staph, with 1-2 small crusty honey colored lesions that may start looking like a mosquito bite.

tx?

impetigo, common bacterial infection of skin.

tx with topical antibiotics or if have multiple lesions, use systemic antiobiotic

bacterial infection:

furuncle:

tx:

boil

warm, moist compress, I&D, educate not to squeeze or puncture.

what are most childhood skin infections?

ex: high fever that resolves, then have rash.

viral!

roseola, benign, gets confused with the measles.

viral infection confused with child abuse?

warts are viral!

herpes

type one ex:

type two:

tx:

one: cold sore, fever blister

two: genital

tx: topical penciclovir or oral acyclovira, antivirals

when does baby get chx pox vaccine?

careful with what?

at age 1.

so need to be careful to shingles exposure, varicella viral disease!

tx pain and with acyclovir

tineas' fungal infections live where

ex: capitis:

corporis:

cruris:

pedis:

live on skin

head,

anywhere on body

crotch,

athletes foot

thrush:

diaper rash:

tx of both:

both examples of what?

white patches on tongue that don't scape off.

bright red confluent lesion in skin folds that follows antibiotic therapy

tx: nystatin rinse or cream

both fungal candiasis or yeast infections.

what is more than 50% of derm pbs in kids?

what can cause this?

contact dermatitis

animals, metals, materials, plants, oils.

wash with cold running water, supportive tx with calamine or topical steroids.

lesions heal within 10-14 days

where does scabies burrow?

have intense puritis when?
tx:

burrow in a linear line in epidermis

have itching ~30-60 days after contact

tx: scabicide at HS over whole body

pediculosis capitis

what lays white eggs?

where have puritis?

tx:

louse lays eggs or nits that are crazy glued to hair shaft

itching back of head and behind ears.

tx: Pediculocide cream rinse, and then can go back to school.

lyme disease:

stage one:

stage two:

rash or reddness at site of bite

two: most serious, have systemic involvment of neuro, cardiac, and muscles.

stage of what?

late stage wehre have muscle pain that involves tendons, bursae, and synovia, even arthritis.

can have deafness, chronic encephalopathy

lyme disease:

usually catch in stage 2, but if have travelled and have flu like symptoms, need to do blood test.

tx:

rinse wound with lots of saline or ringers lactate under pressure with large syringe.

wash surrounding skin with mild soap, clean pressure dressing, may need antibiotics, tetanus and rabies.

dandruff!

treat with salicylic acid, coal tar, zinc, resorcin, ketoconazole, or selenium shampoos, wash for 5 min

common and benign birthmarks of infancy:

1. blue spots in butt area, looks like bruise

2. raised blood vessel that resolve after one yr of age

1. mongolian spots

2. capp hemangiomas

vascular stains of infancy:

transient flat mark

2. flat, deeper color, worry about effects on eye if on face

1. stork bite

2. port-wine stain

allergic hereditary autoimmune disorder of skin

managment:

atopic dermatitis or eczema

tx: hydrate skin, relieve pruritus, reduce flare ups, benadryl and hydration creams during winter months

excessive sebum prod, overgrowth of bacteria.

use gentle cleansers!~

when do kids crawl?

pull to stand?

wal?

crawl at 6-8 mo

pull to stand 8-10 mo

walk after this

allergic to eggs?

any anaphylactic rxns to prev imms?

mod/severe illness, if eyes are closed, aren't eating, don't give!

don't give live MMR, varicella vaccine to immunocompromised pts.

where to administer vaccines?

needle length:

anterolateral thigh

needle length 1 inch for baby

weakened live virus, produce immunity w/o causing disease.

may devleop rash 10 days to 2 weeks, and it's ok.

DTaP, Tdap, Td, DT, Hib, Hep A, Hep B, and IPV are what type of vaccine?

how many doses?

inactivated diseases that cannot cause disease in anyone.

require 3-5 doses

rule: never give a live vaccine to kids under:

also don't give a different second live vaccine within ___ days of another, b/c it won't count

under one

within 28 days

permanent CI of immunizations

temporarty:

permanent: prior anaphylactic rxn or allergic to eggs

temporary: mod to severe illness, pregnancy, immunosupression blood prod in last yr

Hep A:

given as __doses IM in all children age ___

vs

Hep B:

give ___ doses

1.

2.

3.

hep a: 2 doses, for over age 1.

hep b: 3 doses, at newborn, 1-2 mo, and 6 mo and after

what is DTap?

give in ___ doses

at what ages?

do not give after what age?

has boosters at 15-18 mo and 4-6 yrs

Diptheria, Tetanus, and pertussis

give in 3 doses at 2, 4, 6 mo

don't give after 7 yrs, but can give Td (tetanus and diptheria)

Tdap is what?

how give?

Tetanus, diptheria, and pertussis

given at 11 to 12 yrs (similiar to DTap, but don't give that after age 7)

poliovirus

give __ doses at 2,4,6 mo

and booster 4-6 yrs

what is MMR Live

when is it given?

measles, mumps, rubella

given after age 1

at 12-15 mo SQ

and booster ages 4-6

how is HiB given?

ages:

booster:

IM at 2, 4 and possible 6th month.

booster 12-15 mo

what does rotavirus prevent against?

precautions if have previous hx of what?

prevents against gastroenteritis and diarrhea

caution with hx of intussception, and Chronic GI disease

varicella (what is this?)

__ doses at ___ mo and again 4-6 yrs

chx pox.

2 doses

1. at 12 mo then again 4-6 yrs

pneumococcal vaccine prevents what?

given 3 doses at 2, 4, 6 mo IM

booster 12-15 mo

use opposite leg as DTaP

prevents against strep infections (septicemia, meningitis, otitis, sinusitis, pneumonia)

when do you start giving influenza shot?

how to give to kids < 8 yrs

6 mo and older annually in early fall.

<8 yrs: two doses 2-4 weeks apart.

who is at high risk for meningococcal infections?

when is vaccine given?

give in opposite arm as Tdap

freshman in dorms

give at 11-12 yrs

what are leading causes of injury in kids?

accidental death injuries?

falls, ingestion, and burns.

suffocation from latex balloons, MVA in car seats, and drowning

no forks until > ___mo

water heater at ____ degrees

18 mo

120 degrees

when should ADHD symptoms occur before?

and must be in 2 settings or more

before age 7.

these kids dont have friends, impact social relationships.

give what kind of med for ADHD?

give how often?

psychostimulants, or tricyclic antidepressant.

ritalin!

give child limits and consistency

give BID with or after meals. give high cal snacks!

pervasic delvopmental disorder where intellectual and social behavior deficits.

cause?

autism

unknown, may be genetic, or pre/post natal brain development

s/sx of what?

no babbleing, does not make meaningful gestures by age 1, does not speak on word by 16 mo, does not combine 2 words by 2 yrs, does not respond to name, loses language or social skills

autism.

will never make eye contact, makes uncomfortable

where does glucose come from?

where is it harvested?

what happens if its not available?

what s/sx would you see if this was the case?

from carbs, grains, fruits, candy, milk.

used in kreb cycle

use proteins or fats if not around, will produce ketones toxic biproduct.

see polyphagia, polydipsia, polyuria

DKA:

see what in the urine?
in met acidosis so see:

level of CO2 in blood?

glucose, ketones, and electrolytes in urine.

see hyperventilation, kusmaal (very rapid) breathing, will have low CO2 in the blood

what is this?

ketones in urine, no vomiting, pH >7.3, HCO3 >18, newly diagnosed

tx:

mild DKA

tx: manage from home, oral hydration, inc insulin dose

what is this?

large amt of ketones in urine, persistent vomiting, pH 7.2-7.3 (slightly acidic) and HCO3: 10-20

tx:

moderate DKA

tx: if established may manage at home, or maybe in ER with IV hydration and inc insulin dose

what is this?

large ketones in urine, pH <7.2 (acidic) HCO3 <10,

tx:

severe DKA

tx: IV start with .9NS then .45 NS with K labs q2h

replace fluids slowly over 48 hrs to prevent cerebral edema.

don't want to dec BG by more than 150/hr if that's the case add 5% dextrose.

anion gap to see how correcting metabolic acidosis

eqn:

normal:

Na minus (Cl + HCO3)

normal: 8-12 mEq/L

normal HCO3:

normal CL:

normal: Na:

normal HCO3: 18-26

normal CL:98-108

normal: Na: 135-145

what kind of insulin to give in DKA?

why can't push insulin?

regular ONLY

do not push insulin b/c have huge drop in BG and can cause cerebral edema

nursing diagnosis for what?

nutritional deficit, knowledge deficit, risk for dec fluid volume, ineffective breathing.

what is a late sign of resp depression?

we need to monitor more than RR with ventilation

what regulates basal metabolic rate, RR, HR, peristalsis.

kicks in during puberty. If child stops growing before puberty, is a big endocrine flag.

thyroid

Hypothalamus: TRF (thyroid releasing factor)

and the pituitary: TSH (thyroid stimulating hormone)

enlargment of thyroid gland

Is this diagnostic?

found in:

goiter

not diagnostic.. some ppl have large thyroids

found in hypothyroid, hyperthyroid, and even euthyroids

what does ADH do?

where is it prouced?

hashitmotos

need to replace the thyroid hormone

hypothyroidism:

T4:

TSH:

s/sx

T4: low

TSH: high

poor thinking, low HR, low peristalis, dry skin, tired, cold intolerence.

everything is slow

replace thyroid hormone.

synthroid!

can give in water or fruit crushed up

autoimmune disease peak during 12-14 yrs.

have exothalmos

graves disease

autoimmune b/c irritates thyroid causes hypersecretion, causes hypo eventually

tx for graves or hyperthyroid?

se of drugs;

want to dec thryoid prod.

use PTU, Tapizol

SE; sore throat and fever

can also have ablation with I2 and surgery to remove thryoid part

undersecretion of ADH from pituitary

s/sx of this?

DI.

have polyuria and polydipsia

most are idopathic

there is no glucse in the urine or high BG level

both drink tons of water

give DDAVP or vasopressin

lasts 12-24 hours, given at bedtime

need unrestricted bathroom privileges

dec cortisol production in adrenal cortex

overprod of adrenal androgens

cortisol TID: AM, noon and HS

medic alert identity

or solucotef (injectable)

need to dble during stress, fever, surger y, and accidents

tests for adrenal insufficiency

cortisol levels fall and fail to rise when ACTH levels are stimulated. have addisons or hypoadrenal

what doubles in size in a child the first 6 mo?

achieve 80% adult size by age :

head

by age 2.

primary: occurs at time of trauma, poorly reversible

secondary: tissue response to primary injury... occurs minutes to days after injury and is reversible and preventable.

s/sx of what?

bulging fontanels, anemia, separation of cranial sutures, vomiting, irritability, inconsolable like a dying cat scream.

s/sx of what?

hemiparesis or hemiplegia and anisocoria (inequality of the pupils)

if a TBI child has HR <60 give atropine.

signs of deterioration are Ha, dec LOC, signs of inc ICP.

epidural hematoma

ICP may rise rapidly and dramatically

loss of all functions of the entire brain including the brainstem.

loss of function is irreversible and absent cerebral functions.

sometimes need ECG to confirm this

what is doll's eye response?

(test for cerebral fx in brain death)

single occurrence of sBP <90

need to keep volume up to keep BP higher

how many cc/kg of blood in kids?

can lose blood fast in scalp lacerations!

70-80cc/kg in kids!

bleed out 5ml/min in scalp cuts

scale of 3-15.

GCS: severe:

moderate:

mild:

3-8

9-12

13-15

decorticate: protect your core, with your arms flexed over chest

decerebrate: arms extended down by sides with wrists turned outward

need to follow trends on ICP.

newborn normal ICP

adult:

newborn: .7-1.5

adult: 5-15mmHg

how long up to can inc ICP occur after midistribution of CBF?

how long for inc cerebral water content?

and ICP > what is time to treat?

24-48 hrs

water in: 48-72 hrs.

>20

around the clock motrin to keep child normocephalic, avoid hypotension, HOB 30 deg, individualize pt care, stool softeners, decompress stomach with NG, monitor for seizures

nursing considerations for what?

what are the three classic signs of herniation imminence?

as early signs may be subtle

low temp is a sign of possible spinal injury

what should be administered IV within 8 hrs of SCI to prevent secondary edema and inflammation?

CI after 8 hrs.

dobutamin, dopamine, and milrinone are what kind of IV med?

SE include: arrythmias, inc HR too much, inc BP too much.

inotropes that inc contractility and CO.

antiarrhythmis.

good for VT and SVT

CRRT: continuous renal replacement therapy:

used if have ARF and have no urine output

use this when pts are in severe resp and/or cardiopulmonary failure who are refractory to maximal conversion therpaies.

only 1/3 come off sucessfully.

Venovenous (VV) ECMO

vs

venoarterial (VA) ECMO

only pulmonary support where oygenates blood and puts it back into femoral artery

vs

cardiac and pulmonary support where blood is drained and then put back into aortic arch

bridge therapy to heart txp in children that works to pump the blood throughout the body

can't go home with this.

cardiogenic shock def:

s/sx: dec BP, dec urine output, diaphoretic, hypoxia, cool skin, SVR.

 altered cardiac circulation.

have dec CO despite good enough preload.

what is this?

delivers freq small tidal volumes that keep lungs expanded.

see fast tremors in chest with a fast respiration rate of

tx for when conventional ventilation fails

upper aiway obstruction (respir failure) may occur in the:

change in voice, stridor, inc WOB, poor chest rise b/c air can't get in, inc duration of inspiration resulting in a dec resp rate.

s/sx of what resp obstruction?

what are the causes of upper airway obstruction?

tx:

foreign body aspiration, object obstruction

tx: remove object IF visible, back slpas and chest thrusts for <1 and >1 abd thrusts

lower airway obstruction occurs where?

Acute inflammatory disease of the lower airway caused by a virus – Respiratory Syncytial Virus (RSV), rhinovirus, parainfluenza virus type 3, adenovirus, and influenza virus.

tx: lots of oral and NP suctioning

clinical cond that affect the substances of the lung tissue

what are these s/sx of?

grunting, inc RR, crackles, inc WOB, NF, retractions, inc HR, hypoxemia

dec LOC, irregular respirations, variable resp effort, shallow breathing, central apnea

are s/sx of what?

s/sx of what?

high BP, low HR, irregular respirations

family stress theory: children _______ under stress

developmental theory is useful for:

regress

anticipatory teaching/guidence

Family:

stress, adjustment, adaptation

human ecological theory

Bronfenbrenner:

microsystem ex:

meso:

exo:

macro:

micro: family

meso: school

exo: health and welfare services

macro: educational stds and expectations

communication is the art of nursing

holistic nursing is the science and art together.

family centered care

what should you start with upon entering a room for the first time that day?

introduce self and call parents by name, and then How can I help you today or what are you worried about?

Listen and then take action to provide help

head to toe and center to periphery

movement: reflexes to gross motor to fine motor

psycho-social development (8 stages)

personality develop; core pbs as individual strives to master

by who?

cognitive:

how children think and changes that occur in mental activities

by who?

moral:

how acts are viewed as "right" or "wrong" based on cog development

who?

what does this mean:

cardiac sphincter relaxed

eustacian tubes straighter

heart grows slowly

skin is half the thickness of adults

throw up (esophogeal sphincter)

more prone to infection

heart?

dehydrate easier

Infant:

age:

ant fontanels:

post:

infant is birth to one year

ant: 12-18 months (one yr to one yr and a half)

post: 6-8 weeks

toddler:

age range:

describe body shape

toddler is 1 yr to 3 yrs

have rounded out bellies from immature abdominal muscles and slightly bowed legs

also have maturation of digestive system

when do toddlers have voluntary control over spincters?

when does bladder capacity inc?

can maintain body temp

spincters: 18-24 months

bladder: 14-18 months

preschool

age range:

describe body:

gross and fine motor refinement:

3 to 6 yrs

slender, sturdy, graceful, agile, and posturally erect

boys and girls similiar

refined eye hand coordination

school age child

age range:

known as age of _______ _____

6-12 years school age

age of tooth loss

boys and girls similiar

fat diminishes and muscles increase

adolescence

age range:

early:

middle:

late:

12 to 20 years

11.5 to 14

15-17

18-20

infant and toddler

grasp ages for:

reflex:

palmer:

pincer:

2-3 months

palm: 5 months

pincer:8-10 months

infant and toddler

rolling over ages for:

abdomen to back:

back to abdomen:

5 months

6 months

infants and toddlers

sitting ages for:

supported lean to sit:

sit alone with hand support:

sit alone unsupported:

supine to sitting:

3-4 months propped

7 months sit alone with hands

8 months alone unsupported

10 months supine to sitting

trust vs mistrust

autonomy vs shame and doubt

initiative vs guilt

industry vs inferiority

identity vs isolation

erikson:

age 0-1

develop hope

erikson:

2-3 years

willpower developed

automony vs shame and doubt

toddler

erikson

3-6 years

purpose strenthened

initiative vs guilt

preschool

erikson

6-12 years

competence gained

industry vs inferiority

school age

erikson

adolescence

love gained

what psychosocial dvlp stage?

internal conflict with independence and dependence.

-simple choices

-negativism, ritualism, egocentric behavior

erikson

toddlers (1-3 years)

autonomy vs shame and doubt

what psychosocial developmental stage?

play, work, live to the fullest.

activities provide satisfaction

erikson

preschoolers ages 3-6

initiative vs guilt

what psychosocial dvlmt stage?

work ethic is established

peer approval strong motivator

erikson

school age child 6-12 yrs

industry vs inferiority

what psychosocial dvlpmt stage?

identification means an integration of all prev self images (including neg ones)

seek place in society

try out roles

freq idealistic

erikson

adolescent

ages 12 to 20

identity vs identity diffusion

sensorimotor

preoperational

concreate operational

formal operational

piaget's stages of cog. dvlpmt:

learn through senses and reflexes

manipulate materials

what age?

sensorimotor

birth to 24 months

piaget's stages of cog. dvlpmt:

form ideas solely based on what they can see and touch (perceptions).

-can only focus on one variable at a time.

-overgeneralize based on limited experiences.

what ages?

preoperational stage

2 yrs to 7 years

piaget's stages of cog. dvlpmt:

form ideas based on A+B=C reasoning.

Limit thinking to objects and familiar events

what ages?

concrete operational

ages 7-11

piaget's stages of cog. dvlpmt:

think conceptually and hypothetically

the what ifs of the world.

what ages?

formal operations

11-15

piaget:

piaget:

concrete operation

6 or 7 to 11 years

piaget:

abstract thinking, adaptability and flexibility

formal operation

11 or 12 to 15 and older

cognitive:

sensorimotor

stranger anxiety:

object performance:

4-8 mo

things that are out of sight are gone (this ends around 9-10 mo)

cognitive:

preoperational ages 2-4

pb solve based on what see directly bs what recall.

egocentric

magical thinking

preoperational

magical thinking: child thinks two events or things are related or caused but this is not true.

ex: divorce- child broke toy and daddy left

preoperational cogntive:

ages 4-7

cog piaget stage?

bases for logical thought

concepts of conservation (numbers, liquid, mass, lenght, weight, volume displacement)

piaget:

abstract thinking

hypothetical reasoning

idealism

formal operations

ages 11 to 15

list kohlberg's moral dvpmt:

preconventional

conventional

postconventional

kohlberg 2-7 years

what level: 

parrallels preoperational phase.

good vs bad (pleasure vs punishment)

no basic moral order

kohlberg moral level:

parallels concrete operational thought.

rules and being nice are important.

kohlberg moral level:

parallels formal operational thought.

"right" behavior correllates with rules and laws but can change rules based on societal needs and rational considerations

postconventional, autonomouse or principled level

11-15 years

want baby happy in mom's arms.

if quiet: do heart, lungs first

if screaming: check head, mouth etc

what age?

best if sits on parents lap, talk to parents first.

use animal to demonstrate exam

permorm BP last

praise cooperative behavior

examination of what age group:

expect cooperation.

-allow child to examine equipment

-give limited choices, not yes and no questions

-use story to aid in procedures

exam of what age group?

examine genitalia last

-explain purpose of equipment

-exam time is teachable moment

exam of what age group:

respect need for privacy.

-explain findings

-be matter of fact about sex develop.

-emphasize normalcy of develop