSESSMENT – Presence of murmurs & age @ – Frequent resp. infections
which first noted – Cyanosis
– Feeding problems, including – Periorbital & peripheral edema
fatigue or diaphoresis during
– Respiratory difficulties
feeding & poor weight gain
– Color changes:
– Respiratory difficulties, including
• Pallor or cyanosis
tachypnea, dyspnea. SOB,
– Persistent or intermittent
cyanosis & freq. URI
– Pulse alterations
– Chronic fatigue or exercise
• Tachycardia or bradycardia
intolerance
• Dysrhythmias
• Diminished peripheral pulses
– Activity intolerance • NURSING ALERTS • NURSING ALERTS

– Hypotension or unequal blood
pressure in arms & legs
• Electrodes for cardiac • Infants rarely receive > than 1
– Abdominal distention,
hepatomegaly, splenomegaly
monitoring are often color ml (50ug or 0.05 mg) of Digoxin.
– Clubbing of fingers & toes
coded: white for right, green (or A higher dose is an immediate
red) for ground, & black for left warning of a dosage error
– Murmurs, bruits, thrills
– Squatting • O2 is a drug & is only • Chest tube drainage > than 3
– Hypoxic spells (“tet” spells R/T
administered with an ml/kg/hr for more than 3
transient cerebral ischemia) appropriate order consecutive hours is excessive
• Therapeutic serum digoxin & may indicate post-op
levels range from 0.8-2 ug/L. hemorrhage
Signs of toxicity - bradycardia &
vomiting

• NURSING ALERTS • Help ↓ cardiac workload

CARDIAC SYSTEM – Organize nursing care to provide
• The early signs of CHF are: NURSING for periods of uninterrupted rest
– Prevent excessive crying in infants
– Tachycardia, especially during IMPLEMENTATIONS
rest & slight exertion – Provide diversional activities that
& THERAPEUTIC involve limited energy expenditure
– Tachypnea
– Profuse scalp sweating, especially MANAGEMENT for older children
– Encourage parents to stay with
in infants
infant to provide holding, rocking,
– Fatigue & irritability & cuddling to help infant sleep
– Sudden weight gain more soundly
– Respiratory distress – Minimize stressors
– Keep warm
• Observe for & assist in
managing CHF
• Help maintain optimal nutritional • Prepare child/family for • Evaluate fluid status
status by: diagnostic studies & surgery – Strict I&O
– Provide small, frequent meals if • Help prevent infections – Daily weights
child tires easily – Careful handwashing – Assessing for edema & severe
– In infants use soft nipples to ↓ – Avoid contact will sick persons diaphoresis
work during feeding; gavage – Monitor electrolyte values
– Ensure immunizations up to date
feedings may be necessary
• Limit feedings to 45 min or< • Promote normal growth & • Provide family members with
• Anticipate infant’s hunger to avoid development appropriate discharge teaching
crying – Medications
• Administer meds & monitor for
• Feed in semi-erect position – Activity restrictions
• Burp frequently
side effects
– When to call doctor
• Observe for vomiting & diarrhea if • Help ↓ child’s & family’s anxiety
– Diet & nutrition
high-caloric formula ordered & ↑ understanding by providing
• Daily weights – Wound care
information on medical &
surgical treatments – Follow-up appointments

IMPLEMENTATION
• Observe for & assist in

managing resp. distress : cough,
tachypnea, tachycardia,
retractions, grunting, nasal CANCER IN
CANCER OVERVIEW
flaring,cyanosis CHILDREN
– Administer O2 as ordered
– Positioning to ease breathing
– Administer meds as ordered
• Administer meds as ordered
• Monitor fluid status
– Strict I&O
– Daily weights
• Prevent infections
• Cancer is the leading cause of • Classification is by tissue of – Nerve tissue:

death from disease in children origin: • Neuroblastoma - originating from
neural crest during embryonic dev.
from 1-14 yrs – Blood & related cells:
• Glioblastoma - originating from glial
• Leukemia is the most frequent • Leukemias cells
type of childhood cancer, • Lymphomas • Retinoblastoma - originating in the
followed by tumors of the CNS – Connective tissue: retinal tissue
• Fibrosarcoma - originating in fibrous – Renal tissue:
• In recent years survival rates tissue • Wilm’s tumor (nephroblastoma) -
have ↑ so that > 70% of all • Osteosarcoma - originating in bone- originating in the kidneys
children with malignant producing cells
• The child & family adjust to the
neoplasms treated @ major • Ewing’s sacroma, originating in
midshaft of long bones & flat bones process of living with a life-
centers will survive > 5 years threatening illness
– Muscle tissue
• Rhabdomyosarcoma • Child’s reaction depends on his
age

• Interventions used: – Biologic Response Modifiers • Stages of treatment consist of:

– Surgery: (BRMs): – Induction
• Useful for diagnosis • Uses monoclonal antibodies and • Goal to remove most of tumor
other agents
• Used for tumor removal • Often the most intensive phase
• Changes host’s biologic response to
• Often used in conjunction with tumor cells • Side effects of treatment potentially
radiation &/or chemotherapy life-threatening
– Bone marrow transplant:
– Chemotherapy: – Consolidation
• Transfused marrow or stem cells
• Primary form of treatment produce functioning nonmalignant • Goal is to eliminate any remaining
• Protocols combine drugs to allow for blood cells cells
optimum cell cycle destruction with • Types: – Maintenance
minimum toxic effects & ↓ resistance • Goal is to keep child cancer free
– Autologous - transplanted with own
by cells to the agent harvested marrow • Uses chemo & may last for several
– Radiation: – Syngeneic - transplanted between yrs.
identical twins
• May be curative or palliative – Allogeneic - transplanted from a
nonidentical donor
OVERVIEW ASSESSMENT
– Observation • Specific clinical findings vary

• Goal is to monitor @ intervals for depending on particular body
evidence of recurrent disease &
complications of treatment ASSESSMENT OF system involvement
• Treatment is complete: may continue
in this stage indefinitely
THE CHILD WITH • Cardinal S&S of cancer in
children include:
CANCER – Unusual mass or swelling
– Unexplained paleness & loss of
energy
– Sudden tendency to bruise
– Persistent, localized pain or
limping
– Prolonged, unexplained fever or
illness

– Frequent headaches, often with • Help child cope with intrusive

vomiting procedures
– Sudden eye or vision changes
CANCER
– Provide information geared to
– Excessive, rapid weight loss IMPLEMENTATIONS developmental level & emotional
& THERAPEUTIC readiness
– Use medical play
MANAGEMENT – Allow child some control in
situations where possible
• Provide patient & family
teaching covering:
– Diagnosis & nature of disorder
– All treatments & procedures
– Side effects of chemo & radiation
• Support child & parents – Bone marrow suppression: – Nausea & vomiting
– Acknowledge feelings & • Decreased RBCs • Administer antiemetics as ordered
– Provide frequent rest activities before chemo & repeat PRN
encourage communication
• Decreased WBCs • Ensure adequate oral intake or
– Provide contact with another – Monitor temperature elevations administer IV fluids as necessary
parents or an organized support – Evaluate any potential site of infection – Alopecia
group – Good handwashing a MUST
• Advise to buy wig before hair falls out
– Isolate from children with known
– Try to keep life as normal as communicable disease • Help choose caps or hats to wear
possible • Decreased platelets – Stomatitis
– Always tell the truth – Make environment safe • Inspect mouth & rectum daily
– Avoid use of salicylates
• Minimize effects of treatment: – Select activities that are physically safe
• Meticulous oral hygiene
– Skin breakdown • Use soft-sponge toothbrush, cotton-
– Interpret peripheral blood counts tipped application “Toothettes” to
• Keep clean & dry to guide specific interventions & avoid trauma
• Do opt wash off radiation markings precautions • Apply lip balm
• Avoid topical agents with alcohol
• Local anesthetics to ulcerated areas

• No juices containing ascorbic acid & – Nutritional deficits

hot or spicy foods • Measure height & weight frequently
• Avoid lemon glycerin swab ( irritate • Provide small, frequent meals
eroded tissue
• Provide high-calorie, high-protein
• Avoid hydrogen peroxide (delays
healing by breaking down protein)
supplements BIBLIOGRAPHY
• Administer meds as ordered • Assist child in interacting with
(antiinfectives & analgesics) peers
• Wash perineal area after each
• Assist family discuss fears &
toileting
• Apply protective skin barriers to
anxiety about procedures &
perineal area prognosis
• No rectal or oral temps
• Lippincott’s Review Series.

(1992) Pediatric Nursing.
Philadelphia, Lippincott
• Wong, Donna (1999). Nursing
Care of Infants and Children .
(6th ed). St Louis, Mosby
• Ashwill, J.& Droske, S. (1997)
Nursing Care of Children:
Principles and Pracatice.
Philadelphia, W.B. Saunders
Company

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TOPICS TOPICS

• PEDIATRIC HEALTH • DISORDERS OF CHILDREN

HESI • GROWTH & DEVELOPMENT

PEDIATRIC HEALTH PEDIATRIC HEALTH

ASSESSMENT – Maintain eye contact, bend to

Pediatric HESI Review 1

PHYSICAL GROWTH & PHYSICAL GROWTH &

Pediatric HESI Review 2

DEVELOPMENTAL SOCIAL SOCIAL

Pediatric HESI Review 3

IMMUNIZATIONS INJURY PREVENTION HOSPITALIZATION

Pediatric HESI Review 4

FEVER FEBRILE SEIZURES CARE DURING

Pediatric HESI Review 5

OTHER SELECTED PHYSICAL GROWTH &

• Atopic Dermatitis (Eczema) GROWTH & results from underdeveloped

Pediatric HESI Review 6

DEVELOPMENTAL DEVELOPMENTAL DEVELOPMENTAL

Pediatric HESI Review 7

SOCIAL NUTRITION & FEEDING NUTRITION & FEEDING

Pediatric HESI Review 8

• Refer to RNSG 2504 Pediatric GROWTH & – Handedness clearly established

DEVELOPMENTAL DEVELOPMENTAL DEVELOPMENTAL

– Dev. a conscience & guilty

Pediatric HESI Review 9

SOCIAL SOCIAL SOCIAL

Pediatric HESI Review 10

PHYSICAL GROWTH & DEVELOPMENTAL DEVELOPMENTAL

Pediatric HESI Review 11

SOCIAL SOCIAL SOCIAL

Pediatric HESI Review 12

DEVELOPMENTAL DEVELOPMENTAL DEVELOPMENTAL

Pediatric HESI Review 13

SOCIAL DEVELOPMENT SOCIAL DEVELOPMENT SOCIAL DEVELOPMENT

• Effects of Hospitalization: • Guidelines for intervention: • When possible, provide for

Pediatric HESI Review 14

Pediatric HESI Review 15

• Resp. infections easily spread • Infants ↓ 3 mo have lower

• Poor tolerance of nasal • Fever:

Pediatric HESI Review 16

• Vomiting: • Abdominal Pain: • Respiratory Sounds:

ASSESSMENT ASSESSMENT ASSESSMENT

Pediatric HESI Review 17

• NURSING ALERTS • NURSING ALERTS

IMPLEMENTATION IMPLEMENTATION IMPLEMENTATION

• Ease respiratory efforts • Prevent spread of infection • Promote hydration

Pediatric HESI Review 18

• Dysfunction of the GI tract can

Pediatric HESI Review 19

• Diarrhea & vomiting occur more • Most important basic nursing

• NURSING ALERT • Obtain accurate weights

Pediatric HESI Review 20

• If postoperative, monitor for • Support parents by encouraging

Pediatric HESI Review 21

• Kidney development not

ASSESSMENT ASSESSMENT ASSESSMENT

• Health history findings • Health history findings • Health history findings

Pediatric HESI Review 22

• Older child (cont.) • Physical assessment might • Physical assessment cont.

– Hypertension – Signs of congenital anomalies

• NURSING ALERTS • Accurate measurement of

Pediatric HESI Review 23

• Refer to RNSG 2504 Pediatric

Pediatric HESI Review 24