Present in Childeren and they heal faster (abundant bllod supply to bone)

Physical- metabolic, circulatory, (caused by casts, traction), renal (renal calculi) skin

Psychological-diminished environment stimuli, reduced social contacts, altered perception of self, hhelplessness

RICE

rest

ice

compression

elevation

Injuries s hould be treated immediately to limit damage from edema/bleeding

Compound

complicated

comminuted

greenstick

spiral fractures

Fractures in different stages of healing

femur fractures in childeren less than 1 year old

Sternal/rib/facial fractures

inconsistent stories on how injury occurs

spiral fracture

occurs secondary yo ischemia from a vascualar injury r/t swelling and tissue trauma

painful condition that reults when pressure within the muscles builds up and prevents nourishment from reaching nerves and muscle cells

pain (classic sign) unrelieved after 1 hr after medication is given, ( 5 ps) pain, paresthesia, pulseless, pallor, paralysis

If paralysis/numbness sets in= cell death has begun

(growth plate) it the weakest point (at the end of each long bone) it is the cartilage growth plate

could affect future bone growth

keep dry,

don't use heated fans or blow dryer to dry cast

Manual traction

Skin traction

skeletal traction

bryants traction

(uni/bilateral) congenital, more common in males, involves both bone and soft tissue,

Entire foot is pointing downward with toes turned inward

Talipes Varus- Inversion

Talipe Valgus - Eversion

Talipes calcaneus-Dorsiflexion

Talipes equinus-plantar flexion

Mild/postural- may correct spontaneously

Tetralogic-congenital abnormalities which may require surgery

Idiopathic-bony abnormality- always requires surgery

importance of early intervention

Newborn - age 6 months = use Pavliks harness for abduction of the hips (It immobilizes the joint)

Acetubular dysplasia

Subluxation (most common) incomplete dislocation

Dislocation _femoral head loses contact with acetabulum

heterogenous inherited disorder

Disorder of connective tissue (brittle bones)

demineralization

multiple fractures

blue sclera

careful handling to prevent fractures.

Pain managemnt

Biphosphonate therapy with IV pamidronate

type 1 - functional- casued by poor posture

Type 2- Structural- change in the shape of the vertebrae

femoral head loses its blood supply, (avascualar necrosis)

As a result, the head of the femur collapses on arising from chair or after exercise

rest, no weight bearing initially,

try to keep head of femur in acetabulum

Fever (first sign)

rash

hepatosplenomegaly

pericarditis

pleuritis

x linked recessive inherited disorder characterized by absence of the muscle protein dystrophin.

Duchenes MD is the most common type.

High pitch cry, cushings reflex (decrease HR, Increase BP, cheyne stokes= late sign of IICP. )

Please be sure to cluster activitied together in care to avoid over stimulation

Consist of eye opening, verbal response, motor response

Score of 15= normal

Score of 8 = coma

External Ventricle Drain

-treatment allows the temporary drainage of CSF from the ventricles of the brain

neurosurgeon sets the level of drainage.

label lines, regularly check drip chamber of manometer is set at the height prescribed. Clamp the drain if patient ambulates.

Document the color and the volume every hour.

excessive neuronal discharge in the brain.

It is the most common, treatable  neuro disorder.

medical emergency, lasting more than 30 minutes (refractory >60 minutes)

Give IV ativan

ease child to the ground, remove from hazardous area, Observe time of onset and length,

Teach CPR training for home

rectal diazapam for intractable seizures

no swimming alone

take showers not baths

Medical alert bracelet.

Absolutely not. Monitor treatment level

increase dose as child grows

stop when free of seizures for 2 years, normal EEG, avoid stopping during puberty

Phenytoin, (Dilantin) -gingival hyperplasia, ataxia(no coordination)

osteoporosis-frequnt oral care is needed

Phenobarbital -causes hyperactivity.

high amounts of ketones in the body reduces seizures

this diet is high in fat, no carbs, low protein

requires a trial period of 2-3 months.

Then patient is kept on it for 2 years, weaning off is done gradually

Monitor blood sugar for hypgycemia

nausea, vomit, diarrhea, hypoglycemia (will cause a seizure)

Long term complications- hyper lipids/kidney stones

liver excessively converts fats into fatty acids and ketones which are used for rnergy

when body produces ketone bodies-ketosis

inflamation of the CNS- transmitted by droplets.

Thank heaven there is a decrease incidence from HIB vaccine.

bleeding between dura and cerebrum.

Should be evaluated for shaken baby syndrome.

most common mild brain injury

SS confusion, retrograde amnesia

glascow coma scale Q hr

check for vomiting more than 3 times 

ICP pupil change

nose ears drainage

NPO

fluid management

no suctioning

Surgery of tumor is accesible, Chemo, radiation, (for buggers over 2 years old)

Post op care

close obeservation of VS

Temp is critical

log roll

temozolamide

procarbazine

lomustine

methotraxate-injected intsthecal

early onset of impaired movement

posture and coordination 

Results from hypoxia

hypotonia, upward slant of eyes, depressed nasal bridge, high arched palate, space between great and 2nd toe.

increased risk for leukemia, hypothyroidism, dementia, cervical injury.

intelectual and social deficits

confirmed by 24-48 months

high risk recurrence in families

restricted repetitive patterns

no eye contact= classic sign

speech delays

lazy eye (treat it by 6 years old)

dr will patch the good eye, to make the lazy one work harder

congenital malignant intraocular tumor

white cats eye reflex, eye pain

blindness= late sign

stress, lack of nurturing quality, anger

Warning signs-incompatibility between history of injury

high fever, head ache, nuchal rigidity,

positive kernigs sign

positbve brudinzki sign, purple rash

monitor cerebral edema, I/O Neuro assessment, Lab values

Prevention- avoid Salicylates (aspirin)

Spina Bifida Occulta-not visible, sacral dimple, port wine nevus, dark sacral hair

Spina bifida cystica-visible, saclike protution

neural tube fails to close, sac contains meninges, CSF and nerves. Will have neuro deficit,

Sac is proned to leakage, can be easily ruptured.

Below 2nd lumbar vertebrae= flcid paralysis of lower extremeties.

Shunting, (Ventriculoperitoneal shunt) shunt divers CSF to a part of the body where it will drain. (has Valves)

assess for redness along shunt, vomit, headache, fever

post op-position pt flat on unaffected side for 24 hours, never pump the shunt, good skin care.

neglect, shaken baby syndrome, munchausan syndrome

Assess failure to cry from pain, growth failure, poor hygiene/health

heredity-hemoglobinopathy, occurring mainly in african americans

caused by an abnormal type of hemoglobin called hemoglobin S

Triggered by:Trauma,infection, stress, dehydration, anything that increases need for oxygen, extreme weather

Vaso Occlusive thrombotic-most common crisis, stasis of clumping blood,

SS fever, engorgement

Splenic sequesteration-life threatening blood pools in spleen SS: shock, hypovolemia

Aplastic crisis-destruction of RBC triggered by viral infection or <folic acid S/S anemia, pallor, found often in areas where malaria is common, If you have the trait, you have a survival advantage

If both parents have trait, each offspring will have 1/4 chance of having the disease, (25%)

found in greeks and italians,

minor-asymptomatic

trait-microcytic

Intermedite- dplenomegaly

Major-Cooleys anemia which requires transfusions to survive

HGB electrophoresis, RBCs change often by 6 weeks of age

Child presents with severe anemia

immunosuppressive therapy, bone marrow transplant

Hemostasis defects

Hemophilia A - most common, deficient in factorVIII - X linked trait (common in males) females are carriers

Hemophilia B- Christmas disease, deficient of factor IX.

often follows upper resp infection characterized by Thrombocytopenia (excessive destruction of platelets)

purpura-discoloration caused by petechiae beneath the skin

Hypertonic Uterine dysfunction -usually occurs before 4 cm cause is unknown, may be related to fear and tension

Fetal asphyxia with meconium aspiration can occur


Hypotonic Uterrine dysfunction- cause is cephalopelvic disproportion or fetal malposition

fetal infection and fetal and neonatal death can  occur

Inadequate Voluntary expulisve forces

Involves abdominal and levator ani muscles

Occurs in second stage of labor: casue may be related to nerve block anesthetic, analgesia and exhaustion

fetal asphyxia can occur

contractions decrease in frequency and intensity

uterus is easily indentible even at the peak of contractions

uterus is relaxed between contractions

maternal diabetes, obesity, multiparity, large size of both parents

CPD

cephaloplevic disproportion

(maternal pelvis too small to accomodate infant)

R/T macrosomia

hypertensive complications of pregnancy, gestational hypertension, preeclampsi, eclampsia, fetal death, chorioamniotis

maternal medical conditions, diabetes melitis, renal disease, cardiopulmunary conditions, antiphospolipid syndrome, chronic hypertention

acute, severe fetal distress

shoulder presentation (tranverse lie)

floating fetal presenting part

uncontrolled hemmorhage

umbilicle cord prolapse

active genital herpes infection

placenta previa

previous uterine incision that prohibits a trial of labor

grand multiparity (>5 pregnancies that ended after 20 weeks gestation)

mulitiple gestation

suspected cephalopelvic disproportion

breech presentation

inability to adequately monitor FHR or contractions (or both throughout labor)

chemical, mechanical, physical, and alternative methods are used to ripen the cervix and induce labor.

Intravenous oxytocin (pitocin) and amniotomy are the most common methods used in the United States

Inducibility

Bishop score of 8 or more is indicitive that induction of labor will be successful

cervical ripening, eliminating the need to administer oxytocin to induce labor

decreased oxytocin induction time and a decrease in the amount of oxytocin required for successful induction

non reassuring FHR and pattern

maternal fever

infection

vaginal bleeding

hypersensitivity

regular progressive uterine contrations

have woman empty bladder

have woman lie supine with lateral tilt or a side lying position for 30-40 min after insertion

document the number of dilators and sponges insrted during the procedure

the number removed

assessment of urinary retention

rupture of membranes

uterine tenderenss or pain

contractions

vaginal bleeding

infection

fetal distess

Prostoglandin E2

Dinoprostone (cervadil insert, prepidil gel)

Cervidil Insert 10 mg 0.3 mg/hr over 12 hours

Prepidil Gel

Dosage is 0.5 mg of dinoprostone in a 2.5 ml syringe

delivered with a catheter inserted just belove internal cervical os

max cumalitive dose 1.5 mg (3 doses in a 24 hour period)

informed consent obtained,

assess the maternal and fetal unit before each insertion, and durng treatment following agency protocol for frequency

Assess maternal VS and health status

FHR and pattern

status of pregnancy

including indications for cervical ripening or induction of labor

signs of labor or impending labor

the bishop score

abnormal (non reassuring FHR pattern)

maternal fever

infection

vaginal bleeding

hypersensitivity

regular progressive uterine contractions

use with caution if the woman has a history of asthma, glaucoma, renal, hepatic or cardiovascular disorders

bring gel to room temp just before administration

do not microwave

keep it frozen just before administration

have the woman void before administration

asssit the woman to lie in a supine position with hip tilted or side lying for 30-40 minutes after administration

2 hrs for the placement of the insert

Allow woman to ambulate after the recommneded period of bed rest and observation

delay the administration of oxytocin for 6 -12 hours after the last instilation of gel or for 30 to 60 min after the removal of the insert

follow agency protocol if ripening has occured but labor has not begun

document all assessment findings and administration procedures

prepare to administer terbutaline 0.25 mg sub q if significant adverse reactions occur.

perform daily fetal movement counts

assess for signs of labor

call the primary healthcare providor if your membranes ruptire or if you feel a decrease in fetal movements or no movements at all.

keep appointments for fetal assessment tests and cervical checks

go to the hospital soon after labor begins

it is a normal physiologic function that occurs with maturity

(meconium passage being infrequent before weekd 23 or 24 with an increased incidence after 38 weeks) or with a breach presentation

it is a response of hypoxia induced peristalsis and sphinter relaxation

may be a sequel to umbilicle cord compression -induced vaginal stimulation in mature fetuses

severe form of aspiration pnemnoia, that occurs in term or post term infants who have passed meconium in utero

the presence of a skilled neonatal resuscitation is required at birth of any infant with meconium stained amniotic fluid.

assess the amniotic fluid for the presense of meconium after rupture of membranes

if meconium stain is present, gather all needed equipment that may be needed for neonatal resuscitation

have at least one person capable of performing endotracial intubation on the baby present at the birth

assess babies respiratory efforts, heart rate and muscle tone

Suction only the baby;s mouth and nose using either a bulb syringe or a 12-14 inch french catheter to suction if baby has

strong respiratory efforts,

good muscle tone

heart rate >100/min

depressed respirations

decreased muscle tone

heart rate <100b/min

variable or prolonged decelerations during uterine contractions

woman reports feeling the cord after membranes rupture

cord is seen or felt in or protruding from the vagina

call for assistance. Do not leave woman alone

have somepne notify the primary health care providor immediately

glove the examining hand quickly and insert two fingers into the vagina to the cervix

with one finger on either side of the cord or both fingers to one side, exert upward pressure against the presenting part to relieve compression of the cord

do not move your hand

another person can place a rolled towel under either the right or left hip

place woman into extreme trendelenburg or a modified SIMS (side lying top knee forwrd)

or knee-chest position

if cord is protruding from vagina, wrap loosely in a sterile towel with warm sterile normal saline solution

do not attempt to place cord back into cervix

administer oxygen by non rebreathing face mask at 8-10L/min until birth is accomplished

start IV fluid or increase existing drip rate

continue monitoring FHR, by internal fetal scalp electrode if possible

explain to the woman and support person what is happening and the way it is being managed

prepare for immediate vaginal birth if cervix is fully dilated or cecearean if it is not.

abnormal non reassuring FHR tracing including variable decelerations, bradycardia,

absent or minimal variability

loss of fetal station

constant abdominal pain

uterine tenderness

a change in uterine shape,

cessation of contractions

signs of hypoveolemic shock (tachycardia, hypotension, pallor, cool clammy skin)

fetal parts may be palpable through the abdomen ,

if placenta toltally seperates there will be no FHR.

starting IV fluid, tranfusing blood products, administering oxygen, assisting with the preperation for immediate surgery.

supporting the womans family and providing information about the treatment are important during this emergency.

aka amniotic fluid embolism

characterized by the sudden acute onset of hypoxia, hypotension, cardiac arrest, and coagulopathy

during labor,

during birth

30 min after birth

placenta previa-placenta is an improperly implanted placenta in the  lower uterine segment near or over the internal cervical os

marginal >3 cm from internal cervical os

partial < 3 cm from internal cervial os

complete- complete covering of internal cervical os

premature seperation of the placenta from the uterine wall after the twentieth week but before the fetus is delivered

Assess

dark red vaginal bleeding. If the bleeding is high in the uterus or is minimal, there may be an absense of visilbe blood

uterine pain and tenderness

uterine rigidity

severe abdominal pain

signs of fetal distress

signs of maternal shock if bleeding is excesive

Intervene

monitor maternal vs and fetal heart rate

asssess for excessive vaginal bleeding, abdominal pain, and an increase in fundal height

maintain bed rest, administer oxygen

intravenous fluids, blood products as prescribed

place client in trendelenburg position if indicated to decrease the pressure of the fetus on the placent, or place in in the lateral position with the head of bed flat if hypovolemic shock occurs.

monitor and report  uterine activity

prepare for delivery of the fetus quickly as possible with vagianal delivery is preferable if the fetus is healthy

emergency cecarean is indicated if the fetus is alive but is showing signs of distress.

monitor for ss of DIC in the postpartum period.

placenta previa-painless, bright red vaginal bleeding, and the uterus is soft, relaxed and non tender

Abruptio placentae there is dark red vaginal bleeding, uterine pain or tenderness or both, and uterine rigidity.

Abruptio-rigid, dark red blood, pain

previa-soft relaxed, bright red, painless

difficult labor that is prolonged or more painful

occurs as a result of problems caused by uterine contractions, the fetus or the bones and tissues of the maternal pelvis

may have a macrosomic infant

abnormal presentation

hypotonic or hypertonic contractions

hypertonic contractions are painful, occur frequently, and are uncoordianted.

treatment depends on the cause and includes pain relief measures and rest.

dystocia can result in maternal dehydration, infection, fetal injury or death.

Assess

excessive abdomnal pain

abnormal contraction pattern

fetal distress

maternal or fetal tachycardia

lack of prgress in labor

assess fetal heart rate, monitor for fetal distress,

monitor uterine contractions

monitor maternal temperature and heart rate

asssist with pelvix examinations, measurements, ultrasound, and other procedures

administer prophylactc antibiotics as prescribed to prevent infection

administer intravenous fluids as prescribed

monitor I and O

maintain hydration

instruct client in breathing techniques and relaxation exercises

perform fetal monitoring if oxytocin is prescribed for hypotonic uterine contractons

(oxytocin is not prescribed for hypertonic uterine contractions)

monitor color of amnioitc fluid

provide rest and comfort as with a normal delivery, such as back rubs, and position changes

assess the clients fatigue and pain, and administer sedatives and pain med as prescribed

assess for the prolapase of the cord after the membranes have ruptured.

metabolic status is signifigantly influenced by increasing levels of estrogen and progesterone

these hormones cause an increase in insulin production which decreasesperipheral glucose

women with insulin dependent diabetes are prone to hypogycemia during the first trimester

pregnacy exerts a diabetogenic effect

rising levels of human chorionic somatomammottopin, estrogen, progesterone, prolactin, cortisol, insulinase act as insulin antagonists (insulin resistance)